Recently, I interviewed Dr. Aumatma Simmons, and we talked about her journey into fertility specialization, the complex factors affecting fertility, why comprehensive testing is essential, why both partners must be a part of the fertility preparation process, advanced testing methods she recommends, how thyroid imbalances impact fertility, management of thyroid conditions during pregnancy, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
Very excited to chat with Dr. Aumatma Simmons about fertility. We are going to tie this into thyroid health of course. Let me go ahead and give her very impressive bio here.
Dr. Aumatma is a double board-certified naturopathic doctor and endocrinologist in practice for close to 15 years. She specializes in fertility and is the best-selling author of two books, Fertility Secrets: What Your Doctor Didn’t Tell You About Baby-Making and (In)Fertility: Secrets, Struggles, and Successes. Dr. Aumatma was awarded the “Best Naturopathic Medicine Doctor” award locally in 2015 and 2020. She was recognized as a top “Women in Medicine” doctor in 2020 and 2021.
Dr. Aumatma is also the creator of Fertile Foundation Supplements, a line of research-driven nutrients that support your fertility journey. She is also the host of the Egg Meets Sperm podcast.
In addition to supporting couples through individualized care in person and long-distance, Dr. Aumatma also trains practitioners who want to specialize in fertility. She has been featured as a holistic fertility expert on ABC, Fox, CBS, KTLA, mindbodygreen, The Bump, and other media, along with being interviewed for countless podcasts on topics of fertility, pregnancy, and post-partum health. Thank you so much for joining us.
Dr. Aumatma Simmons:
Thanks for having me, Dr. Eric.
Dr. Eric:
It’s a pleasure. I of course want to dive into fertility, but before we do that, why don’t we talk about how you became more of a specialist in fertility? I don’t know if this was right from the start, or if this was something over the years.
Dr. Aumatma:
It was actually a personal experience that brought me into fertility. I used just to be a women’s health doctor. I was seeing all kinds of women for all kinds of things, everything from anxiety and depression to perimenopause and menopause. Interestingly, fertility was never part of that mix.
I was married to this person who started to talk about having children. Every time he mentioned it, I had a full-body reaction, which was “Ahhhh, no way!” We were already married at that point. It was a little bit of a shock initially. I was in my very early 30s and aware that what I had learned in medical school was fertility drops off the cliff at 35.
I had a lot of introspection around do I not want to have children with him? Do I never want to have kids? As that was a possibility. Do I want children, and if it’s not with him, then what do I do about my fertility? Because by the time we separate, get a divorce, and then find a different person who is going to be the right person, I was looking at a very long period of time potentially between those things happening.
I did what I feel like most doctors would do. My response was: I’m going to spend every waking hour researching the crap out of fertility. Maybe this thing I learned in medical school is not actually true. Fertility doesn’t drop off a cliff at 35. I can do something about it now, so that I don’t have to worry when I’m ready.
What I came to was two big realizations. One was there was a lot I could do that I started doing right away. Simultaneously, awareness of myself and being like, “Yeah, I actually do want to have a child, just not with him.” Working on the personal aspect while optimizing whatever I could do for my hormones and fertility. Simultaneously, realizing that this idea that fertility drops off a cliff at 35 really wasn’t based in science. Okay, if that’s not based in science, why are we giving so much credence to it? That was my process. It took about nine months. I was internal about it all.
As I was being interviewed on podcasts about health, I would just be mentioning it. It was amazing how many women kept calling me up, “Oh my god, can you help me with my fertility?” Everything I know is theoretical. I have literally never done this before, you guys. But the number of people who were calling me was really high.
Eventually, I said, “Yes” to this woman, and she became our first client. I said, “Yes, but you should really think about this because it’s not going to be cheap. I have never done this before. I have zero success stories to tell you about. You probably don’t want to do this with me.” I was trying to talk her out of it. She came back a few days later and said, “Nope, you’re the right person. I’m really sure. I want you to help me. I don’t care how much it costs.” She ended up being my first client. Three months later, she got pregnant.
I simultaneously was invited into this clinic where one of my friends needed help. He was like, “Our naturopathic doctor just quit. Can you come help us?” They were a general clinic. I had no idea they had an acupuncturist who specialized in fertility. I had said yes to this thing. I walked into the clinic, and the acupuncturist was like, “I have been checking out all of your podcasts. You’re the perfect person. Here is a whole pile of cases that I have had no success with. Maybe you can help them.” This is happening way too fast. I fell into it at that point.
