Fertility Foundations: Is IVF the best option for PCOS? with Sarah Nash
Welcome to the latest series of Fertility Foundations, where we speak in depth with expert guests about how to prepare the foundations for healthy pregnancy. This week Sandra Greenbank is talking to Sarah Nash, a registered Nutritional Therapist who specialises in PCOS, about IVF as a first-line treatment to try and conceive with PCOS.
Sarah is passionate about supporting and educating women with PCOS and their partners on their journey to parenthood. In this episode Sandra and Sarah discuss the difficulties of diagnosing and treating PCOS and the need for a holistic approach to addressing the root cause and key drivers in each individual case. Sarah’s own PCOS diagnosis in her twenties led her to specialising in this area and, now a mum to two children, she uses her knowledge and experience to support her nutritional therapy practice.
You can find Sarah’s website here: www.sarahnash.co.uk
Or find her on Instagram here: @sarahnash_fertility
This podcast is sponsored by Invivo Healthcare, a human microbiome company. They specialise in accurate testing of different microbes such as the gut, vagina, oral and urinary, as well as a range of specially curated supplements focused on the microbiomes. They support healthcare providers and their clients navigate the complex world of the human microbiome and it’s one of the most used labs and supplements by our own fertility specialists at the Fertility Nutrition Centre. Visit the Invivo website for more information at www.invivohealthcare.com.
Podcast transcript
Sandra Greenbank 00:06
Hello and welcome to the Fertility Foundation’s podcast where we go into detail about how to prepare the foundations for healthy pregnancy. We dive deep into the underlying root causes for fertility issues and natural solutions. I want you to know that you’re not alone and you’re not broken. I hope that by sharing these episodes, it will help you move from feeling overwhelmed and lost to feeling hopeful and empowered to take charge of your own path to parenthood, because there are actually lots of things that you can do to help rewrite your own story. I’m Sandra Greenbank, Nutritional Therapist, Functional Medicine Practitioner, coach and educator specialising in fertility, pregnancy and postpartum health. I’m also the founder of the Fertility Nutrition Centre, where you can find fully trained experts in nutrition, lifestyle and functional approaches to healthy fertility and pregnancy. You can find out more information over at www.fertilitynutritioncentre.org and also begin a free strategy call with one of our experts.
Today I’m speaking with Sarah Nash about IVF as a first line treatment to try and conceive with PCOS. Sarah is a BANT-registered Nutritional Therapist helping women with PCOS manage their symptoms and increase their chances of conception. Diagnosed with PCOS in her late twenties, it was Sarah’s own fertility journey that led her to nutritional therapy and showed her firsthand the impact that personalised nutrition and lifestyle changes alongside targeted supplementation can have on a couple’s ability to conceive. Now a mum of two daughters she is passionate about educating and guiding women who struggle with PCOS and their partners on their journey to parenthood. Sarah takes a holistic approach in her work with clients, digging deep into their medical history and current symptoms to uncover and address the root cause and key drivers behind their individual PCOS picture.
This podcast is sponsored by Invivo Healthcare, a human microbiome company. They specialise in accurate testing of different microbes such as the gut, vagina, oral and urinary, as well as a range of specially curated supplements focused on the microbiomes. They support healthcare providers and their clients navigate the complex world of the human microbiome and it’s one of the most used labs and supplements by our own fertility specialists at the Fertility Nutrition Centre. Visit the Invivo website for more information at www.invivohealthcare.com.
Now let’s get into today’s interview with Sarah. Hi, Sarah, thank you for joining me on the podcast today.
Sarah Nash 02:30
Hello, thank you so much for having me.
Sandra Greenbank 02:33
Please could you introduce yourself for those who don’t know you? Yes.
Sarah Nash 02:37
So I’m Sarah. I am a registered nutritional therapist. And I work with fertility clients, mainly with women who have PCOS and are trying to conceive. Okay,
Sandra Greenbank 02:49
and you’re one of my practitioners in the Fertility Nutrition Centre group as well. So obviously, I know you very well. And your special interest is in PCOS and what made you decide to specialise in that area particularly.
Sarah Nash 03:03
Um, so it was really my own fertility journey and my own PCOS journey. So I was diagnosed with PCOS in sort of my late 20s, I want to say maybe, sort of around 27, 28. When me and my husband were thinking about starting a family and we had sort of been trying for a little while and nothing was really happening. So I went to see their GP who then obviously sent me for multiple tests, and I had an ultrasound and they they had confirmed the PCOS diagnosis and they offered me kind of ovulation stimulation drug, I think it was Clomid at the time. And I didn’t really want to take it, I’ve never been sort of a big fan of taking medications. So it wasn’t really something that I wanted to do. And I, I think deep down I kind of felt there must have been a different way or, you know, a more kind of natural way of going about this. So we just kind of waited for a bit and you know, that have put it in the back of my mind. And we just carried on trying for a while. And just Yeah, absolutely nothing happened. At that point. It had probably been about two years. And I was just getting to the point where I thought I just don’t know what to do anymore. And you know, this is something that I come across with PCOS clients all the time now that there’s just no support from the GP, they kind of diagnose you and then they send you on your way, you know, maybe with a drug to take but there’s nothing no sort of no kind of advice or suggestions on what to do you say. I then kind of started trawling through the forums, you know, and then obviously you go down this little rabbit hole of trying different supplements and you know, to trying all these different things that people recommend. And that also wasn’t working. And then I just really randomly came across a nutritionist and I, you know, I just thought I haven’t got anything to lose, and I’m just gonna go and see her. And just kind of talking to her was so yeah, it was just amazing. You know, I think firstly, just the fact that she cared, she was listening, she wanted to know what was going on. She then sent me for some private blood tests. And then she, you know, she just had malnutrition. And she spoke to me about my lifestyle. She put me on a supplement program, and I was pregnant in three months is
Sandra Greenbank 05:44
the usual story. It’s like what you know, and then what people get to say, as I wish I’d come to see you for you know, as soon as I knew there was a problem. Yeah.
