The Whole Pineapple

OK, we knew the human gut had one of these, but the vagina too? What's actually going on in there?

Microbiomes are incredibly diverse ecosystems: we are more bacteria than we are human. Yep. Read that again — there are more bacteria in us than human cells. You, my friend, are a moving, breathing microcosm that is incredibly cooperative when you're healthy.

Don't panic. Katy Bradbury is back to explain what all this means and how we can use this knowledge to be healthier.

Things to know:

• A healthy gut is NOT free from bacteria. We need the friendly bacteria to survive. Yes, it's a bit icky to think about, but it's important.
• "Bad" bacteria is opportunistic, like weeds in a garden, says Katy. You need to keep your "good bacteria" healthy and plentiful so the bad can't get a foothold.
• We want a diversity of good bacteria in both the gut and the vagina, but these are not the same critters. Lactobacilli are best for the vagina, so knowing how to protect lactobacilli by keeping the vaginal environment at the right pH is a good thing.
• This is important for fertility but also for avoiding infections like yeast infections and UTIs, so care is a life-long need.
• Douching and using other "cleaning products" is NOT vaginal care unless you have a specific medical reason. These products disrupt the natural vaginal pH and aren't necessary for this self-cleaning organ.

There's so much good information in this episode, so please give it a listen and share with others. While it may be difficult to overcome the traditional shame around our bodies, this shame is, frankly, not helpful. Sharing information and talking openly are the best way to erase the shame and be healthier.

Ready to learn more? Listen up!

More about Katy Bradbury: Katy is founding member of the Fertility Nutrition Centre, a clinical advisor at Fab Fertile, a content provider for women's health platform Xena, and a clinical supervisor for nutritional therapy students at the University of West London. You can find her at Katy Bradbury.com. Be sure to check out the robust back catalog of episodes from her podcast Fertility and the First 1000 Days: katybradbury.com/podcast

To hear more from Anne and Ruby, find all their episodes at thewholepineapple.com.

Scheduling to record with this guest was a bit of a journey of its own, but the end result was totally worth it!

Registered Nurse, nutritional therapist, and former fertility patient Katy Bradbury understands the fertility journey as thoroughly as anyone can. But her own difficult experience had a genuine bright side: it led her into her career in fertility-centered nutrition.

As nutrition often isn't included in fertility advice or treatment in many places (looking at YOU, USA), this episode can be particularly useful for those who want to optimize their health and physical condition to support a healthy pregnancy.

Fertility treatment in the UK is, as Katy says, a bit of a "postcode lottery" meaning that where you live can determine the level of treatment you receive, and there's not a national level of service. Some people may wait a year or longer to start, which can be really tough when age is such a factor.

Fortunately, improving nutrition can start (and ideally should start) well in advance of that first round of IVF or before treatment begins.

Here are some tips to keep in mind!

• Those first 1000 days — conception to age 2 — are so important to a child's development and health.
• It's best to work with all partners to fully understand the issues and be proactive about health and nutrition.
• Get ready to work on your gut! Gut health is so important and often so ignored.
• "Bespoke" nutritional guidance is best: bodies, lifestyles, tastes, etc. are all different. A fertility nutritionist can help you learn the foods that work best for you.

Ready to learn more? Listen up!

More about Katy Bradbury: Katy is founding member of the Fertility Nutrition Centre, a clinical advisor at Fab Fertile, a content provider for women's health platform Xena, and a clinical supervisor for nutritional therapy students at the University of West London. You can find her at Katy Bradbury.com and be sure to check out the robust back catalog of episodes from her podcast Fertility and the First 1000 Days.

To hear more from Anne and Ruby, find all their episodes at thewholepineapple.com.

Resources:

Fertility Nutrition Centre: fertilitynutritioncentre.org

Xena: xena.life

Katy's website: katybradbury.com

Fertility and the First 1000 Days podcast: katybradbury.com/podcast

As anyone born with a uterus will tell you, living in a body equipped with one of these and all that goes with it comes with a special set of challenges. And many of us don't really know all we need to know, so think of this episode as a sort of Owner's Manual.

