The Impacts of Mental Health on Infertility with Nora Pope, FCP & Dr. Jessica Liu, ND Ep. 52

Today, we're talking about the intersection of mental health and fertility. As of 2017, upwards of 1.9% of all infants born in the United States were conceived using assisted reproductive technology, a otherwise called ART. Studies of those who have undergone ART reveal that upwards of 54% of couples experience depression and 28% report clinically significant anxiety and potentially even higher numbers of lasting post traumatic stress disorder. The relationship between our emotional well being and fertility is complex. And today you are going to walk away with a greater understanding of the following. First, what is the relationship between stress and fertility ptsd? Next, what can you do to relieve symptoms from PTSD related to fertility? How does cycle charting fit into fertility ptsd? And how your cycle can give you information about healing from stress and fertility PTSD. Welcome to the get yout Life Back podcast. I'm Dr. Nicole Kane. Today I'm interviewing Dr. Nora Pope and Dr. Jessica Liu, experts in cycle charting, progesterone, HRT and fertility enhancement. They are the founders of fertility continuing education and can be found on Instagram at Fertility Cell. I loved this interview, and I think you will, too.

And which naturopathic school did you go to? I'm just curious, Nicole.

The Southwest College of Naturopathic Medicine. Yes. What about you two?

The Canadian College in Toronto.

Yeah. Awesome. That's amazing.

Yeah.

Great school. Really great school.

So exciting.

And I love that you're having conversations about mental health. I find that oftentimes a lot of clinicians who don't specialize in mental health, they feel uncomfortable even dipping their toe in the water. And it's often, well, I'll refer out for that. Or it's oftentimes questions on message boards. What can I do to stop anxiety? It's this need to help the person move past their emotional suffering as opposed to exploring the why behind the emotional suffering. And so I love that we're having this conversation today about fertility, PTSD and cycle tracking and how we started this entire conversation looking at men. You know, I feel like they're often forgotten when we have a conversation about fertility. And a lot of the focus is on the woman, on the person who's going to and tempt to bear and carry the child. But thinking about how it can impact men in the process and even after the process, I think is really important.

Good points. Great.

Yay.

So what I would love, I would love to learn a little bit about what got you interested. Each of you interested in this topic to begin with? Can you tell me a little bit about your stories?

You go first.

I like Your story?

Yeah. No, I read an article in Toronto Life magazine written by a woman called Linda Lee Tracy. And it was thinking about her process of becoming a mother. And she had quoted a feminist in the article called Martha Crean. And I loved what Martha Crean had to say about reproductive health. It was very holistic, very natural. So I phoned the magazine and I said, could I get, you know, my name is Nora Pope, and please give Martha Crean my name and number. Martha and I met three days later, and then she introduced me to the Fertility Care center in Toronto. They were looking for board members. And I go cycle charting. Mucus. Ooh, what's that? Cervical mucus. Anyway, make a long story short, I was in exhilarated by learning about cycle charting. And this was back in 1992, I would say. And then. And so. And then I started naturopathic studies in 1998 at the Canadian College of Naturopathic Medicine in Toronto. And I just did a poll. I said, raise your hand if you know whether or not you're fertile today. And I was the only person in the classroom who raised her hand. No one knew about cycle charting. I said, alrighty, let's get. Let's get going. And so I've been advocating cycle charting for naturopathic doctors since 1998. And then I started teaching courses, and then Jessica Liu and I became business partners in 2020. And now we're just. We're going gangbusters and we're surfing the waves and we're getting the word out. And we've. We have, you know, hundreds and hundreds of registrants who are healthcare professionals all over the world, including naturopathic doctors, of course, medical doctors, pharmacists, nurse practitioners, occupational therapists. And the pharmacists have been great. We want to get the word out that fertility doesn't necessarily mean making babies. Fertility means it's women's health. And so we want to make it media friendly so we don't go, ew, cervical mucus. We call it white flow. And when you have a period, won't go, ooh, menzies. We call it red flow. We want to make it media friendly. And we must say, this is a photograph of a healthy woman. She has five days of red flow, five days of white flow, and anywhere from 10 to 15 days after her red flow. We call it the rule of five. And we want to get this out there so it's at the tip of everyone's tongue when they're doing an intake with every patient in the world about their cycle. And it's a fifth vital sign. It correlates to good cardiovascular health, bone health, mental health, and not just reproductive health. And so I don't have any. I've never been pregnant. But I'm very passionate about this because when you explain this to your female patients, you will know very quickly whether or not they're healthy. And so it's a wonderful tool for healthcare professionals. So there. That's my spiel.

Very good.

I'm here because of her. I was already a practicing ND and my story is every possible negative result that could happen reproductively to a person. I felt like I went through, through that. You know, I was lactating at age 19 for no reason, and no one could figure that out. I had crazy cystic acne, the worst menstrual pain. You know, when I had my babies, I was lucky enough to be able to deliver them naturally. You know, I think I was 8 cm and no drugs. And I'm thinking this is not even as bad as my menstrual pain. When I was growing up, it was, you know, and that was just normalized for me. Post pill amenorrhea, post pill pcos. And so I went on in my naturopathic profession to basically try to heal myself and in doing so, realize that there's such a need for this for women. And we're just not told we have any other options other than the birth control pill. Right. And then I met Nora. A few, well, we went at a doula course actually in 2005.