I had really no reason to say no. All of these people are here and need help. No one else has been able to help them before. Let’s see what I can do. I started calling them up. “I looked over your case. I have some ideas for you. Come on in.” Out of all of those people who came in, a majority of them got pregnant that year. That was when I was like oh my gosh, it’s so amazing because obviously, the reward is huge.
But it’s also amazing because I get to influence the health of not just that person but their child and then their grandchild all within one very short period of time. To me, from a health perspective and a person in the world, it was the perfect thing for me to be doing. That’s how I got into fertility.
Dr. Eric:
Awesome. How long ago was that, that very first success story?
Dr. Aumatma:
That was 12 or 13 years ago at this point.
Dr. Eric:
Wow.
Dr. Aumatma:
For a little while there, I was still working with some other menopause/perimenopause. Since the last 10 years or so, I haven’t taken on any new non-fertility people. I feel like if you’re a specialist in something, at least in my brain, there is no space for anything else. I breathe and sleep and dream in fertility. That’s all I want to do. That’s all I want to talk about. That’s all my focus is on.
I feel as much as I would love to help everyone, I am very cognizant that it’s really that period of time, preconception, where I can make the most difference. It’s been about 10 years, where it’s just been all fertility. It’s always funny when people are like, “I would love to have you on my podcast. What would you like to talk about?” I’m like, “Do you know me? Do you know who I am?” There is no space for anything else.
Dr. Eric:
Same here. I focus on thyroid health with more of an emphasis on hyperthyroidism, even though I also help people with Hashimoto’s, because of my experience with Graves’. It’s similar. We both could help people if someone randomly came to us with a gut problem or something else. There is also only so much time we have to spend with patients. There are some people who are generalists and try to see everybody. That’s great that all you do is focus on fertility.
Let’s start off with the question: Why do so many women have problems getting pregnant? Why are there so many cases of infertility out there?
Dr. Aumatma:
Great question. When I started out in this field, the stats were one in eight women between the ages of 18-35—we are not even talking about all of the women who waited until later in life. We are talking about that age group who generally should be fertile. Out of that, one in eight were struggling with fertility. Now, the current stats are 1/5-1/6 are struggling with fertility. We are seeing this massive increase in fertility issues.
It’s a multi-factorial thing. I don’t think there is one specific answer. I think it’s a combination of toxins in our environment, which are not only affecting females but also affecting the male side. It’s been said that in the next 20 years, statistically, we may have a majority of men with no sperm. This whole Handmaid’s Tale coming to life. The toxins are a piece of it, but I don’t think it’s everything.
Another big component is when people are choosing to get pregnant, women more and more are waiting until later in life. They are not being counted in those stats. There is that aspect.
There is also the aspect of stress. Everything is stress. We are all messed up because of stress. That is true to a certain extent. I would be remiss not to mention it because there are about 4,000 studies that point to how much stress actually impacts our HPO axis, which is the hypothalamus-pituitary-ovarian axis. There is an indicator that how much of what we’re experiencing in our life is going to massively impact fertility.
Stress is such a generic term, so I don’t love using it. If there is a shift in our bodies, in our emotional experience, in the way that we view the world, where we are in survival mode, instead of creation or reception mode, then it’s going to be a really hard place to conceive. The pace of the world feels like it’s speeding up. There are more things that we are constantly worrying about. The political landscape, the wars that are happening. There is just so much.
We may not be actively thinking about it, but it’s happening in the background. If the story that our body is creating about that is, “Hey, your priority in this moment is how do you survive,” then it’s really hard for the body to be like, “Oh yeah, I’m trying to survive, but I’m going to create another human.” On a very basic level, all of the stress that is contributing in our bodies is going to work against our fertility in a lot of ways.
Those are the big ones that I think are across the board. Of course, we can get into hormonal imbalances, which is different from person to person. I think the factors that are impacting all of us are pretty solid and consistent.
Dr. Eric:
Stress is big. Toxins are big. You mentioned it’s not just the female; it could be the male, lower sperm counts. I imagine when you work with someone, you obviously take that into account. Do you consult with both partners?
