Wholesome Fertility Podcast

Did you know your fertility could be declining due to something deeper than hormone levels or age? In this solo episode, I explore a powerful yet often overlooked aspect of reproductive health through the lens of Traditional Chinese Medicine (TCM): Kidney Qi.

In TCM, the kidneys are not just responsible for filtering blood—they are the energetic source of your reproductive potential. I unpack how Kidney Jing (essence), Yin and Yang imbalances, and pre-heaven vs. post-heaven Qi all influence egg and sperm quality, libido, menstrual health, and even your nervous system. You’ll learn how to recognise the signs of weakened Kidney Qi and discover lifestyle, nutrition, and mindset shifts to nourish this vital essence naturally.

This episode is packed with practical tips and ancient wisdom to help you reverse the hidden energetic causes of declining fertility and move forward with more confidence and vitality.

Key Takeaways:

• In Chinese medicine, fertility is rooted in Kidney Jing, the essence we inherit from our parents and support throughout life.
• Signs of depleted Kidney Qi can include fatigue, night sweats, low libido, shortened cycles, delayed ovulation, and emotional anxiety.
• Anti-aging and egg/sperm quality are closely tied to mitochondrial health, which reflects the state of your Kidney Qi.
• Lifestyle factors like sleep, stress, nutrition, and warmth (especially around your lower back and feet) can significantly boost reproductive vitality.
• Foods that nourish Kidney Jing include bone broth, goji berries, black sesame seeds, walnuts, seaweed, dark leafy greens, and cooked foods over raw.
• Practices like acupuncture, meditation, and even visualization can support Kidney Qi and overall reproductive wellness.

For more information about Michelle, visit www.michelleoravitz.com

Grab your copy of my Be Calmm ebook—a mind-body guide to creating a fertility-friendly nervous system https://www.michelleoravitz.com/be-calmm 

To learn more about ancient wisdom and fertility, you can get Michelle’s book at: https://www.michelleoravitz.com/thewayoffertility 

The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ 

Instagram: @thewholesomelotusfertility

Facebook: https://www.facebook.com/thewholesomelotus/


Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care.

On today’s episode of The Wholesome Fertility Podcast, I’m breaking down the truth behind two of the most talked-about fertility hormones: AMH and FSH. Whether you're navigating IVF, trying to conceive naturally, or just beginning to explore your fertility, understanding what these numbers actually mean (and what they don’t) is essential.

In this solo episode, I share what AMH (Anti-Müllerian Hormone) and FSH (Follicle-Stimulating Hormone) reveal about your ovarian reserve, what doctors are looking for, and why these values are only one piece of the fertility puzzle. I also offer insights into how lifestyle, nutrition, and stress management can positively influence your hormonal health and egg quality.

Tune in for a science-meets-soul discussion that will empower you to move forward with more clarity, hope, and confidence on your fertility journey.

Key Takeaways:

AMH indicates the estimated quantity of follicles, while FSH reflects how well your ovaries respond to stimulation.

These values don’t measure egg quality—and they certainly don’t define your fertility potential.

Numbers like AMH and FSH are just a snapshot in time; they can change with the right support.

Egg quality can be supported through lifestyle shifts, acupuncture, and antioxidant-rich nutrition.

Natural conception is possible—even with “low” AMH or “high” FSH.

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For more information about Michelle, visit www.michelleoravitz.com 

To learn more about ancient wisdom and fertility, you can get Michelle’s book at: https://www.michelleoravitz.com/thewayoffertility 

The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ 

Instagram: @thewholesomelotusfertility

Facebook: https://www.facebook.com/thewholesomelotus/ 

Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care.

On today’s episode of The Wholesome Fertility Podcast, I am joined by Hannah Davis (@rooted.with.hannah), a Registered Dietitian and certified meditation teacher who specialises in women’s health, hormones, and autoimmune conditions. After being diagnosed with Hashimoto’s while navigating early motherhood, Hannah shifted her clinical nutrition practice to focus on uncovering the deeper root causes of symptoms like fatigue, cycle irregularities, and PCOS.

We dive into how nervous system dysregulation often underlies hormonal imbalances and why functional testing, mineral status, and emotional safety are crucial for true healing. From decoding PCOS types to understanding thyroid antibodies and the connection between trauma and calcium retention, Hannah offers a deeply integrative and compassionate lens for supporting women on their fertility and healing journeys.

This conversation is packed with practical tools and fresh insights—don’t miss it!

Key Takeaways:

PCOS is not just about ovarian cysts—it's a metabolic and inflammatory condition with many root causes.

Nervous system regulation is foundational for hormone balance, digestion, and fertility.

Functional lab testing (like Dutch and HTMA) reveals hidden patterns traditional labs may miss.

Excess calcium in tissues may indicate trauma or over-supplementation with Vitamin D.

Diet, stress, sleep, and gut health all influence autoimmune and hormonal symptoms.

Guest Bio:
Hannah Davis, RD (@rooted.with.hannah) is a Registered Dietitian and certified meditation teacher with advanced training in functional nutrition, lab testing, and spiritual psychology. She specialises in supporting women with hormonal imbalances, autoimmune conditions like Hashimoto’s, and chronic fatigue through an integrative approach that blends clinical science with deep nourishment and nervous system healing.

After navigating her own health challenges postpartum, Hannah now helps women reclaim their energy, resilience, and sense of safety through 1:1 coaching and group programs at Pivot Nutrition Coaching. She’s especially passionate about working with mothers, self-healers, and cycle-breakers who are ready to feel like themselves again.

Links and Resources:

Follow Hannah on Instagram

Visit the Pivot Nutrition Coaching website

Book Mentioned: The Body Keeps the Score by Bessel van der Kolk

For more information about Michelle, visit www.michelleoravitz.com 

To learn more about ancient wisdom and fertility, you can get Michelle’s book at: https://www.michelleoravitz.com/thewayoffertility 

The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ 

Instagram: @thewholesomelotusfertility

Facebook: https://www.facebook.com/thewholesomelotus/ 

Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care.


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Transcript:

# Audio: TWF 340- Hannah

[00:00:00] [00:01:00] Welcome to the Wholesome Fertility Podcast. I'm Michelle, a fertility acupuncturist here to provide you with resources on how to create a wholesome approach to your fertility journey.

**Michelle:** Welcome to the podcast, Hannah. 

**Hannah:** thanks for having me.

**Michelle:** So I'm very excited to have you on. We're gonna be talking about a lot of really cool topics, but before we get started, I always like to start out with kind of like an origin story and learn how you got into the work that you're doing. 

**Hannah:** Yeah. I am a registered dietician. I've been mainly practicing medical nutrition therapy for the last 10 years in a more clinical setting. And you know, and then [00:02:00] I became a mom. I have two. One's almost eight, you gotta say almost eight. And the other one's, and the other one's nine. So they're really, they're really young and I, you know, working at the hospital part-time and I started noticing.

**Hannah:** My own symptoms of, of things that just felt like off. And simultaneously I was also becoming more interested in learning about more integrative functional nutrition. And so that really led me down. It, it started off as, oh. A way for me to kind of figure out what was going on with me, because of course, like so many of my, the clients I work with now you know, you go to the doctors, you ask for some labs to be done and they just say, oh, you're absolutely fine.

**Hannah:** You might just be stressed. You're stressed out, you're a young mom. Of course it's normal to feel exhausted all of the time and stuff like that. So, I just was like really interested [00:03:00] in doing more digging and so I, we got some training in advanced lab testing and more like integrative functional nutrition.

**Hannah:** And so. From there I was able to figure out what's going on with me, and I, I actually have an autoimmune condition. It's called Hashimotos. And so that really affects, you know, your, your energy levels, your, your gut health, your immune system obviously is involved. So I, it was so incredibly validating and it really excited me.

**Hannah:** I was like, I feel. If I can figure out a way to use advanced lab testing and combine that with my. More of my more clinical, you know, expertise and combine that together to really like, help women feel empowered about how to support their health and, and how they feel and their showing up in their lives every [00:04:00] day.

**Hannah:** And so it just really, really excited me. So that's kind of what got me started with that. And then I, I pivoted towards, towards that about three years ago started my own virtual practice working more in like the women's health space. So like hormones, gut health, autoimmune conditions.

**Hannah:** And then I, as I was doing more of that work, I was like, okay, there's. I'm seeing a common theme here. These women at their root, cause a lot of the time is nervous system dysregulation. And I got really. Tired of just saying over and over again. You know, you need to manage your stress a little bit better.

**Hannah:** I wanted to be able to give them so much more than that. And obviously I knew that from my own journey. I really had to integrate that. And so, but I wanted to like, figure out how to help my, my clients integrate that. So then I became a certified meditation [00:05:00] teacher. And spent a year studying spiritual psychology, which is like a blend of Eastern ritual and practices with western psychology.

**Hannah:** That, yeah. Yeah, yeah. So now I really like to supplement my, programs with giving my clients tools on how to regulate their nervous systems as well. And so, we'll, you know, you know, it's more of like life coaching almost. And then maybe we'll integrate some, some things like, meditation or breath work together.

**Hannah:** It really just depends on what the, how the client wants to be supported. So 

**Michelle:** Awesome. 

**Hannah:** Yeah. 

**Michelle:** You know it's interesting 'cause I 

**Hannah:** Yeah.

**Michelle:** an episode on. Nervous system. Really the vagal tone and 

**Hannah:** Yes.

**Michelle:** there's a link with a weaker vagal tone and things like endometriosis or 

**Michelle:** PCOS, and I thought that was just fascinating. [00:06:00] 

**Michelle:** So, yeah, I'd love to really kind of dig deep on all of these things. So just for people listening and they're kind of like hearing nervous system for the first time. 'cause well maybe they've listened to my podcast, maybe not when I talked about the nervous system. But what should people, like, explain the nervous system, explain how the nervous system ties into certain conditions.

**Hannah:** I mean, that's a very, like, that's pretty broad because it's like, you know, it really depends on what.

**Michelle:** the nervous system like tie into certain conditions? 

**Hannah:** I don't know what condition it doesn't, honestly. Uh, the more, the more I get like deep in the weeds with this, so, you know, a lot of my clients we, you know, so I am typically working with people with autoimmune conditions and hormone. I balances gut health, that kind of stuff. And I, you know, I would say the nervous system impacts all of those areas [00:07:00] because ideally, especially when we're talking about women's health and like hormones, things like that we really just want to create safety in the body, right?

**Hannah:** So that we can. Manufacture hormones and ovulate naturally and things like that. So, and then, you know, inflammation's another, another piece of that. It really just, it's a great way to, like, it just connects to everything right.

**Michelle:** Yeah, well the vagus nerve is incredibly important when it comes to gut health. the stronger the vagal tone, the better the vagus nerve, the better. It's able to lower inflammation in the body. 

**Hannah:** Mm-hmm. Mm-hmm.

**Michelle:** fascinating and interesting. And so what are some of the things that you do suggest for people. they wanna regulate their nervous system and support that aspect. 

**Hannah:** So First of all, I think it's important to just figure out what are the systems for that client? What are [00:08:00] the systems that are working for them and what's not? And really get really honest about that. And then, you know, it could be something like starting a.

**Hannah:** Very doable meditation practice or some breath work like before, before meals, right? Getting into rest and digest me activating that vagus nerve so that we can digest our food properly. So it really just depends on what is feels a lot most aligned for the client and, and is doable for them. But also I think another big piece of this, which is not really talked about often is eating for blood sugar balance.

**Hannah:** Because even like blood sugar swings throughout the day can cause fluctuations in your mood and your anxiety and cravings and all, all of, and even inflammation as well. So 

**Michelle:** that 

**Hannah:** like a whole body [00:09:00] approach. Mm-hmm.

**Michelle:** It's such a good point. And I remember like looking into this and researching like just really the gut brain connection and. And it's interesting 'cause you can see it really go both ways. So if you have imbalanced gut microbiome that can ima impact your brain and your mood and your state and your emotions.

