On today’s episode of The Wholesome Fertility Podcast, I am joined by world-renowned fertility specialist and Harvard-awarded scholar, Gabriela Rosa @dr.gabrielarosa, founder of The Rosa Institute. Gabriela has dedicated her career to helping couples overcome infertility, miscarriage, and failed treatments to create healthy families. With over 20 years of experience, her Fertility Breakthrough Program™ boasts a remarkable 78.8% success rate, even for couples who had previously faced long-standing fertility challenges.

In this episode, Gabriela explains why infertility is a symptom of deeper health issues and shares how addressing these root causes not only improves fertility but also enhances overall health. She also delves into her innovative, evidence-based approach that combines modern science and natural medicine to deliver transformative results. Be sure to tune in for this enlightening conversation packed with practical advice and hope for anyone navigating the fertility journey! Key Takeaways:

• Infertility, miscarriage, and failed treatments are symptoms of deeper health imbalances.

• Gabriela’s Fertility Breakthrough Program™ has helped thousands of couples worldwide overcome complex fertility challenges.

• Addressing the root causes of infertility leads to better reproductive outcomes and long-term health benefits.

• Low AMH does not mean no baby—natural conception is possible with the right interventions.

• Fertility challenges are clues pointing to underlying health issues that need attention.

• Thorough testing and a personalized approach are key to addressing unexplained infertility.

• Integrating natural and modern medicine optimizes fertility outcomes and overall health.

• Ignoring infertility as a symptom can increase the risk of chronic illnesses like diabetes and cardiovascular disease.

• Fertility is a whole-body process—issues with egg or sperm quality often stem from broader health concerns.

• Community and support are essential for navigating the emotional challenges of infertility.

Guest Bio: Gabriela Rosa @dr.gabrielarosa is a world-renowned fertility specialist, author, and Harvard-awarded scholar. She is the founder of The Rosa Institute and creator of the Fertility Breakthrough Program™, which has transformed the lives of over 140,000 couples in 110+ countries. Gabriela’s work focuses on addressing the root causes of infertility using an evidence-based approach that combines modern science with natural medicine. With extensive training in reproductive health, naturopathy, and public health, Gabriela is passionate about empowering couples to achieve their dream of parenthood while improving their long-term health and well-being. Websites/Social Media Links: Website: https://fertilitybreakthrough.com/ Facebook: https://www.facebook.com/FertilitySpecialistGabrielaRosa 

Instagram: https://www.instagram.com/dr.gabrielarosa/ 

Fertility Breakthourgh Instagram: https://www.instagram.com/fertilitybreakthrough/ 

Fertility Breakthourgh Facebook: https://www.facebook.com/rosainstitutefertilitybreakthrough 

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

To learn more about ancient wisdom and fertility, you can get Michelle’s book at: https://www.michelleoravitz.com/thewayoffertility 

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

Instagram: @thewholesomelotusfertility

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

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[00:01:47] **Michelle Oravitz:** Welcome to the podcast, Gabriela.

[00:01:55] **Gabriela Rosa:** Thank you so much, Michelle. It's so lovely to be here.

[00:01:58] **Michelle Oravitz:** So lovely meeting you. We just [00:02:00] had a really nice pre chat and I would love for you. I always like to hear an origin story. I would love to get your background and how you got into the work that you're doing right now.

[00:02:11] **Gabriela Rosa:** And sure. Look, I think if for me, I've been doing this work since 2001. So it feels like a very long time, probably because it is. when I start seeing my patience, babies graduating from university. I'm

[00:02:23] **Michelle Oravitz:** Oh my God. That is crazy. Cause you look so young.

[00:02:27] **Gabriela Rosa:** Oh, thank you. It must be all those herbs and nutrients, you know, but, it's funny because like, that's exactly last two years ago, I had this experience of like seeing, literally seeing one of my babies graduating from university and thinking, Oh my God, where did the time go?

[00:02:44] You know, like, that's just crazy, but, but it's, it's been wonderful. It's been a wonderful journey. don't know that I have. In a way, I think that, you know, we, as, Steve Jobs says, you can't, or said, you can't join the [00:03:00] dots in advance. You know, sometimes you can only join the dots in retrospect. And as I look back, I think, you know, I don't know that I planned to be where I am, but in a way I plan to be exactly where I am, if you know what I mean.

[00:03:14] It's a very strange kind of

[00:03:17] **Michelle Oravitz:** It found you.

[00:03:19] **Gabriela Rosa:** certainly found me, that's for sure. and it was really through my experiences with patients that That it shaped the specific area that we focus on because we really only treat couples who typically have been experiencing infertility, miscarriage, failed treatments, and really have, you know, have tried everything and nothing has worked like that's who we treat.

[00:03:41] And it certainly didn't start out that way. My, passion when I first started doing what I do was that I wanted to make sure We had a contribution to making the world a better place, one healthier baby at a time. And I really had in my young mind that I wanted to help as many people who wanted to have a baby to [00:04:00] prepare, to do preconception preparation, to be the healthiest version of themselves because we know epigenetics matters.

[00:04:06] We know that the way in which, you know, prospective parents go into a conception attempt and certainly conception in general will. either increase or improve the health of a child or, decrease it, you know, there is no zero net some kind of effect. There's only ever always positive or negative effects.

