Ep 146: Optimizing Western and Eastern Medicine to Help with Infertility and IVF, with Dr. Mary Sabo

We are excited to welcome Dr. Mary Sabo to the podcast. Dr. Sabo is a licensed and board-certified acupuncturist, Doctor of Acupuncture and Chinese Medicine, and the founder of Lily +Horn, an integrative reproductive health clinic in New York City. Today, she joins us to discuss acupuncture and its role in the fertility journey. Dr. Sabo shares how she marries Eastern and Western approaches, the mission behind Lily + Horn, and her views on the importance of an interdisciplinary team and the collaboration of healthcare workers in achieving optimal health. We delve into the specifics of acupuncture and fertility, exploring what acupuncture entails and when, during your fertility journey, it’s best to see an acupuncturist. Tune in now to hear her valuable tips and advice about acupuncture! Thanks for listening.

Transcript

Speaker 1: 0:13

Hi everyone. We are Rena and Dara , and welcome to Fertility Ford . We are part of the wellness team at RMA of New York , a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford Podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.

Speaker 2: 0:37

I am so thrilled to have Dr. Mary Sabo on today. She is a doctor of acupuncture and Chinese medicine and founder of Lily and Horn , which is an integrative reproductive health clinic in New York City. She has been practicing since 2007 and believes that integrating tools like acupuncture, nutrition, and mental health support with modern medical care provides patients with the most effective path to reach their goals, helping them become healthier and more empowered in the process. She uses this integrative approach to conceive her son Sebastian. At the age of 43, Lillian Horn specializes in supporting hormonal health fertility, including IVF and egg freezing cycles, pregnancy, postpartum, and perimenopause. Mary and her team also perform acupuncture on site at IVF clinics in New York City. She has been featured on the Dr . Au show and is a frequent contributor to national blogs such as Fertility iq, Robin Motherly and MINDBODY Green. Wow. Miria, I'm so happy to have you on today. Thank you so much for being here. I'm thrilled to hear you . You know , I've met with a number of acupuncturists over the years, but I'm really enamored like , or I , I , I find it really interesting that you have an interesting combination to your practice. So I would love to hear first how you got into acupuncture. Mm-Hmm. <affirmative> and kind of how you've married this eastern and western approach together. Sure. I've always loved western medicine. I grew up in a very scientific household. My mother was biology teacher and I've always had this reverence for medicine and wanting to learn how the body worked. And I was pre-med in college, so I really, really wanted to learn western medicine. But as I worked through, I worked in like several medical schools in college in the summers, and I just saw how it was being practiced and I realized I wanted to have the knowledge, but I didn't wanna practice western medicine, but I wanted to help people. And so I studied abroad in my junior year of college and I went to Scotland where they had just adapted acupuncture into the national healthcare system there. And I was like, oh, I didn't even know acupuncture was still a thing, you know, I had learned a little bit about it, heard about it, but I was getting into Eastern philosophy and the philosopher Alan Watts . And I was in love with like Taoism and I know, and just the whole that way of living and thinking and being. And so, oh , this is so cool. And as I looked into programs, I realized, wow, there's a ton of schools in America. And the one I went to Pacific College of Oriental Medicine, it's now called Pacific College of of Health Sciences. They are very pro western medicine. And you learn a track that's both mostly eastern medicine but also with some western medicine. So you graduate with the ability to understand your limits and what are red flags to refer to a doctor. And I, I just really resonated with that way of thinking. So I did actually start doing fertility work support right away. Once I graduated, I went to a four year master's degree and then I also did an additional year of a doctorate. And I did my doctorate after, I think I'd already been practicing 10 years. Mm-Hmm . <affirmative> . And so that was an interesting addition. But basically my first job was in Chicago and I worked at a clinic that was already well known for fertility. Mm-Hmm . <affirmative> . And I will be super honest, when I was in acupuncture school, I already had so much Western medical knowledge having been pre-med in college, that I kind of struggled a little bit with the theory. It's very abstract. All the Chinese medicine theory is just like blood and qi and stagnation and yin and yang and these terms that are such just like concepts. Right? And so for me, I still had this view of the body from a Western medical perspective and I was overlaying my Chinese medicine knowledge onto it and trying to figure out how both of them worked from the very get go . And it was extremely confusing and hard. It made school hard, but I'm a big old nerd inside and I, you know, I got all my As and really crushed it. And then I immediately started trying to think about how I could help people in both ways. And the best way to do that, I fantasize a little bit about still going to medical school, but the really, the best way is to help people find care in both sections simultaneously. And with me for fertility work that was IVF , like really focusing on helping women who were struggling to conceive and using my tools to prepare their body, help them with natural fertility. But then it also is a really huge tool for IVF . And so like my path kind of just winded in that way, the confusing part of Chinese medicine with all the theory, the