From Chore To Fun – Enjoying Sex While Trying To Conceive

Betsy Greenleaf, DO, FACOOG (Distinguished)

Welcome back, everybody, for another session of the Solving Sexual Dysfunction Summit. I am with Dr. Aumatma Simmons, and we are going to be talking about fertility and its effects on sexual wellness. 

Thank you so much, Dr. Simmons, for being with us today.

Aumatma Simmons, ND, FABNE, MS

Thank you for having me, Dr. Greenleaf.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I always love people’s backstories. I know we go through this every time I talk to you, but I can never hear it enough. What? How did you end up in the fertility space?

Aumatma Simmons, ND, FABNE, MS

It was kind of a trip because I was married to this man who wanted to have children, and every time he mentioned babies, my uterus would scream. I was like, That was weird. Do I not want to have children? Do I not want to have them with him? I went into a lot of introspection and a lot of research, only to figure out that I just did not want to have children with him. That sent me on a whole different road than I thought I was signed up for. We ended up getting a divorce. Just all of the things that I had learned in medical school about fertility and how it drops off a cliff at 35, the more I researched, the more I came to this belief that was not true. 

Why are we telling women that? It is extremely disempowering to have the belief that at a certain age your fertility just dies or your ovaries shrivel up, That is just not the reality. It is a gradual decline, and different people have different declines at different ages. Yes, there is an average. Yes, we can generalize things, but they are generalizations, and we just have to remember that it is not a belief system that we need. It will have a greater impact on our awareness. But it is also important to realize that that may not be our story. I started sharing about that. women were saying, Great, you can help me have a baby. I saw you doing fertility. 

I got into it because, just my own story and just feeling, I wanted a different voice in the space. 

This is now 13 years ago, when there were a lot of doctors talking about fertility, and fertility was not so prevalent, at least in culture. It was happening. It was just not as talked about as it is now. I just wanted to be that voice that said, Listen, if you are over 35, that is okay. Figure out what your hormones look like. Figure out what this means for you. Do not settle for, You are too old to have children because that is just not true. 

That is kind of my story and why I got into fertility. Still, 13 years later, I am doing the thing to help people have babies because I did such an amazing thing. This year you are so you are. Yes, I know all about babies. But just the joy of seeing these beautiful children come into the world that, a year prior, were not able to come in. Women have been told, You will never have your child, or you need an egg donor, or whatever. Despite all the different things that they have been told, it is nice to see them overcome those challenges.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I was thinking, too, about how fertility, sex drive, sexual function, and all that; go hand in hand. Many people separate it. But even with your story, we are going to see relationships kind of come into play because if you are kind of finding out you are having a hard time not just getting pregnant, but having a hard time having sex with your partner, there may be something going on more from a relationship standpoint than actual, mechanical, or there is something biologically wrong with me.

Aumatma Simmons, ND, FABNE, MS

Yes. Even I can say this about my ex-husband, and I have never shared this publicly, but every time I had sex with him, it was painful. That initial release should have been a red flag. But we had waited until marriage and the whole thing, We were already married by that point. This was supposed to be; this is not good. But in reality, looking back at it now, I just was never emotionally connected. I had very much chosen the wrong person, and they call it my starter marriage. I am good. There was no baggage around it. But it was a beautiful learning experience because if that emotional connection is frayed or not optimal, then sex becomes challenging. Sometimes our body is aware enough to show us physical signs and symptoms. The pain of sex is sometimes an emotional thing; sometimes it is hormonal; and sometimes it is endometriosis.

There is always the need to remember that if this is new for you, All of a sudden this is painful, or All of a sudden my husband can no longer ejaculate or no longer stay erect, then it behooves us to take a step back and say, Is it a physical thing or is there some emotional underpinning that is causing some of the challenges that we are experiencing? With fertility especially, it comes up so often, that so many men who are partners and who are struggling with fertility, end up having erectile dysfunction, it is a  common thing. I have been known to say, Women kind of take this burden on, and it is my fault we are not getting pregnant. 

