Is It Really Your Eggs? Rethinking Unexplained Infertility with Aimee Raupp (Episode 620)

Full Transcript: Episode 620

Lisa: Amy, welcome back to the show.

Aimee: Lisa, thank you so much for having me. I’m so excited to be here.

Lisa: Yeah, it’s always fun connecting. Today we are connecting to celebrate the newly expanded edition of Yes, You Can Get Pregnant. We had a conversation when your initial book was released, which is kind of crazy to think about because you just said it was the 10-year edition. And it’s actually like 12 years, which is funny.

Aimee: Yes. It’s crazy. You have always been in my corner and being so supportive and I so appreciate you. But I remember our first ever podcast. We’ve come a long way.

Lisa: Well, for anyone who might’ve listened but it might’ve been a little while ago, I’d love for us to just tell us a little bit about where you started, where you’re at now, and what’s been happening. I mean, there’s so much more attention on that field of fertility. I’m sure things have changed, but I’m also sure that not everything has changed from then.

Aimee: I think there’s a lot that’s changed in me since writing Yes, You Can Get Pregnant. I wrote that book in 2013, it came out in 2014. At the time I was in my mid-thirties and I was single. I was childless. I’d been practicing clinically for 10 years and I think I had a solid education and grounding, but now I got to become a mother in my forties. I went through loss. I had a miscarriage at 45, and then I have another 10 years of clinical experience under my belt.

I was so excited to do the revision when it came up because the core, the bones of the book are the same. And that makes me very proud. The things that we’ve been teaching, the things we’ve been talking about — like getting in touch with nature, slowing down, moving your body, listening to the vital signs, listening to the signs that your body’s giving you — that has remained the same.

What has changed is me as a more seasoned practitioner and clinician. I’ve learned more clinically, but then I’ve also now lived the experience and that’s shifted the writing and the approach quite a bit. And now just a decade later, it’s wonderful to see the amount of research. There’s more attention on fertility, sadly, because the fertility challenges just continue to persist and get worse. More and more women and their partners are impacted by it.

We’re seeing sperm play a much bigger role. It’s much more a part of the conversation now than it was 10 years ago. And the amount of research that’s out there now to support things we’ve always talked about — now we actually have terms like nervous system and circadian rhythm, which we were talking about, but they were not these catchphrases that everybody knows about. We were just talking about getting back in touch with nature and slowing down and being in tune with your body. There’s a lot more support for the same basic tenets of what we would say to do to optimize overall health and fertility and vitality.

Lisa: I couldn’t agree more. I love it when that happens, when there’s these fundamental tenets of what you’ve been teaching and what you’ve been using with clients, and finally you get the research paper to actually put to science what you’ve been saying. And I feel like that speaks also to the fact that we live in a time where we want to have all of that research to support what we’re saying, to legitimize all of this information, because there are so many voices and so many people out there saying all kinds of things.

But on the other hand, it also reminds me that we don’t have research for every single thing. I’m sure you have a wish list a mile long for all of the things that you would love to have research for.

Aimee: Endometriosis is a big one, environmental toxins. There’s a growing body. And I think, to your point, the research helps validate and legitimize. And not that we need that as practitioners, but the world is really loud and information travels really fast and there’s a lot of misinformation out there. It’s really nice to have this data to say — look, blue light exposure at night is impacting melatonin, which impacts oxidative stress, which is impacting egg and sperm quality. It’s clear now. It’s in the data. Ultra-processed foods, environmental endocrine-disrupting chemicals, environmental toxins — we’re seeing it. Your partner’s lifestyle is totally impacting sperm health. And that’s impacting not just the embryo, but the placental development.

Now we can really piece this together in a way that I also think makes the person or persons going through the fertility challenges — it helps them prioritize what’s important to focus on and what’s not. And it’s not just keep doing IVF, or see yet another fertility specialist that’s going to just try a different protocol on you, versus getting to the root of the problem, understanding the why.

For me, yeah, trying to really get rid of this dogma around unexplained infertility — there’s no such thing. It’s always explainable and it’s not just your age and you’re not falling off some fertile cliff somewhere. And I’m happy to see that the presentation of the data is shifting and I’m hoping that impacts the conversation that’s happening with women and their physicians.

