Recently I interviewed Sarah Clark, as she discussed how to overcome infertility. If you would prefer to listen the interview you can access it by Clicking Here.
Dr. Eric Osansky: With me, I have Sarah Clark, and we are going to chat about fertility. When Sarah was 28 years old, she received a diagnosis of premature ovarian failure. She had both of her children through IVF (in vitro fertilization). Years later, she realized the root cause of her infertility was a food sensitivity and later a gut infection.
Sarah is a certified life coach with accreditation from the International Coaches Federation and a health coach with training from the Institute of Integrative Nutrition. She is the author of Fabulously Fertile: Supercharge Your Fertility Naturally. Her fertility coaching program, which includes functional lab testing, supports couples to make diet and lifestyle changes that dramatically improve the chances of a healthy pregnancy and baby. On her Get Pregnant Naturally podcast, she shares with functional medicine and natural fertility solutions, we can eventually reverse infertility. For more information, you can visit her website, FabFertile.com. Thank you so much for joining us, Sarah.
Sarah Clark: Thanks for having me, Eric.
Dr. Eric: You’re welcome. Let’s dive into your background. Let’s talk about how you started helping coaches with infertility.
Sarah: In my early 20s, I had irregular cycles. During my teen years, I had great skin, and all of a sudden, I got acne in my early 20s. I had a weird fungal rash. With irregular cycles and acne, I went to see my conventional medical doctor. They put me on hormonal birth control. That obviously regulated the cycle, but falsely, and helped the acne a little bit, but not a lot.
I’m a big planner, so I had a life plan of getting married at 25 and having kids at 28. I got married at 25. Shortly before I was 28, I knew I needed to get off the pill and figure out what’s going on here. I went off the pill. That is when I had the diagnosis of premature ovarian insufficiency or failure as it was known, which is a loss of function of ovaries before the age of 40. I was told the only way I would ever have children was through donor eggs. I remember the OB-GYN reaching up on her shelf, grabbing the brochure for IVF, and saying, “Here you go.” I was completely shocked, devastated. That wasn’t my plan of how to have my children.
But I didn’t take any time to grieve. I went straight into action. I got on a list for a donor egg. Back then, the donor egg profile came in the mailbox. I waited for the maternal and the paternal info. I got the profile. We were lucky enough on our first transfer to have our daughter. She is about to turn 21.
When I said “donor egg” back then, people didn’t know what that was. Now, we have more couples going through IVF. We have embryo adoption and embryo donation. I had a guest recently who did embryo adoption. She adopted an embryo that was frozen for 13 years. The natural siblings are 13 years to her little children, who are now two and four. Science can do some cool stuff.
We had a couple embryos left over. We wanted the kids close together. I was super stressed about having them close together. I went back in after a year. That first transfer did not work. I went on another list for a separate donor egg. We were lucky enough after three years to have our son. He is about to turn 18. I don’t know where the time has gone.
After I had my daughter, I had nine colds. Every cold turned into a sinus infection. I thought it was a good idea to take tons of antibiotics for all those sinus infections. I had chronic bladder infections, sinus infections, yeast infections, toenail infections, dandruff. My immune system was low. I caught every cold and flu that went by. I still wouldn’t have said I was unhealthy.
I was working in a corporate environment. I was in HR for years. I decided I wanted to bring a life coaching course into HR.When I did that, I had my own personal wakeup call. It’s always health and wellness I have loved. I took a health coaching course. That is when I discovered all these food sensitivities: dairy, gluten, and later, corn. I had gut infections, bacteria, and parasites.
The thing I discovered that took me forever was chronic stress. I actually thought I wasn’t stressed. When I got that diagnosis, I wouldn’t have said I was stressed. I am the kind of person who likes a lot of energy. Let’s go. That was stress all along. I was disconnected from my body. I didn’t discover this until years later.
Now I help people who have been told donor eggs are their only option. Most people have gone through multiple failed IVF cycles. We are helping them get pregnant naturally, or if they go to IVF, they get pregnant with their own eggs.
Dr. Eric: You said that with your daughter, it was successful the first time. With your son, you had to do two rounds?
Sarah: We had embryos left over from my daughter’s donor. That didn’t work. We went on another list for a separate donor. I had to wait for that. Then I had my son. Both times, it was on the first transfer of the fresh embryos, when they used to do fresh transfers. They do fresh and frozen now.
