Infertility and Endometriosis | Is Surgery The Answer? | Dr. Naomi Whittaker, MD (Episode 582)

Episode 582

Lisa Hendrickson-Jack: If you’ve ever felt frustrated by the limitations of conventional medicine, especially when it comes to women’s health, I think you’ll find today’s episode both informative and extremely eye-opening. In today’s episode, I’m sharing my interview with Dr. Naomi Whitaker. She is an OB/GYN fertility surgeon. She’s fellowship trained in NAPRO technology and the Creighton Model FertilityCare System and she specializes in restorative reproductive surgery. Not only does she share about some of the challenges to receiving a diagnosis and finding an experienced surgeon, she also sheds some light on why many American women struggle to get their surgeries covered by insurance, obviously making it a huge barrier for many women to get the treatment that they need, especially when their condition or symptoms are quite extreme.

And before we jump in, I’m just going to share a little bit more about Dr. Whitaker. Dr. Naomi Whitaker is the founder of RRMAcademy.org. And as I mentioned, she’s a board-certified OBGYN fertility surgeon specializing in women’s restorative reproductive medicine. She is fellowship trained in the Creighton Model FertilityCare System and NaProTechnology, offering compassionate care that treats underlying causes of gynecologic issues like endometriosis and PCOS. So without further ado, let’s go ahead and jump into today’s episode.

And I’m excited to be here today with Dr. Naomi Whitaker. Thank you for being on the show.

Dr. Naomi Whitaker: Truly an honor and a privilege. So thanks so much for having me.

Lisa Hendrickson-Jack: Well, thank you so much for being here. I feel like we should have met by now. So this is the first —

Dr. Naomi Whitaker: It just feels overdue.

Lisa Hendrickson-Jack: Totally overdue. I reached out to you because I was like, it’s about time that we have a conversation. So really, really glad to have you. And of course, I talk a lot, especially in my offline life in my practitioner program with my clients. I talk a lot about NaProTechnology. We’ve had a variety of NaProTechnology practitioners in the background who’ve done presentations for us and training sessions. And I always say that NaProTechnology is kind of like the perfect version of allopathic medicine because it really does use the menstrual cycle as a vital sign. So I’d love to start by hearing a little bit about your story. So what drew you into medicine in general and then what drew you further into this other area of reproductive health, particularly NAPRO?

Dr. Naomi Whitaker: Sure. As a child, I always was drawn to healing and I wanted to do something big and I wanted to change lives. I wanted to save lives. I’ve always just been someone drawn to that, to healing. And so this started when I was really young and my parents are immigrants. They’re actually refugees. And so they always taught me to dream big dreams and I really took that to heart. And my family doctor did help us as a family emotionally and physically with our health. And that was my exposure to medicine just as a patient. And to me there was just so much opportunity to heal mind, body and soul. And that was my introduction. And so family medicine was what I thought I was going to do. And in a sense I am, but in a very different way in that I’m really focusing on the health of a woman and her fertility as a precursor to the family and as a strong foundation for a healthy family. And yeah, I accidentally stumbled upon all of this. I definitely not interested in women’s health at first. I actually said OB/GYN was the one field of medicine I didn’t want to do because I thought it would be boring. I thought it would be pap smears and STDs and I just that didn’t sound very intellectually stimulating whatsoever. And so it was my experience as both a patient going through my own women’s health trying to figure out family planning and what I was comfortable with there and trying out different things and really exploring things on my own personal journey where I stumbled upon this cycle charting thing that totally blew my mind. And I didn’t learn this until a lunch session in medical school. It wasn’t a formal class. It was just an optional session with free lunch. And I thought, okay, well, I’m going to show up. I couldn’t believe that I didn’t know any of this. I wasn’t ever taught about the physiology, the basics of the menstrual cycle and how this opened up a whole new window into women’s health and treatment options and restoring health. And that drew me in. And after that, I couldn’t look away. I kept trying to because I didn’t want the 24-hour shifts and being up all night delivering babies really. That was not something I was wanting to fully embrace that work life balance fear. But I couldn’t look away. I did my rotation with a restorative approach alongside just the standard model. And I kept trying to do something else and be drawn to something else. And I kept thinking, but here I could make such a difference. I could offer something more. Yes, women can choose the standard model if they’re happy, but women were flying in from all over the world from like Poland where my parents immigrated from to Omaha, Nebraska of all places to get these really intricate surgeries that exposed all these answers to all these problems that these women were experiencing for decades, and it restored their fertility and their health. And clearly it spoke for itself if people were coming.