Lisa: There’s so many directions that we could go together today. You mentioned unexplained infertility, so I’d love for you to just talk a little bit about that. I find that just even in my work with menstrual cycle awareness and having clients chart, if you have a client who’s not conceiving, even from my purview, there’s never nothing. That stands out when you’re doing a full intake, when you’re going through with them. It’s never that you’re sitting there like everything looks completely perfect. Has anything shifted from the conventional medicine perspective on this? Or is it still where they just kind of put their hands up and say, we don’t know?

Aimee: It’s mixed. The pressure still tends to fall on the woman, unfortunately, and her eggs. And her age — it doesn’t matter if she’s 25, 35, or 45, it’s falling on her age for some reason and her egg quality.

What I always like to point out is the embryo is made up of the egg and the sperm. It’s also impacted by the development in the environment in which both of those develop. Then we have to think about the house. We have to think about the uterus and the uterine environment. We have to think about the immune system. At minimum, there are four factors that we have to think about with every single case.

With that, we always usually find something in one of those four factors when we’re digging deeper, and there’s no such thing as it being unexplained. Some medical practitioners are starting to think outside the box. Maybe they’re looking at metabolic issues, maybe they’re looking at insulin resistance. Maybe others are considering, yeah, the uterus is important — we should be checking out the structure and testing the microbiome and seeing if that’s impacting. More and more people are paying attention to sperm, but the WHO sperm parameters are based on the lowest 5%. And then that’s considered what’s within normal range.

If you take the basic sperm parameters and you look at them from a functional perspective, or even compare them to 20 or 30 years ago, we have a significant sperm problem. And then if we layer in DNA fragmentation testing, we are seeing significant issues with sperm. The research is at least there to help us back up our desire for more testing. But it’s still hard for the average fertility client to really get the deeper-dive testing that they need. They still need to seek out practitioners like us to help piece all these things together.

Lisa: Yeah, I mean, there’s so much to get into there. I have taken to pulling up that study that the numbers were based on. And really explaining that — Lily and I talked about that in the sperm chapter as well. Because when you actually break it down to your clients and they actually understand — wait a minute, so they had a study with almost 2,000 couples, and within one year they took all the people that conceived, and they actually based what’s normal on the lower five. So 95% of the men in the study had better sperm than what they’re saying is normal.

Aimee: That’s right. That’s right.

Lisa: There’s a lot of questions I could ask, but from a practical standpoint, for women who are listening or practitioners who are wanting to guide their clients, how do you recommend empowering your clients to actually get the testing done? And one thing I’ll just say — many clients come in thinking that it’s all fine because they were actually told that it was fine. So they’re not even thinking about the sperm at all because they were already told that he’s good to go.

Aimee: I now do a comparison chart of every semen analysis. I literally like to plug in their results. I then have the WHO results to show where these are the parameters. And then I have what the functional results are. I kind of say, listen, the WHO says this, and I explain where it comes from. I explain that 95% of the men in the study had better sperm. And I just say, our goal should be the functional range, but can you meet me in the middle? Can we get the volume up? Can we look at this?

And there are a lot of ways we can access the DNA fragmentation test on our own. I’ll use Legacy. We can even get it through Reprosource. I’ll have them push and inquire to dig deeper. But ultimately, what I also do, whether or not they want to do that DNA frag and spend the extra money, is he should be doing everything you’re doing. So if you’re here for nutrition advice and you’re here for lifestyle advice, if you’re making X, Y, and Z changes, I expect that in the household.

I always say to my female clients — manage what you can. Change over the household stuff, anything he’s using on his body. Change over the nutrition in the house, the food in the house, the environmental exposures. We should be looking deeper into what is he being exposed to at work, what are you being exposed to — really looking at this from a very holistic perspective.

And then I always add, we have to think about this for the child that you’re trying to bring through. Is the environment you have right now conducive for a healthy child, to create a healthy child, and to maintain the health of that child?

A lot of it is pushing. A lot of it is — I find a part of my job these days is I’m helping write scripts for them, meaning a verbal script for them to communicate with their doctor about how they can get additional testing. Obviously there’s a lot of testing I can run on my clients, and when I can, I do. But you do want that team energy.

