709: Root Causes of Infertility, Declining Sperm Count, and How to Fix It With Dr. Nashat Latib

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Katie: Hello and welcome to The Wellness Mama Podcast. I’m Katie from wellnessmama.com. And this episode is all about the root causes of infertility, why we’re seeing declining sperm count and how to fix it. And I’m here with Dr. Nashat Latib. I really enjoyed this conversation. She has over 20 years of clinical experience. She was a Board Certified Emergency Physician and now she’s one of only a few Functional Medicine Certified Physicians in the world, specializing in regenerative medicine and especially fertility.

And she shares her own personal story, what led her into this work from being an emergency physician and how it came from a story within her own life. And we also get to go deep on the functional medicine side of fertility, which I have not yet touched on in this podcast. She talks about a lot of the factors that go into fertility, why in many cases couples are able to get pregnant naturally, even if they’ve been told they can’t, or even if they’ve had IVF or IUI. And she takes a root cause approach that’s very individualized couple by couple, but also shares a lot of the universal things that are helpful in this podcast. She’s a really fun interview in person to talk to, and I think that you will enjoy this conversation and learn a lot. So let’s join Dr. Nashat. Dr. Nashat, welcome and thanks so much for being here.

Nashat: Thank you for having me. I’m honored to be here.

Katie: I think we’re going to get into some very important topics today and you’re going to get to spread a lot of insight into some potentially very confusing areas of medicine. And for background, before we jump into those specifics, I would love for you to give us a little bit of actually your own story because I know you started off as an ER doctor and then transitioned into the work that you do now. And I think this story also involves the birth of your three children in a way. So I would love to hear your background and your story and how it led to what’s now your life’s work.

Nashat: Yeah, great question. That’s a very involved story. But yeah, lots and lots of years in the emergency room. And I spent many years actually working in a level one trauma center in the Bronx. So you can imagine the scope of things that I saw was very, very broad. I lived in New York City for about 15 years before I moved to Houston.

And what I realized in the emergency room was I was finding that we were using an acute care model to treat chronic disease. And so what happened in the emergency room was we ended up having a revolving door. So patients would come in and we would treat them. We would put a band aid on the problem. They would go out the door and then they would immediately return and come back.

So I started to notice this pattern and I thought, okay, well, clearly there’s something wrong with this traditional model. And there’s probably some paradigm shifts that are needed, but quite honestly, I didn’t really know what or how, because I had gone to medical school and I was basically just practicing what I had been taught.

So fast forward, many years later, I sadly lost my mom in 2018 and she was hands down probably the healthiest person I knew. She worked out regularly, she ate organic, you name it, she did it all. Really complex carbohydrates, she kind of did all the things. And unfortunately start developed a very rapidly progressive neurodegenerative disease. And here I was as an ER doctor, saved lives for a living, yet I could not save my mom.

And so she went from well and spinning with me multiple times a week to gone over a course of seven months. So it was very, very tragic. She was my best friend. And so I really used her as a source of inspiration for everything I do today. And it was in that moment that I realized that the traditional medical model was not just failing me and… My mom, one of the people I’ve loved the most in my life, but also my patients.

And I started to look into other things. Now, of course, I kind of started this journey probably several, many, many years before that, because I’ve always been very committed to health and being proactive about it. But I started to do some functional medicine training, and that’s when I realized, okay, this is really the direction that I need to go. And, you know, by that point, I had already had three kids. You know, using the traditional fertility approach. So obviously in medical school, you go through years of training. I was a little older when I started. And so I fell into the category of unexplained infertility. So all my levels were normal. I was used to having regular cycles. And then all of a sudden, here I am trying month after month and unable to have these babies and grow the family of my dreams.

So it was interesting when I started to explore functional medicine and went back and looked at all of the ladders that I had done during my fertility journey. And I had done multiple rounds of IUI and IVF, spent well over a hundred thousand dollars on treatments to have my three children. And while I’ve always, you know, and still continue to feel extremely blessed, there was something very broken when I looked back into my files and realized that there were clear root causes that were keeping me from getting pregnant, and that in reality, I didn’t need any of those fertility treatments in the first place. And that was a big aha moment for me when I realized something has got to give and something has got to change.

Katie: That makes sense. And I know that term unexplained infertility seems to be one of the things that’s on the rise. And to me, it makes sense that… Not obviously having the medical background here, but it makes sense that there would be root causes. Because my understanding is that things like our fertility and certainly like our skin health, our body views those as like not first line of defense important. So if something else is going on in the body that seems more acute, the body’s going to prioritize and it might even be, to my understanding, something as simple as like elevated stress levels. Or if the body thinks it’s in danger, it may not want to prioritize the resources for things like having the best skin we could have or making a baby if it doesn’t feel like it’s safe to do that.

But I know there’s probably a lot more that goes into it beyond that. But is that what you mean by root causes? That there can be underlying things in the body that are not actually causing a permanent infertility, but a temporary one while the body deals with those other things?

