Episode 300: The Fertility Episode with Lisa Hendrickson-Jack
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In this week’s episode, Erin welcomes back Lisa Hendrickson-Jack, previous podcast guest and co-author of the groundbreaking book "Real Food For Fertility." They embark on an insightful exploration of the menstrual cycle as a vital sign, the profound impact of nutrition on fertility, and the nuanced effects of hormonal contraceptives. They also navigate the terrain of timing conception, delve into male fertility considerations, and uncover key factors influencing sperm quality. Get ready for a deep dive into reproductive health as they guide you on your path to fertility success.
Lisa Hendrickson-Jack is a certified Fertility Awareness Educator and Holistic Reproductive Health Practitioner who teaches women to chart their menstrual cycles for natural birth control, conception, and monitoring overall health. She is the author of three bestselling books The Fifth Vital Sign, the Fertility Awareness Mastery Charting Workbook, and her most recent book Real Food For Fertility, which she co-authored with Lily Nichols RDN. Lisa works tirelessly to debunk the myth that regular ovulation is only important when you want children by recognizing the menstrual cycle as a vital sign. Drawing heavily from the current scientific literature, Lisa presents an evidence-based approach to help women connect to their fifth vital sign by uncovering the connection between the menstrual cycle, fertility, and overall health. With well over 4 million downloads, her podcast, Fertility Friday, is the #1 source for information about fertility awareness and menstrual cycle health.
In this episode:
Why we should consider the menstrual cycle a vital sign [7:41]
The main factors that impact a woman’s fertility [9:43]
Tracking your fertile signs [19:12]
How stress can impact ovulation [26:40]
Birth control contraceptives and how they impact fertility [30:16]
The male counterpart: what men can do to improve sperm quality [42:03]
Resources mentioned:
Connect with Lisa Hendrickson-Jack:
Grab a copy of Real Food for Fertility
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Learn more about Hormones & Functional Nutrition
Related episodes:
213: Understand Your Cycle; Take Back Your Power with Lisa Hendrickson-Jack
241: Post Birth-Control Syndrome
254: Releasing Shame around Sexual Health with Dr. Jolene Brighten
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Erin Holt [00:00:02]:
I'm Erin Holt, and this is the Funk'tional Nutrition Podcast, where we lean into intuitive, functional medicine. We look at how diet, our environment, our emotions, and our beliefs all affect our physical health. This podcast is your full bodied, well rounded resource. I've got over a decade of clinical experience, and because of that, I've got a major bone to pick with diet, culture, and the healthcare model.
Erin Holt [00:00:18]:
I've got over a decade of clinical experience, and because of that, I've got a major bone to pick with diet, culture, and the healthcare model. They're both failing so many of us.
Erin Holt [00:00:28]:
But functional medicine isn't the panacea that. It's made out to be either. We've got some work to do, and that's why creating a new model is my life's work. I believe in the ripple effect. So I founded the Funk'tional Nutrition Academy, a school and mentorship for practitioners who want to do the same.
Erin Holt [00:00:45]:
This show is for you if you're looking for new ways of thinking about your health and you're ready to be an active participant in your own healing, please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment.
Erin Holt [00:01:00]:
I would love for you to follow the show, rate, review, and share because. You never know whose life you might change. And of course, keep coming back for more.
Erin Holt [00:01:14]:
Hello, my friends. Today we're going to talk all things fertility with the queen herself, Lisa Hendrickson-Jack. She's been on the show before. Gosh, it was over five years ago that I first talked to her, which is totally insane. And then we rereleased her original episode for episode 213, understand your cycle, take back your power. So if you want to do a little refresher after this one, you can go listen to that. There's not a tremendous amount of overlap between the two episodes. Lisa is so incredible. We had a lot of tech issues.
Erin Holt [00:01:50]:
Suffice it to say, we had a lot of tech issues. And she was so kind, courteous. Grace gave us so much. Just, I just have to shout her out. She's truly, truly incredible. So Lisa is a certified fertility awareness
Erin Holt [00:02:04]:
educator and holistic reproductive health practitioner who teaches women to chart their menstrual cycles for natural birth control, conception, and monitoring overall health. She's the author of three best selling books, the Fifth Vital Sign. Chances are, if you have listened to the show or followed me in any capacity, you probably already own that book. If not, you should.
Erin Holt [00:02:25]:
The Fertility Awareness Mastery Charting Workbook and her most recent book, Real Food for Fertility, which she co authored with Lily Nichols, RDN. Lisa works tirelessly to debunk the myth that regular ovulation is only important when you want children by recognizing the menstrual cycle as a vital sign. So we'll talk about that on the show. She draws heavily from the current scientific lit, and she presents evidence based approaches to help women connect to their fifth vital sign. So this show is a good one.
Erin Holt [00:02:59]:
You're going to want to probably take some notes for you, perhaps for your partner. Like I said, we had some tech issues, so I'm going to pick up a little bit midstream. In the conversation, I had asked her what it's like to be Lisa lately. I said, hey, welcome back to the show. It's been five years, like, how you living? How you been doing? And so this will pick up right where she starts to answer that question. I know you will enjoy it. She's great. It's a great episode.
Lisa Hendrickson-Jack [00:03:28]:
Thanks for having me. Well, that's an interesting question because it's a very busy season of my life. A lot of things have happened in the last couple of months and some good, some not so good, but the book has taken the better part of the last three years. So Lily and I have been really diligently working on that. And during that time, we both actually also run programs for practitioners. So I have my Fertility Awareness Mastery Mentorship Program. I also have an 18 month old baby. It's been a busy season, but I would say a good one.
Lisa Hendrickson-Jack [00:04:05]:
I think that it's just a season of life. And the reason that I take on all these things is because it really comes down to wanting to make life better for women. It's still the goal. And when I do my client work, whether it's in my practitioner program or my client programs almost on a daily basis, I'm still hearing a lot of the same things. Women having issues with their cycles or with fertility or with hormones, and they go to their care providers and they're not being provided with answers. And so that's really still the root of why I'm so busy, because it's all about trying to make an impact and improve this.