I also really help my clients position themselves in a way that — we work on that emotional piece where I try to take them out of almost desperation and just so hungry for answers and support, into this position of: there are other clinics out there that I could seek support from. If you’re not the right fit for me, then I’m going to move on. Really owning that power — it’s your body, it’s your time, it’s your resources, it’s your family building. You can take it elsewhere if you’re not getting the right support.

Now it’s great to have the research. Often in these scripts that I’m helping my clients create to get the proper testing, I’m saying things like metabolic, low-lying insulin resistance. We also know it doesn’t just impact mitochondrial function, which impacts egg and sperm quality — it impacts implantation. It’s very clear in the data. I’ll include citations and I’ll include current research. I’d say 50% of the medical practitioners out there, when presented with something like this, they actually take it seriously. They dig into the research. They say, this is a good point.

I’m pushing my clients for more imaging. I think you and I probably have similar antennas — I can pick up endometriosis pretty quickly just based on symptoms, even the silent type. There are other symptoms that we’re looking for beyond just a pelvic condition. It’s not just a bad period problem. We know that. We’ve always known that. The imaging is there now, and there are specialists now that change the game when we get that diagnosis and understand what we’re dealing with. And it’s not saying we have to rush off to surgery. There are lots of things we can do. But now we know — 50% of unexplained infertility is actually endometriosis. And as a clinician with 21 years of clinical experience, I’d argue it’s probably closer to 70%.

Lisa: It’s so interesting. Just the topic of unexplained infertility — there’s also a lot of research out there that looks at practitioner knowledge. Those are research papers that I like to highlight on the podcast whenever I find them. Because whether it’s PCOS, whether it’s endometriosis, there is a documented practitioner gap in knowledge. In addition to the research you’re talking about, there’s also research to support the fact that most of them, if they’re not specialized, may not actually know the common signs. And as terrifying as that is, I would love for you to speak to that, because we definitely live in a time where medical professionals are put on these pedestals and we’re expecting the doctors to know everything. But the research would definitely suggest otherwise.

Aimee: And it used to be too — I remember there was a time, even when I first wrote Yes, You Can Get Pregnant, that there would be a lot of medical practitioners who would say something like, diet has nothing to do with your fertility. You can’t improve your egg quality. And what I love about what’s changed from when I first wrote that book to now is what the research is showing — whether or not that clinician’s up on the research. It’s not chronological age. It’s biological age. It’s mitochondrial function that’s actually impacting things. It is not how old we are. And egg quality declines with age. Fertility can decline with age. But it’s a slope. It is not a cliff. And for a lot of women, it’s recoverable. We can improve even as we age.

I like to believe that a lot of these practitioners out there who aren’t up on the current research or aren’t able to diagnose properly — they’re still functioning under the guise of do no harm. They weren’t taught how to properly diagnose it. It just wasn’t part of the conversation.

I remember two doctors that I tend to work really closely with and admire. They were on a panel recently and talked about how they went through medical school 10 years apart. One went through 10 years prior to the other. When he went through medical school and was specializing in fertility — he became a reproductive endocrinologist — they were taught to diagnose and treat endometriosis in women when they found it. By the time the other one went through school 10 years later, they decided, no, we don’t do that anymore. We just push them to IVF. IVF is the solution for endometriosis. So you don’t have to identify it. You don’t have to diagnose it, because it does not matter.

However, we have research that shows there was one study — about a thousand women who had endometriomas on their ovaries. They were comparing them to women without endometriomas, same age, same parameters across the board — AMH, FSH, that type of thing. When they removed the endometrioma, the women with endometriosis started to match their counterparts in IVF. With the endometrioma still there, untreated, the endometriosis group had poorer outcomes. They retrieved fewer eggs. They had lower AMH. They had poorer blastocyst rates. They had poorer egg quality across the board. But just surgically removing that endometrioma matched them to the other women who did not have it.

Lisa: That’s not shocking at all. And I always explain it — I’m like, well, no. How many reports I read on a regular basis, ultrasound reports where I’m like — did anyone point out to you that you have a chocolate cyst? They still call it that. It’s shocking to me. No, it’s an endometrioma. You should call it what it is. It’s very distinguishable.