Nashat: Absolutely, and you hit the nail on the head. And there are so many overlooked root causes that the traditional fertility paradigm simply doesn’t address. So gut health, for instance, is a really big one. Stress, you named it. I mean, the reality is that stress affects our cortisol rhythm. So how much cortisol our bodies naturally produce over the course of a day is altered when we are under severe amounts of stress.

And here’s the crazy thing is that our cortisol levels actually interfere with our sex hormone production. You know, they interfere with our thyroid. They interfere with our sleep and our ability to rest and restore at night, which is such an important part of cellular repair. I mean, I could go on and on with regard to the root causes. There are multifold. And unfortunately, the traditional approach to fertility really doesn’t look at them. There’s lots of stones left unturned.

And I can’t tell you how many couples have come to me and have been told, for instance, they need a donor egg or, you know, IVF is the only option. And one, they get pregnant without IVF and two, they end up doing it with their own egg and not with a donor egg. So absolutely there are root causes.

There’s actually kind of a… A vignette or a little metaphor that I used to kind of talk about fertility and all the fertility factors. And, you know, it’s really male and female we have to consider. I also think that’s one of the biggest problems is in our traditional model. Oftentimes we’re focused on the woman. And we have to focus on both sides of the equation. And so I kind of, I don’t know if you ever played with dominoes when you were little and lined them up and you push one down and they all go down. I see if you line it, I think of the dominoes as basically male and female fertility factors all mixed together. And so they’re all mixed together, we’re lining them up. But if a few of them are just a little too far apart, we’re going to push down the dominoes and they’re not all going to go down, which doesn’t mean that you can’t get pregnant. It just means we need to make some shifts, move a few dominoes a little closer together, and then we can get pregnant naturally. Does that make sense?

Katie: It does make sense. And I would guess inspires a lot of hope in couples. I’m sure that wanting to have a baby and not being able to is a very deeply painful experience. So probably that message brings a lot of hope to couples who are experiencing that. But it also seems like this is going to be, it’s going to have positive ripples in so many areas because I had another guest that explained it so beautifully. She said, every time you’re having what you would call a symptom, your body is actually mounting a healing response. Your body’s trying to heal and either maybe needs something it doesn’t have or it has something it doesn’t need. But if we can figure out how to support our bodies in that healing response, then what we view as the symptom often goes away.

And so I think your root cause perspective takes that into account so beautifully and also inspires hope that for a lot of these couples, maybe their infertility doesn’t need these more extensive treatments. And I would guess by addressing that root cause, they’re probably also increasing their odds of a healthier pregnancy and better outcomes for the baby as well, because they’re getting to the more foundational things. Is that your experience as well?

Nashat: Absolutely, absolutely, 100%. What we do in the 90 days pre-conception directly influences egg and sperm health, and also obviously influences one, the chances of conception and the chances of having a healthy baby. And actually the clinical research and studies have shown that by being proactive in the pre-conception period, which is really 90 days prior to conception, 90 to 120 days, you will actually have a child with fewer health problems, not just short-term, but actually chronic long-term problems too.

I’m not sure if you’re familiar or our audience is familiar with the concept of Epigenetics, but Epigenetics is kind of all the rage right now because we actually have the power, even though we pass down the same DNA, we can’t change the DNA that we pass down, but our DNA is complex. So we have on and off switches for our DNA. And by making the right choices and preparing our bodies, optimizing our health during the 90 to 120 day preconception period, we can actually turn on the good DNA and turn off the bad DNA. And so what you get is actually a genetically more favorable child. Which is wild.

Katie: That’s fascinating and it makes sense. I’m curious if maybe new data has updated our understanding of this area, but I know for a long time it was thought that egg health was somewhat static and if that was the problem, there was nothing you could do to improve it. Is that still the case or as we’ve learned more, is that actually not as static as we once thought?

Nashat: Absolutely false, 100%. Yeah, it is totally a fluid thing. And AMH is a number that can sometimes be really traumatic for women who are trying to get pregnant. So AMH stands for Anti-Mullerian Hormone and it is traditionally used as an indicator of ovarian reserve and like how many eggs you have left. And really what is AMH? I really think it’s important for women to understand that AMH is simply a hormone that is produced by the outer layer of the egg that is kind of in hibernation in the ovary. And the cool thing is that by influencing egg health, we can actually increase AMH. AMH was once thought to be a static number that does not change. However, we’ve proven time and time again that that is indeed false.

In fact, my protocol has as much as quadrupled AMH in women. So traditionally, a woman with a low AMH may not be considered, for instance, an IVF candidate. Especially if they have an AMH as low as say 0.2. But in my experience, I have been able to work on egg health proactively with my couples, quadruple that AMH, and then they end up getting pregnant naturally and not even needing IVF. So it is absolutely something we can influence. It’s never too late. And that’s part of the reason that I’m not, I don’t buy into the concept that, you know, 35 is like the dead end of the road, which is what we’ve been taught. What is caught in medical school?