Lisa Hendrickson-Jack: That is amazing. I was fully laughing when you were like, well, I came for the free lunch and look what happened from the free lunch. There’s a couple things I want to ask. I always make a point of asking some of these questions whenever I get the pleasure and opportunity to interview a doctor. But you did share that somewhere in the midst of your training, you had this session that wasn’t even part of your official training and that’s where you learned all of this information about the menstrual cycle. Could you share with us just so that everyone understands what is kind of the standard level of information that is part of medical school so that people can understand, because I think one of the hardest things for someone like myself and for our practitioners who start working with women who want those answers is how to explain why they can’t always get them from their regular doctors.

Dr. Naomi Whitaker: Honestly, I don’t think there is a standard physiology curriculum of women’s health. What I was taught, what I remember — I don’t know what other medical schools teach around the country, I can’t speak for that. What I can tell you is what’s typically on the tests and you study for the test. So the test studies when you take a test, if the answer is IUD, you choose IUD. That’s kind of where you study. You study for the test. So what I remember in my introduction to women’s health 101 in medical school was ovulation is a risk factor for cancer and that was my introduction. That’s honestly what I remember. I don’t know if they said that verbatim but it was absolutely implied and so that suggested that birth control was the default better state than physiology. That was the underlying tone that I do feel like persisted throughout my medical school and OB/GYN residency training. So I think because we see ovulation as a dysfunction, it doesn’t make sense that for some reason this event that only happens to women that you would think is typically healthy is determined to be unhealthy. It just doesn’t make any sense. It didn’t make sense to me. And it made me question a lot of everything that I learned after that. And so to me, we don’t really have to understand it if our options are mainly suppressive. And as I’ve dove deeper over the years in this space and listened to podcasts like yours and read naturopathic literature and books, really understanding the naturopathic approach and integrating that into the gifts of regular good quality medicine and healthcare and the allopathic model — if we could combine those together, we could really advance women’s health.

Lisa Hendrickson-Jack: Absolutely. Even before we started recording and we were talking a little bit, I shared that NaProTechnology, it’s really such an interesting field. I only know about it because of my background in menstrual cycle health and fertility awareness. I wouldn’t have necessarily known about it otherwise, but it kind of is that perfect mix of allopathic medicine and actually understanding a woman’s cycle. So do you want to share a little bit then how did you wind up getting the surgical fellowship with NaProTechnology? Share a little bit about how that all came about.

Dr. Naomi Whitaker: Well, I really was intrigued by the options that this gave women and the healing and the window into the body through the menstrual cycle. And because I saw this corrective type of care and I saw the outcomes and I saw how there are very few people that approach women’s health in this way, I felt a duty to serve in this way. How could I treat asthma and pneumonia the same way everyone else does when I could have these women that clearly desperately want this type of care? How could I do anything else? I felt like I had no choice. Plus, I was obsessed with it. I loved reading everything about fertility and obstetrics and it was so fascinating. And to have two patients in one. And now I’ve really come to a deeper appreciation of how this is just so impactful for generations. You invest in one woman and you invest in a healthy pregnancy and healthy offspring and that will affect epigenetics in many generations. And so it’s just opened this beautiful doorway to just transforming human beings as a whole through a single woman.

Lisa Hendrickson-Jack: That is amazing and very inspiring. And so for anyone who doesn’t know about NaProTechnology, maybe share a little bit about what that is so that people understand what it is and what that’s all about and also introduce us to the idea of restorative medicine and surgery and how that is different from the standard of care for women.

Dr. Naomi Whitaker: Yeah. So what restorative reproductive medicine is — it’s just good medicine. It’s just good quality medicine to restore physiology. For example, ovulation. We’re going to support ovulation and not suppress it. Ovulation is actually extremely healthy, a sign of health, and it’s the critical event of the menstrual cycle that promotes health. So we really want to embrace ovulation and we want to support it where it needs help. So there are different flavors of approaches that would fall under restorative medicine. Basically anything that isn’t going to suppress or override the hormones that the body so beautifully should be releasing and promoting health with. And so there are different flavors. NaProTechnology is one and that stands for natural procreative technology. And this subsection of restorative medicine really focuses on the surgical approach. And there’s also benefits through menstrual cycle tracking. So that’s the foundation. So that’s called the Creighton Model System. And the beauty of the Creighton Model System is that it objectively quantifies the biomarkers that a woman is observing. And so she’s educated on the menstrual cycle more than I was in medical school about the physiology, about what she can observe herself. And she has this wonderful knowledge that she observes and tracks, because women are the experts of their body. And so we trust this woman and we entrust her with the knowledge to understand her own body, which she deserves. And we use this data to run specific tests for hormones. And then hopefully we can use that to optimize her hormones. And if we still see biomarkers that are off, then perhaps there’s something even more going on such as endometriosis or other women’s health diseases or reproductive issues that we need to address surgically potentially. And so it’s a window into the body. For example, we can see signs of inflammation and evidence of PCOS as soon as a woman walks in the door if she’s charting her cycles. Within minutes, I know pretty much what’s going on. Obviously, I have to confirm that and speak with her and run tests, but I have a good idea of how to counsel her and what her care is going to look like.