Sarah Nash 05:54
And I think that’s sort of one of the main things for me, you know, most of the clients I work with will come to me and they say, I’m ready to try anything. Now. It’s been such a long time, and nothing has worked. And I’m just throwing everything at it. And I think, for us, you know, especially from the FMC from the fertility Nutrition Center, it’s very much about getting the word out there and kind of encouraging women to see it as, as a first step rather than a last ditch attempt, because then we have so much more power and more time. And, yeah, I think it’s important to get the word out,
Sandra Greenbank 06:33
yeah, get your ducks in a row. Because whatever happens if you don’t get pregnant naturally, or if you have to have some treatment, whatever that treatment might entail, you’re going to be in such a better place physically and mentally and emotionally, to not just get more positive results, but also cope with it better, you know, because it’s tough, isn’t it? And so, when you when you went before you went to the GP and before you started to conceive, did you have any inkling that there was something going on? Do you have any symptoms? So
Sarah Nash 07:11
I have always had really irregular periods, or I guess, when they always I guess it was this, you know, you start getting your period, and it was always wacky. And I just thought that was sort of part of the normal process. And then I started going onto the pill. So that obviously, I think everything is fine, but you know, looking back, and in hindsight and knowing what we know, now it’s the you know, the pill, it’s not, it doesn’t regulate anything, it just cupboard going on. And then when I stopped taking the pill, my cycles were still really wacky, but I was always kind of putting it down to the fact that, you know, I had just dropped the pill and probably things were okay. And I sort of, yeah, I didn’t really I knew something wasn’t 100%. Right. But I had no sort of idea that it would be PCOS. And I think I hadn’t really spent a lot of time looking into it really, I just, you know, you sort of go into anything, everything will be fine. And we were young. And I just said, Oh, this will be easy for us. And then yeah, it’s it’s easy until it’s not.
Sandra Greenbank 08:21
That’s really interesting, actually. And yeah, some people you know, there’s the classic symptoms that things like facial hair grows, or you know, testosterone related symptoms or difficulties, weight. But you’re right, if you don’t, if your symptoms are quite diffuse, and yet they’re just irregular periods, and you’ve been on a pill for 15 years, you have a quote unquote, period, which is just a false bleed, and you might have no idea at all. And then what did your GP do today? Just send your first scan and blood tests.
Sarah Nash 08:59
Yeah, they just sent me for a scan and blood test. I don’t remember quite what came back from the blood test. But I know that they diagnosed me based on the ultrasound where they could see that the stroke, those sort of, you know, I know they call it stiff but fuzzy is like under mature follicles, a lot of them. And it gives us sort of sift like appearance. Right now we know that, you know, we should be diagnosing based on the Rotterdam criteria, and there’s different things that they should be looking at. But I think I mean, I think things have come on so much like at the time, I think it was all a little bit slapdash. You know, this is 15 years ago now. But yeah, that’s that’s what
Sandra Greenbank 09:47
happened. Did they ever talk to you about IVF? Because that’s usually kind of like the bonus.
Sarah Nash 09:52
They didn’t actually, they didn’t then they just offered me the medication and I declined. And, and then yeah, they just send me on my way. So there was no, no signposting, no. No support in any way at all at the time.
Sandra Greenbank 10:11
So I think this can be very sort of dependent on your GP surgery and also individual GPS within the same surgery as well, and what support they offer and what they the, you know, the guidelines, I suppose if they’re following the guidelines, they are quite clear, and you know, the only option really, is to try some drugs. And then if they don’t work, let’s go for IVF. And so what are your Where did you come into that? And how do you support these women? But women, I mean, you know, that it always takes two to tango, and I don’t want to say you just put in the woman but you know, specific diagnosis is with the female. And then that does never mean that the male partner is also, you know, off the hook. But,
Sarah Nash 10:55
ya know, no, that’s exactly right. And I do always encourage my client to bring their male partners along, if they’re willing to because you know, like, you say, it does take two to tango, and only because the female might have a PCOS diagnosis, that doesn’t mean that there might not be something wrong with that there’s not any room for improvement. And yet to see someone where there’s not any kind of room for improvement, there’s always something that we can do. But yeah, so I support them, you know, in a few different ways. So obviously, I look at their nutrition and with PCOS, specifically, one of the kind of key hallmarks of that is insulin resistance. So that inability to, to efficiently balance our blood sugar levels. So, you know, when I look at insulin resistance with clients is very much about looking at the composition of our meals, they’re making sure that loads of protein in there, loads of healthy fats, lots of lovely, brightly California, vegetables, all of those kinds of things. It’s just, it’s just about making sure that you put your meals together in a balanced way. And then we also look at gut health, because we know that we need a healthy gut for healthy hormones. So you know, we’re looking at probiotics, and prebiotics, prebiotics, that things like onions, and leeks, and garlic, eggs, legumes, soy beans, and lentils, and things like that. But also making sure that we avoid any kind of inflammatory things. So making sure we don’t have too much sugar alcohol, not too many sort of processed foods, making sure we tried to cook from scratch as much as we can. And, you know, it’s also about making sure that they have an adequate nutrient intake. So obviously, depending on our preferences, what we like to eat, what we don’t like to eat, we all have our own individual nutrient gaps, it’s about making sure that we lack those gaps, because, you know, our body obviously, needs an adequate amount of nutrients to function properly. But also, kind of looking forward because we’re doing this hoping to increase chances of conception. So, you know, pregnancy is so taxing on the body, it requires a huge amount of nutrition. So it’s, it’s really important that we just build up those nutrients stores, you know, in preparation for pregnancy.
