Fertility and Reproductive Health: A Holistic Approach
featuring Anna Cabeca, DO, OBGYN, FACOG
Audio Only:
Episode 77
Published October 15, 2024
In this episode, Dr. Anna Cabeca and Dr. Jaclyn Smeaton discuss the multifaceted nature of fertility, exploring the impact of ovarian health, toxic burden, hormonal influences, and autoimmunity on reproductive health.
Dr. Cabeca and Dr. Smeaton also discuss:
- How toxic burden can significantly impact fertility and hormonal balance
- The importance of lifestyle factors and testing when it comes to fertility
- The often-overlooked role of male fertility in the conception process
- Taking a holistic approach to fertility that integrates both conventional and functional medicine
- Empowering patients in their journey towards conception
Key Moments
00:00 Exploring Fertility: A Multifaceted Approach
03:05 The Impact of Toxic Burden on Fertility
06:14 Understanding Hormonal Influences on Fertility
09:08 The Role of Autoimmunity in Fertility Challenges
12:03 Empowering Patients: Strategies for Improving Fertility
15:02 The Importance of Male Fertility
18:07 Navigating the Path to Conception
20:53 The Power of Lifestyle Changes in Fertility
23:49 Testing and Assessing Fertility
27:14 The Future of Fertility Treatments
Jaclyn (00:01.416)
So welcome Dr. Anna Cabeca, it's always so great to have you on the DUTCH Podcast.
Dr Anna Cabeca (00:05.404)
It is good to be here with you, Jaclyn. Thanks for having me.
Jaclyn (00:08.446)
So I'm so excited because we get to talk about one of my very favorite topics today, which is fertility. Of course, that's really where I've spent my time in clinical practice. You and I have different backgrounds. I'm a naturopathic physician. You're a conventionally trained OBGYN with a wealth of experience in functional integrative medicine. So I'm so excited to get your perspective on this topic and really learn from you as well. So thank you. Let's start by just talking a little bit about fertility today and what are some of the things that you're seeing in the world and the media in your practice in regards to fertility?
Dr Anna Cabeca (00:43.85)
Well, know, I, as you said, I trained at, as an OBGYN at Emory, but I really got into functional practice through my own story and trying to help my patients and with my own infertility journey specifically as well. And so a lot of things I, from, I'll tell you pre-pandemic to post-pandemic, seeing a lot more infertility in for multiple reasons now. So paying attention to fertility because of ovarian health is necessary for longevity is more important now than ever. Whether we want conception or they want to be pregnant or not, healthy ovarian function is a marker of longevity. so, you know, there's been global trends, whether it's partly fertility related, partly culturally related. But in the 1950s, there were you know, typically four or five children per woman. And now we're at, you know, 2.3, according to the research, 2.3 children per woman. And it's projected to fall below 2.1 by mid 2050s. So we're seeing a decline in conception, and there can be multiple reasons for that. Certainly, economy is a big one.
But yet think fertility is playing a role in this too.
Jaclyn (02:10.12)
Yeah, well, I love, I want to roll it back to what you said about ovarian health as a marker for longevity because there's actually some, there has been some published data in men on sperm health. I haven't seen any in women, so I'd love to talk more about that. But I think about fertility as the canary in the coal mine. Like testes and ovaries are such sensitive tissues and they also have the highest demand for mitochondria of any tissue in the male or female body. Like hundreds of times more than our somatic muscle cells, like the heart, which is where we learned about mitochondria when it comes to medical school. And so it is fascinating when you look at like mortality rates, even all-cause mortality in relationship to, in the studies that I've seen, sperm health of men in their 30s. And it has been suggested that sperm analysis be done to actually stratify risk for men because it is such an early marker.
Now tell me a little bit more about the ovarian health. And I love this concept because it really speaks to a lot of the complicated causes of infertility that couples face today as well.
Dr Anna Cabeca (03:19.318)
Yeah, yeah, and I think it's multifactorial. When we look, you talked about the mitochondria, know, mitochondria in the heart. think it's, what is it, you know, five, 50,000 in the heart, but over 200,000 in the ovary, something, you know, a huge magnitude difference. And this is true for the testes too, but what we've seen now in research and brain health and neurologic studies, especially as we age, the longer we maintain healthy ovarian function, the...
Jaclyn (03:31.198)
That's right.
