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doctor said you gotta be serious now go on girl just lose some weight till i took the symptoms into my own hands and reversed them naturally so i became take control of yourself join your sister [Applause] hello sisters welcome to this episode of the podcast we have dr mark ratner back on the back on the podcast and today we're going to talk about fertility with pcos we're going to talk about dr mark ratner's experience with treating ivf patients as well as how to help women achieve fertility through natural supplements that are over the counter and much more for those that don't know dr mark ratner is a fertility doctor he is the inventor of acetol and therologics and uh dr mark reiner welcome back to the podcast thanks guys of course so uh we should just start off the podcast by asking you first could you tell us about your experience working with ivf patients who have pcos sure so um women with pcos who are hoping to conceive um are faced with the obvious challenge of not really being able to predict when they're going to ovulate okay if their periods are extremely irregular um trying to time intercourse um trying to figure out when they're fertile when they're not becomes near impossible um and so there's really two approaches that that one can take one can try to restore a more predictable ovulatory kind of schedule okay in which case if there are no male factors in other words if the if the male partners fertility is normal um you know in any given month here's a statistic that you may not know in any given month of trying where the male and the female the man and the woman both have normal fertility the chances of conception are only 15 to 20 percent so this is why we say when we say what's infertility you know is a couple infertile technically the definition is a full year of trying to conceive without a pregnancy um and so now that's basically when we then suggest okay go start seeing some professionals okay typically the first doctor that that is on the list is going to be the women's ob gyn but in the case of a woman who has pcos and extremely irregular ovulation irregular periods it's not going to be a mystery as to why she probably hasn't conceived and so one approach is to try and restore normal regular menses uh and have her ovulate on a very more much more predictable uh schedule um but that does take patience and so and it's not something that can happen typically as quickly sometimes doesn't happen as quickly as treatment might occur and and ovulation might occur in a fertility clinic now fertility clinics have basically two tricks that they use they're not really tricks two techniques um where they can put the sperm and the egg together okay um one technique is called intrauterine insemination they call it iui for short okay and iui is sort of a it's an upgraded sort of version of the old turkey baster technique okay basically you uh uh you put the woman typically is gonna be put on medication oral medication to try and stimulate ovulation and then when the woman ovulates a specimen is collected from the guy he produces a specimen they process that specimen and they inject it up through the cervix and into the uterus so it's intrauterine insemination um one iui cycle one attempt at iui um is usually going to have about a 15 success rate okay so in theory you may have to try for a few months of doing iui before statistically you may end up with a pregnancy okay um ivf on the other hand um for individuals who are sort of unfamiliar with what is involved ivf actually involves extracting eggs from the woman's ovaries and then taking sperm the guy gives sperm in a specimen and then in the lab the sperm and the egg are put together and once it's yeah so once they put it back together in the lab and once it's like successful there they put it in the woman's body correct okay typically what happens is i'm sorry i say it again sorry to break it down it's typically because the woman isn't able to ovulate and like release the egg herself yeah but they also want to try and increase the chances for a successful cycle so under normal circumstances when a woman ovulates she makes one egg each month that she ovulates one egg is produced sometimes it's from the right ovary other times it's from the left ovary okay rarely a woman might produce two eggs and if they both fertilize she's going to end up with fraternal twins not identical twins right but typical month a woman is going to make one egg okay when they do ivf they give the medication to women to the woman to make her ovaries just go into like crazy overdrive okay so that during that month that she's taking those medications her ovaries might make 10 12 15 20 eggs all at the same time they watch those eggs develop using ultrasound and then when the eggs are ready they extract them with a needle procedure a woman has to be under anesthesia for that um and so they extract those eggs now in the lab you've got 20 eggs and they're floating in a dish of fluid and under the microscope they either just pour the sperm into the same dish and let the sperm actually find the eggs and fertilize them on their own or there's a technique that's called ixy icsi intracytoplasmic sperm injection and what they do in the lab in that case is they take