**Michelle:** And it actually is linked with certain emotional um, imbalances or like mental disorders. It's really fascinating. And then they found. On the flip side that people who meditated for many years, like Tibetan monks, they had a really vast microbiome that was a lot more enriched and had a lot more diversity.

**Michelle:** So it's really fascinating how you really can literally get it at both ends or either end. 

**Hannah:** yeah. Like I tell my clients all the time, if you're breathing into your shoulders, the majority of the time it's gonna signal, [00:10:00] or that's gonna signal to the brain that you're in fight or flight. So it's gonna send all the blood to your extremities. It's not gonna be sending the blood to, you know, your, your GI track and your, you know, your organs there.

**Hannah:** And so. it's gonna be a lot harder to digest your foods, whereas if you are really taking these deep breaths into your belly, it's sending all the blood there. And that's, that's a, and I mean, I often get skipped, you know, people are just like, no, just gimme a, just gimme a meal plan. I wanna feel better.

**Hannah:** I wanna lose weight, or I wanna, you know, but it's like, you really gotta think about not just what you're eating, but how you're eating, like what your nervous system state is. You know, when you're, when you're eating food. 

**Michelle:** That's so true. It's 

**Hannah:** Mm-hmm.

**Michelle:** true. And it was funny 'cause I was reading about that and it was one of the things to do is just stand. This is why they say like, don't drive and eat at the same time. Because when you're driving naturally, you're gonna be in a little bit more of a fight or flight or kind of ready for anything and. Also just to kind of throw it out [00:11:00] there, it's not bad to be in that state, in that sympathetic state. It's part of life. It's just that sometimes you need that and then sometimes you need the other. But what you're saying is so true, like it's actually like becoming mindful of getting yourself into that state and maybe 

**Michelle:** doing those exercises to get yourself in more parasympathetic state, which is more of 

**Michelle:** the rest and digest, so that you're priming your body when you do eat. To digest better. So I think 

**Hannah:** Yeah. Of course, and, you know, if you're digesting better, you're absorbing nutrients better, which is gonna impact your energy levels, your mood, your hormones, everything. So yeah, there really, I feel like the more I get into it, the, more I see that there really isn't an aspect of our health, our med, our metabolic health, everything that is not touched by, your nervous system.

**Michelle:** Yeah, it's really fascinating. I like, the more I dig into this, the more I'm just like so [00:12:00] amazed at how Willy, you know, it's the nervous system is kind of like this wiring of like. Information. 

**Michelle:** It's almost like information that kind of signals to your body, all kinds of different states, but especially that safety.

**Michelle:** I agree with you. You know, when you, when you feel safe, you can be more creative. And what does that mean really in the body fertility and it also regeneration growth. 

**Michelle:** So yeah, it's pretty cool, 

**Hannah:** Yeah. And I mean, hormones, that's how hormones work too. They're just chemical messengers in your body.

**Michelle:** right? and so talk about PCOS, 'cause I know that you work with P-C-O-S-A lot just to cover. 'cause I think of people don't really understand it fully because it is you know, there's so many different types of PCOS and people get confused and sometimes people show PCOS symptoms, but then some doctors, and we don't know if they're just not like looking. Thoroughly into it. Dismiss it. Oh, that's not PCOS. So 

**Hannah:** Right. 

**Michelle:** that and just kind of,

**Hannah:** Yeah. 

**Michelle:** [00:13:00] it is, 

**Hannah:** Okay, well, we'll just start what, like, so what is PCOS? So PCOS stands for polycystic ovarian syndrome. So a lot of people get confused by that right off the bat. They think, oh, so that mean I have cysts on my ovaries. Does that mean that I have it? So it's actually not a physical ovarian condition, like of the presence of cyst, but it's rather a hormonal condition and it's a, what I like to call a spectrum condition.

**Hannah:** You know, 'cause there's different varieties and there's different root causes. It's important to understand, first of all what kind of PCOS you have and what the root causes are which is why we, we use functional lab testing in practice. But but yeah, I think a lot of women often it's like a long confusing road full of mixed messages of like just lose weight advice, 

**Michelle:** Yeah, 

**Hannah:** [00:14:00] you know.

**Michelle:** really thin. PCOS patients, so that's where it can get so confusing for 

**Hannah:** Right, right, right. And so, A-P-C-O-S isn't in an ovarian condition, you know, what exactly is going on? I mean, in a nutshell, it's basically, blood sugar issues plus inflammation, plus genetic susceptibility, which is going to lead to the ovaries to begin to produce large amounts of androgens.

**Hannah:** So, you know, and I say genetic susceptibility because, you know, just because you have like insulin sensi or insulin resistance or diabetes, that doesn't mean you automatically are gonna get PCOS. Some people just have really sensitive ovaries right. And so they're, they're going to develop the, the condition, so I like to talk to my clients about well first of all, we start by running some tests [00:15:00] to find out, you know, what what their root causes are. And then we're gonna really go deep with, you know, working on the blood sugar issues with the inflammation, real food strategies lifestyle interventions, things like that.

**Michelle:** One of the things that I find is pretty common just in my own practice, is that.

**Michelle:** there's a huge link of gut imbalance 

**Michelle:** or, you know, gut microbiome 

**Michelle:** imbalance and inflammation, you know, that is part of the contributor to the inflammation and can really impact PCOS conditions. 

**Hannah:** Yeah. Because you know, if we, if that inflammation in the gut is going unchecked you know, that's also gonna drive that insulin resistance even more. 

**Michelle:** Yeah. 

**Michelle:** what are some of the tests that you do for PCOS? Functional 

**Hannah:** Well, yeah. Well, first of all, I, I like to start with a Dutch test. It's a, have you heard of [00:16:00] Dutch? The Uhhuh? Yeah. Oh, you do? Okay. Yeah. So I would run a Dutch you know, so that we, 

**Michelle:** out just for people 

**Hannah:** yeah. Yes,

**Michelle:** I've never heard of it before. So it's dried urine testing for comprehensive, or I forget 

**Hannah:** it's a Dr. It's a. Yeah, yeah. Dried urine test for comprehensive hormones. I know I used to think, oh, it's of Dutch, like it's from the Dutch, like, you know, but it's just an abbreviation. 

**Michelle:** right, right. 

**Hannah:** But yes, it's a very unique way to look at hormones. 'cause traditionally before this test was available, you would have to rely on blood work for hormones.

**Hannah:** And, you know, saliva for cortisol, which is okay, but it's just not great. So this test really helps us get a lot more specific, a lot more personalized, and helps us get some answers that would probably. Be left unanswered if we were just, you know, looking at, at blood work alone. So, you know, it's gonna tell us, you know, give us a snapshot [00:17:00] of all three sex hormones, estrogen, progesterone, testosterone.

**Hannah:** It's gonna show us how they're being metabolized in the liver. And then what I really like is it looks at your cortisol awakening response. So someone is struggling with sleep, mood, energy levels. Things like that that could also be driving your symptoms and, and your inflammation as well. So I, mm-hmm.

**Michelle:** cortisol is your friend in the morning. 

**Hannah:** Yes. Yeah. Yeah. And then I like that it also has that organic acid test at the end there, which some of those other markers are gonna be important for looking at, for hormone production. So it's nice if they include that. So I, I like to do a Dutch, I also like to do HTMA testing, which stands for hair tissue mineral analysis.

**Hannah:** Because, you know, you know, when we're looking at hormones it's, you know, we, we also wanna be, look thinking about minerals too because and not just like, our minerals through blood [00:18:00] work, but more on a cellular level. Like what is the body doing with those minerals? And how is your body utilizing them?

**Hannah:** Are they even getting up into the cell? So, and we can, you know, you know, minerals, they impact hormones, which means they're gonna impact PCOS. So I like that one too. And it's like a little, it's a, it's a nice way to, I like it 'cause it's, it shows your body's like, it's like a blueprint. It shows you your stress pattern.

**Hannah:** know how your body is using minerals after you've maybe gone through a season of. Really high stress and you know, the fertility journey too is so stressful on its own that I'm like, yeah, let's look at what your body does with all this stress and how we can really like, you know, deeply nourish your body and, you know, make it feel safe for ovulation.

**Michelle:** Yeah, I know that there's a lot of minerals that you can't really test in blood and for example, magnesium. That's a

**Hannah:** Mm-hmm.

**Michelle:** one to test for. So does this test for magnesium as well, like all [00:19:00] minerals or, 

**Hannah:** yeah, yeah. It looks at all of the minerals. Specifically the ones that I'm gonna be focusing on. The minerals that impact PCS would be magnesium, zinc, calcium, iron selenium iodine. So, you know, and in a nutshell, you know, these, these minerals. they can exacerbate insulin resistance, hormonal imbalances, oxidative stress, which is important for like egg quality, sperm quality, things like that.

**Hannah:** So women, get your men to your partner. 

**Michelle:** Yes. 

**Michelle:** So, so this is a hair test. 

**Hannah:** yeah, it's a hair. They're using just like a teaspoon amount of your hair to analyze the mineral content in your tissues.

**Michelle:** Fascinating. I know they've done those for like heavy metals and, and just testing the 

**Hannah:** Yeah, yeah, 

**Michelle:** I haven't heard of the mineral testing yet. 

**Hannah:** yeah. And this, yeah. And this test does include heavy metals and we look at, mm-hmm. 

**Michelle:** heavy metals. Oh, [00:20:00] okay. 

**Hannah:** Mm-hmm. Mm-hmm.

**Michelle:** it's really high. Just like for people that don't have symptoms sometimes I almost feel like it's like high for everybody. 

**Hannah:** The heavy metals. Yeah. Yeah. You know, and 

**Michelle:** somebody who's not, who doesn't have like, 

**Hannah:** yeah, and I mean, we we're exposed to heavy metals all of the time. It's, you know, it's, there's, it's kind of impossible to get around it, you know? It's in our food, our water, the soil, you know. And so my approach is, you know, we might see like an acute.

**Hannah:** Exposure to the heavy metals. But what we wanna see is that you, you're able to detox and excrete those heavy metals safely. You know, that's why, you know, we have our detox organs, our liver, right? And so if I ever see those metals like pushing into the tissues, it's just a really good indication that, hey, your liver needs some.

**Hannah:** Some attention, like we need to work on supporting that. And also working on not just our [00:21:00] detoxification organs, but our drainage pathways. So like our lymphatic system you know, making sure we're having daily bowel movements that we're sweating all of that. All of that stuff. Yeah. 

**Michelle:** Yeah.

**Michelle:** for sure. I think that that's key is really detoxifying, and I think that it, you had a good point. You mentioned the word safely because 

**Michelle:** that can be an issue, like if you detoxify too harshly. I'm really big on that, especially when you're trying to conceive and you're actively trying, you definitely don't wanna do something that's so strong that it actually circulates more toxins in your bloodstream. 

**Hannah:** That's right. Yeah.

**Michelle:** So they have like binders, right? Or things 

**Hannah:** Yeah, That is one approach for me. I rarely will do like a heavy metal detox with somebody. I will just wanna work with them on, you know, first the foundational things of, are we optimizing the gut health, the, you know, the liver function are we getting those drainage pathways [00:22:00] open?

**Hannah:** Because your body should be able to do all that on its own if it's, you know, optimal. but I mean, if someone's already doing like a gut protocol or something with me, then yeah, they, they'll be taking like those types of supplements and then it'll, it'll still act on the heavy metals and things like that, as.