Dr. Aumatma:
In our practice, it’s mandatory that the partner is on board. We have a lot of women who are like, “Can you just work with me? You don’t ever need to talk to my husband.” No, that’s not what we are doing. There are plenty of other practitioners out there who will be happy to support you, but we’re not those people.
Unless you are a solo mom by choice, who we do support, there is no reason your partner shouldn’t be on board, even if their sperm are great. This is the conversation that a lot of women will have reflexively. “My husband’s sperm is great. You don’t need to worry about him.” I’m like, “Sperm is the bare minimum we need to worry about. What is his lifestyle? What is his mindset? What toxins is he being exposed to? Is he methylating properly?” All of those things are going to impact not only whether you can get pregnant, but they are impacting what we really care about, which is the health of your future child.
What is that pregnancy going to be like for you? Let’s suppose that a male has great sperm, which happens very frequently. But the DNA of his sperm is a total shitshow. He doesn’t know because there is no test that is regularly performed on the DNA of the sperm. There is a test for it; it’s just not commonly done. On the surface level, sperm look amazing. On the DNA level, sperm are absolutely not amazing.
The woman gets pregnant, and she continues to keep having pregnancy losses. She is not sure why she is having those losses. Our society says it’s her fault, something she did. Internally, women take a lot of responsibility for fertility and pregnancy. She is also thinking, “Something is wrong with me. I’m doing something that is triggering the pregnancy losses.” When in fact, it starts with the male.
But if he has never been tested, no one is looking at it. No one is saying, “Hey, it’s the DNA. It’s not even your sperm. It’s the DNA.” We can fix it if we just look at your epigenetics. If we dive in a little bit deeper on your health stuff, not only are you going to get her pregnant, and she will stay pregnant, but you’re impacting the health of this future baby in a very meaningful way.
We won’t work with couples who are already coupled, already married, and the partner says, “I don’t need to make any changes.” That’s a no-go for us. I have fired people for that. “Here is a full refund. I want nothing from you. Goodbye.” It’s not what we’re about. People can do whatever they want to do. Our goal is healthier babies in this world. The how matters just as much as what the outcome is.
Dr. Eric:
That makes a lot of sense. You don’t want to spend all this time, and just the woman spend all this money, and three months later, six months later, find out everything is optimal with her, but the problem is with the significant other.
Dr. Aumatma:
They end up wasting time that way. They come back six months later and are like, “We’re still not pregnant.” The guy finally gets tested, and he is like, “Oh, sorry, it was my sperm all along.” It is a little bit of a bummer when that happens.
We just want to cover all of the bases from the get-go, especially for fertility. They don’t have time on their side. Most of them don’t have patience. Even if it was a 30-year-old, she still wants to be pregnant yesterday. She is not in here, “Four years from now, I’d love to have a baby.” “I started trying, and I should have gotten pregnant last month. It didn’t happen. What the heck?”
Once that decision is made that they want to have a child, that pull is so strong. It’s so anxiety-provoking when it doesn’t happen quickly. Regardless of how old they are, time is not always on their side, just because of how we are as humans. We want everything now. They end up saving time in the future.
Believe it or not, so frequently, men are the ones who are like, “I was never paid attention to. No one ever talked to me. I was always looked at as the sperm donor. ‘Who cares about you?’” As much resistance as they have coming in, once they start feeling different, then they’re like, “Huh. I didn’t realize it was possible to feel so good. My energy’s better. I sleep better. My sex life is better.” Those are the things that they care about, and those are the tangibles they’ll see improve. Most of them are like, “You changed my life.” It didn’t take a lot. Doesn’t have to be major anomalies or things out of whack. It’s just taking a 7/10 or 8/10 to a 10/10 experience in life.
Studies are coming out that men with optimal levels of testosterone will have lower rates of cancer and longer lifespans because they have optimal testosterone. Similarly, it’s been some of these studies have shown that men that had sperm issues were more likely to have cancer later in life. Men with lower testosterone is on the rise.
When we think about the preventative aspect of this, they are getting what would have been 10-15 years down the line as far as their health decline. We can catch it now and change the trajectory of their whole life.