We met. So that was 16 years ago.

Yes. And it was love at first sight. Just saw this brilliant woman and we're so passionate and aligned. And then fast forward a few years later into my practice. I took her cycle charting course several years ago and it changed my life, it changed my practice. I hit the ground running the next day. And the impact that it's been able to have on my patients and my success rates with patients and even just their owning that awareness, so empowering. And we want to do this for girls. We want to do this as soon as they start having their menstrual cycles. We want them to honor that and normalize it and be able to tune in and not jump to thinking about the birth control pill as the automatic choice to deal with things that come up. So that's sort of our mission here.

I think that's brilliant. And I like that you come together from two kind of different perspectives. Like Dr. Nora, you, you're child free and you're educating and you're passionate and you're supporting people. And so you're coming at it from this perspective of we're not women because of our fertility. This is a greater conversation that you're bringing to the table. And so I really, really admire that because I feel like oftentimes women's health is based upon, well, have you had children? And how was that? And that's when we start to look at hormones. Is either when our symptoms are so bad, like you were just describing, Dr. Jessica, is when our symptoms are so bad, we investigate it. Otherwise we kind of ignore it unless we're looking to have children. And then, Dr. Jessica, I love that you kind of bring to the table this experience of going through these hormonal challenges with the menstrual pains and that you are able to bring to the table being a mother and what's involved in that. So it feels like you two kind of have this beautiful balance so that you can support women from both ends of where they're coming from to get this education and wisdom. Yeah.

Match made in heaven.

Match made in heaven.

We're having a lot of fun as well. And the power of teaching practitioners is that now we can help not just, you know, a few patients, we can help thousands of patients together as a community. Right. So we have amazing doctors and NDs and nurse practitioners, practitioners that we can connect with right away. I recently just had a patient from California hear about us on a podcast. And she's like, can I work with you? And I said, you know, in Ontario, we can't work with patients, unfortunately, outside of the province. And I was so happy to be able to refer her to one of our practitioners in our community in California. And we know that they are aligned with that cycle awareness and restorative approach. You know, we're not trying to band aid the symptom. We're actually trying to, like I see in your. Your language on your website is yay that you have symptoms, because we can use that as our guide to dig deeper into the root cause and treat that and restore with properly timed interventions. So because your symptoms get us excited.

Yes. And I love that. That wisdom of looking at our symptoms as opportunities to heal, and I love that you're doing that. I was so eager to learn a little bit more about the fifth vital sign. You mentioned that, and I was curious if you could expand on that.

Well, just, you know, any. Any frontline healthcare worker, when they're assessing someone's health, they're going to look at the basics. The basics. So what Is their temperature? Do they have a fever or not? What is their heart rate? You know, so is the circulation all right? Are the tissues staying healthy with oxygenated blood? What is their pulse? You know, so is there, is there integrity in the, the vessels? So what else are they?

I'm running out of respiration.

Respiration. So can they breathe? Is there diaphragm working, blood pressure and blood pressure. And so these are basics. And then for women, what is the menstrual cycle like? Do they have five days of red flow, five days of white flow, and a 10 to 15 days after that, you know, the white flow ends, which is correlated to ovulation. And if yes, that means good, she has healthy estrogen, healthy progesterone, and that's going to, you know, give her protection for her health throughout her life until menopause. So anyway, so that's, it's basically, it's the meat and potatoes of how you assess someone. And so I'm very sad when I hear my patients or my former patients, I closed my practice a couple years ago, but they would say to me, oh, I'm so lucky. My period's only two days long and aren't I lucky since I have barely any period at all. And I'm thinking, well, you know, so let's work on that. If you don't have two days of red flow, that means you have very low progesterone, you have very low estrogen, you have potential for osteopenia, you have a potential for depression, you have a potential for brain tumors because balance hormones are highly correlated to protect you against cancers. Cardiovascular health, metabolic, bone health, musculoskeletal conditions. On, on it goes. Neurological conditions like epilepsy and Ms. So for me, it's not about making babies all the time, because women don't make babies all the time. But you want your health all the time.

And the power of the cycle chart for a woman to own that part of her life, right? So I know for me, when I'm in my pre ovulatory phase, those are the weeks I try to capitalize on. Getting in my good workouts and making sure, you know, I'm booking meetings, I'm thinking about projects, and then once I flip over to my post ovulatory phase, I know within myself that's my yin time. I need to slow it down. I need to self care. Maybe I'm doing more journaling, maybe I'm tuning into meditation and yoga and protecting my sleep a little bit more. Because I know for me, my Little bandwidth for stress kind of dips a little bit when I'm in that phase. And so now you have this. We are cyclical beings, so why wouldn't you want to know that critical piece about your life that's every two weeks there's a shift. Right. Or roughly. Right. We know that not every woman will ovulate on day 14. And that's the other beauty of it. I have a lot of women who have unfortunately suffered miscarriages because they were not aware of their fertile time and it wasn't the right time for them to conceive. They were not optimized in their health. And so these are some of the things I think about in avoiding that stress. Piece of. If you know your cycle well, you can be very proactive about your days of fertility and also honor your days of infertility equally.

