[00:00:00] You are not someone
who falls apart. You're the one that handles it. You research everything,
you're tracking, you probably have a whole bunch of tabs, like me, open right
now on your desktop. You wake up at 3:00 AM, your mind is going, and you just
start the day. You're training hard, maybe you skip some meals, you run on
coffee.
You say yes to everyone, and rest? You don't have time for
that. If anyone asks, you would tell them your stress is handled 'cause you
feel fine. You did the therapy. You meditate. You're fine. What no one told
you, this isn't a personality. That's a nervous system that's been in high
alert for years, and it does not announce itself as feeling stress.
It shows up further down in your sleep, in your thyroid, in
your progesterone, in the environment your ovaries and your developing eggs are
in The diagnosis was handed to you. The low AMH, the failed cycle may be
sitting downstream one system that nobody measured. This episode is the seven
things a standard workup never [00:01:00]
checks.
I'm Sarah Clark, and this is Get Pregnant Naturally. A quick
thing before we get into the seven, if this show has helped you make sense of
your numbers, validated what you already knew was missed, and given you some
information to make informed decisions and be your own advocate, please leave a
review. It helps other women find the show and helps them be their own
advocate.
Here's who is reviewing your picture if you book a call with
us. I'm Sarah Clark, founder of Fab Fertile. I had my own journey with
fertility, had both my kids with donor eggs. Years later, discovered functional
medicine, functional nutrition, being able to help couples be their own
advocate and make changes to help improve the chances of pregnancy success.
This podcast has got over one million downloads. My functional
fertility team works with couples navigating low AMH and failed IVF and
recurrent pregnancy loss, high FSH, diminished ovarian reserve. We look at
functional lab testing, the stool, gut microbiome testing, the DNA of your
stool, food sensitivity [00:02:00] testing.
I've said it a lot, but we have people that are intolerant to
lettuce. If you have food sensitivities, that can impact the health of your
ovaries. Vaginal microbiome, we talk a lot about this on the podcast. Not just
about you doing one vaginal microbiome test. We need to go upstream looking at
the gut microbiome.
If you've got bacterial vaginosis or UTIs, anyone on the
fertility journey, pregnancy loss, we've got to look at the vaginal microbiome.
But we don't do it in isolation. We see a lot of infections there. Also, the
seminal microbiome. Nutrigenomics, different than the karyotyping you're gonna
do at the fertility clinic.
Being able to customize this. I see a lot of people taking a
boatload of supplements, spending a lot of money, and then just following
generalized recommendations, doing a Mediterranean diet, a carnivore diet,
which is better than the standard American diet or the standard Western diet,
but maybe it's not right for you.
People doing vegan, not getting enough protein. It's very
customized and we don't just take a approach that's generalized. Our bodies are
all unique. Looking at hair tissue mineral analysis, low [00:03:00] nutrients or toxic overload. Looking at
the Dutch test, you can see your adrenals are flatline. You're just going.
They're flatline. It's supposed to go up in the morning, the
cortisol. Down at night, you're getting a second wave. You feel like you're
gonna clean the house at 10:00 at night. So it's important to be able to look
at some of these things in black and white so we can just know. Toxin testing,
so You've got toxins.
We're in a toxic soup right now. We're all exposed to this, and
that could be impacting your endocrine system and the blood work for you and
your partner alongside the nervous system. It's not, "Oh, we're gonna do
the food sensitivities and the gut microbiome, but don't worry, I'm fine from
the stress side.
I already got this." I'm gonna tell you, the people that
tell me that they're fine are the ones that are not fine. Just because you're
coping, you're not in the corner crying and not functioning, does not mean your
body, the physiology, is not impacted. We help identify patterns that may not
have been considered, and we work alongside your medical team, not instead of
them.
So here's the seven. This is physiology, not a mindset issue.
Your body runs on a hierarchy, survival first. [00:04:00]
Your body will deprioritize your reproductive health to keep you alive. It's
not a choice. It's just what the body does. The stress axis and the
reproductive axis sit on the same place in the brain and share the same wiring,
so if one is running hot, the other gets turned down.
So a 2017 review in the International Journal of Molecular
Sciences concluded that activating the stress axis su- suppresses reproduction
at every level, from the brain down to the ovary itself. Here's the catch for
you specifically. The researching, the tracking, the second-guessing, the
switching protocols, the feeling you're running out of time, that's not
diligence.
