Georgia: Ah, so we’re going there are we?

Andrew: Can you take us through a more pertinent background please and tell us a little bit about what really interested you about fertility once you’d finish naturopathy?

Georgia: So, yes, I’m a naturopath and a nutritionist, and have been in naturopath for I think coming up to 19 years now. So, time is getting on, but probably about 10 years ago is where I really started into reproductive medicine. And I think that really, I guess, the catalyst for that is having my own journey with fertility issues, and then some pregnancy complications, and then now, raising kids. So that really, I guess, lit the fire for me as far as really wanting to be able to help other women and couples with that. And just reproductive medicine in general I find fascinating. So…

Andrew: So, let’s talk about unexplained fertility. When we talk about fertility or infertility is this word that I know that you are not a fan of. But unexplained, take us through this. What does it encompass? What are we talking about? How’s the diagnosis?

Georgia: Yeah, so unexplained in fertility is really where standard fertility testing hasn’t found an obvious cause to explain when a couple has been trying to conceive, whether it’s naturally through intercourse, or through, yeah, IUI…donor insemination for more than a year and that conception hasn’t occurred. So, when we’re talking about standard fertility testing, we’re talking about where they’re assessing for ovulation if that’s occurring, looking for if there’s any structural issues in relation to the uterus or fallopian tubes, looking at ovarian reserves, see what’s happening with that.

And of course, analyzing sperm parameters. And so, it’s looking at all of those. And so, when none of those have come up as being an issue, that’s where unexplained infertility or that other term I guess, that’s used is idiopathic infertility, which is I guess, that catch-all for idiopathic, which is, we’re not really sure. And so, it affects… Well, it’s estimated to affect about up to 30% of couples who are experiencing infertility, which if you think about it, that’s a substantial number. And it can be primary or secondary. So primary is where we talk about whether a couple hasn’t conceived before, or where secondary, which is where they have, and then in subsequent attempts or subsequent, say, they’ve had a child or a couple of children, then subsequently, then they find themselves in this situation.

So, which is actually really common as well. And it can be a really frustrating and difficult diagnosis to receive when you’re trying to conceive because there’s that sense of, well, if they can’t explain it, well then it can’t be addressed and it can’t be fixed. And so, often we find from a naturopathic point of view is that it’s more often than not, it’s a case of not being investigated thoroughly enough. And often, couples are sent off into assisted reproductive technology, which can be amazing and can make such a big difference to a lot of women and a lot of couples. But often, they’re sent off into that before they may need to be without assessment of causes that are beyond the ones we mentioned. And I guess that encapsulates really where we’re looking at from an unexplained fertility point of view, broadly.

Andrew: Okay. So, if we are talking about “idiopathic infertility,” affecting around about 30% of couples experiencing fertility issues, why isn’t it standard practice? That’s a huge number. So are we talking about economic medicine here? It’s cheaper to go down the assisted reproductive technology pathway than it is to investigate the real causes of infertility.

Georgia: I think it comes down to the different paradigms, if you like. So, the medical paradigm and the naturopathic paradigm. And there can be a lot of crossover between the two and that can be amazing when that is really used well. But I think it just comes down to the way that HR trained and what they’re looking for, if that makes sense when we’re talking about unexplained, well in general medicine. But when we’re talking about this topic, I think it can come down to that because when we’re looking at say causes, and that’s a really big question, do you know, in terms of what causes unexplained infertility?

So, when we’re looking from both a naturopathic and medical perspective, when we’re looking at the causes, we need to review what’s actually required for conception to occur. So we need to look at, there needs to be the synthesis of viable sperm. It needs to be able to be motile, so it needs to be able to swim, there needs to be a good standard of morphology in terms of the structure, and then, of course, the DNA integrity needs to be there. So that all needs to be at particular levels. That sperm needs to then be able to move through the male genital tract and into the female genital tract, right?

And then on the female side, you need to have normal oocyte production, and then both the sperm and the oocyte need to be able to move through the female genital tract into the fallopian tube, so the site of fertilization. And then the sperm needs to be able to penetrate into the oocyte for fertilization to occur. And then this pre-embryo development needs to then transport and implant into the uterus. So, when you think about, I mean, that’s a pretty basic overview, but each of those on their own are really complex processes. So really, when you think about that, there’s a lot of things that can go wrong at each of those steps.