Sandra Greenbank 13:38
There’s some classic ones that are almost always missing and PCOS isn’t there like vitamin D, for example, which is independently so important for fertility. So it could it could be that like I said, plug in those gaps actually, take gets you a really, really kind of fall on your way to being able to get pregnant, but also, you know, once you are pregnant, the body does adjust so that your digestion and absorption increases. And you do get more from the food that you eat. But actually, if you haven’t got enough in your stores are coming in, baby tends to get what baby needs at the expense of mum and so actually for you to stay well be well and stay well throughout pregnancy. And also post pregnancy is a key concern for us because as long as mom as well, baby will be well and looked after. And this is kind of like sometimes a bit of a leap for people to because they think they want that positive pregnancy test and the rest is sort of not irrelevant, but it’s kind of like not even it’s not on the radar and it’s like you know, we really want to do all have it and that’s also part of why we take some time isn’t it sort of really allow you that time to get yourself up to up to scratch? Sorry, I
Sarah Nash 14:58
interrupted you there but yeah, No, absolutely. And I think, you know, if you go into pregnancy already kind of on the cusp of depletion, like you say, baby will take what it needs and then in that phase really, really hard to, to get your levels back up. And, you know, having those kind of nutrient levels is not just important for obviously, the baby’s development. But it’s also helping you then to feel better throughout the pregnancy. Because if you’re running out of different things, then that will manifest in just not feeling great not having energy, you know, all of that kind of
Sandra Greenbank 15:42
pre or postnatal depression. You know, what to think, to makers, all of those important nutrients, which is so important for baby but so important for moms brain health, as well. And you know, they’ll be baby brain phenomenon, which I think is definitely because baby just take so much. Yeah. And we still fats in our brain was still the healthy fats in our brain. And that’s where it’s going to come from, if it’s not in your diet.
Sarah Nash 16:07
Yeah, absolutely. And I think actually, you know, getting those healthy fats into your body, just through diet alone is really hard. So I yeah, I would always recommend a really good Omega three supplement, anyway, because, yeah, I mean, really, unless you eat like oily fish, you know, three or four times a week, it’s difficult to get to those levels that you need, particularly in pregnancy. But also, you shouldn’t be
Sandra Greenbank 16:39
in oily fish three or four times a week if you’re pregnant, because it’s highly contaminated. So yeah, it’s tricky. Yeah, it’s definitely that balancing. But you know, it’s such an easy thing to check as well, your Omega three levels versus other fats, and yeah, blood test to
Sarah Nash 16:55
see. Yeah. And actually, then on that topic of contamination with fish, you know, it’s just as important when you look for a supplement that you really go for something that is of really high quality and as pure as it can be. So you know, and that is something that I talk to clients a lot is, when you look at supplements, you it’s actually one of the things where you do get what you pay for, you know, obviously, there’s a huge amount of things that you can just, you can just go into boots, or Holland and Barrett and there’s loads of things that you can just buy there. But a lot of the times, they’re just, you know, the dosages that they’ve on therapeutic, or the ingredients are quite good quality as we’d like them to be, and particularly with fish oil, you know, or omega three, that’s, that’s the really important point.
Sandra Greenbank 17:49
Yeah, and there’s very few brands that we would use this now and they’re all independently but that’s checked for contaminants, and you can check, you can look those up. And, you know, that’s, that’s obviously an expense for the company producing the fish oils, which is, you know, it is passed on to you, but it gives you that safety, in the knowledge that you’re not inadvertently getting a load of, you know, whatever the contaminants may be, which, sadly, is in fish now.
Sarah Nash 18:14
So,
Sandra Greenbank 18:16
we touched a bit about bit on the fact that the man, if you’re in a, you know, a couple with a man, man and a woman trying for baby, it’s not always the case, either. But you know, and I think that, you know, as soon as a problem is found with one of the partners, or the other checks, stop, and I just think actually, you know, you, you might have PCOS, but that might not even be the reason for you not getting pregnant, because if you’re ovulating, even if it’s once every two months, you know, you are actually potentially able to get pregnant. And the reason why you’re not getting pregnant could be to do with something else. Yeah, yeah. So, you know, men don’t have to go through anything invasive, hardly ever, you know, all we need is a sample in a pot. You know, and you’d be checking the usual, you know, usually use of similar analysis and probably a DNA fragmentation test. I mean, ideally, that, and what do you think about that?
Sarah Nash 19:18
Yeah, yeah, really important. And I always recommend at least a standard semen analysis through the GP, that we can get an overall idea already of what’s going on. And, you know, we know that semen parameters falling off a cliff. So it’s, it’s really, really important to look at that and with DNA fragmentation, you know, I, I wish that was just part of the NHS testing routine, because it’s, it’s just so important to look at that and, you know, when we get back, a semen analysis, it could be looking great, but actually there could be quite Got a lot of DNA fragmentation going on which then obviously, it’s really detrimental for the ability to conceive. So yeah, it’s, you know, I recommend it a lot. It’s, yeah, it’s very dependent, obviously on, on the willingness of the client to do it.
