How To Fix Infertility & Get Pregnant Without IVF | NaPro Dr. Gavin Puthoff, MD

You are a fertility doctor who is solving infertility without freezing embryos and not doing IVF. How are you doing this? We don't see infertility as a disease. We really truly see it as a symptom of some other underlying condition. So we practice what's called restorative reproductive medicine. You can do a full evaluation with NAPR technology, several months of treatment, and even a restorative surgery for less than the cost of one cycle of IVF in almost all cases. IVF says...

It just genuinely doesn't matter why you can't get pregnant. So they're equally okay with calling this unexplained infertility versus tubal blockage versus male factor. The biggest issue that it's ignoring is... The woman's health. The couple's health. IVF has never made anybody healthier. Ever. Full stop.

Ready to unlock the secrets behind beating infertility without ever stepping foot in an IVF clinic? In this episode, we're diving deep into revolutionary fertility solutions that you've probably never heard of. From cutting-edge natural fertility tracking...

to groundbreaking surgeries that fix hidden issues like blocked tubes and post-C-section damage that you may not know you have. We'll also reveal why so many couples get labeled with unexplained infertility when there's always a cause waiting to be uncovered.

If you or someone you know is struggling to conceive, this conversation, I feel, will change totally how you think about fertility and treatment options and give you so much hope. Joining us is Dr. Gavin Puthoff, a board-certified obstetrician He is the founder and medical director of Veritas Fertility and Surgery, where he

specializes in treating infertility, endometriosis, PCOS, recurrent miscarriage, and advanced reproductive surgery. With years of surgical expertise and a compassionate, personalized approach, Dr. Puthoff is helping couples worldwide discover real lasting solutions beyond IVF. Watch this episode, share this episode, Real Alex Clark on YouTube. You can also watch on the Culture Apothecary Spotify.

Also, I have to shout out Wireify once again, letting us use their studio. They're amazing if you are suffering from... extreme student loan debt. There is also a Facebook group for fans of the show called Cute Servatives that you should join as well. Please welcome NAPRO technology expert, Dr. Gavin Puthoff to Culture Apothecary.

Women who have their tubes blocked are often told, sorry, IVF is your best option, your only option. Is that necessarily true? It really isn't. And actually, tubal blockages are very, very common among couples who have infertility. About 25% of couples with infertility have blocked. tubes. One problem is that the way that the tube test is done has a high what we call false positive rate, which essentially means that a woman can go in for this test.

have what she thinks is an abnormal test but it actually is a false positive means it's actually not abnormal that's a certain type of issue that shows up with these tubal dye tests you know so we always offer a more specific type of test A more specific test is where we can actually check each tube independently. It's called a selective salpingography. And it also allows us to reopen the tubes with a little wire.

So actually, we just got an email from a patient this morning. She had seen us for an initial consult back in October of last year. She was told by several IVF clinics, both your tubes are blocked. We've tried this multiple times. There's no chance for pregnancy outside of IVF.

And she was adamant that she didn't want to do IVF and she wanted to get answers and actually have another option. So she reached out to us. We had her come into the office after her initial consult. We did this fallopian tube dye test. where we were actually able to thread this little floppy metal guide wire through each of her tubes, unblock the tubes, and allow her to conceive on her own just four months later. She actually just emailed us today and let her...

let us know that she's 26 weeks pregnant. Oh my gosh. So it's awesome. This is somebody who's told basically this will never happen for you on your own. How do tubes get blocked? A couple different ways. There can be inflammation inside the fallopian tubes. There can be past pelvic infections that can block the fallopian tubes. Even sometimes really severe conditions like endometriosis can cause a distortion of the normal anatomy so the tubes become blocked.

Of course, if somebody has a tubal ligation, they're blocked. And we also do microsurgical tubal ligation reversals to allow couples to be able to conceive on their own.

after we did the procedure so they can conceive without having to use IVF in those cases. 30% of women have C-sections, but two out of three may have a defect that nobody ever told them about. What is it? Yeah, so this is an interesting topic because...

it's so common and yet unfortunately so misunderstood and underdiagnosed even by physicians who should know about the condition. So when we talk about the C-section scar defect, a lot of people will think of the C-section scar that they have on their skin. That's not the one we're talking about.

So after the obstetrician makes the incisions to get down to the uterus to deliver the baby, the baby needs an escape hatch, right? So that's the incision across the lower part of the uterus. Once the baby's delivered, the uterus is then sewn back together in the delivery room. And of course, the obstetrician at that point is really focusing on, we want to make this uterus.

stop bleeding we want to be done with the surgery want to get mom back to recovery so she can hold her baby right so there's a little bit of a different focus at that point the problem ultimately is that in cases where the uterine scar doesn't heal correctly there can be a small divot or pouch

on the inner wall of the uterus and then that actually becomes a very substantial source of inflammation so blood will get trapped there during the menstrual cycle and it'll stay there literally for months and that inflammatory pocket basically of that blood being trapped there increases the risk for miscarriages, it increases the possibility of infertility.

And also, it can even increase the risk for having a C-section scar ectopic pregnancy. So this is something that women who are experiencing secondary infertility should really be looking into. Correct. Yeah, I actually think that this is the leading cause. of secondary infertility after a C-section. Holy smokes. Very, very common. We're right into the juice here. We're like barely five minutes in. This is crazy. It's also tough because two thirds of the time, they're not even symptomatic.

We've had couples who've gone through secondary infertility for four, five, six years. They've seen doctors. They've been in the IVF clinic. They've been in the fertility clinic to try to get answers. And they actually can see a defect. The patient can see the defect on the ultrasound. They'll ask.

