Navigating The Fertility Journey With PCOS

Aumatma Simmons, ND, MS, FABNE

Yes. Awesome. Thank you so much for having me. Dr. Gersh is excited to be here today. I got into fertility because I was actually married to this man who wanted to have babies, and my uterus would scream. “No.” Every time you talked about children, I was like, “Well, what is happening? Am I going to have children one day or not?” I was getting close to the age of 35, when fertility dropped off the cliff and all of that. I started researching for myself. What can I do to preserve my fertility? Should I freeze my eggs? Should I have babies with the wrong guy? There were a lot of questions on the table. What I decided after nine months of a deep dive into all the studies was that there’s actually a lot that natural medicine can offer for fertility. I’m not having babies with this man. I went through a divorce and waited until I found the right person, and I eventually had a child eight years after that point. I got into it because of my own struggles, but what I realized in the process was that women are not being empowered around their fertility. Like everyone. It’s almost as if there’s this message being sent out. Women are smart enough to, like, figure out our cycles and understand what’s happening in each part of our cycle. We dumb it down. Instead, what I found is that women want to know what’s happening in our bodies month after month. What I’ve come away with is that there is so much that we can do to support women. For all of those who are struggling with fertility, there are just so many possibilities for supporting fertility in a natural way, regardless of whether they want to have babies on their own or go to IVF. There’s still a lot to do before they get to that point.

Felice Gersh, MD

Oh, I 100% agree that you need to prepare, even if you’re going into IVF. What can you do in terms of preparing women before they even try to conceive? We’ll call that the pre-conception process, so then we’ll get into, like, what if they conceive? What are we going to do? But just for every woman out there, maybe she hasn’t even started to try. But what should she do to prepare to get healthier before she even tries to conceive?

Aumatma Simmons, ND, MS, FABNE

Yes, it starts with reflection. If we can start with what my cycle looks like on average, what am I bleeding for? How many days do I bleed? How frequently do I bleed? How many days are in between the cycle—day one and the end of that cycle—before I start my next period? We want to look for regularity, and with PCOS women, a lot of times that regularity is that I have a cycle every 60 days or every, cycle every 45 days, and that’s better than irregularity. But we still want to get to a point where cycles are about every 28 to 32 days. I tell most PCOS women that as we heal and regulate your hormones, we should start having cycles that are a little bit closer together. We may not get to the magical 32 days; if they started at 60 days or irregular cycles, we may get to, like, 35 days, and we can be okay with that. For each woman, her own body needs to be in sync and have the flow of hormones throughout the month, and I know we still have this term of hormone balance. I’ve been moving away from that into hormonal harmony, which means that at different points of our cycle, different hormones should be in rhythm with each other. If we optimize that rhythm before a woman starts trying to conceive, the chances of her getting pregnant are going to be better. But we’re going to help support the health of that baby and the health of the pregnancy. I’m carrying her to full term, which is way better if her hormones are synchronized. and then the other piece is all of the other factors of health. like blood sugar and insulin. How’s our weight? How’s our thyroid? How are adrenals? There are many underlying things that a lot of times we write off, or I’ve at least heard so many clients write off and say, “Oh, it’s just because I’m getting old,” and I’m like, “You’re 30. That’s not getting old. You’re not two years old.” If we can, encourage ourselves to just reflect and say, “Maybe it’s not normal that I fall asleep at the wheel driving home from work, or maybe it’s not normal that I feel exhausted before I have my four cups of coffee every morning.” If that’s the case, then those are the things that we want to get to a point where we feel amazing in our bodies because we’re going to have healthier babies.

Felice Gersh, MD

Oh, for sure. Now, you brought up so many times the cycle—of course, the menstrual cycle—that is amazing. There were viewers out there. Why is it that women with PCOS don’t have regular cycles? What’s going on in their bodies?