Dr Anna Cabeca (03:48.714)
better quality of life and longevity we have. So that's a piece of this puzzle and why it's so important to maintain healthy ovarian function as we age. So when we're looking at reasons for some of the infertility, we definitely have an increase in total toxic burden. And within that total toxic burden, there's endocrine disruptors. And that affects ovarian production of hormone as well as ovarian hormone utilization within our body. So that's a piece of, that's a huge piece that I find is a big component. And I would say the second largest piece is stress. Is real and perceived stress creates a huge burden on ovarian function. And the third is autoimmune issues and adjuvant, you know, invasion, if you will, that can affect ovarian health and ovarian health production. So post pandemic, seeing more infertility, excuse me, post pandemic, seeing more infertility and lower AMHs. So antimullerian hormone, one of the markers that we test in fertility, we're seeing issues with that. I'm seeing it a lot more now than I did 10, 20 years ago.
Jaclyn (05:15.71)
Absolutely. And I want to touch upon those pieces because I think you're right. These are the underlying factors that affect chronic disease but also affect fertility oftentimes first. So let's talk a little bit more about toxic burden. When I think about toxic burden, certainly it's what's affecting our patients today. I also, when I get thinking about root causes, I think about the patients that I see today that were in their mother's wombs. They were in utero.
in the late 70s and in the 80s, early 90s. But this is like before the EPA really had a hold of chemicals in our environment. The EPA didn't even come about until the 1980s, I believe. So you had industry dumping waste into rivers at the time that these women that we see were developing fetuses in their mother's wombs. And that's when the ovaries are developed. And we actually have grandmothers even, because you were women, if you're a female listening to this, you were actually in your grandmother's womb because you were a follicle in your mother's developing ovary. And so everything that your grandmother was exposed to, everything that your mother was exposed to throughout her whole early lifespan until you were born affects your fertility now and your health now. And that's really fascinating when we think about toxic burden and how things have changed over the years. I do think that
And these are difficult studies to have, but it's likely that many women have a reduced fertility capacity due to just epigenetic changes that happened in utero. And I know I was talking, I heard Paul Turek speak. He's a male fertility expert, a reproductive urologist, and he's done tons of research. And he had said actually for testicular exposure, the biggest risk of harm is four to six weeks gestation for males. When it comes to toxic exposure. And that's before many women even know they're pregnant. Yeah, anyway, fascinating topic.
Dr Anna Cabeca (07:14.016)
Right? Right. It is, it is. And when we think about it, you know, when we talk about toxic exposure and also the lack of pharmaceutical regulation as well. So we had DES babies from 1940s through early 1970s. And so there's still a, you know, a chance that there's exposure from that. And then we know from research, there was a study published in France several years ago that looked at third generation of women that were girls that had their mothers exposed in utero to DES. And what it showed is a decline in fertility, an increase in cancer, an increase in, they call it gender confusion. And they saw these things in the third generation. So it's important to look at that generational change. again, it can be scary if you're listening to this right now, but I want to assure you there's so much we can do.
Jaclyn (08:11.038)
Mm-hmm.
Dr Anna Cabeca (08:11.062)
in advance to improve our overall health and our fertility and our gestation and our pregnancy and the lives of our children coming. But also there was a study published, I think it was in 2010, that looked at umbilical cord blood. And in this umbilical cord blood study, they had sampled 10 samples of umbilical cord blood and there was over 200 chemicals. Over 127 of those were known to be hormone disruptors are carcinogenic. And you think of that, like, wait, this is the safety, this is a safe space, this is our room, this is a safe space. And all these chemicals are coming in and they're passing on now, we know at least to the third generation in some studies to the seventh generation, some things are, we don't know when we'll be able to get rid of those chemicals from us. And so we have to look at, okay, there's certain things we can control and there's certain things we can't, but we'll...change the things that we can control. And that becomes empowering. And DES was a big one. So in utero exposure, what they noticed when children were seven, eight years old, they were having increase in cancer. For boys, was decrease in testicular distension, increase in testicular torsion, and then for young girls and women, increase in vaginal cancer.
And so you're like, whoa, mean, that is, and that's, you know, incredible toxin to our body. We know about thalidomide, right? That that thalidomide caused limb abnormalities. We know accutane causes genetic malformations. And we know today, even in studies done, mean, studies done today, the FDA does not require generational studies. They do not look at results on the health of the child after exposure to chemical or whatever given or mandated in utero. that is, I mean, those are huge unknowns yet for us. one of the big things that I advocate for is we need generational studies on medicine and to know the effect long-term for the next generation. And yet that is not.
Jaclyn (10:28.862)
Hmm.
Dr Anna Cabeca (10:33.714)
at all a consideration or priority for our FDA.