[00:04:26] Neutral effects are generally kind of weighed down to negative effects. So for me, and I'll talk more about that if you want to, but, you know, for me, it was that whole idea that I wanted to ensure That we were making that contribution. And it was interesting because although some people were really interested in being the healthiest that they could be, most people were not, most people are like, Oh, this is just too much work.

[00:04:50] Let's just start trying. And if we have a problem, then we can do something about it. And that was never really my attitude towards it because the way that I see certainly the [00:05:00] work that we do. There is another layer to it, which is not so much about the physical and the functional. Although, of course, we address that our program has a 78.

[00:05:09] 8 percent success rate for people who previously, you know, were infertile, lots of failed treatments and all of those things. And we validated those results through my masters in public health at Harvard. So we know that, you know, what we're doing certainly makes a difference. But. It really, for me, the undercurrent and the underlayer of why I wanted to do this work was actually for self actualization of the patients who came to us, you know, it was for really being able to reach one's full potential in terms of health and how that impacted other areas their life.

[00:05:43] And that's how I wanted to work. And the people who were coming in for preparation really were not into that kind of work. And so I started to see that the people who are more in alignment with the work that I wanted to do and the legacy that I wanted to leave in the world were the people who [00:06:00] were having difficulty.

[00:06:01] And so I started to kind of focus more and gravitate more towards, you know, those, challenging experiences and how to help people overcome them and, Transition and almost kind of transmute what they were going through. And about five or six years into it all, I had a patient who really changed the trajectory of my whole career.

[00:06:25] And she had been referred to me by a friend who thought that she should have a conversation with me. She had been infertile for 10 years. She had done multiple failed IVF cycles at the time. And even though now I talk about that case and it's kind of like, Every day in the office for me at the time, it was the first time that I was seeing that.

[00:06:44] And so I was like, Ooh, I don't know that we can help that kind of sit or that I can help that kind of situation. You know, I don't know that there's much that I can do, but she was really insistent and quite adamant. I actually talked to her the other day and told her this story because she didn't even know.

[00:06:57] Yeah. And she was like, Oh my God, that's so [00:07:00] amazing to know. But you know, it's, what I ended up happening was that because she was so insistent at doing something, she said to me, she said, look, it's going to be my last try. I'm not going to do any more treatment after this. You know, I'm getting older. I don't want to continue this.

[00:07:15] It's been long enough. So I said, look, that's fine. Let's do what we need to do and we'll see what kind of result we get. And Three months later, after years of nothing working, she was actually, it was about four months later, she was pregnant and I was like, Oh, okay. So there's, there's something here, you know, but then at the same time, I thought, Oh, that's, that's strange.

[00:07:33] I actually doubted my own, my own results, you know, I was like, Ooh, I don't know, I don't really know if this is just one of those. Luke situations, you know, one of those kind of like random occurrences. But then there was another patient who came to me not long after her, who was infertile for 19 years and yeah, and then I was really like going,

[00:07:54] **Michelle Oravitz:** Wow.

[00:07:55] **Gabriela Rosa:** I really don't think that I can do anything for you.

[00:07:57] She was 44 by the time she came to me. I [00:08:00] had a conversation with her. I said, look, it's not usually, obviously what walks through my door is not 19 years of infertility, but just recently I had a lady who had been trying for 10 years. We can give it a go and see what happens. And we did that. About five or six months later, she was pregnant.

[00:08:15] And so I was like, okay, now to, you know, randomness can occur, but to is a bit like a lot. and so I started to, after we had that, success, so I had that kind of experience. I started to then really decide that, okay, you know what, I'm only going to treat people who have been. Trying for more than two years and nothing has worked.

[00:08:37] And I did that for many, many years. And when I finally went to do our study for the for the fertility breakthrough program and its results when I was doing my masters at Harvard, we realized that Yes, we had a 78. 8 percent live birth rate for people who had been infertile for almost four years on average, plus or minus almost [00:09:00] three years.

[00:09:00] So it really helped me to realize that, okay, this definitely makes it, you know, what we do and the methodology that we use, and that obviously I've developed over the years. really does make a difference to address these really difficult, complex cases of couples who, and individuals as well, you know, sometimes we do get solo reproduction patients who come to us who have been experiencing FALD, or egg cycle, or IVF cycle, but mostly couples who know that there is more that they kind of intrinsically know there's more they can do, but they don't know what.

[00:09:34] And they also are very unclear typically about why it's not working. You know, they have these unexplained diagnosis of either infertility or failed treatment or miscarriage, and they keep being told, Oh, everything is normal. Just keep trying. And we know that clearly, What is normal is that you have sex, you get pregnant, you hold your baby, that's normal.

[00:09:59] A [00:10:00] deviation from that tells me that, okay, there's more that we need to ask in terms of what's going on here and certainly more that we need to answer if we're going to get somewhere. So that's how it all started. And I guess that's how it's going, you know,

[00:10:13] **Michelle Oravitz:** That's awesome. I mean, those stories are pretty amazing. I mean, really, really like shockingly amazing. And a couple of things came to mind as you were talking about it. And I love the fact that you were saying about really approaching a person that To make them more vital, like to really improve their overall wellbeing.

[00:10:33] And rather than just focusing on disease, you're really focusing on their health and seeing them in almost a positive light. And it is actually, we don't really notice this, but it is actually a perspective. of many healthcare professionals or like older types of healthcare, like not older, I guess more like conventional.

