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Lorne Brown:
By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition in either yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guest or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical hypnotherapist. I’m on a mission to explore all the paths to peak fertility and joyful living. It’s time to learn how to be and receive so that you can create life on purpose.
Today I have Dr. Lora Shahine on the Conscious Fertility Podcast and I got to meet Lora personally back when I was running the Integrated Fertility Symposium in Vancouver. And you gave an amazing talk around miscarriages, so hopefully we’re going to talk about that today. You guys need to know that she is a reproductive endocrinologist at Pacific Northwest Fertility and she’s also the clinical assistant professor at the University of Washington in Seattle. That’s where her clinic is, and she completed her fellowship in reproductive endocrinology at Stanford University and her residency in obstetrics and gynecology at the University of California over in San Francisco. And those that don’t know, she is so dedicated to educating, advocating for increased awareness of fertility miscarriage and the impact on environmental toxins on health through an active presence that she has on social media teaching clinical research. She has blogs, she has her own podcasts and books, and she has a bestselling book called Not Broken. I have a copy of that. I’m an approachable guide to miscarriage and recurrent Pregnancy loss. Dr. Lora Shahine, welcome to the Conscious Fertility Podcast.

Lora Shahine:
Oh, Lorne, I’m so excited to connect with you again and really honored to be here. Thank you.

Lorne Brown:
Just to everybody know, busy schedule, we got a hard stop, so if you weren’t like Lorne, you’re hitting your heart with questions. I want to get as many questions in before we both have to jump off and do our other day job.

Lora Shahine:
Perfect.

Lorne Brown:
So I think of you when I first met you, I think of you as the person that really talks a lot about miscarriages. So I kind of wanted to learn more about your practice and kind of the myths around the practices of fertility and so around miscarriages. I want to ask you this question, men male sperm, I’ve been told that they can impact unexplained infertility and miscarriages yet still in 2025. Seems like all the blame and shame is attributed to the female. How is it in your practice, are men contributing to infertility? Are they contributing to miscarriages?

Lora Shahine:
Absolutely. This is a team sport and men need a seat at the table. We’re so focused on fertility for female issues, and that’s a society thing. It is just deep embedded in us in movies and books and what our families talk about that anything that has to do with family building, if it’s not going well, not getting pregnant, having miscarriages, it must be the woman’s fault. And one of my favorite historical examples is we didn’t know until recently that sex of an embryo is really from the sperm. And King Henry II would’ve kept many more wives if he had realized that because he kept getting rid of his wives in order to have a son and it was his fault the whole time. So that kind of resonates and we’re learning so much. Really recent studies have shown that unexplained recurrent miscarriage, you can sometimes find high DNA fragmentation in the sperm of the partner, and it makes so much sense because most miscarriages are embryo related. It’s so much about genetics and balance of chromosomes, et cetera, in the embryo, not the person that’s getting pregnant. And sperm is half of the genetic equation. So it’s just finally paying attention, dedicating research and money to answering and asking more questions. We’re really learning about just how important men are to this whole family building process.

Lorne Brown:
We’ve both been in practice for a while. I’ve started in 2000 and in my first decade of practice, Chinese medicine talks about takes two to make a baby sperm and egg cells, those two cells are required and we consider the men important. I always wondered why in the western reproductive world why men weren’t considered, I mean, I know often a male dominated profession possibly, but I don’t think that was the reason actually. I think it’s because reproductive endocrinologists are gynecologists and you guys don’t get to play with the penis very much. So you don’t even have it on your mind. It’s always about the women. So I always wondered probably that’s why the men were left out of this is because you guys didn’t really work with men, you worked with women, all your practices. You think that could have been part of the contributing?

Lora Shahine:
I think you are onto something. Yeah, I mean, reproductive endocrinologists are fellowship trained and in the United States we all do a four year residency in obstetrics and gynecology where we’re really focused on women’s health. And then we do a three-year fellowship in reproductive endocrinology and infertility, and then we’re doing IVF and building families. So that absolutely can be a piece of it. And one of the things that I’ve really felt passionately about my entire career and really brought in a reproductive urologist into the practice at Pacific Northwest Fertility is because we can have the mistake of being too laser focused on eggs or the assumption that IVF can overcome anything, right? So the thought that, oh, sperm is just a genetic vehicle and even if we’ve got a male factor contributing to fertility, as long as we can help the eggs and sperm fertilize in the lab and we can get embryos, then it really doesn’t matter so much what is going on with the sperm and realizing that it’s so much more than that.
You’ve got to think about lifestyle optimization, not just for the female partner, but for the male partner as well, and just to really give tribute to what you and your whole field does. I mean, I have so much respect for eastern medicine and traditional Chinese medicine. It’s not something that I’ve trained in, but just working in the Bay area, doing my fellowship at Stanford, lots of learning about how it is so important. What I really appreciate is Western medicine is so focused on fixing a problem. You break your arm, you want to go to an orthopedic surgeon to fix your arm, but health is so much more about everyday choices, nutrition, exercise, stress, sleep management, and I think that traditional Chinese medicine does a lot better job at focusing on that. And I’ve always appreciated trying to bring that balance into my practice, even though I am a western trained medical doctor.