the egg under the microscope they hold it still and they put one sperm and they inject one sperm into that egg and so if you've got 20 eggs all you need is 20 sperm so the sexy technique is really good for guys who have extremely low sperm counts where you can only get maybe a few hundred sperm but whether you allow the eggs to fertilize naturally in the dish in other words under the sperm zone power or you inject the sperm typically you're going to get about a 70 fertilization rate so if you start off with 20 eggs you'll probably end up the next day with under the microscope you check them the next morning 14 of them have fertilized and then they put them back in the incubator and they check them 24 hours later and as the eggs develop over the course of several days you're going to lose a few along the way because now you've got embryos okay and maybe on the first day it's only four cells and on the second day it's eight cells and then by the third day it might be 12 or 14 so so the the embryo is is growing and typically they then wait until either anywhere from day three to day five of embryo growth and then take the embryo and put it back into the woman's uterus so that technique in in vitro fertilization ivf okay depending on the woman's age um the best centers around the country some some centers have fertilization and pregnancy rates between 50 and 60 of cycles will result in a pregnancy okay but it's it's expensive it carries certain risks there are drugs that you have to take by injection okay the fertility drugs for an ivf cycle uh the woman has to you know to take injections so ivf has some real advantages but it's not the only solution for women with pcos yeah i mean you you mentioned the 50 to 60 percent for some women they may be like oh that's like a i have a 50 chance of getting pregnant that's probably better than what i'm doing now but i think uh what's really important to highlight is like like being patient waiting for waiting for like things to come to fruition like results like being patient with what you're doing right well the the the key thing to to recognize here is that whether it's iui or ivf neither of those techniques address the underlying issues in women with pcos okay and so what are those underlying issues this gets back to the things we talked about in the last podcast okay insulin resistance excess testosterone in the bloodstream okay all of those metabolic issues um make um a pregnancy once it's achieved riskier okay so women with pcos is a perfect example women with pcos when they do get pregnant they've got three times the risk of developing what's called gestational diabetes okay now gestational diabetes means that late in the pregnancy the woman actually becomes diabetic okay and having pcos and having sort of pre-existing insulin resistance makes the risk of gestational diabetes much higher okay and so a woman who just goes through ivf and they don't think about the underlying insulin resistance they don't think a lot at all about these metabolic issues she's going to have greater risks and in fact it's been shown so for instance going back to the inositols a woman who says she's going through ivf a woman who takes ovatol and then continues ovatol and she takes the obasitol during the time of ivf not only are the chances of a successful ivf cycle better but if she continues it through her pregnancy her risk of gestational diabetes drops in half so addressing the underlying metabolic issues in women with pcos is something that is really important even when somebody even when a couple may be going through iui or ivf unfortunately the there isn't enough resources in mainstream medicine for the women with pcos to know that they can achieve fertility through addressing the underlying issues oftentimes they're handed birth control and then the next thing they're handed is clomid and then if that doesn't work they show up at the ivf clinic they run out of patients they're exhausted and maybe they had no idea that there were other solutions before this can you tell us about their experience once they show up at the ivf clinic and how you know how their process what their state is and what experience is like for them i i think the the safest thing to say is that it varies widely there are some ivf clinics that take a um a really well thought out um holistic and multi-disciplinary approach to women with pcos they have nutritionists and dietitians on staff um they you know they they talk about weight management and in fact there are many um uh ivf practices that that have bmi limits in other words they won't allow a woman with a above a certain uh uh body mass index to undergo ibf because of the increased risks um that's a bit controversial in the field um because yeah can you expand can you expand on why it's controversial because you told us earlier and like it's it's really mind-blowing when you when you hear about the statistics um well look it's controversial because there's data i think in both directions there's data that basically does say um that women who have a very high body mass index obese women have slightly greater risk of undergoing anesthesia okay they have uh greater risks of a poor response to some of these medications that have to be used and the other thing is that the chances of a successful