**Michelle:** Interesting. So, what are some of the nutrient and lifestyle interventions specifically that you would do for PCOS? Or have you seen, because I, I do know that 

**Hannah:** yeah. 

**Michelle:** different types, so that could 

**Hannah:** Yes. 

**Michelle:** the type, 

**Hannah:** Yes. Yeah.

**Michelle:** the things that people should kind of like look out for, think about? 

**Hannah:** Yeah. Yeah. So the first step is, is gonna be improving the quality of your food choices. So, you know, removing inflammatory oils, added sugars a lot of like processed, like ultra processed carbohydrates and, you know, with chemical and artificial additives. Things like that, you wanna replace them with whole real foods.

**Hannah:** It's really that simple. 

**Michelle:** Yeah. I [00:23:00] know, 

**Hannah:** Yeah. Yeah. And then also, you know, the goal is to eat a sufficient amount of carbohydrates to promote ovulation, but while still focusing on those whole real. Food sources, like starchy veggies fruits and then unprocessed whole grains and legumes. 

**Michelle:** So really from natural sources, 

**Michelle:** complex car carbs. So it's not like simple carbs, not white, you know, avoid those like. 

**Hannah:** Yeah. Right. So you, and you would want to make sure you're getting adequate amount of carbohydrates, but you know, if we're also dealing with insulin resistance, then we also need to be talking about you know, maintaining adequate calorie intake and just aiming for. Balance across all the macronutrients.

**Hannah:** So, you know, we're pairing those carbohydrates with good quality sources of protein and healthy fats. And, if you're eating a more whole food carbs diet like. Your carbs are coming [00:24:00] from fruits like, and like root vegetables and things like that, then those foods are naturally gonna have more fiber in them, which is also gonna help with things like insulin resistance.

**Hannah:** And then I would also be focusing on gut nourishing foods, like, bone broth probiotics from fermented foods, cultured. Products. And then lots of prebiotic fibers. So it also just making sure you're eating a wide range of, plant fibers. Like we're not just eating the same, spinach every day.

**Hannah:** You know, let's really mix that up. Maybe like arugula, kale, you know. So that would be the where, where I would start with foods strategies. And then for lifestyle I would be really focusing on exercise. This is a really crucial tool in repairing insulin sensitivity and managing blood sugar levels.

**Hannah:** So first I would just focus on increasing your daily movement. So, you know, maybe try tracking your steps. And then maybe you would wanna consider adding in some resistance [00:25:00] training and some short hit style workouts. Since those really show the most metabolic improvements. In general I would avoid, I would avoid like, really long duration cardio on a regular baseball basis, since that's like very stressful on the body.

**Hannah:** So exercise is number one. Stress management is key. I know we've already kind of touched on that a little bit. You know, that's a big piece of hormonal. Balance balance since the, your adrenal health, you know, has the ability to impact the function of your sex hormones. I would just evaluate the sources of your stress.

**Hannah:** You know, I like to think of it like a bucket, like a stress bucket, and we have all these different inputs pouring in. Some of those things we can't really remove, but some things we can, you can control your nutrition and your sleep quality. You know, you can maybe work on energetic boundaries, right?

**Hannah:** Maybe you wanna include things like meditation or [00:26:00] journaling, acupuncture, right? Those are all really nice ways to support yourself. And then sleep. Sleep is also like so major. That's when you know when you're, you can get good quality sleep at night. That's when your, your body's repairing tissue.

**Hannah:** And it, it has a lot to do with your hormones, like in like your like your hunger hormones, those ones and then also like cortisol, melatonin, things like that. Everything that just keeps all of the systems working together smoothly. So, yep. Do you.

**Michelle:** of sleep. There's a, there like a lot of times we'll increase sugar cravings 'cause you want that quick energy. So 

**Hannah:** Yes,

**Michelle:** that's one example of how that can impact 

**Hannah:** exactly. Yeah. Yeah. If you have like one poor night of sleep, it increases your hunger hormone levels pretty significantly. So we'll see that that issue popping up time and time again. Yeah, so.[00:27:00] 

**Michelle:** yeah. And I also have heard, in some 

**Michelle:** of like go, literally pivot into autoimmune and how you can address that in the case of Hashimoto's?

**Michelle:** 'cause it is so prevalent and a lot of people have it. The first thing that I say is, cut out gluten, corn, and dairy and soy if you can. Now, I always say if you can't do all of them, at least cut out the gluten entirely and talk to us about like what you've done and what you've found to be helpful.

**Michelle:** 'cause it is something that if you catch early, you really can sh shift a lot just from diet alone. 

**Hannah:** Oh, yes. Yeah, and I've helped. Hundreds of women with that. Exactly. Just you know, we [00:28:00] see, I've seen different stages of, Hashimoto's. You know, so if it's like, you know, stage one where we're seeing the presence of antibodies and maybe they have symptoms, maybe they don't. A lot of those women typically will present with like subclinical hypothyroidism.

**Hannah:** So like their thyroid labs look fine. But they're like, I, feel tired all the time. I'm constipated. I can't lose weight, you know? So the first thing I would start with is kinda getting ahead of things with, 'cause the majority of your immune system is in your gut. So I would be doing a GI would run a stool sample, a GI map and see what's going on there.

**Hannah:** Because there's different things that could be driving. That immune response. Yeah. It could be coming from things in the diet like gluten. And that test certainly will show us if you're having an immune response to gluten. So in those cases, I would have those clients cut, cut that out. And some people they, they don't, they don't run the test and they [00:29:00] cut out gluten, but they just feel better without it.

**Michelle:** See that a lot. 

**Hannah:** mm-hmm. I do too. Just kind of anecdotally. I was just gonna say that I think it is because of like, what, what they're spraying on our crops. 

**Michelle:** Yeah,

**Hannah:** Yep. know that it can impact hormones like big time, that's 

**Hannah:** Mm-hmm. 

**Michelle:** one for sure. 

**Hannah:** Yeah. So, and then, you know, obviously if there's a inflammation or like leaky gut. 

**Hannah:** You know, we're gonna wanna address that anyway because that could be driving that immune response and making your symptoms worse, making the antibodies levels worse, right? So I really wanna just get ahead of it with the gut number one.

**Hannah:** And then I like to do mineral testing as well, since so many minerals, not only impact PCOS, but they impact your thyroid. 

**Michelle:** That's a huge 

**Hannah:** Yes, selenium. This is a common thing that I see. I'll see really high amounts of calcium in the [00:30:00] tissues. And that's gonna block your thyroid hormone from getting up into the cell.

**Hannah:** So like maybe their thyroid panel looks great, but that, or they're already taking a thyroid medication, but they're, they feel like it's not doing anything for them. I'm like, look, you have a lot of calcium in your tissues. And so like, that's your thyroid hormone's not even getting up into the cell. So of course you wouldn't feel an impact there.

**Hannah:** And that also is.

**Michelle:** actually? What causes that? Calcification? 

**Hannah:** So, I typically see that from over supplementing with vitamin D. So, that will pull the calcium out of the bone and teeth. And put it into the tissues. Yeah. A lot of people get put on vitamin D by their doctor, like maybe they had low levels at one point, and then their doctor never talked to them about weaning off of the vitamin D.

**Hannah:** They just kept taking it. 

**Michelle:** too high. Yeah. 

**Hannah:** Yeah. Or they'll start them off like a really high dose, like I've seen like 50,000 units of, of vitamin. Yeah. [00:31:00] And they, and they just keep taking it like, then they're never told like, Hey, you're actually supposed to tapered off of that after a couple months. I've also seen an influx of people on vitamin D, zinc you know, ever since the pandemic.

**Hannah:** So they just kept taking it and they don't know how that's impacted their. Mine. So, so yeah, that's one culprit. I, I'll see. The other thing that I notice, and this is pretty prevalent in the autoimmune community is, and I don't think it's talked about a lot, is significant trauma and certain types of trauma.

**Hannah:** It, it's like we call when we see this pattern on an htm. It, we call it a calcium shell where the calcium and the magnesium levels are really high in the tissues. And then we are like really depleted in things like potassium and sodium and other secondary minerals. And it's kind of like the body's way of shielding itself from feeling [00:32:00] big, like feeling really big emotions.

**Hannah:** So like a lot of these clients, I, I'll talk to them about this and they have such a flat effect, like with the then we start moving the calcium out of the tissues and then they become, they're, it's like they really need more emotional support throughout that process. It's very interesting. I'm about to actually do an HTMA on myself.

**Hannah:** It's been a couple of years, but I've just gone, I'm grieving my mom right now and I, yeah, and it's just been a really rough couple of months. I've just been just going through the motions and kind of in that, like taking care of her, taking care of my girls. Like just everything that we've gone through leading up to this point.

**Hannah:** And I'm like, I am so curious to know what's going on with my minerals right now. I would not be surprised if I was having calcium going into my tissues. 'cause I believe that's what was my pattern last [00:33:00] time I ran the test a few years ago. So. 

**Michelle:** Oh, that's interesting. 

**Hannah:** It's like, yeah, this is my, my unique pattern, you know, so I see that a lot with Hashimoto's and yeah, and, and it's interesting because that pattern, like the high calcium in the tissues and the low potassium, that's really really common with like thyroid stuff in general because, you know, first of all, that calcium's blocking the thyroid.

**Hannah:** Hormone from getting up into the cell. It's also gonna be blocking insulin signaling. So there is gonna be a lot of blood sugar swings, and that's gonna be driving the inflammation, making that worse. And then the low potassium, well, you know, potassium is needed for thyroid function as well. So, I see that pattern a lot with that population and it's so fascinating.

**Hannah:** And I would just say like, I wouldn't say it's like. It's more like anecdotal, right? Like and you probably see that too in your practice. Yeah. Yeah. 

**Michelle:** For different things, not this [00:34:00] specifically, but Yeah.

**Michelle:** I mean, you see a lot of that and that's, that matters just because studies are very expensive to have and you can't 

**Hannah:** Mm-hmm.

**Michelle:** rely just on studies. You have to really rely on data in general, like your own experience 

**Hannah:** Oh, absolutely.

**Michelle:** there's so much information that you can get just from that. And then, couple of things. One of the things is, I know that Zyme has been shown to really help, it's an enzyme, it's a pro oleic enzymes that break apart, like fibrous tissue. So I'm curious to 

**Hannah:** Oh

**Michelle:** if it would help with excess calcium or, you know, deposits because it, it works to break down 

**Hannah:** yeah, 

**Michelle:** really needed in the body. 

**Hannah:** yeah. Yeah. 

**Michelle:** up. 

**Hannah:** Yeah. That is interesting. Yeah, because when we see, usually the calcium in the tissues is also associated with things like restless leg syndrome, kidney stones, gallstones, all that stuff, you know, because it's just calcification of the tissues. [00:35:00] Right. What I do is I'll get, if that person is, has actually been on vitamin D what I'll do is I'll say, okay, let's just pause on the vitamin D and then I'll get them on, a form of vitamin K two that will target that calcium in the tissues and, and bring it, redirect it back to the bones. So we'll do that for several months. And if that person's still concerned about their, their vitamin D levels and say, let's just get that checked, you know, and depending on where you're at with that, you, you either, you know, probably need supplementation time from time to time, or maybe just during the winter, right?

**Hannah:** But it's not a long term. You know, supplement for you because of this pattern, this pattern that you typically have.

**Michelle:** Another thing that I was gonna mention is, we were talking about like, antibodies. 

**Michelle:** I remember, One of my patients mentioning she had like a, 'cause I was talking to an REI and I was gonna have him, I had him on the podcast and so she had some questions and she had a very low amount of [00:36:00] antibodies that are considered normal. And he said no, because the presence of any antibody, and that's what's crazy to me. 

**Hannah:** Mm-hmm. 

**Michelle:** normal in labs 

**Hannah:** Yeah. Well, yeah. Yeah. The reference ranges for conventional labs or like in more like conventional healthcare settings. They're not, they're designed to show like if you have a chronic disease or not. Not necessarily if you're optimal. Right. Like thriving, you know?

