Two heads are better than one! In this special edition of my weekly live, I am joined by my dear friend and colleague, Marc Sklar aka @the_fertility_expert! 

In this video we take all of your burning  questions about fertility. 

SEE TRANSCRIPT BELOW OR CLICK ON THE IMAGE ABOVE FOR FULL VIDEO.

Amy:

Hi everyone. It is that time. I am here with you again. Get to go live every single week. And today we have a very special guest. My dear friend, Marc Sklar, also known as the fertility expert. And him and I are going to come to you live and do a fertility Q&A. So you guys come prepared with your questions and I'm going to bring mark right on.

Amy:

Hi.

Marc Sklar:

Hey Amy. How are you?

Amy:

I'm good. How are you?

Marc Sklar:

Good. I'm excited. It's been a long time since we've done one of these.

Amy:

I know. It's so fun. It's so fun. How's everything in San Diego?

Marc Sklar:

Everything is wonderful. How about you? Good 4th of July?

Amy:

Yeah, we had such a nice time.

Marc Sklar:

Good.

Amy:

Really good. Yeah. Lots of firework around here, but it was fun. It was fun. Yeah. So let's see.

Marc Sklar:

That's wonderful.

Amy:

Did we get questions that you saw on your feed at all? No? I don't think I saw any questions. So we're just going to let you guys start rolling in with some questions. What do you want to ask Mark and I?

Marc Sklar:

Yeah. We're here for you.

Amy:

Yeah. Fertility related questions. Let them roll. You guys can use the question box. I will do my best to remember to check that. I'm not always the best at that. Working on it. Always a work in progress. Or you guys can just post in the comments and ask us some questions. But I have a question. I was on a call with Sarah, one of my associates, earlier today, and we were talking about nuclear transfers. The latest and greatest, if you will, of what's going on in the world of IVF. Where they take basically the yolk, if you will, of the younger woman and then replace the white. And so she's got a genetically embryo that's hers, but with youth surrounding it. So I don't know. What are your thoughts on this?

Marc Sklar:

I mean, I think these things are bound to happen with the fertility world that we live in and technology and advancements and people are always trying to push the envelope and do some sort of new thing and hybrid and so forth. I don't know. I think it's really fascinating on one side. I think it's really interesting and cool. It makes me think of some sort of sci-fi movie or show that we're going to start blending all sorts of genetic material and see what happens. And so it's really fascinating from a science perspective. I think from a human perspective, it's a bit scary for me. Yeah. It seems odd.

Amy:

Apparently, it's being done outside of the US. There's one doctor here in the New York area that I guess is sending women abroad to some clinic who's actually doing it. And I know Dr. Mer, he has been talking about it is a potential for the future so stop discarding even immature embryos. Or immature eggs is what he's saying actually.

Marc Sklar:

Right. Because then you could use that material.

Amy:

You could use it down the road. So yeah, I agree. It seems sci-fi but I think so did genetic testing. If you remember PGS testing, it was … Or gender selection. You were like, “Huh, this is fascinating. Really? We can rule out all the genetics is fascinating.” Because that happened during our time. You know what I mean? We worked pre PGS testing and then all of a sudden it was like … Or even the freezing of the embryos and moving to FETs. That wasn't obviously nearly as scientific, but just these trends and these changes. So it's kind of fascinating to see. Okay, we have questions coming in.

Marc Sklar:

It's bound to happen.

Amy:

It is.

Marc Sklar:

That's for sure. Yeah. Bound to happen.

Amy:

So here's a question. “Is there really nothing that can be done for fibroids when you're going through IVF? I have a significant size fibroid outside my uterus that is so large it doesn't allow for them to really see follicles and count them on my left ovary.”

Marc Sklar:

Can they still retrieve from that side or they just can't do anything whatsoever?

Amy:

Yeah. It just says it doesn't allow them to see and count. But I don't know. She doesn't mention about retrieval. So Erica, you're here. Maybe-

Marc Sklar:

You can chime in a little bit. Yeah. Fibroids are, especially that size, on one side, you want to try to reduce the size as much as possible. And then on the other side is you're concerned or they're concerned about potentially damaging something if they can't see everything, if they go in. And if it's on the outside, it's that large, it's a major surgery. It's not something that is going to be small. Recovery takes time. So it really just depends. I've seen women with grapefruit or larger fibroids get pregnant, have healthy pregnancies, maintain a healthy pregnancy. So in the grand scheme, I think part of the reason that they say that is because if they don't believe it should hinder your ability to get pregnant, then they might not want to do anything about it at the time and less is more.

