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Fertility: Are There Ways to Optimize the Body for Conception and Pregnancy?
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Every year, millions of people plan to have a baby. Conception, pregnancy, birth—these are natural processes that can often be taken for granted. But fertility challenges have become commonplace in modern society. More and more, would-be parents are finding themselves unable to conceive or sustain a full-term pregnancy. Do we know why this is happening? Can people take steps to optimize their health prior to starting a family? This episode features our special guest, Dr. Michelle Leary-Chang.
James Maskell: 00:06 Hello and welcome back to the Big Bold Health Podcast. We are making health personal in a world of disease, and we have this week as our guest, Dr. Michelle Leary-Chang, and as ever my cohost, Dr. Jeffrey Bland. Dr. Bland, how are you doing?
Jeffrey Bland: 00:21 James, great to be here.
James Maskell: 00:22 I know you’re excited-
Jeffrey Bland: 00:24 You’re looking well today.
James Maskell: 00:24 Thank you. I know you’re excited about this episode. What is it about what Michelle’s bringing that gets you excited about this conversation in health?
Jeffrey Bland: 00:30 We’re bringing energy that is going to be the energy of change in healthcare because it’s the type of energy that Michelle is going to bring to us, it is exemplary and I think shows the kind of next generation of health care that is focused on health and not just disease. And, there is no person I can think of better to represent that new developing energy that’s going to be the transformative energy for health in our system than Dr. Michelle Leary-Chang. Michelle, welcome.
Michelle Leary-Chang: 01:01 Thank you.
Jeffrey Bland: 01:01 Michelle welcome. What a treat to have you here. You’re the quintessential example of what we consider the 21st century Wonder Woman.
Michelle Leary-Chang: 01:10 Wow.
Jeffrey Bland: 01:10 You’re a mother, a wife, a doctor, a professional, a person who is working and is an advocate of patient care, trying to cross barriers of conversation and communication, looking at networking, being involved with those that are medically disadvantaged as well as those that are creating the new paradigm in healthcare. I mean, it’s a really big swath, palette to play with, but you still have only one life, it’s still 24 hours a day. How are you doing it?
Michelle Leary-Chang: 01:36 You know, I think the best answer to that is that I’m doing the best I can. Most days I feel really energized about everything that I have going on and then there’s other days where it feels like a lot. So, I think that we’ll talk a little bit about that, but honestly it’s really exciting to be in the middle of so many different industrial changes within healthcare. So, I feel fortunate to be in this position.
Jeffrey Bland: 02:07 Could you tell us just briefly about the points of contact you have? Because I think they’re very interesting when you lay them side by side as to how they develop kind of a network of understanding of where we’re going.
Michelle Leary-Chang: 02:18 Yeah. So, part of my life is really dedicated to working for the Institute of Functional Medicine. And you, Jeff, actually really inspired me to get involved in IFM from the get go, and I’m fortunate to work with an amazing group of people that are advancing not only the clinical education aspects of functional medicine, but also the research avenues, and thinking about how we can really develop outcomes-based research protocols to think about kind of taking functional medicine to the masses. And so, that’s one area that, that I’m involved with.
Another is doing patient care. And so, I’m at Vida Integrated Health and I’m fortunate to be starting a functional medicine program there and it’s brand new. So, we’re kind of just testing the waters and seeing what happens. But, I do really firmly believe in the insurance model for bringing functional medicine to those who need it most. And at this time, while the insurance model is not a perfect model by any stretch, I am passionate about using my skills to be able to offer integrated medicine services to those who may not otherwise be able to afford it.
Jeffrey Bland: 03:46 And you know, you came up very interestingly through an Exercise Phys. background and a whole other pedigree and another career. There had to be something that you felt as a calling where this field was going and where you wanted to be in it. You also have talents now in nutrigenomics and you’ve taken on that as an additional part of your expertise. What is it that drives you, and how do you see the future that you’ve tried to align yourself to?
Michelle Leary-Chang: 04:14 Yeah, what drives me? One of the big things that drives me is a calling to create something big. I do come from an exercise physiology background and that was cultivated actually back in 2005 when I started teaching Pilates and got the opportunity to be in front of people in a classroom setting and teach them about their bodies from an exercise standpoint. And, that inspired me to say, wow, if I can do this as an instructor, a fitness instructor, what could I do if I had a bachelor’s degree in this particular area? And, what could I do if I then took that to a hospital setting and cardiac rehab, which I did? And then, what if I started a cardiac rehab program within a larger clinic? And then I did that as a medical wellness director at an organization called Pinnacle Medical Wellness.