Lorne Brown:
You’re fairly integrated. You had said IVF doesn’t necessarily can overcome an embryo issue. IVF can help bring egg and sperm together. IVF definitely lets, you know, we put an embryo in the uterus, but the building blocks come from the egg cell and the sperm cell. And like you said, that holistic approach is the small actions done daily can lead to big results. And so your book though, is your book you also had, was Stephanie part of that book? So

Lora Shahine:
Yeah. So my first book before the miscarriage book, not Broken,

Lorne Brown:
I

Lora Shahine:
Co-authored a book on it’s called Planting the Seeds of Pregnancy with Stephanie Elli, who is a traditional Chinese medicine provider. And she wrote the perspective of treating fertility from acupuncture and a traditional Chinese approach. And my part of the book was talking about just the options that are available if you go to see a western doctor like me, what an intrauterine insemination is, like what IVF is and how it works. And I really do think that combining these approaches can help the patients tremendously.

Lorne Brown:
And so to let our audience know a little bit about you then where you’re coming from, you are a trained reproductive endocrinologist, have an IVF clinic practice and you’re integrated. You have a reproductive urologist there, so you’re not ignoring the male and you also work with allied health professionals that help with more of the nutrition, the acupuncture mind, MINDBODY stuff. So you do have that philosophy of integration. So congrats and my patients will like to hear that. I’d like to ask a couple of questions around age and fertility.
And so I do have patients come to me and they say I’m 35 next week, the switch, can you talk about age and how it impacts fertility? And then the second part of that question is IVF, how old is your patient using her own eggs that you’ve had a live birth? Because in BC patients tend to tell me that the IVF clinics tend to not want to do IVF on somebody who’s 45. They courage donor egg or won’t allow them. And then currently today for you, what’s the oldest that you had somebody with their own eggs have a live birth through IVF?

Lora Shahine:
So I have a one in a million story from my fellowship at Stanford. So this is almost 20 years ago where there was a woman who was 47 years old and she did not have fallopian tubes. So IVF truly was the only way that she could have a genetic child and she had one follicle, we retrieved one egg, it turned into one embryo and she had a beautiful baby that feels like to me a one in a million chance. So I have that case study in my brain and in my personal experience, but I’ve never had somebody since then conceive at that point. And age is such an important piece, but it’s important to understand and explain. So I teach this every single day to my patients because you already feel so out of control when you’re not able to have your family when you’re ready and willing and able and age is the one thing that you can’t change.
So it’s really hard to come at people and just hit them over the head time and time again like well, age is your biggest limiting factor to have a baby and you can’t change it. I try to teach and I try to say, listen, as long as you are ovulating and you have eggs and you’ve got sperm exposure and at least one fallopian tube, there is always a chance of getting pregnant. What changes with age is the number of eggs that are able to do all of the genetic work that they need to in order to fertilize with a sperm and turn into an embryo that turns into a healthy baby. It’s not impossible, it’s just so statistically low that you would actually find a good egg. And a good egg to me just means one that turns into a baby at 45, at 47 that it’s just so important to educate people like hey, we could try IVF, but it could take you 10 egg retrievals and we still might not have a baby. So the thing that’s really important to get is we are born with the same eggs we’re going to have our whole life and they’re frozen in a genetic state. If I can explain this to people, it takes the sting away. I just want them to understand the eggs are born stuck in meiosis one. So they’ve got two copies of each chromosome.

Lorne Brown:
Oh boy. We’re going back to biology, myosis to mitosis. This is great though. I actually love this. I love this. Yes,

Lora Shahine:
Because if we just keep telling people, oh, you’re old and we don’t explain, that’s not fair, that’s not okay to the patient.

Lorne Brown:
I share the same thing. I don’t call them frozen, they get mixed up. I say they’re mummified until they get recruited. They’re dormant.

Lora Shahine:
Yes, I like that. I like that. So you’ve got two copies of each chromosome. One came from the sperm that we came from, one came from the egg that we came from and they’re sitting there when we ovulate, whether we’re 25 or 45, that’s when the eggs get turned back on. They have to get rid of half of their copies of chromosomes in order to meet the sperm. So the difference between eggs and sperm is sperm is made every single day and there’s so many sperm that are made, they’re not exposed and sitting in your body is for 45 years. That doesn’t mean every sperm is perfect but there’s just more to choose from and the egg actually does a pretty darn good job of all the millions to choose from choose a pretty good one. And so there is an age difference with sperm and eggs and there’s an age impact in sperm, but it’s just not as dramatic as with eggs.
So what happens at 35, there’s not a light switch where all of a sudden all your eggs are bad. That’s it. Out to pasture can’t have a baby, but we know about half of the eggs are going to make genetic mistakes. So that’s why it takes longer to conceive. There’s so many things that have to go right to get pregnant and if you only have six good eggs in a year and a couple of times when you ovulate a great year, you get a bum sperm or all the different things that happen, it can just take longer to conceive. Fertility treatments are lower in success as we age because there are fewer good eggs. Miscarriage rate goes up because the most common cause of miscarriage is a chromosome issue. So all of these things go back to age. It doesn’t mean that you cannot get pregnant and have a baby at 42. It’s just really exciting when it happens because there’s so few good eggs at that age. That’s how I would put it.