What is that? And it could actually be causing my infertility. And generally, it's just brushed off. Oh, that's pretty common after a C-section. We don't have to worry about that. But they do have to worry about it because it's a very, very common cause of infertility. Here's the other issue is that... when there's that defect of the pouch in the lower part of the uterus where that scar was made or where that incision was made

The muscle wall at that point is also extremely thin in some cases. I've actually had patients who, when we do the diagnostic testing to find out if they have venous missile, they basically have no muscle residually there. well what does that mean for another pregnancy that's a very high risk pregnancy now that they would grow a baby inside of a uterus that basically has a break in the muscle wall so that's not safe there is a higher risk for

for that uterine scar actually rupturing at any point during the pregnancy. Unfortunately, I've taken care of patients who've lost babies from 22 weeks all the way up to 40 weeks gestation because they had a uterine scar defect that was not diagnosed or treated prior to a pregnancy. And then the scar ruptured and they lost their child. So it's one of these things for me, I'm really passionate about it. And actually our clinic.

probably treats more uterineous micelles than any other clinic in the US. So we have patients who fly in from all over the country for this procedure, even out of the country, they'll come over. I always tell our patients who are coming over from the UK, for example. It's kind of sad, actually, that they have to go across the Atlantic Ocean just to get the surgery that...

technically anybody or somebody, some specialist should be able to do for them or to be able to provide them that definitive diagnosis of what's going on with their C-section scar. And you're in St. Louis? Correct. Wow. Yeah. So we probably are doing two to three S-missile surgeries every single week now. It is that common. You are a fertility doctor who is solving infertility without freezing embryos and not doing IVF. How are you doing this?

our approach to fertility for one thing we don't see infertility as a disease we really truly see it as a symptom of some other underlying condition when you see it in that way it really forces you to do the digging to actually look for that underlying cause look for the underlying diagnosis so we practice what's called restorative reproductive medicine and our sort of flavor of this restorative reproductive medicine really in our clinic is napro technology or natural procreative technology

so natural procreative technology really focuses on identifying and treating the root cause issue behind a couple's inability to conceive so you can imagine a couple goes into a fertility clinic let's say an ivf clinic They get one or two blood tests, an ultrasound, an HSG to check the flipping tubes. And all of a sudden, they're going off into artificial insemination. And before a few months, now it's being recommended they do IVF.

they haven't gotten any answers. And actually our patients who come to see us after having gone through that process will come to us and they'll say, I just felt abused by a system where basically we will do a 10 minute consult. We'll very quickly look at our history. And then it's off to the financial department to understand how expensive IVF is. And that was their treatment option. That was basically the one size fits all for those couples.

So with restorative reproductive medicine and NAPRA technology, we are forced sort of by what we do to do the digging, to really try to fully evaluate what the couple's history is. understand what imaging and what testing is really necessary. And we definitely go several layers deeper than what an average fertility clinic would do. Like what? So for example, we'll look at a follicle maturation study. Very infrequent that a normal fertility clinic would look at this.

We actually watched the ovulation process over a series of three, four, five days to watch how the follicle develops and make sure that it's rupturing normally. There's conditions where the follicle just simply isn't releasing in the egg in a normal way. And that is actually the cause for infertility for those couples.

If you don't do the follicle study, you just don't know. You can have every other parameter looking normal. You can have positive ovulation tests. You can have a rise in your basal body temperature after ovulation and still the egg's not actually being released.

So that's an important part. Something else that we'll do is check hormone levels, especially in that time between ovulation and the start of the next cycle because... if those hormone levels are inadequate to support a pregnancy well that could be an increased risk for miscarriage right so we we just don't stop until we find all the answers you know our patients so oftentimes will come to us and say after about

two appointments and a couple tests, I was diagnosed with unexplained infertility, which is a devastating kind of dead-end diagnosis, right? Is that even real? I'm serious. No, it's a good question. Is unexplained infertility just... lazy doctors. Let's say it's undiagnosed infertility.

I don't want to put a sort of onus on is a doctor not doing what they should be doing? Obviously, our approach is different. So we believe that, yeah, we should be investigating these issues in a lot more detail than what's commonly done. But it's...

It's innate in anybody, right? Why do we go to the doctor? We go to the doctor to find out what's going on, to treat the issue, and to treat it in a way that's going to be a long-term fix. Is NAPRO technology being gatekept from women when they're... considering pursuing IVF? I think I would say it's probably seen in some circles as being unusual or fringe or maybe not evidence-based because it's not the standard medical approach. It's a different, more holistic.

approach to addressing infertility. Really NAPR technology, when Dr. Hilders, who I studied with, I did a fellowship in medical and surgical NAPR technology about 10 years ago, his focus was let's help couples, let's help women understand their fertility, their menstrual cycle in a way that goes far beyond the recollection of, well, I think that cycle was heavier. Well, I don't know if I have pain during that time or not.

but actually to chart it prospectively using something called the Creighton Model Fertility Care System. When we have couples chart their cycle, man, they can pick up so many things in that chart. Hormone dysfunctions, ovulatory dysfunction.

other inflammatory conditions that could be potentially the cause of their infertility. All of those, it's good medicine. I don't know why it would be considered less than, other than, well, we're not using the most fancy technology of creating a baby in a lab and then transferring that embryo to the uterus.

So it's just a different way of seeing fertility. And let's be real, honestly, most of our patients, when they're coming in to see us, many of them have already gone through the regular fertility process with an IVF clinic. And they've really been disheartened by what they've seen and how they felt after those consults. You know, so as part of my residency training, I would do a couple months of rotations with an REI doctor, a reproductive endocrinologist who is basically doing IVF.

And couples would come in to see him and say, we're here to understand why we can't get pregnant. Of course, that's an obvious question. Everybody wants to know what's the underlying reason. And he would just look at them and say, it doesn't matter because we have IVF.

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So easy. Is there a cost difference between NAPRO technology and IVF? Is NAPRO technology less? Is it the same? Is it more? Definitely less. So I always will tell our patients, you can do... a full evaluation with NAPR technology You could do several months of treatment and even a restorative surgery for less than the cost of one cycle of IVF in almost all cases. And people are just not being told this. They're not. And it's unfortunate because they're not getting answers, right?

are looking for answers. Oftentimes, our consults, for example, they're about 45 minutes to an hour long. We want to really dig into their history. We want to look at other imaging that's been done, talk to them about their symptoms, involve the husband. That's a very involved discussion.

versus a 10-minute quick consult and then moving on with the singular Band-Aid treatment plan with IVF, right? So our patients are so enthusiastic by the end of that, they're either already thinking of other patients or couples that they could refer to us. or they're in tears because they're finally feel validated they finally feel heard about what their condition is and they found a doctor now who guess what actually wants to know what's going on so they can actually

help them obtain better health and thereby improve fertility. Because for us, it's really not just about getting a baby. Yes, that's the end goal. That's where we're all headed. That's really what we want. But our approach really is we want you to be healthier through this process. And we can address the root cause issue, address these underlying conditions, and therefore help to improve your fertility. Are you getting into things like diet and lifestyle as well?

