Fertility - masterclass

Episode #91: Fertility — The Conversation We Need to Have

What a gift this episode is. ❤️

Episode #91 of the multi-award nominated podcast Metabolic Wellbeing without the BS is here — and for the first time, we dive into a topic that is deeply sensitive, incredibly emotional, and hugely important:

FERTILITY.

And wow… what a conversation.

I’m joined by the incredible Gabriela Rosa, DrPH (Harvard University) — Harvard-awarded fertility specialist, founder of The Rosa Institute, author of Fertility Breakthrough, and a pioneer in integrative fertility care.

This episode challenges so many of the assumptions we have accepted around fertility.

Including:

👨 Men’s health matters.
Yes — men! Fertility isn't simply a "women's issue." Male health and sperm quality can be critical pieces of the puzzle.

🧬 Superhero sperm matters!
It’s not simply about getting pregnant. The quality of sperm matters — and there is far more we can potentially influence than many people realise.

🍬 Insulin resistance matters.
Metabolic health can play a significant role in reproductive health, yet how often do we connect these dots?

📚 Are our fertility guidelines keeping up?
Gabriela challenges the limitations of guidelines that can be outdated, overly focused on treatment rather than prevention, and often fail to address the root causes.

🌱 Root causes matter.
Nutrition. Metabolic health. Lifestyle. Environment. Sperm health. Egg health. And so much more.

Gabriela has helped more than 204,000 people across 111 countries through her proprietary F.E.R.T.I.L.E. Method®, with published research on her signature programme reporting a 78.8% live birth rate among patients — including people who had experienced years of infertility, recurrent miscarriage and unsuccessful treatments.

And then there is The Fertility Challenge — a free global online programme supporting tens of thousands of participants every year.

This isn't just another podcast episode.

It's a conversation about hope, science, health, partnership and looking beyond the obvious.

If fertility has touched your life — directly or indirectly — this episode is worth every second.

🎧 Episode #91 is out now.

Please listen.
Please learn.
Please challenge what you think you know.

And most importantly…

PLEASE SHARE IT.

Because someone in your network may desperately need to hear this conversation.

Transcript

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SPEAKER_00 0:10

Hi, I'm Martin Glazer with the Holy Spirit of Metabolic Wellbeing with AWS. We have gone down under again to Australia. Um I thought we would get in a little bit of an Australian twang here. Dr. Gabriela Rosa, welcome to the show.

SPEAKER_01 0:28

Thank you so much for having me, Martin. It's wonderful to be here.

SPEAKER_00 0:31

Gabriella, who are you and what do you do?

SPEAKER_01 0:36

Oh, good question. I'll start with what I do, which is help couples overcome infertility, recurrent, miscarriage, and failed treatments. I've been doing it now since 2001. So it's been a minute, you know. And it has been a very rewarding time in my life where I get to meet people at some of the deepest, you know, saddest, more most difficult times of their experience, especially because I treat difficult, complex cases. My initial training was as a naturopathic practitioner, and you know, I went from there and did you remarked on the number of qualifications that I've attained over the years. It hasn't been necessarily a you know a decision to collect degrees, but it happened that after I did naturopathy, I knew that I wanted to specialize in something. And so I went and I knew fertility was very much the conversation that I wanted to have for the next 25 years. So I did a master's in reproductive medicine and human genetics. And from there I decided at about 10 years after I had, well, actually, it was about five years after I finished that master's, I decided I wanted to really deepen my knowledge in science and how to validate scientifically what I was seeing in my clinic every day. You know, I was having people come in who had experienced 10, 15, 19 years of infertility, recurrent miscarriages. And we were getting results for them where nothing else had worked. You know, they were having healthy babies despite all the years of challenges and difficulties. And so then I decided that understanding how to first of all analyze that information and to organize it in such a way that made sense for others to use as well in a very scientific way was the next step. So I went to Harvard to do a master's in public health. And last uh May I graduated from the Doctor of Public Health at Harvard because I realized that understanding healthcare systems and really getting clarity on how to navigate such a challenging experience that it is with lots of misaligned interests, you know, across the board for patients was almost impossible. And of course, when you add all of the other challenges that come with that, um, you know, patients can't do that on your on their own. And so I realized that that was part of the mission from here, really helping people not only get the knowledge and the understanding and the clarity that they need to be able to navigate such a difficult time in their life, but navigating that within a very fragmented system that has misaligned interests, you know, at the end of the day. And so that has been the journey up until here.

