073: [FEMININE FLOW] Fertility: Pre-Pregnancy Wellness for generational health with Alexandria DeVito

Today's episode is all about fertility, and it's not what you think! I am joined by Alexandria DeVito, MS, CNS, a functional nutritionist who specializes in fertility and
preconception health. We're diving into the topic of preconception - from food and environment to age + how your preconception care even affects the health of your FUTURE baby!

 What we cover:

• Misconceptions about conception
• Why Alexandria believes that “age” is not a factor + why!
• The difference between chronological age and bio age and how it might be influencing your fertility
• Why male fertility is just as important as female fertility
• The factors influencing our fertility + what can we do about them
• How preconception influences generational health
• What an “ideal” conception state looks like 

About Alexandria:
Alexandria DeVito, MS, CNS, is a functional nutritionist who specializes in fertility and
preconception health. She is the author of 9 Months Is Not Enough: The Ultimate
Pre-pregnancy Checklist to Create a Baby-Ready Bod y and Build Generational Health. She is
also the founder and CEO of Poplin, the first pre-pregnancy wellness company. Prior to founding Poplin, Alexandria worked in management consulting at McKinsey & Company. She holds an MBA from Harvard Business School. She also has a master’s degree in nutrition, extensive training as a doula, yoga teacher, and personal trainer, and is an Institute for Functional Medicine Certified Practitioner, all of which inform her approach to pre-pregnancy wellness. 

 
To connect with Alexandria:

IG: getpoplin
LI: Alexandria DeVito

9monthsisnotenough.com
getpoplin.com 

Transcript

Kasia: 0:02

Hello and welcome to the Other Way, a lifestyle podcast exploring uncommon, unconventional or otherwise alternative approaches to life, business and health. I'm your host, kasia. I'm the founder of InFlow, a women's wellness brand that designs intentional products to help women reconnect to their unique cyclical rhythm and find a balance between being and doing. This podcast is an extension of my mission within Flow. Here we provide intentional interviews with inspiring humans, trailblazers, researchers, spiritual teachers and more on the journey of doing things the other way. On the journey of doing things the other way. Hello, my friends, and welcome back to the Other Way. I'm your host, kasia, and today I am so excited to welcome Alexandria DeVito, who is a functional nutritionist who specializes in fertility and preconception health. She is the author of Nine Months Is Not Enough, the Ultimate Pre-Pregnancy Checklist to Create a Baby-Ready Body and Build Generational Health, and she is also the founder and CEO of Poplin, the first pre-pregnancy wellness company. They have an exceptional lineup of preconception testing and so much information and y'all this episode is just filled, filled to the brim with amazing, amazing content.

Kasia: 1:32

Today, alexandria and I dive into misconceptions about conception, why Alexandria believes that age is not a factor in fertility and why so unpopular opinion. But so, so, so important and her explanation is juicy the difference between chronological age and biological age and how it might be influencing your fertility, why male fertility is just as important as female fertility, the factors influencing our fertility and what we can do about them, how preconception influences generational health, when to prepare for pregnancy and what an ideal conception state looks like, and so much more Truly. I could have kept speaking with Alexandria for hours, but we ran out of time. I am so excited to really dive into the science. Alexandria is, of course, a very accomplished author and CEO, but she's also just such a researcher at heart, I have to say. She explains all of these concepts from a first principles point of view, so you can understand the link between the data and the why at the root.

Kasia: 2:41

This is such a good episode. Without further ado, let's jump on into it. Alexandria, welcome to the podcast. Thank you so much for having me. I'm so excited we were talking about this right before we started recording, but I feel like preconception is kind of entering that wave of discussion and attention that it finally deserves, and I'm so excited to dive into all the things with you. I have a bunch of questions prepared, but before we do that. I want to start with a question that I ask every guest, and that is what are three words that you would use to describe yourself?

Alexandria DeVito: 3:18

I would probably say curious or inquisitive, I would say passionate and I would say related probably to the first part, but introspective.

Kasia: 3:30

Interesting, like in a meditative way or in a self-reflective way. I'm curious how that shows up for you.

Alexandria DeVito: 3:37

In all the ways. It's related to being highly curious, but I spend a lot of time thinking and analyzing both my own behavior that's a lot of it and motivations, and then also that of the people in the world around me. I'm really motivated to understand the whys, to the extent that we can know them. There are many things we can't know, but why is this happening and how do we make sense of it and why am I acting in this way? Are the people around me acting in this way, and do I have a framework for understanding it? If I don't have a framework for understanding it, okay, what additional frameworks are there that I could potentially come upon to understand it? So I think there's spending a lot of time in reflecting on what I'm seeing, both my own thoughts and behaviors and that of the world around me.

Kasia: 4:23

I feel like that definitely has come in handy as you explore, like from my really first principles point of view, about the importance of not just conception but the whole preconception period of time. I feel like that just makes a lot of sense to hear you describing yourself in that way. Yeah, so let's just dive right into it, Since I have here one of the foremost preconception experts in the world. I would actually love to start with this is going to rhyme misconceptions about preconception. That didn't rhyme, but it sounded like a pretty nice like rap right there. What are the top misconceptions about preconception?

