PRECONCEPTION

015: The Causes Of Unexplained Infertility w/ Kalea Wattles, ND

015

015: The Causes Of Unexplained Infertility w/ Kalea Wattles, ND

Welcome to the Hey Mami podcast!

Our guest today is Dr. Kalea Wattles. Dr. Wattles is a Naturopathic Physician specializing in fertility and Functional Medicine. She earned her doctorate from Bastyr University and is certified as a Functional Medicine Practitioner by the Institute for Functional Medicine. 

Dr. Wattles combines her Naturopathic and Functional Medicine training to treat patients with a “Functional Fertility” perspective, using a root-cause, science-based, body-systems approach to cultivate a fertile body. 

She is dedicated to using this patient centered method to support patients anywhere on their fertility journey – whether they are thinking about getting pregnant for the first time or exploring advanced fertility treatments.

Or listen on Apple Podcasts | Spotify | Stitcher | TuneIn | YouTube

In today’s episode we are talking about unexplained infertility using the lens of functional medicine to unravel its many causes.

Highlights:

  • Dr. Wattles’s story
  • Some of the causes of unexplained infertility
  • Why can inflammation impact fertility?
  • Altered immune activity
  • How does gut health come into play?
  • Why do mitochondrial issues play a role in fertility?

Important Links

Find Dr. Wattles online

Follow Dr. Wattles on Instagram

Quotes

“We know that there’s a little bit of inflammation that’s required for an embryo to actually implant in an endometrium, which is that innermost lining of the uterus. But when inflammation is totally uncontrolled and unregulated, it really makes that area inhospitable.”

“When we’re trying to maintain a pregnancy, it’s really our progesterone that is the most important hormone.”

015: The Causes Of Unexplained Infertility w/ Kalea Wattles, ND TRANSCRIPT

Dr. Carrasco:                      Welcome back to the Hey Mami Podcast. In today’s episode, we were talking about unexplained infertility using the lens of functional medicine to unravel its many causes. Our guest today is Dr. Kalea Wattles. Dr. Wattles is a naturopathic physician specializing in fertility and functional medicine. She earned her doctorate from Bastyr University and is certified as a functional medicine practitioner by the Institute of Functional Medicine. Dr. Wattles combines her naturopathic and functional medicine training to treat patients with a functional fertility perspective using a root-cause science-based body system approach to cultivating a fertile body. She is dedicated to using this patient centered method to support patients anywhere on their fertility journey, whether they are thinking about getting pregnant for the first time or exploring advanced fertility treatments. Thank you so much for joining us today, welcome to our podcast.

Dr. Wattles:                        Thank you so much for having me. It’s an honor to be here.

Dr. Carrasco:                      We are overjoyed to share your wisdom with our audience. So jumping right in there, we would love to hear more about why you do what you do. What’s your story?

Dr. Wattles:                        Well, I’ll just give you a little bit of my origin story, if you will. That I was in naturopathic medical school. And then during my second year of my program, I got pregnant. Becoming a mom was just such a transformational experience and it really opened my eyes that I really want that for anybody who wants to be a mom, I really want that for them, or to be a parent in general. So it led me down this path where I essentially cold called all of the fertility clinics in my area and I said, “Listen, I understand I’m not a traditional medical student, but I really want to learn, will you take me in? I just want to shadow and rotate with your docs.” It took a little back and forth and I had to make my case a little bit, but three clinics accepted my proposal. So I was able to spend time with all my local reproductive endocrinologists and do their new patient intakes and be with them through procedures.

Dr. Wattles:                        What I saw was there were so many lifestyle components that were at play in patients who are being treated for infertility. So I would see super elevated insulin or very low vitamin D and obviously the stress component. There were so many areas where I thought, “Gosh, what I do could really help this patient maybe so that they didn’t even need this treatment. And then if they did still need treatment, I know that I could improve these outcomes.” So I got super interested in how the functional medicine model could support patients going through fertility.

Dr. Wattles:                        Then in my last year of school, so my fourth year of school, I got pregnant with my second daughter. And then started as an intern at Institute for Functional Medicine, where I really was able to make this connection between the functional medicine model and what that could offer to fertility patients. Then I knew that once I graduated, that’s where I wanted to focus my practice. So I think that it was a little bit of my personal journey through pregnancy and also pregnancy loss and then spending the time in the fertility clinics and seeing with my own eyes how the functional medicine approach could really support patients along the spectrum of anywhere on their fertility journey.