**Michelle:** have any, even if it's like minute, it means that there's an autoimmune, like 

**Hannah:** Right. And. 

**Michelle:** your thyroid. 

**Hannah:** Yeah, and I mean, my first thought is like, and just because I've worked in that arena for so long, is I think it's just because they need to have a diagnose, a diagnosis for a chronic disease, number one, so that they can build insurance and blah, blah, blah. 

**Michelle:** Yeah, yeah, yeah. 

**Hannah:** So they typically can't treat you. They can't, they [00:37:00] technically can't treat you.

**Hannah:** Like they don't really run on a, it's more of like a sick care model. It's not really, they can't really treat you for like prevention. Right. That's not like that that's not how insurance companies work. So, I think that that's, that's my theory on that. But, you know, but to, to answer your question, yes, I, I see, low levels that aren't considered Hashimoto's, 

**Michelle:** Right? 

**Hannah:** but I would label that early stages or stage one, and I would say, let's work, let's, let's order GI Map.

**Hannah:** Let's look at what your minerals are doing like that impact your thyroid. Let's just, just start helping you feel better right away so that we can go into remission. I would much rather my client like, just go ahead and work on those things instead of waiting until it's like, you know, now we're seeing tissue damage, you know, and there's a lot of practices.

**Hannah:** I don't, 

**Michelle:** it if it's early enough, like, but if it's 

**Hannah:** yeah. 

**Michelle:** really like far gone, 

**Hannah:** Yeah. It can, and I don't know if you've run [00:38:00] across this a lot in your practice or with your clients, but I've been told a lot of times that they weren't even able to request or see a specialist or an endocrinologist, I guess, until they were able to see tissue damage. And it's like, wouldn't you wanna just prevent the tissue damage?

**Michelle:** crazy to me. Yeah. 

**Hannah:** Mm-hmm. Yeah, so I'm, you know, I just like to get on it like right away, even if it's like, you know, your antibodies are like five, you know? 

**Michelle:** yeah, yeah, yeah, yeah. Really low, but still, 

**Hannah:** Yeah. Really low. Yeah. It's worth working on. Yeah.

**Michelle:** I had actually just recently, I had a case where her TSH was like five and she's young, she's in her twenties. And I'm 

**Hannah:** Mm-hmm. 

**Michelle:** not normal. 

**Hannah:** Mm-hmm.

**Michelle:** just a little abnormal.

**Michelle:** But that's not a little abnormal for try somebody trying to conceive. 

**Hannah:** Yeah. 

**Michelle:** and under. So if you 

**Hannah:** Mm-hmm.

**Michelle:** the thing. If you go to a general doctor or even an ob, they are a little more general in women's health. 

**Hannah:** Yeah.

**Michelle:** they're not going [00:39:00] to look at it the same way as an REI is gonna look at it, which is a reproductive endocrinologist and they're gonna 

**Hannah:** Right. 

**Michelle:** it a completely different perspective. 

**Michelle:** Yeah, so it's, so those things I think a lot of people just don't realize and they're going in and they get the wrong information or they don't get like the full information and many years go by and it's kind of like, you know, that's why it's so important to really get ahead of it.

**Hannah:** Yeah, absolutely. I think you're, you're worthy of feeling better, you know, if, does it have to be something that's chronic or. 

**Michelle:** Right. 

**Hannah:** Like full on disease state before just feeling better.

**Michelle:** Yeah, for sure. So for people who, you know, are curious and wanna learn more about what you do, 

**Michelle:** um, what are some of the things that you offer online? Where can people find you? I. 

**Hannah:** So for people who are wanting to work one-on-one with me or maybe just start off with [00:40:00] a consultation or some have some labs done you can find me at through Pivot Nutrition Coaching. So the website is pivot nutrition coaching com. And then if, for my social media, I'm on Instagram with Hannah.

**Michelle:** Awesome. I'll have all the notes anyway. If anybody like is curious or wants to know exactly how it's written out or find the link, you can find those on the episode notes. So Hannah, thank you so much for coming on today. It was a great conversation. I love really digging deep on just what goes on with these conditions that so many people hear about that are trying to conceive, but they don't really understand it.

**Michelle:** And I think. There's so much power and knowledge and understanding and kind of like going beneath the surface. So I think this is one of the things that I like to do on the show is really to educate people on like really what's going on. So you've really shared some great, valuable information, so thank you so much, Hannah.[00:41:00] 

**Hannah:** Thank you so much for having me and I, I think that this is such an important, important conversation to have and a valuable platform, so it's really an honor to be here. And hope we can chat again soon.

**Michelle:** Thank you. 

On today’s solo episode of The Wholesome Fertility Podcast, I dive deep into the ancient practice of Pranayama, also known as yogic breathwork, and its profound impact on fertility. Breathwork may sound simple, or even unrelated to fertility, but the connection between your breath, nervous system, and reproductive health is incredibly powerful.

In this episode, I explain how specific breathing techniques can shift your body from a state of stress into one of rest and regeneration, promoting hormone balance, improved digestion, and pelvic blood flow all critical components of a healthy fertility journey. You’ll learn practical ways to integrate ancient breathing practices like Nadi Shodhana (alternate nostril breathing), Kapalabhati (breath of fire), Bhastrika (bellows breath), Bhramari (humming bee breath), and Ujjayi breathing into your daily routine.

If you’re feeling overwhelmed, stuck, or simply curious about new tools to support your body naturally, this episode is for you.

Key Takeaways: 

Breathwork regulates the nervous system, supporting hormonal balance and reproductive function.

Ancient yogic practices like Pranayama offer free, accessible tools for stress reduction and enhanced vitality.

Techniques like alternate nostril breathing and humming bee breath can be easily integrated into your daily life.

Breath can help release emotional tension and stimulate vagal tone, a key player in fertility health.

Conscious breathing increases oxygenation, supports digestion, and boosts clarity.

For more information about Michelle, visit www.michelleoravitz.com 

To learn more about ancient wisdom and fertility, you can get Michelle’s book at: https://www.michelleoravitz.com/thewayoffertility 

The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ 

Instagram: @thewholesomelotusfertility

Facebook: https://www.facebook.com/thewholesomelotus/ 

Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care.

Transcript:

# TWF: 339 (solo episode)

**Michelle:** [00:00:00] Episode number 339 of the Wholesome Fertility Podcast. Welcome back to the Wholesome Fertility Podcast. I'm your host, Michelle Orbitz, and today we're diving into a deeply healing and powerful practice that has stood the test of time. It's called Pranayama or yogic Breath Work. You might be surprised to hear just how much breath work could influence your mind and your nervous system, and then in turn influence your reproductive health.

**Michelle:** 'cause we know that the nervous system plays such an important role on reproductive health. So if you wanna find out more about powerful breathing exercises that you can do so easily and they're free, that can influence your nervous system and how you feel. Overall, this episode is for you.

**Michelle:** Welcome to the Wholesome Fertility Podcast. I'm Michelle, a [00:01:00] fertility acupuncturist here to provide you with resources on how to create a wholesome approach to your fertility journey.

**Michelle:** So, so today I'm going to cover a very interesting topic, which is Pranayama. so this is an ancient Indian or yogi or yo guine practice that has been done for thousands of years.

**Michelle:** Pranayama or yogic breath work

**Michelle:** is extremely powerful And can really impact the mind and the nervous system. So if you wanna find out more on how to hack your nervous system, and if you've watched some of my earlier videos, I talk a lot about how your nervous system really can influence your fertility health because it gets you into a more rest and digest state.

**Michelle:** And it can also influence your inflammation and your digestion and even create more balance in your hormones. So if you are trying to conceive and you wanna [00:02:00] find out how you can really hack your body and mind through pranayama this amazing ancient tradition, this amazing ancient practice, then stay tuned.

**Michelle:** So you might be asking yourself, what exactly is pranayama?

**Michelle:** So in Sanskrit prana means life force vitality. So it's very similar to what chi in Chinese medicine means, and it's the life force vitality that goes through our body. a yma means control or expansion.

**Michelle:** So Pranayama in essence, is the art of controlling your breath to influence the life force vitality in your body.

**Michelle:** So it's not just about breathing more deeply though. That's part of it.

**Michelle:** It is about becoming aware of how your breathing can influence your hormone balance and your nervous system,

**Michelle:** as well as reducing stress. And these are all really important and impactful things when you're trying to conceive.

**Michelle:** So, although this [00:03:00] is coming from ancient India, this is something that can control all bodies and all different cultures. and it's one of the many gifts that we get from the ancient Vedas, Which is really linked to Ayurveda and yoga. The yogic tradition is the aspect of the physical, and it's more of the physical therapy aspect of it, but this is all part of really the science of life and how they're perceiving that you're able to, and how they're giving you tools to really access this amazing, intelligent life force that resides in your body.

**Michelle:** So just to kind of give you a little bit of an overview. So Prana is very similar to Q, which is Life Force Vitality, and this is basically the life force that we have that is intelligent and that keeps our body warm and that keeps our body functioning. So this is something that really is intelligent because that aspect of our bodies is [00:04:00] what tells ourselves what to do, and it also helps the self-healing mechanism of the body.

**Michelle:** And when we're in fight or flight, and I always come back to the nervous system than our body is more worried about survival. And regeneration is not as much of a priority because survival is more important. But what happens when we're in survival is that everything moves towards that survival, and it's not worried about digestion.

**Michelle:** It's not worried about inflammation. All the things that are running in the background. And it can also impact your sleep because when you're trying to survive, you can't rest, you can't sleep, you can't afford to, you wanna survive, you wanna be alive. So that's ultimately how the nervous system operates.

**Michelle:** But when we're getting that free flow of energy and that we're able to really be enriched with the QI and the life force of Prana, and we're able to get also in a more rest and digest mode, things will flow more easily and they're not gonna be as constricted as it does, as things [00:05:00] do happen with stress.

**Michelle:** And ultimately as an acupuncturist, one of the biggest things that I do is I work a lot on pelvic energy flow and blood flow. So when there's more flow in your body, there's more blood flow, there's less constriction. And as we know, many times when people have high blood pressure, you know, your blood vessels are actually.

**Michelle:** Muscle and those muscles tighten and it causes more constriction and more pressure. And we know that stress can even impact blood pressure. So that tightening is what happens when we're stressed, and ultimately that tightening is going to block. Impact, as I mentioned with the liberty, which is really its role, is to get that energy to flow.

**Michelle:** So one of the ways that we can hack really our minds and our bodies is through pranayama. And today I'm gonna talk about a couple of different. Techniques of breathing that you can do that will [00:06:00] immediately have an impact on how you feel and how the energy and the prana in your body is able to flow, which ultimately will be beneficial not just for your body and your reproduction, but also your mind.

**Michelle:** And I'm sure you know that if you are on the fertility journey, it can be very stressful. And when you're stressed, there's been studies that show that when you're stressed, you can't really make a clear minded decision. And as we know, when you're on the fertility journey, you need that decision making aspect of your mind because you are going through a lot of different choices and options that are being thrown at you.

**Michelle:** So the first breath that I am going to be sharing with you is called Nadi Shaana, and that is alternate nostril breath. I like to call it the yin and yang pranayama, although that's not really the name, because it balances the yin and the yang in our brain. So both hemispheres of the brain start to function and come [00:07:00] together.

**Michelle:** And this is one of the most immediate calming exercises that you can do. And what it does is it basically you alternate sides and you will block one nostril and breathe in, and you can breathe into like the count of four or the count of eight, whatever feels right. But if you slow it also, you'll start to feel a little more peace so you can actually breathe into the count of eight.