Sandra Greenbank 20:20
Yeah, that’s true. Getting both people in can sometimes be a struggle, but not, not always. But I think that, you know, you know, the more you can make it a joint effort to work together to change your lifestyle to get to the bottom of what’s going on, you know, is, the better you’re going to, again, not just, you know, your results wise, but you’re just going to feel so much better and emotionally, if you can actually feel supported by your partner. And, yeah, these costs, this test costs money, but ultimately, nothing is going to be as expensive as an IVF. Round. Yeah, exactly. Right. And will cost anything like IVF? So, yeah,
Sarah Nash 21:01
yeah, absolutely. And, you know, even if you funded going on an NHS funded IVF course it’s doing those kinds of tests will only increase your chances. Because if you find out that there’s something going on, then you can work on that, you know, if you go in blind, then you might find it doesn’t work. And if only then you go for testing, you’ve already lost that round. And is a huge amount of money.
Sandra Greenbank 21:32
Yeah. And so what would you say some of the challenges are, women are facing them. And when there’s firstly fun, trying to manage their symptoms, which can be quite one of the main symptoms, that actually one of the main things that sort of pushes people to come and see us because this, you know, I think it feels obvious that we can help is the difficulty in losing weight. And so weight gain or trying to lose weight associated with food, and that’s what people understand that we can help them with. So that you know, and that that’s often what I see is, I’ve been told to go and lose weight, because I have to, you know, so that I can get on the IVF treatment list. But I’ve tried to lose weight all my life. And I don’t know how to do it without starving myself.
Sarah Nash 22:18
Yeah. And, you know, with PCOS, and I can say that from personal experience is not about dieting. So you know, a lot of the clients I see already have an amazing diet. So, you know, you, if you look at it on paper, you say, but you should be losing weight, you know, you’re doing this and you should be losing weight. But actually, what’s really important with this is working out like what is your individual root cause that is driving that PCOS for you. So, you know, even though we’re looking at all these women, and they all have PCOS, they all have really varying symptoms. And the underlying drivers can be really different. So we know that there’s four different types of PCOS one is mainly driven by insulin resistance, then we’ve got inflammatory, PCOS, adrenal PCOS are very much stress related. And also post pill, PCOS, which, you know, can be caused by hormonal contraception. And depending on what you kind of underlying thing is your underlying cause that’s really what you have to look at. So, you know, if we assume someone is already having an amazing diet, but they’re not paying attention to their insulin levels, if they’ve got insulin resistant PCOS is then really about kind of going in and making sure that we work on that. So you know, in that case, is probably increasing protein then doing things like going for a walk after meal to kind of help balance blood sugar levels, and, you know, just kind of digging in how they’re, how they live, what their lifestyle is, and just sort of picking out where they can do different things to support that. And equally, you know, if you have adrenal PCOS, you could be eating the most amazing diet, but if you’re not managing your stress levels, then you’re not getting to the root of the problem. So you know, and that’s, I think that’s, that’s all we all do at the fertility Nutrition Center. It’s about personalized, targeted recommendations. So you know, we look at everything we look at their medical history, we look at their current symptoms, we look at their diet, we look at what they do for work, you know, what are they exposed to like, where their touch point Square, environmental toxin, all of this kind of things. And from that, then we get an idea of what’s actually going on. And then obviously, to support that we also offer lots of different functional testing that sort of goes really above and beyond what they would be offered by their GPS routine screening. Yeah,
Sandra Greenbank 25:20
absolutely. And I think, you know, a lot of people will understand that. One of the main ways to address PCOS via diet is to go on a low carb diet. And like you say, if you’re, if your PCOS is adrenal driven, and you’re going on a super low carb diet, but you’re still stressing and not sleeping properly, the low carb is probably going to be an additional stress on your body, and then it’s going to change your metabolism, because that’s a natural, that’s a natural response. And that’s what your body’s supposed to do. So often, your body’s doing something, which is a natural, which is what it’s supposed to be doing in any given circumstance, and you have to then look at the circumstance and change it to change your body’s response and kind of say, you know, this is what’s going on. And, and, you know, because it, it’s ultimately governed by your brain, because the brain listens in on a feedback loop, and listens to hormones, and, you know, your emotions and everything in the blood sugar, everything that’s going on is communicated back into the brain, and then the brain makes the decisions off the back of that, in terms of, you know, is this a good time to have a baby, or, you know, so we’re just kind of looking at what signals are going in and pushing and maybe pulling and pushing some levers to try and support your body to do what we wanted to do, ultimately, which is to feel safe to have that baby. And the same, you know, if you’re going into starvation mode, and over exercising, that is not sending signals to the brain. Yeah. And and also, the other thing I think about reducing carbs is in a diet is one way to reduce your insulin levels. So we’re talking about, you know, when we’re talking about insulin resistance is about addressing, firstly, reducing insulin levels, because high insulin is inflammatory. And it’s a process that we’re just we don’t want to going on. But that’s only one. One piece of that puzzle with insulin resistance, the resistance issues with the cells themselves, and how the cells operate, and how the cells are responding to the insulin that’s in the bloodstream. And if they’re not responding properly, again, the brain is just going to scream, scream louder by putting in more insulin into the into the probe into the circulation. And so, you know, fixing that on a cellular level, it’s actually all to do with diet, exercise, and lifestyle, isn’t it? Yeah,
Sarah Nash 27:55
absolutely. And I think that point you’re making about, you know, eating a low carb diet can be stress on your body. I think that’s really interesting. And I think that’s something that a lot of people are not really aware of, you know, that when we talk about stress, and I find stress is always involved in a PCOS picture for multiple reasons. But, you know, when we talk about stress, what we think of is this work stress or financial stress, or relationship stress, but actually, there’s a huge amount of physical stresses going on all the time that we’re not even really thinking of. So you know, like you said, not eating properly or over exercising is really stressful for the body and the body can’t distinguish what kind of stress you’re experiencing, their response is always the same, you know, in the responses that you’re kind of digestion and any, any kind of system of your body that is not immediately required for the Bible that’s down. So you know, it’s going to affect your digestion, it’s very much going to affect your reproduction, because your body is suddenly in a phase where it’s saying, but I’m, I’m under attack. You know, I’m not saying, though. Stress. Yeah, is a huge factor in PCOS and something that we Yeah, that we really need to look at more closely with everyone.