Lorne Brown:
Alright. And then to use that segue to talk about things that you can do to optimize your fertility. On one of my podcasts, the REI had shared that like you’re saying there’s going to be a good egg in there in your forties, there’s just not as many. And then he liked the integration diet, acupuncture, stress reduction, all these things. He believed that the healthier you are, the fertile you are in that if they’re going to be giving you drugs and manipulating the egg, they want them to have more resilience. So if you have them, you’re born with all your eggs, the environment can be optimized. And in Chinese medicine we say nurse is so before you plant the seed, so this is a question for you, he thinks that this can help because we can hopefully give the egg a little bit more resilience. So when we pound the ovaries with drugs, he says or manipulate them, these fragile eggs so much they’re older so maybe not as great quality because the environment maybe we can support them in this process. So he likes integrative approach. So this ties in how health can impact your fertility because some clinics say your age is it, you’re 42, it doesn’t matter what you do. And some clinics say not all 42 year olds are equal.
And so I was curious of your thought on that.

Lora Shahine:
Yeah, I think I’m taking away a lot of what you just said. I think that health is extremely important and that when eggs are ovulating and combining with sperm and sperm is being made, all of this is cell turnover. And so if you can decrease free radicals and oxidative stress around the time that you’re reading DNA and getting all this information, you’re going to have healthier cells and two cells are eggs and sperm and there’s a balance because I think all of these things are really important, but we have to be careful because sometimes these are so important. But I just want to be really conscious about not adding to the shame spiral to patients

Speaker 3:
Where

Lora Shahine:
They’re like, oh, if I just did this anti-inflammatory diet or I did more acupuncture then my IVF cycle would’ve been successful. It’s not that black and white. But I do think these things are important and there are studies that show that if you have high levels of BPA in the system, in the follicular fluid at an egg retrieval, there’s more miotic error in the eggs and the embryos that result. So we do have evidence for this, but we got to be really careful about how we counsel patients and share. I think it’s empowering to share that yes, your nutrition matters, decreasing toxins matter, but also just being really careful these things are important, but if it still doesn’t work, that doesn’t mean it wasn’t because you weren’t good enough.

Lorne Brown:
That’s a good point. I want to just add to that. The biggest thing is the shame and blame is we both know that you can do everything and still not get pregnant. If anybody guarantees that if you do this, it’ll work. Run.

Lora Shahine:
Yeah. Thank you Lorne. That’s

Lorne Brown:
Run. The other thing is just to put it, what should I do? Well, just to make it the example obvious. So eating lots of fruits and vegetables, berries, green leaf vegetables, it’s kind of like if you’re going to smoke every day and not exercise and not sleep and be around chemicals and plastics, we’re going to see a negative impact on your egg and sperm quality. So when we talk about this, it’s like the scale. Maybe this will help tip it, but nobody can guarantee it. But we can definitely have research that if you’re a big smoker and you’re doing this, you are damaging your cells.

Lora Shahine:
And another thing that you brought up is I’d love to just educate a little bit about what the IVF medications are doing. And you said something that people often come back to me like, oh, you’re giving, these might be really high doses of medication and maybe that’s damaging the eggs. I just would love to give a little bit of perspective. So what I think of an IVF cycle is sort of like a suped up menstrual cycle and we’re just taking advantage of whatever eggs are up for grabs in that particular cycle for that particular person. So we don’t control if someone is going to get one egg or 20 eggs and sometimes we can give high doses of medication and still get two eggs. So I want to clarify that. And I really don’t think that the gonadotropins, which are the exact same hormones that the pituitary gland makes every month to recruit eggs from the ovaries.
I don’t believe that they’re damaging the eggs. I just think we’re trying within reason and we shouldn’t ever give too much medication to anyone for any reason. But we are really just trying to capture whatever is there. And it’s a numbers game, it really is. So if someone is 40, it might take 20 eggs to find a normal or euploid embryo, whereas if someone was 25, it might only take five eggs to find that. I hope I’m kind of clarifying. I just want to be really thoughtful about the feeling that these medications or hormones or gonadotropins are necessarily bad. I think the word hormone has a horrible connotation where at its core it’s just something that’s made in one part of the body to talk to another. So it’s another thing I really try to teach patients like yeah, we’re giving you hormones, but these are the same hormones that your body sees every month to ovulate just amplified. I hope that’s helpful and could reassure some of the listeners.

Lorne Brown:
Thanks for that. Continue down our rapid fire or miss. So frozen transfers. So the data has been showing higher success rates. I know there’s a new study out, I bet you know about it with fresh versus frozen. I’d like you to talk about what the study shared then fresh versus frozen, why we think frozen usually has a higher success rate, why we go to frozen and then why for certain population would fresh be a beneficial based on this latest study.

