A Holistic Approach to Fertility with Dr. Aumatma Shah

Dr. Aumatma is a Naturopathic Doctor & Nutritionist, in practice for close to 15 years. She specializes in women's health, is the best-selling author of "Fertility Secrets: What Your Doctor Didn't Tell You About Baby-Making," and is a sought out speaker on topics related to Women’s Health and Empowerment. Dr. Aumatma was awarded the “Best Naturopathic Medicine Doctor″ award locally in 2015 & 2020, and as a top “Women In Medicine” Doctor in 2020. In addition to supporting couples through individualized care in person and long-distance, she also trains practitioners who want to specialize in fertility. Dr Aumatma has been featured on ABC, FOX, CBS, KTLA, MindBodyGreen, The Bump, etc., along with being interviewed for countless podcasts on topics of fertility, pregnancy, and postpartum health.

Transcript

Dr. Liz Sutherland: Impaired fertility affects over 6 million women in the US alone. Infertility is actually considered a common health complaint. And between 10% and 15% of reproductive age couples will be affected by it. And those numbers are even higher if the childbearing female partner is 35 years of age or over. Today, my guest is Dr. Aumatma Shah. Dr. Aumatma is a naturopathic physician who specializes in holistic fertility. She's also the author of the bestselling book, Fertility Secrets: What Your Doctor Didn't Tell You About Baby-Making. Thank you so much for being with us today, Dr. Aumatma.

Dr. Aumatma Shah: Thank you for having me, Dr. Liz!

Dr. Liz Sutherland: Thank you. So tell us about the kinds of patients you see in your holistic fertility practice.

Dr. Aumatma Shah: I tend to work with couples mostly that are trying to conceive that are maybe having difficulty. And they range from couples who have tried naturally to get pregnant and it's not happening for them, or the other extreme, which is they have been through every possible available treatment that they know of and they're at the end of their rope and coming in at the end with the hopes of natural things are going to save them because the other types of medicines haven't helped them.

Dr. Liz Sutherland: You treat both women and men, is that correct?

Dr. Aumatma Shah: That is correct. Yes. Unless a woman is in a same sex partner relationship or the woman is a solo mom by choice, those would be the exceptions. But we prefer that if they're in a couple, whether it’s same-sex or heteronormative that they come in together to be seen and get treatment.

Dr. Liz Sutherland: That makes a lot of sense. And what are the most common causes of infertility in the patients that you see?

Dr. Aumatma Shah: I think there are some of the more common causes which are polycystic ovarian syndrome, endometriosis. Those tend to be pretty common. And then we have the less common causes, which I think are tied to hormone imbalances. We can use that umbrella in general, whether it's an ovulation due to hormones, thyroid disorders, adrenal disorders, autoimmune conditions like Hashimoto's thyroiditis, which is then going to impact the ability to get pregnant and stay pregnant. So those are some of the common things. And then I feel like the less common things that we encounter, which is just around environmental toxins, mineral, nutrient deficiencies, having unstable blood sugar issues, chronic inflammation. And all of those types of things tend to play a significant role, but they're not often highlighted in the more conventional ways that fertility is thought about.

Dr. Liz Sutherland: Right. I imagine you may sometimes find causes that conventional doctors your patients have seen have missed. So given how multifactorial causes of infertility can be, could you talk us through in general, how you determine the best therapeutic course for your patients?

Dr. Aumatma Shah: I hat you have to listen to the patient and you have to ask a million questions, right? And I feel like it's the lost art of medicine where doctors used to sit with their patients for hours and really dive into what have you been doing? What do you eat? How do you sleep? When do you sleep? And we tend to... Our first visit with clients is three to four hours. So we're doing this deep dive right from the beginning so that we can fully understand who this person is and who this couple is in relationship to each other. And then by the end of that, I usually have a pretty good sense of which lab tests are going to be most appropriate for this person, right?