Yeah, so we obviously, there's a holistic approach, right? So we have to take every angle possible for our couples. So we work with nutritionists in St. Louis who can kind of help the patient identify the areas of their diet that might be impeding.

their ability to conceive certainly you know our modern diet is is filled with ultra processed foods refined sugars things that cause a lot of inflammation and actually have been known to lead to um a higher rate of insulin resistance or even pcos or other conditions that can cause infertility so yeah diet's very very important lifestyle of course we're working on helping to engage with couples so they can lose weight

so they can optimize their overall health and be able to achieve a pregnancy naturally. Can excess weight prevent you from getting pregnant? For sure. Unfortunately, so our fat cells actually create estrogen. So when you have... a massive amount of estrogen that's just basically being dumped into the system that creates this hormonal confusion in the body so the pituitary gland in the brain which is sort of the thermostat

trying to read the temperature in the room it just doesn't know what's going on so it never sends the correct signal to the ovary to actually ovulate normally and so that's one major way where obesity can actually impact fertility because

it can actually lead to not even ovulating or not ovulating well. This is blowing my mind because I feel like on TikTok all the time, I'm seeing couples that are like sharing their IVF journey and they're very clearly morbidly obese. And I'm always wondering like, Were they given any advice on other ways to get healthy, you know, and that might.

help them in their fertility journey or are they just immediately being sold IVF? Yeah, it's hard to say. Quite possibly not because when you use IVF, you have the circumvent route, right? So you don't actually have to address the underlying conditions because it's not... really in the way of you being able to see succeed with ivf necessarily so yeah that's their approach is that we don't need to kind of figure out all these difficult chronic conditions or help you optimize your health

I will just circle around it. Are many fertility issues actually just undiagnosed inflammation? So inflammation is really important because certainly can cause infertility, especially when we're talking about inflammation in the uterine lining. There's a condition called chronic endometritis that...

is known to increase the risk for having infertility but also unfortunately increase the risk for having miscarriages and so much of the time women might not know that they actually have this going on so it's really important for us to be proactive with doing in-office diagnostic testing

that can then allow us to understand whether a couple or a woman might have this issue where it would be impeding their fertility. And there's great treatments to address this. So we talk about dietary changes with inflammation, increasing omega-3. helping to reduce other sort of inflammatory things in their life. We always talk about trying to eliminate these endocrine disrupting chemicals that are super pervasive in our world.

so that couples can really optimize every aspect of their health. You have helped women get pregnant by fixing their uterus. What does that mean? So a couple of different conditions come to mind. Certainly if somebody has an isthmus seal, for example. the main way that that's treated is by a laparoscopic surgery oftentimes a robotic surgery

So we get to use a lot of cool tools when we do these types of reproductive surgeries, like a da Vinci robot. But the robotic surgery, laparoscopic surgery, allows us to resect that thinned abnormal area to remove the entire area of inflammation in the uterus and then reconstruct the uterine wall. So it's...

both safe for a future pregnancy, but also eliminates all that inflammation that was causing the infertility in the first place. Just as an example, I've had patients who've had five or six years of infertility. get pregnant in the first month that we say go for it we usually have them wait about four months after the surgery before they try to conceive it's amazing that that one so-called niche or problem

is that much of an impedance to being able to conceive. And how much does that surgery cost? So it depends on who's doing the surgery and how complex the surgery is. So with us, with our process... All the hospital charges, that's all run through regular in-network benefits, even if somebody's flying in from out of state for the surgery. So there's most of it. The really big expensive hospital bill is covered under in-network. We're an out-of-network practice, so our patients will pay us.

an out-of-network fee for this it kind of depends somewhere between six to seven thousand dollars for example for that surgery in most cases if somebody has a lot more complex history or a lot more complex surgery and we're not just in there for two and a half hours but it's a five or six hour surgery to correct their uterus

Sometimes that'll be a little bit north of that. But again, even that, our charges, for example, even as an out-of-network practice, those can still be submitted to somebody's insurance. So that's also the beauty of NAPRO is that when you're treating underlying organic diseases...

problems in the body, then those are basically billable codes, right? So we can work within an insurance system in many ways to allow the couple to not just have everything be completely cash pay. True or false, if a woman pays...

close attention to her discharge every month or cervical mucus that can actually tell her more about her fertility than her blood work in some cases? That's correct. So actually the cervical mucus is one of the most accurate what we call biomarkers of the cycle. So the mucus is actually responding to... the hormone shifts of an ovulation. So as the ovulation is about to happen, that follicle that has the nice healthy egg inside of it is growing, then the estrogen levels are rising.

When the estrogen level rises, the cervix responds with a more watery, stretchy cervical mucus that allows for the sperm to actually get through the cervix. in other times of the cycle the sperm never even make it through the cervix because there's not adequate cervical mucus or it's not the right type of healthy fertile cervical mucus

So it's really important for couples who are trying to conceive naturally to understand this biomarker. And maybe they're a little bit reluctant at the beginning. Sometimes it's a little bit odd, you know, well, can I just do an ovulation test or can I just do, you know, temping in the mornings? But it just doesn't give you the same amount of information as tracking cervical mucus, like with what we call a fertility awareness-based method, like the Crayton model or Marquette method.

Can endometriosis really be removed without harming fertility or making it worse? Depends who's doing it. So the challenge with endometriosis is that there's stage one disease, which is mild. and can readily be removed by many surgeons. And then there's stage four disease, on the other hand, which is very, very severe. And how often are women...

getting to stage four because they're on birth control for a long period of time and have no idea they're battling endometriosis. Nobody really knows exactly the percentage. However, we know that does happen. Some doctors, you know, the traditional OBGYN, if a girl comes in 14, 15, 16 years old, got really severe pain with periods, really heavy cycles, it's immediately, the recommendation's always going to be...

Take some ibuprofen, but really just go on the birth control pill and stay on it until you want to get pregnant. I've had patients who were put on the pill at the age of 14 come off, you know, 10 years later to have kids and they've got stage four endometriosis. Did they have stage four endometriosis at 14? Absolutely not. We know for sure that endometriosis can develop and become significantly worse.