pregnancy are lower for women who have very high bmi now the fertility world is one of the only specialties in medicine that actually sort of has public grading okay and what we mean by that is that there's actually a website and and you know any individual who's looking around for help in the fertility world should know about this website it's so it's called the society for assisted reproductive technology or sart dot org or jake and you go to the sart website and it'll say there's a one of the drop down menu says find a clinic and so you you drop down and you pick your state and it opens up a list of all the fertility clinics in that particular state and each clinic has to re has to report their data to sart and so you can actually compare let's say you live in a state and it turns out there's 12 different fertility practices in that state their data is reported in a standardized way so you can say okay women from the age of 26 to 30 what's their pregnancy rates and you can look at this clinic versus that clinic okay um one of the things that is the mark of a of a better fertility clinic is how what their rate is of what we call high order births now you know every so often there'll be a story on the news and there'll be like a big press conference at some medical center somewhere and there's you know a bunch of doctors and there's a woman who's now just giving birth to septuplets okay and it's like oh my god you know the babies are all in the nicu and everybody is doing well and everything and in the fertility world everybody is just shaking their heads and the reason is because that's a disaster okay it almost never happens naturally it's always because of poor fertility treatment so you know the optimum okay remember the octomom i mean it's a number of years already i think our kids are teenagers by now but yeah you know this is a woman who had ivf and gave birth to eight babies at the same time and she happened to see a crazy ivf doctor who put you know like six embryos in and two of them split and you know it was like really nuts so the point here is you can go to the start website and they will tell you how many of the deliveries how many of the cycles the couples that went through ivf ended up with twins or triplets it used to be that the mark of a good ivf center was how low not only their pregnancy rates but how low was their rate of triplets or worse in other words three babies four babies five babies at a time okay now we've reached a point where it's twins or worse okay you don't want the the the push in the ivf world at this point is singleton births in other words one baby at a time because the risk of a woman who has to to a woman having twins is significantly greater than having one baby at a time and then once you get the three babies four babies it's just off the charts so the point is um you can get all of this information from the sort website okay yeah um yeah clinic i'm sorry go ahead i'll just i'm just gonna mention so like when you consider that there is some sort of a website that has all the data that now the ivf clinics know that whatever results come out of their clinic is gonna impact the website so when they see a woman with high bmi or maybe um they're gonna know oh it's a higher risk oh if this doesn't go my way it's gonna affect our numbers it's gonna affect our possible i mean quote-unquote sales if you want to say that way yeah i mean that that that's that's a little more cynical view of it but but that in the back listen that has to be in in a consideration in the clinic's mind listen there's the other thing is this if you look at the sart data for most clinics when they and they break it down by the woman's age okay once a woman is past the age of say 42 okay 42 43 the pregnancy rate for for an ibf cycle is you know in single digits okay it's really low okay and so most if not every ivf clinic every every fertility practice has an upper age limit where they would allow the woman to do ivf with her own eggs and the reason is yeah your numbers are the pregnancy rate is so low it's just unethical to tell a woman yeah sure come on well you're 44 we'll we'll try and get some eggs from you and see if we can do an ivf cycle and get your baby you know the chances of that succeeding are tiny okay uh and so what typically will happen is uh past the age of 42 43 most ivf practices uh will only allow a couple to use donor egg okay um and then then there's an upper age limit for how old a woman can be before they'll say listen even with donor egg you know uh once you're past let's say i don't know 48 49 you know then you got to use a surrogate okay yeah you got to find somebody else to carry the pregnancy because the risks are too high so they're balancing all of these factors in an ivf clinic um and unfortunately women with pcos there's the additional consideration of their metabolic issues that underlie um you know their fertility problem so you can't look at it in a vacuum you have to look at it more holistically and and you know make sure the woman's taking a really good prenatal make sure the woman's vitamin d level is good um you know and again a woman who has pcos and wants to try and restore normal ovulation if she's in the hands of somebody of a of a physician or a clinic that is taking that sort of more