[00:10:53] Sometimes they'll focus more on the symptoms and we always say like root cause versus symptoms rather than just [00:11:00] focusing on treating disease. It's like treating health and really kind of a more positive way to approach the journey.

[00:11:08] **Gabriela Rosa:** You know, what's interesting is that we see these days that fertility, and I say fertility rather than infertility. Fertility is highly medicalized, right? So it's, it's about finding the problem and treating a problem as if The ovaries and the testicles, i. e. the egg and the sperm, were the only parts that make this process happen.

[00:11:36] And we know that it's not. And, you know, what's interesting about it, and I think that, you know, to speak to what you're talking about, the issues here are so much greater than where we find ourselves, because it's a, it's a healthcare system problem. The reality of it is that when it comes to prevention, typically public health is focused on [00:12:00] prevention and the healthcare system is focused on the treatment of disease.

[00:12:03] And we see that when it comes to fertility a lot and what ends up happening as a result of it is that It really is just focusing on like, it's almost like, you know, you've got a sore finger. Okay, let's chop that off and fix that problem. Hopefully you don't get to chop it off, but you know, that's typically how it, how it's approached.

[00:12:24] And so what ends up happening is that the entire context of the human being that is meant to produce the result of, which really fertility is a, is an outcome. But it's also a retrospective outcome. You know that it's you're holding a baby once you are, like whatever happens before that moment happens is essentially a part of what is going to lead to whatever outcome you have.

[00:12:51] And so I always talk about it from this perspective. If you are experiencing Challenges in terms of getting pregnant, keeping a healthy pregnancy to term, [00:13:00] these are end results of many biochemical chain reactions that start all the way, you know, way before the result is meant to occur. What IVF tries to do is immediately work from like the immediate part that you can see, i.

[00:13:15] e. egg and sperm. But the reality of it is that there's only so much leverage when it's not very much that you can get from only trying to address those cells, as opposed to all of the biochemical pathways that are leading to the creation of the cells in the way that they are. And that's part of why IVF its own, often fails, because one, it's not looking and addressing What are the reasons as to why we need IVF to begin with?

[00:13:41] And what is it that we need to do to improve the chances of conception occurring, whether it's via natural conception or via IVF? I also want to really kind of underline and highlight the point that whether we're talking about any kind of reproductive challenge, whether we're talking about [00:14:00] infertility or miscarriage or failed IVF treatments, It's almost like those are clues.

[00:14:05] They're not results. They're not the outcome because the outcome of reproduction is a baby. So if we're having failures in that process that are leading us to not hold our baby, it tells us that, okay, the clues that we have are the symptoms that we're experiencing. Infertility, miscarriage, failed treatments.

[00:14:26] Those are symptoms. Right, really to a large extent. And what that means is that we need to treat them as such, because if we don't address the red flags that are infertility on its own, miscarriages on its own, and failed treatments on its own, because failed treatments is relevant here, because the that you have an egg and a sperm together, you have an embryo. You have a baby right in that moment. You have a baby when you transfer an embryo for treatment, [00:15:00] you are pregnant at the time of transfer. No matter what you are pregnant. So if you don't see a positive pregnancy test. That tells us that implantation has failed and that tells us that, okay, there's something there that we need to address.

[00:15:14] Why is it failing? Most doctors, most providers don't care about it. They literally just say, oh, you know, it's a like, it's a numbers game. It's the luck of the draw. Just keep trying. Everything is normal. Just keep trying. When I hear that, literally, this is why I have so much gray hair. Because when

[00:15:30] **Michelle Oravitz:** But you have beautiful skin.

[00:15:34] **Gabriela Rosa:** when I hear that, I just go, Oh my God, like, how can we keep believing this lie that everything is normal, just keep trying whilst we're having very clear symptoms, infertility, miscarriage, failed treatment, that things aren't quite right.

[00:15:49] What we also know about these symptoms, and I like to call them symptoms because really, That is what they are. They're telling us that there is some imbalance within the system that [00:16:00] often left unaddressed will lead. It's not may lead. It is will lead to other health conditions being developed in the long term.

[00:16:09] And we know that being studies about this that show that. For people who have an infertility diagnosis and just bypass it with any other kind of treatment rather than addressing IVF etc, rather than addressing the issue, what happens is that the risk and the rate of all cause mortality in the future is higher.

[00:16:35] So people who are diagnosed with infertility who don't treat it. actually die from all other causes, cancer, cardiovascular disease, diabetes, at a higher rate than people who actually address their problems. And this was demonstrated to happen and be true for females and for males. So literally, if you're not addressing infertility as a symptom, [00:17:00] you are digging yourself a hole sooner and at a younger age than you otherwise would want to.

[00:17:07] Now, I know that this is unpopular and most people are going to feel very confronted by hearing something like this, but the reality is that, sure, you can go and bypass infertility and the symptoms of infertility and go into IVF and get a baby. But are you going to have the quality of life and the ability to be here to raise that child in the long term?

[00:17:29] That's a very important question that people need to ask themselves before they simply just jump onto, you know, overcoming the issue with a band aid and just fixing it as opposed to actually truly addressing the root cause of the problem and finding what is the problem. You know, because there are things, for example, if you have antiphospholipid syndrome, which increases the risk of miscarriage, that's also a marker for cardiovascular disease in the long term.

