#35 Fertility after 40 with Dr. Jordan Robertson ND

Today's episode of The Midlife Feast may not be of interest to everyone, but it's an important conversation to have as many women often find themselves trying to conceive after 40.  And the hormonal changes that are happening in perimenopause can make getting pregnant, and staying pregnant, more challenging.

Dr. Jordan Robertson ND is my guest today, and we talk about why fertility declines as we age, what hormones are involved in assessing fertility, why integrative approaches may be better than alternative ones, and why you shouldn't lose hope if you find yourself struggling to conceive.

Dr. Jordan is a Naturopathic Doctor, author, and podcaster who is taking women's health research and making it more accessible for the everyday woman. Her mission is to create confident women's health consumers and help women learn to take care of themselves and their families with the best research in integrative and conventional medicine. Learn more about Dr. Jordan at www.drjordannd.com

For information about me and how I help support women in all stages of midlife with non-diet health and hormone support please visit https://linktr.ee/Jshuber

Looking for a place to learn more about midlife, menopause nutrition, and intuitive eating? Click here to grab one of my free resources and learn what I've got "on the menu" including my 1:1 and group programs. https://www.menopausenutritionist.ca/links

Transcript

Jenn Salib Huber  0:02  
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Celine Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hi there, welcome to this week's episode of the midlife feast. I'm very excited to be welcoming back Dr. Jordan Robertson, one of my favorite naturopathic doctors, friends and colleagues. And we are talking about fertility after 40. And I think that this is such an important discussion, because as I mentioned in this conversation with Jordan, many of the people that I've worked with over the last 20 years have gotten the diagnosis of perimenopause while they were investigating or looking into concerns around fertility or having difficulty conceiving. And I think that it's a really difficult thing for people to experience those two things at the same time. And for them not to feel hopeless. And so I love having this conversation with Jordan, because we kind of break down exactly what's happening. We talk about the things that you can do if you find yourself in this position. And just hopefully, you know, kind of leave you with not just a little bit of hope, but also understanding of what exactly is happening and what are some of the things that you might want to keep in mind if you find yourself in this situation. So have a listen to this conversation. And as always, I love to hear your feedback. I always appreciate your feedback. And let me know if you have any questions. Okay, Jordan, welcome back to the midlife face because of course, you were on the first season talking about hormone testing, which is one of the top three episodes by the way of that first season. So people love that. And I know that this conversation around fertility after 40 is also going to be very welcome. How are you?

Dr. Jordan Robertson  2:08  
I'm so good. It's so nice to see you. Thank you so much for having me back on the show. John. Every time you and I talk. We're like, we could talk for a whole day and and some. So I'm happy to be here. And I really like this topic and conversation. I think it's going to be a good one.

Jenn Salib Huber  2:24  
It is. And you're right. I feel like we could talk all the time. But we're also efficient. We're both efficient. So we try and get to the point. And the reason why I wanted to bring you on is because I work primarily with people over 40 You work I think primarily with women in general and kind of various ages and stages. You definitely have expertise and experience in fertility. And I often see people who get a diagnosis of perimenopause, at the same time that they're exploring reasons for why they've had difficulty conceiving. And those two realities can be very uncomfortable when you're confronted with them at the same time. And it often feels like for the the people that I'm having conversations with, they feel like they've been given this final diagnosis and that they really can't come out on top anymore that you know, this is it to the end of the road, you waited too long. You know, you've you're past your prime, and this kind of doesn't matter what age they're at, because perimenopause often shows up, you know, as early as kind of mid 30s Naturally. But of course, people who experienced premature menopause, you know, can go through this in their 20s or even their teens in extreme cases. So let's talk a little bit about why that collision, that intersection of perimenopause and infertility happens. So kind of walk us through in the wonderful way that you do what's happening to our ovaries in our eggs.