Aimee: No one has ever pointed out to multiple women that make their way to me that they have endometriosis. And then I explain, well, of course your AMH is going to be lower. AMH is secreted by the ovary. The endometrioma is literally sitting on the ovary. It’s starving it of its blood supply. It’s creating this huge inflammatory response at the ovary. Egg quality is going to be impacted. Putting IVF medications into a situation like that is like gasoline on a fire. No eggs coming out of that are going to be of good quality. And so it has to be treated. We have to figure that part out.

Whether we do it naturally — we use Chinese herbs and castor packs and acupuncture and lifestyle adjustments — maybe we never make it fully go away, but we can change the environment. Or do we go in and remove some of it, with fertility preservation in mind? Some surgeons are just thinking, oh, we just take the ovary. No, you don’t have to take the ovary.

There is a huge gap in treatment protocols, in understanding the impacts and the greater implications. Many practitioners will still just say that it’s just a menstrual problem. It’s a systemic inflammatory condition that has major repercussions to the overall picture of health, not just fertility.

I’m very direct. This is who you have to see. You need a pelvic MRI. You need imaging. And then these are the seven people in the United States that can actually read that MRI and give you the right recommendations on next steps forward. A lot of my women who are dealing with reproductive immunology or recurrent pregnancy loss, repeat implantation failure — they probably have three different medical providers on their team because one is maybe the fertility doctor, one is the immunologist, maybe one is someone like me, one is the endometriosis specialist. And they have to manage that, or I’ll help them manage that, because the doctors won’t communicate with each other either.

Lisa: The difficult reality for women who are seeking support is that if you want to be successful, it’s like you need a whole team. Because I find the discourse to be really interesting. Last year, I was really kind of critical of these papers that were coming out, kind of anti-social media in the sense of attacking women who are just regular women sharing their stories, and kind of saying there’s fear-mongering. But the challenge is that you have all these women who are seeking support and they’re all being told the same thing, which is not up to date and accurate.

I feel like from what you shared, I’m still back there where you said these doctors went to school 10 years apart. You would assume a doctor educated more recently would have a more thorough teaching and training about diagnosing and understanding endometriosis because we clearly have so much more research on it now. But obviously that’s not the case.

I feel like you can lament about it, but I’m at the point — and maybe I’m cynical — where I’m not bashing doctors. I want to educate my clients about what is happening so that they know what to expect. Because if you don’t, then they’re confused. You’re telling them something, the doctor is telling them something else, and they’re confused as to what’s going on because they’re assuming the doctor is the one with the most education on this topic.

Aimee: That’s right. And it’s hard. I had a conversation recently with a PhD scientist at one of the uterine microbiome companies — brilliant, an MD with a PhD as well. We were talking about the uterine microbiome and different strains and findings that could indicate endometriosis or not, implantation failure, recurrent pregnancy loss. And I said, why isn’t every clinic talking about this at this point? To me, it’s a no-brainer. And he reminded me that it takes about 10 years for clinical research to actually hit the mainstream medicine world. 10 years.

In the revised edition of Yes, You Can Get Pregnant, one of the talking points I make — I have a new chapter on IVF, and I have my seven rules of IVF. Two of them: one is, never continue to do the same thing over and over again and expect different results. Two — and this goes to everyone, even if you’re not doing IVF — do not wait for research to catch up to current innovations that are out there.

It doesn’t mean go out and try everything and inject yourself with every single peptide. But do not wait for that research to be presented. Collect data, collect information, make the best decision for you, work with the team, understand the pros and the cons. Things like certain peptides and helping with metabolic health, or things like ovarian PRP. Even things like understanding circadian rhythm and looking at the diet — ultra-processed foods versus whole foods. I don’t know that we need research to show us that making those changes has a strong impact. But a lot of people in the medical community do. So you have to almost make the assumption they’re 10 years behind someone like you or I.

Lisa: And to be fair, some research studies suggest it might be 10 years before they’re talking about it, but 20 before your average doctor is doing this as a part of their regular practice. We have to be aware of that.

I feel like having social media — what has changed is that they’ve lost control of the story, and I think that’s their issue. When I’m looking at these research papers where they’re kind of criticizing influencers for spreading this information — even if the information they’re spreading is actual published research — given what we were talking about, they’re 10 years behind. So you can be providing accurate information that they’re not aware of and they’re calling it inaccurate.

