How To Optimise Reproductive Health For Pregnancy Success

Here is the transcript with the guest's name changed to Ailish:

Dr. Anthony Rafferty: Welcome to the Intuitive Health podcast. I'm your host, Dr. Anthony Rafferty, medical doctor, PhD, Reiki, and shamanic intuitive healer. I'm here to bring you on a journey of holistic healing that explores the science of the physical body combined with mental and emotional well-being, energetic, and spiritual health. And I am so excited to welcome Ailish here onto the podcast today. Thank you so much for joining us, Ailish.

Ailish: You're very welcome. I am delighted to be here. like really delighted to be talking about this, getting this information out there and um yeah, thanks so much for having me.

Dr. Anthony Rafferty: Oh, I love it. I love it. Like I'm on a journey at the moment connecting with um people working in the natural or restorative reproductive medicine field just to be able to empower all these lovely individuals and couples on this journey of fertility um or even just optimizing their reproductive health and their hormonal health. Uh how they can go about doing that and you know giving them some good positive um direction to move in. It can be so confusing in the world of reproductive health with regard to the information that's out there. Um so it's such a pleasure to have you here Ailish so just a bit of background Ailish is a fertility advisor in restorative reproductive medicine and she works with uh individuals and couples that are on a journey of looking at how to optimize their reproductive of health and um I was so so keen to talk to Ailish today because she's helped so many people uh achieve pregnancy success but also optimize their reproductive health for the long term you know for the for their life by getting them to tune in to the body and how to optimize their cycles. So I would love to hear a little bit about um kind of cycle tracking is and the importance of getting to know your cycle.

Ailish: Oh, absolutely. I'm more than happy to share this information. Um, so when we are, you know, starting to menstruate, you know, we're we're just told to focus on the period, okay? Because that is the most significant thing that you see. However, if you only track menstruation, you are missing so much. So, you're going to miss things like when your follicle is beginning to develop. So, we are able to identify that when you start observing mucus we're missing say the LH surge and this is a really key one because the amount of days that your surge is happening over indicates specific things also and then we would also miss your lutal phase length so the amount of time that you're getting um sorry exposure to progesterone which is so important because that impacts your nervous system your mood and so much more so your ovarian hormones that we can track they impact us on such a greater level than just for menstruating. They impact the whole body. So, it's so important that we actually understand how to track the cycle fully and not just kind of have in a a period tracker app, okay, this is day one of my cycle. I was bleeding for five days and that's all I'm going to tell that information. We're we're missing all of that, all the rest of that if we just skip everything else.

Dr. Anthony Rafferty: Yeah. And I love this because even, you know, I do get contacted regularly um by women that I've recommended to have their day three hormonal profiles done. That's the day that I love doing everything to look at the baseline hormone levels. But it's interesting because even the awareness of when day three in the cycle actually is, you know, so I' let's talk a little bit about the different phases of the menstrual cycle. When does the menstrual cycle actually start?

Ailish: Okay, that's a great question. And you know what? It's a starting point. So the day that is day one is the first day of full flow. So any premenstrual spotting that only requires a panty liner or is only there when you use the bathroom, that is not day one. Day one is the first day that you would require a sanity product. So it's a sensation that you can't miss. It's like a it is a really obvious sensation. That is day one. We would then count. So you can have your day three blood obviously between days two and five. So, but from that first day, anchoring that to get those bloods done. Anything premenually. So, if you're seeing spotting for a day or multiple days prior to that full day of first flow, again, that's indicative of something. So, being aware of the difference is crucial. So, that was a perfectly, you know, fair question to ask.

Dr. Anthony Rafferty: Yeah. And like, do you tend to have a cut off during the day? Uh like a time point that if actually if you start bleeding and you have full flow at like 12:00 or 2:00 versus 7:00 at night.

Ailish: No. No. And there are so there's differences between the methods, but no, to answer your question, we don't. So, we wouldn't ignore. So, say a bleed started. So, say spotting started at I don't know 12:00 until 4:00 and then the the full flow began at 4, that's still the first day of menstruation. Whereas, if the spotting began the day before and then the f the full flow was the day after, the full flow is the one whatever time it starts. that

Dr. Anthony Rafferty: yeah,

Ailish: we don't rule out half a day of say men shrinking.

Dr. Anthony Rafferty: And so if you're seeing I love that you're kind of touching on this um on this kind of several days of spotting and some women are getting brown bleeding before um what what do you tend to advise during those times? Because you know with the spotting that's leading up to the bleed, what's normal and not normal?