Dr. Maren:                          That’s awesome, I love that story. I love that you’ve worked with reproductive endocrinologists. And one thing you brought up is just, can you tell people the difference between a naturopathic medical doctor and an MD or DO, but also what to look for when you see a naturopath? Because in certain states, naturopaths you don’t know if you actually went through Bastyr or National or whatever versus something less accredited, right?

Dr. Wattles:                        Totally.

Dr. Maren:                          Tell people what to look for.

Dr. Wattles:                        Absolutely. So naturopathic doctors, you want to make sure that you are looking for an ND who graduated from an accredited university and that they have sat for their licensing exam. So I’m here in the State of Washington. And in Washington, I feel very fortunate we’re licensed as primary care doctors here in Washington. So we can order labs and write prescriptions and make referrals and operate just as any primary care doctor would. But you definitely want to make sure that you are seeing a practitioner that’s following their scope in your unique state. So you can check with their naturopathic licensing or governing body in your state. But I always send people to the AANP, which is the American Association of Naturopathic Physicians, so that you can get a good idea of what the scope is in your unique state. But like I said, I feel very fortunate in Washington, I operate as a primary care doc. So I’m able to serve as that interface and really work in my world and in the fertility world, really work with my patients specialists and collaborative care team to take care of them.

Dr. Wattles:                        So if anybody isn’t familiar with what a naturopathic doctor is, we are trained in the basic sciences and pharmacology and standards of care and then have this added layer of tools in our toolbox in terms of lifestyle, botanical medicine, therapeutic nutrition. And I’ll also layer on the functional medicine aspect. People always ask, “Well, what’s the difference between naturopathic medicine and functional medicine?” And how I describe this to patients is functional medicine basically serves as a framework where I can approach complex cases by using the functional medicine approach, which a body systems method that allows me to map out my patient’s unique history and symptoms and predispositions to health outcomes. I map that on essentially a map of their body systems. Then I use my naturopathic therapeutics to help them meet their goals. So really it’s all beautifully works together using the naturopathic therapeutics and then the functional medicine operating system to approach patients.

Dr. Carrasco:                      It’s a really awesome explanation. I think that part of your story really resonates with Christine and I because we both, I think in our history, really felt like from a lifestyle approach, there was so much more that we could do for our patients before they got to a place of needing IVF or even helping them to be able to be even more able to, I guess, have better outcomes if they needed in-depth fertility treatment. So maybe we can jump into some of the causes of unexplained infertility that you see regularly in your practice and that you feel like perhaps are even overlooked by most.

Dr. Wattles:                        Absolutely. So I’ll just acknowledge right off the bat, unexplained infertility has to be one of the most frustrating diagnoses that we see.

Dr. Maren:                          Yes, 100%.

Dr. Wattles:                        And I always tell patients, “It’s not that there isn’t an explanation, it’s just that we haven’t figured it out yet.” That doesn’t mean that’s a guarantee that we are going to find it. Because full disclosure, I have some patients and I’m really struggling to figure it out. So nothing is guaranteed, but I think what I can offer as a provider is the willingness to stay curious. We see so often that patients get this unexplained infertility diagnosis and then it’s like, no further questions asked, it is what it is, you’re off to IVF and you don’t really care. But there’s always more to the story.

Dr. Wattles:                        And something that I go back to, which I think really hits home with me is I have a mentor that you both probably know, Dr. Robert Luby, and he’s a great functional medicine figure. Something that he teaches is, medicine is actually about, and it’s why it can be a bit anxiety producing, is it’s really about trying to make perfect decisions with imperfect information. I really think about that when it comes down to unexplained infertility because it’s like, okay, now we need to put a label on something where we don’t have all of the information or we have limited information or we have information that’s not fully explaining this story. So we have to put this label on it, unexplained infertility, because we have to label it something, but the information is imperfect.

Dr. Maren:                          That’s such a good point. Our lab testing is imperfect, even in functional medicine. We get these labs back and you’re looking at mold and mycotoxins levels or food sensitivities and you’re like, “It’s imperfect information, but it’s super helpful. This is how we make headway.” And we see it clinically. I don’t all the labs that you test, but I’m sure we’re testing some of the same stuff. And yeah, it might not be perfect but it gives us-

Dr. Carrasco:                      It’s data points that helps us then put the dots together.