So, you know, unfortunately, I think part of the problem also is that. It takes about 50 to 100 years for scientific studies and research to kind of become the standard of care. And so a lot of what we learn in medical school is really antiquated and is based on studies that are completely outdated versus I find that in a root cause of functional medicine approach we’re actually being proactive and taking action on studies, research, and biochemistry that we’ve come to understand in the last 10 to 20 years.

Katie: That’s such a good point. And it’s one of the reasons I’m so fond of saying on here that at the end of the day, we are each our own primary health care provider, because we are the ones choosing the inputs that go in our body each day, we’re choosing our lifestyle and diet factors that can make such a huge difference. And we’re the only ones who have the responsibility for our own health. And I do think the best outcomes happen when you have providers like you who are deeply invested in learning the cutting edge science, understanding the patient, looking at like asking the right questions and getting to first principles of this. But I think it’s also really important for people to be the drivers of their own health and realize how much power we have actually to shift so many of these things in fertility and in every area of health, I feel like.

Another area I know of this that is often talked about, and I’ve seen a lot of news headlines around is the decline in sperm count and the pretty drastic numbers from even two generations ago to now. Are you seeing that in your practice as well? And is that also reversible in individual men?

Nashat: Absolutely. So actually, sperm counts are projected to go to zero in the next 40 to 50 years. How about that? I don’t know where that’s going to leave, you know, our children and their children in the future. But yes, absolutely. That is one of the reasons that I mandate when I work with couples, I really need to work with both members of the couple, male and female, because 50% of infertility does have a male factor associated with it. So, you know, it’s not completely the man’s fault 50% of the time, but 50% of the time, there is something contributing to the situation.

I think one of the things is, for instance, a lot of motility and morphology are at a lower than they’ve really ever been before. And those numbers are continuing to decline. So that is something that we’re very proactively working on. And yes, it’s absolutely reversible. Again, it takes, you know, I think one of the key things for people to understand is that it takes about 90 to 120 days for the sperm to develop. So we can start from zero every time and create amazing, you know, sperm quality, if we do the work. But it’s really about optimizing, you know, the body in a healthy environment.

And that kind of ties into what you were talking about earlier. And I always say the body is smart, right? So the body knows when it’s a safe place to create a baby, and when it should maybe not. So I always tell my couples who are struggling to conceive, it’s not because you can’t get pregnant, your body is talking to you, and it’s screaming for help. So let’s give it the help and support that it needs, so that we can get you easily, you know, to your goal of growing your family and natural conception.

Katie: I love that. And also to your point, I’ve seen this happen in other areas of medicine as well. How you talked about it can take a long time for something to get from research into practice, which makes sense, understanding how busy doctors are and all the process that has to happen from something to be validated and then taught and then now become common practice. But I do think it often means there are gaps that people like functional medicine doctors and even patients, I see a lot of patients, I’ve seen it in the thyroid space are kind of driving that change by requesting different lab tests or requesting different treatments. So that’s back to that whole the best outcomes happen when you have an invested patient and an educated doctor working together as partners. So I love that that’s how you view it as well.

And you mentioned your protocol that you have. I’m curious, I know there’s probably a lot that goes into this, but what are some of the baseline things that you recommend to couples to begin that process of improving fertility?

Nashat: Yeah, well, the first thing is really getting a complete picture of what’s going on. And I actually did a reel about this in my Instagram talking about the labs that you really need to get to work at fertility. You know, I’m not a big believer of needing crazy expensive advanced functional lab testing. Yes, there is a time and a place and I do use all of those tests in my practice, but we can get really, we can get started in a very simple way by just doing regular serum labs. So things that I look at, for instance, are some markers for the gut. We’re looking at markers for inflammation. We’re looking for the possibility of any autoimmune disease, thyroid. Of course we are looking at the hormones, but fertility is not just about hormones and reproductive organs, it’s about the entire body. So I do care what your lipid levels are. There are a lot of things that I care about in order to prepare for conception that are not necessarily prioritized in your normal fertility journey. So that’s definitely one of the things that I look for in terms of assessment.

And I also look at symptoms because sometimes, like you said, the symptom is, it gives us a lot of insight. We in functional medicine have something called a Medical Symptoms Questionnaire, which is a clinical tool that we use to track progress and also get an idea of what may be going on under the hood that is not showing up in the labs. Because it’s not, yes, we’re looking at labs and biochemistry, but I also care about what my patients and clients are feeling. So if somebody comes to me and they’re like, I’m sleeping terribly, I have utter exhaustion every morning. And even though I sleep for eight hours, I feel like I’ve been hit by a truck in the morning. I may not necessarily see that on a regular serum lab, but that is information for me that then I can glean from and take action to create basically a personalized plan that’s customizable to their biochemistry and what their body needs to become the most fertile self.

Katie: That to me is so hopeful to hear because I know I had the experience in the thyroid world of being told my labs were normal and telling multiple doctors, but I am having, my hair is falling out. I’m exhausted. I’m literally taking a nap in front of the door so my kids can’t run in traffic. I’m so tired. And they would tell me like, well, that’s just normal when you have kids. And in hindsight, it was not normal, but I’m so excited to hear that more and more, especially in functional medicine, which I think is really leading this charge, we’re taking into account the actual experience of the patient along with the data that we now have so much more access to. It makes sense that both of those would be valuable tools in this process and not exclusive of each other by any means.