Dr. Eric:
I’m sure that’s very rewarding for you and obviously for them. What are some of the things you do to optimize fertility? When it comes to stress and toxins, do you have people clean up their diet, block out time for stress management, do things to reduce their toxic load? Do you do testing? Look at adrenals, DUTCH testing, or a comprehensive stool test? What are some of the things besides the DNA of the sperm that you do for both partners?
Dr. Aumatma:
We have a sequence of tests we like to see in all of our couples. On the female side, we really want a comprehensive overview of how her hormones are functioning in her body. What are the deeper aspects of how her body is responding to stress? This is not just cortisol.
How is TRH, for example? Thyrotropin-releasing hormone is one of the starting points. It’s a trigger. We have an experience or stress. TRH is the first one on the front lines. We don’t have a way to measure TRH, but we have some indices that we can see on labs. If we extrapolate that data, we have a software program we put it into, and it gives us this deeper aspect of how quickly is this getting on board? Is this over-responding? A lot of cases, it is. A cat jumps in front of you, and your body is responding as if it’s a lion. That’s problematic.
To be able to see that on some lab values is amazing. Then we can dial back and say, “Oh, we see how your body is actually responding to these stressors,” regardless of if you have that stressor or not. Then we can go in with herbs, homeopathics, a whole host of therapies or modalities that can help to shift how that person actually responds to triggers.
We want to change it at the deepest level and see that their body is becoming more stress resilient. I feel like most people, when we mention stress, are like, “She’s going to tell me to meditate.” No, actually. If you have time to meditate, go for it. Meditate all the time that you have. What I find is that if we don’t change these underlying things, then regardless of how much you meditate, you’re still going to have a triggered response.
If we can regulate people’s nervous systems and shift the dynamic that people are having to triggers, how is the body responding? How quickly does that TRH come to the party? Then we really have the ability to create some space before that trigger is creating stress. To me, that stress resilience, that is the first set of tests we are doing.
The second is the hormones. You mentioned the DUTCH test. That’s one of our favorites. We love to see the urinary metabolites. We love to see how the hormones are processing through the body. It’s not just is your body producing a hormone? Also, is it converting it at the right pace? Is it converting it at the right times in your cycle?
That’s giving us information about how to approach it. Rather than saying, “Hey, you have too much estrogen” based on one snapshot of a test, we can say, “You have too much estrogen only from cycle days 3-12. Let’s regulate that only during that time.” We can get hyper-focused on what needs to be regulated when instead of a willy-nilly, everyone gets DIM or whatever. I hate those one-shot everything approaches because it doesn’t work for everyone. The DUTCH test is really high up there.
The other one we love is the nutrient assay. How are your cells absorbing or utilizing these nutrients in your body? Not just how much magnesium do you have floating around in your bloodstream? That’s a really terrible assessment of magnesium levels. How much is actually going into your cells? Do your cells have enough magnesium to do all of the functions? That is going to be a much more helpful approach to figuring out what is going on there.
Our last and newest test is the vaginal microbiome. It’s connected to the gut microbiome, so it gives us a little bit of reflection of the gut. But there are so many studies coming out every single day about how much the reproductive microbiome is influencing pregnancy: the ability to get pregnant, stay pregnant, and have a healthy baby at the end of the process. All of it is predictable through the vaginal microbiome. That has become a really essential test for us as well.
Then we have a bunch of trackers and things like that. We are using CGMs. We are using basal body temperature tracking. We’re using hormone tracking through at-home urine strips. Those are all the ways that we can continue assessing and getting feedback about whether or not the things that we’re doing are actually impacting the outcomes that we want to see.
On the male side, there is the semen analysis. Also, a comprehensive lab analysis to get a sense of the same things that I talked about on the female. How is stress impacting your body? How much of an impact is it? Are there triggers that shouldn’t be triggers? That kind of stuff will help us get the nuances of what this person is going to need to help shift their bodies out of survival mode and into creation mode.
Dr. Eric:
All right. Do you mind mentioning, as far as some of the names of the tests, specifically the nutrient test and the vaginal microbiome test? What companies offer those?
Dr. Aumatma:
Cell Science Systems is the nutrient assay. The vaginal microbiome is MicroGenDx. These are really only available through practitioners. If there are people asking about this, they may need to work with someone who can actually order the tests for them.
