Food Freedom and Fertility Podcast

This episode features real-life Labor and Delivery nurse, as well as the host of the MommyLaborNurse podcast and Instagram page, Lisel Teen! Lisel helps shed some light on a lesser-known fertility issue: secondary infertility. This is the title we give to women who already have a child (or more than one!) and are struggling as they try to conceive the second or third time around. This concept can be mind-blowing for so many women since we have often been told since puberty that pregnancy is going to happen the moment you even think about unprotected sex. This is further reinforced when women get pregnant easily (or relatively easily) with their older children, but then it doesn't happen as easily the next time around. So why does this happen? Lisel explains: Age can be a factor. Remember that you're now older now than you were when you tried for your first. This certainly doesn't disqualify you from having more children, but it may mean that your body needs more intentional support than when you were younger. Your partner - If you have the same partner as before, he is now a few years older too. His semen quality might be vastly different due to his age/diet/lifestyle/stress/sleep than it was when you conceived your older children. If your partner is new, there could be an issue there too. Birth outcome of your prior pregnancy - if you had a c-section or other uterus surgery it could be that there is scarring or some other kind of structural damage that is making pregnancy more challenging than it was before. Toddler lifestyle - Eating a steady diet of toddler scraps and waking up several times per night with your older child can tell your body that now is not a good time to get pregnant again. So what about the transition from postpartum to being ready to conceive again? This is something that really varies from woman to woman. Technically speaking, you CAN get pregnant before your period returns postpartum. Remember, true periods happen because ovulation occurred 12-14 days prior. But what about if you're breastfeeding? Some women who are breastfeeding on demand don't ovulate for many many months. Other women can still ovulate even when they're nursing! The hormone your body makes to promote milk production often suppresses ovulation (a common problem in women with PCOS) but for some women, ovulation can still happen when breastfeeding. If you're struggling to conceive or have a regular period postpartum, you may need to consider how frequently you breastfeed your older child. Some women don't need to ween entirely in order to start ovulation again, while others do. On the other hand, women who don't breastfeed can see a boost in fertility very soon after the birth of their older child. This is a biological response to what you body considers the loss of a child. Back before baby formula and bottles, if you didn't breastfeed your body assumed your baby wasn't alive. This triggers ovulation so that your body can conceive again and bring another child into your family (because your body doesn't understand your baby is healthy and thriving, just eating formula!) Surgical birth can also change fertility. Remember that when you have a c-section, your body is not only going through everything that a postpartum body goes through; but it is also recovering from a major abdominal surgery. Depending on the nature of your c-section, your uterus can have scarring, disrupted blood flow, kinked tubes, or other issues that are making it harder to conceive. Seeing an abdominal massage specialist or pelvic floor physical therapist can help you assess whether or not your surgical birth is contributing to your challenges conceiving the second or third time around. Another factor can be that sex post-baby can be DIFFERENT! Perhaps now that you already have one (or more) children, having sex the same way as you did pre-baby might not be as comfortable or fun. Many women struggle with painful penetration, urinary leakage, weak orgasms, or other issues that make sex less fun after baby. Pain or discomfort with sex is NOT your fault and there are specialists who can help! Women (Sophia and Liesel included) can feel a lot of shame and guilt around this and feel like the pain and discomfort is due to their own lack of sexy-ness or virility. Your vagina, pelvis, and abdomen are filled with muscles that can get tight, loose, kinked, or damaged just like any other muscle in your body! Seek help if you're uncomfortable during sex, because help is available! Disclaimer: Kegals are NOT always the answer! They can, in fact, make some pelvic floor problems WORSE! See a specialist and figure out what's actually wrong. Liesel goes on to share her journey getting pregnant with her second baby. She candidly shares that she did initially get pregnant easily her second time around, but unfortunately she lost that pregnancy at 6 weeks. The stress and lifestyle/work/grief issues she was going through impacted her greatly, and it ended up taking another 6 months to get pregnant again. Liesel also shares about the mental health struggles that came along with trying to conceive as well as dealing with the loss of her second pregnancy. She struggled with anxiety and a lot of over-vigilance that included torturing herself with dozens of pregnancy tests. Taking a pregnancy test can seem fun at first, but over time you can become legitimately traumatized by seeing all the negative tests. She eventually started really prioritizing her mental health, nutrition, and stress relief and that's when she was able to conceive and carry to term again. For her, she was able to make these changes by focusing on one thing at a time. She would start with something small like "eat a healthy breakfast". Then, once she had that happening she would bring on another task like "2 workouts per week". Slowly, she was able to build healthy habits that eventually lead to her body being ready for another baby. We also want to highlight that just because there are some things you *can* to improve your fertility the second (or third) time around; it does NOT mean that your struggle is your fault. There are controllable factors in your life that impact your fertility, but that is not the same thing as being blamable for the struggle or loss that you experience. Liesel shares more of how she helps mothers by offering paid courses, as well as her blog, instagram, and podcast which are resources available to everyone for free! You can find her @MommyLaborNurse on instagram, as well as follow her blog and her podcast for even more free info on all things labor and motherhood!