Dr. Eric: Is it common for everything to go okay with the fresh transfer?
Sarah: Usually with IVF, it takes three rounds at a cost of $60,000. The fact that it worked for me on the first fresh transfer, I had my daughter at 31 and my son at 34. The donor eggs were in their late 20s. That may have helped. Many people we see, that’s not the case. It’s been failed cycle after failed cycle.
Dr. Eric: Like you said, even if it does work on the first try, it’s very expensive. Ideally, you want to try to get to the root cause of the problem, so you can hopefully avoid IVF.
Dr. Eric: Speaking of causes, can you talk about some of the common reasons why more and more women are dealing with infertility?
Sarah: We are coaching couples, even though we are primarily dealing with low AMH (anti-malaria hormone) or high FSH (follicle stimulating hormone). Typically, people are being told that donor eggs are their only option. 50% of fertility can still be a male factor. Even though males are being told their sperm is fine, they haven’t looked at it through functional reference ranges.
Typically, we are seeing all these missed healing opportunities. Obviously, thyroid issues. We see more hypothyroid issues, Hashimoto’s or subclinical thyroid issues. Especially with the high FSH, we see blood sugar irregularities and insulin resistance. We are seeing a lot of autoimmune disease in conjunction with low AMH and high FSH. Typically, Hashimoto’s and Celiac. They go do IVF and have an autoimmune disease, and no one does anything. No one has targeted changes.
We see food sensitivities, non-Celiac gluten sensitivity, gluten off the charts. People may have gotten gluten-light or 80% gluten-free. If you have a sensitivity, even a crumb will cause reaction in your body.
We see the chronic stress piece. Doesn’t matter how old you are. Whenever you decided you want to expand your family, there is a lot of stress in that when it’s not working. Especially if you have gone through failed IVF, thought that was your solution, spent a lot of time and money in there, and it hasn’t worked, fertility can impact all aspects of your life: your social life, seeing families at church, going out in public and seeing families and children and pregnant bellies. You may lock yourself off from some of your friends and family because it’s too painful. The chronic stress of this.
We see alot of trauma, either childhood trauma or trauma from the infertility diagnosis that needs to be addressed. We believe in a mind/body/spirit approach. We look at the biochemical stuff. It’s important to look at mindset and the spiritual side of it, really believing that the spirit of your baby is waiting for you. It’s ready to come down. Here she is. Many people feel that diagnosis from the reproductive endocrinologist can get embedded in their subconscious. “You will struggle. It’s not going to work. You can only use donor eggs.” People start to believe that. It’s really important to believe that you’re not broken. You’re fertile. You can conceive.
Dr. Eric: It sounds like you take a whole-body approach. You mentioned diet and the importance of gluten. Also stress and past traumas could have a big impact, of course. Sleep. You look at the whole picture.
Sarah: Yeah, sleep, for sure. We see a lot of people with dysregulated sleep. Tired and wired when they wake up. Unable to fall asleep. It could be gut bugs or gut infections. Nutrient deficiencies. We see a lot of sleep in both partners. People have struggled for years and can’t sleep at all. After making the changes, they are able to finally get their eight hours.
Dr. Eric: Let’s talk again about diet. You mentioned gluten, which a lot of people listening to this are familiar with the concerns with gluten and gluten sensitivities. You also mentioned Celiac. Even if you don’t have Celiac, you could have a gluten sensitivity. I’m sure there are some people who say, “How can eating gluten prevent myself from getting pregnant?” Either the impact on the female or male. Can you expand on food sensitivities and talk about the relationship between gut health and infertility?
Sarah: Yeah. A lot of people like me were put on hormonal birth control. That can predispose you to food insensitivities, gut infections, and nutrient imbalances. We see that a lot. With the food sensitivities, if you have a food that you’re eating, and it’s coming in every day, it’s causing inflammation in your body, then your body wants to survive, not procreate. It’s causing all this inflammation.