So I guess, that’s from a medical perspective, and it’s where they’re looking for the things that we spoke about before. So is there ovulatory dysfunction or anovulation? Is there something with the egg quality? Is there something going on structurally with the uterine tubes? Is there overt disease such as endometriosis or PCOS or fibroids, any of those sort of things? Is there a diminished ovarian reserve? All these types of things. Are there uterine factors? They’re looking at all of those or hopefully, they’re looking at all of those. And then, there’s obviously all the mal factor side of things, which is 50% of the equation. So in terms of are there structural issues? Is there systemic pathology? Those types of things.

But then, when we look at it from, so I guess, medically then, is where unexplained infertility where none of these factors have been identified. But what we often find when we’re looking at it from a naturopathic point of view is in some cases, they haven’t been thoroughly assessed enough, even just for the medical side. All of these things that are more overt or obvious in terms of things that it would be standard to look for in terms of what, when, where things can go wrong. So, and then when we’re looking at from a naturopathic perspective, to circle back what you were saying before, it comes down to more health being looked at on a spectrum, if you like. So there’s optimal health, the unicorns that have perfect health, and then there’s disease.

And of course, there’s many different stages in between these two spectrums, which is where we all sit somewhere because no one has perfect health. And this applies to reproductive health and fertility as well, if you can imagine this visual, if you’re a visual person, this spectrum that we’re talking about. So, from a naturopathic perspective, what we’re looking at with causes, it’s much broader because we’re not just looking at overt disease and any of the things we just spoke about that are hopefully looked at from a medical perspective, or we’re looking more for also the presence of imbalances or pathologies, if you like, that occur prior to the onset of disease.

And that’s really where naturopathic medicine comes into its own in terms of really being able to assess for those and then being able to address the consequences of them. So that’s where we, I guess, we are looking at. I think that’s what I was saying before, that can be a really nice crossover between the medical side and the naturopathic side in terms of, yes, obviously as naturopaths, we can’t do a laparoscopy, we can’t go in and do surgery and that type of thing. But there’s so much that we can do to really identify and support to be assessing what are the causes for the couples with unexplained fertility.

So then I guess, to sort of wrap up that question is where…what we often find is that when there isn’t the presence of the overt endo or whatever, all those things we spoke about, it’s more the combination of a few minor to moderate imbalances in male and female, that can often be enough to explain why it hasn’t happened so far.

Andrew: Okay. So, when we’re talking about ovulation, structure of the uterus, fallopian tube issues, morphology of the sperm, morphology of the ovum, when we’re talking about those, are they done in the primary phase or are they something that you take over and do?

Georgia: It depends upon when the point that someone has come to us, like at say Fertile Ground or anyone that specializes in this area. And that can vary pretty significantly in terms of couples that have had all the investigations. So hopefully, all of these primary medical investigations to those that say might have just only been diagnosed. They’ve been trying for 12 months, they’ve just been diagnosed and only basic tests are done. So we really just take it as on a case by case basis in terms of, okay, all the investigations are done, great, well then, we’ll go next…what next sort of steps with that. Or okay, these investigations haven’t been done, so then, this is what we’re recommending from here. Do you know what I mean? So, it can be both. So obviously, again, you have to work collaboratively with the medical side for care team to really be effective in that. But it yeah, definitely can be both approaches.

Andrew: Sure. And given that you’ve got two gametes to work with, male and female, how much work do you put into the male side of things? The morphology of the sperm, structure or problems with ejaculate. We sort of think that because ejaculation is a very fast process, it’s like being done and dusted. What about problems, say for instance, with the epididymis from past trauma or something like that, or past infections?

Georgia: Well, most definitely. And to answer the original question is at least 50% of the… It’s a 50-50 deal here. And I think, thankfully the narrative is changing, but for I think the last number of decades, the focus has been too much on the female side alone. And unless sperm parameters have come back as being wildly out of range, so many men and couples are told “it’s not him, his is fine,” whereas thankfully the narrative is changing. And it’s the same, obviously different processes, but it’s the same timeframe that we need to consider here in terms of it still takes around about three months for the maturation to occur in both the male and female system.

And so, there’s lots of things that can impact that along the way. Like you said, like is there overt disease there? So is there diabetes or sleep apnea that maybe hasn’t been diagnosed? Has there been some sort of physical damage to the testes at some point? Are there genetic defects that haven’t been picked up? Is there infection? Is someone a cyclist? So there’s a lot of heat being generated, all those types of things. And then we need to look at stress. I think from a naturopathic point of view, we look very closely for this.

