Are Endocrine Disruptor Chemicals Making It Harder to Get Pregnant? | Dr. Lora Shahine

Dr. Shahine: [00:00:00] There's very interesting studies coming out with sperm DNA fragmentation being associated with a higher risk of miscarriage. And there can be more fragmented sperm or a higher DNA fragmentation in a semen analysis with more chemical and endocrine disruptor explosion. An endocrine disruptor is typically a man made chemical, something that's made in a lab, doesn't have to be, that acts like an endocrine.

And an endocrine is basically like a hormone. And a hormone is a structure that's made in one part of the body to act on another part of the body. 

Dr. Brighten: What can men do to improve the parameters that DNA 

Narrator: fragmentation? Is transforming the conversation around fertility and reproductive health as a double board certified OBGYN and reproductive endocrinologist 

Narrator 2: trained at Stanford University.

She's the best selling author of not broken an approachable guide to miscarriage and recurrent pregnancy loss 

Narrator: and the voice [00:01:00] behind the hit baby or bust fertility podcast. With a social media reach of over 1 million people monthly and features in the Washington Post and the New York Times, 

Narrator 2: Dr. Shaheen is on a mission to educate, empower, and inspire hope for anyone navigating the path to parenthood.

Dr. Shahine: The most common cause of miscarriage is a chromosome imbalance or issue within the embryo. If you are able to test the pregnancy tissue 60 to 80 percent of the time, you will find out that's the issue. And if it's not a chromosome imbalance, I still think it can be. 

Dr. Brighten: What do we currently know about certain endocrine disruptors and their impact on male and female infertility?

Dr. Shahine: You can look at it in a lot of different ways and you can actually 

Dr. Brighten: test. Welcome back to the Dr. Brighten show. I'm your host, Dr. Jolene Brighten. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest.

Most UpToDate information [00:02:00] to help you take charge of your health and take back your hormones. If you enjoy this kind of information, I invite you to visit my website, dr brighten.com, where I have a ton of free resources for you, including a newsletter that brings you some of the best information, including up.

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Dr. Laura Shaheen, welcome to the show. I'm super excited for our conversation today. [00:03:00] 

Dr. Shahine: Thank you so much for having me, Jolene. I am really happy to connect with you. 

Dr. Brighten: It's going to be a fantastic conversation, but for everybody listening, the topic of miscarriage and pregnancy loss is going to come up. I just want to give that little warning ahead of time, because if you're not in a place, where you want to hear about that right now.

I totally respect that. Um, you can skip it. You can look at the transcript notes and know where you can grab things that you want to. You don't have to stay for the whole conversation. I just want to honor everybody in that. 

Dr. Shahine: That is so beautiful. It is really triggering for, for people. So important to share, but I really appreciate your, your time.

You're doing that. 

Dr. Brighten: Yeah. The thing about, you know, I think until you've been through miscarriage through infertility, you don't realize how weird the triggers can be sometimes. Like I shared on social media, you know, after having four miscarriages, then having three, uh, you know, Frozen embryo transfers fail and how like I thought like I've been [00:04:00] processing stuff I was handling it and I was in a department store that I was not familiar with I got lost and I bumped into a Mannequin that was pregnant a pregnant mannequin, which you don't see everywhere I'm just like almost had a full panic attack in the store.

Like it just hit me and so that's why I say like you just You never know, and sometimes it's just weird, like the other night for me, it was like seeing somebody's, um, sharing the fetal heart rate at their first ultrasound, and I just was like, UGH! Like, lost it. Um, I can still hold space and be happy for everyone who is pregnant, and at the same time, I think, like, you just never know when, you know, Those emotions are going to arrive or how you're going to be feeling that day.

Dr. Shahine: Absolutely. I remember being in a grocery store and, you know, walking down the aisle and turning and seeing a pregnant woman and it just shot feeling shattered. And I had to remind myself like, Oh my gosh, Laura, you are pregnant. Like I had struggled so hard to get there, but yet I was still triggered and I always felt like pregnant [00:05:00] people, well, it must have been easy for them.

I don't know why that was the, you know, the assumption. Um, and yeah, it, it, I do really try to talk to my patients about really, learning how to manage stress, learning how to cope because this isn't something that just magically goes away when you have a baby in your arms or you are finally pregnant and kind of getting close to delivery.

It is, um, it's trauma and it's something that kind of, you know, you might be really busy that first year with a baby or something like that, but you really need to take care of yourself because it's something that can kind of stay with you. Um, and you can actually, I mean, grow and learn through the process, although I wouldn't wish it on anyone.

But if you do learn and grow, you can actually kind of build tools that you can use the rest of your life. 

Dr. Brighten: Mm hmm. I want to get into those tools today and I definitely want to get deeper into this conversation, but where I intended to start this I think is a really important topic that I don't see enough.[00:06:00] 

women's health practitioners talking about, which is the subject of endocrine disruptors. And so I'd like to start there about, um, you know, and really back this up. I think that, like, to preface this as we talk about fertility and infertility, what is the current state of fertility in the United States?

We see a lot of information coming out showing that, you know, men's fertility, fertility is declining, that more women are going through reproductive technology, assistant, assisted technology to be able to get pregnant. And it has people saying, there's some people who are like, there's not a problem.

Don't look over here. It's, it's fine. And then there's people who are going through it. I don't know from your perspective, but when I opened up about my own struggles with secondary infertility, I have just been gobsmacked by the number of women under the age of 30 who have approached me saying, I have infertility.

And that is something that I [00:07:00] wasn't seeing 10 years ago. 

Dr. Shahine: Right there. It is so multifactorial. Um, Jolene, I feel that there And whatever news story you read about like, oh, fertility rates are dropping, or 2 percent of the babies born in the U. S. are now from IVF, uh, sperm counts are down 50 percent over the last few decades.

Honestly, whatever story you read, it's usually like a clickbait, you know, title to pull you in. And then it's sort of like, well, there's this factor and that factor. And unfortunately, a lot of the stories that are out there, You know, conclusions are blaming women for waiting, right? Like, it's an age thing.

It's your fault. So I try to be really conscious of that. Um, I do think that people in general are waiting longer. to conceive. But honestly, over the last few decades, it's only increased by two years. Like the average, uh, and I could be wrong about the exact numbers because this is from memory, but you know, two decades ago, first, uh, [00:08:00] age of first baby was around 25.

And now it's like 27. Um, and that doesn't seem that dramatic. But I think when it's happening on the whole, that's an average. There's a lot of people that are waiting until their mid 30s or even close to 40 to start trying. Um, I do think people are talking about fertility more, like you said, and that's great because awareness is really important.

Because there's a generation of women that we're just getting started. completely knocked on their ass, excuse me, can I say that? You can say that. We're 

Narrator: adults. 

Dr. Shahine: Where, you know, middle school and high school health class, for me, it was being afraid of getting pregnant before you were ready and there was so much more information that wasn't left off.