And in their defense, the way that the medical system is set up is patient after patient after patient after patient. When are they supposed to have time to spend thousands of hours doing all this research anyway?

There is one topic that we’ve touched on that I want to dig into a little bit more. I’m sure we’ve talked about this in past interviews, because I remember you’ve always made a strong case to not look at age as the be-all and end-all, the defining factor. Earlier you did mention that age is a factor, but there are so many other factors that contribute to egg quality. Maybe share with us if there is a difference in the approach you take with clients who are in their 20s versus their 30s versus their 40s. Break it down for us — how you look at age.

Aimee: One thing I’ll say is the older we get, the easier the pipes can get clogged. The more impact our lifestyles have had on us for those decades, the harder it is to recover. When they’re younger — I’ve been doing this so long — 38, 40 is still young for me. I actively have women who are 46, 47, 48, 49, trying to conceive with their own eggs.

When I first wrote Yes, You Can Get Pregnant, I did think around 44, 45 was when we were really getting close to dismal. Fertility was declining. But Chinese medicine — which is a big part of my education — talks about how when a woman lives in accordance with nature up until the age of 49, she should be able to conceive children. And in accordance with nature is basically the bare bones of everything we teach: diet and lifestyle and mindset and all the things.

When I have a woman who’s 26 and they have to do IVF due to a genetic condition — she has genetically tested embryos, she has one healthy child from the first IVF she ever did, and now she’s gone on to have four failed transfers, either miscarriages or very early implantations that then miscarried — the conversation has been that it’s her eggs going bad. I’m sorry, but she just made healthy children from the same batch. This is the same batch, made two years ago. No, something else is going on.

But I had this conversation with her where I was like, listen, if we run out of these embryos and we have to make more, time is still on our side. She’s living a very healthy lifestyle. We have this luxury of maybe tweaking a little more or not feeling the pressure of age. However, every woman, no matter what age she is, is on her own timeline. And I always try to respect that and always remind myself of that too — just because I think she’s got plenty of time doesn’t mean her heart isn’t hurting because she wants the life she wants and when she wants it.

If I get to a woman who’s in maybe her mid to late 30s, she’s already really worried about her age because everybody’s told her there’s this cliff, all your eggs have gone bad. I spend a lot of time retraining them. And I always share one of my favorite studies that looked at 20,000 eggs — not embryos — from women undergoing IVF. The largest study of its kind. And it’s not talked about nearly as much as I think it should be. They just looked at chromosomes in the eggs. Women even in their mid to late 30s still had about 70% chromosomally normal eggs. The study went up to women aged 44 — still about 45 to 60% of eggs were chromosomally normal.

I always say to them, okay, we’re going to err on the side of caution. Even if we have diminished ovarian reserve, even if our fertility is declining at some point — and it’s a slope, a very mild slope, not a cliff — we want to keep that in mind. What are we playing with? So there are honest conversations I have about age. Then I talk about regenerative medicine. I talk about mitochondrial function and I talk about the current research and what we know about the timeline of folliculogenesis and spermatogenesis and all the things we can do to optimize embryo quality.

I feel really confident about it because I’ve been seeing it for two decades. I know for a fact that a woman can get older and make better quality embryos. I’ve seen it too many times. It wasn’t anecdotal at this point. It’s clearly clinically significant. But this is where we have to tighten the reins a little. We have to take this a little more seriously. Where maybe a woman in her 20s or even early 30s can get away with lifestyle and diet stuff maybe 60 to 70% of the time, when you start hitting your later 30s and early 40s, I think it’s an 80-20 rule. But typically when they come to me, they’re just willing to do the 90-10 or the 100%. I always impart that we don’t need to be perfect at this lifestyle — none of us are perfect and it’s hard to be perfect in this world.

Another thing — we now know from research that even women in menopause still have a thousand eggs left in their ovaries. The whole idea of waking up one day and they’re all gone is bogus. It’s not true. And there are newer technologies and techniques that can maybe wake up the dormant ones. There’s a lot of nuance. Genetic predispositions play a role. Environment plays a big role. So it’s really just being aware of all the factors and taking that into account for that client. Age tends to be one of the few things I focus on least, because I do think we can massage it. Biology is much different than chronology.