SPEAKER_00 3:44

So many things here, Gabriella. I want to hone in on a particular area here. Now you've gained all this scientific knowledge, but every single case has its own unique aspect to it. How important is that that people understand that they cannot go on to Dr. Google and think that they've found the golden egg for fertility?

SPEAKER_01 4:16

Yeah, absolutely. That's a good question. You know, I think that the problem that patients experience even more than, you know, going the reason that people resort to all types of other ways to try and find information is because they're not being satisfied with the level of investigation and of understanding they have about themselves and their case by seeing their doctor. And their doctor has their hands tied to a certain extent because they have to work within the scope of their specialty and they have to follow the healthcare system guidelines. Right. And for infertility, they are pathetic at best, if you really ask me, you know, because at the end of the day, what happens is that 96.3% of the population is going to concede within two years without really trying, without really putting that much effort into doing so. But it's the 3.5%, the 4% of people for whom it's very difficult, that they require a lot more of the resources and investigations and the understanding of what's going on for them. And instead of getting that, they get slapped on with an unexplained diagnosis. And they that goes on for months and sometimes years. And of course, you know, when you are in a situation where you desperately want to hold a baby and you've done everything your doctor has told you, and you've, you know, looked everywhere that you can possibly find information, you are going to start becoming pretty desperate about finding answers, right? And so one of the biggest things that I see begins that initial kind of you know problem is the fact that the guidelines for treatment of infertility are very limited. And people who experience difficulty end up getting treated in the same way as people in the general population that don't really have an issue. You know, the majority of people who go to their GP and I mean, first of all, infertility is a self-report diagnosis based on time. It's the only diagnosis in medicine that happens in that way. Think about it. If you have cancer or if you have cardiovascular disease, you don't go to your doctor and say, I think I have this disease. Now treat me, right? They do a battery of tests, they do PET scans, MRIs, you know, you name it. There's there's so much that goes into biomarker measuring, and you know, you name it. I mean, my dad has been going through, you know, treatments and after treatments uh for the last since 2018. And so I know what that experience is like, and I'm sure that you do too. And so ultimately it's a very different thing. And sure, those diseases are different in another way, they are life-threatening. And fertility or infertility gets deprioritized for the fact that it's not immediately life-threatening. Now, pay attention to the not immediately life-threatening because infertility is a proxy measure for other the development of other chronic diseases down the track, you see. And so what ends up happening, give you an example. Let's say somebody has insulin resistance, and we know that if you have insulin resistance, it's really untreated, it's a matter of time until you develop diabetes. Again, from the science, we understand that if you have prediabetes, it is literally a matter of five to ten years before you are diagnosed with diabetes. Now, at the point of insulin resistance, a lot of people who are trying to conceive and having difficulty actually have silent insulin resistance. And the reason that I say silent is because they go to their doctor and it's not even metabolic disease panel, is typically not something that is immediately done in a couple experiencing infertility. But insulin resistance can and is associated with increased risk of implantation failure, ovulation disorder, irregular cycles. And we know that all that PMOS, now polyendocrine metabolic disease or syndrome, sorry, um, is something that essentially affects about 15% of women of the reproductive age trying to get pregnant. And it does so by delaying pregnancy because it makes cycles irregular, it makes it difficult to time. Now, underlying that condition, insulin resistance is very common. So it's almost like, you know, if we're turning a blind eye to the symptoms that the body is giving us, of course, we're going to have to look at a more deeper condition or a more exacerbated condition of health at some point down the track. So those factors all combined put a couple and an individual in a very difficult situation, which is they want to get an answer to their problem, i.e., I'm not getting pregnant, I'm not keeping a pregnancy determine, what do I do? When they go to their doctor, and the only four tests that they're required to do because of guideline, you know, scope and all of those things is making sure that their tubes are clear, making sure that they're ovulating, making sure that their uh uterus can house a pregnancy. And maybe, and I say maybe because if a woman goes to her doctor herself and the doctor says, Well, your partner should have a semen analysis, we both know how that conversation goes when there's no skin in the game on the other side, right? It's not like the woman will come home and tell her partner, hey, the doctor said you need to have a semen analysis, and they will quickly jump off the couch, go and make the phone call to make that appointment, right? And so this continues to then roll over month after month until the time where you've hit a year of trying to get pregnant, and you go and you say that to your GP, and the only thing that really happens from there is here's a referral to IVF. So, you know, I can't really blame my patients for turning to Google when they're not really getting the support that they deserve. It's it's a really challenging situation. And at the same time, on the other side of that, there is uh another consideration, which is, you know, sometimes people do go on social media and Google and they will find all sorts of information, you know, and I call it the Wild West because you will get everything, unfortunately, on social media. You will not only find answers, but you will find a lot of noise and a lot of confusion. So, you know, it really is difficult for people to wade through what is real, what's true, what should I try, what should I not. And, you know, it it's a real big challenge for a lot of couples.

