Fertility Do’s and Don’ts

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Intro:

Welcome to Dr. Ruscio radio providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, please make sure to subscribe in your podcast player. For weekly updates, DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hi everyone. Today I spoke with Dr. Shahin Ghadir about fertility for men and for women. What’s important, what to do, what to avoid. This is really an insightful call. We covered a number of topics regarding age-associated, changes in fertility, what your expected “conversion rate” should be – that is, the number attempts at pregnancy to actually becoming pregnant per month, the connection to gut health, what role do herbal female hormone support play, the impact of pelvic abdominal adhesions and Male sperm do’s and don’ts. So it was a really a good call. I hope you guys will appreciate it. If you’re trying to conceive or thinking about it, I hope you take away some tidbits and also have a good referral to his clinic, which is located in Southern California. Also, just want to thank everyone for their support of the podcast. We are growing month over month and I really appreciate your support and patronage. If you haven’t left our show a review on iTunes yet, please feel free to do so. That’s really helpful for us reaching more people and being able to procure the guests that we’re trying to reach. So with that we will now go to the conversation on fertility.

DrMR:

Hey everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio. Today, I’m here with Dr. Shahin Ghadir and we are going to be talking about fertility. This is something that I feel we have not expounded upon enough on the podcast, but definitely excited to pick his brain and have him here on the show.

Dr. Ghadir’s Background

DrMR:

Shahin, why don’t you start off by telling people a little bit about your background, how you found your way into fertility and all that good stuff.

DrShahinGhadir:

Well, thank you so much for having me. I am Shahin Ghadir. I am a fertility specialist at Southern California Reproductive Center. I have been working here for over 16 years as a partner. I did my original training in obstetrics and gynecology, and then moved on to complete a fellowship in Reproductive Endocrinology and infertility at both Cedars and UCLA in reproductive medicine. Our clinic is Southern California Reproductive Center and we’re noted to be one of the top 10 fertility centers in the USA and one of the largest on the West Coast of the United States. Thankfully, we also have one of the highest rates of pregnancy success in the country.

Are Lifestyle Changes Important for Fertility?

DrMR:

The topic of fertility, being integrative in scope, I’m assuming it may be one that frustrates you at times. Please correct me if I’m wrong. There seems to be this over reliance on hormonal injections and things of that ilk, and not the foundational steps of diet, stress, lifestyle, especially food quality, sleep. These things would seem to be fairly important for many things, including fertility. Is it fair to say that there’s a bit of a “cart before the horse” mentality with fertility?

DrSG:

I have to say it depends on how you practice medicine. So I’m very careful to make sure to address all of those things. I think it’s really, really important to look at all of those aspects of someone’s life before going straight to injections and figuring things out. For me in particular, maybe I’m a little bit more rare in my breed of fertility specialists, but I like to make sure that people are in great health. I want to make sure that people are looking at what goes into their bodies, because that is what’s going to be coming out of their bodies. So functional medicine and all of the things that come along with it, even though I’m not a specialist in that area, is something that’s really important for me. I encourage my patients to be at the tiptop shape of their health when beginning this process.

Where to Start With Fertility

DrMR:

Gotcha. So, definitely some overlap there. Where do you start people in this conversation of fertility. What do you think are some of the important fundamental pillars for people to be thinking about first?

DrSG:

First of all, I think timing is an incredibly important topic in the world of fertility. Waiting too long can be harming yourself, even if you’re the healthiest person in the world. So assessing things like, do I need to freeze eggs now, or if I’m in a relationship, do I need to freeze my embryos now for the future is really important. You may be in great health now that you’re 30, 31 years old, but when you’re 39 or 40 or 41 years old, and are ready to start, you may not be in the best of health. So doing things earlier is really important. The American Society of Reproductive Medicine has encouraged many people to try to freeze their eggs at an earlier age. They also recommend that if you’re under 35, and are having trouble getting pregnant for about a year, then you should see a fertility specialist. If you’re over 35, you should go at six months. I think there’s absolutely nothing wrong with seeking the advice of a fertility specialist even sooner than they recommend. Those are really important things. Then, of course, all of the appropriate testing that tells us and gives us feedback of where someone stands is the other side of the coin. That’s really important as well.