Dr. Jordan Robertson  3:51  
Yeah, and that's, it's interesting, because so I'm 40 Right. And so I I did have a big birthday, which you were a part of, actually. So, you know, I feel like my interest in women's health has kind of grown up with me. So I started in the realm of recurrent pregnancy loss and miscarriage because I myself was experiencing recurrent pregnancy loss and miscarriage. And so my research oriented brain decided that I was going to try and solve not only my problems, but everyone's problems when it came to miscarriage. And I spent a lot of time looking at all of the things that will influence miscarriage risk and then subsequently looking at at fertility as a whole. Whereas now my interests have shifted a little bit to looking at women in midlife and that's not a that's not a coincidence because now I am in midlife and I'm experiencing symptoms of perimenopause and when I started to struggle with some cycle irregularity, I was like okay, like this is where I'm this is where I'm interested now. And so, I've you know, shifted to where I'm focusing quite a bit it on women in perimenopause and menopause. And so to answer your question like that, that collision of those two things, like the thing that I find so interesting about perimenopause is that often people don't know that this is happening. While it's happening, because the typical and traditional signs that women are looking for with respect to changes of hormones related to age may not be present at 40. In that in that fashion, right, I think when we think about our, you know, mothers or the people above us going through menopause, we thought about hot flashes and night sweats and, and we maybe had a different image in our mind, like even now, when I think about people who are menopausal, like I think about the image in my mind is so much older than me, and so much older than even the women I work with, because that's just historically the way I always thought of it. But the reality is, is that some of those hormone changes are happening as early as 14 and a 20% of women were, you know, frankly, Peri menopausal at 40. And what that signifying is that those, you're that ovarian pool or ovarian reserve is starting to change. And so the consistency at which we ovulate and at which we create hormones is also starting to change. But women may not be like riddled with all of these symptoms that would drive them to the doctor, they may have a period that comes a little early or comes a little late, or you know what, I didn't have any breast tenderness this month weird. And like, those are the symptoms they're experiencing. And yet the under the surface, you know, what's happening is actually that low ovarian reserve, and they don't know until they've been trying for a couple of years and land themselves in an actual setting that's going to investigate meaning like a fertility clinic.

Jenn Salib Huber  6:47  
Yeah, yeah, exactly. And I think you're right, most of the time when people are given that diagnosis, or, you know, told that based on their bloodwork, or based on, you know, follicle counts, or like any of the investigations that they would do to investigate fertility, that they're in this age and stage of life where they have low ovarian reserve, which is basically perimenopause. Right, it's when you start having fewer good eggs to choose from every month, and therefore you start to have inconsistencies and what I call the hormone soup, meaning that the amount of estrogen and progesterone that's being produced every month really starts to fluctuate, and that's a result of the eggs. It doesn't necessarily influence the you know, the eggs that might be you might be trying to conceive with, but it's a it's a reflection of the fact that you don't have as many kind of quote unquote, good eggs. But that can be a really, I think that's a Well, I think it would be difficult to hear at any age, but I think it can be especially difficult for maybe people who haven't ever considered that, you know, late 30s, or even, you know, early 40s could mean perimenopause, and not just, you know, advanced maternal age, which, you know, is also true, but so what would be some of the things for anybody who might be listening who might be kind of in this, what would be some of the tests or, you know, blood work or, you know, investigations that might be used to provide that kind of clarity and diagnosis, what things might people ask for or expect in that setting?

Dr. Jordan Robertson  8:19  
Yeah, so one of the things to think about is your, your actual story. And so that's, that's sort of, in my opinion, one of these underutilized tools and women's health is asking people about their actual story for how they landed like where they are today. So, like diminished ovarian reserve can happen, you know, primarily from genetics, like there's primarily this genetic experience of when we're going to start to move through perimenopause or have lower ovarian reserve. But there are other things that will contribute to the timing of perimenopause or your ovarian reserve that might be hidden in your history. So, for example, women who have had endometriosis and have had significant endometrial ms, or bleeding on the ovary may have diminished ovarian reserve because the ovary itself has actually been damaged. You may have had surgery, you may have had exposure to chemotherapy, you may have had other things that are part of your past and history that would help inform us of how to think about your ovarian reserve. So even if you're 35, and we go yeah, like we're not age wise, I'm really not that close to historically, there may be something in your history that would help us understand how we felt about your ovarian reserve. Another great example of that would be Hashimotos thyroiditis, which does cause diminished ovarian reserve. So there's a lot comes from that sort of really strong history taking, how old were you when you got your first period? What What's your symptom experience been like? Have you had any other previous pregnancies or miscarriages? You know, or were they with the Same partner, right? Like there's lots of questions we can ask from a history perspective that I often think are overlooked. I know that's not what you asked. But But I think that's super important.

