Category Archives: fertility

Evolutionary Success vs Child Free Living

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As you know, I have been struggling with my biological clock: my age and stress level tick louder than ever. Weighing the cost of motherhood against my career in medicine has never been an equal balance with scales always tipped in the favor of my seemingly insatiable appetite for knowledge. And yet – I’ve been studying fertility since 2004, seeing fertility docs since 2008, and  froze my eggs in 2013. I am always scheming to figure out “when is a good enough time”. Yes, I know there “is never a good time: but as a lesbian with a choice, isnt there a “better time”? And here I am, child free, finally happily coupled, and in my third year of medical school in 2017.

I just completed 6 weeks working with newborns and doing well-baby checks to mostly women under 30 in my first pediatric rotation. I I couldn’t help thinking about the definition of evolutionary success as progeny. Many moms I worked with had 4-8 other babies. Some were on opioids, many smoked pot and tobacco or even took buspirone and SSRIs throughout their pregnancy and had sick/addicted babies. Some were very very young. But evolutionarily, each of them had already surpassed me even with my 2.5 degrees, $500k of education,  and diverse, privileged, happy life. I realized I am currently an evolutionary failure.

I am an archetype of my Generation X.  I don’t have many excuses for child-free living left, having had a bacchanalian and free-spirited 20’s and 30’s. Is it time for me to “settledown”? Who am I if I choose NOT to have a child of my own?

My primary reasoning for not spawning includes RESPONSIBILITY – towards my career/education and more importantly, to the kid. Who brings a child into the world who is guaranteed a mom who is away from home 12-18 hours a day (unavoidable in medical school -residency)? Where is the evolutionary success in that? Generationally, I do not have the same programming my parents had to marry/reproduce, and as a lesbian it didn’t happen by accident. Also, as a kid myself who had a high ACE score, I don’t want to perpetrate even a privileged neglect into another generation. So, here I am: struggling with my generational expectation to break the glass ceiling, achieve my highest ambitions, follow my dreams … and shouldering the unspoken price of doing that.

Maybe I could redefine evolutionary success. Not “survival of the species” but survival of the…planet? Conscious eco-systeming? Or maybe even the more complicated redefining of family/familial success – what if evolutionary success was a life well-lived and well-loved, and a small carbon footprint; a kinship network of peers, lovers, and lifelong friends instead? Children no longer live to serve their elder parents, and even if I had a child, I would not be promised a safe and well-cared for death. Still, at the end of the day, even though I have many cousins with beautiful babies carrying on the family line in all directions, my personal lineage of Wright-Larson will not be carried on unless I have a kid. That feels sad. That does feel like failure.

I stand with my aching feet and my scrubs and pager, knowing raising my own babies is not likely going to be the life I get to live this time around.

I have always been an outlier. I chose Naturopathic medical school in the 90s, chose the urban underbelly in the 2000s, and chose osteopathic medical school in the 20-teens.  I’m 92% reconciled that I will enjoy my child-free life and travel to Tokyo, Vatican City, Barcelona, and live in expensive, romantic urban centers. Because I consistently choose career, love and adventure over a baby and domesticity I will be able to live a certain kind of lifestyle. But that doesn’t make it easier when I come home smelling like babies from a day at work, or when I see my cousins achingly beautiful creative charming kids. There is no consolation prize for evolutionary failure. Only the small faith that I am making the right choice for the kid I would create and maybe a for this planet, and hopefully for, myself and my love.

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Fertility is the New Holy Grail

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Resolve to know more about the underling factors affecting conception and alternative family possibilities. * This article was originally written for the February 2015 Digital Issue of Essential Living Maine*

I had two stepmothers who were infertile for various reasons, and have an adopted baby brother. Several of my close friends and family member have used IVF to conceive, and I have my eggs cryopreserved. A few of my good friends have fostered and adopted, and others have intentionally chosen childfree lives. As lesbian and gay marriage has normalized, and divorce rates have climbed, more and more alternative families are being created using sperm banks, surrogates, egg donors, known sperm donors and more. The quest for fertility is all around us, and has been for the past 30 years in ever-increasing numbers.

The Internet has an enormous amount of information available on this topic, as the World Wide Web offers an enormous cross cultural support network for women trying to conceive (#TTC.) Infertility is usually a silent disease without any visible disability associated; however, it draws deeply on the mind/body and soul in underground ways that cannot be explained to those who do not have to undergo its trails and tribulations. Thus, the web is a great way to connect, share information, and do research while maintaining public anonymity.

220px-Sangreal-1Integrative Medicine is key to enhancing fertility. Integrative Medicine combines the best of modern medicine (reproductive technology) with time-honored complementary and alternative medicines (botanical therapies, clinical nutrition, homeopathy, acupuncture, and stress management support.) The quest to get pregnant (and stay pregnant!) has been a calling of doctors and midwives since the beginning of time and across all cultures.