Dr. Eric:
Same thing with the DUTCH. It sounds like you do a DUTCH Complete with Cycle Mapping on everybody?
Dr. Aumatma:
Yep.
Dr. Eric:
It sounds like you don’t do it on men. Obviously not the Cycle Mapping on men.
Dr. Aumatma:
No, definitely not. We have a few men who I really would love to see a DUTCH Complete on. It’s not a standard. We don’t test everyone. We can get a lot of information just from the basic tests.
It becomes a necessity when their testosterone levels are low, and we have worked on it for a little while, and they don’t improve. That is where I start thinking, if we really had a DUTCH test on you, we would be able to see if your body is converting your testosterone into estrogen. Is that why you don’t have estrogen? Or do you have low reserves? You don’t have the building blocks for the testosterone? It would really help narrow and hone in on what is the best approach to support that person to get to that optimal level?
I’m thinking of a couple of guys right now who have low levels for their age. We have worked with them for a little while. I usually expect to see an improvement within 2-3 months. If I don’t see those levels go up in 2-3 months, I’m starting to think, is there something deeper here? Should we be looking at something else?
If you have the nutrients that you need to build testosterone, and you have herbs that are driving your body’s awareness that testosterone is needed, then we should see that outcome in a measurable way. If we don’t see it in a measurable way, in a reasonable amount of time, then I truly would like to get to the root of it.
Granted, guys are funny because they will wait on testing. Women are like, “Just tell me! I want to know everything. I want to know everything up front.” Guys are like, “Do I really need that? Will it really help me?” I take it a little bit slower with the guys. Ideally, we would like to get those numbers when we can.
Dr. Eric:
Makes sense. Let’s talk thyroid. How common are thyroid imbalances in those who are having problems conceiving? There are a lot of questions I have. What is the optimal TSH during pregnancy? What is the prevalence of thyroid conditions and the impact you think it has on someone conceiving, someone having a healthy pregnancy once they do conceive?
Dr. Aumatma:
Totally. Thyroid is a really huge component of fertility. PCOS, which is one of the leading causes of “infertility,” one in two women with PCOS will have infertility. Thyroid is almost always a cofactor in every woman with PCOS. It’s not just that she has this PCOS picture; almost always, her thyroid is not functioning optimally, which is then contributing to the PCOS picture. Often, not enough production of thyroid hormones will cause anovulation, irregular menstrual cycles, and infertility in general for unknown reasons.
Essentially, thyroid has a direct correlation to fertility. Actually, we don’t know what they do yet, but there are receptors on the ovaries for thyroid hormone. The fact that there are receptors means there is a direct impact. Science hasn’t figured out what it is yet. But that research is happening. Hopefully, we’ll know soon.
My sense is any time there is a receptor on a specific gland or cell or anything like that, it’s huge. This is going to impact, yes or no, not just this is maybe going to be helpful. It’s a direct impact.
Thyroid is our metabolic regulator. You guys probably know that. If that regulation isn’t happening, it makes it really hard to sustain the growth of this little human in our bodies. If the thyroid can’t regulate, which we can talk about thyroid and pregnancy, but there is so much dysregulation. Our body is constantly trying to adapt.
What will happen in pregnancy is—if we are observing thyroid through pregnancy, which if people are working with us, we are—those numbers are changing every single month. The TSH was fine? Now it’s totally not fine. What’s going on? We really have to make sure to monitor thyroid throughout the entire pregnancy.
I have seen a lot of doctors say, “Here’s your dose. See you later. Good luck with your pregnancy.” The reality is our needs are changing in every trimester. Every person is unique. If there is no way to pre-predict what the need is going to be, the only way to know is to make sure that you’re being monitored. That has a really big impact.
The autoimmune aspect of the thyroid is huge. If someone has antibodies to their thyroid, what I’ve seen is that they commonly have recurrent pregnancy loss. That is one of the leading causes or reasons why someone could have recurrent pregnancy loss, which is one of our sub-specialties. We end up seeing a lot of women with these autoimmune thyroid conditions that sometimes are not getting pregnant, but a lot of times, they are getting pregnant relatively easily. But the haywire of the immune system is then impacting the outcome of that pregnancy.
There are a lot of different aspects to how the thyroid is impacting and having a role to play in whether or not someone is going to get pregnant or not, and what the outcome will be.
