Episode 22: Fertility 101 – What no one's told you about your reproductive health
Have you ever wondered how to optimise your fertility – whether you’re thinking about conceiving now or in the future?
In this episode, Dr Peta, Dr Thea, and Sam break down the essential factors influencing fertility.
From understanding ovulation to the impact of lifestyle choices, they share key insights to help you reconnect with your body and take charge of your reproductive health.
🎙️ Listen now to find out:
🌿 The physiology of conception and what needs to happen for pregnancy to occur.
🌿 How to track ovulation naturally – recognising key signs your body gives you.
🌿 The role of stress and nervous system regulation in fertility.
🌿 The impact of age, environmental toxins, and lifestyle factors on reproductive health.
🌿 Why fertility is more than just baby-making – it's a key indicator of overall wellbeing.
Additional resources:
💫 Unlocking the Power of Your Cycle – A self-paced online course from Vera Wellness to understand and work with your menstrual cycle.
📖 The Fifth Vital Sign by Lisa Hendrickson-Jack – A guide to understanding your menstrual cycle as a health report card.
💻 YourFertility.org.au – A trusted resource for evidence-based fertility information.
📱 Yuka App – A helpful tool for checking endocrine disruptors in personal care products.
🥦 The Dirty Dozen & Clean 15 – A guide to reducing pesticide exposure in your diet.
If you struggle with endometriosis, debilitating periods, or persistent pelvic discomfort – find out more about our new online course Heal Your Pelvic Pain.
Heal Your Pelvic Pain is a 9-week program, led by Vera Wellness gynaecologists Dr Peta and Dr Thea, alongside physiotherapist Paula Hindle, which combines evidence-based practices to help you:
✨ Understand the root cause of your pain.
✨ Calm your nervous system.
✨ Reconnect with your body to experience more ease and vitality.
The course begins on Monday, 17 February 2025.
We would love to hear from you.
If you have any questions about you’d like us to answer on a future episode of the podcast, please email them to hello@verawellness.com.au or contact us on Instagram @verawellness.com.au.
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Episode transcript:
E22: Fertility 101 – What no one's told you about your reproductive health
[00:00:58] Peta: Hello, I'm Dr. Peta Wright and welcome to another episode of Women of the Well.
Thea: I'm Thea Bowler.
Sam: And I'm Sam Lindsay-German.
Peta: Today, we're going to be talking about fertility, so just like fertility basics, if this is something you're thinking about in the future, trying to conceive, or if you're even just thinking about your reproductive future and like when might be the right time to conceive and what might be the things you would like to consider to help optimize your chances of conceiving, then this episode is for you.
[00:01:34] Thea: Amazing. Well, should we start by just talking about, I guess, the physiology of how a baby is made very quickly? Because there's a whole lot of different, I guess, working parts that need to be functioning in order for the egg to meet the sperm.
[00:01:49] Peta: And I think a lot of the time when women have spent a great deal of their lives on the pill or on birth control to stop them conceiving or having a cycle, they are a bit disconnected from what actually happens in a menstrual cycle that leads to ovulation, fertilisation and the making of a baby.
[00:02:09] Thea: I think as well, people often find the mental switch quite hard. Because their whole life has been about avoiding pregnancy and then suddenly they have to switch to thinking about actually achieving a pregnancy. But I think to to make it very very simple the process of Fertilization, or the beginning of a pregnancy, obviously has some female factors and some male factors involved.
[00:02:31] For the woman, she needs to be ovulating, so she needs to be making an egg, and that egg needs to be of adequate quality to be fertilized, and when we talk about egg quality we're talking about sort of the genetic material within the egg, and we'll go into that in more detail later in this episode, but the egg needs to make its way from the ovary to into the fallopian tube and start to move down the fallopian tube towards the uterus.
[00:02:56] For the man, he needs to be making sperm that's of adequate numbers and quality, and then when a couple has sex, the sperm enter the vagina, travel up through the cervix, into the uterus, and usually meet the egg somewhere in the fallopian tube. where the egg will be fertilized and then as it matures it moves down the fallopian tube and eventually implants in the uterus, in the endometrium.
[00:03:19] So there are a whole lot of steps along that way where things can, I guess, not be optimized and where things can go wrong.
[00:03:28] Peta: So if you think about the woman and ovulation, so how would we know if we're ovulating? Generally, we'd be having a regular cycle, somewhere between 21 and 35 days. Ovulation usually occurs about 14 days.
[00:03:44] Before the the period, if you have an average like 28 day cycle, which many people have, but many more people have shorter and longer, so an average 28 day cycle ovulation would occur around day 14, and that's when the egg pops out of the ovary, begins its journey down the fallopian tube, around that time.
[00:04:06] Women might notice a little bit of pain in their tummy and they might notice a bit more bloating, might notice increased libido, increased energy, and also, uh, more of an egg white cervical mucus that's like, I can never get this image out of my head, but when I was a medical student, my like endocrinology lecturer would talk about this and be stretching the Egg white mucus between his fingers and for some reason at the time I found that very funny.
[00:04:37] Anyway, now that I'm a mature,
[00:04:39] Sam: I think it's, I think it's really fascinating 'cause I. Only really recently, maybe in the last couple of years, started to really understand that and the fact that we create this sort of mucus plug at other times that kind of protect us from getting pregnant. Really. I
[00:04:55] Thea: know.
[00:04:55] It's really incredible. I
[00:04:56] Sam: absolutely was. I mean, I'm not saying that this is a form of contraception. But kind of those people that have followed the rhythm method will know this. But yeah, I was like, this is so cool. So we actually create the right type of mucus to kind of invite the sperm in and draw it in.
[00:05:12] And the rest of the month, it's inhospitable to that process. I just, I'm like, we are so cool.
[00:05:17] Peta: And I always talk about it, like it creates this super highway for the sperm to travel up. So yeah, like, and if you, you, If you're not paying attention every day, it's hard to figure out there's been that change.
[00:05:31] So often if you do have a natural cycle, even if you're not really wanting to conceive right now, it's a good thing to sort of get to know your own body. It's just to spend like 30 seconds, less even, in the morning and you can just feel that. The discharge really on the perineum, so the area between the vagina and your bottom, and you can feel what that mucus is like.