SPEAKER_00 11:29

Now you mentioned on the four key factors, the last one I want to draw down on the semen analysis. As soon as people talk about fertility, by proxy, using your language, people have this perception that it is a female challenge only.

SPEAKER_01 11:54

Well, where do I begin? So, you know, Martin, the interesting thing is that I've been talking for many, many years on this topic, you know, and one of the things that I've come to has become a little catchphrase of mine is fertility is a team sport. And the reason for that is obvious. You know, 50% of the DNA comes from the female, 50% comes from the male. And for the longest time, probably, gosh, as long as modern medicine has been modern medicine the last 200 years, when it comes to reproduction, women are the ones that take really the forefront of this discussion because we end up housing the baby and just dating it for nine months. But the reality is, and science really does show this, you know, very clearly in 2026, which is without very good quality sperm, especially when things haven't been helpful, you know, have haven't been easy. I like to call it, you know, we need at least superhero sperm. Okay, sperm will not do. We end up in a situation where there is a lot of delay and there's a lot of going around in circles. And if a woman happens to be older or happens to have diminished ovarian reserve or egg quality issues, essentially it's the egg that is responsible for addressing a lot of the um DNA fragmentation errors within the sperm. So at the moment of fertilization, what the egg is doing is figuring out all right, how do we actually fix, you know, do a remodeling of this sperm in a best possible way and continue having enough energy for development and you know, processing of all of the biochemical pathways that are required for development of the embryo. The reality is that when an egg is older and or if it is um struggling in terms of its quality, and by the way, there is no direct measure of egg quality. It's a kind of catchphrase that you know we tend to use in this industry. But uh, when when we do have that situation, what ends up happening is that the egg can't handle doing the work for itself in terms of its own development and you know maturation and having to fix all of the DNA fragmentation errors and or anything else that is coming from the sperm. So it ends up being that you will end up, I see this very frequently. Yesterday I saw a lady, 25 follicles going through IVF, 25 follicles, 25 eggs, almost hyperstimulation, although had a really great collection, right? So lots of eggs, and then after day three onwards, ends up with all of those fertilized embryos attreasing and essentially ending up with zero embryos at the end of that process. Now, she was told, oh, it's your egg quality. Well, actually, no, it isn't. Her AMH is high, she's 33 years of age. Like, really, it's as good as it gets. But what does it point to? It points to the fact when whenever we're having day three onward failures, we know that that's when the sperm DNA starts to take over in the process of embryonic development. And the embryo DNA, uh the embryo uh mitochondria also starts to take over. And so what happens is if those parts of the equation are not actually as robust as they can be, we end up with cells that don't make, you know, that don't develop, we end up with embryos that don't make it to day five or day six. And then it gets blamed on egg quality. But the reality is that you can't address embryo quality at the point in which the embryos are made. You can only address the precursor cells of that, which would be the egg and the sperm, before fertilization happens. So, in a case such as that, we can't just rely on going through another RVF cycle, getting again that number of eggs or a few or less, and ending up with zero embryos and calling an egg quality issue, and then saying to a woman at in that situation, oh, you need donor egg. Because donor egg isn't going to change that situation. What is going to change that situation is addressing both partners effectively. Now, the research points to the fact that when there is a high DNA fragmentation percentage in the sperm, that the success rate of embryo creation through IVF and live birth through IVF decreases significantly. And it also is linked to miscarriage and implantation failure. So we know this from the science. The issue is that by the time a study is conducted and published, it takes 17 years for it to become mainstream knowledge. What does that mean? Most doctors aren't reading their own scientific journals, you know, and then of course, guidelines lag behind. And then as a result of that, we end up with a situation that just keeps perpetuating itself. Now, when we talk about these misaligned interests, we do have to point out that now in Australia, the US, and the UK, approximately 60% of IVF clinics are either private equity-owned or stock exchange listed. What does that mean? They have a fiduciary duty to give profits to their shareholders. So when that is the case, and when doctors are being incentivized to be essentially doing more cycles as opposed to actually investigating, treating, preventing the need for IVF to begin with, what do we think is going to happen? You know, of course the narrative is going to become unexplained infertility. We need IVF. And then when IVF doesn't work, because about across all ages, about 80% of cycles that get started do not yield a live birth. But it doesn't really matter because we then say that it's a numbers game, just keep trying. Meanwhile, per cycle profits go up, and eventually you get a baby anyway. Maybe it will take three cycles, maybe it will take 10. But who who really minds that, right? Because as long as the system is generating what it's supposed to do for what it's optimized for, then it's okay. It it works well enough. And patients, of course, they don't really conceptualize that at the beginning of their journey. They really only start to feel very frustrated by the time their second, third IVF cycle hasn't worked. And because there is a deadline to female fertility, there is the pressure and urgency of action. But really, a lot of that is manufactured given you know all of the other things that we've already talked about. So it is a real challenge for a lot of people.