Jenn Salib Huber  10:10  
We rely so much on bloodwork, right? That, you know, we don't actually I think when it comes to fertility, we look to that bloodwork to be the be all and end all, when in fact, we can probably do you know what they say 80% of the cases in the history. So, you know, kind of really looking at what's there. And it's interesting, because so my family history, so I'm 45, I feel like I say this on every podcast, I'm in the waiting room for menopause, pretty sure that I've had my last menstrual period. And that's very consistent with my family history. Both my mom and my grandmother were also mid mid 40s. I also had endometriosis. I've had, you know, lots of pelvic surgeries. But interesting. I also spontaneously conceived fraternal twins at 32. Which if you think about the fact that I'm now 45, and menopausal, my 32 year old twins, were probably actually Peri menopausal twins, which we also know is a symptom of you know, advanced maternal age as your ovaries sputter and your risk of twins increases. So it's really interesting for me now, of course, hindsight, is always 2020, to be able to look back on that and say, oh, yeah, all of those dots line up. But in the moment, if somebody doesn't know the age that their mom went into menopause, which is not uncommon, I'd say 50% of the people I talked to or less actually have that information, may not actually have a diagnosis of Hashimotos, because it's under diagnosed or, you know, they're just told that it's hypothyroidism. So they don't know that it's Hashimotos. So when when people are starting this process, and they get this diagnosis, how do they not feel defeated by it, because it is easy to look back in hindsight and say, all the signs were there, I should have seen this coming. I should have known this could have happened. And if you're trying to conceive, that can be really, really scary. For for understandable reasons. But how, how can we maybe kind of provide a little bit of light that fertility after 40 isn't impossible, even if you're in perimenopause and have those other things like what are some of the things that we know that are helpful in helping women conceive?

Dr. Jordan Robertson  12:13  
Hmm, that's a good question. And I'm, I'm, I do want to circle back to the lab work thinks I will answer that question, too. But But it's interesting, like the question that you're bringing up there, like one of the things I think we're missing in this whole conversation for women is helping them understand. They're sort of that like that, that timeline, like that reproductive timeline, I think, when we watch, like the generations that have come before us, right, and all the things that they did, right, like, they got married, they had a kid when they were like, 21, or my mom had me when she was 21. Effortlessly, right. And when we when we think about those checkpoints that women are trying to move through as far as their life and their and their life goals. We're seeing so many women who are ready to have babies, when they're 35. Right, and, and even just that part of the conversation, which is an uncomfortable one, for sure is that all of these boxes that we're checking as women right now are delaying our fertility, whether it's going to school, whether it's, you know, xy and z, we are seeing this, like more, just an older generation of women getting ready to have babies at an older age. And this is not something that previous generations have experienced. And so one thing I will notice in my clinical practice is that I have women who are 3537 38. And their the pressure that they are experiencing from their family to conceive and conceive, I'm going to use an air quotes the word naturally, because I'm going to circle back to that in a second. It did that is a different pregnancy in a different conversation than the generation before you who effortlessly fell pregnant by accident at 21. Right. And so I just want to call that out that we're talking like our generation of women are talking about a very different experience when it comes to fertility and pregnancy. And if those that modeling that's around you is not a reflection of your experience, I think that's a really good place to start for where you're going to draw some of that emotion from because your experience might look different than the generation of women behind you. And that is okay. Because to what you were saying there, John is like, where's the hope, Jordan? It's like, well, the hope is in the technology, right? Like the hope is in the fact that we have probably made more advancements in reproductive medicine than in any other area of medicine in the last five or 10 years. And we it is here for you. And I think one of my greatest challenges in working with women over 35 on their fertility is that they didn't feel that the story in their head didn't include IVF or the story in their head didn't include egg donation or sperm donation for their partner who's 47 or what have you. And having to train rewrite that in the moment like in the moment you're being diagnosed with perimenopause is very challenging. And so where's the hope the hope is in the fact that there are a lot of options. And I know, I just spewed out a whole bunch of very extreme options. There's lots of options that are not egg donation. But I want to normalize that, like, there are a lot of ways to build a family over 40. And you may be able to achieve it in the way that you imagined in your mind. But if not, let's remember that the outcome is to build a family.

