Amanda: Like most of us who are, you know, naturopathic clinicians, we really kind of follow our interests and a lot of our own kind of personal health history. But for me, Andrew, I was just so blessed because I got to train and learn with Francesca Naish, who was, you know, definitely kind of considered the kind of foremother of preconception care. And when we were doing preconception care back in the 1990s, it was definitely an incredibly radical idea and very much kind of based on one study, you know, coming out of the UK from the Foresight Group. But Francesca was incredibly passionate and she definitely kind of ignited that passion in me for, you know, looking at kind of nutritional intervention and how we can optimize fertility outcomes, both with male and female fertility.

And then after working with her for 10 years, I kind of started Darling Health about 16 years ago, which has had several iterations and several addresses and a lot of great clinicians. And now I still have a great team of clinicians, associates, and staff who, you know, share my passion for both reproductive health and family health. So, we’re still rolling. So, it’s about 26 years down the track.

Andrew: Wow. And you know what? You hit the nail on the head with the term because, like, I did this, I segmented that thing and said fertility, but it’s family health that you’re into because it’s not just females, it’s males and it’s couples and then it’s the kids. And it’s an interesting differential, if you like, of how we term things. Yeah.

Amanda: Yeah. Absolutely.

Andrew: So, can I just ask you? I know this is a broad brush, I get it, but can we just talk a little bit about patient presentation? Who are the types of patients who come to see you? Have they already been through the mill and not been successful, or are they those people that are just going, “No, this is my choice to go the natural way, if you like, and I’ll seek that support first?”

Amanda: Look, Andrew, I would love to say that they are all committed preconception patients, but those preconception patients were seeing me before they actually even start to try and conceive. Unfortunately, that has changed over the last kind of 25 years. And they actually are a very small cohort of my practice. Most of my practice are definitely, you know, patients who have, you know, done a few laps through IVF or they’ve already had quite a complicated history before they land in my rooms kind of tragically. And I think it’s not necessarily just about the patient group. I think that’s very much a reflection of the prevalence of fertility that we are actually seeing these days too so that it’s becoming, you know, definitely much more commonplace.

Andrew: And are you seeing things worsen in this arena? Are you seeing dramatic changes over the course of your career?

Amanda: Absolutely. I mean, that’s one of the things, you know. I’m a bit long in the tooth, Andrew, but, you know, I’ve kind of seen a generation now. I’ve been in practice for 27 years. I really have. I mean, I’ve actually got my son’s friends, you know, starting to see me, which is incredibly interesting, you know, when they were naughty kids, teenagers in my household. But, yeah. And this is, you know, part of the kind of tragedy as well that we do see.

But, like, even semen analysis is obviously a very good example. And it’s, you know, very much just, you know, discussed that in a generation, like, this current generation, their sperm counts are probably 50% of their grandfathers’. And, you know, back when I started out in fertility, you know, to see a sperm count of 100 million was incredibly common. And now it justifies a high five. If you see a guy come in with a sperm count of 100 million, it’s very rare for me to actually see that, unfortunately, and becoming rarer. Absolutely. It’s a tragedy.

Andrew: And women with their presenting conditions, now I know this is a little bit worse, but let’s say egg quality, egg number, do you find dramatic changes in that over the course of your career as well?

Amanda: Well, yes. I mean, I think egg quality is a bit more difficult to actually kind of measure because our only kind of measurement is actually with IVF, but, obviously, that language, egg quality is very widespread and it’s often the reason. It can be a bit lazy medicine. I have a little bit of an offense to that kind of label because the amount of couples who turn up at my door and they’re just being told by their specialist that it’s egg quality.

So, sometimes that diagnosis is just a bit by exclusion as well, but what we do see an increasing prevalence of without any question is polycystic ovaries, endometriosis. Hashimoto’s is wild. Like, I remember looking back years ago, you might see one Hashimoto’s patient a week, and I would have, you know, four or five every single day in my practice without any kind of question. I mean, it might not be their presentation, but it’s just definitely part of their picture. So, that’s a trajectory that’s also a tragedy. And I think, you know, we need to be having these conversations because, you know, our reproductive health, I mean, health is in decline. I mean, it’s all kind of these increasing prevalence of these conditions, you know, do actually echo that really.