Aumatma Simmons, ND, MS, FABNE

There are too many things that could be going on. One is that there is a synchronicity between the building of different hormone signals between the brain and the ovaries. I say building because, let’s say, an average cycle of FSH, or follicle-stimulating hormone, is going to stimulate the ovaries to produce eggs. As the eggs grow, estrogen goes back and signals the brain, like, “Hey, we’ve got enough eggs. Thank you so much.” The signal, the estrogen surge, helps to shift the signal from FSH to LH, which is a luteinizing hormone. Then the luteinizing hormone goes down from the brain to the ovaries and says, “Hey, push out the eggs; we’re ready for ovulation.” The egg goes out, and then the shell of the egg that’s left behind produces progesterone for the rest of that time. In PCOS women, there are variations of patterns that could be happening that are keeping them from essentially ovulating when they should. Part of what I’ve noticed is that women with PCOS sometimes don’t have enough of that follicle-stimulating hormone to actually signal that they’re estrogen deficient, which is crazy because so often on social media, there’s all this messaging about too much estrogen, too much estrogen, too much estrogen, and we make it out to be the bad guy. I know you agree with this. It’s like estrogen isn’t the bad guy. Estrogen is only the bad guy if it’s out of synchrony or out of harmony with where it should be in that particular stage of the cycle. We want that estrogen to build. If the follicles aren’t growing and developing into eggs, they’re not producing that estrogen to take it back to the brain and cause that signal to shift to LH. The other part is that LH is also sometimes just extra elevated. It’s like the predominant hormone. then there isn’t that surge that happens. It’s instead. LH is just present. It’s present all the time, and it’s present at high levels. What that can do is suppress or make it harder for the brain to understand, like, “Oh, I got to shift to the ovulation signal.” The signal just never happens. The last piece of it is because these follicles are sometimes not of the best quality. Even if an ovulation miracle miraculously happens in PCOS women, they will go on to not have enough progesterone being produced because of the quality of that egg and the quality of the corpus luteum. The shell of that egg that was going to make progesterone is a little bit wonky. It’s like not doing the best job that it could to make the progesterone. Now we have, in the latter part of the cycle, not enough progesterone, which then makes it way harder for conception to happen and definitely makes it harder to carry to term. There are many parts of that cycle that break down when a woman is struggling with PCOS. If there were one pattern, it would make sense. However, with women who have PCOS, there are multiple layers of these patterns. It could be that the ovaries are insulin resistant, and that’s going to make the LH high; it’s going to make testosterone high. There could be other signals or other hormones that should interplay and be in harmony with our main reproductive hormones. But when they’re not or they’re signaling different things, then the ovaries and the brain just have more hurdles communicating with each other. At that point, it’s like, “Okay, what do we do? We got to break this apart and figure out, like, at the core of it, where is the breakdown?” Is it too much testosterone? Is it too much insulin? Is the insulin resistance the thyroid rate? Is the thyroid the issue in why that signal is breaking down? If we can get to the level where we understand better what the overall symphony of hormones is doing, then we can figure out how to tweak the hormones to get to a place where the cycle becomes more regular. With PCOS women, a lot of them, because they were given birth control when they were younger just to regulate their cycles, never had the opportunity to correct the harmony of those hormones. When they get off of birth control, they’re like, “What? Why is this not happening? I didn’t realize this was an issue.” Birth control, in my opinion, has contributed to that breakdown between the brain and the ovaries. Communicating well. We want to restore as much harmony as we can to the point where all of the signals happen in synchronicity with each other when they should happen.

Felice Gersh, MD

What I’m hearing is that it’s complex that you’re talking about feedback systems involving the brain, the pituitary, the ovaries, and the production of hormones in these different sites like the pituitary, the ovary, or malfunctioning for various reasons. It’s not just one cause. Then, on top of that, there’s what you mentioned, like the quality of the egg. It’s not just having an egg. It’s like, How good is it? How healthy is it? For someone out there who says, “Oh my gosh, this sounds overwhelming,” they have very irregular cycles. They are probably insulin-resistant. Maybe they have Hashimoto’s; they have an array of metabolic issues. Where do you start? What should somebody be like, thinking about the timeline for something like this?

