Ep.119: Fertility Tests that shouldn't be skipped! with Dr. Sarah Pederson, OBGYN

Dr. Sarah Pederson joins us to talk about fertility tests that are often ignored in traditional approaches to women's health, but are key to getting to the root cause of issues related to women's health. We started off the episode talking about issues related to infertility, but quickly came to the conclusion that these tests were not only beneficial when trying to get pregnant, but for all women's reproductive health -- regardless of pregnancy goal, marital status, etc! Dr. Pederson talks about her holistic approach to women's health and her  many tools that she utilizes to diagnose and treat women's health issues related to things like endometriosis, inflammation, vaginal microbiome issues, infections, hormone imbalances, psychological stress, and more. You do not want to miss this episode!

NOTE: This episode is appropriate for most audiences, and does utilize anatomically correct terminology.

SHOW NOTES:
Want to work with Dr. Sarah Pederson? You can schedule an appointment with her (in person in Denver, CO or anywhere in the country through telemedicine) at verafertility.com

Want to learn more about some of the topics discussed in today's episode? Check out these previous episodes by Woven Well: 

• Ep. 10: Endometriosis 101
• Ep. 16: PMS 101
• Ep. 72: NaProTechnology with Dr. Kristina Pakiz
• Ep. 113: Inflammation's Impact on Women's health, with Chiara Estes, RD
• Ep.116: Explaining Chronic Endometritis

Interested in learning about the Creighton Model System? You're in the right place! 

• Register for Creighton Introductory Session: Register here for our next Introductory Session

Looking for ways to implement fertility awareness into your life and faith? Check out out most helpful resources: 

• Substack Newsletter (free)
• Website Resources (free)

Transcript

Caitlin: 0:06

Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started. Welcome back to the Woven Well Podcast. Today we're speaking with Dr. Sarah Pederson, a board certified OBGYN, who specializes in fertility, holistic medicine and surgery. She's the founder of Vera Health in fertility in Denver, Colorado, and enjoys thinking outside the box to get to the bottom of why couples are having fertility issues. She's joining me to talk about three tests that are often missed by traditional medical providers when investigating infertility. And we talk a lot about the struggle to get accurate diagnoses and treatment on our podcast. And I'll certainly include a couple extra episodes in the show notes if you want to listen to more of those. And so we know that it can be challenging to find a provider who is willing to dig deeper with you. There are providers like Dr. Pederson out there who are restorative and focused and trained in tools like NaProTechnology. They are eager to help you get to the bottom of things, but what makes them different? What do they do that your standard OBGYN may not? Dr. Pederson's going to share a little of that with us today. Dr. Pederson, I'm so glad to have you on the show with us today.

Dr. Sarah Pederson: 1:37

Thank you, Caitlin. I'm thrilled to be here.

Caitlin: 1:40

I'm thrilled to have you. And I'm really curious what made you even want to get into restorative fertility and NaProTechnology?

Dr. Sarah Pederson: 1:51

In medical training, you really only learn some really basic things about birth control and hormones. And then when you graduate and you go into the real world, you find that these are just one of a tiny number of tools that we can use to help people. And so the more patients I saw, I feel like I was always just craving more. How can we look into things beyond just, okay, we're going to just give you this pill or we're just going to give you this one treatment. How can we go deeper and figure out, okay, what, why exactly is your progesterone low? Why are you feeling tired all the time? Why are you having PMS symptoms? Let's come up with a toolkit where we can really get to the bottom of exactly what's going on and then be able to fix it. Not just to give you a pill so that when you come off of it, you go right back, but so that you can learn about your body and keep it healthy for your entire reproductive life. It's just the best way to take care of people.

Caitlin: 2:52

I love that you said that you were craving more because even while I'm talking with clients and working with them on their individual fertility journeys, they are also craving more. And so you want to have a medical provider that doesn't just settle for the status quo, but really wants to work with you to get to that next level of information and of overall health. And it sounds like that restorative and NaProTechnology approach have been extremely helpful for you. So that is fantastic. It's so interesting to me that even in medical school, you're not getting all of the tools that you would like in order to serve women. And so this restorative approach would be probably surprisingly different from a traditional OBGYN to reproductive endocrinology sort of route for those dealing with infertility. So in your experience, what are things that are missed by most providers when they are assessing for infertility?