abstract theory fertility in a women's menstrual cycle was crystal clear to me. Like the concepts of Chinese medicine in the like building of the follicle is like yin and blood and then ovulation is very active and qi movement. And then the luteal phase is this yang energy and qi . And you know , I could overlay the concept of Chinese medicine to that cycle so perfectly that I started to get lots of different types of patients from migraines or digestive issues or sleep or whatever. And if I could know what their menstrual cycle was doing and fix that, I could fix everything. Wow . And so for me, like I dove into it because that part of a woman's body made so much more sense to me from the Chinese medicine perspective. And I could use all those tools really well . And it's still kind of my entry point for women if they're not, you know, if we're working on like menopause or even just , you know , insomnia or , or anxiety , our health is often reflected in our cycles. And so by fixing the cycle and in Chinese medicine, everything's connected. We can fix many things at once. I find that so fascinating that our health is reflected in our cycles. Mm-Hmm. <affirmative> , I mean it makes sense, but it's not necessarily something that we think of. Right? Right. But in Chinese medicine, everything is diagnosed in patterns. And so when we look at, say, a woman who's having premenstrual symptoms with like breast centerness, headaches, constipation, like super common cramping with her period, maybe darker blood, we call that liver stagnation. It's just a name that is a collection of symptoms. She may also have a lot of neck and shoulder tension like irritability with PMS . Like you get the picture, like there's this pattern of all over the body. And so it's reflecting in the menstrual cycle, but there's symptoms elsewhere with headaches, neck and shoulder tension, digestive issues. Right. So when we see that in Chinese medicine, we call it liver cheese stagnation, it's just a label. And the tools that we use then are points that move the liver chi herbs that move the liver chi . Once you have a diagnosis, it's actually fairly easy to fix. You just do the right points, do the right herbs, and then it kind of all together gets corrected at my clinic. So I do acupuncture. I have several other acupuncturist, Jessica Michelle, who work alongside me. We do herbs supplements, but we also have a lot of other practitioners in our clinic now who are doing accessory techniques too , that are complimentary to reproductive care. And that's including naturopathic medicine, mental health support with the Cala Collective. I have an MD doing somatic experiencing Becca Summer. She's amazing. So this is a technique for trauma and kind of moving forward after experiencing extreme stress and trauma to help release it and integrate it. And it's really helpful for like birth trauma, fertility struggles entering into trying to conceive or continuing. And we have a nutritionist who does a lot of fertility and then we also actually have a holistic facialist. So for women who wanna have some pampering Mm-Hmm . It's safe during trying to get pregnant during, you know, a fertility cycle, fertility struggles, and pregnancy. Well that's great that you really created this space that kind of, it's holistic integrative and it really does touch upon so many different modalities to help support someone. Exactly. Exactly. And that is my mission. I founded Lillian Horn just as a desire to help people along their journey with fertility. I've been doing this work now for 17 years. And then as you read in my bio a couple years ago, I started trying to have a baby and I ended up struggling in a way that I really didn't expect to. I had frozen my eggs. So I froze around at 36 and again at 38. And weirdly the egg from my 38-year-old batch is the batch that worked. But I will say nice, I tried a lot harder. I tried a lot harder with that round because I was like, oh my God, I'm 38 years old. Like I did all the supplements, all the herbs I did that my acupuncture, I , you know, I did all the tools like my diet. I cut out alcohol, all the things just to really try to optimize those eggs. And lo and behold, that's the egg that worked. So in my journey I really realized, you know, I've been doing fertility work my whole career, but there's so much more to it that a woman or people need as they're navigating these experiences. And I wanted to expand our services to include more pregnancy, postpartum support, and also expand access to tools that are beyond acupuncture so that people can just one stop shop , come in, get the support they deserve. Mm-Hmm . That they need to navigate this. It is no joke, really difficult. Even having a ton of knowledge. I was still like on my knees a lot with anxiety and just the stress of it, of not knowing the outcome and not being able to control it. It's just such an intense journey sometimes. Well, I think you made a good point in terms of there's so much that's out of our control. Correct. And finding avenues or finding support that can help you feel like you're, you're doing what you can do. I think that's really important. Yeah. Yeah. And understanding what tools you have available to you and being able to have access to them. You know, sometimes I don't think people understand what tools might be best for them. There's so much advice out there, there's so much information. So getting the right customized support is really important through this, I think to optimize your chances of it working. And that's all we can do, right? Like, we can't force this, we can't control it. You can go to the best doctors, you can work with the best people, but you cannot control the outcomes. Yeah . So I think of us as optimizing what's there and looking for barriers to eliminate that might be in the way. And this is both western medicine and eastern medicine. And then what we also do is provide support