Are there any common dietary things that you see going on or that are seemingly helpful in improving fertility or supplements or what are some of the kind of core places you start with that?

Nashat: Yeah, absolutely. I mean, I really start with basics, right? So I always say optimal health is a lifelong journey because we all have room for improvement, including myself. As far as dietary guidelines, one of the first things we want to do is really eliminate all the highly inflammatory foods. So things like gluten, dairy, soy, corn, peanuts, those are things that kind of right off the bat, we want to really get rid of. And I always tell my couples like, listen, this is not forever. This is for us to evaluate and kind of decrease inflammation, decrease stress on the body. And then we can add them back in in a very customized, slow, controlled way to figure out what’s been causing the problem.

I mean, there are so many couples who come to me and they don’t think that a certain food is an issue. And it’s not until we eliminate it and then try to add it back in, that we start to really understand what’s happening in the body.

I’ll give you just a total side example, which is, you know, relates to my son. One of my twins was, my other kids were complaining that he was keeping them up because he was snoring so much. And so, you know, I didn’t really think too much of it, but then, you know, eventually one of them took a video and showed it to me the next morning and I was like, oh my gosh, yeah, he actually is not really breathing well because he’s snoring so loudly. So he happened to have a check up with a traditional pediatrician, which I love our pediatrician. And of course she said, well, maybe he’s got a tonsil and adenoid problem. I think he really needs to go see ENT because this is dangerous that he’s breathing like this.

So instead of doing that, I decided to eliminate dairy. And within two weeks the snoring was gone. He no longer had, you know, this runny nose that had kind of sneezing and allergy type symptoms. And that’s just an example in a child and he’s only 10 years old of how something may be causing an underlying kind of baseline level of inflammation. And we may not even know it. I also find that a lot of us learn to live with symptoms that we think are normal and we don’t really realize how good we can feel until they’re gone. And then we were like, oh, okay, well, this is pretty awesome. So I’m sure you experienced that with the, in the thyroid space.

Katie: Absolutely. Both with that and then I think doing a lot of inner work and getting myself out of a state of stress all the time, I didn’t even realize how chronically I had felt all those things until they went away. And it was drastic. And I know I remember feeling like the energizer bunny at first when that first shifted because I just had all this energy I hadn’t had before. I know also in your work and your protocol, you also touch on the detox side. And I feel like not a lot of fertility doctors are addressing this and I love that you do. Can you explain the detoxification connection with fertility and how you do that with your patients?

Nashat: Yeah, great question. So unfortunately, we live in an industrialized world and we’re exposed to toxins 24/7. And just the act of getting up and getting ready for work in the morning in our own home exposes most of us to over 200 toxins of which more than half are personagenic. So pretty scary. There’s a lot of things that we can do in our homes to make them less toxic, but the reality is that we can’t also live in a bubble. I definitely, I don’t think that’s practical. I don’t think it’s sustainable. I don’t live in a bubble, but I do adhere to the value of doing, for instance, a quarterly detox.

And so I actually created my first detox program back in 2020 during the pandemic. I found that people were under a tremendous amount of stress and they were really looking to optimize their health and stuck in their own homes. And so I created a four-week detox program that I took people through. And within the first year of having my program, I put over 500 people through it. And it was amazing the transformation that was experienced. And this was a wide range of people because toxins are stored in fat. And so once we’re able to flush out toxins, one, there’s a lot of things that change. Our energies shift. I had one woman tell me her eyesight got better. I had some women who were going through menopause and hormonal changes that said that that got significantly better because they were actually able to detoxify estrogen.

So detox is really important when it comes to general health. And when it comes to fertility, there are a lot of toxins that we’re exposed to that are actually xenoestrogens. And so they mimic hormones and kind of wreak havoc in the body. So detoxifying your estrogen appropriately is such a critical part of a fertility and overall health journey, especially in my women who are suffering with PCOS or endometriosis. They’re going to be in an estrogen dominant state and they have to be able to balance out their hormones and having properly working detox organs is really critical.

I do think it’s really important to talk about the fact that detox is kind of a little bit of a controversial term out there. And I think when I talk about detox, I’m talking about a whole foods detox. I’m not talking about juice cleanses. I’m not talking about just supplements and drinking water. I’m not talking about starving. I’m talking about eating a nutrient dense food that is balanced and colorful and thoughtfully sourced protein. I’m talking about a detox where we actually nourish the body’s detoxification systems naturally.

