Episode 409: Trying to Conceive? This Fertility Case Study Is for You
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If you feel like you’ve done EVERYTHING to support your fertility journey, cleaned up your diet, worked on your gut health, taken all the supplements, tracked alllll the things and you’re still not pregnant… this episode will speak to you.
Erin and TFN Practitioner Nicole Antes are walking through a fertility case study for a client who came to them after trying to conceive for a year with a 16+ supplement routine that wasn’t necessarily supporting her body in the way it needed.
Together, they get into the downstream effects of overly aggressive gut protocols, hyper-fixation, nervous system regulation, and how easy it can be for TTC to feel like a full-time job. There were some subtle shifts that helped this client finally move the needle and get a positive pregnancy test!
In this episode:
The role of methylation, mitochondrial health, and antioxidant support in egg quality and embryo development
Why herbal antimicrobials can sometimes “kill the good guys” after aggressive gut protocols
How Dad’s health influences a healthy fertility journey, and how sperm quality can shift within 3-6 months
Why taking a month off from tracking could be the most supportive nervous system shift
The surprising thing this client did before finally getting a positive pregnancy test
Resources mentioned:
Real Food For Fertility by Lily Nichols and Lisa Hendrickson-Jack (see Chapter 9!)
Manifest Your Health is our neuroscience backed membership designed to help you reconnect with your body, regulate your nervous system, and finally break out of the symptom loop.
Subscribe to Erin’s Substack for a no-nonsense space about health, entrepreneurship, and manifestation.
Organifi Supplement Powder (save 20% on your order with code FUNK)
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Bon Charge (Use code FUNK to save 15%)
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Nicole:
Our mitochondrial health, our mitochondria is the powerhouse of the cell. I'm sure people know that, saying it's so important for our cellular health, for nutrient status, hormone production and egg quality. And so we also know that egg quality and embryo development requires really strong methylation capacity. So we had already been kind of working on ways that we could improve methylation. And it's also really helpful to focus on nutrients that are gonna be very supportive of methylation that are antioxidant rich, that are key cofactors for our mitochondria as well. So a lot of those things include N-acetylcysteine or NAC ala CoQ10. Those are really powerful antioxidants that can be really supportive of egg quality.
Welcome to the Funk'tional Nutrition Podcast, spelled with a K, because we do things a little differently around here. I'm your host, Erin Holt, and I've got 15 years of clinical experience as a functional nutritionist and mindset coach creating a new model that I call Intuitive Functional Medicine™ where we combine root cause medicine with the innate intelligence of your body. This is where science meets self trust. Your body already knows how to heal and this show is going to show you how. If you're looking for new ways of thinking about your health, be sure to follow and share with a friend because you never know whose life you might change.
Erin:
Hi, friends. Welcome back to the show. Today we're talking about fertility. Specifically, we're going to go over a client example that came to us who's trying to conceive. You guys really seem to enjoy these case study episodes and it's the thing that we get the most requests on more case studies where we're actually unpacking real world clients, like how they came to us, what we did. So today I have Nicole here with me to share about a recent client of hers. So welcome back to the show, Nicole.
Nicole:
Thanks for having me. Excited to be here again.
Erin:
So just a quick note before we jump into this. We are certainly not fertility experts. We don't market ourselves that way, we don't talk about ourselves that way. But we have seen a lot of healthy pregnancies. And honestly, one of the reasons that people come to us is for that reason, so they can support their fertility or get themselves in a really comfortable place to get ready to conceive, really work on their body of health before they attempt that. But I also want to note because I just think this is not discussed nearly enough when it comes to fertility and especially fertility challenges. There's a lot of emphasis on the woman and the woman's body. And today's case study will be exactly that because that's who we were working with.
But remember that it takes two people to make a baby. We've had Lisa Hendrickson Jack on the show before a couple of times, and I really appreciate how she will often discuss the male contribution and how crucial dad's health is. And specifically, sperm health is not really the point of today's show, but I do want to give a head nod to that. Just as a reminder, the full sperm production cycle takes around 74 days and changes to diet and lifestyle on dad's part. On the. The male counterpart really can be super influential here to improve sperm sperm quality and sperm DNA, and that can take as little to three to six months. So we want to make sure that we are supporting dad's health too. If you are on a fertility journey, we definitely work with men in our practice.