So then when you're ready to try and, you know, contraception works really well, you stop it. You think it should just be really easy when it's not. We're worried, and I do think that there is something with how food is being produced, how much pesticides are being used, endocrine disruptors. It's like 80, 000 chemicals have been introduced to household products [00:09:00] in the last two decades, and uh.

A fraction of them have actually been tested on how they might impact our health. Not just fertility, but cancer risk and all these sort of things. I mean, the, the feeling in the United States is, um, oh, I'm sure it's safe. Um, so let's just go ahead and put it out there. And then if there's a problem, we'll figure it out later.

But then also FDA has a lot of handicaps and what they can do to sort of restrict products and learn. And I feel like a wonderful example of this to try to get something concrete to you is I interviewed Shauna Swan, Dr. Shauna Swan, the PhD. Everybody should 

Dr. Brighten: look her up. Yes. We'll link to her. 

Dr. Shahine: Great. So author of Countdown, um, that her research put this whole sperm dropping by 50 percent over the last couple of decades on the map within the last couple of years because what's fascinating is she wanted to prove it wrong.

So she went to a medical conference, people were [00:10:00] talking about it and she's like, Oh, I'm sure it's just the way that we're, you know, counting sperm or the fact that we're looking at things more. She's like, I'm sure this isn't right. And so she wanted to actually prove it wrong. She found out. Actually, this is right, and then she went on to test animal models to look at phthalates and how they impact structure and function at an embryologic level.

This is in, you know, rodents, but still, and so to find a scientist that was doubtful, wanted to prove it wrong. Found out the fear was actually correct, and then also proved this cause and effect. That is something to really pay attention to, not all the clickbait noise. 

Dr. Brighten: Yeah, I want to touch on a few things that you said here.

So one, the animal models is really important. So when I was getting my master's in nutrition, because it was in molecular nutrition, I had to take classes that were part of the animal science curriculum. Everybody who [00:11:00] was in animal science Well understood that the reproductive capacity of animals in captivity So those in zoos were significantly reduced if they had bpa lined water sources Even those that they swim in they all knew about endocrine disruptors and the negative impact on fertility and that's when I actually got Um exposed to reproductive technology because they were doing this in animals to figure out.

How do we keep tigers around? How do we keep these animals around because what? So We as humans have put in their environment has impacted them. When I would go into my other courses, which was all on human nutrition, human reproductive health. And I would ask questions about this. No, no, no. It's not a problem.

It's not a problem. It's not a problem. And I have always, I have always said like, look to animal studies. We knew flame retardants were triggering autoimmune diseases in our cats and dogs, the same flame retardants that are in our couches that we're being exposed to. But then we saw in. You know, human medicine that [00:12:00] doctors were like, no, no, no, just don't worry about it.

Uh, you know, the other thing that you brought up is the trouble with the FDA. So there is this mindset and unfortunately many of our colleagues have adopted this mindset that until It is proven without a shadow of a doubt to cause harm. We are going to dismiss anyone's concerns about it. Like, we're just going to be like, there's not enough science.

We just saw this with the tampon concern that came out. And even when I said, you know, this is a small amount, we don't know about absorption. However, it is worth looking into further. We saw people who consider themselves these scientific skeptics say, No, we don't need to spend funding on this. It's not important.

And I was like, this is wild. So, you know, to your point at the FDA, we know that they are limited, but we also know that the same people that sit at the head of these chemical boards will jump onto the FDA, get things passed and jump back over and get a bonus. This is something we've known about for decades.

So I think There's a lot to unpack in this and it's scary. We're going to give solutions [00:13:00] today as well. But I'm just curious, like, from your perspective, when people are saying like, you know, the dose makes the poison so don't worry about it until we actually know it's definitively an issue, what do you share with your patients regarding that?

Dr. Shahine: Yeah, absolutely. I, I start by sharing, um, that it's really okay to feel overwhelmed when you first start to learn about this. And it's actually quite comforting to listen to the posts that say, don't worry about it. Um, it's really like climate change. Yeah. Yeah. You know, I do equate it to climate change, like if you come on too strong and you really scare people, okay, maybe you'll get that click bait, but then they just kind of shut down because it's too much.

And I actually really felt that way when I started learning about this so I can empathize with my patients. I had one lecture in my fellowship at Stanford in 2009 or one scientist there was looking at BPA and egg quality, [00:14:00] and I kind of listened to the lecture and sort of. Forgot about it. Went and started my practice and things and then my patients started asking me questions And I was like, well, this is not something that I learned in medical school, but you know, I'll look into it You know, I'm of the generation.

I'm not afraid of my patients reading. Dr. Google, but I do want to Spark conversations and hopefully people don't believe everything that they read and I started going. Oh my god Gosh, this is really real. And the best studies are truly out of Europe where there's a lot more, um, openness and, uh, you know, allows incredible databases.

You know, they have a healthcare system where they can really look into a lot of information on a broader scale. And so part of it is just feeling overwhelmed. Um. and not feeling like you can do anything you can change. Like you hear about microplastics and you're like, Oh my gosh, this is just everywhere.

And so trying to empathize with that, like, Hey, this is overwhelming, but [00:15:00] fertility is already something that you feel sort of out of control, right? Like you could control your fertility when you're not trying to get pregnant. Now you want to get pregnant and it's like, why isn't it happening? This is actually something that you could control if you just change your mindset.

If you change little habits, you can dramatically decrease your exposure. You cannot eliminate it. So if you get in the mindset, like I have to cut out all chemical and endocrine disruption exposures, you're going to get overwhelmed. And I try to share some of the studies that show, you know, if you just wash your fruits and vegetables.

You know, because a lot of people can't afford all organic and all pasture raised and things like that. If you just wash your fruits and vegetables before you eat them, you'll dramatically decrease your exposure to a lot of endocrine disruptors. That feels tangible. If you invest in, you know, a set of food containers that is pre processed, based in glass as opposed to plastic, you'll, you will never have to change them.

You know how the [00:16:00] plastic kind of stuff, if you put spaghetti sauce in it, it gets all red. All that stuff is seeping into the plastic and think about what's seeping from the plastic into the food. So anyway, I try to think about, um, big picture. Acknowledge how overwhelming it can be and just say, Hey, it's just little steps and you can make a big difference.

Dr. Brighten: Absolutely. I, I love the little steps. I'm gonna, I'm gonna beg you for some more today. But, you know, as we talk about endocrine disruptors, like what are we talking about? Because that might be a new topic. This might be a whole new set of words for people. 

Dr. Shahine: Totally, and words are so important because like people will say toxic or they'll say clean beauty and it like a lot of these things really don't mean anything.

So an endocrine disruptor, um, when you are talking about is typically a man made chemical. So something that's made in a lab doesn't have to be, but that's usually what people are talking about. That acts like an endocrine and an endocrine is basically like a hormone and a hormone and [00:17:00] I'll repeat this a Hormone is a structure that's made in one part of the body to act on another part of the body You know that word hormone has gotten just villainized, but actually we all have hormones and they're actually okay So yeah, it's super important so an endocrine disruptor is that usually a man made chemical that kind of is doing something in the body that that usually hormones do and it kind of disrupts the way hormones are working and acting.