[00:17:59] So you're [00:18:00] literally like, if you are ignoring it for, and just take heparin, take whatever to be able to actually take home a baby and not really addressing the underlying concerns that your body is telling you than a present. Well, You are certainly increasing your risk of cardiovascular disease in the future.

[00:18:18] And like that, there are many other examples. I'll give you an example of insulin resistance. You know, like I was diagnosed with PCOS when I was 18, I had to really understand how to take care of my body in the best possible way to have regular cycles, despite being told by a medical doctor that. I probably would never have Children.

[00:18:37] I was able to conceive two babies twice, literally one and two kind of attempts later by understanding what it is that I needed to do in a holistic way for my body. Now, had I not done that and just jump bypassed the problem with taking metformin, not that I'm saying it can't be a part of the solution, but it can't be the whole solution, right?

[00:18:57] I would have probably at this stage in my life right [00:19:00] now. Have pre-diabetes or have already have diabetes because we know that insulin resistance leads to pre-diabetes, which leads to the development of diabetes and that women with PCOS have and are at highest risk. Now by me ignoring my insulin resistance, yes, I'm increasing the risk of implantation failure.

[00:19:21] infertility and diabetes in the long term. And like I said, if I don't address that at the, at the point in the time that it matters to overcome fertility concerns and fertility challenges, I am choosing diabetes in the long term. So, and we know that one of the biggest killers in the world these days is diabetes, cardiovascular disease, and cancer.

[00:19:43] And there are many cancers that are associated with the insulin resistance condition, resistance conditions and pre diabetes. So again, you know, I already have a family history of cardiovascular disease, diabetes, and cancer. Do I want to add to that? No, thank you.

[00:19:59] **Michelle Oravitz:** [00:20:00] Yeah. I mean, wow. You know, this is such an important topic that you're bringing up and it's something that I don't even think has really been brought up to this level on my podcast and I've been doing this since 2018. I mean, yes, I've talked about how, like I've had people on and say almost like going through the fertility journey saved my life.

[00:20:19] I mean, so yes, people have acknowledged it, but to this detail that you're mentioning, I think it's just so important for people to hear. And I think it is important. It's one of those painful truths. And I think it's important for people to face it and acknowledge it because ultimately you can ignore it, but it's going to come back.

[00:20:38] It's not like ignoring it makes it go away.

[00:20:41] **Gabriela Rosa:** exactly. And I think that that is, you know, if, people take nothing else out of this conversation today, I think what's important is to understand that you cannot bypass infertility and still be healthy in the longterm. You have to work with your body to understand why is it giving you these symptoms?

[00:20:58] What is it that you can do about it? [00:21:00] Not just hearing a doctor say, Oh, everything is normal. Just keep trying. And yet having completely either it. Out of range or out of optimal range test results and continue to think that, well, IVF must be the next solution because it is not. IVF can be part of a solution and it's a wonderful part of the solution for couples who really, truly need it.

[00:21:23] And truly, it was developed for women. with tubal factor infertility. So people who had blocked fallopian tubes for some reason, it wasn't developed for the variety of fertility concerns or issues and, causes that we have today. So we can't just expect that we are going to bypass the problem and are going to have absolutely no negative effect in the long term.

[00:21:48] And I think that that's a really important thing for people to understand is that. Yes, you might use it as a way to support a process, but not without [00:22:00] addressing, and certainly not by ignoring what's causing it to be needed to begin with. I think that one of the biggest things, and for me this is, you know, something that I'm exceptionally passionate about, is helping people get answers.

[00:22:15] you know, we even have a full free program that we give to people. That is a four week program. It's called the fertility challenge. It's completely free. It's literally worth thousands of dollars. And what it does is it helps people to understand, okay, let's understand the diagnosis. For you. Let's understand what are the things that are not working in the way that it needs to and change that.

[00:22:38] You know, the objective really is to get answers, get clarity, to be able to personalize the implementation of whatever it is that you need to do so you can conceive however it is that you're going to conceive and finally hold the baby. Not continuing to go out and around in circles until you run out of time completely, because that is sadly what [00:23:00] happens to so many women, so many couples, they try, and I talk to them all the time, and it's heartbreaking, you know, people who have been trying for 10 years to have a baby and feel like, gosh, I'm at the end of my rope, I need to figure out how else I can do this, or I'm really come to terms with never having a baby, you know, like this is the decision and the place that so many of the patients who come to Mirat and I so hope and wish that people can actually have this clarity, have these epiphanies way before they are at that stage.

[00:23:32] stage where they literally have their back in a corner and there's nowhere else to move. So those are important things for me. I think that it's, you know, getting clarity and getting answers is the number one thing that's actually going to enable you to implement the right strategy in terms of treatment because you can line up.

[00:23:54] 10 men with poor sperm morphology. And you can have 10 [00:24:00] reasons as to why that sperm morphology is problematic in all of those different men. Right? So it's not one size fits all. Exactly. I didn't know for somebody, let's say that they have heavy exposures to like, I've had farmers in my program, you know, heavy exposures to heavy metals and, and heat and, you know, all sorts of things.

[00:24:20] And then I've got doctors, heavy exposure to radiation and so on. So, you know, it's, it's one of those things that you really have to understand the context specific need for the patient to be able to properly and effectively address it. Otherwise you're literally just trialing and erroring until.