Aumatma Simmons, ND, MS, FABNE

Yes. We have to start with: What is the root? Where is the core dysfunction? For a lot of PCOS women, we have to start with gut blood sugar and insulin regulation because if that’s not functioning well, all of the other downstream pieces are not functioning well. That’s generally where we like to start. If those things are good, if we’re like, “Okay, we’ve checked it out, those things are working well, great.” Then we go to the next piece, which is, Let’s get the symphony of hormones playing their notes at the right time. That might take, sometimes, six or seven months to get to a place where they’re all in harmony. PCOS women on average will spend an average of eight months to get to the point where we can say they are optimally fertile, and this is going to go well versus the average non-PCOS fertility person, who is going to be closer to four to six months. We’re looking at a longer timeline and just need it, and I warned the couples that we are working with that this is going to take longer. You already know that this is happening. It’s going to happen like PCOS often: when women are told that they’ll never get pregnant, they’ll never have babies on their own without intervention. That’s so far from the truth. Like these women, they can get pregnant. Like, eventually they will. But it sometimes takes so much longer, and it tests the patience that we have internally to say, “Hey, I’m just going to be patient with the process and know that at the end of it, I will have a good result. But if I don’t follow the process, if I skip over the steps, then I may get pregnant, but it may still end in a loss.” It’s important if you already know that you have PCOS to know that you should start from the beginning to work with a specialist and plan for a longer period of time until conception. If you want to have babies at 33, maybe start planning for this at 31, or 32, so that you’re not in that place of anxiety that it doesn’t match your life plan.

Felice Gersh, MD

Well, absolutely.  So often they say, Well, if you’re in a certain age group, why don’t you try for a year, and then if you don’t get pregnant, then go see someone like you? That sounds like very bad advice for a woman with PCOS. They need to get right too. That’s exactly what happens. They go to their HMO, and they’re told, Well, you’re 28, so just give it a year. It’s like, no, that’s not it. Or they go off of birth control pills and want to try to conceive next month. You have to do this long-term prep. Now, if we think about this prep, like these several months that you’re priming the body to become more fertile, I know people look at different things. They look at nutrition, fitness, sleep, or stress. What kind of things do you look at to help women become more fertile?

Aumatma Simmons, ND, MS, FABNE

We want to look at all of it. By all of it, we mean every area of the body, from the gut to the adrenals to the thyroid to neurotransmitters to the vaginal microbiome. In addition to our regular hormones and the liver, we want every major part of the body that has anything whatsoever to do with fertility or the health of the future of the baby to be at least looked at. At least to say, “Hey, is this part functioning okay?” The number of times cholesterol is off the charts or insulin is higher than it should be. I tell these women, “Oh, let’s work on it. It’s not going to take that long.” They’re like, “But why? I don’t need to do that because I’m trying to get pregnant. It has nothing to do with getting pregnant.” I’m like, “Well if your liver is not functioning well, it’s not detoxing the things that you’re exposed to in your environment and the hormones that it needs to metabolize and detox out of your body. Not happening very well. If we don’t take care of that part, then we predispose your future baby to things that it shouldn’t be exposed to.” if we can handle every part of our body and we haven’t talked about the guy, but the guys are part of this also and they also need the same, like, “Let’s just make sure everything’s functioning well. Let’s do small tests or assessments to make sure that you don’t have high liver enzymes, you don’t have high insulin, or you have methylation pathways that are working correctly,” like just simple things that can be checked in basic lab work that your doctor could order but probably didn’t. If we can test these things, then we can get a sense of, “Okay, we’ve checked that off the list. Let’s focus on what you need.” Like, do you have a high enough sex drive? Do you have enough energy? Do you sleep well, men? Those three things are crucial. I just saw a study that was talking about men with circadian rhythm imbalances. Their sleep-wake cycle is not functioning super well, and they are less likely to have things like a 40% lower sperm count, motility, and morphology just because their sleep system is dysregulated. But we understand that men are driven by a circadian rhythm. If there is circadian rhythm dysfunction, which shows up as I can’t fall asleep, can’t stay asleep, or wakes up tired, any of those are dysfunctional circadian rhythm signs. That’s enough to shut down fertility as the body goes. “This is not important. I need to figure out how I’m going to survive. I do not need to produce another child.” It’s so important for the male side of this. just as important as the woman.

