From Chore To Fun – Enjoying Sex While Trying To Conceive

Introduction to Fertility and Sexual Wellness 0:00

All right. 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 with sexual wellness. So thank you so much, Dr. Simmons, for being us, Dr. Aumatma, for being with us today. Thank you for having me, Dr. Greenleaf. So, you know, I always love people's back story. And 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?

It was kind of a trip, actually, because I was married to this man who wanted to have children and the that every time he mentioned babies, my uterus would literally scream, oh. And I was like. That's weird. Do I not want to have children? Do I not want to have them with him? And I, I went into a lot of introspection and a lot of research. To. Only to figure out, like, I just didn't want to have children with him. So that sent me in a whole different road path that I thought. I was signed up for.

We ended up obviously getting a divorce. And.

Dr. Simmons' Path Into Fertility Medicine 1:32

Just like all of the things that I had learned in medical school around fertility and how it drops off of a cliff at 35 and the more I researched, the more I came to this belief of like, actually, that's not true. And why are we telling women that? Because it's extremely disempowering to have a belief that at a certain age your fertility just dies or your ovaries shrivel up. Right? Like that's just not the reality. It's a way where gradual decline. And different people have different declines at different ages.

So, yes, there's that average. And yes, so we can like generalize things, but they're generalizations and we just have to remember that it's not it's not a belief system that we need. It's more like it's going to have in our awareness. But it's also important to realize, like, that may not be our story. So, so I started sharing about that. And. Women were like, Oh. Great, you can help me have a look. Okay. I saw you doing fertility, so I got into it because. Just my own story and just feeling like I wanted a different voice in the space.

This is now like 13 years ago when women there were a lot of doctors talking about fertility and fertility wasn't so prevalent it. In at. Least in in like culture, right? Like it was happening. It was just not as talked about as it is now. And I just wanted to be that voice that was like, listen, if you're over 35, that's okay. Like figure out what your hormones look like. Figure out what this means for you. Don't settle for the Oh, you're too old to have children because that's just not true. So that's that's kind of my story and like why I got into fertility.

And still, 13 years later. I'm doing the doing the thing to help people have babies because, oh, my God, I did such a. Such an amazing thing. Right. To and, you know, this. Year you are so you're like, yeah, I know all about babies. But just like the the joy of seeing these beautiful children come into the world that, you know, a year prior were not able to come in. And women have been told like, oh, you'll never have your own child or your you need an egg donor or whatever. And like all the different things that they had been told, it's really nice to see them overcome those.

Challenges. You know? And I was thinking, too, about how fertility and sex drive and sexual function like all that, they go so hand in hand. A lot of people like to separate it. But even with your story, we're going to see relationships kind of come into this because if you're kind of finding out you're having a hard time not just getting pregnant, but like having a hard time having sex with your partner. And there may be something going on more from a relationship

How Fertility Stress Affects Sex and Relationships 4:46

standpoint than actual, like, mechanical, like, oh, there are something biologically wrong with me. Yeah, yeah, absolutely. Like, even I can say about my ex-husband and I've never shared this publicly, but like we every time I had sex with him, it was painful. And that initial release should have been a red flag. But we had waited till marriage and the whole thing. Right. And so we were already married by that point. And I was like, Oh. This was supposed to be like, this is not good. But in reality, like, looking back at it now, like I just was never emotionally connected. Like I had very much chosen the wrong person and they call it my starter marriage.

So I'm good. There's no like I don't have any. Baggage around it. But. Like it was a really beautiful learning experience because that if that emotional connection is frayed or not optimal, then sex becomes really challenge. And, and sometimes our body is aware enough to like show us physical signs and symptoms. So the pain with sex sometimes is an emotional thing, sometimes it's hormonal, sometimes it's endometriosis. So there's there's always like the need to remember that if this is new for you, like, hey, all of a sudden this is painful, or all of a sudden my husband can no longer like ejaculate or no longer stay erect, then it really behooves us to take a step back and say, okay, is it a physical thing or is there some emotional under underpinning.

That is. Really causing some of. The. The challenges that we're experiencing? And with fertility especially, it comes up so often, like so many men. That are. Partners that are struggling with fertility, that end up having erectile dysfunction, it's a really common thing. And. You know, I, I, I've been known to say, oh, like women kind of take burden, take this burden on and like, oh, it's my fault we're not getting pregnant. But equally like, men are feeling a distinct level of pressure that causes some like distress and makes that's difficult.