**Michelle:** Then close both nostrils. So breathe in one nostril, close the right, and breathe in from the left. Breathe in to eight, and then hold both nostrils closed to the count of eight, and then exhale from the right to the count of eight. And then breathe back in from the same one, the right to the count of eight, close both nostrils, and then breathe out from the left and then breathe back in for the count of eight out, eight in hold it.[00:08:00] 

**Michelle:** So basically just remember one specific count and you're gonna keep doing that and then alternate your nose. Now you're gonna notice that one nostril is going to be a little more clear than the other. And that is actually very normal. Our bodies tend to go more yin and yang throughout the day, so one side will feel one way and the other side will not feel that same way, and you'll find that that will alternate throughout the day.

**Michelle:** And that's kind of an interesting thing, but our bodies do alternate and we're constantly getting to this place of homeostasis so that our body can find balance. But through that, we do have those two sides, those dualities, which is why doing something like this can be so powerful.

**Michelle:** So by balancing, because our nose is directly opened, you know, the olfactory nerve, which is also the sense is directly linked or connected to the brain. So by alternating those two sides, of [00:09:00] breathing, you are creating that balance from the left and right hemispheres of the brain, and that also can create more clear thinking if you are feeling anxious and it's hard for you to really make a decision.

**Michelle:** This is a great exercise to do, and what this also does is activate the parasympathetic nervous system, which is the more rest and digest nervous system. So if you're feeling extra stressed and you wanna slow down your mind, this is amazing. It also improves oxygenation and it also creates more mindfulness.

**Michelle:** 'cause as you're doing it, you're being very conscious of how you're breathing and how you're feeling because it is a practice that you have to pay attention while you're doing it.

**Michelle:** So you could do this in the beginning of your day and then you can do this at the end of the day. And it could be literally two minutes, two minutes in the morning and two minutes at night. And I think that it is really nice to actually do it in the beginning and end of the day. 'cause you're literally doing it at yin and yang times of your 24 hour cycle.

**Michelle:** So it can help you when you [00:10:00] first start to wake up, and then you can help you end the day really nicely and support your nervous system as you go to sleep. So another one that is one of my favorites is called Kati, and that is skull shining breath. Or you may have heard this, called breath of fire. And so ultimately what it is, is working through your diaphragm and after you do it for a while, you literally feel like you are breathing fire.

**Michelle:** 'cause you can feel a lot of fire in your diaphragm area. So the area that I'm talking about is really the soft area of your belly that's right underneath your ribs. So you start to feel this, it's kind of like right above, it's between the bottom of your ribs and your belly button, right in that solar plexus in that area.

**Michelle:** So you can put your hands there Before I actually go into the description of how to do it, I wanna talk about what it does. Breath of fire is incredible for [00:11:00] digestion and it is one of the more stimulating breaths, and I remember one of my teachers mentioning That there was like a saying that as many breaths as you breathe, that we only have a certain amount of breaths for our life.

**Michelle:** And that is why it's important to breathe slow. And the slower we breathe, the longer we can live. And I asked about this one because it's actually a very rapid type of breath, and they said, well, it's considered one breath because it's, you're not fully exhaling.

**Michelle:** You're kind of like pumping throughout the whole time that you're doing it. So it's actually considered one breath. It's not considered, many different breaths.

**Michelle:** so another thing, the reason why it's called Breath of Fire is because in Ayurvedic medicine, a lot of times they refer to something called Agni, which is our digestif fire. And that justifier, I guess you can say correlates to really our ability to break down foods And really the acid that we have in our stomach that can cook the [00:12:00] food and ultimately the breath of fire. And Agni is very, very important. And sometimes people will have diminished Agni from drinking too much cold or not really eating correctly. And so we don't want that. We wanna actually kindle that fire because when you kindle that fire, it will protect your body, increase your immune system, and also break down foods so that the rest of the digestive system, is able to really assimilate the nutrition from the food.

**Michelle:** Another thing that it can do is clear, stagnant energy. And then when stagnant energy gets cleared, then you're getting more flow in the body and Prana is able to really move. So. This is one of the most powerful breaths to really get things moving. And the only thing that I would say with this, and really everything that I'm saying is not medical advice.

**Michelle:** And I would also say be cautious. If you are about to do a retrieval, I would not do this breath because they are afraid [00:13:00] of ovarian torsion and this is something that you don't wanna mess with. So, and it is a very powerful and moving type of breath.

**Michelle:** But I'd like to compare it to when the Native Americans used fire for brushes, you know, for, to get rid of like old weeds before they created new or planted new seeds. And this is one of those things, you're getting things outta the way, you're burning out the stagnation with this breath in order to get more flow and more new energy coming into the body.

**Michelle:** so here's how you do it. So in between the bottom of your ribs and your belly button, so put your hand there and you could put both hands, one on top of the other. And what you do is you forcefully exhale, and you will find that when you do that, you're naturally going to bounce back almost like a rubber band where it just inhales.

**Michelle:** By nature. And then you don't worry about the inhale 'cause it's gonna happen automatically and you just keep exhaling and you just [00:14:00] pump with the exhale. So you go and you'll feel that bounce when you have your hand there. And over time you'll find that it can get longer and longer as you practice.

**Michelle:** In the beginning, you might get tired sooner and sometimes you might even find that it makes you cough. It is so purifying, it will actually make you cough up old mucus in your lungs. So it is pretty wild how it works.

**Michelle:** So the next type of breath is called baa, and that is also called the bellows breath. And this is a little bit more active and I'll describe it so that you understand how to do it.

**Michelle:** But first let me explain what it does.

**Michelle:** So Bas Rica, very similar to the breath of fire, is also a breath that is very active and it can stoke the internal fire in our bodies.

**Michelle:** It also involves very, forceful inhales and exhales. But in this case, you're gonna be [00:15:00] using the arms.

**Michelle:** It is considered to activate the Kundalini energy in the body. This is the energy that runs up and down our spine and feeds really all of our organs and body

**Michelle:** and supports our body's energetic flow. and it also is considered to have a balancing effect on the doshas. If you've watched my Ayurvedic video, I talk about the different doshas, which are really elements in your body, and this is considered to be a good breath that balances all of that.

**Michelle:** It can also boost oxygenation and mental clarity. And how you do it is you raise your arms up and you have your hands out. So your hands are completely open and your arms are just raised up, and you inhale as you do that, And as you exhale, you close your hands and you bring your elbows to the side, so you bring your hands down so you inhale with your hands up. [00:16:00] stretch hands, and then you exhale forcefully as you bring it down, as if you're bringing something down or pulling something towards you from the top to the bottom.

**Michelle:** So your elbows basically end up by your side and completely folded with your hands next to your shoulders in a fist. So inhale, bring your hands up. Wide open, exhale really forcefully as your hands go down into a fist next to your shoulders.

**Michelle:** So this is kind of related to the breath of fire. There's definitely a lot of heat that will be coming out from it, It is a very good practice to really get that energy moving. If you feel like it's stuck. This is great. If you feel a lot of stress and you feel a lot going on. If you wanna come home and you feel like you've had a very stressful day, this is a great way to break that up.

**Michelle:** So lastly, I'm going to cover something called Ari, or. Humming bee breath.

**Michelle:** [00:17:00] So actually this breath and the way you're supposed to do it is one thing that we know for sure is a technique that stimulates the vagus nerve. And as we know, the vagus nerve is extremely important when it comes to reproductive health That's because it has so many different functions, and one of them, which is really key, is promoting really good digestive health, lowering inflammation, improving sleep, and on and on.

**Michelle:** And it basically helps the body get into a parasympathetic mode. And one of the ways that is known to stimulate your vagus nerve is by humming. So this breath And another thing is that when you do hum on an exhale, you are actually by nature because you're using your voice, you slow down your breath.

**Michelle:** So this is a great way to slow down your breath as you are exhaling.

**Michelle:** So this can also reduce any emotional tension And it could also reduce heart rate and blood pressure.

**Michelle:** so what you do for [00:18:00] this breath is inhale, fully hold it at the top, and then exhale with a humming sound. So.

**Michelle:** And then you just breathe all the way out. So as you'll notice when you're humming, you actually slow down your breath, so it naturally slows down your breath, which has an immediate impact on any kind of state of anxiety. It will really calm your mind. So this is an amazing thing to do, and you can really do this while you're driving.

**Michelle:** Just keep your eyes open for obvious reasons, But you could do this even while you're driving. If you're driving to a doctor's office and you're feeling really nervous, you can do that. a lot of times, om in my car, and this is just kind of one of the things that I do, and I find that it really, it, it feels like I'm singing a song, but I'm just oing.

**Michelle:** So it feels really calming on my nervous system. It feels like an internal massage, having that vibration. So that can help a lot. And again, you could do this also at the end of the day if you had a lot of. Things [00:19:00] going on if it was a very intense day, and you can get yourself ready and your nervous system ready for more rest.

**Michelle:** And actually that was not my last one. I have one more. and this is something that you can do at all times, and it's called UJA breathing. So if you practice yoga, you may have heard of UJA breathing because it's something that a lot of yogis will teach you to do during your yoga practice, and that is something that you can take with you really throughout the day. And what it is, is causing a little bit of constriction in your throat as you're breathing So that your breath could be a little louder. So it's kind of like this constriction where you're able to feel the breath going through your throat. so it's like making a little bit of a, a humming or a sound while your mouth is closed and you could practice. I'm sure you've done this naturally, even when you were little, And it's a very calming and very grounding breath.

**Michelle:** It is thought to increase the lung capacity, and it's [00:20:00] also thought to balance out the heat in the body, and it's also thought to balance out the temperature in the body. So it's kind of like a yin and yang balance.

**Michelle:** And it can also, since it's so grounding, promote a meditative state. So it's something that you can do, and this is one of the reasons why a lot of yogis use this during yoga, because ultimately yoga was a, was a practice that prepared yogis to meditate. It got the body into a state where it was able to meditate more deeply.

**Michelle:** So just to reiterate, none of this is medical advice. It's not something that should ever take the place of what doctors tell you It should not be something that ever takes the place of medical.

**Michelle:** Protocols that you've been given, and also to be aware or talk to your doctor if you are going through IVF, to talk to them about different breathing exercises and perhaps to pause on any of them during the IVF process. [00:21:00] If you have any questions or ideas for future episodes, I would love to hear from you.

**Michelle:** I'm very active on Instagram and my handle is at the wholesome lotus fertility. I don't always respond right away, but I always eventually get to all of them. So thank you so much for tuning in today, and I hope you have a beautiful day.

[00:22:00] 

On this episode of The Wholesome Fertility Podcast, I am joined by Dr. Nirali Jain (eggspert_md), a board-certified OB/GYN and reproductive endocrinologist at Reproductive Medical Associates (RMA). Dr. Jain shares her expert insights on fertility preservation for individuals undergoing cancer treatment, a crucial yet often overlooked aspect of reproductive care.

We explore what options are available for fertility preservation, including egg and sperm freezing, and why it’s so important to initiate these discussions before starting chemotherapy or radiation. Dr. Jain also explains the difference between Letrozole and Clomid, the impact of estrogen-sensitive cancers on IVF treatments, and innovative approaches like random-start cycles and DuoStim protocols. Whether you're facing a cancer diagnosis or simply thinking proactively about your reproductive future, this conversation is filled with knowledge and reassurance.

Key Takeaways:

• Why it’s essential to discuss fertility before starting cancer treatment.
• The role of Letrozole in estrogen-sensitive cancers and fertility preservation.
• Differences between Letrozole and Clomid, and why Letrozole is often preferred.
• How new protocols like DuoStim and random-start cycles are improving outcomes.
• Why fertility preservation is important even for those without a cancer diagnosis.

Guest Bio:

Dr. Nirali Jain (@eggspert_md) is a board-certified OB/GYN and fertility specialist at Reproductive Medicine Associates (RMA) in Basking Ridge, New Jersey. She earned both her undergraduate degree in neurobiology (with a minor in dance!) and her medical degree from Northwestern University, before completing her residency at Weill Cornell/NYP, where she served as co-Chief Resident, and her fellowship in reproductive endocrinology and infertility at NYU Langone.