Lisa Hendrickson-Jack: It’s just you really put into words this — it’s like I’ve been beating the dead horse for the past however many years that the menstrual cycle is a vital sign and you can use it to gather information. And I am not an MD. I am not diagnosing anybody. But what I can see can help this woman to then advocate for herself with her healthcare professional, because what I hear in my world is women going from doctor to doctor to doctor with the same menstrual problems being told that it’s just normal and sent home. And so it’s like someone like me who can read that menstrual cycle, who’s been studying it for years — again, I’m not diagnosing anything, but I’m telling her, okay, ask these questions, look at these things, this is what this is. It’s just so interesting how you said it because you’re saying when she comes in with her chart, you can look within minutes and then the tests just confirm your suspicions as opposed to just throwing around a barrage of tests without really knowing what’s going on.

So maybe share with us a little bit about one of the things that fascinates me about just the concept of NaProTechnology — one of them is how few people have ever heard of it. That’s one thing that really fascinates me. But another aspect of it is the really high pregnancy rate that is boasted, rivaling IVF. So why don’t you talk about that because not only are people not aware of this, but they don’t even know that there’s an alternative to the traditional IVF.

Dr. Naomi Whitaker: Yeah, there’s so many layers to unpack. I want to go back to what you’re talking about, the vital signs. So if this is true, which I totally agree — no one can deny the menstrual cycle is a vital sign. This is fact. Do doctors understand that? They don’t. I mean, we have to know, and neither do researchers. So we have systematic ignorance of this vital basic vital sign. And so most of women’s health research, most of medical treatment options are so limited because they don’t truly work with the physiology. They’re overriding it because that’s what they know, unfortunately. The key event of this menstrual cycle is ovulation and you have to be able to identify that. And you can’t do that with any just calculator or the calendar method — we know that that’s not accurate. So it’s this elusive ovulation. So we really, if we have a way to identify that on a reproducible scale and make it scientific, which is what we have with the Creighton Model System, then we can restructure research. Research is poorly designed all over women’s health, actually, if it’s even existing at all. And when it does, I just assume it’s poorly designed. And typically when I read the study, my suspicions are confirmed.

And so the question was, why do people not know about it? Yeah. I mean, gosh, that’s a good question. There’s not a lot of money behind it. There’s not big pharma behind it, unfortunately. We use bioidentical hormones, right? So that’s the body’s hormones. You can’t really patent that very well. And there’s a lot of competition when you can go to a compounding pharmacy anywhere in the country. So you can’t really slap an expensive patent on it. That’s how you get something in women’s health. That’s how you get something advertised and funded for the FDA. That’s how you get a new gadget or medication. And so what we see in the current model that’s designed in this way is repatenting of the same thing over and over in women’s health. So if you see a new advertisement for a new medication for women, it’s typically either a new form of birth control combined oral contraceptive with a little different chemical structure or a new version of Lupron which is suppressing the woman’s cycle completely in a menopausal state. And so they’re easily able to rebrand these. And how would women know any better that this is not new? This is the same thing with a more pretty label, millions and millions of dollars behind it. So this is just good quality medicine that doesn’t have a marketing agency. And on top of that, our healthcare system is designed for that FDA model for medications that have millions of dollars to get approved and for a healthcare model that gives a pill quickly and gets people through the door quickly. And so both of those are driven by health insurance companies and pharmaceutical companies. So unfortunately, they have the power and they don’t have any incentive with what I do. And so most women’s health surgeries reimburse very poorly. And there’s a whole history behind that. And that has to deal with how the RVU system for credits were allotted originally in the design of the current medical model. That needs to be revisited. There’s a lot of systematic flaws that hurt women built into the system right now. And so that incentivizes cash pay options, organ removal procedures, and suppressive medications. So essentially, there’s no one really rooting for the underdog, which is ovulation.

Lisa Hendrickson-Jack: The way that you explain that is just really enlightening because of course what you said makes a lot of sense. There’s not a lot of money. You did say something that I’d love for you to elaborate a little bit on — women’s health surgeries reimburse poorly. I would love for you to explain what that means in terms of how surgeons make money from surgery so we can understand why certain surgeries for women might not be part of what they care about doing.