So like a really good example is BPA, bisphenol A. This is a chemical structure that was actually made in the 1920s to be an estrogen substitute. It was created to be a pharmaceutical. And when they realized that another one worked a lot better, which is DES, diethylstilbestrol, which is, as you know, No longer allowed to be prescribed.

We could talk about later if you want. So BPA was like, Oh, this isn't as good of [00:18:00] an estrogen mimicker. We're just gonna put that back on the shelf. And someone said, Hey, actually, if you use this chemical and plastics, it helps them, you know, be more malleable and kind of helps helps them be better plastics.

So BPA is literally Like an estrogen, and so when it's in your body, it'll attach to hormone receptors or estrogen receptors. And it's considered disruptive because it's happening at a time maybe in your cycle or when your body is ovulating or things like that where it really shouldn't be. So it's disrupting sort of the natural homeostasis of endocrines or hormones.

That, that was a long answer, but I try to explain too. 

Dr. Brighten: Well, and I want to get into some specifics about what do we know from the research where we're at and, um, for people listening, because I think one of the biggest criticisms that come up is people will say, well, these studies are on animal models.

And I always have to explain how unethical it would be to compromise an individual's in [00:19:00] like fertility. If we knew there's even the prospect that these endocrine disruptors could do that, that these chemicals could do that and how unethical it would be to expose a pregnant woman, because that's going to potentially affect.

Like, we're not talking about just that baby. We're talking about generations to come. So, there are ethical concerns and the best we have sometimes are animal models. With all of that said, what do we currently know about certain endocrine disruptors and their impact on male and female? Infertility.

Dr. Shahine: Absolutely. Well, you can look at it in a lot of different ways, and you can actually test levels of these things like phthalates is an endocrine disruptor, parabens are an endocrine disruptor, BPA. So you can actually study those levels in humans and then see how long it takes them to get pregnant or look at their miscarriage rate.

So a wonderful study that came out of Uh, my, you know, where I did my fellowship at Stanford was just checking BPA [00:20:00] levels in the blood of women with their very first pregnancy test. So you're at an IVF clinic, you, you know, get pregnant, you come in, you get a blood test, and you know, You're making sure that you're pregnant and they just use those samples later with people's permission to test for BPA and higher levels of BPA at that first positive pregnancy test was associated with a higher risk of miscarriage that was independent of chromosome issues.

So that is, uh, you know, a beautifully done study that's actually not putting people at harm. It's an association. Um, and. Uh, okay, we see this, but in order to prove causation or to prove that certain levels have certain impacts on egg quality, egg function, chromosomal rearrangements, sperm counts, you usually have to do that type of study to prove causation in animals.

And I know that's ethically challenging, [00:21:00] um, but you can see relationships, you can look for. Hypothesis in humans, um, you know, levels of phthalates and men and sperm counts. Like that's, it's easier to test sperm. So sperm levels and motility and volume, all that stuff. And so you can see that. And then you might need to go to the lab, just like Dr.

Shana Swan did, um, to say, I'm seeing this relationship and now I'm going to see if this makes sense in the lab. So you can do both. 

Dr. Brighten: Yeah, well, I appreciate you touching on that. You know, the other thing I found shocking is when I came across studies showing that flame retardants actually increase oxidative stress within the ovary and again, these are animal studies, but showing dysfunction in the ovaries capacity to produce hormones.

So that's going to have an impact on us. whether or not we want to have babies. There's a big question of like, how does this affect our risk for [00:22:00] Alzheimer's, dementia, osteoporosis, like other, you know, chronic conditions. But I remember raising this, like we need to look into this a lot more because for people listening, Oxidative stress, you may have heard of free radicals, they rip apart cells.

Your gametes, your, your cells that become baby, that is very, very susceptible. And we know that antioxidants are typically used as part of fertility protocol. So, you know, it's, it's things like that where I'm like, well, Wow. We, we really need to pay attention. And I appreciate that you bring up the male factor because I think far too often it is put on women or it is put on age.

And I, one of my biggest regrets with secondary infertility is letting anybody talk me into it being my age. I was getting pregnant. I was having miscarriages and being told like, it's just your age. It's just your age. You need to go through IVF. And then through my third, third. IVF egg retrieval going into a significant endometriosis [00:23:00] flare, finding that and being like, wow, you know, I, I want to say for people listening, I didn't have painful periods.

I didn't have the hallmark symptoms that you would expect. And yet at the same time, I'm like, I think we're always too quick to rush to say, she's the problem. Her eggs are the problem. Like that's the only problem. 

Dr. Shahine: Yeah. I, um, I mean, there's, Ageism in fertility evaluation and diagnosis. And it is very true that those eggs are in our body for, you know, however many years we're around.

And they're stuck in meiosis one. They've got two copies of the each chromosome, and it's when we. ovulate, whether we're 25 or 45, that they have to go through all of their genetic work. And that's very different from sperm because sperm is made every single day. So I do talk about age every single day in my clinic and with my patients because it is something that I can't control.

But that also doesn't mean that you don't think about lifestyle optimization or evaluate somebody or [00:24:00] assume that they don't have endometriosis just because of age. Um, And, you know, you also don't assume that people are fertile when they're 25 just because they're young. Like, you, it is very important.

It is something to consult and, and just really kind of go through, but it's not the only thing that we should focus on. 

Dr. Brighten: I agree. We've touched on BPA, phthalates, parabens. Where are these things most commonly showing up in people's lives? 

Dr. Shahine: Yeah. Honestly, um, kind of intake. I think about food a lot. So even if, um, you know, a lot of processed food, it comes to us in plastic containers.

I also think about just how things are made. You know, if you go to a dairy farm, you just see that the milk is kind of come in and going into these PVC pipes and getting processed and then it's packaged in a line full of BPA canned foods or, you know, lined, you know, often with BPA. Um, and so I do think about it in our food and we're ingesting it.[00:25:00] 

And then I also think about the largest organ in our body, which is our skin. So, you know, I get nervous when, you know, I see teens on TikTok talking about these 17 step, you know, skin regimens. I'm just like, yeah, talk about like the doses in the poison, right? Like, it's so great for, for, Skin care companies to say, Oh yeah, you need an eye cream and a face cream and a night cream and then, but then at the end of the day, Oh my gosh, all of these different products.

So, um, and other ways, you know, that these get into your skin is through your laundry detergent or, um, scented candles, you know, you're inhaling. Uh, you know, fragrance is often stabilized with phthalates. That's a really common way to get it in. So it's your skin, it's in what you're ingesting, it's in what you're smelling.

Um, so again, not to overwhelm, but it's, it's not just one thing. We will get it to 

Dr. Brighten: solutions. I want people to know. I just, I'm like, we will get there. So, you know, you brought up, candles. I'm always like, that's one of [00:26:00] the first things that I'll tell patients is like no glade plugins, no scented candles, like open up your windows, like get your indoor air when we're talking about air, air pollution, what we're being exposed to has, has there been research showing an impact on fertility?