That's actually a question we get asked a lot because we market so much to women and we talk about the ladies all of the time. But we do work with men. And so if that's something that you're looking to do, we can certainly support you in that. I also want to recommend the book Real Food for Fertility Special. Specifically, chapter nine goes over how to feed yourself if you are looking to become a dad. So I wanted to shout that out, and now I'm going to hand it over to Nicole. Let's start by talking about what's a big thing that you see with fertility clients when you first start working with them.
Nicole:
Yeah. Something I see all the time with my fertility clients is that they're doing anything and everything. They're doing everything that they can do to support their body, support their health as they're trying to conceive. And I would also say that probably around 99% of our clients have already done a lot of the foundations. They've cleaned up their diet, they're on all the right supplements, they've worked with practitioners, yet they're still not better, or in this case, they're still not pregnant. So there's a lot of frustration around you're doing all the right things, but you're not getting the result that you're looking for. So I just want to talk through a case study because I feel like it's the perfect example of somebody that's doing everything. And it's not always about doing everything.
Sometimes it's about supporting your body in the way that it needs and simplifying, identifying and being targeted in that approach. So this specific client came to us trying to conceive for about a year. She had had a history of endometriosis. Thankfully, she was pretty asymptomatic, but she did recently, a couple months prior, have surgery for excision. Just preparing for fertility to make sure that that wasn't going to be impacting it at all. She also was at the point where she had been trying to conceive for about a year and. And she was thinking about exploring IVF. She really wanted to conceive naturally if possible.
So this was almost kind of like her last ditch effort of working with us, of like, is this going to happen for me? And she had also been working with previous functional practitioners in the past. She had done a lot of gut work, she had done a lot of hormone work up until this point. And when she had come to work with us, she had already been on around like 16 plus supplements at the time. So just a lot on her plate with the work that she had done, but also the things that she was doing every day to maintain the work that she had done.
Erin:
Well, 16 supplements. So when she came to you, she was on 16 supplements, like taking that many wild. And it really makes sense because, like, when you want something so bad, whether it's a full body of health or fertility, like, you'll do anything, you're willing to do anything, which is such a beautiful point that you're making. It's not that these clients aren't doing enough. It's like sometimes they actually need to simplify streamline, and maybe potentially even do less and take less pressure off of themselves too. So with this particular client, what was the first place you jumped in? Where did you get started with her?
Nicole:
Within our first appointment, I really sat down with her and I was like, you're doing a lot. You're doing a lot of wonderful things. But I can also see that this is creating stress. So where can we simplify? So during our first appointment, we talked through her supplement list. We cut it nearly in half, which definitely just help to remove some of that stress from her plate of just things that she needed to be doing daily. We also decided that this is a really good time for us to check back in on her gut health after doing a year of a pretty intense gut protocol. And so we had run a GI map and there was some interesting patterns that were coming back. There was a lot of positive change.
Her H. Pylori had been cleared, which is really important and especially in terms of just dysbiosis in general with bacterial Overgrowth, because those can definitely impact fertility. H. Pylori in particular, just really, any, any overgrowth of opportunistic bacteria can be really inflammatory to the endometrial lining. So especially with somebody with a history of endometriosis, we want to be doing anything we can to reduce that load of inflammation or anything that's going to be causing immune dysregulation. We had also found that she had very low beneficial bacteria, also what we call deficiency dysbiosis, which we do see that pretty commonly in practice after somebody has done a pretty intense gut protocol where they've been on antimicrobials or antibiotics or anything that going to be targeting bacterial overgrowth. And this is pretty significant. We know that our beneficial bacteria are really important for keeping inflammation in check, supporting the health of our gut lining, aiding in digestion, and also for supporting really robust immunofunction.