And, that then took me to wow, patients are being referred to me for cardiac rehab or obesity management from an exercise perspective and I want to do more, I really want to help these people on a bigger scale. Well, I need more education—and that led me to exploring different avenues of medicine. I did spend some time at the NIH and talked to several prominent physicians at that time and that really shaped the direction of where I wanted to go, and it led me to go to Bastyr, which offers naturopathic medical training and naturopathic medicine, being very similar philosophy to functional medicine, brought me to this place.
Jeffrey Bland: 06:03 Pretty exciting journey. No kidding.
James Maskell: 06:06 Some of the contexts that we’ve been talking about in the Big Bold Health Podcast is really separating out the sort of disease care model and a health system that’s focused on health, and so one of the things we spoke about in a previous episode was what health means to each of us. And, I’d love to just get your thoughts on what health means to you, because I’d imagine that’s evolved too over this period, right?
Michelle Leary-Chang: 06:25 Yeah, absolutely. I think health means to me when you don’t have to think about it, right? If I go out in the middle of the day and I’m living my best life and I don’t have to think about my own health, then I must be doing pretty good, right? If I am having to think about different ways in which I need to take care of myself because I’m not feeling my best, then health becomes more front and center as my priorities, and what’s really important to me is that I am able to chase some of the ambitions that I just mentioned, and by having health as something that I don’t have to think about every day, and allows me to have joy, allows me to have happiness, allows me to smile and take a deep breath and not worry if I’m coughing, or sneezing, or having any respiratory issues.
To me, health is something that is amazing when you don’t have to think about it on a daily basis. And, there’s a lot of people who aren’t in that camp yet, but there’s ways to get them there.
Jeffrey Bland: 07:39 So let me… you are kind of a role model for me as it relates to aspiring up-and-coming leadership in women. We still haven’t democratized childbearing. It’s still a woman’s thing, and maybe in the future it will change, but right now it’s a woman’s thing. So, you’ve just recently had a child.
One of the things that we know in our culture right now is that there’s a tremendous amount of problems in reproductive medicine. In fact, the concept of reproductive medicine wasn’t even a discipline until the last 25 or 30 years, because of challenges that women and men are having in successful birthing, conception and birthing. So, tell us a little about how you see women, the process of conception, childbearing, and ultimately bringing into the world a new being relates to this whole healthcare movement.
Michelle Leary-Chang: 08:39 Yeah, I just want to start out by saying that I knew I was going to love my child, but I did not know I was going to love him this much. As both of you are fathers, so I’m sure you can relate to this, it is crazy to have this little being and be so responsible for them and yet have a career that you’re going after. So, I just want to kind of say that from the get go. I do think that some of the challenges with being an aspiring… or being a physician, also being someone who wants to have a family life that is very robust, I think that there’s challenges there. And, when my husband and I decided that we wanted to start a family, this is in 2017, I was a little bit ignorant to the fact that it was going to be more challenging than I thought.
And, what happened was we essentially started to think about, okay, what the next steps were. And, I got pregnant fairly quickly and we actually lost that first pregnancy. And, that was devastating, as you can imagine, and you know, I kind of said, okay, well it happens. Miscarriage is something that is very common and is not talked about in our culture, in my opinion, enough. And then, we got pregnant again and we also lost that second pregnancy.
And that brought me to the point where I just said to myself, why are we not talking about this? Why is this not something that is more prominent on social media? Why are women feeling like there’s something wrong with them? And I went through that period. I went through a period of feeling like I was broken and here I was, a recently new physician and feeling like, gosh, I need to fix myself.
And, ultimately it taught me that the process of going into motherhood while also wanting to cultivate a career, made me reflect on my own health, and I had to take a step back and think about what the foundations of health were for me. And, we fortunately were able to have a successful pregnancy and my son was born four months ago.
But, one of the reasons I’m sharing this with both of you is because Michelle Obama recently came out and put in her book that she had some fertility challenges. And, I think that that’s just a really important thing to make women know that there’s no shame, and we need to normalize it, and it’s important to talk about.
Jeffrey Bland: 11:38 Did you make any changes in the way that you were approaching your health over the course of this series of events?