Dr. Shahine: Absolutely. I just did a YouTube video on this because I'm in Seattle and the University of Oregon, which is in Portland, just down the I 5 from me, did a really interesting study showing that with wildfires and poor air quality, they saw lower embryo formation in their lab during that time. And so that was just a really, very straightforward correlation between something human, but also like a air quality or something that we're exposed to.

Um, so I, I loved that study and it sort of sparked, uh, my interest in, okay, well, we shouldn't just think about this when we're having. Wildfires, which are, you know, becoming too common. But anyway, we should think about our air quality in our [00:27:00] home. Think about how much time you're spending in your bedroom, thinking about, you know, what kind of filters you can you can get.

And so it is something definitely to consider. But that's also something that you can think about and help improve. 

Dr. Brighten: It is startling. That I was actually talking with friends the other day about when you look at the air quality At any given time there's places that have really good air quality. But if you follow them over a year Their seasons where they have really poor air quality and I feel very sad that there is Very few places left on the planet where you won't be exposed to some kind of air pollution.

And so as you brought up air filters in your home can make such a big difference. How do you recommend people employ those? 

Dr. Shahine: Yeah, I there's a great episode by the wire cutter, which they do a really good job of, you know, looking at all different types of brands and types of things. And so I mentioned a couple of the help of filters that they recommended, and they're not [00:28:00] always the most expensive.

Some of the most like high priced filters. Tech, you know, gorgeous, you know, beautiful marketing things actually aren't doing anything. Um, so a really great HEPA filter, especially just if you're going to buy one, just in your bedroom. You spend so much time asleep and breathing that air. That's a fantastic way to improve air quality.

Dr. Brighten: Absolutely. I always say, so bedroom is the first place you start. The second place is where do you spend your most time in the day? And for many people, that's an office and you can not. control what is happening in the office. I am the kind of person who will be like, is that a, is that a plugin? Are you using Febreze?

Like, no, I'm not having that in my space. Uh, but just looking at where you spend the most time because that's where you'll make the biggest impact. So we have covered air filters. We've talked about plastics, uh, getting into glass containers, beverages that you drink out of being glass or avoiding plastic as much as you possibly can washing your fruits and vegetables.

So that even if it's not organic, I mean, even when it is [00:29:00] organic, you still need to wash your fruits and vegetables. There's just because it's organic doesn't mean it doesn't have some form of a chemical protecting it, which is not necessarily protecting you. What other things can people be doing in terms of the skincare conversation?

And we're going to like, Listen, if you're a dermatologist and you want to come, you don't get to hate on Laura, but you can come for me. Um, because it seems to me dermatologists are always like, whatever it takes to stay beauty, beautiful and young. Like, we don't care. Uh, attitude sometimes, because they're just like, you know, a phthalate, it's not that much, it's not that big of an issue.

And I'm like, you know, you should talk, you should talk. maybe default to a reproductive endocrinologist and ask them if it is. 

Dr. Shahine: Oh man. Yeah. Just today, actually, I published a wonderful, um, episode for the Baby Your Best podcast where I interviewed a dermatologist that does care about endocrine disruptors.

We love this. We 

Dr. Brighten: love them. 

Dr. Shahine: Dr. Heather Rogers, I'm very fortunate that she is actually my personal dermatologist, but she's created her own skincare [00:30:00] line with just like really very minimalist, uh, ingredients. Um, and so she, and we talked about that in the interview. I said, you are so, unique. Most dermatologists are not paying attention to this.

And they are really thinking about, you know, because chemicals actually do help the ingredients kind of get deeper into the skin. But it's like, okay, at what cost and you don't have to sacrifice your gorgeous skin. to having chemicals. You know, a great example is parabens. Parabens is a chemical that's made and it does a great job of increasing shelf life um, in products and it's in a lot of products and because it decreases fungal and bacterial growth in the products.

Which we want. Which is great. Which is good. Which is great. But there are alternatives, um, that are not endocrine disruptors and parabens are endocrine disruptors. But in the American, you know, Journal of Dermatology, [00:31:00] two years in a row, the best, you know, um, antimicrobial for, you know, that caused the least allergen and skin irritation is parabens.

So dermatologists are thinking about function. of the product that is also causing less rashes and less irritation. And that is great. That is wonderful. Can we just add a third pillar? That's also like, hey, less endocrine disruptors when you have alternatives. And most of the time, and this field of medicine is very much all about the, the poison is in the dose.

Dr. Rogers and myself too. It's like, but okay, that one individual face cream that is totally fine, maybe. But if you have a 11, 15, 17 step skin regimen, who's tracking the buildup? And some of these things have PFAS. PFAS is a forever chemical. You're, you know, it's something that we haven't mentioned yet, but that doesn't mean that you can't [00:32:00] That makes mascara do a great job.

You know, great job. You look gorgeous. But you're adding that plus all these other things, um, you do need to pay attention. So um, I'm really glad you brought that up and there's a lot of wonderful, incredible dermatologists out there. I just, I think they could also, you know, share a little bit about this too.

That would be, that would do a lot of good. 

Dr. Brighten: A lot slower to change because they're not seeing the direct effects. They don't hold the hand of the couple who's crying because of that recurrent loss, the inability to conceive. So I think that having that arm length's distance has made it to where it's not on their radar as much as it should be.

I think it's coming. I just think it's going to be a couple of decades out before we see a real shift in that profession. And And as you were saying, you know, to my knowledge, maybe you have seen it. I have never seen a study that tracks the 13 plus, uh, you know, chemical compounds that we're exposed to, which are beauty products, that we [00:33:00] apply every single day.

We know women tend to be brand loyal. Once you find something that works, you stay with it. So what does it look like to not only do that every day, but to do that every day for the next two, four decades of your life? We've never had that study. We do not have that answer, and I think we do a disservice, and we actually breed distrust in patients and the general public when we dismiss that concern, because we actually don't have the answer.

Dr. Shahine: Yeah, we don't have long term data, that's absolutely true, and that can comfort people, but it should also make people pause. And there is one interesting study that looked at, um, teens, like pre teens and teen girls, and phthalates and paraben levels, using their regular makeup routine, and then they stopped all their products, and two weeks later, looked at levels in their urine, and it was much less.

Yeah. Yeah. So. Um, you know, by changing, um, you can decrease these levels if you want to and that study just [00:34:00] sticks in my mind because I do have a teenage daughter and I, I do talk to her about these things. You know, the sexy ads with these gorgeous, you know, 20 year olds that really don't need any skincare products anyway, um, are really appealing and you want to look like that, you know.

Popstar and it seems like that's something and then also just the whole lure of, um, more skincare products is self care. Um, and I don't want people to lose that self care and if there is one product that they absolutely love and they know, like, you know, it might have a certain endocrine receptors in it, okay.

Keep it. Love it. Enjoy it. But then let's maybe decrease exposure from other things that you might not absolutely need. 

Dr. Brighten: Yeah, we don't have to do all or nothing. And for people who do want like a really good self care skin routine, I always am like, think about a really simple oil for your skin and gua sha.