Sandra Greenbank 29:25
Yeah, and I think that some actually recognized and stress is also sometimes, you know, a little bit misunderstood because somebody might be, you know, there’s the fight. And then there’s the flight, but it’s also the phone, which I think we forget, and if you’re somebody who sort of goes I feel so overwhelmed. I don’t even know where to start. And then you ended up doing nothing and you’re procrastinating an art. Yeah, that is the stress. That’s the symptom that you’re actually so stressed that you’re you’ve just kind of flopped and and your body’s going. I can’t actually cope anymore. And, and also equally that person who’s like, yeah, I exercise and I feel great. And you know, exercise is good and more can only be better. And it’s like, oh, you know, and that’s almost the hardest to convince people that know you need to do like yoga instead of like, the spinning three times a week. And, you know, yeah, just really looking at. Again, like, what, what, what are you putting out? And you know, what, what’s the response to that? So yeah, I find it. So, you know, and this isn’t an overnight thing is that either with PCOS is, especially PCOS, we always want three months at minimum with people because it does take that amount of time to mature a batch of eggs and, you know, but with PCOS, it can, I think can take a little bit longer. Yeah,
Sarah Nash 30:53
and, you know, I always say that PCOS is, if it doesn’t come overnight, PCOS doesn’t come overnight is years in the making. You can’t expect it to, like, be fixed overnight. So you need to give it a bit of time. But what I find really important as well, as, you know, particularly with women who, who are under a certain amount of pressure, to lose weight, to be able to get them to that IVF list, they are trying to lose that weight so quickly. And we need to sort of bear in mind that actually, our adipose tissues, fat tissue is where all of the toxins are stored, that can kind of deal with, you know, everything gets stored in the fat tissue. So it’s really important that we lose that weight in a sustainable way, not just to keep it off, but also to kind of have a really slow release of that adipose tissue. Because otherwise, you know, if you lose weight so quickly, then all of these kinds of toxins are released at once. And then there’s another kind of stress and another issue for your body. So you know, I completely understand this. But I want to get on that list, and I want to lose it quickly. But there’s just a little bit more to think about with that
Sandra Greenbank 32:16
loss. True. And actually, it’s delivered that has the bulk of that work to deal with those toxins and actually deliver so important. When if you are going going to be prescribed medication as well, you know, that’s another thing that the liver is got to deal with. And we don’t want to end up with a bottleneck that sort of, then it spills over. And, you know, yeah, it’s just another reason why you need to work with a nutritionist. Make sure that your detox pathways are properly supported that your guts functioning so that, you know, the toxins are excreted instead of just staying in the system. And yeah, so lots of challenges, but also actually lots of things that you can do, which is, you know, really so empowering for people. And so if, say, you’ve been working with somebody, and they they’re not getting pregnant naturally, what’s the next step for
Sarah Nash 33:14
them? So, I mean, if you know if someone has PCOS, and they, I guess, sort of, if they’ve already worked with me, and, you know, if they then need to go through IVF, for whatever reason, then obviously, we will support them through that, and the kind of changes that we make, you know, even if it means they won’t be able to fall pregnant naturally. And, you know, there’s lots of reasons for that, obviously, there could be something structural going on, or you know, later things like that, then, yeah, we’re there to hold their hand through that IVF process, and help them through it and work with that clinic to support them that way. If they don’t know that we’re here, and they are trying to they’re trying to fall pregnant, you know, for them, then obviously, a lot of people will go to the GP and then the GP will send them for fertility treatment or, you know, I guess the initial step a lot of the time is they will go in and they will be prescribed a Becker stimulation drug like a relation stimulation direct, or Metformin tends to be the kind of drug of choice now I find and, you know, again, the way in which that works is it helps to balance blood sugar but like we’ve already mentioned earlier, if if blood sugar, if not your sort of underlying issue, then those kinds of things don’t tend to work and I you know, I see in clinic, Metformin has got really mixed success rates. So for some people, it works great for some people, it
Sandra Greenbank 35:05
doesn’t work at all.
Sarah Nash 35:08
So, yeah, it’s again, it’s very much about finding that root cause, you know, but if they then go through this Metformin treatment, that doesn’t work and they get referred to IVF, then there’s also often just a huge amount of waiting. And it’s that kind of waiting time that you can be really proactive about, you know, in that time, that’s a great window to then come to see someone you know, like ourselves from the fertility center, who can sort of support you, and may change it and really set you up for that IVF cycle so that you’ve got the best possible chance.
