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Changing the Future of Fertility


Changing the Future of Fertility

Felicity Cohen: [00:00:00] Hello, I’m Felicity Cohen. I’m so excited to introduce you to my wellness warriors podcast. For over 20 years, I’ve been a passionate advocate for helping thousands of Australians find solutions to treating obesity and health-related complications through surgical intervention and holistic managed care.

My podcast is dedicated to all the people past, present, and future who has helped shape my journey and continue to inspire me to work consistently to achieve a healthier Australia in both adults and future generations. I hope you enjoy.

 Welcome to my wellness warriors podcast. It’s my absolute pleasure to introduce you today to Gabriela Rosa.

Welcome Gabriela, and thank you so much for joining me. it’s fantastic to have this kind of technology we can meet wherever we are in the world today. 

Gabriela Rosa: Absolutely. Thank [00:01:00] you. 

Felicity Cohen: So look, you’re a woman of so many different talents. I’d love to hear about your background, your sexuality and women’s health researcher, a fertility specialist, an author, founder, and clinical director of the Rosa Institute.

And you’re also a Harvard awarded scholar. What took you to, what took you to Harvard?

Gabriela Rosa: Yeah, good question. What took me to Harvard was the fact that I wanted to validate our fertility treatment process because you know, I’ve been doing this work now for 20 years. I originally trained as a naturopath, but we, you know, after about 10 years of doing this work, I started to see that there were very specific patterns that I needed to address the patients who were infertile for long standing periods.

That was not being addressed by standard therapy and it wasn’t being addressed in a way that I’ve felt patients [00:02:00] experiencing and fertility and miscarriage. And of course, you know, going through the challenges of conception really needed to be addressed for their best outcome, you know, in a very militaristic way.

So from the very beginning of my, of my career, I have been working to help couples that are coming in fertility and miscarriage, and it turned out from about 10 years on to now. So the last 10 years that we really have focused on helping couples who have tried many different types of treatments and it hasn’t worked.

And about five years ago, I was having conversations with clinical directors in IVF clinics. And I was describing and talking about the types of results that we were seeing for our patients. And because they’re quite remarkable, you know, we were just doing a, we conducted a retrospective analysis including 550 patients in our clinic right now.

And we know that our live birth rate for people [00:03:00] who have tried previously, what they feel is everything and nothing has worked is over 80%. And 72% of those patients had that conceiving naturally on a per protocol analysis. So I knew intrinsically before I even started clinical research, that what we were doing made a huge difference.

But when I was speaking to colleagues around it. They would basically say to me already, you shouldn’t oversell it. You know, it can’t be that good. And I actually had an IVF specialist tell me those very words, you know, you really shouldn’t oversell this, you know? And I’m like, Hey, I know exactly what it is that we do. 

So it was also, we experienced that we help our patients experience. I was annoyed to say the least. That was kind of periods about being told that. And I thought, you know what, I’m going to do a PhD on this and I’m going to validate these results. And what ended up happening was I had a friend [00:04:00] who is a clinical researcher, amazing researcher and doctor.

And, you know, she has been obviously in medicine for a very long time. And I, and she was also a professor of medicine in a Brazilian university. One of the most renowned Brazilian universities. And I messaged her straight away after that conversation. And I said, do you know like, you know, what is the process of deriving a very good question that I can answer scientifically for this purpose? 

And she sent me some information and she sent me a couple of articles and some instructions around how to do that. But also she sent me a link to a course in clinical research at Harvard. And I thought, that’s it. That’s what I’m doing.

And that’s how it started. So I’m just literally about like, I have one subject left to graduate from my master’s in public health at Harvard right now. And, throughout that process, obviously I’ve done a lot of work and receive some academic Awards and you know. [00:05:00] So it’s been an interesting process and I’m just in the process now of applying for my doctorate at Harvard.

So that’s, it’s been a long journey, but here we are. 

Felicity Cohen: Congratulations. I’m an absolute patient advocate for evidence-based medicine and really good quality research in this environment at weight loss solutions Australia, we’ve partnered with Bond university and also with our nutrition research Australia and run a full-time research office here.

So love that you kind of get involved in having a solution to actually inform and educate a patient population that is based on good evidence and yeah. Demonstrate that it’s a great way to, I guess, have that conversation with the traditional IVF model, and show that there’s other options and other solutions.

So if I think back to my early days in my career, IVF clinics were very few and far between. So if we go back to 21 years is like the time that I’ve been in [00:06:00] my practice here. 21 years ago, Monash IVF was probably about the only one around professor Cal-Wood was very well known. He had a small presence up here as well in Queensland, and there weren’t any others.

And now there’s this huge, big plethora of IVF clinics that have just machined out of nowhere. And there seems to develop this incredible need. Can you tell me why do you think that’s the case? Is it because people weren’t talking about their infertility issues in the past? 

Gabriela Rosa: It’s such an interesting question.

And I think it’s very nuanced in its answer because there is obviously the direct relationship between the fact that IVF is a multi-billion dollar industry worldwide. And of course, when you have a technology that is so, emotionally driven for so many [00:07:00] couples and when the health care system and the healthcare model presented to couples who are experiencing challenges and conception is such that the very first conversation and mind you, it’s a very first three minute conversation that you have with your GP about the fact that, you know, I don’t, I’m trying to conceive and I haven’t gotten pregnant in two months. What is it that I need to do? The very next thing that happens is a referral to IVF or to an IVF specialist.