Like that right there is a great way [00:35:00] to love up on your skin. It is really economical. And. It has tremendous benefits and you, you know, there's I'm like, I don't know any studies, but you can certainly talk to the cultures who have used it traditionally and you can look at their skin and you're like, this is, there is something to this.

And so there are other ways to adapt. And I think you're right. Like we can't, Be all or nothing and that's sometimes where like you might compromise and you're someone who's like I'm going to get gel Nails, which we know are not great. We know that it enters your bloodstream We know it can be problematic, but you're like I switched out everything thing for my skincare routine.

I'm only using simple body oils, like instead of lotions on my body, like you may have made other compromises and I would still call that a win. 

Dr. Shahine: Agreed. Absolutely. Agreed. 

Dr. Brighten: So I want to talk about the, you know, the problem with household products because you brought up dryer sheets. before. [00:36:00] So what are the problems with the, you know, household items?

Think cleaning products, stuff that people are using in their everyday environment when it comes to their reproductive health and hormones. 

Dr. Shahine: Yeah. Um, this is just another way for these chemicals to get into our system. It could be on our counter surfaces and we're touching the counter or we're putting our food on the counter.

You know, it picks up the stuff that's from the cleaning products and then it gets into our food. Um, also again, nasal passages, like so many cleaning products are really, you know, being advertised. Like you're going to, you know, your laundry, what is a mountain breeze? Like, what does that smell like? And what does the spring morning smell like?

And why do I have to smell like that? 

Dr. Brighten: It's just like the same thing as like, you know, uh, like all vaginal hygiene stuff. stuff like, why am I supposed to smell like a Clementine? But the one that always gets me is the bleach commercial where the lady sniffs the bleach and is like, Oh, it smells just like this.

And she's like smelling the bleach and I'm like, this should be [00:37:00] illegal to be promoting huffing bleach. Like, what is actually happening in this commercial? 

Dr. Shahine: I totally agree. That is not good for you. Um, yeah. So it's just another. Way that you can kind of look at your products. I tell my patients like hey This can feel overwhelming and it can feel really expensive if all of a sudden you go home and you throw everything out So don't do that.

But just as you're finishing up your laundry detergent, why don't you just take a look at what? What it is, what ingredients are there. And one thing that you could do is maybe just get the same thing, but unscented. Like, um, there's just such a powerful way of getting a lot of chemicals into a product with scent and another really weird loophole and, you know, transparency.

And I had said, States. If a company can claim that an ingredient is proprietary for their scent, that is trademarked and they do not have to list that that is an ingredient in their product. Wild, right? And so if [00:38:00] you, wild, yes. And so if you just see the word fragrance on a product that says that it's also clean and organic and you know, organic, yes, there are strict limitations on food.

That you can label or not label organic and guidelines, but other products like organic beauty products or organic, you know, uh, laundry detergent there, they can just write whatever they want on the bottle. So if you see the word fragrance as an ingredient, that should be a red flag. So why not maybe get unfragranced?

That's what I was going to say. 

Dr. Brighten: Totally, totally. Sorry, because the thing I was going to say is that, and always check because sometimes fragrances. is coming from an essential oil. Um, there has been concern about, uh, lavender essential oil, you know, being an endocrine disruptor and infertility. I'm like, how much lavender are you using?

If you're diffusing in your space 24 7, you're spritzing your pillow, you're putting lavender oil on yourself, it is in your laundry, like all, the Navy, yes. But I'm like, the average [00:39:00] person is not using that much lavender. But one trick I'll tell people, have you seen those wool dryer balls? For people who are like, I just love that.

I take wool dryer balls, and I'll just put a couple of things, cause I have, I have a preteen boy. And um, as we all know, is their hormones shift. So do their body odor, as it's supposed to. This is not shaming. Um, but it is just something that I have just preemptively been like, I'll just put a little bit of peppermint on there, or a little bit of lavender, and I put it on the dryer ball, and I toss it in there, and it doesn't come out.

It's not like I open up the dryer. I'm like, Ooh, look at that smell. It's just this mild thing that is there that I'm like, you know, we, We know these things have a little bit of antimicrobial property. So, and that's just where the odor is coming from for everybody else. And you're not washed and 

Dr. Shahine: go ahead.

Awesome. And you're not putting dryer sheets in a landfill, right? Like it's a wool ball that you can just do that. There's little drops of oil. And that keeps 

Dr. Brighten: you from having static. And if anyone else has hair like me. You know that static will literally sabotage your entire day. You'll be like, why is my hair [00:40:00] sticking to everything?

And I'm shocking people when I walk by. That's great. So I want to talk about, you know, we've, we've talked about, you know, in the home, we've talked about eating. What about an environmental exposure that's happening in our jobs? So occupational exposure and how that is impacting people's fertility. 

Dr. Shahine: Yeah, I think awareness is just really important.

So if I do have patients that are, you know, painters, uh, working in the Boeing factory, you know, cause I'm in Seattle, things like that. I ask about, Hey, what kind of, you know, protection are you using at work? You know, what kind of chemicals are you exposed to? And if you're, you know, think about using a, uh, N95 mask or a respirator.

I have like. first responders that are fighting wildfires and you know, how are they protecting themselves and this? So those are kind of extremes and things that we know, but I also have a lot of nail technicians that are doing those jail gel nails and having a hard time getting pregnant. And that's actually, that has been [00:41:00] studied that in general, nail technicians have a higher chance of infertility and miscarriage.

And so I, uh, you know, trying to encourage my patients to wear. Uh, and 95 masks and try to increase fresh air or airflow or filters in the salon because you can't just say, Oh, quit your job, you know, like, right? Like you have to think about, um, you know, that might be a solution for some people, but you know, what can they do with the current job that they have to protect themselves?

Dr. Brighten: Absolutely. This brings up hairstylists because we know they have really high rates of ovarian cancer. They're one of the highest. Occupational risk for ovarian cancer and so many, anytime I talk about that online, so many women will write me and be like, how have I never heard this before? They, I've, you know, there's also been studies showing that the chemicals that, so there's what we, you know, you dye your hair like every couple of months.

That exposure is very minimal [00:42:00] compared to the individual who is dyeing someone's hair. several times a day. So in those instances, is there anything that you can offer like things that they can consider doing? 

Dr. Shahine: Yeah. Um, I think about wearing gloves, uh, while you're applying. And, um, again, you just think about how strong some of those chemicals can sometimes smell.

So trying to use, uh, like not just a little, you know, fabric mask, but truly like an N95 mask or, I mean, it's extreme. And I. Can't imagine walking into a salon and seeing this, but I mean, honestly, like a respirator, right? Like those, um, really incredible filters. I don't see that happening, but I think that just post pandemic people are a little bit more comfortable seeing people wearing masks, um, than before.

And it. It could really help that person that's, you know, being exposed to those chemicals day in and day out. Mm 

Dr. Brighten: hmm. I also think salons getting really good air filters because I would pay more for a salon that has an air filter in it. Like I [00:43:00] won't go to get my hair cut if somewhere has acrylic nails because I am so sensitive to smells.