Sandra Greenbank 35:47
Yeah, I think I was actually recommended Metformin in pregnancy, because I had gestational diabetes have a very strong family history of diabetes in my family. So it wasn’t surprising that that was an issue for me in pregnancy. But what tends to happen is, your insulin resistance gets worse, the larger your weights, waist circumference. And as your belly grows in pregnancy, your insulin resistance increases. So the problem with going into pregnancy, already needing Metformin because your insulin resistance is a problem, you’re going to need more and more and more probably in pregnancy, if you don’t address the diet and the lifestyle and the cellular uptake. And you know what your diet is doing to actually push the insulin high in the first place. And then, you know, eventually, you might even end up on injections towards the end, which, you know, supposedly is fine, and you know, safe and all this, but it’s not, it’s just not a nice thing to have to do in pregnancy. And, you know, regardless of the safety data or not, as you know, like, it doesn’t feel good to be on a drug when you’re pregnant, because you will be worrying about your baby. And particularly if you’ve had problems getting pregnant, your anxiety is higher already. So I just think there’s so many reasons why you might want to try something else. First, before you get to that point of trying them out for me, because, you know, this, there’s just so much that we can do. And even something like inositol, you know, has been found to be possibly more effective than that for men. And but once you’re on a drug that’s doing something we can’t even use, we shouldn’t really be using a supplement that does the same. So you know, because then you sort of doubling up on the action. And it’s, it might be a detrimental. So it’s just so important to sort of really have a go and try everything before you go down that route. I think personally, and you know, just from my own experience, as well. And but there are some other risk factors as well, I think with PCOS that sort of come later, potentially during IVF. And during pregnancy, that we can also try to mitigate by just pulling back as much as we can before we go into it. So can you talk a little bit about that?
Sarah Nash 38:19
Yeah. I mean, women with PCOS are just generally at a higher risk of developing sort of certain health conditions through our lives. So particularly, you know, type two diabetes and things like cardiovascular disease and high blood pressure meant even things like certain endometrial cancers. So, you know, even if you have PCOS, and fertility is not your main priority. There’s so much to be said, for kind of making sure that you learn to control your symptoms, and you learn to support your body because you are really investing in your future and your health. And, you know, if we are looking at fertility as the main priority, then, you know, obviously, yes, is there’s a huge amount that we want to do to be able to increase the chances of conception, but also we know that the health of a couple at the time of conception has got an effect on their lifelong health of their baby. So you know, investing in your health that way means that you’re not only giving yourself the biggest chances of success when it comes to conception, but you also know that you’re making an investment in your children’s health, which, and they can’t be underestimated, like that’s a massive thing. There’s
Sandra Greenbank 39:54
actually some new data that shows that babies are exposed to higher levels of testosterone in utero are more likely to develop to develop PCOS. Yeah, I think, you know, it may not even be it’s probably partly genetic, but also partly to do with your exposure in utero. And it’s just so interesting. And that’s just another reason why you just want to, you know, and it’s all about the epigenetic imprinting that you’re doing on your baby during the egg development during the sperm development during pregnancy. And that window of opportunity is, you know, when it’s gone, it’s gone. Yeah. Yeah. And if you have gestational diabetes in when you’re pregnant, your children are at high risk of developing diabetes in their lifetime. So yeah, there’s just so many, so many reasons, but also the risk of hyper stimulation with IVF drugs when you’ve got PCOS. And also the high risk of preeclampsia. Yeah,
Sarah Nash 40:59
yeah. Absolutely. Yeah. And I think it’s really interesting. You know, another point where you’re mentioning this sort of link of the children developing PCOS, and I’m, there’s definitely a strong family link. And, you know, personally, I can see if I look at my mom, she’s not been diagnosed, but I can, it’s almost like, I can sort of see, you know, it’s like, do you think if you were to kind of check now, you might have PCOS, and I have two daughters. So there’s definitely a part of me that things, you know, are like, I wish I had put more time into this before I fell pregnant. I just wasn’t aware. You know, and it’s, like, now I know better. So I do better. But for me, it now means I look at my children and I, I do everything I can now to support them already on their journey. You know, like, I never use plastic bottles, or mela mine blade, or, you know, like, I’ve really tried to avoid those kind of touch points with endocrine disruptors for them it like, you know, throughout their life, I cook in a certain way for them, you know, I put in so much work. And I think that’s another thing. You know, if you have PCOS, and you want to have children, and you do end up having daughters, then, because of the things that you’ve learned, you can pass that on.
Sandra Greenbank 42:31
Yeah, absolutely. Yeah.
Sarah Nash 42:36
And I, you know, I look at them now. And they, like, they know, kind of how to either sort of grown up with it, and they’re really comfortable with it. And I think it’s really important for us, you know, when we, when we know something, and for me, personally, I think I’ve gone through their journey, I’ve tried different things. I know what’s worked and what hasn’t worked. And, you know, even though we’re all different, and we all have different causes, kind of recommendations we make for PCOS clients overlap. So there’s certain things that I know I can pass down or read that, you know, I kind of like to think we’re doing our bit for, for the next generation, I
Sandra Greenbank 43:17
think it’s so true. And one of my, one of the things I really sort of visualized as opposed when I set up the fertility Nutrition Center was helping more people. And I was like, I can only help a certain number of people working on my own in my own little, you know, in my house, so work from home, and I thought I’m going to train all this Nutrition has to do the this work, because we can go out and teach more people how to eat for life, and they will pass this on to their children, and they will pass it on to their children. And this will have a ripple effect. And we can do so much more together than one of us could ever do on our own. But I truly believe that public health changes and improvements start with actually preconception health and teaching from teaching parents to be how to eat, because, you know, the biggest burden on the NHS is diabetes, by far. And, you know, that is a life typically diet and lifestyle related disease, you know, the vast majority of those people can be helped and, you know, much reduced medication much reduced kind of complications. And, you know, my dad’s diabetic and you know, I’ve seen it, I’ve lived it, and I’ve I saw it, you know, with the stress and in all of this growing up with the smoking and you know, I’ve seen I see now you know, the results with kind of, you know, he’s on dialysis now and you know, the kidneys have taken such a hit and, you know, it’s just so upsetting. So as opposed to it’s like the mission is to like really get there but it starts with our children doesn’t start before the children are born. Like oh, 100% Like the, you know, I’ve believed this for the last, you know, 15 years I’ve been doing this, but the science is actually now catching up, isn’t it? Yeah. Now we know this to be true now. Yeah,
Sarah Nash 45:14
absolutely. And I think, you know, what I can see has changed from when I was trying to conceive, you know, 1015 years ago, things have changed. There’s a lot more. I mean, I think really, you know, when I went to see the nutritionist, I was living in Australia, I don’t think in the UK, it was not anything I had heard of, at the time. And I think it’s grown so much over the last 10 or 15 years. And, you know, I remember how we came back from the fertility. So this year, we’re really positive about it. Because last year, there was still a lot of people kind of scratching their heads and going, I don’t really understand what you’re doing this year, there were so many people who were really clued up, they had done their research, they know that we’re around, and it’s just really lovely. And it’s, you know, I was saying you can feel that the tide is changing slowly. And it’s, yeah, mind blowing. Really.