Dr. Naomi Whitaker: Yeah. So unfortunately you don’t get reimbursed for the outcome of your surgery, the quality of your surgery, the patient’s happiness. You get reimbursed for the more things that you do and how much that’s weighted. Technically, you want to get people in and out of the OR and turn and do as many cases a day as possible. And the quickest way to get money that way would be organ removal. So a uterus, tube, ovary. And so this has kind of perpetuated myths for things like endometriosis which are very challenging to treat surgically — which endometriosis by definition is tissue outside of the uterus that acts like the lining of the uterus. It grows and spreads and acts like cancer, needs to be treated surgically like cancer, but it’s not reimbursed that way. So if you actually treat it appropriately you technically will not be able to keep your doors open unless you charge cash. So surgeons who are thorough and cut the disease all the way are penalized in the current system for giving good care, even though the patients have better outcomes — better fertility rates, better pain, improved quality of life, improved fatigue. I mean, completely transforming their ability to function. Oftentimes, I saw one today. She said she had a horrible time one week out of the cycle. She was completely bedridden. She just had surgery and her whole life already is improved. She’s doing so much more. And so unfortunately, surgeons who do good quality excision — first of all, it’s hard to get that training. It does take extra training. They tend to have to go to a cash pay model because for example, Medicaid reimburses very poorly. My hospital sent a charge to Medicaid for $40,000 for surgery I did. There’s a whole explanation as to why that’s a very inflated number, but they keep inflating their number in hopes they can get any money back. Medicaid decided to pay them back $200 for a surgery. And the laser alone that I use is $1,100. So I’m not sure how this is ever sustainable right now in the current model without major change, except if we have a cash pay system, which I don’t think is fair for women. I don’t think it’s acceptable that many women are going to be left without proper care if we have a cash pay model.

Lisa Hendrickson-Jack: So it sounds like what you’re saying is that if someone is needing surgery, for other surgeries that are dealt with differently — if they do have insurance coverage, they are likely to actually receive a reimbursement or compensation that is at least somewhat near what the actual surgery costs. Because you mentioned cancer — it’s different.

Dr. Naomi Whitaker: Correct. So gynecologic oncology surgery does reimburse better, and according to the stage for example. But you can’t upcharge for level of complexity for endometriosis, even though it can be an extremely complicated multidisciplinary disease.

Lisa Hendrickson-Jack: So if you have a cancer surgery based on the stages that’s very complex, there would be a fee for that level of complexity of surgery because it would be acknowledged that this type of cancer is actually difficult. But as you said, and in the research, endometriosis acts like cancer — it creates its own blood vessel, it just establishes itself. Even though it’s basically acting as cancer and the surgeries would be similar to a complex cancer surgery, they do not recognize that. They would incentivize removing a uterus for that disease even though that’s not the proper treatment.

Dr. Naomi Whitaker: Correct. And really, just doing what they have to do to survive and how they were trained and doing the best they can to save lives — that’s what they’re there for. They’re there to save lives. If you’re hemorrhaging, remove your uterus. If you have a baby in distress, do an emergency C-section. And they’re amazing people that want to do that. And perhaps they were taught the myths about endometriosis, which is systemic in medical training. So they don’t have time to go and read the latest studies and really talk to people like endo advocates and try to figure out what’s right and what’s wrong. They have to go with what they’re doing because they’re working so much, really dealing with major crises, stillbirths, and things like that. So we do need to give them grace and support them and kindly educate them about the menstrual cycle, about what restorative medicine looks like. And I do think that the change will happen from the women that understand it, because they’re living it. And there’s nothing more powerful and impactful than a person who is living with a very debilitating disease that understands their body, that has done all the research and tells their story.

Lisa Hendrickson-Jack: Yes, I agree. And one of the key kind of themes — you touched on it when you said that the doctor’s role is to save lives. Endometriosis is not a quote life-threatening illness. It’s a chronic debilitating illness, but it’s not cancer and death if it just is left unchecked. Whereas endo just destroys your life, but it doesn’t actually take it.

Dr. Naomi Whitaker: Correct. And exactly. The model is designed for life-saving procedures, not quality of life, unfortunately, right now. I would love to see that change.

Lisa Hendrickson-Jack: And this is one of the reasons why I think when I’m working with a client and they proudly announce that they haven’t seen a doctor in 10 years, I’m like, wait a minute. Because no one goes into med school because they want to hurt people. If you think about it, people generally are going into this profession to help. And so even for yourself, how did you feel when you discovered that even though you went to med school, there was this whole other side that wasn’t included that you had to opt to do on your own independently?