[00:24:38] Unfortunately, many people run out of time altogether. 

[00:24:42] **Michelle Oravitz:** I think that the biggest problem is that people just don't even know what they don't know. So they go to doctors and then, I mean, I was one of them and people know this, you know, my listeners know this. I've been on the birth control pill and that was like my solution to irregular periods and it was just like, [00:25:00] take this.

[00:25:00] And this is the only thing you can do. And apart from this, there's nothing you can do. And that's, um, you know, such a straight statement and such a definitive statement. Statement that I don't know better. So I just believe it. And then until years later, I find different modality and realize, Oh no, there is something I can do.

[00:25:17] So like 

[00:25:18] **Gabriela Rosa:** There's lots. 

[00:25:19] **Michelle Oravitz:** I didn't know. I did not know what I didn't know until I knew. And so this is why I love having people like you on here, bringing light to this because people need to hear this. Cause I think it's going to start to like light up something in their minds. It's like, Oh, wow, this is something that I can really.

[00:25:36] Look into that's number one is people don't know what they don't know. But also number two is that they don't even know they can do anything about it. Then there's a lot of things that you could do about it. And you know, there's so many people say like, Oh, there's nothing you can do. There's no cure. And a cure is kind of like a, you know, very definitive word, but treatment.

[00:25:56] I mean, there's things that you can do that actually [00:26:00] can impact it. It's just that that is not something that is in the conventional world.

[00:26:06] **Gabriela Rosa:** Yeah. And you know what else is interesting, and I think that this is important for people to understand as well, because it's, it's a bugmare of mine, which is when people go to their doctor and the doctor runs some tests and then they go back for results and they literally are told, Oh, we've done all the tests.

[00:26:22] And everything is normal. Now, let's peel this back and let's explain what all the tests actually means because all the tests does not mean all of the tests, okay? And everything is normal definitely doesn't mean that if you're still not holding a baby. And let me explain what that, what I mean by that.

[00:26:39] When it comes to the fertility guidelines around the world, which is what doctors will most of the time will be following guidelines because they don't want to be seen as being stupid amongst their peers. Okay, so what happens with this? doctor will typically refuse to prescribe or request a test result unless they [00:27:00] feel validated in doing so.

[00:27:02] Okay. And the reason for that, and I've had this conversation with doctors, my own providers, as well as colleagues who tell me this, they say, I can't ask for this test because it's not going to be either approved by insurance, or I'm going to be criticized for requesting this test to which I reply. Well.

[00:27:22] What is currently in the guidelines when it comes to fertility diagnosis is that you check for patency in the fallopian tubes, so are the fallopian tubes clear, and usually that's tested these days, it used to be an HSG, these days it's by Hycose, ultrasound with fluid in the tubes and, you know, dye spilling through if the tubes are clear.

[00:27:45] The other test that is done is typically your kind of general FSH, LH, estrogen, progesterone. Progesterone typically recommended on day 21 of the cycle, which also is not necessarily the right thing because some women have irregular cycles and [00:28:00] lengthened cycles and irregular ovulation. So really progesterone should be occurring seven days post ovulation and not at day 21 of the cycle, particularly if a woman has lengthened cycles or shortened.

[00:28:13] cycles. It doesn't mean that a woman is not ovulating in those two instances. It just means that pinpointing ovulation becomes more difficult. And that is pretty much, and then of course, sperm parameters. Most people that come to me, believe it or not, despite years of infertility, have not had a semen analysis done.

[00:28:30] or don't have a recent semen analysis that really understands what's going on with sperm right now because sperm changes literally every four months. And so you can have the flu and end up with zero sperm. It actually can happen. And you know, that doesn't mean that that person is azoospermic forever and always, it just means that they've had a severe infection that has wiped out their for a sperm cycle or for a period of time.

[00:28:57] So Understanding that the major [00:29:00] things, and some doctors are more thorough and some will prescribe or refer, recommend further tests, but as a bare minimum, they're looking for hormonal balance, looking for ovulation and looking for tubal patiency and sperm parameters. So those are four things.

[00:29:15] Out of literally thousands of tests that could be done and that needs to be looked at. And of course, needs to be personalized because testing is also expensive and you don't want to be wasting time doing tests for no reason. So, you know, there is a balance to that. But it's not enough to have four tests and not really exactly know what it is that's being tested.

[00:29:37] And your doctor tell you, Oh, you know, we've done all the tests and everything is normal because very little is going to be picked up unless there is some serious major issue. Very little is going to be picked up by those four, you know, four things being tested or four areas being tested. What's going to happen is that you may end up with some clues about what else needs to be tested, but [00:30:00] Typically, it's going to be insufficient to gain a proper diagnosis.

[00:30:05] to which what happens from there is that people get diagnosed with unexplained infertility. And hence why unexplained infertility is the major, the biggest category of infertility diagnosis, because more tests have not been done. Now, typically, and this is when

[00:30:23] we're 

[00:30:23] **Michelle Oravitz:** I mean, that is such a good statement. Keep going. Sorry.

[00:30:28] **Gabriela Rosa:** the thing about it is that that's what we're talking about conception and conception attempt failures, which IE infertility is what, how it's labeled.