Amy:

Yeah. And I also think there's a lot we can do from a Chinese medicine perspective. We would see the fibroid as some type of blood stagnation or phlegm accumulation and dietary approaches, herbal approaches. I do think things like castor oil packs and avrigo, abdominal massage, things of that nature can also really help reduce the size. I've seen lots of women, not necessarily get rid of the fibroids, but shrink them down. And that could make then the situation more manageable for you.

Marc Sklar:

How long would you say it would take someone? I mean, she's got a considerable size. So how long would you say it takes her, if we did that approach?

Amy:

Six months.

Marc Sklar:

Yeah. I say minimum six months.

Amy:

Yeah. Yeah.

Marc Sklar:

So that's the other piece is just time that you've got to be aware of.

Amy:

I'll do this in some cases where if she's trying naturally, I would during follicular phase use more aggressive herbs. And I would break up the treatment so that if she then didn't get pregnant, then I would go after it again. Because sometimes it's the same thing with fertility. It's on this spectrum of how much is needs to shift? And we never know until we're coming in there doing it. But I do think there's a lot of things you could do on the more natural holistic side to help manage that without surgery. Because I agree, that's a major abdominal surgery. That's like a C-section and the recovery is intense and the uterus takes a while to heal and be able to hold a pregnancy.

Marc Sklar:

Yeah, absolutely.

Amy:

Okay. So egg quality diet for freezing eggs. Attempting my first this November. Any must do to prep for egg freezing for egg quality?

Marc Sklar:

She's doing it right?

Amy:

What was that? Yeah.

Marc Sklar:

She's doing it.

Amy:

Do the egg quality diet. Follow the egg quality diet. I wrote a book called The Egg Quality Diet. I would follow that. I do think actually, I had an interview yesterday and I pitched to the journalist actually. I was like, “If you ever want to do a story, talking more about preparing for egg freezing,” which I had done a story a while ago, and I know you talk about it too, but I think it's a really important conversation to start having, especially all the world and everything that's going on and all the things. That just women are being really conscious of their fertility at a younger age. And so preparing for your fertility is really important. And so just because you're 33 doesn't mean going and freezing your eggs is automatically going to render you the best eggs possible. You might have youth on your side, but there can be a lot of things that are in the way that could compromise quality or even the way your body assimilates and utilizes the hormones. Obviously I have it mapped out in the egg quality diet, but really just focusing on overall health and maximizing that from all the perspectives, like energy and digestion and sleep. And what do you think?

Marc Sklar:

Yeah, I think preparation is key and the wonderful thing for her is she said November. We've got time. You've got time. So you're being proactive, which is what we love to see. And you're on top of it. So all the things you're doing now, following that diet, changing your lifestyle, taking whatever supplements you're taking, all of these things, that's preparation. You're doing that now. So I mean, without knowing your case, I don't know that I would say do anything different. I would just say, do that. Stick to that and be good with that between now and then. And for all those women, like you mentioned, who are thinking about FETs or freezing embryos or eggs, or want to just have a plan, the plan is to start to address your health and your hormones and your reproductive health now, before you ever get to that point in time where you're behind the eight ball. You want to be preventative and proactive.

Amy:

Ahead of the game. Ahead of the game.

Marc Sklar:

Yeah. Where do you see these questions? I don't see any questions.

Amy:

Oh, I guess they're probably just on my side. People are posting them. In that question box. I wonder if you can see the question box on your side. I skipped someone. “Do you think that taking prednisone could help during stem cycle if you have Th1, Th2, and NK cells elevated?”

Marc Sklar:

I mean, my short answer is yes. I mean, I do think. I don't know that there's much explanation if that's … If you're just looking for a yes or no, I would say yeah.

Amy:

It lowers inflammation. At the minimum, low dose naltrexone, maybe during stems. Then once you transfer, if you know you have NK cells, I think with any transfer you should consider some type of immune support and prednisone seems to be one of the best ways to go. So I agree. It's an anti-inflammatory and our whole approach is anti-inflammatory. And natural killer cells are inflammatory and the Th1, Th2 being off. Absolutely.