We have our couples start off with an elimination diet, taking out those top allergens, like dairy, gluten, soy, corn, peanuts, eggs, processed sugar, and alcohol for 10 days. Then we systematically reintroduce over the course of 30. You can really see how each food impacts your body. Most people who come to see us, it’s not a sick population, but they don’t know how unwell they are until they feel amazing. They could have niggling bloating, eczema, post-nasal drip, digestive issues. They don’t know how great they can feel when all those common but not normal complaints go away. The food piece is huge. We see people’s energy and all areas of their life improve by eating the right diet. Taking out those top inflammatory foods, reintroducing them.
We have them tweak it with food sensitivity testing. You may take out foods for 60-90 days. If it’s read on some of the testing, you take it out then. Most of the food, not gluten, you can bring back in, once you’re healing the gut.
We are doing gut testing, looking at the DNA of your stool. We see a lot of people with bacterial infections, fungal infections, multiple parasites. We see H-pylori. You won’t be able to absorb all your nutrients. Passing back and forth to partners. Once you heal the gut and work on gut repair, alot of those food sensitivities you may have, especially if you have leaky gut, your body is mounting that immune response to your favorite foods. People take the food sensitivity test, and lo and behold, you realize you are intolerant toall the foods you are eating on a regular basis. We see that a lot with our clients.
As you heal the gut and eradicate the infections and repair the gut and take out those inflammatory foods, then the body starts to come back alive. We just had someone here who has .02 AMH. She is very young, like 26/27. Within six weeks of working with us, her period is already back, and she hasn’t had it in years. We have had people get pregnant naturally when their AMH is .04. Conventional medicine turns their back on those people.
Dr. Eric: That’s awesome. Do you use the GI Map?
Dr. Eric: For food sensitivity, you said you start them off with an elimination diet and do food sensitivity testing.
Sarah: Yes, we start the elimination diet protocol that they follow. We use the Vibrant Gut Zoomer depending on where they are in the country.
Dr. Eric: Okay. Before doing these interviews, I always do my research and try to listen to an episode or two of the person guesting on other podcasts. I heard you did Dutch testing as well, yes?
Sarah: Yes. We may do an adrenal test to start with. A lot of times, it’s a type A, busy, ambitious person who in the past, they have done a whole bunch of stuff. Now they are throwing everything at this. Maybe their adrenals are completely fried, and their cortisol is flatlined. It’s important for them to see what is happening with their cortisol levels, so they can pull back and work on self-care.
We do the Dutch adrenal or a full Dutch complete, looking at your sex hormones, which pathways are going down, your melatonin. People in the fertility sphere will read It Starts with the Egg, a popular book by Rebecca Fett. There is some good information in there, but some of it is geared toward IVF. Taking melatonin can be helpful, but let’s figure out why it’s low in the first place. It may be necessary. People aren’t even taking magnesium. We use a Dutch test.
We do genetic testing. We do a female hormone panel. It will give us what’s happening with your blood sugar, your thyroid. It looks at the FSH number and more. Female hormone panel. Then it will tell us specific diet and lifestyle and supplement recommendations to support those genetic SNPs. It’s not just, “Here’s your genes. You’re doomed.” It’s, “We can support those with these targeted steps.”
We also do a blood chemistry view. We do a semen analysis, looking through functional reference ranges. We don’t do all these tests at once. They can be overwhelming. We could do a hair tissue analysis testing. Check to see if there are heavy metals or nutrient imbalances. Those can be helpful, too.
Dr. Eric: Quite comprehensive, it sounds like. As far as the semen analysis, a few questions. Do you require the couple to be present? Do you always also evaluate the male, or do you focus more on the female? How does it work in your practice?
Sarah: We will exclusively coach couples unless they are single by choice. By just coaching women, we are missing the whole other piece of the equation. Even if he doesn’t have any issues with his semen, there could be issues in the relationship. This infertility will impact all other aspects of your life. It will either pull you together or tear you apart.
Even when his semen analysis is fine previously, or they have gone through years of treatment- Typically, they have gone through IVF, so they have had a semen analysis. Sometimes, they have tried naturally for two years, and no one has checked the man’s semen analysis. We work with Legacy, a digital semen analysis at-home testing kit for men. They get their testing done. It will give you the count, DNA fragmentation, fertility, and more. We will look at that through the lens of functional reference ranges. We look at the male’s blood chemistry as well.
He has his own health goals. She will have her own health goals. Then they come together as a couple to discuss them all.
