[00:00:00] As a doctor, I see myself as a detective and that's a very strong mission of mine is to make sure that I am helping this person to figure out every possible option to help just increase their chances of getting pregnant and reach their dreams. And so having conversations is a really important part of that.

[00:00:31] And I was thinking about you because I thought, this is what I do with people who are working with me, but I want you to know the Importance of these types of conversations so that you can initiate whether or not you're working with me or not. These are conversations to initiate with your doctor to help open up your fertility chances, because what that's setting up [00:01:00] is just helping your doctor to understand even more about your fertility picture to help find that root cause of what's keeping you from getting pregnant and.

[00:01:12] Once that can be found and addressed, then that's what opens up the best chances of getting pregnant. Does that make sense? So as I was creating this episode, I could have written down 50 conversations to have with your doctor when you're talking about PCOS fertility. But the direction that we are going to go today is, what conversations need to be happening to really set the stage for your fertility plan.

[00:01:43] Okay. So as we dive into this, I just want to thank you for being here. I truly, just love having you in this community and to be able to. share with you on this platform. And if you are loving this [00:02:00] podcast, can you please just jump over to Apple podcasts and leave me a positive review? That would just mean so much to me.

[00:02:07] And it really helps to keep the podcast going. And in the eyes of people who are searching for these answers. So thank you so much in advance. So we are talking about these five important conversations to have with your doctor and, step one in my PCOS fertility protocol is to have an individualized PCOS fertility call.

[00:02:36] And. These are the questions that I'm asking in that first session because they are Vital to understand what's going on in this person's body That's keeping them from getting pregnant and what helps them what needs to happen in their fertility plan Moving forward to help them increase their chances of getting pregnant.

[00:02:59] [00:03:00] Okay, so number one Conversation number one is to talk about what was going on hormonally for you back in puberty. And this is really important because, and it's often missed because so often doctors are just looking at the here and now and what's happening today. You know, your periods have been irregular.

[00:03:27] All right, we're going to get you on this medication so we can get you ovulating today, which Of course, that's the goal. But my issue is that PCOS fertility medications are being used at the wrong time. It's not that they are bad. They're being used at the wrong time.

[00:03:46] So conversation number one is what was happening early on with your hormones around puberty. And this is really important to understand what was happening at [00:04:00] that time. Were similar issues still going on, from right when you started your period? Were they irregular? Were they super heavy? Did you have acne?

[00:04:10] And that has never gone away. To understand what's going on with your fertility right now, it can be powerful to talk about and understand what happened before, not always. Sometimes we have this conversation and it's like, lots of normal stuff was going on at that time. But here's where you are now.

[00:04:29] You aren't getting pregnant. Your cycles are irregular. And that's still really helpful information, right? Because we know that something switched at some point in time.

[00:04:40] Which leads me to question number two, which has, was there ever a big switch in your periods and what was going on in that time? So I have people just kind of talk through their reproductive history from when they were young, when they first started having their periods.[00:05:00]

[00:05:00] We really focus in on, was there a time there was a big switch? Or was this always ongoing or was it more gradual and each one of those stories needs to be approached differently. Yes, I remember there was this big stress back when I was in college and ever since then.

[00:05:23] Periods haven't been the same or I went through this trauma. I lost a parent and ever since then my periods have not been the same. Birth control can also be a time like this. I can say, okay, you know, my periods used to be normal. I was put on birth control or I chose to go on birth control. And now that I'm off it, my periods are different.

[00:05:45] So a variety of things, of course, can lead to cycles changing, but it can be really helpful to understand. Okay. Was it one specific event that really you could tell after this? That's when things [00:06:00] changed because you've got to go back to that time. to see, okay, what still is happening in the body that hasn't been resolved.

[00:06:08] That's keeping the hormones doing what they're doing and not keeping cycles regular. This is important work as a doctor to understand really your whole picture. And I hope that somebody is asking questions like this for you.

[00:06:25] Question number three is hormonal birth control use. And I touched on this a little bit here in the last question and how oftentimes women can say, yeah, when I started hormonal birth control, that was a big switch for me.

[00:06:41] So we're seeing this more and more often that hormonal birth control causes issues coming off of it with periods. So hormonal birth control is either the pill or an IUD that Has hormones in it.[00:07:00] There's also implants for birth control, things like that. Non hormonal birth control would be condoms, diaphragms, things like that.

[00:07:10] If you've used hormonal birth control, it's. Not a bad thing. It's not that it's automatically like, oh, okay, you use that. Well, gosh, like that sucks for your fertility. No, not at all. We just have to understand because, you know, I'm working with PCOS day in day out. I'm always asking. Were your periods regular or different before getting on?

[00:07:33] birth control versus after sometimes I hear yes, sometimes I hear no, it's different. And that's the point, right? We have to understand what's going on with you. What is your picture? And so if you have used hormonal birth control, think about that, you know, was it different before getting on it? Were your cycles?

[00:07:53] specifically different before getting on it. Did your body feel different? Because coming off birth control, a lot [00:08:00] of times for women, it's not just the cycles that are affected. A lot of times, all of a sudden acne comes out, weight gain happens really easily. And it's not like you're eating more or making changes in your, in your life.

[00:08:14] It's just the weight comes on easier. That extra hair growth, on the chin, the chest, the back, things like that can really pop up.