Because I feel like the movement or the trend in functional medicine is to go for, hey, let's go get every single test under the sun. And here's $3,000 worth of tests that you're going to do even before you meet with me. And I feel like when we flip that on its head, we can really make treatment more cost-effective, but also not overwhelm the patient in, "Hey, you have this deficiency and this food sensitivity and this thing," and like really make it about the person and let's figure out what are your main goals based on how you feel in your body and what are the main things that I see as in how it relates to your fertility, and then let's work that up and evaluate further so that we know, hey, actually you have Hashimoto's thyroiditis, but it went undiscovered because your TSH is normal. And here we think that there's some autoimmune things going on and this is how we're going to address it. And really create a whole plan around what it is that's going on for this particular person.

Dr. Liz Sutherland: I love that approach. I remember reading something that a neurologist said: "If you want to learn new things, read old books," because he was referring to the time when physicians, the only tools we really had were to look and listen to our patients instead of looking only at lab tests, which can be divorced from the human you have in front of you.

Dr. Liz Sutherland: On your website, you say that you work with women who have tried unsuccessfully to get pregnant, have a history of miscarriage, or want to optimize their fertility for a later pregnancy. Tell us something about how your approach might differ for each of these patient experiences.

Dr. Aumatma Shah: For someone who is maybe trying to preserve her fertility in the nonconventional methods of preservation as in like she's not going in to freeze her eggs, but she's still concerned or is like, "Hey, I'm 35. I'm still single. What am I going to do?" That person is really going to go through what I would consider like a hormone optimization reset or rehaul of not only confirming where her hormones are at, but really learning the lifestyle things that are going to prolong her ability to have children within her own body within reason. Like we're not saying, "Hey, we're going to prolong fertility till 60, but, we get that you're single right now and you really want to have kids and you're working on trying to find the person that you want to be with. Totally fine. We can definitely support your hormones and your fertility to stay on track until you are ready to go and conceive." I think that's really important. And that's kind of how I started in this fertility world, I realized I was married to the wrong person a little too late. I realized honestly that I wanted to have kids, it was just with the wrong person. I started massively researching like what can I do for my fertility? And in the midst of that kind of came upon what I feel like is the crux of what I do, which is like let's empower our patients to be in charge of their bodies, in charge of their hormones, and in charge of their fertility without making them feel like, oh, there's this factor of age that you can't control and after a certain point, you're just going to be screwed because I don't necessarily agree with that point of view and research actually doesn't support it.

So I feel like that preservation of fertility within our bodies is totally possible. And I think for some people, it could be a huge lifestyle shift. Like I'm in the Bay Area where so many women are working in tech companies. A lot of these tech companies will pay for egg freezing which is the conventional option for prolonging your fertility, and then they'll come in and say, "I haven't felt well after my retrieval and I don't know what else to do for my fertility, but I also work 80 hours a week, I need to go to parties and I'm expected to drink," because that's the old boys club that they're a part of.

It can be a huge mindset shift as well as a lifestyle shift to say, "Nope, I'm not doing those things, even though that's the cultural expectation within this company that I work for, and I'm going to stand up for my own rights, which is like, no, I'm not working 80 hour weeks, no, I'm not going to drink just because you want me to, and I'm going to find other ways to connect with people and socialize." I think that not enough women are given that option or that knowledge, and we get to the end of the road where maybe you think you've frozen your eggs and you're all set and you can go and have babies whenever you want. At 45 if you want.

It's kind of the perspective that's shared with them, but in reality, 1% of frozen eggs actually turn into live babies. Just 1%. Part of that is the eggs are not being used, but the other part of that is the eggs are not being successful in turning into children. So we really have to consider is this the most empowering attitude for couples or women who really know that they want to have babies in the future, but are being asked to like prioritize their work and in the process are maybe losing their opportunity to have children later?

Dr. Liz Sutherland: That's a really excellent perspective. Thank you, Dr. Aumatma. It sounds like you’re saying that it doesn't really matter to some extent if you're freezing your eggs or preparing for the future if at present you’re not taking care of your body. You're not using self-care, you're not standing up for yourself, as you say. It sounds like that's perhaps one of the fertility secrets that doctors don't tell patients. Is that correct?