Lora Shahine:
So this came up from a study out of China within the last couple of months and I actually did a YouTube video on this because I find it very interesting and I have a historical perspective because I’ve been practicing for 20 years. So when I first started practicing IVF, we did all fresh embryo transfers and now 20 years later we’re doing almost all frozen embryo transfer cycles. So there is a reason for this trend, but that doesn’t mean that some people might actually benefit from fresh transfers. So I don’t think it can be all or nothing. The particular study was looking at patients that had diminished ovarian reserve or a low egg supply and said that if they’re not being overstimulated, they don’t have ovarian hyperstimulation syndrome, they’re not planning to do maybe genetic testing on their embryos because that’s one reason that people often will freeze embryos because they want to do PGTA or pre-implantation genetic testing for annuity in their embryos.
They said there’s really no reason to freeze the embryos go ahead and do a fresh transfer and they got pregnant. So it’s sort of saying like, hey, fresh transfers still can work and maybe think about why you’re recommending a frozen embryo transfer cycle and just have that discussion with the patients. And the reason that the trend in my career went from fresh to frozen, a lot of it was more genetic screening of embryos. So it does take time to get that back. But also I was at Stanford when a lot of the studies were coming out and showing that people who were great responders, great egg supply young and they were not getting pregnant with their fresh and they would come back and their very first frozen embryo transfer got pregnant and had a beautiful baby. That’s when we really started to clinically realize this overstimulation high estrogen levels, ovarian hyperstimulation syndrome really gets the embryo and the uterine lining out of sync.
And so if someone is overstimulated, it’s better to wait, freeze the embryos, let the body calm down, let the body come back to a more natural state in order to get pregnant in the future with, and the technology got so much better. One of the reasons we used to not freeze embryos is because we were still learning how to do it and so we were nervous if we didn’t do a fresh transfer, we might not have any embryos survive the thaw in the future. So all of these pieces came together and I don’t think that this recent study out of China is going to make us all of a sudden do all fresh transfers anymore. But it’s like, hey, look at the patient in front of you, exactly what you said, Lorne, individualize, what does this patient need? What is their situation? And have a good discussion on what’s right for them

Lorne Brown:
And what can we tease out of that study. Because it sounded like was it an older population or what they would call lower poor responders that did well with the fresh versus frozen. Do you remember the, because I read that study as well, but what was

Lora Shahine:
The, I’m trying to remember the exact study. I remember when I was recording the YouTube video, one of the criteria was that a low egg supply and they defined that as nine or fewer eggs. And I was like, that’s a great egg. Exactly. I said, wait a minute, that sounds pretty good. So I remember it was also a certain number of embryos that were available and a couple of other criteria, but they were specifically not planning to do genetic screening on the embryos. And honestly I think a lot of them are younger. So younger patients with maybe not very many embryos, not overstimulated, maybe it’s better to put those embryos back.

Lorne Brown:
So talking about the receptivity and on that first you said 20 years in practice. I never know when people are listening. So you started practice around 2005 then?

Lora Shahine:
Yes, I finished my OB GYN residency in 2006, started at Stanford doing reproductive

Lorne Brown:
Technology.

Lora Shahine:
Here

Lorne Brown:
We’re almost

Lora Shahine:
25

Lorne Brown:
Just so when somebody listens to it, you’ll say 20 years, but you could be 30 years in practice. I don’t know. That’s

Lora Shahine:
Right. I know we just keep getting older, Lorne.

Lorne Brown:
So I’ll share a little bit on the Chinese medicine side of this. So I started practice 2000, 2002. Fertility, I remember it was around 2004 ish. I was remembering when they were going from day threes to blasis, most of them are day three fresh, then they started doing blasty and I asked the question why not from Chinese medicine perspective, I think frozen may be a good way to go. And this is when vitrification was starting to happen as well, but it wasn’t as well known, the vitrification part which helps the survive, that thaw really well. And I said, I just always think of Chinese medicine. So my Chinese medicine is you’ve gone in there and harvested the eggs. So surgically you’ve had a puncture of the vaginal wall and poke at the ovaries. In Chinese medicine we call that trauma blood stasis. And blood stasis isn’t conducive for implantation. And I would think from the western we’ve brought in all these immune response potentially I wasn’t thinking the drugs, but later I realized also all those drugs, like you said, the uterus can be out of sink and you’ve been overstimulated hormonally because you’ve had nine eggs grow versus one. And so that was my thinking back then. Frozen would be a cool idea.

Lora Shahine:
Well you were right Lorne.

Lorne Brown:
Chinese medicine was right.

Lora Shahine:
No, I have so much respect for Chinese medicine. I mean it’s been around for thousands and thousands of years and I think one of the things that turns Western doctors off is just the language. So blood stasis or just sort of this sort of, it’s almost like this, oh what’s the right word? Just kind of like woo woo like oh humors. And it’s like, oh well that’s not translation

Lorne Brown:
Because you think of blood states like clotting, you’re like, what? We can test for that. There’s no clotting, right? So the language, it loses something from the Chinese expression to blood in Chinese medicine, capital B is called shui. It’s not the blood that we think of. It goes beyond that, right? It has a whole other concept. Alright, back to you that way. We’re picking your brain here. Alright, so frozen versus fresh frozens still kind have the higher success rate, but there is a population that may need fresh. So don’t think you have to do a frozen embryo transfer is our message here. Going back to sperm matters. So we talked about age in women and I heard you say, and I wanted to unpack it, that age affects sperm as well. And so the research I read is we’re starting to see the sperm impacts placenta health and our goal is healthy baby.
But what about the health blueprint of the child? So the question is often men come back saying, my semen analysis is normal and my interpretation is normal doesn’t mean healthy blueprint because we keep lowering the parameters of the sperm analysis, the motility count morphology. What’s considered normal today was considered infertile 25 years ago. Are you just using that DNA fragmentation seems to be coming more popular. I think it wasn’t used a lot because still expensive, just under $500 compared to under 200 for a semen analysis. What are you doing in your practice? And if money wasn’t an issue, what would you be doing in your practice for the