Dr. Sarah Pederson: 3:49

So there's a whole bunch that I , that I look into and I really do a deep dive, but three things that come up really often: One is hormone imbalance, two is endometriosis or inflammation, and three is vaginal or uterine infections or a disruption in vaginal microbiome. So for one thing, I think hormone imbalance is huge, not only in fertility, but in general in women's entire reproductive life and how you feel. And we as women, we really know our bodies and you know, if something is wrong, but on the other hand you only have your body and so sometimes you don't know, like, that PMS symptoms aren't normal or that taking off a day off of work every single month because you're on the couch chugging ibuprofen because your period is so painful isn't normal. But then once you start talking to other women or you start talking to your doctor and you're like, wait a sec, this isn't normal. That's right. So there's a lot of things that kind of give us red flags about what's going on with our hormones. Like are we tired all the time and exhausted? Are we really irritable or angry especially before our period, do we have any brown bleeding before we get a period or does it start with flow? There's a lot of kind of subtle signals that we really look into that can point toward hormone balance. So number one, you need your hormones balanced because it just makes you feel good. We're designed to have our hormones in certain levels for women to be our happiest, healthiest selves. So we're going to feel our best when our hormones are optimized. And also from a fertility standpoint, if our hormones aren't balanced, we're not recruiting an egg in a healthy way in order to ovulate in a healthy way and support a pregnancy in that luteal phase between ovulation and your period. And I think one common thing is sometimes people get their hormones checked and they're like, oh, my doctor said everything was fine. And you look into it and you're like, well then it wasn't actually fine. They either didn't do a full complete hormone panel, they didn't measure the right things, they didn't look at the hormone ratios, they didn't measure it at the right time of your cycle. For example, I have a lot of people say that they got diagnosed with low progesterone, but they tested their progesterone before they even ovulated when it's supposed to be low. So then people are just getting these, you know, kind of inaccurate diagnoses and they don't really know what they have to work with. So we really pinpoint every single day of your cycle what's going on, and then how can you fix it naturally? So if you really do have low progesterone, well how can we optimize that from your exercise, from your nutrition, from your sleep, from your stress, from your mentality and spirituality? So there's kind of these six pillars of hormone balance that I really focus and look into. Do we need to focus on supplements, that kind of a thing? So hormones is huge. The second one is endometriosis or inflammation. If you're having really, really painful periods, it's not normal. So I do restorative reproductive surgery where I do robotic surgery and go in and take out each individual little piece of endometriosis and then sew the tissue underneath back together. Because from a fertility standpoint, you don't want to go in and do surgery and make scarring worse. You always want to make the body better, whole or happier, healthier. You want to make the body able to heal so that the egg can move down the fallopian tubes appropriately and the ovaries can ovulate. So the reason endometriosis is so tough is because it affects our body's ability to make hormones in proper amounts, because most of our hormone production as women comes from our ovaries. So if they're scarred somewhere, they have cysts, they're inflamed, then a lot of times you tend to have low estrogen and low progesterone. And it also affects the ability of the ovary to ovulate properly and the ability for the egg to go down the fallopian tube, because our fallopian tubes are filled with little teeny tiny hairs. And if those little hairs, or celia, are inflamed, the egg's not going to be able to make it down there. So surgery is one thing, but also inflammation is something that you need to manage lifelong. So I take an an anti-inflammatory approach and also in that approach we look at your gut. Because your entire women organs are bathed in your gut. So is your inflammation coming from your gut, like do we need to do a stool or gut health test? Do we need to do a food sensitivity test to see if there's something that you're eating that's inflaming you? Are there other sources of inflammation? And then how do we lifelong bring that inflammation down? Is it a diet thing? Do we need to focus on our anti-inflammatory supplements? So I use a lot of curcumin and NAC and some of those supplements that can really help bring down inflammation. And so both of those two things we see a lot. The third thing is infections and vaginal microbiome. I think often women come to me and they feel like they aren't heard or their doctor isn't listening to them. And I think they just also don't do a very, get a very complete set of testing because they'll go to their doctor either with, you know, having a low or no cervical mucus, or they say they're always irritated or, you know, something just doesn't feel right down there. Or everything feels completely normal, but they're having fertility issues. And so I do a really extended panel where we look at a whole bunch of different vaginal microflora and different bacterial species because sometimes if your pH is really, really off, so you might either have an issue with the sperm being able to get through the cervical mucus and to the uterus and you might have an issue with your actual cervical mucus itself. And sometimes something will come back and patients will say, well, I had no idea, you know, I had no idea. Like, I have no symptoms, I don't have any irritation, I don't have any itching. And I say, well that's 50% of the problem is that you aren't symptomatic. So that's why we test for it. And sometimes it's, it's as easy as, okay, we can put you on a really good vaginal probiotic, we can work on reconstituting your vaginal microflora. And sometimes there's such a humongous overgrowth that we need to put you on antibiotics. But I've had a number of patients that were struggling with infertility for years. No one could figure out the answer. We figured out that their vaginal microbiome was really ated 14 days of antibiotics, their partner was on antibiotics and the next cycle they got pregnant. And they would've no idea, like they never would've known because it's not something that is commonly tested for in OB. But I think when you think of fertility and reproduction, you have to just think of the whole picture of the whole tract. And sometimes you have to open doors that you otherwise have never opened and really think outside the box to get to the bottom of the issue sometimes.

