Welcome to the Brilliant Fertility Podcast.

I'm your host, dr Katie Rose, and this podcast exists to help illuminate the path ahead of you. With expert interviews, clinical pearls and real client success stories, my intention is to bring you hope for what's possible on this journey and to give you tools and resources to navigate the ups and downs on the road before you. If you find this podcast helpful, don't forget to subscribe on your favorite listening platform. And I have a big request If you have a minute, can you leave us a five-star review and let us know what did you learn? What did you come away with? Did you leave with that spark of hope? This helps more people like you find the podcast. My mission is to support as many humans as possible on their path to become parents, and by you sharing and subscribing, you're part of that mission too, and I'm so grateful for you for being here.

Welcome back to the Brilliant Fertility Podcast. This is part two of our lab testing series, or fertility testing series, and today's part two is all about how to get the labs you need. So, if it feels like it's taking too long to get pregnant, if you've had irregular cycles or a miscarriage or more than one miscarriage, or if you have symptoms that just make it feel like there is something else going on here. Or maybe you've already been told your labs are normal but you feel like you're just being brushed off. This episode is for you, and first I want to do a quick recap of part one in this series, because there were four main takeaways I'd love for you to come away with part one and are really necessary for going into part two. So number one we discussed when to start testing in the fertility journey. So the diagnostic guidelines will say after one year if you are under 35 or after six months if you are over 35, but I would argue that that is a very reactive approach and if we want to be proactive, we can be testing earlier and should be testing a lot of these markers three to six months before someone starts actively trying to conceive, because this gives us time to support anything that might need support or a nourishment or a change in strategy before the pressure is already on when you start actively trying to get pregnant. Number two we discussed the critical timing of labs within the cycle itself. So FSH, lh, estradiol, prolactin should really be tested on cycle day three and progesterone should be tested seven days post ovulation. Obviously, there's going to be nuance here People who have irregular cycles, people who are having an ovulatory cycles. This is something that really requires some one-to one guidance to figure out when and how to test strategically. But in general, we just we can't be going around testing these hormones on arbitrary days because we can't accurately interpret that information.

Number three is the question did we really test everything we need to understand fertility potential? So this you know. Number three and four of these takeaways will really relate to the question of all of your labs look normal, like well? Number one what are all of the labs? If all you tested was the bare minimum, do we really understand what this person needs? Or did we just look at a few hormones that tell us what might result with IVF? If we can't actually understand what the body is telling us about nutrient levels, inflammation, insulin sensitivity, so many other factors that we can't gather from those very basic labs, how the hell do we actually know? We don't, and it's so frustrating.

And then the second part of that statement of all your labs were normal, is the normal part? Well, what is normal, even anyway, because normal isn't optimal, and when we have these reference ranges that are really wide, especially in the case of nutrient markers, thyroid hormone markers, inflammation we cannot deduce that things are optimal based on where these reference ranges are. So when someone tells me, well, my labs look normal, I want to see what those actually were. What they tested. Were they in an optimal range for fertility? Or was it based on this very general population ranging from 18 to 70 years old, in what they're calling generally healthy? But like, have you looked around at our population lately? I would not be calling our general population very healthy. So that's all my soapbox on part one.

But you may also be coming away with this awareness like, oh crap, there's so much more I need to have tested. And that might be feeling a little stressful if it means you have to approach a provider who hasn't been warm and fuzzy to deal with so far. So how do you actually get what you need from your providers? How do you come at this from a place of what I describe as personal power. So if you've had the experience of going to a provider appointment feeling like really anxious or worried about how this interaction is going to go, you maybe come with your list of questions, you start asking questions and feel totally brushed off. Or maybe you do step into that advocate role for yourself and then you have a four-day hangover from that experience.

This is an episode that you're going to want to listen to and probably re-listen to and use the resources that I'm going to be putting in the show notes for stepping into that personal power and also I talked about this a little bit at the end of part one the feelings that can come around your labs themselves. So beyond just the communication with the providers, but that sense that you might find out something bad and that can create a lot of anxiety as well. So we're going to cover both of those aspects today as well. So we're going to cover both of those aspects today. And, number one, diving into that interaction with your medical provider. So there could be quite a spectrum of expertise in who you're actually starting out with requesting these tests from.