Lora Shahine:
Guy? Well, I am counseling about lifestyle optimization and certain supplements that can decrease that oxidative stress and certain things like staying out of hot tubs and saunas and being healthy and thinking about your sleep. Sperm is so important for so much of fertility and pregnancy and reproductive health and we don’t have great tests for it yet. So a semen analysis is just a count and Im motility and we do have morphology, like a percentage of normal shaped sperm. But it’s really just making sure there’s adequate sperm for sperm exposure and ability to get pregnant. It can help you decide whether maybe something low tech like intrauterine insemination could help or if there’s drastically low sperm. You got to look at the overall health of the person. Does that person have diabetes? Do they have a hormonal condition? Do they have a ocil? Get information, find ways to improve it.
DNA fragmentation testing I think is interesting, but I still don’t think it’s absolutely perfect as well. There’s so many different types of assays, they are not all perfect. They sometimes take weeks to come back. Sometimes you’ll do multiple different tests on maybe three times in the same week and you’ll get drastically different results. So just I kind of tell people like semen analysis or DNA fragmentation, it’s sort of like a snowflake. It can give you a picture of what’s going on in that particular day or maybe truly the guy’s health two and a half or three months ago. So it doesn’t mean it’s like a snapshot for what’s coming for the rest of the year, but it’s all we have. And the reason I said that about the timing is sperm is on about a two and a half or three month cycle. So just this weekend I was counseling a patient where really great counts three months ago, six months ago, all of a sudden coming in for an entry and insemination, total modal sperm count, 2 million. Whoa, that’s a big drastic drop. Turns out he had a horrible flu fever for about five days around New Year’s, about two and a half, three months ago. And so I’m like, Hey, I think this is temporary, but I just want to make sure that you know this and let’s keep an eye on this. So these things are really important

Lorne Brown:
And that’s why guys got to watch hot tubing, infrared saunas if they’re sick. Similar story. We worked with a couple and he had really poor sperm parameters and so he changed his diet lifestyle. We did acupuncture and supplements and his sperm were like Olympic swimmers. They look great. And then they did another sea analysis. The cow mat were terrible. And he is like, I don’t understand. I’ve been doing everything right. I eat this, I take these vitamins, I do this. I’m infrared sauna every day. And I go, excuse me, can you not do the infrared sauna for three to six months and retest?
And then they became back to normal. Here’s something that I didn’t know. I got this from Dr. Paul Turk, a reproductive urologist. If you could say abracadabra and everything was fixed, theoretically three months later the sperm should be better because spermatogenesis, they say 72 to 90 days. He says that usually when they do a varicose seal repair, it’s often two cycles of spermatogenesis before they see it improved. So if it’s not normal after three months, often it will be after six months. He doesn’t know why. He just knows. It often takes two cycles of spermatogenesis to see the sperm improve.

Lora Shahine:
And I have learned that from my reproductive urology consultants. And that’s something that I really try to talk to patients about because oftentimes by the time they get to see me, they have been ready to be parents for a long time and hearing that it’s going to take a couple months to get the surgery and then six months at a minimum to see if it’s a benefit. Sometimes they’re like, listen, we still want to start doing treatment, so maybe we’ll just forget about doing this. And I try to say, listen, these don’t have to be mutually exclusive. We can absolutely start doing treatment, but I would encourage you to still have this fixed because we don’t know where we’re going to be six months or a year from now and maybe our treatments didn’t work and you’re going to be so glad that your sperm is better in the future. Or maybe we’re focused really on treatments for baby number one, but if you get this fixed baby number two is going to be a lot easier. So I don’t know how if you’re counseling patients about that, but it doesn’t have to be exclusive. You don’t have to choose one or the other. You can maybe do both at the same time to meet your goals.

Lorne Brown:
Absolutely. I like strategy. I used to be a chartered accountant. So back in 2022 when everybody was still getting COVID and we were concerned, I encouraged the guys to freeze their sperm. So if they got COVID, they had good sperm to use so they didn’t have to cancel their IVF cycle. And even today, if you travel a lot, if you’re worried, I have a gentleman that has really good sperm right now, but he loves to do hot tubbing and those kind of activities. So I said, well you should freeze that sperm, it’s good right now and then continue. And if the sample you give at the time of IVF is not good, you have

Lora Shahine:
Backup. Yeah, I love that. And I think people, we’re not there yet, but people often talk about egg freezing for fertility preservation and Dr. Turk has talked about guys should consider freezing their sperm when they’re young. It’s only going to get worse and worse as they age. People can go back and forth on that, but it’s not a really wild thing to think about.

Lorne Brown:
And then women, there’d be a lot higher divorce rates because then women know they don’t need to stick around with this guy. They got their sperm on ice. Guys will have to become a lot nicer and attentive.

Lora Shahine:
That’s great.

Lorne Brown:
That is good. So back to health and tips around fertility and optimizing people’s cycle. What’s your take though on that mind-body approach and can stress impact fertility from your perspective, your study, your clinical experience, and how do you counsel patients and what are some of the things that you like to educate patients around stress and mitigating stress?