After ten years of fertility specialization, here are my Top Ten Integrative Medicine Fertility Fundamentals to know about when mapping your journey:

  1. First, while on oral contraceptive pills, rings, or IUD’s and for at least 6 months coming off them, it is important to supplement with a good quality multivitamin that contains at least 10-20mg of all of the B vitamins, magnesium, vitamin C, and 800mg folic acid. These are depleted by synthetic estrogens, and a deficiency can cause long term fertility issues down the road.
  1. If you have a family hx of miscarriage, have had a miscarriage yourself, or have any anemia or high homocysteine on lab work, you may want to test for a genetic defect called MTHFR that leads to a folic acid absorption issue. http://www.apothecarybydesign.com/blog/archives/332
  1. DHEA is a fat-soluble antioxidant and hormone precursor produced by the adrenal glands. DHEA is also a key player in egg health, showing improved embryo quality and higher live birth rates than controls. Studies have used 75 mg of DHEA daily. 1 DHEA supplementation also evidenced higher rates of spontaneous pregnancies in long-term poor responders to IVF in another study using 25 mg three times per day. 2 DHEA supplementation slows the aging process by preventing lipid oxidation while improving energy and metabolism.
  1. CoQ10 is imperative to egg health. Egg division from 46 to 23 chromosomes requires effective mitochondrial function. 3. It has been suggested that mitochondrial DNA defects that effect metabolic capacity may be a cause of failure in egg maturation, fertilization, or early embryonic development. 4. Aged eggs have decreased mitochondrial energy which can result in deficient energy to divide properly resulting in Downs’s syndrome and other genetic anomalies. All women over 30 who are still considering pregnancy should be on 100mg of ubiquinol daily to maintain efficient mitochondrial activity.
  1. Test your hormones early, and keep testing every few years for an objective measurement of fertility reserves. Follicle Stimulating Hormone (FSH) levels must be tested on day 3 of the menstrual cycle with Anti Mullerian Levels (AMH) levels before beginning fertility protocols. FSH reflects the relationship between the ovaries and pituitary and higher levels indicate perimenopause and poor ovarian function. Therefore, levels of FSH under 10 are best. AMH is also called the “egg timer” as it gives an accurate level of the follicular reserves of the ovaries. AMH levels do not fluctuate throughout a cycle and can be tested at any time. Serum AMH levels decline throughout ones reproductive life cycle, and are undetectable after menopause; therefore, higher levels are more desirable.
  1. Don’t wait too long to consider IVF. If you have been #TTC for more than 9 months and have not become pregnant with regular, timed inseminations, IUI’s or intercourse, make appointments with a fertility clinic and an Integrative fertility specialist. Having a Plan B will decrease stress, and it takes time to consider the financial and medical burdens associated with reproductive technology. However, it is worth it to have that baby in your arms! If IVF is needed, committing to the process earlier in your fertility journey can increase your chances for that #BFP (Big Fat Positive) on your first attempt.
  1. Don’t forget the men! At least 30% of infertility is male factor. Too often one half of the couple is doing everything possible (yoga, clean eating, no caffeine, no alcohol, meditation, support group, acupuncture, etc) while the other half is the root cause of the issue. Getting a sperm analysis is one of the first steps in a fertility evaluation, and can bypass months of angst from non-conception.
  1. Sperm need fertility enhancing supplements too! Omega 3 fats, 15 mg zinc, and stress busting herbs like Maca or Ashwaganda will improve sperm health, tonify libido and boost fertility.
  1. Have your thyroid hormones including TSH, Free T3 and Free T4 and your progesterone levels tested. Low thyroid function leads to low progesterone, which leads to frequent miscarriage in a classic vicious cycle. Some Endocrinologists and Family Docs may have conservative opinions on these levels and may use outdated reference ranges or be unwilling to test for Free T3. Consulting an Integrative Medicine Doc, Naturopathic Doctor or anti-aging Hormone Doctor may give you more information about optimizing your hormone levels rather than operating at a subclinical deficiency.
  1. Consider alternatives to the traditional nuclear family. There are many beautiful babies who want safe, stable, loving homes and need fostering and adoption. I know three amazing families of beautiful fostered babies! There are also women able and willing to carry babies to create families that are not their own. While a biological birth is what we are taught to dream for, this is not the answer for some. Infertility is tragic and real for people who have always assumed they would be able to birth when they are ready. Allow your self to grieve as a couple, but do not close the door on other options even if they seem inconceivable at first.

On another note, childfree living also has many blessings. Our culture is slowly shifting away from the definition of having a (nuclear) family as the ultimate success. Childfree living allows for a more relaxed and abundant lifestyle with more freedom, ability to travel, and heightened romance for a couple. We are an overpopulated planet, and I know from my life, having an auntie that is invested and involved in my life is incredibly valuable. Here are many ways to be a part of a family, and each version needs to be recognized as equally valuable and important!

I could keep typing another ten set of treatments supports, and probably another ten after that,  I am so passionate about fertility! However, as I said earlier the Internet is a rich resource. Some other articles I have written on the topic include:

I wish each of you success on your Holy Grail of Fertility. May your journey connect you to your own Divine nature as you experience one of the great, uncontrollable mysteries of life: Conception!