Marc Sklar:

Yeah. I mean, you mentioned LDN, low dose naltrexone, which is one of my favorite to use when you can and when it's appropriate. Really safe and typically get a lot of good results. So that's also a way to go.

Amy:

Yeah. And there's … It's like ldn.com. You can go online if you're in the US and get a prescription wherever you are for low dose naltrexone.

Marc Sklar:

Oh, I didn't know that.

Amy:

Yeah. One of my patients discovered it. I'm pretty positive it's called ldn.com. Let me just double check. And you do a little quick interview. I think it's a couple hundred bucks. It's not-

Marc Sklar:

Yeah. The physician is evaluating you and then making that prescription. That's a wonderful resource.

Amy:

Yeah. It's not ldn.com. Ldndoctor.com I think is what it is. But I just googled LDN script and there's one get.agelessrx.com. CFS pharmacy.

Marc Sklar:

Those are great resources for everybody because that's a wonderful way to get it. Yeah.

Amy:

Well, I said this the other day, it came up of like, someone was like, “Is it safe?” I'm like, “I'll tell you this.” What got me looking at it more was I have a lot of physicians, female physicians in my practice who are trying to conceive in their 40s and every single one of them is doing LDN. Because they've just read the research. And they're coming to me, they're like, “I'm on 4.5 milligrams of LDN.” And I was like, “Oh, fascinating. Yeah.” And so I think it's one of those things, like you said, it's very safe. It can't hurt. We know it's going to help with inflammation. Yeah.

Marc Sklar:

I will say the only thing I'll say about the dosaging there where I've seen it work better without any initial side effects is start lower and then-

Amy:

Yeah. And move up.

Marc Sklar:

And then ramp up. Yeah.

Amy:

Low and slow. Another question's come in. Interesting. Okay. How many sessions of acupuncture should you do before going through IVF? I'll let you take that.

Marc Sklar:

How many sessions? What the research specifically says … And then we have two different conversations here, because now IVF used to be a catchall phrase to mean the whole process and now it's different. Now for the most part, there's retrieval cycles, there's transfer cycles unless you're doing the fresh cycle. And so just thinking about it at each section, each piece of that. But in general, the research is pretty clear, which is an odd number. It's 11.

Amy:

Leading up. It's like consecutive treatments.

Marc Sklar:

Leading up. Yeah. So we ramp it. Yeah. So we round it up to 12. So it's not about necessarily spreading them out. If you're going to do it once a week, that's three months. If you have less time, then you're doubling up sometimes per week and we get calls, “Hey, I'm three weeks out. What can I do?” And that's where we see you more frequently and recommend that more frequently. So that would be before retrieval and then also before transfer and then additionally, there's the transfer day treatment as well. Yeah.

Amy:

Yeah, yeah. Agreed. Agreed. The newer research is interesting that it's the more consistent acupuncture in the lead up to the cycle is actually the most beneficial. Not just doing the pre and post, although we all still do those and find them highly effective as well. And the fertility doctors love us for that. Okay. Let me go back here. Oh, tap to answer the question. Oh, I see. This is interesting. Look at that. So now can you see the question?

Marc Sklar:

I can see the … Oh. Oh, on there? Oh yeah. I can see the question there. But I was looking now that you told me where you were seeing.

Amy:

Oh, okay. Okay. Oh, this is interesting. Now I have a little Q&A thing that popped above my screen. I've never done it this way. I like it. So ERA was done at 127 hours of PIO, which is progesterone. Does it have to be done right at 120 hours? So if it's … Oh, now I have to go back here.

Marc Sklar:

Now you can't see it here.

Amy:

So if it's receptive, does it matter when it's done? FET was done at 125.5 hours.

Marc Sklar:

Yeah. It does matter when it's done. Yeah. When you get the … Or not when you, but when the doctor gets the report for the ERA, they don't usually say, “Oh, it needs to be done on this specific hour.” They're giving you a window of time. It's an hour's window. And that's where they say you are receptive in this window of time and as long as it's done in that window of time, then you're fine. Which it sounds like it was.

Amy:

Yeah, exactly. Okay. I did the fibroid one. Okay. Failed FET, PGT normal for AB. PIO and prednisone. Have done all the tests. All is normal. What should I do next?