Dr. Eric: I’m guessing you have them both follow maybe not the exact same diet because it depends on the testing, it sounds like. It’s up to the person obviously. You would ask them to both follow a strict diet.
Dr. Eric: And make other lifestyle changes, too.
Sarah: Yes. If they are living together, cooking together, eating together, we wouldn’t want the woman over here making all her changes, and he is over there eating Big Macs and pizza. No. They are doing this elimination diet together. At the end of it, she will get more tweaking with food sensitivity testing. We will look at his semen analysis and blood to see if that’s necessary for him, if he presents with any kind of fertility issue. He has his own goals.
Sometimes, in the partnership, the woman ends up nagging the man to take his supplements, change his diet, get rid of alcohol and caffeine, but she needs to focus on herself. He will come over when he is ready. That’s why it’s important to have a coach here. We never recommend coaching your partner. It’s disastrous. Focus on yourself. We will coach the male partner. 99% of the guys are ready to make the changes. They are open-minded and ready to go. If they’re not, it’s not a good fit for the program.
Dr. Eric: I’m sure you screen them before, just to make sure they are both on the same page, and you can coach both of them.
Can you talk about environmental toxins in fertility? Obviously, that has been a huge issue overall, over the last few decades. It seems like it’s getting worse as far as our toxic world, the impact that that has.
Sarah: We always ask our couples to check all their products against the Environmental Working Group. You want to get lower than 3. You want to ditch the plastics. You want to slowly move up the personal care. You don’t want to throw it all in the garbage; as each one expires, you would get a new product that is non-toxic. All of these are endocrine disruptors. There are the Dirty Dozen in the EWG.
Make sure that you have filtered water, that you’re not drinking out of a plastic water bottle. All of these things can leach into the body and disrupt the endocrine system. If it’s freaking you out, and you want to go around the house with a garbage bag, we say to slowly do it as each one expires.
I interviewed Dr. Shanna Swan, who wrote the book Count Down. She had a study that just came out talking about how in the last 40 years, male fertility has dropped by 50%. A lot of it is due to some of the environmental toxins, like glyphosate spread on food crops. Make sure you go organic. Stuff that’s in our water, over 85,000 chemicals we’re exposed to. Looking at that stuff is really important as a first step. Go organic. Cheap food is not good. Good food is not cheap. You can do the clean 15 or the dirty dozen. Make sure the dirty dozen foods are organic. The environmental toxin piece is key. Slowly do it.
Dr. Eric: Organic food, filtered water, cleaning products, cosmetics. A lot will be in their own home because once you step outside, there is only so much you can do. Do you recommend air purification systems or supplementation to help the detoxification process?
Sarah: You can get an air filter and do that. Blue light impacts the body, too, from the tablets and screens. We recommend blue light blocking glasses.
From a supplement perspective, we are recommending a whole protocol based on the testing, your health history. We have binders and things to mock up if we see exposure. With detox symptoms, we look at doing rebounding and dry skin brushing. We always recommend a castor oil pack over the liver to help move the sludge out of there. We have some teas, like milk thistle tea
Drink lots of water. Many people come to us, “I am drinking 1-2 glasses of water a day.” Make sure you have a good filter, like a Berkey water filter. A Brita is okay; it’s not our favorite. Get a glass or stainless-steel water bottle to drink out of.
Dr. Eric: I’m not a big fan of Brita, but it’s better than just drinking tap water.
Sarah: People do the fridge or the tap.
Dr. Eric: Fridge is not much different. I would agree with that. Do you ever recommend infrared sauna?
Sarah: Yes, we can recommend that, too. It can be good.
Dr. Eric: Earlier, you said you see mostly hypothyroidism, which is a lot more common than hyperthyroidism, which is what I and a lot of my patients deal with. We also get listeners who have Hashimoto’s. Most people who have hypothyroidism have Hashimoto’s. When you see someone who has lower thyroid hormone levels, and part of the testing is to see if they have Hashimoto’s, if they haven’t been diagnosed, you test for the auto antibodies and maybe recommend for them to see a practitioner with prescribing rights to be on thyroid hormone. How do you handle your hypothyroid patients?
Sarah: 99% of the people we work with, there is something going on with the thyroid. They have been told their TSH is normal, and it’s 3 or 4. Typically in the reproductive endocrinology world, for fertility treatments, they like to have it under 2 or 1.5. They may be taking a T4 supplement, a Synthroid or levothyroxine. Maybe they are already taking that. No one has looked at the full panel or the antibodies.