References

  1. Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500Accessed September 13 2013
  1. Leonidas mamas, Eudoxia Mamas. Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. Current Opinion in Obstetrics and Gynecology 2009, 21:306-308.
  1. David Meldrum, MD. Aging gonads, glands, and gametes: immutable or partially reversible changes? Fertility and Sterility 2013; 99:1-4.
  1. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5.

To book an appointment:

http://www.agemanagementcenter.com/contact-amc/  or call 207-774-1356

Clinical Practice:

www.agemanagementcenter.com

www.facebook.com/AgeManagementCenter

For more information about Infertility see:

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LGB Trans HRT ~ New Program, Fresh Vision, New You

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imagesWIDJJQD2The flame of Trans* Health has been burning steadily brighter in my life over the past 3 years. I was keen on the practice while still living and working in Toronto, ON but without a scope of prescribing hormones, my work with the Trans* community was peripheral medicine – acupuncture, restoration of transman fertility, anxiety support etc. I continued to take trainings in the hormone and lab protocols to better understand the medical aspects of transition, without the vision of guiding transition myself.

Once I moved to Maine in 2011, my scope of practice as a ND changed. Naturopathic Doctors have different abilities to prescribe and order diagnostic lab work in each state and province. Most of the west coast states plus British Columbia have full prescribing rights, can do IV therapies, and can act like primary care docs for their patients. In the more conservative middle North America and east coast, Vermont and New Hampshire are the only states/provinces with a full scope of practice. However, for me, from Ontario, the ability to prescribe most hormones and antibiotics was a big change of pace!

I mentored and practice with Dr. Michael Bedecs, an Osteopathic Doctor specializing in hormone therapies for the past  3 years. Under his guidance (plus several conferences on trans health, anti-aging and hormone optimization) I have come to better understand the intricacies of the endocrine system, and how they interrelate through reproductive, thyroid, adrenal, pancreatic and pituitary pathways. All this time, my brain has been making subtle connections in Trans* health, drawing pathways to hormonal optimization the bridges the cultural and gender fluidity required with treating the LGBT community with medical advancements in metabolism, subclinical hypothyroidism, fertility, adrenal exhaustion, cortisol excess, insulin resistance and more.

Dr. Bedecs and I have created a new program called LBGT HRT that includes the dynamic possibilities of gender and hormone variation, bioidentical hormone replacement, transsexual transition and transgender health. We will be offering this through our concierge style practice at Age Management Center in Portland, Maine.

Age Management Center is a cash based practice. We do not accept any insurance plans for visits, medication or laboratory services. Some patients are able to pay for our services through Health Savings Accounts, or get third party reimbursement. Working outside of insurance allows us to provide a standard of care far above  the norm. We offer blood work here in our clinic, at physician pricing. Because we are not limited by the current scope of insurance, we are able to test for and evaluate metabolic parameters that are essential to our complete understanding of hormonal health and wellness.  We spend an average of 90 minutes for first visits, and offer a free 30 minute consult before any commitment is required. Furthermore, within our framework of concierge medicine, each visit is not priced and ticketed; rather, the ongoing support of our doctors, nurses and medical staff is included in the program, allowing you unlimited access for questions, concerns, and follow up until your program is fine tuned and ship shape.

We know this style of medicine is not accessible for all members of the LGB and Trans community. Therefore, I created a monthly sliding scale clinic at Justice in The Body the first Monday of each month from 9am – 12pm to meet the needs of the lower income members of the gender queer and Trans* community here in Portland, Maine, and beyond. This clinic is limited in that a prescribing MD, NP or DO is still required to Rx the Testosterone for FTM and Spironolactone or Cyproterone for MTF; however, I am able to order lab work through insurance in Maine and can work with your prescriber to optimize current hormone protocols and work on supporting the Integrative aspects of general health and wellness that come with transitioning. Many of my patients at the Trans* Health Clinic have been fully transitioned, and we are working on other aspects of preventative medicine and optimized health through the lens of Trans* medicine. I am currently working on expanding the scope of the JITB Trans * Health Clinic by finding a prescriber to work directly with us in house. Stay Tuned!

Follow me on Twitter for Trans* Health @LGBTHRT

Follow me on Facebook for monthly updates about the Trans Health Clinic at JITB

Note: Trans* is a new-ish term. The asterisk denotes that the term is encompassing the entire transgender, transsexual and gender fluid spectrum of individuals without having to write all of that every time.

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5 Steps for Fertility Preservation Over 35

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1Rope_Cross. CoQ10 preserves the quality of the eggs mitochondria  – essential for replication and good “egg energy” aka ATP for cell division. 100-400 mg daily prevention, 400 mg twice daily during a stimulation cycle.  ( The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5. )

2. DHEA is a lipid antioxidant and youth-reviving hormone precursor. I suggest 10 mg daily for prevention,  25 mg daily 6 weeks before stimulation cycle. Up to 75mg daily is evidenced to improve egg and embryo quality and enhance spontaneous conception. (Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500 Accessed September 13 2013)

3. This is your individualized medicine step – what do you need to tonify your specific reproductive patterns and enhance the chances of conception?