So when that happens and when the health care system is modeled in that way, what ends up happening is that, of course, every single patient who perhaps is either anxious or concerned about the fact that they may or may not be able to get pregnant and whatever else is surrounding that, is going to be given a referral to IVF treatment becomes the very next thing that happens from there very early on.

And in fact, for many couples too [00:08:00] soon before actually addressing all of the factors and the things that could be getting in the way. Now, I often talk about the reality that infertility or miscarriage. It’s an end result. It’s an outcome of a biochemical chain reaction that starts all the way much before we actually have that result or that outcome.

But what happens is that IVF wants to address that outcome immediately from where we always experiencing it, which is, you know, where we have just experienced infertility, miscarriage, rather than looking at what are all of the other preceding factors, perhaps in the obstacles to optimum health, obstacles to optimum fertility that we could address to create a different result or a different outcome. And those questions aren’t asked in the beginning, they aren’t asked immediately when a couple presents for a conversation around fertility and therefore what ends up happening is that people will go and do IVF, but the [00:09:00] problem, and we know that, you know, the live birth rate of IVF across the world is somewhere between 30 to 50%. 50% being the very high end and super conservative, you know, and have that life birth rate. And what ends up happening is that it’s not until you have 50 to 70% of a population that is not getting pregnant after multiple failed cycles to then question, what else can I do about this?

You know, and I know for a fact, because these are the types of patients that we see typically they’ve experienced numerous failed IVF cycles and other treatment attempts that haven’t worked and they come to me and they say, Oh, gosh, I never realised how much more I could do to improve my chances of getting pregnant and to change my previous diagnosis.

Then obviously having now this understanding that you’ve taught me and I say, yeah, I mean, [00:10:00] obviously there is, it’s wonderful to be able to know that you can take charge, but they often tell me, they say I’m so frustrated because throughout my entire journey, I have asked, you know, what else can I do? What can I do to improve my chances of conception?

Can I improve my diet? You know, how do I need to exercise? What are the environmental factors that I need to be aware of? Is there anything that I need to be aware of and they’re constantly and consistently told no, there’s nothing you can do. Technology can bypass that. We know very clearly that technology cannot bypass that when we have 70% of patients going through a treatment and not ending up with the outcome that they want, which is a healthy baby at the end of it.

So there’s, there’s many contextual aspects in terms of that. Now, of course, you know, there is the other aspect that yes, even though fertility and infertility is still taboo. It is being talked about more. It is being in the open more, but also as our population ages and women, either [00:11:00] through the fact that they haven’t necessarily met the man that they want to have a baby with, or the woman that wants to have a baby, which earlier in life, or because they’ve chosen to prioritise other aspects of their life like their career, or, you know, other opportunities in their life. They have decided to delay parenthood and that can sometimes also create a difference in the ability to be able to conceive compared to earlier on in their lifetime. But also there are people who experienced health conditions and, you know, there are other challenges that get in the way of them actually deciding, okay.

I’m about to go and have a baby and I want to have it now. And you know, this is essentially what’s going to happen. Sometimes it just doesn’t happen that way. 

Felicity Cohen: Well, okay. We’ve opened up a massive big can of worms. I’ve got a billion questions running through my head right now. So I think it’s really interesting that integrative medicine model has often be seen as it’s [00:12:00] alternative. It’s a bit taboo still. 

And hasn’t had a place, obviously it’s not seen as mainstream medicine, but there has also been an increase, I think, in attitude around the support for holistic integrative medical model, 

which is so valuable and obviously the one that you subscribed to, and that you’re so fascinated by, in terms of how you treat your patient population.

And I wish they’d be more exposure to how the traditional and not so traditional could meet somewhere. So, how did you actually then look at things like, you know, how do I actually employ an integrative holistic model 

to treat infertility? Where did that, where did that start for you? 

Gabriela Rosa: Yeah, I mean, for me, what ended up happening was that, you know, as I mentioned, because I was, I had been trained as a naturopath and I actually, in my training, I was incredibly [00:13:00] fortunate to work, almost a decade, for an obstetrician gynecologist who saw lots of patients in general practice for obstetrics and gynecology. And he was an immense mentor, you know, for me at the time in being able to discuss and understand what are the challenges of people going through this conversation of infertility and, or trying to conceive.

What was fascinating at the time I was, I was still studying and, and working in his practice. And I said to him one day I said, I know that I want to specialise in something and I really want to specialise in pediatrics. And he literally turned around to me and he said, that is the worst idea you’ve ever had.

I’m like, oh, tell me what you really think. You know, and this man, just to put it in context is the most loving, kind, sweet man. You know, that one of the sweetest men I’ve ever met and he’s just very direct and blunt, it’s like the [00:14:00] worst idea I’ve ever had. I’m like, whoa, hang on a second. Where did that come from?

And he said, well, think about it. You know, if you’re dealing with babies, your patient is not your patient, your patient can’t speak and tell you what’s wrong. And I’m like, oh yes, I understand what you mean by, you know, by that. And, and so that’s it got me thinking about it. What else is there? What else can, because I was having training in herbal medicines and system supplementation, diet, lifestyle, medicine.