But I think it’s still underestimated the mental stress, physical, emotional and environmental and all of these are such a big part of unexplained infertility and fertility in general. If you just take one of those things, so environmental toxins, and this is relevant for both male and female, what we’re talking about here. So environmental toxins are also reproductive toxins. And it’s not so much if you live on planet Earth that if we’re exposed to these things, but it’s just how much we’re exposed to these and what the consequences are for you individually, depending upon your own system, and your strengths and weaknesses in terms of your physiology.

So heavy metals and smoking, whether it’s active or passive smoking, xenobiotics and pesticides, and radiation, and alcohol, of course. And then recreational drugs, all of these things as well. And that’s just environmental toxins. So I think…does that sort of answer what you’re asking me?

Andrew: Yeah. I was just… While you are talking about this, I’m actually… I’ve got an image in my mind about the era of rock and heavy metal, and very tight jeans. I could understand like lower sperm counts, for instance, being a real issue in that era when you had Robert Plant basically wearing lycra, or he may as well have been wearing lycra rather than jeans. And then you had the glam rock era, which was lycra. But then, you’ve got the grunge era, where pants were riding lower than half mast, one would’ve thought that sperm counts would’ve risen. But indeed that’s not the case. They’re still dropping. So we’ve gotta look further.

Georgia: Yeah, absolutely. And I think it’s one of the more interesting segues how we went down the rock and roll path there for a bit. One of your more random segues that we’ve had, I’m just gonna say.

Andrew: Thanks. But so, when we’re talking about at least 50%, and we talk about the production of sperm three months odd, but that’s not necessarily just or including the time of exposure of clearing toxins, of things like that. So, how much time do you need to work on the male sperm versus or including the female’s ovum?

Georgia: A little bit of…

Andrew: What sort of time limit are we talking here?

Georgia: Well, I think that’s a little bit of a, how long is a piece of string question because for some couples that have been diagnosed with unexplained infertility, it might only be that three months, whereas for other couples it could be quite a bit longer. If say, for example, in the first example we said…like I said, it takes three months. That would be more where you’re seeing where there’s a couple where there’s not overt disease, there’s no overt pathology, there’s no structural sort of things going on on both sides. And it really is just where we identify a combination of, I guess, mild-to-moderate, sort of, imbalances in both male and female that have, sort of, impaired things happening.

That’s where you might tend to see more that sort of three-ish month timeframe. Whereas for others, it can take quite a bit longer where there is more in terms of…that tends to be more where there’s that combination of say like for example, a woman has endometriosis and it’s not just in the uterine area, it’s like maybe more in the bladder or what have you, wherever it might be type of thing. And then we know the endometriosis affects gut function and all the consequences of that. And then you might have a male that’s say for example, in their 50s and they’re wanting to conceive.

And males can still conceive in their 50s, but there’s a lot more consideration with regards to the exposure over their lifetime of their body, in general, just to all the things we mentioned before, but also just the consequences of age on sperm quality and the sperm parameters we spoke about. So it can vary significantly really depending upon the individual situation for the couple.

Andrew: Yeah. I mean, older males would’ve been exposed to a lot more of the devastatingly toxic pesticides and herbicides that have now been banned. The 1971…I think it was dieldrin. So there’s a lot of work that has to go into these older males.

Georgia: Yeah, yeah, that’s right. And that’s say for example, if they might have had procedures, so say vasectomy, that type of thing, so that that can be common as well. And then wanting to then conceive children after that. So there’s more to consider, like all of us, you don’t get to your 40s and 50s and not have some sort of baggage, whether it’s emotional or physical, do you know? It just is. And so that applies to reproductive medicine as well, is that there’s going to be physical consequences just by virtue of your age, that are not unassailable but they need to be taken into consideration.

Andrew: Also the issue of females being allergic to the semen. Are we talking about a reactivity to something here, or is there something way more complex going in? Like are we talking about it’s as simple as detox to get the sperm cleaned up? I know that sounds like a really glib comment, but to get the semen clean again, or is it something that you have to really delve down deep into?

Georgia: I think it’s more the second. Yeah, I think that’s not necessarily as simple, and that’s also not something that would exist as a standalone, you know? Because then, even if you’re just taking the immunological side, it’s a whole other big area when it comes to reproductive medicine with the immunological side of endometriosis or we’re talking… That’s what you just were talking about. Do you know what I mean? Yes, so, to sort of answer the question that you asked me, it’s more of a…more in-depth investigations when that’s the case.