So for instance, our liver has two phases of detoxification. And so to support Phase 1 of our liver detox, we want to nourish the body with lots of vitamins, minerals and nutrients. For Phase 2, we need a distribution of amino acids to support that. And essentially what we’re doing when we’re kind of revving up the liver, I always say the liver is your laundromat, we’re taking like fat soluble toxins, we’re turning them into water soluble toxins so that our body can then get rid of them through our breath, sweat, defecation and urination. And so by doing that, we’re kind of cleansing the body of disruptors that may be wreaking havoc and negatively impacting our fertility. And we do it in a very gentle way. That’s another thing people are always wondering am I going to be in the bathroom all day? I’m like, no, absolutely not. You are not. It’s very, very gentle. In fact, most of my couples and clients don’t even know that they’re doing it.

Katie: That’s such an important distinction. I always try to remember like detox is not a thing to your, you do to your body. Detox is a thing that your body does naturally that you can support and make it more efficient at, but it’s already knows how to do that. So I am glad that you made that distinction and that if this is not like really harsh cleanses or taking… Know, things that are going to flush your body and deplete you of things. This is actually just supporting what the body already knows how to do in its wisdom and help it to do it more efficiently or help to kind of like unkink if something’s already blocked in you, but your body already has that wisdom.

You also touched on, you mentioned PCOS and endometriosis, and I know these were two categories I was going to ask specifically about because it seems like women in these categories are often given kind of grim news related to their fertility or that there can at least be fertility concerns that come along with the diagnosis in either those conditions. But I’m guessing from what you said that these are actually often resolvable as well and often without extreme measures. But is there a difference in how you work with women who have PCOS or endometriosis or different considerations to be aware of for women who do have those?

Nashat: So yes and no. No in a sense that every person who comes into my world is treated as a unique individual. So PCOS, endometriosis, you know, whatever the circumstance is, you know, I see every single person who comes into my world is unique because I sort of think of all the body systems that we’re tackling for fertility as a cobweb. And so if we pull on one thing, everything else is going to shift. The good news for women with PCOS, which is kind of interesting, I actually had a discussion with somebody the other day about this, is that a lot of times with PCOS, women are not ovulating every single month. And so one of the sort of unknown benefits or sometimes perks is that because they’re not ovulating, much throughout their life. They can be older in age and still ovulate and conceive naturally, because their AMH is typically a little bit higher. In fact, I have a woman who I just spoke with last week who is 44 and has an AMH of 2.4. Now, obviously AMH can also be sometimes falsely elevated, but still for the most part, because you’re not ovulating as much. You know, and not, and probably not every cycle, you may have a larger egg reserve than you even realize that you have. So I feel like that gives a lot of women hope with PCOS.

And there’s a lot of things, like I said, that we can do to detoxify estrogen and balance hormones naturally. That we can get the body into the right rhythm. One of the other tools that I forgot to mention that I would use pretty intimately in my treatment protocols is I look at temperature tracking because basal body temperature tracking over the course of a woman’s cycle gives us a lot of insight.

And I always, I’m an ER doctor, right? So I’ve spent my career reading a lot of EKGs’ and I kind of say that the BBT chart is kind of like the EKG of fertility in the sense that it’s the window into what the body is doing. I can tell if the follicular and luteal phases are too short, too long, if they’re ovulating at the right time, we can also see gut issues manifest on a temperature chart. We can see thyroid issues manifest and on and on. When couples come to me, they’re like, well, are we going to track labs every single month? And I’m like, no, not necessarily. We may have to repeat labs in a certain period of time. But as far as what I’m doing on a weekly basis to keep track, to make sure we’re going the right way is I’m tracking your symptoms and I’m tracking your temperatures. And that gives us a wealth of information.

Katie: I’m so glad you brought that up. So I’ve been doing some form of natural family planning for almost 20 years now. And so I’ve tracked my basal body temperature over a lot of years. And I’ve definitely seen when I was in the thyroid issues phase, I had a much lower basal body temperature and now it stays much higher, which I view as a good sign because it means hopefully my metabolism is working much better. My sleep is certainly improved.

Is it very specific person by person? I know that I see, for instance, lower temperatures and then temperature rise in the second half of my cycle very reliably. But within that pattern, are there ideal ranges of temperature or does that vary by person to person? So for instance, in this part of my cycle, my basal body temperature is like 98.2. Is there like a target we’re aiming for good temperatures in different points of the cycle or is it relative to the individual?

Nashat: It’s relative to the individual. I really look at the pattern. The pattern is the most important thing. So estrogen tends to be a very cooling hormone. So we’re looking for low steady temperatures in the first half of the cycle. We’re looking for a spike after you have your LH surge in the middle of your cycle. And then progesterone is a very warming hormone.

So we are looking for a beautiful warm curve towards the latter half of the cycle. I do find that you are going to have really rock and roll in cycles if you do have gut health issues, if you’re under a lot of stress. I’ve seen some pretty big alterations in terms of if somebody is traveling and maybe going between time zones. And here’s the funny thing, I can also tell when somebody is cheating on their diet because their BBT charts held me. So I can tell right away if they’ve been really good and maybe they have a cheat week and eating a lot of inflammatory foods because your body reacts to everything that you do. You kind of can’t hide from it.

