THE WHOLESOME FERTILITY PODCAST

Michelle Oravitz 6/2/25 Michelle Oravitz 6/2/25

Ep 339 Breathing to Conceive? It Sounds Crazy… Until You Try It

On today’s solo episode of The Wholesome Fertility Podcast, I dive deep into the ancient practice of Pranayama, also known as yogic breathwork, and its profound impact on fertility. Breathwork may sound simple, or even unrelated to fertility, but the connection between your breath, nervous system, and reproductive health is incredibly powerful.

In this episode, I explain how specific breathing techniques can shift your body from a state of stress into one of rest and regeneration, promoting hormone balance, improved digestion, and pelvic blood flow all critical components of a healthy fertility journey. You’ll learn practical ways to integrate ancient breathing practices like Nadi Shodhana (alternate nostril breathing), Kapalabhati (breath of fire), Bhastrika (bellows breath), Bhramari (humming bee breath), and Ujjayi breathing into your daily routine.

If you’re feeling overwhelmed, stuck, or simply curious about new tools to support your body naturally, this episode is for you.

Key Takeaways:

Breathwork regulates the nervous system, supporting hormonal balance and reproductive function.
Ancient yogic practices like Pranayama offer free, accessible tools for stress reduction and enhanced vitality.
Techniques like alternate nostril breathing and humming bee breath can be easily integrated into your daily life.
Breath can help release emotional tension and stimulate vagal tone, a key player in fertility health.
Conscious breathing increases oxygenation, supports digestion, and boosts clarity.

For more information about Michelle, visit: www.michelleoravitz.com

Check out Michelle’s Latest Book: The Way of Fertility!

