Sleep, Unexplained Infertility, and the Drawbacks of IVF

Sep 7, 2023 | Let's Hear From The Experts

Dr. Samantha Briguglio is a Naturopathic Doctor and owner of  Walk the Natural Path Hormone Health and Fertility Care. She began her practice because of her passion for helping women achieve their wellness and fertility goals. As an ND, she is licensed to treat – and teach – patients from a mindset of natural healing that treats the root cause of symptoms.

In This Episode:

  • Pros/cons of IVF
  • Most common causes of “unexplained” infertility
  • Understanding AMH and what it means 
  • When to worry about male factor infertility
  • How much does diet really matter for egg quality 
  • How to plan if you want to be pregnant in the next 3-6 months

Connect with Samantha:

Podcast Transcript

Lindsey Lusson  00:00

But I see this a lot like all in the infertility space about how following a very strict anti inflammatory low sugar, low carb, like just just a very strict diet can improve egg quality. And I’m curious, like, is there more to the picture? Like, is it all about diet? Or is it more holistic? 

Samantha Briguglio  00:23

Yeah, I love that question. And yes, it was pretty funny. I was like, wait, what isn’t a quality diet? Like you said, it’s totally holistic, right? I talked about the foundations for health all of the time, sleep being like the number one like the end all be all. I feel like many people are sleep deprived, and so sleep to me is going to be an anti-inflammatory diet all day every day. 

Lindsey Lusson  00:44

Welcome to the period recovery and fertility podcast. Here we discuss the challenging warning and life changing process of recovering your period and finding freedom with food and exercise. Whether you’re hoping to regain your cycle to get your health back on track, or you’re ready to become a mama, this podcast is for you. While the recovery process isn’t always rainbows and butterflies, it’s my hope to bring you both information and inspiration during your own recovery journey. I’m your host, registered dietitian and fellow at a woman Lindsey lesson. 

Lindsey Lusson  01:15

So we have Dr. Samantha Briguglio who’s a Naturopathic Doctor and owner of Walk the Natural Path Hormone Health and Fertility Care. She began her practice because of her passion for helping women achieve their wellness and fertility goals. And as an MD she is licensed to treat and teach patients from a mindset of natural healing that treats the root cause of symptoms. Welcome, Dr. B. 

Samantha Briguglio  01:39

Hi! Thank you so much for having me here. I’m so excited. And yes, on our live, we were just so chatty, so I couldn’t wait to chat again. 

Lindsey Lusson  01:47

Yes, I was like, obviously, we need more time to talk about all the things and funny enough, like when we originally scheduled the live, we had to reschedule it. And then when we scheduled this podcast, I had a sick kid, we had to reschedule. So we’re finally doing it. And I’m so excited to talk about all the things. So getting into everything. Why don’t you tell us a little bit more about your background? Like obviously, there’s so many things you can do as a doctor of naturopathic medicine. Why fertility, like why did you get into this space?

Samantha Briguglio  02:15

Yeah, that’s a great question. I’m gonna try to give you the shorter answer. I’m gonna do my best but kind of starting out, I actually wanted to be a pediatrician. And then you know, they say you make plans and like God laughs or whatever. And I literally had people laughing because I liked pediatrics. I loved it. But it was always like I came up with a new next obstacle like it was really hard to shadow or, you know, the end of my biggest learning years like COVID head and there was like all these things that kept happening. And I finally was like, I need to go in a different direction. And I love women’s health. I was already taking a bunch of extra courses in women’s health, specifically in school. So I was like, Well, I really like this. Let’s just keep going with it. And then I actually met my mentor and her name was Dr. Jacqueline Chassis. She got married. So I think it’s changed in different but she actually is a naturopath that specializes in fertility. And I took about 10 credit hours with her specific on fertility and I was like, wait a minute, I’m in love with this. 

Samantha Briguglio  03:18

Once I started learning more, I actually learned more about actually how my grandmother’s struggled to get pregnant for 10 years. And then my mother had her own fertility journey. And it was so interesting that I felt so called to it when I’ve had a lot of women in the past also kind of struggle with the fertility journey. And then I actually took her mentorship, Dr. Jacqueline’s mentorship and that was a year long program that I did after school to be able to, like say I specialize in fertility, right, like I just I went in, I did Grand Rounds, I worked with different patients, I took many, many extra credit hours specific to fertility, and just like, fell in love with it and felt good at it, which I think is something as a physician, you should feel good at what your specialty is. And so I was like, let’s do this.