Jenn Salib Huber  15:42  
Yeah, no. And that's so true. And I want to circle back to what you're saying about how the pressure to conceive naturally, you know, it is, it's like a it's like a reproductive trophy. Right, if you've conceived naturally. And, you know, I mentioned that I, you know, spontaneously is the word that I prefer, because I don't like that word natural woman talking about conception, but, you know, like, I spontaneously conceived twins, and the number of people who would ask me, Are they natural? Did you have, like, you know, like, the robots, these ones are? Like, they were like, they were less worthy of the label, you know, like, well, they're not real twins, if they were conceived with help. So it's like, it's this idea that like, it's not like a real baby. I mean, I'm being extreme with that. But there absolutely is a hierarchy in the language and the value that we place on conceiving whether it's conceived without help, or with help, and how quickly and how many cycles and, and all of that just needs to go because at the end of the day, even an 18 year old, only has a one in four chance of conceiving on any given cycle, right? Or I'm having like a live birth from that cycle. So I think that we, we, we need to normalize the fact that not everyone gets pregnant every time they try, even if there are no known issues. And so asking for help, and under any circumstance, should be something that we're encouraging people to do at any age. Like, if you feel like something isn't right, isn't working, you have questions about it. That's what we're all here for. Right is to help you get the answers so that you do feel comfortable and empowered and confident moving into that stage of life.

Dr. Jordan Robertson  17:25  
Yeah, I cannot prove what oh, you go. No, I was just gonna say sorry to cut you off there. I was just gonna say like, I can think of so many metaphors for it too, right? Where, you know, if, if one of your friends had a medical condition that had a treatment that was available to them to improve their quality of life, or decrease their pain or improve their survivorship? How would we how would we frame our thoughts and conversations about that? Right, like what makes fertility different than any other aspect of medicine? Right? If we had a friend who was really significantly suffering with their mental health, we'd be like, Girl, just like take the medication. And yet there is like such a stigma that still exists around getting support for fertility. And I've tried to figure that out in my head why that is? And I do think that, you know, if I was diagnosed with a medical condition, I don't right now, I don't know if I would look to my mother to have that conversation with right like, she's of a different generation, she maybe wouldn't understand what I was going through. She wouldn't understand this. Were the sciences that with this particular medical condition, I would look very, I would look elsewhere for support. And yet, because we're talking about that families, right, we're talking about like, something that feels a bit transgenerational actually, and that we do we look to the people around us and the family members around us to give us advice and thoughts and feelings about fertility care. We don't do that in other areas of medicine like this, right? We don't, we don't take what our mother says about our fertility, like about our journey with our the rest of our health, as with the same weight that we do around fertility, there is something there that I just like, and I can't even put my finger on what it is, but I want to call it out. Because I think it's the like these women who are listening and you that are listening, like you're a high performing, maybe career oriented person who probably can problem solve in every area of your life. This is not that different than that actually, when when I think about what I want for women that are going through fertility what in their 40s is I want them to feel like they're empowered that they have choice you know that like all the all the amazing things that have led them to wanting to build a family at 40 they can actually use to their advantage right rather than feeling like their age is like this soul and single thing that's gonna get in the way of them achieving their their dream family. Like I think we're bigger than that, right? I think we women at 40 are bigger than that. But it does It brings up so many of those themes around like, you know, you know, I don't know, just like women being overworked and like I could honestly go on forever. So that's the thing that I want women to know the most is that there is a there's hope be there are solutions, but see, you're gonna have to really break down a lot of barriers in your own thoughts, but also the thoughts of those around you to achieve it. And I think are strong enough to do that. We just need to feel like it's being modeled to us that it's okay.

Jenn Salib Huber  20:27  
Yeah, absolutely. I totally agree. So let's circle back a little bit to bloodwork. And so the reason why I want to bring this up too is that on when you were on the podcast, last season, we were talking about how bloodwork can't be used to diagnose perimenopause. But this is one of those situations where we had mentioned you know, that you can get whiffs or hints of perimenopause in the bloodwork. And it's often when that is picked up while doing a workup for you know, infertility that we kind of get a hint of what's what's happening. So what are some of the things that might be looked at or measured that can tell us what's happening?