Dr. Wattles:                        Absolutely, it’s data points, it’s information. And we can talk about all of that, about how hormones, this comes up all the time in my practice, is I love to look at hormones. But is it just a snapshot in time? Absolutely. It’s just the information that we can capture at any point in time. So when I have patients that come with unexplained infertility, I think this is where the functional medicine approach really shines. Because it’s already part of our philosophy to approach patients from a body systems approach. So I always say when it gets really complicated, we got to go back to the basics. So thinking about, how are all of your body systems working together? Because we think about body systems as a web and so I know if I pull on your digestion and your assimilation, that that’s going to affect your hormones and your detox capabilities and your ability to produce energy inside yourself, it’s all connected.

Dr. Wattles:                        So how can we start to make sure that all areas, all of your body’s systems are supported because I know that that’s going to roll in to your whole comprehensive health as a human organism? So I’m thinking about things like, what’s going on with your gut health? We can talk about that in more specifics, but gut health is everything. I know as a naturopathic doctor that’s so stereotypical of me to say, but it’s so true. What’s going on with your nutrition, your nutrient adequacy? What’s going on with your immune activity? When we think about hormones, I’m really thinking about progesterone is a big one, thyroid function. And then how is our body interfacing with the outside world in terms of oxidative stressors, toxic exposures? What’s going on with our adrenals>

Dr. Wattles:                        I find patients come to me and maybe some of these things have been explored before. Maybe a little thyroid, maybe the progesterone a bit, but most of this stuff is totally new, completely unexplored. And I think maybe that’s an area where we can really provide some hope, is you know what, there actually is more to look at. This isn’t the end of the story, we haven’t done every test, we haven’t asked any question. I think when you’re a patient who’s been diagnosed with unexplained infertility, the fact that, oh gosh, maybe there’s actually more to this picture is really reassuring.

Dr. Maren:                          Maybe there might be an explanation.

Dr. Wattles:                        Exactly. And I’ll just throw this in there because I always think about this when we’re talking about unexplained anything. Also anything that we label a syndrome like PCOS (polycystic ovarian syndrome), a syndrome is really just medical for, we don’t know.

Dr. Carrasco:                      Constellation of symptoms that we can define but we don’t necessarily know why they have occurred.

Dr. Wattles:                        Exactly, exactly. So I guess all of this to say staying curious. And just the way that I think about this is, and sometimes it’s hard, this is the practice and the art of medicine is, I have to very carefully and intentionally listen to what my patient is telling me and connect that back to the signs and symptoms and lab values that I have for them. Because something about that story is going to tell me where to go next, it’s going to tell me what that thing is that we haven’t explored yet. Is it something going on with their gut? Is it something going on with their stress resiliency? Is there some raging inflammation that I should be thinking about? I know that part of their story is going to guide me to that next step if I’m listening carefully.

Dr. Carrasco:                      I would love to dive into the inflammatory piece because I do think that that’s something that goes unexplored with a lot of patients. I feel like you’re right, a lot of providers will check thyroid, basic thyroid and maybe some people will check, I don’t know, an online food sensitivity test, but really deep diving into inflammatory response and oxidative stress and what that could mean for mitochondria, which what could that mean for egg health, et cetera. I feel like that’s something that’s often overlooked.

Dr. Wattles:                        Absolutely. So inflammation is a big deal. I’m excited that I’m seeing more and more evidence emerging about the role of inflammation in things like unexplained infertility. Also another diagnosis that I think is really frustrating, which is premature ovarian insufficiency or just diminished ovarian reserve in general. Inflammation certainly plays a role in both of these things. So I think about this from a couple of different angles. So I’ll try to remember this, remind me that there’s three things that I want to talk about if I forget to loop back.

Dr. Wattles:                        So the first thing is just with endometrial receptivity. We know that there’s a little bit of inflammation that’s required for an embryo to actually implant in an endometrium, which is that innermost lining of the uterus. But when inflammation is totally uncontrolled and unregulated, it really makes that area inhospitable. So we see that endometrial receptivity is compromised a bit when there’s just chronic unregulated inflammation. So that’s one piece to the puzzle.

Dr. Wattles:                        The next piece is inflammation can very much impair progesterone production, which we know is so responsible for maintaining a pregnancy. So the example that I go back to all the time, which is going to connect some of these body systems, is with intestinal hyperpermeability or leaky gut. So we know that when our intestinal barrier function is compromised for lots of reasons that we can talk about, we have inflammatory messengers that are able to traverse our intestinal barrier, enter our systemic circulation, and that inflammation can even travel to our ovaries and cause inflammation within. The ovaries that really impairs our progesterone production. When we’re trying to maintain a pregnancy, it’s really our progesterone that is the most important hormone.