Alexandria DeVito: 5:07

So I think there's a bunch, and I'm so glad we start with this, right, let's go, let's start with a bang. So I think the first one, probably the most common one, is that age is the biggest predictor of fertility. So like, why don't we even, just you know, get into it and start right there? And so I think that that has been a myth that has been perpetuated, certainly among you know my peer set for for many, many years, and it's been you know what we've been told, and I think it's a misconception because the data does not actually support it. So right, there's a big difference between chronological age, meaning someone's age and years, and biological age, meaning the vitality of their cells.

Alexandria DeVito: 5:42

And in the current healthcare system we treat all 30-year-olds as equal, all 35-year-olds as equal, all 40-year-olds as equal, but cellularly that's just not true. And as someone who's run a ton of lab tests on people, I know that right, practically speaking right. Because if you cover up the number on a lab test, the age on a lab test, a lot of the time you can't guess how old someone is, and someone who's actually 25 years old may look cellularly 10 or 15 years older, and vice versa. So I think that we've been missing the mark when we're treating women as just all the same age when it comes to fertility, and I think that this idea of cliffs and, you know, like geriatric pregnancies and all this other nonsense that we're being told, is much, much more overstated. Yes, age is a factor, but it is one factor of many and, to my knowledge, we can't yet control chronological age, but we can manage biological age. So I think it's much more empowering to focus on the things that we can control.

Kasia: 6:40

Love that, love that. Right out the gate with a bang. Do you have any others that you would throw in there before I move on to actually asking you about that? Because I'm like, yes, let's dive into that.

Alexandria DeVito: 6:51

I think I mean there's a few others, but I think one other big one that I want to also start with is that preconception is just about the female reproductive partner, and the reason I say that is because I've worked with so many clients as a nutritionist.

Alexandria DeVito: 7:04

When I was seeing clients one-on-one, most of the time the female would be coming in herself and much of the time the couple was struggling to conceive.

Alexandria DeVito: 7:13

And what I affectionately but not so affectionately say is that biology does not care about our cultural construct, that fertility is a female problem. It is literally a 50-50 biological equation, and this is true regardless of relationship construct. So this idea that we have, that we're going to shoulder the burden and we're going to do all the things and we're going to clean up our environment and we're going to stand on our heads and twirl around and our reproductive partners are not going to take any part in that, is not only ineffective, right, but it's also inefficient right. If we're only optimizing 50% of an equation, we're going to be missing a large swath of factors, nevermind the fact that globally, sperm counts have dropped 60% six zero in the last 40 years and testosterone has also taken a pretty big dive. So I think it's really important. If you know, if we're going to be parenting together, then I think it really is important to be inviting your reproductive partner into the process of preparing together.

Kasia: 8:20

Amen to that, amen to that. I heard you talk about that on another podcast and I like literally starred the note because I think it's just so true we invest so much into the female part of the equation, but not enough, I think. On the other side of things, I'm curious, and I do want to go back to the age thing, but I want to talk about the sperm count. 60% sperm count has dropped 60%. What would you kind of attribute that to, like? Are there any hypotheses out there Like kind of what are some of the factors that are affecting that? You know the sperm count and also you mentioned testosterone, right?

Alexandria DeVito: 8:56

Yep.

Kasia: 8:56

Yep.

Alexandria DeVito: 8:57

So I think that a lot of the factors that are affecting female fertility are also affecting male fertility, and I think the thing about male fertility is we're able to measure it in a much less invasive way than we can with female fertility right, and new sperm are being produced all the time, so we can get good metrics on sperm counts in a much more efficient way than we can on even egg counts and egg quality. So I think that's part of the reason why it's a really good harbinger of what's to come and what's already happened. So I think there's a whole bunch of factors at play. A lot of people will say, oh, we have no idea, we don't know what's happening, but I think there is really good evidence to suggest what is likely happening, which is that our bodies were designed to conceive, but our modern environment was not.

Kasia: 9:49

Oh, all right, Like hard-hitting punches. Okay, tell me more.

Alexandria DeVito: 9:53

And so our bodies essentially down-regulate reproductive function when they perceive, essentially, war or famine. And so, if you think about it, your body will always prioritize survival over procreation. So if it thinks, if your body thinks that you are in an unstable or unsafe environment, it says probably not the best time to be conceiving. We're going to switch gears here and, practically speaking, it actually shifts from making your sex hormones to making stress hormones, because that's what it thinks your body needs. And so, over time, while that happens, your body doesn't actually have the raw materials to, in females' case, get a cycle, never mind sustain a pregnancy.

Alexandria DeVito: 10:37

So, with that understanding, then we have to say, okay, well, what are the things that are causing our body to think that we are in this fight or flight state, in this war or famine? It's well, what I call fertility blockers, and there's a bunch of them in our environment, right? First is we're eating less nutrition, less food and more food-like substances. We're consuming food, but they're devoid of true nutrient density in many cases, and so our body thinks we are starving, literally. Right, that's one big thing.