Andrew: Yeah, yeah. But what’s also springing to mind is that we need to revisit the prevalence of these conditions. We need to teach differently. So, we’re going to need the expertise of people like yourself who are on the call face to be giving us this information because what we’re learning from is so old and outdated that we’ve got these outdated specs, prevalence stats, data in its entirety. It’s not reflective of current day.

Amanda: Oh, absolutely. And it’s been normalized, and that’s the thing that really, you know, upsets me as a clinician, just to be like, “Oh, you’ve got thyroid disease. You’re on thyroxin for the rest of your life.” And I can see amongst my generation of friends versus amongst my daughter’s generation of friends just watching them all being, you know, diagnosed with thyroid disease. It’s kind of outrageous that we’re not kind of yelling from the rooftops about what is kind of going on here.

And all of those things, whether it’s polycystic ovaries, endometriosis, you know, elevated levels of obviously oxidative stress, thyroid disease, all of those things can affect egg quality. So, sorry. That was a very long detour to come back to answer you that. And that all of those conditions are, of course… You know, oxidative stress is really part of their kind of pathophysiology, I mean, why we’re seeing the kind of prevalence of them. So, they will also affect kind of egg quality. But, you know, women who are going through IVF, you get that information because you can see the cohort of their eggs, how many of their eggs are kind of getting to embryos, you know, the percentage that are getting to blastocyst, how healthy they are, etc.

Andrew: Right. So, changing my vernacular, rather than saying egg quality should be instead be looking at numbers of eggs that are able to be harvested? Would that be more appropriate? Tell us.

Amanda: Yeah. Look, I definitely think egg quality is part of the picture, but it doesn’t really tell us the root cause.

Andrew: No.

Amanda: For a lot of couples, they end up having to make urgent decisions about going to, you know, oocyte donors, you know, when their specialist will just be like, “We can’t do much else because it’s coming back to your egg quality. And we’re not really finding the root cause of that,” you know. Is that environmental toxins? Is that endometriosis? Is that poor nutrients? Very likely as part of that picture. And if those things aren’t being investigated, yes, the outcome can be egg quality, but it doesn’t really tell us about the cause.

Hormonal reasons, of course. I mean, if they’re very elevated, you know, prolactin levels, you know. Definitely, there are some disturbances to their adrenal hormone profile. We know that all of those things can affect egg quality. So, it just comes back to the way that we practice, that we wanna always be making sure that we just don’t kind of stay with, “Oh, well, you’ve got an egg quality issue,” without really finding the particular pathways that has led to that diagnosis.

Andrew: Okay. So, I said broad brushstroke before. Here’s a rabbit hole. In 20 words or less, what assessments and investigations do you do?

Amanda: It is a total rabbit hole. But again, I’m going to just leave with, you know, we practice personalized medicine. So, we are going to do those tests that is going to help us understand about the presentation. A lot of my couples are fairly worked up by the time they arrive, so I often will see, you know, all their hormones. But, you know, if they’re having implantation failure, Andrew, we’ve got a recurrent miscarriage history. We’ve got to go down looking at a lot of their immune profiles, looking at their antibodies. We need to be looking at methylation profiles if we’re seeing chromosomal error in their embryos or, you know, a long history of infertility without even a positive pregnancy. I, of course, test a lot of their nutrition. So, I’m trying to find the gaps in their workup. So, what hasn’t been tested a lot of the time? So, I’m doing a lot of their nutritionals.

And you also wanna make sure that they’ve, you know, had a tubal check, that, you know, anything anatomical or obstructive has been ruled out. And the gold standard with the guys… I test nutrients on the guys. I’m looking at a lot of methylation influences as well. But the gold standard is, of course, we do a semen analysis, which also looks at DNA fragmentation as well, which is, you know, an indicator of how healthy the DNA is in the head of the sperm and its ability to kind of pass on healthy chromosomes to the embryo as well.