so that people keep going because sometimes it just gets so hard that people just wanna bow out. They don't wanna continue. It's too painful. And so having the right support with that is so crucial to feel like, you know, I think we talked about this in our previous conversation, that we've seen some horrendous experiences for people. Just tragic, awful things can happen. And if those people have the right support, they will keep going and they will have their conclusion to the chapter and move on with their life in a way that is graceful and usually positive and happy. Right. But with not the right support, if you don't have good support through this, even little blips can be, you know , PTSD and really wreak so much havoc. And so that was the biggest thing that I learned is like, you can't, even with all my knowledge, I still had experiences where I was like, oh my gosh, my nervous system went into such overdrive. Mm-Hmm . <affirmative> that without having the right tools and the right people around me, I would've been floundering. And just, who knows. Right? I was so grateful of the people around me. 'cause I couldn't do it by myself. So with the right support, eliminating barriers, optimizing conditions, continuing to pursue your path to its conclusion, that is the name of the game and that is what we do. And that is why I also love working side by side with physicians because no one medicine does it . All. Right. Yeah, it's interesting. It sounds as though, and I, I , I'm not quite sure, but even in your studies, which it seems like you did your masters and you , you continued your path to learning and growth, which I'm sure you're still on, but it sounds as though there's a lot of interconnection. Mm-Hmm . <affirmative> . So, you know, here I'm thinking, did she specialize in fertility, acupuncture, or in learning the parts of the body, a woman's lifecycle or a person's lifecycle? There's a lot of connective pieces. Sure. Together. So is it's not, is it necessarily something that's specialized or is it just part of what you studied at a school? I mean, in acupuncture school, everybody learns the same things. We learn all about, like every organ system you graduate with the ability to kind of support anything. A lot of people choose to specialize in something because they're passionate about it. And that was my path. And then I just sought out mentors and books and anything I could get my hands on. I did a study with Dr. Muji at RMA when I was in New York at first. And we did this survey and we surveyed our mutual patients and I presented at ACOG our paper, and I wrote down some highlights. Most of our patients felt more empowered when they combined both medicines. And 98% recommended doing both cam , we call it cam complimentary and alternative medicine and IVF , both for psychosocial and the physical support. And they felt that, and it kept them in the game and enhanced the retention for the physician because patients were willing to like keep going with it. So I learned a ton from Dr. Mukerji when I did that. So things like that, where along the way my thirst score , my passion for doing this type of work was driving me to just lap up any information I could to learn to help my patients in any capacity mentally, physically, you know, especially with my tools, but really my knowledge, I think of the Western stuff skyrocketed when I started working in IDF clinics providing onsite acupuncture support because I had access really to just ask any question. And physicians are so wonderful in this industry that they just answered everything and we end up, you know, so now when I'm sharing a patient and I share patients with every IVF clinic in the city, refer , you know Mm-Hmm . <affirmative> refer to us and a lot are willing to collaborate on care , then I can say, you know, thank you for referring this patient, you know, I'm gonna do this and this with supplements, obviously when they start injections for IVF or whatever fertility treatments, we pull our patients off supplements and herbs unless the physicians approves and is okay with it. And that is just the choice I make to limit variables and give the physician kind of full control when they're in that arena. Mm-Hmm . <affirmative> . But the collaboration on care I feel like really taught me a lot. 'cause I would ask, why are you doing this particular protocol? What made you make this choice? And you know , they taught me a ton. I'm sure having the background going to med school in the start, I'm sure made you have an understanding also of the res and mm-Hmm . <affirmative> and kind of how they operate. But what I, I love is you now bringing your knowledge, and I think a big part of it is the education. I think my hope is to see Eastern and Western really continue collaborating and really working together. And I think a big part of it is there's just sometimes just the lack of, of knowledge. Mm-Hmm. <affirmative> . So even having that collaboration with Dr. Mukherjee was a great way for you to learn, but also I'm sure for him to, to have that opportunity to ask questions. Yeah. And that is why I've chosen, you know, when I'm collaborating with a physician, I try to take a backseat and support what they're doing. Like it's a different use of the medicine. Obviously in ancient China, they were not doing idea f . And so, you know, I've taken what I've learned from what the points are doing, what the herbs are doing. And I have just over the 17 years I've been practicing, think of fertility in two parts. The fertility of like natural when people are trying naturally Mm-hmm . <affirmative> , you know, it's my ballgame. I'm just doing all my tools, supplements, diet changes, herbs, acupuncture or lifestyle changes. But then once they start down the path with an re and I've really over the, I've been practicing almost 13 years now in Manhattan, I've gotten to know who likes what. You know, like some doctors will send