Felice Gersh, MD

I’m glad you brought up the men. I know statistically it’s about equal between male and female contributors to infertility for a couple, and then many have both. It’s not just one. It’s much more complicated. Males and females may both have issues. A low sperm count is now a huge problem. not just the count, the motility, the morphology, all of that. I’m glad, every woman out there with PCOS, doesn’t forget her partner, his health, and his sperm tremendously to the success of this project. One of the things that almost never gets talked about, so you just piqued my interest because it’s one of my interests, and that is the role of the vaginal microbiome and fertility, and we know in the medical arena that when women have BV or bacterial vaginosis, they can have more infertility. If they do get pregnant, they have higher rates of preterm labor and delivery, which also happens in women with PCOS. They have very high rates of pregnancy-related complications and miscarriages. Can you introduce what the heck the vaginal microbiome is to all of our listeners, and what can we do about women with PCOS having so many yeast infections? What kind of testing do you do? How can we fix a messed-up vaginal microbiome?

Aumatma Simmons, ND, MS, FABNE

Yes. The vaginal microbiome is kind of the cutting edge in fertility for women’s health right now. Like all of us doctors who geek out, I love geeking out on the microbiome, and the vaginal microbiome is just one of these areas. That was surprising to researchers because, for the longest time, and I remember learning this in school, the uterus is sterile. Like, we would hear these messages that it’s sterile. There’s supposed to be nothing there. What we’re finding is that there is actually something there. But what is there? What’s fascinating to me is that yes, there is PCOS, as women will often have yeast infections, which have to do with the microbiome imbalance, and the short way of thinking about this is that the gut microbiome needs diversity. It needs variety; there are hundreds of different types of microbes in the gut, some of which we don’t even know how to measure yet. In the vagina, it’s the opposite. The vaginal microbiome does not need diversity. It needs only a handful of specific microbes that are like the healthy microbiome, quote unquote. I’m putting it in quotes because who knows? We don’t know all the details yet. But what I’m finding most surprising in there is a test, which is a swab. You kind of stick the swab up the vagina and kind of get to the cervix and do a little sample. 

Based on that, the lab can do things like PCR analysis to figure out which microbes are present in what capacity, like how many of them are present, and what I found is that the women who have symptoms, of course, have microbiome imbalances, but there are hundreds of women that have no symptoms of vaginal yeast infections. They never had an issue there. They also have microbiome imbalances. The most surprising aspect for me is that vaginal microbiome research is still in its early stages. We’re still learning so much. There’s a new study all the time. What I found is that sometimes we’ll see these, like, weird patterns, and we go and see if there’s any new research about them because the field is just changing so quickly. One of them, one of these women, had infertility for three years and, like hormones, was not able to get pregnant. There was nothing that we could point to that was like, “Oh, that’s the issue.” We got her vaginal microbiome study back, and we said, “Oh, lactobacillus, iners, is what the results said. I dug it up because I was like, It’s 100% lactobacillus.” There’s lactobacillus for me. Initially, I was like, “Oh, no problem, that’s great.” Then I went and looked it up. What I found is that specifically, if Lactobacillus iners was present for African-American females, it was totally normal, totally fine, and not antithetical to fertility for everyone. non-African-American Lactobacillus iners were anti-fertility. I was like, “What?” It’s just so inconsistent and so random to have this differentiation between even our genetic inheritance, which then has a role to play in whether or not this microbiome is normal for us or not. It’s been mind-boggling to just test everyone because now we’re realizing a lot of these women don’t have symptoms. We just test everyone so that we know, and then if we can or if we need to, when we see these, like, weird patterns that we’re like, well, is that related to something, then we have to just go and dig up the PubMed studies and see if there’s any new research about it because that landscape is so frequently evolving.

Felice Gersh, MD

Yes, it is the great new frontier of women’s health. The vagina is grossly neglected. It is. I’m trying to keep up with this field. There are things that we don’t know. We just have to use our own intuition, like, maybe use organic pads for a while; don’t put things into the vagina. If you’re going to use a tampon, try to make it organic and think about lubricants. Some of them can actually be spermicides. Who knows what some of these lubricants can do? And the chemicals—they have pesticides, or they have preservatives and all kinds of things in them that could kill your commensal microbes. It’s so interesting. I know I better study that in women who get gestational diabetes and pre-eclampsia, the microbiome of the placenta is different. But of course, you don’t know which came first—the abnormal microbiome or the medical condition that was abnormal in pregnancy. it’s fascinating. Everyone out there needs to introduce their own doctor to this topic and think about everything that is coming into contact with that region. It’s such an underappreciated but important area. even birth control pills. Or the types of IUDs can impact the microbiomes.