And a semen analysis gives us a lot of information that we can kind of extrapolate whether there is a toxic load, poor antioxidant load as well based on, you know, the percentage of abnormal to normal forms, how well that sperm is moving, etc. So, you know, there’s good tests. We’ve just got to make sure that we extrapolate the key information from these investigations to design their treatment plans.

Andrew: Yeah, yeah, absolutely. And part of that is managing costs as well. Can I ask, though, do you ever question hormonal assessment as a snapshot versus hormonal assessment over a cycle?

Amanda: Oh, yeah, absolutely. And look, you just get a lot more experienced with this. So, you know, I’ll have patients turn up and say, “Oh, my hormones are okay.” And they’ve been done at a ridiculous time in their cycle. That’s not reflecting ovulation or it’s not reflecting baseline at day two or three. And it’s the dance of their hormones. It’s always kind of the pituitary versus the ovarian dance. And so, you know, there’s a lot of great doctors. I mean, obviously, fertility specialists are very experienced in this area, but sometimes GPs will be a bit kind of confused about the dance between the pituitary and the ovarian hormone.

And so, you know, our aim is to test them at baseline, which is around day two, day three. But also I do a lot of DUTCH tests with women too, Andrew, because you not only can, you know, understand what’s going on hormonally, you can see those hormonal metabolites and their impact, and you get great methylation markers. Like, it’s not entirely comprehensive, but for one test that gives me a lot of information for this group, you know, I’m seeing cortisol metabolites. I’m seeing, you know, the ovarian hormone metabolites. We’re seeing how well she’s ovulating. We also have markers for oxidative stress, you know, and a lot of the B vitamin and neurotransmitter markers. So, it can help pull a lot of information together just to kind of really understand that kind of matrix of what’s happening hormonally for her.

Andrew: And we have to obviously talk about therapies. Now, obviously, this is gonna be a very personalized approach. I get it. So, it’s very hard and very dangerous sometimes to say, “Yes, I use this all the time.” But can I ask about some hints and tips about therapies that you might find, let’s say, advantageous, you know, in most of the cohort suffering from a condition?

Amanda: Yeah, absolutely. So, I mean, if we’re talking about all complex fertility cases, which is definitely my patient cohort as well, you know, I mean, the mitochondria is really where it’s at, and all the things that are impacting the health of the mitochondria, Andrew. And look gratefully. Even in the last, you know, five years, there has been a lot of further research and evidence into the role of antioxidants and to the impact of oxidative stress. And as we know, you know, there’s so much kind of published data and the impact on environmental factors, heavy metals, endocrine-disrupting chemicals, the plastics, etc., etc.

So, it’s great. So, that’s where kind of the research dollars are going and the researchers are really looking. And there’s a great test which will soon be…and it’s incredibly equally exciting for us clinicians who work in this space of antioxidant nutrition infertility, but it’s also equally kind of a tragic reflection of where the trajectory, again, of where male health is going.

And there’s emerging test, which will absolutely be the gold standard that is called MiOXSYS test, which basically measures oxidative stress in seminal plasma. And it basically takes four minutes to gather all this information. And it’s been spearheaded by the world kind of Andrology Forum and by a researcher called Ashok Agarwal, who any of my fellow fertility naturopaths will like me have just, you know, spent our careers reading his research. He’s been around as long as I have been, Andrew. I feel quite familiar with him because he has been just absolutely spearheading this area of research.

And I remember working in Francesca’s clinic back in the days where we would photocopy the journals and take them home to read them at night when we were still working off paper. But this test is going to really help all of us, again, just really help our treatment plans be a lot more kind of focused, and I think really help the communication with integrated practitioners and IVF because it’s gonna kind of revolutionize kind of andrology really. So, it’s interesting.

And his group are definitely proposing that we actually need a change to the nomenclature because, as we mentioned before, you know, male fertility is in an incredibly sharp decline and especially in this last generation. And they are now proposing that, you know, because 50% of male infertility has been basically, you know, recorded as being kind of idiopathic. Again, another area of kind of, like, laziness with diagnosis.