Dr. Eric:
That’s interesting. What you’ve seen is someone with thyroid autoimmunity might not have a problem getting pregnant. I’m sure it depends on the person. Some might have issues. Even if they have no problems getting pregnant, carrying the pregnancy, having the recurrent pregnancy loss is what you see very commonly with thyroid autoimmunity.
I don’t know how many cases of non-autoimmune thyroid you see. If you see someone who has elevated TSH and/or lower thyroid hormone levels, but antibodies are negative, does that make it less likely for them to conceive in the first place?
Dr. Aumatma:
The non-autoimmune thyroid people tend to struggle with fertility. The autoimmune thyroid people tend to struggle with recurrent loss. That’s a big generalization. There are always going to be people outside of that generalization.
In general, the autoimmune component, I think, creates an unhealthy environment for that baby in utero, whereas the sub-optimal thyroid function creates a difficulty in conception. Or we see it show up in other ways. We see it in anovulation. We see it in dysregulation of the menstrual cycle. It’s showing up as direct hormonal fertility issues. But actually thyroid is playing a huge role in dysregulating those hormones.
Dr. Eric:
I imagine most of the cases are hypothyroidism/Hashimoto’s. Do you have any experience seeing people with Graves’ or hyperthyroidism at all?
Dr. Aumatma:
I would say Graves’ is probably not high on the list of people that we see. We have had a handful of cases where Graves’ was present, and they didn’t know it. A lot of times, people know that they have Graves’. In that case, I’ll just be like, “I might not be the right person for you.”
If they didn’t know that they had Graves’, but we see it in their antibodies, we see it in their TSH and T3 and T4, then we certainly will make an attempt to try and help them. We are not always successful. But we are successful some of the time.
Hashimoto’s and hypothyroid, all the time. That’s the more common situation. We see it a lot.
I also feel like even though Hashimoto’s and Graves’ get put together as autoimmune thyroid disease, Graves’ is certainly way more complex. Someone like you who is hyperspecialized in that is a better fit for someone who has Graves’.
Hashimoto’s, to me, falls more under things that we can do a lot about, especially if they are dealing with fertility issues. If they’re not, they should go to you regardless. If they have thyroid issues and are dealing with not fertility, go to Dr. Eric.
Dr. Eric:
Thank you. When it comes to the antibodies, someone with Hashimoto’s, because they have Hashimoto’s, that recurrent pregnancy loss is common. You will do things to improve their immune system health, I imagine. Do they absolutely need to have negative antibodies when it comes to TPO or antithyroid globulin antibodies? Is that your goal? Get them negative, or get them as low as they can before they start conceiving?
Dr. Aumatma:
Yeah, it’s multi-layered. I have seen cases in which we start out with antibodies at 800. Crazy high antibodies. I have talked to other thyroid experts who are like, “Oh no, the number doesn’t really matter. If you have any level of antibodies, you have antibodies, period.”
Whereas to me, I’m like, the amount of antibodies makes a difference. If we go from 800 to 25 or 40, that’s going to be a significant difference in how much your immune system is responding and contributing to the dysfunction. Yes, my goal is let’s get them as low as we can possibly get them.
The other factor, however, is when people have those minor elevations in antibodies, sometimes they don’t go away. But we have addressed the root cause of why they had the antibodies to begin with. Their symptoms go away even if there is no change in the actual number of antibodies. In that case, we say, “It’s okay that your antibodies didn’t go from 40 to 0. But we addressed the root cause. We have healed a lot of what was happening under the surface. You’re no longer having the reactions and symptoms that you’re having. Your fertility hormones have optimized. At this point, we think it’s okay and safe for you to go ahead and get pregnant, and we’re going to keep managing the antibodies as well as your thyroid through pregnancy.”
Mostly, it’s just a time factor, I think. If we had more time, then we would wait until their antibodies were totally zero. A lot of these women are 35+. A) They don’t have the patience, and B) We are like, “How long is it okay to wait before your fertility really does take a turn?” We don’t always know the answer to that. We are looking at 3-6-month periods where we have focused time with someone before we have to be like, “They have waited long enough. Now they need to go and start trying.”