4. Fertility Massage is key for addressing muscular and ligament stress lodged deep in the pelvis that could mechanically impair the ability to maintain pregnancy. Concomitant castor oil packs clear debris from the ovaries and fallopian tubes, flushing lymphatic channels for a more balanced local immune response. The self massage/ hands on aspect maintains a connection between the cerebral, medicalized experience of ART and the physical sensations of the lower belly while reducing emotional stress. http://natural-fertility-info.com/fertility-massage.

5. Optimize your nutritional status with: extra leafy greens on a regular basis; superfoods especially in smoothies;daily  fresh vegetables; and choosing clean meat and dairy whenever possible. Reduce or eliminate sugar during high intensity hormone treatments including birth control pills.

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Ideal Weight Program

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photo 3Welcome to a new way of working with body image, metabolism, eating patterns and ultimately, weight management. This is not a diet. Let me repeat. This is not a diet.

Study after study have shown that only 2% of people who lose weight by dieting are able to keep it off for life; 98%  of dieters gain back the weight they have lost plus more. This endless cycle slowly but surely adds pounds while eroding your sense of self worth. It also creates chaos within the blood sugar, hormone and neurotransmitter system that leads to further metabolic disruption.

Now is the time to change the old patterns. With awareness and a commitment to change, you can rewrite the story of your body. Your cells are constantly regenerating themselves; with direction from your mind and an individualized, functional medicine approach to improving structure and function you can reach your ideal metabolism, energy, and physique.

This program is divided into four phases. Each phase is at least 90 days long. Some people will need more time in an individual section, and can stay in each section as long as needed. The four sections are like a wheel, and where you start depends on your health, area of interest, and life circumstances. Some people will move in a linear direction through each step, and others will hopscotch from one area to the other. The secret to success is that we follow your body, your life, and your needs to unlock your ideal.

The four treatment sections are: FOOD, DIGESTION, STRESS, HORMONES

FOOD:  It only makes sense to work with food when addressing weight. Food is actually a very complicated topic, and one that most people have layers and layers of  complex conditioning around. We will start with a comprehensive 200 food ALCAT sensitivity test that will empower and educate you to make food choices based on YOUR immune system reactions to food (food sensitivities.) There are so many diets, so much information, so many food gurus and opinions out there! This test allows you to claim your own power around food choices based on your body’s unique message. In this section we will also teach you how to identify when you are hungry, and when you are full. These simple intuitive eating approaches build awareness and compassion, connecting you to your own primitive need for food as fuel.

DIGESTION: Effective food breakdown and waste elimination is crucial to a healthy body. Nausea, bad breath, appetite fluctuations, heartburn, indigestion, gas, cramping, bloating, constipation, hard stools, soft stools and diarrhea are all signs that your body is not digesting effectively. We will use a CDSA (Comprehensive Digestive Stool Analysis) to investigate all parameters of digestion including beneficial and pathogenic flora levels to truly repair and restore your digestive tract. This will have multiple health benefits including a more balanced immune response, increased energy,  regular bowel movements, potential pain relief and much more. As your digestive system is renewed you will be able to maintain your ideal weight more effectively as the body processes the food you eat with ease.

STRESS: Our brain decides when we are hungry, and when we are full. It also decides when we will eat. These two actions are not neccessarily in harmony. By looking at neurotransmitter levels that are intricately linked to food and well-being, we can understand some of the complexity of the mind-body-food relationship. During this time we will assess the stress in your life, and build stress management skills. Using botanical medicine we will tonify your endocrine system, enhancing your capacity to experience stress with ease and resiliency. At the same time, awareness exercises continue the weight-related exploration of finding and maintaining your ideal physical body with a healthy, relaxed mind.

HORMONES: Most people gain weight when their hormones begin to decline. This usually refers to reproductive hormones like estrogen, progesterone and testosterone, but  thyroid and adrenal hormones are also crucial to a vibrant and efficient metabolism. Finally, Human Growth Hormone levels dictate the speed at which we age.  This section utilizes the Age Management comprehensive hormone blood work panel to thoroughly investigate the state of your hormones. Using cutting edge anti-aging therapies and Bioidentical hormone treatments we will optimize your hormones, rejeuvenating your sex life, cognitive function, energy levels and more.  Some participants may also choose to do a 26 day HCG diet as part of this personally tailored hormonal wellness program for more radical weight loss.

Each of these components make up the whole that is your living body and each have a profound effect on weight. Whether you want to lose 10 lbs or 100lbs, or even want to learn how to maintain your current weight in a more relaxed fashion, our Ideal Weight Management program will bring you closer to that which we all seek – your ideal Self. As your awareness of the triggers behind your disordered eating patterns come clear, your need to medicate with food will shift. Functional issues like constipation, heartburn, and nausea will transform into easy, successful elimination of your body’s waste, allowing a more effective fuel-burning metabolism to emerge. And, you will feel more energized and better able to handle the stresses of everyday living without food as a crutch.

This program is not for the faint of heart. It is for people who have dieted all their life. It is for all genders and all ages. There is no standardized program that you must sacrifice and change to be accepted into – this is a truly individualized series of sessions that unearths the inner you …that you will adore.