Michelle Leary-Chang: 11:48 I did. At the time, during the first pregnancy, I was working five days a week and then also on the weekends—I ran a private exercise therapy company still. So, I took a step back from that, I decided to hand the reins over to someone else and said I need more time; I need to take care of myself better. I put myself on a fertility protocol—and I’m fortunate enough to have the education to know how to do that—that involved nutraceuticals and certain dietary changes, and I did the same thing for my husband.
It also drove me to think about what was really important in my life. It allowed me to reflect on the priorities that I had and if this was a goal of mine in my life, then I really needed to step back and think, okay, how can I take better care of myself? I’m talking to my patients every day about this is what we need to do to kind of get you back on track towards health, towards optimization, and I wasn’t living that best life at that time. I can’t say I definitively am now, but I certainly felt like it was an important time of reflection.
Jeffrey Bland: 13:19 Well first of all, thank you so much for being willing to share that. I think it’s a hugely important message and I’m sure that the people listening and watching this are just really moved for both your willingness to share it and also kind of the deep reflection that this is a problem in our society. And, I think as James and I are trying to develop in this whole podcast, the big bold health concept, that health is very personal.
This is one marker, right? It’s not the only marker, but for you and your husband having a healthy child was a very big, important objective. So, health for you would surround that as a very high and important objective. For me at my age, that wouldn’t be considered an important objective. I’d want my grandchildren to be very healthy, but for me, I wouldn’t be considering how could I make myself healthy enough to be able to conceive a new child.
I think that this is an important part of the whole context of personalizing our objectives of health to achieve our objectives, because they can be different from person to person.
And I’m reminded, just as a quick story, that a doc came up to me—this is a number of years ago now—in a seminar that I was giving in Minnesota and he said, “Jeff, I just wanted to share something with you. You know I’ve been coming up to your seminars for the last six years and I’ve been saying how we’ve been unsuccessful in having a child in our family and you gave me some thoughts about what I might be doing and my wife and I to kind of change our nutrition and our thought patterns towards conception. And I just want to show you the photograph of our new child, Jeff, which we have named after you.”
James Maskell: 15:00 Mini Jeff.
Jeffrey Bland: 15:01 Yeah. It was the greatest compliment. Well, the go forward on this is that when Jeff graduated from college, it’s been that many years now, I was invited to his graduation and he is going on into health care in reproductive medicine. So, the concept of how these things get woven into the texture of our understanding of the psychosocial, biomedical, environmental, nutritional lifestyle principles that control how our genes express themselves through the function of our life is a superly important part of our life process. And, that’s what we’re trying to get people to understand in Big Bold Health.
James Maskell: 15:40 Yeah, I can’t tell you how many times I’ve heard that exact story in 13 years in this world, of like I was having problems, this is where we first noticed it. I was… You know, it’s funny what you said at the beginning is that if you don’t notice it, then it’s not happening. And for a lot of people, this can be like the first wake up call to, hey, something’s not happening in the way that it should. And then, ultimately, that’s sort of like a moment of… can be a moment of transformation. I’ve heard that from so many practitioners, from so many people who have had pregnancy as the sort of moment where it was like, okay, this is real now.
And, it comes back to what is health for you and it seems like health for a certain number of people, for myself and my wife, was like being able to live a life of having a child. It’s amazing how it’s sort of almost like, sort of like an early litmus test, right, that most people are connected to at some point.
Jeffrey Bland: 16:36 So, I think you said something very important I wanted to ask Michelle about, because in part what you’re talking about, what we’re all talking about is resiliency, right? Building the reserve. Let’s face it, when you have a child, you better have some reserve. Because it’s going to push every button and every limit of your ability to manage time, manage all the functions of daily living. So, as you’ve gone through this process, Michelle, and it would translate obviously into how you communicate with your patients, how has that influenced how you are now talking about health to your patients?
Michelle Leary-Chang: 17:09 Yeah, it’s been transformational to be honest. I am grateful for that experience, as difficult as it was, because I have a whole new level of relatability for women who not only have gone through fertility challenges, but also women who have lost a pregnancy. It’s made me so empathetic and compassionate to the point where I really believe that we need to just open this conversation up and continue to talk about it and be willing to share these stories, because otherwise women are going to continue to feel like there’s something wrong with them and ultimately it may not be anything that can be changed or controlled, but there are foundations of health, there are ways that the body prepares an egg or sperm to be optimal, and we need to get that information out, and that’s what I mean by when you’re healthy, you don’t have to think about it.