Kasia: 11:09

Another Wait, can I pause? First back in there. How would you also kind of speak to the obesity statistics in that, like I guess, are we starving from like a nutrient point of view, where we're not nourishing our bodies Like we might be gaining fat but we're not nourishing ourselves, bodies Like we might be gaining fat but we're not nourishing ourselves properly, like I'm curious about that there.

Alexandria DeVito: 11:29

Yes, so I think you you hit on the point, and I would also say, just as we, we pause on this just as our environment is obesogenic meaning predisposing us to obesity, it is also infertile genic, meaning predisposing us to infertility.

Alexandria DeVito: 11:42

Wow, so the way that I describe that people is if you live in the modern world which, if you're listening to this, I presume you do then if you do not take compensatory action, it is reasonably likely that you will gain body fat and therefore become overweight or obese by the clinical definitions and we can have a whole discussion around the clinical definitions of that, not my favorite, but it's what we have to work with Maybe likely to experience fertility challenges. So, just getting back to the question that you were asking, yes, what is happening is that we are consuming calorically dense food, but not nutrient dense food. Right, so we're getting a lot of calories in us. A lot of times they're predominantly through flour and sugar, but those things are devoid of actual nutrients, like micronutrients, vitamins and minerals and phytochemicals, and those are the things that signal to our body that we have the stores necessary to sustain ourselves and that of a baby.

Kasia: 12:43

Wild, wild. Okay, so you started to touch on food. What are some of the other factors that are impacting fertility for both men and women?

Alexandria DeVito: 12:53

Another big one are chemicals in and around our environment, and so there are tens of thousands of chemicals that have been put on the market in just our lifespans, and most of them have not been tested for human safety. They've been grandfathered in, and so what's happened is that we're running a worldwide epidemiological study that no one opted into, and we are now seeing the effects of the cascading set of chemicals. And the thing that people get confused about sometimes is people will say well, don't our bodies naturally detox? Yes, they absolutely do.

Alexandria DeVito: 13:31

However, our bodies were never designed to manage the volume and pace of chemicals that are coming at us on a daily basis through food, water, air, personal care products, home care products, and so our bodies just can't keep up with how much is coming at them on such a regular basis, and so it's really important to be conscious about these things, because there's actually a class of chemicals called endocrine disrupting chemicals EDCs, and they do exactly what they sound like.

Alexandria DeVito: 14:00

They interrupt with our endocrine signaling, and so that means sometimes they encourage our body to produce more of a hormone, produce less of a hormone. They interfere with the communication of our hormones and their receptor sites, so it basically creates a whole jumble and then your body's confused and maybe down-regulating things when it should not be down-regulating things, maybe up-regulating things when it should not be not be up regulating things, and so our bodies get really confused. So I think that's a really big one, and we're seeing worldwide effects of this, not only in fertility, which is, you know, the infertility stats are rising, but also in precocious puberty. The incidence of young girls who are getting puberty in eight or nine years old is on the rise, and that is also a function of the same factors where we have a lot of endocrine disrupting chemicals in and around our bodies and we're very highly sensitive to those, and so it's messing with our own hormonal systems.

Kasia: 14:57

It is so wild. I was just speaking to somebody about this yesterday. She's a, I guess, a aunt of sorts and she's in her 60s or 70s and she was talking about how, you know, she consciously chooses real fabrics. Like let's just use fabrics as an example, Because if you think about when you wash your clothes, if they're, you know, kind of made with all sorts of weird plastic chemicals, with all sorts of other weird things in them, from the dyes to the actual fabric material itself, it gets into the water system and like we can't get away from this stuff.

Kasia: 15:29

As you mentioned, it's like in everything. So if it's in the food you eat, if it's in the clothes you wear I recently heard about you know, just kind of came to my awareness like products like underwear, products, like, you know, workout pants, like all these things have these weird chemicals in them. So yeah, it is. I mean, it kind of makes sense, unfortunately, as to why our body may not be able to detox all of that. But I think you just shared so clearly that connection between the chemicals that literally interfere with hormones and how that might contribute to something like a testosterone decrease or downregulation in men, and also some of the issues that we're seeing with women who are struggling with infertility as well.

Alexandria DeVito: 16:15

Absolutely I wish it were not the case, but I think it's important that we understand this because then, as you said, we can't control everything, but let's as much as possible. I encourage people to have informed consent, which is to be aware and to make the choices where they can, because there's going to be plenty of places where you can't. So this is, you know, in and around your home, trying to optimize as much as possible, also without driving yourself completely nuts, because, like you know, there's there is a point of diminishing returns to where we're obsessing so much about everything that it can be a stressor unto itself, which is a whole other factor that we haven't even touched on. So I think balancing that is important in this journey as well.

Kasia: 16:54

Absolutely. So I'm curious. I want to kind of go back to what you mentioned earlier in terms of the you said it so well, I'm not going to be able to paraphrase it properly, but it was. You know that the kind of opposite side of the coin of a fertile like thriving fertile life is basically a life that is stressed out and chemically overwhelmed, and so I'm curious when it, when it comes to kind of that stress connection, can you talk a bit more about how stress affects fertility? Because you started to talk about the hormone connection there and I think that's super fascinating.