Katie: That’s so fascinating. And I’ve been excited to see more tools available recently that help this data be more accessible to all of us. Like I know early on for me, it was like specific thermometers having to make an actual physical paper chart. And now apps can do so much of this for us. And if I make it easier on your side as well, because you are able to access that data in real time with your patients. But definitely on a personal level, I would encourage women to track that because it’s so easy now. And it’s such fascinating insight into your health on a monthly basis. So I’m very excited that that data is now available.

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What about couples who maybe have been told that they’ve already been through IVF or IUI and sort of been told they’re a lost cause? Do you work with couples like that? And do you find that that’s not always the case, even if traditional medicine has given up on them?

Nashat: Great question and absolutely. I don’t care if anyone’s… IUI or IVF because we haven’t really uncovered the root cause of why it hasn’t worked. And actually, I’ll tell you a funny, a great story. And that is a couple that came into my world. And she, we actually help a lot of healthcare providers because, you know, they find me relatable because I am a traditionally trained board certified physician. And so I have a lot of physicians that we actually support struggling with infertility.

And so this physician happens to be an endocrinologist, the irony of it, right? But she master’s hormones, like that’s what she does for a living. And so she came to me and her husband is a physician too, he was an internal medicine doctor and they had failed seven rounds of IUI. And then they went on and they did three rounds of IVF. And as an endocrinologist, she knew exactly what was happening on obviously a much more intimate level than the typical lay person and unfortunately ended up getting overstimulated and got really, really sick from all of the hormones. So they had been trying for years, failed all of those rounds, had obviously spent an exorbitant amount of money and then they found me and they said, well, what can you do for us because we’re definitely not going back to IUI or IVF. We want is to grow a family. And I was like, well, let’s see what we can do.

And when I work with couples, one of the first things I asked them to do is in the pre-conception period, we’ve already, you know, outlined as 90 to 120 days. And I think 12 weeks, it’s kind of like that happy place. So I always say for the 12 weeks that we’re working together, I want us to just remove, you know, actively trying from the forefront of our minds and just focus on our health, focus on our relationship with our loved one, focus on bonding, you know, focus on into me, intimacy, because you want to be intimate and not because you’re trying to create a baby and create a life.

And so I had told this you know what, I need you to take a break for 12 weeks. So you open to that. They said, absolutely. They came and they worked with us. And we got an email eight weeks into them working with us, apologizing because they were pregnant. And it was the most heartwarming thing because they were like, we promised we weren’t trying. But the bottom line is here is this couple endocrinologist, internist, highly educated board certified physicians failed seven rounds of IUI, three failed rounds of IVF, and then get pregnant naturally in eight weeks. And it was not a coincidence is what I’m trying to say.

It’s because we were actually able to dial back. You know, take a step back, take a bird’s eye view of the entire body, not just our hormones and our fertility organs, figure out the root cause and then heal the root cause from the foundation up in order for them to be able to conceive naturally. And that is something that I see time and time again with the couples that I work with, is that even when everything else has failed, there actually is still a chance of natural fertility. We just need to do the right things in the right order based on what their body and biochemistry needs.

Katie: And that’s amazing how quickly too, that really speaks to just how rapidly the body is able to move back to a state of homeostasis. I’m sure even just taking that stress out for eight weeks was probably tremendous for them.

And you touched on something else that I was going to ask, which is… That she kind of reached a fatigue point with the hormones and everything required for all of those cycles. And I wonder, is there a risk to those sort of artificial hormones being used in big doses during all those rounds of IUI or IVF?

Nashat: Yeah, unfortunately, yes, I would say that, you know, they can be linked to lots of chronic health conditions. You know, there are lots of hormone imbalances that can ensue afterwards. I can’t tell you how many women have come to me after having gone through all those hormones and saying, you know, my body is destroyed. Now I have terrible sleep. I’ve gained, you know, 30 pounds. I have a lot of brain fog. You know, my muscle mass has been depleted because what they’re doing is they’re really, like I say in my free masterclass online, that, you know, the traditional approach is basically forcing pregnancy on a body that’s. Screaming I’m ready.

And, you know, and so it’s just, it’s sad because it obviously does have a lot of side effects. And of course, you know, there is, you know, there are, there is some data out there to indicate that it could potentially increase risk of certain types of cancer. It obviously really depends on what the individual regimen is, you know, in the traditional approach, there are so many different regimens that can be given to a woman in different degrees of stimulation. So I wouldn’t feel comfortable making a blanket statement, but I can say universally that it’s not a pleasant experience. I went through it myself and I was very conservative with my doses exactly for that reason. But I still felt terrible in the process.

And, you know, and I really… My heart breaks when I have couples that have come to me in that state of exhaustion after having gone through all of that. And then they come to me and then after the fact, they say, why didn’t we find you sooner? You know, I wish we had done this first. Now, I do want to say that there is a place for IUI and IVF, and it’s not that I’m not a believer in it. I just believe in uncovering the root cause and healing the body from the inside out, optimizing health. And really exhausting all of our natural routes before we turn to that, because the reality is that. If we prepare the body and lay the foundation before we do IUI and IVF, we’re actually going to have much higher success rates of the procedure themselves.