Again, kind of thinking about endometriosis, we want to be supporting the immune system as well. And there can be a lot of overlap in deficient beneficial bacteria in the gut, translating to low gut bugs in the vaginal microbiome as well, which I do want to speak into, because obviously those are our urinary, vaginal and gut microbiome are close in proximity. And oftentimes when we're doing gut protocols, it can definitely impact our other microbiomes as well. And obviously the vaginal microbiome is important when we're thinking about fertility. Like I said, it can be common to see beneficial bacteria trending a little bit lower, especially when protocols are either over aggressive or just when people aren't focusing on bringing in the proper support afterwards. Aftercare is just as important as all the stuff that people are doing during a gut protocol. The other thing that we saw was her digestive enzyme markers were very, very low. That's elastase on the GI map.
And so we could see that she wasn't breaking down her food well, which I think is pretty important because she came to us eating a really robust, amazing diet. She's like, I don't really know what else I could be adding in at this point. I'm doing it all. Which is true, she definitely was, but she wasn't digesting things properly, which is huge. If you are eating all the right foods, but we don't the proper digestive juices, that is absolutely going to impact how well we are able to absorb nutrients, how well our beneficial bacteria are going to thrive. So that was pretty significant. And then the last thing we saw on her stool test was that her secretory IGA was very low. And this is an immunoglobulin that lives within our gut mucosal layer.
And we do often see this depleted when beneficial bacteria are deficient as well, because our beneficial bacteria make up about 80 to 90% of our immune system.
Erin:
So it's like pro column. They clear the H. Pylori with whatever protocol that she was on. But then there was these downstream side effects, which are not uncommon, especially to Nicole's point, if a kill protocol is overly aggressive because the antimicrobials, even if they're herbal, which is what many of our clients come to us with if they worked with another holistic or or functional provider or a naturopath, we're typically using herbal antimicrobials that are like herbal antibiotics, but they can kill the good guys too. So we always want to use discretion with how gnarly we go with that. I've been literally talking about this for as long as the podcast has been a thing because we just see it so much. So I like how you describe it as aftercare, Nicole. When after we do put somebody on a protocol to get rid of some of the opportunists and or the overgrowths or the pathogenic bacteria, we also have to kind of stick around as practitioners to make sure we're doing damage control, make sure we're doing cleanup on the other side of that, which is why, you know, I've said this for so long, but we don't really believe in template medicine.
We don't really believe in just running labs and putting people on a protocol. I mean, like, hey, good luck out there. You know, like, this is the stuff that we're seeing so much as downstream side effects. So I appreciate you speaking into that.
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Erin:
It's interesting that you started with the gut because when people think about fertility, I think the first place they go is hormones. And we know how much the gut can really influence our hormonal health. But did you do anything specific from a hormonal perspective with her as well?
Nicole:
Yes, absolutely. We did start with the GI map, but we also did do a Dutch test. She had done some Dutch testing in the past, had also when she had done her original gut protocol with the previous practitioner, she had also been on a hormone protocol, which is likely why she ended up on as many supplements as she was on. And so we decided to take a look back at what was going on with her hormones and retest her Dutch test and the Second time around, retesting it, her hormone production looked much, much better than it had been in the past in terms of estrogen, progesterone, dhea, testosterone. So that was all really positive. But we were also seeing that her hormone production improved. She just wasn't clearing her hormones. Well, her methylation was very.
And we were also seeing that her body was favoring some more inflammatory pathways for estrogen as well. And then we were also seeing that in terms of her stress hormones with cortisol, she wasn't producing much and she also wasn't clearing it well, which does make sense. If our liver is struggling to clear out our sex hormones, it's going to happen pretty similarly with our stress hormones as well. So it just kind of was speaking into that. We needed to do some liver love, but we also needed to do more work on the nervous system side of things.
Erin:
And we'll get into some of the specifics in just a little bit. But I mentioned at the start of the discussion that diet can be a big factor in male sperm quality. How does nutrition and nutrient status factor into female fertility? And is this something that you had to address with her? I know you said she was eating a pretty good diet, but did you have to make any tweaks here?