Even if you're on hormone suppression with the birth control bill, for example. What do you think about doctors telling women, you know, the best way to deal with your severe endometriosis is being on birth control? So that's been shown that, yeah, it can help to improve symptoms, but it's been shown not to resolve the diseases.

self. Unfortunately, that is the mainstay treatment. And I say, unfortunately, because, well, two reasons. One is when somebody is on the pill, it potentially allows endometriosis to get worse meaning they're not having the same severe side effects and symptoms

and so therefore the endometriosis can become worse over time and now they've gone to stage two stage three stage four which does have more of an impact on fertility and the other thing of course the birth control pill has side effects it has

um you know the a lot of you know chronic changes to a woman's cycle obviously it's a synthetic hormone and it takes months for someone to sort of have that completely leached out of their system before they'd want to go on to conceive a pregnancy when it comes to treating advanced endometriosis

it really requires a specialist in this in this condition because endometriosis really behaves in many ways like cancer it invades other structures it can damage the normal pelvic anatomy pretty substantially actually And then removing it can be very, very challenging because it's so inflammatory and it's so disfiguring. For example, I just did a surgery for a patient yesterday. It was a six-hour surgery. She had stage four endometriosis. She had had severe pelvic pain for the last 12 years.

She's been told by doctors, it's in your head. You just put on the birth control pill for a while. Go do pelvic floor physical therapy. Take more ibuprofen. All of those were the recommendations. At some point, basically, she said, There were times I was in so much pain, I would curl up on the bathroom floor and I would be okay if I were to die. That's how severe it was. And she would pass out due to the severity of her pain.

significant pelvic pain symptoms, significant bladder symptoms as well. Her ultrasound was normal. So that's the other remarkable thing is you can have really severe disease with normal testing. So that's why in part she was told, hey, this isn't an issue if you have to worry about.

When we did our surgery, we're very carefully resecting these areas of endometriosis because our goal with excision is complete removal of all disease so that it has a very, very low risk of ever coming back. With excision, there's only about a 10% chance of recurrence at any point in the future. compared to the way most doctors will treat endometriosis is with a method called fulguration where they simply just burn the surface of the disease it's kind of like

mowing over a patch of weeds in your yard. I don't know if you guys have weeds in your yard here in Phoenix. We have no grass, but I get it. The analogy is not going to land. But if you just mow over the weeds, well, guess what? They're just going to grow back. So we're actually taking the roots out. And really truthfully, that's what we're doing with endometriosis.

so this patient had endometriosis that was growing into her bladder her left tube and ovary had been completely damaged by the endometriosis unfortunately did have to be removed She even had endometriosis in her diaphragm. She said, I've had pain in my shoulder for the last five years. I've had pain in my shoulder blade, pain in my ribs. It only happens during my cycle. She was basically saying all the classic symptoms of severe disease, and yet nobody would listen.

So the awesome thing for us is when we treat these patients, yes, it's very specialized surgery, very complicated surgery, but it can still be done in a very, very safe way. These patients, I mean, truly it changes their life. And I'm not just saying that just to say that. Of course. We've had patients who called us about a month after the surgery, even after eight, 10 hour surgery for advanced stage four endometriosis. They'll call us and they'll say, I'm bleeding.

I'm not having any pain. So I'm really worried about what's going on. I know this is not my period. No, that is actually their period. They just, they're so used to the pain.

They can't conceive of a cycle that doesn't take them down to the ground, basically. Why are women being told your tubes are done and you're like, what are you talking about? I can literally reopen them in my office. Yeah. So for a couple of reasons, I think. On the one hand, there's IVF, right? So if there's a workaround treatment that's available, that's so-called easier, it's not actually easier, it seems more straightforward. The other concern is...

If your tubes are blocked, everybody worries about, well, there's got to be a huge increased risk for ectopic pregnancy if you reopen the tube. That's actually not necessarily the case, especially if the blockage is near the uterus. Oh, really? For blockages that are near the uterus, you're basically just dislodging debris or mucus or something.

something else that's blocking the tube inflammation. And the tubes will stay open usually at least a year in about 70 to 80% of cases. And again, you can conceive with basically the same rate as somebody who has open tubes at that point.

There are different types of tubal blockages. Like if you have a pelvic infection in the past and then you develop a lot of scar tissue on the ends of the tubes, that's called a hydrosalpings. A lot more challenging and it's something that surgeons used to treat a lot in the 80s and 90s. And then once IVF became more mainstream. taking the tubes out and going to ivf right

Our approach is we like to fix those tubes so you can be able to conceive naturally because we know that natural conceptions, natural pregnancies are so much healthier for baby and for mom than those IVF pregnancies. How so? What do you mean by healthier? So lower risk of preterm delivery.

substantially lower risk, about four or five times lower risk of preterm delivery, about a two to three times lower risk of having congenital defects like heart defects, cleft lip and cleft palate, spina bifida. All of those are higher risk in IVF pregnancies. So obviously increased risk of multiples with an IVF pregnancy, usually somewhere in the range of 12 to 13 times higher risk of having multiple pregnancy.

like a twin or triplet. So our approach then with these blocked fallopian tubes is to surgically go in and correct the fallopian tube to reopen it with microsurgical technique. It's a procedure called a neosalpingostomy if you want to go home and Google it later.

But the neosalpinjosomy then reopens a tube. And remarkably, a lot of times you'll find a fairly normal tube inside of that blockage. And once that happens, then you've potentially restored that patient's fertility for life. I've had patients who are told, you got to take out your tubes, got to do IVF.

who we've then done the neo-salp and jasmine for and they now have three kids i know because they send me a christmas card every year so that's the goal is really can we fix the issue so not just you can get pregnant this time but so you can have ongoing recurring fertility and that's how it is with

polycystic ovary syndrome that we treat or endometriosis, pelvic adhesions. Everything is for the goal of making you healthy for the long term, not just for this pregnancy. So people can go see you, your practice in St. Louis for PCOS or endometriosis, not even if they're just trying to get pregnant.

Oh, sure. Yeah, we see patients for these conditions. What are you doing for PCOS? So for PCOS, obviously, it's an endocrine disorder primarily. So we talk a lot about helping to optimize hormone levels. We do post-ovulation hormone support. So that's where it's helpful for them to be charting their cycle.

we also will do dietary modification something like the mediterranean diet or pcos diet is really effective in helping to reduce the insulin levels and help to improve insulin resistance which then oftentimes will help to restore natural ovulation and normal cycles again. What are some of the worst beauty products someone with PCOS could use? Any beauty product that has BPAs or phthalates.

or other types of endocrine disruptors can certainly affect a lot of the hormone system not just for pcos but things like endometriosis or even insulin resistance those become inflammatory. They basically get taken up by the body and used as either anti-estrogens or as pro-estrogens. It kind of depends on which receptors they're hitting.