Marc Sklar:

That was a lot to take in. I'm trying to find it so I can read it.

Amy:

I mean, I'll start and then you add in. I think I have a couple questions right away.

Marc Sklar:

Oh, I see it. Okay.

Amy:

Is it the first failed? Because that could be just not every IVF transfer takes and you could be doing everything perfect. If it's not the first failed and you've done this protocol now more than once and it hasn't worked with the PGT normal, I'd do some further testing. I'd consider endometrial biopsy if you haven't already had it or the ALICE and EMMA tests for looking for endometritis.

Marc Sklar:

Or the ERA.

Amy:

The ERA. There's the Receptiva too, to see is there endometriosis. Things like that to see … Even I would consider … I mean, depends on the case and all the other things. We'd be looking at you full picture if we were with you in the clinic or coaching you. But if there are signs or symptoms or previous history of autoimmune conditions, I might consider something like the Pregmune testing just to rule out any other inflammatory issues or immune issues that are going on that are preventing implantation from happening.

Marc Sklar:

Yeah. I mean, all the right things. I'm always skeptical and I'm not saying this is something on you when you say this, but I'm always skeptical when someone says to me, “I've done all the testing and everything's normal.”

Amy:

I agree. And it's not you. Because then I'm like, “Send me the testing.” And then I'm like, “Oh, they didn't do this and they didn't do that and they didn't do this. And how much prednisone did you … Maybe you should try adding the baby …” There's so many things.

Marc Sklar:

Right. There's so much nuance to it.

Amy:

100%. And it is, it's frustrating for us because you're in the middle, if you will. The doctor says, “Oh, we've ruled out all the clouding factors.” And then you'll send the test to us and we're like, “You didn't check this one or this one or this one.” And so it is this kind of game. And I feel sorry for you that you've gone through it, but keep digging. I think another great book to look at Is Your Body Baby Friendly. I do think there's some really useful information in there to educate yourself and bring that to your doctor as well too. I do think the egg quality diet, part of what is really helpful about it is reducing inflammation, regulating the immune system, which can also in essence, make the uterus more hospitable and help with implantation as well.

Marc Sklar:

Yeah. Yeah, absolutely.

Amy:

Okay. My left tube has fluid and is blocked. What can I do other than removing my tube? I'll let you.

Marc Sklar:

I mean, certainly if there's fluid and more specifically that fluid is coming into the uterine cavity, that's a problem. I mean, I would personally first start with some … Before we decided to remove it, I would start with some acupuncture, some herbs, some supplements, change your diet. Really things that would reduce any inflammation that that might be causing and then see what's going on, reevaluate it. And at that point, if it's still there, then maybe at that point it does need to come out. Because that fluid coming into the uterine cavity will definitely impact implantation and be a problem.

Amy:

Yeah. 100%. So yeah, I agree across the board. Okay. Here's another one. Read the whole thing here though. Sorry, “I'm 43. I've been experiencing perimenopause symptoms and wondering if I will have to do IVF in order to get pregnant or is there still a chance I can get pregnant on my own?”

Marc Sklar:

I mean, look, I always believe in someone's ability to conceive naturally. I think there's variables that need to be looked at. Are you having a regular cycle? What do your hormones look like? And so forth. I always believe that's possible. If you're looking for maybe the better way to conceive, the hopefully faster way, then I do think IVF would be something that should absolutely be considered in the mix. And depending on what your hormones look like, how you approach it, who you work with and all of those things. So you're having premenopausal symptoms so that's to me a sign that says, okay, we've got to be more aggressive with this right now, whether it's more aggressive with treatment or more aggressive saying I'm going to do IVF, whatever that might be. But that's something that needs to be regulated and supported. And at the same time then that has to be factored into your plan. Now, if you said to me, “I have no intention of ever doing IVF,” then I'd say, “Okay, well let's be aggressive in getting your hormones back on track and then you've just got to keep trying.”

Amy:

Yeah. I think ovarian PRP could be a good consideration here as well to-

Marc Sklar:

Absolutely.