Deeply passionate about women’s health and fertility preservation, Dr. Jain blends the latest research and cutting-edge treatments with compassionate, patient-centered care. Her interests include third-party reproduction and oncofertility, and she is especially passionate about supporting patients navigating fertility preservation through a cancer diagnosis.

Outside of the clinic, Dr. Jain is a trained dancer, a dedicated global traveler, and an adventurer working toward hiking all seven continents with her husband. Her diverse experiences, from international medical rotations to personal connections with friends and family navigating infertility, have shaped her into a warm, resourceful, and determined advocate for her patients.

Links and Resources:
Visit RMA website
Follow Dr. Nirali Jain on Instagram

-----------------------------

For more information about Michelle, visit www.michelleoravitz.com  

To learn more about ancient wisdom and fertility, you can get Michelle’s book at: https://www.michelleoravitz.com/thewayoffertility  

The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/  

Instagram: @thewholesomelotusfertility 

Facebook: https://www.facebook.com/thewholesomelotus/  

Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care.

-- 

Transcript:

# TWF-Jain-Nirali (Video)

​[00:00:00] 

**Michelle Oravitz:** Welcome to the podcast Jain. 

**Dr. Nirali Jain:** Thanks so much for having me

**Michelle Oravitz:** Yeah, so.

**Michelle Oravitz:** I'm very excited to talk about this topic, which, um, actually you don't really hear a lot of people talking about, which is how to preserve your fertility if you're going through a cancer diagnosis and if you have to go through treatments. 'cause obviously that can impact a lot on fertility.

**Michelle Oravitz:** I have, um, seen actually like a colleague of mine go through. And she also preserved her fertility and, and now she has a baby boy. so it's really nice.

**Michelle Oravitz:** to

**riverside\_nirali\_jain\_raw-video-cfr\_michelle\_oravitz's \_0181:** so nice.

**Michelle Oravitz:** So I'd love for you first to introduce yourself and kind Of give us a background on how you got into this work.

**Dr. Nirali Jain:** Of course. Um, so I am Dr. Narly Jane. I am, um, an OB GYN by training, and then I did an additional, after completing four years of residency in OB GYN and getting board certified in that, I did an additional training in reproductive endocrinology and [00:01:00] infertility or otherwise known as REI. So now I'm a fertility specialist.

**Dr. Nirali Jain:** Um, I trained at Northwestern in Chicago, so I went to undergrad and medical school there. And then, um, home has always been New Jersey for me, so I moved back out east to New Jersey. Um, I did all my training actually in New York City at Cornell for residency and NYU for fellowship. Um, and then moved to the suburbs.

**Dr. Nirali Jain:** Um, and now I'm a fertility specialist in, in Basking Ridge at Reproductive Medical Associates. 

**Michelle Oravitz:** Very impressive background. That's awesome. 

**Dr. Nirali Jain:** Yeah.

**Michelle Oravitz:** I'd love to hear just really. About what your process is. If a person has been diagnosed with cancer, like what is the process? What are some of the things that you address if they are trying to preserve fertility, and what are some of the concerns going 

**Dr. Nirali Jain:** yeah, yeah. All great questions. So, you know, there's a lot of us, uh, the Reis. Are a very small, [00:02:00] there's a very small number of us. So in terms of specializing in fertility preservation, technically we all are certified to treat patients with cancer and kind of move them through fertility preservation before starting chemotherapy.

**Michelle Oravitz:** Mm-hmm. 

**Dr. Nirali Jain:** Um, luckily we've been working closely with oncologists in the past several years just to establish some type of streamlined system because having a diagnosis of cancer and hearing all that information. Especially when you're young is so hard. So I think that's, that's where my interest started in terms of being able to speak to and counsel cancer patients.

**Dr. Nirali Jain:** I think it is a very specific niche that you really have to be comfortable with in our field. Um, I. So I'll kind of walk you through, you know, what it, what does it look like, right? Um, you go into your oncologist's office suspecting that you have this, this lump. I'll take breast cancer, for example. It could really be any kind of cancer.

**Dr. Nirali Jain:** Um, but breast cancer in a reproductive age patient or someone that's in those years where you're starting [00:03:00] to think about building a family, planning a family, um, or if you have kids at home, that's usually the type of patient that we see come in with a breast cancer diagnosis. So. Kinda just taking that, for example, um, the minute that you're diagnosed, it's really your oncologist's responsibility to counsel you on what treatment options are going to be offered to you.

**Dr. Nirali Jain:** And then based off of the treatment options, it's important to know how that affects your reproduction. So how does it affect your ovaries in the short term, in the long term, um, in any way possible. So. Once a patient is initially referred from their oncologist to myself or any other fertility specialist, they come into my office and we just have a 30 minute conversation really talking about family planning goals.

**Dr. Nirali Jain:** Any kids that they've had in the past either naturally conceived or through um, IVF, and then we talk about where they're at in their relationship. Are they married, are they not? Are they with a partner, [00:04:00] a male partner, a female partner, whatever it might be. It's important to know the social standpoint, um, especially in this sensitive phase of life.

**Dr. Nirali Jain:** So patient patients usually spend anywhere from 30 minutes to an hour. Um, just kind of talking through where they're at, how they're feeling, what their ultimate childbearing goals are. And then from there we do an ultrasound and that's when I'm really able to see, you know, the, the reproductive status.

**Dr. Nirali Jain:** So what do the ovaries look like? What does the uterus look like? Is there something that I need to be concerned about from a baseline GYN standpoint? Um, and all of those conversations are happening in real time. So. I think one of the things is patients come in and they're like, I'm already so overwhelmed with all this information from my oncologist, and now my fertility specialist is throwing all this information at me.

**Dr. Nirali Jain:** Luckily, the way I like to frame it is you come in and you just let go. Like you let us do the work because in the background we're the ones talking to your oncologist. We're the [00:05:00] ones giving that feedback and creating a timeline with your oncologist. Um, and really I think just getting in the door is the hardest part.

**Dr. Nirali Jain:** So once patients are here to see us, we go through the whole workup. We do anything that we would do for a normal patient that came in for fertility preservation. And then based off of where they're at in their journey, we talk about what makes sense for them, whether that means freezing embryos, freezing eggs, they're very similar in terms of the, the few weeks leading up to the egg retrievals.

**Dr. Nirali Jain:** So I have that whole conversation just at the initial visit. And then from there we talk about the timeline behind the scenes and make sure that it works with their lives before moving forward.

**Michelle Oravitz:** So for people listening to this, why, and this might be an obvious question, but to some it might not be, 

**Dr. Nirali Jain:** Mm-hmm.

**Michelle Oravitz:** why would somebody want to preserve. eggs or sperm. 'cause I've had actually some couples 

**Dr. Nirali Jain:** Yep.

**Michelle Oravitz:** come to me where the husband preserved the sperm and they had to go through IVF just because he was going [00:06:00] through cancer treatments. So he had to preserve the sperm ahead of time. 

**Dr. Nirali Jain:** Mm-hmm.

**Michelle Oravitz:** people need to consider doing that before doing cancer treatments? 

**Dr. Nirali Jain:** So there are certain cancer treatments that do affect the ovaries and the sperm health, and you know, for men and women, it affects your reproductive organs. In a similar way, um, depending on the type of chemotherapeutic agent, there are some that are more dangerous in terms of, um, being toxic to your ovaries or toxic to your sperm.

**Dr. Nirali Jain:** And those are the instances where we are really thinking about what's the long-term impact because there's medications that oncologists do give patients, and our oncologists are amazing, the ones that we work with, Memorial Sloan Kettering from Reproductive Medical Associates through RMA, um, and.

**Dr. Nirali Jain:** They're just so good at what they do and are so well-trained, so they know in the back of their mind, is this going to impact your ovaries or your sperm health or not? Um, and I [00:07:00] think that any chemotherapy, you know, your ovaries are these, these small organs that are constantly turning over follicles every month.

**Dr. Nirali Jain:** So every month we're losing those eggs, and if they don't become. If an egg isn't ovulated, it doesn't become a baby, it's just gonna die off. So I counsel even patients that don't have cancer, I counsel them on fertility preservation as young as possible. You know, between the ages of 28 and 35, that's like the best time to preserve your fertility.

**Dr. Nirali Jain:** So in cancer patients, there's an extra level added to that where even if they are a little bit younger, a little bit older. Your eggs are not gonna be the same quality. There's gonna be higher level of chromosomal errors, more DNA breakage, um, and, and bigger issues that lead to issues with conceiving naturally afterwards.

**Dr. Nirali Jain:** So I think that it's important to consider how that chemotherapy is going to affect them or how surgery would affect them if it was, for example, a GYN cancer where [00:08:00] we're removing a whole ovary, you know, what, what do we have to do to preserve your fertility in that case? And those are important conversations to have.

**Michelle Oravitz:** Yeah. for sure. I know that a lot of people are also concerned, you know, with going through the IVF process, you're taking in a lot of estrogen, a lot of hormones, and many cancers are actually estrogen sensitive. So I wanted to talk to you about that. 'cause I know that the data shows that it's. It's been fine, which some people might find surprising, but I wanted you to address that and just kind of

**Dr. Nirali Jain:** Yeah.

**Michelle Oravitz:** from your perspective. 

**Dr. Nirali Jain:** That's so interesting that you asked that question because I actually, my whole I I graduated fellowship last year and my entire, like passion project in fellowship was looking at one of the drugs that we use to suppress the estrogen levels specifically in cancer patients. Um, and I had presented this at a few of our reproductive meetings.

**Dr. Nirali Jain:** Um, A SRM is one of our annual meetings where all of the reiss get together. A lot of male fertility [00:09:00] specialists come and we kinda just talk about. Specific things and fertility preservation for cancer patients is, has been an ongoing topic of interest for all of us. Um, and it's important to know that there are different medications that we can offer.

**Dr. Nirali Jain:** Letrozole is the one that I, um, have a particular love for and I, uh, you know, I use all the time for my patients, um, for different reasons, but it suppresses the exposure that your body has to estrogen. And there's mixed data, um, out there in terms of, you know, does Letrozole suppression actually impact, you know, does it help or.

**Dr. Nirali Jain:** Or does it have no impact on your future risk of cancer after treatment? Um, and that honestly is still up for debate. But what we do know is that there's no increased risk of cancer recurrence in patients that have undergone fertility preservation with or without Letrozole. Um, Letrozole is one of those things that we can give, and the way it works is basically.

**Dr. Nirali Jain:** It masks that [00:10:00] conversion. It, it doesn't allow for conversion from those androgens in the male hormones over to estrogen. Um, and so your body doesn't really see that estrogen exposure. It stays nice and low throughout your cycle, and it does help with actually ovarian maturation and getting mature eggs harvested and, um, helps a little bit with, with quality too.

**Dr. Nirali Jain:** So I think that it's really nice in terms of having that available to us, but know that. It's not, it's not essential that you have it, really, the data showing plus minus. Um, but there are certain things that we can do to protect the ovaries, protect your exposure to estrogen. Um, and so that shouldn't be top of mind of concern when we're going through fertility preservation, even with an estrogen sensitive cancer.

**Michelle Oravitz:** Actually, so, uh, on a different topic, kind of going back to that, so Letrozole versus Clomid, I, it's like a, the questions I personally feel just based on what I've heard and like my own research that Letrozole would be kind of like the more. [00:11:00] Um, the, it's, it's a little better, but I know that it really depends on the person as well. 

**Dr. Nirali Jain:** Yeah,

**Michelle Oravitz:** they might do better with Clom, but I'd love to hear your perspective and kind of pick your brain on this. 

**Dr. Nirali Jain:** totally. You're choosing all the, all the right questions because these are all of my, my specific interests and niches. So 

**Michelle Oravitz:** Oh, 

**Dr. Nirali Jain:** Letrozole is basically, you know, we use Letrozole and Clomid in. Patients that don't have cancer and patients that come in for an intrauterine insemination, that's kind of the most common scenario where we're thinking about, you know, which medication is better?