So a substantial impact on somebody's overall health. What about fragrance? Fragrances, same sort of thing. They can have these endocrine disrupting chemicals that can affect male fertility, lower sperm counts, lower sperm motility. but also affect female fertility and affect the health of the eggs even and potentially affect the ability for ovulation to occur correctly and for the hormones that should occur after ovulation that they might have more of a hormone deficiency.

a man being excessively exposed to car air fresheners become more feminine? More feminine is tricky. However, you know that it's going to potentially increase their ashton levels, right? So it's very similar to if some guy is obese, then same sort of thing. His fat cells make estrogen and therefore he will be more estrogen dominant even as a guy. compared to somebody who's lean, normal weight, exercises regularly. That is interesting. I didn't think about that with...

being more overweight and a guy that might be more like emotional all the time or more sensitive to things. Well, I don't know about that, but certainly we do see it affect the sperm qualities. The sperm parameters very, very consistently will... be more affected or more harmed by those scenarios let me ask you something when was the last time your doctor gave a single crap about you

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What is the biggest issue that IVF ignores? It's hard to decide which one. I think the main thing is IVF says it just genuinely doesn't matter why you can't get pregnant. so they're equally okay with calling this unexplained infertility versus tubal blockage versus male factor so i'd say in some ways the biggest issue that's ignoring is the woman's health the couple's health ivf has never made anybody healthier ever

Full stop. It only assesses the basics. So therefore you can go on and do the embryo transfer, do the IVF process so you can get a pregnancy in a very artificial way through the lab, truthfully. You know, the women who go through IVF... their hormone system is fully hijacked for at least one month, but oftentimes more than that. They are injected basically with multiple doses of very, very high doses of

gonadotropins that hyper stimulate the ovaries that tell the ovaries to make 10, 12, 15 follicles per ovary, something that they should never do. So they're blowing up to basically four or five, six times the size of a normal ovary.

Those ovarian follicles then are harvested in the office. And actually the IVF clinics usually arrange it so that all their patients who are going through a stem cycle will all come in based on the same Saturday, the same Thursday. So you have... everybody's coming through with basically their number and you're up next you're up next let's go and then they are fertilizing these eggs in the lab that's the embryologist job at this point and once those embryos are cultured to a certain

maturity, usually day five embryos, then they're ready for transfer. This opens up the big issue, of course, of, well, are those embryos people? Are those embryos human beings? Absolutely. They're genetically human. So I would say, well, how could they be anything other than people? Quick story. I was actually with an embryologist one day in one of my fertility rotations. And, you know, I was a philosophy major in college. So I kind of wanted to get some conversations going back there.

So I went and I said to the embryologist, I said, what's the going theory around here? Are embryos people? Guess what he said? What? He said, no, they couldn't be. And I said, well, why not? He said, because we see so much wastage. That's his quote. What does that mean? Because so many embryos are lost in the process of IVF. The vast majority of embryos that are created in IVF never make it to a transfer, never make it to live birth.

That's why. They can't say that it's a person because then what would that mean, basically? Yeah, exactly. They wouldn't be able to drive to work every day, right? And then, of course, I said, well, then when does this embryo become a human being or a human person? We know it's genetically human, so when does it become a person?

And he said something pretty nebulous. He basically said, when the mom wants it to be and after it's implanted, then it's a person. It's dark. It's kind of weird, you know, because he's a scientist, right? I mean, if you survey, actually there was a survey several years back that... surveyed embryologists and i remember the exact percentage something like 94 97 percent of embryologists agreed life begins at conception

why would they say otherwise this embryo is growing on its own yes with little assistance and nutrients and those sort of things whether it's in vitro or in vivo in the mom but it it takes on all the characteristics of a new life and it is genetically human

President Trump campaigned on this idea that he was going to get insurance companies to cover IVF. It's kind of come out that he's not now going to be doing that. Will this be a net negative or net positive? You think if. American insurance companies are not required to cover IVF. It's interesting, you know, this is a president who wants to make America healthy again. And yet early on in the campaign, and then, you know, even into his presidency, he was saying, we're going to basically force it.

insurance companies to cover the cost of ivf on its face it looks like a nice pro-life effort and and we want to grow families and this is great and there's fertility But it's not, unfortunately, making America healthy to go through IVF. It's helping couples achieve a pregnancy in cases where they maybe otherwise wouldn't have, unless they'd maybe come and seen a restorative reproductive medicine specialist like our practice, for example.

but it's actually not making anybody any healthier. Again, IVF does not treat any condition other than helps you get pregnant. It treats infertility. So it makes sense in some ways to say, well, actually it's kind of more consistent with a Maha movement to say, we're actually maybe going to dial this back just a little bit and to say maybe we're not going to force this issue into the hands of insurance companies you know during this whole early phase of this

uh you know this movement toward covering ivf with insurance there were many of us in the restorative reproductive medicine community who said Wait a second. Why would we just cover one particular treatment option, one particular technology without also expanding coverage for others? Exactly. Because we are actually helping couples to improve their overall health. We are actually helping to make America healthy again and fertile again.

right and for the long term not just for that one cycle that they would potentially be doing a treatment so we did there were actually CPT codes procedure codes and diagnosis codes that were submitted for review And the idea was to say, look, there are so many things that are uncovered or undercovered in restorative reproductive medicine. And ultimately, unfortunately, that's hurting the couples who are trying to pursue that type of care.

So why aren't they also being considered equally with IVF? You said exactly how I feel. It was very controversial. I had posted that when that came out that we were not going to be requiring insurance companies to fund it. I said, praise God, this would have been a disaster. many fronts. But also just, I think it's already bad enough with women wanting help, wanting to understand why they're not getting pregnant and then being thrown IVF at them as like their only option.

If that becomes just covered by insurance and the standard, I mean, that's the standard of care everyone is going to get now. Like there, it was just a slippery slope of a lot of bad things. Plus, you know, my audience. Probably you're familiar with my moral issues with IVF. Just even from a health perspective, you can even keep that totally out of it. You can keep me being pro-life completely out of it. And I would still say.