Can you teach us a little bit more about cycle charting and what actually is happening throughout the menstrual cycle throughout the month?

Sure, I'll jump in and then go for it. Yeah. So the first day of your menstrual cycle is the first day of your bleeding. Oh, can't say. Oh, bleed bloody. That sounds violent. So red flow. Your first day of red flow is the first day of your cycle. And ideally you want five days of red flow. Typically three or four days is either heavy or medium flow, and usually the fifth day is a light flow. Then with some women, they may have some dry days. When I say dry days, is that when you're wiping from front to back, you're going to experience maybe a draggy feeling and that's considered a dry day, meaning the blood levels of estrogen are still low and they haven't had a chance to turn on the cervical crypts in the cervix to produce that white flow, which is an estrogen driven white flow, which is full of sugar and it changes the PH of the woman's environment and can keep sperm alive for many, many days. Incidentally, a woman's white flow is the same as a man's white flow. So you can't say seminal fluid on tv. They get very jittery. When I talk to high school students, I talk about boys and girls, white flow in seminal fluid. It's also very. Lots of sugars, lots of fructose, lots of zinc, that man's mineral, lots of potassium, and it's very alkaline, meaning it's very slippery. Imagine if you dip your hands in a bucket of water with some bleach in it, you have that slippery feeling. Because it's alkaline. Men's white flow is also slippery. And this aids in the passage of sperm to enter the woman's body and travel all the way to fallopian tubes. And those are considered days of fertility. Back to the cycle. You have that five days of red flow, you have a few days of dry days, and then when you're wiping from front to back, it's no longer draggy, it's slippery. And that means your body's producing that slippery, alkaline, sugar rich, nutritional white flow. And you're going to feel it when you're wiping. It's very, very obvious. Ideally, it's about five days of white flow and that coincides with a growing follicle pumping out estrogen. Estrogen circulating around the body and peaking estrogen blood peak will basically create a critical mass of estrogen to trigger luteinizing hormone to rupture that follicle. Boom. The next day it's dry. And that correlates highly with that severe drop in estrogen which triggers lh. That peak day of estrogen is highly correlated to ovulation within about a 24 hour range. Then after that, the follicle has ruptured, it's hatched the egg. As the egg is traveling down the fallopian tube, that ruptured follicle shrinks like a yellow raisin and becomes a yellow body producing progesterone. Progesterone is very drying on cervical mucus. Basically it's estrogen free, it's progesterone dominant and the cervix is closing. And basically that signals the end of your fertile days. Then the role of progesterone is to work in concert with estrogen to secure the lining of the uterus like a nest. So estrogen hatches the egg, progesterone builds the nest, and you want that yellow body or that corpus luteum pumping out progesterone for 10, 15 days, rule of five again. And then if you're not pregnant, if there's no hormonal changes to prolong the production of progesterone from the corpus luteum, you have a period and then the cycle begins again. So lots of events coinciding with those wiping observations that you do morning, noon and night, they're real time observations and you record them at night. You can record them on an Excel spreadsheet. I was taught the Crate and Model fertility care system. So we have charts for that. You can also record on your phone electronically, but it's real time observations. Your observations and you tell the technology what you're recording, you start again. Then after three months, you see patterns emerge.

Oh yeah.

I've only got a four day period or a three day period. Oh, yeah. I've only got two days of white flow. Oh, yeah. My post, you know, peak day is only eight days or sometimes it's 16 days. And you, you get a lot of good information and then it's really good for testing.

Yeah. And we have, you know, I have patients coming in and they, they, they just. There, there's a disconnect with their bodies. Right. They're putting all of their reliance and their trust in an app. And there's been studies that show that half of them don't get it wrong. Right. Because you're basing that information on last month's data. Whereas who knows, maybe you took a trip, maybe you got stressed, maybe you lost some sleep. And that's going to shift your hormones and you're going to miss that window if you're not paying attention every day in real time. And so a lot of the time is just getting our clients comfortable with the idea of checking in with their body. You don't have to dig around for it. Gravity should pull it down and you should feel that slipperiness, that change on wiping. It's very elegant. You don't even have to look at it. You should know just by feel, it's a 3D observation. As Nora often says, this is time honored. This is proven to be effective. Three months of cycle charting and fertility awareness using the cervical fluid method, you know, over three months can increase your chances of a successful conception by up to 90%. So taking away. And that's, that's free. That's, that's available to you every day. So there's power in that.

That's fascinating. And 90% is an impre. It's an impressive statistic.

Right?

Yeah.

And you were comparing. I loved the comparison with white flow between men and women. And so we know in the medical community that there is this cycle of fives that you're talking about in a woman's cycle, generally, give or take. Is there any sort of a cycle with males who are tracking fertility and looking at white flow?