https://www.michelleoravitz.com/thewayoffertility

The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/

Instagram: @thewholesomelotusfertility

Facebook: https://www.facebook.com/thewholesomelotus/

Michelle: [00:00:00] Episode number 339 of the Wholesome Fertility Podcast. Welcome back to the Wholesome Fertility Podcast. I'm your host, Michelle Orbitz, and today we're diving into a deeply healing and powerful practice that has stood the test of time. It's called Pranayama or yogic Breath Work. You might be surprised to hear just how much breath work could influence your mind and your nervous system, and then in turn influence your reproductive health.
Michelle: 'cause we know that the nervous system plays such an important role on reproductive health. So if you wanna find out more about powerful breathing exercises that you can do so easily and they're free, that can influence your nervous system and how you feel. Overall, this episode is for you.
Michelle: Welcome to the Wholesome Fertility Podcast. I'm Michelle, a [00:01:00] fertility acupuncturist here to provide you with resources on how to create a wholesome approach to your fertility journey.
Michelle: So, so today I'm going to cover a very interesting topic, which is Pranayama. so this is an ancient Indian or yogi or yo guine practice that has been done for thousands of years.
Michelle: Pranayama or yogic breath work
Michelle: is extremely powerful And can really impact the mind and the nervous system. So if you wanna find out more on how to hack your nervous system, and if you've watched some of my earlier videos, I talk a lot about how your nervous system really can influence your fertility health because it gets you into a more rest and digest state.
Michelle: And it can also influence your inflammation and your digestion and even create more balance in your hormones. So if you are trying to conceive and you wanna [00:02:00] find out how you can really hack your body and mind through pranayama this amazing ancient tradition, this amazing ancient practice, then stay tuned.
Michelle: So you might be asking yourself, what exactly is pranayama?
Michelle: So in Sanskrit prana means life force vitality. So it's very similar to what chi in Chinese medicine means, and it's the life force vitality that goes through our body. a yma means control or expansion.
Michelle: So Pranayama in essence, is the art of controlling your breath to influence the life force vitality in your body.
Michelle: So it's not just about breathing more deeply though. That's part of it.
Michelle: It is about becoming aware of how your breathing can influence your hormone balance and your nervous system,
Michelle: as well as reducing stress. And these are all really important and impactful things when you're trying to conceive.
Michelle: So, although this [00:03:00] is coming from ancient India, this is something that can control all bodies and all different cultures. and it's one of the many gifts that we get from the ancient Vedas, Which is really linked to Ayurveda and yoga. The yogic tradition is the aspect of the physical, and it's more of the physical therapy aspect of it, but this is all part of really the science of life and how they're perceiving that you're able to, and how they're giving you tools to really access this amazing, intelligent life force that resides in your body.
Michelle: So just to kind of give you a little bit of an overview. So Prana is very similar to Q, which is Life Force Vitality, and this is basically the life force that we have that is intelligent and that keeps our body warm and that keeps our body functioning. So this is something that really is intelligent because that aspect of our bodies is [00:04:00] what tells ourselves what to do, and it also helps the self-healing mechanism of the body.
Michelle: And when we're in fight or flight, and I always come back to the nervous system than our body is more worried about survival. And regeneration is not as much of a priority because survival is more important. But what happens when we're in survival is that everything moves towards that survival, and it's not worried about digestion.
Michelle: It's not worried about inflammation. All the things that are running in the background. And it can also impact your sleep because when you're trying to survive, you can't rest, you can't sleep, you can't afford to, you wanna survive, you wanna be alive. So that's ultimately how the nervous system operates.
Michelle: But when we're getting that free flow of energy and that we're able to really be enriched with the QI and the life force of Prana, and we're able to get also in a more rest and digest mode, things will flow more easily and they're not gonna be as constricted as it does, as things [00:05:00] do happen with stress.
Michelle: And ultimately as an acupuncturist, one of the biggest things that I do is I work a lot on pelvic energy flow and blood flow. So when there's more flow in your body, there's more blood flow, there's less constriction. And as we know, many times when people have high blood pressure, you know, your blood vessels are actually.
Michelle: Muscle and those muscles tighten and it causes more constriction and more pressure. And we know that stress can even impact blood pressure. So that tightening is what happens when we're stressed, and ultimately that tightening is going to block. Impact, as I mentioned with the liberty, which is really its role, is to get that energy to flow.
Michelle: So one of the ways that we can hack really our minds and our bodies is through pranayama. And today I'm gonna talk about a couple of different. Techniques of breathing that you can do that will [00:06:00] immediately have an impact on how you feel and how the energy and the prana in your body is able to flow, which ultimately will be beneficial not just for your body and your reproduction, but also your mind.
Michelle: And I'm sure you know that if you are on the fertility journey, it can be very stressful. And when you're stressed, there's been studies that show that when you're stressed, you can't really make a clear minded decision. And as we know, when you're on the fertility journey, you need that decision making aspect of your mind because you are going through a lot of different choices and options that are being thrown at you.
Michelle: So the first breath that I am going to be sharing with you is called Nadi Shaana, and that is alternate nostril breath. I like to call it the yin and yang pranayama, although that's not really the name, because it balances the yin and the yang in our brain. So both hemispheres of the brain start to function and come [00:07:00] together.
Michelle: And this is one of the most immediate calming exercises that you can do. And what it does is it basically you alternate sides and you will block one nostril and breathe in, and you can breathe into like the count of four or the count of eight, whatever feels right. But if you slow it also, you'll start to feel a little more peace so you can actually breathe into the count of eight.
Michelle: Then close both nostrils. So breathe in one nostril, close the right, and breathe in from the left. Breathe in to eight, and then hold both nostrils closed to the count of eight, and then exhale from the right to the count of eight. And then breathe back in from the same one, the right to the count of eight, close both nostrils, and then breathe out from the left and then breathe back in for the count of eight out, eight in hold it.[00:08:00]
Michelle: So basically just remember one specific count and you're gonna keep doing that and then alternate your nose. Now you're gonna notice that one nostril is going to be a little more clear than the other. And that is actually very normal. Our bodies tend to go more yin and yang throughout the day, so one side will feel one way and the other side will not feel that same way, and you'll find that that will alternate throughout the day.
Michelle: And that's kind of an interesting thing, but our bodies do alternate and we're constantly getting to this place of homeostasis so that our body can find balance. But through that, we do have those two sides, those dualities, which is why doing something like this can be so powerful.
Michelle: So by balancing, because our nose is directly opened, you know, the olfactory nerve, which is also the sense is directly linked or connected to the brain. So by alternating those two sides, of [00:09:00] breathing, you are creating that balance from the left and right hemispheres of the brain, and that also can create more clear thinking if you are feeling anxious and it's hard for you to really make a decision.
Michelle: This is a great exercise to do, and what this also does is activate the parasympathetic nervous system, which is the more rest and digest nervous system. So if you're feeling extra stressed and you wanna slow down your mind, this is amazing. It also improves oxygenation and it also creates more mindfulness.
Michelle: 'cause as you're doing it, you're being very conscious of how you're breathing and how you're feeling because it is a practice that you have to pay attention while you're doing it.
Michelle: So you could do this in the beginning of your day and then you can do this at the end of the day. And it could be literally two minutes, two minutes in the morning and two minutes at night. And I think that it is really nice to actually do it in the beginning and end of the day. 'cause you're literally doing it at yin and yang times of your 24 hour cycle.
Michelle: So it can help you when you [00:10:00] first start to wake up, and then you can help you end the day really nicely and support your nervous system as you go to sleep. So another one that is one of my favorites is called Kati, and that is skull shining breath. Or you may have heard this, called breath of fire. And so ultimately what it is, is working through your diaphragm and after you do it for a while, you literally feel like you are breathing fire.
Michelle: 'cause you can feel a lot of fire in your diaphragm area. So the area that I'm talking about is really the soft area of your belly that's right underneath your ribs. So you start to feel this, it's kind of like right above, it's between the bottom of your ribs and your belly button, right in that solar plexus in that area.
Michelle: So you can put your hands there Before I actually go into the description of how to do it, I wanna talk about what it does. Breath of fire is incredible for [00:11:00] digestion and it is one of the more stimulating breaths, and I remember one of my teachers mentioning That there was like a saying that as many breaths as you breathe, that we only have a certain amount of breaths for our life.
Michelle: And that is why it's important to breathe slow. And the slower we breathe, the longer we can live. And I asked about this one because it's actually a very rapid type of breath, and they said, well, it's considered one breath because it's, you're not fully exhaling.
Michelle: You're kind of like pumping throughout the whole time that you're doing it. So it's actually considered one breath. It's not considered, many different breaths.
Michelle: so another thing, the reason why it's called Breath of Fire is because in Ayurvedic medicine, a lot of times they refer to something called Agni, which is our digestif fire. And that justifier, I guess you can say correlates to really our ability to break down foods And really the acid that we have in our stomach that can cook the [00:12:00] food and ultimately the breath of fire. And Agni is very, very important. And sometimes people will have diminished Agni from drinking too much cold or not really eating correctly. And so we don't want that. We wanna actually kindle that fire because when you kindle that fire, it will protect your body, increase your immune system, and also break down foods so that the rest of the digestive system, is able to really assimilate the nutrition from the food.
Michelle: Another thing that it can do is clear, stagnant energy. And then when stagnant energy gets cleared, then you're getting more flow in the body and Prana is able to really move. So. This is one of the most powerful breaths to really get things moving. And the only thing that I would say with this, and really everything that I'm saying is not medical advice.
Michelle: And I would also say be cautious. If you are about to do a retrieval, I would not do this breath because they are afraid [00:13:00] of ovarian torsion and this is something that you don't wanna mess with. So, and it is a very powerful and moving type of breath.
Michelle: But I'd like to compare it to when the Native Americans used fire for brushes, you know, for, to get rid of like old weeds before they created new or planted new seeds. And this is one of those things, you're getting things outta the way, you're burning out the stagnation with this breath in order to get more flow and more new energy coming into the body.
Michelle: so here's how you do it. So in between the bottom of your ribs and your belly button, so put your hand there and you could put both hands, one on top of the other. And what you do is you forcefully exhale, and you will find that when you do that, you're naturally going to bounce back almost like a rubber band where it just inhales.
Michelle: By nature. And then you don't worry about the inhale 'cause it's gonna happen automatically and you just keep exhaling and you just [00:14:00] pump with the exhale. So you go and you'll feel that bounce when you have your hand there. And over time you'll find that it can get longer and longer as you practice.
Michelle: In the beginning, you might get tired sooner and sometimes you might even find that it makes you cough. It is so purifying, it will actually make you cough up old mucus in your lungs. So it is pretty wild how it works.
Michelle: So the next type of breath is called baa, and that is also called the bellows breath. And this is a little bit more active and I'll describe it so that you understand how to do it.
Michelle: But first let me explain what it does.
Michelle: So Bas Rica, very similar to the breath of fire, is also a breath that is very active and it can stoke the internal fire in our bodies.
Michelle: It also involves very, forceful inhales and exhales. But in this case, you're gonna be [00:15:00] using the arms.
Michelle: It is considered to activate the Kundalini energy in the body. This is the energy that runs up and down our spine and feeds really all of our organs and body
Michelle: and supports our body's energetic flow. and it also is considered to have a balancing effect on the doshas. If you've watched my Ayurvedic video, I talk about the different doshas, which are really elements in your body, and this is considered to be a good breath that balances all of that.
Michelle: It can also boost oxygenation and mental clarity. And how you do it is you raise your arms up and you have your hands out. So your hands are completely open and your arms are just raised up, and you inhale as you do that, And as you exhale, you close your hands and you bring your elbows to the side, so you bring your hands down so you inhale with your hands up. [00:16:00] stretch hands, and then you exhale forcefully as you bring it down, as if you're bringing something down or pulling something towards you from the top to the bottom.
Michelle: So your elbows basically end up by your side and completely folded with your hands next to your shoulders in a fist. So inhale, bring your hands up. Wide open, exhale really forcefully as your hands go down into a fist next to your shoulders.
Michelle: So this is kind of related to the breath of fire. There's definitely a lot of heat that will be coming out from it, It is a very good practice to really get that energy moving. If you feel like it's stuck. This is great. If you feel a lot of stress and you feel a lot going on. If you wanna come home and you feel like you've had a very stressful day, this is a great way to break that up.
Michelle: So lastly, I'm going to cover something called Ari, or. Humming bee breath.
Michelle: [00:17:00] So actually this breath and the way you're supposed to do it is one thing that we know for sure is a technique that stimulates the vagus nerve. And as we know, the vagus nerve is extremely important when it comes to reproductive health That's because it has so many different functions, and one of them, which is really key, is promoting really good digestive health, lowering inflammation, improving sleep, and on and on.
Michelle: And it basically helps the body get into a parasympathetic mode. And one of the ways that is known to stimulate your vagus nerve is by humming. So this breath And another thing is that when you do hum on an exhale, you are actually by nature because you're using your voice, you slow down your breath.
Michelle: So this is a great way to slow down your breath as you are exhaling.
Michelle: So this can also reduce any emotional tension And it could also reduce heart rate and blood pressure.
Michelle: so what you do for [00:18:00] this breath is inhale, fully hold it at the top, and then exhale with a humming sound. So.
Michelle: And then you just breathe all the way out. So as you'll notice when you're humming, you actually slow down your breath, so it naturally slows down your breath, which has an immediate impact on any kind of state of anxiety. It will really calm your mind. So this is an amazing thing to do, and you can really do this while you're driving.
Michelle: Just keep your eyes open for obvious reasons, But you could do this even while you're driving. If you're driving to a doctor's office and you're feeling really nervous, you can do that. a lot of times, om in my car, and this is just kind of one of the things that I do, and I find that it really, it, it feels like I'm singing a song, but I'm just oing.
Michelle: So it feels really calming on my nervous system. It feels like an internal massage, having that vibration. So that can help a lot. And again, you could do this also at the end of the day if you had a lot of. Things [00:19:00] going on if it was a very intense day, and you can get yourself ready and your nervous system ready for more rest.
Michelle: And actually that was not my last one. I have one more. and this is something that you can do at all times, and it's called UJA breathing. So if you practice yoga, you may have heard of UJA breathing because it's something that a lot of yogis will teach you to do during your yoga practice, and that is something that you can take with you really throughout the day. And what it is, is causing a little bit of constriction in your throat as you're breathing So that your breath could be a little louder. So it's kind of like this constriction where you're able to feel the breath going through your throat. so it's like making a little bit of a, a humming or a sound while your mouth is closed and you could practice. I'm sure you've done this naturally, even when you were little, And it's a very calming and very grounding breath.
Michelle: It is thought to increase the lung capacity, and it's [00:20:00] also thought to balance out the heat in the body, and it's also thought to balance out the temperature in the body. So it's kind of like a yin and yang balance.
Michelle: And it can also, since it's so grounding, promote a meditative state. So it's something that you can do, and this is one of the reasons why a lot of yogis use this during yoga, because ultimately yoga was a, was a practice that prepared yogis to meditate. It got the body into a state where it was able to meditate more deeply.
Michelle: So just to reiterate, none of this is medical advice. It's not something that should ever take the place of what doctors tell you It should not be something that ever takes the place of medical.
Michelle: Protocols that you've been given, and also to be aware or talk to your doctor if you are going through IVF, to talk to them about different breathing exercises and perhaps to pause on any of them during the IVF process. [00:21:00] If you have any questions or ideas for future episodes, I would love to hear from you.
Michelle: I'm very active on Instagram and my handle is at the wholesome lotus fertility. I don't always respond right away, but I always eventually get to all of them. So thank you so much for tuning in today, and I hope you have a beautiful day.
[00:22:00]

Michelle Oravitz 5/26/25 Michelle Oravitz 5/26/25

Ep 338 Eggs, Estrogen & Empowerment: Navigating Fertility with Dr. Nirali Jain

On this episode of The Wholesome Fertility Podcast, I am joined by Dr. Nirali Jain (@eggspert_md), a board-certified OB/GYN and reproductive endocrinologist at Reproductive Medical Associates (RMA). Dr. Jain shares her expert insights on fertility preservation for individuals undergoing cancer treatment, a crucial yet often overlooked aspect of reproductive care.