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Using Herbal Medicine in Pregnancy

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pregnancy-tonic-tea-220x231There are always questions about which herbs are safe to use in pregnancy. There is considerable historical and clinical information on the use botanical medicine for enhancing fertility, treating common conditions of pregnancy, and supporting postpartum care and lactation. The modern push for evidence-based studies to confirm safety of use is hindered by the ethical issue of conducting clinical trials during pregnancy. Therefore, there are very few if any double blind placebo controlled studies to reference for this population. For this reason, most online and allopathic resources will list herbs as “not safe in pregnancy” even if they have been safely used for centuries as part of maternal medicine. Furthermore, the World Health Organization label requirements for botanical medicines includes information on the use during pregnancy and lactation. As there is insufficient evidence-based studies on botanicals in pregnancy, almost all products will say Not Safe in Pregnancy or Lactation. This is good in some ways, because it protects the fetus from harmful herbal constituents accidentally taken by an unsuspecting parent. On the other hand, it limits many people from accessing safe and effective supportive herbal therapies during this unique time of life.

As a general rule of thumb, almost all herbs are best avoided during the first 12 weeks of pregnancy unless specifically prescribed by an expert in this field. Ginger is one exception to this, as it has significant clinical evidence to reduce nausea of pregnancy. Still, even ginger can be too stimulating and is best taken in moderation. *Dosage for hyperemesis gravidum could be 5-10 drops of a ginger glycerite tincture as needed, up to 70 drops daily. Ginger tea or  chrystallized ginger can be used 2-4 times a day, and ginger candies up to 10 daily. Roobios is another herb that is a safe tea in early pregnancy. This is a traditional pregnancy medicine in Africa, and a very common tea base. Nettles are also very gentle and provide a mineral-rich tonic for the newly pregnant mom. Nettle is a lovely tea base to use throughout pregnancy and lactation for hydration and nourishment. As every person’s body is different, it is sometimes best to stick with what your body knew pre-pregnancy rather than trying new things in these sensitive weeks to avoid unexpected allergic reactions or other physical repercussions.

There are some herbs which must be completely avoided throughout pregnancy as these are known to be harmful in some way. For a complete list see:  http://thewrightdoctor.com/womens-health-2/herbs-not-safe-in-pregnancy/

Herbs with strong alkaloids (identified by a bitter taste) are to be avoided. These often have a strong action on the body, whether digestive or cardiac. There are many gentle herbs and nutritional supports which are safer digestive tonics for pregnancy. Laxative herbs exert their effects through muscular contractions and can stimulate uterine contractions as well. Most herbs with strong hormonal activity are to be avoided completely , as are all anti-parasitic formulas. Certain herbs that are to be avoided in pregnancy can be prescribed by experts in this field in the last few weeks of pregnancy to prepare the uterus for labour.  These are only to be used under the guidance of an experienced midwife or prescribing professional with obstetric training in botanical therapies.

There are many herbs which help pregnant women connect to their body and the environment in a grounding, tonifying way that are safe and effective. Some women will make their own creations from local plants, and others will buy them. When purchasing plant remedies, it is important to buy from reliable brands. Gaia, Apollo herbs, Herb Pharm, Vitanica, Wise Woman and Avena Botanicals are all ethical and responsible manufacturers of high quality herbals. If you are concerned about whether or not a product is safe for you, simply do not use it! Or, find a local Naturopathic Dr, Midwife, or Herbalist to guide you in your pregnancy care.

These are some herbs which are safe to take. * Alfalfa is very high in chlorophyll and rich in minerals and vitamins. This is a great greens powder in smoothies. Burdock can be used in small doses of 20 drops 1-2 times a day after the first trimester. Burdock supports women with blood sugar difficulties or constipation later in a pregnancy. Dandelion greens are a great tonic for women pregnant in the spring. They are robust in vitamins and strengthen the urinary system. Dandelion root can also be used in small amounts like burdock, for sour stomach, nausea and itchy skin. Oatstraw is a soothing tea or tincture which calms an overstimulated nervous system. This is a must have for pregnant moms with other small children! Up to four cups of Oatstraw tea daily is safe or use in tincture form 40-60 drops in water 2-3 times a day.

Rose hips are safe throughout pregnancy. These have abundant vitamin C to support collagen production in skin and help maintain vascular wall integrity.  They have a sour zip, and make a yummy tea with nettle and honey. Saint Johnswort herb is a safe and gentle mood support during pregnancy as well as a safe option to treat herpes outbreaks both topically and internally. It should not be used with other medications, but is a reliable ally for women during this time of life. Red raspberry leaf is very well known as a late pregnancy tonic. This silvery-green leaf strengthens the uterine muscle without stimulating contractions, preparing the body for the adventure of labour. It is rich in iron to support the increased blood volume in later pregnancy. It is best drank as a tea 1-3 cups per day for the third trimester. Finally, Valerian is a safe sleep support. It is best to use the smallest dose needed for therapeutic value, so start with 1 cup tea before bed or 10-30 drops of tincture and increase as needed.