We are not diagnosing, but we see things out of alignment. The physician on our team is licensed in about 27 states, so she can do a prescription with a consult with her. Practitioners in other states can then get a prescription. Sometimes people are like the idea is to be off the thyroid medication. For us, bioidenticals may be necessary. Thyroid medication may be necessary. It’s also important to do the targeted diet and lifestyle changes with them because medication alone is just a Band-Aid.
We have had people with antibodies at 900 and making these changes come down under 100. People who have Hashimoto’s and are trying to get pregnant before they come to see us with repeat miscarriage, failed IVF cycles, and it hasn’t worked. No one addressed the Hashimoto’s or the high antibodies.
There is lots to do from a thyroid perspective. I do a masterclass and ask the question, “How many people here have a normal TSH?” All these people are struggling with low AMH and high FSH. No one has looked at the full panel, the T3 or T4. There is no due diligence. The doctor can’t run it because of insurance issues and stuff like that. So dig deeper.
Dr. Eric: Sometimes, what we’ll see is they will say it’s normal, and it is normal according to the lab reference range, but it is outside of the optimal range. TSH is maybe 3.8, which is within the lab range, but definitely above optimal. Same thing with the T3 and/or T4. It’s on the lower side but still within the lab range but outside the optimal range.
Sarah: Yeah, that was me. My TSH was 3.5. My hair was falling out. My skin was dry. Everyone is like, “Your thyroid is normal. There’s no problem.” But there was a problem.
Dr. Eric: Before we started the interview, I mentioned that years ago I wrote a blog post on infertility. There are a few statistics. I wish I could say I remember it all, but I have it right here. One of the studies show that the prevalence of infertility was 47% in those with Hashimoto’s and 52.3% in Graves’. Either way, whether you have Graves’ or Hashimoto’s, much higher incidence, prevalence of infertility.
Also, you mentioned the TPO antibodies. I did come across some studies that show that in female infertility, there is a higher prevalence of positive TPO antibodies when compared to controls. A few other studies have shown increased risk of miscarriage with thyroid autoimmunity. There was one more here that showed that during the first trimester, the pregnant woman with autoimmune thyroid conditions carries a significantly increased risk for miscarriage. Actually, even when they had normal thyroid hormone levels, so when they were euthyroid. Obviously, the low thyroid hormone levels are a concern. Or high if you have hyperthyroidism.
Most of the evidence I presented was related to the autoimmunity. Whether you have Graves’ or Hashimoto’s, definitely get the thyroid hormone levels balanced, but you also want to do things to improve the health of the immune system.
Sarah: Going to IVF when you haven’t addressed these things, you’re at a higher risk for miscarriage and the devastating effects of that.
Dr. Eric: If a couple has problems conceiving before looking into IVF, they should seek someone with experience like you. When would you say that IVF is necessary?
Sarah: It’s a very personal choice. IVF can be necessary if there are structural issues. We think most people are fertile, but there are other healing opportunities that haven’t been addressed. IVF is there to push it. If we address the chronic stress, food sensitivities, mindset, all of this is how we get you out of the fight or flight, down to the parasympathetic, reduce inflammation, and get you in that receiving stage. Then you can get pregnant naturally.
IVF can be there. It’s typically in the patience piece. We find more of an average of 12-18 months. We have a six-month program, but then it goes into our monthly piece. It’s 12-18 months before you can get pregnant. People want to push it. It’s a personal choice. Obviously, the older you get, you may feel your window is closing in, so you have to do it. To me, there is never any negative side effects of you working on your health. Either you get pregnant naturally, or IVF will actually work.
Your RE won’t tell you any of this stuff. I heard an RE say the other day, “You should go gluten-free and dairy-free.” That’s good. Some of this stuff is permeating into the conventional side of things. Typically, it’s pushing you over there.
It’s a personal decision. You have to do what feels right for you. They are selling packages of IVF. Buy a three-cycle package. A lot of insurance and egg freezing. There is a Wild West of fertility industry, which is billions. The stuff that’s going on in the world right now, infertility, 1/8 mistakes and 1/8 couples are trying. Most people know someone who is struggling. It’s only going to get worse because of all these environmental toxins and things that are coming at us.