Dr. Wattles:                        So I’m always thinking about, when I have patients with unexplained infertility or they have what some people might call a chemical pregnancy. So they get a positive home pregnancy test, so exciting, all of us are ecstatic and then two days later, they get their period just like normal. So frustrating and heartbreaking. When that happens, I’m so suspicious about what was going on with that progesterone. Why did that progesterone drop so quickly? And perhaps it’s because there’s all this inflammation that’s very much impairing progesterone production inside the ovary.

Dr. Wattles:                        Then the third piece, look, I remembered all three I want to talk about, the third piece is this connection with inflammageing. So I think inflammageing is the coolest word because it basically describes the interconnectedness between inflammation, oxidative stress, which you mentioned, mitochondrial dysfunction, and then the aging process. So we know that when there’s chronic inflammation, that that can really impair our mitochondria. And mitochondria, I can always hear my 10th grade biology teacher saying in my mind, “It’s the powerhouse of cell.” And our mitochondrial function is really what drives ovulation, fertilization, implantation, the maturation of an embryo. So when those processes are compromised by inflammation, we have a really hard time getting and staying pregnant.

Dr. Wattles:                        So that was my very long-winded answer to show that inflammation is such a big deal. So I’m checking this in the blood, if anybody is preparing to do some labs. I look at a high-sensitivity C-reactive protein, that’s my favorite. There’s lots of ways that we can look at inflammation, but that tends to be my favorite. So then if I see that inflammation is elevated, number one, I’m going to ask more questions about what’s going on. Is there gum disease? Is their gut infection? Are there toxic exposures? What’s driving that inflammatory process? And then we can call upon all of these awesome botanical and nutrient anti-inflammatory solutions to really help lower that inflammatory burden.

Dr. Maren:                          Yeah, totally. We check hs-CRP a lot. And it’s an interesting marker. It’s not very expensive either, right?

Dr. Carrasco:                      Totally.

Dr. Maren:                          It’s available to us, it’s super available. I always tell my patients even though the name says high sensitivity CRP, it’s not necessarily specific. It could be elevated with other kinds of things like [crosstalk 00:17:27].

Dr. Carrasco:                      Very sensitive not specific at all.

Dr. Maren:                          Yes, right. So anyways, it’s a good marker and why not check it.

Dr. Wattles:                        I think that’s a great conversation to have, is like, we’re going to do this lab, we’re going to look for inflammation. And like you said, if it comes back, it doesn’t tell us where that inflammation is coming from. But that’s my job as an investigator to now do a little bit of digging. I always also, to be fully transparent, sometimes it’s hard to figure it out, to figure out where that inflammation is coming from. You ask all the questions and it’s not always straightforward.

Dr. Carrasco:                      That’s correct.

Dr. Maren:                          Fully agree. I think a lot of times too, we’re not simple organisms, there’s a lot of things going on. I always go back to the bucket analyze or what’s that word?

Dr. Carrasco:                      Metaphor.

Dr. Wattles:                        Analogy.

Dr. Maren:                          Analogy.

Dr. Wattles:                        Metaphor.

Dr. Maren:                          Whatever.

Dr. Wattles:                        One of those.

Dr. Maren:                          You know what I’m talking about, where it’s just all these different things that fill our bucket and then something makes it spill over. [crosstalk 00:18:26]. Yeah and then someone kicks your bucket over and then you’re just screwed. So yes, there’s a lot. We just have to empty that bucket. There’s also the onion one, so we’re peeling back layers of the onion and really trying to figure out what is that the root. But as we remove a lot of these impediments to our health, I think our body spins back into orbit a lot of times. And we heal ourselves.

Dr. Carrasco:                      I often tell my patients my analogy is that I view them as a bonfire, my job is to pull out the logs. And the logs are your food and your gut and your infections and your toxins and then the fire starts to smolder and become smaller and smaller.

Dr. Wattles:                        I’m going to use that, I like that.

Dr. Carrasco:                      But I don’t want to add logs to the fire, I want to pull logs out.

Dr. Maren:                          Totally.

Dr. Wattles:                        One thing you reminded me is oftentimes when we reduce inflammation… I always try to reframe this as like, yes, we’re working on your fertility, that’s our goal, we’re holding that on our pedestal, but really we’re cultivating your health as a human. That’s the goal, is making you more resilient and cultivating fortitude in your health. And when we start removing inflammation, I think it’s so motivating because then your eczema gets better and you have less migraines and your PMS is better and you just feel so much better that wow, how motivating to keep going when your symptoms are improving. And we know that your fertility improvement is likely to be a side effect.

Dr. Maren:                          Totally.

Dr. Carrasco:                      Absolutely.

