1. Can we see the peak of progesterone through body temperature? If it rises quickly then progesterone is also going up quick?
Progesterone causes an increase in basal body temperature of 0.5º - 1.0º F, so a sustained increase in temperature after ovulation can tell us a lot about progesterone levels. Other things can affect basal body temperature, including poor sleep, alcohol the night before, a fever, or an overheated bedroom, so it's important to consider those things when using a basal body temperature chart to map hormonal changes.
2. Is loss of cervical mucus around ovulation a sign of estrogen deficiency? What can be done to get it back?
Scanty cervical mucus can be related to low estrogen, though it can also be caused by dehydration or poor circulation. It's also worth noting that some medications or supplements can dry up cervical mucus, including over-the-counter antihistamines and even high doses of vitamin C. At Yinova, we troubleshoot this issue by giving our patients yin tonics. IN our over-the-counter herbal line, this would be the fertility formula for the Dry Type.
3. How much is loss of fertility associated with stress? Since it is an extraordinary stressful time, do you have any practical tips from eastern tradition for managing stress?
My patients become stressed about being stressed, so I'd like to reassure you that people who are stressed get pregnant. However, it is clear that stress affects reproductive hormones, and physical tightness can affect blood circulation and impact fertility. We can't avoid stress altogether, but we can limit its effects by learning how to recover after a stressful event. To come back to your center, focus on your diaphragm and feel how it moves down when you inhale and up when you exhale. The diaphragm has a relationship with the pelvic floor, so practice inhaling, moving the diaphragm down, and relaxing the pelvic floor, then exhaling, tightening the pelvic floor, and feeling your diaphragm rise. Focusing on the breath is calming and allows your sympathetic nervous system to down-regulate, and by breathing all the way down to your pelvic floor, you create a wave of relaxation that affects all of your organs.
4. Our bodies show patterns to tell you what's going on internally, for someone who is starting to analyze their body, what are some easy ways for them to start monitoring those patterns?
The first thing is that your period is actually a visible sign of what is going on inside your body. And you kind of know that cause when you've had a really stressful month, you get more PMS. It's not psychosomatic. You've created more stagnation, you have gotten tighter and tighter your shoulders have come up by your ears, and nothing in your body is communicating as it should and all your hormonal transitions end up being a little glitchy and things like that. First of all, looking at your cycle is really important, that's why Oova data is really important. Second, I would look at your digestion. To give you an example, lots of people just put up with constipation. So many of my patients tell me, "Oh I've always been like this. I'm just constipated and I go every other day or every three days". You should be movin your bowels every day. This is important because your body gets rid of excess estrogen in two ways - 1) Your liver takes it up and deals with it and 2) It goes out through the stool. If your stool sits there for any long period of time, your body pulls water out of it and this pulls the estrogen back into your body. One of the causes of mild estrogen dominance in relation to progesterone is constipation. When patients they are constipated, I get them moving. I usually start with something simple like magnesium citrate at night because it's good for stress too and it helps people sleep.
5. I heard that being vegan makes you bleed less. I typically bleed for only one day (as a vegan). Is this bad?
It's not bad. Nothing is bad! But, yes, it's a little short. Sometimes vegans are a little undernourished. The fertility type definition we use is the pale type. The vegan diet is so healthy in so many ways. Eating plant-based is so good for you. It's good for your heart and all sorts of things but you do need to make sure you're getting enough protein. This can be difficult. I suggest a good iron supplement (I recommend Floradix). Also, ensure you're consuming enough protein. You'll see changes in your period by lengthening by one day at a time.
6. There are multiple entry points for Chinese medicine and trying to conceive depending on your budget. What would be the initial offering for someone who wanted to dip their toe in this field and what results could they expect?
There are different price points. What Yinova is a boutique practice where you are alone with the practitioner, you have a lot of privacy, and a lot of personalized attention. We try to keep our costs down as I believe a healthy practice has a wide variety of people coming to it. It's obviously more expensive to have undivided attention. There are practices called community clinics where you are treated more communally and this can be cheaper.There are also school clinics which are good options for many people if you want to save some money. You will be treated by students but they are supervised by licensed practitioners so that is a good option.
7. How can women use chaste berry to enhance fertility?
You can use it to tighten up the action of the pituitary gland to optimize ovulation. However, I believe it gets overused. I often take women off of chaste berry. It has a reputation of treating luteal phase defect which it does by tightening up when you progesterone goes up but it doesn't have as high of an effect on progesterone as people think and I don't think it's the best option for low progesterone. If you look at your Oova data and you can see that your LH goes up and there is a gap from when your progesterone goes up in a slow slant rather than a steep slope, then it would be a good use for chaste berry. I usually give it to people about three days from when they normally ovulate to three days after ovulation.