global holistic approach and she's not pushing the age limit in terms of egg quality you know the problem is that once a woman gets past the agency 3637 you start to see a decline in the quality of the eggs that she's producing it's not that she won't produce an egg and ovulate it's just that the quality of the egg the genetic material inside the egg starts to become less reliable and so the ability of that fertilize and grow into an embryo becomes compromised that's why women over the age of 37 38 people think oh i'm 40 but i'm still getting my period that's not the issue it's not whether or not you're ovulating it's the quality of the eggs that you're producing each month okay so as i was saying when a woman is older like that and you got to be careful how you define older um but for women passing agents say 36 37 beyond that um uh you know you you don't have the luxury of saying hey let's work for six months to try and get your ovulation regulated um you know it's it's it's typically you know you want to press ahead um and women with pcos also struggle with egg quality and ovulation just like women who are over that age limit so are there supplements that they can take to help with their egg quality and i know there's a great prenatal supplement that can help while trying to get pregnant speaking of the underlying issues i think this is a perfect segue into like how they can actually get down to the real cause so i think most women who are thinking about conceiving are aware of prenatal vitamins um and this is particularly an issue for women with pcos the prenatal vitamins that if you go to the corner drugstore or you go to amazon and you look for a prenatal vitamin the prenatal vitamins that are sold for the most part are designed for women who are already pregnant the nutrient content of those prenatals includes things like extra iron okay because when you're pregnant as you get into your pregnancy you need more and more iron as the baby grows many women laid in their pregnancy become iron deficient okay and so you know the government's regul i'm sorry the government's recommendations as to how much iron intake there should be right uh on a daily basis is much higher for a woman who's pregnant than it is for a woman who's not pregnant and just getting her period every month okay um you know and then the iron recommendations for men who don't get a period every month and lose the iron that way are even lower okay sorry was that they're lower than the recommendations would be for a woman right i see okay yeah so the the point i'm getting at here is a woman with pcos who may be trying to conceive naturally okay using ovocitol perhaps to try and restore normal you know regular periods um she needs to be on a prenatal okay and we'll talk a little bit about some of the other nutrients that are typically going to be in the prenatal and why they're important but the key is she doesn't need extra iron in fact too much iron is going to be bad for her okay not only is it constipating but it can cause stomach upset there's even some data that shows that excess iron causes increased oxidation of the egg and damage to the egg so you don't want during a preconception time frame when you're not pregnant yet you don't want a prenatal design for pregnancy and virtually every one that you can buy on amazon or at the corner drugstore is designed for women who are already pregnant so it's got lots of iron in it and it'll typically contain dha which is an omega-3 fatty acid and dha is a perfectly great i mean you know it doesn't present any dangers um but the point is that it makes the prenatal much more expensive to have dha in it and you don't need the dha until you're pregnant okay why don't you do that like it's sort of a one-size-fits-all type of approach uh in other words what we did at therologics what we did a number of years back is you know we focused on the fertility market okay and what we realized was that women who are going through fertility treatment where they may be in treatment for three months six months nine months trying to conceive maybe they're going to go through multiple cycles of iui maybe they're trying to conceive naturally with intercourse they don't need all that extra iron they don't want to be taking a gestational prenatal we say a prenatal for pregnancy we call that a gestational prenatal because gestation is you know nine months during pregnancy and so we develop prenatal vitamins that are focused on women who are trying to conceive so it's got lower amounts of iron i mean this is especially important in a woman who's not getting her period okay if you're going months without a period um technically during those months you shouldn't be taking in all that extra iron you're not losing the iron because you're not getting your period um and so our prenatals are focused on on women trying to conceive and especially pcos women trying to conceive um and so then the question is are there you you asked a moment ago are there other nutrients that can help um uh with egg quality and and fertility and the answer is yes there there are um i will say that um the the nutrient that probably gets the most attention from obstetricians uh in terms of prenatal vitamins is what's called folate or folic acid okay um and the reason why folic