Holiday Episode: How to navigate the holiday season- emotionally and nutritionally, when you've been trying to conceive? Remember to be gentle with yourself and prepare for what's coming. You can rehearse your responses to common pregnancy questions and social situations and have a game plan for whatever might be coming your way. While during COVID, these situations might come up less than in previous years, it's still helpful to prepare for if they do come up. Find ways to experience the holiday joy even when there is a lot of pressure around getting pregnant. This is a time of family and celebration! Remember that your feelings are valid no matter what! You don't need to feel guilty about anything that you feel. Sad, stressed, overwhelmed- that's all OK. We are here to give you support! You aren't alone- lot's of women are feeling these things. While you might be the only person in your family who has had a hard time getting pregnant or the first person who is changing their diet, other women are going through similar things. Thanksgiving- what comes to mind when you think about this holiday? Cooking all day, being with family, feeling busy? Feeling bored and hungry all day and then starving when you finally sit down to eat? Thanksgiving food classics: Protein (ham, turkey, prime rib, tofurkey), mashed potatoes, sweet potatoes with marshmallows, stuffing, corn break, dressing, green bean casserole (fresh, frozen, canned? Pick your poison). Navigating the Thanksgiving menu There is a lot of food, which can feel overwhelming. Do you love all the foods? How do you enjoy what you love when you're trying to conceive? Remember: YOU ARE NOT GOING TO RUIN YOUR CHANCES OF TRYING TO CONCEIVE WITH ONE MEAL! Maybe it will delay your ovulation for a little bit but it's not going to derail your plans for months if it's only one or two days of holiday eating. If you love it, go ahead and enjoy it. It's just one day! Food is not just energy- it's an experience. Remember that you are celebrating family and love and community. Nutrition tips for thanksgiving: How to find balance when fertility is your goal: Eat high carb foods (pumpkin pie) with protein, Remember how important getting good sleep is, Don't "save up" your calories for one big meal (this will help you not overeat when the big meal starts) Take care of yourself- going into the day hungry, tired, hungover, etc. can really make it more stressful and might cause you to make further unhealthy choices: set yourself up for success. Start with a high protein breakfast, lots of veggies. Feed yourself appropriately through the day. If you haven't fed yourself, your blood sugar will drop (hint: don't get "hangry"!) What if you're drinking? Make sure to eat! Alcohol might make it more challenging to be around certain family members in an emotionally charged situation. Making choices about food Consider dessert- just because it's available and "traditional" doesn't mean you need to eat it. If you like pie, eat pie. You don't like pie? Eat something else. You can say "No, thank you!" That's totally valid. Don't worry about your meals being judged. You make your own choices and you don't have to validate them to other people. If you don't want to go to a gathering- that's valid too. Especially during this COVID year. Get some additional help if you feel like you need it! Absolutely go see a therapist and get some tools for navigating the holidays. It helps to just talk it over sometimes. Holiday drinks- Pumpkin spice lattes, eggnog, peppermint lattes, gingerbread lattes. Having these drinks day after day can seriously impact your hormones, sleep, blood sugar, and cravings. All these drinks are super sugary- basically a hot milk shake. You can have them but consider it a DESSERT, not a beverage or a breakfast. There is nothing wrong with enjoying them but consider when and how much you are having. Tips: choose decaf, get a small, eat it with or after a very protein rich meal or snack. You can change the order by asking for fewer pumps of sweetener. You can make your own! Add spices (nutmeg, cinnamon, turmeric, all spice) to whole milk in your coffee and 1 teaspoon maple syrup. You are familiar with all these ingredients AND they are great for you. Experiment: when you have one of these drinks, really pay attention to how they make you feel? How did you sleep? How is your energy later in the day? Did you get a headache or stomach ache? Ideas for using leftovers Turkey pot pie, turkey chili, turkey enchiladas Shepards pie with extra mashed potatoes Bone broth: use the carcass for bone broth- bone broth is great for your gut health, your skin, your fertility. Pick off all the meat and simmer the bones and skin, add veggies, and a little lemon or another acid source (ie: 3 tablespoons vinegar) to pull out extra nutrients. You don't want to use raw bones- make sure they are cooked. You can even bake these first to make sure they are fully cooked. Cook low and slow (12 hours on low heat) or do it in your pressure cooker for about an hour for a similar result. Pick out bones or strain to get out additional sediment There is nothing wrong with throwing away what you aren't going to eat! It's OK to toss it! Alcohol and mocktails Can you drink alcohol when you're trying to conceive? It really depends on the person. Can you drink in true moderation and leave it at one drink or does that lead to having more and more drinks? Consider your personal habits around drinking. Alcohol can affect your estrogen levels and your cycle but one drink is not going to be the difference between getting pregnant or not. If you're going to drink, pick the drink that you really actually love and not the one that you think is healthier. If it gives you anxiety, it's fine to skip! You can decline a cocktail. TIP: Declining a cocktail carries a lot of meaning ("are you pregnant??")- you can rehearse and prepare an answer that takes the pressure off of you, like "it really hasn't been agreeing with me lately." Questions from instagram: How do you get around the "when?" questions? Consider who is asking and how much you trust them. Some people you can share the truth with. Other people you might be a little more protected around because you don't trust them as much. You can give short answers or longer! Totally up to you how you respond and what you feel comfortable with. This question can really hurt, especially if you're been trying for a long time and it might be helpful to rehearse answers that you feel comfortable giving when this comes up. How do you handle stress in the holiday season, especially during a COVID year? Take care of yourself; make sure you are exercising regularly, exposing yourself to light, prioritizing sleep, checking in with your mental health. Consider all the things that you normally do for your mental health and double down your efforts to keep up with those things. What is sometimes extra stressful about the holidays is being off of your regular schedule (like your regular breakfast and your movement routine). Focus on what you can do to stay in your normal routines and stick to some sort of regular routine as much as possible (remember to eat!). Serve someone else! If you have the mental space to do so but are feeling lonely and discouraged or stuck, find ways to safely reach out and serve someone else. This can be very healing and relieve stress, and loneliness. Ask yourself: what gifts do you have to serve other people? If finances are tight and gift giving is hard this year, consider giving other types of gifts; make something, write a letter, send a card. If you do have the ability to give gifts, consider buying off of etsy to support a small business that might be struggling right now. We are thinking about trying to conceive during the holiday season? Is this a good time, especially during COVID? Do what feels right: There is no right or wrong time to start your family. If you feel comfortable with it, go for it! Consider if you'll be ok with some potential changes like going to ultrasounds alone. There is really no research that shows that being pregnant comes with additional COVID risks. Trends show that a lot of people do conceive during the holidays because it's often a time of relaxation (lots of September babies!). How are you defining "trying to conceive": Depending on how you are planning to conceive might also impact this decision. If you are going down the path of making major changes or using medical interventions, this might be a stressful time to do it. If you are planning on stopping birth control, that is much less stressful and it might actually take some time to get in touch with your fertility and ovulation signs. Holiday Parties: Eat a nutritious meal before you go! It's not going to work well to make your whole meal out of cocktails and appetizers when you arrive hungry. You will not feel good and there might not be choices that fit with how you want to eat. Skip the stuff you don't care about! You don't have to eat it.