Nicole:
Yeah, absolutely. Especially thinking about, yes, she was eating a good diet, but she wasn't absorbing nutrients properly because we were seeing those low digestive enzyme markers. And something important about pregnancy is that it's a very nutrient intensive process for the body. So we really want to be thinking about how can we optimize nutrient status ahead of time so that we can support healthy ovulation, healthy potential baby. So we do want to be thinking about making sure that nutrient levels are in the right spot as well. So we did also decide to run an htma, which is the hair tissue mineral analysis. And we pretty quickly saw that what her patterns were looking like on the HTMA was tracking with what we saw on her GI map in the fact that a majority of her minerals were suboptimal or depleted, Which I know seeing this testing was really frustrating for this client, reasonably so, because she was very intentional with her food and eating in a way to nourish her body. And this is how it really ties back into the absorption piece with what we had seen and the low beneficial bacteria that are going to be affecting how well nutrients are being absorbed.
And it can definitely, definitely become a vicious cycle. Which is why I really like to run an HTMA alongside of something like a GI map because we know that Minerals like sodium and cobalt are so important for building our digestive juices. And it kind of becomes this loop where we don't have enough minerals to build our digestive juices and then we don't have the digestive juices there to absorb the minerals. So we kind of have to intervene and really start to think about how we can build back nutrients and get digestive juices and flowing properly. I can share as well with her HDMA that her mineral ratios were pointing towards active stress, which can also increase how quickly the body is burning through nutrients. So this isn't just a digestive problem or an absorption problem. It's also about calming the nervous system so that her body is holding onto nutrients better as well.
Erin:
There's like this old. Is it a wives tale or. It's like an old saying, it's a tooth for every baby because it's not uncommon back in the day, especially for women to lose teeth after giving birth. As a female, your body's always going to prioritize baby. So it will take everything from mom that it can to prioritize baby and baby's health. And I remember after having. And keep in mind that I was a nutritionist when I was pregnant with Hattie. This is, you know, I like knew all the right things to do, but I was also a vegetarian and I do not, I don't think I was supporting my gut health.
I had my optimized it as much as I could. So my digestion was still pretty wonky and I don't think I was absorbing the nutrients and just probably wasn't eating all the right nutrients. I ate really well, but after having had it, I, I'm not surprised that that is when my health just went into an absolute crash crisis. And I just think that really prioritizing these things before going through pregnancy, which is such a huge demand on a female body, is. Is such a gift that you can give to yourself because it's really going to support your postpartum experience too. So it's going to support a healthy pregnancy, but it's also going to set you up for success on the other side of having a baby. And that's a real shit show. You know, that is a threshold you are walking through in so many different levels.
And I wish I had known then what I know now because I think I would have been able to set myself up for success and maybe not have had the immune crash and crisis that I did on the other side of having a baby. That's just my personal experience. I know, people really do love to hear specifics, and of course we can't. You know, this is one client that we were working with and we had her labs and we had her specifics in front of her. So this is not medical advice. This is not something we're saying like, oh, if you just do all of these things that we did with her, then all of your fertility issues will be solved. But just because I think people learn from through storytelling. Can you talk through some of the specific strategies that you did with her that really helped to move the needle?
Nicole:
Yeah, absolutely. I think pretty quickly we were really able to identify areas of her health that needed to be supported, which is why we did all the testing that we did. So we had the data and had something to go off of. Instead of adding in more, we were able to simplify and get more targeted, which is kind of what I was alluding to at the beginning of. It's not always about doing everything or doing more. It's about figuring, figuring out what your body needs, which is also kind of what you're mentioning of like, yes, we're going to walk through this treatment plan. That doesn't mean that you need to be doing all of these things. It's very, very individualized when we're working together.
So this is individualized to her specific needs. But there are absolutely a lot of foundational takeaways in here that can be really supportive for somebody who is trying to conceive.
Erin:
And I know you keep saying this, but she was already doing so much and she had already been through a gut protocol, she had already been through a hormone protocol. She was eating really well. This was not like you had to come in and build somebody from the ground up. This was just like a lot of like refinements, like subtle tweaks that you had to do with her to like optimize her health.
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Erin:
So you had mentioned on the GI map that you found low beneficial bacteria. How did you start rebuilding that with her?