Fertility Rates and Age

DrMR:

Now, what do the data show on age? You know, this is not a body of literature I’m well versed in. I don’t know if the cutoff is 35 as you may be alluding to, or if it’s 40, that complications go up. Although I personally know some people who’ve had some of the healthiest kids I’ve seen at 40. So what’s the breakdown of age associated risk with a pregnancy.

DrSG:

That’s a really good question. And the results of what I’m going to say right now are going to be shocking. Studies have shown that egg count and quality start to decline as early as 26, 27 or 28 for women, which is shocking. The other statistic that people happen to forget all the time is related to conception rate as a whole. Let’s say at age 20, when you’re in the best of shape, we put a man and a woman together and they are told to have intercourse every month, what do you think is the chance of being pregnant? Most people think around 80% – 90%. I’ve even heard 100%. But the reality of it is that the highest conception rate that we can ever have as human beings, at our peak fertility, is between 20 to 25% a month, which is shocking to people.

DrSG:

That number goes down significantly with age. By the time that you hit age 30, it’s already probably down to around like 10% per month, 10 to 15% at the most. And it keeps going down and down. Now there are people that get pregnant in their forties and have no problems. There are also people in their early thirties already having problems. One of the other things that happens is the decline in egg quality which happens with age. This becomes rather significant for many people at around the age of 35 and on, so it’s not that people can’t get pregnant at 40 or 44 or 45. Their bodies can handle pregnancies, but their egg quality is reduced. We’ve had many women who are like 46, 47 years old, and in the best health carry pregnancies to term. But unfortunately they were not able to use their own eggs and had to use egg donors, which resolved their issues. And they were able to move on. But their age was a big problem in terms of their own egg, not being able to be used.

Infertility Defined

DrMR:

Perhaps we should define infertility. I can imagine a couple looking at your 25% procreation rate per month, at best. And maybe they’ve been trying for three months and they are getting really kind of worried and concerned, although perhaps it isn’t yet time to be concerned. So my question is, is there a diagnostic criteria for when one is infertile.

DrSG:

There are many different areas that will deem someone infertile. For example, it doesn’t matter if you’re 20 years old or 40 years old, if your tubes are blocked, you are infertile. If you’ve already had your tubes tied, you’re now infertile. We have that happen all the time. When someone may have their tubes tied with their previous partner, and then out of nowhere met someone that they want to have more kids with. For men, poor sperm quality can make them infertile and can make conception very, very difficult. If people have ovulation problems like polycystic ovarian syndrome (PCOS), that makes it very difficult for them to get pregnant. If it’s age related and their egg quality goes down, that is a problem. If their egg count goes down, we call that diminished ovarian reserve, that causes issues with pregnancy. Recurrent pregnancy losses, which don’t necessarily have to do with anything in particular, but that is something we have to figure out and that causes major problems as well.

DrMR:

Is there a certain, and I know this is a very broad question, but is there a certain time window. For example, if a couple has been trying for X number of months with no success, when should they consider having some professional insight?

DrSG:

The standard industry recommendation is if you’re over 35 and you hit six months, you should be seeing a fertility specialist. If you’re under 35 and you hit one year of trying, you should go see someone. I have a big problem with that because there are so many different factors. For example, if you don’t have regular periods. I don’t see the purpose of waiting one year to seek professional guidance. You’re not going to get pregnant without having regular periods. If you know that your tubes are blocked, if you know you’ve had a history of STDs, if you know there’s a sperm problem, waiting that period of time is a completely waste of time.

DrMR:

Sure. That makes sense.

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Tubal Blockages and Adhesions

DrMR:

You mentioned tube blockages. This ties into something that we’ve discussed on the podcast before, which is essentially abdominal and or pelvic adhesions. We’ve had Larry and Belinda Warren from Clear Passage on the podcast. I believe they’ve published papers showing the ability to rectify fertility by this kind of intense abdominal pelvic massage that can break down adhesions and scar tissue that may be occluding the tubal lumen. What should people be thinking about there? How common is it? Are there some signs or symptoms? As one example, one of the things that I try to be attentive to is ovulatory pain in that same region as a potential flag that there may be some type of adhesion or blockage. I’m curious to learn more about that aspect.