Amy:

[inaudible 00:20:37] the ovaries and kind of jumpstart things. And then I also think, and I'm sure you see this too … And this isn't a criticism of you Donna, asking the question, but are they actually perimenopausal symptoms or is it just hormonal imbalance leading to an irregular cycle at the age of 43? Because we really need that FSH, I think, to know whether or not we're really headed there.

Marc Sklar:

And estradiol with it, but yeah.

Amy:

Yeah. And estradiol with it, of course, because one impacts the other. But if you haven't done all the things that we recommend from a diet and lifestyle and supplement perspective, that is I think the first starting point to see the cycle regularity. But for certain, I know you have and I have, at 43 for sure have we helped women restore normal ovulatory cycles? 100%.

Marc Sklar:

Yeah.

Amy:

And so I would still consider doing some of that work before starting IVF just so you have better outcomes as well.

Marc Sklar:

Yeah.

Amy:

Okay. I did the fibroid one. Okay.

Marc Sklar:

These are great questions by the way, everybody.

Amy:

Yes. So good guys. Infrared sauna while trying to conceive. I understand the concern of heating for heating up the testicles. If husband uses it, for how long should we wait to try to conceive?

Marc Sklar:

I don't know that if he's using it regularly … Well, first, is there even a sperm issue, right? If the semen analysis is good and everything looks fine, I would have no concern using the sauna. Maybe minimize-

Amy:

And the infrared too versus-

Marc Sklar:

Yeah. Because there has a lot of benefits for it. But maybe you reduce the time a little bit. Maybe you're reducing the frequency. Maybe you're not doing it right … Or he's not doing it right during your fertile window, but he can do it before and after. So I think there's ways to work that in. Now, if his sperm quality is really poor, I'm taking to extremes really poor, then that might be caused to pull back for sure and see. But on the same token, the infrared might be beneficial. So it's hard. I think you've got to look at the whole picture. But I think reducing time, reducing frequency is the safe way to do it. Yeah.

Amy:

100%. Agreed. Okay. “Trying since 2019. POI diagnosed in 2016. Had a child with my own eggs in 2018.” So she beat POI diagnosis. “I've done the egg quality diet, supplements, ovarian PRP in February, fertility acupuncture since 2019. Haven't gotten any eggs during IVF since March. Anything else I can do?” And she's 39.

Marc Sklar:

Yeah. I mean, look, I often question the POI diagnosis.

Amy:

Same. It's too reversible.

Marc Sklar:

Yeah. I don't always find it to be an accurate diagnosis when I evaluate things. So that's the first question I would have. The second question is it seems like you've been pretty aggressive trying to make all these changes. Who's guiding you on all of that? Because you might need to take a step back. If you've been on all these things for a while, you might need just to reevaluate and take a slightly different approach. So it's a hard one to answer without really diving deeper into the case.

Amy:

Agreed. And also another thing, I feel like it came up a lot. I was just in my private group doing office hours this morning and this conversation comes up a lot. And I think from an emotional perspective too, of stepping back and just saying, “But am I going to stop?” You know what I mean? Or, “What am I willing to do moving forward to maintain my health and give myself and my fertility the best chances possible without maybe trying too hard or letting that lead?” And so having that really honest conversation with yourself of, even though it hasn't worked yet, are you ready to walk away from trying for this second child. And just emotionally checking in with yourself. Because a lot of women, I find when I work with them, it's like, “Oh God, no, I'm not going to stop.” And it's like, “Okay. So then let's find what's livable for you. What's an actual plan that feels good, that is beneficial to your health and your fertility?” And this next baby is like the cherry on top versus I have to be done with fertility altogether. And it's a bit of surrender. It's easy for me to say it, not always easy to do, but another piece of that I think to think about.

Marc Sklar:

I really like that approach. I would actually just add as well, it doesn't sound like you had a lot of time between your first child delivery and then trying, and maybe you just need a little space to recover and allow your body without all … Again, I don't know everything you've been doing, but it sounds like you've been on a bunch of hormones and cycle. So maybe you just need a break and a little time to just allow your body to recover as well, to give it the space that it needs to achieve the results that you're looking for.

Amy:

I love that part. And it's such an important point. I think, especially women and the trauma of fertility treatments and trying, and when they get pregnant, then they're already planning number two, because they feel like this time crunch. Chinese medicine. We really like a year and a half between birth and next pregnancy. And that is for recovery and for your strength and your ability to go back in. And there's other factors too. Were you breastfeeding? I mean, there's just so many layers to it too. So I think that's such a great point, Marc. Thank you for making it. “I heard sperm can contribute to chromosome abnormalities.” You heard correctly.