Lindsey Lusson  04:03

That is amazing. I think that while experience is key, education is key, I think that there’s just this whole different part of passion for your profession where it has more of a personal story. Like you mentioned your mom and your grandmother. And I think that that’s really really really wonderful. And it sounds like you’ve seen so many cases of infertility.

Lindsey Lusson  04:28

And one of the thing that I hear you kind of pride yourself on, which I think is so cool, is whenever you see couples for unexplained infertility. I think something you said in one of your Instagram reels, which I was like, “well that’s freakin amazing”, is you were, I sit down with people and we have like this hour long conversation and typically like a couple minutes in or asking a certain amount of questions, people come in with an unexplained infertility and I’m like, I think I know why you can’t get pregnant. Tell me more about that. Like how can You have so much insight, what kind of questions are you asking? What are you looking for?

Samantha Briguglio  05:03

Well, kind of like you read earlier in the bio, finding like the root cause and treating it and, you know, treating the whole person’s everything. So, you know, a lot of times patients are talking to me, and they’re telling me like, they get migraines, like every time in their cycle, and I’m like, well, boom, there’s like something right there that like needs to be fixed, or needs to be altered. And so when I, I think it’s a matter of just listening and hearing the patient’s talk about, you know, what they’re going through. I rarely have patients that come in, or that are unexplained and like, everything’s good, they feel great. They have energy when they wake up, like, they eat perfectly, like, there’s usually something that we can work on. And then a lot of the times when I’m looking at values like, lab values, I look at optimal versus normal. And a lot of people have normal values or looked at like normal ranges. And so then they show me their labs. And I’m like, instantly, like, well, there’s so many things that we can, you know, work on to improve. So there’s a lot of things that actually can go on based off just symptoms, plus looking at optimal labs, and then just talking about, you know, other symptoms, such as, you know, skin health, gastrointestinal, health, endocrine, health, all of that.

Lindsey Lusson  06:14

Yeah. And I think that’s something we can all relate to. Because how many times like I’m thinking about myself, and I know, listeners, like, how many times do we go to our OB request hormones, and are probably first met with a little resistance like, Well, why do you need that, you know, like, who cares, I’m paying for it like ordered test. But then, you know, we get these tests, and we’re so excited, because we’re finally gonna get some insights into why our cycles are irregular, or why we may not feel our best. And then we just get a phone call from the nurse three days later telling us our labs are normal. It’s like, wait a second, like, if I’m not getting my period at all, that’s not normal. So I just like the idea of taking a deeper look, because I do think that like, obviously, labs are really powerful. But when we’re looking at an incredibly broad range, and it’s like, well, you’re not in menopause, and you’re not pregnant, like, but what about like that big range in between? 

Lindsey Lusson  07:06

So talk to us a little bit more about like, optimal range for like, let’s just start with estrogen. Because I think that that’s one where I know, personally, like in the throes of period loss with Hypothalamic Amenorrhea. I do remember one time having an estrogen reading of the hive. And I was told that that was normal. But like, if you looked at the breakdown, it was like, well, that’s normal for somebody who is perimenopausal, and like 127. So this doesn’t make sense. So talk to us more about like the optimal range for estrogen. Of course, it’s going to depend upon where somebody’s in their cycle, but like maybe talking more specifically about like an HA patient, like, where do you see people come in? And where are you trying to get them when it comes to optimal ranges on estrogen?

Samantha Briguglio  07:51

Yeah, so one, like stress, and like when you’re talking about HA, right, like, it’s so interesting, because I don’t see a lot of people with lower or higher, it can be just like either one, because like, you know, they’re hormones being thrown off, and your body can respond in whatever way it decides to. But I do see estrogen and progesterone being off. I normally see in HA like all hormones lower, they tend to be. When we’re talking about like, optimal sorry, like bringing myself back to the optimal ranges. Estrogen specifically, I like to see on day three, I just really like to pull estrogen LH and FSH on day three of your cycle, those who don’t know, that’s your third day of bleeding. And I really like to see it between like 30 and 50. I think that’s a really good range to be in. It depends if like someone’s over, say they’re at like 60, but their progesterone is at like 17, 18 or 20. Or something, I’ll be like, like, that’s an okay ratio, right? That’s gonna be different than if your estrogen was at like 55. But your progesterone was at like six, because then that’s out. So it’s kind of confusing, but I tell people, I look at optimal ranges, but there really is so much more that goes into it. Because I also look at like those ratios, because that’s gonna be really important. Because you could be at the high side of normal for estrogen, but the low side of normal for progesterone, or optimal, same thing. And that could still be an issue. So we really have to look at that. And then also consider the symptoms on top of looking at the lapse. 