me patients and be like, do whatever she says, you know, take everything. Yeah. And then other doctors that I know do not like, they don't trust Chinese herbs, whatever. Like, I don't even fight it . I just , you know, we take patients off herbs anyway when they start treatments, but I try to respect their wishes because I know that they're just trying to do what they think is best for their patient too. Mm-Hmm . <affirmative> . And they are running the show. Right. And they are making choices based on their understanding of their protocols and they need to have full control of that. So I do understand that and I respect that. And that is, like I said, I love western medicine. It's an incredibly powerful tool. Mm-Hmm . <affirmative> . And it's how I was able to have my baby. And so it is only through I think the mutual respect of understanding what each tool does and how it shines best, that we're really gonna maximize support for our patients . I had given a lecture with Dr. Notman from CCRM , I lecture with her and Dr. Sian sometimes, and we share a lot of patients. And Dr. Ottman said something so profound that I had not even a clue that it ever went through her head, but she was like, at one point I just realized nobody has to like win or, or take credit. Right. Like, when you're working with a patient and you're trying to help them get pregnant, who cares? What does it, you know, like it doesn't have to be my medicine. It doesn't have to be her medicine. She was just like, I don't care if the acupuncture is the thing that can make the difference. Like do it. Yeah . Like, there was none of this fighting of like, you know, don't do IVF or you know , don't do acupuncture, you know, don't do that stuff. It's kind of woo woo . It's like whatever a patient needs to get them there, if we can help tip the scales even just a little bit that embryo can implant and stick. Right. There's so many different modalities that can help. Medication and medicine in many instances can really be helpful. Absolutely. Um, but that shouldn't be a reason why people shouldn't focus on lifestyle changes or modalities that can really help. Right . I mean, I wish I knew you when I was going through my fertility struggles 14 years back, or almost 15 years ago now. And you know, just the notion of finding time when I , and I have worked with an acupuncturist during one of my pregnancies and what I loved, it was just a time i , I know there was lots going on, but in terms of having that hour or two to just lie back and have someone take care of me. Right. For real . Um, and you know, I think a lot of times we wanna have explanations for things of why things, you know, for me, especially when I have a science mind of Okay, explain to me how that happened. And there's so much that's unexplained. I, I had an acupuncturist help turn my baby Mm-Hmm . <affirmative> when she was breach and she, I think it's called, is it moa ? moa MOA Basian . Yeah . moa moa . And I was like, what is that? What is this? And, and I , I was like, this is the strangest thing I've , you know, but it was just something, it was my ignorance. I had no idea what it was. And I also didn't ask, but I also had faith that I'm coming here, I'm trying something different. And it was such an incredible experience. And then once I had that experience, I'm like, how could I not believe? Right, right, right. Some things that are unexplainable or maybe it is explainable Mm-Hmm . But maybe not to my science mind. Right, right, right, right. Yeah. I think that's where a lot of doctors struggle is there's an enormous amount of research now on acupuncture working. But this is where my nerd brain like really starts to go into overdrive because it is hard to design a really good Yeah . Standard study with acupuncture, because you have to have, like the gold standard is double placebo controlled , double blind that , you know, you , you would know <laugh> you like you , it's almost impossible to do that with Chinese medicine, with acupuncture to make it work. Like every treatment is customized. So one of my colleagues in Portland did a study, Lee Holland , Dr. Lee Hollander Ruen is her name, and it's called Whole Systems TCM. She looked at a study impact of whole systems , traditional Chinese medicine on in vitro fertility outcomes, fertilization outcomes. It was in reproductive biomedicine online. And basically she looked at people who used, worked with an acupuncturist in the months leading up to and including an IVF versus people who didn't and went through, you know, the same number of IVFs and people who worked with an acupuncturist those months and including had better live birth outcomes. And I think the live birth outcomes is really important to focus on because part of what we do is help optimize people's entire body. And so healthier pregnancy, lower miscarriage risk , you know, obviously we can't control those factors either, but if we can help a patient be as healthy as they possibly can going into these cycles, then helping them have the baby in their arms, not just a positive pregnancy test is the actual goal. Mm-Hmm . <affirmative> . And so there are more and more studies coming out, looking at different parts of how acupuncture and Chinese medicine can support patients going through fertility journeys and IVF cycles. And as that data comes out, I think more and more physicians are becoming curious. But really the kicker is if you, you know, this is how I built my practice is every time I saw a patient and I got their doctor's information and the patient's permission to contact them, I would write a letter and be like, hi, I'm so and so . I'm seeing this patient of yours. Here's what I'm doing. Please let me know if you have any questions. I respect your wishes, you know, and mm-Hmm . <affirmative> over time that physician would be like, oh, the patient's working with this acupuncturist actually doing rather well. And then