Alexandria DeVito: 17:30

Yes, I think this is really important and, as a I won't say former type A, because I still exhibit a lot of type A characteristics, but maybe trying to be slightly type A, less type A individual, right, this is something that I relate to a lot, and certainly a lot of the clients that I was seeing when I was working predominantly in New York City were high functioning individuals who are juggling a lot of balls at the same time, and we get adapted to our own levels of stress that we may not even realize it.

Alexandria DeVito: 18:03

So the connection between stress and our reproductive function is as follows your sex hormones and your stress hormones operate in the same biochemical pathway, and so when we are consistently stressed out and that could be because we're training for a marathon, or it could be because we really don't like our job, or it could be because we're not living in alignment with what we truly want to do right, there are things like chronic stressors, and what happens is our body diverts resources from making our sex hormones to making our stress hormones, so literally the pathway diverts and so you don't actually have the raw materials to make adequate sex hormones, which means you won't have adequate hormones to have a regular cycle, and you also will likely not have adequate hormones to get pregnant and sustain that pregnancy, and so this is important.

Alexandria DeVito: 18:58

And so stressors can be physiological, like some of the things I was mentioning so, like training for a marathon or mold in your home or chronic infections that you're not aware of. They can also be psychological right, and those are the things that we oftentimes think about, and we can measure our stress with a hormone called cortisol, and that lets us know are we operating with a high degree of stress in our system? And a lot of times, people will feel and I'm putting this in air quotes feel fine because they've adapted to a high stress load, but their body is tapped out. Their body cortisol level is really elevated.

Kasia: 19:36

Yeah, a question there. When you talk about actually measuring that stress level using cortisol, does that apply to both kind of psychological stress and physiological stress, like it's both, because I think a lot of the time you know, if you listen to any of the wellness podcasts out there or are on Instagram, everyone talks about stress only from you know the kind of stressful experiences with a stressful job or something like that. But this does apply as well to stress that comes from a toxic living situation or actual chemicals in the air or in your body, right? Does that apply in both cases?

Alexandria DeVito: 20:14

Yes, it does Wow, and I think that's why it's so important, because there's lots of ways we can perceive stress, but our body lets us know how we are handling that and how we're managing that.

Alexandria DeVito: 20:26

And the thing I will say about stress, though, is that I think it's important to give a public service announcement which is like not all stress is bad. You know, we don't want to avoid stress. That's actually not the goal. It's really chronic stressors that deplete our systems, so our bodies were designed for this, like very short duration stress levels, like the proverbial running from a lion. Our bodies were designed for that acute high stress situations, and then it dissipates, but what's happening now is that we have that stress state turned on for months and months, and months and years, and years and years, and those are the conditions which really, really drain our bank account when it comes to our adrenal function and our resilience, and so those are the things that we want to be conscious of. It's not the occasional like I have a presentation at work and I'm feeling stressed out about that, totally fine, right, it's the. I really, really, really don't want to be working at this job for years and years and years and years. That will stress your body and that will deplete your resources.

Kasia: 21:25

Yeah, and it's kind of wild to think how really not just chronic this stress is, but how omnipresent, right, because you already alluded to the foods that we eat, some of the clothing that we buy and purchase.

Kasia: 21:39

And don't worry, folks, we'll get into, like, what to do about this, because I feel like that needs to come next. Yeah, there's hope, but, like you know, we talked about that and then we talked about, you know, just the regular. You know I hate my job or I'm struggling with this boss situation. But then you think about the fact that we're constantly plugged in, receiving this nonstop download of media that, frankly, optimizes for being negative most of the time, because anything that is that is going to warrant a reaction is going to contribute to that kind of post going viral, making money from ads, like it is literally wired and designed to in some way get a rise out of you. So this stuff is just everywhere and I think it's just, it's so important to start to just highlight these connections from a physiological side and then also from just how we're living our lives and the choices that we have here.

Alexandria DeVito: 22:34

Absolutely.

Alexandria DeVito: 22:34

And I think this brings up another really important point which is kind of like that maybe inviting people into a what got you here may not get you there.

Alexandria DeVito: 22:44

And there is this right, like this understanding where we've operated, and I think there's you know, there's I know you've touched on this, this topic before but I think there's also this like very again type A or like go getter, I mean I do everything on a timeline and I, you know, have my checklist and look, I mean I wrote a book with a checklist in it, so I get it.

Alexandria DeVito: 23:05

And right, I think also there is an element for which this stage of life and when I say stage of life, this is around conception and pregnancy and may require different things of you than a previous chapter, and in particular, it's it's a, it's a very interesting balancing of masculine energies and feminine energies, and I don't actually mean male-female, but I mean masculine in the sense of like linear and logical and goal-oriented and data-driven, and feminine around surrender and flow and intuition. And right, if we're so used to operating in this one-pointed way, which for many people made them very, very successful in a corporate setting, for example, it may feel new or awkward or different to try on this other approach, and yet I think oftentimes that may be what this stage is calling people to.