Sandra Greenbank 46:15
I think it is, but until everyone who’s about to try for a baby comes and says, What? My work is not done. Yeah. Yeah. Struggling and and you know, another thing actually, that I’ve seen, I’m seeing kind of a little bit of a change. It’s actually young women who come to us and they say, I’m not ready to have a baby yet. But when I am, I want to know that I’m not going to have a problem, because I’ve been told I’ve got PCOS. And I just want to get my ducks in a row now. And yeah, that is like,
Sarah Nash 46:51
the dream.
Sandra Greenbank 46:53
The dream, you know, it’s just such a nice thing to be able to help people with, because then you know, that, you know, they can maybe learn their family in a different way, which is so nice. And yeah, like, I agree with you. I do you know, my kids. You know, they’re like, oh, you know, and I’m like, you have to have protein, but you know, beans of protein, and meat and beans. Look at me. And I’m like, you’ll be able to have some chicken. And I’m like, and have another, you know, and they’re like, Oh, I know, because we count that I just make them have like a certain number of colors every day. And they’re like, Oh, I’ve already had five and you know, I had an Apple as well. I was always like a negotiation, but like, they know the principle. Yeah. You play, you have to have the colors. You know, not too much bread or potatoes if you have not, you know, like, it’s just about that balances such as really quite simple things, really, but I think, yeah, it’s almost just sort of like coming away from and also that I think the English thing of, you know, I come from Sweden, so we eat quite differently, but it’s like that very sweet carb breakfast, which is like, as soon as you change people’s breakfast, they feel so different.
Sarah Nash 48:09
Yeah. I mean, I must say, personally, I struggle with the savory breakfast, I know that it’s, you know, what I should be doing. But I really struggled with it. And I think kind of, you know, having worked on the way I eat for a lot of years, there are ways that you can have a breakfast that it’s not savory savory, you know, but you can have something like a really nice French toast with a really good sourdough bread and then with like a heavy sort of Greek yogurt and some fruit and a little bit of honey so suddenly, you’ve got a
48:50
sweet Tish like breakfast that still really good for
Sarah Nash 48:55
you, you know, still got all the proteins but the fruit and then I sprinkle like seeds over the top so you’ve got healthy fats and these It’s just about making sure that you sort of balance it properly and you know, always looking at meals and going What can I do better about this? Can I add something else into it that will make this better for me, like I find I sprinkles seeds and everything is like my go to or nuts on things, you know, just for like half an avocado. It’s just about kind of looking at it more closely. And I think once you get into the habit of planning your food, it’s really hard to go back by that.
Sandra Greenbank 49:35
I mean we do the same so it’s like if you have pancakes on a weekend 10 Stop eating pancakes, just put an extra couple of you know one or two of it with some nut butter on top some Greek yogurt and then choose berries or fruit instead of jam and that’s like huge, you know, that immediately is like a million times better than your standard batter which is awesome. Add flour and then with sugar and lemon, or we didn’t have it yet. Well, like jam is 50% Sugar, isn’t it? And yeah, you know, you can just shift it a bit. And that’s what we always do, isn’t it? You just start where you are, and move it along slowly. So yeah, you’re not gonna go from kind of eating, you know, a sugary cereal to kind of capers?
Sarah Nash 50:24
No, no. Yeah, no, exactly. It’s about building habits, you know. And I also always say to clients, like, we make those recommendations. And I can sometimes almost see the panic. And there is no, I’m not expecting you to nail this in a week or even two weeks. But it takes time you’re changing habits. And, you know, we know from James clear that changing habits takes 66 days, you know, it’s like, give yourself a break, like, be kind to yourself in that process of making the changes, because it’s not going to happen overnight. It’s, you know, it’s like New Year’s resolutions. I always say, if I wasn’t able to do it in the whole of the last year, I’m not going to be able to do it in the first two weeks of January, you know, doesn’t work, you know, you need to give yourself the time. And you just, I think sometimes clients will come to us and they are worried. And a lot of the things I say is, are you going to tell me to stop eating this? Yeah, you know, is, I do think that’s necessarily how, like, we work, I would never say to someone, you will never be able to have that biscuit again. But what I always say is work out a way to have it, where it doesn’t affect your body in the same as if you were to have it on its own randomly as a snack, you know, have it as like, have it as a little treat after lunch or cooking from scratch. And there’s lots of ways that we can still allow ourselves to have, like, a piece of dark chocolate or whatever, you know, it’s not about cutting everything out. And it’s the 8020 rule. Isn’t that where you have to make sure or you try to make sure that you really well, 80% of the time, but don’t beat yourself up over one thing. Yeah. The
Sandra Greenbank 52:28
one thing that you did on a weekend isn’t going to undo all the good stuff you did throughout the week. You know, it’s just not like that.