Lindsey Lusson  09:32

Yeah. Are you typically doing draw multiple times during a cycle? Because you mentioned about progesterone being a certain number and what progesterone only be higher in a luteal phase?

Samantha Briguglio  09:44

Yes. Yeah. So I’m glad you clarified that. I only really try to draw progesterone on I say day 21 But everyone’s different, right? So seven days or after predicted ovulation. That’s where I really like to pull progesterone because it’s only gonna go up if you you’ve ovulated. So it’s also nice because it confirms ovulation for us. And then we can also see if it’s going to be high enough for implantation to occur and so on.

Lindsey Lusson  10:08

Yeah. And I love I love like the serial draws, too, becau se a lot of times when I’m looking at labs with clients, I’ll be like, well, this is cool. Like, this is a starting place. But this is our baseline. And hormones can fluctuate up and down throughout your cycle. So I love like the more thorough picture of drawing multiple labs. Why do you feel like this isn’t typically done in the conventional medicine setting, like when I just go to my OB? 

Samantha Briguglio  10:30

Yeah, I like don’t want to say lazy, but I feel like bad for saying that. Because there’s some really, like, Great OBs out there and conventional medicine has its 100%  place and  they do things that I can’t do. But at the end of the day, I mean, one, I have to put two separate lab orders in so it does create more work for me. Sometimes, if I put them in together, the lab will draw them at the same time. And I’m like no, even though I write like all these notes in there not to do it at the same time, but it still happens. Um, so then you have to go in again, like later on in someone’s cycle, and then put them in so it takes more work on the backend. Like I know that it’s almost a silly reason, but it does. And then also, I don’t think necessarily every practitioner knows how to read them that way, or why it’s important. And so you don’t know the why or the how, then you’re not going to do it. Because when you see the results, you’re not gonna even know what to do with them.

Lindsey Lusson  11:25

Yeah, I’ve definitely heard a lot on other podcasts kind of talk about, “Well, the reason why we don’t do it is because it’s not going to change how we’re going to treat” and like, oh, I guess I get that, right. Because if your MO at the end of the day as well, all we’re going to do is IVF and everything’s going to be a stimulated cycle anyways, then yeah, probably isn’t going to, you know, change how you treat. But on that topic of IVF, you know, we’re both pretty passionate about natural fertility. IVF always having its place all these other more invasive treatments, absolutely having a place but we both feel that this shouldn’t be the first line of defense. And so tell me a little bit more like in your practice, like, what do you in your opinion, like, what would be the downsides of someone coming in and they have HA, or they have unexplained infertility? And the message that they’re given is, well, let’s just start IVF. Like, that’s probably going to be the fastest way to pregnancy, we both know isn’t always the case. What are the downsides to thinking about things that way? 

Samantha Briguglio  12:24

Yeah. So, when you go in, it’s like your, this is your option, it’s IVF. In my opinion, the root cause hasn’t been addressed at all, right. So if you’re not getting pregnant, there’s a reason behind it. Right? If that reason is the uterine lining isn’t like supple enough to accept implantation, or you’re not, you know, getting high enough levels of progesterone to maintain your pregnancy, or your egg quality is not the best, or whatever the reason is, all those reasons that I just named are something that we can work on to get better to either get pregnant naturally, or to help improve the chances of IVF. But if you just go straight to IVF, nothing’s been addressed. And if nothing has been addressed, like the chances of IVF working just are even smaller than before. So a lot of times, I encourage people, I’m like, let’s treat what’s going on now. Even if we want to go to IVF, that’s totally fine. But like, let’s increase those chances by, you know, increasing that egg quality, increasing your progesterone levels naturally, you know, having a regular cycle, whatever it is. Now, people who jumped to IVF, because they have like a fallopian tube blockage, right? That might be a little bit different case scenario. I actually work with people with tubal blockages and I work hand in hand like a visceral manipulation therapist, and she goes in, and I’m like can help a lot of that. But you know, there are cases that it’s just not going to happen, and it might not work. And so that’s, that’s where I kind of understand jumping to IVF, right? Because that’s like a physical blockage that is getting in the way. And IVF is actually therefore kind of treating that root cause if you want to, like kind of get into the nitty gritty, but yeah.