But equally, men are feeling a distinct level of pressure that causes some distress and makes that difficult. then, the more that happens, the more they start kind of tripping about it and making it bigger than it is. A lot of men at that point will start taking the hormone testosterone, thinking, That is going to fix it, when in fact that is the opposite of what we want to do if you are trying to get pregnant. Yes, it is present in the fertility world. I think so much of it is that emotional degree of distress.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I remember when I was trying to get pregnant, it was all of a sudden. I was in my late 30s, and I felt I had an expiration date. You go by the eggs from the supermarket, and they have an expiration date. It felt like a mad rush to beat this expiration date because you have old eggs. that made it terror. I find the getting pregnant thing horrible, at least for me, because I just always assumed that I spent so many years trying not to be pregnant. Then I just got my birth control and it automatically happened. Now, all of a sudden, late 30 is, and it did not happen. 

Then it was that every month became stressful, and then even sex became stressful because we did the ovulation predictor, and then we had to go, we had to look at each other and be, today is the day. Both of us are, and we have to do this. I am. We do not do it. It is going to be a whole other month. I am sure you see the stress of dealing with infertility, which affects fertility even more and then affects the sex drive.

Aumatma Simmons, ND, FABNE, MS

Yes, absolutely. I think the other thing you just said about the time sex or ovulation predictor kids we are seeing when we are ovulating. We are only having sex when we are ovulating, which leads to even more pressure, especially for men, but for women, too. We kind of suck the joy out of sex in baby-making when we are dealing with fertility stuff. We have to remember to infuse that back into our relationship and back into the fertility journey.

Where. I always say this to clients: Most of the people who get pregnant quickly do it when they least expect it. They always come back, and they are, I did not even realize I was always ovulating, perfect. That is exactly why you are pregnant. You did not realize you were ovulating. You took the pressure away, and you guys just had fun and, honestly, followed your bodies. When hormones are in alignment and you are in your most fertile peak state, your body already knows. That. Most of the time, women say, ‘I had this amazing sex drive before ovulation. I say, Yes. That is how nature is designed. You do not have to do anything.

When things are aligned, you will have a higher sex drive just before ovulation, and the pheromones and all of that, men are picking up on that subtly, so they do not need to be told, Hey, time to have sex, time to make a baby. They already are, Hey, how do I get to be able to just relax into that instead of, Are we all ovulating today, now, this minute, Who cares? That, in and of itself, is not necessary. It adds extra pressure where you do not need it. Taking that away sometimes will help, make it way more fun, and take the pressure off, which is a great little hack. We tell people to do that a lot.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I was going to ask you to explain how sex and stress can exist at the same time.

Aumatma Simmons, ND, FABNE, MS

It cannot exist at the same time. 

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yes. Stress cannot.

Aumatma Simmons, ND, FABNE, MS

Yes, it is okay. This is, I think, especially true for women, but men sometimes have it. If we are stressed about something, if we are experiencing some degree of added things that our body or our emotional mental state has to deal with, then, at least for women, what I experience is that the body shifts out of making the hormone and testosterone that will help support sex life and shifts it into producing cortisol and epinephrine, depending on the types of stressors. 

Our body just shifts what hormones are going to be most conducive to helping us adapt to what is happening in the world, what is happening around us, and what is happening with us emotionally. If all of the energy needs to go to something else, then, biologically, the body is not. How do I also have sex at the same time? It is either we are in fight or flight, or, for women, it is especially feeling safe and secure. When we have that feeling of safety and security, it is a lot easier to relax. It is a lot easier to be open to sex, and it is a lot easier to get pregnant than when we are in that fight-or-flight survival mode.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I always say that when you are running away from the lion, it is not the time to be digesting and having sex. I have this image of somebody running from a lion, trying to have sex while eating pizza at the same time. Not going to happen. Is she going to survive? Something’s got to go.

Aumatma Simmons, ND, FABNE, MS

Absolutely, and fertility in sex for women is not a survival tactic. For men, I think they are slightly different. Men can have sex under pressure and stress, or they can compartmentalize. Just put it to the side. I am just having sex now. It is; sometimes men come back and they are. Yes, sex is my stress relief. They are wired a little differently. But in general, yes, this idea of running from the lion and doing anything else is not what our bodies are designed for.

Betsy Greenleaf, DO, FACOOG (Distinguished)

When you are talking to clients who are struggling with fertility, what kind of recommendations do you make for them?