And of course I had the model of wellness in the context of how it is that I wanted to treat. And I had the other side of the equation in working with James, you know, for being able to actually understand the medical side of, of the equation as well. And so it was interesting at the time because he was telling me this and I decided then that, okay, babies is probably not going to be the path for me. But I knew that babies was part of the answer for me because I’ve really, I [00:15:00] was very drawn to babies and children and, you know, and I thought, okay, well maybe helping to bring healthy babies into the world could be the thing that I focus on. 

And so immediately upon graduating, he invited me to actually work as a clinician in his, in his practice. And I did that for a few years. Then I worked in a medical center and integrative medical center with very renowned doctors who were the leading edge of integrative medicine at the time.

And what was wonderful in that experience is that they were, one of the doctors that I used to work very closely with, he is specialised in cancer. So oncology was his field. He had lots of cancer patients, but he also had people who would come in because either they were experiencing hormonal imbalances or other issues that needed to be improved in their health so that they could conceive.

And that’s really how then, you know, that whole process and that path started in working with those doctors. It made me see very clearly that, [00:16:00] of course the diagnostics were incredibly important, but also the ability to work holistically with addressing those diagnostics. What was found that ultimately pathology tests really we’re looking at what’s pathological as opposed to looking at what’s optimal.

And it started because I worked in that environment for almost a decade. It started my thinking around the fact that, you know, and the, the amazing doctors that I was working with, they really would look at every and they would teach us, you know, okay, what are we actually looking for in all of these ranges?

Because pathological ranges, for example, Give a brief example in terms of thyroid and thyroid dysfunction. You know, the range to the thyroid CSH is 0.5 to five, depending on the lab that you go go through international units per milliliter or whatever it is that this in Australia now. but basically if you’ve got a 0.5 to five range, [00:17:00] That’s not, that’s a big range, and you’ve got to think that the people who actually go for that test are thought to perhaps have thyroid dysfunction, which means that what really, what we’re doing, you’re looking at those results and looking at those ranges that become aggregated is we’re looking at of all the population, potentially “diseased population” in terms of thyroid function, what is it that we’re seeing? What’s the average that we’re seeing and that gets averaged out into a test result range. Right? 

So what then happens is that let’s say, for example, me as a woman, who’s trying to get pregnant and I go and have a blood test and my TSH comes up at 3.17. Right. Let’s just imagine that number.

And because it actually was a number that came up for me personally the other day. And I was like, Ooh, that’s a bit elevated because I know that but most people don’t know that. Because what happens is 3.17 is within the [00:18:00] range of “normal”. However, we know that for women trying to conceive who experienced miscarriage and who are likely and prone to having miscarriage 2.3 is the maximum top of that range that you want to actually have.

Because if you have more than 2.3, you are most likely to actually experience a miscarriage. And so what ends up happening is that if we don’t understand these, these particular aspects, then we start to look at everything and say that it’s normal, but really is normal optimal. And when it comes to fertility, that’s a very important question.

Felicity Cohen: I think we’ve got to be really careful about the interpretation of the pathology results as well, because those ranges have changed so much.

Gabriela Rosa: Absolutely. And they change all the time. 

Felicity Cohen: It’s a very interesting conversation because if we look at, you know, what was that norm 30 years ago, or maybe even go back to the 1970s, those, those, that bell curves changed so much.

I’m really fascinated in the [00:19:00] thyroid issue. I can’t even describe how many more patients we see with diagnoses of Hashimoto’s, of underactive or overactive thyroid. And they’re all on site, rock scene and their doses they’ve been increased and increased incrementally, consistently over time. and then with that comes so many other medical concerns, complications, and for me, obviously my patient population, so many weight-related concerns as well. 

What do you think has been, do you know, or do you have an understanding of what this increase in thyroid conditions firstly has been impacted? 

Gabriela Rosa: Yeah, absolutely. Look, the thyroid is highly sensitive to the nutritional deficiencies, highly sensitive to electric magnetic radiation, as well as radiation in general, and many other environmental modifiable risk factors.

You know, there [00:20:00] are even nutritional components in terms of artificial sweeteners that will impact thyroid function. There are different chemicals in our environment and in our office. We don’t think of chemicals of, for example, BPA, we don’t think of the fact that you might touch a receipt and it’s full of BPA.

And then you might go and think that your hands are clean and it might touch your lips. So you might eat something and ingest BPA as a result of just, you know, the fact that you’ve touched a seat or plastic cup, you know, coffee cup. So the most terrible example of this, you know, as an exposure risk factor, because what ends up happening is that the lining of the cup is actually coated with BPA and other plastic components that will directly negatively impact thyroid function.

So what ends up happening in our environmental exposures is that we often don’t realise the fact that every single thing we do. Whether it’s an air freshener that we’ve got going [00:21:00] on in the bathroom, which will have a volatile organic compound component that can impact thyroid function, but really any other organ system. And the thyroid, because it is so sensitive to these types of exposures, it will imbalance itself. It’s that whole metabolic. And if you think about thyroid, and if you think about weight in particular, all of these estrogenic compounds that are in our environmental plastic to the spindles, you know, all of these will certainly make a huge difference and it will have a huge impact on the thyroid’s ability to regulate, but also all of those positive and negative biofeedback loops that happen in our biochemistry.