And so when you kind of rule out trauma, infection, you know, anatomical kind of reasons, they will describe the rest of male fertility as idiopathic, whereas 80% of idiopathic male infertility is now being deemed to be associated with high rates of oxidative stress. And so there will be a new name for male infertility called MOSI, which is M-O-S-I, which basically stands for Male Oxidative Stress Infertility. So, I think we’re going to a whole new paradigm with male fertility, and I think it’ll be a really kind of interesting space to watch with increasing acceptance of some of the nutrients that we use. So, it’s fascinating. But, yes. But some of those things that are key to my protocols.

I mean, definitely, nicotinamide riboside is totally the new kid on the block. And I’m embracing it and just as excited by a lot of other kind of practitioners out there. I’ve probably been using it in the clinic for the last kind of, you know, 12, 18 months or so and been watching the research on it, which still is majority kind of animal studies, but incredibly convincing male studies where they’ve been able to reverse-aging in the oocyte and definitely seeing great outcomes in the… I mean, it really… Yeah. I hesitated to use the term anti-aging and reverse-aging historically, but nicotinamide riboside is really one of those kind of key nutrients. We need more human studies on it, but the animal studies are incredibly convincing. Even some of the human studies, it’s been added to the embryo culture of embryos as they’re being grown, again with very, very positive outcomes as far as embryo quality and the grading of the embryos.

Andrew: Can I just ask about differentiating it between just normal everyday B3, whether it be nicotinamide, the amide form, or nicotinic acid, or niacin? Do you find a great difference, like, in activity here? And forgive me. What I want to explain for our viewers, our listeners, is if you can visualize a clock from 12:00 to 6:00, then that’s the B3 side, if you like, of the Krebs cycle. And from 6:00 back to 12:00, that’s the B2 side of the Krebs cycle. Forgive me. Brain fart there. And then that goes into oxidative phosphorylation and the electron transfer chain. So, do you find a great benefit of NR, nicotinic riboside, NR?

Amanda: Yes.

Andrew: I’m stumbling over my words. Do you find a real difference here, like, way more than just using B3?

Amanda: Look, I am definitely kind of seeing that clinically. I’ve used a lot of B3. I’ve used a lot of B3 historically, especially where there’s been a history of recurrent miscarriage, and I suppose for a lot of those methylating kind of pathways, B3 and B2 if we’re seeing a lot of blocks on those with our patients. Where I see a bit of a difference with NR is its role in insulin sensitivity, Andrew. It seems like it’s got much more anti-inflammatory effects. I definitely see a difference with embryo quality with women who’ve been taking it for, you know, four to six months. I’m not gonna explain to you the structure of it. I am just a lowly clinician and not necessarily a researcher. But it’s obviously got the nicotinamide and the ribose sugar, you know. It seems to be what is kind of key to it.

But as far as egg health outcomes, like, definitely B3, I’ve seen a lot with recurrent miscarriage, implantation failure. I’ve used it a lot and had had good results with that historically. I still use B3 for different patients for different reasons. But the NR… And look, you know, I mean, it’s all very kind of empirical use, but I’m definitely seeing it with the health of the egg and the embryos. And look, definitely, I’m sure it’s got a role in implantation. There’s definitely discussion about that. But that’s where I’m noticing it. Absolutely.

Andrew: But I felt like you’ve just given me a knock over the head with a piece of 4B2. Of course, why didn’t I realize this? Of course, the inclusion of the ribose sugar, which, of course, is used as an energy fuel.

Amanda: ATP, absolutely.

Andrew: Wake up, Andrew.

Amanda: All of us, Andrew, sometimes, you know, things can be plain as day. But I think we also have to be kind of careful. There’s definitely some conflict about dosing in the research, so I’m watching that. And it does seem it can be potentially a bit of a bell curve. And these are tiny studies where people actually take the NR in 100 milligrams, 300 milligrams, 1000 milligrams, and they measure the amount of NAD in that person’s bloodstream. And it seems there is a bit of a sweet spot. So, I think we have to still be kind of careful. We just don’t have that kind of research around dosing. But, yes, I’m a convert. I’m a devotee.

Andrew: What are you finding, though? What are you seeing?