Dr. Maren:                          I think that’s such a great point because men never get this opportunity. Well, that’s not true, some men do go down this deep dive. But for a lot of men, they don’t think they’re struggling with infertility necessarily, obviously, that’s a whole other story. But women, when we go through pregnancy either infertility or just complications in pregnancy, we end up learning so much about our underlying health. And like you said, just cultivating your health as a human. Sometimes if you can step back and think of this as an opportunity and time to cultivate that health, obviously it will improve fertility to some degree, it’s got to.

Dr. Carrasco:                      In my cohort of patients that aren’t looking for fertility yet but thinking about it in the future with a functional medicine approach, I often tell them this whole approach will actually support your fertility because it’s going to support your health. And there’s always stories of people that we support their health and get them feeling better, decreased their inflammation, and then they get surprise pregnancy.

Dr. Maren:                          Then they have unexplained fertility?

Dr. Carrasco:                      Then they have unexplained fertility.

Dr. Wattles:                        I think I joke about this all the time when I put folks on an elimination diet, it’s like, “Please, if you don’t want to get pregnant, please use your contraceptive method of choice.” Because once we start, you’re detoxed and your inflammation is going down, and you’re all of a sudden absorbing your nutrients, watch out because it happens.

Dr. Carrasco:                      It happens.

Dr. Maren:                          Totally. We’ve all-

Dr. Carrasco:                      We’ve been there. So let’s talk about some other causes of unexplained infertility. I think maybe discussing altered immune activity would be interesting as well because that’s something that many are not discussing.

Dr. Wattles:                        Yeah, absolutely. This one is so complex. So what I will say about this is our immune system if we think about it, it’s so strange how our immune system has to be vigilant enough to keep us from getting sick. We’re asking that of our immune system, “Please protect me.” But then when we’re wanting to get pregnant, we’re saying, “Please protect me but also I’m going to bring on board this entire thing that’s not me and I want you to relax enough to not be bothered by that thing.” So we’re really asking our immune system to be quite flexible during pregnancy. Even if we think about sperm, so sometimes I talk about anti sperm antibodies and how we can make antibodies to sperm, but isn’t it quite profound that we don’t always make antibodies to sperm that are these non-self?

Dr. Maren:                          Yeah, totally.

Dr. Wattles:                        The things that are entering our body, it’s actually really stunning to me. So the immune activity piece is very complex. And there is a couple of areas that I think about. So I think the one that I address the most in the primary care setting is thyroid autoimmunity, autoimmune thyroid disease. There’s all of this data that’s been emerging about, if you have elevated thyroid antibodies, even if your thyroid hormones look good and your TSH is normal, we are at higher risk for subfertility pregnancy loss, gestational hypertension, preeclampsia. So these are things I want to investigate while we’re in that preconception phase. Because I know that the traditional teaching is, oh, you have elevated antibodies, there’s actually nothing that we can do about that. But we know that we can, we can shift that with dietary interventions, with nutrients, with ensuring vitamin D status. So these are things I like to know about.

Dr. Wattles:                        Then I also know that I want to keep a closer eye on thyroid function as we’re in early certainly because that can change. It can be a little bit of a rollercoaster anyway, but it can change more rapidly when there’s autoimmune thyroid disease. So that’s something that I’m thinking about in great detail. Now, I think over the last, I don’t know, maybe five or 10 years, the field of reproductive immunology is just expanding and it’s a mind-blowing field. So a book suggestion I have is there’s a book I think it’s called Is Your Body Baby Safe by Dr. Alan Beer. And it’s all about reproductive immunology. It’s a great read. It’s a little complex, but it’s really gets into the details of how the tone of our immune system can affect our pregnancy outcomes.

Dr. Wattles:                        So I’m starting to work with more reproductive endocrinologists who are getting trained in this area and who are measuring more specific markers of immune function and I think that can be helpful. It’s where I’m going now when I actually do all the functional workup and I do all the tools that I know how and my patient is still not getting pregnant. And it’s like, gosh, I’m suspecting that there’s an immune component here that we haven’t explored yet. It’s where I am, as a personal development goal, want to do more research and have more training because I think the data is really building.

Dr. Maren:                          That’s a really interesting workup. I have a couple patients who have gone to, I think it’s called the Alan Beer Center, and their workup is fascinating.

Dr. Wattles:                        I had a patient I was sharing, she had traveled to the clinic. And for a variety of reasons, I was the one that was selected to order the labs. So they sent me their list of labs that they order and to be quite Frank, it was things I had never seen before. So it was a really good learning opportunity for me to say, “Okay, if this comes back abnormal, what do I do?” But it was the largest lab order I have ever placed in my life. There are so many things to measure. And it’s very insightful, the results that you get back. So I’m definitely have my eye on that whole field as it continues to grow.