Ailish: Yeah. Um so I don't really like to see anything more than a day of spotting. Yeah. And then if we're going into two to three days of spotting straight away, my mind is going to low progesterone. Um we'd definitely be looking towards getting some blood tests in the lutil phase, which we can discuss a little bit later, just to time um progesterone and estrogen in that lutal phase to ensure they're optimal. But when there is spotting pink or brown, it can indicate low progesterone if there's two to three days or more.

Dr. Anthony Rafferty: Okay, I love that. This is really great. information for people. And so what does it look like when the bleed actually starts? Let's say you're getting your full flow that's coming on. How many days should that typically last?

Ailish: So between 3 to seven days, but then we'll dive in a little bit deeper. I don't want to just know that you're bleeding for those amount of days. I want to know kind of how much you're bleeding because blood loss, you know, yourself if there's too much as well, that can indicate other issues and maybe warrant further testing for maybe your iron or your feritin. Um, so let's say a normal healthy bleed would be changing probably three regular size pads or tampons. Now people use cups and period underwear as well. So just be mindful of their different methods that they will use to change for during menstruation. But if we're talking about regular size pads, probably three pads are almost full a day for maybe three days and then two days of spotting. So whereas if a woman is soaking through her sanitary wear having to double up, having to get up in the middle of the night to change her jammies and her bed sheets. This is not normal at all. And as a teen, I know I experienced that. And I think this is where my fire comes from for this work. For so long, I'd be getting up and having to change my my bed sheets. And I was just told, "Oh, it's just your period. It's grand." Like had no idea that it actually indicated a hormonal imbalance.

Dr. Anthony Rafferty: And this is so so so important, you know, and I love that you're speaking into this and giving people an idea of what's normal and not normal because I had this lovely lady in yesterday and I was like, "Oh, you know, she is in her late 40s now. She was started on the pill immediately upon getting her first bleed because it was so heavy and painful at that time. She she went to the GP and they popped her onto the pill. She's been on hormonal contraception her whole life. She transitioned into the coil into her in her 40s. So when I was asking her about her menstrual cycle and what it was like, she's like, "I actually have no idea what my normal menstrual cycle is like because from the very outset it was horrendously heavy, very, very painful and I immediately started birth control." So it's just wild, isn't it? Like um this kind of journey with with pain and heavy bleeding and knowing what's what's heavy versus what's normal, you know?

Ailish: Yeah. Yeah.

Um, unfortunately that's the narrative for for so many. Um, I can relate to that story myself. Um, not obviously not throughout my whole adult life, but as a teen, but I think um, kind of honing in on the fact that when the periods are beginning in younger girls, so in teens, let's say, the brain and the ovary are only starting to connect. Okay, so let's imagine you're new at a job. You're going to need a little bit of time to get good at it. So the brain and the ovary are just starting out their journey on this job together. And initially, the ovulatory event isn't optimal. We don't have enough progesterone. The bleeds are heavy. Yes, there can be pain. There's a, you know, but the thing to really understand is it's just because the communication between the brain and the ovary are is only beginning. And if you kind of take away the opportunity to allow those cycles to become regular by just suppressing it with the pill, that's doing a disservice to women. Because not only do hormones being secreted by your ovaries, Yes, they're important for fertility, okay? No doubt about that. But they're important for your whole body, for everything. Like I said earlier, they they impact your blood sugar, their bone formation, your your mood, you know. So, and I think also giving that that medication without giving that information, you know, it's not fair to do to women.

Dr. Anthony Rafferty: Yeah, I totally agree. And, you know, I had this beautiful um uh lady in her early 20s in with me a couple of weeks ago. and she's actually she was getting such heavy bleeding in her late teens. She was put on backtoback pills. So, she actually hasn't had any bleed for many many years. H but it was never investigated. And actually, she came through to me her CRP which is a marker of inflammation was through the roof. Her body is in a state of complete inflammation like systemically whole body inflammation. And sending her even for pelvic ultrasound, it looks Even on the ultrasound, we're seeing that there's evidence of significant endometriosis. And people don't realize that actually it's so important to to identify and manage these things and intervene early because things like endometriosis, they can have it can ravage the system. It can have such an impact causing adhesions, so many issues that then impact later fertility. So, if there's any young women listening to this and they're their ears are breaking up here thinking, "Oh my god, what has been happening here?" I encourage you, even if you don't know that you want to have a baby now, it could be something down the line. Make sure that you're investigating and managing all of these things from an early age. Um, and I love, Ailish, that you're speaking into into this so people can kind of be like, "Oh, actually, maybe what's happening for me and has been from day one isn't normal."