Sarah Nash 52:35
No, I think it’d be try to avoid things too much. It becomes then too much of an issue and then fell, you know, and that’s been another stressor on your body. And we don’t have that.
Sandra Greenbank 52:47
Absolutely. Yeah. So in a summary, then do you have your sort of top tips for somebody who’s got PCOS probably tried to conceive for awhile and feeling lost and confused.
Sarah Nash 53:06
I think, you know, my main tip would be find someone who can help you with this like a holistic practitioner, because PCOS is a whole body disease, you know, and it needs a whole body approach. So, you know, taking a drug or like going for IVF does not address the issues. So it’s really important to look into those. And I mean, if I had like, three top tips that I would always give to like a PCO and a client, I would say, eat more protein. Always aim for the 30 ish gram meal. You know, I’ve got a really handy protein content sheet which you can download from my website, actually. What’s the link to that? Oh, it will be Sarah nash.co.uk forward slash freebies. We’re thinking downloaded there. So yeah, more protein. Make sure you always have healthy fats with every meal or snack so thank you knowing that the avocado day etc. And do I’d say 30 minutes, a very light to moderate movement every day. So, you know, that could be a couple of just 15 minute walks after lunch or dinner to kind of stabilize your blood sugar or it could be something like yeah, baby yoga class or swimming or you know, just something that is not too strenuous, but movement is. It’s really, really important for PCOS.
Sandra Greenbank 54:57
Yeah, and that’s better Sleep. Also something that builds a little bit of muscle can be really useful. Just yeah,
Sarah Nash 55:04
training or resistance training. So things actually one of the things that I like to recommend to clients is, like movements lacking. You know, like, if you brush your teeth, just do a few squats while you’re doing it. Or if you’re waiting for the kettle to boil for a cup of tea, just grab a couple of bottles and do bicep curls, or, you know, just little things like that just to keep moving and, and just build in throughout the day. But just Yeah, make sure that that you keep moving daily,
Sandra Greenbank 55:39
I think I would like to add to that, just get a really good, really a comprehensive blood test, which your GP most certainly won’t have done. So, you know, even if you go if it can’t afford to work with a practitioner, go and buy, you know, there’s lots of companies out there that do private blood testing like medi checks and some of the they have some super comprehensive panels that you can actually order yourself carry out yourself. And then with those results, you can go back to your GP and start pushing for more tests more information more, you know, because they will show things out there. They just don’t check the day or, you know, at least at least if you can only afford to have one session with the nutritionist, you know, they can sort of at least pinpoint you in the right direction with those blood tests. I think that’s so important because you know, the standard tests on the NHS just, but not not helpful if
Sarah Nash 56:41
they’re just so limited, and then what they can do, and there’s a lot of thing that they just ran tests. One of the things specifically again for PCOS is thyroid. So, you know, if you have PCOS, there’s a really strong link between PCOS and thyroid issues. And even though the GP does run a thyroid
Sandra Greenbank 57:05
panel, they
Sarah Nash 57:07
don’t look at the big picture, they generally won’t check TSA, and maybe one or two other markets, but we really need to have that kind of entire picture that they don’t test us. So there’s a lot of private tests that we can recommend. And they’re actually really affordable. So it’s not a huge expense, but it just gives us so much more insight into what’s going
Sandra Greenbank 57:31
on a couple of 100 pounds out there. But then you can actually
Sarah Nash 57:35
say even just 90 pounds, the thyroid test, yeah, they’re
Sandra Greenbank 57:39
pretty good. Yeah, the more comprehensive ones, that you can also get a discount code online or out, I just think it’s so important. And you know, and thyroid, and then, you know, iron ties into the thyroid, but there’s about sort of five iron markers really, that we want to look at. It’s not just all about ferritin, you know, which, you know, and then there’s like, it’s all sort of interconnected, isn’t it? But
Sarah Nash 58:04
yeah,
Sandra Greenbank 58:06
definitely needs checking. Thanks so much, Sarah. So, what? You mentioned your website?
Sarah Nash 58:14
Yes. www.sarahnash.co.uk.
Sandra Greenbank 58:18
Put that in the show notes if anybody wants to get in touch. And you’re also on Instagram, as
Sarah Nash 58:26
@sarahnash_ fertility. I have attempted Facebook, but I just don’t I’m not really on there. So definitely Instagram is the best place to find me and kind of stay. Yeah, stay in touch. And yeah, or just contact me through my website or my email is hello@sarahnash.co.uk. And I always Yeah, always respond, though. If you want to chat, just drop me an email.
Sandra Greenbank 58:54
Yeah, always, always available for a free sort of quick discovery call to you know, because we wouldn’t ever take on a client unless we thought we could help them. And so we always tend to have a call beforehand, just a shortcode sort of find out more and so there if you’d like to have more of a chat about your personal situation. And yes, thanks so much, Sarah. It’s been so nice to talk to you.
Sarah Nash 59:18
Thank you for having me. It was really lovely.
Sandra Greenbank 59:25
I really enjoyed this chat with Sarah and I hope you enjoyed listening to this episode. Please like, share, save and rate this podcast if you find it useful, as it helps us reach more people. And if you’re looking for fertility specialists to support you, our practitioners can be contacted over at www.fertilitynutritioncentre.org And they all offer a free strategy call to help you decide on your next best steps on your journey. Thank you for listening.