Dr. Maren:                          Totally. How do you think that gut health plays a role with the immune piece?

Dr. Carrasco:                      Component?

Dr. Maren:                          Yeah.

Dr. Wattles:                        I love this. So we talked a little bit about intestinal permeability earlier when we were talking about progesterone. The way that I talk to patients about this, so the first thing is when we’re taking in, our gut is the way that we interface with the outside world. So we’re taking in foods and we’re taking in potentially some toxic exposures through our gut. And then if we have intestinal hyperpermeability because we’re eating foods that we’re sensitive to or because of our medications or because of toxic exposures and those things from inside our gut are entering our systemic circulation, our immune system is smarter. It’s going to say, “That doesn’t belong there. I know that.” So our immune system is going to be hyperactivated, it’s going to be very hypervigilant and trigger it. It’s going to say, “There’s a danger here.”

Dr. Wattles:                        So I think whenever I see someone, just in general, that their immune system is super responsive, I always want to know what’s going on with your gut, is that the trigger? And if we have access to things like comprehensive stool analysis, I love to look at what’s going on, do a little stool sample. Which I always tell patients it’s not glamorous, I’ll tell you that right now, it’s not a glamorous [inaudible 00:27:21] to collect. But there’s so much information that we can can take from those results to see what’s going on with the constellation of bacteria in your gut. Because we know that there’s some bacteria that belong there and are really protective. And then there are some others that either don’t belong or they don’t belong in high concentrations. And how can we shift that composition to make your immune system less reactive?

Dr. Maren:                          Yeah, that’s awesome. I love the way that you break it down simplistically like, “our immune system is hyperactivated.” And ultimately, it’s like our body is here to protect us and serve us and sometimes these symptoms are such a pain and they suck. But your body is trying to tell you something and we just got to listen to it.

Dr. Wattles:                        Thank goodness we have an immune system, right?

Dr. Maren:                          I know, thank goodness.

Dr. Wattles:                        So it is such a bummer, yes when our immune system is acting a little extra. But then let’s try to ask some questions and figure that out. Then maybe while we’re talking about gut health, I think that there is some interesting research that is coming out about H. Pylori, so H. pylori being an organism that can be found in our guts. One reason why folks might have symptoms of heartburn and other things. But what we’re finding is that there is this connection between, so if you have H. pylori in your gut, sometimes you have H. pylori antibodies that are circulating. So there’s this very interesting research that is saying maybe one mechanism of unexplained infertility is women who have H. pylori in their digestive tract, they’re making antibodies that show up in their cervical fluid.

Dr. Wattles:                        And then sperm enter that vaginal canal and the goal is that the sperm are going to make it through the cervix and go to fertilize an egg. But if there’s antibodies there, that they can actually damage the sperm and make it less effective at swimming and also cause some damage to the sperm itself so that it’s not as effective at penetrating the egg. So this was something that was so eye-opening to me because then I started thinking back to all the patients I have that aren’t to get pregnant and we have treated them or someone else is treating them for H. pylori. And I’m thinking, is there a connection here? Because sometimes we see gut stuff going on, but you treat the gut and the patient gets pregnant and I actually don’t know why that happens. But now we’re starting to see some of these threads of connections.

Dr. Maren:                          I have a patient that comes to mind, hope you’re listening, now we know why. Because she got pregnant right after we treated her H. pylori.

Dr. Carrasco:                      It’s fascinating. And I’m seeing a ton of H. pylori right now. I don’t know if you all are seeing an uptick, but I am seeing so much in my practice.

Dr. Wattles:                        Christine, someone else messaged me about that the other day, that they’re seeing lots of H. Pylori too. I wonder if it’s because we’re multitasking so much, we’re eating and we’re in front of the TV, and our all of us have hypochlorhydria, low stomach acid now it’s just allowing all these things to proliferate.

Dr. Maren:                          Maybe.

Dr. Carrasco:                      Do you have a favorite non-antibiotic regimen that you use to treat?

Dr. Wattles:                        I’m pretty skeptical to say because it’s real hit or miss.

Dr. Carrasco:                      I know.

Dr. Wattles:                        In my experience. My success rate with strictly non pharmaceuticals is not super great if I’m going to be really honest.

Dr. Maren:                          What I really like Alinea, Which is an antibiotic.

Dr. Carrasco:                      But there’s a good study on triple therapy with that.