Today we are joined by Dr. Loree Johnson, a licensed marriage and family therapist who has more than 25 years of experience coaching clients in her private practice. She helps others overcome the emotional challenges that come with infertility. Dr. Johnson has served on state and national boards, and she is on the board for the Society of Reproductive Medicine. So, needless to say, she is the perfect guest to bring on. According to Dr. Loree, having a therapist on board is key for a few reasons: 1) physical well-being sacrificed through all of the medications and procedures; 2) close relationships being sacrificed from support exhaustion; and 3) mental well-being takes a big hit through each of the milestones, so having that support from a third party is vital to staying healthy through the journey. Do you find yourself saying, "not ANOTHER appointment to schedule!" when someone mentions seeing a therapist? If so, iit might be a good time to prioritize going to therapy over other activities because of how much it can greatly benefit your health in multiple ways. Dr. Johnson introduces therapy as an invitation to explore through having a simple conversation that that person might not have otherwise. She counsels women, men, and couples alike, so each person in the journey has a role to be recognized. Her role to her clients is to help them practice skill building to manage stress/emotions, offering encouragement/support, and often act as a coach to help her clients get through their fertility journey intact. Some of Dr. Loree's top conversations she hears from clients are that the woman's husband does not understand what she's going through, or that he doesn't care enough. She also discusses how sex is such an obstacle for couples because a lot of times women don't actually feel sexy but are pressed for timed intercourse during ovulation, or that the man has performance anxiety as a result from the pressure. She enjoys helping couples reclaiming the fun in sex to produce authentic sex. Dr. Johnson also shares how her own fertility journey has been a struggle, including losing a child, and she explains how her own experience inspires her to help others get through theirs. "Infertility issues can feel like trauma. You can't mindset your way out of trauma." - Dr. Loree Johnson Therapy doesn't have to be a lifelong commitment. You can come in with specific issues you want to discuss, even if it has nothing to do with your relationship with your husband or anxiety about your fertility journey. You can breeze in for 5 sessions and utilize the tools you learn, or you can continue on for continued support and skill building. Having an amazing therapist like Dr. Loree Johnson could help you make great strides in enduring the trials and tribulations throughout your fertility journey -- if you're just beginning it, or if you are in the trenches -- anyone is welcome. You can find Dr. Johnson on instagram or on her website. She shares her Self Care Guide and her Grief Guide for free on her website. Do yourself a favor, and don't wait to start therapy!

Today we dive in talking about the most free resource there is to not only improve your chance to conceive, but just improve your health in general...ESPECIALLY if you are having hormone issues. You might've guessed it..sleep! Discussing sleep as a health intervention is so under-appreciated because it's not glamorous and businesses can't make a profit off of marketing it by itself. BUT- it is so crucial for our body's everyday demands - digestion, hormone control, stress balance, appetite, and so much more. Although there is limited research on sleep for fertility specifically, we do discuss one NIH review on sleep hygiene for fertility. Sleep hygiene is directly controlled by the HPA axis, which is comprised of your hypothalamus, pituitary, and adrenal glands. These glands basically control your brain/body response to stress and rest. This article discusses primarily that if one area within your HPA axis is out of whack, it can directly influence your sleep quality. The second pathway that this article discusses is how your sleep hygiene can be negatively influence your sleep duration. The third pathway is disruption in your circadian rhythm - or your body's alarm clock. The most significant factor that is derived from poor sleep is lack of production of fertility hormones. If you don't get enough sleep, your body does not produce enough of some hormones and so much of others. The same part of your brain that's responsible for sleep/appetite hormones is the same place that produces fertility hormones, which is why it's so important to not neglect sleep habits when considering fertility probability. But how much sleep is good sleep? One study found that women who were undergoing IVF and had between 7-8 but no more than 9 hours of sleep consistently had the highest chance of having a successful IVF cycle. In this episode, we talk about how you know you actually got a good night's sleep, and below are some tips that we discuss that will enhance your sleep: Resetting the circadian rhythm: expose yourself to natural light as soon as you wake up for 10-15 minutes to get your eyes adapted to the full spectrum light. This will help your body to naturally make melatonin easier later in the evening. If you aren't able to do this (i.e. working long shifts), try buying a full spectrum lamp to shine on your face while you're getting ready for work. Or, sit by your window and let the sun hit your eyes! Limit caffeine. While every person has different genetics and processes caffeine differently, a solid recommendation would be one serving (i.e. 8-9 oz medium roast coffee) and stop drinking by 11am or noon. Caffeine can impact the length you're able to sleep, but every person is different. This might not apply to you, but if you're experiencing a lot of these symptoms, try limiting caffeine to get more restful sleep at night. Stabilize Blood Sugar. Be mindful of having a balanced dinner (protein, fiber, complex carbs) to prevent high blood sugar spikes that can disrupt sleep. Also possibly add a bedtime snack that has protein in it. Adding cherries or tart cherry juice right before bed can improve melatonin production. Limit alcohol. It is taxing on your body in terms of antioxidant production to process alcohol (which it views as a toxin) and regulating hormone metabolism. Limiting blue light at night. Wear blue light filtering goggles - not glasses - goggles will cover light coming from any angle. Pick activities like reading or journaling instead of looking at your phone or TV. Limit sounds/interruptions in the room (i.e. don't let your animals in your room if they disrupt your sleep, get an eye mask, black light curtains, or ear plugs if your spouse snores). Move your body! Even an hour outside will improve your sleep quality. Create a soothing bedtime routine. Our bodies love habits! Maybe you take an epsom salt bath, light a candle, read a book, use essential oils, journal, or pray. Remove all clocks/alerts/phones away from your bed. This will help reduce anxiety about answering texts or looking at the time and thinking "oh my gosh, it's already midnight and i'm not asleep?!" Orgasms! They help produce prolactin and oxytocin which can help you wind down. Supplements like Melatonin, Magnesium, 5HTP, Linden leaves, Holy Basil, Chamomile, or Ashwagandha. Always talk to your naturopath MD, RD, or healthcare professional before starting a supplement. Start with whatever in this episode sounds do-able for YOU! This should be personalized and what you think is a priority - where you really had your "AHA!" moment... and then if you feel ready, continue to work through the list. We hope you enjoy this episode!