Dr. Aumatma Shah: I didn't talk a lot about that in my book, but yes, I think that the idea that your fertility is solely dependent on the eggs that you have is not actually true, right? Like we know as doctors that yes, you need good, healthy eggs, you also need good, healthy sperm, and you also need a good, healthy uterine environment to grow this child. So if you lived a completely inflammatory life for the last 25 years and you get to 45 and you're like, "Hey, I want to use these eggs," but your uterus is still inflamed, it's not going to happen. There's nowhere for this embryo to implant, even if it turns into an embryo.

One of these things that I talk about a lot is you may freeze your eggs, which is freezing them in time. If you're freezing your eggs at 25, then great, you have 25 year old eggs that are in a bank that you can get to later, but your uterus is still in your body. There's nothing that's freezing your uterus. And sure, it's not "aging," as much as your ovaries, but it is being impacted by the environment within your body. So there was a study that came out in 2017 that showed that if you have inflammation in your gut, intestinal permeability syndrome, leaky gut, whatever you want to call it, if that is happening in your gut, it is also happening in your uterus.

So, okay, you drink alcohol. Your microbiome is out of whack in the gut. You probably have food sensitivities. All of that is leading to intestinal permeability, which is then causing this inflammatory environment in your uterus. You continue doing that for five, 10, 15 years and then you go in and you're like, "Hey, I want to use those eggs I froze at 25." I'm not anti egg-freezing. Hopefully those eggs will work. But my question is, what environment are we going to give to that future child? And could you have done something differently had you known? And that's the part that I think is, as far as like fertility secrets being revealed, it's the truth that doctors somehow know, but we're not sharing this with women that are choosing whether or not to freeze their eggs. So it's up to us as doctors to be like, "No, it's great. Freeze your eggs. You have the money, go for it. Freeze your eggs. But also take care of yourself. Also preserve the environment within your body because this is the environment that you're going to bring your child through."

Dr. Liz Sutherland: Right, the inner terrain is crucial. Switching gears a little bit to the kinds of treatments that you offer, I saw on your website that you use cold laser therapy. Could you tell us a bit about that?

Dr. Aumatma Shah: Cold laser therapy is a technique that's being used mostly in Europe and Japan. This is where most of the studies have come from that have suggested that women who have struggled to conceive, they've been struggling for four to nine years, depending on which study we're looking at. And they have tried everything. They've done multiple IVF cycles, they've tried acupuncture, they've tried literally like everything that they have access to and still haven't conceived. And then 30% of those women in the studies get pregnant after doing a cycle of low level laser therapy or cold laser therapy. I was looking at these studies and observing and more studies came out and I was like, "Okay, we need to get some lasers in our office," Sure, 30% doesn't sound great, but when you put it against these women have been trying for four to nine years, that's pretty impressive.

We don't necessarily do it as our sole therapy, but it's part of a larger program that people are a part of. I have found that not everyone needs the laser therapy, but if we know that egg quality is a major issue, I usually will recommend getting the laser. And if sperm health is an issue, the laser therapy is really amazing because lasers have shown to increase sperm count, motility, and morphology. And all of the protocols that I've seen are 12 sessions over the course of six weeks, or we've created a modified protocol because people come from all over. So when they are flying in from somewhere else, we will generally do a shorter... Like a six day protocol. It's more back to back, but it stacks all of the treatments in one.

Dr. Liz Sutherland: I imagine the duration of therapy will vary depending on whether you're treating a man or a woman. Is that correct?

Dr. Aumatma Shah: Yes and no. Our overall programs are five months, which is, I feel like the optimal amount of time. If they're going through it the way that we've recommended, they can go through a program and come out on the other side in five months with a much likelier chance of getting pregnant. However, women's hormones tend to be less predictable than male factor fertility. What I have found is that sometimes women's hormones, because we're so complex, we're amazing, we tend towards needing more shifts and because our shifts are not visible really till the next cycle. So it can sometimes take many more cycles to get those hormones perfectly aligned. And there are times where I've seen... Like endometriosis I feel like is a really big one, polycystic ovarian syndrome, another one, where if it's a condition that they've had for a really long time, it may take a longer time to actually bring those hormones back balance.