So the truth is that if the thyroid isn’t working properly, every other metabolic system isn’t going to work effectively. And so the conditions that develop from that will be range everything from reproductive health conditions, to weight, to [00:22:00] diabetes. So, you know, you name it. So really looking at the fact that the things that we’re doing our day to day make a huge difference to the way in which our body operates.

And of course, those lock and key systems that the hormones that we need to be imbalanced for optimum health and optimum fertility actually maintain some kind of optimal range of balance for the body is going to be critical. You know, people often ask me, okay, That’s a lot of things, you know, it’s a lot of things in terms of modifiable risk factors and things that you can change.

What is it that I can do to improve my fertility? The truth is I, and I talk about this to my patients all the time, what you really want to focus on is you want to act pregnant now to get pregnant later. You know, that’s my little motto for my patients, because what I know for sure is this, we all know, and I’m not sure, you know, people who are listening to this that may or may not have had children.

I think that even men can identify with what I’m going to talk about [00:23:00] next, which is just imagine for a moment that you could birth a child that you could, you know, develop a child inside yourself and actually birth the child. I know that we would have many fewer people in the world if men could have children, but that’s a whole nother conversation.

 but if that was the case that, you know, you’re holding inside yourself, right now that healthy little baby that you want to create. The immediate question that a woman, as soon as she sees a positive pregnancy test asks, what can I do to make sure my child has the best possible start in life, you know, has the best possible, health and is going to be a healthy baby.

And she asked that question. And she also asked the opposite question. What do I need to stop doing right now in order to be able to give myself the best possible chance of creating a healthy baby and in those two questions, what do I need to start doing? And what do I need to stop doing is really what we need to start and stop doing prior to a conception [00:24:00] is even in place because the truth is, women are born with all the eggs they’ll ever have. And men are born with all of the cells that produce the sperm that literally happens on a daily basis, but that can become damaged as a result of these environmental impacts. And if we don’t address those factors, we end up with a situation.

Male fertility also declines over time because of cellular damage because of DNA damage that happens within the context of aging. And so it’s going to be critical to look at what are the things that I can start doing. What are the things that I can stop doing and start to action those things straight away.

Because if you think that you’re going to do that when you are already pregnant,and that’s going to give you the healthy, the healthiest possible child. That’s actually not the case. We know that most pregnancies don’t get identified until about eight weeks. Obviously, if a woman is not trying or has irregular cycles or perhaps is [00:25:00] overweight, they might not even identify that they’re pregnant until much later on.

But what we know is that new or choose close in about five weeks, we know that a baby’s health blueprint is set for the rest of their life by eight weeks, this, this gestation in about eight weeks gestation we have all of our little organs, all of our little fingerprints already set and that embryo just grows from then on.

So if we are really to optimise the health of our children, the health of humanity in the long term, we need to take into account and into consideration all of the things that you need to do to be the healthiest version of yourself way before our conception is even in place. And this is incidentally, one of the reasons as to why IVF fails so often as well.

Is that the issues, the obstacles to optimum health are unaddressed prior to actually beginning treatment and having the outcome that we either are going to [00:26:00] have a positive pregnancy test or a negative pregnancy test. If we have a positive pregnancy test with unaddressed manufacturers or obstacles to optimum fertility, we are going to be impacting the health of that child in the longterm as well.

And of course increasing the risk of miscarriage at that rate also.

Felicity Cohen: I love that you’ve raised the environmental factors. And I did take note of one of your TikTok, presentations. I’ve got a glass on my desk, glass jug glass bottle, and definitely I’ve really got to fight, it made me really think about plastics and really reducing use of plastics overall, whether it’s plastic film over, you know, that we use in the kitchen.

Everything. We really need to be a lot more mindful about what we’re doing every day and if it’s not good for us, and it’s not good for the environment, we really need to think about the whole picture about what we’re actually doing. 

Gabriela Rosa: Yeah, actually that point reminds me of something very important [00:27:00] as well, too that is vital for people to understand. Is that clingwrap, like, you know, that plastic wrap and plastic containers in microwaves is probably one of the absolute worst things you can do when it comes to estrogenic compound and impact onto hormonal imbalance of these plastics, satellites be spindles and so on.

But what’s also really interesting and really important to understand is that fat tissue, it starts to overproduce estrogen. And one of the estrogen dominant aspects that create irregularity in the cycle and also feminised men and decreased sperm health is going to be coming from these plastics. And what happens is that because plastics and other chemicals get stored away, in fat tissue, those are two factors to really consider as well.

Because what will happen is that if we’re not addressing. One [00:28:00] weight aspect and making sure that we are at our most ideal, and sometimes we’re not going to be at our ideal weight at the time of conception, but we need to think long-term in terms of how is my body’s ability to hold a healthy pregnancy, determined, decrease the amount of toxins in the environment in which my child is going to develop.

And what is it that I need to do in order to do that? Of course, achieving and balancing weight is going to be important, but also making sure that we are maintaining that over time so that we’re not getting pregnant, you know, too soon after weight loss surgery or after, you know, a procedure that is going to then have a negative impact on the ability to, for that environment to self-regulate and self balance and remove some of those toxins from that fat tissue. And of course, the outcomes that we will see down the track, whether it’s a healthy baby or a miscarriage, unfortunately.