Andrew: So that’s three more podcasts.

Georgia: You might have to note that one down for next time.

Andrew: So, Georgia, just about prioritization of where you get your most bang for buck, basically with investigations versus cost. And indeed, the… I’m gonna call it trauma, but the taxing of stress on the patient, on the couples with the onslaught of investigation after investigation, and their hopes being raised and dashed, this whole cycle. Like it really is torture for them. So where do you prioritize for the most common and the investigations that give you most bang for buck?

Georgia: So I know you’re going to get frustrated with me, but I think it does depend upon the couple. But I will go into a bit more detail for you because I know you’re only trying to pin me down.

Andrew: I need your word.

Georgia: But I guess for a broad answer to the question, and then I’ll go into more specifics. I think when someone’s being diagnosed with unexplained infertility, it doesn’t mean you won’t conceive. And that’s not the case for everybody, but many who are diagnosed with it will go on to have healthy babies, whether it’s naturally, or through fertility treatment, depending upon their individual circumstances. And the journey from there can vary significantly in terms of whether it is just a case of…I don’t mean just a case of, but whether it’s a case of trying to conceive naturally for longer with the types of investigations and treatment that we’ll talk about, or having a simple, I guess, simple fertility treatment like IUI or having to go down IVF and there’s variations of that type of thing.

And it can be really variable what the journey is for each sort of situation. But I guess, as far as the best bang for your buck is that it’s always that balance between, from a naturopathic point of view is making sure that your investigations are broad enough that you are not missing any of these. Particularly because when we’re talking about the more mild-to-moderate imbalances, and because we’re talking about there’s a lot of different systemic and local factors that can affect the process we talked about in the beginning in terms of the conception to occur, we need to make sure our investigations are broad enough to encapsulate all of those. Do you know?

In terms of the impact on their physiology and all these, like what’s going on with all of their…what’s going on with their hormones, what’s going on with their gastrointestinal tract, what’s going on with their thyroid. Even just thyroid alone, that’s a whole other podcast. Thyroid and fertility, that type of thing. What’s going on with their exposure to all these lifestyle factors we spoke about? So it’s always that combination of there’s no just one bang for buck, I guess, to answer the question that you asked me. There needs to be that combination of thorough but appropriate functional pathology investigations, along with a really good investigation of the lifestyle factors that are also a big part of it, as well as a thorough investigation of dietary. So it needs to be the combination of all of it, otherwise you’re really missing a big part of the picture. Did I answer your question?

Andrew: So you’ve got initial investigational visitation to, I would imagine just a GP, not just a GP, but a GP who then gives them the diagnosis of unexplained infertility. Then you’ve got that two-pronged ways, do you go naturopathic, do you go IVF, whatever? What’s the…

Georgia: Can I just jump in there and say it doesn’t have to be…it doesn’t have to be mutually exclusive, it doesn’t have to be one or the other. It doesn’t have to be the naturopathic approach or the medical approach. They can work really well together.

Andrew: No, I was gonna bring it back.

Georgia: Yeah. Okay. I’ll wait till you finish.

Andrew: I was gonna…You cut me off again. But so, when we’re talking about the merits of naturopathic medicine, like it’s not without controversy. I remember a couple of papers or writeups, they were based on one study and I dunno how good the study was, but it was saying naturopathic intervention was of no benefit. And yet you’ve got many, many fertility specialist groups, medical specialist groups, that are wholly embracing of the integration of natural medicine into their approach. And they willingly defer patients, refer patients when they can’t help or when they’re struggling to have successful resolution, successful pregnancies.

So, in your experience, what is the merit, the place of naturopathic medicine in the whole of the health-care framework that we are talking about? Because we’ve gotta talk about more than just outcomes. We’ve gotta talk about money that’s spent on these interventions and outcomes.

Georgia: Yeah, I agree. And I’ve mentioned this a few times, but it’s a really important point to make. In terms of, I think when we’re talking about naturopathic medicine and unexplained infertility and reproductive support, I think it can just be a really…not, I think, I know it can be a really effective adjunct to whether it’s the couple we’re talking about that is trying to conceive naturally for a longer period of time, or whether they’re having to go down the IVF track. And the reason we say that is circling back to what we said before is reproductive health is a reflection of general health.