If you haven't actually been trying to get pregnant for very long, or maybe you are in that group of people who's being really proactive you haven't been trying, but you know you want to within the next year Maybe there's a family history, maybe there's a personal history with irregular cycles or thyroid or PCOS and you just want to do everything you can to ensure a more easeful fertility journey. Where I would typically start is I'm making almost like a. This is. This reminds me of back when I was single and I wasn't necessarily looking to be in a relationship, but I was really thinking about what I wanted in a relationship and my very wise mother was like well, you really should just make a list of, like, what values are important to you and what's important to you in a relationship and you know. Things beyond like, oh, they're handsome and they're successful. Things like they listen to me, they make me feel seen, they respect me. Uh, the same is true for your provider in this relationship. You want to make sure that, even if they don't know everything, that they are respectful of your needs as the patient. Ultimately, they're in a place of authority.

Insurance companies are dictating a lot of what providers can do. So making a list of what is important for you in your provider relationship and if you don't already have that with a provider that you are established with, imagining what is the best case scenario of how this interaction can go Like before you go into that appointment, you can journal it out, you can talk it out with yourself. You can imagine it If you are really great at visualizing and you close your eyes and you're like okay, like I'm walking in, I sign in, they call me back right away, I don't have to spend any time in the waiting room. I get there, they make eye contact with me, they ask how I'm doing and then we start to answer questions and I ask all my questions and they're really thorough in how they answer, etc. Okay, like you practice a little bit of that on your own, let me know how that feels. But this is like setting the stage right. This is priming your mind for this experience, and it's important because if you've had negative experiences with providers in the past, you may already be going in with this anticipation that it's going to be terrible and that they're not going to listen to you and you're going to be waiting forever and it's just. You're not going to get anything valuable from it. So I want you to prime yourself for actually being able to come away with something of value for yourself.

Number two there is an exercise that I use almost on a daily basis, especially if I'm engaging with patients one-to-one in person, or if I'm engaging with other providers that I'm communicating with or if I'm in the role of the patient, I create this little energy bubble and I describe this in detail in my five tools for nervous system regulation, which is linked in the show notes. This is the first exercise in those tools. It takes four minutes max. Once you start practicing it and you get really good at it, you can put your little energetic bubble up within 30 seconds and this just ensures that what's theirs is theirs, what's yours is yours. Your love intelligence can easily transcend the bubble, but no one else's negative crap is allowed in that bubble.

So if that doctor has been having a bad day, that's on them. You know what they need to take personal responsibility for that. I am so tired of hearing stories from my own patients about how their providers seem to be just really miserable and projecting their own misery onto their patients. I'm sorry but like I'm just so over it, and I can really appreciate what it feels like to be in the provider's shoes and being overworked and underpaid and micromanaged by insurance companies. But it's not the patient's fault. So when you put your little energetic shield up, you will start to notice your interactions change. It's just like this energetic boundary that says I'm not here to take on your stuff, and even if our interaction isn't rainbows and butterflies and sunshine and waterfalls, it's not at least going to be a transference of negativity.

Number three is being your own best advocate. Now, if you've had a hard time advocating for yourself in the past, there are some practices that you can begin to put into place to ensure that advocating for yourself can feel easier, that you feel stronger and more confident in that role. One of them is imagining that you are advocating for a loved one, because if you can't do it very well for yourself, but you can imagine that if you are taking your parent to the doctor or your child is already here and you're advocating for them which I would argue when you were advocating for yourself on a fertility journey you are advocating for your child, you're advocating for your future child, and you can start practicing that by advocating for yourself. And even if you have struggled with that and you've struggled with self-love, this is a practice that will not steer you wrong and will set you up for an even more confident parenting journey. So there's a meditation that I have used and I can't believe I'm even giving this away. I wasn't planning on this.