[00:08:24] So be mindful of timelines in your life of, first off, were you on hormonal birth control? And second off, what does that look like for my cycles and my body and my reproductive health.

[00:08:37] So the 4th important conversation talking about your fertile window, do you know your fertile window, and if not, how can you adequately figure that out? So the fertile window are the few days in the cycle that you're fertile.

[00:08:54] We, as women, are not fertile every single day of the month, of [00:09:00] the year, of our lifetimes. That has to do with, hormones that are going on in the body that keep us from getting pregnant for, you know, the fertile windows about five days and we're not fertile the rest of that time.

[00:09:16] Sperm can live up to five days, that's within your fertile time, but it's before you're actually showing signs in your body of ovulation happening. So. You want to know, are you aware of your fertile window?

[00:09:32] And the 1st step is to ask, are you having signs in your body of ovulation happening? Little mild pelvic cramping, breast tenderness, maybe some spotting. And those are giving us different signs of ovulation or different hormone imbalances that are going on that are keeping you from ovulating.

[00:09:54] And so then the next step would be figuring out is [00:10:00] ovulation happening. So you can use an ovulation predictor kit, an OPK, temperature tracking can also be helpful with figuring out ovulation in your fertile window. There's also a menstrual cycle mapping test. Even before that, just running a basic progesterone test is really important because if it's below a certain number, that indicates that you didn't ovulate.

[00:10:24] It's got to be above a certain number to say, hey, yes, you have enough progesterone, you ovulated, and if you were to get pregnant, you could carry that pregnancy forward. So getting that progesterone test is helpful. And then also a menstrual cycle mapping test to understand are your hormones doing what they're supposed to be doing in order for you to ovulate.

[00:10:46] So a menstrual cycle mapping test is a urine test and what that does, you provide a sample almost every day of your cycle. And then the lab will provide you, based on your samples, [00:11:00] what your estrogen is doing throughout your cycle, what your progesterone is doing throughout your cycle, and what your LH levels are doing.

[00:11:08] So this is a powerful test to understand, is your estrogen doing what it's supposed to be doing? all throughout the cycle. When does progesterone rise? When are you seeing that ovulation happening? Because for many of us, it's not in that mid cycle. And if you're someone who has a very long cycle, you can say, Oh, well, you know, for ovulation is not happening until day 35.

[00:11:35] And I figured it was going to be like day 22. And so, yeah, we have been having sex on the wrong days of the month. Okay, so that's a pretty Straightforward reason why you aren't getting pregnant. That's why this conversation is really important to figure out that fertile window. And if you don't know it yet, what are the best ways for you to be able to figure that out?[00:12:00]

[00:12:00] Then the fifth conversation that's really important to have with your doctor to set this fertility stage is what was always taught to me as seems. This is how I have now used it in my practice, is to ask about stress, sleep, energy, mood, libido. Yes, L is not in the word seems, but it's sex in the word seems, okay?

[00:12:29] So, these don't, well, outside of libido, these don't have to do. Directly with fertility. So it's like, okay, why are we talking about my sleep when I am in a fertility appointment. Actually, that has a big impact on hormones. So if you're somebody who struggles with insomnia. And you're not sleeping, you're only sleeping like three hours a night, or maybe you're sleeping and yet you're waking up [00:13:00] every 45 minutes, something like that. That's interrupting your sleep.

[00:13:04] Well, that's interrupting your hormone patterns, which is then affecting your fertility. Having insomnia, not sleeping well, increases stress throughout the day, which increases insulin, which then shuts down ovulation. Okay. So outside of sleep, let's just talk about your stress levels.

[00:13:26] How are those? Are you super stressed throughout the day? And do you have stress coping mechanisms? And I'm not just talking about meditation, meditation. If you do it, it might be helpful. And that's awesome. Like you go get them. But. It can be easy to say, oh, you know, your stress go meditate and that'll take care of it.

[00:13:46] And when it comes to fertility and stress, you're missing out if somebody is telling you that, like, okay, just go meditate and everything will be good. No, you've got to figure out physiologically what's going on in your [00:14:00] body. Are your cortisol, your stress hormone levels actually doing what they're supposed to be doing throughout the day?

[00:14:06] Are you able to respond to stressors around you? Because if you're in adrenal fatigue, after months and years of being continually stressed out and not having the support your body needs to respond to those stressors. Then that leads to insulin issues, which shuts down ovulation that leads to, thyroid issues and, progesterone and estrogen issues. So it's just not good. Is your doctor asking you about this?

[00:14:40] Libido we've got to talk about that when it comes to making a baby,

[00:14:44] mood, how is your mood? You know, that plays a big part in libido. In stress in sleep in all these different aspects of your life, which are then, setting up this cascade to affect fertility.[00:15:00]

[00:15:00] And so is your doctor asking you about these things? Because if not, then there are missing pieces out there for you and your fertility journey. So, as you now have these five powerful conversations to talk about with your doctor, I am excited for you to hear how that goes, how that opens up even more for your fertility journey.

[00:15:28] And if you get answers back that are unhelpful to you, or if your doctor is not open to have this. Kind of holistic conversation with you about your health and your fertility. Then I invite you to reach out and talk with me. You can book a PCOS fertility breakthrough session with me at drangelapotter. com forward slash PCOS. And you and I will talk about this.

[00:15:52] If nobody has told you today, you are amazing. You are loved. You have [00:16:00] amazing gifts to share with this world. Thank you so much for being here.