Oh, they're hormonal every day, those men, I tell you, just like, like, holy moly. But I actually, I want to jump in, you know, so men, men are hormonal or have high libido, whatever. Many days. Women have libido anytime in the cycle. I think this is very important. You would think that there'd be more research in women's libido based on their sometimes sex obsessed culture. But anyway, this is. There was a study done in the 1960s in England and back then to say sexually active woman, you'd say married woman. That was the custom of the day. So libido in married women, and this was the conclusion. You can have high libido any day of the month. There was no correlation between white flow and libido, or red flow and libido, or dry days in libido. It was very, very interesting. So like with some women, when they get their period, the release of hormones actually is a relief and they feel great and they have high libido in some women. Rising estrogen gives them that confidence. Rising libido in some women during a dry day, towards end of the cycle, they have maybe slightly rising testosterone, increased libido. So that's the good news with cycle charting. So women are hormonal and have high libido any day of the cycle. And as for men, do you want to comment on men?

To be honest, I think the only time that I do ask about libido, always for men, because that's their fifth vital sign, right? So like when, when their libido is compromised, then you need, you need to start digging. Is there testosterone low? Is there DHEA low? What's going on in their life? Is there a backstory? Is there depression, anxiety in the back end?

Diabetes. Diabetes, yeah.

So definitely something, something to consider. But I think, you know, if you Wikipedia seminal fluid, there's a lot more written about that than cervical mucus. So we need to do better there for sure.

I love that and I challenge our listeners if there's anyone listening who is interested in research. Here's a topic run with would sell really well.

Oh, yeah, you know what? So we do, I mean, you know, if we had nine lives, we would build a Wikipedia page on cervical fluid and we would honor the physiologist Eric Odablad. He died maybe two, three years ago in his 90s and he had a PhD in physiology and he got the Swedish prize for developing MRI technology. And he used MRI technology to study the cervix and study the different types of fluid in the cervical generically. But there are different, I guess, permutations of this flow. Some of it has different types of channels based on the time in the cycle, different types of actions. And he went into a lot of detail in this technology and he deserves pages and pages on Wikipedia and he's not there. Eric Odeblad O D E B L A D He's a lovely man and, you know, may he rest in peace. And he, we deserve, we should, we should do that for him. That'll be our 2022 project.

So I'm going to ask you about that. A lot of our listeners are dealing with stress, anxiety, depression, ptsd. And so tell me a little bit about how cycle charting can help with understanding that and maybe even as clinicians help in diagnosing that.

Yeah, I mean, I would say 30% of my patients have the diagnosis of unexplained infertility and that already carries with it a huge degree of stress. You know, medically they're told, oh, there's nothing wrong with you. That doesn't make them feel better. They want to find an answer, they want to know why. What's wrong with me? Right, Is the question circulating in their head. And when I started doing this research, you know, in my practice we do something called a heart womb connection. So with every single one of my patients, they can't get away with it without doing this. It's like getting into the spirit of connecting with yourself again because through that, through that stress of all the labs and the poking and all the needles and it can become very overwhelming for our patients. Right. And so, you know, I was shocked to find out that, you know, for patients dealing with any stage of fertility, but you know, particularly IVF, it's like 50% of patients qualify for the diagnosis of PTSD and that is far above the national average. In Canada, it's about, you know, 10%, 6 to 10% of patients qualify for the diagnosis of post traumatic stress disorder. The stress is so intense that it is the same degree of stress as if they were getting a severe diagnosis of cancer or going through something like a heart attack. It's under serviced. We are not providing enough of a safe space and support for our families that are going through this. It's the long duration, it's not just one single event. It's grieving month after month. It's all the needles and the poking and the blood tests and the ultrasounds. It's the grieving every month. It's cyclical, it's repetitive. The long treatment cycle. There's so many nuanced layers to that stress. What we may not realize, it has actually a direct impact on sperm and egg health, quality of the lining, implantation, receptivity, inflammation. There's so many ways that stress can directly impact our physiology. So we have to think about that and we have to support that and treat that right from day one.

Yeah. And I think in terms of cycle charting and stress, I think the number one question you're always asking at follow up appointments is what's changed, what is different, what is the same? The cycle chart is a nice visual record of what's the same number of days or what's changed. It's a nice progress tool as well. Then also it's very grounding for the patient because they're getting to know their body. I think here I want to focus a bit on the stress of those fertile days. I think depending on where you are in your life, if you're a younger woman or a younger couple and you, you know, not ready to start a family, those days of infertility sort of have higher value, shall we say. And then when you're a bit older and you want to start a family, those days of fertility have higher value. And I think what's important is that it forces the woman to compartmentalize her health, which I don't think is ideal. You want to appreciate the fifth vital sign day in, day out, and that the days of infertility are your friend and the days of fertility are your friend. And they're your friend because you don't want to be fertile every day and you don't want to be infertile every day. And then when you start to embrace a natural cycle and the natural peaks and valleys of your hormones and the absence and presence of white flow, it's all good. And then there you take the pressure off because the dry days are healthy. You want those dry days and actually you want to really love those dry days as much as the days of fertility if, when you want to start a family. And I think that's that. That message took me a long time to register when I was taking the training and all this, you know, methodology, it, it's so important, but it's part of being a woman.