Dr Carrie Jones Podcast Episode On today's episode we have Dr. Carrie Jones, a naturopathic doctor and the medical director at Precision Analytical's DUTCH test - AKA the Hormone Doctor herself! She loves to empower women to understand more about their bodies so that they can advocate for themselves. We dive in with Dr. Jones to talk more about what women can do that struggle with estrogen dominance and endometriosis, since so many women suffer from these conditions and no one ever prepares us how to navigate them. Many times we find women who are diagnosed with endometriosis face multiple dead-end suggestions by their doctors: 1) suck it up and move on; 2) go on birth control to treat symptoms; or 3)... get pregnant. Well- we know these are not ideal solutions to our problems. Many women go years without getting a proper diagnosis and therefore suffer from crazy symptoms for far too long, just to get tossed birth control as the end-all-be-all solution. Does this sound all too familiar?! In this episode, we discuss how endometriosis should properly be diagnosed, how it can disrupt the TTC process, foods that can help estrogen detox, and natural techniques to detox our livers of estrogen. We also review the mechanism of how soy is linked to estrogen, the hidden beauty of castor oil, and how valuable unpeeled organic carrots can be. Dr. Jones discusses estrogen detoxification in depth; the 1st and 2nd step happening in the liver and the 3rd step happening in the kidney. In the liver, phase 1 and phase 2 rely on veggies like broccoli, kale, unpeeled organic carrots, and brussel sprouts to detox optimally (cruciferous veggies). Magnesium, zinc, and choline are also essential to detoxing in the second phase within the liver. She elaborates on the mechanism of why these veggies aid estrogen detox. The third step in the estrogen detox process occurs in the kidneys and hydration helps this to run efficiently. So - make sure you are having regular bowel movements every day! We discuss more about staying hydrated, having a regular peeing schedule, and Dr. Jones' favorite electrolyte powders. Have you ever wondered why you might feel bloated, have a ton of gas that could clear out a room, or have heartburn after a meal? Have you ever wondered how autoimmune diseases caused by gluten intolerance are formed? Dr. Jones shares with us techniques like how simply chewing your food completely with your mouth closed can really enhance digestion, absorption of nutrients, and prevent autoimmune diseases. Lastly, Dr. Jones discusses common patterns she sees on a DUTCH test that indicate estrogen dominance or low progesterone production with regards to endometriosis. She also talks about what an ideal cortisol, melatonin, and glutathione pattern should look like throughout the day on DUTCH test results.

What if we told you your mindset has a lot to do with your fertility? This might be a shocker for some of you! Today's episode we dive into what a healthy fertility mindset looks like and how that affects your overall fertility journey. You don't want to miss this episode as we connect the physical aspect of becoming pregnant to the mental side of BELIEVING you CAN become pregnant! Although we are practitioners helping women bring home a healthy baby, we are still human and have our own doubts. In this episode, we share our own stories about how we struggled internally with the mental olympics of believing we could become pregnant despite our own personal obstacles. First of all - take a step back and tell yourself you ARE a person that can do hard things. You do believe in yourself. You are taking steps to shift your mindset...after all, you are taking ownership of your life and listening to this podcast! You do not wear a badge that defines your struggles. You do not wear a badge that says "Hi, I'm infertile." No...you are YOU! Talk to yourself like you're talking to your best friend. Is the first thing you think about your best friend is "oh...she is infertile.." ..No! It's likely more along the lines of, "She is strong, beautiful, and she WILL become pregnant." It's as simple as that. Begin to speak to yourself in a kind and gentle way. Simple techniques to begin developing this healthy fertility mindset are: Inclusion vs Elimination: add in foods and nutrients that your body needs instead of removing things that you love! How can we add in more foods and nutrients that will enhance your diet/overall health? Can you add two cups of veggies to your dinner, and still have cheese sprinkled on top? How can you add more colors to your plate? For example: Make a taco bowl with anti-inflammatory spices like turmeric, add grass fed ground beef, bell peppers, and black beans (healthy fats, lots of protein, micronutrients) and STILL include mac and cheese as a small topping to still enjoy the foods you love without making it the focal point of the meal Honor your body. Have the pasta dinner if you want a pasta dinner. Just learn to be strategic about adding things in that can better serve your fertility journey! You don't have to take away your favorite foods...but begin to think about how certain foods will serve or take away from your fertility journey. Focus on YOUR progress, not HER progress. In the world of social media, it's easy to judge your behavior and habits and compare your progress to others. This will do nothing but make you feel inferior to others and isolate you. What works for someone might not work for you, so remember you are an individual and don't let others' journeys distract you. Celebrate each other's victories and stay on your own journey. Build positive patterns. Look for consistency and improvement in these small habits - adding in more colorful vegetables, possibly changing habits in your sex life, or going to bed 15 minutes earlier to get more sleep. Little by little these small actions will add up. You don't need to strive for an A+ in "Fertility Nutrition"… we are just trying to accomplish a goal, so remember to find joy in life while still implementing small, consistent healthy habits. When an obstacle comes up, like you miss a spin class, pivot and try something else. Take your dog for a longer walk or do a YouTube exercise video. Stay on a "winning" path! If you go to a birthday party and eat cake, pivot and make a healthy choice following that. Let setbacks set you up for comebacks! Don't let these small things snowball into huge unhealthy habits. Be flexible. Don't let things you read or hear on social media dictate your behavior. Listen to your body and let that be your guide. If you see someone post about eating more seeds, don't force them down your throat if you hate them just because they tell you they are the key to fertility. If someone talks about how good spin class is for your health, don't kill yourself to make it to that 7am class if you feel run down. Make these habits fit for your individual lifestyle to honor your cravings, energy levels, and mood. Focus on your own continued growth, not your past mistakes. Setbacks are a part of the growing process! Let them prepare you for comebacks. If you ate that chocolate cake you swore you wouldn't, learn from it. Look at the details of your day leading up to that choice...were you hydrated? Were you in a bad mood? Did you go grocery shopping starving? How can we better prepare you for next time to not make the same mistake? Mistakes are great propellers to help you grow. YOU WILL NOT BE PERFECT, MISTAKES WILL HAPPEN! Celebrate improvements - in your cycle, in your hormones, indications for ovulation, insulin/sugar cravings, etc. Every step that you improve is worth celebrating and worth being excited about even though you haven't reached your ultimate end goal of becoming pregnant. You are getting closer and closer to reaching your goal, so enjoy every step of the way! Remember to enjoy and celebrate the small victories along the process. There needs to be JOY in your journey. You can do all of the things - take the courses, have sex, buy the tests, but if you struggle with developing this healthy mindset, don't hesitate to see a therapist. Your mind is part of your body and it's just as important to nurture and invest in your mind as it is your body.