[00:05:51] And so a few days before ovulation, it will start to get that consistency, to like, you know, a day or so after. And that's when you're at peak fertility, because it's coinciding with the high or the peak of oestrogen. Which is happening when you're ovulating. Some women also, if they're really into fertility tracking, they might notice that their cervix even comes down a little bit more into the vagina.
[00:06:16] Like as a gynecologist, nothing brings me like greater joy if I'm doing an examination and I see someone's cervix that's looking like they've just ovulated and it's just like so amazing. It's like you've gotten this window into this magical time and you see the cervix, it's a little bit open. So the, the opening is like a little bit, a little bit ajar and you can see that beautiful mucus and it's like, Oh, everything's working.
[00:06:41] It's very cool. And especially
[00:06:43] Thea: when you correlate that with where a person is in their cycle. And then sometimes we can even do a scan at the same time and show them their beautiful follicle on their ovary. It's It's
[00:06:51] Sam: very beautiful, very empowering. So mesmerizing that this is what we do. And I think you're absolutely right going back to how you started by saying many of us have spent so long trying not to get pregnant.
[00:07:03] We've totally shut off to this amazing occurrence that's just happening naturally in our body each month. And so. If we start to sit in awe and wonder, it can possibly be quite helpful for us.
[00:07:16] Thea: Very helpful, and I think for so many women, it's actually the first time that they start to feel connected with their cycle.
[00:07:22] You know, because it has been switched off for so long, it's the first time that they're actually tuning into it all. And it's very beautiful. The other thing, the other way, I guess, that we can think about confirming ovulation is the retrospective confirmation of ovulation, which is that rise in basal body temperature, which is when we measure our temperature first thing in the morning before we've done anything at all for the day, before we've moved or gotten up to go to the toilet or anything.
[00:07:49] And you have to do this every day of the cycle. And then what you will see is that. 24 hours after ovulation, our temperature will go up by sort of half a degree or a degree. So it's more confirmation that you have ovulated.
[00:08:02] Peta: And I would say, and if you've got like a clever aura ring that does it for you without having to do anything, that's really good.
[00:08:08] But I would also say if people are tracking their ovulation or checking that they're ovulating, if they have a fairly regular cycle and they've done this a few cycles in a row, then just stop tracking it. Just have fun and, and like, realize that that's normal. You know, because I don't think that you need to keep tracking it if you know what's happening at the right time.
[00:08:26] Um, the other thing that some people can do if they're not sure is like the pee on the stick and check your LH surge which is the hormone that causes ovulation. And so some people do that and they'll see like the two little lines a bit like a pregnancy test that will confirm ovulation. at the time. And then if you're seeing a doctor and maybe there's some, any doubt over ovulation, sometimes we'd recommend doing a blood test that checks progesterone levels about a week after when we think ovulation's supposed to have occurred.
[00:08:58] And then we see the rise in progesterone that's happened as a consequence.
[00:09:02] Sam: I used to get pain when I was ovulating. Is that quite common? Yeah. And so I would know that. That was a good time to have sex because I would have that pain and actually I think I got pregnant every time That was always a really good sign for me
[00:09:16] Thea: for sure And I think that's it like if we can really identify our fertile window If we can really know when we're ovulating then we can really just try and focus Episodes of sex around that time to really really optimize the chances of spontaneous conception I guess it's also important to know that like sperm usually can survive for about five days and the egg can survive for about 24 hours, so Really?
[00:09:42] There's about that kind of week around ovulation with five days prior to ovulation and about 24 hours after ovulation where you're most likely to fall pregnant.
[00:09:52] Sam: I used to do a really cool thing that was in, in the army, you march, do this marching thing that goes 12, 13, 14, 1, 2, 2, 3, 1, anyway, it's a silly thing, but when I was trying to get pregnant, That's how I would go.
[00:10:04] We're day 12, so we'll do day 12, day 13, day 14, and then two days after. Ah yes, very good, very good. That was what I did. I never, I mean, Did they know that what they were teaching you was? It was just really funny because it was just one of those things that stuck in my head and I'd be like, these are the days that we will have sex, um, when we were trying to get pregnant.
[00:10:26] And yeah, it was very interesting. And I remember there being some statistic about if you want a girl, then girls tend to be the sperm that survives longer. And if you wanted a boy, then they were the fast shooters. And so, you know, it was really interesting, just these little funny things that I had in my mind when I wasn't doing any other tracking whatsoever.
[00:10:44] Well, it obviously worked for you if you had four children. Four babies. So did you do anything? Did you have any funny things?
[00:10:50] Peta: I came off the pill, I had five months of no periods whatsoever, then I thought, I think I'm ovulating, and then that was the month, because I said to Rob, do you think that you should just get your sperm checked in preparation, and he said, no, I don't need to have my sperm checked, it's fine, and then when it was, that was the ovulation, he said, see, I told you, you didn't have to, you just needed to ovulate.
[00:11:14] Thea: I remember I had come off the pill and I knew when I was ovulating and my friend had given me a really sexy bra and I remember the day because I knew I was ovulating and I put on this really sexy bra and then went on to conceive a child that evening. Yes. Did you wear the sexy bra for all the subsequent children?
[00:11:35] No, I didn't. No, I didn't. It hasn't become your lucky.
[00:11:40] Peta: I do think though, like we can talk about all these like. things that you can track and do. But I think also like if you are in your body and in tune with your body, you feel that sense of, especially if you're wanting to conceive, you really feel it and you will like that will override and your body is telling you this is the right time to conceive.
[00:12:01] Totally.
[00:12:02] Thea: And your body knows, like, I think your body almost knows. At that moment of conception, if it has been the right time and you have been really tuned in, like you almost have an inkling of like, that was the time. I know that was the time.
[00:12:14] Sam: We have a yogic practice or a ritual which is about calling in the soul, which is very beautiful where when you're actually thinking, this is the time I want to do that, you actually spend time before the event, sort of talking about what you're going to do and preparing for it.
[00:12:28] And then sort of thinking, okay, we're going to come together to call in the soul of our child and then. You have sex and then after, you lay down and I always say to women, put your legs up. I don't know why, it's just one of the things that I've always done myself. Just sort of laid with my legs up the wall and then just have your partner lay next to you and just talk about what it is that you're calling in.