And in terms of the connection between the couple, you know, as, as Nora alluded to, when you're older, that fertility imposition is placed, that pressure is placed on the man. It's like, let's go where I'm fertile, let's do this, perform. You know, it's very difficult. You know, it's, it puts a strain on the relationship. And I wonder if a woman could relax into her non fertile days knowing that these are important days to build up to those high estrogen days, then those are days to really honor that connection, honor, playfulness, spice, intimacy in a different way, and take fertility off the table, that's equally valuable for both parties. Right.

So, yeah, I think the stress is important, too. You know, we see in the literature that oftentimes when people stop trying, that's when. When they get pregnant. And so I think you're. You're really hitting the nail on the head in terms of both parties. You know, traditionally, male and female trying to conceive is how that stress reduction can make a giant impact. And we know about the relationship between cortisol, which is an adrenal hormone responsible for the stress response, in part, and how that can impact inflammation. And then, of course, inflammation impacts your endometrial lining and your hormone production and metabolism. And so I think that's a really interesting point that. That you bring to the table and another thing that you're describing. So we're looking at cycle charting to help us with understanding and diagnosing stress and fertility, ptsd. And so I'm kind of imagining if somebody has an Excel spreadsheet and they're like, okay, I'm looking at red days, I'm looking at white days, and then I'm assessing my other metrics, you know, other vital signs. And with measuring stress and maybe even PTSD in specific, how would you recommend that people start to gauge that throughout the month?

Yeah. So again, let's go back to the beginning. Let's say you chart for the first three months. So a wise word is when you don't know what's going on, always go back to the history. So some women know about their cycles for decades and decades, others don't. So at least you start with the first three months. And what. What is their template? What is their benchmark? I should say. And. And you ask them. I say, okay, in this. In the last 30 days, describe your life. You know, were you traveling? Did you have a lot of deadlines at work? And you. And then you look, you see if there's a correlation saying, oh, okay, then this next month, I went on vacation actually, and I had a lot more white flow. So immediately you can start connecting, you know, the change in life, change in schedule, change in attitude, and the change in what we call those biomarkers. And so because stress will give you limited white flow and limited red flow, and. And in some cases, stress can give you spotting, spotting, spotting, spotting, spotting before your period because your progesterone is declining. So think of stress as low, like low estrogen and low progesterone. I think that's the easiest way, you know, the quick and dirty way of saying it.

Sure. Yeah, yeah. Cortisol has such an impact even on basal body temperature. Right. You might see somebody with peaking cortisol levels in the morning. So they're waking up at five in the morning and they can't go back to sleep. And so as a clinician, even before we get to menstrual cycle hormones, it's what's happening with your sleep. For me, that's another vital sign. Right. And you don't let insomnia run rampant. You have to treat it. Even something as simple as considering maybe melatonin is something here, because A, I love it. It's a dual impact. It preserves progesterone in the luteal phase. It's very concentrated in the follicular fluid, so it helps with egg quality and it can help to protect at least the initial part of insomnia to get a better sleep onset. These are things that are going to have a direct impact on white flow, on basal body temperatures looking a little more regulated. And you're going to see that shift month over month. Right. So people get really excited when they recognize that the things that they've been empowered to do on their own are making a direct impact on their chart.

I was wondering if you could share an example, maybe from your clinical practice or conversations that you've had with people where they used cycle charting to help them with fertility ptsd.

That's a really good question. Let me try to think here.

I know I kind of pulled that out. I didn't help you with that one.

No, no, that's okay. I have a client who. And just to say that it's such a complex issue because a lot of the time there's a chronicity. Right. So you're not necessarily going to see it within the one cycle. It's sort of over. Over three cycles. What's happening? Is there a gradual decline in their red flow? Is it looking kind of thinned out? Right. Is it, is it not as blood rich? Is it more cloudy over time? Are they seeing dryness and that. Actually dryness or reduced white flow is a PTSD trigger for a lot of our fertility patients. Right. They're so obsessed with that. Oh, my God, I only had one day of white flow. Well, it's not impossible to conceive with one day of white flow. It's not optimal. But the more important thing to treat before you get to the white flow is their stress. Right. So we, for a lot of these patients, we back right off on all of the minutiae of all that. It's all about self care. It's all about, are you protecting your sleep? Are you setting healthy boundaries? How are you approaching family members who are saying, when are you guys going to have a baby? All of these things need to be protected and honored first. Before we even go to, well, let's start putting in some B6 for your cervical fluid. Because if you don't connect them with their bodies and recognize that the things they're thinking are directly impacting their hormones, then you're going to lose them. You're not going to see those shifts in the cycle. You have to be careful about how, I guess, tuned in, your patients need to be with their chart when they've got so much else for, you know, flooding their mental health system and their nervous system is so stuck in fight or flight that the very first thing you have to do is you got to get those stress hormones down. Because that is the one sort of commonality between you might be mildly stressed or you've been in fertility PTSD for years because you've been trying in multiple cycle failures, what have you. The common thread is hypothalamic, pituitary, adrenal dysregulation, long term. But basically you're stuck in fight or flight or a freeze response. And they're coming in really overwhelmed, really down. And that, that you have, you have to support right away.

And that can be an obstacle, so an obstacle to them achieving their goals. And so when you have your clients come in, you kind of start at those foundations of health and you're getting an idea of what's happening with their cycles. They're getting awareness of their bodies. They're mindful of, okay, I had poor sleep. And then I noticed this over, you know, the three month cycle.