Felicity Cohen: Thank you for raising that because for us, [00:29:00] it’s so important to make sure that people do understand if they are going through weight loss surgery that we want to get into that point in time where optimum wellbeing is a hundred percent, you know, that we’re right. That we feel like that we’ve got them nutritionally. And that we’re ready then to guide, assist and support them to go through, you know, fertility and hopefully a successful, not just pregnancy, but long-term. Looking at the bigger picture and making sure that they have healthy, healthy babies at the end of it.

So I’m really clear that you raise that it’s an important point. 

So other than all the environmental factors, diet, the influence of diet, the food that we eat, everything that we ingest on a daily basis.

 How does that impact our potential, you know, profile for fertility?

Gabriela Rosa: It’s a fantastic question. And I was incredibly just so fortunate in my last semester at Harvard, to take classes with Walter Willett, for [00:30:00] anyone who knows nutritional epidemiology, you know, he is the father of nutritional epidemiology and is one of the first, primary investigators of the nurses health study in the U S. The nurses’ health study has given rise to many of the understandings that we have now about nutrition and diet and fertility and how those things are related and how they’re impacted. And, you know, so taking classes with, with him was an incredible history lesson for one, you know, and understanding. I mean, he was one of the people responsible, for example, for the evidence and the data that mandating food enhancements actually, to be a thing that, to be done for the general population. Because what we were seeing is that before folate enhancements, people were having a lot more neural tube defects [00:31:00] because of the fact that they didn’t have, you know, the, the truth is, like I said, four or five weeks is when your tubes actually will close.

Most women don’t even know that they’re likely pregnant at that time. And so what ends up happening is that because they don’t have enough, B-vitamins. They then end up with a situation where spinal bifida and other neuro tube defects are much more likely to occur. And since the introduction of B vitamin supplementation in foods we have seen a dramatic decrease in these neural tube defects and also in, in spinal bifida and all sorts of other neural tube defects.

But, so in terms of nutritional epidemiology, specifically, there are some very incredibly leading edge research and researchers are really working in this area right now. And what we see already, I think that, you know, we already know trans fats, for example, trans fats they’re found in foods that [00:32:00] contain vegetable oils, foods that are typically fried, baked.

 you know, like all of your fats vegetable component, vegetable oil type foods that would include that in some way, pizza bases, baked goods, you know, you name, it will contain trans fats. Fried foods will contain trans fats. And what we know is that a 2% increase in trans fat consumption. And 2% is like a tiny little packet of chips from McDonald’s.

It’s like that’s enough to really kind of over consumed those trans fats. And we know that just a 2% increase for a person with PCOS, for example, is responsible for at failure to ovulate by 73%. So we know that if you are a woman who has irregular cycles, perhaps has PSOs, cos perhaps is a bit overweight.

If you consume trans fats, you are going, it [00:33:00] respectable whether you lose weight or go to whether you exercise or you have enough nutrients, you are going to be much more likely to be infertile and unable to concieve as a result. And we also have seen the same effect in terms of trans fats in sperm and sperm quality.

So it’s very clear that, you know, junk foods in general will be linked to an inability to conceive and an inability to keep a healthy pregnancy to term. There’s also a lot of evidence now talking about soda drinks and sugary drinks. Not just soda, but sugary drinks, fruit juices, et cetera, and their relationship with inability to conceive, inability to keep a healthy pregnancy to term.

So there are many different components that often are not either talked about or are dismissed and really ignored for the detriment of the public, you know, public health, really? Because if you think about it from a public health perspective where [00:34:00] most people who will conceive will conceive without trying.

That’s what happens out there in the general population. And most people will then who will experience negative outcomes in terms of production, they won’t know what to do. But if this piece of education, if this piece of understanding is much more elaborated on and people understand the fact that the things that they eat, the things that they drink, the things that they bring into their body, in various ways is going to either positively or negatively impact their chances to conceive and keep a healthy pregnancy to term. 

Of course, they’re more likely to then be able to implement those things, but often when you go to your doctor as a patient experiencing longstanding infertility or miscarriage, and you say, what else can I do?

And you’re simply told that there’s nothing you can do. It doesn’t really help the situation, does it now? 

Felicity Cohen: Not at all. And I know that you’ve developed some fabulous, meal plans for [00:35:00] fertility. Can you tell me a little bit about the foundation of your meal plans and over what do you ration you recommend to your patients to actually go on specific meal plan before starting their journey? 

Gabriela Rosa: Yeah, absolutely. What we know is that the egg maturation period takes two stages of approximately four months. So really the truth is, and this is based on, you know, scientific research in terms of biology of a maturation of the follicles and the eggs.

And what we know is that from, as we said before, We are born with all the eggs we will ever have. And so what happens is that in our lifetime process, those eggs just mature. There are two main stages, as I’ve mentioned in the first stage from primordial follicles to primary follicle, there’s about a four to five months period.

And then from primary follicle to overian follicles, there’s about a four to five period there as well. So what [00:36:00] that means is that the quality of your eggs and improving the quality of your eggs is not going to happen by being on a healthy diet for a month, for two months, for three months. It optimal time that is going to improve your body, your health, your general overall wellbeing, as well as your egg quality is going to be a minimum of six months.