Caitlin: 10:38

I love each one of those three. And you brought up a really good point in the beginning. You're like, well, there's a lot. We're just choosing three . That's exactly right. We want it to be a realistic episode where you can take three things and walk away, you know, knowing some next steps. But even those three things, the approach is totally different from that traditional path. And one of the ways that I think about that is you were talking about if they get hormones tested and they say, well, all my results came back normal, or they don't have any symptoms of any issues , we know that endometriosis--yes, if you have painful periods, you often think I may have endometriosis--but a lot of women who have endo do not have any symptoms. And then certainly in the vaginal microbiome, you may not have any symptoms at all. So in each one of these scenarios, normal isn't necessarily optimal. And so finding out what is the optimal health for you, what's the optimal supplement routine or approach or treatment is going to be individualized to you. And that's something that I love about your work and your focus, but I also know that all these things are going to take a little bit longer to investigate, to treat. And a lot of times , women and couples are kind of put on the reproductive endocrinology route. So why is it worth pursuing these things and this type of an approach to health instead of doing something like an IUI or IVF when those are often promised as more like a quicker solution to infertility?

Dr. Sarah Pederson: 12:14

Yeah. And I think that's common where women go to their OBGYN, they are started on maybe some ovulation medication. It doesn't work for a couple cycles, and the OBGYN says, oh, well there's nothing we can do. Like you have to go, I do IVF and then they go to IVF and the patient says, well, is there anything else, other than IVF ? Like, boom, you're just shooting me right to IVF and there's nothing in between. And so finding that in between is not only going to help your fertility, but it's just going to make you feel better and know your body for your entire reproductive life. So for example, I have a lot of patients, so I have my patients map their hormones every single day. And so we look at their hormone map, which tells us intimately are they having a high LH surge? Are they recruiting a follicle? Did they have a healthy ovulation? How are they? And then we map it with how they're feeling. Like, are you feeling good in your luteal phase? Are you still having PMS symptoms? Things like that. So it's just one tool that yes, we use in fertility, but also just so that we can feel good always. And I often ask my patients like, how's your gut? And sometimes people are like, oh, my gut's fine, nothing's wrong. And some people are like, oh my gosh, my gut is a mess. They just know like their bowel movements aren't good. They have IBS symptoms, they have gas, they have bloating. It's so much worse before their cycle. And so if we can figure out, for example, like what's going on with your gut? Is it an inflammation issue, an imbalance of a certain micronutrient? Something like that. Then not only is it going to help your body make hormones in more proper levels, but your , the goal is to, you never is the goal is to have a whole day where you never think about your gut whatsoever.