Kasia: 24:00

So beautifully said and it really reminds me of the concept of yin and yang in Chinese medicine and the Taiji symbol and like how I think as a society we are so optimized for yang like the fire, energy, the heat, the productivity and we totally undervalue and under prioritize yin, but you really need both in balance.

Kasia: 24:23

It's like you can see what happens in the environment when there's just an overwhelm of heat and not enough rain, you have drought, you have wildfires, like these things are connected and I just so appreciate you mentioning that because it really does require a pivotal kind of perspective shift in order to start to prioritize change and also to think about things for maybe a different way. I love that quote that was such a good one about I think there's a there's a Buddhist quote that relates to that where the level of consciousness that created the problem may not be the one to solve it, and that is just so, so true. So before we move on to solutions cause I do want to get there I'm wondering if you mentioned at the very beginning of this podcast how there's chronological age and then there's biological age versus toxicity overload. Are those some of the things that are either contributing to a, I guess younger biological age versus older biological age. What are some of the things that we should know about chronological versus biological age? What are some of the factors that influence that?

Alexandria DeVito: 25:37

Yeah. So one of the things that I like to talk about and teach about is this concept called pre-pregnancy wellness, and the way that I think about it is that it has five components to it, and that's your blood status, your hormone status, your immune status, your metabolic status and your nutrient status. And the reason that I talk about it in that way is because, historically, we've treated fertility as a below the waist conversation. It's about our reproductive organs and it's also about our hormones and like that's really it, and that is true. It does involve your reproductive organs and it does involve your hormones and it involves a bunch of other things, and so if we myopically focus on only those things, we miss like at least 70% of the equation, which is part of the reason why I think we have such a rampant case of unexplained infertility going on is, to me, in many cases, it's not yet explained infertility because we are not going broad enough and we are not going deep enough in our detective work. So I think that it's really important to understand that fertility is an extension of our overall health, and so if we want to understand our fertility, then we want to take a look at our overall health, and there are plenty of factors that we know.

Alexandria DeVito: 26:47

The clinical literature, by the way, is incredibly clear about this. There are studies talking about all the factors that we know that could potentially interfere with fertility. That is why, with my business hat on, I talk a lot about there are KPIs for fertility, so key performance indicators for fertility, just like there are KPIs in business, and ideally we want to be using leading indicators, not lagging indicators, right? So symptoms are lagging indicators. Symptoms occur late in the disease process. If we're waiting until we, quite frankly, feel like crap, that's late in the disease process. Biomarkers like blood and urine those are the leading indicators. We can see physiological changes early in a disease process or even before disease has manifested, as things start, and so that's why I'm a huge fan of screening and looking at our pre-pregnancy wellness, because then fertility doesn't have to be a black box and we don't have to wait until we try to get some indication of what is going on in our bodies and that of our reproductive partners. So there are many, many things that you know we're looking at, and and all of these things, aside from blood type, are modifiable, meaning you have agency over changing them through oftentimes diet, lifestyle supplementation, sometimes medications and procedures in collaboration with your doctor.

Alexandria DeVito: 28:08

But there's, you know, this idea that we have, you know, we could just cross our fingers or, you know, throw some stuff at the wall and see if it sticks, which doesn't resonate, I think for a lot of people is just not the case. There's so much agency that we have and so things like I'll just touch on a few that I see very often, which is inflammation, is a huge challenge that I see in over half of the folks that we're running testing on Hormonal imbalance, again over half of folks. Nutrient deficiencies in 80% to 90% of people, nutrient deficiencies I mean this is basic blocking and tackling, and the vast majority of people have at least one, if not multiple, nutrient deficiencies and all of these things again right are addressable once you know, Wow, I'm curious, how does inflammation show up Like?

Kasia: 28:54

what does that look like in the leading, not lagging kind of KPIs?

Alexandria DeVito: 28:58

So I mean like there is the. You can actually look for their inflammatory markers. There's a bunch of them, so one that we look at is high sensitivity C-reactive protein, hscrp. That's one marker. There's also homocysteine, which is another marker, and you could also use iron storage, which is ferritin, as an inflammatory marker as well.

Alexandria DeVito: 29:19

The thing with inflammatory markers is that they're nonspecific, so we can say, okay, there's inflammation going on in the body, but we're not sure where exactly it's coming from.

Alexandria DeVito: 29:27

So, again, this is where we have to get our detective hats out and say, okay, well, and we're looking at. In the company that I founded, we're looking at 70 different biomarkers, so there's a lot of other information there to say we noticed that there's inflammation. What else is going on? And you can start to correlate the different things that we're seeing. Sometimes you have to do additional testing to really understand what's going on, but you can start to connect the dots, and that's why taking this broader lens gives us a much better understanding of what might be going on. And again, the whole idea is that these are factors that not only and we haven't touched on this yet, because I think it's important these are factors that not only affect your ability to get pregnant, but it's also going to affect the health of a pregnancy and that future child, because the state of your health and your reproductive partner's health at the point of conception is what epigenetically sets the stage for your child's lifelong health, or what I'm calling generational health.