DrSG:

So we’ve had historically patients undergo pelvic massage for breaking up of adhesions and also to open up tubes. I have to tell you most of the etiology and causes of scar tissue or the blockages of the tubes, are rather irreversible, meaning that it happened from an STD that caused cellular damage at the level of the fallopian tube. One other very common thing is endometriosis. I personally don’t believe that aggressive pelvic massage can really correct that. I think that massage in some ways can help other aspects of people’s health, but not necessarily to open up things that are blocked.

DrMR:

So there’s no other surgical procedure or way around this? You kind of said this, but I want to make sure I’m not missing anything.

DrSG:

There are. It depends what exactly is the issue. If it’s a simple adhesion that maybe snagging a fallopian tube and tying it, or sticking it to something that could be released and opened. But many times it’s not so simple and it’s usually a complex issue going on all over the pelvis. I mean, it usually affects not only multiple areas of scar tissue and damage, but also damage to the fallopian tubes themselves, which doesn’t make them functional, even if we’re able to open the end of the fallopian tube.

DrMR:

Is it common for someone, if they’re doing a fertility workup, have an ultrasound that’s used to assess the viability of the tubal lumen? Is that fairly well integrated into the practice model? Is this something that people should be proactive about getting?

DrSG:

There is an x-ray test called hysterosalpingogram. It is something I’m licensed to do. We do them right here in the office. We take a clear dye, we insert it vaginally with a tiny little catheter into the uterus. We then inject it slowly as it goes up into the uterus and then falls out through the fallopian tubes. We double check with an X Ray picture under fluoroscopy, which is like an x-ray video, to see if the dye is going through. Right then and there, you can tell if there’s a problem, if there is an issue and exactly what is going on and be able to tell that to the patient. Sometimes the pushing of the fluid through is able to unblock some mucus buildup or other things that could have potentially caused an issue. But generally speaking, it cannot cure the problem.

Speaker 2:

Outside of your office, is this something that is routinely done or, or should patients be asking about this specifically?

DrSG:

So many people go to radiologists to do that procedure. We’re lucky that we have that procedure here and I can do it and I’m licensed to do it. I think doing it with a fertility specialist is much better than doing it with a radiologist.

DrMR:

Gotcha. Okay. Coming back for a moment to diet and lifestyle, is there anything there outside of the obvious that you think people should be aware of?

Diet and Lifestyle Support for Fertility

DrSG:

First of all, those aren’t as obvious for many people as we think they are. I’ve had patients who were overweight. When I was trying to explain that maybe they shouldn’t intake as many carbs, they said to me “what’s a carb?”. I assume not everyone understands everything that I necessarily am explaining, but I think that nutrition is very, very important. For the purposes of fertility, your body mass index, your BMI, which is your weight and height, all taken into consideration is incredibly impactful to fertility. The higher your weight, the more overweight you are, the lower the chances of successful implantation and pregnancy.

DrMR:

I’m assuming there’s also a sweet spot where you can go too low in weight as well?

DrSG:

Absolutely. 100%. I was just about to go there. There are also women are very, very underweight and have no body fat on them. Unfortunately what happens there is that the reduction of fat to the point of being unhealthy and having no fat in your body that converts to estrogen makes it very hard for these people to ovulate and also have good implantation.

DrMR:

Makes sense. Dietarily speaking, you alluded to being careful about over indulgence in carbs, I’m assuming healthy fat is also important. Anything else from a dietary standpoint?

DrSG:

I’m a very firm believer in the Mediterranean diet, which involves a lot of healthy things, such as olive oil and fresh vegetables and omegas and fats are healthy for you. Avacados, just things that are just overall healthy for you. Unfortunately, sometimes these diets don’t allow people to lose weight if they’re trying to lose weight. So they have to be very careful. You alluded to a word that’s very important. I think sleep has been very underrated for years and years. And I think the importance of good sleep is very important in your cycle and also in your overall health.