Dr. Jordan Robertson  21:08  
So typically, when we do a fertility assessment, and we did talk about this, like a lot, was that you know, your hormones are changing, like almost every day, right? It's kind of easier for us to say their hormones are different every day of the month, are changing. Women are like every day, how about every four hours? And so that's what makes like a spot assessment really challenging for women of any age in stage, right? And unless we get really granular around, which danger cycle did you go on? And how does that line up with, you know, your cervical mucus and basal body temperature, both of which, if you're trying to conceive should should be be tracked. In addition to hormone assessment, we need to get pretty like granular around when we send to you in your cycle for your bloodwork and what your hormones look like they're doing because we do have an idea of the way they should flow between those for those traditional four weeks of the of the menstrual cycle and some women's natural cycle might be a hair longer hair shorter, but in general, we've got sort of these four distinct phases. When we send you for lab work for fertility, we're typically trying to grab two time points in the same cycle so that we can assess whether or not an egg was released. And we do that by checking day 21 Or seven ish days post ovulation bloodwork, we should be seeing signs of both estrogen and progesterone being present. And that would indicate that an egg was released and the hormones required for developing uterine lining and all the things that we need in the second half of that cycle are being done. And quite often women in perimenopause are ovulating, lots of the time. And so that particular set of lab work might be normal, right? And it might be we tested on day 19. And it's normal and we test it on day 24. And it's normal. And so often, that piece of lab work can give women some peace of mind that they are ovulating. It's the other set of lab work that maybe is a bit more telling when it comes to us trying to figure out those whispers of perimenopause. And so you ovulated The question we kind of want to ask is like, well, how hard was that right for your body. And in perimenopause, when hormone production or when it sort of egg production is a little bit less consistent. The the messaging and the signals that have to go from brain to ovary start to get dysregulated. So your brain which normally just casually asks for ovulation once a month has to start sending a really prominent signal to try and ovulate because the ovaries response is weak or is delayed or is not on time or maybe doesn't happen at all. So we see rises in FSH, which is follicle stimulating hormone, which is that principle signal to the ovary to start to grow that dominant follicle for ovulation. And we can see whispers of perimenopause when we test FSH on day three, and typically that would be when we've sort of we've finished the previous cycle, right? So you've had your period, you're on the third day of your actual menstrual period. Your estrogen and progesterone have fallen from the highs of where they were last month, and now they're in a relative low state. And FSH should also be like, reasonably low. It's like everything is like it's like the calm before we try and ovulate again. And what happens in perimenopause is we can see elevations both in FSH and an Astra dial on day three, which is showing us two things, one, that it's a little harder to recruit an egg. And so we know when patients have an FSH of typically we want to see it below eight, when it's measured on that day, if it's 1012 Right. We're starting to see that your your brain is yelling a little bit at your ovaries, if we see it over 20, even once in your life, so even if you had blood work done in three years ago, and an FSH was 20, that's actually quite telling that your, your cycles are heading into an, like a ovarian insufficiency. And you may need more support with your fertility journey. And we'll also see elevated Astra dial during that time as well, which typically is because we have some leftover hormone from the cycle before. And so women will often report in perimenopause that their cycles are coming a little bit closer together than they had in the past, or they're feeling PMS symptoms at times of the month that they maybe didn't expect. And what we're seeing is that because the those signals are getting a bit mismatched each week of the month, is that your estrogen you actually may have released eggs, like on the wrong timing, and so your estrogen levels may be higher on day three than we typically expect. And so, a day three estrogen of like 170, at 200 to 30, I would be quite convinced that we maybe have some leftover hormone from the cycle before, which is showing us that things are starting to starting to get out of sync. That's literally what it's about. It's an out of it's out of sync oscillations, which makes timing intercourse like really challenging.