That's the alert state itself, and you've been doing the thing
that keeps the system switched on and calling it being proactive. And I know in
times of stress, I will go into complete action mode, like so much action it's
craziness, where sometimes I just need to give it over to someone else, to let
it sit for a moment, and be able to see, okay, what is it that's triggering me
here and what do I need to then work on?
It's hard [00:05:00] when you
are type A, you're a doer, you're, you're the person that they go to to get
things done. Especially in this piece, you're trying to figure it all out. Yes,
there's testing, and yes, we have data, but the nervous system was potentially
could be driving all this. We need to look at it, not something in isolation
and just focus on one thing.
It is multifactorial. When someone tells you your stress is
normal, ask what they measured. A single cortisol blood draw is one dot in the
moment. It tells you almost nothing. We look at Dutch testing, the cortisol
over the 24-hour period. It's over the course of the day, which should rise in
the morning, get you going, then taper down so you can sleep.
If it's under years of low, that's gonna flatten or it flips
low in the morning when you need it up, up at night when you should be having
your beautiful sleep. That's the wired but exhausted pattern. Dragging all
afternoon, a second wind at 10:00, you're cleaning the house and then awake at
3:00. It does not show up a standard workup, and that's the physiology side of
this, and you're [00:06:00] trying to figure
everything out, but your sleep is a mess, and you already know it's a mess, and
you probably have an Oura Ring, you have the Inito, you're tracking all this
stuff, and sometimes that just makes it worse.
It's not about beating yourself up. This is making small,
impactful changes that can actually shift the needle on this. Number three,
your thyroid looks fine, but it's not. Done a lot of episodes on the thyroid.
I've talked extensively about the thyroid, and yes, I have a thyroid problem
and so does my mom.
A lot of times it runs in the family. Just because that's your
genetic predisposition does not mean that's your destiny, and so maybe you need
more support on that. Stress can impact your thyroid, and just looking at the
TSH number and everyone says, "Hey, your TSH looks great." No one
looked at the full thyroid panel.
No one looked at the antibodies. Maybe your reverse T3, we like
it below 15, maybe yours is elevated 'cause of the stress, but the TSH stays
normal the whole time, so so many women are told their thyroid is totally fine,
then the thyroid symptoms continue, and that could be what's impacting your egg
quality [00:07:00] Number four, your stress is
competing with your progesterone.
Sometimes you do need progesterone cream. Sometimes you do need
hormones. But the cortisol and the progesterone are built into the same raw
material, so when your body's under constant demand to make cortisol, demand
gets the first call on the supply, and progesterone is what's left over. This
is one of the patterns we see behind short l- luteal phase and early loss.
It rarely gets investigated because the focus stays on the
reproductive numbers instead of the system pulling the raw material away from
them. Progesterone is often the first hormone to move before AMH or FSH show
anything at all. And yes, progesterone cream can help, but why is your
progesterone reducing?
We need to look at that. If you wanted to get all this in
writing with the markers behind each one, we have a guide called What Your
Clinic Missed. It'll walk you through it. Send me a message at
hello@fabfertile.ca, subject line, "Missed." We'll send it over to
you. That's hello@, @fabfertile.ca, subject line, "Missed."
Number five, the 3:00 AM wake-up is not anxiety. We see this a
lot with our clients. Waking up [00:08:00]
between 2:00 to 4:00 in the morning with your mind racing and you've been told
it's stress or anxiety or it's just how you are. You're an anxious person.
Maybe it's your physiology. It's your blood sugar. It's dropping overnight.
The body releases cortisol to bring it back up, and the
cortisol spike, spike wakes you up. It's physiology, not a character flaw.
You've got to take medication. Sometimes we do need medication. We're not
against it, but we haven't gone down to see exactly what's causing this. Maybe
you need a little snack at bedtime.
Maybe you need protein and fat. Making sure you're not having
screen time an hour and a half before bed. You need to do a whole bedtime
routine. We work with people for months on your sleep hygiene. It is the
cornerstone of good health and fertility. We all know this. And if you've
struggled with sleep, you have probably tried everything.
But it is small, impactful steps which we see all the time with
our clients that sleep can improve, and that's gonna impact your whole life and
the health of your fertility journey. Looking at a continuous glucose monitor
to get the blood sugar aligned can be one of, one of the first steps. [00:09:00] The marker got flagged and then dropped.
A lot of women in this position have a prolactin result that
came back mildly high. The MRI was ordered. It came back clear. The
conversation ended, but prolactin is held down by dopamine, and chronic stress
suppresses dopamine. Stress p- physiology pushes the prolactin up. We see
prolactin raised a lot with people.