[00:12:49] And I think it's these, also these ritualistic moments that can just be really beautiful as part of the conception journey rather than what it tends to have become, which is just so Yep, follow the tracking of your aura ring and pee on a stick, you know, because I feel like having those sort of moments might not work every month and it might not be that that's when you get pregnant, but having those moments of coming together in ritual can be really, really helpful as well.
[00:13:16] Peta: Plus you're connecting with your partner and you're kind of relaxing into your parasympathetic nervous system, which are all going to probably help your chances. And I do wonder sometimes, like, when we have conception just as another tick box thing that has to happen this month on our list of all the other things, it makes sense that Um, our body isn't quite going to be in the right relaxed state for it to happen.
[00:13:43] So, I think it's so true, Sam, what you're saying about carving out that time to basically take away all the noise, the checking, the, Outside things that other people are telling you to do and tune in with your own body and make that time I mean, sometimes you have to just go come home and let's have sex.
[00:14:00] Yes
[00:14:01] Sam: But
[00:14:02] Peta: yeah, but that's still listening to your own Instincts in your own body and prioritizing it because that's that's actually another thing like if you have those primal urges, right But we are pushing it away because we've got to be doing something at work, or we've got to attend to all these other things, then those are the chances that we'll be missed, because we're, our priority or our attention is
[00:14:26] Sam: elsewhere.
[00:14:27] So, if someone is currently trying to get pregnant, what are some of the things that you would be telling them as a doctor to be doing in preparation? And how long before trying to get pregnant would you consider doing these things? I mean, things like lifestyle choices.
[00:14:46] Thea: Well, I think the most important lifestyle choice that a couple can make, but particularly a woman can make, is the age at which she and they decide to get pregnant.
[00:14:56] Try and have a pregnancy, because age is the one thing that Medicine cannot overcome, IVF cannot overcome, and we know that there is a real decline in fertility with age. You know, like, for women who are below, or for couples who are under 30, there's about a 30 percent chance of conception per cycle. 30 to 35, it's about 25 percent chance of pregnancy.
[00:15:21] Sam: Only 30? Sorry, just say that again. So if you're under 30, it's only 30%? Wow.
[00:15:26] Thea: Yeah, so for people who are 30 to 35, it's about 25%, 35 to 37, it's about 20%, 37 to 40, 10, and then above 40, less than 5. So that's percentage chance of pregnancy per cycle. And so, there's a very real decline in fertility with age. And I think that the world would like us to keep working.
[00:15:51] and not take time out for pregnancy. And there is a lot of pressure on women to keep doing that. There is a lot of publicity around egg freezing and things at the moment, which is an imperfect way of preserving fertility. And ultimately, like, age is just the biggest factor in determining whether or not We can achieve a pregnancy and really that is relating to egg quality because the eggs of a woman form while she is a fetus in her mum's uterus.
[00:16:21] So we have all of our eggs sitting there from even before we were born. And so that DNA has been sitting there our entire lives. And the longer that it's sitting there, the longer it's exposed to, you know, environmental damage. And I guess the stickier the DNA becomes, and there's a really complex process of Sort of division of DNA both in ovulation and fertilization that can become sort of less effective as the DNA becomes more damaged with time.
[00:16:49] So that's why, you know, if a woman is older she probably has eggs that are having different numbers of chromosomes in them that then can't result in a chromosomally normal pregnancy, which then doesn't fertilize and doesn't continue to grow.
[00:17:05] Sam: That is so brilliantly explained. I don't think I've ever really sat with that before, but that's really
[00:17:11] Peta: cool.
[00:17:11] So if someone is 37, on average, just a general person, obviously there will be outliers, but about 50 percent of their eggs will have genetic damage and so won't be viable. At 42, it's about 80 percent of their eggs will have damage and will not be viable. So that means that, you know, IVF, if they are, you know, 42, even if they are able to get a number of eggs, like even if we get four eggs, and because number is also lower as we get older, 80 percent of those eggs are not going to be viable.
[00:17:49] So that's three out of four of them. So would that be one of the reasons why we might have early miscarriages? Yes. So it's why miscarriage goes up as we get older and why chromosomal abnormalities, you know, things like Down syndrome and other things increase as we get older. Why we have to go through screening so much more.
[00:18:08] Sam: Yeah, because I remember when I had my children, I turned 30, I was classed as geriatric, which always blew my mind. But now listening to those stats, I can kind of go, wow, okay, that makes perfect sense as to why I would need to be checked more when I was 32 having my last child than now. When I was 26, having my first.
[00:18:27] Peta: So I really think, if you are a woman listening to this, who wants to have children, I think it's very difficult because of the society in which we live that we are seen as successful if we are ticking the career boxes and we're not prioritizing, I guess, having a family, finding the partner, all of that sort of stuff.
[00:18:47] And then, ultimately, we end up like I did, you know, as well, and many women in their early, mid, late thirties, then for the first time thinking about having a baby. And I think we really have to think about the impact of that on our journey going forward because yeah, nothing will be a more important decision than the timing.
[00:19:08] And so I think we are biologically probably the most optimum time is. Mid twenties to mid thirties and that is going to dramatically increase your chances of having success.
[00:19:23] Thea: Yes, having a spontaneous pregnancy because you know the whole idea that IVF is there and we can just do IVF and we Will just get pregnant and IVF is wonderful and very very effective for so many people But it's really expensive and very invasive and doesn't work for everybody
[00:19:38] Peta: and certainly doesn't work for very many people when we're looking at that upper end of the egg.
[00:19:42] Well, yes, it's only
[00:19:43] Sam: going to work, it's still got to work in that first instance with the eggs that you have. That's right. So, therefore, if you're older, I'm presuming, that's still going to have an impact, which needs to be considered. IVF
[00:19:54] Peta: is very good if you have issues like your tubes are blocked and so there's a problem with the eggs and the sperm getting together, because IVF, which is really, so it stands for in vitro fertilisation, where you're getting the eggs out of a woman and you're getting sperm from her.