Ailish: Yeah. Yeah.

Like so powerful.

Um, I I just think it's really important even for me as a teen. I actually didn't understand how the pill worked and I just thought I was having regular periods. I genuinely thought, "Oh, the pill has regulated my bleed. That means I have regular periods." I had no idea that my ovaries were essentially quietened and my own hormones that positively impact my whole body were suppressed. I think giving that information to women so important as well.

Dr. Anthony Rafferty: Well, it's it's so interesting. I love that you've brought this up because actually um a lot of women don't realize that when they bleed because they've come off their packet of the pill. That's actually withdrawal bleed. It's not truly an actual uh menstrual bleed like you would get with a regular cycle. Uh and is that something that you find is a common people unaware that that's the case?

Ailish: All the time. Like all the time. So I would have calls and I'd say, "Okay, so tell me a little bit about your history." And they'll say, "Well, I had regular bleeds when I was on the p the pill from regular periods when I was on the pill from X to Y. And I'll be saying, "Okay, so you you're menstruating. You weren't actually menstruating on the pill. That is a withdrawal bleed. Menstruation is followed by an ovulatory event which is suppressed while you're on the pill." And it's like,

Dr. Anthony Rafferty: that's literally the reaction. They're like, "What?" Yes.

Ailish: You know, it's not even an awareness that ovulation is suppressed. It's just this is regulating my periods.

Dr. Anthony Rafferty: Yes.

Dr. Anthony Rafferty: Oh, I love this. Well, let's move on then from the menstrual cycle, I or well, the menstrual period when when you're actually bleeding into the end of the bleed. Um, and then the when the hormones start to kind of ramp up, tell us what's kind of happening and what you might see at at the tail end of a bleed that may or may not be normal.

Ailish: Yeah. So, again, during the end of your your menstrual period, you know, depending on the length of your cycle. So, if we have somebody that has a really really short cycle, let's say we're saying 21 days here, we can actually see the follicle kick off early. as in, you know, it's being stimulated by a hormone called follicle stimulating hormone and it's starting out on its journey to grow at the end of menstruation and we can see an early ovulatory event around day 10 or something like that depending on you know how long it takes it to develop. That would be in a really short cycle. In let's say a more regular length cycle, we'll just pick 28 days. Um we'll we'll typically start to see the follicle developing around day 10. So, We can actually observe that by allowing the woman to track her cervical mucus. And the reason we can observe when the follicle begins its journey to rapid maturation is because the follicle is being stimulated to grow. Within the follicle that's growing, there are um there are cells that produce the hormone estrogen. So when estrogen is being secreted into the bloodstream, it's a chemical messenger. It goes to the cervix and it basically says, "Hey, I need you to produce m mucus." The cervix then starts to produce mucus as a result of that follicle growing. So that's how we know the follicle has started to mature. Now as the estrogen rises and and the follicle gets bigger in its journey towards ovulation the estrogen charact or sorry the mucus characteristics change. So initially the mucus might be quite gummy. It might be white or cream in color and it'll be quite tacky. As the estrogen becomes more abundant in the bloodstream the mucus characteristics change because when the estrogen is a high levels. It stimulates different crypts in the cervix to produce a different type of mucus. So really close to ovulation, we might see clear, slippery, stretchy mucus or just a wet or slippery sensation. So observing that change in mucus over a number of days is how we kind of follow the follicle if you like.

Dr. Anthony Rafferty: Oh, I love that. So this is really important um for all these gorgeous listeners listening to this. So as you come out of your bleed, you start to get the production of FSH or follicle stimulating hormone which then stimulates the ovary to produce the follicles. Um so I I was speaking into this in a previous episode that you actually get multiple follicles start to develop and then one of them becomes the queen and she's like hey like I want to be dominant here you know and um so with the with the growth of these follicles it's like the feedback mechanism you're talking about you're getting estrogen prod production. Now, and I always uh I love talking to women um about what estrogen does. It's such a beautiful hormone in the body. People feel fantastic. So, during that follicular phase, as the follicle develops um on the journey, people are starting to feel better. And the closer that they get to ovulation, they're obviously starting to feel um they're feeling themselves, they're feeling good, you know.

Ailish: Yeah.