And I, by all different definitions of conventional medicine, I was very healthy and yet I had these two experiences. Ultimately, I was fortunate to have a third opportunity and have a healthy pregnancy, but not all women are. And, a lot of women are going in the direction of either giving up or potentially seeking out care that very well may be necessary, it may also be not. It’s so individual and I would never tell a woman, no, don’t go consult with a reproductive endocrinologist or OB/GYN. I think it’s very individual. But…
Jeffrey Bland: 19:14 So interesting, like at that moment there’s a crossroads—am I going the disease management route? Is this a disease? And if it is, should I go and see a reproductive endocrinologist and talk about IVF, or is this a health issue and should I go into the health world and look at eating differently and otherwise? I think there are so many women that are caught in that crossroads right there where there’s two very clear paths. These are very different paths, and both could have success, but one is… I think… Well, what do you think? What do you think of that choice, because now you’re probably speaking to people who are on that precipice, right?
Michelle Leary-Chang: 19:53 I don’t think it has to be either/or. I think it can be an and. If a woman or two potential parents decide that they want to seek out consultation from someone who is a specialist, reproductive endocrinologist, and they want to understand what options they have from assisted conception technology. I think that that can be very empowering, to know that that is potentially an option for them, and you don’t have to feel like there’s no possibilities.
At the same time, I think that we need to think about the health of both parents, and there is so much we can do as health oriented practitioners to optimize the body, typically 90 days prior to trying to conceive, at least 90 days, in order to help support a healthy embryo. And, having those conversations in parallel, if that’s the choice of the parents… now I have a lot of patients who may have that conversation with me before they go see the reproductive endocrinologist and want my advice on, oh, do I need to do this? And, the standard recommendation is if you’re under 35 and you are, as a woman, and you have been trying for less than a year, that the recommendation is not to go in that direction yet.
However, you tell that to a 32-year-old busy woman who has, you know, all her friends are having children and she feels like, gosh, there’s something wrong with me. If she wants to go have that conversation and understand what other options, go for it. Meanwhile, let’s optimize how your body is functioning and that’s going to translate into supporting your ovaries.
James Maskell: 21:48 So, give us a few examples of what that looked like for you in your protocol and what you recommend to others. What are those sort-of, on the health side, what do you recommend?
Michelle Leary-Chang: 21:55 Yeah, so for me, I did a lot of nutrient support, something called myo-inositol was an important nutrient for me. I reduced my intake of sugar because I wanted to balance out my insulin, that was another factor. I used something called saw palmetto, which helped lower testosterone. I had a particular condition called PCOS, and that was contributing to, or it very likely was contributing to what was going on with me, and so I wanted to optimize my body to not have as many different follicles in the ovaries and to really focus on a dominant follicle that could nurture a healthy egg ultimately.
The majority of mutations, chromosomal mutations from the mother, is just at random, but there are ways that we can help, again, support the body to produce healthy DNA within that egg.
Jeffrey Bland: 23:03 Can I speak just for a second? I think you’ve really hit on a specific example that exemplifies what we’re trying to get across in Big Bold Health, and this is really kind of a seminal moment and I appreciate you kind of taking us across this threshold. So, let’s look at PCOS just for a second. Polycystic ovary syndrome, right? It’s not a disease, it’s a syndrome. And in your case, you’re a healthy fit, exercising, nutrition conscious person. The traditional woman who has PCOS would be a woman who has a reasonably elevated body mass index, so she’s a little overweight, she’s got insulin resistance, she’s got blood fats that are disturbed, she’s got inflammation, and she’s got some problems of hyperandrogenicity, of too much testosterone. So, we start looking at that kind of the way that she would look. Well, you would not think of you being that architecture, right?
But it’s individualized, and it’s unique, and it’s personalized. No one template defines the individual, and this is very important what we’re trying to get across, because we need to read ourselves and then match it against what our health aspirations are. It’s not somebody else that we’re matching against, it’s ourselves.
And I think that this is a very, very instructive moment because you then took charge—you were not a person that would fit into the standard definition of a PCOS woman, but you said, okay, you’re going to give me a name, but that really is irrelevant. What’s really relevant is I want to tune up to my maximum capability, to provide the opportunity that I’m going to have a healthy outcome in my pregnancy by doing some adjustments, right? Some tuning up.