So what do we need to know through the decades of our life?

TEEN YEARS: Irregular periods are normal, but if they're super problematic or painful, a discussion with your primary care provider or a gynecologist might be in order. Time to start screening for sexually transmitted diseases if you're sexually active.

TWENTIES: Is it time to consider protecting your future fertility? This is prime time for fertility, but if you're not ready yet, it might be good to at least consider what's ahead.

THIRTIES: Do you know how large of a family you want? As you get into your mid- and late-30s, fertility can be more challenging — definitely know your options!

FORTIES: Celebrities having babies in their 40s should not convince you that you have plenty of time, especially if you're wanting to use your own eggs to conceive. "Time is eggs!" as Anne says.

HINT: talk to a menopause specialist at this point – perimenopause is a critical stage of life for protecting your future health!

FIFTIES: Pregnancy is still possible, but celebrities at this age are most likely using frozen eggs or donor eggs.

SIXTIES: Pregnancy is probably not a concern, but STIs are, so protect yourself!

Obviously, this is just a hint of what Ruby and Anne have to share at each stage, so make sure to listen and share! And find more from our hosts at thewholepineapple.com.

Ectopic pregnancies may be rare, but given how devastating and dangerous they can be, taking steps to prevent them is never a bad idea!

For those worried about ectopic pregnancies, remember they generally amount to only 1-2 percent of pregnancies. For those who have had an ectopic pregnancy, that number may go up to 10 percent, but it's still unlikely.

That said, it's understandable that those seeking to be pregnant want to ensure the safest, healthiest, and most viable pregnancy.

Guest Dr. Amy Criniti suggests taking a look via tubal imaging, called an HSG. This procedure can give the doctor an idea of the status of the fallopian tube. Listen to our previous episode on uterine/tubal evaluation for more details:

Snack 6: The Camera Goes Where? Assessing the Uterus and Tubes

Additionally, an ultrasound can tell you which side you're going to ovulate on, so you can aim for trying to get pregnant when the egg is traveling on the side with a functioning, healthy fallopian tube.

Patients may also opt for IVF, which has a lower (but still not zero) chance of resulting in an ectopic pregnancy.

Quick quiz:

1. True or False: ovulation switches sides each month, so if it's the left fallopian tube in January, it'll be the right one in February.
2. True or False: smokers have a higher chance of ectopic pregnancy.
3. True or False: if you've had an ectopic pregnancy, there's nothing doctors can do to decrease the risk next time.
4. True or False: a fallopian tube can be repaired and returned to full function after an ectopic pregnancy.
5. True or False: having your "tubes tied" for contraception is an easy surgery to reverse.

Listen up to hear the answers! If you've had an ectopic pregnancy and would like to share your story, we'd love to hear it. Please send us a message at [email protected].

As always, please be sure to share this episode with anyone who can benefit, and please subscribe, rate, and review. You can find more information about our medical team at seattlefertility.com, and you can hear more episodes at thewholepineapple.com.

Ectopic pregnancy is when the pregnancy implants outside the uterus, most often in the fallopian tubes. As much as 1-2 percent of pregnancies end up in this category, even when the pregnancy results from IVF.

In this episode, Ruby and Anne talk with Dr. Amy Criniti, another member of the Seattle Reproductive Medicine team, about some of the questions (and myths) out there about ectopic pregnancies.

Why are they so dangerous? If not caught early, the embryo can grow inside the tube. Unlike the uterus, the fallopian tubes aren't meant to stretch to accommodate a growing embryo. Eventually, the tube will rupture and cause internal bleeding. Left untreated, an ectopic pregnancy can endanger the life of the pregnant person.

Can an ectopic pregnancy be "relocated"? Despite wishful thinking among some non-medical persons, no. An ectopic pregnancy, once disrupted, cannot reimplant elsewhere.

Does a "pregnancy of unknown location" always mean an ectopic pregnancy? Not necessarily, says Dr. Criniti; sometimes blood work can indicate there's a pregnancy, but it's not yet visible on an ultrasound. If the embryo can't be located, the patient will be closely monitored until they're sure the fertilized egg has implanted where it should.