[00:20:10] their partner or donor or whomever and then you're putting them together in the lab and then making an embryo and then putting that embryo back in. So it's good for that. It's often helpful to get around certain sperm quality issues because you can select sperm that are better and help them to fertilize the egg rather than having them to go do the big swim up to the egg but it doesn't get around the egg.
[00:20:35] Aging issue. We're still, it's like making a cake and we've still got to have good ingredients to make the cake. And IVF is just making the cake in a different way, in a more high tech expensive way, but if we're still using ingredients that aren't as good, we're not going to end up with the result that we want.
[00:20:52] I
[00:20:53] Thea: always find myself saying to patients, like, because people are always like, well, I'll just do this and then I'll have a baby. I'll just get here in my job and then I'll have a baby. And I always say, there's never a good time to have a baby. You will never think it's a good time to have a baby. If it's truly, truly something that you desire, just do it now.
[00:21:08] Sam: So the answer is if you're wanting to have a child, the best advice is start three years ago.
[00:21:13] Peta: Or prioritize it and or think about how you can push back on because think honestly about who it is benefiting. I mean, I was just thinking about this the other day. It's crazy that. As women, we've been told we have to hit these markers of career success and then we should worry about having a baby and if we kind of don't, like I still think it's true now, definitely it felt true to me when I was growing up, but that if I had said I'm going to Have babies at 25.
[00:21:43] I would have been like looked at like I was some kind of failure, right? And that's how I felt and I still think now if someone was to say, well, I actually want to prioritize having a family and doing things to support that choice. People would be like, but don't you want to like do this at university and get this career goal and make this much money?
[00:22:04] But what we're then doing by falling into that trap is we end up actually paying massive corporations I know I work for such a massive corporation, but we end up paying a corporation for our fertility and then we have our baby later in life with a lot of Heartache and financial impact and then we end up having babies when we're like in our late 30s or early 40s when we're about to go into perimenopause and we wonder why that's more difficult for the sake of working and having this job that serves the capitalist patriarchy, we end up paying to have babies.
[00:22:44] Sam: Well, that's kind of part of the machine. The machine creates the problem and then solves it. Well, that's the whole point. So it's creating the problem, solving the problem. So the new hashtag we want to create is Baby First, Career Second. Because at 50 you're ready. Yes,
[00:23:02] Thea: Kelly Brogan, the controversial psychiatrist, but she has a lot of wisdom.
[00:23:06] She said in one of her podcasts, we should be freezing our careers, not freezing our eggs. And I really think there's a nugget of truth in that. Like the career, our careers can wait, like wherever you are in your trajectory, you can get back there again, you know, but you can't get back to the right time to have a baby.
[00:23:23] Sam: My daughters seem to be talking about having babies. Now I'm really interested in it because I know we go through cycles of sort of evolution and we always you know It's a bit like fashion. We go in and we go out but I'm certainly seeing and I don't know if it's just my girls And no one else is doing it, but it can't be normally it's a window into something They're definitely talking about wanting to have children earlier, which I think is really good It could be because I'm not pushing them to have massive careers.
[00:23:50] I mean I'm saying go study but That's not everything, but at the same time, I do feel like, to me, I hope that they do manage to do that. But of course, to do that, you've actually got to meet someone. And I think this is a really good way of getting back to that conversation because some of the women listening might not actually have partners or may not be married.
[00:24:11] But one of the things that I think about is just how important it is to meet someone who is matched for you, which comes back to the way that we meet, which is by being attracted to the other by smell. And we were talking about smells just before and how the way that we have all these fragrances in our world really does affect both our fertility and then obviously our capacity to know if we're attracted to the right person, I'm presuming.
[00:24:40] Peta: Yes. And also interestingly, the pill, like there has been research on the pill. If you're on the pill and you meet someone, you might choose the wrong person for you because it changes. Your brain has changed and you might be attracted to things that you wouldn't be if you're on the pill. There's good research around that.
[00:24:59] So that is also like quite fascinating. That's the work of, is it Sarah Hill? Oh
[00:25:04] Sam: yeah. Because we're presumably, we are attracted to someone whose DNA in some way matches ours. Well, it's all about pheromones. Yeah, that's right. And that's all about that way in which we would not, because we're so clever, how can that not happen?
[00:25:18] And so if that's being affected by the pill or anything else that's occurring in our Very artificial environments, then that's going to have an impact which is going to be part of this machine That's going to need us to have help in conceiving. Yeah,
[00:25:34] Peta: and I mean there's also a lot there I know we're probably getting off the topic, but it's like also all of the stuff about heterosexual women, but not needing men and then this rise of like sex toys and vibrators And I mean all very well and good, but also I don't know like is that helping the
[00:25:53] Sam: Yeah.
[00:25:53] You're absolutely right. So I don't actually need a man I can pleasure myself. Therefore I'm not actually going to go out and find someone. I'll be happy with my career and my vibrator and therefore I leave it potentially too late.
[00:26:05] Peta: I mean, it's not like, I think that we should have all of those things, but also I just think that the, that this kind of mentality of, I don't need.
[00:26:15] Thea: I think there's that whole mentality of we don't need men, but there's also the whole mentality of like. It'll be fine, I'll just do IVF. And, well certainly for a lot of my patients, they're often shocked
[00:26:27] Peta: when
[00:26:27] Thea: they hear. the numbers and shocked when they end up having difficulty in their
[00:26:32] Peta: early 40s, say.
[00:26:34] People think that you just do one round of IVF and that is really What is the general, how many times? It depends on how old you are, but, you know, as a rule, someone probably pre 35, it would still take an average, and again, it depends on what the cause of the issue is, but on average, maybe three. Cycles or three embryo transfers to four pregnant and that number goes up as you get older because of the egg quality issue.
[00:27:00] Sam: Can we talk about sperm quality? Because I do feel sometimes when I'm talking to women, it does always seem to be, I know that there's a conversation about sperm and I'm sure you have it with your patients, but I always feel like the women seem to take the brunt of everything. But it is important. And so.
[00:27:16] What are we thinking in terms of sperm quality in men and age? And what are those things? How do how do they affect? Well, it's 50
[00:27:25] Peta: 50. Obviously we need the sperm. We need the egg and alarmingly sperm quality is going down. drastically in, yeah, numbers in industrialized countries since like the 70s. So you're talking about the
[00:27:38] Sam: quantity of sperm that a man is producing?