Pregnancy is a time of life when so much is unknown, and so much can go wrong – there is so much responsibility for both parents and care providers. For this reason much of modern medicine has erred strongly on the side of caution when it comes to using herbal medicines in pregnancy. This caution is compounded by the high cost that many IVF assisted pregnancies carry. Every move becomes highly medicalized, and simple acts like a cup of herbal tea are forgotten as effective therapeutics. The bottom line when it comes to using herbs in pregnancy is: if it makes you nervous, dont do it. You cannot rely on the internet, on your OB,  or on labels to tell you what is safe to take during this time of life. However, there are some very reliable books on using herbs in pregnancy, and many Herbalists, Naturopathic Doctors and Midwives have expertise in this area. Enjoy!

http://apps.who.int/medicinedocs/en/d/Jh2945e/9.5.html

http://www.ahpa.org/default.aspx?tabid=70

*ABC Clinical Guide to Herbs. M. Blumenthal p. 174

*The Natural Pregnancy Book. Aviva Jill Romm

*Herbal Childbearing Year. Susun Weed p. 19, 51

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#TTC – Safe Treatments for Fertility & First Trimester Anxiety

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The work of becoming/being pregnant marks a time in a woman’s life when the game changes. Alcohol is no longer an option for stress management. Most herbs and even common teas are viewed with suspicion, and many medications are frowned on. Many of our crutches for managing the stresses of daily life are taken away, and the stress of in/fertility is added. However, there are natural treatments available for this time period to reduce stress, ease anxiety, and support a healthy first trimester.

Flower Essences are very safe for all expecting and #TTC moms, and are especially useful for women using multiple fertility and metabolic medications as they have no interactions or side effects! Flower remedies are literally essences of the particular flower in a brandy solution. Bach flower essences are the most commercially available. FES (Flower Essence Society,) Alaskan Essences, Perelandra and more are other well respected flower essence brands. Bach has 38 different flower remedies available; however the following are especially pertinent for fertility and first trimester. Dosage is 3-5 drops in water 2-4 times daily or as needed. The very small amount of alcohol in these medications will not cause any fetal problems as it is so minute a dose.

Aspen: For apprehension and vague fears

Gorse: Brightens perspective and increases optimism.

Holly: For envy or jealousy of others

Larch: Gets one out of the success/failure paradigm and increases self-confidence

Wild Rose: Restores interest and joy when feeling apathetic or resigned.

White Chestnut: Restores a peaceful mind when caught in repetitive thoughts

Botanical Medicine: Some herbs are appropriate for this time period, however most herbs are best set aside until the pregnancy is well established or beyond breastfeeding. One herb that is a #TTC and first trimester best friend is viburnum prunifolium otherwise known as black haw. This is different from viburnum opulus aka cramp bark – do not mix the two! Black haw quiets an “irritable” uterus, and prevents miscarriage. It is very safe and quite effective. I recommend 1/4 to 1/2 tsp daily for the first trimester as needed. For questions and concerns, refer to your local Naturopathic Doctor who can take your full history and prescribe according to your individual health care needs. Oatstraw or avena sativa is also a wonderful tonic that is nourishing to the body and calming to the mind. This herb is best taken as a tea. It is gluten free, hydrating with rich minerals (therefore great for morning sickness) and soothing to frazzled nerves. Valerian is perfect for nighttime anxiety. It is safe in pregnancy, breastfeeding, and for pediatrics. This is Mother Nature’s truly sedative herb. Used in doses of 5-30 drops before bed, this can help quiet the mind and improve the duration and quality of sleep. I like it as an alcohol free (glycerite) tincture as the taste is slightly sweeter than the alcohol based formula. Capsules are also an option although I prefer the smaller dosing options of the liquid form. (Valerian is very well researched, please contact me for a formal monograph if desired.)

imagesFinally, lavender essential oil has a time honored place in the treatment of anxiety.  For those whom lavender has a calming effect you can use lavender products liberally that have the real essential oil in them – avoid synthetic fragrance analogues. There are now lavender essential oil capsules that are quite effective for treating occasional or situational anxiety. These act quickly and safely to diminish feelings of panic, irritability and stress. Typically essential oils should not be used internally during pregnancy, so these lavender caps are best used only until the day of ovulation. There is a lavender glycerite tincture also available which can be used sparingly while pregnant in doses of 1-2 drops for anxiety and panic as needed. There is some (internet) controversy surrounding the use of lavender in pregnancy; however, it is not listed in any of the classic literature as a herb to avoid in first trimester.  My opinion is that if this botanical medicine is the one thing that works to soothe your fears, use it in moderation. If it increases your anxiety due to the multitudes of internet opinions, avoid it! Here is a link to a well researched blog post on the safety of lavender essential oil in pregnancy: http://roberttisserand.com/2011/07/lavender-oil-and-pregnancy/

Acupuncture and Registered Massage Therapy are also fabulous safe care therapies for anxiety and stress while #TTC. Acupuncture has a proven track record of efficacy when it comes to enhancing not only assisted reproduction but also all conception. Studies have shown that weekly acupuncture greatly reduces the rate of miscarriage during first trimester, especially for women with a previous miscarriage. This is in part due to its ability to support the expectant mom through the first 12 weeks. The therapeutic touch offered by massage therapy also has the ability to soothe anxiety, ease depression, and support the physical changes of pregnancy. The resulting relaxation offers an anxious expecting mom a few moments to quiet the mind, which can have great positive effects overall. It is important to see an acupuncturist or massage therapist trained in pregnancy massage as there are specific techniques and positions used for this treatment.