I don't know how anyone could disagree that this would be a bad idea. Yeah, sort of going toward one goal at the detriment of fixing somebody's underlying issues and improving their health, right? And obviously that's what we're here for as physicians, as a medical community. We should be there to support and help.

to better the health of our patients, not just to say, hey, we've got a Band-Aid treatment called IVF. What is the most shocking thing you've ever seen hidden in a woman's fertility chart? So I think one thing that we oftentimes will see and...

the woman herself, when she's tracking, won't know that it's actually an issue, is very subtle changes of bleeding patterns. So something like premenstrual spotting, spotting a couple days before the onset of a period. It's a very strong indicator of several things. One thing could be...

significantly reduced or lower post-ovulatory hormone levels like progesterone deficiency or estrogen deficiency, which obviously can impact the ability for her to be able to carry a healthy pregnancy from implantation on. and the other thing is actually there's data to show that in couples of infertility having two to three days of spotting before a cycle is actually the single strongest indicator that they have endometriosis

And oftentimes we think of endometriosis as just being this very painful condition. That's the only way that you would ever suspect a diagnosis if somebody has pain. But actually this can be one of the more subtle things that you can find in a chart.

that can very quickly and easily lead to a clear diagnosis and that's of course one of the frustrating things about endometriosis is that the symptoms that a woman experiences don't necessarily line up with her actual disease somebody can have really severe symptoms and really mild disease or actually no symptoms and they can still have extreme or severe endometriosis so it really behooves us to say if we see a subtle finding like premenstrual spotting

Let's talk about the possibility of a laparoscopy check for endometriosis. Let's talk about how we might make a sequence of steps in our plan to get you that tailored personalized treatment that you actually are looking for.

Let's just pretend, you know, I'm a woman coming to you. I have tried everything and I don't understand why I'm not getting pregnant. What does that... look like step by step? What are you looking for first with that woman in your clinic? So we always start with a very thorough initial consult. These consults usually last 45 minutes to an hour. We're asking everything about their history. We're like detectives that won't leave you alone until we get all the answers, right?

And I'm guessing not only just the woman, but also the husband. Right. Yes. It's really important to take them as a couple and really understand because fertility is one of these complex conditions that obviously there's so many things that can go wrong. It's actually a miracle it ever goes right in many ways.

but it's also one of the few conditions other than pregnancy really it's the only condition that involves two individuals right so there is more that can potentially go on between the two and so yeah it's important to really dig into what their history is what their symptoms are um i always say you know women are complex and far more complex than guys so there's far more things that can go haywire

um with fertility and therefore our diagnostic testing which is kind of what we would do at an initial consult is we'll roll out here's what we think our top three or four or five things might be

You might have one of these. You might have none of them. You might have all five. So then we kind of go through this sequence of very thorough and comprehensive diagnostic testing. It doesn't necessarily have to be invasive. You don't necessarily have to go for a surgery just to find out whether or not you have some condition necessarily.

You can do most of the stuff in the office or through a lab. Then we'll have our patients come back and we'll review everything. We'll go through everything that we already collected and starts to put the puzzle pieces on the table in the right spot. And then we can come up with what is going to be their perfect treatment plan. So there's no one size fits all approach with restorative reproductive medicine because we truly see every couple, every individual.

is so unique in their history, their story of why they're not getting pregnant is going to be different from one to the next. I think we're going to have a culture apothecary baby boom after this episode. People that are struggling are going to go see you. They're going to get pregnant.

finally. And we're going to hear about all these little culture apothecary babies. I love that. We can make t-shirts. We can have a parade, you know, whatever you want to do. I survived the culture apothecary baby boom. And all I got was this t-shirt on the baby.

onesie. Can you surgically fix infertility without leaving scar tissue? Yeah, it's really important. So the answer is yes, but it's challenging and it's not 100%. I'll be dead honest. We always want to be able to treat and excise problems like scar tissue or endometriosis.

uterine problems like fibroids or issues inside the uterus. But if we go in there and we do all of this surgery, even if it's a really great surgery, we're really happy about our outcome. Everything looks great. All the endometriosis has been completely excised, which is by the way, not the norm.

but we've excised all the endo and we don't do anything to prevent scar tissue, then unfortunately we've just traded one problem for another. So scar tissue actually can hurt fertility, especially if it's around the tubes and the ovaries. And it can also cause pelvic pain.

So it's really important for us and part of our NAPA technology training is... adhesion prevention techniques so there's multiple things that we can offer our patients that are very advanced and can help the body heal better after a surgery to help to reduce the risk of scar tissue forming which is

It's extremely important. And it's unfortunate and frustrating because there's a lot of good endosurgeons out there. Well, maybe not a ton, but there's some good endosurgeons out there. But they are kind of nihilistic on whether they can actually do anything to prevent scar tissues. You'll watch their video, find all the endometriosis taken out.

but they're not taking any steps. So sometimes what we'll do is I'll use a temporary dissolvable stitch to actually hold the ovary up out of the pelvis. We stitch it to a ligament outside the pelvis. The benefit of that is

the healing that happens after the surgery, those pelvic tissues are going to regenerate themselves within about seven to 10 days. You just don't want the ovary to sit adjacent to those surfaces as it's growing back because then they can get stuck together. So when we suspend the ovary with a dissolving stitch, Holds the ovary up out of the pelvis for about 10 to 14 days. Once that stitch dissolves, the ovary goes back to a healed pelvis. Very, very low risk for scar tissue at that point.

We also have things like amniotic chorionic membrane grafts that are harvested from other ladies' C-section deliveries. And then we can use these grafts as basically tissue implants to lay across the ovaries, lay over the uterus. And that helps to accelerate the healing process after that surgery so they can have a lower chance for having scar tissue form. You do the coolest job ever. It's pretty fun, actually. And the last thing is we also can use things like platelet-rich plasma.

So we've been doing PRP for about the last year at the time of laparoscopy. I don't know if you're familiar with PRP, but basically it's... We take our patient's blood at the beginning of the surgery. It's used a lot in orthopedic surgery and even cosmetics like vampire facials or PRP usually. Kind of weird to talk about vampire facials with a restorative reproductive surgeon, but we'll go there.

And what we'll do is we'll generate the PRP, which is rich in growth factors and signaling proteins that help to accelerate the healing process. We'll spray the patient's PRP across their pelvic tissues. And that basically tells the body, hey, this is a really important place.

We need to heal this, but we need to reduce inflammation, recruit stem cells to go to those locations and heal the tissues more rapidly with a lower inflammation and a lower risk for scar tissue. Cool. It is cool. Kind of aside, which I know this could probably be a whole separate conversation, but I am curious.

a Catholic, fertility doctor, what do you think about all the stem cell stuff going on? Do you like it? Do you see benefits? Are you like, no? I'm always in favor of adult stem cell research because there have actually been multiple, I think somewhere in the 80s or 90s, as far as the number of diseases. or conditions that have been treated with adult stem cells. And there's no more implications.