In this episode, we are honoring pregnancy and infant loss awareness month. Caitlin and Sophia are digging in deep about this topic with OBGYN and Reproductive Endocrinologist Sasha Hackman, MD. While we know this may seem like a downer, this is purely to inform all of you about statistics, where pregnancy loss is most common, and how we can try to stop this from happening. We all realize most people don't feel comfortable talking about this, but if this has happened to you, this is NOTHING to be ashamed about. This is something that happens frequently. You are not alone, you do not need to keep your feelings to yourself, and you are not a failure. In this episode we are trying to educate more people to know how to approach situations like these, become more informed about miscarriages, to open up the conversation and how to hold space for someone who has gone through a pregnancy or infant loss. Sasha starts talking about how women in early pregnancy can tell the difference between normal discharge or if they are having a pregnancy loss. She says that unfortunately, sometimes a miscarriage can be completely asymptomatic so many women do not find out until they go in for an ultrasound. Some symptoms do include cramping, vaginal bleeding, spotting, low back/ pelvic pain, and sometimes more. The symptoms are very nonspecific and can lead to stress especially with a woman who has had a miscarriage in the past. Truth be told, spotting is not necessarily normal when pregnant, but it is common. If you are having bleeding or spotting, there is a really good chance it is completely benign and will still lead to a healthy pregnancy! Additionally, discharge can be very normal and does not indicate a miscarriage at all. We had a question about what normal HCG values would be for women before their first ultrasound, around 4-6 weeks pregnant. Sasha explained how HCG should be doubled, or at least increased, after the first few days. Sometimes women only see a 20% increase and will still have a healthy pregnancy. However, the typical minimum cut off where they are absolutely confident about a healthy pregnancy is 53% or more. Sasha dives into telling us what the main cause is for early pregnancy loss. She say by far, the main cause is genetic abnormality. With technology now, they can do something called a "Microarrye Test" that doesn't require them to culture a tissue, but instead, they can ID small, little deletions rather than chromosomal duplications or lack of entire chromosome. They have distinguished that at least 75% of pregnancy losses are because of chromosomal abnormality. This is practically nature's way of removing and absorbing pregnancy that eventually would not result in a relatively healthy child. That being said it doesn't make this loss any easier. We asked if someone has experienced early pregnancy loss, what would be the medical model of care, when should they do extra testing, and do they have to experience multiple pregnancy losses before going through diagnostics. Sasha said that technically, there should be 2-3x more losses before you start evaluation. However, it is all patient orientated. If a patient wants to get tested after one loss, that's great. If a patient has had over 3x miscarriages, doesn't want any tests done at all, and still wants to try to get pregnant again on their own, then that is totally fine, it's her autonomy. She describes her role as a reproductive endocrinologist and how they see pregnancy as a very sacred thing that doesn't come easy to many people. They understand that one loss is too many and they want to see how they can prevent another loss. In this case, they will always do a workup for their patients. This mentality is how they (and us as dietitians) are trying to handle medicine now. They are trying to shift away from paternalistic mentality where the doctors just give recommendations based on past evidence. She says everyone's body is different, so this "old school" way of thinking needs to get thrown out the window. It should always be about the patient and what they want. Catering to their needs can make a world of difference. Frequency of pregnancy loss, you ask. Well, Sasha gives us a very descriptive answer on what is really going on in terms of how many miscarriages are happening. Even though this is a "loaded question", the general number of pregnancy losses would be 12-15% of clinically recognized pregnancies (pregnancies actually recognized by an ultrasound). However, if you were to actually count, a lot of the miscarriages happen before that first ultrasound or before the couple even knows they are pregnant. If you were to combine the clinically recognized pregnancy losses with the clinically unrecognized losses, the incidence rate would be around 30-60%. This HUGE range depends on multiple factors such as age and pregnancy history. If under 30 years, and you have already had a live birth and/ or abortion your changes of miscarriage is LOW at a 4-6%. Generally, if you are under 30 years of age, your chances are only 7-15%. If 35-39 years old, your risk is about 30% and if you are over 40 years, your risk is about 35-50%. If you have a history of pregnancy loss your risk for reoccurrence is about 25%. With each miscarriage, the risk will go up slightly and will usually plateau at 50%. Yes, this seems high, but there is STILL a substantial chance of a live birth! Sasha also says that there is not really a difference in natural conception, IUI, or IVF in terms of miscarriages. Pregnancy loss really just depends on medical and pregnancy history, and age. And unfortunately, age is the biggest prognostic factor and is NOT a modifiable one (say what?!). Some other reasons why someone might miscarry other than genetic factors is Asherman's syndrome, developmental abnormalities, translocation of chromosomes, and well as other disorders. Asherman's syndrome is when some women develop scar tissue within their uterus which can be caused by a history of abortion or miscarriages and need a DNC or any other type of instrumentation of the uterus. This can increase risk of scar tissue, poor vascularization, and the risk of miscarriage. Probably the developmental abnormality of the uterus that increases the risk of miscarriages the most is called a septum. With this septum, there is not enough vascularization to support a pregnancy, which can easily be fixed by removing the septum, the procedure being minimally evasive, and a patient can go home after. Although not as common, the translocation in one of the parent's chromosome, meaning two pieces of chromosomes switch in both parents', causes chromosomal abnormalities which can lead to a miscarriage or having a child with a developmental disability. IVF with genetic testing is a good option for parents having this issue. Clotting disorders, endocrine disorders (poorly controlled diabetes), thyroid disease, luteal phase deficiency, PCOS, and age can also increase the risk of a pregnancy loss. These are known things that will increase risk before going into a pregnancy so Sasha always want to tell these patients to not get pregnant until they can optimize their conditions first so they can decrease risk of miscarriage in the future. Chemical pregnancy versus miscarriage? Sasha explains that a chemical pregnancy is an actual pregnancy with the presence of HCG, but there is nothing in the ultrasound to show sac is being formed. On the other end, there is something called a "blighted ovum" meaning that there is a gestational sac present but no embryo present. Both of these conditions are considered spontaneous abortions. Again, with all of these conditions, whatever they may present as, women should not be ashamed with themselves because IT IS NOT THEIR FAULT. Does obesity increase risk of miscarriage? Sasha tells us that studies have shown that once you are in the range of obesity it definitely increases the risk. There is a huge correlation there. Sometimes even very mild weight loss, even 5% of total body weight, will show improved outcomes in pregnancies. This is when it is important to remind women it is not just the weight that matters, it is their overall lifestyle. Being dietitians, we had a few things to say in regard to obesity and pregnancy. We want to tell our listeners that if you are a woman of a larger body size are not eating things that are helpful for fertility, that it is possible to change the way you are eating into a way that DOES support fertility. This will make your fertility completely transformed but your body size does not have to change. This is why the "just lose weight" statement from doctors is not realistic or the issue, we need to talk about how to change the diet and lifestyle with the nutrients that are going to support a healthy