Jaclyn (10:37.212)
Yeah, it's unfortunate because I think you're right. have so little data. And of course, America compared to Europe and UK and many other parts of the world, we don't have the same level of regulation, even over food. You have manufacturers that make products uniquely different, usually much cleaner abroad, Canada, Europe, et cetera. In the United States, we have a lot more coloring additives, et cetera.
Dr Anna Cabeca (11:02.96)
and allowing toxins like mold toxins, for example, xaorelone. And I write about this in my first book, The Hormone Fix, in the toxicity chapter, because it's so important, right? It takes more than hormones to fix our hormones. So xaorelone, we allow a hundredfold more than they allow in Europe in our food source. And so xaorelone is a toxic mold derivative, right? It's a toxic mold chemical, essentially, or derivative that is associated with infertility and cancer.
Jaclyn (11:14.758)
Mm-hmm.
Jaclyn (11:22.302)
Hmm.
Dr Anna Cabeca (11:33.288)
So like we can't allow it. And then I think, okay, yeah, you think about mold and grains, but then I think of my corn chips and I'm like, darn, you know, like that darn Zarelin. Yeah. And pecking for these things.
Jaclyn (11:35.068)
It's hard to do anything right. Yeah.
Jaclyn (11:45.022)
Yeah. Now with toxins, can, right, I mean, it can be overwhelming for patients to be thinking about all this. Are there ways that you streamline what patients should pay attention to or how they can do this without it being this overwhelming, daunting task?
Dr Anna Cabeca (12:03.702)
Yeah, yeah, and it is always one next right step at a time. And often it's about substitutions versus eliminations. So you don't feel like, I'm missing, you know, my, I was gonna give my, you know, tortilla chip example. You're not missing the tortilla chip. You're having sliced carrots or tomatoes or almond crackers or whatever it be, making a healthy substitution, organic, clean, healthy substitution, and incorporating that into our lifestyle, not drinking.
For example, not drinking milk, drinking water, or figuring out some other substitution for avoiding the hormone disruptors that are specifically in much of our dairy and includes antibiotics and other hormones. So we want to really look at what can we avoid or what trade-offs can we make, skincare products, like switching to something clean, organic, or essential oils instead of...many of the cosmetic products that we have or skincare products that we have. And oftentimes, especially if a client's coming in for infertility, looking at their toxic burden and just looking, you know, because if you're dealing with infertility, there's toxins. There's 100 % there's toxins, whether it's mold, whether it's, you know, plastics, chemicals, parabens, you know, there's a litany of them, but then you know how to get rid of it. For the most part, we know how to get rid of them and empower your body.
Jaclyn (13:29.118)
Mm-hmm.
Dr Anna Cabeca (13:32.81)
to eliminate what's in our system circulating and reduce exposure so that we're not continually exposed to the same toxins.
Jaclyn (13:43.858)
Now how do you typically test patients for toxin exposure or do you do questionnaire type assessment or do you do lab testing?
Dr Anna Cabeca (13:50.992)
Definitely everyone gets a questionnaire. Everyone gets a questionnaire. so that, you know, just based on your score, I know you're toxic, right? We can start with step one right there with a healthy nutritional lifestyle and nutraceutical support of our detoxification system plus like infrared sauna, hot, alternating hot and cold bath or shower, ice baths, doing lymphatic brushing, things that we can incorporate into our routine.
Jaclyn (13:53.032)
Mm-hmm.
Dr Anna Cabeca (14:20.246)
that also start to help moving toxins out of our body. So start with the questionnaire. And I do lab tests on my patients. I look at routine blood markers, but also inflammatory markers, and really want to get optimum numbers. then when I'm, for infertility specifically, or in general, hormone disruption, I like to do a total toxic burden test. There are a couple different companies that I look for that through, whether we're looking for heavy metals, whether we're looking for mold toxicity, whether we're looking at other environmental chemical toxicity, etc. So we have that now where when I started practice I even I would say what are you talking about?
Jaclyn (15:02.812)
Yeah, there's nice, there's so many options available. Another tool that I use in my practice that's really inexpensive, and I do use a functional testing as well, but looking at overall toxin burden is GGT. I don't know if you use that, but Joe Pezzorno has developed, well, he wrote this great book called The Toxic Toxin Solution, which is a consumer facing book, really worth a read, great for clinicians as well. It's like definitely a very scientific approach, but he looked at all of the different standard blood markers. There's like Billy Rubin, platelet count, like all these markers that actually change with exposure to different toxins and GGT is the most sensitive, but it's within the normal range, like the top third of the normal range, he says absolutely is toxic. And I followed up with him this summer, we were chatting and he said he's been able to get his GGT down to 12. And he's like, I've done everything to live a toxin free lifestyle. And I feel like that's where we should set the bar as optimal. So that was very interesting.