Kasia: 30:25

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Kasia: 31:35

All right, now back to the episode. Let's talk about that. I mean, I don't have the stats off the top of my head, but they were pretty wild when I looked at them. I will actually unless maybe you know them about like what the stats on miscarriage are, but it's like rampant when it comes to, I think, especially first of holding the pregnancy but then the future health. Can you talk about how that is all connected and really, what would it look like to optimize in the preconception stage? I know that's a loaded question, but yeah.

Alexandria DeVito: 32:20

I'm here for it, so guide me if I miss any part of that question. But yes, I mean I think there's. These things can be related, although not necessarily right. So miscarriage is still not super well understood. We understand some factors that can affect miscarriage and I think we haven't studied it enough to understand some other factors and so, right there, the stats vary again, because sometimes people are measuring, sometimes they know I think we also are identifying pregnancies earlier than we may have in the past. So there's that as a factor. But, all of that being said, there are factors that we know that can increase the probability of miscarriage, and there are many factors that we don't know. And there's also an understanding that miscarriage is also and I want to say this with an extreme amount of sensitivity for anyone who's listening, who is going through or has gone the miscarriage mechanism is our body saying sometimes that this is not going to be a viable pregnancy and therefore it's your body's way of addressing that, and so that can be uncomfortable to hear or receive, and I completely understand that. So if that is not helpful to you, then please compartmentalize it and put it somewhere else.

Alexandria DeVito: 33:44

But I think also there are things where we start to see recurrent miscarriages. And you know that is something where we say, okay, something might be going on in the body and sometimes autoimmune conditions can be at play, for recurrent miscarriages. And autoimmune conditions are disproportionately present in the female population. There'll be about 80% of diagnoses are in females. They take, on average, five years to diagnose five different providers. So it's incredibly long road, you know.

Alexandria DeVito: 34:06

I know you've spoken about endometriosis before, so you know that is. You know there are some suggestions that endometriosis maybe have autoimmune components as well. So, right, I think that those paths of really long diagnostic times, lots of different providers, very varied symptoms, right, they're similar. And so the more that we can try to be doing screening upfront, I think the more heartache we can save people from so powerful. Oh, sorry, I was just going to. I went on for a little bit of a detour, but if you want to bring me back to the original question that you were asking about just how we think about preparing to get pregnant- yes, we must go there.

Kasia: 34:43

I feel like now everyone has been properly shooketh with the data and the research, and I think this is so important and I'm so glad that you're bringing it up and explaining it so clearly from the perspective of I love how you called it a detective hat but also, just like first principles, like you can measure inflammation. There are markers for inflammation, there are markers for everything that you kind of called out. And so, with that being said, what does preparation look like and how do we get to that point of successful preconception, conception, and then a successful, healthy life for both mother and father and child, right? So?

Alexandria DeVito: 35:22

I want to just say one more thing on what you just mentioned, because I think it's so important, which is, you know, around this idea of like what I was talking about earlier, this question around biological age, chronological age, and you know what we've been given. I am deeply passionate about us creating new data sets around fertility. And, right, we have the standard of care where we again are treating everyone based on age-based curves, which is inefficient at best and really really wrong at worst, and so I think it's really important to build these new data sets to understand, okay, what is the physiology going on for people? And then, therefore, what do we see? What are the biggest factors and how do we actually look at these different data points? So I think there's a new science around this idea of fertility that's coming out and that's really important is understanding more, rather than relying on this old way of doing things, which is like just taking a single number and clumping everyone together, bringing all of these data points together to actually understand what's going on in your unique physiology, because not only is that more effective, but it also is more efficient, and if you're getting pregnant later in life which many individuals are you want to be really targeted in your approach. So, all that being said, I think that preparing to get pregnant is.

Alexandria DeVito: 36:39

Everyone gets to decide what their timeline is and how they're doing it. Generally speaking, what I recommend is at least a year. You know, a year, yes, okay, yeah, all right, and here's why. So the average actually looked into this because I was so fascinated. So, on average, people spend 15 months planning their wedding and, um, the average wedding cost is like $33,000 in the U? S. So just if we, like you know, if we just think about life stages that tend to go near one another, they don't have to. A lot of people do it in different orders, a lot of people don't do it in that order, but it's interesting to think about how much, culturally, we have set up the time and energy around preparing ourselves for a wedding and how that's not being applied to preparing ourselves for pregnancy. And again, that's not a judgment, it's an observation. And so, in the spirit of what I was saying earlier about kind of being introspective, I just sit with this and I wonder okay, why is that? What is motivating that right? And if you look, actually in a lot of historical cultures there are preparatory rituals for people that are even planning to get married. They prepare them before they get married with the presumption that once they get married they will conceive. And so in the Maasai tribes, for example, they would give couples milk from cows in the wet season because the grass was lusher and so the nutrients from the milk was more nutrient dense. And so they kind of intuitively they may not have known specifically like, oh, this has a higher degree of fats, but they understood that it had a certain effect. So a year, why a year? So it takes some time to build up our nutrient stores and for those nutrient stores to be reflected in our cells.

Alexandria DeVito: 38:25

The egg development cycle is about a year, but the last stage of egg maturation, like three to four, the last three to four months, is when your eggs are most susceptible to the environment that they're in.