This is a meditation that we recorded for the Brilliant Fertility Program. It's called Calling your Power Back and it's based on a recapitulation exercise that I have learned throughout my time in a program called Business by Design. So it's funny that some of what I have pulled into my own fertility practice I've actually taken from this very holistic business training. But as we were doing this exercise I realized there was a lot of overlap in my training in hypnosis and timeline therapy and emotional processing and I was like, oh, this is gold. I am totally going to turn this into a meditation for our members and you want the call your power back meditation? Please shoot me a DM on Instagram or email us at info at brilliantfertilitycom. I'm not going to put it in the show notes because it's just it's kind of a sacred exercise.

I really want to make sure that we're putting this in the right hands, because this is not about this like patriarchal, authoritative dominance type of power, right. This is about stepping into your own truth, being able to speak your needs from a regulated place and having those needs met. And when we are in this dynamic with someone who's in a place of authority, who is used to acting from that place of maybe toxic power and they're engaging with someone who is not used to stepping into their power, who's used to being in the role of people pleasing or smoothing things over and doesn't advocate for themselves, then that pattern is going to continue to play out. So we have to be able to step into that place of power and stay regulated and believe that we are worthy and deserving of getting the answers that we require before we can start actually voicing those needs right, and that's a practice.

Another practice that I will use stepping into this is embodiment. So if you were to imagine that your child is already here, they are already earthside, they're already safe, they're already healthy, part of you knows that that is on the horizon, even if you're not sure the when and the how yet. And if you tap into that part of you that already knows and it's already done, and if you've been through the meditations in the retreats that we have done and you've actually seen it and felt in and I have this list of questions, I have this list of labs that I want ordered what's the energy that I'm bringing into this interaction? Who do I be in this moment? Do I shrink down and hunch my shoulders and I'm kind of like with you know, mumbling my questions. Or do I take a deep breath and pull my shoulders back and say this is already done and I'm going to get my needs met in this moment. And I'm going to get my needs met in this moment and you sit up a little bit taller and you feel that energetic shield around you and as that doctor comes in, you feel ready and prepared and part of that is the embodiment practice.

Next on this list is how to actually communicate with them. Like what are the words that you actually use with the provider? Sometimes they'll pause and say do you have any questions? Sometimes there's like barely even eye contact, which is just wild. Maybe a whole different rant that I could go on. But what do you actually say? I mean, if you come in, if you've printed off this guide that we linked in the first part of this series and you have your fertility lab checklist, you say okay, like okay, I have this list, can we order these? And they look over the list and they say none of these are clinically indicated. Where do you go there? So first I would actually coach you on before you give them the list.

You say I realize that it may be challenging when you have patients Googling things and bringing you things. I've done a lot of work to educate myself on this topic and, knowing my history, and that I don't want to jump into something like IUI or IVF without having all these bases covered. I would like to request some additional tests so that I can understand what my individual body needs. And then you would say I've been following this fertility expert and they have a checklist based on the research that they have done. I am wondering if we can order some of these specific tests and then you might give them the guide and then you would gauge their response.

Now, if there's someone who just rolls their eyes and tosses it to the side and they're like listen, you need to stop Googling. That to me would be a sign that this person is just not invested in your overall wellbeing and maybe it's time to find a different provider. But if they're kind of like, okay, well, yeah, I mean some of these I can understand, but I wouldn't know what to do with some of these results. Is that if they don't have specific training in, say, the impact of homocysteine on fertility and what that represents, they are liable for what that lab result comes back with and if they don't actually know what to do with it, it can make them very nervous about having that on their hands. So I can appreciate that element of where the provider might be coming from and you can also address that.

If they say I wouldn't know what to do with some of these markers, say thank you. I really appreciate that. I really appreciate your honesty in that, since it could take me three to six months to get into someone else who might order these for me, I am wondering if you would be willing to do that. And I am more than okay with you putting in my chart that we discussed that you may not know what to do with them and that I am still requesting them. If they're kind of somewhere in between the I wouldn't know what to do with these and completely rolling their eyes and brushing off, I tend to get just a little spicier and I might say something along the lines of if you are refusing to order these tests, could you please document in my chart note that you were refusing to order them. This can make a provider pretty uncomfortable, no-transcript.