Lindsey Lusson  14:03

But in most cases, going to IVF isn’t really dealing with someone’s infertility issues. And the downside, you’re saying is lower chance of success of IVF. Because the reason why we’re doing it isn’t actually being addressed. We’re just like, hey, like, here’s some medicines, let’s try to stimulate what should be happening in nature. And, you know, I feel like IVF is relatively new, like we talked about, like some of like, the oldest IVF kiddos are like in their maybe 50s. Now, so like, that’s, you know, in the grand scheme of life, like that’s still pretty new. Do you feel like there’s information that we don’t know about IVF yet, or do you feel like, you know, I know that there is some fear from some schools of thought of like, well, what happens with all of it, you know, we’re injecting higher levels of hormones in the body mix naturally. Do you see that as being something that could potentially come up in the future or do you feel like we would have discovered something by now?

Samantha Briguglio  14:58

I mean, that’s a great question that one I feel like, like a mix between like scientific and like a philosophical question. I mean, it kind of makes me think of epigenetics, which for those who don’t know what epigenetics are a very, very short version is basically how our grandparents and mothers and even great grandparents treated themselves in packs us today. And I mean, so there’s definitely there’s definitely truth to that, like epigenetics has been studied. And it’s been proven, like how our, you know, mothers and grandmothers act during pregnancy impacts us, or even before, right, because our little eggs already there. And it kind of makes me think of that a little bit. I, you know, anyone in the fertility world, you know, that needs to go to IVF. I don’t I was like, careful to say like, yeah, my cause this because, you know, this could be the only option that they have for a baby. And for me, I think I would say, if you do all those natural things first and get your body in, like the best place it can be, it will be a lot less likely that you have the negative effects from like an IVF procedure.

Lindsey Lusson  16:05

Okay, yeah, if you’re taking care of her body in the first place. Yeah, yes. I love it. And I want it framed that way, too. One of the things we kind of touched upon that I want to dig into a little bit deeper here is egg quality, right. So honestly, I don’t see air quality come up in a lot of my clients. But I know that there’s a lot of fear in getting that diagnosis of poor egg quality. In particular, I feel like a strap extrapolated from an AMH value. So tell us a little bit more about AMH, like, what is it? How do you use AMH in your practice? And like, should somebody be worrying about this, If they aren’t having a regular ovulatory cycle?

Samantha Briguglio  16:45

Yeah, so you’re right, a lot of people come into my practice really nervous about their AMH. And like, based off their AMH are told they like, can’t conceive, which like blows my mind, because AMH is one part of the picture, you know, there’s so many other things that like need to go right or go wrong, right? Like, it’s not just this one thing is like the end all be all.  AMH is an estimate, and I like to emphasize that word, “estimate” of our ovarian reserve. Which just basically means how many healthy eggs we have left. And like I said, it’s an estimate, it is a hormone. So one, you know, different hormones, like like anything, it’s not going to be same every single time you draw it. And two, it can also improve. And I know a lot of people don’t believe that, but I kind of say like, okay, it’s an estimate of ovarian reserve, right. Ovarian reserve or egg quality, basically, people talk about, you know, you can’t fix it, blah, blah, because it’s dependent on age and genetics, which it is. You can’t change your age or genetics.  But just like some people age really well, and some people don’t, depending on how you take care of yourself, it’s going to be the same thing, right? So if you take care of yourself, and you’re treating and you’re reducing, you know, reactive oxygen species, lowering overall inflammation, then or egg quality is going to be able to get better, it’s going to be able to improve. So even if it’s lower, I tell people like don’t worry, like, we can work on this to improve things as well. And don’t like focus, hyper focus on that number, because it’s not the end all be all. I’ve seen people get pregnant with very, very low AMHs. And they were like, there’s no way I’m like, I promise you like it’s not like don’t put all your eggs in. Oh, god, that was so dorky. Don’t put all your eggs

Lindsey Lusson  18:27

in one basket. But I think that that’s such a good message to hear. Because I do feel like there’s so much emphasis in the fertility world on this AMH number. And it is like to drive that point how being an estimate. Right? Like people get pregnant with low AMH, there are things you can do about it. I feel like there is this and it’s funny because we were chatting before we started recording about this idea of an egg quality diet. And your answer like kind of makes me laugh because you were like, Wait, what is an egg quality? But I see this a lot, like all in the infertility space, about how following a very strict anti-inflammatory low sugar low carb, like just a very strict diet, can improve egg quality. And I’m curious, like, is there more to the picture, like is it all about diet or is it more holistic?