Dr Anna Cabeca (15:59.2)
That is really good to know because we look at those GGT levels and you're like, okay, well, you when are they flagged?
Jaclyn (16:05.502)
Absolutely, but they don't even have to be flagged. Even just in the normal range is really identi- and there's this is evidence-based approach like there's significant data showing that. So it's nonspecific but it's another really nice like if people are listening and you want to try to see if that's a problem that's something that any provider even your primary care doctor could add and it's not expensive. It could be part of like a wellness check and it would you know insurance wouldn't bat an eye on that for the most part. So another really good good one to throw in there.
Dr Anna Cabeca (16:08.286)
No.
Dr Anna Cabeca (16:34.196)
Yeah, no, that's great. And LDH is another one too we don't think about too much. like looking at, know, sometimes like you said, the routine blood work we are getting drawn, like liver functions, optimal is, you know, is not normal, right? Like we want to look at optimal levels, not normal levels. And so that's critical, even antibodies, thyroid antibodies, etc.
Jaclyn (16:37.47)
Mm.
Jaclyn (16:50.728)
They're different.
Dr Anna Cabeca (16:58.554)
You can have thyroid antibodies, it depends on the lab, but pretty very, very high when no thyroid antibody is acceptable, right? We don't want to detect them at all. And I think that's really critical. And then with fertility, like with a woman's menstrual cycle, if you're having PMS symptoms, if you're having irregular cycles, if you're having painful cycles, there's toxicities involved of some sort.
Jaclyn (17:07.198)
That's right.
Jaclyn (17:23.134)
Well, let's talk more about the hormonal aspect of fertility, because of course at Dutch we love hormones. It's our jam. It's like what we do, right? We love hormones. So tell me a little bit about some of the common hormonal causes of infertility that you see in your practice.
Dr Anna Cabeca (17:37.686)
So probably one of the most common is a luteal phase defect. So shortened second stage of your menstrual cycle. with ovulation, after ovulation we begin our luteal phase. So the luteal phase defect is probably the most common one that I see. And so with that deficiency in progesterone, low suboptimal progesterone levels.
And that can be at any age, that really can, but we definitely see it starting in the mid thirties and beyond. And so that is something that always, you you always want to look at. so with testing, looking at, I'll use the Dutch complete on day 20, somewhere between day 20, 21, or at least seven days after ovulation, if we can determine ovulation, seven days after ovulation, we do the Dutch testing and look at the, you know, all the hormonal levels and estrogen detoxification levels during that time. Also with looking at, you know, suboptimal fertility is cycle day two or three, FSH, LH, estradiol, and AMH. I mean, it thinks importance. Oftentimes, Jacqueline and I get clients in my office and recently had a client in my office and she is in her late 30s and she had one... normal pregnancy seven years ago. And then in the pandemic, she had a trisomy pregnancy and then she had miscarriage. Then she was told she was in early menopause and wasn't a candidate for IVF. And so she flew down to see me and, know, devastated, but very educated. She was figuring things out, right? She was devastated that her AMH, you know, about her AMH level and devastated of this diagnosis.
She said, don't know if I'm able to get pregnant again, but I don't feel like I want to give up. And so a couple of things that we did together was hugely detoxing because also she had had COVID and she'd been vaccinated. And so there's, you know, in the entire long haul COVID protocol or post vaccine protocol that I implemented with her with supplementation, but also high dose IV vitamin C.
Dr Anna Cabeca (20:02.186)
IV ozone therapy, so we were aggressive with her. And nutrients, the key supplements, always part of my foundation for fertility is my Mighty Maka Plus supplementation product, CoQ10 and carnitine. are kind of, and vitamin D, optimizing our vitamin D levels. Little, you know, like little.
These are, it's not a huge, it's not a lot. It's not a thousand dollars a month, right? It's a couple, it's a few hundred a month for all the supplements that we were doing on the IV therapies. But, and so we worked on her detox pathways, worked on her level and in two months we repeated her AMH and it had increased 10X. So still not, she was sub-fertile. You know, she, you know, was, so that was an issue. I was using cyclic progesterone with her to have some...
Jaclyn (20:43.984)
Wow. Yep.