And you don’t have to be a nutritionist and a naturopath to know all the different things that we do and don’t do that can significantly impact that in terms of what someone’s eating, how often they’re eating, how they’re exercising, and the disease states we spoke about, all those types of things. So if they’re not identified and addressed, whether it’s with trying to conceive naturally or going through IVF, anything that improves your general health and your reproductive health can only be a benefit in terms of improving your chances of conception.

And also, particularly if you are going down the track of IVF, helping to moderate the impact of that treatment can have in terms of the side effects that it can have or the… What am I trying to say? In terms of like so the side effects of that, or improving the outcomes of it. So, I feel very strongly about the fact it’s not one or the other and it’s not a case of giving everyone 10,000 supplements and it’s the same ones for every couple. Do you know what I mean? It has to be really nuanced. But people have unexplained infertility, there are imbalances somewhere there otherwise they would’ve conceived. And diet obviously has to form the basis of any naturopathic medicine. Absolutely.

You can’t out supplement a bad lifestyle and a bad diet. But there are particular interventions that are warranted to say your issues are really basic, isn’t it? Like iron. Iron, the most common nutrient deficiency that women have and how widespread iron deficiency is. And again, that occurs on a spectrum as well from your overt disease to the lead up to that. And for some cases, diet will be enough, but in most it will not be for a certain period of time. So intervention is required for a period of time in an appropriate way to address that in a way that, say, diet alone may not have.

And that’s a really simple example, but I think that applies to how we use, say, supplements and herbs and that type of thing in couples like this where there needs to be some extra support for a period of time to really, I guess, overcome or support the particular part of their physiology that is stopping them being able to conceive.

Andrew: Yeah, totally agreed. My only addition to that would be like it’s been said to me previously by… It was an integrative doctor. In fact, it was two integrative doctors, and we were having a conversation. And it wasn’t to do with fertility, but the words were said that some things just happen. And I remember feeling instantly at odds with those words. Nothing in this cosmos just happens. There is always an antecedent, there is always a physics reason for this. It just depends on whether the person observing it has the wherewithal, the expertise, the support to be able to investigate that, to find the reason. Otherwise, e does not equals mc squared. We wouldn’t know that. Everything, everything happens for a reason whether we can find it or not. But that’s not my question. The question…

Georgia: No. Okay.

Andrew: Sorry, you go.

Georgia: No, you go. I was just gonna say but like with… But I think what does need to be also raised is that everything we’ve spoken about so far, that in the vast majority of cases that have been diagnosed with unexplained fertility is that we know from a naturopathic point of view, as well as combining with the medical side is where we find reasons for that. But then, there’s a certain proportion of that where there aren’t. But then, I think that comes down to in naturopathic nutritional general medicine and reproductive medicine the research is always ongoing and there’s plenty of things that we still don’t know. It’s there is…

Andrew: Time now is appropriate. Time now is appropriate. Just happens is not appropriate.

Georgia: No, it’s not. But there’s still plenty that needs to be discovered and learned like in particular some populations. So I think like medicine in general, particularly reproductive medicine, I think otherwise I feel strongly that it’s a combination of the science, but also kind of a little bit of magic, if that makes sense. It’s that combination of, so like when you look at IVF, I guess, from the outside, you might think all the answers are there, everything is known. But it’s not, it can be a great tool, absolutely.

But if there’s also a little bit of, well, we’ll just give this a go and see if this works for this particular couple, because a lot’s not understood necessarily about every couple and every individual who are experiencing fertility issues. And thankfully, there’s a lot of research going on to that. But my point is, is that there’s still, for what you said originally is that there’s always an answer, but we don’t always necessarily have all the science necessarily now to answer that for everyone.

Andrew: No. And it may not lead to success, but to find the answer. Anyway, we are getting off on another tangent of mine. But so to follow on from there, Georgia, I know that you are gonna say this is a totally personalized approach. I get it. But what sort of therapies do you employ? Which do you find of greatest value, and particularly when given that stress and guilt and shame which result in stress are such a massive factor in so many couples’ issues with fertility?

Georgia: Absolutely. And having experienced fertility issues myself and then working with couples all the time who do have it, obviously, there’s a physical side and all the physical stuff that we’ve been focusing on today. But the emotional side, I think, is harder when you are going through it than the physical side. It’s just this ongoing process, it feels like, of this rollercoaster and largely feeling like you don’t have any control over the process. So I absolutely agree, it needs to be that combination of the physical and the emotional support. But we spoke about diet.