**Dr. Nirali Jain:** Letrozole or Clomid and Clomid used to be the, the most common medication that we use, we dose patients, you know, have 50 milligrams of Clomid, give them five days of the medication. It's an oral pill. Feels really easy and. The way it works is really, it recruits more than one follicle, so it really helps with the release of, um, more than one follicle growing more than one follicle in the ovary.

**Dr. Nirali Jain:** Um, but it has a little bit [00:12:00] higher of a risk of twins because that's exactly what it's good at. Um, Clomid, not so much in the cancer. In the cancer front, it's not really used there because it's considered, from a scientific perspective, it's considered like a selective estrogen receptor modulator. So it doesn't necessarily suppress your estrogen levels in the same way that Letrozole does versus.

**Dr. Nirali Jain:** Letrozole is an aromatase inhibitor, so it really blocks the chemical conversion of one drug or one hormone to the other hormone. Um, the reason we love Letrozole so much, and I don't mean to like gush over Letrozole, but um, it's a mono follicular agent, so it works really well at recruiting one follicle 

**Michelle Oravitz:** Mm-hmm. 

**Dr. Nirali Jain:** you know, every OB-GYN's nightmare in a way is having multiples when you didn't intend on having multiples at all.

**Michelle Oravitz:** so 

**Dr. Nirali Jain:** Um.

**Michelle Oravitz:** were saying that, um, there's more of a chance of twins, it's Clomid, not letrozole. 

**Dr. Nirali Jain:** Yes, there's a higher chance with Clomid versus Letrozole. And I mean, don't get me wrong, there's a chance of twins with [00:13:00] any type of assisted reproductive technology. Even when we're doing single embryo transfers, there's a chance that it's gonna split. So, um, the chance is always there just like it is in the natural world.

**Dr. Nirali Jain:** But we know for a fact that. CLO is really good at recruiting many follicles. It's good for certain patients that don't respond well to Letrozole. Um, but Letrozole is kind of our, our go-to drug these days just because of all the benefits that we've seen. 

**Michelle Oravitz:** Awesome. 

**Dr. Nirali Jain:** Yeah,

**Michelle Oravitz:** These are all fun things to ask because I, I love talking to our eis 'cause there's so much information that I'm always 

**Dr. Nirali Jain:** totally.

**Michelle Oravitz:** learn a lot from my patients in my own research, but it's really cool. Picking your guys' brains. So another question I have, and I have actually talked to Dr. Andrea Elli, he's been on, 

**Dr. Nirali Jain:** Mm-hmm.

**Michelle Oravitz:** and he does a lot of endometriosis and, and immune related work as well, 

**Dr. Nirali Jain:** Yeah.

**Michelle Oravitz:** so. I'd love to know just from your perspective. One thing that I do know from, based on what I've heard is that the, [00:14:00] guess like you were just saying, that breast cancer or estrogen sensitive breast cancer doesn't seem to be affected by IVF cycles, however, and endometriosis lesions do get affected. 

**Dr. Nirali Jain:** Yeah.

**Dr. Nirali Jain:** that's a great question. So, you know, every, there are so many complex G mind diagnoses that the, that our patients come in with. Um, and endometriosis is a big one because there is clear data that endometriosis is linked to infertility. So we think about, you know, when a patient comes in with endometriosis, we really do think about the different treatment options and what are the short-term and long-term impacts of the hormones that we're giving 'em.

**Dr. Nirali Jain:** Um, these days, again, kind of going back to Letrozole, we, letrozole is something that I give all of my endometriosis patients because it helps suppress their estrogen because we know. 

**Michelle Oravitz:** interesting. 

**Dr. Nirali Jain:** is very responsive to estrogen and leads to this dysfunctional regulation of all the endometrial tissue that can really flare in a, [00:15:00] in a cycle, or shortly after a cycle.

**Dr. Nirali Jain:** I. So we really, for endometriosis patients, the, the best treatment is being on birth control because we don't see that hormonal fluctuation. The up and down of the estrogen and the progesterone, that's what leads to those flares. Um, so I really, I watch patients closely after their cycles too, because you definitely can have an endometriosis flare and we say the best treatment for endometriosis is pregnancy, right?

**Dr. Nirali Jain:** That's when you're suppressed, that's when you're at your lowest. Um, and patients, my endo patients feel so good in pregnancy because they have. Hormones that are nice in that baseline, they're not getting periods of course. Um, and that's truly, truly the best treatment. 

**Michelle Oravitz:** That's interesting. 

**Dr. Nirali Jain:** But it is important to consider when you're going through infertility treatments.

**Dr. Nirali Jain:** How does my endometriosis affect the short and long-term effects of the fertility medications? And really not to, not to say that they're bad in any way. I think a lot of endometriosis patients go through IVF and have success and do really, really well, and that's kind of the push that they need. [00:16:00] Um, but it's important to be mindful of the bigger picture here.

**Dr. Nirali Jain:** It's not just, you're not just a number of. A patient with endo coming in, getting the same protocol. It's really individualized to the extent of your lesions, what symptoms you're having, what grade of endometriosis, where your lesions are. So we're the RAs are thinking about everything before we actually start your protocol.

**Michelle Oravitz:** It's crazy how in depth it is, and it's, it, there's just so, it's so multifaceted, 

**Dr. Nirali Jain:** Yeah, 

**Michelle Oravitz:** when it's females 

**Dr. Nirali Jain:** totally.

**Michelle Oravitz:** are a little, I mean, they can, you know, there, there's definitely a number of things, but it's not as complicated and interconnected 

**Dr. Nirali Jain:** Exactly. Exactly. That's so true.

**Michelle Oravitz:** And so one question I actually have, this is kind of really off topic, but something that I was curious about.

**Michelle Oravitz:** 'cause I heard about a while 

**Dr. Nirali Jain:** Yeah.

**Michelle Oravitz:** a, a type of cancer treatment that was used. I'm not sure exactly what it was, but for some reason it actually caused follicles to grow, [00:17:00] or to multiply. And they were

**Dr. Nirali Jain:** Interesting.

**Michelle Oravitz:** this definitely. Puts, um, the whole idea of like a woman being born with all the follicles she'll ever have on its head, I thought that was really Interesting.

**Michelle Oravitz:** Now I learned a little bit about it. I don't think it really went further than that, 

**Dr. Nirali Jain:** Mm-hmm.

**Michelle Oravitz:** one of those things that they're like, Hmm, this is interesting. I don't know, it was kind of a random side effect of this chemo drug. I dunno if it was a chemo drug or a cancer drug. 

**Dr. Nirali Jain:** Yeah. 

**Michelle Oravitz:** ever heard of that.

**Michelle Oravitz:** So I was just

**Dr. Nirali Jain:** I haven't, I mean, that's interesting. I feel like I'd have to look into that because that would be definitely a point of interest for a lot of Reis. But it kind of does go back to the point of, you know, women are really born with all the eggs we're ever gonna have. So it's about a million, and then it just goes down from there.

**Dr. Nirali Jain:** And the, by the time you start having periods, I like to kind of show my patients a chart, but you have a couple hundred thousand eggs and you ovulate one egg a month. That's, you know. Able to [00:18:00] progress into a fertilized egg and then into a, an embryo into a baby, um, if that's your goal. But otherwise, patients that are having periods and not trying to actually get pregnant, we're losing hundreds of eggs a month.

**Dr. Nirali Jain:** So. 

**Michelle Oravitz:** Mm. 

**Dr. Nirali Jain:** It's important to kind of think about that decline, and it's important to know that that rate can be faster in patients with cancer, patients with low ovarian reserve. And sometimes when you have the two compounded, that's when a fertility specialist is definitely, you know, in the queue to, to have a discussion with you in terms of what that means and how you can reach your family building goals despite being faced with that, with that challenge.

**Michelle Oravitz:** Yeah.

**Michelle Oravitz:** I mean, 'cause we know oxidative stress is one of the things that can cause, uh, 

**Dr. Nirali Jain:** Yeah,

**Michelle Oravitz:** quality eggs, but it's also can cause cancer.

**Dr. Nirali Jain:** Yeah,

**Michelle Oravitz:** um, similar, you know, like things that really deplete the body could definitely impact. Um, and then what are your thoughts? I know I'm asking you all kinds of random questions,

**Dr. Nirali Jain:** I love it.

**Michelle Oravitz:** are your thoughts about doing low simulation in certain [00:19:00] circumstances versus high stem?

**Michelle Oravitz:** Sometimes people don't respond as well to higher stems. 

**Dr. Nirali Jain:** Yeah, that's a great point. I think that it kind of all goes back to creating an individualized protocol. If. A patient's going to a practice and basically just getting a protocol saying, this is our standard. We start with our standard of, you know, I, I think about the standard, which is 300 of the FSH or that pen that you dial up, and then 150 units of that powder vial.

**Dr. Nirali Jain:** And we have patients mixing powders all the time, and that's kind of our blanket protocol that we give patients. But that's not really what's happening behind the scenes. And if you're given a protocol that's, and being told, you know, this is kind of what we give to everyone, it's probably not the right fit for you.

**Michelle Oravitz:** Yeah, I 

**Dr. Nirali Jain:** Um, there are certain patients that respond to a much lower dose and do really, really well, and then some patients that need a much higher dose. Um, and I think it's, that's kind of like the fun part of being an REI of being able to individualize the [00:20:00] protocol to the patient. Um, and I know for a fact there are so many, luckily, you know, we have so many leaders in REI that have been.

**Dr. Nirali Jain:** Have dedicated their entire careers to researching these different protocols and how they can help different patients. Um, patients with lower a MH, you know, might benefit from a duo stim protocol, for example. That's kind of the first one that comes to mind, but a protocol where we're using those follicles from the second half of a cycle.

**Dr. Nirali Jain:** I would've never thought that those were the follicles that 

**Michelle Oravitz:** Oh, 

**Dr. Nirali Jain:** would be better than the first half of the cycle, 

**Michelle Oravitz:** Wait, 

**Dr. Nirali Jain:** but,

**Michelle Oravitz:** that. Explain that. Um, because I think that that's kind of a unique 

**Dr. Nirali Jain:** mm-hmm. 

**Michelle Oravitz:** that I haven't heard of. 

**Dr. Nirali Jain:** Yeah, so there's this new day. It's still kind of developing, but um, kind of going back to, you know, what's an individualized protocol? Duo STEM is one of the newer protocols that we've started using. I, I've used it once or twice in patients. Um, but it goes back to the research that shows that you might actually have two different periods of time in a menstrual cycle where you could potentially recruit [00:21:00] follicles.

**Dr. Nirali Jain:** You could have a follicular phase where there's a certain cohort of follicles recruited, and then you have a follicle that forms creates a corpus glut. 

**Michelle Oravitz:** um, protocols 

**Dr. Nirali Jain:** Yep. And then you basically go through the follicular protocol and then a few days after a retrieval, instead of waiting for a new follicular cohort or follicular recruitment from the first half of your menstrual cycle, you actually use the luteal phase and you recruit those follicles that would've actually died off or have been prematurely recruited in a prior cycle.

**Dr. Nirali Jain:** So

**Michelle Oravitz:** that's So 

**Dr. Nirali Jain:** yeah,

**Michelle Oravitz:** you just do a similar, I guess, um, medicine, 

**Dr. Nirali Jain:** go right back into it. 

**Michelle Oravitz:** do the same exact thing, but right after ovulation. 

**Dr. Nirali Jain:** Yeah. 

**Michelle Oravitz:** Fascinating. That's really interesting. 

**Dr. Nirali Jain:** Yeah, 

**Michelle Oravitz:** has been your experience with that? 

**Dr. Nirali Jain:** I think it's, honestly, it's mixed. Um, so far, you know, our data from fertility and sterility and A SRM, it, it shows support for these DUO STEM [00:22:00] protocols, saying that if patients don't have that great quality of eggs or if they have a very low number, maybe they'd benefit from starting the meds earlier and recruiting follicles.