Amanda: I’m just trying to be kind of bang average at the moment because I don’t like to really kind of experiment with my patients. So, I’m just trying to be really kind of Ms. Average with that. But, yeah. But sometimes you might…

Andrew: So, we’re talking around the 300 milligrams?

Amanda: Around the 300 to 400 milligrams is the kind of dose. Yeah. But, you know, sometimes their IVF doctor might be prescribing it at really kind of very elevated doses. But I do think it’s one of those nutrients that potentially, you know, we might see the future that less is a bit more with it. So, I think…

Andrew: Interesting.

Amanda: …we’ve gotta be careful. Yeah. I think we’ve just gotta be…

Andrew: And what about when we go back to sperm motility and function and indeed quality in this issue? The merits of CoQ10, ubiquinone, ubiquinol. What’s your preference? What’s your dose?

Amanda: Yes. The same thing. I’m a total devotee to ubiquinol. I mean, a lot of the research was with ubiquinone historically, but, you know, definitely, emerging research and definitely research that’s funded by certain producers of ubiquinol is kind of coming to the market. So, we will see that. But absolutely, I mean, ubiquinol is a fantastic nutrient, both in male and female fertility. Any of my patients who’ve had a history, or we’re looking at aging being a role, or, you know, declining AMH, or if there’s a lot of kind of sperm parameters that are definitely compromised. So, look, it depends. But definitely, it’s that 300 to 600 range. Sometimes I have to go higher towards 900 if we’re seeing really severe compromise.

And again, it’s very dependent on the commitment of that patient as well. I mean, it’s very different if they’re 45 or 35, Andrew. And it also depends on the male kind of sperm, DNA fragmentation rate too, so if I’m seeing a very elevated fragmentation rate. And they all wanna be pregnant yesterday, as you understand, Andrew, so you have to kind of counsel them around that. I’m often saying to my patients, “I don’t want you to be seeing me in two years’ time and us just kind of bumbling through with, you know, a bit of a kind of vague protocol.” I’d rather us be putting on our therapeutic boots, “This is what we’re doing for the next six months,” you know, is how that I often kind of counsel a lot of my patients, definitely.

Andrew: Now, I know that we can spend all day going through different nutrients, but just thinking about some star players that we know are so important in fertility, iron, iodine, folates. Can you give us some little clinical pearls?

Amanda: Look, absolutely. They are all star players. I measure them too. So, I’m just kind of measuring them because I’m always trying to, you know, consolidate what I’m prescribing for people. So, I will measure their iodine levels. Again, if they’ve had, you know, quite a long road to fertility and they’re still having very kind of disastrous outcomes, we will often prescribe higher-end folate and definitely B12. I’m seeing way more deficiencies in B12. B12, I’m way more kind of concerned around than folate. And again, such a crucial nutrient of genetic expression often found to be low in both seminal plasma and follicular fluid. So, there’s a lot of great research. And you’ll often see that correlate with high homocysteine levels in follicular fluid and seminal plasma. So, B12 is a total go-to. And just definitely I’m testing their holotranscobalamin levels just to make sure we’re on top of that.

And everyone’s got gut issues, Andrew. So, you’ll often see that they’re just low in B12. Because, you know, if they’ve got Crohn’s disease or ulcerative colitis or celiac disease or something, you know, that will again direct you to ensure that, you know, we’re definitely seeing replete levels with those nutrients.

And the other two I use a lot when I’m kind of just going my absolute favorites and heavy hitters is definitely N-acetyl cysteine for both men and women and Inositol as well. And I compound a lot of these up together. So, we regularly have NAC and Inositol, and NR going out for the women. And definitely, men, you know, N-acetyl cysteine, definitely sometimes with the carnitine, arginine, NR for the guys as well. And just to limit the amount they’re taking, I’m often kind of compounding these nutrients up together. But my dear, blessed staff just pour off those combinations like 20 a day. It’s just constant. We have them compounded on our shelves, you know, because we have so many patients who are actually kind of taking versions of those compounded formulas, definitely.

Andrew: Yeah. I need to ask you a conundrum, which you’ll face, and that is that you’re seeing a heck of a lot more Hashimoto’s, yet we have guidelines of 150 micrograms for every pregnant woman by the NHMRC. How do you navigate that one?