Dr. Anthony Rafferty: And in and around then ovulation, obvious you're going to get some testosterone production, which actually makes them feel even better again, you know. Um so for ladies on a journey with menopause or permenopausal um times, you're getting reduction in this estrogen production, the type of estrogen that produced by the body changes and you know that's why women are kind of don't have as much energy and they're not feeling as as fantastic. The so and and that's something I I I I see quite a lot. Um depend on who's coming through the door. So, as you're kind of coming up on this ovulation time, I love that you're speaking into the mucosal changes because as I speak to some of the the women when they come through, I'm like, "Do you know when you ovulate?" And they're like, "Well, I kind of have an idea. Can you talk about ovulation pain? Can you can you speak a little bit more into the specifics like you were saying of what you might see? How stretchy does the mucus become? That sort of stuff in and around the ovulation."

Ailish: Yeah. So, really close to ovulation. It's really important to remember that every woman is unique, okay? And one woman's mucus may not look the exact same as another, but just close to ovulation, we look for mucus that is called peak type, okay? And peak mucus has either clear, slippery, or stretchy characteristics. Now, it only has to have one of those, okay? Or you might just feel a really wet or slippery sensation. A sensation is really, really key. Especially if I'm teaching somebody with an absent visible mucus observation, I focus so much on that sensation. So in the day when you're walking around when the fertile window opens and close to ovulation, there's there's obvious changes. And when we bring in those techniques to not miss the sensation, we start to notice, okay, there is mucus there. There is a sensation there. But to answer your question, the stretchiness can go really, really long or it could just be like it can be short. But once it has has either clear or slipperiness or it's um stretchy. That is a peak type mucus. So, not focusing too much on I think a lot of people get really kind of focused on having this abundant raw egg white type of mucus. But in reality, not every woman sees that and that doesn't indicate anything. As long as you're having a mucus pattern over approximately 5 to six days, that is changing. And we're seeing the nice LH surge. And then we get those bloods done at peak plus 7. We get those hormones tested, we don't just kind of focus on one thing. It's so important to bring It's like a piece to a puzzle.

Dr. Anthony Rafferty: Yeah. And so, just before we speak into what LH is and what a peak plus seven blood is, is it possible to kind of um just clarify, are women using their fingers to stretch the mucus? What's the best way to like to to kind of do this for women to assess this themselves?

Ailish: Yeah, of course. So, firstly, throughout the day, my advice would be be mindful when you're walking. Is there a sensation of slipperiness or wetness? When you're using the bathroom, wipe before and after you go, be mindful of the sensation. Does it feel slippery or not? Then visually look at your tissue. If there's something to take off that tissue, so mucus will come off the tissue, it will lift off and it will either stretch. So let's say you you tried to stretch it and it just bounces back to the finger or the thumb. That means it doesn't have a stretch. Whereas if you stretch it, you literally take it off, become familiar with your secretions, and open those fingers and see if it's stretches. If it's a short stretch, it will it will be quite small. And then a long stretch will be anything over say 2 cm.

Dr. Anthony Rafferty: That's you take off the tissue.

Ailish: I love that. I love that. And so it's just because some people when they come through they're like I'm not sure how to do that or what that looks like. So I think you're given such amazing just very clear tools to be able to really start tuning into the menstrual cycle.

Dr. Anthony Rafferty: Um and to just kind of highlight, you know, that um I think we've been told uh through standard kind of medical education and practices. You know, for a standard 28 day cycle, ovulation occurs on day 14. That's what we're told in medical school. That's what everybody's told. But actually, what we see in clinical practice, that's very very different for a lot of people. And you know, a lot of the women that that I work with, they're like, "Oh, I'm not sure if I get mucosal changes or uh cervical um changes in my mucus." But You know, I think that some of the stuff happens. I'm not quite sure when ovulation is occurring. And when we do follicle tracking on ultrasound, actually when they're ovulating is a very different time to what they think, you know.

Ailish: Absolutely. I exactly the same experience as you. Like the 28 day cycle, I might see ovulation occurring on day 19 and we know then you're like really at the lower end of that luteil phase as opposed to if you're ovulating on day 14, you a nice lutal phase length into a 28 day cycle.

Dr. Anthony Rafferty: Yes. And so just speaking into the duration, we kind of talked a little bit about the duration of the bleed. Um, and do you tend to see that the that the duration of the follicular phase changes at all?