Erin Holt [00:04:46]:
I completely understand and hear what you're saying. I think that. And sometimes I'm like, really? We're still struggling with the same thing all these years later. But I also understand that people kind of find their health journeys at different moments in time based on what's going on with them in their life and what they're working on. Do you feel like that? That's kind of your North Star? I feel like for ambitious women who do a lot, we kind of need that guiding force to continuously remember, like, oh, this is why I'm working so hard. This is why I'm doing what I'm doing. Do you feel like that? That's yours?
Lisa Hendrickson-Jack [00:05:24]:
Yeah. It's a combination too, because I remember when I had my eldest son and I was not doing this full time at that time, and I remember thinking that I'm spending all this time working and now that I have him, it's time away from my child. So I remember feeling this drive to do something meaningful, so that if I'm spending time away from my children making a living, that it's something that I really feel passionate about and really good about, if that makes sense. So it's certainly a combination with that personal aspect of it, but also this piece of it, because I sometimes joke that if I didn't do this work and I didn't have my podcast, I'd be standing on a street corner somewhere with a sign just like screaming at the top of my lungs because of how frustrating it is. Because when you hear similar stories over and over and over, it's just like, what do you do? So this is my contribution to try to help the situation. Because at the end of the day, I discovered fertility awareness charting in my late teens. And so for me personally, this has been something I've been able to use for over 20 years, and I've been teaching women for almost as long. And so this is something that I've been able to take for granted and I've been able to benefit from.
Lisa Hendrickson-Jack [00:06:40]:
And even though a lot has changed in 20 years, 20 plus years, it's a lot more common now. So many women know about it. This information is getting out there. Your average woman still doesn't really understand how her cycle works, let alone her fertility. And that's a huge piece of Lily and I writing this book together because we want to provide that information and knowledge that women need in order to make informed decisions about their fertility and about their health and their reproduction and building their families.
Erin Holt [00:07:13]:
I mean, that's a perfect segue into what we're going to talk about. And I know that this is a bit of a review I'm going to link to the original episode that we recorded because there was so much good stuff there. And that was really based on your first book, the Fifth Vital Sign, which I recommend to everybody, practitioner and non practitioner alike. So this is definitely going to be a review question, but I think it's a good place to get started. Can you just explain to us what a vital sign is and why we should consider the menstrual cycle a vital sign?
Lisa Hendrickson-Jack [00:07:48]:
Yeah, absolutely. I mean, a vital sign, put simply, is just a way that the body, it's a measure, a bodily response that we can measure. And the most common vital signs include your heart rate, your temperature, your respiratory rate. So if you think about blood pressure, I'll throw that one in there, too. If you think about any of these common vital signs, if you go to your doctor and they're measured, not only does it give your doctor general information, so if the blood pressure is too high, it tells him that something's wrong or her. It also provides a bit of a roadmap, because we know that there's a handful of things that are going to contribute to high blood pressure or high temperatures or whatever the case is. And so when we look at the menstrual cycle as a vital sign, what that means is we're acknowledging that there is this normal range, and we can break the menstrual cycle down into a variety of different factors. We can look at the period itself, the length, the quality of menstruation, those types of things.
Lisa Hendrickson-Jack [00:08:43]:
We can look at the overall cycle length. We can look at how long it takes you to ovulate, what happens in that pre ovulatory phase, if you have normal cervical mucus patterns. And we can look at the length and quality of your luteal phase, the second half of your cycle. So we can actually break it down into a number of different factors. And when we understand that there's a normal range for those things, then when your cycle is outside of that, or an aspect of your cycle is outside of that, not only is it general information that something's wrong, but it can provide sometimes a more specific roadmap, and it can be something as simple as you have cervical mucus discharge every single day, and that could be a sign of a potential infection to something more serious, where if you are not having a period at all for six months, that could be a sign of hypothalamic amenorrhea, exercise induced, stress induced undereating scenario that we need to address.
Erin Holt [00:09:43]:
So if we're talking about fertility, this is kind of like a high level question. What are the main things that's going to impact a woman's fertility if you had to kind of distill it down into main pillars? So this is still kind of like an introductory part of the conversation, but for folks who are like, wait, what? This is all news to me. If you could summarize, what are the main categories of things that are really going to impact a woman's fertility or infertility?
Lisa Hendrickson-Jack [00:10:14]:
That's a great question. And I think that to kind of start, to answer that question, you want to think about your fertility as a sign of overall health. We want to think about if you have a healthy body, if you have an optimal hormone balance, healthy menstrual cycle, then fertility is a byproduct of that. So if we think about fertility as a natural kind of sign of just overall health, then it really starts with maintaining health. And so in Real Food for Fertility and the work that we're doing, we're arguing that your diet is a huge piece of this. So the foundational piece of it. And so we're breaking it down into, from the most basic level, making sure that we have sufficient macronutrients on board in a good balance, maintaining healthy blood sugar balance. So having that as a baseline to increasing specific micronutrient ratios.
Lisa Hendrickson-Jack [00:11:13]:
So making sure that not only do we have enough of the protein, the fat, the carbs, but we're also looking at our micronutrient intake and optimizing that. And so we really get into the weeds about how not only does it matter that we have enough protein and sufficient fat as a building block for our hormones, if we don't get enough of those, I mean, we need all three. But I think for women, we often undereat those specifically protein. And a lot of women shy away from fats. And so, interestingly, when we add in the menstrual cycle component to it, we can actually see in real time if what you're doing is working, because if you are getting sufficient nutrition, whether the combination of macros and micros, then you would expect your menstrual cycle to be in better balance. So I think that's the interesting piece of it where we can actually look at how we're doing when we look at the menstrual cycle as a vital sign and track it. And so in addition then to that general overall picture, we can get into more of the specifics, but this is a higher level question. We also then want to look at hormone balance.