We explore what options are available for fertility preservation, including egg and sperm freezing, and why it’s so important to initiate these discussions before starting chemotherapy or radiation. Dr. Jain also explains the difference between Letrozole and Clomid, the impact of estrogen-sensitive cancers on IVF treatments, and innovative approaches like random-start cycles and DuoStim protocols. Whether you're facing a cancer diagnosis or simply thinking proactively about your reproductive future, this conversation is filled with knowledge and reassurance.

Guest Bio:

Dr. Nirali Jain (@eggspert_md) is a board-certified OB/GYN and fertility specialist at Reproductive Medicine Associates (RMA) in Basking Ridge, New Jersey. She earned both her undergraduate degree in neurobiology (with a minor in dance!) and her medical degree from Northwestern University, before completing her residency at Weill Cornell/NYP, where she served as co-Chief Resident, and her fellowship in reproductive endocrinology and infertility at NYU Langone.

Deeply passionate about women’s health and fertility preservation, Dr. Jain blends the latest research and cutting-edge treatments with compassionate, patient-centered care. Her interests include third-party reproduction and oncofertility, and she is especially passionate about supporting patients navigating fertility preservation through a cancer diagnosis.

Outside of the clinic, Dr. Jain is a trained dancer, a dedicated global traveler, and an adventurer working toward hiking all seven continents with her husband. Her diverse experiences, from international medical rotations to personal connections with friends and family navigating infertility, have shaped her into a warm, resourceful, and determined advocate for her patients.

Websites/Social Media Links:

Visit RMA website
Follow Dr. Nirali Jain on Instagram

For more information about Michelle, visit: www.michelleoravitz.com

Check out Michelle’s Latest Book: The Way of Fertility!