Lora Shahine:
Yeah, they’re absolutely connected, but what I don’t want to do is for my patients to learn that and then stress about being stressed.
I’m a big fan of Allie Domar. She is a longtime friend and colleague and we’re working really closely on some of her updated research and the mechanisms to help people get that biofeedback, the auto device to get biofeedback and learn how to decrease their stress so they can see improvements in their fertility still kind of new and in the works, but the way I describe it to people is it’s a chicken or egg. What comes first, stress or infertility? They’re interrelated. And I try to focus on teaching my patients the importance of stress management because we can’t eliminate stress, but if two people walk up to a bus stop and they both step into the intersection and a bus comes flying by, they jump back out. They’re safe. The person who’s worked really hard on stress management, breathing techniques, journaling, whatever it takes to kind of calm their mind, mindfulness meditation is going to recover from that huge surge of cortisol fight or flight faster and it’s going to have lower long-term impact.
The person who doesn’t work on those type of things is going to have the same level of stress, but it’s going to impact their wellness and their reproductive health for a lot longer. And so I hope that that’s empowering. I do know that there are people in the fertility field that says, Hey, there’s studies that prove that stress doesn’t impact IVF outcomes, so just don’t worry about it anymore. And they think that they’re being helpful with that. They’re trying to decrease stress. I just don’t think it’s that black and white. I think it’s got to be interrelated, just like stress can impact risk of heart disease, metabolic disease, insulin function. Our bodies are interconnected. I mean, I’m preaching to the choir, Lorne. This

Lorne Brown:
Chinese medicine doesn’t separate. It’s not mind and body. It’s mind body. And western medicine has a term called psycho neural immunology and they’ve added a term rather than PNI. Your thoughts and your feelings affect your immune system and your nervous system. They’ve added endocrine to it and your hormonal system.

Lora Shahine:
Absolutely. Absolutely. And so it shouldn’t be a negative thing to learn that just like it’s an empowering thing to learn, wow, if I really do quit smoking, I can truly impact my egg quality. That should be an empowering thing. Oh, if I learn to manage my stress and learned techniques, this could not only improve my fertility or my outcomes with my IVF cycle, but it’s actually going to help me be a healthier person for the rest of my life and be the healthy parent to the child that I’m working towards.

Lorne Brown:
So let’s use that example of smoking and stress because you don’t want to blame and shame and make people more stressed out. But if somebody is a smoker, I wouldn’t lie and say smoking’s, okay, for your health infertility because I’m worried I’m going to offend them. My approach would be the fact is smoking is bad for your health and your fertility. Do you want to quit smoking?

Lora Shahine:
Yes.

Lorne Brown:
And if they say yes, we find ways to help ’em with it saying no, great, they got the information and I continue on. That’s my approach. Just so, but going back to the stress perks, I wanted to hear more about the approach. I love your bus analogy, A background in clinical hypnotherapy, and I do a lot of mind body in my practice. I just want to unpack that. So two people have the same situation that happens, but they both experience it differently. So we’re learning from trauma and stress. It’s not the situation that’s the biggest concern. It’s how you internalize and experience it. And you said if somebody’s had as a practice or tools, I call it, they can metabolize this stress. So

Lora Shahine:
Oh, I like that.

Lorne Brown:
You’re still going to have a stress response that’s healthy. That’s why you’re alive. If you don’t have a good stress response or your ancestors, you’re not here, they were eaten by something. That’s great. So the stress response is important. What’s the difference? What we’re talking about is there is the stress response that should go through your body in a couple of minutes. So you have the cortisol and the epinephrine heart changes, and within two to three minutes you’re back to that parasympathetic back to that safe mode. The person that has a dysregulated nervous system or doesn’t have the practice is chronic. So tomorrow they’re talking about how they almost got hit by a bus yesterday and they’re still feeling the stress of it. That’s the damaging part is that you keep re-experiencing and reactivating all those stress chemicals in your body. And so whether somebody is trying, because not everybody I see is trying to get pregnant, not all fertility people just want to be happy.
And part of being happy is having ability to regulate your nervous system, to have these hacks to take yourself out of a fight or fight or flight. For example, somebody thinks they’re going to get laid off. There are companies laying off people that can create a stress response, but there’s no survival benefit. So it’s not benefiting them to have that response. Or if they get a negative early pregnancy test or blood test, you’re going to have reactions. So neither of us are saying you shouldn’t have a reaction. What we’re saying is if that reaction’s living on you day in day in day, then it can wreak havoc on yourselves. That’s what I think we’re both saying.

Lora Shahine:
Yeah, I really like how you explain that and we are saying the exact same thing.

Lorne Brown:
So what are some of the counseling and tips that you’d like to share that you have found helpful for those that have stress and that just as, again, whether you’re trying to get pregnant or not, these are just things that people can do to give them better joy and happiness in their life.