[00:27:41] Yes,
[00:27:41] Thea: there was
[00:27:41] Sam: a,
[00:27:41] Thea: there was a study that showed sperm numbers were dropping from the 70s. I think it was up until the 90s were dropping by about 1. 3 percent per year. And that since the 90s to now, it's actually accelerated. It was like 1. 7, 1. 8 percent. Do they know why?
[00:27:58] Peta: Yes, because of all of the chemicals that we're exposed to on a daily basis.
[00:28:03] So plastics and parabens and phthalates, so scents and the, yeah, Teflon and forever chemicals and non stick things and pesticides. and plastic water bottles and all of those things that are not tested but definitely have an effect on both male and female reproduction. I think with BPAs for example, many people might have heard of BPAs which are an ingredient in plastic and we know that they're banned now, but there are Probably just as damaging other compounds in plastics that are not tested and that was found because it was a woman in a lab who noticed that the rats who were drinking out of this particular water container that contained bpa had a much higher rate of miscarriage and fertility and stuff And that's how they first recognized that but there are so many compounds and things that are not tested and that are just flooding our systems on a daily basis that not only affect the number and the quality of sperm and or potentially our egg quality, but also affect us in utero.
[00:29:10] So if you are growing an embryo in your tummy, and you're consuming or exposed to those chemicals, your embryo, which has way less cells than you do, the effect on that developing fetus is much greater.
[00:29:24] Thea: Also in pregnancy, There was a study that showed that actually the concentration of some endocrine disruptors that they studied, BPA being one of them and I think Thalate being another, that they were actually concentrated through the placenta, so that like the levels in a fetus were like 300 percent more than what they were in the
[00:29:43] Peta: mum.
[00:29:44] And then it can change, so one of the ideas with sperm health is that yes you can try and do things to help your sperm health later on when you're a grown up man, but much of the damage may be. being done to the embryos in utero, through that exposure.
[00:30:00] Sam: Is it the same as women? Is the sperm created when they're in utero?
[00:30:03] Or does sperm continually replenish? It starts later, with puberty.
[00:30:08] Thea: And it's continually, continually replenishing.
[00:30:11] Peta: And the other thing is, it's not just our Like the ingredients that we need to make a baby that can be affected. It's also, you know, it can affect things like endometriosis, probably polycystic ovarian syndrome, which affects our ability to ovulate, may increase inflammation in the body.
[00:30:27] Also, There has been lots and lots of studies that high amounts of endocrine disruptors and exposure in utero or in childhood may increase things like turning on and off genes that may predispose people to obesity, diabetes, you know, all these other chronic health conditions that then have an impact on fertility as well.
[00:30:50] So
[00:30:51] Sam: one of the things that You would recommend is to work on detoxing from some of these things.
[00:30:57] Thea: Yeah, I mean, I think it can be really stressful for people and scary for people and overwhelming. And then that adds to all of the stress of the fertility journey anyway, which then has also has a negative impact on, on chances of pregnancy.
[00:31:11] But I think thinking about it and thinking about Easy switches that you can make, you know, so having glass or metal Tupperware, trying not to have nonstick cookware. What else? Avoiding cosmetics,
[00:31:25] Peta: anything that says fragrance, perfume, perfume, they'll all have phthalates in them. So like if you walk through the cosmetic counter at Myra, David Jones, that overwhelming sick feeling is all the phthalates that you're breathing in.
[00:31:39] There's also
[00:31:40] Thea: an app called Yuka where you can scan. products and it will tell you like whether it's got high levels of certain chemicals. It's really good because it gives you alternatives
[00:31:50] Peta: too. And pesticides as well, and so, you know, eating organic when you can, like looking at the Dirty Dozen Clean 15 website.
[00:31:59] There's a good website that I often use for my patients called yourfertility. org. au which has got a really good, sensible section on endocrine disruptors. And I mean, like, I know that it worries people, but It's better to be, have awareness of this now, like before you try and conceive rather than like one day when I had a newborn baby and my husband came home and was like, what on earth are you doing?
[00:32:22] And I'd thrown out all the cleaning products. I was making my own washing liquid with, um, natural things, just freaking out about the endocrine disruptors that my baby had been bathed in for the past nine months. I
[00:32:33] Sam: would say exactly the same. I think it can be really overwhelming, but I also think it's.
[00:32:38] It's okay to say to people, there's never going to be a good time to get pregnant or to give up all these things is never going to be easy. These are big choices and we have the choice, you know, yes, they're out there and you have to make an absolute choice not to have these things in your home or to put this stuff on your body.
[00:32:56] And that can feel overwhelming initially and quite expensive to get rid of everything. But in the long run. It's got to be better for us. Yeah,
[00:33:03] Peta: it's better for you. And we have to have an awareness of the system in which we're swimming in at some point. I think it becomes something that people can achieve or is more achievable because they have the motivation when they have something like a baby that they desperately want or they want.
[00:33:19] Or they look at their newborn baby and they think, Oh my God, I don't want those chemicals to be affecting them. But we need to be thinking about that for our health as well. So it's a good kind of, it's a wake up call, but I think it's one we all need. Yeah, that's right. What about other ways of optimising egg and sperm quality?
[00:33:36] So I think for a woman, obviously paying attention to her menstrual cycle. And making sure all of those markers of ovulation are there, periods aren't too heavy or too painful. Then, you know, having a diet that is high in whole foods, like again, organic if we can, avoiding pesticides and things like that.
[00:33:53] Eating adequate amounts of food, so we need good amounts of food in order to actually ovulate, you know, I'm not, I don't recommend calorie counting at all, but you know, just for people to understand, cause there might be people listening to this today who are having like, I don't know, 1800 calorie a day diets and for most people, of course it varies depending on height and other things and degree of activity, but for most people you need around 2000 calories.
[00:34:21] If you don't have a sedentary life, if you have an active life, it can be up to 2, 600, can't it? So, making sure that you're, you're doing that, we might get one of our, we might get our amazing naturopath Alicia Humphreys to come on and talk more in detail about that. What about things like? Alcohol, coffee.