Nicole:
Yeah, so she did eat really well. She was doing a really good job with plant diversity fiber. And so to take it another level beyond that, we did add in a targeted prebiotic for what her gut specifically needed. Sun fiber is a go to that I will often use in practice when several species are low in the gut. Just because it's generally well tolerated, it works well to cross feed a lot of the different species. But we also were focused on improving her digestive juices because her digestive enzymes were very, very low, which is to lead to maldigestion and can also negatively impact beneficial bacteria even when you are eating all the right foods. So we did this by focusing on targeted bitter foods, bringing in Digestive bitters, and also really making sure that she was eating in a calm state. When our nervous system is revved up, digestive juices and blood flow to the digestive tract are not going to be prioritized.
So that can also impact stomach acid, digestive enzymes. And based on what I had just mentioned with her hdma, we also got her on a targeted electrolyte blend based on what her body needed, since we know that minerals are so foundational for building digestive juices as well.
Erin:
I feel like I've said this a bunch in the past month. You know, I always talk about our body has this self healing capability and capacity, but in the gut specifically. But I'm like, in order to do that, we need healthy blood flow. In order to do that, we need healthy circulation. And so I appreciate you saying that, you know, stress and kind of a revved up nervous system to use your language can impact that. So that it's part and parcel with supporting the overall body. Now, when you had run the Dutch test, the hormone test, you mentioned some methylation issues. What specifically did you do there to support her?
Nicole:
Yeah, methylation is a biggie. Not even just for hormone health detoxification, but even fertility as well, because we know that methylation can impact egg quality, embryo development. So that was definitely that caught my eye when we saw that on her Dutch test. And so we really focused on getting specific with the plant foods that she was eating by prioritizing sulfur rich foods. So think like your cruciferous veggies, your broccoli, your cauliflower eggs, those sorts of things. We also focused on a lot of key nutrients that are cofactors for methylation. So nutrients that are needed to facilitate methylation, things like B vitamins, magnesium, choline, trimethylglycine, all of these nutrients are just gonna help to make sure that her body has the nutrients that it needs to methylate properly. We also were thinking about supporting bile flow.
We did that by bringing in digestive bitters, which are, have a lot of like bitter nutrients, dietary cholagogues, things that just help to kind of promote bile flow, which is really important not only for digestion, but also it's how we kind of package up hormones and toxins in the liver and send them to the gut for clearance as well. And then she was pretty fortunate in the fact that she had access to a sauna. She really enjoyed, enjoyed heated yoga classes. So we got her back into a solid routine with that to just help support detox pathways as well.
Erin:
When you mentioned B vitamins Magnesium, choline, trimethylglycine. Are those supplements that you were recommending to her, are you getting that through food?
Nicole:
Good question. Because she's trying to conceive. She was already on a really good quality prenatal that did have B vitamins in it, it had magnesium, it had choline in it. So she was, was covered mostly through the prenatal. But we were also focusing on foods. There's a lot of wonderful food sources for those nutrients as well that are also really important to be eating when you're trying to conceive as well. Kind of to your point of mentioning, when you were vegetarian, you lose out on a lot of your really good quality B vitamins and some other nutrients like iron, things like that. So we were also focusing on that through food as well.
Erin:
And then when you're optimizing digestion, you're going to also optimize the nutrition that you're extracting from the food. So. And then you had mentioned nervous system quite a bit. What specifically with her? And I know this is, this is really, really individualized because what revs somebody up is not going to rev another person up. So what did you have to do with her to help her prioritize calming down the nervous system?
Nicole:
Absolutely. I think one thing that I want to point out is that because this can be a biggie for anyone, not even just people trying to conceive, but I think in this, this type of population, we can really get hyper fixated on tracking everything because we want to understand what's going on with the body and optimizing things. And so she had been tracking everything really closely, which makes sense. But there also is a point where that level of focusing in on all the details and the shifts on a daily basis can create stress in the body. And our body doesn't just respond to the foods that we're eating, the supplements that we're taking. It also is responding to what we are perceiving. And so she had actually decided, without me even saying anything, she just kind of decided that she wanted to take a month off of tracking just to give herself some more space and take the pressure off of the stress of trying to, to get pregnant as well.