And I think that’s what we’re trying to get… and that’s not medicalizing, that is healthizing, right? There’s a difference there as James is pointing out at that crossroads. You were healthizing, you weren’t medicalizing, right? So, I think that’s a very important lesson.
James Maskell: 25:06 If I could synthesize your career into one concept that could come from this as a big bold way of solving this problem. You talk about how functional medicine is going to make it to the underserved, and a lot of times we talked about making groups of people, and one of the things you see in pregnancy is that post-pregnancy when people have young kids, mothers now get together and you’re grouped by literally like how old your kid is, right? That’s one of the things that I saw. My wife’s friends were people whose kids were the same age. No other reason, just that they were in the same age, they were in the same Pilates-and-Me class, or otherwise.
A preconception group visit where you have a group of people working together, because I feel like there’d be so many questions that would come in that that would help everyone understand, and then to put someone in that visit who, like yourself, has come through that journey and can answer questions from the other side. I mean you happen to be a physician, but I know in that group setting, the person that’s done it is ultimately far more credible than even the doctor in that case. So that seems like that could be a good plan, right?
Michelle Leary-Chang: 26:10 I absolutely agree. I think that there are so many women who, whether they are ready to have a child now or in five years, there are foundations that we could teach in a group visit that could optimize the way that our reproductive system functions. And, I think that the majority of young reproductive age adults, focusing on women, but you know, men too, who have an interest in having children in the future, could benefit from something like that.
There are so many different ways in which we can affect positive pregnancy outcomes that are noninvasive. And, I just have to mention, I have a good colleague and friend that is a physician as well, she runs an Instagram blog called Functional Fertility and really advocates for exactly this—promotion of health and learning about your body through explaining different hormones and having women know what’s going on with their ovulation cycle. Some women don’t even know how to track their ovulation and that’s something that we could teach, easily teach. And perhaps for some women they say, no, I just want to see if it happens, and that’s fine too. It’s a very personal, personal choice.
But, for those who want to have a little bit of control, and in pregnancy there’s very little you can do, once conception happens, you know it’s really out of your control in a lot of ways. And then, once the baby’s born even more so, but there are definitely things we can do to optimize health in those preconception months to years.
James Maskell: 28:06 And is there a triggering moment where you could be like, okay, this is the moment when you should start doing it? Because like we said in a previous episode, Jeff, prevention of issues in a pregnancy doesn’t become real until you have issues in the pregnancy.
Jeffrey Bland: 28:20 Yeah.
James Maskell: 28:21 Is there a moment where you can be like, okay, everyone has to have this group visit?
Michelle Leary-Chang: 28:25 I like to recommend at least six months prior to trying to conceive. Again, it takes about 90 days to have an egg go from the time that it’s going to be chosen to the point where it’s released to be fertilized, and I think that there is a lot of opportunity during those six months to think about ways to improve health and to potentially improve pregnancy outcomes.
Now, I do want to mention, I don’t treat pregnancy. I am not a perinatal practitioner. However, I, because of my experience and because of my training in functional medicine and naturopathic medicine, I do feel like there’s a lot we can do as a preconception time period.
James Maskell: 29:16 Yeah, it’s interesting just to think, coming back to it as well, is that there’s been a medicalization, now sort of like almost like a de-medicalization, because this role traditionally probably would have been grandma in the community setting. The grandma knew how to work this kind of stuff out. So, it’s interesting to see it coming back.
Well look, I really appreciate coming to share this and be vulnerable with the story because I know, just like you said with Michelle Obama being vulnerable about it, it is helping a whole new group of women be vulnerable about it and how you sharing this here—you know, we wanted to talk about things that matter and we want to talk about what health means to people and making it really personal. And, I appreciate you sharing your own personal story, and I think this has been another great episode of the Big Bold Health Podcast. Thank you so much for being part of it.
Jeffrey Bland: 30:05 This is big and bold. Thank you so much, Michelle.
Michelle Leary-Chang: 30:05 Thank you for having me.
Jeffrey Bland: 30:08 Thank you.
James Maskell: 30:08 Thanks for being with us here for the Big Bold Health Podcast, making health personal in a world of disease. We’ve been with Dr. Michelle Leary-Chang, and also my cohost, Dr. Jeffrey Bland. Thanks so much for watching.
Subscribe everywhere you find podcasts. We’re on iTunes and Stitcher and everywhere else you download your podcast. Thanks so much for listening, and we’ll see you next time.
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