Even a mild elevation can suppress ovulation and lower your
progesterone. Mildly high MRI, n- normal, no medication. Cause, and then nobody
asked the next question, which is, "Why is it elevated?" It could be
your nervous system. Again, we need to be our own advocate, look deeper, and
see what's being missed.
Number seven, is it inside your ovary? The nervous system is
not just affecting your ovaries, it's inside of them. This is the one that
changes how you think about the whole thing. In 2005, researchers at UC San
Francisco mapped close to 100,000 cells in human and mouse ovaries. They found
that the fight or flight nerves, the same ones that fire when you are in alert
Mode [00:10:00] run in dense networks right
through the ovary.
And those networks get denser with age. When they switch those
nerves off in mice, it changed how eggs were held in reserve and recruited. And
the nervous system is not near the ovary, it's wired into it. This is also when
sleep comes back in. I know with the melatonin you're told to take it to
improve IVF, but we need to see why is your melatonin low to begin with.
So we may wanna take it, but we need to also look to see why
it's low. It's one of the main antioxidants protecting the egg as it matures,
and it concentrates in the fluid around the developing follicle. When the cor-
the cortisol stays high at night, the melatonin stays low, and that protection
drops. A small 2025 trial in women with low ovarian reserve found that
melatonin lowered oxidative stress in the follicle and improved the quality of
the eggs retrieved.
Stress has been linked to lower ovarian reserve markers in
studies, but those are associations, not proof that stress alone set the
number. The nervous system is active inside the ovary, and it's one of the few
things upstream of [00:11:00] egg development
that you can actually change. The point on all of this is you can make some
changes.
That high stress job working 50, 60 hours a week serving other
people is no longer serving you. It's not about quitting your job. It's about
having an honest conversation with yourself. Why are you burying yourself in
work? Why are you accepting these long hours in this stressful position that is
not right for you right now in this time?
You've got- stressful relationships that you need to protect
yourself from. Whatever is driving the stress. You're in your 40s and you feel
like the window is closing and you feel in a panic. People in their... Get
pregnant. Obviously, the older you are it's gonna reduce. You don't want to be
blind to your age, but we can have someone in their 40s that is very healthy
and someone in their 20s that's not.
We need to see what's driving the stress. And I've talked about
this before with the nervous system. It's getting little glimmers of safety.
It's not about it being safe all the time. You're in this perfect little bubble
of no stress. No, that's not practical. But what is driving it? You got to
journal.
Maybe you need to meditate [00:12:00]
to think about this. But many times people are meditating and journaling and
doing yoga, but the physiology of your body is still on high alert, and that's
why doing that piece doesn't always work. You're over-tracking and that's
causing you stress. It's small steps. Yes, it can be meditation.
Yes, it can be yoga. Yes, it can be heart math to be able to
look at your heart rate variability. And so yes to all of that, but maybe
you're just in the hypervigilance stage where you're just feeling such on high
alert trying to figure this out. You did not fail with all this. It's like a
lot of times then we're gonna be like, "Oh, it's my fault.
I need to not be so stressed." So it's not about beating
yourself up. The therapy, the breathwork, all the meditation, none of that was
wasted, right? Because you've probably done a lot of that. But it was working
on how the stress feels. It was never gonna move a flat line cortisol curve or
an elevated reverse T3 or the progesterone that was being pulled toward the
cortisol.
Those are ph- physiology. We need to be able to have some
strategies to help with this piece. And then when we go into an IVF [00:13:00] or an egg retrieval, we can improve the
chances of this working. So if you're listening thinking that, hey, no one's
ever looked at this for you before, or you already knew something was going on
with, this is just validating what you already knew, and you wanted to have
someone take a peek at this for you and give you some strategies to help for
your specific case, this is where the functional fertility second opinion comes
in.
It's a call where I review your full picture, your blood work,
your blood sugar if you've got that, any labs that you have, and then for you
and your partner, and we can develop a action plan to help improve the chance
of this working and to be able to support your nervous system and help you make
a informed next decision.
So email me at hello@fabfertile.ca, subject line fertile.
That's hello@fabfertile, subject line fertile. Or go to the show notes, click
on the link in there, and you can book a call with your partner, upload your
labs, and we'll give you some options to help. And make sure you subscribe to
this podcast so you don't miss an episode.
Take care.