Dr. Naomi Whitaker: Every day is a battle. Every day is a battle to explain this to employers, to patients that haven’t been exposed to this understanding and break through all the misconceptions that are out there. And so I’ve been a fighter since — I guess I was born one because my parents were refugees in the womb. They were fleeing communism. So I guess ever since the womb, that’s kind of what my life is here for, to fight for good quality, for truth and what’s good quality healthcare. So yeah, I would just say that’s just been kind of my everyday now — not accepting the status quo is okay. And the more I find out, the more yes I am shocked, but the more motivated I am, especially as I have women come to me in my practice, but also in my inbox on social media and telling me, wow, this information changed my life. And it’s sometimes so simple. Or you validated me and you listened to me. Those kinds of things are what keep me going. I don’t ever expect to win any awards or make a lot of money this way, but that’s not why I’m here. And so yeah, I hope though that this kind of medicine can be more accessible.

Lisa Hendrickson-Jack: Well, so going back to endometriosis, you did mention that there’s certain myths that are really prevalent in the field held by medical professionals. Did you want to talk about what some of those myths are?

Dr. Naomi Whitaker: So many. It’s a disease of the uterus, so you should remove the uterus. Clearly that’s not — hysterectomy doesn’t cure endometriosis because it’s tissue by definition outside of the uterus. Oh my gosh, so many. Where do we begin. That stage correlates to disease severity. Oh, a big one is infertility is a symptom of endometriosis that’s not recognized for some reason. Every other symptom — well, pain matters only if you can’t get out of bed. But for some reason your three, four, five years of emotional trauma and pain doesn’t matter in seeking that diagnosis of endometriosis. And what I did is I’m trying to bring more access and awareness to the public. So one thing I did was I developed a three-tier endometriosis symptom self-survey so that women can see the symptoms for themselves on paper that I see often associated when I go in with a camera at the time of surgery and see endometriosis. And that’s another myth — endometriosis unfortunately is a surgical disease. That’s the only way to definitively diagnose and treat this disease. So to me, an endometriosis suspicion score that I made with my survey is my brain on paper when someone walks in with their symptoms. It includes cycle charting symptoms on there, actually. But really listening to the woman — she knows something’s wrong. There’s a reason she’s coming to the doctor. There’s a reason she’s interested in a significant surgery, a significant intervention.

Lisa Hendrickson-Jack: Yeah, so many important ones. I don’t remember who I was speaking to recently, but I was mentioning it can be anywhere — it can be in the lungs. I interviewed a woman who had endometriosis on her lungs and her symptoms were breathing issues in her luteal phase consistently.

Dr. Naomi Whitaker: I had one coughing up blood during her period. It was there. Yeah. And you mentioned infertility and so infertility in and of itself that’s quote-unquote unexplained should certainly warrant investigation because I know when I was researching for Real Food for Fertility and I was looking at some studies there was a really high correlation with infertility and endometriosis that was asymptomatic in the sense that they weren’t necessarily having pain, which I would fully put in there that that’s a myth — that if you don’t have pain that it couldn’t be endo. Because it’s insane that women could have stage four endo with no pain just based on where it’s located.

And yeah, I would question that narrative, right? That’s a narrative we’ve all been told — it’s asymptomatic endo. No, what it is is our medical model has not identified all those symptoms of endometriosis. So that’s what my survey is supposed to do. It’s supposed to help break that barrier of asymptomatic, because if infertility is a symptom, then clearly that’s not asymptomatic for example. But typically they have some other things going on like tail-end brown bleeding, low cervical mucus, short luteal phases, luteinized unruptured follicle syndrome, which is an ovulation disorder. We see these types of things with endometriosis, also family history of endometriosis, fatigue, nickel sensitivities. There’s a lot of things that are there. We just don’t know to look for them. We haven’t put these dots together because again our foundational knowledge of women’s bodies and women’s specific disorders is very limited, very narrow-minded. We need to restructure our knowledge from the foundation up, which starts with the menstrual cycle.

Lisa Hendrickson-Jack: I’m so glad that you went into that because it’s just so powerful to hear that. At the end of the day, as women, do we even notice our own symptoms after so many years of being dismissed?

Dr. Naomi Whitaker: Exactly. So I mean, there’s a lot of things. So it’s an invisible disease. So then we do gaslight ourselves too — what I’ve noticed. I’ve learned so much doing the survey and how I brought my biases into it. So one thing I’ve noticed is women underplay their own symptoms because they have to get through the day and they’re doing the best they can. Like I’m going to get through it and then they forget because that day was yesterday and now they’re on to something new. So women sometimes we do this to ourselves where we undermine our own symptoms — well I’m just weak, I just need to push through it. And so some of it we do. That’s one thing I’ve noticed with the survey is that we downplay it ourselves and then the system does the same. And so that reinforces just this whole model of, well, it must not be that bad, so maybe I shouldn’t get treatment. And then they show up for surgery and they’re like, should I really be doing this? That’s one of the most common questions right before we’re about to do surgery. I hope you find something. Am I crazy for doing this? And that’s a very common thing to say before endometriosis surgery.