Dr. Wattles:                        I think sometimes patients are hesitant to use pharmaceuticals in general. This intervention or I use Letrozole in my practice for ovulation induction. And the conversation that I have with folks is, “I hear you.” You probably sought out a naturopathic doctor because you wanted all of these non-pharmaceutical options. But sometimes we use medicines but the difference is, it’s not the only thing on the treatment plan. It’s going to be the stress management and the dietary interventions and the mental, emotional, spiritual considerations. That’s different from anything you’ve ever had before. It doesn’t have to be either or, it’s an also and situation. That’s actually where patients benefit the most, is I have all these tools in my toolbox and what a beautiful thing.

Dr. Maren:                          Totally

Dr. Carrasco:                      Agree.

Dr. Maren:                          I always tell patients, it’s all risk benefit. So it’s all a ratio. If the risk is too great and there’s drug-drug interactions and huge side effects, we’re probably not going to go there. But if we really think it’s going to provide a lot of benefit and the risk is quite low, then you’ve got sides are in your favor usually.

Dr. Carrasco:                      Yeah, absolutely.

Dr. Wattles:                        So before we move on from talking about that, can I just add one more?

Dr. Carrasco:                      Yes, absolutely.

Dr. Wattles:                        I think a big part of the conversation is we put patients on these beautiful preconception diet plan. So I love the Mediterranean diet or there’s some Institute for functional medicine food plans that I utilize quite frequently. Sometimes I am guilty of getting tunnel vision in like, “Here’s your food plan, we’re going to do all these foods, we’re going to do fermented foods and it’s going to be so awesome.” But then we have to make sure that we’re absorbing these great foods that we’re calling upon in our diet plan.

Dr. Wattles:                        So I think gut health is a really important consideration because we need to actually be able to utilize those nutrients from all of those amazing food choices. So I’m also thinking about what’s going on with your stomach acid? And do you have all of these digestive symptoms? Do we need to do some testing? Whether it’s a comprehensive stool analysis or is there some SIBO happening that can compromise your nutrient assimilation? Making sure that we’re really hashing out that whole gut health piece because all of the other stuff isn’t going to matter if our intestinal barrier function is compromised or our ability to assimilate those nutrients at the level of that interface is not healthy.

Dr. Maren:                          Totally. And that’s such a good setup too because postpartum depletion is a huge thing. And if you’ve got a baby nursing, it makes it all the worst? So it’s a big deal.

Dr. Wattles:                        I always tell patients we have to start from a place of fullness. Your company needs to be overflowing in the beginning because once you’re sharing with another human, that cup of energy and abundance is going to drain quickly.

Dr. Carrasco:                      [crosstalk 00:34:06]. I agree with that. I agree with that. Could you speak about mitochondrial issues and how that could play a role as well?

Dr. Wattles:                        So mitochondria are my favorite. They’re just the coolest little organelles. So a stat that I love to share is our oocyte or our little egg cell within the ovary has the highest concentration of mitochondrial DNA in the human body. That’s so stunning. I think people would think like, oh, it’s got to be your brain or your muscle.

Dr. Carrasco:                      Your heart or something.

Dr. Wattles:                        But these oocyte egg cells are so energy dependent. And that makes great sense, what an energetically expensive process to take this little cell and now we’re going to grow and grow and grow we’re going to make a whole baby. A whole human that didn’t exist before, we’re going to make that from scratch. And so mitochondria, like I said before, they generate the energy. Or sometimes I describe it as a currency, like it’s making the money that our cells are using to pay for doing really expensive things like ovulating, fertilizing an egg, implanting that egg, and then that egg turning into an embryo.

Dr. Wattles:                        So mitochondria can be compromised in a number of ways. So we think about oxidative stress. And oxidative stress is a nuanced conversation because by being alive, by making cellular energy, by the air outside and being exposed to normal environmental pollutants that we can’t really avoid, we regenerate some oxidative stress. This is totally fine in a body that has enough antioxidants to combat that. So we have to make sure that we have adequate antioxidant capacity just to meet the needs of being alive because that oxidative stress can really damage our mitochondria. So patients always ask me like, “Okay, I really want to protect my mitochondria and I want to avoid oxidative stress. What are the most common routes of exposure?” So we think about things like if you’re eating a super high sugar or processed food diet, that’s going to generate some reactive oxygen species or oxidative stress. Low antioxidant intake, obesity, smoking, environmental toxins, heavy metals, even hormone imbalances, that can all really contribute to an excess of oxidative stressors.