Lisa Hendrickson-Jack [00:12:19]:
We want to look at lifestyle factors. You can look at your toxin exposure, you can look at the different things that you're exposing your body to. So we can kind of look at, even in terms of your exercise and whether you're eating sufficient calories to sustain, offset your activity level. But I feel like just for that higher level overview, we really want to look at that piece of it first and then go from there.
Erin Holt [00:12:45]:
That makes a lot of sense. And I mean, definitely, we're encouraging everybody to go out and buy the book. Real food for Real Food for Fertility. There's a lot of f's there. I know it's a fantastic book, and it's going to get into the nitty gritty of all of the nutrition. I mean, that's what you guys are really doing so well with that book. Huge need for it. You said it took you three years.
Erin Holt [00:13:11]:
I always wonder how long it takes for these books to really come to life. Three years? Is that what you said?
Lisa Hendrickson-Jack [00:13:17]:
Yeah, because Lily and I are both working on it. It's kind of like two books in one book. I hesitate to say, but it's 500 pages. And the interesting thing about it, though, is that it's not extraneous detail. I mean, Lily's an expert in her field regarding the nutrition, and she really goes into a lot of depth. And we strive to create a resource that's not just know, eat this thing, because we told, you know, we strive to create a resource that's really providing the science behind the recommendations so that you're empowered not only to know what to do, but to know why it's important. And then when you add in the menstrual cycle piece of it, so there's nothing like it because it's adding this foundational piece. But then there's this whole other part of the conversation when it comes to understanding your menstrual cycle, knowing how to use fertility awareness techniques for optimal timing, paying attention to the male factor.
Lisa Hendrickson-Jack [00:14:18]:
So a huge part of this conversation as well is the man's contribution. So, from some of our early reviewers, some of the comments that we've received is like, wow, I didn't expect you guys to talk about men so much. But what's interesting about it, I always share this joke because I think it gets the point across, but it's like I carried my babies for nine months, and they all came out looking just like their dad. So, fortunately, he's handsome. But the point, though, is that he's 50% of the genetic material, and when we're looking at fertility challenges, 20% to 30% of the time, the man is the sole reason for infertility issues, and not up to but 50% of the time, he's a contributing factor. So we want to look at optimizing for both parties. Of course, the book, there's a lot of talk about women, but we have a really significant sperm chapter. Funny story.
Lisa Hendrickson-Jack [00:15:11]:
There was a time when I wanted to write a whole sperm book, and so I went a little wild on the sperm chapter, but the reason for it is because this is a huge piece that's overlooked as well. When you get into the weeds with menstrual cycle charting, you really can identify when in your cycle you can conceive. And this is one of the big myths that I'm still busting how many years later? But we're not fertile every day. And a lot of women find that out at some point in their fertility journey. If they're trying to conceive and it's not happening right away and they're trying to figure things out, they stumble on this information that you actually are not fertile all the time and you want to time sex in relation to your ovulation to some degree. And so from that standpoint, when I first started charting my own cycles, I was in my late teens, early twenty s, and I was not trying to have a baby. And so I would avoid that window like a plague. And so then when I started to work with clients who were trying to conceive, and I started to see that they were having sex at the right time, cycle after cycle, and nothing was happening.
Lisa Hendrickson-Jack [00:16:13]:
At some point you have to wonder, well, what's going on? What's his sperm status like? And so that's a whole conversation if you want to get into it. But it's a really important piece of this conversation because as you know, most of us as women, because we have the physical evidence of pregnancy, we really take it on as if when we're having fertility challenges that it's completely our fault. And often we're told as well that our partners are completely fine, even if they're not. So it's a whole conversation I definitely.
Erin Holt [00:16:43]:
Have in my notes to get into the male counterpart because it's so under discussed. And as women, we have a tendency to take a lot of things on. To your point, it's a very under discussed part of it, but it takes two to tango. It's a part of the puzzle.
Erin Holt [00:19:12]:
You had said something earlier that I would love to talk a little bit more about. There's a big uptick in external data points, in ways to track things, whether it's HRV or it's cgms. There's all these gadgets and there's gizmos, and everybody's collecting data points, external data points about our bodies. Still, we're struggling to understand what's right for us, what's the right diet, what's the right exact percentage of macros. And people are still searching for this information. And one of the things that I attempt to do with my work is bring people back to their internal data points as well. And this can be a little bit tricky for folks to wrap their heads around, because sometimes it's like, well, sometimes it's intuition. What is your intuition? What is your inner knowing leading you to? But sometimes I'm talking about things like this.
Erin Holt [00:20:06]:
What is your cycle doing? So when you attempt this new diet or this new exercise or these new food changes, what happens with your sleep? What happens with your energy, what happens with your mood, what happens with your cycle. These are all, I would consider, internal data points that we can use to guide us toward the path that is correct for us, because the path that's correct for us might not be the same path for Sally or for Jane. And so I just want to take a moment to kind of highlight that, since we've been talking about that a lot on the podcast, this is one of the things that we can use. But with that said, there's also a lot of different trackers that people can use for their cycle, and I would love to hear your perspective on some of those.
Lisa Hendrickson-Jack [00:20:55]:
Yeah, it's such a great question. I am a little bit biased on that because I've been in this field for so long. So I think that I'm not against tech. I think it's great. I think that it invites a lot of people into the conversation. I think that for a lot of women these days, it really is the thing that's introducing them to this whole concept that their cycle is important for health and that it's connected to their fertility and those kinds of things. So I think there's a lot of benefit for it now. I think it depends on what you're using it for and how you're using it.
Lisa Hendrickson-Jack [00:21:24]:
So when it comes to fertility specifically, if someone is trying to conceive, I think that it's not the greatest idea to depend entirely on tech to say, tell you when you're in your fertile window. Not because it can't be beneficial to use tech, but I think in a perfect world, in my perfect world, you would also have that knowledge. So you'd have the opportunity to learn about the full conversation about how your body works, because you can actually track your fertile signs. So the main fertile signs that we tend to talk about in my world are the cervical fluid. So this is the cervical fluid you produce as you approach ovulation. It can look like the creamy hand lotion or the clear, stretchy, like, raw egg white type. We produce that as we approach ovulation. It has all these interesting properties.