Samantha Briguglio  19:27

Yeah, I love that question. And yes, it was pretty funny. I was like wait, what is what isn’t egg quality diet? Um, and I like  kind of heard it before but I couldn’t place it. But like you said, it’s totally holistic, right? I mean, I talked about the foundations for health all of the time. Sleep to me, being like the number one like the end all be all. I feel like everyone is sleep deprived. And I shouldn’t say everyone shouldn’t generalize, but you know, many people are and so like sleeps to me is gonna be an anti-inflammatory diet, all day, every day. And so that’s just something just right there. I think like you said, diet, the 80/20 rule is like my favorite rule. I’m also like, during like, really like fun, like crazy times maybe 70/30 Like, it’s like, it’s everything ebbs and flows. And, you know, doing the best you can is important. You know, you can still buy, like, the healthier brands of foods and, eat things that you might think are, like, “bad for you”, but like, you’re gonna be okay. Our systems amazing and beautiful. And as long as we, get our sleep and, follow the 8020 rule, and move daily, and take time to really nourish ourself and reduce overall stress in our life. It takes all of that, you know, and maybe that’s egg quality diet, right?

Lindsey Lusson  20:56

Yeah. And I love to, 70/30, 80/20, like, whatever. Because I do feel like a lot of people that I work with are like, 95/5 or 90/10. And they feel like that’s optimal. And what I always tell people is like, at the end of the day, you can have the healthiest diet in the world, but if you’re stressed and greeting ingredients list every single time you’re making a food decision, if you are freaking out about what the food, what oil the food is prepared with, when you’re out for date night, It’s supposed to be a fun, intentional time with your partner. That stress around the food, it’s probably doing more damage than like the actual food itself. And so it’s a balance, right of like figuring out, you know, yes, we want to optimize our diet and make sure we’re feeding ourselves well. But this egg quality diet, like we don’t have research to say like, you need to eat this way to improve your AMH per se, but there are a lot of just general healthy lifestyle principles that we bring in when we’re talking about improving egg quality. Is that right?

Samantha Briguglio  21:59

Yeah, exactly. And I think we talked about it before, too, but you know, eating healthy fats, like lots of fruits and veggies like that, those are gonna be things that yes, help, right. But those also help like everything, you know, like all our hormonal processes, and just overall inflammation is just gonna help with so many different things. And that’s why we eat them. It’s not even just for like egg quality.

Lindsey Lusson  22:25

I feel like we overcomplicate it too. For whatever reason, we want this specific egg quality diet, when in reality, some of us might already be doing a lot of things right when it comes to our nutrition. But there might be other, you know, things that are holding us back from getting pregnant. Not to mention that fertility and getting pregnant, it takes two people, right. And so male factor infertility can happen, but I feel like it’s something that’s really under talked about, I was interviewed for a podcast recently, and kind of asked that question, and that was like, it gets pretty high. Like, I think it’s like, one in five. And then I like looked it up later. And I was like, Oh, wow, it’s like way higher than that. So talk to us about male factor infertility, how common is it? And why aren’t we talking about this more often?

Samantha Briguglio  23:11

Yeah, well, it’s 50%. Right? Like, it’s 50% of the time, it’s male factor. And then I have couples where it’s both right. And then I have couples where, yes, it is female factor. But I think it’s not talked about because, again, this is also a generalization. But a lot of women are like the let me research. Let me figure out like, I want to be like, Go Go, go, go go and like get it done and figure it out. And like the male side is more like sure, like, whatever. And I think it’s not for most my couples, it’s not because the male side doesn’t care. It’s just, I think the male system just seems so less complex that it’s just like, No, it’s simple, like A plus B, equals C. So like, the sperm should be fine. But sometimes it’s not. And there’s so many environmental toxins nowadays, that, you know, that impacts way more than we ever really know or think about. I feel like I’ve talked about environmental toxins forever. But at the end of the day, it’s kind of the same thing with like, nutrition, it’s like you got to do the best that you can. There’s, there’s so many around us. And I don’t want to like overwhelm any everybody. But yeah, I think it’s just because I think it’s almost like I said it, the male system just is a little bit more simple. In the sense of like the hormonal picture, right? It’s a little bit like it’s about, it’s almost the same all the time. It does fluctuate a little bit. It really does. Like there’s some there’s some bumps, but like like when I’m talking about bumps, I’m thinking of a graph of the male hormones. And like for females, though, it’s like up and down in our cycle. And there’s a lot more that we can, you know, go off of like, oh, well, it might be me because I have severe cramps in my cycle. Yeah, right. I don’t want you to have severe cramps, but if just because you have really bad cramps doesn’t mean you’re infertile. And the male’s like I’m fine. I’m kind of tired in the morning but other than that, like the common good, and it’s really the male side in that time because their testosterone is low, or whatever it is.