Lisa: I love how you break it down because even if you’re working with a 20-something — she’s got the benefit of age. But if she has all of these lifestyle habits, if she smokes, if she’s always drinking, if she really has a diet that’s devoid of a lot of key nutrients — her eggs potentially will still be of a pretty decent quality because of her age. But there’s so much more potential if she were to tighten that up. And I feel like that’s exactly the part that’s not being discussed — yes, there is some variation within age limits, but most women haven’t even started to optimize in terms of the recommendations that you would be making.

Aimee: And they can recover and bounce back quicker. That’s almost what I would say until that late-30s category. But then it’s also the women that I’ve had success with in their late 40s — a lot of them come to me and they’ve been living a really healthy lifestyle since their 30s. They are so optimized.

I’ve often been quoted saying, I have a woman that’s 42 and she has better eggs than a 32-year-old. I’ve seen that enough times that to me, it’s not the number of years old you are. It cannot be that. It has to be how you’ve lived your life. And in Chinese medicine, we talk about prenatal essence and postnatal essence. The prenatal essence is like what you were given — the environment in which you grew, this ancestral, generational piece. We now know the eggs that are in me all the way from my grandmother. We know this timeline and this impact. We can build what we call in Chinese medicine the postnatal essence. And that’s where we can really work to improve fertility, no matter the age.

Ideally, if a woman’s still ovulating and menstruating, I think we have a shot. There are also newer technologies now that can restore ovulation and menstruation. With my perimenopausal women — now there’s a term for that too — I have no shame in using some bioidentical HRT if we need it. Maybe we need a little estrogen boost. We test. We always test, we don’t guess. That can maximize fertility outcomes in a lot of these women. Some women in their 30s need that support. It’s so not age.

Lisa: Well, there’s something I want to circle back to. You had mentioned sperm DNA fragmentation, but I didn’t ask you to define that and talk about it a little bit more. I feel like this is the perfect opportunity. There’s some really interesting implications in the research about the egg and its ability to repair some degree of sperm damage. But we have more of a capacity to do that when we’re younger and our eggs are younger versus when we’re older.

I’d love for you to talk about the role of DNA fragmentation in this process, because obviously that’s going to play 50% of the role regardless of age.

Aimee: What’s interesting too is you can have a pretty normal semen analysis in functional range and a high fragmentation. We’re looking at the sperm and not just motility, morphology, count like we do in a semen analysis. We’re looking at how fragmented the DNA is specifically within the sperm. Fragmentation is typically correlated with oxidative stress — it’s telling us the level of oxidative DNA damage that has been done to this sperm.

I always think about nature. The egg is so smart. She’s got like hundreds of thousands of mitochondria and just this intellect. Why does she not let it in? What is she sensing about this, that she’s maybe rejecting it? Or does it not have the capacity to actually penetrate and do its thing because it’s so compromised? Or does the egg and sperm start to fertilize and then completely disintegrate because they don’t have together the mitochondrial capacity to actually make an embryo?

The DNA fragmentation test is super important because, like I said, you can have what looks like a considerably normal semen analysis, but then there’s this high amount of DNA oxidative stress damage that tells us basically the mitochondria in that DNA doesn’t have the capacity to make a healthy child. Or if it does fertilize, we’re worried about placental formation. We’re worried about implantation. We now know the sperm plays a much bigger role in placenta formation and in the long-term health and development of the child in utero.

I always think about the egg — especially if her egg quality is in good shape and she’s still not getting pregnant. Why? Either egg and sperm structurally can’t meet. Or egg and sperm meet and maybe the sperm can’t penetrate. Why? Or the sperm and egg fertilize, but then they can’t continue on. Why? Now that’s where I think about sperm. Oh, but they’re implanting, they’re not staying — now I’m thinking about sperm, about the uterine environment, about the immune system. It’s so much more than just the egg.

We’re at 50% male factor impacting now. Whereas when I first wrote Yes, You Can Get Pregnant, I had these two circles, sperm and egg, and there was this little overlap. It was about 30% or so that we thought male factor was impacting. Now we’re at 50%. And I think in the last decade and few decades, the amount of ultra-processed foods and environmental chemicals has really impacted sperm in a massive way — the DNA fragmentation and the oxidative damage.