Lisa Hendrickson-Jack [00:22:09]:
It keeps sperm alive for up to five days. It's the perfect ph. It's like a home away from home for them. And then it also serves as a way for us to time, because when you're paying attention to your cycle, assuming you're not on hormones and you're ovulating normally, then when you are approaching ovulation, you start to see this change in your cervical fluid. That is a sign that this is the fertile time. And so this is something that all women can learn. And there's interesting research studies that show. There was one research study that I looked at, and they taught women to score their cervical fluid on a scale of one to four.
Lisa Hendrickson-Jack [00:22:45]:
And so the highest score you would get if the mucus was the clearest, stretchiest type. And just based on that score alone, these women outperformed the ovulation strips just based on timing their sex, timing their intercourse, based on the highest score of mucus. The point that I'm making is that I think that it's important to have that knowledge. And that's one of the things I'd love in this world. Right. For all women to understand this, because it's kind of basic. We spend a lot of time in biology class learning about our ears and stuff. And as interesting and important as that is, this is how we build our families.
Lisa Hendrickson-Jack [00:23:19]:
So I feel like this is even more important. And then when we can marry that knowledge and understanding with the tech, then I think we have a really great opportunity. Let me give you an example, because I think it might not. Like, maybe this will help to kind of solidify why I feel this way. So one of the most common ways to track especially related fertility would be, like, an ovulation strip. And I talk about that a lot. And so these are strips that are basically luteinizing hormone detectors. They're programmed with a certain level of hormone.
Lisa Hendrickson-Jack [00:23:48]:
So once, if you hit the certain level of hormone in your urine, then the strip is going to turn positive, and we produce luteinizing hormone as we approach ovulation. So what happens is our estrogen rises to a certain point. Like, kind of like, if you think about the thermostat in your house, that kind of tells the furnace to go on. So once the estrogen reaches a certain level as we approach ovulation, and the estrogen, we're making it, because those follicles are like, as the follicle is developing, it's kicking out estrogen. So it's all like a little symphony. So estrogen rises, it reaches a certain point, and then it sends this feedback message, and then our pituitary releases this luteinizing hormone. And the greatest analogy for that that I've heard is if you think of your ovary or the follicle, the ovarian follicle, as like a balloon, and the lh is the pin. So the lH, we release that about 24 to 36 hours before ovulation.
Lisa Hendrickson-Jack [00:24:41]:
So when we're. Ideally, we use these strips, it's going to tell us that the lh is going to, like, the thing is, it'll go flashy or whatever, and then that tells us that we're going to ovulate, most likely in 24 to 36 hours. But it doesn't always work like that. So, for example, if you're doing midday urine, you've had a lot of water. You could have a false negative. Maybe the LH isn't high enough, or there's some situations where women actually frequently have elevated lH. So in the case of PCOS, it's characterized by elevated lh. So some women will actually show a positive multiple times when it's not necessarily related to ovulation.
Lisa Hendrickson-Jack [00:25:20]:
And another scenario that can happen is you could show that positive, but maybe something stressful happens and your ovulation is actually delayed for a bit. So the tech is helpful, but I think it needs to be put in context. And when we have that knowledge and we can marry it with the tech, then we have this really incredible opportunity to kind of get the best of both worlds.
Erin Holt [00:25:40]:
So everything you're talking about right now is so cool. I've been talking a lot about the body being this sacred thing. We have to kind of take back the sacredness of our bodies, because I don't think historically, women have really been taught to look at our bodies as a sacred thing. So me saying that is kind of like blasphemy a little bit. But these are built in mechanisms that we all have. We are quite literally designed this way. And to Lisa's point, we've never been taught. Know, I was taught about parallelograms in school, but never about my cycle.
Lisa Hendrickson-Jack [00:26:16]:
Oh, those parallelograms. Never used it after high school once.
Erin Holt [00:26:21]:
Never. I'm sorry to all the math teachers out there, we love you. But I could have stood to learn about my menstrual cycle and these fluids that were coming out of my body, because I'm like, oh, my God, I'm broken. What happened? Somebody fix it? No, that's by design. And the other thing that you said is that stress can impact ovulation. So would you be willing to expand upon that a little bit more?
Lisa Hendrickson-Jack [00:26:50]:
Sure. When you're tracking the menstrual cycle, I think there's kind of two broad ways that stress can impact. So you can have kind of like a chronic stress situation where it's not a situational thing, and that can cause kind of like a systematic reduction in overall hormone production. If you think about just a kind of situation that your life is generally stressful, or something's happening on a regular basis, we can even think of stress outside of emotional stress and think about it like stress on your body. So, for example, if you were chronically undereating or if you were chronically working out a lot, or I'm giving that as an example a couple of times, or even if you had some sort of underlying infection in the body. So that's something that is stressful, but it's not emotionally stressful. That can have a similar effect on hormones. And then we can also look at acute stress, and that's like the thing that happens, that's the traffic issue or the travel or the family thing or whatever it is.
Lisa Hendrickson-Jack [00:27:47]:
And depending on where you are in your cycle, it could have a different impact. So if you are approaching ovulation and you experience a stressful event that's like an acute issue, then it has the potential to delay your ovulation. And so you could show signs that you're approaching ovulation, like see that cervical mucus flowing and et cetera. Think that you're ovulating or think that you're going to ovulate and then that stressful event can take place and your ovulation could be delayed for a couple of days or something like that. And so that's something to be aware of when you're trying to conceive, because sometimes, if that's what's going on, you could miss that window. And similarly, if the acute stressor happens after ovulation, then what can happen is it can have a negative effect on your progesterone levels and in order to have a healthy luteal phase. So the period of time between ovulation and your next period and that period of time should be about twelve to 14 days, generally in a healthy cycle. So if you have that acute stressor during that phase of the cycle, it can have an effect of reducing progesterone, maybe shortening that luteal phase, so it's not quite long enough.