Right. And so what happens is that the longer that people are on a healthy eating regime, the better, because that’s just going to optimally improve and continue to improve the way in which the body operates metabolic function in general improves and so on. So it’s not something that you can just go, oh, I’m going to go on a healthy, I’m going to go on a detox, you know, for a week or two.

And then I’ll go back to eating all of the trans fats that I used to eat before, because that’s not going to support what it is that we’re [00:37:00] trying to do, which is to change the way in which those signals are misfiled. Or being imbalanced in some way so that we can have a different outcome in terms of a quality sperm quality.

And of course the junction of those two cells to create a healthy baby. So as a minimum I recommend that people stay on a healthy eating regime at least six months before beginning conception attempts. But that really, that continues throughout their entire reproductive life. I do talk about, you know, the 10% for the soul because a lot of times people think, oh my gosh, you know, like if I’m constantly on a “diet”, how am I going to live?

Well, the reality is. You know, there is a little bit of variation in terms of things that, you know, you might be able to add into the, the nutrition from time to time that it means that let’s say, for example, this is essentially what I say and what obviously what you recommend to your patients might be very different.[00:38:00] 

But for my patients, what I recommend is that let’s say we have 21 meals in a week. If for those 21 meals, one or two of them is outside of the ideal, it’s going to be fine. You know, when I was going through my own preconception preparation, I have polycystic ovarian syndrome. I was diagnosed when I was 18 by a doctor who literally told me over the phone, you have polycystic ovarian disease and you probably are never going to have children.

And I’m like, oh, thank you for that feedback. So directly over the phone, and then it goes any other questions. And then we hung up, you know, cause I was like, I was still caught. I was still caught up on there. Hang on, I’ve got polycystic, apparently, what disease am I going to die? You know, so really for me was a really long time of kind of figuring out, thinking that, well, I may never have to, or like he told me that I’m never going to have children.

So it’s probably true that I’m not never going to have children. as it turned out, I went on my own program and I treated myself and I have two beautiful [00:39:00] boys and they’re nine and six and I conceived them naturally. Literally, first-time trying with both, despite the fact that in between I had a nice hiatus of about 19 months where my period was completely Abel and I had to do a lot of work to rebalance and get that back to where it needed to be.

It took a long time, like, from the time that I met my husband and that we decided that we might want to have children, because we were working and we were busy and, you know, I was still young. So was he. We actually had an eight year period in our relationship of being together before we decided, okay, we’re going to have children now.

But two years before we actually made that decision, I had already started working on my cycles. I had already started working on my diet. I was already taking my nutrients and doing all of the things that I now recommend to my patients, because my cycles were still very irregular. And I still hadn’t quite gone on top of them, but what’s interesting is after having children and [00:40:00] continuing to implement all of that, my cycles now are literally clockwork.

You know, I have since having my second child, who’s now six years of age, I have a perfectly balanced monthly cycle that I have never had in my life before. And it really is as a, as a function of the continual implementation of the things that we talk about. Right? So in terms of the fact that diet is going to be vital, it’s vital for the longterm life spectrum of a human being to be in the healthiest possible version that you can be. 

So I think that that’s a minimum but one of the things that is also very important for people to understand is that the composition of a fertility diet is a little bit different to what I would just recommend to anybody out there in the general population.

Because what we know is that for couples who are experiencing infertility and miscarriage, they often have higher levels of inflammation in the system. They [00:41:00] often have immune systems that are a little bit more over-reactive then again, your general population. And so ensuring their nutrition doesn’t contribute negatively to all of those factors is of paramount importance.

So when I look at fertility diet and certainly what we recommend for our patients, I’m looking at low inflammatory diet. So I’m looking at basing meals on vegetables and good quality protein, organic wherever possible. But really making sure that we remove from the diet as best as we can, other than our little 10% for the soul, perhaps, gluten and diary.

Because gluten and dairy are both going to negatively impact a body’s ability to manage when it’s already under stress from other situations, you know, from other environmental factors and from other exposures. So with gluten and dairy, I always say if somebody is really intolerant or has an analogy, for example, if somebody is celiac, they should [00:42:00] absolutely avoid gluten altogether.

But if somebody has a documented in like, you know, reaction when they eat gluten. I also recommend they avoid it pretty much all altogether. However, if they just have symptoms here and there, when they haven’t once or twice a week, then probably could continue having it once or twice a week, but they shouldn’t increase it.

And certainly the less they have it, the better, you know, and that also is the same for dairy because also if we think about it, dairy is designed, milk is designed. Baby cows grow seven times faster than human babies. And it’s designed for that purpose. It’s designed to ensure that they grow really fast.

So you can imagine the growth promoters and the hormones that are in cow’s milk is going to have a huge impact on our body and our body’s ability to balance and self-regulate. And to be honest [00:43:00] those kinds of like, you know, nut milks and other types of milks that coming Tetra Paks, which we talked about BPH and biz phenols and, you know, satellites before those, those cardboard boxes are full of them in the lining.

It’s really not going to be ideal anyway. Right. So it’s something that I absolutely recommend my patients to avoid. So those are some interesting nuances, I guess, of, you know, the fertility diet compared to your general population diet. 

Felicity Cohen: So interesting. So we should probably actually be making, are making our own almond milk.