Embryonic stem cells sort of became vogue because it was edgy, it was new, it kind of seemed like it was going to be this great option for being able to create all these regenerative therapies, but unfortunately it does come with this significant burden. and this complexity of now we're taking human embryos, we're processing them in the lab to get the stem cells. We're potentially mixing and matching one embryo to another, even unfortunately one species to another.

This can get really dark and really strange pretty fast. You're listening to this podcast because you're into wellness, but not the kind of wellness where you get duped by some girl on TikTok into buying a $600 quartz comb that heals ancestral jaw tension and comes with a handwritten note from the moon. No, you're smarter.

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What are the biggest fertility mistakes that girls in their teens or women in their early 20s make without even realizing it? Well, it's complex. So I'd say one is being promiscuous, unfortunately. If you're having sex with multiple different guys, then there's a much higher chance of developing an STD.

If you develop an STD, a sexually transmitted infection, then you're at much higher risk of having tubal blockages. And I've had patients who've had extensive pelvic infections and pelvic scar tissue. And it basically has decimated their fertility. Obviously, we'll try to help them as best we can. But in some cases, it's so severe. That's it. It's over, right? I think that's one thing. Another thing is continuous use of birth control pills. Because of the fact that the birth control pill...

suppresses those symptoms where your body's trying to say hey there's a problem here i'm having really heavy periods really painful cycles why don't we go see a doctor and you know get this figured out if you're just on the pill all the time you don't get those signals and you don't have that That knowledge, basically, there could be some problem that maybe if I could get diagnosed and treated earlier.

I would have a better outcome long-term. Why is ovulation pain or spotting often ignored when it can actually signal deeper issues? Well, for one thing, it can be semi-normal in some cases. So I think there's something called middle schmurz, which is a natural amount of cramping that happens around the time of ovulation.

and sometimes when the follicle ruptures, there's a little bit of bleeding, it can cause some spotting or even the hormone changes can cause some spotting. So I think that's one thing is that not wrongly, doctors might say, oh, that's kind of normal. Don't worry about it. the problem is if it becomes more persistent or if the pain becomes more severe that should be a signal but again if this is a spectrum somebody doesn't know necessarily know

When did I just cross over into the abnormal zone? When should I actually get this evaluated as, do I have a problem with my ovulation? Am I just forming cysts every single month instead of actually releasing an egg like I'm supposed to be doing? What is one thing every woman should track in her cycle that almost no one is tracking?

cervical mucus is is if you're trying to achieve a pregnancy cervical mucus is the single most important bio indicator of what's happening with fertility if you're not ovulating you don't create good cervical mucus

if your ovulation is at an abnormal time of the cycle let's say instead of being day 14 15 16 it's day 27 28 those are good indicators that there's an underlying problem so uh you know a lot of times people ignore it a lot of people just don't know that that's a normal part of the cycle that

is telling you something about what's happening hormonally and also with respect to ovulation in the middle of the month. What does healing really look like for you with a patient who feels like her fertility journey has just been jacked around by different doctors and clinics for years? Well, obviously, it starts with that.

what's their story what's their issue what's their symptoms and i think healing is more than just physical healing i think a lot of times when when a woman goes through the suppressive treatments that she might have done with another doctor to just suppress the symptoms the band-aid treatments so to speak or even with fertility, the workaround treatments with IVF, there can be a lot of emotional baggage and a lot of emotional hurt there.

And so I think it's really important to have the ability to talk about that and to actually have an opportunity to heal just from the process that they've been put through. A lot of women are tough and they'll put themselves through a lot. for the goal of being able to achieve a pregnancy, especially when they walk away empty-handed, you know, drain bank account, no kiddo. Now what?

that's tough that is really tough and and they feel sort of betrayed honestly by by the medical community in that in that moment so you really do need to rebuild that that level of trust and i think that just comes from being honest with our patients to be able to talk with them about what their past experiences have been, also what their past treatments have been, and help them understand how there is actually a much better approach where we can actually...

be respectful of the dignity of their femininity or the dignity of their womanhood the fact that they're you know they're supposed to be naturally fertile and we want to help to support that naturally not just subdue it or work around it what's been one of the most obscure reasons you have discovered

was keeping a patient from getting pregnant. Just not knowing where to put things. Please don't tell me somebody was just repeatedly doing anal and then literally just was like, why can't I get pregnant?

Not my own patient. My own patients are very... They're a little smarter than that? Very smart, very educated. I have a really, really close friend who's struggling to get pregnant. I mean, she's like me. She is all into health and wellness. She's one of the healthiest people I know. And the only thing... In all of the testing she's done that she is repeatedly seeing is her leptin is low. And so she's convinced, like, I have to get my leptin up, that there's something with that that's causing.

Yeah, certainly there can be those really subtle issues, hormone deficiencies or hormone problems that can definitely affect ovulation or even affect implantation. I think the challenge is always to say, is that the only thing or could there actually be more that is still also going undiagnosed? I always talk about kind of the percentage game, which is there are some things that are...

that will only move the needle a small amount. Maybe leptin is one where, yeah, maybe we can move the needle another 5%. But what if she also has silent endometriosis? You know, one in five women who have endometriosis basically have no symptoms with the disease.

Their only symptom in some cases is just infertility. So what if she also has endometriosis? In that case, then we might be actually missing the main thing, the big 70 or 80% cause for infertility, just because we've kind of zeroed in, not inappropriately, but it zeroed in on another.

abnormal lab value or something like that. If a woman has had two or three miscarriages, what should be the first thing that she is asking her doctor? Why is always the question that they should start with. And with recurrent miscarriages, it's tough because obviously they're able to get pregnant. So we're sort of like halfway there, but then that rug is just ripped out from underneath them when they have that loss. So recurrent miscarriage can be...

really emotional for the couples who come in, obviously. The other issue with recurrent pregnancy loss is there are so many conditions that can be at play. Those are very in-depth consults with our patients because we need to go through the physical issues or the structural issues that could be a problem with the uterus or a problem with the fallopian tubes that could be increasing the risk for miscarriage. We also have to talk about autoimmune conditions or hormonal deficiencies.

or genetic issues. So there's so many things potentially at play and you don't just have to have one condition. You can actually have multiple static conditions that are causing multiple losses. I think the important thing is for couples to understand.