Ailish: Yeah, I mean it depends again. So your follicular phase is the most variable phase of your cycle. So if there's anything kind of impairing ovulation, it It will obviously happen in the follicular phase. So I work with everybody I work with realistically has an irregularity in their cycle. So we might start to see the the follicle developing a little bit later. And that's what I tend to see most. If the follicle is not beginning its development until the late teens, meaning the ovulation isn't occurring until say day 22, which is is showing us that the follicle is struggling. Why isn't it developing around day 10? What's impairing it?

Dr. Anthony Rafferty: Yeah. Yeah.

Ailish: Now there's all the questions we need to we need to kind dig our teeth into and then get some bloods done to like assess it, find the problem, and then restore healthy parameters. That's the objective.

Dr. Anthony Rafferty: I love that. And so, when we're entering into the the ovulation window or the fertile window that you spoke about, how long does that last? And does it start before you ovulate? Um, and is it always does it if if things are going well, it does is it always associated with those mucosal changes?

Ailish: Well, a really important consideration that not many people seem to know is that mucus actually keeps sperm alive. So, if you're trying to conceive, okay, there needs to be mucus there because the pH of the vagina is too acidic without mucus. So, sperm cannot survive. So, we need mucus firstly for that. And then the fertile window is prolonged just past kind of the ovulatory event because of the fact that cervical mucus can keep sperm alive for between 3 to 5 days or in some extremely optimal conditions research found up to seven days. But um let's say you start observing mucus until sorry on day 10 and until day 14 and then you know we confirm ovulation. Your ferile window is the time you have mucus until peak day which is the approximate day of ovulation plus the count of three. That's the time that we would consider you fertile within that cycle.

Dr. Anthony Rafferty: Oh I love that. Okay. So you're fertile for up to three days essentially after you've ovulated.

Ailish: Yeah. Well, Most women ovulate on peak day or day either side. But it was found that it can go up to peak plus three. So we have to allow that for every woman unless we're like follicle tracking scan at the exact moment to to confirm ovulation, you know, because obviously if the egg we don't know exactly when the the egg is released. So we have to allow that.

Dr. Anthony Rafferty: Yeah.

Ailish: Um you know

Dr. Anthony Rafferty: I love that. And so when people are having um intercourse, when's the best days to do it during the fertile window?

Ailish: So first of all, one of the most important things I say is that you want to enjoy the fertile window. You don't want to make it sort of any sort of military style robust thing. This is supposed to be like a loving connection. So genuinely and for women you feel your libido increases. So just follow your body. Um now getting more technical I suppose um depending on the the the semen analysis if everything's absolutely fine you can have it more frequently whereas if there's any kind of parameters that need support and there's support being implemented we'd say like every second day to essentially like give the sperm a chance to you know regenerate if you like. Um so I'm not using every single day but any day of mucus and um maybe the day after peak day as well.

Dr. Anthony Rafferty: I love that. I love that. And now so we see a lot of um women coming through the practice that um they use different methods to identify when they've ovulated. So sometimes we see the ovulation sticks people are using basil body temperature What can you speak into kind of the different methods of determining um when ovulation has occurred, whether they're accurate first of all, and what do you find works the best?

Ailish: Well, for me, okay, I want you to like imagine the foundation of fertility charting is your cervical mucus. Like, I cannot stress that enough. Every other biomarker is like what comes in line after it. LH is a lovely biioarker as well. It is. I do like it, but it can throw people off, especially in PCOS. In PCOS, there's less exposure to progesterone throughout the whole year, if you like, because there's less cycles allowing that LH to run wild. So, it can be really confusing. Whereas, when you're tracking your mucus and combining it with LH and temperature, you get a far more accurate reading.

Dr. Anthony Rafferty: Yeah.

Ailish: Combining those three together, I have found, is the best way to truly identify the fertile window, confirm ovulation.

Dr. Anthony Rafferty: Lovely. And so, for those listening, LH is luteinizing hormone. hormone that's released um from a little gland in the brain and it goes down and stimulates the follicle to release its egg. So, it's basically it's it's used in some of these um strips or these um tests that people pee onto sticks and things like that um to be able to determine um when there's a surge in that hormone because it occurs at a very specific time in order to trigger trigger the to release the egg. Um, so obviously like I love using my ultrasound um like my synographer Trish just phenomenal at doing fertility um follicle track and to so we can see when the follicles um on its journey to release the egg but if people don't have access to that um you're suggesting it's okay to use the LH strips um tracking your cervical mucus which is really important and also what happens with the temperature?