Lisa Hendrickson-Jack [00:28:52]:
Or you could see some signs of low progesterone, an increase in PMS symptoms, or some spotting before your period starts, things like that. So stress can impact your cycle in different ways in your hormones, and it can have a slightly different impact depending on when it's happening in the cycle.
Erin Holt [00:29:09]:
That's helpful. And you had started this by talking about how we need to look at our menstruation and our cycle as like an overall byproduct of our health. And so when it comes to fertility, it's not always as simple as be like, oh, just take this supplement, or you just need to eat more of this one food, you just need more Brazil nuts. And then, you know what I mean? It's really like all of these factors play. And I know that can be so frustrating, especially for people who are on their fertility journey. But it really is true. We do not specialize in infertility. However, we've seen a lot of women and help a lot of women get pregnant, really by focusing on the health house foundations, eating enough, fueling your body appropriately, looking at the different stressors, whether those are physical stressors or more emotional mental stressors, the body perceives it all as the same.
Erin Holt [00:30:05]:
And so these are all things that we need to think about before we get. I know you're sperm obsessed, so I promise we will let you talk about sperm. But one question that we get often is about, and I'm sure you do too, is about hormonal contraceptives and birth control. So obviously, you're a huge fan of using fertility awareness as birth control since you've been doing it since you were a teenager. But I would love for you to speak into hormonal contraceptives and whether or not they have the ability to impact fertility.
Lisa Hendrickson-Jack [00:30:40]:
Yeah, and such a good question. And I mean, the conversation about hormonal contraceptives, I think when you're thinking about whether you're thinking about trying to conceive now or if you're thinking about trying to conceive in the near future, one of the things that we're encouraging you to do is to start thinking about how you're going to go about it. Because I think that as women, we make certain decisions for ourselves, often in our late teens, or we go on certain medications for different reasons. But then as our life progresses, we sometimes don't reevaluate those choices and we don't necessarily have the information to guide us on how they could affect us at all. So when you're looking at how hormonal contraceptives affect fertility, there's different ways you can approach it. So when we're looking at the research, you can look at what happens to the menstrual cycle parameters in general, when a person comes off contraceptives, like how long do they take to normalize? You can also look at how long it takes a person to get pregnant. And so what's interesting, there was a study that it examined over 200 women who had been on hormonal contraceptives. And so they had just recently come off of it, compared to about 200 women who had never taken hormonal contraceptives.
Lisa Hendrickson-Jack [00:31:54]:
And so when you compared the two groups, the group who came off, it took an average of about nine to twelve cycles before all of those parameters had normalized, to the point that if you were looking at the information for both groups, they would be indistinguishable. And so during those first few months off of contraceptives, the most common things we were seeing were the overall length of the cycle being extended. So delayed ovulation, short luteal phase, abnormal cervical mucus patterns and things like that. So that's something to be aware of. It doesn't mean that when you come off the pill, you can't get pregnant, because I think we all know that some women come off the pill and they get pregnant right away. Some women even get pregnant on the pill. But what we do know is that especially with long term use, and interestingly, in the research, long term use is defined as two or more years. It's wild because your average woman today maybe has taken it for five years or ten years or 15 years.
Lisa Hendrickson-Jack [00:32:51]:
And so the longer that you're on it again, if you meet that definition of long term, which the researchers say is two years or more, then what we know is that there is this temporary period of subfertility when we look at the time to pregnancy studies. So it's interesting because a lot of the time to pregnancy studies will say, there's no problem, everything's great, but there's a couple of things to know about when you're looking at them. So the first thing is that any woman who had any type of menstrual cycle issue prior to going on the pill, they're excluded from the studies. So if you had somebody who had irregular cycles or kind of a big problem, they don't even include those women in the studies. So first and foremost, another interesting piece of when you're kind of diving into the weeds with these studies is that they're often just looking at the twelve month mark. And so they're saying like who conceived after twelve months? Well, x percent of these women who didn't have any cycle problems conceived after twelve months, but they're not always breaking it down month to month. So there was a really interesting study that they compared women who had used condoms, so non hormonal methods, and then they started to try versus the combined oral contraceptive pill, the hormonal IUD, the shot, the implant. So a variety of different hormonal contraceptive methods.
Lisa Hendrickson-Jack [00:34:12]:
What they found was that the women who were using the combined oral contraceptive. So the pill, the most common, it took them an average of twice as long. So the women who had stopped using condoms, they conceived in an average of four months, and the women who came off the pill, it was an average of eight months. And so when we only look at the cumulative twelve month conception rates, we're really missing out on what's going on. After many, many years of being told that you could conceive at any time, to the point that most of us are absolutely terrified in our 20s, we definitely come off the pill thinking we're going to get pregnant. And so when it doesn't happen in month one, month two, we're already freaking out. And by month three and four, so a lot of women are already in the midst of some sort of fertility consultation and or treatment by the time they're at month six or seven or eight. And this information, knowing that there is this temporary period of subfertility, knowing that it can take longer, knowing that all of that information would equip us better.
Lisa Hendrickson-Jack [00:35:11]:
So this is like a long way of saying that our recommendation then, for women who are using hormonal contraceptives is to really start to think about planning ahead. So if you have the ability to plan ahead, if you never really had any significant cycle issues, like you went on the pill for birth control, you can't remember that your cycle was kind of weird or any of that kind of stuff, then we are recommending a minimum of six to twelve months. So come off ahead of time when you still need birth control. So have a backup plan and take that time to let your body come off of that and your hormones to normalize while you're also nourishing yourself. So those two things together. But if you had a history of cycle issues or you were one of those women who you didn't know when your next period was coming, or you had extreme pain to the point that you needed to be put on something all the time, though those could be signs of an underlying issue, and the pill simply masks those issues, it doesn't fix them. So then what happens is it puts you in a category where you're more likely to experience maybe a delay in the return of your ovulation, and you wouldn't really know that until you come off. So if you fall into that category, we suggest 18 months to two years, which sounds crazy, right? Like, it sounds like, wow, this is just such a long time, but I have car insurance and I don't want or expect to have an accident.