Gabriela Rosa: A hundred percent. And you know, it’s really interesting cause it’s the almond milk is the easiest thing there is to make. All you do is you get some organic almonds, you rinse them on the water because of aflatoxins every nut, every grain, every legume is going to have aflatoxins growing on them because what happens is as they harvested, they’re stored in these massive you know, that’s and they create mold. [00:44:00] So irrespective of where you find your nuts to seeds, your legumes, your grains, you want to make sure that you wash them when you bring them home. So after washing them, you prepare it. So for your nut milk it’s the easiest thing to do. All you do is you rinse it on the water.

You literally, I take a half a cup of, of almond or cashew. I love cashew nut milk. So I take a half a cup. I rinsed it out on the water filtered water. I put it in a blender with a cup of water, and I literally bled for three minutes and that is the smoothest creamiest, most delicious nut milk you could possibly have.

And if you make a smoothie, for example, you don’t even need to make the milk in advance. You just put, I put a handful of nuts in there with my water and whatever else I want in my smoothie. And I blame that for two minutes. Well, you have the most amazing, you know, kind of creamy, delicious, smoothie that you could buy anywhere else because you know what is in it one and [00:45:00] you know, it’s organic and you know that it’s going to be great for you.

Felicity Cohen: I love that you’ve totally converted me. I’m going to start making my own nut milk. I’m going home to do it this weekend. 

Gabriela Rosa: And as you need it, you know, like that’s the thing as well with nut milk is that ideally you want to make it as needed because you don’t want to have it stored. I mean, you can make it for one or two days in advance, but you know, you don’t want to make it for a week.

You want to make it as you need it.

Felicity Cohen: mind you, I’m not having children. I’m just thinking about optimum wellbeing. I’ve had my, my kids are 23 and 27. 

So do you see any, any patients of yours who come through, who may have had previous eating disorders who may have been, maybe they’ve had issues with bulemia or anorexia nervosa or any of the other potentially harmful eating disorders, but they’ve now, they might’ve, you know, they’re in a recovery phase and they’re actually want to have children. Are you able to [00:46:00] help those people who haven’t had regular cycles as well? 

Gabriela Rosa: Absolutely a hundred percent. That is one of the biggest things we actually do. And we so much, so, and we have so much interest in the clinic for people who have hormonal imbalances who want to optimise. They’re not necessarily trying to get pregnant. We’re creating a brand new program around. Right now, actually, because we’ve had so many people ask us, you know, we know that you’re great with fertility. We want you to help us with our reproductive health and, you know, can you do that?

And I’ve been literally for years now going, no, we don’t do that. No, we don’t do that. And then this year I thought, you know what? Why don’t we do that, let’s go. And so we’re creating that program as we speak and, you know, but with something, because we we’ve seen such incredible success with addressing these very patients that you’re describing in the fertility context.

That we know, and we have to do that in order for them to conceive anyway. Right. And so it’s something that is [00:47:00] absolutely essential for us to be able to derive as an outcome of our treatment, as I thought. Okay, well, it’s, there’s so many women out there who need this very outcome, but are not trying to conceive.

And so that’s essentially when we’re catering for both of those types of patients at the moment. 

Felicity Cohen: That’s fantastic and great to hear. It’s amazing work that you’re doing. I’m fascinated in the program that you’ve created, which you have called fertile. 

Gabriela Rosa: that was the method. Yes. 

Felicity Cohen: So that’s actually your actual program that you implement the patients coming to see you, is that correct?

Gabriela Rosa: Yeah. So basically the name of the program is actually, it’s actually Fertility Breakthrough. So Fertility Breakthrough is the program that we implemented the fertile method into. And the method is really what I like to call a framework. You know, it’s a framework so that we know in medicine, you know, Atul Gawande has made an [00:48:00] incredible contribution to the field of medicine.

From the field of aeronautics, you know, more places. So basically what they realise is that if you’re going to fly a plane, you need extremely comprehensive checklist. So that, you know exactly, you know, your pilot and copilot are sitting next to each other and they know exactly what it is that they need to do.

And Atul Gawande, he actually implemented that whole thinking into surgery. And what he did was he created the process in his surgical procedures, where there was a checklist that every single person in that operating room needed to follow in order to prevent, you know infections, post surgery in order to ensure that the patient went through surgery well, and so on and so forth, he then wrote a book on it, called the checklist manifesto.

And, and he happened to be one of the professors in my course as well. But what’s fascinating in terms of that process, and this is what the fertile [00:49:00] method really became, and it was that inspiration that I went, okay. We want to make sure that we absolutely miss nothing when it comes to treating the patients that we treat, because they’ve already been around the block multiple times.

Right. And so the last thing I want for my patients is for me to lie awake at night thinking, have we covered this, this, this, this, this, this, or that? And missing something. So I decided one day that I would put into place, you know, like I created this massive, huge checklist, out of this humungous, most mungus mind map that I have ever created to this day with every single possible thing that would need to be talked about in the consultation or in resources or in any way shape or form, to educate couples on what it is that they need to do. And what it is that they need to stop doing, but also to educate my clinicians and ensure that all of my clinicians had a [00:50:00] very systematic, methodical process to know that we have left nothing to chance and no stone unturned, and that we can replicate that across our entire clinic and across all of our clinicians.