Exactly.

And so in terms of obstacles to cure or obstacles to them having freedom from fertility ptsd, it's, it's challenging. Right? Because if they're still going through fertility treatment, how do you, how do you mitigate those obstacles?

Yeah, well, I think I liked what you said about sleep, Jessica, but also, I think, and this is very seductive for a clinician, you say, okay, we're going to help your estrogen, we're going to help your progesterone. And really, especially as a naturopathic doctor, you want to step back. And for me, what was very interesting is the high incidence of asthma, eczema, psoriasis in my infertility patients. And then I had a special interest in neurology in my practice for many years. So I sought a lot of women with epilepsy and then I, and I saw a lot of autoimmune, you know, conditions like rheumatoid arthritis. And so step back and you treat the whole person, you treat the whole enchilada. And I noticed, especially with one patient in mind, she had, you know, what happened was she came in, her skin was quite clear when we started working together. And in about. And it took three years for her to get her and her husband to get pregnant. And about a year and a half in, she got the worst flare up of psoriasis on her eyebrows. She says, I haven't had this since I was 10. You know, return of all symptoms. And I say, okay, don't fight it. No steroids, please. We're just going to keep working at it. And as soon as the flakiness start and the itchiness started going away, that's when she got pregnant. Because she was also using certain medications, you know, low dose medications to restore her health. But it was, for me, I thought that was so homeopathic and naturopathic to really work from the inside out and the outside in, so to speak. So I think that's important. And also in terms of asthma, like the good old basics, people with asthma have low stomach acid, for instance, and they, you know, just by eating three meals a day, it's a very allergenic, you know, experience. So how do we make it hypoallergenic for them? So you have to think about that. You think about mind, body and soul. And that gets esoteric. So I don't know about you, Jessica, but when I was in practice, sadly, my patients want to know about the supplement and the schedule and the herb and this and that. Very hard to talk about spirit. So I do, I do a quick spiel. I'd say, okay, spirit, this is spirit. Because what's. What does that mean? Spiritual. I'm spiritual. What does that mean? So this is my. I would say this to most patients, okay? Don't forget spirit. What's that? Okay, spirit, Spirit. If you have no spirit and a body, it's a corpse. And if you have no spirit and a soul, it's a ghost. So don't be a corpse, don't be a ghost. Be. Be a body with a soul. Just. And I would just command them and I'd write it down on the plan because we had 30 seconds to talk about spirituality. And I go, okay. But it was so beefy that definitely they would think about that because there's a lot of walking wounded out there who are going through the Motions, they're grieving in private. They're very, very sad. And they're almost ghosts and they're almost corpses. And we don't want that. We want vital, happy patients that are vibrant with a soul and a healthy body.

I think for a lot of my patients, too, they are coming in, as Nora said. They've already Googled all the supplements, right? They're already on that perfect diet. They're eating organic, they're doing all the things, they're tracking their cycles. But they're missing that deep sense of trust in their body. And so part of it that I work with is I do a lot of Chinese medicine. And in Chinese medicine, the spark of conception cannot happen unless a woman's heart and her womb are connected. And what does that even mean? It means that she aligns herself with who she is and what she values at her core, regardless of whether there's a baby in her life. And somewhere along the way, she's forgotten that. She's forgotten that she has a purpose, to actualize and be the best version of herself, the most aligned version of herself, to do things that spark joy, that have nothing to do with her fertility or nothing to do with any outcomes in the journey. Because really, they're coming in and they don't. They don't care about any outcome other than that positive pregnancy test. Like, that's the goal, right? So you say, hey, you're sleeping better, you know, you're eating great, your BMI is coming down. Like, they don't care until they get pregnant, right? So it's just a reminder to them that they need to still stay grounded in who they are, because that's when the fight or flight hormones start to come down. And I do a lot of somatic therapy in my practice. So there's a lot of getting on my table, doing some body work, connecting with their breath, doing some containment, physically, very simple things, right? How do we teach a baby that she's secure? We support their neck, we support their back, we have their back, right? We cradle them, we swaddle them. Grownups need that, too. So a lot of times in my prescription, it's like we're taking baby making off the table, and they're looking at me like I have two heads. And I said, this month, you're playing with each other, you're finding intimacy, you're cuddling each other, you're touching skin to skin, face to face, chest to chest. And that's all I want you to do this month. Because when you activate your pleasure centers, Your stress hormones come down, your egg quality goes up, your chance of conception increases. And if you can honor that, and then they realize, I can. I can do that. That's not something I have to outsource. That's in me. Right. And you're empowering them. You're giving them that empowerment. That's key.

Oh, I feel so happy just listening to you.

Beautiful. I was thinking about what you said and that connection of heart to womb. And I'm working with a client who's in the process of doing in vitro, and we started to explore that going beyond, like, what you're saying, going beyond the supplements and going beyond the diet. And one interesting thing that she expressed is that when she was a little girl growing up, she felt like she was a problem for her parents. And she felt like, yes, and that kids are a bother and that kids are inconvenient and that mom and dad were happy, but when she entered the room or entered the picture, that they were angry and sad. And we started the process, and we're in the beginning phases of this process, but exploring what it means to her to connect that heart and that womb and to explore the relationship between how she feels about herself as a little one and thus how she feels about having a little one. And so I feel like that relationship that you're touching on, that. It's kind of like a soul sickness. Definitely can experience.