[00:30:38] But when we're talking about miscarriages or implantation failure, it's even worse. Because, guess what? The healthcare system expects that a woman has to have at least three miscarriages before testing is done. Now, really? I mean, I don't know, for anybody who has ever had one miscarriage, it's traumatizing enough.

[00:30:58] Waiting to have three [00:31:00] before you actually do any further testing, to me, is pretty extreme. That's why, you know. It's unacceptable. It's, as a woman, I think it's just like, it's ridiculous, right? Now, the other thing then that happens is failed IVF You end up with an embryo. Most people who go into IVF, and it's not everyone, but most people will end up with at least one embryo, and there will be a decision to transfer said embryo.

[00:31:23] If it doesn't work, and of course, if the cycle gets cancelled for any other reason before we get to that stage, or even then. after getting an embryo, i. e. embryo doesn't develop, doesn't, you know, there's no blastocysts to transfer, whatever it is. Every single one of those points of failure, so to speak, needs to be questioned and needs to be specifically tested and addressed because otherwise, again, you can end up with the same problem.

[00:31:51] Now, In the case of IVF, it's more problematic because it's also extremely costly. In the United States, an average IVF [00:32:00] cycle costs about 17, 000 U. S. dollars. And around the world, you know, the price varies. But let's just go with the United States data. And we look at an average cost of 17, 000. That is whether you get to transfer or not.

[00:32:13] you are paying that money.

[00:32:15] **Michelle Oravitz:** Yeah.

[00:32:16] **Gabriela Rosa:** you have an embryo or not,

[00:32:18] you are paying that money. So the thing about it that I questioned is like, okay, and there are published studies that show that in order to have a close to 80 percent live birth rate, cumulative rate for IVF, i. e. having a baby, close to 80 percent cumulative rate of chance of having a baby, you have to have eight IVF cycles.

[00:32:39] That's the average. Now imagine, imagine eight times seventeen thousand dollars, I mean for some people that's a house.

[00:32:48] **Michelle Oravitz:** Yeah.

[00:32:49] **Gabriela Rosa:** Right. So no wonder people can't afford to go and do IVF. No wonder there are so many challenges. But even if you can afford it, would you rather do something else first to [00:33:00] understand what is the cause and address that before going and doing another cycle?

[00:33:04] You know, we have so many patients who come to us after failed cycles and go, look, I want to prepare to have another better cycle. Typically, those people end up conceiving naturally. They didn't even need IVF to begin with. And when they do, they end up having one or two maximum cycles afterwards, once you understand what the problem is.

[00:33:23] So again, hence the critical importance of understanding what is the problem you are dealing with, rather than just expecting that you are going to be okay with some unexplained diagnosis. for your expertise.

[00:33:37] **Michelle Oravitz:** So walk us through, like, if you have certain cases, like the ones that you were mentioning, that are really, really complex and many, many years of dealing with. really being on this journey, what are some of the steps you would take? You had mentioned doing testing and functional testing also just for people listening, if you don't know about it, is a lot more in depth and [00:34:00] detailed than what you'll typically get when you go to the doctor's office.

[00:34:03] **Gabriela Rosa:** Yeah, no, I agree with that. And look, the testing piece, it's almost, it's a science and an art, right? Because it's almost like you need to balance. various things when requesting a test, you have to balance what is the return on the knowledge that you're going to gain? What's the time spent? What is the money spent?

[00:34:22] What are the things that are actually going to give you a lot to be able to do about it versus not very much for a very expensive test? So there's, so for me personally, and certainly, you know, in the first time method, what we use in the pro in our programs, really, what we're looking at is we kind of go back to the drawing board, we collect all the data.

[00:34:42] We really look at everything that the patient brings from their lived experience, whether it's test results, other things that they've done, whatever it is, we collect and analyze all of that information to really first understand, okay, what has been done? Where are the gaps? Where are the places of opportunity?

[00:34:58] What are the things [00:35:00] that. we need action that is absolutely urgent. And one of the things that we don't actually need to address because there will be addressed as part of addressing the, you know, some of the basic major root issues, root causes. So it's understanding that nuance that actually ends up being able to direct a path, particularly in those cases that we treat that are very difficult and complex because you can do a thousand tests.

[00:35:28] You know, there's thousands of tests that you can actually do. Will you do them? No, no. So then we have to really be able to identify, okay, what are the red flags that if we were to understand more about them? Or where the gaps that if we don't know is going to change the direction of our, say, of our choices, then we're starting to look at those things, you know, in cost effectiveness, cost effectiveness analysis, which is a big [00:36:00] field of science, really, the idea is this, if you are going to treat anyway, don't test.

[00:36:07] Right. So for example, and there are pros and cons to this, but you know, there are certain things that you're going to treat anyway. So is there a need to test it? Sometimes there is. But sometimes there really isn't and that's the thing that we really need to kind of balance in the whole scheme of things is the things that are going to be absolutely essential and the things that are not really going to be that important.

[00:36:34] **Michelle Oravitz:** And what were some of the protocols or what are the types of ways that you treat people or. What is included in the protocols?

[00:36:44] **Gabriela Rosa:** It's depends because it's very personalized, you know, so we will use a blend of medical. treatments and even medical diagnostics, of course. And we then are going to utilize the best of all of the worlds that we have access to, whether it's [00:37:00] naturopathic medicine, integrative medicine, traditional Chinese medicine, lifestyle medicine.