So, there's that. With men, I feel like it's pretty consistent. And the studies tend to be pretty consistent as well in that if you're giving them the things that they need, whether they have count issues, morphology issues, or motility issues, and if you're treating whatever it is that's happening for them while addressing the underlying causes, which even for men, they have plenty of adrenal issues that are affecting their production of testosterone, which then leads to the production of sperm, we can know that within three to four months, we can expect to see improvement in the sperm, or I would say the semen parameters. I feel like they're more predictable. You give them certain things and most of the time it works and there isn't a million hormones going on that are like, "Oh, I'm going to go in this direction now."

Like I love it because men are just like, "I'll do whatever you tell me. I am simple. Whatever you say makes sense, I'll do it." And then they come back two months later and they're like, "Oh my God, I feel amazing." And then four months later, we will test their sperm again and sure enough, their sperm are great. So I was looking at semen results for one of my patients. He literally had almost zero negligible amounts of sperm. They saw maybe a couple of thousand. And "normal" is considered 20 million or more, and optimal for natural fertility, I would say is like 100 million or more. And this man had a few thousand. And I was like, "I don't know if this is going to work for you." But we did what we always do, which is you need the laser protocol for six weeks, 12 sessions, and you're going to do these supplements.

And then we had him tested four months later and he had... I think his sperm numbers were like 35 million, motility was 50%. I think it had been 30%. And then the morphology is still the part that needs improvement, but I was like, "Wow, we just went from zero, like barely could see anything to very mild male factor infertility," which is really amazing to do in four months. But I feel like as long as we're doing research for male factor infertility is actually more prevalent and more available, and those things, those natural things that we use generally work. Women can sometimes take longer depending on what kind of hormone imbalance, how much of an imbalance, and how long have they had it or how long have they been experiencing it? And that might determine like, oh, this might take actually closer to eight months to address or something like that.

Dr. Liz Sutherland: Do you have reproductive endocrinologists banging at your door trying to understand what it is you do, because it sounds like you have such a wonderful approach to your patients?

Dr. Aumatma Shah: I wish. I have talked to reproductive endocrinologists in Canada where I feel like they're more open to naturopathic medicine. I'm not sure what it is, but I've talked to some of them, they have NDs within their clinics running pre-IVF programs. So in Canada, I believe, that IVF is somewhat covered and a lot of these clinics have really long waiting lists. So it might be like two years before you can even get to see the RE, but in the process of that, they're like, "Hey, we have this huge naturopathic clinic. We require you to go work with one of the NDs before we even start working with you."

And their success rates are so much higher than we have access to in the US and I'm like, "What a brilliant model." Like you already have a waiting list, you know that these women are desperate to get pregnant. And if you can just offer them something else, which I feel like REs are dedicated to like, hey, we want to help everyone have babies, but in the US I've found l there is the very quick response of where's the research? And I'm like, "But look, here's binders full of research." I have so many data points that I could say almost everything that we do is research-based or research-driven, and yet a lot of the REs that I've talked to are like, "I don't know about this. I don't really understand what all this does. So, no."

I will say I have a really good partnership with a doctor who is out on the Cayman Islands, believe it or not, and he often has patients that are like, "Nope, I want to do the natural thing first." And he just sends them to us. And then he's the doctor on the ground, right? So in that capacity, I kind of work like a consultant and then he's more than happy to say, "Sure, you want to prescribe them something or you want to order a lab test or whatever." He will take care of all of that on the ground. So that's the kind of partnership that I feel like is possible with every RE clinic in the country. If they just would open their minds to like, hey, natural medicine, maybe I don't understand it fully, but I see the possibility and really the opportunity within it, we could really transform the lives of so many couples. That is my dream is one day REs will get it and we'll just be like, "How do we get a naturopathic doctor to work with us?"

Dr. Liz Sutherland: I couldn't agree with you more. And I hope that that kind of model is one that could become prevalent for all aspects of health and wellness, including true prevention.

Dr. Aumatma Shah: Absolutely. I feel like the integrative models are really where the future is. So I definitely appreciate the spaces, especially AARM, for example, is such a beautiful organization in how many MDs and NDs and nutritionists and just like all the different health professionals coming together and connecting deeply in a collaborative way, which I think hopefully will feed into more of these collaborations in helping support the transformation of health in this country.