Dr Anna Cabeca (20:53.664)
to try to create withdrawal bleeds and a cycle. And I said, okay, we need another, we need at least another two, three months of protocol before you start trying to conceive again. And she called me for her two month followup visit and we had a telemedicine visit and she's like, Dr. Anna, don't be angry. I'm seven weeks pregnant. I was like, yes. Yeah, no, exactly. was like, because you told me to wait, but.
Jaclyn (21:14.334)
how you be angry? That's fabulous.
Dr Anna Cabeca (21:20.362)
I'm like, I am so happy. And now she's 30 weeks pregnant. every, yeah, so healthy and she's not alone, right? That is empowerment of ovarian resuscitation, increasing longevity. mean, that's a huge bonus to have her pregnancy. But just by doing these protocols, even after the diagnosis of infertility, early menopause, forget it, right? You're not even a candidate for IVF. And I sat in those shoes.
Jaclyn (21:21.342)
Hahaha
That's great.
Dr Anna Cabeca (21:50.106)
know, 20 years ago, I sat in those shoes and was able to reverse that early menopause diagnosis and have a baby naturally and conceived naturally at age 41. So these little tweaks that we can make in empowering the system and knows what to do, our body knows what to do. You just have to give it the opportunity to heal itself in so many ways.
Jaclyn (22:08.668)
Yeah, absolutely. mean, with naturopathic medicine, one of the tenets and the foundational philosophies is a respect for the healing power of nature. I see that all the time. And I think it's a disservice to tell women that fertility can't be improved. And I think that's been disproven. And it drives me crazy when patients have heard that from their providers. Because I see it over and over again, those improvements in day three markers.
But not only that, pregnancy, improved fertility rates, positive pregnancy tests, and fertility, pregnancy outcomes, live birth, which is what of course matters the most. So I love the approach that you're taking. And it is, it's like, you need to remove the things that are stressing the system, whether it's toxins or infection or dysbiosis, et cetera. But then there's also nutrients that have been pretty well researched and shown to improve ovarian health. And a lot of it is around balancing out oxidative stress, balancing the blood sugar, and supporting mitochondria, which is where the co-cutan and the carnitine come in that you mentioned. It's really, I mean, I'm sure you've seen it a lot of times. I have as well. It's really an area that there's so much promise. And I think about the benefit where everything that you're doing is also improving the overall health of the patient, not just their ability to get pregnant.
Dr Anna Cabeca (23:35.926)
Exactly. If it increases fertility, it increases longevity other than the injectables.
Jaclyn (23:40.22)
Yes. So you'd mentioned that you use the Dutch complete. What are the main markers that you take a look at on the test for a patient who's trying to conceive?
Dr Anna Cabeca (23:49.216)
So I definitely look at overall total hormone levels. And probably one of the most important things is their cortisol curve. If that cortisol curve is not optimized, it is. just don't. We have to fix the cortisol curve. We have to fix the circadian rhythm in order to get in the circadian cycle, in order to improve fertility and health.
Cortisol curve within the Dutch test is critically important. I also, of course, look at the estrogen detoxification pathways, as well as progesterone and its metabolites. I really want that to be high optimal in patients that want to conceive. And we want the detoxification pathways to be prioritized down the two hydroxy pathway and to methoxy pathway, a strong pathway. And so we want to see that pathway improved and less of the four and 16 pathways. So I look at those. And also, I think one of the nice things about the Dutch complete is the neurotransmitter piece, the indicators on the neurotransmitter as well. Also the indicand. I think, again, we have to have
Jaclyn (25:05.15)
Mm.
Dr Anna Cabeca (25:13.224)
a healthy gut, healthy metabolism, healthy microbiome in order to have a healthy pregnancy. And as a gynecologist, looking at, know, considering the consequences of hormonal imbalances and gut imbalances on vaginal health, vaginal pH, you know, and that is a critical consideration that really doesn't get much attention and the fertility doesn't get enough attention in the fertility space that it has to be taken into consideration for fertility.
Jaclyn (25:45.722)
I that. And I'm glad you highlighted kind of that last page of the report, the oats page. I tell my patients that's like the secret treasure chest because there's so much additional information that helps you understand the root causes of the hormonal changes that you're seeing earlier on in the report as well. And things like the nutrient deficiencies for B6 and B12 or the 80HTG is another one, the very last marker on that page that looks at oxidative stress levels and balance. like you said, the Indicin.