So that’s how the fertile methods developed. It was really as a, as a way of ensuring that we kept on top of everything that needed to be looked at, because as you can imagine, there are thousands of things, you know, now we are up to thousands of things and places that we look and things that we do in order to know before we even have a first consultation with our patients, we build what we call tables of correlation about everything that they’ve actually given us, the information they fill out a 50 page questionnaire before they start treatment with us, where we’re really going through very methodically and systematically every possible thing that we need to understand so that we can best support them. And in that process, We then start to build tables of correlation to be able to understand, okay, how do these things fit in the continuum of that [00:51:00] biochemical chain reaction that we talk about?

What a causative factors, what are results of causative factors and how can we address the 20% of the effort that we put in so that we get 80% of our result and not the other way around. Because the vast majority of patients who come to, sadly, they’re doing too much, but they’re doing too much of the things that are not going to be effective in transforming their results.

They’re doing 80% of the work that’s only going to give them 20% of their results. And so what ends up happening is that they keep going around in circles in failed treatments until we actually turn that equation around. And really look at the whole picture but then narrow down on what is the 20% of the effort that will give us 80% of our results.

And that’s how we are at a situation now where we get our patients who have done what they think is everything to end up conceiving and taking home healthy babies, even when other treatments have failed. 

Felicity Cohen: I have to tell you that one of my [00:52:00] favourite patient population cohorts in, in our environment are those that come here because they want to have children.

And, you know, over the years I’ve seen so many of what I refer to as our WLSA babies. it’s such rewarding work to see them go through that surgical pathway to reduce all of the symptoms of PCOS, endometriosis, and all the other issues that they’ve had in the past combined with their weight concerns to get into that point where they’re healthy fit well and able to conceive and have beautiful babies.

They definitely are one of my favourite patients to look after, and it’s so, so rewarding. So I can imagine the satisfaction for you that you must feel going through this process and watching couples who’ve experienced sometimes multiple miscarriages before they come to you. and those that come to you just because they really want to be able to put themselves in a position where they are optimally, you know, well and capable of [00:53:00] conceiving and having healthy children. It must be an incredibly satisfying outcome for you to watch. 

Gabriela Rosa: It absolutely is and I actually wish that more people would come to us in that latter category that you’ve said, which is, you know, people who want to put themselves in the best possible place to conceive and take home babies.

You know, often, unfortunately as humans, what I find is that people, until it’s broken, they don’t want to fix it. And so, you know, unfortunately. But really part of why I pursued the MPA. I’m pursuing the doctorate at Harvard is really so that this becomes a part of standard therapy because it has to be in order to be able to give populations around the globe a better chance of not only being healthier for their own life in the longterm, you know, having better quality of life in general, but to be able to actually have a situation where humanity benefits from the [00:54:00] process of parents who are as healthy as possible prior to conception. Because we know for a fact that when babies are born to people who are healthier versus to those who are unhealthier, they have a better quality of life in the future themselves, you know? 

So we need to make sure that we are addressing this, not just from the perspective of wanting to pregnant and to have a baby. I mean, that’s lovely. But really we need to look at the future of humanity here and what are we actually doing? Because if we are going to continue to pretend that we can bypass nature and biology and, you know, we can use technology to do that. We are going to continue to breed infertile people.

You know what I mean? We know for a fact that if we use ICSI for a man who has a chromosomal deletion in the Y chromosome, what’s going to happen is that, that child, if that man, or that couple has a male child, that child will be infertile. [00:55:00] They will not be able to conceive without assisted reproductive techniques and technology.

So we know that we are breeding infertility within our human genome. And so we need to understand that this is not really just about, you know, getting pregnant and having a baby. We want to make sure that we have a continuation of the species that is a healthy continuation of the species to the best of our ability.

I totally understand. And I don’t fault people and judge people who want to have a baby, in respective of the challenges that they face in terms of their health, but those are isolated cases. If we keep them as isolated cases by ensuring that for the vast majority of the population, we’re doing everything that we can, and we’re using minimally invasive technology in order to conceive our children and carry healthy pregnancies to term. 

Felicity Cohen: Oh, a hundred per cent agree with you that the bigger picture in terms of protecting people right throughout the course of their lives, we see so many [00:56:00] patients here as well, who have incredible issues when they get to menopause, perimenopausal, all those.

So if we start a lot sooner, you know, that whole life cycle of good health and optimal wellbeing is going to be completely transformed. So totally love all the work that you’re doing. 

I could keep talking for a long time and I know that you’ve got so much to share a lot to say, and I actually can’t wait to see you presenting your research at a future point in time. I think it’s going to be really exciting to see all the things that you’re doing in this space. 

I do have one final question that I do always love to ask people who come on my wellness warriors podcast. And that is, Gabriela, what does wellness mean to you? 

Gabriela Rosa: Wellness means doing things that make me feel like sunshine.

I think that that is the best, most succinct way that I can put it, you know, and [00:57:00] essentially taking care of my health in general so that I can be as healthy as I can possibly be and contribute to the best of my ability. 

Felicity Cohen: Thank you for joining the wellness warriors podcast. It’s been a pleasure to have you online with us.

If you enjoy the series, please leave your review, subscribe and follow. And we look forward to sharing many more stories with you in the future.

Nutritionist & Dietitian

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