https://www.michelleoravitz.com/thewayoffertility

The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/

Instagram: @thewholesomelotusfertility

Facebook: https://www.facebook.com/thewholesomelotus/

[00:00:00]
Michelle Oravitz: Welcome to the podcast Jain.
Dr. Nirali Jain: Thanks so much for having me
Michelle Oravitz: Yeah, so.
Michelle Oravitz: I'm very excited to talk about this topic, which, um, actually you don't really hear a lot of people talking about, which is how to preserve your fertility if you're going through a cancer diagnosis and if you have to go through treatments. 'cause obviously that can impact a lot on fertility.
Michelle Oravitz: I have, um, seen actually like a colleague of mine go through. And she also preserved her fertility and, and now she has a baby boy. so it's really nice.
Michelle Oravitz: to
riverside_nirali_jain_raw-video-cfr_michelle_oravitz's _0181: so nice.
Michelle Oravitz: So I'd love for you first to introduce yourself and kind Of give us a background on how you got into this work.
Dr. Nirali Jain: Of course. Um, so I am Dr. Narly Jane. I am, um, an OB GYN by training, and then I did an additional, after completing four years of residency in OB GYN and getting board certified in that, I did an additional training in reproductive endocrinology and [00:01:00] infertility or otherwise known as REI. So now I'm a fertility specialist.
Dr. Nirali Jain: Um, I trained at Northwestern in Chicago, so I went to undergrad and medical school there. And then, um, home has always been New Jersey for me, so I moved back out east to New Jersey. Um, I did all my training actually in New York City at Cornell for residency and NYU for fellowship. Um, and then moved to the suburbs.
Dr. Nirali Jain: Um, and now I'm a fertility specialist in, in Basking Ridge at Reproductive Medical Associates.
Michelle Oravitz: Very impressive background. That's awesome.
Dr. Nirali Jain: Yeah.
Michelle Oravitz: I'd love to hear just really. About what your process is. If a person has been diagnosed with cancer, like what is the process? What are some of the things that you address if they are trying to preserve fertility, and what are some of the concerns going
Dr. Nirali Jain: yeah, yeah. All great questions. So, you know, there's a lot of us, uh, the Reis. Are a very small, [00:02:00] there's a very small number of us. So in terms of specializing in fertility preservation, technically we all are certified to treat patients with cancer and kind of move them through fertility preservation before starting chemotherapy.
Michelle Oravitz: Mm-hmm.
Dr. Nirali Jain: Um, luckily we've been working closely with oncologists in the past several years just to establish some type of streamlined system because having a diagnosis of cancer and hearing all that information. Especially when you're young is so hard. So I think that's, that's where my interest started in terms of being able to speak to and counsel cancer patients.
Dr. Nirali Jain: I think it is a very specific niche that you really have to be comfortable with in our field. Um, I. So I'll kind of walk you through, you know, what it, what does it look like, right? Um, you go into your oncologist's office suspecting that you have this, this lump. I'll take breast cancer, for example. It could really be any kind of cancer.
Dr. Nirali Jain: Um, but breast cancer in a reproductive age patient or someone that's in those years where you're starting [00:03:00] to think about building a family, planning a family, um, or if you have kids at home, that's usually the type of patient that we see come in with a breast cancer diagnosis. So. Kinda just taking that, for example, um, the minute that you're diagnosed, it's really your oncologist's responsibility to counsel you on what treatment options are going to be offered to you.
Dr. Nirali Jain: And then based off of the treatment options, it's important to know how that affects your reproduction. So how does it affect your ovaries in the short term, in the long term, um, in any way possible. So. Once a patient is initially referred from their oncologist to myself or any other fertility specialist, they come into my office and we just have a 30 minute conversation really talking about family planning goals.
Dr. Nirali Jain: Any kids that they've had in the past either naturally conceived or through um, IVF, and then we talk about where they're at in their relationship. Are they married, are they not? Are they with a partner, [00:04:00] a male partner, a female partner, whatever it might be. It's important to know the social standpoint, um, especially in this sensitive phase of life.
Dr. Nirali Jain: So patient patients usually spend anywhere from 30 minutes to an hour. Um, just kind of talking through where they're at, how they're feeling, what their ultimate childbearing goals are. And then from there we do an ultrasound and that's when I'm really able to see, you know, the, the reproductive status.
Dr. Nirali Jain: So what do the ovaries look like? What does the uterus look like? Is there something that I need to be concerned about from a baseline GYN standpoint? Um, and all of those conversations are happening in real time. So. I think one of the things is patients come in and they're like, I'm already so overwhelmed with all this information from my oncologist, and now my fertility specialist is throwing all this information at me.
Dr. Nirali Jain: Luckily, the way I like to frame it is you come in and you just let go. Like you let us do the work because in the background we're the ones talking to your oncologist. We're the [00:05:00] ones giving that feedback and creating a timeline with your oncologist. Um, and really I think just getting in the door is the hardest part.
Dr. Nirali Jain: So once patients are here to see us, we go through the whole workup. We do anything that we would do for a normal patient that came in for fertility preservation. And then based off of where they're at in their journey, we talk about what makes sense for them, whether that means freezing embryos, freezing eggs, they're very similar in terms of the, the few weeks leading up to the egg retrievals.
Dr. Nirali Jain: So I have that whole conversation just at the initial visit. And then from there we talk about the timeline behind the scenes and make sure that it works with their lives before moving forward.
Michelle Oravitz: So for people listening to this, why, and this might be an obvious question, but to some it might not be,
Dr. Nirali Jain: Mm-hmm.
Michelle Oravitz: why would somebody want to preserve. eggs or sperm. 'cause I've had actually some couples
Dr. Nirali Jain: Yep.
Michelle Oravitz: come to me where the husband preserved the sperm and they had to go through IVF just because he was going [00:06:00] through cancer treatments. So he had to preserve the sperm ahead of time.
Dr. Nirali Jain: Mm-hmm.
Michelle Oravitz: people need to consider doing that before doing cancer treatments?
Dr. Nirali Jain: So there are certain cancer treatments that do affect the ovaries and the sperm health, and you know, for men and women, it affects your reproductive organs. In a similar way, um, depending on the type of chemotherapeutic agent, there are some that are more dangerous in terms of, um, being toxic to your ovaries or toxic to your sperm.
Dr. Nirali Jain: And those are the instances where we are really thinking about what's the long-term impact because there's medications that oncologists do give patients, and our oncologists are amazing, the ones that we work with, Memorial Sloan Kettering from Reproductive Medical Associates through RMA, um, and.
Dr. Nirali Jain: They're just so good at what they do and are so well-trained, so they know in the back of their mind, is this going to impact your ovaries or your sperm health or not? Um, and I [00:07:00] think that any chemotherapy, you know, your ovaries are these, these small organs that are constantly turning over follicles every month.
Dr. Nirali Jain: So every month we're losing those eggs, and if they don't become. If an egg isn't ovulated, it doesn't become a baby, it's just gonna die off. So I counsel even patients that don't have cancer, I counsel them on fertility preservation as young as possible. You know, between the ages of 28 and 35, that's like the best time to preserve your fertility.
Dr. Nirali Jain: So in cancer patients, there's an extra level added to that where even if they are a little bit younger, a little bit older. Your eggs are not gonna be the same quality. There's gonna be higher level of chromosomal errors, more DNA breakage, um, and, and bigger issues that lead to issues with conceiving naturally afterwards.
Dr. Nirali Jain: So I think that it's important to consider how that chemotherapy is going to affect them or how surgery would affect them if it was, for example, a GYN cancer where [00:08:00] we're removing a whole ovary, you know, what, what do we have to do to preserve your fertility in that case? And those are important conversations to have.
Michelle Oravitz: Yeah. for sure. I know that a lot of people are also concerned, you know, with going through the IVF process, you're taking in a lot of estrogen, a lot of hormones, and many cancers are actually estrogen sensitive. So I wanted to talk to you about that. 'cause I know that the data shows that it's. It's been fine, which some people might find surprising, but I wanted you to address that and just kind of
Dr. Nirali Jain: Yeah.
Michelle Oravitz: from your perspective.
Dr. Nirali Jain: That's so interesting that you asked that question because I actually, my whole I I graduated fellowship last year and my entire, like passion project in fellowship was looking at one of the drugs that we use to suppress the estrogen levels specifically in cancer patients. Um, and I had presented this at a few of our reproductive meetings.
Dr. Nirali Jain: Um, A SRM is one of our annual meetings where all of the reiss get together. A lot of male fertility [00:09:00] specialists come and we kinda just talk about. Specific things and fertility preservation for cancer patients is, has been an ongoing topic of interest for all of us. Um, and it's important to know that there are different medications that we can offer.
Dr. Nirali Jain: Letrozole is the one that I, um, have a particular love for and I, uh, you know, I use all the time for my patients, um, for different reasons, but it suppresses the exposure that your body has to estrogen. And there's mixed data, um, out there in terms of, you know, does Letrozole suppression actually impact, you know, does it help or.
Dr. Nirali Jain: Or does it have no impact on your future risk of cancer after treatment? Um, and that honestly is still up for debate. But what we do know is that there's no increased risk of cancer recurrence in patients that have undergone fertility preservation with or without Letrozole. Um, Letrozole is one of those things that we can give, and the way it works is basically.
Dr. Nirali Jain: It masks that [00:10:00] conversion. It, it doesn't allow for conversion from those androgens in the male hormones over to estrogen. Um, and so your body doesn't really see that estrogen exposure. It stays nice and low throughout your cycle, and it does help with actually ovarian maturation and getting mature eggs harvested and, um, helps a little bit with, with quality too.
Dr. Nirali Jain: So I think that it's really nice in terms of having that available to us, but know that. It's not, it's not essential that you have it, really, the data showing plus minus. Um, but there are certain things that we can do to protect the ovaries, protect your exposure to estrogen. Um, and so that shouldn't be top of mind of concern when we're going through fertility preservation, even with an estrogen sensitive cancer.
Michelle Oravitz: Actually, so, uh, on a different topic, kind of going back to that, so Letrozole versus Clomid, I, it's like a, the questions I personally feel just based on what I've heard and like my own research that Letrozole would be kind of like the more. [00:11:00] Um, the, it's, it's a little better, but I know that it really depends on the person as well.
Dr. Nirali Jain: Yeah,
Michelle Oravitz: they might do better with Clom, but I'd love to hear your perspective and kind of pick your brain on this.
Dr. Nirali Jain: totally. You're choosing all the, all the right questions because these are all of my, my specific interests and niches. So
Michelle Oravitz: Oh,