Lisa: It’s so interesting because there are women potentially listening to this, or working with clients, who’ve had this experience of trying to conceive, going to a specialist, and basically being told there’s nothing they can do and they don’t understand. But within the span of what, like 45 minutes, we have created an incredible list of opportunities. It might sound daunting — oh my goodness, what if my partner has DNA damage, what if I have — but at least when we can find an issue, when we know what to investigate for, that does give you hope.

Let’s talk a little bit about that — you can kind of go over some of those things that couples can do, as a reminder to leave with that message that there’s a lot that we actually can do.

Aimee: We can see DNA fragmentation improve in like three months with all the lifestyle adjustments and targeted supplements. Anything you’re doing to maximize your hormones and your egg quality or to fight the aging process — he needs to be doing that too. It has to be. And I think that really helps from an emotional perspective and for the support.

There are three parts to the book. In part two, I call it the fertility rejuvenation protocol. There are four or five chapters. The first chapter in that is about becoming one with nature. That’s where we’re really dialing into circadian rhythm. I was always talking about becoming one with nature, spending more time in nature, having plants in your office, getting outside, getting the morning sunlight. Getting that unprotected sunlight for 20 minutes every day, at least. Living in accordance with the seasons, understanding your cycle. Now I’ve added a lot more detail on blue light, circadian rhythm, red light, and all these things.

One of the best pieces of advice in that department is the first hour of waking. Ideally, you get outside within five to ten minutes, no matter what the temperature is, and you’re getting some morning sunlight. No screens for that first hour upon waking. I don’t even recommend turning on overhead lights — just kind of letting the natural light come into the house.

The other part of that would be healthy habits at night. If you are watching a show before bed, we’re wearing blue light blockers or we have amber lights on. We set the house up with the right lighting for nighttime. The blue light exposure at night is definitely impacting melatonin, and that’s impacting oxidative stress in men and women. It’s clear in the data.

The next section is diet. Another thing we really know now — ultra-processed foods are just crushing egg and sperm quality. I think one study showed in women, their AMH was about 30% lower on an ultra-processed food diet. Remove the ultra-processed foods within three months, their AMH levels doubled. It was fascinating. Getting back to just eating whole foods. Good quality foods, eating enough, not skipping meals, balanced blood sugar. The metabolic health research is really supportive of what we’ve always been saying. The goal is to eat six to eight servings of vegetables. You have to have a lot of antioxidant-rich and fiber-rich foods.

Then I talk about the emotional component. The nervous system work. There was a full research study that came out of UCSF — and of course we always knew this — but now we know the ovaries are literally wired to the nervous system. They literally react to your nervous system. If you are in constant fight or flight, it does not feel safe. And safety is what we need to procreate. And I would say the same for the men — emotional stress really impacts DNA damage, DNA fragmentation, and oxidative stress on the sperm.

Emotionally coming together, moving your body on a regular basis, meditating, getting good sleep, Vitamin J — which is joy — such an important part to try to get in. My spiritual teacher would say, I want you to be happy on your way to baby, not just when you get baby.

And then I spend a lot of time in this section talking about environmental toxins. Since the 80s, we’ve introduced over 100,000 chemicals into our environment. They’re definitely triggering autoimmunity in men and women. Beyond that, they are endocrine-disrupting chemicals. They are messing with our hormones. Going non-toxic with your lifestyle — slow and steady can do it. It’s a huge overhaul to change out your water, change out your pots and pans, change out all your detergents, anything you put on your body. But eventually that’s the kind of household you really want to be living in.

That really will maximize fertility outcomes. I also see it as it takes a huge burden off the liver. And then say you are doing IVF — now your body can actually fully utilize those hormones and detox from them when you’re done doing the IVF cycles. Those are the main pillars that I work on with everyone. The research also supports that shifting these four pillars will maximize outcomes for man and woman.

Lisa: My takeaway — Vitamin J. That’s my favorite thing.

Aimee: It is important. Getting back to what lights me up.