To me, working on your health first, either pregnant naturally or doing IVF, when you’re ready, if necessary, then you can make that decision.
Dr. Eric: Are there a lot of side effects associated with IVF?
Sarah: I have done an episode on that. Some of them can be at higher risk of ovarian cancer and other things from these drugs. There is not a lot of research around some of these things. If you are pushing your body to do something that it’s trying to say, “Hey, I’m not ready right now,” because the reproductive system will be deprioritized, and it wants you to keep walking and moving. You’re pushing it. We don’t really know.
Even with IVF children, both my kids, I didn’t figure any of this out. Both of them have food sensitivities. Both of them have mood imbalances. I didn’t work on my stuff beforehand, so they got that? Maybe. I think so. Epigenetics, they are saying you can pass infertility on to your children. We want it done yesterday is the culture we’re in. Taking the time to prepare your body instead of rushing, it just makes more sense.
Dr. Eric: Yeah, I definitely agree. I also speak with many women who I’m working with on their thyroid conditions or autoimmune thyroid conditions. Many of them want to get pregnant, too. They are at the age. They are telling me, “Can I start trying within three months or six months?” They are putting a timetable on it. I definitely understand.
I agree that you want to try your best to avoid the IVF, but even if you end up doing the IVF, you want to try to do things prior to that to improve your health, not just jump into the IVF. It makes sense that you wouldn’t want to give it just three months or six months. Maybe in some cases, it depends on the person. If six months isn’t enough, 12 months might be the answer for you. It would be a shame for someone listening to give up after six months and get the IVF when they maybe just needed another three to six months.
Sarah: Just to dig a little bit deeper on some of these things. If you have a targeted plan with testing and someone looking at it to see how we can optimize it. Many times, people are finding generalized guidelines of fertility diets and superfoods. These things may work for someone else and not you. If you take a targeted, functional approach, and have a team to help you dig in and work on a lot of these limiting beliefs or dealing with stress, this can be helpful, too.
Dr. Eric: If couples have been struggling with infertility and really want to try to avoid IVF, what are some action steps they could take?
Sarah: If you are ready to go hardcore, do the elimination diet. I have an episode on my podcast about how and why to do the diet. If that’s too hardcore, at least go organic. Really work on the diet piece with your partner together.
Second would be focus on sleep. The most restorative sleep is between 10pm-12am. Go to bed before 10 if you can. Really prioritize sleep. Get the full amount.
Work on your intimacy. It’s not just about baby making; it’s lovemaking. Date nights. There is often a lot of strain on the relationship. Reconnecting with your partner. Don’t put joy on hold until the baby comes. Focus now on what makes you happy.
That whole self-care piece. It’s a buzz word, but it’s important to mother yourself and parent yourself now before your future child comes.
Work on diet, sleep, and dig into that self-care to get yourself out of the fight or flight. If you are feeling panicked, and you feel your eggs are too old, dig into that piece. You are fertile. You are a parent now, the moment you start trying. Dig into that intuition that you know your body better than someone else who may have labeled you with this diagnosis. It’s important to know that and be empowered by that.
Dr. Eric: Wonderful. Is there anything we missed? There is a lot of information on your podcast. Anything else, or did we cover at least the basics?
Sarah: The basics are covered. It is this mindset piece of if you have the diagnosis, you are not the label. To dig deep or get a second opinion. Don’t let the medical gaslighting of you, thinking “I should get my full panel,” and your doctor won’t run it. Know your numbers. Dig deeper. Take charge.
Dr. Eric: Definitely check out Sarah’s podcast, Get Pregnant Naturally, as well as her book Fabulously Fertile. Also, you have a fertility challenge opt-in. The website is FertilityDietFreebie.com.
Sarah: There are summer recipes available there. There is a meal plan and grocery shopping list. It helps you dig your toe into the fertility diet. It takes out those top allergens. There is some awesome food in there. It’s not about you starving.
As the seasons change, if you’re listening to this later on, there will be fall recipes, winter, and spring. Right now, we’re doing summer.
Dr. Eric: Thank you again, Sarah. Appreciate you sharing your experience and knowledge with everyone. Look forward to maybe having you back in the future.
Sarah: Thanks for having me, Eric.