That microbiome piece is really rising in the fertility field, just like it is in every other field. But there's some really interesting data out around that, where they're looking at patients who've had failed embryo transfers in IVF with embryos that have gone through pre-implantation genetic diagnosis, and they're known to be normal. What they found is that there's a very high rate of, I would call it dysbiosis, inside the uterine lining. For some, it's a...an infection, like a low-grade chronic infection, like chlamydia is one of the organisms that can cause that, but also Gardnerella is a really big implicator in that. And when it's treated with antibiotic therapy plus probiotic therapy, the combination works the best. They get like an 85 % remission rate on further testing and then much higher pregnancy outcomes on subsequent IVFs.
It really speaks to that, well, the importance of immunity, like you said, autoimmunity rising as an important piece and the importance of the microbiome. So let's touch a minute on the immunity side of it, because you brought that up as another root cause. Tell me more about what you're seeing in your fertility patients in regards to autoimmunity.
Dr Anna Cabeca (27:36.374)
So definitely seeing a lot more thyroiditis and autoantibodies, whether we're looking at lupus, or ANA, or we're looking at the whole list of autoantibodies. I think one of the tests that I do is the Aviz Autoantibody Test. It's very in-depth, and it gives us so many areas in biomarkers and...
levels and we know optimum versus normal. And so we're looking at that early on to see what's going on. Is there a reactivation and you think of reactivation of Epstein-Barr virus. I'm seeing that in abundance right now. And that also affects our immunity. And all these viruses have, you know, a significant effect and impact on our immunity.
So looking at those antibody levels and then working to empower, mean, that's it, our solutions within us, like to empower our bodies' natural immune protection systems, and that really stems to healthy gut microbiome, to really empower that to fight off these antibodies and to reverse them. So often, again, I see numbers normalize, and I think that's really important to...empower the individual with knowledge that things can change. And it's not their fault, right? It's not their fault. We didn't know where these exposures come from or how we got them. for the most part, we can do so much to empower the immune system. And looking at these things, and this is a test that we just had on its panel. So make sure they hear this part. But oxytocin.
Jaclyn (29:19.654)
listening. The Hoxytocin.
Dr Anna Cabeca (29:21.446)
Measuring oxytocin, is the power, it is one of the most powerful things to support our immune system. It is really very, very, I know, critically difficult to measure oxytocin in any good, consistent way at this point, because it's such an energetic hormone. We got to use bioenergetics at some point. But measuring oxytocin, because I incorporate these practices into my clients to make sure they're getting play time.
They're doing things they enjoy. They're doing things that make them laugh with people who make them laugh that they enjoy being with. They feel safe and in a trusted environment. And so those things increase oxytocin, also decrease cortisol. And it's, of course, the hormone of pregnancy and postpartum. So increasing oxytocin in our life. And it's challenging working with a fertility patient that is so depressed, right?
Hormonal fluctuation, you've got to empower the body, empower the physiology, create a high vibration individual too. At the same time we're doing the detoxification, same time as we're doing the nutraceuticals, the supplementations, adaptogens, all the hormones, because that moves the needle the fastest, I think.
Jaclyn (30:42.802)
I love that because I mean, really, we do know that stress hormones change the HPO axis. Like the HPA and HPO, they share hypothalamic and pituitary signaling. And while there's different signals that speak to the adrenal glands versus the ovaries, it's been shown that when the HPA axis is stimulated, it impairs the communication of the HPO axis. there are, and it's not only around hormone production.
There's also evidence that in the ovaries, receptors change when there are a lot of like cortisol, epinephrine, norepinephrine around. So I love that you're focusing on that and not only reducing stress, but infusing joy because it's hard to be joyful and stressed at the same time unless you have young children and then it feels that way all the time.
Dr Anna Cabeca (31:34.858)
Well, and it's a practice. It's a decision. It is. It's a principle and a practice. mean, I, you know, from being at a point in the past where I was really depressed and suicidal, you know, to think, okay, the daily practices I create improve my joy, my passion, my pleasure on a daily basis. And it's critical to keep up those practices because it's noticeable when I skip one, don't have time, feeling rushed, overstressed.
And I don't have time for these practices. And you're like, I'm slip sliding away again. And so I think the practices, the mental training that we do is a big part of this empowerment piece too for the individuals struggling with infertility. And I love Jacqueline, what you said about the receptor sites being sensitive to cortisol, adrenaline, noradrenaline on the ovaries, so the ovarian receptors, because that's part of my story. I think that's part of my story. you know, I completely suppressed ovarian function. for those who don't know my story, naturally conceived at age 41, but then finally went through menopause, you know, I had a little glitch there at 48, figured out my method, which I call the keto green way, keto green lifestyle and nutrition. And then really, at age 56, I finally became postmenopausal. So, or menopausal, now postmenopausal at age 58. like being able to maintain ovarian longevity, I mean, it could have been 20 years ago, completely different health picture versus now at age 56, or now I'm 58, but having that. It's huge, it's pot minutes. There was no magic peptides or exosomes or stem cells that I was infusing, although sometimes.