Lindsey Lusson  25:06

Yeah. Yeah. You mentioned toxins. And I love that approach too. Because I do feel like it can be really, really overwhelming. What would be like a few like maybe three, like best things for your buck that couples can do as they’re trying to conceive?  Because male and female, right, like it’s impacting both of us. What would be like some really good bang for your buck on ways to reduce toxin exposure?

Samantha Briguglio  25:30

Yeah, I think the first thing would be like eliminating extras. So that means like, dryer sheets, the glade plugins, the toxic candles, there are other versions, if you want to try like there’s some essential oils, and there’s some non toxic candles out there. But eliminating those extras are going to be important, like perfume cologne, just like take them away. Another one would be things that you use every day, swap out. So lotion, shampoo, conditioner, dishwasher soap, laundry detergent. Basically, if you’re using it very often, not even not even daily, but even like multiple times a week, then switch it out. Yeah. And then the last thing would be honestly filter your water. These are the top three, by the way. Filtering your water is going to be really important because most people do not have clean water. And so filtering your water out is going to be really important. I kind of tell people any filter is better than no filter. But if you can get one that at least takes like fluoride out, that’s going to be ideal.

Lindsey Lusson  26:29

Do you feel like toxins impact everyone, because I’m thinking about like, so I only kind of recently went down that rabbit hole after we were done, like completing our family. And so I was like, Oh my gosh, like if I would have read this while we were trying to conceive it would have stressed me out. But also I’m like, oh, like, we definitely did not have optimal fertility. But yet here we are three kids. So do you feel like like some people can like fly under the radar? And is it a catch up, catch up with us eventually? Like, what’s what’s Why do some people seem to be more sensitive? Are certain people are more sensitive to toxin exposure. 

Samantha Briguglio  27:06

Yeah, I think people are. I mean, it’s just kind of like, kind of like everything, right? Like, some people have a lot of allergies. And then some people don’t. Some people have allergies because they have a gut issue. So some people all of a sudden, you know, are suffering from something else. And all of a sudden they become more sensitive to environmental toxins. Or you’ve been so submerged in toxins that you don’t know what it’s like to feel like without them. So the moment you start removing them, you start feeling better, and then you add them back and you’re like, Whoa.  A big example of this for me is when I went to my naturopathic medical school are actually like a fragrance free campus. I was like, what does that like, I like change my shampoo, and everything is like crazy. And I was like, Okay, I like got back into the real world. And I was like, What is this fragrance like these scents smells and scents, like, I was sensitive to everything, which I wasn’t before. So there’s something to say about like, definitely having, like a balance, like now I’m not like hypersensitive to everything anymore. Because I use shampoo and conditioner that are all very natural. But you know, they do have some, like scents from essential oils or whatever. And so like, I’m not gonna get a headache from that anymore. But that’s kind of a point that some people I feel like don’t think about, it’s like you’re submerged in it. You might not even have it’s bothering you.

Lindsey Lusson  28:18

Yeah, yeah. Well, and just recognizing that, you know, people who live in like, like more like urban environments, like there’s going to be toxin exposure that like you literally can’t control course. So like doing your best is really, really important. One of the things that I have come across more recently, or maybe just thought about more recently on the topic of male factor infertility is the idea that there’s like a male version of hypothalamic amenorrhea. Well, so like amenorrhea, they don’t have periods. So like, clearly, that’s not the actual name, but we talked about how over exercise, stress and under eating can really negatively impact female fertility. Do you see that in any of your male factor infertility patients?

Samantha Briguglio  29:01

Yeah, 100%. I would say more on like the stress side for the males. Usually, again, this isn’t like knocking any of the males but I don’t see the overactivity like for males to be like overactive, they have to be like fairly overactive. Usually, like the lifting weights and things like that are gonna be really helpful with testosterone levels. Like it has to be pretty intense maybe like, if you’re going to if they’re getting ready for like a show or something. I wouldn’t recommend that you know, for fertility, but most of the guys like they they do really well with like movement, but stress for sure. The men with blue collar jobs, honestly, I see it be a little difficult. They’re okay sometimes on their testosterone side because they’re like, you know, they’re building things.