In those cases, there are things like LDN that are great to support the antibody autoimmune picture while they’re pregnant and sustain it through pregnancy. They do relatively well and have healthy pregnancies. Their thyroid is managed, which is not always the ideal, I understand. But we do the best in that case, so they can quickly go to pregnancy.
Dr. Eric:
You do have some people on LDN during pregnancy if you have difficulty getting those antibodies where you want them to be.
Dr. Aumatma:
Yeah. LDN is considered very safe in pregnancy. It’s a good tool if we absolutely need to use it. It’s not my go-to. it’s not the first thing that I want to be doing with people. But if we worked on the underlying factors, we worked on the things that we know to work on, and their antibodies are still high, absolutely. LDN will save the day all day long.
Dr. Eric:
How frequently do you recommend retesting the thyroid panel as well as antibodies during pregnancy?
Dr. Aumatma:
If they started with thyroid issues pre-pregnancy, then every 4-6 weeks. If they didn’t, then 8-10 weeks. They can go a little bit longer in between tests if they have no thyroid issues.
Like I said earlier, the number of women that I see have dysregulated thyroid through pregnancy is really high. If we are supporting and are on the team of pregnancy support for people, then we always want to see the thyroid. We will see plenty of women who are like, “Hey, I didn’t have any thyroid issues. What the heck, Doc?” Pregnancy will sometimes bring the need for support for the thyroid up way more.
The other piece that we didn’t talk about is often pregnancy is stimulating antibodies. I haven’t seen it as much during pregnancy, but there will be a rise in autoimmune thyroid conditions post-partum.
A lot of those women will struggle with the second baby. First baby, they’re fine. They got pregnant, no problem. They had a healthy pregnancy. Gave birth to a healthy child. Then baby #2, they’re like, “We have been trying for three years, and it’s still not happening. What’s going on?”
Oftentimes, they have got a thyroid autoimmune condition that popped up post-partum because the pregnancy is a hard thing to metabolically regulate. It’s a really high demand on our body. It’s not a surprise that our body would wig out after a pregnancy. It’s a lot of change, a lot of hormonal flux, a lot of nutrients being pulled that all of a sudden, what your body was able to do before you had any children is completely different from what it’s able to do now. It doesn’t have enough of the reservoirs to be able to do that.
Dr. Eric:
A lot of these women with post-partum thyroiditis, if you were to test the thyroid antibodies during pregnancy, they would come back positive. The problem is with conventional medicine, if the TSH is within the reference range, if it’s a 3.5, which is in the lab reference range, they probably won’t test the antibodies. If they did, they would most likely see that those antibodies were elevated.
When they give birth, it’s almost like the straw that broke the camel’s back rather than the trigger. They had this autoimmune component, and it perpetuates sometimes after that, is what you’re describing, making future pregnancies difficult.
Dr. Aumatma:
It’s also absolutely what you said about the TSH not being abnormal enough to trigger the antibodies. I have seen so many people who try to go through the insurance route who will have struggle with getting their doctors to order antibodies. “Nope, they’re fine. Why would you test those? Your TSH is fine.”
We didn’t talk about optimal levels of TSH, T3, and T4 in that fertility period. To me, I think it’s slightly different than what is normal. I like to see TSH pre-pregnancy below 2, for sure, ideally even below 1.5. I should put a cap on that. Above 1. Between 1-1.5, which is a really narrow range.
T3 and T4 ideally somewhere in the middle of normal is good, optimal.
For pregnancy, the ACOG organization has put TSH below 2.5 as the optimal. We will generally go with that. If they were below 2 pre-pregnancy, and it goes up to 2.5, we’re not freaking out. But TSH in pregnancy is also very important for the development of the baby.
If we don’t have optimal T4 during pregnancy- T4 is the hormone that crosses the placental barrier and impacts the brain development specifically of the baby. If we don’t have optimal TSH or optimal T4, then the health of the baby is at risk. We definitely care about that. That’s a significant factor.
Also, a lot of times, women have fine TSH, fine T4 but are struggling with T3. They feel like shit through pregnancy. We could give you a tiny little snap of T3, and you would feel so much better. They go to their doctor, and their doctor says, “Absolutely not. You don’t need T3. You’re fine.”