Ailish: Yeah. Yeah. Absolutely. So, um definitely using that LH test strip and just I suppose an important one is we like to see the LH surge around the time that there's mucus because keeping in mind the peak estrogen that gives us that peak um type mucus also then is the the feedback to the brain to release that LH like you mentioned. Then when we get the LH and the follicle ruptures, we get the new gland called the corpus lutium that gives us that progesterone. Now pro Prosterone is produced after ovulation. Well, a little bit during and after ovulation. And what happens is it has a thermogenic effect on the body. So it heats things up in the body and it increases your temperature at rest. So your basil body temperature. So the first thing when you wake, what we would advise is if you're using a basil body thermometer, take your temperature at the exact same time every morning when you wake. So it has to be the same time. So say you set an alarm for 8:00 a.m. And after you ovulate, your temperature rises and it stays elevated above all of the follicular um phase temperatures

Dr. Anthony Rafferty: and this confirms ovulation for us as well. It's a gorgeous visual biioarker. Really really nice one to you know especially when somebody's only learning their mucus. It's it's really really important to have that in there.

Ailish: Oh, I love that. Oh, another amazing little tool um to to uh to help women identify what their journey is like towards ovul And so once ovulation has happened, I love that you've already kind of started speaking into the production of progesterone. And um for those listening, so um Ailish just spoke into the development of the corpus lutium. So what happens after the follicle releases its egg, the follicle then becomes something called the corpus lutium, hence the lutil phase of the cycle. And that then begins starting the production of progesterone. So, generally speaking, if there's a successful pregnancy and there's an implantation, um that corpus routine will continue to to keep producing progesterone up until the placenta takes over. Um and that can be in uh into the early stages of pregnancy, midway through the first trimester. Um we see changes as the corpus lutium starts to to recede uh in its production of progesterone in around kind of 5 to 7 kind of weeks of early pregnancy. Um, but generally speaking, what I tend to find um is this lovely surge in the progesterone. So, can you talk a little bit about this luteil phase when the corpus lutium is active and you've released your little egg?

Ailish: Look, such a lovely little visual. My my course has all these little visuals. I have a smiley face for an egg because, you know, I really want to f I'm such a visual learner. So, um But yes, I can talk about it. So after your egg is released like you mentioned and a new gland is formed from that ruptured follicle. So it's really important to keep those two things together. Your corpus lutium is formed from that follicle that that housed your egg essentially. So when we're looking at the quality of the corpus lutium, it tells us about the quality of your follicle that ruptured. So after you ovulate and that gland is formed, we ideally want to see it secreting progesterone for like minimum 10 days, but ideally more like 12 to 14 And that's to give your body exposure to progesterone which is being secreted from that corpus lutium. And we can identify your lutal phase length. If it's shorter than 10 days, it straight away indicates low progesterone. Like it's a strong indicator for low progesterone. So let's say we identify your ovulatory event by identifying peak day, which is the last day of any mucus that is either clear, slippery, or stretchy, or you just feel wet or slippery. After that, everything will dry up from a mucous perspective. Because when progesterone is secreted, it acts on your cervix to produce a mucous barrier that's so thick and dense that it stays up there and you don't see it and you don't feel it. So that dry up after ovulation, if it's shorter than 10 days, straight off, it's indicating low progesterone.

Dr. Anthony Rafferty: Okay. Okay. That's really interesting. And so generally speaking, we do blood tests again um on the peak plus seven days. So, like you were saying, if you can identify your peak day with all these beautiful tools and um really paying attention to your mucus or you've had an ultrasound that identifies the day of ovulation, seven days later, we do tests. Now, through restorative reproductive medicine, we do hormonal tests that aren't necessarily done um as standard by other practitioners, but they're so important to look at all of the hormones. So, can you speak into a little bit about what we're looking at seven days after the peak?

Ailish: Yeah. So again from that corpus luteine we want to know how it's performing. We want to know how much progesterone and how much estrogen is being produced. So we'll test it when we are at peak plus 7 to see if those two hormones are at optimal ranges. And like you said they're you know not this isn't commonly known. Most people just do that standardized 21day

Dr. Anthony Rafferty: progesterone test. Now, if you ovulate on day 20, tell me what is the point in testing one day later and expecting to see optimal progesterone?

Ailish: Yeah.

Dr. Anthony Rafferty: it's just not going to happen. And that woman is going to be told she's got low progesterone or she's not ovulating. And that's just in the test that was timed wrong. It's no fault of that woman.