Erin:
It reminds me a little bit of weight loss. When people are attempting to lose weight and they're looking at the scale every day, every day, every day. It's like that can create, create such internalized pressure and even more stress on the situation. So sometimes I think there are some types of brains that do better. So maybe some of the More like linear thinkers or like, you know, people who do well with like math and engineering that might just do better with that consistency. But I think for the most part a lot of people can benefit from taking a little bit like eyes off the prize for a little while and give it some breathing room and, and allow their body to kind of relax. So that makes a lot of sense. Anything else that you did with her,
Nicole:
We also really shifted into like a few months into us working on her beneficial bacteria, digestive juices. We also started to think a little bit more about how we can support her mitochondria and egg quality, our mitochondrial health. Our mitochondria is the powerhouse of the cell. I'm sure people know, know that saying it's so important for our cellular health for nutrient status, hormone production and egg quality. And so we also know that egg quality and embryo development requires really strong methylation capacity. So we had already been kind of working on ways that we could improve methylation. And it's also really helpful to focus on nutrients that are going to be very supportive of methylation that are antioxidant rich rich that are key cofactors for our mitochondria as well. So a lot of those things include n acetylcysteine or NAC ala CoQ10.
Those are really powerful antioxidants that can be really supportive of egg quality. And there actually is an egg quality support that I really like from the brand needed that it has a lot of those ingredients in there. It's got pqq, it has egcg, it has ala, it has L carnitine, which a lot of those are really powerful anti inflammatory antioxidants mitochondrial support. So I do like to bring that in. And I also will often recommend needed has a sperm support that also has some really good antioxidants and mitochondrial support specific for male partners. So generally I will recommend that early on with good quality multivitamin for male partners as well. Because as you mentioned earlier, it can take a little bit of time for the things that we're adding in to have a beneficial impact on sperm, but also for egg quality as well. I always like to tell people that the egg that you ovulate in this cycle was created 90 days ago.
So things that you're doing now may not take full effect until 90 days later. So it's really good to bring in all these supports early on so that you're getting that kind of gradual build of benefit over time.
Erin:
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Okay, so you made some. Like we said, this was not like rebuilding somebody's health house from the ground up. There were some specific tweaks that she really needed support with. You guys laser focused in on those with these tweaks. What were you able to see with her?
Nicole:
Yeah, so fast forward into us working together. She was seeing a lot of benefits just in terms of how her cycles were feeling. Her. We got her luteal phase to be a little bit longer, which is important when thinking about ovulation. She was seeing improvements in like, energy, her cycle, all of that stuff. But she was also still in the process of getting her ducks in a row to start IVF because she still hadn't had a positive pregnancy test yet. And as she was getting ready to do that, she had had a longer cycle, which was unusual for her, and she decided to take a pregnancy test and it was positive. And I do want to be really clear that this isn't about.
We fixed everything in a few months because like you just mentioned, she had been on this journey for a while. She had been doing all of the things up until this point. I think what really moved the needle for her is us being able to figure out what her body needed and how we can simpl and support her body properly and just make her routine more realistic, more doable and just removing some of the pressure from it as well.
Erin:
I never not tear up whenever something like this happens because it's just so exciting and it's such a. It's such a beautiful thing to be a part of. So thank you so much for sharing that story, Nicole, and listeners. If you like more of these episodes, definitely let us know. Send me a DM on Instagram or email us and we will put together more case study episodes. I think that they're just really. I know we have a lot of practitioners that listen to the show, so it's probably helpful to hear how other people are, you know, going about their practice. But I just think it's really hopeful and inspiring to hear somebody's like, before state into their after state.
I know when I've been on my different health journeys, it was always really helpful to hear like, oh, it's possible. Healing is possible. Health is possible. This is available to everyone us and so can certainly create some more episodes. And if you are on your healing journey and looking for support, fill out the application to work with us in the show notes and we can get started with you. And maybe you can be on our podcast. Your win.
Thanks for joining me for this episode on The Funk'tional Nutrition Podcast but anyway, thank you so much. Please keep in mind this podcast, created for educational purposes only and should never be used. It means diagnosis or treatment. If you got something from today's show, don't forget, subscribe, leave a review, share with a friend and keep coming back for more. Take care of you.