SPEAKER_00 19:20

Now you've mentioned several times the two words that can distract the fear of people, or they put their head in the sand on it. Insulin resistance. Can you go a little bit deeper in that in terms of what do you regard insulin resistance as and the impact that it can have on couples not addressing it on a fertility pathway?

SPEAKER_01 19:54

Yeah, it's a great question. So, what happens with insulin resistance is this. So when the body is working well, it's going to process its carbohydrates that are incoming in an efficient and effective manner. And so what happens is that you will eat carbohydrates, you will eat sugar, your insulin levels will rise moderately, and your blood sugar levels will stay stable and you know, homeostasis is found once again. Over years of overconsumption of carbohydrates, because you know, overconsumption of carbohydrates is an interesting thing because each person has a carbohydrate tolerance, and that their body can actually, based on their behaviors, based on their diet, based on their way that their body processes, you know, the it's going to be essentially a case of some people might eat a lot more carbohydrates, but because they use those carbohydrates through heavy physical activity and or you know, they're basically they're just processed, they have more muscle, they just process their metabolic function is just better in terms of carbohydrate tolerance. It ends up being that you don't really see a rise of insulin to maintain blood sugar levels. Insulin resistance starts to occur when either we are overconsuming our carbohydrates for many, many years and at the same time not necessarily process processing it very well. And so what ends up happening is that insulin will rise above what it typically would to maintain blood sugar levels at a stable fasting level and you know, at a stable level throughout the day, especially post meals. And so, what will happen with that after a long period of time is that insulin will keep rising if nothing changes, right? Insulin will keep rising to meet the need to maintain blood sugar levels regularly. At some point, you're going to have. You can have up to 20 times higher levels of insulin for maintaining blood sugar levels at a normal constant rate. So, what that means is that at that point, you're definitely having to produce a lot more insulin to be able to maintain glucose levels at a regular point in the body. Now, the problem with that is that at some point the body stops either being able to produce that much insulin or it really stops being able to actually regulate the amount of insulin that's producing, it stops to be able to regulate blood sugar levels. If you go to a doctor and they only are testing your fasting glucose and calling it, ah, yeah, it's good, it's normal, without doing your fasting insulin at the same time, you don't know if at the same time that your glucose is normal, your insulin is actually also at a normal rate, right? At a normal level. So I like to call normal insulin at fasting levels under 10, under 11. Okay. The reason is that when it starts to go above that, particularly when we're fasting, gosh, that that's huge, right? Um, I like to see it usually at around five at a fasting level, but if it's anywhere above 10 or 11, I'm thinking, okay, this is a problem. Okay. And the reason that that is the case is because of what I said before. If we are going through a situation where we're continuously consuming glucose, sugars, carbohydrates, and the body isn't processing it as well, that insulin rise actually starts to become systemically inflammatory. And that level of inflammation, you know, let's say that there is no such thing as good or bad inflammation, but you do need a level of inflammation for implantation to occur. Beyond that level, if it's too much or if it's too little, implantation won't happen. Too little would have to be intervened with by drugs, medication. You know, it's very unusual to have too little inflammation. Usually you have too much inflammation. And insulin actually acts as this fuel to the fire, so to speak. You know, it acts as this inflammatory medium. And what ends up happening is that not only you have the inflammation that's going on systemically that you can't see, but you also end up with a situation that