Lisa Hendrickson-Jack [00:36:33]:
And so our advice is simply to. We don't want or expect you to have any challenges with fertility. But if you fall into one of those risk categories, doesn't it just make sense to give yourself more time? If you have the ability?
Erin Holt [00:36:46]:
Yeah. And it's like setting the expectations, too, can be so helpful. So a woman doesn't spiral into shame, self flagellation. What's wrong with me? Something's really wrong here. It sets the framework of, like, okay, this might take up to two years, and that is still within the threshold of normal. So I think it just takes a lot of the pressure off, too. I also really appreciate and love what you said about reevaluating choices because I know from experience and talking to so many women, there can be a lot of blame or self criticism or guilt or shame about being on birth control. Like I didn't know back then, or you were a different person back then.
Erin Holt [00:37:28]:
You had different knowledge, you had different data, you had different choices, you had different. What's the word I'm looking for? Things that we want. Goals.
Lisa Hendrickson-Jack [00:37:37]:
Well, we can never go back in time. This is something you can imagine. This is something I hear a lot because most women don't discover fertility awareness when they're 18. Right? It's just not a thing. And so we all do the best that we can with what we know, and we can only really make those different choices when we have more information. And that's a huge part of having the conversations, like what we're doing now, to just kind of put that information out there. And in the book, I go so far, and in general, I go so far as to say that when you start approaching the age of 30, you should start to think about your birth control choices. I actually think that if you want to have, and this might be, I don't know if it's.
Lisa Hendrickson-Jack [00:38:14]:
You tell me if it's controversial, but I think that if you are at some point in your life, you're thinking, I think I might want kids. I think that when you get to those late twenties, you should actually start to think, is this still the right choice for me? Because the hard part is when we are in our 30s or our mid thirties, you don't have two years to get, you know what I mean? For your body to restore. So this is something, but your body might need it. So this is something that we want to start thinking about. I would encourage, and I'm not trying to bash the pill. I'm not trying to say it's bad. I'm trying to just be honest about the fact that there are these effects and your body sometimes needs time. And we know the pill depletes a whole slew of nutrients, the specific ones we need to build babies like folate and b twelve and selenium and all of these important nutrients, zinc, that we need for optimal fertility.
Lisa Hendrickson-Jack [00:39:07]:
So I think it's worthwhile to have this conversation and to really start thinking about as I get a little bit older, should I be looking at maybe non hormonal methods? Like, should I be looking at something else? Is this still serving me? Because no one tells us to do that. They only tell us that you can't get pregnant every day of your cycle. There's no safe days and da da da. But they don't tell us how our fertility changes with age and how this can have an effect on our ability to build our families as we get older.
Erin Holt [00:39:36]:
At the end of the day, it's just information. And then you get to choose what to do with that information. You get to make the choice that aligns with your needs in any given moment. But if we don't have the information, we don't have that choice available to us.
Erin Holt [00:42:03]:
Let's switch gears to talk about the male counterpart. I do not know a whole lot about sperm, so I know that there's sperm guidelines, and I would love for you to talk about, is that legit? Are those current sperm guidelines really optimal for conception, or what do we need to know about the male counterpart?
Lisa Hendrickson-Jack [00:42:26]:
Yeah, I mean, I think it's just such an interesting and important topic. And the reason that I am so obsessed about it, as you said, which is true, is that I can't tell you how many conception clients I've worked with over the years who have been trying to conceive for a while. And a while typically means a year or more, and they're told that their partner's sperm is fine. Which is my not favorite word. Fine. Everything's fine. Everything's fine. And I've even had clients who haven't.
Lisa Hendrickson-Jack [00:42:57]:
They've been trying for quite some time, and they go to ask for a sperm analysis, and they're kind of told, like, he doesn't need it, even though they didn't test it. Oh, my God. Yeah. So it's a problem, is what I'm saying. It's a big problem. And essentially, it's something that needs further investigation, I think, in most couples. So from a statistical standpoint, if you have a couple who's been trying to conceive for a year to two years or more, statistically, it's far less likely that a sperm is optimal. So when we look at studies that are specifically testing the sperm parameters of men who have been trying with their partners for a year or two or more, statistically, their parameters are poorer than the parameters of men who do conceive within a year.
Lisa Hendrickson-Jack [00:43:44]:
So that's the first thing a lot of people have heard, the kind of amusings, the stats that the sperm counts are declining. A lot of us have heard that, and it's really severe when you look at the research. So the average man, taken from a 1940s study, had a sperm concentration of about 113 sperm per milliliter. And the average man today has somewhere around 50,000,000 (five zero) sperm per milliliter. And so that's anywhere from a 60% to 70% decline over the last 60, 70 years. And that's huge. And if it continues in this downward trajectory, like, where are we going to be? And so in the sperm chapter, we've got a couple of tables. And so one of the tables, the current guidelines come from the World Health Organization.
Lisa Hendrickson-Jack [00:44:35]:
They released a document in 2010, and in that document, they're detailing what would be kind of the minimum amount. So this is generally used on all the semen analysis. So if your partner is above this number, then he's told that he's fine. And so, interestingly, then the sperm concentration outlined in the 2010 document is 15 one five. So if your partner. So, again, average amount in the 1940s, over almost 100, and, like, almost ten times, let's say 115, but 113,000,000 sperm per milliliter. So if your partner's sperm concentration is over 15, he's told that it's good motility, 40% motility, 40% or higher. So motility means the sperm is moving.
Lisa Hendrickson-Jack [00:45:22]:
So does that mean 60% aren't? And then 4% normal morphology. So normal morphology means if you picture a sperm in your mind, you picture like a circle and a tail, like a sperm. But what the abnormal morphology sperm, they might have like a mashed head or like a squashed head or missing head or two heads or whatever. So visually not appealing. If you meet the guidelines, four out of every hundred are normal, and 96 out of every hundred are, like, not okay. And so, interestingly, when I'm working with clients, I share some shots, some screenshots from this document of what the abnormal sperm looked like. And often when I'm presenting that information, it really clicks. Like, oh, my gosh.