All in all, this is such a time of mystery, of waiting, and of trust that it can be overwhelming to have to “go with the flow.” Every couple experiences some level of anxiety, and some have a very hard time as #BFN’s happen again and again.  Flower essences, black haw, oatstraw and lavender glycerite are natural remedies that any couple can use to support their own mental and emotional wellness on the road to becoming a family. There are many more herbs, vitamins, and therapies available for #TTC and expectant moms that are based on the individualized medicine offered by a licensed Naturopathic Doctor.

Links and Resources:

http://www.gowonderworks.com/flower_essences

http://www.bachflower.com

http://www.fesflowers.com

http://www.biomedcentral.com/1472-6882/12/20

http://www.fertilityfactor.com/infertility_acupuncture.html

http://americanpregnancy.org/pregnancyhealth/prenatalmassage.html

 

 

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#TTC Obsession – Confessions

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Getting pregnant is scary and exciting. The process of wanting to conceive and then waiting to find out…. not priceless. I am intimately aware of this as a Naturopathic Doctor with a focus on In/Fertility. I have also been privately preparing for this moment of my late 30’s when I am ready to conceive.  I have treated and supported many women through this process already. And here I am, alone with my OPK stick in the bathroom, discerning the workings of a secret universe. CONCEPTION.

I am amused at my complete immersion in the consuming nature of trying to predict my own ovulation. I cannot believe how often I think of the subject. I am constantly turning the information over in my mind. I read fertility forums online to gather information; I delve into friends’ personal experiences. Medicine looks so different when one is the patient! Suddenly there are a thousand things I do not know… Ovulation Predictor Kits are only the beginning.

And, in the obsession of pregnancy, it becomes everywhere. Books and television remind me that women have been torturing themselves about the ability to get pregnant forever! First, it was conceiving a boy, and whether or not the First Son would be born.  With rampant infertility, the collective obsession has turned to the BFP and away from gender preference.

We want to be able to control this event with every ounce of heart and mind. We are so used to be able to create what we need, if we only put enough effort into the act! It is maddening to have to develop techniques like trust and patience to achieve our highest goal…. and yet that is what it comes down to in the end. Do we hold the ultimate responsibility of whether or not life occurs in our very body?  It is appears to be the hugest responsibility, and yet it is one we cannot. create. on. our. own.  As my friend said yesterday, “We are accomplished and often privileged women! Powerful creations, and yet…” we cannot read what should be the simplest signs of all from our flesh. Are we ovulating today? Are we pregnant? It’s a huge pressure.

For same sex couples and single folks, there is the additional stress of genetic material to procure. The art of conception (often) looks very different for lesbian and gay couples. Not only will the inseminations need to be precisely timed, but the acquisition of said tools of conception must also be arranged. The cost of becoming pregnant begins with the very first try, an additional ingredient in the pressure-cooker of preparation. (In a call-out to women with biologically male partners, I do understand that when women hit the fertility clinics, we are all in the same machine.  The sex or gender of our partner becomes much less relevant although issues of accessibility to and cost of genetic material remains an additional stress.) It’s a wonder any of us become pregnant at all! But we do, in every increasing numbers.

The minute details, test results, and potential scenarios become an endless gerbil wheel of anxiety. It is important to step back from your own fertility and restore some normalcy to your daily routine. I was wound up over the timing of what was only a pre-cycle. Imagine how physically stressed out I could be for the real thing! One of my friends advised me after her first birth – make it fun. Try to relax around it. And she laughed knowing how hard that would be. I suggest distracting yourself as much as possible from thinking the same old anxious thoughts.  HOW? Listen to music that makes you sing. Watch a movie that engages you. Make time for friends or family who you like talking to and who are interesting. Write in a journal so you can get the thoughts out of your head and onto paper. The less time that is spent obsessing about the timing or prediction of said events will be in your best interest overall!

There is no conclusion to the story. The (new brand of) OPK kits wait for next cycle in my bathroom cupboard. I am going to pray for myself, light candles of hope, and continue to make the daily small offerings I do towards pregnancy – high quality prenatal vitamins, DHA essential fats, green tea, and other things appropriate for my personal care. My sweetheart and I also have a plan B, and C in place to rely on. When I get in the hamster mind of prediction anxiety again, please remind me of this post. Stress inhibits Ovulation!