How does an "implanted" pregnancy (like IVF) end up in the wrong place? We don't entirely understand how the fertilized egg moves around before implantation, and short of attaching a tiny Go Pro, we may never know. But even an "implanted" pregnancy can move before attaching, though like ectopic pregnancies generally, the risk is pretty low.

In this age of conflict over reproduction, it's important to know about the risks of ectopic pregnancy and what your choices are if you find yourself in that 1-2 percent.

More about Dr. Criniti: Dr. Criniti joined the medical team of SRM in 2006. Her clinical interests include fertility assessment, PCOS, age-related infertility, as well as the entire spectrum of fertility treatment. She currently teaches University of Washington medical students and is the Medical Director of the donor egg team. She was recognized in 2013, 2015, 2022 and 2023 as one of Seattle Magazine's Top Doctors in infertility, as well as Seattle Metropolitan Magazine Top Doctor in 2014, 2015, 2018, 2019 and 2021.

Be sure to share this episode with anyone who can benefit, and please subscribe, rate, and review. You can find more information about our medical team at seattlefertility.com, and you can hear more episodes at thewholepineapple.com.

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Sooooooooo…. Whether it was your choice or not, whether it's for a happy reason or a difficult one, starting over can be one of the most difficult things we do as adults.

New job, new home, new realities can mean uncertainty and disruption. So how do we get our heads and hearts ready to take on the challenges of change?

In this episode, Anne and Jamie are discussing exactly this topic, as Jamie announces a big and exciting change in her life (and yes, you'll have to listen to find out what it is, but it's good).

One big takeaway here is that there are two coping strategies most of us tend to fall into when confronted with big change: avoidance and control. Do we duck the change that's coming until we realize we really can't breathe with our heads in the sand? Or do we take control (maybe a bit too much, sometimes)? Or do we vacillate between the two, making ourselves and those around us a little bonkers?

And how is any of this related to The Good Place? (If you haven't watched it, we recommend you do, and you're welcome.)

There are stages of change when starting over, and it's important to give yourself grace and acceptance. You might be, as Jamie talks about, "solidly moving forward," only to find yourself set back and frustrated.

But knowing your strengths under stress can be so helpful. Concentrate on those to get your self-confidence back and make progress. Or take a break! Let your energy renew, so you can re-engage from a healthy place.

Hear more about the ways you can stay afloat during the chaos of starting over in this episode, get the mental headspace from Jamie's soothing meditation, then go back and listen to all Jamie's episodes at thewholepineapple.com.

Stay tuned for more information on Sound Perinatal and Fertility Counseling and how you can work with Jamie!

Phew! Ruby, Anne, and counselor Suzi Mohn are going to fix All The Things today, so the rest of us can relax by the pool.

OK, maybe not, but they certainly can help, so listen up!

Today's question is: How can you support your partner in a difficult fertility journey?

Often, the one who will not be carrying the baby feels a little helpless and useless during the process. (For ease of communication, we'll call this person "the partner.") Partners want to support the one who will bear the child, but they don't know how, and it seems everything they say gets tangled up with all the big emotions and the hormones and does nobody any good.

Though attention generally focuses on the one hoping to get pregnant, partners are suffering too. They're sad and scared and hurting, but their attempts to help are perhaps a bit clumsy because they often can't understand the ramifications of fertility treatment on the body, the heart, and the psyche.

And the one going through the fertility treatments may not have the time or language or mental space to teach their partner how to help.

Because of this, a couple of Suzi's therapy groups undertook the task of creating a list — a list of what those hoping to carry a child wanted to hear so that their partners could truly be as supportive as they wanted to be.

All the points on the list are powerful and valid. Here are some of the highlights:

"Tell me you love me and know why I'm sad."

"Share with me your vision of our child."

Take my fears and doubts seriously, but also remind me that we're a team and we'll work this out."

If you want someone to climb into the cab and stare at the ground with you (and that'll make a lot more sense after you hear the episode), ask them to listen to this episode. Share with them the list (with your own additions and subtractions) to help open those critically important lines of communication and mutual support.