baby. Sometimes this will result in a natural weight loss. What we want is to get your hormones under control, blood sugar more regulated, thyroid supported, digestion under control, and stress and inflammation reduced. Sometimes body size will change and sometimes body size will not. Your chances of having a healthy pregnancy will be dramatically increased but it will not always impact your body size. Let's say you are experiencing a loss in pregnancy. What can you expect in terms of medical intervention, managing it on your own, and how long should you wait before seeking medical care? The best practices are giving the women the option between 3 interventions. Do nothing. Sit and wait to see if your body will take care of it on its own. Advantage: is there is minimal risk. Downside: if it doesn't happen right away, you may be waiting several weeks to actually complete the miscarriage and even then, it might not happen, and intervention would be needed. Medical intervention would involve medication like Misoprostol where it can be given orally/ vaginally. Downside: cramping is really intense. Advantage: avoid having to go into surgery. Another medical intervention would be having a plastic tube inserted into the uterus which would suck everything out. Advantage: all products of conception can go for genetic testing so you can get a better answer (especially now with "microarraye" testing) which really helps with closure for patients. Surgery: if you are experiencing hemorrhaging of if you develop an infection. What is an ectopic pregnancy and how would someone know if they are having one? Ectopic pregnancy is different than a miscarriage because the embryo is actually implanted outside of the uterus. There is medication to manage an ectopic pregnancy if the woman is stable, but if unstable, then surgery would most likely be needed. You can tell if its ectopic when you go into doctor's office and the HCG levels are fairly low compared to what is expected. Also, if the HCG levels are high, then they wouldn't be rising as quickly as it should. The suspicions would either be a miscarriage, ectopic pregnancy, or sometimes it can even turn into healthy baby. (Wouldn't it be nice if we could scoop up the ectopic pregnancy and plant it in healthy uterus???) If someone has an early pregnancy loss, how long can they wait until they can start trying again? What about a further- along pregnancy loss (around 27 weeks)? Sasha says that for an early pregnancy loss the answer would be to start trying whenever you are emotionally and physically ready. Generally, she tells her patients to go for whenever they want, but it might be helpful to wait until they have their next period. For a further along pregnancy loss, also called a fetal demise, you really just want to give months for physical and emotional recovery and grieving. However, she really recommends looking into why this may have happened and if there is something specific that can be changed, then you want to work to see how you can change that and try to reduce risk for the next pregnancy. Sasha explains that trying to prevent a miscarriage can be tough because the majority of the time it is chromosomal. Sometimes it can be stress related, which no one knows for a fact, but why they believe in this is because there is one intervention for recurrent pregnancy loss that's called TLC (tender love and care). This is when they will bring patients in for weekly ultrasounds (or really whenever they just want it) to reassure them that their pregnancy is still viable and ongoing. Studies have shown that the live birth rate with this intervention is significantly higher. (Wow!) There is something to be said about constant reassurance, really being there for a patient, and allowing them to get as many ultrasounds that they need. This treatment may help you if you have been through a pregnancy loss more than once and might be scared it will happen again. Reassurance that everything is okay will reduce your stress. Staying active, staying distracted, including lifestyle interventions like proper sleep, mindfulness, mediation, eating whole foods, and doing things that make you feel good, will help you enjoy your pregnancy more, as well as taking care of your mental health and your growing baby. To end on a happy note, to any woman who has gone through a miscarriage/ recurrent loss, the chances of you holding a baby in the next pregnancy is 70%. THAT'S HUGE. Just remember that and that will help bring you back some optimism.

*Trigger Warning* - It's a story about labor and birth! Here we dive in with Cohost Caitlin Johnson, RDN to hear about the birth of her sweet little girl! Caitlin answers all my questions about her birth prep, the birth itself, and the postpartum period. Caitlin's prep: She and her husband did a Bradly birth class before her first baby was born so BJ (Caitlin's man) could get all the juicy deets on what to expect and what to do when his baby was being born. This time around they were already prepared from the last baby! Red raspberry leaf tea and a nutrient dense diet were Caitlin's nutrition prep for this birth. Dietitians have a hard go when it comes to early pregnancy nausea. Caitlin was no exception. It's hard to talk about food all day for work when you feel like you could gag at any second. Caitlin also upped the protein and sodium to combat low blood pressure and a family history of preeclampsia. She also altered her supplement and herb routine since she had SUCH a struggle nursing her first baby Fiona. Turns out there is a link between PCOS and nursing struggles! Home birth was the option of choice for Caitlin and her husband. However, we DO want you to know that even though Caitlin chose that, we DO NOT think EVERY woman needs to birth that way! We don't think you need to quantify your choice, so you choose whatever is right for you. What it comes down to is doing whatever makes you and your family feel safest. For Caitlin, that meant having her baby at home. Early in the week before Fiona was born, Caitlin had a visit with her midwife. The midwife offered some cervical work to get the baby moving, but Caitlin decided that wasn't right for her. Instead, later in the week she decided to see her acupuncturist! The acupuncturist also suggested that perhaps Caitlin get the cervical treatment done with her midwife later in the week. As the week rolled on, Caitlin decided that she was ready to bring the baby along, so she decided to tell the midwife she was ready to have her cervix swept. The midwife spent a lot of time explaining the process of a cervical sweep to Caitlin, and it was great. Caitlin and Sophia are both BIG fans of informed consent, and they believe women should be informed of the risks, benefits, and procedures involved with any medical intervention. Lo and behold, the sweep opened Caitlin's cervix a bit more! She then went on a walk with her neighbor, had dinner, and around 8:45 she began having real contractions. Soon thereafter, labor was in full swing! Caitlin's family set up her birthing tub, and soon thereafter the labor got really intense! This phase was called "transition", meaning the baby is now low in the cervix, approaching the birth canal, and it's almost time to push! Fun fact, this is usually when mamas start feeling the "I can't do this" or "give me the drugs!" feeling. It feels bad, but this is actually good! The midwife came back, and saw that this baby was coming quick! Caitlin was really feeling intense labor feelings, so the midwife suggested that she break her water and then try some new laboring positions. Up out of the tub she came, and tried a few positions before deciding sitting reverse cowgirl on the toilet was the way to go. A few pushes later, Caitlin decided that birthing a baby in the toilet was not the deal, so she waddled back to the bedroom with the baby's head about to crown. The next push, the baby FLEW out, head to toe, and the midwife caught her! By the way, it was 2:40am and Caitlin went into labor at 8:45p, so it was less than 6 hours from start to finish (this is Sophia's dream, by the way!) Baby is born, and for a second there they thought it was a boy! Side note, babys have pretty swollen genitals when they're born. After a second look, the midwives announced with joy that Fiona, a beautiful baby girl, had arrived! Caitlin decided to do a delayed cord clamping, in case you're interested, because that can help baby have more time to start breathing in case that's a concern. Then that was that! They cut the cord, Caitlin delivered the placenta (eventually), began to nurse her baby girl, and life continued! The placenta was huge (common with PCOS pregnancies) but caitlin's was extra huge since she had a big blood clot attached to it.