Dr. Liz Sutherland: Thank you for that wonderful endorsement of my organization!

Dr. Aumatma Shah: Of course!

Dr. Liz Sutherland: Do you also work with patients postpartum?

Dr. Aumatma Shah: Yes, we do. We often will have women who have gone through our fertility programs and want a little bit of support with their pregnancy and potentially postpartum health. Because we don't necessarily share a lot about postpartum health or how to support your fourth trimester, I would call it, we don't necessarily attract a ton of clients for that, but yeah, we're definitely open to helping support that transition. And I feel like I understand it better now that I've been through it. I have a two and a half year old, so I have a very distinct experience and memory of what that was like and have a much greater appreciation for that journey.

We do support women who are in that fourth trimester and beyond, but a lot of them don't necessarily need our help because if they've been through the fertility program, they kind of know what it is like as much as I can. I have some exceptions of couples that go through the programs and they're like, "We're doing this to get pregnant and that'll be it. Thank you, but no thanks." But the majority of them I feel like have gotten through to a much deeper level and they're going to continue living the lifestyle even well after they have given birth to that child.

Dr. Liz Sutherland: Fantastic.

Dr. Aumatma Shah: And that's really our goal, right? Is healthy babies, healthy families. Changing the course of what could be happening for someone. Like the number of men that I've seen and diagnosed with either being pre-diabetic or diabetic is really, really high. And I just wonder. I'm like, "Do you never go to the doctor?" And they're like, "No, I go to the doctor once a year for a checkup." And I'm like, "So they've never screened you for blood sugar issues?" I'm not understanding how so many men have blood sugar issues that they don't know about. So they're very appreciative. They're like, "How come my doctor never told me?" And I'm like, "I don't know why your doctor never told you, but you have all the signs and symptoms and we're going to test you." And then sure enough, they have high hemoglobin A1cs or whatever is happening. And usually, the lifestyle shifts that they make, they start feeling better. They're likely to stick to those changes for hopefully a really long time.

Dr. Liz Sutherland: And I imagine those lifestyle changes also support their fertility.

Dr. Aumatma Shah: Yes, exactly. 

Dr. Liz Sutherland: You only ever hear about that, weight, for example, with regard to women as being a factor in fertility, but it only makes sense that overall health quality would be a factor in men as well.

Dr. Aumatma Shah: Oh, it's huge. So overall health is a factor, but also there are quite a few studies now. When I first started noticing this link, it was like pre-research phase. I was like, "Doesn't anybody else see this in their practice?" And I felt like I was the weirdo on a ledge. But I kept seeing women with recurrent pregnancy loss specific. And that is my subspecialty. So we see a lot of those women. And these women would come in and say, "Hey, I have recurrent pregnancy loss. I've had maybe two, three, four losses. What are you going to do for me?" And I'll often look at their hormones and say, "Okay, yeah, I see some small hormone imbalances, things that we should really address, and then I want to work up your partner."

And I started with just looking at the basic semen parameters, right? I would look at their count, motility, morphology, which is the standard infertility medicine. And I would look at it and basically most of the time come to the same conclusion, your sperm are great, which is what they had been told by their IVF doctors. And I started thinking like there has to be other things going on here because there's no way that this woman with mild hormone imbalances keeps having a loss. So I started testing their blood sugar levels, hemoglobin A1c, and homocysteine levels. And then there's a few other tests that we do, none of which directly correlate to the pregnancy loss. But those two tests in particular would always lead back to, "Hey, you either have one or both of these factors as an issue that I think is directly connected with your partner having experienced a loss."

And they would do something about it as in like do the lifestyle, do the diet, do all the shifts, and their hemoglobin A1cs would go down or their homocysteine would go down. And the next time they got pregnant, these women would go on and have healthy babies. And this kept happening and I was like, "Okay, there's definitely a link here. I don't know what it is." And I believe last year, I saw some papers finally that connected high hemoglobin A1cs in men to recurrent pregnancy loss in the partner, and same for hyperhomocysteinemia in the men. And I was like, "Hallelujah, I'm not crazy." Because I had been seeing the link for a while and I was like, "Where are the studies? Why aren't there any studies on this?" So I was really excited to find them last year.