Marc Sklar:

Yeah.

Amy:

Yeah. 100%.

Marc Sklar:

100%.

Amy:

Hundred thousand trillion percent. “41. Had one egg retrieval, 10 follicles. But when I woke up, I only had five. They said the other five had gooey like substance in them. They said it was endometritis/endometriosis? I don't remember which one.” I would assume end endometriosis. I don't know if they would call them chocolate cysts or something like that, but-

Marc Sklar:

That's interesting.

Amy:

Yeah. Because you don't normally see that with an egg retrieval.

Marc Sklar:

No, you don't.

Amy:

A gooey like substance. Perhaps they saw other signs of endo when they were in there for the retrieval, although they're not really looking around that much.

Marc Sklar:

I'd be curious to read the report.

Amy:

The report. I agree. It definitely is endometriosis though, is what they said over endometritis. I would assume because endometritis is in the uterine lining and usually is a bacterial infection or something of the sort or a microbiome imbalance. So yes, there's a lot you can do to manage endo endometriosis. Marc and I both have a ton of information on that. But I do think we both firmly agree that some kind of autoimmune paleo style diet, good quality fats, protein, low inflammation, acupuncture, Chinese herbs, castor oil packs, all of those things to really improve circulation and blood flow as well to the ovaries can be really helpful here.

Marc Sklar:

Yeah, absolutely. Look, it's a big drop off from 10 to five so I understand the disappointment with that, but I'd also look at the sizes of all of those. Like if those were the ones that were on the smaller side and more immature, maybe they wouldn't have made it anyway and so we're just counting them because we want to have a higher number, but the reality is you would've ended up with five anyway. So it just depends.

Amy:

Yeah. And fertilization, right?

Marc Sklar:

Right.

Amy:

Like it really comes down, you could get 10 and only have fertilized … So it's like the attrition is painful, but it's pretty common to cut off like that. And so it is 12:32. How much time do you have left? Because there's more questions.

Marc Sklar:

I've got time. I'm good.

Amy:

Okay. Let's go for another 10. How about that?

Marc Sklar:

That's fine.

Amy:

I feel like they're coming in kind of erratically. I want to jump … I want to honor the people who posted them first. You know what I mean?

Marc Sklar:

Yeah.

Amy:

Let's just see. Okay. Those are answered questions. Oh, okay. So I see. They're just moving them up. Okay. Oh, but if … Okay. Nevermind. Let me get back. There's a lot of questions.

Marc Sklar:

There's one that I see about injections on day three. So, “On which day of IVF meds will I feel any symptoms? Is it normal not to feel anything on day three of injections?”

Amy:

I think it's normal.

Marc Sklar:

Yeah. It's early.

Amy:

You're just juicing them up. It's getting there. It's getting there.

Marc Sklar:

And it depends on dosage of the medication and how many follicles you have growing. So yeah, I wouldn't worry about it.

Amy:

Suggestions for improving sperm morphology specifically. Other factors were fine, but morphology was 3%.

Marc Sklar:

I might not worry about that. I'm not saying I wouldn't do anything, but I might not worry about a 3% morphology if the count is nice and high. If the count is on the-

Amy:

Yeah. She's [inaudible 00:30:15]. Yeah.

Marc Sklar:

Right. But normal could … Like 15 million normal, eh, that's different.

Amy:

There's still lot.

Marc Sklar:

3% of 15 million is different than 3% of 50 or more. Right? But 3% is really not a bad number and I've seen plenty of men have successful pregnancies with 1% normal when all the other parameters were nice and high. So not saying I wouldn't do anything about it, but I might not worry so much about it and focus on other things and then just do a little bit to support that in terms of some nice antioxidants. Same things that you would think of for egg quality, you think of similarly for sperm quality. This would be sperm quality.

Amy:

Yeah. 100%. I have a video too on the healthy daddy protocol, if you will. And I'm positive Marc has YouTube videos on this too. You just go on our YouTube channels and they're there.

Marc Sklar:

Yeah. Someone keeps calling.