Here comes a special one! This episode features fellow dietitian Ayla Brammer, owner of Boston Functional Nutrition and creator of Full Circle Prenatal! Caitlin and Sophia both use this prenatal for themselves, and recommend it frequently in their private practices. Ayla shares the roots of her practice and how she came to be the powerhouse dietitian she is now. She also works in pregnancy and preconception, but her passion is working with couples when they are first starting their journey to become parents. Ayla shares her thoughts on one of the most common pieces of fertility advice shared by OBGYN and RE docs alike… "Lose weight before you get pregnant". Of course we hate this blanket advice and don't see it as helpful to women who want to be moms; but Ayla takes it a step further. Rapid weight loss is never a good idea, but when you're trying to become pregnant, it's even harder on your fertility systems. Our fat reserves can contain toxins and other dangerous compounds that we do not want to be rapidly circulating throughout our bodies. Remember that one tree in Ferngully, that had the weird evil smoke in it? Fat stores can be kinda like that. Though some women do see some positive changes when their weight is stabilized, all 3 of us dietitians see the preconception period as a time to fill your body with nutrients, vitamins, and minerals with the right foods; not slashing and restricting everything in the name of weight loss. Our focus tends to be more on how to get your nutrients absorbed and kept, versus how to make your body smaller in order to somehow change your fertility. Ayla explains some of the functional lab testing she uses in her practice. She's an advocate of a comprehensive vitamin and mineral assessment to show patterns and gaps in the way your body is processing what you eat. This can also reveal stressors, genetic abnormalities, and other anomalies that impact your ability to get pregnant. Hormone and stool tests are also important tools to getting your body ready for pregnancy. The girls talk about their pregnancies and nutrition choices while pregnant for a while, so if you're not ready to listen to a pregnant story, skip from 17:30-22:30. Ayla lists her 3 favorite foods for the preconception period! Ayla's fertility curry - lots of veggies, protein, and nutritive spices Stinging Nettle Leaf Tea - very high mineral and easy to drink! Sophia's husband isn't a fan of her giant bag of nettle leaf taking up space in the cupboard, but it's great for you! Liver - we all love/hate it. It's so nutritious, but the taste is rough. Hide this food in meatballs, meat sauce, burgers, taco meat, etc. A little goes a long way. If we are losing you on the liver, you're not alone. Each one of us grew up on pizza and freezer waffles, so it was hard for each of us too! Please don't try to just eat boiled liver. We want you to enjoy your food, and not choke down whole mouthfuls of liver. Start by hiding little 1oz portions of liver in ground beef dishes. On to Ayla's specialty creation: Full Circle Prenatal Vitamins! The Full Circle prenatal is the best on the market for most pregnant women. One of the things that sets it apart is the Vitamin D content. This is slightly controversial, but Ayla made this leap since she is an RD and really sees the importance of Vitamin D in pregnancy. Vitamin D is vital for ovulation as well, so taking a prenatal like Full Circle while TTC is a great idea. PCOS sister especially need to test and treat their Vitamin D levels, as none of us have ever seen a PCOS patient who also have adequate levels of this vital nutrient! Full Circle also has much more iodine than other prenatals. Ayla shares that this was a deliberate choice to put her vitamin in line with the optimal supplement in pregnancy recommendations from most major medical associations. A huge number of women don't get enough iodine, especially when women aren't eating dairy. Iodine isn't only important for pregnancy, but it's important for thyroid function in the preconception period and for postpartum. Iodine can also be found in fish and seafood, even sea vegetables like nori and other seaweeds. Choline is another star of these kick-butt prenatals! Some folks are taken aback by the 8-capsule dose of these prenatals, but the reasons the serving size is what it is is for choline. If you look at other prenatals, you'll see only a fraction of the amount that you'll find in Full Circle. It's a bigger nutrient, so it takes up more space. 95% of women aren't consuming adequate choline; and it's vital for fertility too. Choline is needed heavily for the processes of early pregnancy and to develop healthy eggs for quality ovulation. Yet another reason why we here at the FFF podcast looooooove Full Circle! Choline can be found in food too; mainly in beef liver and egg yolks. However, you'd need to eat a TON of egg yolks to get everything you need in preconception and pregnancy without supplementing with a product like Full Circle. Ayla then touches on why her supplement isn't "real food" based. Listen, we are dietitians and OBVIOUSLY we stake our careers on using food as medicine… yet here we are recommending a prenatal that isn't made entirely from real food sources. Heres why: Concentrated and dried veggies don't give you that much nutrition per volume. A concentrated and dried spinach leaf gives you a teeny amount of nutrition compared to actually eating real food! When you buy green food powders or food based pills, you're getting only a very small amount of fruits and vegetables per dose. Full Circle's goal is bioavailability - what will your body absorb and use? Often, the "real food" version won't give you enough of what you need or can absorb. Ayla hand-picked each nutrient in this supplement to ensure you're getting enough of what you need, and in forms that can be readily absorbed. Full Circle also does not contain iron, a controversial choice! Ayla explains this choice through explaining the variable iron needs during preconception, pregnancy, and postpartum. Not all women need iron, while some need a lot of it. Iron also has a lot of side effects and poor absorption in supplement form. Iron also can limit your absorption of other nutrients, and vice versa. Ayla chose to leave this nutrient out so that the rest of the nutrients can be absorbed well. If you need additional iron, it needs to be either eaten in food or taken at a different time of day from your prenatal vitamins. Ayla gets a lot of questions and scrutiny for this choice, but she stands behind it. Developing this product has been very difficult, but Ayla is so proud of what she has created. Caitlin and Sophia are certainly glad she's braved this world since they both take this supplement themselves. So now the burning question on everyone's mind… Why NOT a gummy?? Ayla explains that in order for gummy vitamins to be tasty, they skimp on nutrients while loading up on sugary syrups and flavors. Not conducive to actual preconception health! If you compare any gummy vitamin to Full Circle Prenatal, you'll see just what we mean. Ayla shares a message of hope; so many women get empowered and find their fertility through better nutrition and getting to the root causes of issues. If you're feeling like you're on the conveyor belt at your fertility center, it's time to reach out to practitioners like Ayla, Sophia and Caitlin! A big thanks to Ayla for stepping into the challenging supplement market, making a great product, and coming onto our show to share all her goodness! If you want to try Full Circle Prenatal for yourself, use the code FFF10 at checkout for an exclusive 10% discount!