Amanda: Well, I mean, I definitely kind of follow that protocol of trying to get their selenium up initially…

Andrew: Thank you.

Amanda: …which you often kind of go in with first and then you can introduce iodine. I suppose, again, that I’m also very careful about being very kind of reductionist on all of this. There’s a whole lot of reasons for thyroid antibodies. And thyroid antibodies are often the canary in the coal mine of a lot of other autoimmune mechanisms that are going on. So, iodine is definitely part of the picture. And again, if I’ve got a woman with Hashimoto’s and she’s got fibrocystic breasts and subfertility and she’s been miscarrying and, you know, she’s got a goiter and everything, she’s gonna probably need iodine. I’m gonna bet my house on it. She’s gonna come back with low iodine. So, we might have to do a preload with selenium. But I test their antibodies all the time. And look, you definitely can catch women’s antibodies going up at some points, but I don’t think that’s just related to iodine, Andrew. That can be…

Andrew: No. Stress.

Amanda: …a whole lot of causes. Yeah. And cortisol. You will see it definitely associated with cortisol and stress, or if she’s having… Even if her inflammatory markers, like we’re seeing CRP or, you know, ESR or ANA antibodies are going up, you can see this kind of soup of inflammation, this kind of swamp of inflammation that’s happening for her. And we need to quieten down that tendency just for her own health before we kind of pursue fertility.

Andrew: Okay. So, again, I’m doing this. I’m so sorry to do this to you, because we’re talking about this many conditions and we’re trying to get you to deliver this in 40-odd minutes. And I get it’s a rush. So, please forgive me. And everybody listening or watching, this is just a whet your appetite. Please don’t think this is a therapy. Please do your due diligence and learn more from Amanda and people like her. So, the question is some case histories, where have you found these nutrients just shine and make a real difference to people’s lives? The linchpin, if you like.

Amanda: Yes. So, I mean, obviously, we practice polypharmacy and we practice kind of personalized medicine, so I always like to kind of preface it with that. But, you know, one couple that kind of came to mind when I was kind of thinking about this this morning, and they were just front of mind because they’ve just sent me photos of their baby. And again, just a real indicator that a lot of us who work in this space really kind of struggle to recruit the blokes in. We can really kind of struggle to recruit the blokes. And that can also be because a lot of the conversation with their specialists is like, “Oh, it’s an equality issue. It’s an equality issue,” especially if they’re having IVF failure. And it is never 100% one member of the couple unless their only reason is some sort of obstructive, you know, like a blocked tube or that man is totally not producing sperm or something.

And obviously, there can be, you know, quite a difference in the share causative, you know, mechanisms going on amongst both members of the couple. And they just kind of had… I mean, this is just a very typical example of a couple that I see where, you know, they turned up and they’ve had, like, five miscarriages, including miscarriages of two perfect chromosomal embryos. And they were that couple that turns up who are just so gun-shy and so flattened by their fertility journey that their major stress is their fertility without any kind of question. And their case was incredibly multifactorial, but they also turned up going, “We cannot go through another miscarriage and we cannot go through IVF again. And this is it. And we’re throwing all our eggs in this basket.”

And they had a bit of everything. I mean, they were both homozygous for the MTHFR gene. He had extremely elevated DNA fragmentation at, like, 52%. She had all sorts of autoimmune markers, positive ANA antibodies, and she had a luteal defect. So, we knew that there was something going on with progesterone. She had very elevated prolactin because of a polycystic history. And also stress. Prolactin is one of the red flags for me and something I always investigate because we’re living in times where people are under a lot of stress, and fertility is stressful.

But equally, this couple were also just so great because they were like, “We are not going near each other until you give us the green light, Amanda.” And I was really like, “I don’t know when we’re gonna be ready for this,” because their mental health was a primary concern. We recruited in my psychologist. They were doing acupuncture. And our clinic was very much their place of care.