[00:37:04] So we then are putting together a very personalized process. That is going to help that individual that is part of that couple. Because like I said, you know, you have 10 different men, you have 10 different reasons. Therefore, we need to understand what is the reason here and what do we then make as recommendations.

[00:37:24] My biggest focus always is minimum effective dose. I want to do the least possible to get the biggest resolved. Right. That is my focus. So I'm always assessing and addressing the case from that lens of like, okay, what do I need to touch? What do I have to leave alone? Because there are certain things that, you know, for example, I'll give you an example of heavy metal toxicity.

[00:37:46] Heavy metal toxicity is a really tricky one. In some cases, it will increase the risk of miscarriage. Like, hugely. I had patient once who basically had 40 times the, elevated rate of what's kind of acceptable in a [00:38:00] human. And essentially had had 8 miscarriages a result, was coming to me to figure out, okay, why am I having miscarriage after miscarriage, even though I'm getting pregnant, she was only 30.

[00:38:10] So we went on to identify that she had really high level of mercury toxicity, which was causing these miscarriages. And there were other factors too. So we addressed all of it and we had to make a decision in her situation to actually go for medical chelation therapy. Because what ended up happening for her with that high level is that she was going to continue miscarrying.

[00:38:32] And we also knew that chelation therapy would take a long time because it doesn't work quickly. It took us 12 months of treating her, doing chelation, doing retesting, more chelation, more retesting to actually get to a point where she could start trying to conceive again. So it's not everybody has that kind of time, which means that we might find high heavy metals in a person and have to leave it alone because literally we have two years until this [00:39:00] is all over, right?

[00:39:01] So it just depends on the situation and we have to make those critical clinical decisions that are going to really help the outcome that we are looking for. So it's highly personalized. So it's not. I don't have, we have a framework that we make sure that we don't leave things to chance, that we really are, you know, checking off every box, but we don't have a, this is the only way that we do this because we have to ask and answer questions and address and adapt accordingly.

[00:39:29] **Michelle Oravitz:** So I guess, my question wasn't specifically like a protocol that's customized, like for all, cause I get it. We do the same thing, but do you use, what kind of tools do you use

[00:39:39] **Gabriela Rosa:** Oh, we use all sorts of things from, yeah, from drug therapy to herbal medicines, to nutritional supplementation, to exercise, to sleep, to diet, like, All of the things, you know, so in terms of what it is that we're going to use, we're going to use whatever it is that we need to use. You know, sometimes we find infections that we're not going to waste time [00:40:00] trying to use.

[00:40:00] I was just going to go straight to antibiotics. You know, because that's just the thing that's

[00:40:04] going to give us the result the fastest. So, again, even the treatment part is going to be very, I guess, personalized to whatever it is that that person needs, because at the end of the day, I want speed. 

[00:40:18] **Michelle Oravitz:** Yeah, 

[00:40:19] **Gabriela Rosa:** speed and I want effectiveness.

[00:40:21] So it's, it's balancing all of those worlds.

[00:40:24] **Michelle Oravitz:** definitely have a unique perspective though, in a sense that you use tools that are conventional and, a little bit more alternative and holistic. So it is a really great combination because you can get amazing results with both. Yeah.

[00:40:41] **Gabriela Rosa:** way that I see it is like, we really do want to blend the best of both worlds. We don't want to say, Oh no, this is not something that we use. I'm not. Look, honestly, I am not, I'm not a purist. I'm not a purist, you know, like, I don't think that there's only one way to do things.

[00:40:57] I think I always am looking for what is the best [00:41:00] way to do something, you know, what's going to get us the outcome that we're looking for, balancing all of the constraints and challenges and situations that we have in front of us. So, but how? And I always say to my patients, I'm completely impartial as to how you get pregnant.

[00:41:15] I don't care if we have to use IUI, IVF, you know, like I don't care donor egg. That's not the thing. The thing is, if my patient comes to me and says, look, I'm, I want a baby no matter what. we are going to explore every, every opportunity to be able to do that. Then I also have some patients who come to me and say, I will only try natural conception.

[00:41:36] I'm like, okay, cool. Let's explore and make sure that we maximize that opportunity. You know, what are the things that we need to do? But it's, values and preferences of the patient that will determine where we go and what recommendations we will make.

[00:41:52] **Michelle Oravitz:** Yeah. I love that. I mean, I think that that ultimately just shows that you're present with your patient because that is [00:42:00] ultimately what it is. It's not a one size fits all because then it's something that you pre craft and just give out. But when you're present with a patient, you're able to really assess what you have in front of you specifically.

[00:42:11] One topic that I did want to actually ask you about, you know, to get your thoughts, A lot of times people will come in with like, What they say, quote unquote, low AMH, which as we know, sometimes fluctuates in itself, but people get really hung up on it in response to how their doctors get really hung up on it, and I've seen this my, in my own office is that it really doesn't make as much of.

[00:42:38] I guess the challenge is people think it does. I've seen people with very low numbers that were told that they needed egg donor conceive naturally like multiple times after that. So I just wanted to get your thoughts on that.

[00:42:50] **Gabriela Rosa:** Yeah, absolutely. It's a great question. And look, you know, what happens is that AMH levels, which measures the ovarian reserve, it's measuring the hormones that are excreted by [00:43:00] the eggs themselves, right? And so the more of AMH you have, the more eggs you're likely to have, the less AMH, the less eggs you're likely to have.