Lisa Hendrickson-Jack [00:46:11]:
Even though he was told he was fine, we kind of intuitively are like, this is not fine. Another interesting fact about the guidelines is that they've changed multiple times. So we're on, I think, the fifth edition. And so they've gotten lower. They've lowered those parameters. So I think the important takeaway is that the guidelines are not intended to tell us what is optimal for natural conception. The guidelines are providing this kind of baseline where if you were lower than that, it might even be difficult to do artificial reproductive technology.
Erin Holt [00:46:44]:
Oh, wow.
Lisa Hendrickson-Jack [00:46:45]:
And to go further into the weeds about how they came to this number, I found it really interesting. So I found the paper where this information came from. And so they took over 2000 men and couples, but the couples, and they looked at how many of these couples conceived within one year. So then they kind of segmented all of the couples who conceived within one year. And then they measured the sperm parameters of the men. And so these guidelines come from the lower fifth percentile of all the men. So in the study, 95% of the men had better sperm than the one, like, than the number that we chose. So I think they do that.
Lisa Hendrickson-Jack [00:47:31]:
I think that when they're looking.
Erin Holt [00:47:33]:
Let me pause and interrupt. So of the couples that conceived within one year, these men had the method man, super sperm. They had more sperm than what the current guidelines says are good. Right.
Lisa Hendrickson-Jack [00:47:55]:
Basically, to try to explain it, it was almost 2000 men. Okay. And all of these men had successfully, like their partners had successfully conceived after one year of trying. Got it. So we are looking at the fertile pool overall. Got it. Okay. Within the fertile pool, they divided it into centiles.
Lisa Hendrickson-Jack [00:48:18]:
So back to math class, right? Oh, my God.
Erin Holt [00:48:22]:
Our math teachers are now rejoicing.
Lisa Hendrickson-Jack [00:48:24]:
They're so happy. And so we looked at the lower fifth percent. So that's where the number comes from. The lower fifth percent of the men that successfully conceived in a year. Okay, does that make sense? Yeah. So I know that it's getting a little bit into the weeds, but I think it's like when I explain this to my clients, their minds are blown because they're like, wait a minute, that doesn't seem like this would be the best number. And that's the point. The point is that the number that they use is not the number of what optimal would be.
Lisa Hendrickson-Jack [00:48:54]:
There was a different study that actually measured at what point did lower parameters start to decrease your chances of conception? So it's a different question. These researchers were asking a different question. And what they found was that they were able to identify what would be optimal parameters. So the optimal parameters that the researchers described in this other study, they had a minimum sperm concentration of 48 million sperm per milliliter. They had a motility rate of 63% as opposed to 40%. And then the morphology number that they identified was 12%. So what's interesting, so just to kind of repeat that, because I know I'm throwing a lot of numbers, so bear with me here.
Erin Holt [00:49:42]:
Yeah. People's eyes are glazed over of people who can't do numbers and math. But we can summarize what all this means exactly.
Lisa Hendrickson-Jack [00:49:50]:
But we have also women who've been trying to conceive and no one's ever explained this to them, 100%. And that's why I think that even though it makes our eyes glaze over a little bit. That's why we should hang out here for a minute. So basically, you have the men who are considered optimal. It's quite different to what the kind of baseline typical guidelines are. And I would argue that in between is what we could call the subfertile range. We could call that the gray area. So there's a lot of men who are going for their tests or sperm tests when they're having difficulty conceiving their partners and they're being told that they're fine, and that's the end of it.
Lisa Hendrickson-Jack [00:50:32]:
They're fine. But what we're highlighting here is this subfertile range that's not being discussed. This range that's like, you're not infertile, but you're not optimal. And no one's telling you. They're just telling you you're great. And when we can identify that, it gives us the opportunity to do something. Because what I always say is that there's no man alive that's so healthy that he can't benefit from improving his diet or taking some targeted supplements, like women are taking prenatal vitamins. He could take something.
Lisa Hendrickson-Jack [00:51:03]:
So this is the whole point. The whole point is that when you have a couple that's struggling, he's probably statistically not perfect, and we need to be looking at him, too.
Erin Holt [00:51:15]:
What you're saying is not dissimilar to taking a functional approach to traditional lab work. We're not waiting until the disease has taken hold. We want to catch you if you're suboptimal. We want to do the things, take the steps to get you into optimal range. It's the same exact thing. So, with that said, I don't want to keep you too much longer, but I know that everybody wants to know this next question. What are some of the things that men can do to improve their sperm quality?
Lisa Hendrickson-Jack [00:51:44]:
Of course. I mean, I always think of this analogy, like, there's certain things that make sperm worse. So it's like, if you think of driving a car, it's like the brakes are on, and then there's other things that can make it better. And so the foot's on the gas. So knowing some of the things that can make it worse. So if your partner has a semen analysis and it's particularly low, what I found is that there's usually some things. There's usually a couple of factors. So some of those factors could include, I think some of the biggest factors are like smoking tobacco and marijuana.
Lisa Hendrickson-Jack [00:52:14]:
And especially being in Canada, it's legal now, it's getting a lot more common. So there is a really significant association of cigarette smoking or weed smoking, or even, because some people would say, well, what about the edibles and things like that? And there is some research that would indicate that it could be related to the THC, at least in part. The smoke doesn't help either. So that's a piece of it. No one thinks alcohol is a health food. So in general, some of those pieces are important. You could look at overall diet quality. So consumption of highly refined processed carbohydrates, having poor metabolic health, high blood pressure, all of those kinds of things are also related to poorer sperm quality.