The health of the mom matters. How she is going through this pregnancy matters. It’s really important for her not to feel exhausted the entire pregnancy. It could be avoided with microdoses of T3, which are not going to cross the placenta but are going to make a difference in how she feels.
It’s a lot of things to weigh out. For me, I’m like Mom first. Yes, we absolutely care about the baby’s health. We care about what is happening for the baby. We care about pregnancy and post-partum. But we also want to support this mom as she is going through this journey. It’s not just about the baby.
It’s really not fair to moms who are just the carrier of the child. “Grow this human. We just care about this human who will come out of you,” which is the attitude of a lot of doctors. We want to be the advocate for the women. You can have a different experience. If you’re exhausted, and your thyroid hormones are suboptimal, but they’re meeting the status quo, your body’s need is still a little bit higher than the status quo. Supporting that will help you so much.
Dr. Eric:
Sometimes, you do go by symptoms regardless of what the thyroid panel says, or if someone is a little bit on the higher end but still within the lab range, you might recommend thyroid hormone or some T3. Is desiccated thyroid hormone safe during pregnancy?
Dr. Aumatma:
I don’t like it. It’s adding dysregulation amongst dysregulation, right? Pregnancy is this time of massive flux. The need is going up and down. Then you add another variable, which is desiccated thyroid, which is also not consistent. It’s really hard to regulate. My ideal would be microdoses of T3, which is just going to push it a little bit but not so much that it’s going to replace or be overwhelming to her body.
I feel safer with that. I need to look into the studies. Is desiccated even safe? I don’t know if it’s contraindicated. I will look that up. I never use it. Oh god, that sounds so scary to me, to add another layer of dysregulation there.
Dr. Eric:
One last question I have is when it comes to supplements. I know you have your own supplement line. I’m guessing you don’t just recommend a prenatal. You probably do recommend a prenatal, but in addition to that, do you recommend Omega-3 fatty acids? Based on the nutrient testing you do. Some of it depends on what comes out on the test results.
Dr. Aumatma:
There is a standard for pregnancy, which is a prenatal, Omega, or DHEA, and a good vaginal and gut probiotic. Those are the foundations.
On top of which we could tailor to whatever people need. Those can really start in the fertility period or preconception phase. The fertility line of supplements is really to dial in what do people actually need based on what’s happening for them? Infertility is often a blanket diagnosis. “You have infertility.” It means absolutely nothing for the majority of people.
Instead, our supplements. The first thing will be you don’t just go online and take a bunch of random supplements. Totally anti-that. If you land on our website, it will take you through a quiz that will point you into the direction of which is going to be the right supplement to layer on top of the core supplements that you’re taking.
Our approach is very different in the fertility space. Instead of every supplement under the sun, every nutrient under the sun, if we could figure out that your issue is with the uterine lining, for example, let’s just give you the things that are needed to support the uterine lining instead of every single nutrient that is going to overwhelm your body, make really expensive pee and poop, but do nothing actually to support your fertility.
Essentially, how do we tailor this to each person rather than how do we make blanket recommendations? That’s the foundation. If they’re working with us, then of course, the custom nutrients and things that their body specifically needs can be tailored even more than our analysis. It’s called a Smart Fertility Analysis.
By the way, I should say that since you mentioned the supplements. We just rebranded. It’s coming out really soon. The new line is going to be called Madre Fertility. It has the analysis on the website. If someone looks up Fertile Foundations, they will still find my line, but it doesn’t have the fancy analysis guiding them into what they should take.
Dr. Eric:
That sounds awesome. Very cool. Congratulations on the rebranding of the supplement line.
I know you covered a lot. Is there anything else that you wanted to share? Anything else I didn’t ask you that I should have asked you?
Dr. Aumatma:
No, I think this was really good. There is a lot of good questions in there.
Dr. Eric:
Thank you so much. Dr. Aumatma, where can people find out more about you? If you could let them know about your website, your podcast, anywhere else, like social media.
Dr. Aumatma:
Sure. The podcast is called Egg Meets Sperm. That’s a really good starting point if you want to learn more about fertility, how to navigate stuff.
Our website is HolisticFertilityInstitute.com. Social media, I’m @HolisticFertilityDoctor on any platform.
Dr. Eric:
I appreciate your taking the time to share this with everyone.
Dr. Aumatma:
Thank you so much for having me, Dr. Eric.
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