Aumatma Simmons, ND, FABNE, MS

Yes, so we work on all the different levels. mind, body, spirit—all of it has to be incorporated on the body side. We start with diet and lifestyle. That has to be the foundation for everything. then we do a lot of testing to figure out, What are your hormones doing if your cortisol is flatlined, that is a very different scenario than your cortisol being off the charts and needing to be lowered. Figuring out: what is the stress, how did this stress impact your body physiologically, and how are we going to tweak it to get the outcome that we want? We will do that. 

Then, on the mental-emotional side, I think our focus is on how we shift people from fight to flight. Because most of us live in that mode. That is the only mode that most of us know. How do we shift from that to safety and security? How do we shift into a state where we are not surviving? We are thriving. We have some men who are biohackers; I call them just two-minute little resets to reset the nervous system. Into shifting from this sympathetic to a parasympathetic state. 

On the spiritual side, I think it is the exploration of, both for yourselves as well as for the couple, to explore, What? Why do we want to have this child? What does it look like? What does our family look like? What is going to shift, and why am I being called to this? That one is interesting because, now and then, I have had two couples now, one ten years ago and one just last month, who came in. They both came in. They were, We want to have a child. Both of them, intuitively, I was, Are you sure you want to have a child? Is this for real? 

The couple most recently, came back a month later, after two months of being in the program, doing all the things, and they were, We just got it clear that we do not want to have a child. We already have one. He is about to turn eight. We are good. I was, This is what I was suspicious of the entire time. 

Then the other one, the one from ten years ago, they were, Thank you so much. They finished my entire program. They improved their health. But at the end of it, they were, and all the reflections that we have been doing, we did not realize that neither one of us wanted this. We were in it for the other person. They are saying, Thank you so much for helping us realize this because we have been working on it for 10 years and we do not know when each of us decided we did not want it. We are just going to support the other person. But our whole life has been about this for 10 years. We are so grateful that we get to stop, get off this roller coaster, and just live our lives. 

That spirit piece is interesting because it can go differently than we expect sometimes. But most of the time, people come out of it, I understand why my spirit is guiding me to have a child in this moment, in this time, now, even though it is challenging. Even though the world is challenging, some people are, I do not know if I want to bring a child into this world, but I want to have a child and am coming to terms with it. How does that look and what is the bigger life plan? What is the bigger picture? 

We often have those conversations because, to be holistic, we cannot just put that on the back burner and ignore it. We just have to listen to our spirits and follow the guidance that we are being given. Yes. the body, mind, and spirit, all three of which we are incorporating in some way. I know that doctors most of the time are in the body space, but I think those other pieces are important.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I agree with you. I am always saying that you need to have all three aspects to have any kind of semblance of health. Then, as you were talking, I was just trying to think about couples that are going through this fertility journey. I was thinking I was lucky enough to get pregnant. It took six months. But yes, I think if it had gone any longer than that, I probably would have lost my mind because it is such a given to you. The level of stress during the period when you are dealing with fertility has to be so much more. 

I am assuming then that you are just dealing, and I am not that I am, just dealing with sexual dysfunction because that is also very stressful. But I think, especially for women, because of this whole idea that there is this ticking time clock that is going on. Do you see couples that are going to start to, and I am sure you try to bring them back? But you see couples that are coming in, and there is this resentment towards each other because they are not getting pregnant.

Aumatma Simmons, ND, FABNE, MS

Yes, there is. There are different types of resentment. One of the most severe was a couple that were relatively young. I think the woman was 33 or 34 from what I remember, and the guy was 36. But his life plan was to have three children. When they came to me, they were. We have been struggling with this for three years, and we should have started when we first got married. They were high school sweethearts or something. 

They were married for a long time. He was. I have been telling her that I want this forever and that I want three children. I do not even know if I want one. We are on completely different pages here. That initial consult, which is usually 2 hours for me, turned into 7 hours because there was just so much resentment and anger. At some point, they were just screaming at each other. I was.

Betsy Greenleaf, DO, FACOOG (Distinguished)

You definitely cannot have sex drive or fertility when that is going on.