Samantha Briguglio  29:53

But sometimes are exposed to even more environmental toxins. You know, like my welders and my plumber. That’s a harder task for me because I also can’t be like, stop your job. But yes, I can see it on I know what you’re talking about, I can see that I just think there’s different contributing factors than the female side. Yeah, I guess also, though, with the diet, like, there are men who like don’t eat enough, and especially like protein, like, I’m like, come on, like, let’s, let’s get this protein intake up, it’s gonna help so many different things. So there is that too. But I think it’s really the stress that like gets a lot of men stress and the environmental toxins.

Lindsey Lusson  30:36

Okay, good to know. When you see people, when you have couples come into your office with fertility issues, and you suspect HA is going on? How do you address that with people? Like, do you feel like it’s hard to get people to come around the idea of needing to eat more, exercise less? I feel from a lot of doctors that I visited with on this topic is like, they still scared to go there sometimes with their patients. How do you approach it?

Samantha Briguglio  31:06

Yeah, so I guess it really depends on the person. Some people, I can kind of make jokes with and we can be like, no, like, let’s like, let’s increase this. And then some people have to be like, very, very slow with and when I mean, slow, I mean, like, let’s take this baby step by baby step. And so again, like, obviously always case by case basis, but I think the majority, I definitely always address it 100%. I think it can be something that can be nerve wracking to talk about. But if you kind of ask like, you try to get down to the root of why things are the way they are like, Why do you stress over this? Or, you know, why don’t you eat as much as you do? Is it because of time? Is it because of stress? Are you worried about like gaining weight? Like, what is it? So kind of like not even just a just addressing it, but figuring out like, why is it happening? Why is it that way? What causes the most amount of stress? Why aren’t you eating enough throughout the day, and once I figured those things out, then I can make like a plan that is really going to help someone achieve the goals that we need to reach, right? Some people be like, I hate cooking. And I’m like, okay, like, that’s fine. So you’re under eating literally, because you just don’t want to cook. Right? And I hear you on that. So then we’re like, let’s find you a good meal plan, like go and get those meals where you can warm up and people are like, well, that’s not good. You’re warming food up. And I’m like, but they’re eating food. Like, that’s right. That’s all that matters to me at this moment.

Samantha Briguglio  32:31

So it’s like finding little things like that some people do get nervous about the idea of gaining weight. And sometimes, they say you might gain weight, it depends on where they’re at, in their journey. Some women that are more nervous about that want to lose weight already. And they’re like, and I’m like, you might lose it too like, you’d never really know how your body’s gonna respond. But you have to honor your metabolism, you have to honor like what your body needs to have fuel and to move forward. And so I know that was a really long answer. But ultimately, it’s like finding the why things are the way they are now. And then treating it according to that.

Lindsey Lusson  33:05

I love that. I love that. Because there’s so many different reasons why someone might be under eating, it could be literally a practical issue. And I run across this in my practice as well. Somebody is a surgeon and are in surgery for like eight hours straight. You can’t eat when you’re in surgery. So like what do you do, right, versus somebody who has a past history of an eating disorder. And so there’s still all these lingering thoughts. And so that’s when we have to start talking about how to support somebody on a higher level. And so yes, like looking at it, because there are so many different pathways that can lead to HA, that makes sense that we need to figure out like, why is this happening? And what’s the best next step for those for those people? A big hesitation that I do hear in a lot of HA clients, and I’m sure you’ve come across this too, is the fear of weight gain. And so can you talk a little bit about like how weight gain can actually be helpful for fertility?

Samantha Briguglio  33:55

Oh, yeah. Well, first off, you know, people talk about women’s body fat percentage versus like males, like we’re supposed to have a higher one for many reasons, but a big one is for hormonal balance, right? You know, we need to have the right amount of fat percentage. A lot of people will link actually estrogen to fat, like, let’s just kind of throw that together. And a lot of people hear about it, but there’s some validity to that. I mean, not I didn’t, I didn’t get very technical with it. But at the end of the day, like we can’t produce enough estrogen, progesterone.  We’ll probably be good on the testosterone side for a little bit on the leaner side, but there’s all these different hormones that are really important, that just aren’t gonna get enough like nutrients or anything to be able to actually create a cycle. That’s why when people get really, really lean, when I say people like women, when they get really lean, sometimes their cycle just like disappears because there’s like, I just I kind of explained as there’s just like not enough there’s there’s not enough for your body to do ever everything plus create a cycle and you’re body’s gonna get rid of that first because that’s not necessary for survival. Right? Does that make sense? Like your period like it’s supposed to come so you can like, eventually create life. But if you’re not, if you’re not getting enough fuel yourself, it’s like, oh, we’re not gonna bring that into the picture right now. Like, right now we need to take care of you. And we’re not we don’t even have enough to sustain ourselves at the moment.