they get asked like, oh, what do you think about acupuncture? And they're like, oh, if you wanna do it, go see this person. You know? And then I built the trust like that. Mm-Hmm . Yeah . And the collaboration, you know, I'm willing to work within their desires and, you know, boundaries with things that they don't feel comfortable with their patients taking. But I do think research is coming, but I think physicians also have to understand that it's incredibly difficult to get to their level of, yes, this is absolutely the thing that did it. Darn it. Double-blinded placebo. Mm-Hmm . I mean, it's , it's hard. It's hard . Especially I would , I would think like to put the needles in a different spot like that also may not be a pro , you know, also . Correct. You're still doing acupuncture. It , it's , and and for your listeners, let's just clarify. Double blind placebo controlled study means both the practitioner and the patient have to be unaware of whether or not they're receiving treatment. And so how do you fake putting a needle in someone? I mean, there are ways people are trying to design it and get past it. Like even using toothpicks in this like application thing that the practitioner doesn't know if you're putting in a needle or a toothpick. But even that, if you're, if you're like touching the skin, you're doing a little acupressure and like , yes , the patient is still receiving like, I don't know . And all of those studies, by the way, the placebo is always a little bit tiny effective or the Yeah. What we're using as the placebo, either the toothpick or whatever, I'm not surprised or the points not on the meridian, but then the actual acupuncture is always way more effective. But the placebo's always a little bit effective. And then the no treatment, you know, is not as effective. So you made a good point. I mean, even placebo, like the placebo effect I find super fascinating. I do think amazing that there's amazing , yeah. The power of the mind. Oh my god. Yeah. Uh, plays such a big role, I think in outcomes. Yeah. And that's why it's the gold standard of care to figure out if something is helping. But it's easy to do when you're taking like an oral medication, but it's not so easy when your product is a service and it's care. Right. And so what we do encompasses way more than just inserting a needle. It is like you were saying, like you come in, you allow yourself to be cared for, you allow yourself to let go. You know, I have a conversation with a patient the first time that can last 45 minutes to an hour, usually just 30. But sometimes people need to talk and vent and cry Mm-Hmm . And process what they've been through. And then we make a plan and they lay down on the massage table. I insert the needles really quickly, does not have to hurt. I don't think that, my whole philosophy is acupuncture does not have to hurt to work. Mm-Hmm. <affirmative> , I hone my skills to be extremely gentle because a lot of times people are going like doing multiple injections a day and blood draws and it is can be a lot of skin punctures towards the end of an IDF cycle. It's just crazy. So these are the good needles and you relax at them and , and if you're ever uncomfortable, you tell your practitioner they'll adjust or you move the needle, whatever. Mm-Hmm . <affirmative> . And you rest with them in like 30 minutes. And it doesn't matter what we're doing with acupuncture, what we're targeting, it could be migraines, it could be GI symptoms, whatever. Every treatment is going to help the nervous system switch over from that fight or flight that most people in Manhattan especially are in. And especially right now in the world, everyone's kind of in , you know, there's a lot of stress happening and into that parasympathetic state, which is what we call rest and digest. And so it helps balance the nervous system. And when you do that and you switch the nervous system out like that once or twice a week, and you help your patient, I'd like people to bring in either music or like a guided meditation. And so their brains kind of get used to having the help of the needles to listen to that music or the guided meditation. They do it at home too. When you balance the nervous system like that, you really help build resilience and so that the nervous system can handle more. And so oftentimes people will report when they're working with an acupuncturist, their stress levels go down. But really what it's doing is that it's allowing them to tolerate stress better. And that can apply to personal relationships or work stress or family stress or like whatever your tolerance for stress goes up. 'cause your nervous system feels more balanced and secure. Yeah. And , and that's something that they can also take outside. I think it's great also marrying the music, the breath work , the meditation. I think that's a great add-on. Mm-Hmm . <affirmative> , which is something when I had my experience, I don't remember music or breath or meditation. And I think that is a wonderful addition that coupled with acupuncture really can make a big difference. That's interesting. Yeah. Usually after I'm done needling, especially if it's someone's first time or just first couple times, I'll say take nice slow deep breaths and focus on letting your body sink into the table. And it's like such an easy thing to remember. It's such an easy meditation. A lot of people, you know , learning to meditate can be overwhelming. Trying to be perfect at it, which is impossible basically, unless you're a monk <laugh>. But if you can with each exhale or every 10 exhales or something, think, okay, let those thoughts go next. Exhale. I just let my arms sink into the table. Like just letting your body get so heavy that's gonna naturally help things along. And they can take that. It's very simple. You can take that with you next time you're like freaking out and you can like rest somewhere. Just focus on everything getting