Obviously, diet needs to be the basis from a macronutrient point of view, caloric intake point of view, micronutrients, all that type of thing. But also, when we say, if you’re talking about the impact of emotional stress and adrenal nervous system, stress with couples that are going through this. Diet is also very important in terms of helping to ameliorate the impact of that if you like, as well as the consequences of… So if they’re going down fertility treatment. They all work together. So then, there’s obviously all the lifestyle things, like all the stuff we’ve spoken about is really moderating the impact of all those smoking and alcohol and recreational drugs, which we know can have an impact. So diet’s important, but that’s also important.

You can’t just do one of these things because it’s the nature of fertility and reproductive medicine is because when we spoke about it at the beginning, there are so many factors that are contributing to this complex, I guess, the complexity of your reproductive hormone system, and then the other endocrine hormone pathways, and they’re all interrelated and there’s so much that can… They impact each other significantly and there’s so much within your body and outside your body that can impact that as well. Which is a way of saying you can’t just do one thing when this is something that’s presented for you. But then, there’s also obviously nutrient support as well, which is really important. And herbal support, which we can go into a little bit more.

But along with that, it really needs to sit with things like acupuncture and with things like as appropriate counselling and where appropriate where there might be structural sort of issues there as well. Osteopathy, all those types of things as well. So it needs to be… And not everyone’s going to need to do all of those things, but we usually find with couples that are having reproductive difficulties is that it needs to be a combination of a few of these things to really overcome where they’re at.

Andrew: So with regards to whether it would be meditation, or exercise, or some form of stress relief and indeed improving health, general health, to diet to then, and I’m going top down here. Forgive me if you’re only listening to this podcast rather than viewing the video, I’m going top down so I’m prioritizing from the top down to the bottom. So, lifestyle obviously first and diet is very close obviously there. Exercise, where does that play?

Georgia: I think exercise in terms of say, if we’re talking about males, what type of exercise are they doing? Is it the type of exercise that generates heat? Are they cyclists? Do they wear lycra? That type of thing. Are they exercising where they’re training, say 10, 15 hours a week? Like that’s a consideration. So from a female point of view, are they exercising too much? Again, is it affecting their cycle, or are they not exercising enough? And so, having that sort of middle ground depending upon where they’re at or are they going through fertility treatment, in which case particular movement.

Moving is good, but then, it might be more, okay we’re really talking about more your nourishing, nurturing type of movement as opposed to going hard out and training for a marathon type of thing. So and then in pregnancy, I know you and I have spoken about this before, but there’s so much evidence around movement and how important it is during pregnancy in terms of pregnancy outcomes for the mother and the baby and labour. So exercise, and obviously it’s very individualized, there might be certain cases where exercise is not appropriate. But that that needs to be, and I get that’s just one thing, but that needs to be considered most definitely.

Andrew: And what about isometric, isotonic versus fluid movements? Sports, dancing, flexibility, stretching, yoga, that sort of thing? Any preference?

Georgia: I think it comes down to say, if you, the person, say for example if you have a…so say the female part of the couple, and there tends to be that really adrenal HBA type of lots of energy needing that type of thing. And they’re used to training say, five or six times a week doing quite high intensity type of exercise. And for whatever reason, conception hasn’t occurred. But, so for that sort of individual, it might be not taking away all of that because that can be something that can really help with their disposition.

But also say exercise is a cortisol inducing activity and when there’s already an imbalance there, that needs to be more, okay, let’s consider more coming to a bit of a compromise with just pulling that back a little bit while this is happening in a way that, so you might be going for more your yoga, your Pilates, that type of thing, as opposed to say going for a run six, seven times a week for that period of time because it can be counterproductive.

Andrew: Yep. And I know this is a piece of string question, I get it again. But which supplements do you find that you very commonly prescribe? How about I say that? Rather than if I say of merit because they’re all of merit.

Georgia: They’re all of merit. Okay, so let’s talk about the most common ones. So preconception multi obviously is pretty standard with that need most. Any couple will be on that. Then the individualized sort of vitamins is appropriate like vitamin C, B12, D, that type of thing, choline. Then we’re talking about minerals. So your iron, your zinc, magnesium, your iodine, chromium, that type of thing. And then we sort of go down to amino acids where it’s appropriate like glutamine, like, is there gut lining issues? Do we need to add some glutamine there? Is there L-arginine? So, in terms of really promoting blood flow. It has a role to play in terms of spermatogenesis or that type of thing. Or taurine, that’s an antioxidant we know, but that’s also correlating with your mood symptoms, sperm quality, there’s a role to play in insulin resistance, that type of thing.