because the body is in that level of disarray, you end up having hormonal imbalances that can accompany it. You end up have having a situation where implantation becomes affected, ovulation regularity becomes affected, cycles become irregular. That is what happens for women. For men, it actually does impact egg, uh, sorry, the sperm parameters. It impacts count, morphology, motility. And what ends up happening too is that usually in a situation like that, when we have that level of metabolic disarray, we then probably also start having difficulty losing weight or having increased weight. We know that when waste circumference in men is increased, uh, particularly above 85 to 90 centimeters around the belly button, we know that the quality of sperm is also decreased. So sperm morphology and motility can also be impacted. We know that when somebody is overweight, it's going to increase heat to the testicles. It's going to have that inflammatory uh and heat to the testicles again negatively impacts, you know, male fertility and can increase DNA fragmentation in the sperm as well. So you have this kind of like cascade of events that ends up happening that we don't necessarily can can see um you know going on in the body, but we have the symptoms that we start to experience. Where, let's say, for example, if you go down the RVF path and you do have embryos, and at the time of transferring that embryo, you are pregnant, absolutely 100%. If you don't see a positive pregnancy test at the end of two weeks, does it mean that you were never pregnant? No, because you had an embryo actually be transferred to the uterus. What happened was that implantation failure happened or early miscarriage happened. And that typically gets disregarded as, oh, it's okay, just keep trying. But there are usually signs, there are signals that things actually need to be looked into further. And when we don't look into these areas further, we end up in a situation that we just keep perpetuating. But the other interesting aspect, and there was a really interesting study that was done in females and males, looking at um a diagnosis of infertility and what that meant for all cause mortality down about 10 years later. And for all of the major diseases, there was an increase, increased all cause mortality of cardiovascular disease, diabetes, and cancers for people with an infertility diagnosis. Now, why is that? Exactly because of this phenomenon that I'm just explaining right now is that it takes it's a matter of time between you go from insulin resistance to pre-diabetes to diabetes. And then by the time you end up having a diagnosis of diabetes, complications are more likely. And we know that you know those these days, you know, the biggest killers in the world are non-communicable diseases, the diseases that I just mentioned before. We're not dying of infections anymore. We now have antibiotics, and we're dying of you know modern diseases of the modern age. And infertility, in my view, is a proxy to what else is coming down the track if we don't address the underlying reasons and the underlying cause of what's going on.

SPEAKER_00 28:05

Gabriella. That is incredible. How do people find out how they can either work with you or more information that you can share?

SPEAKER_01 28:19

Yeah, absolutely. So I have a free program that I've been running for the last 10 years. It's called the Fertility Challenge. And people can just go to my website, which is fertilitybreakthrough.com, and or they can just Google me, Gabriela Rosa, G-A-B-R-I-E-L-A-R-O-S-A. There's also um my book, Fertility Breakthrough: Overcoming and Fertility and Recurring Miscarry when other treatments have failed. It's free on YouTube and Spotify. I wanted as many people as possible to get their hands on it, so they will be able to find it there. And I do a lot of patient education on Gabriella Rosa Fertility on Instagram. So those are all of the ways.

SPEAKER_00 29:02

Gabriella, I cannot thank you enough for a getting up so early in the morning, B, your knowledge of wisdom here. I've taken a hell of a lot of notes here. I want to thank you for a masterclass on fertility that I'm looking forward to getting out there so other people can have that information and contact you at EP.

SPEAKER_01 29:33

Thank you for having me.