You know, one of the things also that I find is a little bit misleading is when a fertility clinic quotes a success rate, it’s over six rounds of IVF, not one. I don’t know about you, but I don’t know any woman who wants to go through six rounds of IVF. I don’t know anyone, any woman who’s been able to sustain that. I kind of see people tapping out. I think the most I’ve had is maybe four or five, but nobody wants to go through six cycles. It’s not sustainable.

Katie: Yeah. Well, that makes complete sense too, that even if someone does end up going the IVF route, that addressing all of these things would increase the likelihood of a positive outcome there as well. It’s like I often talk about in other areas of general wellness, it’s like if you dial in the foundational things, the sleep, the morning sunlight, the hydration and diet, just gentle movement, all those things, anything else you do that might be more biohacking or more complicated or supplements that cost money, those are all going to be more effective if you get those foundational pieces in line first. And it makes total sense to me that that would also be the case in the fertility space as well.

And I would guess for a lot of people listening, maybe they are somewhere on the spectrum of this or are not even trying to get pregnant right now, but it might be a consideration for the future. Are there any sort of good general principles at either different ages or just in general good principles to maintain our fertility as long as possible? And then also just to keep our hormones healthy as we get older with fertility being linked to health in so many other ways beyond just having a baby. Are there any good general guidelines for all of us to keep in mind?

Nashat: Yeah, absolutely. So I have a free download, which is the 10 steps to optimal health, which I really think is kind of a baseline foundation for anybody trying to optimize their health, really at any age, and really preparing for preconception. And some of those concepts are things that you’ve already touched on.

Sleep is probably one of the most underrated health advocacy actions that anybody could take. And so I’m a firm believer in eight to nine hours. And the thing is, we don’t just want quantity. We want quality of sleep. So I wear this little thing, an Oura ring, because it helps me track. You got one, too. It helps me track my sleep phases. And I know really in real time whether I’m getting high quality sleep or not. And sometimes it tells me when I’ve woken up in the middle of the night, and I don’t even remember that I’ve woken up and had broken sleep. So sleep is really important.

Hydration is something else that is really underrated. I always say you really want to take half your body weight in pounds, and that’s how many ounces that you should drink over the course of the day. And if you are consuming caffeine or exercising, then you definitely want to talk a little bit more onto that. I personally drink about three liters a day to stay hydrated.

Sunlight is something you talked about that’s huge. Getting just good old sunlight and having your feet on the ground, grounding is really important. Sunlight, usually just 15 minutes a day, especially in the morning if you can do it. It really does help set the stage for your circadian rhythm and also improve the quality of your sleep. What else?

Food is really, really important. Unfortunately, the nutrient density of our food has plummeted because most of us don’t eat seasonally anymore. So I always say, if you can try to eat seasonally and how do you do that easily? Go to a farmer’s market. That’s probably the simplest way to eat seasonally is because if you go to a farmer’s market, most of the time what they have is going to be only the stuff that’s in season. I also say when you’re shopping, stick to the perimeter of the grocery store. That’s where you’re going to find all your perishables and your lean proteins.

And also, source your protein thoughtfully. So things like you know, grass fed beef, you know, hormone free and antibiotic free organic chicken preferably free range, you know, all those types of things are going to contribute to you nourishing your body with more nutrient-dense food. Because I’m also a firm believer, yes, we need supplements. I do use supplements routinely with my couples in order to speed up the healing process. But it’s not for me, supplements are not forever. You know, in an ideal world, we really want to use a food first approach. And I do that with a lot of my couples. So women who, for instance, have low progesterone and a lot or half of a cycle, are really going to try to support them with progesterone-forming foods and so forth. Rather than, you know, turning to, for instance, a prescription or adding another supplement. I mean, if we have to do it, we will, of course, because we want to get them, most couples who come to me are very anxious to start, you know, trying to get pregnant. So we want to make the healing process as quick as possible.

But I think in anybody who’s not actively in that phase, and, you know, you really want to set yourself up for optimal health, i think just doing some of the tenets movement is obviously a really important one too. Making sure you’re getting your steps in every day and making sure you’re getting a mix of strength training and, you know, aerobic exercise. I think muscle strength is probably one of the most underrated things too, as we get older. The amount of muscle mass that you have really sets the stage for your metabolism and vibrancy and longevity. So I think muscle density and muscle strength is really important too. So those are just a few. I think I have more on my free download that our listeners can definitely access.

Katie: I will make sure those links are included in the show notes and definitely echo what you say, especially about muscle and that the data on that is really compelling and we know that that improves a lot of outcomes as we get older, not just fertility, but even our risk of all-cause mortality and risk of injury, all of those things are correlated with having enough muscle and we do lose some naturally as we age. So I feel like that as a focus, especially for women, is such a great thing to focus on.