Aumatma Simmons, ND, FABNE, MS

I do not know. Yes, there is that resentment a lot of times. With. Other couples, I have not seen that as severely, there will be some levels of resentment because You are not doing all the things. I am over here doing X, Y, and Z, but you are not doing anything. It is usually the guys who are not expected to do anything, but then they come to us, and we are. No, you guys are in this together.

We are changing this conversation because if you are going to create a child, 50% is from you and 50% is from him. Both of you take equal responsibility. Both of you make equal efforts to have a child. That helps to shift it because now the woman is no longer saying, I am doing this, and he is just along for the ride. It is more that he has to take some steps, and he has to go through the hard stuff. 

They will often come back and say, Thank you so much for getting him on board because I was exhausted from telling him what it is to stop drinking—the most basic things. It was exhausting to just say, Stop drinking. You are not supposed to drink. I am not. No one wants to be monitoring your partner and what he is doing with his life, You do not want to be the mom. That can shift relatively easily, I think, when the men are being told, Hey, you have a role to play, and it is equivalent. The reason that you are not getting pregnant is not just her; it is also you, and most men take it like, I will get my stuff together. I will do the stuff now that I know. It’s just that no one ever pays attention to the man. They are saying, Nobody has ever asked me anything. They swear we are good, so I am good.

Betsy Greenleaf, DO, FACOOG (Distinguished)

There is also there is this theme about communication. I was thinking, about whether it is fertility, because I think you need to be communicating a lot when you are dealing with that, or if it is just or if it is a sexual stressor, that if the partners do not communicate because one partner has expectations of yet, for example, I want to have three kids or I want to have three kids by this time, or even you get married in that partner’s, I think we are going to have sex this many times a week for the rest of our lives. If those expectations are not communicated, then it kind of creates this adversarial role between the couples. Nobody knows why they are annoyed with each other.

Aumatma Simmons, ND, FABNE, MS

Yes. The expectations thing is so big; I feel we are not taught to have these conversations, and a lot of times we are not aware that we are having those conversations internally. When we are annoyed with our partner. Why did you not wash the dishes? No one has had a conversation about who is washing the dishes when and how frequently. How do we balance this in our relationship? How do we both feel about it? Once the conversation ends, it becomes a lot easier to be resentful. I have to feel resentful because we are on the same page. We had the conversations that we needed to have to come to a place where we felt good. This. Equally.  Both people feel good about the situation.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yes. You have so much information on this topic, which is amazing. Is there anything that I have not asked you that you think is important for us to know?

Aumatma Simmons, ND, FABNE, MS

No. I think in terms of erectile dysfunction on the male side, we talked about painful sex, which is often a sign and symptom for women not to be ignored. Yes, I think, the other piece that we have been seeing a lot of, and I am curious what you think about this: the kind of illnesses. The sexually transmitted illnesses that are being transmitted back and forth that affect sex life? 

Either we are making it challenging or the infections definitely affect fertility, and yet we often do not know or test for them. Just being mindful of, Hey, there are. It is important to get these things tested and understand that if the microbiome has shifted or if there are viruses present, we need to address those early and quickly so that they do not go under the radar and then lead to further issues down the line.

Betsy Greenleaf, DO, FACOOG (Distinguished)

That is such a great point because this is something I see often in my practice. Then, as I got more into functional medicine and looked at the microbiome, I was originally focusing on the vaginal microbiome in my practice, and we are finding that if that shifted for whatever reason, it does not even need to be. As I said, though, a lot of the bacteria that we do not consider STDs can be passed back and forth through partners. For women who are getting recurrent vaginal infections and recurrent bacterial infections, sometimes it is something that they are having a cold and you are passing that cold back and forth, even though it is not considered sexually transmitted. 

But there has been so much research showing that if the vagina of the bacteria in the vagina is off, there is that feedback loop to the brain that says, It is not time to make a baby. But the brain does not know the difference between wanting to just have sex or trying to make a baby and will shut down the whole process. then, as I got deeper into that research, I found that for men because I was, Well, there has got to be something similar. 

We found that in both men and women when you look at the gut microbiome. These bacteria and organisms in the gut, if they are off too, are another stressor for the body. the body goes, all of us are stressed. not trying to reproduce or shut everything down. Yes, I am glad you brought that up, because I would have forgotten to mention that.