And then, like, the more that happens, the more they start kind of tripping about it and making it bigger than it is. And a lot of men at that point will start taking hormones like testosterone, thinking, oh, that's going to fix it, when in fact that's like the. Opposite of what we want to do if you're trying to get pregnant. So yeah. It's yeah, it it is. It's definitely present in the fertility world so much. And I think so much of it is that emotional degree of distress. And I remember when I was trying to get pregnant, it was all of a sudden like, I'm in my late thirties and I feel like I felt like I had an expiration date, you know, like you go by the eggs from the supermarket and it's got the expiration date.

It was like it felt like this mad rush to beat this expiration date because you have old eggs. And that made like it was terror. I find the getting pregnant thing was absolutely horrible, at least for me, because I just always assumed like, all right, I spent so many years trying not to be pregnant. And then I just, you know, I just got my birth control and automatically happen. And now all of a sudden, late 30 is and it didn't happen. And then it was like every month became stressful and then even sex became stressful because we do the ovulation predictor and then we'd go, we'd like look at each other and be like, Oh, today's the day.

And like, both of us are like, we really have to do this. I'm like, Oh, we don't do it. It's going to be a whole nother month, you know, like I'm sure you see like that whole, like stress of dealing with infertility affecting the fertility even more and then affecting the sex drive. Yep, absolutely. And I think the other thing what you just said about the time sex or like ovulation predictor kids we're seeing when we're appreciating we're only having sex when we're obviously dating, that leads to even more pressure, especially for the men, but for women, too.

Like we we kind of suck the joy out of. Sex. In baby making when we're dealing with fertility stuff. So I, we really have to remember to, like, infuse that back into our relationship and back into the fertility journey. Where. I always say this to clients, I'm like most of the people that get pregnant quickly do it when they least expect it, right? And they always come back and they're like. I didn't even realize I was always bleeding. Like, perfect. That's exactly why you're pregnant. Because you didn't.

Realize you were ovulating. You took the pressure away, and you guys just had fun and honestly, like, followed your bodies. And when hormones are in alignment and like you're at your most fertile peak state, your body already knows. That. Most of the time women are like, Oh, I had this, like amazing sex drive right before ovulation. And I'm like, Yeah. That's. Like nature's designed, right? Like, you don't 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.

Like men are picking up on that subtly, so they don't need to be told, Hey, time to have sex, time to make a baby. They already are like. Hey, how do I get to, you know. And like being able to just relax into that instead of like, Oh, are we all living today right now, this minute, like, who cares? Who cares like that in and of itself is not necessary. And add extra pressure where you don't need it. So taking that away sometimes will will help and like make it way more fun and take the pressure off, which is a great a great little hack.

We tell people to do that a lot. I was I was going to ask you to explain how come sex and stress can exist at the same at the same time. It can't exist at the same time. Yeah. Had tense. Cannot. Yeah it's a it's okay. So this is I think this is especially true for women, but men sometimes have this. Where. If we're stressed about something, right, like if we are experiencing some degree of added things that our body or our emotional mental state has to deal with. Then the. At least for. Women, what I experience.

Mind-Body-Spirit Approach to Fertility Care 12:40

Is like the body shifts out of making the hormone and like testosterone that will help support sex life and shifts it into producing cortisol and or epinephrine, epinephrine depending on the types of stressors. So our body just shifts like what hormones are going to be most conducive. To. Helping us adapt to what's happening in the world, what's happening around us, what's happening with us emotionally and if all of the energy needs to go to something else, then but like biologically, the body's not like, how do I why how do I also have sex?

At the same time, it's either we're in fight or flight or for women it's a specially like feeling safe and secure. And when we have that feeling of safety and security, it's a lot easier to relax. It's a lot easier to be open to sex and it's a lot easier to get pregnant than when we're in that fight or flight like survival mode. I always say that, like when you're running away from the lion, it's not the time to be like digesting and having sex. So I have this image of somebody like running from a lion, trying to have, like, sex and eating a pizza at the same time.

Not going to happen is she going to survive? Like like something's got to. Go, though, so. Absolutely. Absolutely. And and like fertility in sex for women are not survival tactics. Right. For men I think they're slightly different. Um. Some men can have sex under pressure and under stress, or they can compartmentalize. And just like, put it to the side, like, I'm just having sex right now. And it's like, sometimes men come back and they're like, Yeah, sex is like my stress relief. So they're wired a little differently.