Lisa: Well, Amy, I mean, we could talk all day. This has been so much fun. I want you to tell us about the new expanded edition of Yes, You Can Get Pregnant. Tell us what is new.

Aimee: There’s a whole new chapter on improving egg quality and sperm quality over the age of 35. There’s a whole new chapter on IVF — there was no chapter on IVF before. There was always a chapter on getting to the root of common fertility challenges, or helping yourself maybe diagnose yourself. That chapter went from being about 12 pages to being almost 50 pages. My editor literally was like, we have to cut. I was like, we’re not cutting a single thing out of this.

Deep dive on endometriosis, PCOS, premature ovarian failure, premature ovarian insufficiency, whatever you want to call it, uterine microbiome, sperm health, DNA fragmentation, recurrent pregnancy loss, repeat implantation failure. Basically guiding you — if it’s not happening, these are the places to look and why. I go into what are the Western tests, and then these are the things you can do from the more holistic perspective.

There’s also a new chapter on ovarian rejuvenation that I did with Dr. Murphy, who is a good friend and colleague and a leader in fertility innovations — he is a reproductive endocrinologist. There are some cool new interviews with leading reproductive endocrinologists and endometriosis specialists. The volume of the book has doubled. The resources actually have to live outside the book — there’s just too many. They have their own PDF that you have to download. My editor said I 10X’d the amount of citations. It’s an abundant resource covering every angle and I’m very proud of it.

Lisa: That’s amazing. Well, congratulations. And congratulations on the 10 to 12 years. It’s crazy how fast the time goes. My favorite thing is the days are long but the years are short. It’s been a pleasure having you on the show, Amy. Just in case, let everyone know where they can get the book and where they can connect with you.

Aimee: Everything’s on my website — amyraupp.com has everything. The book is available anywhere books are sold. In English at this point; we’ll probably have some translations down the road and hopefully an audiobook soon as well. Then follow me on Instagram and TikTok — that’s where I’m most active and you’ll get all this information there as well.

Lisa: Amazing. Well, this has been so fun. Thank you so much for being here.

Aimee: Thank you.

Lisa: I hope that you enjoyed today’s episode with Amy. We covered so many important topics and I feel like the takeaways are very similar. Amy has been for decades a champion for fertility for women of all ages, and she certainly has been someone standing in the forefront, challenging this idea that age is the only factor.

When we look at the research, age is a very significant factor in fertility. We can’t get around that. But there’s so much variation with respect to egg quality. Age is not the only part of the story. And I’m glad we were able to talk about that today. There is a lot that we can do to support egg quality, to support sperm quality, to investigate, to identify. If you or your client has been given a diagnosis of unexplained infertility, know that you really should not be stopping there. If that’s what you’re hearing, then it means that you need additional members on your health team to help you thoroughly investigate.

I’m glad that we talked a little bit about endometriosis and the topics we covered — so, so important. I’m also glad that we talked about sperm DNA fragmentation, because there’s so much more to the sperm story. I can only imagine how many women are on their fertility journey and if their partners are even screened, if their partners are even given the opportunity to do a sperm analysis. And how many of them are told that everything’s fine without a thorough investigation.

If anything, I hope that today’s episode has just really demonstrated the importance of thoroughly investigating the matter and making sure that you have the right people on your care team. One of the things that I talk about a lot, and I wrote about it in The Fifth Vital Sign, is this idea of the boardroom analogy. If you picture yourself sitting at the head of the table and there’s a large boardroom table and you’re dealing with a health challenge — you’re going to need more than your general practitioner. You’re going to need more than your family doctor. You may need a fertility specialist, but you may also need a fertility coach who specializes in what you’re dealing with. You may need an acupuncturist. You may need a certified fertility awareness educator to help you really optimize timing. You may need a naturopathic doctor to apply advanced testing from a functional perspective. You may need a functional medicine doctor. You may need a nutritionist. You may need a urologist to further look at any male factor issues that may not have been addressed.

It’s really important. If you can think of someone who needs to hear this episode — whether it’s a friend, a colleague, or a client — I would highly encourage you to share. You’ll find the show notes page over at fertilityfriday.com. And if you’re listening in your favorite podcast player, you’ll find the details in there as well. I hope you have a wonderful week, and as always, until next time, be well and happy charting.