And then we go down to more… So then more specific I guess. So like things like your CoQ10 ubiquinol and I know what you’re gonna ask me in relation to that. Myo-inositol and N-acetylcysteine, obviously, we use that a lot. Love those two. For both male and female, lots of different applications there. Resveratrol, we use that a fair bit particularly where there might be endometriosis in terms of the lesions and pain, that type of thing.

Fish oils, is there anything that fish oils can’t do? But fish oils in terms of anti-inflammation, fish oils and magnesium, really, I think everyone should just take them. Curcumin, then we’re circling back to gut stuff. It’s like your prebiotics and probiotics for both. There’s just, again, that’s a whole other topic about pre and probiotics and gut health and reproductive health. Acetylcarnitine, then there’s more like berberine, collagen, electrolytes, all those types of things. So not everyone’s taking all of those things, but it’s appropriate use of the right dosage for the individual couple for periods of time, depending upon what they need. So they’re common ones.

Andrew: And integrating it into their…I find one of the biggest challenges, one of the biggest, it’s actually a fun thing for me is trying to work out which supplements are going to give not one action, but three actions. And I guess, that’s the art of our science is trying to find the right thing that will get more than, forgive the horrible acronym, but kill more than two birds with one stone. So…

Georgia: Awesome. Yes. You can do the best prescription in the world, but if they’re gonna feel nauseous when they take it and they don’t stick with it, well then it’s a waste of time. But also, it’s around educating… There’s a lot of education involved in naturopathic consults in general, but particularly with reproductive medicine because by the time, say, a couple might have come to us, not all the case, but they might have had some investigations or what have you. And then they’ve come to us, and they may be really well-educated, but often they’re not in terms of this whole process we’ve spoken about or the steps involved for conception to occur.

And then how these things actually are working and to do, to achieve what we need to achieve. So there’s a lot of education that’s required along those lines as well, rather than just take all these things and come back in three months. So there needs to be that as well as well as like the basis of naturopathic care, which is really developing that trust with the person that you’re helping here. And so, when you develop that relationship and that trust, and also education around what you’re doing and why you’re doing it, they’ll come along with that.

Andrew: There’s a whole other discussion podcast that we could do on the MTHFR issue and folic acid versus folate, which we get from food. Folic acid is a cheap synthesized form of folate. And there may well be huge issues in this, certainly in a segment of the population and that segment appears to be larger than what we originally thought. What’s your take on that? Is it, rather than getting into a whole podcast on this, do you agree with that thought that we’ve really gotta look at MTHFR issues?

Georgia: I mean, I think it’s a fairly standard part of investigating that needs to be considered when we’re talking about all the assessments we spoke about for reproductive health. It’s one of the standard ones that we look at in terms of is it MTHFR? And if so, how does it look like for them? In terms of then how you’re addressing that? I think there can tend to be a slightly different approach between the medical side and the naturopathic side in that situation.

So, and not to say they can’t come together and there needs to be respect on both sides in that regard, but I think it’ll be interesting to see where the research comes over the next 5, 10 years in relation to that. But I think we also need to be careful with not over-emphasizing MTHFR in all cases, obviously. Absolutely, it can have a devastating effect on fertility, but it’s not always the case.

Andrew: No. One of the… An example. Two patients, one very few vegetables. And so, I really encourage them to get into the green foods, the green smoothies, the green whatever, apart from malt. But to really start incorporating these vegetable matters in their diet, in whatever form they could, and certainly to potentially look at this. But then, there was another beautiful couple, really healthy, loads of vegetables in their diet. And I said, “Stop worrying. Stop worrying about it. It’s not a switch that you turn on and off, like it’s yes or no. You can really influence this with diet and it seems like you are.” So, I totally agree with you that it’s a personalized approach and that it’s a piece of string that you can’t just address with one supplement for all.

Georgia: No. And like say that’s another big discussion. But obviously, if someone has MTHFR and they have the forms that are significant for them and obviously, the right supplementation needs to be really considered for them and there’s more research coming out to do with a metabolized folic acid and the impact of that, it’ll be interesting to see where that goes in terms of should folic acid be the supplement that’s used for individuals who have this? Which, but it still tends to be the approach that a lot of doctors use because most of the research in terms of folic acid neural tube defects has been done on that. So, yeah.