[00:34:38] What about those? What are the, what do you recommend on things like that? So coffee's alright. Usually like two cups of coffee a day, more than that can, there have been some studies to show that it might increase miscarriage risk. So two cups of coffee, of course, like looking at our stress levels and making sure we're getting enough rest and we're spending more time in our parasympathetic nervous system states, because of course, if we're living in that survival state.
[00:35:03] Our bodies are going to be inflamed, it's not going to be conducive to the right hormones, messenger's being sent to our ovaries, and it's not being, we're not in a receptive state to have a pregnancy, so looking at that, alcohol I would say is just universally generally not a good thing and is inflammatory and, you know, obviously not having it when you're trying to conceive or reducing it as much as possible and even in the few months before you're trying to conceive, even thinking about cutting it out.
[00:35:33] Again, like these are, if I had to put the most optimal advice. Is this for both men and women? Yes, men as well. Yeah, of course, for both of them. And like, if you're doing this together, looking at both of your diets. And both of your alcohol consumption and especially with sperm health, alcohol can have a massive effect on sperm health and so it can like trans fats, so lots of like fried foods and things like that.
[00:35:59] There have been studies that show that really has an impact on both egg and sperm health, but they can measure it more readily in in sperm health. So yeah, looking to reduce those things. Obviously smoking movement. is really important as well and there are lots of studies that say having a healthy body weight is conducive to fertility because we have less inflammation
[00:36:20] Sam: as a rule.
[00:36:21] But generally speaking, I mean, a bit like when Brooke and I were talking yesterday about pain and things like to do with pelvic pain and pleasure in order to actually get pregnant, presumably our nervous system has to be regulated and that's probably going to be. One of the biggest things is are you actually happy?
[00:36:41] Are you feeling safe? Are you content in your relationship in your life? And those things must be some of the most powerful things that we can do Because there can be a lot of relationship conflict when we're trying to conceive like we worry about the financials Maybe one of us isn't quite as keen as the other, you know, there's always these types of things So it's It's getting on that that same page together, really wanting this together, working together, being happy, doing those things that make you feel content, figuring out what you're going to do about work life balance now, not when you've got a baby or when you're pregnant are going to really help the nervous system.
[00:37:19] Using this time, the time before you conceive to actually, if you need to go and see a therapist or go and talk through some of the things that have been affecting your joy or your capacity to feel content and experience pleasure in your life. So actually addressing any of the underlying traumas that are in your life would be very beneficial now at the point before conceiving rather than actually trying to do all that.
[00:37:46] Thea: Absolutely, all of those things are going to be incredibly regulating for our nervous system, which is going to bring down cortisol, which has lots of flow and effects to the way that we make our reproductive hormones. So yes, all of that is incredibly important. And I think like we always say, you have to make space in your life for the baby that you want to have.
[00:38:04] To bring in. And so if we're living lives that are just like completely maxed out, you know, running, racing from here to there, never stopping, never being still, never connecting with our partner. Well, it kind of makes sense that our body isn't going to be receptive to it. Okay. The energy of the baby that we want to bring in.
[00:38:24] Peta: And also if we have a bit of a mentality of it. And I think this is common because of the way we live our lives and the expectations we have placed upon ourselves is well, because I've done this course, I'm now doing this career, I've checked these boxes, now I want to have a baby. Now. It has to come now.
[00:38:43] And if it doesn't come now, in the next three months, on this timeline, then Stress and anxiety rise hugely, but like we always talk about how fertility, or especially if you're on a bit of a fertility journey, it is a massive magnifying glass on the fact that we don't have any control. And the control is an illusion.
[00:39:04] And when we, it doesn't matter how good you are at succeeding in every other area of your life, this is something that requires a letting go and a surrender and a patience in order for it to come through. Because not only will it probably help that happen probably quicker, but it will make the whole journey
[00:39:25] Thea: less stressful.
[00:39:26] You can't control when you get pregnant. You can't control what happens in your early pregnancy. Or any part of the pregnancy. You can't control the birth. You can't control the child. And so it is, it's that first inkling of that need to
[00:39:41] Sam: completely surrender to what will be. And I guess it's about taking back the sovereignty where we can, which is about our own health and our own well being and the way in which we're managing our personal system.
[00:39:54] And that's the only thing and we can't control that fully. But we have the most control over that. As a woman, we have that capacity to optimize our beautiful ecosystem, and sometimes we forget that and then want to sort of get someone else to do that for us or get something else to do it for us. But ultimately we can't do that.
[00:40:15] We have to get back in touch with ourselves, get back into listening to what does my body need today? Does my body need rest? Does my body need activity? Does it need that to eat? Does it need this to eat? And trusting that and getting into that natural flow is going to really bring that ecosystem back on line, which is then really the only thing we can have control over.
[00:40:37] Which is exactly what happens in pregnancy. It's the only time we really have full sovereignty and control over our baby. That in itself, we can describe that as, as we have in previous episodes, being hard work. Or saying, this is work we want to do. This is the real work.
[00:40:56] Peta: And I think as well when you're bringing another human into this world, when we keep saying like, I know it's hard, it can be overwhelming, all that, but you're about to bring another human into the world and it's a very good time to question things that you have felt have been maybe imposed or have just been what you've been conditioned to think or believe or do.
[00:41:16] Because if you haven't been able to do those things for you in the past, having this little human entering the world for the first time, like there's no other reason, there's no better reason to find that sovereignty and figure out what is the best for us to live our lives. Yeah, which is going to make the whole journey a lot easier.
[00:41:36] I mean, then in terms of practicality things, you said, what other things should people be doing? I would say, doing a blood test to check things like iron and iron levels and thyroid function. Oh, vitamin D, is that important? Vitamin D, absolutely, yep. Absolutely. And then if you need to take some supplements to address those things or address them through diet, you can do that then.
[00:41:59] So looking at that even a year, ideally, like six months out from having a baby, at least three months, because our eggs take like 90 days to be recruited as an immature follicle to a follicle that is released and is, um, It's going to be the egg that gives the baby.
[00:42:13] Sam: When I was trying to conceive it was all about we had to be taking folic acid.