Resetting Menstrual Cycles for Fertility

DrMR:

Now, if a woman is irregular in her cycle, one of the things that I’ve found to be helpful first is this foundation of a healthier diet. Perhaps it’s a Paleo like diet or Mediterranean or depending if they’re overweight, maybe lower carb, maybe if they’re underweight, upping their carbs. That paired with improving their gut health, which seems to have a lot of secondary negatives, interfering with with sleep quality in some people as an example. It seems that this gets one fairly far, at least from what I’ve seen. This isn’t the focus of my practice, but there have been a number of cases where by achieving those end points combined with using herbs that help to get a woman back to a regular cycle, we have been quite successful. With irregular cycles, is there a methodology you’re using to try to get someone back on a regular cycle?

DrSG:

So I’m okay with patients using herbs and natural approaches and herbal regimens to help them ovulate. I’m totally fine with it. However, I try to see if we can make things work first, maybe without that assistance. You know, when too many things are put onto one patient at one time, you sometimes determine what the benefit was because you don’t know which one helped and which one didn’t. I like to kind of start things one at a time. To be honest, we’re not really exactly sure how to assess how some of these herbs affect and what they affect in the body. So other than the fact that we know historically many of these herbs have helped people get pregnant or ovulate. It has to be for a specific reason that we already know and a specific treatment that we know could be treated with that. Because I have too many people that go to alternative sources of treatment for fertility and are taking things without knowing why. Or they’re doing it at an age where they are already at such a low probability of getting pregnant, that they’re actually wasting their time. For example, taking a year to do an herb at the age of 44. So I think there’s a time and place for it that I’m very open to. If they are in good hands, like someone like yourself or the colleagues that we work with, very locally as well that we trust. I think it’s great. I find some people trying to push their herbs onto people and it’s a method of income for them. And I’m very careful about that with my patients.

DrMR:

Yeah. I think those are great items for people to be cognizant of. We’ve discussed on the podcast, probably a couple of years ago now, a few that people really should be wary of. One is using something like Vitex or chaste tree to help with cycling. Let me frame that as a consumer would see it. “To improve your progesterone levels”. Now for a woman who’s perimenopausal or menopausal, that herb really won’t have the desired effect because it works through facilitating dopamine action in the brain and dopamine inhibits LH. Which sets off a whole kind of cascade in the brain where if you’re too stressed that decreases dopamine, dopamine is needed to help with LH signaling. So if dopamine goes low and it thwarts LH signaling, then it causes a problem, obviously with the luteal phase of the cycle. But that is only viable if someone is still cycling. So if you’re an older woman, and this doesn’t so much so directly apply to fertility, but it does apply to the conversation regarding herbs for female hormone balance. If you’re not cycling, then Vitex doesn’t really seem to have any merit. The same thing also occurs with wild yam extract. That is actually not something that contains progesterone, although it’s oftentimes marketed as such. It actually has to be bacterially fermented to form progesterone. I think that’s been left out of some of the information with some of these companies that are marketing wild yam as something to help a bolster progesterone. It won’t, unless it’s been through a very specific process of bacterial fermentation. So just there, there are two things that could be very misleading to the consumer. So your points are well taken that while the herbs can be helpful, they can also be very easily misused the wrong way.

DrSG:

One more, very important point on that is also, having elevated progesterone levels at the wrong time of the cycle can actually be very detrimental to ovulation and the quality of the egg and not releasing the egg. So the normal 28 day menstrual cycle of a patient starts off with elevations of estrogen. And after ovulation, progesterone kicks in. Patients sometimes are taking progesterone supplements and creams at the beginning of the month when they’re not supposed to and that can completely be a disaster as it inhibits the ability to ovulate healthy.

DrMR:

Great point. So just because you can buy a cream over the counter, doesn’t mean it’s the right choice. You want to be careful how you are using these things.

Gut Health and Fertility

DrMR:

What about gut health? Is that something that you find has a significant tie in to fertility?

DrSG:

So I don’t think there’s a lot of research that has been done on that, but I think that gut health overall has a lot to do with someone’s health. And there’s no way if your gut is unhealthy and you are ingesting things that are unhealthy, that the rest of your body can be healthy. All the nutrients of our body go through our gut.

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Male Fertility

DrMR:

So what else? I mean, those are some of the most pressing things I wanted to touch on, but I’m sure there’s a lot in your brain that our audience could benefit from. So what else here deserves some expansion.