When I've got this issue where I'm having pregnancies that are lost early or even lost later in the pregnancy, it's important to pause and to know I've got to get help for this. I've got to figure out what's going on so I don't keep on having repetitive losses. The great news is that once we can identify and treat those issues that cause miscarriages, patients will have generally about a 70% to 75% chance of having a full-term healthy pregnancy. So they really should not give up on trying.

If a couple is listening right now and they were told that IVF is their only hope, what do you want them to hear right now? So IVF can help couples achieve pregnancy. But to call somebody's only hope, I think is disingenuous because in most cases, those clinics that have offered that as the end all be all option, the only way they're ever going to get pregnant.

They just simply haven't completed that diagnostic evaluation to the level of actually finding what the underlying cause is. That's why one of the most common reasons for pursuing IVF for an IVF clinic is so-called unexplained infertility.

Well, unexplained, again, just means we haven't diagnosed or figured out what the issue is, but we kind of don't care as much because we can just circumvent this issue with IVF. Yeah, I mean, I think most of our patients who have gone through the IVF process who are now seeing us will say,

I knew that there was something going on. I knew that there had to be a reason that we weren't able to conceive or maybe weren't able to carry a healthy pregnancy. And they are pushing for answers, which is awesome. But that's the time that we have a chance to say, all right. Let's get going. Let's figure out what's actually the matter and figure out how can we address your specific issues with root cause treatments that actually fix the underlying issue that can help the couple to...

be healthier and then have a better success rate actually than what ivf would have been we have so many patients who will come and say i've been told ivf is my only option i'm never going to get pregnant with anything else they've told me i need to do donor egg ivf because my eggs are bad and truthfully after you know a couple you know cycles of evaluating the cycles or maybe a treatment here there a surgery

These patients are getting pregnant at a very high level. What are the success rates of naprotechnology versus IVF? So they're measured slightly differently. So IVF success rates are generally measured by this cycle. per cycle success rates are very age-based but somewhere around 30 to 35 percent

For most couples who are in their 20s, it goes down to under 20% for couples who are in their early 40s. So then you say, well, what's a cumulative pregnancy rate? If a couple were able to afford and tolerate doing four or five, six cycles of IVF, what's their overall chance of getting pregnant? Usually it settles at about 55, maybe up to 60 to 65% at most. With NAPRIC technology, with what we offer our patients, we will routinely see couples have about a 60 to 80%.

chance for pregnancy why the range well because some couples have really challenging male factor issues or really challenging severe stage four endometriosis that's affected their ovaries more substantially than our so-called average patients coming in but our average patients actually been trying to for over three years. And we're still seeing success rates in the 60 to 70% range. Like what I hear, you guys, is this is cheaper and it is a higher success rate and it's more natural.

And you're not excessively discarding human beings. Why are people not? considering this as their first option. And bonus, you actually get healthier at the end, right? We always will say to our patients, obviously, we want you to get pregnant, right? The so-called worst case scenario is you're a heck of a lot healthier at the end of all this treatment, but unfortunately you haven't for some reason been able to achieve a pregnancy. Yeah. And that's obviously...

We want them to be able to get pregnant, but knowing that we actually care enough about who they are as a person, what their symptoms are, what their history is, that we want to identify and treat those issues, help them live a healthier life, help them be able to go back to work, to be able to...

function normally, not miss events and things with their friends, that's huge. Just getting their life back because they've actually had the underlying issues fixed. Well, I hope this episode is just a miracle.

for tens of thousands of families. If you could offer one remedy to heal a sick culture, physically, emotionally, or spiritually, what would it be? I guess I'll start by saying, Mother Teresa was fond of saying, if you want to change the world, go home and love your family.

And so for me, I would say I've dedicated my life's work to helping couples have families. So in some kind of indirect way, I'd say that's going to change the world. If we can help couples have more kids and have healthier families, that will change the world.

Separate from that, I would also say if you have symptoms, if you have unexplained infertility, if you have something you know in your core, something's not been fully evaluated, something's not been fully treated, do not give up the fight to find the answer.

keep finding that second opinion that third opinion you need to have the answers right you're just not going to be satisfied until you know that hey i've done everything possible i've sought out those specialists who could actually fix these issues and help me feel better

And then what happens in the end? We all get healthier, right? So if we can actually fix those problems, then we can live better, healthier lives. How can somebody work with you? So anybody can reach out to us either by phone or even on our website. We have a new patient consult form.

that they can fill out. And they can also reach us through social media. And once we establish that new patient contact, then sometimes patients will come to St. Louis so that they can do in-office diagnostic testing procedures or maybe in some cases surgery. A lot of our patients are... flying in specifically for the surgical treatments that we can offer. What's the clinic name and website? Veritas Fertility and Surgery. It's veritasfertility.com.

We're Veritas Fertility on Instagram. I really want to be able to help as many couples to learn about these issues and to learn about options, right? So I've been sort of reluctant to get on social media and do all this stuff. I'm very busy. I have a busy practice. We have a busy surgical schedule. that I need to keep up with. But I've had patients kind of come to me and say,

Shame on you for not being on Instagram. Why did I not know about this four years ago? Seriously. So I've started to do this and I think that's important to be able to get the information out there to people who could use it. So my personal Instagram account is gavinputoffmd.

So we're starting to roll out some real, hopefully, helpful educational material for people who are looking for answers. We want to be able to be a kind of guide through this very complicated process of looking at gynecologic issues and infertility. Dr. Puthoff, this was... a phenomenal interview i'm just gonna say like i enjoyed this i feel like i learned so many things

I have like a newfound sense of hope for, you know, anyone I know in my life that, you know, unfortunately may have to cross the bridge of infertility. I feel like, wow, I can tell them about this. And I know so much more about it. I've heard it. I know my audience has requested, please get an upro technology doctor.

on like for a very long time. So I'm so glad it was you. You're just incredible. And I hope many people are introduced to your clinic through this episode and lives are changed. So thank you for coming on. I really appreciate the opportunity. Thanks.

How incredible was this episode? Absolute top 10 of the year for me. This one is so crucial. I think we could totally change this generation, especially with infertility just rising 1% every year. Please, please, please share this episode with the women in your life. to your Instagram stories, to your Facebook groups that you're in with other women struggling with fertility. We're on a mission to heal a sick culture.

twice a week, Mondays and Thursdays, 6 p.m. Pacific, 9 p.m. Eastern. Subscribe to Real Alex Clark on YouTube. Please leave that five-star review. This episode especially, this is worth five stars. I'm Alex Clark. This is Culture Apothecary.