[00:42:16] Yes. Is that still
[00:42:17] Peta: a
[00:42:17] Sam: thing?
[00:42:18] Peta: Yes. So, I would usually recommend a supplement with methylfolate in it, though, which is a, does the same sort of thing, but it's activated. So, for people who don't have as much of an enzyme that they need to break down folate, it's already done for it in the product. So, it's probably a better supplement.
[00:42:38] So, we can maybe link to. For a man, like we have as women, we have a little bit of a window into what's happening with our fertility in terms of our cycle. Men don't have that. They have the sperm and the sperm is a really good window, but it needs to get tested. So like sometimes for some people doing a test, which is very, very simple and checking that that's all good.
[00:43:04] Before they start, I actually think is not a bad idea, particularly in the climate that we're in with terribly declining sperm rates. Because then, men have time in order to look at the lifestyle things like changing diet, taking supplements, which we'll get Alicia to talk about in more detail, eliminating certain things, looking at sleep, stress, etc.
[00:43:26] That they can actually improve their sperm quality so much that they then may not need to have any other intervention and may increase their chances of conceiving naturally. And again, like how we talk about the menstrual cycle is a report card for our health, sperm is a really good report card.
[00:43:41] There's been really good studies that show that the poorer a sperm quality is in a man's 20s, it predicts the degree of like chronic disease that they'll have in their
[00:43:51] Sam: 40s. Literally you just have to go and have your sperm tested. It's not about their desire for sex or anything like that. Nothing shows.
[00:43:59] Wow.
[00:44:00] Thea: I think the other really important thing, sorry this is getting away from men, also for people who are on contraception that suppresses ovulation. It's really important to be cognizant of the fact that when our ovaries have been shut down for a long time that they can actually take quite a long time to come back online again, because you know, we often see women who stop the pill and want to be pregnant.
[00:44:24] immediately, but often may not get their period back for a year. So that's the
[00:44:28] Sam: difference between being on an oral contraceptive pill and the Mirena?
[00:44:32] Thea: Yes, because the Mirena, you're still ovulating in the background. Whereas with the pills, by and large, ovulation is switched off. Like, for the majority of women, yes, you'll stop the pill and start ovulating, usually within three months.
[00:44:44] But there are definitely people for whom it
[00:44:46] Sam: takes 12 to 18 to do. Yeah. I'm thinking of falling pregnant in the next year, but I'm not ready yet. Can I swap to a Mirena?
[00:44:54] Thea: Yeah, I mean, or you could just stop taking, I often say to my patients, just stop taking the pill a year before you actually want to start trying to fall pregnant.
[00:45:02] You can use condoms in the meantime, which if used as they're meant to be used, like no penis in vagina without a condom on. They're as effective as the pill and for most people in that year, if they were to fall pregnant, it's not the end of the world.
[00:45:15] Peta: I think that is such an important thing to say because so many women I've seen who have been 35 come off the pill.
[00:45:20] Well, that was me. 36 came off the pill. And then when they don't get their period, they're like, okay. And then they get kind of shunted into the fertility treatment, IVF world quite quickly because they run out of time. And so going off the pill earlier gives you A chance to know your own body, to have that connection again, to understand about ovulation and also the other thing is sometimes the pill masks things that are going on that might interfere with ovulation which you would know about when you're not on the pill because it's a bit like in a car.
[00:45:57] with a warning light saying something's wrong and the pill's a bit like putting a band aid over that, putting a tape over it so you can't see. So for example, like in my case, I probably wasn't ovulating if I wasn't on the pill because I was a bit too skinny and I was doing too much exercise, but I wouldn't have known that.
[00:46:12] on the pill because I would have had a bleed every month, right? So then I had to confront that when I came off the pill and then do something about it. But if I had been off it for a longer time, I would have known more, and, you know, my fertility might have returned earlier. Same with things like PCOS, and we can do a lot with, um, improving, you know, insulin resistance and other things.
[00:46:32] and helping women to start ovulating naturally. I know that everyone probably knows this but I'm just going to answer it. PCOS. Polycystic ovarian syndrome. We should do a whole episode on it because it's an umbrella term that I find annoying and wrote a whole thesis on why it was a stupid name. But basically I mean ovulatory dysfunction which is often caused by insulin resistance.
[00:46:55] Or, a whole gamut of other things, um, but it's worth having its own program. But basically, ovulation, dysfunction. And
[00:47:01] Thea: being on the pill would suppress that? Well, being on the pill totally turns your ovaries off. So you have no idea what your ovaries are actually doing in the background.
[00:47:09] Sam: I was put on the pill for that.
[00:47:11] So that's exactly why I was put on the pill at 16, because I had cysts on my ovaries.
[00:47:14] Peta: But that was probably totally normal for your This is one of my, if you're a teenager, 70 percent of girls who are in that age group will have that appearance on their ovaries and it's totally normal and yet they get completely pathologized.
[00:47:28] Anyway, a whole other. And that's going to be a great episode. Yeah. That'll be good. It's amazing as well, isn't it? The pill is such a good thing to like turn everyone's cycles off and prevent pregnancy. And then, you know, I think it does have an effect on. Fertility in the way that it disconnects us from our bodies and then we run out of time and then, of course, capitalism has a solution for the Well, it's create a problem, solve a problem.
[00:47:52] Create a problem, solve a problem.
[00:47:54] Sam: And it's just we're being sort of funneled into a system that actually the best thing we can do is Never go there
[00:48:02] Peta: unless unless you have really good informed consent So I honestly think unless you've had someone sit in front of you and say these are all the things you get to choose And I always say whenever someone does choose a pill, which isn't very often, but they do sometimes, is if I never see you again would be rare, but if that ever happens, please go off the pill.
[00:48:26] If you want to have babies, go off the pill at around 30 or something, or like a few years before you want to have a baby so we can see what's actually happening.
[00:48:33] Sam: That in itself is just such brilliant and beautiful advice. And I think that's exactly why I don't regret being on the pill or being on that.
[00:48:41] Injection thing when I was because it served a purpose at the time in my life Absolutely, it didn't you know, and I I can think about that, but I was fortunate to stop at 26 or 25 probably Which I think is rare in this day and age But now I I can see that yeah, if you don't know about it, you don't think about it You would carry on for so much longer And, yeah, we need to know that it's important to have the opportunity to see the window of our full health without anything interrupting.