Jenn Salib Huber  26:22  
And also because you know, when things get out of sync, and I kind of liken it to fruit, right that when you have like a perfectly ripe peach, it's, you know, everything about it is great, but if you eat it, and it's a little too hard, and it's not as good. And if you eat it as a little too soft, it's not as good. And the same thing happens when your hormones are under thing because it you can overripe in the egg, but you can also, you know, ripen it too quickly. So if you've gone, you know, 40 days before you ovulate, the chances of that egg conceiving a pregnancy that carries the term is much lower than if you had ovulated at quote on time. And so, you know, part of the problem that I think is sometimes difficult to grasp is that it's not just that you have fewer eggs, is that you have to ripen them and mature them at the right time. And so you have, it's just about timing, right and that you have fewer eggs, yes, it doesn't mean you can't get pregnant doesn't mean you won't get pregnant and doesn't mean that you can't have a healthy successful pregnancy. But we have to work harder to catch the good eggs. So you know, we have to work at keeping the eggs that you have healthy, right. So like, you know, speaking of diet, lifestyle, naturopathic interventions, you know, all of the don't smoke, don't drink too much. Don't do drugs, like eat your vegetables, like all of those basics. But also like, like we were saying before, like get help ask for help use the technology that's available. I tell people all the time that while I'm 100% in support of every integrative option that will help you, you know, have a successful pregnancy. Now is not the time to try the alternatives for a year. You know, if you have been told that you your FSH is rising, or that you're you know, you're in this variant insufficiency or diminished ovarian reserve, now is the time to go like do not pass go go straight, you know, to wherever you you can access and whether that's IVF or you know, whatever it is that you need, but this is the time to be all in with any shame at all.

Dr. Jordan Robertson  28:28  
Yes, yeah, I very much appreciate that perspective. Jenin it's the same as mine, it's like, even when we're starting to look at some of the research on fertility support. And if we go back a decade, right, and women who are between 30 and 40. The research is also starting to point towards delayed care being one of our greatest barriers to success with patients, meaning that the longer we wait to support people, the less likely they're going to be successful. And so for seeing that literature even creep back into that decade, then we definitely at 40 are not doing women any favors to say, well, let's try and shed a couple pounds or get on a good exercise regime. And if we haven't fallen pregnant by the fall, or what have you, then then we'll look at solutions. It's like actually, we probably should look at solutions starting today. So that we give you that best shot of having having a positive outcome.

Jenn Salib Huber  29:25  
Yeah, and I mean, especially on the diet and exercise front, I find that you know, people are given advice all the time for conditions that really don't have a lot of evidence for, like weight loss, for example. I mean, I know that you work I've done a tremendous amount of work with women with PCOS and helping them to really kind of sort fact from fiction and, you know, how often do women delay seeking treatment because the only advice they've ever ever been given for PCOS is lose weight. Right? And, you know, that's kind of the worst piece of garbage advice you can give to someone one piece TLS because it's it's not it's it's less under their control, I think than anyone else. And so for someone you know, I've seen this so often that people who get to be 40 have PCOS have had PCOS for more than a decade are now in Peri menopausal and are now really in a position where they're, they're struggling to conceive and, and they felt like they failed, because, you know, they haven't been able to follow that advice, when in fact, it's really kind of the healthcare system that has failed them by not giving them appropriate care.

Dr. Jordan Robertson  30:32  
And the evidence is starting to point towards, you know, weight or BMI not being as influential as we ever thought on success around fertility. And so hopefully, we start to see a shift in the recommendations that are made there where women are told you know, that they don't qualify for IVF, because of their body shape or size like that, that needs to go away. And I think it's going to be in that will be an in progress, change that happens over the next five years. But really, if that's advice that you've received, like, that is like a huge red flag to look for a second opinion. Because that's not that's not the thing that's getting in your way, time is going to be the thing that gets in our way, not your body.

Jenn Salib Huber  31:14  
Yeah. So I love this conversation. And I always do love our conversations. But I hope that for anybody who's listening, who's in this unique circumstance of, you know, being in their late 30s, or early 40s, and you know, trying to conceive and maybe feel like they're facing an uphill battle, I think what we would both want you to know is that, it doesn't mean that you can't or won't conceive, but it does mean that time is of the essence. And, you know, now's the time to act, and you know, to really use the time that you have wisely, so to speak, but not to feel hopeless, because it's not hopeless, as long as you are still having a cycle as long as you were still ovulating with or without help. You have the potential to conceive, right?