And. Like I, a few times I've been like, you're being a baby, like stop being extra. And then I leave with the worst headache. And I'm like, no, it's not. I have a headache. Like, no, I don't need to go to a salon. That's doing acrylic nails. 

Dr. Shahine: Yeah. That's great that you've figured that out and you can protect yourself.

Yeah. 

Dr. Brighten: You've brought up microplastics. What are microplastics and how are they impacting fertility? 

Dr. Shahine: Oh my gosh. Well, they're just everywhere. I mean, they're in. sea salt that you're putting on your food. I mean, it's just basically so much of the chemicals that are from plastics are just throughout our water source, our food, um, sitting in our oceans and it's just, you can't escape them and people are starting to realize like, Just how [00:44:00] prevalent it is.

Um, again, this is another source of overwhelm and it's just the point that, okay, so if you know that that is kind of in your environment, no matter what you do, then why not get the big sources of plastic in your own kitchen, you know, kind of decrease that exposure. That's what you can control. 

Dr. Brighten: And have we seen microplastics?

associated with fertility issues. 

Dr. Shahine: Yeah. And we also know that it gets into breast milk. It can, you know, they can test the placenta for it. Like we're exposed and we're so vulnerable, you know, as we're developing and, you know, as, um, a fetus, uh, you, These exposures are absolutely coming just as early as possible and um, it's, I'm not aware of just the general term microplastics being examined in a scientific study, but all the things that are in these plastics like BPA, [00:45:00] that'll be studied in a scientific study or phthalates will be studied.

Um, and I think microplastics is more of a little bit of a layman's term to try to. Explain like, hey, that the stuff is, is everywhere, you know, cause you can think to yourself, I don't have any more plastic water bottles in my house, therefore I'm fine. It's like, well, no, we got to still keep thinking about this.

Dr. Brighten: And I think, you know, as you say this, we need to go upstream and we need to think about how when we're told like, don't worry about your single use plastic, you'll be able to excrete that. But that single use plastic is going out into the environment. I think about the same thing when people say like, there's no health benefits.

to buying organic, like, don't worry about it, what you're exposed to is so little, and I think about, well, if I have the means to buy organic, I should because the people who are farming that food are experiencing significantly higher cancer and infertility rates. So we have to go outside ourselves, outside of the individual, and we have to [00:46:00] keep going upstream.

If we have a microplastic issue, it's because we have a single use plastic issue. And it's not just this concern about you as the individual, but the planet overall. And so looking at, The high level of things because the reality is, is that when we often talk about, oh, you know, do this for the planet, like the planet's not going to be okay.

This planet is going to be fine. We have to get, we have to be get sober up about this. This planet is going to live on past us. It's us who is not going to be fine. It is our species that is under threat, for all intents and purposes right now, by the dismissal of the concerns about these environmental toxins, and by the mass consumption of things that we have all participated in.

I am not finger wagging at anybody, but I think when we We come to realize that when you do make the change at the individual level, you make a change on the community level and at the global level [00:47:00] and you do have that much power, even if it is just as simple as today. It's the dryer sheets like you're making a huge impact.

Dr. Shahine: Well, I think the only way things are going to change is if customers change their buying patterns. Always. Because that is the way companies listen. An excellent example of this is Johnson and Johnson with the talc in their famous and brand associated baby powder. talc and ovarian cancer was linked for decades.

People could show the association. Johnson and Johnson kept fighting back with the FDA, doubting the studies, doubting the levels, um, et cetera, because it's really the talc is, um, mined next to, uh, asbestos. They often grow together. So it's really the asbestos. It was only when people [00:48:00] started stopping buying the baby powder because they started believing the scientists and the people that were suing Johnson Johnson that they finally changed and they changed from talc to cornstarch.

And that is, you know, that's an incredible story. And it's amazing. It's just really, um, that story highlights, you know, not believing women. It highlights, um, marketing towards people of color. Uh, it's incredible what Johnson Johnson did this, uh, you know, as soon as they realized that, you know, people might not be buying it, then they really tried to market it and change the culture of, um, people of color in the United States to buy it.

Uh, this story is really well outlined in an excellent series podcast called Verified High school friend of mine, uh, Natasha Del Toro, Verified, uh, it's one of the seasons of this podcast. It's like, uh, multiple episodes. Incredible, um, if you really want to learn about how the FDA is so limited and what companies can [00:49:00] do and the power of, um, customer purchasing, uh, I highly recommend listening to that, uh, that season of Verified.

Mm hmm. 

Dr. Brighten: Yeah. That's a great recommendation and I love that you brought up women of color being disproportionately affected by this because we know So I know as a Latina who has curly hair how things are marketed and how bad How bad they can be when you start reading the labels and you know what I know and it gets I mean I have been traveling places before where I like had to go with a carry on and i'm like i'll just go pick up a hair product and I've gone and I'm like, I can't buy any of this at this store.

Like I can't, knowing I want to conceive in good conscious use this product. But when it comes to douches and I outlined the science behind this in my book, is this normal douches? And when it comes to hair products that are known carcinogens, known endocrine disruptors, like [00:50:00] known to cause harm, they are still marketed heavily.

to black women and Latinas. And it is astounding to me. And it is so hard when generationally, this is what your grandmother and your mother has told you to do and what works because of predatory marketing. And that I just find so unethical and so unfair and something that really does have to change in the market.

Dr. Shahine: Yeah, I, um, I interviewed, uh, an incredible Dr. Larissa Edwards, who's done a lot at Columbia, kind of looking into women of color and, um, toxins and marketing. Um, she's a woman of color herself, and in the episode of My Baby or Bust podcast, she really talks about this, um, just paradox and struggle that she has, like she knows when she straightens her hair and uses these products.

That she gets treated differently and it was just so eye opening for me to just listen [00:51:00] to her and her self, all she knows and trying to balance like what she's buying. Um, I just, I really learned a lot, um, from just talking to people. 

Dr. Brighten: And it's so important because it's not as simple as just let your hair go natural.

Um, I mean when I was In medical school, I remember getting, and I wish I had saved this, getting in one of my evaluations where the professor, he actually said, the attending, he said, Um, she should wear her hair back because her unruly curly hair is unprofessional, and I was like, The audacity for you to evaluate, to mark me down because I have curly hair, like, and that, like, Yes, if I was doing a physical exam, I tied my hair back, like, but if I'm just doing an intake, like, I'm not touching anybody, like, my, what does it matter that my hair is down?

But, um, that is so minor in compared to what black women face. [00:52:00] And so it is this difficult thing of, like, there's the way that society will treat me and perceive me, and then there's the risk. It's the inherent risk of, you know, undertaking some of these beauty practices. It's not, there's, we're not at a point where we've got an easy answer.

So I just want to acknowledge that for anyone who's listening, I'm not going to pretend that I have like, just do this thing. Like it's so easy. It's not that simple. 