Lisa Hendrickson-Jack: Yeah, it does not surprise me. I know that over the years I’ve certainly had to expand my questionnaire to ask very specific questions because I think there’s just so much there. So many women experience pain with menstruation. We’re told that it’s normal. And I was speaking with a past client a few weeks ago and she told me that I was the first person that ever told her that her periods shouldn’t be ridiculously painful. She was not 20. She was a grown woman.

Dr. Naomi Whitaker: Yeah, it’s incredible. It reminds me of something you said earlier — you’re doing lots of education on the socials and all of the work that you’re doing and I do education and sometimes you think that it’s going to be this profound study that you share that’s going to make this big difference, but often it’s those basic things like giving a woman permission to acknowledge her pain that she’s experiencing or her discomfort or recognizing that it could be cyclical, where this weird thing that she’s experiencing happens five days before her period every time and no one ever picked up on that.

And going back to the medical model and what we’re taught — we’re taught what’s abnormal. We’re in medical school, what do we — we don’t, in general, we do a bad job in medical school curriculum of what’s normal. I don’t remember being taught how often patients should be having bowel movements, what a beautiful menstrual cycle, what the ideal menstrual cycle looks like, what is an ideal thyroid. We don’t teach what’s optimal or decent. And the studies for thyroid were very messed up as well. So as far as science, we did a very bad job. We really need to understand what’s normal before we can treat what’s abnormal. And somehow we miss that in our curriculum.

Lisa Hendrickson-Jack: Well, and given that it’s not in the curriculum, it’s also not in even the minds of regular women who are trying to live their lives. So it’s interesting because going through the normal parameters — I’ve had flack. I’ve had people come at me when I say things like, oh, periods shouldn’t be painful. Because again, we’re not only not normalizing it, we’re clinging to it. Don’t tell me that it’s not normal to have pain. Right? Because I had this conversation on a podcast interview sometime recently and I was sharing that the average age of menstruation is about 13 years old and when a woman is 16 and she hasn’t had her period yet we should be looking at it. I got someone came at me for that. Some families just have later menstruation. And I was like, well I’m not saying that just because someone’s 16 and they haven’t had it that they’re automatically having a problem. We should screen it, shouldn’t we? Yeah. And then she kind of backed off. But this is what I’m saying. We don’t even know what’s normal and we cling to this nonsense. And women are suffering.

Dr. Naomi Whitaker: Yeah. And we see that. If your mother had painful periods, she’s going to tell you that’s normal and you’re going to cling to that. Like you said, you’ve been living with it that long. How could you have been wrong that whole time? So we have a lot of work to do and awareness for sure. And we have extra obstacles with that because it’s a very deeply personal issue that affects us on such a cultural level, political level. And so unfortunately, that makes women’s health messier. It’s a lot easier to discuss how to manage a heart attack than how to manage endometriosis because you add endometriosis, then you add the fertility aspect, pain — and you know, it’s not life and death, it’s quality. And so that’s you know, how much is this woman worth technically and her ability to function. So these are cultural phenomena that we’re opening up in women’s health. So it’s a very messy space to be in and there’s a lot of emotions, there’s a lot of pain, there’s a lot of trauma too.

Lisa Hendrickson-Jack: Well, in shifting again — the endometriosis conversation is of course linked to fertility, but shifting back to those high fertility rates of women who seek alternative care through NaProTechnology, restorative medicine, alternatives where they’re having whether it’s a surgical procedure or other types of interventions outside of IVF. Talk a little bit about that because I don’t think people know about that. I know that when I share this information with clients they’ve never heard of it. I’ll encourage them to look into if there’s a NaProTechnology doctor close to them that could provide them with more detail to understand what’s going on in their cycle. I try to explain why it might be harder to get a series of ultrasounds at the correct time with a doctor who hasn’t been trained that way to see if ovulation is happening normally, things like that. So I’d love for you to share a little bit about just this alternative world for women who’ve never heard of it.