**Dr. Nirali Jain:** A little bit earlier. Um, so we've seen positive results so far. A lot of work to be done in terms of really understanding it. Um, and of course, as a new attending, I have a lot more experience to kind of build on. Um, but I, I have seen success from it.

**Michelle Oravitz:** That's fascinating. Are there any other new technologies, like new add-ons, um, that you've seen, that you've found to be really cool or interesting? 

**Dr. Nirali Jain:** I think the biggest thing, actually, kind of going back to our whole topic for today is fertility preservation cancer patients. One of the biggest things that I've learned recently is that we used to start fertility, um, patients. You know, only in the beginning of the cycle days, two or three is technically like when most.

**Dr. Nirali Jain:** Most clinics, um, start patients, but for our cancer patients, sometimes you don't have that time. You don't wanna wait a full month to [00:23:00] restart, um, your, you know, your menstrual cycle and then do the fertility preservation and then delay chemotherapy a full month. So we started doing what we call random starts.

**Dr. Nirali Jain:** So you basically start a patient whenever they come in. You know, it could be the day after your consultation, the day of your consultation. I've kind of seen all of the above. Um, and we've seen really good success with random starts, per se. Um, and we've been doing a lot more of that, where it's not as dependent on where you're at in your cycle.

**Michelle Oravitz:** Mm-hmm. 

**Dr. Nirali Jain:** Um, obviously there's a difference in outcomes. You might not be a great candidate for it, so definitely it's worth talking to your doctor about it. But it kind of gives relief to our cancer patients where if you have a new cancer diagnosis and you're like, oh, I just finished my period, like, I can't even start a cycle until next month.

**Dr. Nirali Jain:** That's not always true. Um, so it's always worth it to go into see a fertility specialist and just get, you know, get the data that you need right away, and then you can make a decision later on.

**Michelle Oravitz:** For sure. Um, Yeah.

**Michelle Oravitz:** and I wanted to kind of cover a lot of different topics 'cause I know that [00:24:00] some people are gonna wanna hear what you have to say that don't necessarily, or, uh, have cancer. But it is important. I, I think that, you know, if you get to thirties and you haven't gotten married or you don't have a partner, I think it's really important to preserve your fertility in general. 

**Dr. Nirali Jain:** Yeah,

**Michelle Oravitz:** important thing. And then if you were going through a cancer diagnosis and you decided to preserve your fertility, um, guess more for women because they're eventually going to be thinking about transfers after they go through treatment. So what are some of the things that they would need to consider as far as that goes?

**Michelle Oravitz:** Like after the 

**Dr. Nirali Jain:** yeah,

**Michelle Oravitz:** then they go through the cancer treatments. Um, and then what, how long should they 

**Dr. Nirali Jain:** yeah. Like what does it look like? So I've had patients that come back, you know, in my fellowship training I did a, a couple research projects on patients that came back to pursue an embryo transfer, um, after chemotherapy agent. And basically compared them to how they did, um, [00:25:00] compared to patients that didn't have cancer and just froze their embryos or froze their eggs and then came back to pursue a transfer and.

**Dr. Nirali Jain:** I think the, the most reassuring thing from the preliminary data that we have is saying that there's no difference in pregnancy rates and no difference in life birth, 

**Michelle Oravitz:** Awesome. 

**Dr. Nirali Jain:** of whether they had chemotherapy or not. After freezing those eggs and going through fertility preservation. 

**Michelle Oravitz:** Amazing. 

**Dr. Nirali Jain:** Um, in terms of where your body needs to be, I think the oncologist, we, we wait for their green light.

**Dr. Nirali Jain:** We wait for their signal to say, you know, she's safe to carry a pregnancy. 

**Michelle Oravitz:** Mm-hmm. 

**Dr. Nirali Jain:** And then once we do that, we basically treat you like any other patient. So if you're coming in for a cycle, if you're having periods, then it's reasonable to try a natural cycle protocol, wait for your body to naturally ovulate an egg.

**Dr. Nirali Jain:** And instead of obviously hoping that egg will fertilize, we, um, use a corpus luteum. We use the progesterone from the corpus luteum to really support this embryo being implanted into the uterus. Um. Yeah. [00:26:00] And then there's also another side. I mean, some patients don't get their periods back and they always ask like, what if I never get my period back?

**Dr. Nirali Jain:** What if I'm just like in menopause because of the chemotherapy agents? And for that, we can start you on a synthetic protocol or basically an estrogen dependent protocol where you take an estrogen pill for a certain number of days. We monitor your lining, then we start progesterone, um, to support your hormones from that perspective instead of relying on your ovaries to release the progesterone that they need, um, and then doing the embryo transfer a few, few days after progesterone starts.

**Dr. Nirali Jain:** So there's definitely different protocols depending on where your menstrual health is at after the chemotherapy or after the cancer treatment. Um, but it's important to kind of just know that. That there's options. It doesn't mean that it's the end of the road if you all of a sudden stop getting your period.

**Michelle Oravitz:** Yeah, for sure. I mean, 'cause you, technically speaking, you can really control a lot of that. More so for transfers 

**Dr. Nirali Jain:** Yep.

**Michelle Oravitz:** Retrievals really is kind of like what [00:27:00] eggs you have, what the quality is. But people can be in complete menopause and you guys can still control their cycles for transfer, which is kind of. A huge difference 

**Dr. Nirali Jain:** Yeah, 

**Michelle Oravitz:** in the 

**Dr. Nirali Jain:** exactly. That's exactly right. Yeah.

**Michelle Oravitz:** interesting. Any other, um, new, new things that you're, you guys are excited about? I always like to hear about like the new and upcoming things 

**Dr. Nirali Jain:** Of course. 

**Michelle Oravitz:** actually before, which I thought was fascinating. Yeah. 

**Dr. Nirali Jain:** I feel like there's always like updates and, and new data and things like that coming out, but just know, I think it's important for patients to know, like we're constantly, we're, the reason I chose to even pursue this field was because it's new. Right. There's something that we are discovering every day, every year, and that's what makes our, our conferences so important to attend, um, to really just stay up to date.

**Dr. Nirali Jain:** Um, but we are, uh, constantly updating our embryology standards, the way we thaw our eggs, and the success rate associated with a thaw and [00:28:00] how we treat our embryos and the media that we use, right? Like, so we're really thinking about the basic science perspective every single day, and that's what makes this field so unique.

**Michelle Oravitz:** It is really awesome. And so do you guys specialize specifically on, um. Egg freezing and, and I mean specific fertility preservation in patients that do that have cancer that are going through treatments, do you guys specialize specifically in that? I mean, I know you do range 

**Dr. Nirali Jain:** Yeah. Yeah, because it's such a small community, we all have our own niches and we all kind of have our own interests and 

**Michelle Oravitz:** Yeah. 

**Dr. Nirali Jain:** no like specific training. There are a couple courses that you take that I took in in training as well, just to kind of understand what it sounds like to, I. Council of fertility preservation, patient with and without cancer.

**Dr. Nirali Jain:** Um, and then, you know, you kind of just learn by experience and you form a niche for something that you're passionate about. 'cause that's what makes you, you know, really thorough in, in your treatment. [00:29:00] So that's one of my interests. Um, and, but I would say, 

**Michelle Oravitz:** training for that. It's just like 

**Dr. Nirali Jain:** yeah,

**Michelle Oravitz:** just know how to treat that in 

**Dr. Nirali Jain:** exactly. 

**Michelle Oravitz:** especially if you're interested in doing that. 

**Dr. Nirali Jain:** Exactly. That's exactly right. It's kind of, it just comes with the experience comes with your mentors and who you're surrounded by, and everyone kind of helps each other get to that point. But there are several specialists in our practice at RMA that specialize specifically in fertility preservation in cancer patients.

**Dr. Nirali Jain:** So we have a close communication with our oncologist and they know who to refer to within the practice because everyone has their own little interests. 

**Michelle Oravitz:** Amazing. 

**Dr. Nirali Jain:** Yeah.

**Michelle Oravitz:** Um, definitely. I, like I said, I really enjoy picking your brain because it's a lot of fun for me. I, I do 

**Dr. Nirali Jain:** Totally. 

**Michelle Oravitz:** acupuncture, so 

**Dr. Nirali Jain:** Yeah,

**Michelle Oravitz:** and I, I think that it's just so crazy that our fields don't work together. I mean, we kind of do, but I think, I just feel like it would be so great 

**Dr. Nirali Jain:** exactly.[00:30:00] 

**Michelle Oravitz:** the expertise because you guys have immense. Benefits like in, in, uh, technology and incredible innovations and, and then the natural aspect of really understanding the, the body. And I, I just think that it would work so amazing together if it was more of like a thing. 'cause it, I know in China they actually combine the two 

**Dr. Nirali Jain:** Yeah. 

**Michelle Oravitz:** eastern. 

**Dr. Nirali Jain:** Yeah, I mean I think that that's so important and there is data that shows, you know, there's actually a recent study that came out just a few weeks ago on the benefits of acupuncture for fertility patients. And we know that, I mean, I recommend it to all of my patients, specifically the day of the embryo transfer.

**Dr. Nirali Jain:** We, luckily, we offer it on site at RMA and we have acupuncturists that come in and, and do a session before and after the embryo transfer, and I think. A lot of that is targeted towards stress relief. But I also think that holistically it's important to feel at your best when we're doing something that's so crucial to your, to your health.

**Dr. Nirali Jain:** So to really focus on the diet, focus on stress relief, [00:31:00] focus on meditation, yoga, whatever it takes to get to your best wellbeing when you're going through fertility treatments, um, is so important. So I appreciate 

**Michelle Oravitz:** Mm-hmm. 

**Dr. Nirali Jain:** like you that really specialize in the other side of. Of this, because I do consider it still part of the holistic medicine that we need to really maximize success for our patients.

**Michelle Oravitz:** Awesome. Well, 

**Dr. Nirali Jain:** Yeah,

**Michelle Oravitz:** Jane, this is such a pleasure Of talking to you. You've given us some, so much great information and we've definitely dived into a, do a topic that I don't typically, I haven't yet spoken about. But, um, that being said, it's such an important topic to talk about. And thank you so much for coming on today.

**Michelle Oravitz:** Oh, 

**Dr. Nirali Jain:** course.

**Michelle Oravitz:** I get off, how can people find you? 

**Dr. Nirali Jain:** That's a great question. So I have, um, a social media page. I, it's called Expert nc. So like EGG, 

**Michelle Oravitz:** I 

**Dr. Nirali Jain:** um, expert nc. Try, tried to make it a little bit humorous. Um, but I'm all over social [00:32:00] media and would love to hear from anyone that is listening. I, you know, every, every day I get different, um, dms and I'm happy to respond.

**Dr. Nirali Jain:** I love hearing about everyone else's. Stories and things like that. Um, so that is kind of my main, main social media platform. Um, and then through like RMA and Reproductive Medical Associates, we also have a YouTube channel. We have an Instagram page, um, of our office available, um, as well that is public.

**Dr. Nirali Jain:** So you can find us pretty easily if you just kind of hit Google. But um, yeah, I'm kind of developing my social media platform as the expert and I hope it grows. 

**Michelle Oravitz:** Love it. Great. 

**Dr. Nirali Jain:** Yeah. 

**Michelle Oravitz:** was such a pleasure talking to you. Thank you. so much

**Dr. Nirali Jain:** Thank you.

**Michelle Oravitz:** today. 

**Dr. Nirali Jain:** Of course. Thank you so much for having me. 

[00:33:00]