Dr. Shahine: Yeah. Well, and the worry too is that, um, we're coming from a place of privilege and we're saying like, oh, buy all organic or buy these, you know, clean and air quotes, um, products that are often not actually safer and just, um, marketed heavily as clean because there's no, you know, uh, restrictions on how to use that term on a label.

And so there's greenwashing. You know, like the companies are like, Oh, if I can label it this way, then I can charge more for it. And so one of the ways both [00:53:00] Dr. Edwards and Dr. Rogers talk about is using less products actually, you know, and, and maybe you'll save actually overall by using less products and maybe they can be higher.

Um, but just being very deliberate, you know, Dr. Rogers talks about, you really don't need a separate eye cream. Like that is absolutely marketing. And so just use that same moisturizer, but just maybe a little bit more around your eyes. Um, you know, and, uh, you know, Dr. Edwards sort of said the same thing.

You just don't need a lot of different products. And that, and so not coming at it as like, Oh, you have to buy more expensive stuff, but maybe using less you could save overall. 

Dr. Brighten: Absolutely. Yeah, I love that. Do you think there's valid concerns surrounding environmental toxins and miscarriage? 

Dr. Shahine: Oh, yes. So I talked about that, you know, study from Stanford showing higher levels of BPA in the blood of women with their first pregnancy test being associated with an [00:54:00] increased risk of miscarriage.

Um, and it is something that is, um, It needs to be, uh, studied wider, of course. Uh, we need more funding, we need more research, um, but, you know, for example, uh, there's very interesting studies coming out with, uh, sperm DNA fragmentation being associated with a higher risk of miscarriage. Let's talk about men for a second, right?

That's half of the genetic equation. Yeah, so. 

Dr. Brighten: What is DNA fragmentation and what's 

Dr. Shahine: going on? Sure. So basically, you can test the sperm to see if the sperm is fragmented. If it's fragmented, the DNA is exposed and you're able to do like kind of a special test for this. Um, the hard part is like, you know, not every time will it show up.

And, uh, it's just, it's, um, it's not a perfect test, but it's showing. You know, a male factor that can be associated with fertility and there can be more fragmented sperm or a higher DNA fragmentation in a semen analysis with [00:55:00] more chemical and endocrine disruptor exposure. So I'm expressing a trend, uh, uh, you know, association that we're seeing, a thing that with biologic plausibility, like, oh, that makes sense.

And so now we're waiting for the studies to actually show causation, like, is this really true? So, we're learning, it makes sense, let's pay attention, but we're, you know, I just wanted to kind of point out something with the guys and genetics and miscarriage. 

Dr. Brighten: We know DNA fragmentation is problematic, irregardless.

of there being environmental toxin exposure. So for people listening to this right now, what can men do to improve those, the parameters that you are screening for when it comes to DNA fragmentation? 

Dr. Shahine: Sure. I just honestly think about if you can focus on your overall health and wellbeing and make positive lifestyle optimization choices within reason, cause that doesn't mean take away everything you enjoy.

You have to [00:56:00] have some balance. Um, so things are looking at your nutrition. And, you know, less processed foods, right? Even just fast food is absolutely so full of BPA and phthalates, and we're not, a lot of it is how the food is processed and gets to the restaurant, but it's also the containers that it's in.

So that kind of a thing, thinking about your nutrition and exposure that way, uh, moving your body, you know, regular exercise and not running, you know, marathons and Ironman races, but just moving your body pretty consistently, you know, more than two or three times a week, uh, will improve your overall health and wellbeing.

Uh, sleep is important. Stress management is important. You brought up antioxidants. So Coenzyme Q10, selenium, zinc, vitamin A, vitamin E. E, all of these things and I'm not saying go out and buy a whole, you know, health food store of supplements. If you have 

Dr. Brighten: high DNA fragmentation, I will say yes, [00:57:00] do it. Like, I mean, you know, we've been on a fertility journey and the supplement protocol, I have my husband on.

Um, it's, you know, because we also use N acetylcysteine, and we'll do straight glutathione, and we've got, uh, N M N M N, which is a precursor to NAD to support mitochondrial health, um, and, like, he, when he went on that protocol, and then we tested, like, three months later, it was, like, It's about 72 days, right?

So it's like ish about three months. He was so proud, so proud of the parameters. And I will say any patient that I'm like, Hey, like get your guy on this, like eat it. Like when you see the shift in the sperm, I'm like, it's worth it. But as you said, with the health food store, just be cautious what you buy, right?

Because as we know, you know, So my, I have a supplement company, Dr. Brighton Essentials, and we, and part of why I started it is because when I was taking a prenatal, I did not trust So much stuff on the market, [00:58:00] and sure enough, one of the ones that was supposed to be the natural, the best, that got bought by a really big company, then knowingly had arsenic levels off the charts in their prenatal, and like, at that point, I was like, it was my Thanos moment, where I was like, fine, I will do it myself, and that's where we started, and I was like, we will screen all of our ingredients before they even get into a capsule, and then we're gonna screen it again.

If there is heavy metals, or At all. Throw it in the trash. It is not, like, you know, within reason. I do want people to know that, like, some plant matter will have some degree of heavy metals because it's in the soil, but if it is anything that, like, you know, is surpassing, like, Prop 65, which is very, very strict and very limited, I'm like, I don't want it, because I take it, my family takes it, and like, I am just so cautious with that because I have seen people have issues where we test for heavy metals, we go through everything, and we're like, yeah, so you know that powder that you're [00:59:00] adding several times a day, like, It's too much.

It's like, and especially when the product's not intended to be more than once a day. So it's not even being tested at that degree. So I don't want to freak people out. I just want to make smarter consumers to look out for things for like, you know, third party testing and making sure that you, um, that you can get that information for the company that they can supply that, um, like this was tested.

This is, You know, this is something that we will put our name behind because a lot of companies out there know that like Nobody's going to be looking over their shoulder 

Dr. Shahine: No, uh 40 000 brands of supplements in the u. s today And I do talk to my patients about it doesn't have to be the most like fancy expensive But just make sure it's third party tested.

I really try to emphasize that I will 

Dr. Brighten: say fish oil and coq10 You If you think you're getting it, it's really cheap, and you're like, I got a really good deal on this, [01:00:00] you did not. You did not. Whenever people are like, CoQ10's expensive, as you know. It's very expensive to manufacture, to keep stable, and when somebody's like, I got this giant bottle for like 15, I'm like, Mmm, yeah, you just throw it in the trash.

I'm sorry, because it's not gonna be what it's, it's because, and I think when you don't, I mean, I understood this when I was getting my nutrition degree because I did so much research around this, that what I understood is that There is a price point on certain ingredients where everybody is paying like that, and if somebody is significantly below it, it's not what they say it is.

Dr. Shahine: Yeah, yeah, I know. And then, but also to, I mean, sometimes the most expensive stuff, they're spending their money on marketing. Absolutely. And they're not really making sure that their ingredients are being paid for. And so, yeah, I, I, it, it is really on the consumer and that is too bad. Like, it's [01:01:00] not fair.

Yeah. It is so unfair. 