Dr. Nirali Jain: Letrozole is basically, you know, we use Letrozole and Clomid in. Patients that don't have cancer and patients that come in for an intrauterine insemination, that's kind of the most common scenario where we're thinking about, you know, which medication is better?
Dr. Nirali Jain: Letrozole or Clomid and Clomid used to be the, the most common medication that we use, we dose patients, you know, have 50 milligrams of Clomid, give them five days of the medication. It's an oral pill. Feels really easy and. The way it works is really, it recruits more than one follicle, so it really helps with the release of, um, more than one follicle growing more than one follicle in the ovary.
Dr. Nirali Jain: Um, but it has a little bit [00:12:00] higher of a risk of twins because that's exactly what it's good at. Um, Clomid, not so much in the cancer. In the cancer front, it's not really used there because it's considered, from a scientific perspective, it's considered like a selective estrogen receptor modulator. So it doesn't necessarily suppress your estrogen levels in the same way that Letrozole does versus.
Dr. Nirali Jain: Letrozole is an aromatase inhibitor, so it really blocks the chemical conversion of one drug or one hormone to the other hormone. Um, the reason we love Letrozole so much, and I don't mean to like gush over Letrozole, but um, it's a mono follicular agent, so it works really well at recruiting one follicle
Michelle Oravitz: Mm-hmm.
Dr. Nirali Jain: you know, every OB-GYN's nightmare in a way is having multiples when you didn't intend on having multiples at all.
Michelle Oravitz: so
Dr. Nirali Jain: Um.
Michelle Oravitz: were saying that, um, there's more of a chance of twins, it's Clomid, not letrozole.
Dr. Nirali Jain: Yes, there's a higher chance with Clomid versus Letrozole. And I mean, don't get me wrong, there's a chance of twins with [00:13:00] any type of assisted reproductive technology. Even when we're doing single embryo transfers, there's a chance that it's gonna split. So, um, the chance is always there just like it is in the natural world.
Dr. Nirali Jain: But we know for a fact that. CLO is really good at recruiting many follicles. It's good for certain patients that don't respond well to Letrozole. Um, but Letrozole is kind of our, our go-to drug these days just because of all the benefits that we've seen.
Michelle Oravitz: Awesome.
Dr. Nirali Jain: Yeah,
Michelle Oravitz: These are all fun things to ask because I, I love talking to our eis 'cause there's so much information that I'm always
Dr. Nirali Jain: totally.
Michelle Oravitz: learn a lot from my patients in my own research, but it's really cool. Picking your guys' brains. So another question I have, and I have actually talked to Dr. Andrea Elli, he's been on,
Dr. Nirali Jain: Mm-hmm.
Michelle Oravitz: and he does a lot of endometriosis and, and immune related work as well,
Dr. Nirali Jain: Yeah.
Michelle Oravitz: so. I'd love to know just from your perspective. One thing that I do know from, based on what I've heard is that the, [00:14:00] guess like you were just saying, that breast cancer or estrogen sensitive breast cancer doesn't seem to be affected by IVF cycles, however, and endometriosis lesions do get affected.
Dr. Nirali Jain: Yeah.
Dr. Nirali Jain: that's a great question. So, you know, every, there are so many complex G mind diagnoses that the, that our patients come in with. Um, and endometriosis is a big one because there is clear data that endometriosis is linked to infertility. So we think about, you know, when a patient comes in with endometriosis, we really do think about the different treatment options and what are the short-term and long-term impacts of the hormones that we're giving 'em.
Dr. Nirali Jain: Um, these days, again, kind of going back to Letrozole, we, letrozole is something that I give all of my endometriosis patients because it helps suppress their estrogen because we know.
Michelle Oravitz: interesting.
Dr. Nirali Jain: is very responsive to estrogen and leads to this dysfunctional regulation of all the endometrial tissue that can really flare in a, [00:15:00] in a cycle, or shortly after a cycle.
Dr. Nirali Jain: I. So we really, for endometriosis patients, the, the best treatment is being on birth control because we don't see that hormonal fluctuation. The up and down of the estrogen and the progesterone, that's what leads to those flares. Um, so I really, I watch patients closely after their cycles too, because you definitely can have an endometriosis flare and we say the best treatment for endometriosis is pregnancy, right?
Dr. Nirali Jain: That's when you're suppressed, that's when you're at your lowest. Um, and patients, my endo patients feel so good in pregnancy because they have. Hormones that are nice in that baseline, they're not getting periods of course. Um, and that's truly, truly the best treatment.
Michelle Oravitz: That's interesting.
Dr. Nirali Jain: But it is important to consider when you're going through infertility treatments.
Dr. Nirali Jain: How does my endometriosis affect the short and long-term effects of the fertility medications? And really not to, not to say that they're bad in any way. I think a lot of endometriosis patients go through IVF and have success and do really, really well, and that's kind of the push that they need. [00:16:00] Um, but it's important to be mindful of the bigger picture here.
Dr. Nirali Jain: It's not just, you're not just a number of. A patient with endo coming in, getting the same protocol. It's really individualized to the extent of your lesions, what symptoms you're having, what grade of endometriosis, where your lesions are. So we're the RAs are thinking about everything before we actually start your protocol.
Michelle Oravitz: It's crazy how in depth it is, and it's, it, there's just so, it's so multifaceted,
Dr. Nirali Jain: Yeah,
Michelle Oravitz: when it's females
Dr. Nirali Jain: totally.
Michelle Oravitz: are a little, I mean, they can, you know, there, there's definitely a number of things, but it's not as complicated and interconnected
Dr. Nirali Jain: Exactly. Exactly. That's so true.
Michelle Oravitz: And so one question I actually have, this is kind of really off topic, but something that I was curious about.
Michelle Oravitz: 'cause I heard about a while
Dr. Nirali Jain: Yeah.
Michelle Oravitz: a, a type of cancer treatment that was used. I'm not sure exactly what it was, but for some reason it actually caused follicles to grow, [00:17:00] or to multiply. And they were
Dr. Nirali Jain: Interesting.
Michelle Oravitz: this definitely. Puts, um, the whole idea of like a woman being born with all the follicles she'll ever have on its head, I thought that was really Interesting.
Michelle Oravitz: Now I learned a little bit about it. I don't think it really went further than that,
Dr. Nirali Jain: Mm-hmm.
Michelle Oravitz: one of those things that they're like, Hmm, this is interesting. I don't know, it was kind of a random side effect of this chemo drug. I dunno if it was a chemo drug or a cancer drug.
Dr. Nirali Jain: Yeah.
Michelle Oravitz: ever heard of that.
Michelle Oravitz: So I was just
Dr. Nirali Jain: I haven't, I mean, that's interesting. I feel like I'd have to look into that because that would be definitely a point of interest for a lot of Reis. But it kind of does go back to the point of, you know, women are really born with all the eggs we're ever gonna have. So it's about a million, and then it just goes down from there.
Dr. Nirali Jain: And the, by the time you start having periods, I like to kind of show my patients a chart, but you have a couple hundred thousand eggs and you ovulate one egg a month. That's, you know. Able to [00:18:00] progress into a fertilized egg and then into a, an embryo into a baby, um, if that's your goal. But otherwise, patients that are having periods and not trying to actually get pregnant, we're losing hundreds of eggs a month.
Dr. Nirali Jain: So.
Michelle Oravitz: Mm.
Dr. Nirali Jain: It's important to kind of think about that decline, and it's important to know that that rate can be faster in patients with cancer, patients with low ovarian reserve. And sometimes when you have the two compounded, that's when a fertility specialist is definitely, you know, in the queue to, to have a discussion with you in terms of what that means and how you can reach your family building goals despite being faced with that, with that challenge.
Michelle Oravitz: Yeah.
Michelle Oravitz: I mean, 'cause we know oxidative stress is one of the things that can cause, uh,
Dr. Nirali Jain: Yeah,
Michelle Oravitz: quality eggs, but it's also can cause cancer.
Dr. Nirali Jain: Yeah,
Michelle Oravitz: um, similar, you know, like things that really deplete the body could definitely impact. Um, and then what are your thoughts? I know I'm asking you all kinds of random questions,
Dr. Nirali Jain: I love it.
Michelle Oravitz: are your thoughts about doing low simulation in certain [00:19:00] circumstances versus high stem?
Michelle Oravitz: Sometimes people don't respond as well to higher stems.
Dr. Nirali Jain: Yeah, that's a great point. I think that it kind of all goes back to creating an individualized protocol. If. A patient's going to a practice and basically just getting a protocol saying, this is our standard. We start with our standard of, you know, I, I think about the standard, which is 300 of the FSH or that pen that you dial up, and then 150 units of that powder vial.
Dr. Nirali Jain: And we have patients mixing powders all the time, and that's kind of our blanket protocol that we give patients. But that's not really what's happening behind the scenes. And if you're given a protocol that's, and being told, you know, this is kind of what we give to everyone, it's probably not the right fit for you.
Michelle Oravitz: Yeah, I
Dr. Nirali Jain: Um, there are certain patients that respond to a much lower dose and do really, really well, and then some patients that need a much higher dose. Um, and I think it's, that's kind of like the fun part of being an REI of being able to individualize the [00:20:00] protocol to the patient. Um, and I know for a fact there are so many, luckily, you know, we have so many leaders in REI that have been.
Dr. Nirali Jain: Have dedicated their entire careers to researching these different protocols and how they can help different patients. Um, patients with lower a MH, you know, might benefit from a duo stim protocol, for example. That's kind of the first one that comes to mind, but a protocol where we're using those follicles from the second half of a cycle.
Dr. Nirali Jain: I would've never thought that those were the follicles that
Michelle Oravitz: Oh,
Dr. Nirali Jain: would be better than the first half of the cycle,
Michelle Oravitz: Wait,
Dr. Nirali Jain: but,
Michelle Oravitz: that. Explain that. Um, because I think that that's kind of a unique
Dr. Nirali Jain: mm-hmm.
Michelle Oravitz: that I haven't heard of.
Dr. Nirali Jain: Yeah, so there's this new day. It's still kind of developing, but um, kind of going back to, you know, what's an individualized protocol? Duo STEM is one of the newer protocols that we've started using. I, I've used it once or twice in patients. Um, but it goes back to the research that shows that you might actually have two different periods of time in a menstrual cycle where you could potentially recruit [00:21:00] follicles.
Dr. Nirali Jain: You could have a follicular phase where there's a certain cohort of follicles recruited, and then you have a follicle that forms creates a corpus glut.
Michelle Oravitz: um, protocols
Dr. Nirali Jain: Yep. And then you basically go through the follicular protocol and then a few days after a retrieval, instead of waiting for a new follicular cohort or follicular recruitment from the first half of your menstrual cycle, you actually use the luteal phase and you recruit those follicles that would've actually died off or have been prematurely recruited in a prior cycle.
Dr. Nirali Jain: So
Michelle Oravitz: that's So
Dr. Nirali Jain: yeah,
Michelle Oravitz: you just do a similar, I guess, um, medicine,
Dr. Nirali Jain: go right back into it.
Michelle Oravitz: do the same exact thing, but right after ovulation.
Dr. Nirali Jain: Yeah.
Michelle Oravitz: Fascinating. That's really interesting.
Dr. Nirali Jain: Yeah,
Michelle Oravitz: has been your experience with that?
Dr. Nirali Jain: I think it's, honestly, it's mixed. Um, so far, you know, our data from fertility and sterility and A SRM, it, it shows support for these DUO STEM [00:22:00] protocols, saying that if patients don't have that great quality of eggs or if they have a very low number, maybe they'd benefit from starting the meds earlier and recruiting follicles.