But in general, yeah, this idea of, like, running from the lion and doing anything else is it's not what our bodies are designed for. So when you're talking to clients who are struggling with fertility, what kind of recommendations do you make for them? Yeah, so we work on all the different levels. So 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. And then we do a lot of testing to figure out like, what are your hormones doing if your cortisol is flatline?

That's a very different scenario than your cortisol being off the charts and needing to be lowered. So really figuring out like how what is the stress and how did this stress impact your body physiologically and how are we going to tweak it to get the outcome that we want? So we will do that. And then on the mental emotional side, I think really like our focus is how do we shift people from fight or flight? Because most of us live in that mode. That's the only mode that most of us know. How do we shift from that to safety and security?

How do we shift into we're not we're not surviving. We're thriving. Right. And we have some men like Biohackers, I call them just like to two minute little resets to reset the nervous system. Into. Shifting from this like sympathetic to parasympathetic state. And and then on the. Spirit. Side, I think it's really the exploration of between for yourselves as well as for the couple. To. Explore. Like what? Why do we want to have this child? What does it look like? What is our family look like? What's going to. Shift.

And why am I being called to this? And that one is really interesting because every now and then I've had two couples now, one like ten years ago and one just like last. Month who. Came in. They both came in. They were like, We really want to have a child. We want to have a child. We want to have a child. And and both of them, intuitively, I was like, Are you sure you want to have a child? Like, Is. This for real? And the couple most recently, they came back a month later, month of being two months of being in the program, doing all the things.

And they were like, you know, we just got really clear that we don't want to have a child. We already have one. He's about to turn eight. Like we're good. He was like, Okay, this is what I was suspicious of the entire time. And then the other one, the one from ten years ago, they were like, Thank you so much. They finished my entire program. They improved their their health. They but at the end of it, they were like all the like reflections that we've been doing. We didn't realize that neither one of us really wanted this.

We were in it for the other person. And they're. Like, Thank you so much for helping us like realize this because we've been working on this for ten. Years and. We don't know when each of us decided we don't actually want it. We're just going to support the other person. But our whole life has been about this for ten years. We're so grateful that we get to like stop, get off this roller coaster and just like live our lives. So it really like that spirit piece is interesting because it can go in a different way than we expect sometimes.

But most of the time people come out of it with like, oh, like I understand why my spirit is guiding me. To. Have a child in this moment, in this time, now, even though it's challenging, right? Like even though the world is challenging, there are people that are like, I don't know if I want to bring a child into this world, but I want to have a child and really coming to terms with like, what does that look like and what's the bigger life plan? What's the bigger picture? So we often are having those conversations because I feel like in order to be really holistic, we, we can't just put that to the back burner and ignore it.

We just have to listen to our spirits and and follow the guidance that we're being given. So, so, yeah. So the body, mind, spirit, all three, we're incorporating in some way. I know that like doctors most of the time are in the body space, but I think those other pieces are really important. Oh, I totally agree with you. I'm always saying that you need to have all three aspects to have any any kind of semblance of health. And then as you were talking, I was just trying to just thinking about couples that are going through this fertility journey.

And I was thinking I mean, I was lucky enough to get pregnant. It took six months. But yeah, I think if it had gone any longer than that, I think I probably would have lost my mind because it is such a given to you. The level of stress during the for like when you're dealing with fertility has to be so much more, I'm assuming then, then just dealing and I'm not that I'm, you know, putting just dealing with the sexual dysfunction because that also is very stressful. But I think especially for women, because of this whole idea that there is this ticking time clock that's that's going on.

And do you see couples that are going to start to and I'm sure you try to bring them back, but you see couples that are coming in and there's this resentment because towards each other, because they're not getting pregnant. Yeah. Yeah, there is. There are definitely different types of resentments. The most one of the most severe was a couple

Resentment, Communication, and Shared Responsibility 21:38

that had they were relatively young. I think the woman was like 33 or 34 from what I remember, and the guy was like 36. But his life plan was to have three children. And. When they came to me, they were like, We've been struggling with this for three years and we should have started when we first got married, which. They were like high school sweethearts or something. So they were married for a really long time. And he was like, I've been telling her that I want this forever and I want three children.

And she's like, I don't even know if I want one. Like, we're on completely different pages here. And that initial consult, which is usually 2 hours for me, turned into 7 hours because there was there was just so much resentment, anger. They like at some point they were just screaming at each other. And I was like. And you definitely can't have a sex drive or fertility when that's going. I don't know. Yeah, yeah. And yeah. So there's that the the resentment a lot of times. With. Other couples, I haven't seen that as severely like there will be some levels of resentment of like, oh, you're not doing all the things right.