Ailish: Yeah. And similarly, like for some women that come through, they might ovulate on day eight or nine. You know, we've seen really early ovulations and if they're getting the day 21 test done, that that is wildly inaccurate for their cycle as well.

Dr. Anthony Rafferty: Yeah. Probably their next menstruation by that day.

Ailish: Exactly. And I've seen this people are booking in for their day 21 bloods. They're already they're getting their bleed the day before. And you know, so I I just want to I'd love for you to just kind of um speak into the importance of the lutil phase. How long should that be? What should we be seeing during that phase? And um yeah, I because this is This is so such an important part of the menstrual cycle, isn't it?

Ailish: It's absolutely crucial. Um, you know, it's so so important to not kind of overlook. So, the length of it, you know, like earlier on I said, you know, between 10 and 16 days, but realistically, we're looking between a minimum of 12 12 days, okay, that we'd like to see it at. Um, and that's to give that brain, you know, to allow your body to be exposed to progesterone, which is such a lovely calming hormone. Um, So we want to see it to be that length and again ideally we don't want to be seeing premenstrual spotting because you know that indicates that that endometrial lining because progesterone maintains your endometri lining whereas if we don't have enough we might start to see kind of you know that bit of spotting premenally and if we're seeing that for multiple days and we're pairing that with a short lutil phase. I'd almost wouldn't even need to be suggesting for peak plus sevens because I'd be so confident that it's suboptimal anyway.

Dr. Anthony Rafferty: Yeah and I suppose at this stage it's probably really um important to talk about the different stages of when fertilization occurs and implantation occurs because uh the reason why the luteil phase is so important is because you know after ovulation you're not going to get implantation for many days later. So if your endometrial lining is starting to break down and this can be a byproduct of having low progesterone you although you could have achieved conception,

Ailish: that endometrial lining isn't going to be able to to sustain the implantation and the the development of an early pregnancy if it's already starting to come away. So, can you talk a little bit about um kind of after ovulation? When does fertilization occur? What happens, you know?

Ailish: Yeah. So, after ovulation, your the little egg will be, you know, swept into the flo or into the fallopian tube and it generally happens in the outer the core of the fallopian tube and then it has to go on its little journey to the womb and implant. Now generally this can happen between six to nine days post ovulation but now it was found in some research for a very small number of women that it occurred on day 11 or 12. So if you don't have a sufficient lutial phase length if your endometrium is starting to break down on day 10 sure there's no opportunity for it to reach the womb. So optimizing that lutil phase length is so important for everybody. And again the two hormones hormones, estrogen and progesterone build that endometrium to make it nice and kind of let's say fluffy and then maintain it. So those secretary glands that are stimulated from progesterone, you know, the progesterone gives that endometrial lining what it needs to be sustained. So those hormones together are so so crucial.

Dr. Anthony Rafferty: I love that and this is so so important. I love that you're speaking into this with regard to you know the this little embryo isn't going to implant straight away and like Ailish is saying can it can be many many days like coming up on a week and a half um after um ovulation event before you get the implantation. So it's so important that the luteil phase is exactly where we want it um and that you're getting adequate progesterone production. And to be honest with you, this is probably one of the most common things that I tend to see in practice is having a short lutil phase. And you know like Ailish is saying we're doing bloods peak plus seven, seven days after your peak day, your ovulation day. We're looking at estrogen, we're looking at progesterone, and you know, the reason that we do estrogen progesterone, you can see the quality of the ovulation and whether we actually need to be supporting um the the follicle to improve follicle quality and and its growth, but also is there a support needed for this um for this lutil phase to to support a pregnancy that may arise from that. And So on a journey helping your clients um if you've started to get them to really pay attention to things, how do you work with them then to kind of improve the different stages of the cycle?

Ailish: So generally I work with restorative reproductive doctors and the plan is really individual. So there's usually a really gentle approach to see if we can bring the the cycles back into balance and that will be throughout diet and lifestyle supplements initially because you know a lot of people might overlook the fact that stress is a huge player in knocking off the menstrual cycle. Like you really need to take care of yourself on so many more levels than just taking medication or supplements, you know, really minding yourself, really just being who you are, being true to yourself and allowing yourself to just be and also like getting outside as much as you can and nourishing your body with whole foods. They're all really important um things that we consider as well. And then know we we start to like we do start to see nice kind of improvements then if there is a a time then when medication is needed that's absolutely implemented so there will be follicle supporting medications and luteil supporting medications involved the plans are really really individual depending on what that cycle chart is showing so we have the fertility chart which will present any issue so if I'm looking at a fertility chart and I'm seeing say multiple days of brown bleeding that might indicate a low grade endometrial infection. So that warrants a specific treatment to target that. So your fertility chart is like so so crucial to this journey.