[00:43:08] Yeah. Does it mean that if you have low AMH that you can't conceive naturally and what is the best way to conceive? Well, actually, all the science shows that if you have low AMH, typically the best option for conception is actually natural conception or IUI. As opposed to IVF. Most, and this is why most women with lower MH go to their doctors and they refuse to do IVF cycles if they are good doctors.

[00:43:35] If they just want to take their money, they might not be that kind of doctor. Right? And so the reality of it is that Low MH in itself does not preclude a woman from conceiving with her own eggs naturally. I see the same thing in my clinic. In fact, our study, our Harvard study shows that even in the very low MH category, the less than one, the one to four is low, less than one is very low.

[00:43:59] [00:44:00] We had the majority of patients conceive by natural conception in that category group. So very possible, very doable. However, it's not as easy as it used to be. Thank you. Right. When a woman had higher AMH, and this is also part of the reason why you need to make sure that you're addressing the full context of the patient, because a woman's ovarian reserve is just going to, it's going to decline at the time, no matter what.

[00:44:26] And if you're treating the wrong problem, i. e. let's say, for example, we have very poor sperm quantity, quality, you know, all of those things. And you are continually treating the woman because she has low ovarian reserve. Well, you're actually leaving a lot on the table because she probably with a better sperm partner would actually have already conceived.

[00:44:50] And so it's about understanding, again, this is where I always say fertility is a team sport. And I say that for a reason. You can't expect that a woman [00:45:00] with lower age is going to conceive with crappy sperm. If you have a lower age, what you need is superhero sperm, right? And so it's, and men's sperm quality decreases over time as women's fertility decreases over time.

[00:45:14] So it's a, it's a matter of understanding. What it means, like, for example, if you have just low AMH and your FSH is normal on day two, then you have a much better chance of conceiving and taking home a healthy baby, whether it's naturally or any other way, than a woman who has low AMH and high FSH.

[00:45:34] Because then, if you're having high FSH, it's telling you that already on day two, your ovaries are already struggling to release the eggs that are remaining. So that tells me that, again, IVF is definitely not the best option, and you need to figure out, okay, what else is there that you can, what are the levers that you can pull, because probably egg quality is [00:46:00] not going to be enough.

[00:46:01] Right? And so then you have to address and adjust treatment accordingly. But just as a full answer to your question, just as a, as a very big summary, Lower MH does not mean that you can't conceive. It does signal the onset of perimenopause. Typically ovarian reserve lowers quite significantly five to ten years before menopause, and particularly for women who smoke, that happens even five years before women who don't smoke.

[00:46:30] So it's certainly if you, if you are trying to get pregnant and you smoke, well, you better stop. Right now, because you are definitely almost kind of poisoning your chances of taking a healthy pregnancy to term at any point, like you're literally certainly decreasing your chances by at least five years compared to non smoking counterparts.

[00:46:54] And if your partner smokes secondary, you know, kind of smoke is also going to be a problem. [00:47:00] So, and of course, that's going to be a problem for sperm. So there's all of those, those contexts as well that we have to take into account. But yeah, it's, it doesn't necessarily translate that low AMH means no baby or low AMH means that it must be donor egg situation.

[00:47:15] We had patients, and again, this is in our analysis, the majority of patients who had low AMH were told that they needed to have donor egg. We, in the entire sample of 544 patients, we only had 5. 6%. actually need donor egg. So, and the majority were consuming naturally. So, you know, I take that with a very large grain of salt.

[00:47:38] **Michelle Oravitz:** Yeah. And this is why you have to get many multiple opinions and really do your research and find the right practitioner. Maybe a couple of different practitioners. but I love your approach and I think that a lot of what you're saying, first of all, it makes a lot of sense, but it's also, is research based and empowering for people listening.

[00:47:59] [00:48:00] And so for people listening who are interested or want to learn more about your work, what are the things that you offer online, like

[00:48:08] **Gabriela Rosa:** Yeah. So

[00:48:09] **Michelle Oravitz:** far away,

[00:48:10] **Gabriela Rosa:** they can go to my website, which is fertilitybreakthrough. com and they can also search my name, which is Gabriella Rosa, G A B R I E L A R O S A. they will find, I have my book, Fertility Breakthrough, Overcoming Infertility and Recurrent Miscarriage When Other Treatments Have Failed free on YouTube and Spotify.

[00:48:29] So they'll be able to get the audio version there. It's also available on Amazon and every other bookseller. And of course, as I mentioned earlier, you know, we have the free fertility challenge program that is designed for couples who want to overcome infertility and miscarriage, and most importantly, want to find answers, you know, and want to know what it is that they need to do and how to personalize their journey so that they can hold their baby sooner,

[00:48:53] **Michelle Oravitz:** amazing, and you work one on one as well, right?

[00:48:56] **Gabriela Rosa:** our team does absolutely. So, yes.

[00:48:59] **Michelle Oravitz:** [00:49:00] amazing, Gabriella, this is an amazing conversation. I've seen you around before. I've looked at your information before we spoke and I was very impressed and this exceeded my expectations. So thank you so much for coming on.

[00:49:14] **Gabriela Rosa:** Thank you. Thank you for having me. It's a real pleasure. [00:50:00]