Like I'm over here doing X, Y, Z, but you're not doing anything. And it's usually like the guys who are not expected to do anything, but then they come to us and we're like, No, you guys are in this together. We're changing this conversation. Because. If you are going to create a child 50% is from you, 50% is from him. So both of you take equal responsibility. Both of you, you. Take make equal efforts to have a child. And that helps to shift it because now the woman is no longer like I'm doing this and he's just along for the ride.

It's more like he has to take some steps and he has to go through the hard stuff. And. They will often come back like, thank you so much for getting him on board because I was exhausted of telling him what it's like to stop drinking, you know, like the most basic things. Like I, it was exhausting to just be like, stop drinking. You're not supposed to drink. I'm not like, no one wants to be monitoring your her partner and what he's doing with his life. Right? Like, you don't want to be the mom, you know.

So the that can shift relatively easily. I think. When. When the men are are being told like, hey, you have a role to. Play and. It's equivalent. The reason that you're not getting pregnant is not just her, it's also you and most men take you out like, Oh, okay, I'll get my shit together, you know, like I'll do the stuff now that I know. It's just that no one ever pays attention to the man. They're like, nobody's ever asked me anything. Like, they swear we're good, so I'm good. So, you know, it's it's also there's this theme about with communication because I was thinking, you know, whether it's fertility, because I think you definitely need to be communicating a lot when you're dealing with that or if it's just or if it's a sexual stressor, that if the partners don't communicate because one partner has like, you know, expectations of yet like, for example, I'm want to have three kids or I want to have three kids by this time or even you get married in that partner's like, I think we're going to have sex this many times a week for the rest of our lives.

Like, if those expectations are not communicated, then it's kind of creates this, this adversary like role between the couples. And nobody knows why they're annoyed with each other. Yeah, yeah. Isn't it? It's. It's. Yeah. The expectations thing is so big, I feel like we're not taught to have these conversations and, and a lot of times we're not aware that we are having those conversations internally. So when we're annoyed with our partner of like. But. Why didn't you wash the dishes? It's like no one's had a conversation about who's washing the dishes when, how frequently.

And. Like, how do we balance this in our relationship? How do we both feel good about it? Right. And once you have the conversation ends that it becomes a lot easier to be like, Oh, I have to feel resentful because we're on the same page. We, we like had the conversations that we needed to have to come to a place where we feel good about. This. Equally. Like both people feel good about the situation. Yeah. And this is you have so much information on this topic, which is amazing. Is there anything that I haven't asked you that you think is important for us to know? Uh.

No. I think in terms of like we talked about the erectile dysfunction on the male side, we talked. About. Painful sex, which is often a sign and symptom for women not to be ignored. And yeah, I think I think, oh, the other, I guess the other piece that we've been seeing a lot of and I'm curious what you think. About this. Is really. The. The. Kind of of. Illnesses, illnesses this the sexually transmitted illnesses that are being transmitted back and forth that affect sex life. Right. That yeah. Either are making it challenging are the the infections definitely affect fertility and yet we often don't know for the know them test for them.

So just being mindful of like hey there are it's really important to get these things tested and

Microbiome, Oral Health, and Fertility 28:38

understand that if the microbiome has shifted or if there are viruses present, we really need to address those early and quickly so that they don't go under the radar and then lead to further, further issues down the line. And that is such a great point because this is something I would see often in my practice. And then as I get more into functional medicine and looking at the microbiome, I was focusing originally on the vaginal microbiome in my practice and we're finding that if that shifted for whatever reason, it doesn't even need to be.

And that's as I said, though, a lot of the bacteria that we don't consider STDs can be passed back and forth through partners. So women who are getting recurrent vaginal infection and a recurrent bacterial infection, sometimes it is something that they are like having a cold and you're passing that cold back and forth, even though it's not considered sexually transmitted. But there's been so much research showing that if the vagina of the bacteria in the vagina is off, there's that feedback loop to the brain that says, okay, it's not time to make a baby.

But the brain doesn't know the difference between you want to just have sex or you're actually trying to make a baby and will shut down the whole process. And then as I got deeper into that research, I found that for men because I was like, Well, there's got to be something similar for men. And we found that in both men and women when you look at the gut microbiome. So these bacteria and organisms in the gut, if they're off too, it's another stressor for the body. And the body goes, all right, we're stressed.