Lisa Hendrickson-Jack [00:52:58]:
And although men don't go through menopause and men are fertile from puberty onward, there is a relationship between a man's age and overall sperm parameters and sperm quality and even the level of potential dna damage. So those are a few things. That's not necessarily something you could control, but it is something to be aware of, because as men get older, then it would mean that they would have to, similar to, as women, pay more attention and make a bigger effort, concerted effort, to improve sperm parameters. There's a few other things I should highlight as well. I think one that people are less familiar with, but it's like a huge contributing factor. But a lot of people don't know is men who use testosterone or steroids. So testosterone, when you look at the research of men who are using testosterone, it has kind of a similar effect to birth control pills, like, it renders men sterile. And sometimes a man could have low testosterone and they go to a practitioner who gives them testosterone and not necessarily making the connection that it could be rendering him sterile.
Lisa Hendrickson-Jack [00:54:08]:
And the research is not the greatest on that, because for a percentage of men, when they come off the testosterone, it can take quite a while for their sperm production to restore. So there's a lot of different factors that we should be aware of, because you can just imagine that there are couples out there who wouldn't necessarily know that that would be playing a role. And maybe he's not even getting a sperm test, so we don't even know what's going on there. So that is other medications as well. So I think if your partner is on certain medications, you don't just go off medication, but to be aware that certain medications could contribute so that you can have that conversation with your practitioner. So those are some of the factors, I think some of the big ones, and then in terms of what you can do. So we go into just extensive detail in the book about the dietary choices that you can make. And so we're advocating for a real food diet that contains animal foods and plant foods and some of the foods that are associated with improved fertility for both men and women, because the interesting thing is that it's very complementary.
Lisa Hendrickson-Jack [00:55:14]:
The things that are bad for his sperm are not good for our eggs. And similarly, the things that improve his sperm quality tend to also improve our egg quality. So incorporating fish, particularly those omega three fatty acids, are really essential for both egg and sperm quality. Making sure that we're getting sufficient protein, making sure that we're incorporating some degree of animal fat, because animal fat contains cholesterol. And although cholesterol is demonized, that is the backbone of all of our steroid hormones. So in order to make testosterone, that's the precursor. And similarly for us as women, in order for us to make estrogen and progesterone and testosterone and even vitamin D, we need the cholesterol. So looking at those types of things, and for men in particular, the research shows that men who consume a greater degree of green leafy vegetables, high antioxidant foods like the berries and especially citrus as well.
Lisa Hendrickson-Jack [00:56:16]:
But men who consume a high amount of vegetables that are heavily laden with pesticides don't fare better. So there's a lot of interesting kind of nuances in there. And I have to shout out to organ meats. So I like to do a shout out to liver and organ meats because they are just packed with nutrition. And interestingly, just to go on a little tangent, because this was a really interesting study that I found, I pulled up the study and in the abstract, it basically talked about eating fish and kind of the mediterranean diet. And it was like these things were found to be associated with improved sperm parameters. And then I open up the full text study and I'm reading, and I noticed that they actually also had the men, like they were measuring the parameters of men who had also been consuming organ meats. And they found that the men who consumed organ meats had a significant improvement in their sperm parameters.
Lisa Hendrickson-Jack [00:57:09]:
And they just didn't mention it in the abstract at all, because it kind of goes against their probably preconceived notions and biases. It's just the whole thing. So, I mean, there's a number of reasons for that, I think. Not the least of which is liver is one of our main sources of vitamin a, preformed vitamin a, retinol, which is essential for both male and female reproduction, to the point that there are actually research studies out there looking at the possibility of interfering with a man's ability to process retinol as a potential contraceptive. So it's that important.
Erin Holt [00:57:47]:
Wow.
Lisa Hendrickson-Jack [00:57:49]:
So when they do animal studies, it's like when they take away the entirely take away the vitamin a, the rats stop making testosterone type of thing. So it's really essential. So I think that's not the whole reason. It's also really nutrient dense. Folate, zinc, all the b vitamins, all the things. I could continue, but I'll just stop it there. I think that the good news is that there's a lot of things. And then in addition to the diet piece of it, I'll just mention that we also talk in depth about some of the supplements that have been found to really support sperm quality.
Lisa Hendrickson-Jack [00:58:22]:
Things like coenzyme Q, ten things like lcarnitine. And a lot of these supplements are. They have antioxidant properties that really reduce the level of dna damage. Because when we're thinking about making a human, there's a lot of dna replication that needs to take place. But also, we're looking at supporting mitochondrial health, because when it comes to sperm and egg quality, it's a huge piece of the health, especially egg quality and sperm quality, it's a huge piece of that to support mitochondrial health.
Erin Holt [00:58:57]:
Quickie follow up cue. If somebody just can't stomach liver or refuses to stomach liver or organs, how do you feel about freeze dried supplements?
Lisa Hendrickson-Jack [00:59:09]:
Excellent question. I mean, we just live in such a great time where a lot of my clients hate it, but the good news is you don't have to actually eat it if you don't want to, because. Yeah. Supplement form, desiccated liver that come in pill form and things like that, it's the same. It's just in a different way. And the benefit is you don't actually have to consume it if you don't want to.
Erin Holt [00:59:29]:
Yeah, totally. Way more convenient. Going to pay more money for it, but it's a way to get it in. This was fascinating. Super helpful, packed with information, as we said, if you want more specificity and more information, if you or your partner or anybody you love is on a fertility journey right now, or you want to procreate in the future, this book is going to be a resource for you. So thank you so much for writing it, for spending three years working on it. And it's out now. As soon as this is released, it will be out.
Erin Holt [01:00:05]:
So we'll make sure we link it up in the show notes so you can grab your copy. Thank you so much, Lisa. You have so much information, I am not surprised that your book is 500 pages. We really appreciate you being here.
Lisa Hendrickson-Jack [01:00:20]:
Well, thank you so much for having me. This was a great conversation. You asked great questions, and yeah, this was a lot of fun.
Erin Holt [01:00:27]:
Thank you.
Erin Holt [01:00:29]:
Wow.
Erin Holt [01:00:34]:
Thanks for joining me for this episode of the Funk'tional Nutrition Podcast. If you got something from today's show, don't forget to subscribe, leave a review, share with a friend, and keep coming back for more. Take care of you.