acid or folate uh which is sort of the activated form of folic acid the reason why that's so important is because if if a woman is deficient in her levels of folate in her body the risk of having a baby with what's called a neural tube defect goes up neural tube defects are things like spina bifida okay and it was recognized probably 20 25 years ago that if you supplement adequate amounts of folic acid or even better activated folic acid which is folate um you can dramatically reduce the risk of having a baby with spina bifida so most obstetricians are focused on that but we've been trying for years to also try to get them to focus on vitamin d because a typical prenatal is only going to have maybe 400 units 800 units of vitamin d yeah and that's not just not enough yeah it's really important for ovarian function correct vitamin d absolutely it's not only important for ovarian function and for um and for uh women with pcos but once you're pregnant having a normal vitamin d level in your blood um is is critical okay so vitamin d is one of the only vitamins where you can go into your doctor's office and get a routine blood test to check your level of vitamin d in your blood we call that test at 25 ohd okay or 25 hydroxyd and it's inexpensive it's a simple tube of blood um and they basically can tell you whether your vitamin d level is super low or it's in the normal range and the point is that having a normal vitamin d when you're trying to conceive improves your chances for conception but then once you're pregnant having a normal vitamin d level lowers your risk of preeclampsia it lowers your risk of bacterial vaginosis these are complications of pregnancy it lowers your risk of a pre-term delivery of a premature birth okay so vitamin d is critical for normal fertility and normal pregnancy our prenatals because they focus again on the fertility aspect of things um our preconception prenatals have 2 000 units of vitamin d um which really kind of separate them out from everybody else's sort of prenatals and the gestational prenatals are we all we have prenatals both for before you conceive and then once you're pregnant and the prenatals that we have for once you're pregnant they've got 3000 units of vitamin d per day along with dha and other nutrients that are important once you're pregnant yeah so getting on a good prenatal um for somebody who's trying to conceive is absolutely critical you do not want to wait until you're pregnant this is a real problem that whole thing with folic acid and spina bifida that part of the baby's spine finishes development eight weeks in wow so by the eighth week of pregnancy the spine the spinal column is is finished sort of fusing and so the risk of spina bifida after eight weeks your folate level doesn't matter it's too late so you've got to have good folate in your system before that time so you need to start a prenatal when you're trying to conceive don't wait until you're pregnant it's a real problem a lot of women they walk into their obstetrician's office they haven't been taking a prenatal vitamin and they'll say i think i'm pregnant okay now that's not an issue with a lot of pcos patients but the point is you want to be on a prenatal before you can see yeah i love how you're it's like a very specific to the needs is it before getting pregnant or is it during the gestational period because you want to be specific to what you need you don't want to take everything under the kitchen sink just to get pregnant because it's not a lot of it may not be what you need and you're going to pay like an arm and leg extra when you could just get that one specific thing to get pregnant first and then move on to the next stage of supplements if absolutely one other nutrient i should mention uh getting back to your question soraka and that is a specific nutrient that can improve egg quality is coenzyme q10 coq10 um and this is especially important for uh women past the agency 35 36 because the um the decline in egg quality in the genetic material inside the egg the dna um that decline in dna quality can be slowed and the egg quality improved by supplementing with coenzyme q10 in the months prior to conception and so um our therologics our preconception prenatals is basically two of them okay there's one which is called core and it is one tablet a day okay it's got two thousand units of vitamin d it's got the a thousand micrograms of uh methylated folate um it has the amount of iron that you want prior to conception okay and it's one tablet a day and it's pretty inexpensive the other preconception prenatal is that same core tablet plus coenzyme q10 in a soft gel actually it's two soft gels with that core tablet so you're not only taking the core tablet with all those vitamins and minerals the d the folate but you're also taking coenzyme q10 to improve egg quality and so that prenatal is called ovivite that is intended for women over the age of 35 36 years of age so i see okay so if it was for someone maybe a bit younger whose egg quality might not be um as low they would go for something like theracore and then if they it's not there it's just it's just cool called core therian natal therinatal core core yeah and then ovivite is the one for uh women past the age of 35 36. either one of those uh would be perfectly uh uh sort