8. Do you ever combine eastern and Western medicine in your recommendations?
Yes, all of the time. However, I do not make western medical diagnosis but I do coordinate doctors all the time. It's really important for fertility acupuncturists to be very medically literate which is why I wrote my book with a doctor. Most people want the best of all possible worlds and they want the best that Western medicine has to offer without being over medicated and they all the wisdom from Eastern medicine accrued over thousands of years without being completely alternative. That's usually what I hear from patients. I do take your Western diagnosis into account as I diagnose you.
9. Do you have any food recommendations for improving fertility?
Yes and no. In making babies, we gave five separate diets because we wanted to really target it. There isn't a one size fits all when it comes to that. Although there is some basic advice. Don't get too hung up on very strict fertility diets. You'll drive yourself nuts and it's not worth it. I've had so many patients that got so tight with trying to control their diet and we actually have a blog article written by a patient and what happened to her when she got so rigid about her diet. This was secondary infertility (she already had a child) and she wouldn't eat cake on her child's birthday. It became a superstition - If I do this, then I'll never get pregnant. You have to have a regimen you can live with it. And you can cheat here and there. 80% is perfection which is an old Chinese saying. If you're 80% of the time, you can slack off a little bit for 20% of the time. What we're aiming for is some good quality protein, if you're vegetarian, that will be vegetable protein which is completely fine. Or some good quality meat and fish. Don't eat too much of it but regular portions. If you're going to eat fish, choose the lower mercury ones. The fish higher up the food chain tend to eat the little fish and they've got more mercury in them. Be cognizant of mercury. Healthy fats are really important. In the early days of my practice, everyone was on a low fat diet and they were all having trouble getting pregnant. There is loads of evidence that people with ample amounts of healthy fats do better and less likely to have ovulatory problems. You need to be well hydrated to produce good quality cervical mucus. Go easy on the coffee. It's not the caffeine, it's coffee. Coffee is very acidic and it affects fertile cervical mucus. Easy on the alcohol. When Dr. David and I wrote Making Babies, we thought 5 drinks a week was fine, as long as you didn't have them all in the same evening. You should have some alcohol free evenings every week. Lot's and lot's of colorful fruits and veggies and you'll be fine. We give more targeted advice in Making Babies.
10. With the Oova data we see that many women are reporting that they're peri-menopausal but are they actually? Are they actually perimenopausal or are they of just advanced maternal age with irregular cycles? Are there any patterns women can look for to indicate that she's actually perimenopausal versus just irregular cycles?
I remember being in my 30s and reading that everyone over 35 was somewhat perimenopausal and being horrified! It's a long period of time. Here's what I see in perimenopause. People assume that your estrogen just slowly goes down until you go into menopause. But that isn't what happens. What happens in the years before menopause, and it can be quite a few years, up to a decade in fact, you just get a bit more surge-y, particularly of estrogen. It's not that your estrogen is going down but it's surging in irregular patterns and it's hard for progesterone to offset and people get a bit estrogen dominant. There is no hard and fast rule about it. If you start to have symptoms, particularly around your cycle that you have not had before and you are in your forties, it's worth getting a little advice on how to manage this. You don't have to call it perimenopause which sounds kind of dire. It's just age related minor hormone imbalances. They can be addressed.
11. You mentioned you like to see the progesterone plateau happen post-ovulation and you don't like the zig zag behavior of the progesterone rising up and then drastically dropping down. We see this a lot with our Oova users. It's pretty common. What do you think the cause of that is and what would be your recommendation for them?
A little bit of up and down is just fine. However, if it's going up and down a lot, it is a combination of stress and fatigue. Your body is tired and you don't quite gather the resources to provide enough energy to get your progesterone to go up. Stress actually moves your progesterone up and then exhaustion pushes your progesterone back down. If I see a sore tooth BBT or Oova chart, I think of that. I also think that alcohol can sometimes play a role in that. I don't mean alcohol in an excessive amount. Women process alcohol less well, sadly and unfairly, as we get a little bit older. Sometimes that is affecting the data a little bit too.
12. Does natural progesterone cream work uniformly for low progesterone to support pregnancy?
I am not a fan of the natural progesterone cream for this. I am fan of this cream for perimenopause which is what it is designed for. It is designed to offset that little bit estrogen dominance in perimenopause and it does that really well. However, when you're trying to get pregnant, what do you need? You need your progesterone levels as uniform as you can and you can imagine dosage is an issue with natural progesterone creams. On a dry day, more goes into your skin, if you're sweaty, less goes in. You can put a glob of it on your arm and you try to make sure the glob size is the same each day. It's a little imprecise for my taste. For someone who likes to find the most natural solution possible for every problem, I send people to their doctor to get pharmaceutical progesterone because their dosage is stable. I think dosage is really important when trying to manage progesterone for proper implantation.