Aumatma Simmons, ND, MS, FABNE

Whatever is going into our vaginas is going to have an impact. I love what you said about the tampons and pads because cotton is one of the biggest sprayed plants with glyphosate. Glyphosate, as we know from gut health research, destroys the microbiome. If we’re using non-organic glyphosate, glyphosate-sprayed cotton inserted into the vagina, or even close to the vagina, it’s enough to disturb the harmony of microbes that are supposed to be in our vaginas. A lot of women say, “Oh, it’s uncomfortable, it’s weird, or I have some discharge after my period.” That is often an indicator that your cycle will disturb the microbiome, but also that whatever you use during that cycle may have disturbed the microbiome. Just realizing that even those symptoms of “Oh, I have like two days of discharge that smell weird” are enough of an indicator that something was disturbed in the microbes that are in the vagina. We just have to eliminate as much as we can so that we can restore harmony and not disturb the microbes as much as we can.

Felice Gersh, MD

Well, your story of the infertile woman for three years whose life was transformed through changes in her vaginal microbiome resonates. Talking about microbiomes, like the gut microbiome, I’m sure that’s a very important part. and food. Sometimes people talk about certain foods, like fertility foods or a fertility diet. What’s your position on what to eat? Just get into like people talk about seeds, like what’s magical about seeds or are they magic? Is this like folklore?

Aumatma Simmons, ND, MS, FABNE

Well, for the seed that they’re talking about, there’s a thing called seed cycling. Theoretically, there are nutrients and hormonal impacts from these seeds. They’re very mild. I will tell women to listen because this is not going to harm you, but if you have severe imbalances with your hormones, is seed cycling going to fix them? Probably not.  Let’s just be real about it. It’s great to do. It will help. It will slowly shift your hormones toward more balance. But seed cycling is not going to magically fix hormone imbalances. I’m not opposed to it. But I also am not like, “Hey, this is it. This is what we give you to help address your hormonal balance.” Then, in the other part of your question, I forgot the gut.

Felice Gersh, MD

The fertility diet

Aumatma Simmons, ND, MS, FABNE

Diet. Yes.

Felice Gersh, MD

Official food.

Aumatma Simmons, ND, MS, FABNE

Yes. anything with antioxidants, which is basically like all of our fruits and vegetables are going to be core and central to helping support fertility. I say to our clients: more vegetables and fruit. Like it, a lot of times we’ve grouped this together with our vegetables: eight to nine servings of fruits and veggies. Yes, let’s make that like one to two servings of fruit, and the rest of it is veggies. That’s a very different dynamic because a lot of people are like, “Wow, that’s a lot of veggies.” Yes, you get to eat your veggies; you get to eat a variety. We can extend that to plant-based foods. For me, I’m like, if once a day I can get people to eat a plant-based meal that is high in fiber and not processed, we’re not talking about bread and pasta, but wholesome plants like lentils, beans, brown rice, and things like that. That’s going to help support the microbiome in the gut. It’s going to help support our hormones. It’s going to help increase the amount of plant foods and fiber that we’re getting into our diet. That, to me, has become an easy thing for people to do. I find that a lot of people have been fired into not eating carbs, which for fertility is not what you want to do. Complex, unprocessed carbs will actually support the production of progesterone. We don’t want to cut out a whole food group called carbohydrates. We just want to make sure that they’re not processed, but if you still eat them, eat them. They’re right on, especially during the luteal phase. For a lot of women in the luteal phase, the effects were like, Let’s see how we can get you to eat more complex carbs. They’re like, “What? I like to eat carbs. I’ve been paleo for so long,” and I’m like, “Yes, that may be part of the issue.” I’m a believer that we need to make sure that the balance of our diet is such that we’re getting all the major food groups. You don’t need to cut any food group out except for maybe dairy, which has lots of issues with hormones. But other than that, eat all the food groups and eat them in the form that they were made from the earth. Don’t eat them in their processed form, which takes all the nutrients out of them. Even wheat.  Which sometimes had such a bad rap with the gluten, and all of that, I saw a study recently that studied wheat like today’s wheat versus ancient kibbutz, which also has gluten, but comfort is like a different profile of nutrients compared to this wheat that we put out today. If we can eat the wholesome forms of these foods, they’re probably not going to be negative. I’m not saying everyone should go out and include it, but I am saying that we may not need to stay away from things that we hear like buzzwords in our social media world. Instead, we need to focus on what form this food takes and, like, how much processing they did in a laboratory to get to the point where I’m finally receiving it to eat it.