Amy:

“27, two recent miscarriages. First was unknown but second was Turner's. My AMH, FSH and recurrent miscarriage panel labs are all normal. I'm working on egg quality improvement. Would it be smart if my husband gets DNA frag tests before we start trying again?”

Marc Sklar:

I would.

Amy:

Yeah. Same. It's not going to hurt anything. And then the same thing that we said to the other one that had all the tests, make sure that recurrent miscarriage panel was complete and all done. That's one thing that I would really consider too. And continue with doing all the things. Anything else there, Marc?

Marc Sklar:

No. I mean, look, we know that there's Turner's Syndrome, so it's not like there's not something there that we're aware of.

Amy:

Exactly.

Marc Sklar:

So just make sure everything else is ruled out. Yeah.

Amy:

Here's a good question. I think we're on the same page with this, but, “Should caffeine be avoided in the fertile window? Is an alternative okay, such as a mushroom one?”

Marc Sklar:

I don't know. You want to start and I'll tell you if we're on the same page?

Amy:

I think caffeine is fine. I always say 81 milligrams or even 100 milligrams of organic caffeine on a daily basis. The key is not on an empty stomach. It does a number to the adrenals. And so I always recommend it with some protein and some fat. So yeah, I think we're on the same page.

Marc Sklar:

Yeah. We're totally on the same page. When I have my coffee every morning, I make it with-

Amy:

I know. I remember getting your coffee that one time out in San Diego and it was like-

Marc Sklar:

Oh yeah. That's right.

Amy:

Remember Bulletproof was brand new and it was-

Marc Sklar:

It was brand new.

Amy:

Putting butter in the coffee.

Marc Sklar:

Yeah. It's my version of Bulletproof. I've got gee in it and I've got a little bit of honey and I've got my colostrum in it. Some collagen. Blend it right up and you're good to go. But I agree, a little bit …

Amy:

I'm going to do this colostrum.

Marc Sklar:

I think the only time you might have to be … What was that?

Amy:

Which colostrum do you use?

Marc Sklar:

Oh, my favorite. Surthrival.

Amy:

What is it?

Marc Sklar:

Surthrival. It makes it nice and creamy.

Amy:

Ooh. [inaudible 00:33:34].

Marc Sklar:

Yeah. The only time to be concerned about the caffeine, I think is if you've had recurrent pregnancy loss. Then I might pull back a little bit more. But other than that, you can have some caffeine. I agree with Amy. And I want to stress the point she said. She said organic. Coffee beans are highly sprayed full of chemicals. It's a really important crop. And so they want to make sure that it survives and they make money off of it, which means chemicals and Roundup and pesticides and all that sort of stuff is used heavily. So you really want it to be organic as much as possible so that you're not getting those chemicals and toxins.

Amy:

Yeah. Coffee has one of the highest pesticide loads and does a tremendous amount of damage to us. So only have it with organic and with protein and fat. Okay. “43. How can I optimize my chances with IUI? At this time, I can't afford IVF.”

Marc Sklar:

Okay. Yeah. I mean, I don't see an issue with IUI versus IVF at your age.

Amy:

Same.

Marc Sklar:

Optimizing is all the things that we've been saying. Doing all the preparation work that we've been talking about when we answer all these questions today. So I do think that has to be part of your mix. But so much of the success is also going to depend upon how much of the medication they give you and how closely are they monitoring you and how well is the timing with IUI. I love back to back IUIs, and by back to back, meaning consecutive days of IUI. I do see a higher success rate. So I do like to recommend that, meaning they're going to do it either the day before you ovulate and the day of ovulation or the day of ovulation and day after. So it's back to back. That's what I mean. Not consecutive cycles.

Amy:

Yeah. And I agree too, of less is more a lot of times with medication. But you could also do injectables with IUI and get .. Yeah. I agree. There's no reason that the IUI can't work. And especially if you were going to do IVF and not genetically test, you know?

Marc Sklar:

Yeah. And sperm quality becomes uber important here because the sperm, so make sure that's being supported and you've tested because that sperm have to be able to swim to get to where they want to go.

Amy:

Okay. Thoughts on red light therapy panels like Joovv? How long each day? Is there any caution during the luteal phase?

Marc Sklar:

Yes. We've been using it, not that specific machine, in our practice since January and seeing some nice results.