Dr. Nirali Jain: A little bit earlier. Um, so we've seen positive results so far. A lot of work to be done in terms of really understanding it. Um, and of course, as a new attending, I have a lot more experience to kind of build on. Um, but I, I have seen success from it.
Michelle Oravitz: That's fascinating. Are there any other new technologies, like new add-ons, um, that you've seen, that you've found to be really cool or interesting?
Dr. Nirali Jain: I think the biggest thing, actually, kind of going back to our whole topic for today is fertility preservation cancer patients. One of the biggest things that I've learned recently is that we used to start fertility, um, patients. You know, only in the beginning of the cycle days, two or three is technically like when most.
Dr. Nirali Jain: Most clinics, um, start patients, but for our cancer patients, sometimes you don't have that time. You don't wanna wait a full month to [00:23:00] restart, um, your, you know, your menstrual cycle and then do the fertility preservation and then delay chemotherapy a full month. So we started doing what we call random starts.
Dr. Nirali Jain: So you basically start a patient whenever they come in. You know, it could be the day after your consultation, the day of your consultation. I've kind of seen all of the above. Um, and we've seen really good success with random starts, per se. Um, and we've been doing a lot more of that, where it's not as dependent on where you're at in your cycle.
Michelle Oravitz: Mm-hmm.
Dr. Nirali Jain: Um, obviously there's a difference in outcomes. You might not be a great candidate for it, so definitely it's worth talking to your doctor about it. But it kind of gives relief to our cancer patients where if you have a new cancer diagnosis and you're like, oh, I just finished my period, like, I can't even start a cycle until next month.
Dr. Nirali Jain: That's not always true. Um, so it's always worth it to go into see a fertility specialist and just get, you know, get the data that you need right away, and then you can make a decision later on.
Michelle Oravitz: For sure. Um, Yeah.
Michelle Oravitz: and I wanted to kind of cover a lot of different topics 'cause I know that [00:24:00] some people are gonna wanna hear what you have to say that don't necessarily, or, uh, have cancer. But it is important. I, I think that, you know, if you get to thirties and you haven't gotten married or you don't have a partner, I think it's really important to preserve your fertility in general.
Dr. Nirali Jain: Yeah,
Michelle Oravitz: important thing. And then if you were going through a cancer diagnosis and you decided to preserve your fertility, um, guess more for women because they're eventually going to be thinking about transfers after they go through treatment. So what are some of the things that they would need to consider as far as that goes?
Michelle Oravitz: Like after the
Dr. Nirali Jain: yeah,
Michelle Oravitz: then they go through the cancer treatments. Um, and then what, how long should they
Dr. Nirali Jain: yeah. Like what does it look like? So I've had patients that come back, you know, in my fellowship training I did a, a couple research projects on patients that came back to pursue an embryo transfer, um, after chemotherapy agent. And basically compared them to how they did, um, [00:25:00] compared to patients that didn't have cancer and just froze their embryos or froze their eggs and then came back to pursue a transfer and.
Dr. Nirali Jain: I think the, the most reassuring thing from the preliminary data that we have is saying that there's no difference in pregnancy rates and no difference in life birth,
Michelle Oravitz: Awesome.
Dr. Nirali Jain: of whether they had chemotherapy or not. After freezing those eggs and going through fertility preservation.
Michelle Oravitz: Amazing.
Dr. Nirali Jain: Um, in terms of where your body needs to be, I think the oncologist, we, we wait for their green light.
Dr. Nirali Jain: We wait for their signal to say, you know, she's safe to carry a pregnancy.
Michelle Oravitz: Mm-hmm.
Dr. Nirali Jain: And then once we do that, we basically treat you like any other patient. So if you're coming in for a cycle, if you're having periods, then it's reasonable to try a natural cycle protocol, wait for your body to naturally ovulate an egg.
Dr. Nirali Jain: And instead of obviously hoping that egg will fertilize, we, um, use a corpus luteum. We use the progesterone from the corpus luteum to really support this embryo being implanted into the uterus. Um. Yeah. [00:26:00] And then there's also another side. I mean, some patients don't get their periods back and they always ask like, what if I never get my period back?
Dr. Nirali Jain: What if I'm just like in menopause because of the chemotherapy agents? And for that, we can start you on a synthetic protocol or basically an estrogen dependent protocol where you take an estrogen pill for a certain number of days. We monitor your lining, then we start progesterone, um, to support your hormones from that perspective instead of relying on your ovaries to release the progesterone that they need, um, and then doing the embryo transfer a few, few days after progesterone starts.
Dr. Nirali Jain: So there's definitely different protocols depending on where your menstrual health is at after the chemotherapy or after the cancer treatment. Um, but it's important to kind of just know that. That there's options. It doesn't mean that it's the end of the road if you all of a sudden stop getting your period.
Michelle Oravitz: Yeah, for sure. I mean, 'cause you, technically speaking, you can really control a lot of that. More so for transfers
Dr. Nirali Jain: Yep.
Michelle Oravitz: Retrievals really is kind of like what [00:27:00] eggs you have, what the quality is. But people can be in complete menopause and you guys can still control their cycles for transfer, which is kind of. A huge difference
Dr. Nirali Jain: Yeah,
Michelle Oravitz: in the
Dr. Nirali Jain: exactly. That's exactly right. Yeah.
Michelle Oravitz: interesting. Any other, um, new, new things that you're, you guys are excited about? I always like to hear about like the new and upcoming things
Dr. Nirali Jain: Of course.
Michelle Oravitz: actually before, which I thought was fascinating. Yeah.
Dr. Nirali Jain: I feel like there's always like updates and, and new data and things like that coming out, but just know, I think it's important for patients to know, like we're constantly, we're, the reason I chose to even pursue this field was because it's new. Right. There's something that we are discovering every day, every year, and that's what makes our, our conferences so important to attend, um, to really just stay up to date.
Dr. Nirali Jain: Um, but we are, uh, constantly updating our embryology standards, the way we thaw our eggs, and the success rate associated with a thaw and [00:28:00] how we treat our embryos and the media that we use, right? Like, so we're really thinking about the basic science perspective every single day, and that's what makes this field so unique.
Michelle Oravitz: It is really awesome. And so do you guys specialize specifically on, um. Egg freezing and, and I mean specific fertility preservation in patients that do that have cancer that are going through treatments, do you guys specialize specifically in that? I mean, I know you do range
Dr. Nirali Jain: Yeah. Yeah, because it's such a small community, we all have our own niches and we all kind of have our own interests and
Michelle Oravitz: Yeah.
Dr. Nirali Jain: no like specific training. There are a couple courses that you take that I took in in training as well, just to kind of understand what it sounds like to, I. Council of fertility preservation, patient with and without cancer.
Dr. Nirali Jain: Um, and then, you know, you kind of just learn by experience and you form a niche for something that you're passionate about. 'cause that's what makes you, you know, really thorough in, in your treatment. [00:29:00] So that's one of my interests. Um, and, but I would say,
Michelle Oravitz: training for that. It's just like
Dr. Nirali Jain: yeah,
Michelle Oravitz: just know how to treat that in
Dr. Nirali Jain: exactly.
Michelle Oravitz: especially if you're interested in doing that.
Dr. Nirali Jain: Exactly. That's exactly right. It's kind of, it just comes with the experience comes with your mentors and who you're surrounded by, and everyone kind of helps each other get to that point. But there are several specialists in our practice at RMA that specialize specifically in fertility preservation in cancer patients.
Dr. Nirali Jain: So we have a close communication with our oncologist and they know who to refer to within the practice because everyone has their own little interests.
Michelle Oravitz: Amazing.
Dr. Nirali Jain: Yeah.
Michelle Oravitz: Um, definitely. I, like I said, I really enjoy picking your brain because it's a lot of fun for me. I, I do
Dr. Nirali Jain: Totally.
Michelle Oravitz: acupuncture, so
Dr. Nirali Jain: Yeah,
Michelle Oravitz: and I, I think that it's just so crazy that our fields don't work together. I mean, we kind of do, but I think, I just feel like it would be so great
Dr. Nirali Jain: exactly.[00:30:00]
Michelle Oravitz: the expertise because you guys have immense. Benefits like in, in, uh, technology and incredible innovations and, and then the natural aspect of really understanding the, the body. And I, I just think that it would work so amazing together if it was more of like a thing. 'cause it, I know in China they actually combine the two
Dr. Nirali Jain: Yeah.
Michelle Oravitz: eastern.
Dr. Nirali Jain: Yeah, I mean I think that that's so important and there is data that shows, you know, there's actually a recent study that came out just a few weeks ago on the benefits of acupuncture for fertility patients. And we know that, I mean, I recommend it to all of my patients, specifically the day of the embryo transfer.
Dr. Nirali Jain: We, luckily, we offer it on site at RMA and we have acupuncturists that come in and, and do a session before and after the embryo transfer, and I think. A lot of that is targeted towards stress relief. But I also think that holistically it's important to feel at your best when we're doing something that's so crucial to your, to your health.
Dr. Nirali Jain: So to really focus on the diet, focus on stress relief, [00:31:00] focus on meditation, yoga, whatever it takes to get to your best wellbeing when you're going through fertility treatments, um, is so important. So I appreciate
Michelle Oravitz: Mm-hmm.
Dr. Nirali Jain: like you that really specialize in the other side of. Of this, because I do consider it still part of the holistic medicine that we need to really maximize success for our patients.
Michelle Oravitz: Awesome. Well,
Dr. Nirali Jain: Yeah,
Michelle Oravitz: Jane, this is such a pleasure Of talking to you. You've given us some, so much great information and we've definitely dived into a, do a topic that I don't typically, I haven't yet spoken about. But, um, that being said, it's such an important topic to talk about. And thank you so much for coming on today.
Michelle Oravitz: Oh,
Dr. Nirali Jain: course.
Michelle Oravitz: I get off, how can people find you?
Dr. Nirali Jain: That's a great question. So I have, um, a social media page. I, it's called Expert nc. So like EGG,
Michelle Oravitz: I
Dr. Nirali Jain: um, expert nc. Try, tried to make it a little bit humorous. Um, but I'm all over social [00:32:00] media and would love to hear from anyone that is listening. I, you know, every, every day I get different, um, dms and I'm happy to respond.
Dr. Nirali Jain: I love hearing about everyone else's. Stories and things like that. Um, so that is kind of my main, main social media platform. Um, and then through like RMA and Reproductive Medical Associates, we also have a YouTube channel. We have an Instagram page, um, of our office available, um, as well that is public.
Dr. Nirali Jain: So you can find us pretty easily if you just kind of hit Google. But um, yeah, I'm kind of developing my social media platform as the expert and I hope it grows.
Michelle Oravitz: Love it. Great.
Dr. Nirali Jain: Yeah.
Michelle Oravitz: was such a pleasure talking to you. Thank you. so much
Dr. Nirali Jain: Thank you.
Michelle Oravitz: today.
Dr. Nirali Jain: Of course. Thank you so much for having me.
[00:33:00]