Jaclyn (33:19.87)
That's amazing. Yeah.
Dr Anna Cabeca (33:28.51)
you know, there's clients that I will use these technologies in for ovarian resuscitation, especially specifically for fertility. But yet, like, it's like, we're gonna do all this other stuff.
Jaclyn (33:42.748)
And when you think about the importance that your female reproductive hormones like estrogen have on things like bone health, and the longer you can delay that menopausal transition, you're going to be exposed more to estrogen in that way, bathing your tissues in that. So I want to talk a little bit about, from the point of view of a patient coming in with maybe a known struggle with fertility, they've seen a traditional reproductive endocrinologist. It seems that there's so many things that they could do. There's so many tests they could run, assessments they could do. And then from a therapy perspective, how do you know where to start? What advice would you give to a patient when it comes to knowing where to get started?
Dr Anna Cabeca (34:32.638)
Yeah, you have to meet the patient where they're at, right? Because everyone comes in with something different and different capacity. Like the client I had told you that had had the trisomy and the fear around having another trisomy, let alone after her trisomy, she had a miscarriage and then diagnosed as infertile, then diagnosed as early menopause. So there's a lot of fear wrapped into that. So being able to meet the client where they're at and you have to start that, that reprogramming and she's like, I'm not giving up. have this amount of time. I want to throw everything at this. I'm like, okay, well, if you're going to do it, stress stay, that's not me that's going to take care of you, right? You got to look, you got to meet them where they're at and I don't take hope away. So encourage that. I have a client who's 27 and all the classic symptoms of PCOS was diagnosed with PCOS. She was 40 pounds overweight, had acne, hercetism, her period was once every several months and you know her, she was, that was it, she was given spironolactone. And I was like, okay, well let's do a few things. I always start with my foundations and for me that's my keto, easy 16 day keto green plant, keto green 16 plant from my second book. It's the simplest, most medicinal recipes in a short amount of time. I get that turnaround and what the nutrition, medicinal side with the intermittent fasting is to create insulin sensitivity and start to modulate cortisol, increase alkalinity. So that combination is part of foundation. Then adding additional detox support. So for me, that's in my superfood combination. So we use that. And also, you know, on her lab work, her lab work she brought in from her other doctor, her fasting glucose was in the 80s, her hemoglobin A1c, was like 5.3 or something. And I said, well, let's do a two hour glucose to insulin and start this process and let's do these labs and see where you're at. And so she did everything I told her and she did the two hour glucose to insulin challenge test. That's really important. And labs just aren't like, you have to really spell it out when you write that lab order to your lab and you have to explain it really well to the patient because
Jaclyn (36:37.758)
Mm.
Dr Anna Cabeca (36:58.134)
The lab will mess it up all the time. They will mess it up to be really specific and the patient needs to know what she's getting and to be advocating for herself when she gets there. So it's a 70, you know, you do your fasting glucose and insulin, a 75 gram glucose load, then glucose and insulin at 30 minutes, one hour, and two hours. You can do it all the way to three hours. And what we saw on her glucose curve, again, because her hemoglobin A1C and her fasting glucose were
Jaclyn (36:59.966)
Thank
Dr Anna Cabeca (37:28.288)
Fine. But what we saw on her glucose curve, it followed the normal curve, but her insulin shot up at one hour to 79 and at two hour, I mean 76 and at two hours it was at 79 and still climbing. That's classic insulin resistance. And during this time, so I had been traveling and so she followed up with my mid-level in the meantime, but when I saw her back two months from my original visit, she lost 40 pounds.
Jaclyn (37:42.654)
Hmm.
Dr Anna Cabeca (37:57.174)
Her periods were regular. you know, like, can't, you just like, that's without any prescriptions. No progesterone, no anything else at this point. And I took her off the spironolactone. So like, that's one type of client. She's like, okay, I'm gonna do everything. I'm seeing results. I'm gonna keep going with it. And completely turned her health around in a very short amount of time. So.
Then I have a client who's 48 years old wanting to get pregnant, wanting to conceive. It's another kind of discussion, right? There's a more challenging 48, you know, having irregular cycles than it is at 27 having irregular cycles. And so this is where, you know, the Dutch test is really empowering and you have the cycle mapping and there's this type of situation with a motivated patient. You want to look at that number one, so they see what's in front of them.