Lora Shahine:
Yeah. Well, when I’m counseling patients, I bring it up. So I talk about it. That’s a really big first step to recognize how stressful this is. I ask about things that they do that are a healthy coping mechanism, and I acknowledge and validate their feelings of frustration. Why me difficulty going to their sister’s baby shower. That is normal. And also recognize the duality of feelings that we can have. We can be both grateful that we have access to IVF and maybe even an insurance benefit that allows it to relieve the financial burden, but also really don’t want to do it and angry that they have to do it in order to have a baby because of maybe an anatomic issue or something like that. So feeling both is okay. And then because I am the doctor, I’m not a therapist, I have so many resources, whether it is a list of therapists that I know are in the area that can help resolve.org, wonderful online group therapy, my podcast, the Brave and Curious podcast.
I interview people that are really helpful, like Dr. Ali Delmar to share her research, but also fertility coaches, miscarriage doula. I don’t know if you know Arden Carnett, she’s in North Carolina. She’s a grief doula. She’s not a licensed mental health therapist, but she’s had miscarriages and she’s really training other people how to just be there for people with miscarriage because sometimes you just want to talk to somebody that gets it how scary it is to just go to the bathroom when you’re pregnant. What are you going to see that revisiting trauma like you talked about. So just having resources like, Hey, go listen to my podcast, find resources. Here’s a list of therapists. But as the doctor, I can acknowledge how stressful it is and just listen.

Lorne Brown:
Yeah, and I think holding the space there is we’re learning more that there is healing around being heard. So when somebody holds the space, rather than dismiss your feelings, try to fix it, you’ll get it next time. People just need to be, I call it authentic. They got to feel their feelings to heal the feelings. So mindbody, there’s a MINDBODY tools, I have some toys, I have a sound table that helps get that vagus nerve going and bring it into parasympathetic. So it has all these woofers and stuff on the table that does certain frequencies to help people chill. I got a bunch of toys in my practice. I’m the boy with the toys. I love toys.

Lora Shahine:
That’s awesome.

Lorne Brown:
Nutrition.
When I was practicing back in the early two thousands, they’re like, ah, IVF is all you need. Nutrition doesn’t matter. I consider nutrition building blocks, but can you talk about nutrition? And because there’s so many diets out there, what are the core principles of pillars of diet that you’d recommend? And then if we can end with supplements, because you talked about oxidative stress, there’s a few supplements that are, these are the ones I definitely like, but always we let everybody know. Dr. Lora is a doctor, but she ain’t your doctor. So do talk to your health professional. Okay,

Lora Shahine:
Go on. I talk to my patients all the time about nutrition, even though I am not a registered diet or nutritionist or dietician, but I absolutely know how important it is. And I think about moderation. I’m on the 80% plan. So if 80% of the time you can have less processed foods, more fresh fruits and vegetables, good balanced proteins, I am not a fan of extremes. I’m not ever going to tell a patient, oh, you’ve got PCOS cut out carbs. That is unrealistic. That’s a shame cycle that we’re just starting because if their symptoms don’t get better, then obviously they aren’t being in air quotes good enough.

Lorne Brown:
You

Lora Shahine:
Have to be very careful. I’m also not a fan of extremes, like, oh, cut out all gluten for anyone that’s trying to get pregnant or all dairy because they are inflammatory foods. So in certain situations, if you are diagnosed celiac and you are truly sensitive to gluten, cutting out gluten will decrease your inflammation and absolutely improve your fertility. That is proven and amazing in that certain patient population. Does everyone need to cut out gluten in order to get pregnant? No. And the whole thing with dairy too, dairy is evil. We have to cut it out. Actually, the nurses health study, decades of observation of people who were tracking their diet and tracking ovulation and tracking conceiving. If they actually had more whole dairy, they had more regular ovulation and a shorter time to getting pregnant. So does everyone need to cut out dairy? No. And some people do do it and they feel better and awesome.
That is wonderful. But it’s oftentimes like an influencer that’s trying to make someone scared, tell ’em what their problem is, and then sell them a solution. And the shame cycle that starts with that, oh, I must have not really cut out all my gluten because I’m still not pregnant. I didn’t think about that salad dressing I had at the restaurant two weeks ago. This is my fault again. So just really careful with that. So 80% plan, mainly fresh fruits and vegetables, getting protein. If you really do look at diets, there are wonderful studies that show that if you got to choose a diet, the Mediterranean diet is the best for your fertility. And what is that? Fresh fruits and vegetables getting protein. Animal protein is okay, but less red meat. And the Western diet that’s full of trans fats and lots of processed foods and lots of red meat is not as good for your fertility. So I sort of give that general feel and stay away from shame and say like, yeah, decrease processed food, but oh my gosh, every once in a while, ice cream is amazing. Decrease your fast food. There’s lots of BPA in the packaging. There’s lots of trans fats, but if you’re on a road trip and McDonald’s is right there and you got to get a Big Mac, oh my gosh, you got to get a Big Mac. Just really trying to be cautious about extremes.

Lorne Brown:
The body’s resilient so it can handle that Big Mac. I love that you said the 80 20 rule, and I want to give a shout out to our fertility diet book. So we wrote the Accu Balance Fertility Diet book, me and my colleague naturopath and get a load of this. It’s based on the nurses study that Harvard study plus the Mediterranean Diet plus Chinese Medicine principles.

Lora Shahine:
Oh my gosh.