Alexandria DeVito: 38:35

So your eggs exist mostly in like a sleeping beauty-like state. They're kind of in like suspended animation, and then they wake up and then they start to grow. And it's in that kind of one-year period from when they wake up and to when they ovulate that they are most kind of aware of what's going on around them, and in particular that last three to four months. So sometimes you may need multiple of those three to four-month cycles to get your egg quality to a point that would, you know, be optimal. And then sperm development cycles are just under three months. So again you may need especially because of what we're seeing with sperm counts and sperm quality, you may need several of those cycles to get to the point where it's optimal, and certainly it depends on where your starting point is and all that other stuff. But that's, generally speaking, what I suggest. And then this preconception period, preparing A makes it easier to get pregnant and then B increases the probability of a healthy pregnancy and baby Wow.

Kasia: 39:30

And then B increases the probability of a healthy pregnancy and baby Wow. So when it comes to actually preparing, you know, kind of a year in advance, at least three months for the man over there, I guess what do we take into account, right? So I'm guessing it's kind of related to the original things that you test for. But, like, looking at what should we be looking at and I know that everyone will be different and obviously if they work with you and they get the specific tests, their protocol could look very different. But what is an ideal picture look like? Like if you could give us a holistic overview of the factors to look at and just maybe like a key point for each.

Alexandria DeVito: 40:02

Okay. So I would say, in terms of the preparatory points, right, I'm hugely biased. Everyone should take this with a grain of salt, but I do believe in pre-pregnancy testing. So, like to me, getting a baseline is really helpful, because then you you're not kind of shooting in the dark. So there's that piece. You could also choose to do genetic testing, you and your reproductive partner. That is not for everyone. Some people opt to do it, some people do not. Genetics are not changeable, but you may make different decisions if you understand certain things about your genetics and your partner's genetics. So that is something that I like to call out Having a preconception visit with your doctor. Most people don't even know there's such a thing as a preconception visit.

Kasia: 40:40

Do doctors even do that? They do that yes they should. What doctors I? Know, Do you have a list? Come on, oh my gosh. That is wild, I know. Do you have a list? Come on, oh my gosh.

Alexandria DeVito: 40:52

That is wild, I know. We'll link that in the show notes, Don't worry. Yeah, so we've. We've put something together to help with that, because it is.

Alexandria DeVito: 40:56

It can be challenging to find, and this is, you know. This is part of the reason why I wrote the book is so that you know what kind of what goes into the evaluation and a preconception visit, so that you can advocate for yourself, Because a lot of times look, this is not the fault of a lot of providers. A lot of times they're given like 15 minutes to have a conversation with you. That's not enough time, and so, even if they wanted to help, their hands are tied. They're not trained a lot of times in preconception health, and this is where I think, when the system is not able to serve the needs of individuals, this is where I think businesses can do a really good job, and so this is kind of where I put my CEO hat on and I think that you can fill that gap in a different way. But I think preconception visits and just understanding your health history, your family's health history, your reproductive health history, is important. Medications that you're taking, supplements that you're taking, making sure all of those are fertility and pregnancy safe, right. All of that goes into that evaluation and then it's going to be managing right. So that's the micro right, Like your own environment. And then I think about the macro factors which, as you said, are the things that are in the world at large that we're managing right. So our food intake, our environmental chemicals, our stress levels, our movement, right, these are the things that are, you know, kind of affect most people and you know we want to be optimizing those.

Alexandria DeVito: 42:06

And then you asked a really interesting question which is like what would ideal look like? I don't think anyone's actually ever asked me that question and, right, Great, I like, I love that question. So here's what I would say, in the spirit of kind of starting to paint a picture, Although, you know, maybe, maybe it's like you know the whole thing which is, like you know, even if we, you know, shoot for, shoot for the um, the moon, we get there right. Like you know, shoot for the stars, right, we may. So, um, ideal, so it would be a seamless menstrual cycle that comes regularly and has minimal to no symptoms.

Alexandria DeVito: 42:43

Minimal to no symptoms, right? Just because period symptoms are common does not mean they are normal, meaning the way our bodies were designed to conceive. So that's going to mean the absence of extreme period pain. That's going to be the absence of large clotting. That's going to mean the absence of you know. It's going to mean regular ovulation. A lot of times people aren't ovulating regularly. Just because you had a period does not mean that you ovulated. So regular cycles, regular ovulation, minimal to no period pain that is a barometer unto itself.

Kasia: 43:15

Quick question when we talk about ovulation, because this is really interesting does the timing of ovulation matter? Right, Because ovulation tends to happen around day 14, right, but some women maybe skip ovulation or have it much later. Does that also matter? Is that also something that can come with, like certain changes of reducing stress or something? Or maybe there's no data there? I'm just curious. I think it's a great question.

Alexandria DeVito: 43:40

I think there are a couple places where it may matter.