And there.

Yes. And how that can have a profound impact on. Are we receiving implantation of the embryo? Are we holding on to that embryo? Yeah, yeah.

In Chinese medicine, there's a belt meridian, and the belt meridian runs right in the midsection of your pelvis, and it connects to old traumas that are unresolved. Right. So if you're hanging on to this feeling that as a child, I wasn't worthy of unconditional love, was highly inconvenient for me to be here. Look at the mirror, look at what she's going through, the process, how difficult it's been to conceive, to receive that life. And so healing that early attachment. You know, we know that PTSD has been. Shows up in the genes. Right. Seven generations. That's been proven. For Holocaust survivors and other people who've gone through ptsd, it's. It stays in the epigenetics. Right. So the more that you can, as a. As a person going through fertility challenge, whether male, female, the more that you can do some healing work. You don't have to be all solved. Right. It's messy. Life is messy. But it's Just tuning in to what you need to feel whole. Every little thing that you do is indirectly going to help your fertility along the way, for sure. So lots of love to her, hope that she has a good.

You uncovered a very important piece of the puzzle there.

Yeah.

I think combining that with the work that you're teaching about cycle charting and starting to gain an understanding of how that mind body connection is playing out, I think could be a really powerful asset to not, you know, kind of keep them separate. Because I think oftentimes medicine can be like an eggo waffle, where it's like your neurologist is over here, your gynecologist is over there, and kind of marriaging those two together, I think could be really powerful because our, our heads aren't separate from our hearts, right?

Absolutely. That's, that's what we bring to the table. I mean, medicine right now is practiced in silos, and you really want to bring it all together. And that's, that's why I loved, you know, being part of the naturopathic community, that's for sure.

And then when you're educating your patients, they realize, oh, that's why I'm taking this supplement at this time of the cycle. The knowledge is power for them. Right. And it's like they then that spiritual connection to the medicine, they trust it, they know why it's working, what it's doing. You have to make sure you're thinking about that as a clinician, for sure.

I was hoping before we finished up today to just expand and touch on the conversation of our relationship as men and women to our fertility are in root chakras, if you will, and the way that abuse, sexual abuse in particular, can impact our fertility and, you know, that link between our heart and our mind and our bodies.

Right?

Yeah, yeah.

I think, like as you alluded to earlier, I mean, you, you got to go back to the history and when in doubt. I mean, I was speaking to someone yesterday who was asking my advice for someone who has reproductive challenges. And I say just go back to the history and think about it. I mean, oh my God. We live in a world where people love to talk about themselves. And so if someone is suffering, they're probably going to put a smile on their face and not talk too much about that suffering. It's just culturally not, you know, invited, shall we say. But when you're seeing a naturopathic doctor, you know, we have a wonderful opportunity to go back in the history and a lot of people don't have maybe sexual abuse on Their intake form, maybe you should add it if you're, if you're so inspired. And sadly, I'm feeling very sad right now because right now the Jeffrey Epstein trial is going on. It deserves way more attention than it's getting. They're supposed to give seven weeks of testimony, they're only going to give it two. And I get, I feel very sad for all those young girls. And when you think of many boys and girls, their first sexual experience is from a predator. And it's very high. I, I, I could say it's 30, 40%. It's very, very high. It's very, very high. And they don't get punished. They don't get punished because these madams and these procurers of young children use this to blackmail people in power. And boy, it's, it's very sad. What, I'm very sad just thinking about it. So, stepping back, you know, when you invite someone to talk about their sexual abuse, it's very rare. You're probably the first person and I heard that in my practice a lot. I've never told this to anyone before but, and it could be all kinds of things, all kinds of things about not feeling loved, not trusting, being confused. When I was at McGill University, you know, I was in my second year, I was 19 and I had a girlfriend called Marianne Kelly and we really liked a professor, we liked this English professor and we'd hang out the pub and so forth and he was brilliant and he said to me, oh, you got 79% on your essay, come to my apartment and we'll talk about your mark. So, and I was a teenager, I didn't know where to go. And I'm 5 11, I'm not a wallflower. I was devastated. So I went to the doctor and I said, this is what's going on. Anyway, this was in the 80s, so there. It wasn't me too yet, but boy, it was a me too moment for me. Anyway, so I brought another girlfriend and he says, okay, blah, blah, blah, I guess we'll stay at 79% or, you know, 69%. No, 79. It wasn't an A, it wasn't, it wasn't 80, 79%. I remember that to this day. And so for me as a 19 year old, 511 girl, you know, privileged background, I was devastated. Imagine if you're 9, 10, 11, what do you do? And so, so you think of, you know, the sexual pleasure or the trust or admiring that person. It's very confusing. So when the idea of starting a family, there's all kinds of flashbacks you're going to get. And I think just talking about it is a very important first step.

Yeah. Just holding space.