Felice Gersh, MD

Yes. I just want to give you a hug because I’m defending whole ancient grains, like millet and buckwheat, which can bring in my own isotope. They have quinoa, and there are so many wonderful ancient grains that are just shunned by people who are anti-carb. It’s so different. so there are different forms. Assuming you don’t have celiac, you don’t have that. But that’s a whole different thing. big hug to you, and so one other thing, just touch on, like people talk about, well, just go on a vacation and relax, and then you’ll conceive. Can you touch on the role of stress and how you incorporate it? Any mind-body medicine in your fertility practice?

Aumatma Simmons, ND, MS, FABNE

Oh, thank you for asking that. That’s great. This is the idea that we’re just going to go live in a bubble for a little while, which is going to be relaxing. First of all, if you talk to most of my tabby women, they go within days and say, “Oh my God, I’m itchy. I have to go do something.” Going to quote, unquote, and just relax is probably the worst that we can give women. I started to, like, break down. Why did this advice come about? What we’re talking about is not relaxing. It’s actually like an active form of something that I would call closer to surrender, which is very different. The energy of relaxation and surrender is very different. Surrender to me comes from the feeling of being nourished, safe in our bodies, and trusting that we and our bodies are designed to do what it is that we want to do. We have that ability already, but a lot of times we’ve been told, “Oh, you’ll never have a child. Oh, you’re over 35. That’s never going to happen.” We’re like the medical world, and often the news and all of the things that we hear around us take that trust away. It’s a little bit harmful because instead of helping us gain that trust back into our bodies until, “Oh, my body was designed for this,” if I can stop hearing all of those messages and focus on what my body is saying, and for example, let’s take a PCOS woman, for example, if she goes from 60-day cycles to 30-day cycles, she’s like, “Oh, it’s been a few cycles where I’m bleeding every 30 days. I see my BBT charts, and my basal body temperatures, and I see that I’m ovulating. I see a nice luteal phase.” Those are all reinforcements that if she is getting empowered, then someone is reflecting back to her and saying, “Wow, that’s amazing.” Your body is starting to do what it should. then she can get excited and say, “Oh yes, like, Yes, I am doing that.” The level of trust that builds allows for that surrender to happen. When that surrender happens, it’s a lot easier to get pregnant because now she’s not stressed and constricted around. “Oh my God, is this ever going to happen?” Instead, she’s like, “Oh, but I’m ovulating.” That’s a good thing. I see that, month after month, my hormones are regular. We teach the women how to read their basal body temperature charts. They will often look at their charts and be like, “Hey, Doc, it looks good. It looks good this month. Good. Yes, it actually looks great. Thanks for affirming that.” Or they may see little fluctuations, and they may say, “Oh, there’s something I need to tweak. It’s like going awry again.” Then they can be in the driver’s seat understanding that their body is giving them that signal every single month. They’re not in the guesswork of whether I’m doing the right thing. If you eat a crappy diet, we’re going to see it on your BBT charts, and I’m literally going to be the first person to be like, you fall off of your food plan. They’re like, “Oh my God, did you? It’s all cameras in my house. How do we do that?” I’m like, “I see it on your chart. You cannot lie to me.” There is literally no way that you can go over that or skip over that. that, like helping women get back to that place of trust in their bodies. As they are on the journey of healing, they see the reflection; they see, Oh, my cycles are better. Oh, I’m sleeping better. “Oh, I don’t have bloating anymore. My blood sugar is better.” There are so many things along the way that are going to be little indicators that are helping to give that trust back. If we do that effectively, she will get to the point where she’s completely in her power, and there’s no woman who has gotten to that state without getting pregnant.