Amy:

You're using that one?

Marc Sklar:

Yeah. So the low light LED. And so the minimal research that's been done shows that you need to do it repeatedly throughout the week. So once a week is not going to be sufficient. So I would say at least two to three. If you have one at home, then go ahead and use it every day, 30 minutes. It's usually set on a program so it's usually 30 minutes. Yeah. I don't recommend using it in the luteal phase at all. So you're doing it in the … If you're actively trying, you're just doing it the first two weeks and not the last two weeks of every cycle.

Amy:

100%. “What levels of testosterone and DHES would warrant supplementation of DAGA?”

Marc Sklar:

Do you want to start?

Amy:

Yeah, you go ahead.

Marc Sklar:

It's hard to say.

Amy:

[inaudible 00:37:30]. Well, go ahead.

Marc Sklar:

Yeah. There's ranges and there's dosages. So I tend to be cautious. So unless someone's is extremely low in their labs, I'm not ever putting anyone on 75 personally.

Amy:

Ever. Yeah. Same.

Marc Sklar:

Ever. So let's just say they were at 40, then I might say, “Okay, we're going to do 75 for a month. Let's retest, let's track it.” I'm going to watch it closely because there's a lot of potential side effects and issues that can arise. So I'm pretty careful with it. And depending on where the levels are, you might just start at 25, you might start at 15, you might start at 10. It just depends-

Amy:

I think it's one those low and slow.

Marc Sklar:

If it needs a little boost.

Amy:

Right. Because everybody has their own reaction. But same thing. Getting the DHES tested. And usually that'll impact the testosterone as well. But if they're both low, it could be reason to supplement, but I would start really low. And like Marc said, you stay on top of the testing. I think both of us agree. I've never seen great success at the 75. I feel like, I don't know, ovarian burnout is kind of more like … It's like a very … And then also a lot of the doctors at the Dutch, and we both use the Dutch test a lot, they do not like that level of 75. And they say once you start taking that, your body does become dependent on it. So when you stop, there's also great implications too. It's such a high dose. So low dose is … It stimulates follicular genesis and it just encourages those ovaries to do what they need to do. So you've really got to be careful with DHEA.

Marc Sklar:

Yeah. And you mentioned that Dutch test so I was actually going to say, if I'm really concerned, I'll run a Dutch panel and I'll see how you're metabolizing your DHEA and how strong your androgen levels are and where you have a preference. And depending on what that looks like, I might be a little bit more cautious or a little bit more carefree because that's telling me how you can metabolize it and use it. So I feel a little bit more comfortable being able to manage that better. Yeah.

Amy:

100%. Okay. Let's do one more and then we're going to let ourselves wrap this up. Okay. Oh, let's see. “Husband is a competitive cyclist. I've had two losses. I have Hashi's. It's managed with meds, supplements, diet, acupuncture. Ari, the husband. Does wearing tight cycling gear and working out for hours at a time negatively effect male fertility?”

Marc Sklar:

I mean, yes, but the question becomes-

Amy:

Sperm analysis.

Marc Sklar:

Yeah. What are his labs showing? If his semen analysis looks fine, his DNA fragmentation looks fine, there might not be any real concern. And you mentioned several things that you already know on your side that we know can be impacting things. So yeah, I mean, you can also do a test and ask him.

Amy:

Yeah. The immunological testing. That's the one thing I would recommend for you, especially knowing that you have Hashi's. Yeah. So agreed, across the board.

Marc Sklar:

Yeah. And you can also ask him, is he willing to give you three months or six months of not just to test it out.

Amy:

And see.

Marc Sklar:

And see. And go from there. So meet in the middle someplace.

Amy:

Yeah. 100%. Okay. This was amazing. Let's do this once a month. I love it.

Marc Sklar:

I love it. This was fun.

Amy:

Yeah. It was so fun. Okay. You go enjoy your day.

Marc Sklar:

You too.

Amy:

And everybody else, thank you so much for the amazing questions. We loved it. And Marc and I will do this again soon and continue to support you guys so you can bring home that dream baby.

Marc Sklar:

Yes. Thanks everyone for joining. Have a wonderful Thursday. Bye.

Amy:

Bye. Talk to you later.

Marc Sklar:

Okay.

END TRANSCRIPT.

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