And the providers also have an opportunity to decide to learn more, and that's that onus is on them. So, having that language of just being able to say if you are refusing to order these tests, can you please document in my chart that I have requested them and that you refuse to order them? That's at least it's there, and it may be another indication that it's time to find someone who is at least a little more open-minded, if not a heck of a lot more educated, on the specific needs of someone who's on a fertility journey, especially if there have been fertility challenges or pregnancy losses. I have to collect my thoughts for just a moment, because I have something that just was like on the tip of my brain that didn't make it into my notes. Yes, it was the commentary that it may not be clinically indicated if you're not experiencing specific symptoms.

So, for example, if someone is not experiencing specific symptoms of hypothyroidism and you can refer back to the episode we did about thyroid health and fertility, thyroid health and fertility that may also lead to some hesitation on provider's part to order a lab, because if they were audited by insurance companies and the insurance company said, hey, like there wasn't actually anything going on in this clinical picture to warrant you ordering this test and us paying for this test like we're not going to pay for that, and if that happens too often, then a physician getting audited beyond that one chart note can be an extremely stressful process for them. So, again, that's a scenario that I can really appreciate on the provider's behalf. And when it comes to advocating for yourself to get certain tests run, for example with thyroid health, with knowing that TSH has this wide range of normal, but we know that for fertility purposes we have a much narrower mid-range of that TSH and that if someone has had autoimmune type symptoms or pregnancy losses or diminishing ovarian reserve at an early age, that could be indicative of a thyroid autoimmune picture like Hashimoto's, it's worth educating yourself up front so that you can have that discussion with the doctor of yes, I understand that I may have minimal symptoms and here are the studies to show that there may be a connection between those, and they can put those studies in your chart. So, even though there may be some physicians and providers who I roll at patients educating themselves, I actually would still advocate for you to learn how to do your own research. And this does not mean like, unfortunately, like the way it's come off in social media with influencers, the whole do your own research trend does not mean following a blog post or following influencer. It's like actually learning how to look up valid research, and I love to refer to people who have actually done the research and, like Lily Nichols, whose episode was a couple episodes back, has her research briefs that she posts on her website and they're phenomenal and I love them. And learning how to go into PubMed and find studies that are relevant for your needs will be really valuable, because it takes average 15 to 17 years for research to make it into clinical practice. So while we can't expect every single provider to stay up to date on that research, we can learn how to do it and advocate for ourselves. So I hope that this gave you some tools to prepare for these appointments and your interactions with your providers Some tools for when you're actually in the room and how to approach some different personality types or different responses from your provider, so that you can actually get your needs met.

Now, if it's within your resources, I would highly suggest working with a functional medicine doctor, a naturopathic physician, who is trained in fertility. It's such a specific niche that requires so much additional training beyond what we learned in medical school that I wouldn't expect a generalist to really have the experience and the wherewithal to do the body of testing that we would want to do that. We would want to do so. If it's within your means, please find someone that you can work with who can order the right tests for you, oftentimes even if your insurance doesn't cover it. There are so many cash-based labs now that are so reasonably priced. For a couple hundred dollars, you can get a wealth of information. So please don't despair.

If you haven't gotten the answers you feel like you need yet there are options available. And if you listen to this and you feel like, okay, wait, I still have questions, then please don't hesitate to reach out to me or my team and ask those questions, because we're here for you, I'm always rooting for you and I want you to get the answers that you need as well. If you got something from today's episode, please pause, take a moment to rate this podcast, leave us a review. It helps it get into more hands of people like you and hopefully create a world where all of you are treated better, as patients as well. Sending you so much love as always, and prepare for part three. We're going to be diving into AMH. You may have been wondering why I hadn't addressed it yet. It hasn't even been a blip in the conversation in the past two episodes and I know that some of you are just jonesing for the AMH conversation. So stay tuned for part three.