Andrew: Yeah, that’s right.

Georgia: Referring to in terms of, it’ll be interesting to see where the research goes in that regard and hopefully there’s kind of more of a meeting in the middle in that.

Andrew: Now you’ve recently joined a practitioner in her group who I totally admire, that’s Charmaine Dennis of Fertile Ground. Tell us a little bit about the meeting of the ways and also, take us through what Fertile Ground offers with regards to resources to help them empower patients. Because as we said, stress, and guilt, and shame, they’re such a huge factor in this. And if we can educate and settle patients down with regards to their options, I think it takes away a huge burden for them.

Georgia: It can definitely not necessarily take the burden away, but ameliorate the impact that it’s having on them. So yeah, Fertile Ground is a Melbourne-based clinic, but everyone’s available online in terms of telehealth, so available to anyone. But really, we specialize in reproductive health and fertility. So whether it’s the type of individuals and couples, excuse me, that we’ve been talking about, or just more general reproductive support and health that’s required. And so we’re very much about the collaborative approach. Like say, within the clinic there’s obviously fertility naturopaths, there’s general naturopaths, there’s osteopaths, there’s counselors who are amazing.

There’s acupuncturists who are amazing. And so, really very much about collaborating within the clinic group, but also significantly with the medical side and the care team that each couple and individual have. We’re very… feel very strongly about that. So there’s a lot of respectful communication between us and the medical support team that that they have. But there’s heaps of free and interesting, really useful information on the website in terms of blogs. They can also, if couples are wanting to conceive or trying to conceive, there’s a free 12 Steps download, 12 Steps to Create a Fertile Life they can go onto, which is… There was a book that was released out last year, which is fantastic.

So that, I guess, it’s a bit of a short version of that. So there’s lots of really useful information on… A bit of information about everyone who is available there and a bit about them. So can get a bit of a vibe if you like about… But you can always just have a look on there or contact if you have any questions. And they’re also… Most of the modalities offer a free 10-minute… If you have any questions, you’re not quite sure if they’re the right fit for you, you can have a free 10-minute just to have a bit of a chat to us before booking into any appointment as well. So that’s absolutely an option too.

Andrew: I said before, I have such admiration for Charmaine Dennis and what she’s worked really hard to achieve with regards to the respect of the fertility groups with which she works in the Melbourne area and indeed now far more abroad within Australia. But I have to say, Georgia, I know that you’re a friend, I get it, and we sort of riff, but I really do have such admiration for you as well because you temper my simplistic questions. Because you have such care for your patients and you are a true, I mean, God, you’re a detective. You’ve teased apart… You’re like a bulldog you will tease apart, down to the nuance to find out what it is that is affecting their health, whatever that issue may be. And I have such respect and admiration for you, my friend. So well done to you and to indeed, the Fertile Ground group for having you on board. Well done.

Georgia: Thank you. And can I just say they’ve just celebrated 21 years of when Fertile Ground started, which is amazing.

Andrew: Wow.

Georgia: And so, I was down in Melbourne recently, so I got to meet everyone face to face. Then also met some of the practitioners that were there from the start or not long after it started. And it was just amazing just to hear how much they’re really trailblazed in this area. They were the first naturopaths to go to the FSA sort of meetings. Fertility Society of Australia, they’re the first ones to go. And you sort of think this was 21 years ago. Imagine how intimidating that would’ve been, but they did, and writing letters and all of that. So it’s just been… I feel very lucky to be part of that. It’s a really exciting group to be part of.

Andrew: Well, as you say, it’s trailblazing on their part, but it’s also the dedication and indeed the knowledge that Charmaine demands of her practitioners to earn the respect of orthodox practitioners. And that’s how, indeed Fertile Ground has gained this respect of them. And so, I’m glad that you are on board because indeed you are one of that ilk. Well done.

Georgia: Thank you. Yeah, and I think as I’ve been touching on all the way through, it really does have to come down to mutual respect on both sides and that collaboration. Because at the end of the day, it’s about getting the best outcomes for the individual and for the couple in the cases of fertility cases. And so, putting professional egos aside, there’s no place for that. It needs to come down to what’s best for this and really being able to respectfully work together for that.

Andrew: And thank you, everyone, for joining us today. Remember, you can catch up on all of the show notes for today’s podcast and, of course, the other podcasts on the Designs for Health website. I’m Andrew Whitfield-Cook; this is “Wellness By Designs.”