of appropriate for a woman with pcos who's trying to conceive yeah um yeah and we should mention that when if they're logic has a great support line so if sisters if you want to call and ask them direct questions about the core versus overvi and where you are like they'll be very happy to help you with uh with you support you through your pregnancy process yeah yeah there's also melatonin correct melatonin yeah now you know i was gonna i was gonna bring that up but you know sometimes it seems like oh my goodness you know there's all these different things you know which ones could i take him which shouldn't i take um yeah so melatonin you know everybody always thinks about melatonin as being just for sleep you know i'm gonna take some melatonin because i can't get to sleep at night right um and melatonin is a really interesting uh compound technically it's a hormone melatonin is actually produced in our brain we make our own melatonin and um technically it's intended to sort of make you sleepy and your brains start to make melatonin when the light level drops and you're supposed to get sleepy from it and go to sleep um melatonin is also a very strong anti uh oxygen and anti-inflammatory um and just as totally sort of parenthetically a complete aside here um it has dramatic benefits in immune health and a study was published two weeks ago by the cleveland clinic which you know the cleveland clinic has this huge health care system in ohio and so over the course of time since the past six months they've done something like four hundred thousand coving tests and so they took all the data from those hundreds of thousands of cobit tests and they did this computer algorithm and extracted the data to see which patients that came in for a covet test had a positive test and you know had had coping and who didn't and what were the risk factors and what they discovered was people who were taking melatonin had a 32 reduction in risk of testing positive for covet so i mean and and actually then they even stratified it further individual african americans had a 52 risk reduction so melatonin does some very cool stuff but one of the things it actually does is it helps egg quality and it's been shown that um melatonin plus inositols um are better than inositols alone so melatonin is pretty inexpensive stuff i mean you can yeah we make a very high quality melatonin it's called serotonin uh you may be seeing the pattern here of thera a lot of a lot of thera products but uh and it's actually very important to um to look for a a a high quality product there was actually a study published two years ago uh out of uh a university in canada where they went out and they bought i think 30 melatonin products in north america uh you know so it's all over the counter and they had them tested and they found something like 70 of them were mislabeled um that the amount of melatonin in each dose was incorrect not what they claimed on the label and like something like 25 of them were contaminated with serotonin which you do not want yes especially in a pregnancy or a fertility time frame so you want to get if you're going to get a melatonin product and actually if you want to get any type of fertility supplement or prenatal vitamin that's over the counter you want it to be independently content certified yeah okay so because yeah the supplement industry uh has more than its share of fly-by-night bad actors and so there's two programs i might have mentioned this in the last um podcast there's actually two non-profit programs in the united states that will certify the content the the content accuracy and purity of dietary supplements so one of those products is i'm sorry one of those programs is called usp and the other one is called nsf okay therologics we were actually the very first company to ever go into the nsf program 18 years ago um every one of our products goes to nsf content certification and so i believe our serotonin is the only melatonin product that's independently content certified in the united states so that's something if you're going to go to the drugstore and you're going to look for any kind of dietary supplement you really should restrict your your choices to something that either has the usp logo or the nsf logo on it is that great advice yeah you're getting what you think you are yeah it's amazing do you have any other questions no that was that's a great overview of fertility ivf and the other options that women with pcos have yeah the ins and outs like the struggles that a lot of people go through when they when they um go through ivf clinics as well as supplements that people can buy over the counter from their logics for those listening we'll put the links in our bio or in the podcast description and you can use our code for 15 off on those products but i mean it was a great episode thank you dr mark grander for explaining everything so well like always take care guys talk to you too bye if you enjoyed listening to this podcast you have to come check out the sisterhood it's my monthly membership site where sisters just like you are learning how to move through the stages of pcos from stage one cold and alone at the doctor's office to stage five nailing the pcos lifestyle gluten and dairy free get ready to finally feel in control of your body again