heavy on your exhales. Yeah. You notice , I know in terms of stress, like adrenal fatigue Oh well , yeah. Is something that's common. So I'm sure that's something that you work with. Yeah , absolutely. Absolutely. Some Chinese are actually really good for that. And diet is super important for that too, with balancing blood sugar and you know , making sure that's not crashing. Making sure you're not going into starvation mode. But yeah, there are lots of herbs like ginseng astragalus that help with their adaptogens. And there's tons of them in Chinese medicine that help replenish the adrenals. And I actually think there's no studies on this yet. Maybe one day there will be that some of those we call those ketonic will also be helpful. Some of them are young tonics and they'll be helpful for mitochondrial energy production in the egg . I think some of those I try to use for egg quality in people who are really depleted. And I think that they'll end up being like the coq 10 aspect of egg quality where it's like we're focusing on mitochondrial health and the health of the cell in that way. Yeah. I , I'm interested to see how acupuncture and integrated health evolves and changes over the years. Mm-Hmm. <affirmative> , I think research is, is one of them. It's great to see that there's a lot more than there was than when I started, you know, at the clinic 14 years ago. It's, it's fabulous to see how much more accepting and evolved and the collaboration that we're seeing, but I think there's still so much more and just, I think it's, this is why it's so great to have you on to really disseminate that knowledge to make people aware of it. Because I do think in some ways it's less taboo than it was before for sure. But I still think it's not something that people are as knowledgeable and really the fact that you bring both together, I'm, I'm really fascinated. So is there a specific time that is optimal to come meet with you? Would it be three months before or is it when you're struggling or <laugh> ? Is there a perfect time? There is no perfect time. The perfect time is probably whenever you have the desire or interest honestly. Or if you feel you need support guidance. Like some people come to me like they haven't even started trying yet and they wanna just have a coach through it and they want to , you know, try and like optimize their body before even starting their journey. And we make a plan and that , you know, we'll I'll say let's do three cycles together and you know, sometimes people just wanna be with me the whole time. But sometimes they're like, I just wanna have some support going into it and we , you know , make a plan for let's get your cycles really healthy and then, you know, go try for six months. And then depending on their age, you know, I go by the guidelines, the physician set up like under 35, try for a year over 35, try for six months. Mm-Hmm. <affirmative> . But I also then mm-Hmm . <affirmative> have the caveat of like, if you're ever, especially when a patient's trying naturally, if you're ever super anxious, I love blood work and getting more information. Like let's just get the basic tests done like baseline HSD or you know, HSG. Like, let's make sure , I can't tell if your tubes are open. I can't tell if your partner has brown . Yeah. Like, let's just make sure whenever you want, whenever a patient, 'cause and Ari , you'll see anybody now, right? They'll do like for freezing eggs and you can bang em like whatever. There's no right or there's no right or wrong way to do this. It's kind of like whatever desire that patient has and however they're managing their anxiety. Mm-Hmm . <affirmative> . But anyway, back to your question, sometimes patients have been trying and if they don't wanna go see an re yet, and so they'll come in or sometimes their re sends them in 'cause they've had two retrievals and didn't make any healthy embryos, or they only have one embryo and they wanna make more , you know, this all types, we get every patient type in the , and it's great. It sounds as though you also, you work with them throughout a pregnancy also, if there's any Oh, for sure. Yeah. Yeah. So my , in my own journey, I really realized we need way more support than just getting pregnant. Sometimes we'll send our patients off once they hit their second trimester, but to be fair, most people feel pretty good in their second trimester. And then we often say, come back around 33, 34 weeks to get ready for labor and delivery. Mm-Hmm . <affirmative> . But really my focus most of my career was helping people get pregnant. But now it's shifting to be also focused on throughout the, the pregnancy. And some women just come in during their pregnancy for support and postpartum, postpartum is like a wacky transition too hormonally and you need support for all of that. So I have Michelle Han one of my new , uh, team members is amazing. She's been in practice for 12 years and does postpartum support. That's her specialty partum. She does, you know, we all do women's health. We all do Mm-Hmm . <affirmative> reproductive health. But among us, our little specialties of more for pregnancy. Jessica, our other practitioner was a doula for 10 years. Like, she's amazing with pregnancy. Oh wow . So, you know, it's like the whole gambit. And now it's like perimenopause is having its moment in social media. I'm going through it <laugh> . I mean, I'm on the , I'm knocking on the door before now. And so I'm just like, oh, I like squeeze that out. And now I'm like, okay, I can feel it. But again, these hormonal transitions are no joke. And they're a stressful mind, body , everything. And we deserve support through it and we deserve tools that work . And we deserve collaboration amongst providers so that no one is thinking their tools are it. And so that people, you know, if my tools are not working, I wanna know where to send you so that you can feel good and reach You made a good