PCOS is treatable! Here's how to start: Personal Baseline: What do your labs say? What symptoms are you dealing with? Have you had any imaging done? These are all the first things to start looking at when it comes to PCOS. It's important to note that while Caitlin and Sophia love working with women with PCOS, and we have many years of experience, we are dietitians, not doctors. We don't diagnose! So what to do with nutrition: Balance blood sugar Make sure that there is a higher quality and quantity of protein at each meal and snack "Quality" means it's not inflammatory and provides more protein than it does any other macronutrient. Examples: meat, cheese, nuts, and seeds Most women with PCOS tolerate high protein dairy products like greek yogurt, cottage cheese, and cheese! SOME women do have fewer symptoms when they eliminate gluten and dairy, but it's not the magic answer to PCOS management that it's often believed to be Not everyone needs to be dairy free! Veggies, fruits, nuts, and seeds are your best sources of fiber! Pro tip: artichoke hearts have a ton of fiber! Fiber is great at filling your plate and filling your belly! You'll find that you get to eat a lot of food while managing your PCOS Eating real food, vs. a protein bar or shake will keep you full for longer. It will help you slow down and feel full, versus slamming down a protein bar in under a minute To succeed, you have to eat enough to feel full! Fiber and protein are keys in making that happen FIBER! Starting your day with nutrients and blood sugar balancing protein! Even though it might seem like a lot of calories to have 3 egg scrambled with spinach and feta, a slice of toast with nut butter, and with a cup of coffee; you will feel full for so long and it will keep your blood sugar steady for hours! Swapping sweet for savory when possible. Eating sweet makes you crave sweet! It's not your fault, its PCOS! Eating the right fuel first thing in the morning will keep your cravings at bay. Breakfast Try cronometer.com! Plug in what you're eating and let's look at your vitamin/mineral/fiber intake in a day! Sometimes you can be eating "healthy" but missing key pieces for PCOS fertility Take a peek at your protein/carb ratio! Typical American diets can have way more carb to protein than is helpful for PCOS fertility Check out your current nutrition status Keto, Atkins, and other super restrictive diets are not needed to boost fertility with PCOS Food is slow medicine; sometimes it takes several months of eating right to balance your cycles and get pregnant! You need to do something that can be sustained long term, not another crash-diet plan. Sustainability Supplements Remember to check with your doc!! Some of these supplements can interact with medications or are contraindicated for certain medical issues. Is there insulin resistance present? How about high testosterone? Or high stress? How's the thyroid? That's where we start to dig into what supplements can help. We recommend myo-inositol and not d-chiro. PCOS ovaries can make too much d-chiro, so we are careful not to exacerbate that Inositols Helps improve insulin sensitivity and can boost egg quality, plus helps you make great cervical mucus NAC Another powerful blood-sugar/insulin supportive supplement Berberine Wherever you live in the world, most of us are vitamin D deficient. As levels of vitamin D rise, insulin resistance lowers! It's also important for maintaining a healthy pregnancy! Vitamin D Support egg quality and improve insulin resistance Zinc Common mineral of deficiency in PCOS, helps with gut health, insulin resistance, and ovulation Magnesium You don't want to wait until you're pregnant! Start on a quality prenatal ASAP! (And stay tuned for our episode on prenatals dropping soon!) Prenatal We're here for the omega-3's! Omega-3's are essential fatty acids that are vital for reducing inflammation and supports your body in building new tissues. Eggs, endometrial lining, and babies are all new tissues your body grows! DHA/EPA are the omegas you want! Don't be seduced by algae oils! They don't have the same DHA/EPA ratios as fish-based supplements Fish oil Movement and Exercise Sleeping 6-7 hours vs. 4-5 hours is a game changer for PCOS Blackout curtains or a sleep mask can help you stay asleep longer. Here is a link to Sophia's fave sleep mask Meditation apps and sleep stories can help you quiet your thoughts and get into a deeper sleep Blue-light blocking glasses can help if you're using screens prior to bedtime Sleep environment is key Sleep and stress management Many times women with PCOS have been told to lose weight in order to get pregnant, that they're total exercise junkies! All that effort can be misplaced when it's cranking up your stress hormones and stressing your immune system If you're dreading your workout and coming up with every excuse not to go, find something else! Keep your own body in mind - if you're 280 pounds, putting weights on your back and trying to squat is only going to put more strain on your body. Bodyweight exercises can be a lot more helpful! Cardio isn't always the answer. Strength training and resistance workouts can do wonders for building muscles and changing insulin Find something that you like Stretching and breathing can lower your stress and help your body relax. Quality ovulation is dependent on your body feeling safe enough to become pregnant. Lowering stress hormones can be a big key in this Yoga Exercise Check out Caitlin's program: Find Fertility with the PCOS+ Method.