Felice Gersh, MD

Oh, well, I love that, just that your patients—these women—feel that they have some control. So often, if you’re the patient, there is the doctor, and the doctor gives you stuff, and you just do whatever is told to you or you take something you don’t know why, and you’re just feeling victimized here. These women are feeling empowered, and they see control over their own bodies and their own destiny. I love that. Understanding that you can change the course of your life and your fertility is like stress reduction. Just to know that you can take charge and that you’re not like in a world of things happening that you have no control over. I love that now I have to; you’re a naturopathic doctor. I have to touch on what particular supplements can do for the augmentation of fertility. They’re called supplements for a reason. They’re not replacing; they’re adding to all of these other amazing things that must change a woman’s life to improve her fertility status. Can you share with our audience a few key supplements that could help improve fertility?

Aumatma Simmons, ND, MS, FABNE

For PCOS in particular, there are probably three; there are so many, but my top three would be myo-inositol combined with D-chiro-inositol, like a 40:1 ratio. That’s what research has said. And myo-inositol supports insulin resistance or improves insulin resistance, blood sugar control, and ovulation, and supports LH and egg quality. You get a lot of benefits from just one thing. That was my first one; A-Nocito 15 is probably the second, and there are studies that have shown combining myo-inositol with NAC has better outcomes, so we should probably do that. That’s my second one. NAC is a precursor to glutathione, so it will support liver function, which oftentimes, as we talked about earlier, helps support hormone harmony. That’s a good thing. then it will also support egg quality. It’s a super potent antioxidant, and it has some impact on blood sugar. Again, I like the idea of hitting multiple things with one supplement I’m a fan of, so I like that one a lot. The third one is probably like chromium because it’s specifically designed to help support blood sugar and insulin dysregulation, which often has a lot to do with PCOS. We save chromium until we know for sure if they have insulin resistance; if they’re deficient in chromium, then it’s helpful. Otherwise, it may not be, but it’s a good one to have in the back pocket just in case.

Felice Gersh, MD

Well, those are the three prime ones that I love as well. I have to bring up another one because it’s been in the news lately. As everyone out there knows, there will be this overwhelming use of certain types of drugs that are called GLP-one agonists. like they’re mimics of this little peptide slash hormone that the gut makes that has a lot of control over fat burning, appetite, insulin production, and so on. Some people have talked about Berberine as a potential replacement for this drug, and Berberine is often used in women with PCOS. So maybe just because people have heard of this, a lot of people out there like Berberine. Like, what is Berberine, does it actually have a role, and do you use it?

Aumatma Simmons, ND, MS, FABNE

Yes, I do use that. I love Berberine. It’s a great way to support, again, blood sugar, insulin, and weight loss. It will also support the microbiome a little bit because it has antibacterial properties. You get lots of benefits from one supplement or one herb.

Felice Gersh, MD

Now everyone’s appetite is whetted by this conversation, and they know that they need to learn more and that they’d like to maybe learn more from you. How can people find you and follow you? What can they do if they want to work with you?

Aumatma Simmons, ND, MS, FABNE

Yes. The best place to find us is on Instagram. I’m @holisticfertilitydoctor. I’m on TikTok and threads and all the places. Same handle, @holisticfertilitydoctor. You can reach out to us there. We’re pretty easily accessible on chat, so that’s probably the best place to get started. then we have some free resources that we can share. If people want resources to help educate themselves,

Felice Gersh, MD

Well, you’re going to have a boatload of requests. that’s coming. Do you have a book out there?

Aumatma Simmons, ND, MS, FABNE

It’s called Fertility Secrets. What didn’t your doctor tell you about baby-making? It’s an easy read. You should be able to read in a day. There have been lots of women who will write right in and say, Thank you so much. I got pregnant just by following what you told me to do in the book. It’s all very exciting.

Felice Gersh, MD

Oh, well, I couldn’t let you leave that out, so I can’t thank you enough. This is so wonderful. With all this information that women can take charge of, there’s so much you can do to improve your fertility. Even if you’re not trying to have a baby, this is all fantastic advice because, remember, fertility is a vital sign of health for reproductive-age women. It’s just great to be fertile. Thank you so much, and I look forward to following you on Instagram myself.

Aumatma Simmons, ND, MS, FABNE

Thank you so much for having me. Dr. Gersh.