Dr. Liz Sutherland: That is really fascinating. Thank you.

Dr. Aumatma Shah: I think that has made a huge difference. So yes, general diet lifestyle and all of those things make a difference. Healthy weight makes a difference. But if we can find the lab tests, guys are really intellectually driven. So I like to always feed that side, right? It's like here's the data, here's what your labs say, here's what I need you to do about it. And I've only had one person who has refused and obviously, they were no longer part of our practice. We were like, "Sorry, you got to go. If you're not going to do the thing, you got to get out. Here's your money back." And they were like, "What?" I was like, "You're not willing to do the plan. If you're not willing to make a lifestyle change, you're in the wrong place."

But most of the time guys will hear it and say, "Okay, great. Tell me what to do." And they will do it. And they often live by that. Like they're really easy with the rules. Like, here's my rule. All right, I can do that. There's going to be no pushback. So most of the fertility men are really easy as far as patients go to just take and follow the plan and stick to it.

Dr. Liz Sutherland: Do you do fertility focused genetic testing in your clinic?

Dr. Aumatma Shah: Yes and no. It's not fertility focused so much as it is partly related to homocysteine. So hyperhomocysteinemia related to methylation issues, which then connect to genes or epigenetics in general. So my cutoff for homocysteine, if it's... And this is kind of arbitrary. So I will admit that there isn't a ton of science saying that this is the number to stick to. But what I've seen in practice is if the homocysteine is below 10, we can generally just give light nutrients and support the healing and have the homocysteine levels go down. Almost always. After it's above 10, we can give that same blend of nutrients and have the homocysteine go up, which brings into question like, hey, I think there's something going on with the genes that we don't fully understand.

So, if the homocysteine is above 10, I'll usually suggest that they do an epigenetic screening. So for simplicity sake, we've used 23andMe or ancestry.com or any one of those that will give a raw data file of the genes, and then we push it through StrateGene or some multiples of other resources to get a read of the genes that we want to see related to detoxification, methylation. And then usually we're also doing, I think PureGenomics has a profile creator. So I always also look at that one just because it's more broad and generalized.

So, we do that generally for the men and then for women, it's a certain factors or certain things that they're saying often that will trigger me to be like, "Maybe we need to do an epigenetic screen." And that's usually like if they have estrogen detox issues or they have high estrogen levels and their DUTCH test shows that certain pathways are not functioning well, it's really nice to see is this a genetic thing that the enzymes are not functioning well or is there something else happening or do you just need to support those pathways to detox better?

It helps to know in which cases, because we don't do it on everybody. And I always tell patients like, "This is different than the genetic profile that you will do in your fertility clinic should you go down that path." The fertility clinics are looking for major genetic disorders that can be passed down and they're looking for the overlap, right? Like Tay-Sachs disease or syndrome X or whatever else. They have a list that they're looking at and they'll put the two partners next to each other and say, "What are the chances of potentially having a child with x, y, z disease?" We're not doing that type of analysis. We're strictly around epigenetics and optimizing function rather than like treating disease.

Dr. Liz Sutherland: Which would fit entirely with your philosophy about optimizing the health of the inner terrain.

Dr. Aumatma Shah: Yes, exactly. 

Dr. Liz Sutherland: Dr. Aumatma, thank you so much for all of your amazing clinical pearls. Before we end, I'm wondering, is there anything else that you would like to add?

Dr. Aumatma Shah: No, this was so much fun. This was great. If anybody wants to reach out to me, I'm on Instagram, @holisticfertilitydoctor. Anybody's welcome to message me on there. And we do have a training program for practitioners if anyone's interested.

Dr. Liz Sutherland: Thank you so much. It has been a pleasure talking with you and I'm grateful for the excellent and really revolutionary services that you are providing. So thank you again.

Dr. Aumatma Shah: Thank you so much, Dr. Liz.