Dr. Naomi Whitaker: Yeah. So I would say the success rates are very difficult to study, but I would say that the IVF success rates are not that great. Okay. And that’s for women who are lumped in this diagnosis of unexplained infertility. And now we’re adding more and more women to that pool that likely don’t need it. Really young women who were not given a workup. Very easy to get pregnant. So IVF statistics should be very robust as far as success. But if you look at the Cochrane database, there is no strong evidence that IVF is better than expectant management for unexplained infertility. Dive deep into different treatments such as IUI. If you compare IUI to expectant management without properly educating even on timed intercourse, there is no benefit to doing nothing versus IUI. Expectant management is basically not doing a medical intervention — doing nothing and not even teaching them about timed intercourse. They know nothing. Just random intercourse versus IUI, there is no benefit to IUI, which is a very expensive way to time something similar to active intercourse. So the question is how do we frame these studies? They haven’t been done proper in my opinion. What you can do is you can look at literature reviews at specific medical conditions and compare that medical condition of doing nothing versus this medical treatment option versus IVF. So one such example would be tubal reversal has been shown in women without infertility that had a tubal ligation to be superior to IVF. So to me that shows it’s not better than nature. So we do need to acknowledge that because I have had IVF doctors come at me and say, well, I could argue that egg retrieval is safer than ovulation. They just said that. Okay. So that is the literal argument. Are human interventions better, like the pill or egg retrieval? Are those better than nature? I mean, I think we’re walking dangerous ground if we’re saying it’s better. Okay. So let’s just say infertility is a culmination of multiple health issues stacked on each other. It’s rarely just one. But just if we could just look at one single condition such as something called proximal tubal occlusion — so the tube is blocked where it inserts into the uterus. I use something called selective hysterosalpingogram. So it’s like a regular HSG or tube test with dye and I have a pressure gauge to see if there’s a partial occlusion. I can open up the tubes. This has a very high success rate for pregnancy. Just that alone without addressing all the other health issues, optimizing male side or endometriosis, just that alone we see a 30% success rate within 3 months. And this is a very, very easy short procedure that all OBGYNs should be doing and has a 30% success rate versus IUI which is 0 to 10%. And I compare this to my IUI. I’m like, well, this is my less involved intervention. That’s how common IUI and IVF are — well, infertility equals IUI IVF. Well let me reframe that. My version of IUI is let me open your tubes. Let me make sure your tubes are wide open. And that’s going to give you 30% versus 0 to 10% IUI success.

So you have to really — the analysis is very complicated because no two cases of infertility are the same. So it’s very hard to study. Think about all the things — not only does a woman technically have often about five things wrong, you add the man, he’s going to have a few things wrong. And then you have the mechanical and the hormonal component for both the man and the woman. So that’s a lot of moving parts that are going to be very hard to put in a randomized controlled trial. But if you piece each specific medical condition together and you give good medicine to it, it just makes sense. You’re going to have a better outcome. It may take a little more time up front in some cases depending on the issue, but long term — we’re not looking at a 3-month view. We’re talking 6 to 12 months really after you correct something. If you’re really looking at the big picture, overall pregnancy rates — I would be confident if the studies were done appropriately, which again we have a whole bunch but they’re just kind of scattered all over. And we list them at rrmacademy.org/library — 2,500 plus articles that you could reference for your specific condition. I would argue that if it was done appropriately, and we need better research to show this, there would be great success. And we do see some IVF doctors identifying this and they do sometimes treat specific conditions in certain cases such as endometriosis prior to IVF. So they see improved IVF rates from that. There is a widespread acknowledgement that these issues such as PCOS and endometriosis lead to infertility. The question is how do we want to go about this. And success rate is only part of the picture. That’s not actually the most important technically, by the way, because it’s going to be hard to prove that. And for each case, you’re not going to be able to predict success. But what you can control in such a difficult situation is the impact and the outcome on their finances and on their health, with the goal of a baby. Obviously, that’s — we’re never saying we wouldn’t support someone in that. It’s saying let’s restore health. Let’s treat your disease appropriately. This is a true medical condition and let’s support you emotionally. What helps them financially, emotionally, and physically to that outcome and then sets them up for a healthier pregnancy really is treating the underlying medical issues head on. And if someone says, well, I have this diagnosis and I choose to do X, Y, or Z, I mean, that’s fine. But we really should be giving more power to the patient with that knowledge to truly make an informed consent. And I think we know that that’s missing in women’s health, period. But it’s missing even more in infertility. And that’s why we see this elusive diagnosis of unexplained infertility.

Lisa Hendrickson-Jack: Well, you tied it together by talking about the financial impact, the emotional impact. And often the restorative medicine approach — it depends, if it’s cash pay maybe not, but often it does result in a lower fee obviously than the IVF, which is astronomical and not necessarily sustainable for a lot of women. But then again, we are not necessarily addressing whatever the health issue is. And I think people really overestimate the IVF success rates. So it’s really good that you point out they’re not as high as people think and they certainly don’t address male factor. That is how they address male factor.