[00:49:11] Peta: Yeah, and that being not on a contraceptive is an option that's perfectly valid.
[00:49:15] Thea: That's a funny thing, isn't it? That, like, it's become such a thing, like, all women have to be on contraception. Like, it's, people panic if you're not on contraception. I was just
[00:49:23] Sam: thinking, actually, even if you are someone who Transcripts provided by Transcription
[00:49:31] Peta: Outsourcing, LLC.
[00:49:34] You it changes your brain Changes all the systems in your body. Anyway, so really what we're trying to say is inform consent Having an alternative knowing that it's okay to have your natural cycle or their alternatives for contraception They don't have to be hormonal And the very important point is, if you do want to conceive, think about going off your hormonal contraceptives maybe a year
[00:49:58] Sam: or so before.
[00:49:58] So yeah, coming off the oral contraception, looking at ways in which we can limit some of the things that we know might hinder fertility, like any of the endocrine disruptors, going on an organic or pesticide free diet. making sure that you're happy in your relationships and in your life and in your work, maybe starting a small garden and spending a bit of time each weekend just planting something.
[00:50:27] So these are very simple. And actually, I'm just, as we're saying this, It's incredibly cheap. They don't require us to be spending money. So we're not saying you need an aura ring. We're not saying you need to go and get those tests from the chemist.
[00:50:41] Peta: And I also don't think we all need to be, I know we talk about our Stardust app because we just like the witchy messaging, but I don't think you just specifically need like a fertility app for the app to tell you when your window is like, it really annoys me because I just am like, no.
[00:50:55] I feel like it's more disconnecting and again, like not to bang on about patriarchy and capitalism again, but they get your data and probably sell it and know, Oh, this is when they're ovulating like the algorithms like, well, this is where we're going to target the ads for whatever you want to not.
[00:51:14] outsource your body and you want, you want to connect to your body not to be told when certain processes are happening.
[00:51:21] Thea: Well also, Sam Koster, our lovely fertility nurse friend, did a study showing that actually when the apps predicted that you would be ovulating, it was quite incorrect a lot of the time.
[00:51:31] Sam: So actually what we're saying is get a diary, start writing each day what it is that you're feeling and the day in which you're on your cycle. Maybe even draw a picture of what the moon is doing at the same time. And there's a
[00:51:43] Peta: really good book called The Fifth Vital Sign by Lisa Hendrickson Smith and she's a fertility awareness.
[00:51:50] So I think
[00:52:06] Thea: that's it. I think it's just tuning into your own body, knowing your body, because you don't need to know what day of the week it is. The cycle you are if you're like, oh, there's a bit of pain. Oh, I've noticed my cervical mucus has changed It must be around ovulation
[00:52:18] Sam: You're absolutely right because I feel like I can remember those stages when I was younger Watching the difference in the change of mucus and not really knowing why it was occurring but knowing that was different It just wasn't discussed with me by anyone at that time, and I didn't know about it, but now I would be actually really fascinated to go back and have that experience.
[00:52:36] Thea: It's a wonderful experience because it's like external confirmation of the beautiful things
[00:52:40] Sam: going on internally. So if you're young enough to be experiencing this in your panties each day, then please make the most of it because I'm not, and I would like to. Do it so Sam can
[00:52:54] Peta: live
[00:52:54] Sam: vicariously through
[00:52:55] Peta: you.
[00:52:55] And write in and share what you find. And the big tip is think about this earlier than later. Yes. Yes. Age is a massive factor. And that's what I wish many of my patients who come to see me at 40, 45, even like late 30s, what I wish someone would have told them. And what I wish the society would have given them the permission and the support to have been able to make that choice.
[00:53:20] Sam: But just for um, really nice confirmation for everyone, so how old were you when you had your first child, Peta? 36. 36. Yeah. 32. 32. Yeah. I was 27 when I had Ollie. But the point is you were both in your thirties. Yeah. And yeah. You successfully conceived without intervention. Mm-hmm . Yeah. And I think that's just a really nice message that, you know, in the thirties, this is, you know, yes, it, the percentage of dropdown, but it's completely possible.
[00:53:48] Having had. You know, you'd both had full careers up to that point and you've been on the contraceptive pill. So yeah, we're not saying We're not painting the bleakest picture We're just saying it is and it is still hard at 40 But I definitely have friends who have conceived naturally after 40. Oh for sure, lots of people do.
[00:54:03] Sometimes accidentally.
[00:54:04] Peta: Yes.
[00:54:04] Sam: My
[00:54:05] Peta: beautiful grandma who just passed away on Monday. I was doing the maths. She had seven children And her last was born at 42. Wow. And then the very final thing would be if you're having trouble conceiving, if you're under 35 and it's been 12 months, definitely see somebody, whether that's a nurse, a naturopath, a fertility doctor, GP, if you're over 35, just.
[00:54:27] because the time frame is less, um, six months and if you're any of those ages and you're either not having a regular cycle, so indicating that you might have an ovulatory problem, just see someone kind of then, or if there are any other symptoms, then see, see someone.
[00:54:43] Sam: And do you mean see a gynae?
[00:54:44] Peta: Yeah, a GP or a gynecologist, yeah, or a fertility specialist and that may not mean, and in the vast majority of times it doesn't mean you're going to be having IVF or fertility treatment.
[00:54:53] It's often just checking that there's nothing that's wrong and then if we have done those investigations many people then go on to conceive
[00:55:01] Thea: naturally. I would say it's like one of my favorite things, you know, when a person comes to see you. And they've got irregular periods and you can get to the bottom of it and their fertility plans are maybe two years away or three years away, but they start ovulating again and they start having regular periods again.
[00:55:14] So they're so well, they're then so well set up for the time when they do want to try to conceive.
[00:55:19] Sam: So we're thinking about fertility as a health journey, not just about child outcome, but actually we want to be fertile because that's an indicator that we're healthy. So let's make sure that we are as much as we can through all our fertile years.
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DISCLAIMER:
This podcast is for information and educational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment.