point. Yeah. I I think collaboration really is pivotal for health. And I think that part of it has been , again, the knowledge. I , I think a lot of western doctors just may not understand or realize what services you can provide, how you can help. Right . And working collectively and having that communication, having that discussion, letting them know what you offer and how it's, you know, I , I think a lot of times people feel maybe, I wouldn't say feel threatened, but the notion of just not understanding it and feeling that it , it may be contraindicate and I'm sure there may be elements, but again, if you don't have that discussion. Right. Yeah. And that's why I loved Dr. Nauman's comment about it of like, we don't have to compete, that we should be working together. And part of also what I'm trying to do, both with Lily and Horne in my career and as I'm working with physicians, is to teach them what we're capable of doing, but also let them know that I understand my limits too. That I understand when it's time to refer out and I'm not gonna try to do everything with a patient. And I understand when it's time for them to do IVF and sometimes I'm the one that convinces them. They don't wanna do it, but it will help them get there. Mm-Hmm . <affirmative> . And, you know, we've run the line of what I'm capable of and it's, you know, the clock's ticking and it's time to bring out the big guns. Stuff like that where I think it's important to understand what's out there, all of us, and to know where to refer. That's why I'm bringing in all these different providers in my clinic because having access to vetted people who know how to work together and even under the same roof, but you know, anywhere too. Mm-Hmm . <affirmative> it's important to just work with people who know how to collaborate and make sure that you're getting the support you deserve and that you're reaching your goals and you're not just spinning wheels, you know? Yeah, yeah . Being experts in your own field. But I think the notion of collaboration really is so important for people's health, health and so nice to see that you've created this really, it sounds like such a remarkable place to go. Thank you. I'm curious if you have a couple of tips that may be really a great starting point for people who are curious about acupuncture, kind of some things that they can take home. Sure. Yeah. I mean, finding an acupuncturist is important in your area. It's important to have it be convenient for you because the benefit is the repetition really. You know, some people just do, there is evidence that just doing on the day of embryo transfer, like before and after, sometimes day before day after of embryo transfer can be helpful for implantation. But really, like I said with Dr. Lee Hollander Ruben's study, working with an acupuncturist in the months leading up to including an v better life birth outcomes. So finding someone in your area who has some experience with fertility, they don't have to be a specialist. Like I chose to be, become a specialist out of my passion. And , and really being in Manhattan where there's so many acupuncturists and so much access to knowledge and collaboration. So like a lot of people in different areas of the country just do everything. And also, like I said, all you have to do is like balance a menstrual cycle and everything gets better. So like, you know, coming out of school, most people know how to do that part of, you know, using Chinese medicine. So whether or not they know what to do with IVF , that's a conversation for them. But most of us undergo certification through N-C-C-A-O-M Mm-Hmm . <affirmative> . And they have a list of acupuncturists by area on their website. So that's a good place to start, look for someone who's licensed and then have conversations with people about their experience and how they like to work. You know, especially if you're about to do an IVF cycle, ask about their opinion of IVF mm-Hmm . <affirmative> and their experience with it. Because there are acupuncturists out there who are like, you don't need IVF . Right. And it drives me a little nuts because it's like you don't know that. Right. Nobody knows anything with the future when it comes to fertility. Right. And that confidence is nice, but you know, just, yeah . So , and letting people know the options I think is important too. Right . Yeah . You know, there's, there's so many different options and I wanna , I mean, you're so nice that you're, you know, selling other people, but I do think there is something to be said about someone who has a specialty and someone who's really passionate and who and who has really worked with this population group. Yeah . And then of course, on top of that, someone who isn't afraid to communicate with the medical team. Correct, yes . And who wants to , you know, having that openness, letting them know your thoughts and your plan, but also wanting to hear from them and wanting to, I love that. I , I see you have a lot of respect for these reproductive endocrinologists and , and wanting to work with what they feel comfortable with. If mm-Hmm . <affirmative> , this person is going to see a , an re or going to a clinic, I think that's great. Exactly . Yeah. So having that conversation, I think with the acupuncturist can , you can screen people that people to see, you know, what's your journey gonna be like, is it gonna be combative between them or is it gonna be harmonious and supportive? But, you know, depending on where people live, you know, there may not be many options, but you're right. Making sure that you have a licensed acupuncturist who has the N-C-C-O-M accreditation and some fertility experience, great step in the right direction. And then you can also, I think, advocate for yourself on saying, I'd really, you know, I'm gonna do IVF , I'd really love for you to be as supportive about this. Just do whatever you can to help me get through this. I think