Michelle Oravitz 5/19/25 Michelle Oravitz 5/19/25

Ep 337 You’ve Tried Everything for Endo… But Have You Tried This?

On this solo episode of The Wholesome Fertility Podcast, I dive into a powerful and often overlooked connection in reproductive health, the link between endometriosis and vagal tone.

While many approaches to managing endometriosis focus on supplements, surgery, or hormonal therapies, few consider the role of the vagus nerve in regulating inflammation, digestion, and nervous system balance. In this episode, I break down how vagal tone directly influences endo symptoms, and why it could be the missing piece in your healing journey.

On this solo episode of The Wholesome Fertility Podcast, I dive into a powerful and often overlooked connection in reproductive health, the link between endometriosis and vagal tone.

I also share practical and accessible tools to stimulate vagal tone, from breathwork and cold exposure to acupuncture and mindfulness techniques. Whether you have endometriosis or are simply looking to support your fertility naturally, this episode offers actionable insights to help you regulate your body’s stress response and boost overall well-being.

Key Takeaways:

Endometriosis is not just a hormonal issue—it’s also tied to inflammation, gut health, and nervous system function.
Research shows women with endometriosis often have lower vagal tone, which can worsen symptoms.
Improving vagal tone can reduce inflammation and support digestion, egg quality, and hormonal balance.
Simple practices like belly breathing, humming, and ear massage can stimulate the vagus nerve.
Heart rate variability (HRV) is a useful tool for tracking nervous system health and vagal tone.

For more information about Michelle, visit: www.michelleoravitz.com

Check out Michelle’s Latest Book: The Way of Fertility!