Alexandria DeVito: 43:43

So, first is that when we think about ovulation, the reason that ovulation time may matter is if the second part of your cycle is too short for implantation to effectively take place, basically, and that is something called luteal phase defect. So it is, you know, whether you happen to have a longer cycle and then you know your longer, let's say, follicular phase. So I know you've talked about this before, but, like so, you have your follicular phase and you have your luteal phase, and so if you happen to have a longer follicular phase and right, then that's you know and a shorter luteal phase, that may ultimately mean you still have a longer cycle. But as long as your luteal phase is adequate at least 10 days probably, like it's usually about 14 days, it's pretty consistent for most people. It's the follicular phase that tends to vary more widely then it should not be an issue. But if your luteal phase is much shorter, then yes, you may actually have issues from an implantation perspective and it also suggests, right, that you're not generating enough hormones to sustain that pregnancy.

Kasia: 44:50

Okay, really helpful. I love, by the way, that you're not generating enough hormones to sustain that pregnancy Okay, really helpful. I love, by the way, that you mentioned these markers that I think a lot of women can actually see within themselves, which is so amazing, because I think that will tune in a lot of the audience into whoa, okay, like where am I at now? Like if that is ideal, like maybe there is some work to be done, something to explore here. I think that's really important. So I interrupted you around regular ovulation. Did you want to add anything to that, to that kind of list of ideal On the menstrual?

Alexandria DeVito: 45:20

cycle. I think that's probably it. The other things that I would just say to look out for would be that, ideally, any chronic conditions that you have are well managed. So this could mean, if you have hypothyroidism, that your thyroid function is in a healthy range and the preconception ranges are different than normal ranges they're much narrower, so I think that's important to call out. It could mean, if you have an autoimmune condition, that again you have that under control, because uncontrolled autoimmune conditions can be responsible for recurrent miscarriage.

Alexandria DeVito: 45:54

It would mean that any medications that you are on the dosages and the types of medications are fertility safe and pregnancy safe. So that's something that you'd want to chat with your doctor about. It would likely mean that your blood sugar is balanced, and usually if your blood sugar is not balanced, we will see that in your cycles. But I feel like it's a very important thing to mention and so I think all of those pieces and then you don't have any other markers that are far out of range. So in other words, like really high inflammation can cause challenges and really low nutrients, like we're seeing a lot of people with low iron stores, lots and lots and lots of people. So that is something that can really affect things. So if your five categories of pre-pregnancy wellness are in the at least normal, if not optimal range, you have regular cycles and any chronic conditions that you do have are managed well and your medications are appropriate for this life stage, then I would say that's probably the large set of factors that would go into an ideal pre-pregnancy status.

Kasia: 47:03

This is amazing. I mean I could keep going, but we're actually running up on time and I'm so glad we're ending on this incredible note, which is a how much of this we can control. And, by the way, alexandria, I intentionally did not go too deep down the rabbit hole of what to do with choices around endocrine disruptors and chemicals, because I have a couple of episodes actually talking about that, so we were able to go really deep on, you know, kind of some of the I love how you call them the KPIs, the leading and the lagging KPIs what ideal looks like and what we can start to do. And I mean, I'm just going to put a plug in for your book, but you can just learn a whole lot more by reading your book, which we will hyperlink in the show notes as well. But before we wrap, is there anything that you want to share with our audience? Where can people find you? Anything that you want to give a shout out to, please? I'm sure everyone would love to hear.

Alexandria DeVito: 47:54

Well, we thank you so much for having me and just opening up the conversation. I think that it's just. It's such an honor to be here and to be talking about this. I think you know, as we were talking about at the beginning, preconception is at the intersection of so many different things and I think it's an opportunity to really be intentional and to really ask the questions around, like am I in the state of health that I'd want to pass on to a child? And also to take a moment to explore our lives and use this as an opportunity to say okay. Like is my physical space in the condition that I want it to be in? Is my financial life in the condition that I want it to be in? Is my financial life in the condition that I want it to be in? And is my relationship in the space that is conducive to bringing another being into this world?

Alexandria DeVito: 48:38

And some of the answers may be no, and the goal, again, is not for everything to be perfect, but I think the inquiry is part of this process and really just allowing ourselves to understand how holistic getting pregnant is and um and that journey is. And again, this is also this is relevant whether it's a first time pregnancy or a fifth pregnancy, whether you're 23 or 43, preconception applies. So I think it can be, you know, a really, really beautiful opportunity to treat it with care and intention and to invite your reproductive partner into that conversation and to open up that, that conversation. So hopefully we talked a lot about the physiological stuff, a little bit of the psychological stuff, you know, and just a reminder that this is holistic and to use this phase in whatever way is best of service to you and your future family.

Kasia: 49:22

I love it. Thank you so much for joining us today. Thank you so much for having me. Thanks everyone for listening today. Thank you so much for having me. Thanks everyone for listening. Thank you so much for tuning into the Other Way. If you enjoyed this episode, please leave a five-star review. It really helps the podcast grow and I'm ever so grateful. If you want to stay connected, you can find information on how in our show notes. And finally, if you're curious about inflow and want free resources around cyclical living or moon cycles, check out inflowplannercom. And, of course, for all my listeners, you can use the code podcast10, and that's all. Lowercase podcast10 for 10% off any purchase. All right, that's all for today. See you next time.