Aumatma Simmons, ND, FABNE, MS

Yes, the microbiome is just becoming such an important piece of how our bodies work, The more we figure out about it, the more it is—are we microbes? Are we just a body with microbes in it? Because it is everywhere and is interconnected. The oral microbiome has an impact on the gut microbiome, which has an impact on the vaginal and reproductive microbiome. If there are imbalances, we are going to see them in all three, and they are interrelated. 

There is some cool research on the oral microbiome and the presence of cavities. Having had dental work or taken antibiotics locally, threw off the oral microbiome, which then affected fertility outcomes. It is all connected, and, I am just as fascinated with the microbes and what it means for us, and what you said about passing it back and forth is so important because they are who we were. We started with, We are going to work on the ladies. Then we quickly realized, If they have it, they have sex, they are passing it to the men, and the man’s going to pass it back. We have to test both people, know what is happening on both sides and treat it effectively for both of them, usually at the same time, to make sure that it does not affect fertility.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I love how every part of the body is connected, and I am glad you brought up the thing about oral health because I have not thought about this since I was in residency. At the time, we did not have a model to say this was connected. We were just like, This is weird. I remember I had two cases. One was a woman who had infertility, and she had horrible, horrible teeth. I just assumed she was someone who took care of things. She took care of her teeth. It is not. 

Sometimes there is this judgment of somebody who has bad teeth that they are not involved in self-care. She was taking care of teeth and she was having it, and then there is this: maybe she was doing drugs, and it wasn’t that she just had bad problems with getting recurrent cavities, and I remember once they pulled a bunch of her teeth out and her fertility got better. But now I think that was a microbiome issue. Because we were, how is that connected? 

Then we had another woman who was pregnant and came into the hospital. She was very early in her pregnancy, and she went into pre-term labor and had an exam. Usually, as gynecologists, we are not checking people’s mouths, but for whatever reason, we checked this woman’s mouth, and she had a bad cavity. But she was in the hospital and on bed rest for her pre-term labor, and trying to get a dentist to come into the hospital was next to impossible. They do not usually do that. 

This poor woman was on bed rest for a couple of months, and finally, they got a dentist to come into the hospital. The same thing pulled that the tooth that was infected and her cervix, which had been opening because she was going into pre-term labor, all of a sudden closed up, and she finished out that pregnancy completely normally. I love the fact that you brought up oral health because I always forget about that.

Aumatma Simmons, ND, FABNE, MS

Yes, It is cool. I feel our bodies are just incredible in terms of how one thing over here affects a completely different system. That is why we do what we do.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I have been thinking about fertility a lot lately. Yes, with fertility and sex, it is when there is a problem in those departments that we get too focused on it. It is a problem in that department when our bodies are going. Hello, I am trying to get your attention. There is something else going on.

Aumatma Simmons, ND, FABNE, MS

Yes, and, to a certain extent, fertility is the least necessary part of our human survival, As a race, we need it, but as individuals, we do not. The body goes, Well, I have other things to deal with now.’  This is an area where I can conserve my energy and refocus on what I need to deal with. Often people will say, I am dealing with my SIBO before I come and see you. I am, That’s funny. 

Because that is kind of what we do: deal with all the other stuff so that you can get pregnant. Yes, it is, it is, and it is hilarious. To have it framed in the way of, I need to work on this little thing over here first, and then I can come to work on my fertility. I am, No, if you are working on fertility, you are working on everything. There is no difference; fertility is not different from everything.

Betsy Greenleaf, DO, FACOOG (Distinguished)

That is such an important message. With that, where can people find out more information about you?

Aumatma Simmons, ND, FABNE, MS

A few places. Our website is HolisticFertilityInstitute.com. You can find us on Instagram at @holisticFertilityDoctor, and I always forget to mention this podcast, which is  Egg Meets Sperm. If you listen to podcasts, Egg Meets Sperm.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I love that. Thank you so much, Dr. Aumatma, for taking the time to talk with us today.

Aumatma Simmons, ND, FABNE, MS

Thank you for having me. I hope everyone goes out and has an amazing sex life so that they can support their fertility.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I agree. I second that motion. Just to remind everybody, stick around, because we have some more amazing sessions coming up.