DrSG:

Male health. I think for men, it’s also really important not to ignore themselves in any way. There is this idea that you’re just perfectly fine and it’s always the woman’s issue. It’s easy enough to get a sperm analysis these days that men should be evaluated and assessed. There are a lot of environmental factors such as excessive heat, jacuzzi, steam rooms, saunas, too much spinning or cycling, excessively tight underwear or clothing, that all could be environmentally affecting sperm in a detrimental manner. So I think that men have to be evaluated as equally as women.

DrMR:

You pose a question that’s a little bit near and dear to my heart as I’ve been really enjoying doing post exercise sauna therapy. I know that heat obviously is not good for sperm count. Is there a threshold or is there a way to get the benefits of sauna without also kind of detracting from sperm health.

Speaker 3:

You know, unfortunately there is a reason that the male testicles are outside of the body in the scrotum. It is to keep them cooler than the rest of the body. Anything that increases that testicular temperature is damaging sperm.

DrMR:

Now I’ve, I’ve heard some anecdotes of people kind of “icing their boys”, so to speak. Is that something that would have a purpose here?

DrSG:

For exactly the same reason, icing is also not good because that’s also not the normal ambient temperature. So “icing the boys” is also getting things too cold, and too cold is also bad.

DrMR:

Gotcha. So you want to be wearing semi loose fitting underwear and avoiding high temperatures?

DrSG:

If the sperm analysis and everything is perfect and you are doing some of those things. Your body’s probably not as susceptible to the damage. If you have done a sperm analysis and you do have issues and it doesn’t look perfect, then I would say that at that point, it’s probably best to assess all those things and try to fix them.

DrMR:

Now, what else can men be doing for sperm? I believe that zinc helps with sperm motility. There’s a number of things that I’ve just heard these kind of here and there, but what else can men do to help with sperm counts?

DrSG:

There are a lot of amino acids and proteins that are involved with sperm wellbeing. And there’s not a lot of male supplements out there that I trust, but there are a few that we recommend for our patients. With that being said, I think that it’s important to kind of look at them very carefully and see which one is appropriate for your body and for the issue that you’re having.

DrMR:

So there’s a few different mechanisms these supplements can support and you want to match the person to the supplement based upon that.

DrSG:

Yes, exactly.

DrMR:

Okay. Anything else that men should be attentive to?

DrSG:

You know, I guess, these days, it is important to discuss cannabis use, which has become legal and everyone thinks it’s because it’s legal, it’s fine. It needs to be really, really carefully addressed because lots of studies have shown that smoking, excessive alcohol use, and also the use of cannabis have detrimental effects on egg quality and sperm quality.

DrMR:

Now do you know if that breaks down along the line of THC versus CBD because that does seem to be one thing that differentiates why people might be using cannabis.

DrSG:

We’re going to have a lot of data coming out on all of these topics in the future. Unfortunately right now we don’t.

DrMR:

Gotcha. Okay. Understanding that there is not a lot of data, is there any kind of threshold that you think is appropriate with cannabis? Like with drinking, we could make a recommendation for avoiding excessive drinking and encourage moderation.

DrSG:

I really don’t think there’s a moderation point with the use of drugs. And I think that during the time that you’re trying to conceive, it’s pretty clear that being the healthiest you can be is the most important.

DrMR:

Okay. All right. Is there anything else here that we should touch on?

DrSG:

You know, I think we’ve done a great job. It’s been very, very informative and I’ve loved learning things from your perspective as well. I’m happy to answer any other questions you have.

DrMR:

Tell people more about your, your clinic, your website, anything else that you want to point people to, if they want to try to learn more from you?

DrSG:

Absolutely. So Southern California Reproductive Center. Our website is SCRCivf.com. For my social media, DrShahinGhadir on Instagram and Facebook are really great ways to learn a lot about what’s going on in the world of fertility. We have webinars going on every single week in my practice that are complimentary, and we have lots of specials going on during the summer months for fertility treatments and especially egg freezing. So we are here to help. And if anyone needs anything from us, please let us know.

DrMR:

Awesome. Well, I enjoyed picking your brain here and thank you so much for taking the time.

DrSG:

Thank you so much. It was a pleasure. I really appreciate it.

Outro:

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