You can find out more about Suzi Mohn and get her contact information at the HERE. You can find more from Ruby and Anne at thewholepineappple.com

Individual and family couples counselor Suzi Mohn has helped families navigate crises for years, and she knows how important support can be during a fertility journey.

Infertility can put a huge strain on relationships — stress, financial worries, blame and guilt, turning pleasure into obligation, differing expectations or goals, etc. etc. are all legitimate concerns.

Ironically, in the quest to build a family, the family you already have can be put at risk. Fortunately, there are counselors and therapy groups to help couples overcome the difficulties, together.

In this episode, Suzi, Anne, and Ruby discuss the struggles people face when dealing with infertility. Couples may find infertility one of the first major crises they face together — they may not have been married long; they may not have dealt with the trauma of losing a parent or losing a job — and suddenly something they thought would be simple and natural … isn't.

Also, people may believe they've done All The Things right: they waited until they were financially and emotionally ready. They established their lives before preparing to welcome children into it. And their reward for such responsibility? Trouble conceiving or maintaining a pregnancy.

Couples may be on different timelines, too. One partner is ready to go to the doctor TODAY; the other isn't feeling the same urgency. And that can make both of them feel like they're taking this journey alone instead of together.

What do you do when you're facing so much, and the one person you turn to in difficult times is dealing with their own concerns? What do you do when the person who is usually a big part of your solution is suddenly a big part of your problem? (or so you think…)

There's help! Listen up for ways couples can navigate the challenges of infertility. Then, please share this episode with anyone you think could benefit.

You can find out more about Suzi Mohn and get her contact information HERE. You can find more from Ruby and Anne at thewholepineappple.com.

July 25, 1978 was a great day, and not just because July 25 is Ruby's birthday. This particular day in 1978, the first IVF baby, Louise Brown, was born!

IVF is a lot different now than it was then — a lot was learned on the way to this first successful human pregnancy, and a lot has been learned since. In this snack, Ruby and Anne are talking about the research and experimentation that got us where we are now.

One of the biggest changes (and dare we say, improvements) from the experience of Lesley and Peter Brown is how much less invasive (physically and frankly, of the Brown family's privacy) the process is now than it was then.

Early hurdles included getting past people's notions of whether or not IVF was ethical. And IVF cycles were so much more involved, including blood draws every four hours. Egg retrieval was a surgical process back then, it involved a single egg, and it was much more often unsuccessful. Transfers were done in the middle of the night until one didn't and it worked out fine, and that was (thankfully) abandoned.

The fact that Louise Brown was later able to conceive without medical intervention helped allay fears that IVF would create a generation of people unable to reproduce on their own.

So Happy Birthday, Louise Brown, and thank you, Lesley and Peter Brown and Elizabeth Carr (first IVF baby in the US) for going through so much to get us where we are today.

Learn more about All Things Fertility at our website: thewholepineapple.com!

With laws and regulations changing so fast and all over the place, it can feel overwhelming and futile to try to do anything at all. But it's important that we don't give up and let decisions be made for us.

What can people who aren't professional lobbyists do to make our voices heard?

According to Sean Tipton, you can do exactly that – you can make your voice heard. Register to vote and then vote. Talk to candidates for political offices, especially when they're in an election season, as they're most likely to listen at that time. You have a right to be heard, so get in there and get talking.

Have anecdotes to share (with permission, of course): if you can tell a relevant story, that is often much more effective than straight data. Faces, stories — those are the ways to get folks to listen. Showing how your policy position will solve problems is also effective. Most of us don't like being presented with problems, so come at policy makers with solutions.

Be sure to check out the Resolve website (resolve.org) for tools to help you get started. Please share resources, including this episode, with anyone who is looking to help preserve medical fertility assistance and reproductive rights in general. Sean's organization, ASRM (American Society for Reproductive Medicine), is also a great resource: asrm.org.

And of course, please rate, review, and share this podcast to help others be informed about All Things Fertility, including advocacy. thewholepineapple.com.