Holding space and then finding people who love you unconditionally. Your partner probably does. And one. One step leads to another, but you take one step at a time. And I'm still sad about that, Professor McGill. I'm still sad thinking about it because I really liked his intelligence and I felt, you bastard. And. And I should have gotten an 85% or a 90 on that paper. It was a good paper, but screw you, I'm not going to sell my soul. And. And anyway, so I want to jump.

In just to talk about, you know, root chakra. At its base is a sense of unworthiness. Right. A lack of unconditional love for oneself and lack of deep trust in the way that you can actualize your life. Right. And so, so many that. That common theme of I'm not worthy to have a baby, there's something deeply wr me. Even if there is a lack of sexual trauma, it doesn't mean that there isn't trauma or a block in the root chakra. So even just to pose the question, do you. How do you feel about pleasuring yourself just for fun, you know, and you'll have patients who are like, I don't go there. I don't know what that looks. The stuff looks like down there, you know, and. And it's like, you know, there's. Let's explore that if you're comfortable, because that's part of being a woman, is that we're sexual beings too and we have a right to self pleasure. And that's a topic that I think a lot of people in their culture, it's. We don't go there. Right. So already they're conditioned not to have full trust and not to want to explore that part of themselves. And so I want to bring that up because I see that a lot in my practice. It's super important.

I see that in a lot of religious denominations too. And I know. Yeah, yeah, absolutely. I mean, I know growing up, I was baptized Missouri Synod Lutheran, which is a very strict form of Protestantism. And sexuality is only intended to be between a man and a woman, according to what I was raised. And having sexual thoughts or even thinking about sexuality with one's own self is really naughty, real sin, bad. And then they expect. Well, then you get married and then sex is great and God is blessing it, and then you have lots of babies and the end. And so I think that there's this confusion that can come from cultural, societal, religious narratives about sexuality and about our body. Oh, it's dirty or, oh, that's strange. Like you were saying in the beginning, Dr. Noor, about how we don't want to call it our periods anymore. We call it. We're having to change the narrative because there's so much stigma around verbiage. And so I think that having a conversation about what our belief system is about ourselves and our bodies and our sexuality and how that could be impacting our psychological experience in fertility, whether it's reproduction or not, but in our bodies. I have this client who. She got pregnant when she was 17. It was an accidental pregnancy. And her family, very, very religious family, they found out from the pastor. She confessed to the pastor, the pastor told the parents, and they sent her to an unwed mother's home to live her pregnancy in shame. This is the seventies. This is the late seventies. Those. Thankfully, those. What she went to is no longer allowed in the United States. It's not a legal institution. But she went there to live out her pregnancy in shame. And she had her baby. She had no say over labor, delivery, pregnancy, and they adopted out the baby. And she didn't. She didn't have any say over it. And many years later, when she was in her late 30s, she started to develop really extreme menoragia. And so there's. She was having heavy periods, lots of pain with her periods, and she was trying medications. Nothing was working. And the final conclusion was just to take the whole uterus, ovaries, and cervix out.

Wow.

And I feel like it's worth having a conversation about. Could there be. And I don't want to put meaning somewhere where it may not be, but I think it's worth exploring. Could there be a link to that grief and trauma? Oh, yeah, sure.

Yeah.

No, Absolutely. Absolutely. No, for sure. Yeah. So, anyway.

Heavy. It's heavy stuff.

It's heavy stuff. But, you know, I thank you for bringing. For having space to talk about this, because I'm sure there are listeners there who don't have anywhere else to go with. With this kind of thing. So thank you for. For holding space for that for us to discuss.

And just a couple. Just. Let's end in a story of hope. You know, there is. There's the reality of ptsd. There is the reality of trauma. There is the reality of difficulties with conception. There is the reality of just horrible menstrual cycles that feel like they're trying to murder you every month. Right. And so if you, if you can share us some hope.

Well, the good news is it's actually, you know what if you see a naturopathic doctor, because I have no shame, but I really love the profession. If you see naturopathic doctor for three or four visits and you work on your cycle, you will see changes and I promise you, and you will feel better. So you talk about sleep, you talk about eating your healthy meals three times a day. You talk about drinking water, you talk about a bit of exercise. There are foods that you can eat, like flax seeds that are very, you know, they're anti inflammatory, they're painkillers if you wish. They're getting in touch with your friendships, getting in touch with the fun in your life. You will see changes in your cycle by making certain changes with seeing a naturopathic doctor. And at the end of the day, love your days of infertility and love your days of fertility equally. That's part of being a woman. And there, that's my spiel.

I'll maybe end with a story. I have one of my most beloved patients who was told because of a genetic issue, that she would likely not have more than a 1 or 2% chance of conceiving a healthy child to term. So she was given the option of IVF with icsi, with genetics testing, and that just wasn't philosophically an option for her. So we went back to the basics. We went back to treating her yin and focusing on the root chakra and trying to honor her body. And now she's got three healthy babies, children, all on her own, conceived on her own. And it's a miracle. And had she have listened to that, you know, that message early on, maybe she wouldn't have continued to try. And we didn't. We weren't really treating the fertility. We were just supporting her and her herness, you know, and so that's. Yeah, that's one of my favorite stories and why I do this every day.

I love it. Thank you for the work you're doing. It is so.