Dr. Anthony Rafferty: Yeah. And so a lot of women come through and they're like, "Oh, well, I'm tracking it in my flow app. I'm doing it here, there, and everywhere." When you talk about fertility charting, are there specific apps that you use that you um prefer to see um women coming through with because there's more detail or what would you generally recommend that people can access and start actually really taking a deep dive with regard to their cycle?

Ailish: Yeah, of course. Um, so I use and I recommend the Chart Neo app. It is a really superior app for tracking mucus. So again, if you're tracking an with sorry, if you're tracking your cycle with an app that does not count mucus, it's it's literally missing the foundation of the charting. And the the mucus observations on the Chart Neo app are extremely indepth. So we don't know we don't miss anything because limited mucus patterns indicate a hormonal imbalance also. Yeah.

Dr. Anthony Rafferty: So remember the mucus is coming from the follicle. Yes. Just keep that in mind. It's not just okay I'm just going off to observe mucus because that's when I'm ovulating. Where is it coming from? Why are you getting it? What's happening at an ovarian level?

Ailish: I love this.

Dr. Anthony Rafferty: Really important.

Dr. Anthony Rafferty: Well, it's all root cause kind of stuff. You know, I absolutely love I I I love that we're kind of really taking a nitty-gritty deep dive into this. Um, and just keeping in mind not everybody can use a chart neo app. So obviously Ailish is specialized in this and you know just being able to train your eye to look at these things. So there's a couple of restorative reproductive medicine doctors um like myself that can be able to um support women on this journey. But I highly highly recommend if you are starting out on this journey that you can um that you can touch base with Ailish start to learn the basics of how um how we may be able to improve your cycle even before we go on to medicines. People don't realize that actually once some people that just identify when they might be ovulating or whether there's any tweaks needed here and there. That is all the difference after months and months of trying and you know I've seen so many people end up going down the IVF path that didn't need that you know that didn't need it.

Ailish: I couldn't agree more. Um and when you're speaking about this I had a lovely lovely wake up message yesterday just to with a positive pregnancy test. It was a timing issue. That's it.

Dr. Anthony Rafferty: Just a timing issue. It's this thing of you ovulate on day 14. You you use those days for intercourse. We identified that was not the case.

Ailish: Then when we implemented the true ferto window, that was used and I woke up to that gorgeous message.

Dr. Anthony Rafferty: I love that.

Ailish: You know, and it's funny. It's so simple, but I promise you it's so so effective when you know your body.

Dr. Anthony Rafferty: I love that. And I had a similar one yesterday. It was actually a male factor contribution um with regard to testosterone related issues and once we actually spoke about that and corrected it the pregnancy the following cycle and they've been trying for over a year. So there's a lot to be said for this type of work you know and is there any way that people can work with you? How do people find you? How do people reach out?

Ailish: Yeah, of course. Um so my website is women'snaturalopath.com and my I only have one social media and that's just my Instagram which is also women's natural path. Um so you can find me on either of those and you can yeah you can work along I'd be happy to always work alongside women and couples and just support them and you know allow them to take take their the control of their health and their fertility into their hands.

Dr. Anthony Rafferty: Oh, I love this. Yes, I absolutely agree with this because that's the thing. Sometimes people feel very powerless when they're seeing the GP but they they don't have any answers or direction. Um and similarly through the clinics you're kind of If you get in and you're fied through a certain uh path of of the way you need to go, there's no autonomy or feel like that there's any there's a lot of powerlessness in that.

Dr. Anthony Rafferty: So, we'll include Ailish's details in the show notes. Um, absolutely reach out Ailish I have to say your Instagram posts are so informative. They are absolutely incredible. So, for anybody who hasn't checked out Ailish's uh Instagram, Women's Natural Path, absolutely do that. And um if you have any questions, please reach out to Ailish Arise. and um yeah, we can support you on your journey to optimum reproductive success. So, thank you so much for joining me, Ailish. I'm so grateful. It's been such a beautiful chat.

Ailish: Yeah, I really had a I enjoyed that conversation so much and I'm so so happy to have been here. Thank you.

Dr. Anthony Rafferty: Oh, thank you, Ailish. I'll see you soon. Byebye.

Ailish: Take care.