Dr. Naomi Whitaker: Oh my gosh, that’s a sore spot. When we make women go through this huge process for a male issue and that’s hurting everyone, that’s hurting the man — it can impact his health. If we’re ignoring his report card of health, which is the seminal fluid analysis, is just like a cycle chart for women. It’s a window into what’s going on in the body. And those little sperm, they’re very susceptible to oxidative stress. And so they tell us when they’re in distress very quickly. And so it’s an opportunity for improving his health. But how easy is it for a urologist to just say, I wipe my hands clean. I don’t want to deal with this fertility stuff. Just have your partner do IVF. To me, this is very concerning and very upsetting. And that’s a whole other episode. But male fertility is totally — there’s not many people doing that. It’s extremely — just an abandoned field of medicine, trying to figure out male fertility. I mean, there’s a crisis there as well.

Lisa Hendrickson-Jack: Oh yeah, that’s a whole podcast. Well, Naomi, we have covered a lot of ground and obviously we could keep talking for the rest of the day. But I would love to end on a bit of a positive note. I mean, this is a lot of information. This is heavy. I feel like for me, I’m in this world. This information isn’t necessarily new to me, although I definitely learned a lot from you today. But I can just imagine some of the listeners who are now just like, what is wrong with our medical system? So for women listening who are wanting to find a good supportive doctor or practitioner, for women’s health professionals who are listening who want to help their clients advocate for themselves and help them to find the practitioners that can support them, what would you want us to know? Where do we start? What do we do?

Dr. Naomi Whitaker: We start with cycle charting, right? Truly understanding the science behind the menstrual cycle, what is normal, what is going on in you, and what you suspect, and doing all the research you can. And so that’s what I do with my page and what you’re doing is getting information out there and truly trying to find answers for yourself and be your own best advocate. And so working through your cycle charting instructor to find the doctors that are curious. That’s basically what you need. Supportive, curious, and open to working with you and your desires. You definitely can be an advocate for yourself and get this type of care. I’ve helped women online get this type of care within their reach. They don’t have to have a certain label such as NaProTechnology. They could be a naturopath doing this or a midwife. Midwives absolutely love — I would love to teach midwives how to do this. I’ve had people at work trying to learn from me that are midwives. They love this type of medicine. So increase awareness through your advocacy for your own care, sharing your stories, understanding as much as you can about the menstrual cycle, and holding your doctor accountable too for risk-benefit alternatives and offering choices, being a voice on social media, starting a ground-up movement with what we’re calling Uterus Allies. We’re going to get people together and activate them to do things like that, to feel empowered, to try to get resources so that we can be a force from the ground up to help each other feel empowered to advocate for good care.

Lisa Hendrickson-Jack: Love it. Love it. Love it. Well, tell us where we can find you on socials, where your practice is if anybody happens to be fortunate enough to be able to come into your office, and anything exciting that you have on the horizon.

Dr. Naomi Whitaker: Sure. So I’m most active on Instagram. You can find me at naprofertiitysurgeon. I have a website, naomiwhitaker.com. I practice in central Pennsylvania. And gosh, this new Uterus Allies club is going to be just so exciting. There’s so many opportunities that we’re going to have moving forward. That’s my next big project. And I also just really highly recommend the three-tier endometriosis symptom self-survey. And I want to do more things like that that women can identify issues for themselves and really advocate for good care.

Lisa Hendrickson-Jack: Well, we will be sure to link all of those things in the show notes. Thank you so much for being here, Naomi. It was my pleasure and I’m so excited to share this episode.

Dr. Naomi Whitaker: It went by too fast.

Lisa Hendrickson-Jack: Totally. Thank you for listening. If you enjoyed today’s episode and you’re wanting to share it with a friend or you’re wanting to grab any of the links that we talked about, head over to fertilityfriday.com/582. I hope that you enjoyed today’s interview with Dr. Whitaker. As I mentioned, I found our conversation extremely informative and I really appreciated that we touched on some topics that I hadn’t really thought about before. And her explanation of endometriosis surgery, how it’s more similar to an invasive cancer surgery because you’re actually going in and carefully removing all of the diseased tissue in a way that, when you’re doing a restorative medicine approach, is less likely to create opportunity for recurrence. And in that situation, it requires a lot of time and care, as she said. And learning that the insurance providers really prioritize a different type of surgery for non-life-threatening conditions shows just one of the built-in challenges related to this specific issue and really sheds some light on why so many women are directed to hysterectomy — not necessarily because it’s the best possible option for them individually, but because in many cases that’s what the insurance will cover. And that’s really the tip of the iceberg because there were just so many important takeaways from today’s interview. So with that said, I hope you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.