Lorne Brown:
And what we did is we went and looked at all the diets and realized they are so many diets that say they work for fertility and they conflict. No carbs, carbs, no meat, meat. And we looked and saw that this is what they all have in common. They all say no processed food, no refined flour, no refined sugars and flour, no trans fats. That’s what they all say. So if you get rid of the processed food, the refined flour in the trans, you’re good. And then the carbs. One of the gynecologists we had on our podcast, Dr. Kyla Smith in the uk, she was a dancer herself, works with dancers and high end athletes. She shares that from the hormonal perspective, hormones need carbs. And as women get older, they get an energy deficit if they’re over exercising undereating, which makes their perimenopause and menopause worse.

Lora Shahine:
And

Lorne Brown:
Guess what? Our patients are all in perimenopause. And so I like that you say carbs are okay. There’s just certain carbs that aren’t helpful and there’s certain carbs that are, so my shout out is, and we’re not selling something, it’s free. The Accu Balance Fertility Diet, you can download free from our [email protected]. And our naturopathic doctor Kaylee, created 21 days of recipes. Love it. My original draft, I did the recipes and they were terrible. She says, did you ever eat any of this? And I go, no. I just kind of put things together. She goes, they’re terrible. And so she cooks. So she changed them and gave us great recipes in the 80 20 rule. I want to give structure for that. Some people like structure because we say 80 20, but then we deny, and it’s actually 40, 60 maybe. I have found that if people want some discipline and structure that Sunday to Friday at four o’clock, perfect. Eat well, and then Friday at four happy hour until Saturday at midnight, do whatever the hell you want. That means out of the 21 meals, only four of them are poor, which is 80 20. So if I love

Lora Shahine:
It.

Lorne Brown:
Okay, we got to wrap supplements. What kind of supplements do you like

Lora Shahine:
For both partners? A multivitamin. So for the female partner, a prenatal vitamin, because it’s a little bit more folic acid and a little bit of the things that they need. Vitamin D for all of my patients in the Pacific Northwest, 85% of people in the state of Washington are deficient. So extra vitamin D. And then I love co-enzyme Q 10. It is just a powerful antioxidant. Multivitamins are full of antioxidants, a e, C, zinc selenium, and so that’s great for sperm and eggs, but coq 10 is a little bit more expensive. It’s a little harder to put in with a multivitamin. So it is something that you usually have to get outside of that,

Lorne Brown:
Especially the right dosage. You need to get out of a multi.

Lora Shahine:
Yeah. And so that is what I really talk to most of my patients about. And then there’s always exceptions or kind of clarifications with the individual person that’s in front of you,

Lorne Brown:
NACN, acetal cysteine, yes or no. Do you ever use that

Lora Shahine:
One? I’m still learning I, yep.

Lorne Brown:
My acetol yes or no

Lora Shahine:
For PCOS, especially with insulin resistance, big fan

Lorne Brown:
And then fish oils.

Lora Shahine:
Oh yes. For baby’s brain health. Absolutely. So always thinking about that. In pregnancy, I’m doing a lot of procedures on patients like egg retrievals, hysteroscopies, and it can increase the risk of bleeding. So I’m sometimes not fish oils. Yeah, so it acts like aspirin. So I’m thinking about it definitely in pregnancy, but not always really talking about it during treatment.

Lorne Brown:
I know we do a lot of fish oil. A question for you. If somebody’s on aspirin and fish oil and on some of these, sometimes you guys put them on heparin, right? Depending on,

Lora Shahine:
Yeah, it’s a lot. You

Lorne Brown:
Got to be careful. And we do need some inflammation for ovulation implantation. So I always wonder about our dosaging around our fish oils. Again, we’re still learning, right? So

Lora Shahine:
Exactly.

Lorne Brown:
Anything you want to share as we wrap up? We stayed on time, I think, and I really enjoyed this, but any last words?

Lora Shahine:
I really enjoyed connecting with you, Lorne, and I love that we’re coming from two different fields of medicine and study and background, but we’re actually saying a lot of the same things with compassion. You’re really good about paying attention to the emotional piece, which is just such a huge piece of this whole puzzle.

Lorne Brown:
Well, thank you. Well, my training is that I’m more impressed by you because Western Medicine doesn’t have a lot of nutrition training and you are nutrition educated and the emotional aspect, you’ve got that down. So more my tip my hat off to you because it wasn’t really part of your training. So it speaks a lot of who you are. They can find [email protected]. And that’s Dr. You’re on Instagram, YouTube, TikTok, your name of your podcast. Do you have more than one podcast?

Lora Shahine:
It’s a new name for the same podcast. It’s called Brave and Curious.

Lorne Brown:
Love it.

Lora Shahine:
Thank

Lorne Brown:
You. So we’re going to put that in the show notes so people can find your channels because you are a massive educational contributor, and so really appreciate that and I love sharing your information with my patients. Thank you very

Lora Shahine:
Much. Thank you, Lorne, and so happy to be here. Really grateful.

Speaker 3:
If you’re looking for support to grow your family contact ACU Balance Wellness Center at ACU Balance. They help you reach your peak fertility potential through their integrative approach using low level laser therapy, fertility, acupuncture, and naturopathic medicine. Download the ABA Fertility Diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to ACU balance ca. That’s acu balance.ca.

Lorne Brown:
Thank you so much for tuning into another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you, so please direct message me on Instagram at Lorne Brown official. That’s Instagram, Lorne Brown official, or you can visit my websites, Lorne brown.com and ACU balance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart center and breathe.