Dr. Jordan Robertson  32:01  
Yeah, and I and funnily like, I mean, I go straight to talking about advanced reproductive technology, there, there are things to think about with your naturopathic doctor or with your integrative practitioner as well, that are great things for you to be doing while you're in progress with the rest of your assessment and the rest of your care. So if you're if your value is for you, the work that you do on your fertility, to incorporate that integrative approach like that, actually, probably is the best approach to combine both worlds. First, with lots of patients where they'd had a previous, you know, IVF, that, you know, they didn't have a very successful retrieval or not very many eggs. And we put our heads down and worked really hard for five months on changing things about their life and their antioxidants and supporting, you know, various aspects of their health and then having a more positive outcome with their reproductive technology. So you definitely can incorporate or marry those values of you wanting to take care of yourself and your body and do things, you know, that add that integrative support. It's just that knowing what the scope and limitations of each realm of medicine is, like, is especially true when it comes to fertility, because we do have a window of opportunity to support you. And so I just want you to feel I want you to feel like you're getting like that best solution possible, which probably is a combined approach. If you've had those some of those whispers of perimenopause.

Jenn Salib Huber  33:36  
And it's that integrative piece, right, that, you know, the more people that you have on your team, is, as long as we're all working towards the same goal is likely to get you there faster. And yeah, absolutely. I mean, I think that there is so much that our, you know, kind of our area of expertise has to offer women's health in general, but especially in that realm of fertility. care, I don't even want to call it medicine, because sometimes it's it's really just care that women need, they feel like they need to be taken care of. And you know, whether that's taking care of their physical health or mental health, their emotional health, whatever it is, it's just, you know, women need to be cared for in all stages of life, but especially when they're going through this time, which can be really challenging. But, you know, there are more and more positive outcomes every year, like we were talking about earlier that this is, you know, the golden age of Reproductive Medicine in all in all respects. Absolutely. Thank you so much. So I'm going to ask you again, even though I asked you the first time, what do you think is the missing ingredient in midlife?

Dr. Jordan Robertson  34:47  
Oh, I mean, you have a different answer. Now. I don't even remember what my answer was last. You must give me some great ones.

Jenn Salib Huber  34:55  
Do I actually really like it? And I actually now don't tell people that I'm going to ask them because I I think it's, I like the answers, but

Dr. Jordan Robertson  35:01  
not to be more spontaneous. What's the missing? You know what I think? I think it's friendships. Oh, I like oh, yeah, this is where I'm going with it today. I think it's because I like the idea of modeling. Right? I think that, you know, we would I know, there's a quote, and I butcher it every time because actually actually should go back and look up what the, like actual OG quote was, but it's something to the effect of like, we would rather be the same than Right. Right. And so we, we will do what everyone is doing, even if it's not the right thing for us, right, we will engage in activities are not engaged in activities, because the community we're in the culture we're in the workplace we're in, is doing the thing, even though it's in contrast to what is actually best for us. And none of the culture, none of the workplaces, none of our friend groups, like none of it was actually built for the midlife woman, right? It was built for other people, and we just borrowed it. And it's not actually serving us. But that's, so what I want or what I think that missing ingredient is, is for us to have the culture and the modeling with each other for how to build our lives that's in our best interest for the midlife woman rather than borrowing the ideas and the mentality and values of everybody else. Because I actually think our needs are different. And I actually think we can just do a better job if we started from scratch and said, like, what kind of kind of community do we all want to live in? But that's what I think.

Jenn Salib Huber  36:37  
And I love it. Totally agree. I mean, I don't know about you, but you know, friendships in all stages of life, but certainly my friendships that I have had and made in the last 10 years, really feel important. And not just an A, like nice to have, but isn't like need them in my life kind of way. And just the support from those friendships knowing that it's unconditional, that it's you know, it's really Yeah, I agree. That's such a key ingredient. I love it. Thank you so much, Jordan. I know that this conversation will help so many and I appreciate you and your time. Hey there. Thanks so much for tuning in to this episode of the midlife feast. You can find a link to my group program beyond the scale and anything else that I've got on the go in the show notes. You can also find a link to download my free menopause nutrition for underwriters guide which includes some of my favorite recipes to help you implement gentle nutrition. And as always, come hang out with me on Instagram at menopause dot nutritionist. It's where I love to connect with people who are in this stage of life and are looking to try different instead of harder