But, yeah. And she was like… Everything was going in decline. Her AMH was in decline and her progesterone was very lackluster. But the great thing about working with couples like this, they’re so motivated and they’ve been everywhere, done everything. It was very their last port of call. So, you know, I put them on these kind of compounded formulas that we use in the clinic. We were being very heavy-handed with their methylating nutrients. I had him on semi because his DNA frag and a few of his methylation markers were absolutely less than ideal. And his sperm DNA was really terrible. And then all the antioxidants. There was ubiquinol. He had high doses. I had him on 600 milligrams of ubiquinol, but also, you know, the zinc.

And lipoic acid, that is also one… Lipoic acid is often really forgotten, but especially with these couples where, you know, the cost can be a real kind of barrier to their treatment plan. We’ve got to remember humble old lipoic acid is such a fantastic antioxidant recycler, Andrew, you know, both fat and, you know, water-soluble antioxidants. So, if we’re really having to pare back their treatment plan, I’ll often kind of use lipoic acid with them. And also they’ve had some history of some toxic exposure due to mould and paint in their house and they did a huge renovation, etc., etc. So, we had them on kind of lipoic acid too. And there’s great evidence for lipoic acid and polycystic ovarian syndrome, which she definitely was on that spectrum, even though she was ovulating. But, you know, as I said, I just got the photos of their beautiful daughter, you know, just last week. So, it was just a very, very happy outcome. But…

Andrew: Yeah.

Amanda: Yeah.

Andrew: You live for those stories, don’t you?

Amanda: Absolutely.

Andrew: That’s the kick.

Amanda: Yeah. But those kind of stories, they’re the longest pregnancies in the world for me. Every time I see them, I’m like, “You’re only six weeks pregnant. We’re only eight weeks pregnant.” They feel like they have elephant pregnancies for me because we’re hanging on the edge kind of constantly, especially when they’ve had such history.

Andrew: Yeah. And constant, like, chronic hypervigilance, you know, hyperstress because of this concern. Amanda, like, I wish we had another hour, and even then we’d be just scratching the tip of the iceberg. But would you join us back on another podcast if we wanted to delve down another couple of rabbit holes on another couple of topics? Would you mind?

Amanda: Yeah, absolutely. Love to. Absolutely.

Andrew: I’ve loved chatting with you. It’s been great. And I’ve learned so much in a very short period of time. Thank you.

Amanda: Thank you, Andrew. Thank you for listening. I know I can… I mean, like, it’s what I do. It’s what I do day and night. And I feel forever blessed that still, I’m able to do what I love. Absolutely.

Andrew: Can I just ask you one last quick question? Where can we find out more? Do you offer practitioners mentorships? Do you do ebooks? Anything like that? Like, for instance, you know, Leah Hechtman?

Amanda: Yes. So, I definitely do a lot of mentoring with practitioners or, you know, definitely, if they’ve got kind of difficult cases, they seek me out and book in to see me. So, I do that, absolutely, very happily. I’m like everybody else, got an ebook, you know, about 90% kind of complete, but what actually happens, Andrew, then there’s further evidence that comes through and you feel like you have to start again. I’m really fascinated by this, you know, new diagnosis of MOSI with, you know, male fertility. I think it’s gonna be a really kind of exciting area and a very kind of inclusive area for the kind of work that we do. Absolutely. So, yes, I do have an ebook.

Andrew: Particularly with males, I think you’re finding it hard to rope them in. You want a quick test.

Amanda: Yeah. Yeah, absolutely. And then they’ve got the evidence of, you know, their total antioxidant capacity and what nutrients can make a difference. And you’ve got really that evidence. And it also helps recruit them in just to tell them, you know, “Hey, dude, you are actually part of this picture and we’re gonna get to the outcome, you know, that you want.” And, you know, as we always say to our patients, it’s not just about pregnancy, it’s about a healthy child, Andrew. So, if we’ve got all that starting material, the sperm at its most optimal health and the egg at its most optimal health, we’re gonna have, you know, obviously, the best possible outcomes for that child, you know, and the generations beyond.

Andrew: Wise words from a wise and expert woman. Thank you so much for joining us today, Amanda Haberecht, on “Wellness by Designs.” And thank you, everyone, for joining us today. Remember, you can catch up on the show notes for this, and there will be many for these show notes and the show notes, and the other podcasts on the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”