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A Note from Behind the Curtain

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So many patients are looking for answers. As a doctor I know that the best answers are in each individual. Usually, we do not want to know the real answer. We want a pill, or a cream, or a smoothie containing the essential nutrients that will add up to the ultimate results. Dont get me wrong – products will help. Testing can uncover imbalances and deficiencies to be corrected and appropriate formulations to improve symptomology. However… until you are actually ready to change something – that thing- – which needs changing in your personal landscape, it is unlikely that you will find your own true answer to health. I will use myself as an example.

After I graduated from Naturopathic Medical School in 2000, I opened a clinic in downtown Toronto with some of my classmates. Over the next 12 years I developed my professional identity, grew my patient base, and pursued my personal passion of fertility medicine. I had a wonderful partner, a beautiful home and fantastic friends. I was never fully content, despite my abundance. I doubted my career and profession, and was constantly seeking something outside of myself to fill the inherent void. No amount of adrenal supplements, detox regimes or magnesium quieted the inner voice. This was not an organic condition, it was a calling that took me many years to acknowledge.

Eventually, I moved to Portland Maine in March 2011. I sold my clinic, left my clinic faculty position, and my sweetheart and I parted ways. Here, life is different. I smell the ocean every day. I do yoga (occasionally.) I walk the dog. I drink green tea. I am redefining myself as a Naturopathic Doctor and am inspired by the new turns my professional identity is taking. I am becoming a better doctor – the best version of myself. It has been a massively stressful process to redefine my life in my late 30’s. However – the gray hairs are worth the evolution. I am happy in a way I have never been. And it is not because my physical, emotional, or mental health has changed drastically. It is because I have found my own answer.

Not everyone’s answer will involve so many miles and such upheaval. The answer to your own health and wellness questions may simple or complex. Part of my job as a Naturopathic Doctor is to look beyond pills and dietary restrictions to see your truth behind your curtain, and support you in finding your own evolutions. If I can do it, I am sure to believe in you.

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Coffee Addiction

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I am a coffee lover – dark, black, strong, sometimes sweet.   I am the girl who will get out of bed for a french press. I have known for some time though that I will need to break the addiction – for detoxification, for adrenal fatigue, for hormone health, for fertility. And, I have finally decided that its time to start weaning myself from the dream bean. I know my skin will improve in hydration and texture, that my energy levels will improve (after I get through the caffeine withdrawal) and that my body will thank me in the long run. Coffee is a strong, complex mix of chemicals, and eventually any constant chemical exposure must play its toll.

I don’t intend to become completely abstinent! I just want to break my daily reliance on the drug. I want to become someone who savors the delicate flavors of organic green tea on sunny mornings. I will know a gen mai from a jasmine or sencha, and my cells will bathe in the anti-cancer catechins from the green tea flavonoids. However, I am not there yet. This week I am weaning to “half-caf,” and then to decaf (french press.) I will still have occasional, even weekly hits of delicious (full strength) coffee. I am also using a black/green tea mix to break the coffee habit while also slowly weaning off caffeine.

In her NDNR (Naturopathic Doctors New and Review) article Managing Caffeine Withdrawal in the Patient Undergoing Detoxification (V. 7 Issue 12 p. 8-9) Dr. Erica Peirson ND recommends supplementing Magnesium Citrate, a B Vitamin Complex and Adrenal Botanicals while weaning off caffeine. She also explains how caffeine works as a CNS stimulant. “Blocking adenosine receptors in the brain is a primary way that caffeine acts as a stimulant given its structural similarity to adenosine, Adensoine is not a neurotransmitter but a neuromodulator. Adenosine receptors inhibit the release of neurotransmitters. The release of neurotransmitters is increased when adenosine receptors are blocked by caffeine, resulting in central nervous system stimulation.” She then goes on to explain that the headaches associated with caffeine withdrawal are in part from increased sensitivity of these same receptors leading to dilation of blood vessels and hypotension.

To take the biochemistry of caffeine one step further, the binding of caffeine to the adenosine receptors means instead of slowing down, the brain/nerve cells fire up. The pituitary notices this increased action and sends hormones to tell the adrenal glands to increase production of adrenaline, giving you a boost of fight or flight energy. At the same time, caffeine slows down resorption of dopamine which is our pleasure neurotransmitter. With extra dopamine, you not only feel alert, but you feel good!

All of this is great occasionally – but I know that years and years of this cycle cant possibly be good for me. I am dehydrated, magnesium deficient, and my adrenaline and dopamine levels are pushed beyond their natural limits of production. Stepping off the caffeine / coffee platform will give my body the opportunity to restore adrenal health, balance my brain chemistry, and a great side effect will be improved liver detoxification leading to improved skin texture and color.  Its not going to be all fun – I am sure I will be more tired than usual, need more rest, and I may even be a little grumpy as my dopamine deficiency gets exposed. At least its winter in Maine, and I can tuck in early!

http://science.howstuffworks.com/caffeine5.htm

Arousal effect of caffeine depends on adenosine A2A receptors in the shell of the nucleus accumbens. The Journal Of Neuroscience: The Official Journal Of The Society For Neuroscience [J Neurosci] 2011 Jul 6; Vol. 31 (27), pp. 10067-75.

http://scienceblog.com/community/older/2003/C/2003921.html

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