So not tying to reproduce or shut everything down. So that's yeah, I'm glad you brought that up, because I would have forgotten to mention that. Yeah, the microbiome is just becoming like, such an important piece. Of all. Of the. The ways in which our bodies work. And the more we figure out about it, the more it's like, are we microbes? Are we just. Like a body with microbes in. It? Because it's literally everywhere and it's, it's interconnected. Like the oral microbiome has an impact on the gut microbiome, which has an impact on the vaginal and and reproductive microbiome.

So if, if there are imbalances, we're going to see them in all three and they're interrelated. There is some research, really cool research on oral microbiome and like the presence of cavities, having had dental work or taken like antibiotics locally, which this this like threw off the oral microbiome which then affected fertility outcomes. So really like it's all connected and to me I'm just as fascinated with the microbes and. What. It means for us and. And. What you said about passing it back and forth is so important because.

They're who. We were. We started with like, Oh, we're going to work on the ladies. And then we. Quickly realized like, oh. If they have it, they have sex, they're passing it to the men, the man's going to pass it right back. So we, we really have to test both people. And. Know what's happening on both sides and be like treating it effectively for both of them, usually at the same time to make sure that it doesn't affect fertility. I love how like every part of the body is connected and I'm glad you brought up the thing about the oral health because actually I never haven't thought about this since I was in residency because at the time in residency we didn't have a model to say like this was connected.

We were just like, Oh, this is weird. I remember I had two cases. One was a woman who had infertility and she had horrible, horrible teeth. I just I mean, she was somebody that took care. She took care of her teeth. It's not like, you know, sometimes there's this judgment of somebody who has bad teeth that they're like not involved in self care. She was taking care of teeth and she was having it, you know, and then there's this like maybe she was doing drugs, you know, 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'm thinking like that was really a microbiome issue then. Like, because we were like, how is that connected?

And then we had another woman who who is pregnant who came into the hospital and she was very like early in her pregnancy and she went into pre-term labor and on her exam. And usually as gynecologists, we're not checking people's mouths, but for whatever reason, we checked this woman's mouth and she had a really bad cavity, but she was in the hospital and bed rest for her pre-term labor and trying to get a dentist to come into the hospital is like next to impossible. They don't usually do that. So this poor woman, like was on bedrest for like couple months and finally they got a dentist that to come into the hospital.

Same thing pulled that the tooth that was infected and her cervix which had been opening because she was going into pre-term labor now all of a sudden closed up and she finished out that pregnancy completely normally. So I love the fact that you brought up the oral health because I'm like, I always forget about that. Yeah, yeah, yeah. It's it's. So cool. I feel like our bodies are just incredible in terms of like how one thing over here affects a completely different system. And like, that's why we do what we do.

And I think for so many times, like with fertility. Yeah, with fertility and sex, it's when there's, when there's a problem in those department, we get too focused on like it's a problem in that department when it's really our bodies going, Hello, I'm trying to get your attention. There's something else going on. So like, yeah, yeah. And. And like to a certain extent, fertility is the least necessary part of our human survival, right? Like as a race, we need it, but as an individual, we don't. So the body goes well, I have other things to deal with right now.

So this is an area that I can like conserve my energy and refocus on what I need to deal with. And so often people will say, Oh, I, I'm dealing with my SIBO before, I come and see you. And I'm like, That's funny. Because that's kind of what we do is like deal with all the other stuff so that you can get pregnant.

Where to Find Dr. Simmons and Closing Remarks 35:48

So, yeah, it's, it's, it's hilarious. To. Have it framed in the way of like, Oh, I need to work on this little thing over here first, and then I can come work on my fertility. And I'm like, No, if you're working on fertility, you're working on everything. There is no like fertility is not different from. Everything. That is that is such an important message. And with that, where can people find out more information about you? A few places. Our website is HolisticFertilityInstitute.com You can find us on Instagram at: holisticfertilitydoctor and I always forget to mention this which is the podcast which is Egg Meets Sperm So if you like listening to podcasts then Egg Meets Sperm I love that.

Thank you so much, Dr. Aumatma for taking the time to talk with us today. Thank you for having me. I hope everyone goes out and has an amazing sex life so that they can support their fertility. I agree. I second that motion. And just to remind everybody, stick around, because we got some more amazing sessions coming up.