Dr. Wattles:                        Now, because we’re on this topic of unexplained infertility, this is really interesting because when we look, most of this research is derived from an IVF setting where they have the ability to do some testing with embryos and with follicular fluid, which is that soup that egg cells are swimming in. We see that women with unexplained infertility have higher markers of oxidative stress inside their abdomen, inside their pelvis, inside their follicular fluid. So seems like, wow, that is really something that we should explore. Then even further, we see that increases in oxidative stress that damage our mitochondria are associated with poor egg quality, endometriosis, and then we can’t forget about sperm too. Mitochondrial damage can really affect our sperm health too.

Dr. Wattles:                        So I there’s testing that you can do. There’s that you can do looking at things like eight hydroxy, two DEOxyguanosine, which is this marker of DNA damage particular for mitochondria. But to be honest, I’m just calling in mitochondrial support for all of my patients who are thinking about getting pregnant. Let’s just do it, let’s just bring on some mitochondrial support. So my favorites are things like Co Q10, people always ask me like, do we need to use ubiquinol? So I am mostly using ubiquinol, resveratrol, alpha lipoic acid, curcumin. It’s really a choose your own adventure, there’s a million things that we could use, glutathione. But I think that mitochondrial support is a non-negotiable aspect of any preconception plan and then especially for my patients with unexplained infertility.

Dr. Carrasco:                      Yeah. I love that. That’s true.

Dr. Wattles:                        I love Mito.

Dr. Carrasco:                      Think astaxanthin is a good one too.

Dr. Wattles:                        Absolutely. It’s funny that you mentioned that, I in the Seattle area, we don’t get a ton of sun, but astaxanthin is super protective against sunburn.

Dr. Carrasco:                      Totally.

Dr. Wattles:                        We’ve been taking it. And I don’t know if I really noticed a difference cause we don’t have like crazy sun, but I feel that it is protecting me from those UV waves.

Dr. Carrasco:                      Yeah, I think there’s some good studies on that as well.

Dr. Wattles:                        Totally.

Dr. Carrasco:                      So I know that our time is coming to a close, but I want to ask one more question and then I want to share where people can find you. But what would you recommend to women who want to have a baby yesterday? There’s a cohort of people that are like, I don’t want to wait three months, I don’t want to wait six months, I want to try now. So do you have any tips or any words of wisdom for those people?

Dr. Wattles:                        This is everyone. Once you want to get pregnant, you wanted to get pregnant yesterday.

Dr. Carrasco:                      My favorite say.

Dr. Wattles:                        Nobody wants to wait, I totally completely relate to that. So I always go back, and this is just a conversation, a back and forth that we have to have as doctor and patient to decide the best path forward. But I always anchor into the fact, if we look at normal folliculogenesis, which basically describes this process of where we recruit a cohort of eggs and then those eggs become big enough to ovulate and then to fertilize, that process of recruiting a new cohort of eggs takes roughly 120 days. So I want to set the scene that, yeah, we can do everything right now and you can try to get pregnant. But if we can give this 3, 4, 6 months, we’re really setting you up for success because that whole egg maturation process, that egg that can become your baby is going to be in the setting of supported stress management, nutrient sufficiency, lower toxicity, all of these things that we know can really affect your outcomes in a positive way.

Dr. Wattles:                        I think we have to really focus our energy on the big picture here, that yes, I know what it feels like to want to get pregnant and want it right away. But we have to think about our end game. Then that baby, that’s a lifetime of being together. So can we dedicate 3, 4, 6 months to really laying the foundation because I am 100% positive that it’s going to help in some way. But it’s hard, it’s a tough conversation to have. Time seems really precious.

Dr. Carrasco:                      Yes, absolutely. Wow. Well, this was such an awesome interview, so many wonderful insights. We’re going to have to have you back because you are a wealth of knowledge and we love picking your brain. But can you let people know where they can find you if they want to learn more about your work?

Dr. Wattles:                        Totally. So Instagram is probably my favorite, I love Instagram. So you can find me at Functional Fertility and you can also visit my website at drKaleawattles.com.

Dr. Carrasco:                      Awesome. Well, thank you.

Dr. Maren:                          And if you’re not following on Instagram, plug to do it because it is for-

Dr. Carrasco:                      It is really good. It’s great, great info.

Dr. Wattles:                        It’s my hobby. Thank you.

Dr. Carrasco:                      Thank you. Thank you so much for joining us today, we’re so thankful. And we will definitely reach out to have you back on.

Dr. Wattles:                        Such a pleasure. Thank you both.

Dr. Carrasco:                      Thank you.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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