Jaclyn (38:39.642)
Exactly. Yeah, they're different.
Dr Anna Cabeca (38:54.492)
And also you can counsel on the level of aggression they want. At this point, they're not IVF candidates, right? There's multiple levels. And all I can say is I would create a body that is as vital and healthy and do as much ovarian resuscitation as we can in this individual, whether able to conceive or not or what we're going to do there. But it's really something to look about. And I want to just make a note.
I'm doing fertility because 40 % of infertility is male factor. You have to see the sperm, the semen analysis. You have to see it. Yeah.
Jaclyn (39:32.094)
Thanks for bringing that up. Let's not overlook it. Women take on such a burden with fertility to carry that process forward, but yes, 40 % of the time, it's actually more because it's 30 % it's male factor only and 30 % it's a combined factor. So 60 % of the time there's male involvement. So it's so important. Don't overlook. I have so many women that are going through test after test after test after test and their partner's not even had a semen analysis.
Dr Anna Cabeca (39:53.589)
Huge.
Dr Anna Cabeca (40:03.061)
now.
Jaclyn (40:03.71)
You got to do it. It's not that hard in comparison to, you know, hysteroscopy and, you know, all the things that are done in the female workup.
Dr Anna Cabeca (40:14.866)
Absolutely. And part of the female workup too, like you mentioned, hysteroscopy or Hyster sonogram. Those are, you know, I used to do in-office Hyster sonogram because number one, I want it painless. The patient knows me, they can relax, be comfortable and, you know, create that environment. And at least we can tell if one tube is open by free fluid in the peritoneum afterwards. But if otherwise, then the next level, and plus you get to see what's going on inside the uterus. And then I would send to a Hyster sonogram, a hysteroscopy.
Jaclyn (40:25.47)
Mm-hmm.
Dr Anna Cabeca (40:45.207)
a yeah, HSG.
Jaclyn (40:48.67)
Yeah, hysteroscopy. that's great. I it can be so complicated to get started, but ultimately, you I love what you're saying, which is you're really starting with the information that's easy to access and then kind of digging a layer deeper in it. I think the other thing that stands out to me, if I was a patient listening, is like, don't try to do it on your own. Because I can hear, as you describe these different patient cases, how for you, sometimes that path looks really clear and it's in a way that the patient would really have struggled to uncover that on their own. So finding someone that you trust is really a very important piece. I think, because I see a lot of other clinicians in my own practice that it's, or when I was in practice, I'm not seeing patients right now, but when I did, it was like they came saying, I tried to this on my own. It's just so stressful because I'm always questioning whether I'm doing the right things. Can you help? And you do need to just
Give it to someone that you trust to help you through that process.
Dr Anna Cabeca (41:49.054)
Yeah. Yeah. And then to see, what's the biggest, what's the, I like to look at this, what are the smallest things we can change to get the biggest results? And what's that biggest needle mover that we need to really focus and hone in on? She can't do everything at once. So I think that's, yeah, that's very good advice.
Jaclyn (41:58.152)
Yes, absolutely.
Jaclyn (42:05.726)
Mm-hmm.
Jaclyn (42:09.586)
Great advice. Well, thanks, Dr. Anna. It's been so nice to have you on the podcast today and to see you and I look forward to getting the chance to talk with you again.
Dr Anna Cabeca (42:17.758)
I look forward to it. Thanks for having me.
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About our speaker
Dr. Anna Cabeca, “The Girlfriend Doctor,” is a triple board-certified OBGYN who is passionate about helping women understand and improve their health. Dr. Cabeca wants her patients to live happy, healthy, and vibrant lives, especially as they transition through menopause. She’s spent years perfecting her life-changing programs that tackle symptoms like fatigue, depression, weight gain, loss of libido, vaginal dryness, and hair loss. Dr. Cabeca is also the author of two best-selling books: The Hormone Fix, and Keto-Green 16, both geared toward helping women live healthier lives.
Show Notes
Learn more about Dr. Anna Cabeca and her upcoming program, Magic Menopause Coaching Certification, launching October 15.
Follow Dr. Anna Cabeca on Instagram @thegirlfrienddoctor.
Watch Dr. Jaclyn Smeaton’s DUTCH Webinar on Fertility and the DUTCH Test to explore how the DUTCH Test can be a useful tool to explore fertility.
Become a DUTCH Provider to learn more about how the DUTCH Test can help you profoundly change your patients’ lives.
Please Note: The contents of this video are for educational and informational purposes only. The information is not to be interpreted as, or mistaken for, clinical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment.
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