And I would love to just dispel a little more of the myth as well because i know when I was having babies, I had all of mine by 29, but I remember women being there at the same time as me and anybody over 35 was told they were advanced to maternal age. And I know women are told fertility declines and it’s very hard to get pregnant after 35. I would love to hear your experience with that and if you’ve seen couples be able to get pregnant naturally after age 35 and up to what age is that potentially possible?

Nashat: So I get that question a lot and I never want to put an age on it because it just depends on your biochemistry. I mean, I have a woman who I talked to the other day who is 44 and has an AMH of like 2.5 because she’s had PCOS. She has regular cycles. She has zero signs on her labs and her symptoms of being perimenopausal. And so she’s somebody that I told, you know what, I can get you pregnant naturally. Absolutely.

So I had all my kids after the age of 35. I went through unnecessarily, you know, invasive treatments in order to have my kids because I didn’t know then what I know now. But I don’t really see 35 as a deterrent. That I work with, the women that I work with, are over the age of 35. I do get some that are younger, but for the most part they… Over the age of 35 and I always tell them, you know, age is just a number. You know, there is a lot that we can do. You know, I am very transparent. I do believe in that too. So when I do my discovery calls with my couples, I’m always very upfront and I tell them, you know, if I don’t think I can help you, I’m going to be the first to tell you what the chances are. And I’m going to give you my, you know, best professional advice as to, you know, the most logical and best next step.

But, you know, I’ve also been very pleasantly surprised. There have been couples where I thought, you know, this may not work and they’ve ended up getting pregnant naturally. So I kind of say the sky’s the limit. I mean, obviously if somebody is having irregular cycles and having menopausal symptoms, you know, those are, that’s when for me, it’s more the symptoms that are going to drive that number rather than the actual age itself. I mean, we know that obviously it becomes more difficult. I mean, the statistics make that very clear, but I don’t think it’s just age. I think it is multifactorial is the bottom line.

Katie: That makes sense. And I know you have so many more resources available on your website and then you work directly with couples as well. I’ll make sure all of those links are in the show notes so people that can find you and work with you directly. But I love that you’re spreading this message of the body’s ability to heal and move back to a state of fertility, even if people have been told by traditional medicine that they aren’t going to be able to have a baby. And I love the work that you’re doing and how purpose-driven it is for you and how your journey has been. So I’ll make sure those links are included in the show notes. And a couple of questions I love to ask at the end of interviews. The first being if there is a book or number of books that have had a profound impact on you personally and if so, what they are and why.

Nashat: Gosh, I have so many to list, but I’m going to pick the most recent one. And the most recent one is a Joe Dispenza book, which is Breaking the Habit of Being Yourself. What was really fascinating about that book is that it really inspired me to attend a deep self-development retreat back in March, which was all about really identifying behavior patterns in childhood and figuring out how they are manifesting in my adult life. And not just understanding the behavior patterns, but actually learning to rewire my brain into a new way of being. And I feel like that concept is so critical to each of our respective health journeys, whether we’re trying to get pregnant, whether we’re trying to balance our hormones, whether we’re trying to just become the healthiest version of ourselves, whatever our personal health goals is, because new habits are really, really hard to form. And a lot of us have been stuck in this vicious cycle and a rut because life is busy and life is consuming.

And having the tools and the knowledge to be able to rewire your brain and kind of create a new version of yourself has been really, really powerful for me in the past six months or so. And I’ve been able to really apply that to the delivery of my care to my couples and my patients, because all of us, in order to optimize health, are going to be required to make a variety of lifestyle changes that might feel like we’re going a little bit against the grain. So that’s probably one of my favorites right now.

Katie: I love that. I will put that link in the show notes as well. And lastly, any parting advice for the listeners today that could be related to everything we’ve talked about or entirely unrelated advice that you find helpful.

Nashat: Yeah, I just say don’t lose hope. And, you know, I don’t subscribe to the concept that as we get older, you know, we start to feel more tired, we start to get fatter, we start to have poorer sleep. I don’t subscribe to any of that. And this is alluding to what you said earlier, Katie, I do believe that you are the CEO of your own health.

And I do feel like it is essential that each and every one of us are always striving to optimize our health and really also understand the “why”. I don’t believe in band-aid approaches. I don’t believe just in doing what your doctor says. I believe in really understanding why you’re doing what you’re doing so that you can make an intentional informed choice so that you can live a long, vibrant life. And all of the couples out there struggling to get pregnant, there is hope. And just because somebody has told you that you can’t get pregnant or that you need a donor egg or this is never going to happen for you, I say follow your gut. I always ask my couples, like, do you feel like in your gut you can get pregnant naturally? And nine times out of 10 of people talking to me say yes, but I’ve been told otherwise. And my advice is trust your gut.

Katie: I love that. I think that’s a perfect place to wrap up for today. This has been such a fun conversation. Like I said, I love the work you’re doing and I’m so glad we finally got to chat. Thank you so much for your time and for being here.

Nashat: Thank you, Katie, it’s been a pleasure. Honored to be here, thank you.

Katie: And thanks as always to all of you for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did, and I hope that you will join me again on the next episode of The Wellness Mama Podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.