https://www.michelleoravitz.com/thewayoffertility

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Michelle Oravitz: [00:00:00] Episode number 337 of the Wholesome Fertility Podcast. Welcome back to the Wholesome Fertility Podcast. I'm your host, Michelle Orbitz, and today we're diving into a powerful and often overlooked connection when it comes to reproductive health and specifically with endometriosis. And this is the link between endometriosis and vagal tone.
So that is definitely something that I haven't heard of originally when I first got into this work, and it's definitely something that you don't really see much out there. So endometriosis is a chronic inflammatory condition where tissues similar to the lining of the uterus called the endometrium grow outside of the uterus.
The tissue can be found on ovaries, fallopian tubes, and outer surfaces of the uterus, and even at times. On the bladder or the intestines, if it's really, really severe each month, just like normal, you shed the [00:01:00] uterine lining and misplaced tissue responds to those hormonal changes. So this can cause a lot of pain and it can also lead to inflammation scarring and the formation of adhesions, which are bands of scar tissues that can cause organs to stick together.
So some of the common symptoms include chronic pelvic pain, painful periods, so you can really feel severe pain where it's to the point where you can't really function when you're getting your period. It can also happen to increase pain during sex, and many times it is linked to a lot of digestive imbalances and microbiome imbalances as well.
This can often cause issues. Also trying to conceive, in many cases people might need surgery. There are many different things that people can do. Of course there are supplements that people can take. And today I'm gonna talk more about the connection between the [00:02:00] vagal tone and endometriosis. So it's really fascinating.
It's not something that you'll find often, but I'm very excited to share this. And if you wanna find out more, stay tuned.
Welcome to the Wholesome Fertility Podcast. I'm Michelle, a fertility acupuncturist here to provide you with resources on how to create a wholesome approach to your fertility journey.
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Michelle Oravitz: Episode number 337 of the Wholesome Fertility Podcast. Welcome back to the Wholesome Fertility Podcast. I'm your host, Michelle Orbitz, and today we're diving into a powerful and often overlooked connection when it comes to reproductive health and specifically with endometriosis. And this is the link between endometriosis and vagal tone.
So that is definitely something that I haven't heard of originally when I first got into this work, and it's definitely something that you don't really see much out there. So endometriosis is a chronic inflammatory condition where tissues similar to the lining of the uterus. Called the endometrium grow outside of the uterus.
The tissue can be found on ovaries, fallopian tubes, and outer surfaces of the uterus, and even at times on the bladder or the intestines if it's really, really severe. Each month, just like normal, you shed the [00:01:00] uterine lining and misplaced tissue responds to those hormonal changes. So this can cause a lot of pain and it can also lead to inflammation scarring and the formation of adhesions, which are bands of scar tissues that can cause organs to stick together.
So some of the common symptoms include chronic pelvic pain, painful periods, so you can really feel severe pain where it's to the point where you can't really function when you're getting your period. It can also happen to increase pain during sex, and many times it is linked to a lot of digestive imbalances and microbiome imbalances as well.
This can often cause issues. Also trying to conceive, in many cases people might need surgery. There are many different things that people can do. Of course there are supplements that people can take. And today I'm gonna talk more about the connection between the [00:02:00] vagal tone and endometriosis. So. It's really fascinating.
It's not something that you'll find often, but I'm very excited to share this and if you wanna find out more, stay tuned.
So now that I mentioned what endometriosis is and really the condition and how it can impact your fertility health, I'm gonna also talk about vagal tone and really what the connection is between the vagal tone and endometriosis. If you heard some of my earlier episodes, you'll know that I talk a lot about the vagus nerve and about how the nervous system is so impactful when it comes to reproductive health.
It's gotten to the point where that has become my [00:03:00] obsession as a fertility practitioner. It is so important and it really explains the yin and the yang process and really how the body's able to get into a homeostasis and regulate itself. And it's so pivotal when it comes to fertility health. So the vagus nerve is a cranial nerve, and it's the largest cranial nerve in the body, but it plays an incredibly important role.
And I've mentioned this before, but I'm gonna mention it again in case you haven't seen it before. What it does is it actually communicates with the enteric nervous system which is your digestive nervous system, and it's , hundreds of millions of neurons that go throughout your whole digestive process.
And it can be one of the causes for people having issues with digestion when there's a low vagal tone. Because it is so impactful when it comes to digestion, and one of the things that Vagus nerve does is that it impacts the parasympathetic or rest and digest [00:04:00] aspect of the body. So when your body is in parasympathetic, that is the optimal time to digest food, and it can also cause a more.
Calm state of mind where your body is not in fight or flight, but it's more regenerative. So when it is in fight or flight, it's a little bit more of a sympathetic response. Now, there's nothing wrong with being in the sympathetic response. It's not like the bad state to be in. It's actually part of our nervous system and part of the autonomic nervous system, which composes of both the sympathetic and the parasympathetic.
But when it becomes too chronic, then it can cause a lot of different problems, and the body gets into a more survival state. So vagal tone basically refers to the vagus nerve's ability to function. So the stronger it is, the stronger it functions, the stronger the vagal tone. One of the ways that you can actually measure vagal tone is through something called heart rate variability, HRV, [00:05:00] and you can see many different apps, many different devices that actually measure that.
And HeartMath Institute also discusses a lot about that, and they talk about the heart brain coherence, and they look at. Heart rate variability and vagal tone. And there was actually certain types of exercises, , that you can do to actually increase vagal tone and increase heart rate variability and also increase.
Just by doing so, heart, brain coherence. So the higher the heart brain coherence and the higher the heart rate variability, the more calm we feel, the better state that we have. And apparently in conditions of endometriosis, the vagal tone. Is actually lower. So one of the things that I would definitely suggest if you do have endometriosis is to improve that vagal tone.
And I'm gonna be discussing many, many different ways to do that. So as we know with endometriosis, one of the things that it's linked to is [00:06:00] digestive issues. And the higher the vagal tone and the better the biggest nerve is functioning, the better it can talk to and basically communicate with the enteric nervous system, which is really your.
Digestive nervous system. And so we know that when we stimulate the vagus nerve, it can actually improve your digestive system. And when that happens, you're not only improving your ability to take in nutrients, but you're also decreasing the inflammation in the body, which is really pivotal when it comes to not just endometriosis, but egg quality and overall.
Fertility health. So this is something that anybody who's going through the fertility journey, male or female, can benefit from regardless if you have endometriosis or not. So just to kind of go back on the endometriosis topic, one of the ways really the only true way that you can know if you have endometriosis is by getting [00:07:00] a laparoscopy.
It is a surgery, so I'm not saying to go and do that. However, if you suspect that you might have endometriosis based on inflammation, gut imbalance, really strong menstrual pain, pain with periods and kind of lower back pain around that time, then you could still do this because you're gonna benefit from it anyway.
So I would go and talk to your doctor if you do suspect that you have endometriosis to get your options. So besides looking at heart rate variability, you may kind of realize if your heart rate variability is high or your vagal tone is high based on how well you get back from really stressful situations.
So if you are the type of person that. Gets anxious pretty easily. Startles really easily has like an off nervous system, gets really nervous around people. That's okay to a certain extent, if it's not [00:08:00]chronic, if it's not something that's really impacting your life. But if it is impacting your life and it's something that happens and when you get out of those environments that trigger that.
You continue feeling like that, that may mean that you have a lower vagal tone, which means that you're not able to adapt from one state of stress to a more calm state of your nervous system. So while that doesn't confirm heart rate variability, and ultimately the best thing to do is really to measure it, and you can measure it with many devices like even, or ring, you know, there's many devices that actually track your body and your heart rate variability.
And that would be the ultimate way to confirm it, but there are definitely symptoms that you can feel as well. So studies do confirm that women have a lower vagal tone if they have endometriosis, and that a lower vagal tone is also linked with higher inflammatory conditions. , some of the things in life that can impact [00:09:00] vagal tone really do have to do with high stress.
So if you're constantly exposed to high stress in your life, that can impact your vagal tone. And also, I've mentioned this before, it's really important to know that if you do have high stress. It's not the end of the world if you have some stress, but high stress chronically can really impact your overall health and it can also throw off your nervous system balance.
So even if you have IBS or any kind of gut conditions or inflammation or bloating, I'll be covering things that will also benefit you as well. So what's pretty amazing is that there have been studies, actually animal studies that have shown that increasing that vagus nerve stimulation, which will improve the vagus nerve function has been shown to decrease lesions in animals of endometriosis.
This is thought to be because vagus [00:10:00] nerve stimulation can regulate and decrease inflammatory markers in the body. So I'm gonna cover a few ways that you can stimulate your vagus nerve overall. I. So breath work is amazing and it works with the diaphragm, especially belly breath. So as a child, you probably knew how to breathe. You'll see babies breathe from their bellies because that belly breath is actually the way we're supposed to breathe.
But as we get older, we actually learn habits that are not really great for breathing. So belly breath is really good. So you could put your hand right underneath your. Ribs, which is where your diaphragm is, and start to use that, really the diaphragm as a muscle and breathe in and out and do this a couple of times a day to retrain yourself.
To breathe from the belly. I remember not doing that. And then years ago, learning and retraining myself to the point where it became unconscious and I was just a [00:11:00] belly breather. And it really impacted how I felt in general because I used to have generalized social anxiety. And I remember going in for body work.
A massage and the woman said, oh, you're a belly breather. So it, it is something that I was like, oh, I'm so happy. I'm so proud of myself that I actually trained myself. I wasn't even focusing on trying, and she noticed it. So it is something that you can train yourself. It's a habit that we have. It becomes unconscious.
So just like a good habit can become unconscious, a bad habit can become unconscious, but you can also change that bad habit to a good unconscious habit. So I've talked about slow, deep breathing, but you can also do something called box breathing, which is inhale to four, hold to four, exhale to four, and then hold out to four.
And then you can slowly increase that with time. I remember when I used to teach Kundalini yoga, we had something called, it was like the meditation [00:12:00] aspect of the yoga training, and it was something called the 16 seconds.
breath. We would breathe in so it's not quite the box. It would breathe in to 20, hold for 20, breathe out to 20 and that's 60 seconds.
And doing so really calms the mind. And of course you'd have to work yourself up to doing that and not do that right off the bat. 'cause it is very hard and it is a practice you have to build up to. So another thing that can help stimulate the biggest nerve is cold exposure. Now with Chinese medicine, you may have heard me say that it's not really great to have chronic cold exposure.
So I often tell people, keep your feet warm or put socks on and don't put your feet on cold tile. Now this is. A chronic thing, this is doing something day in and day out. And also we do have our first kidney point on the bottom of our feet. The kidneys are in charge of our reproductive health, so you don't want that coldness from the tile to come up from the feet [00:13:00] into the channels.
So this is why I say that for a day in and day out. But once in a while, you can give yourself a little cold exposure. Doing so, like maybe doing a quick cold shower once in a while is okay. Now, if you are, of course this isn't for everybody. If you are somebody who tends to be cold all the time, this may not be for you.
But what they do find is that that quick stress effect of the cold exposure, like even a cold plunge. Can actually stimulate the vagus nerve. So it's a quick stress response. And then the body goes from stress, which is the sympathetic to parasympathetic. It starts to stimulate that nervous system regulation.
Another thing that can really be beneficial is gargling or humming. And I personally love to ohm. If I feel really stressed, even if I'm driving, I just om or hum what humming does. Is, it actually slows down your breath. And you may have heard me say this before in [00:14:00] previous episodes, is that when you breathe slow and deep, you actually calm your nervous system.
So, and especially your exhale. So the longer your exhale, the calmer your nervous system, and the more it's gonna go into parasympathetic mode. So when you're inhaling and you're exhaling with a hum, it slows it down. It actually stops it from being cleared fast. Of course, meditation and mindfulness. Now, what meditation does is it really gets us to a state of receptivity and a state of listening.
When we're in meditation, we're paying attention to ourselves, even ourselves, when we're anxious or we're feeling uncomfortable. When you're feeling that sensation, it's almost like a somatic acknowledgement of your body sensation, so you're aware, you become more aware. Of what happens when you are feeling uncomfortable, and then having those times during the day is really beneficial for that mindfulness to increase.
Because the more [00:15:00] you give yourself opportunities to pay attention to yourself, your mind, your body, how it feels, the more mindful you become, the more you can get really tuned in with your nervous system. And that awareness has been shown to really improve your overall physiology, which in turn. Can help your nervous system regulation and your vagal tone.
And of course, one of my favorites is acupuncture. Acupuncture can help tremendously, and we actually have a bunch of points that I use often to stimulate the vagus nerve, and part of it is an ears. So another thing that I would suggest if you can't get to acupuncture is just massage your ears or even massage your feet.
Anything that really stimulates that calming effect. The ears are one of the ways that we can access the vagus nerve. So I hope you enjoyed this episode, and feel free to share this with anybody that you think can benefit from this information. [00:16:00] It is information that you may not often hear. I haven't heard about it before until I stumbled upon it and I was like, Hmm, that's very interesting.
And then the more I learn about the nervous system, the more impacts I see that it has over reproductive health. So I hope this was beneficial for you and. If you ever have any questions, ideas, or thoughts for future episodes, you can always reach out to me and DM me on Instagram where I am very active and my handle is at the wholesome lotus fertility.
So thank you so much for tuning in, and I hope you have a beautiful day. So that concludes today's episode. You can find all of the links mentioned on the episode notes. If you're enjoying these episodes, please take a moment to share and leave a review. Reviews mean everything to podcasters and I really enjoy hearing from my listeners.