Caitlin: 13:56

I love that approach too, because I also agree that every woman's body and health matters, every woman's reproductive health matters. It doesn't matter if you are trying to conceive or not, doesn't matter if you're married or single. None of those situations should influence whether or not you deserve to feel healthy and to pursue that optimal health for yourself. So I completely agree.

Dr. Sarah Pederson: 14:22

That's a good point too off of what you said. Some people think that they don't have to worry about the hormones until they're going to have a baby until they're married. And I always tell people, you should always be focusing on optimizing your hormones no matter what state of life you're in. Because sometimes people, we as women, we just tend to suffer sometimes like we'll have really bad period or bad PMS symptoms. We'll be like, okay, I promise I'll go to the doctor and then it'll get better. And then we think, okay, we don't need to to go to the doctor anymore. Or, oh, I'm just going to stick it out and tough it out and then I'll worry about it when I get married and have kids. But I always tell people like, we need to be setting goals and making sure we're meeting those goals. And it's never too early to focus on your hormone health, no matter what stage of life you're in, whether you've just started having your period or you're in perimenopause. So one thing that I have my patients do a lot, I mentioned that I have them ma their hormones because whether or not we're trying to get pregnant, it's important to have a cycle every 21 to 35 days. And those cycles should be very, very regular. And another thing that's important is you want your period to just be part of your life and not a huge burden to you. So if your period is something that you're really kind of getting worked up about and you're worried about and you're like, oh crap, I'm about to get my period, then that is a huge goal that we need to fix because that means that something is going on. Either you're really inflamed or your hormones are off or something else is going on, that your body is feeling your period so immensely. So just the way that we feel throughout the month and the way that we have our period tells us a lot about our hormonal health, our state of inflammation, and just our mental health in general too, because it all is connected. For example, stress is huge with relation to how we ovulate. If you have a really stressful month, whether that's physiologic stress like we're traveling or we're moving, or psychologic stress, that can decrease our entire hormone production and prevent us from ovulating. So the more that we learn about what our bodies are supposed to be doing and how they work and what's normal and what's not normal, the more that we can help our body improve every single cycle and optimize our hormones for fertility. And I always tell my patients, the goal is for you to learn about your body so you can manage yourself lifelong . I do a lot of, for example, I have people do continuous glucose monitoring where they'll monitor their glucose and keep a really strict food diary for two weeks and they're , they say things like, well, Sarah , I don't want to do that because then you're going to not let me eat ice cream every single night, and I love my ice cream. I need it. And I say, okay, well it's not about being super duper restrictive or going on a diet. It's about learning how you manage yourself all the time. Like I had a patient who was eating two cookies every night before she went to bed. And I was like, I just , she said, I need my cookies. You're not going to make me get off cookies. So I said, well, just play with it, see what they do. So she ate two cookies. Her glucose is through the roof, she ate one cookie. Her glucose was completely fine . So I said, okay, can you, are you okay just eating one cookie? She was like, yeah , completely fine. She felt so much better. She was like, Sarah , I never knew. I woke up and I didn't feel like lead anymore. I didn't feel so tired. I got my energy back. And I said, and this also is going to help your body make estrogen proper amounts. So just learning about how what you eat, what you're doing to your body, those different pillars of hormone balance, how they make you feel and how they affect your hormones can also help us narrow down what could be going on behind your fertility.

Caitlin: 18:13

That is great. I have no doubt that there are going to be listeners who want to work with you, who want to partner with you to get to that next level of understanding now and in the future. We're going to make sure in the show notes to have the best way to get in contact with you and to begin working with you. So listeners, make sure to look there, but thank you so much for being here, being on this episode and sharing your experience and wisdom.

Dr. Sarah Pederson: 18:39

Thanks for having me.

Caitlin: 18:41

Listeners, I know it can be challenging to navigate your fertility journey. There's so many unanswered questions and uncertain next steps here at Woven Well. We hope to provide you with solid, trusted advice for caring for your body and your fertility in a restorative and holistic manner. So if you'd like to begin diving deeper into your cycles and what your body may be telling you about your reproductive health and hormones, I'd love to invite you to our next introductory session. It's online. It's a great next step to take in your fertility journey, and I would love to see you there. The link will be in the show notes. As always, thanks so much for listening as we continue to explore together what it means to be woven well.