Dr. Brighten: Especially with, I think, with all the gummy marketing these days, where, uh, Yeah, I like have to tell people that like, there's, so people understand with gummies, they're really tricky when it comes to like a prenatal gummy. I get you want to eat candy instead of swallow pill, because I want that too.

However, you have to put even more B vitamins than what you expect because they degrade so quickly in that form. Selenium is not usually added in, so things have to be left out. And so there's a big issue where I'm like, you know, certain things that are out there, like. Creatine got me, probably going to be fine.

Probably going to have a lot of sugar because creatine tastes awful. Uh, but you know, there's just certain things that can't be done well, or can't, they're not even in therapeutic levels, but yet you see tremendous marketing and big celebrity names on it, and it really is being pushed to the consumer as this wonderful thing, and it's so unfair that like, It's on you to [01:02:00] have to navigate that.

I mean, that's part of why I do what I do as well, because I was just like, I hate this. As a doctor with a background in nutrition, I hate having to navigate this. It's so infuriating. 

Dr. Shahine: Yeah, I agree. And it's so confusing. It really is. Yeah. Yeah, I hear you. So 

Dr. Brighten: I want to leave this tangent because I'm conscious of time and I want to talk about it.

You know, with miscarriages, so often women will think it's my fault. What did I do wrong? I think the, if I could sum up infertility, it is every single day wondering what more you could do and what more you did wrong than it was the previous day. I don't want people to walk away from this and say, I drank out of a plastic water bottle.

That is why I had a miscarriage. What do we know right now are primary causes of miscarriage because they're not totally in your control? 

Dr. Shahine: Yeah, absolutely. And I, I say this every single day. If I diagnose a miscarriage, the first thing I say is [01:03:00] this is not your fault. You did nothing wrong. The most common cause of miscarriage is a chromosome imbalance or issue within the embryo.

If you are able to test the pregnancy tissue 60 to 80 percent of the time, you will find out that's the issue. And if it's not a chromosome imbalance, I still think it can be genetic within the embryo. And so, incredible studies going on, uh, at an NIH level, looking at chromosomally normal, normal, uh, euploid.

Chromosomes are totally balanced. Finding single gene mutations that are leading to miscarriage. So just because you got that report and the person called and said, Oh, the pregnancy genetics were normal. That doesn't mean it's your fault either. You know, so still, I really think the vast majority are an embryo issue.

Human reproduction is extremely inefficient. And it is more critical. It's more common to have a miscarriage than people realize. People always hear one in four. I'd like to clarify. People say one in four women. No. [01:04:00] It's one in four clinically recognized pregnancies. So it's probably more like almost all women, you know, like, and if, and if you include biochemical miscarriages, which is just a positive, not just, that diminishes it.

I did not mean to say that, but a positive pregnancy test that is a late, you know, your miscar, your period comes a couple of days later. That's still a loss. Um, so I know I'm kind of getting, you can see I get excited too. The name of my book is on miscarriage is not broken because I'm tired of women feeling broken.

Um, and thinking it is their fault. So I really think a lot of it is an embryo issue and I get to practice for 20 years and see people that do have six miscarriages and then 10 miscarriages and then finally have a baby. What changed? Not the person that got pregnant. It's, you know, the embryo. But things that you want to look for are anatomic issues, right?

So if you have fibroids in the uterine cavity, or they're really, really big, not all fibroids cause miscarriages. That is [01:05:00] not what I'm trying to say, but certain ones can. A uterine septum, a fibrous band of tissue you're born with in the uterine cavity, not all women that have septums will have miscarriages, but it can increase your risk.

So anatomic issues. I think about hormonal issues, like really, Untreated hypothyroidism, high prolactin levels, untreated diabetes, um, you know, certain hormonal conditions. Uh, I think about antiphospholipid syndrome. You know, an immune issue that can absolutely be associated with it. Uh, one genetic thing.

It's very rare. less than 3 percent of people with multiple miscarriages, but a balanced translocation. It's something that can be in the parent, either the person with sperm or the person with eggs. If they have a chromosome rearrangement, it doesn't impact their personal health, but it can explain why they have so many miscarriages.

So I think it's really important. Anyone that has had two or more miscarriages should have a thorough evaluation because you don't want to miss a septum [01:06:00] that you could repair. You don't want to miss a thyroid issue that you can treat. Um, and you do want to think about overall lifestyle optimization, decreasing toxins exposure, things like that.

But that's not to carry around self care. And truly, honestly, I just want to leave with positivity. If all you do is get pregnant again, and it's a brand new embryo, the most likely thing that will happen is you have a beautiful baby. 

Dr. Brighten: That is so well said. I want to wrap this. You in the very beginning had talked about, you alluded to the emotional impact of miscarriage.

I think there's a lot of conversation about how long does it take to, for your body to recover from miscarriage. The emotional side of things. What do you say to patients who are, who are, Recovering from a miscarriage, but need to tend to that emotional self. 

Dr. Shahine: Do it. Whatever you need Physically, medically, most people could start trying.

I usually say wait for another [01:07:00] period You know have the loss or the resolution of the pregnancy Ovulate, get a period and then start trying. So physically and medically that I usually recommend that although It can happen faster and people can be just fine, but I usually recommend that, but emotionally if you need more time, listen to that.

I mean, it's really important. I mean, I feel like we're in a very, like, if I work hard enough, I will get what I want, or Go, go, go, or like a, you know, Amazon Prime delivery kind of society where I want a baby and I want it in 48 hours. And so we're, and so we're pushing, you know, for this outcome, and we're not allowing this base to heal.

And so I do talk to my patients about if you need it, let's, let's talk about it. Like, okay, physically you could, but do you need another month or two or whatever it takes? Um, let's take care of you. 

Dr. Brighten: Well, wonderful. Well, thank you so much for this conversation. I could definitely [01:08:00] keep you a whole nother hour and talk about so much more.

We are going to link to your podcast because you brought that up. We'll link to all of your social media, your book as well. So everyone can find that in the show notes. Are there any parting words that you want to leave women with who are listening to this today? 

Dr. Shahine: Oh, well, I would like to thank you for this opportunity, Jolene.

It's lovely to connect with you again. And I would love listeners just to please not give up hope that, you know, if you're taking space for this mental break that you need, that's not giving up. It's actually building the strength. that you need to keep trying if that's what you want, and I would really encourage people to advocate for their care.

I think it is so easy to be dismissed, um, to say, Hey, I have painful periods and so many doctors say, Oh, well, that's just normal, you know, deal with it. But if, you know, keep talking to people, find that doctor that will listen to you. I mean, that's why I wrote my book on miscarriage. I can't see [01:09:00] every single person in the world that has miscarriages, but they could learn what questions to ask their doctor and kind of go through the evidence.

So educating, not believing. Everything that's on the internet and advocating for your care and finding that right doctor for you is just essential. 

Dr. Brighten: Hmm. I love all of that. I love this conversation and I love you. Thank you for sharing your time with us today. 

 

Dr. Shahine: Thank you again, Jolene. Truly my honor. It's so good to be here.