that's a super important part. Yeah. Yeah. And I, I mean, I'm also super intrigued by the fact that you sometimes can even work in a clinic that's, I mean, like , that's also blown my mind. I'm like, I never knew. That's a great possibility too. Which is great you to have acupuncturist on site . That's what you said, I think in your Oh , yeah , yeah , yeah . Found idea. I , I mean, first of all, some patients choose the clinics based on that. Right. I've had patients say, oh , I came here because I knew they had acupuncturists on site . Mm-Hmm . You're right. Like it is becoming, not only is it becoming more talked about, but it's kind of cool. Mm-Hmm . It's kind of hip. There's some like hip acupuncture places around and yeah , Gwyneth Paltrow does it and like Michael Phelps and, you know, with the cupping marks. But patients are starting to kind of demand it and expect it . And so I can tell you there have been many clinics in the city that want this, but strategically it's very hard for them to figure it out because we spend a half an hour with the patient before and after the transfer. And so like the larger clinics just logistically, it's hard for them to figure out how do we do this? And so we just, you know, collaborate on care and patients come to us before and after. But yeah, if you can work with someone in your area who has that level of being in the IVF clinic, their knowledge will be exponentially bigger just by being around it and understanding what it's like to go through it. I'm excited to see what your company, how it continues to grow and flourish, really. I wanna , I wanna check it out myself. I'm , I'm come down . Yes . Oh my gosh . We're in Chelsea on 26 and six . Oh , it's my neighborhood. But yeah. I am so happy to see that you've turned something, this passion and this knowledge into this incredible community of collaboration, of marrying the Eastern and western together. I can see your , your openness and your curiosity for research, and I'm excited to see where this takes you and where acupuncture in general, how it becomes a lot more open and accepted here in America and beyond of course. But I'm so happy to have you on and I would love our listeners to know, how can they find you? What's the best place to find you? Instagram website? Oh yeah , we're on , we're on Instagram at lily and horn , and our website is lillian horn.com. I mean, those are the two best ways to do it. You can email me too. We have our email info@lillianhorn.com and you know, I love to help people in their journeys and help them find the right support. That's my whole passion in life. I , I feel your passion and it's so nice, really so nice to have you on. You've taught me so much in terms of what can be done and how you can support really women, not just in the beginning stages of thinking about conception, but throughout and beyond. Yes . Well, thank you for having us . This has been so lovely. Oh , course . I love chatting with you. I feel like we can just chat forever . Ah , I appreciate that. Me too. So, how we like to end our podcast is with Words of Gratitude. So what are you grateful for today, Mary? Oh, I am grateful for the opportunity to share my passion and my knowledge with you and your listeners. I am grateful for my journey and honestly my struggle. I really did not think I would struggle because I worked so hard to prepare myself and use my tools. But the struggle really changed me a little bit in understanding what my patients go through and how to help them even better. And then I'm also grateful for my family now that I did stick with it and was able to move on to the next chapter in the way that I help my patients do too. I love that. Well, I'm gonna piggyback on that one too. It's so nice to look at, you know, a challenging moment in time and really look at it in terms of something that served a purpose to help you grow and to help you evolve. And like reframing that negative, somewhat, it sounds , you know, a , a challenging moment in time as that's something that really helped you in your path to evolving and growing. So I'm grateful for my own fertility struggles 'cause it Mm-Hmm . <affirmative> helped me start a career also working at a fertility clinic and , and helping other people and, and learning and, and really just to see this evolution in the space and to see it really evolving quickly now. Mm-Hmm. <affirmative> , it's , it's really exciting. It's, it's exciting and humbling a bit to be a part of it all and to be trying to drive it in a direction that's patient focused . I think one more thing, as women come up and more and more physicians are women, I think the experience of navigating this journey is changing for patients too, and having all genders and types in the field and represented. Being able to find that support that resonates with you and having the variety, I think is really opening up to including even more parts and pieces. Yeah. As my colleague Rina would say, all woman men, all woman <laugh>. Yeah . So it's, you know, it's, it's, I love that. Yeah. Yeah. I do appreciate that. It's constantly evolving and , and expanding and being able to support people going through this very potentially challenging time and giving them some guidance and, and collaborating with people to give them the best care is, is great. And really what you're doing. And , uh, I can't wait to see what is up for you down the road. So we'd love to have you back on. Thank you . I would love that to share your experience. And again, really, really happy to have you be here today. Thank you so much. Thanks for having me.

Speaker 3: 41:39

Thank you so much for listening today. And always remember, practice gratitude, give a little love to someone else and yourself. And remember you are not alone. Find us on Instagram at Fertility Forward . And if you're looking for more support, visit us@www.rmany.com and tune in next week for more Fertility Forward .