Lindsey Lusson  35:22

Yeah, yeah. And when people are afraid of gaining weight, like we talked about, well, like, obviously, it can, it can help with your hormone balance, it can bring your cycle back, if you’re not getting it at all, are there any other like, things that you try to share with your clients who are scared of the weight gain or hesitant towards it? Like just kind of like nuggets of wisdom on this is helpful for your body or for your future, baby? Because…

Samantha Briguglio  35:48

Yeah. Well, one, kind of like I phrase it with like, you’re gonna give energy one to yourself, but also to future baby. So like, when you eat, you’re not eating just for yourself, you’re eating for baby. And then also I again, this is diving into the why, like, why are you nervous to gain weight? Is it appearance related? Do you do you look at that as unhealthy? And then talking about mindset shifts, and thinking of like, you know, instead of looking at yourself, if you gain a little bit of weight, and like, Oh, I’ve gained a little weight being like, wow, I look really healthy, like, I look really good. And then also focusing on how, like, the, how they feel, right? So I’ll be like, just see how you feel like you’re gonna eat a little bit more. If you’re eating more, and you’re coming back to me and being like, I feel sluggish. I feel worse, like all these things than me, like maybe like you were at your right size. But in most patients that come to me and they start gaining a little weight, if that’s a conversation that we’ve had, they’re like, I feel amazing, I feel more awake, I feel more alert, I feel less anxious. Like, it’s still a mental like struggle sometimes to like, get into that healthy, like my body’s healthier space. But ultimately, they feel so much better that a lot of times they start releasing, like I don’t really care almost as much because I feel so good.

Lindsey Lusson  37:00

Yeah, yeah, I couldn’t agree more. And it makes total sense. When we think about things like on a physiological level, right? Well, like if your body is depleted of carbohydrates and nutrients and you start to replete, those, your body is going to start working better digestion is going to improve and you’re going to have more energy and physically feel better. So I agree, sometimes it is just getting over that hump of allowing yourself to, you know, focus more on making nutrition a priority, actually eating. So I think that that’s so, so great. Like, I know that people need to hear that even if they’ve heard it a dozen times, I think that hearing it from you, is really helpful, too. Let’s wrap up by talking about preconception planning. So let’s say someone’s listening to this and they don’t want to be pregnant right now. But like we’re prepping, right like we’re like all right, like I’d love to be pregnant by the holidays or 2024 is our year what are your like top recommendations for people as they’re preparing to prepare to get pregnant?

Samantha Briguglio  38:03

I love it preparing to prepare gets so great. Um, well, I mean, I usually give people like a timeline like if you’re really working on preconception care start at least like three to four months out. But you know, even if you if you know now like eventually want to have a child it’s just easier to honestly start the healthy lifestyle habits like now because then it’s just gonna take you really far and it’s just good they’re good habits to have anyway. But they’re the foundations of health are going to be what I talk about all the time I repeat it I feel like I sound like a broken record but I think it’s so important to emphasize. So you know the sleep, nutrition, movement, you know, stress management, and then like eliminating environmental toxins or reducing them those are going to be so important. So really focusing on those if you know you have a hard time going by yourself this is where you find like one of us as a practitioner to help guide you but just like slowly starting with those it’s going to be most important like I said sleeps gonna be like number one so I’m always like start with sleep.

Lindsey Lusson  39:08

 I think that people underestimate what optimal sleep is because I’ll get people who would be like oh yeah, like I’ve gone from five to six and a half sometimes I get seven hours. What’s optimal sleep?

Samantha Briguglio  39:18

Got it? Well optimal at the end of day is when you wake up and you feel really rested. So there are some people that are definitely on that like edge where they only need like five to six hours and like I wake up and I feel great. I’m like wow, I could get so much done if I was like you. But I want the end that means like eight to nine so I’m on like the other end. Yeah, most people are within the seven eight hours. Some people do like oversleep and they feel groggier too, so a lot of times I actually find people I tell people to like find their sleep sweet spot. So sleep like maybe if you feel like it seven, eight hours, sleep seven hours, sleep seven and a half hours ,sleep eight hours, sleep eight and a half and then see where you feel the best you know if you get a good night’s sleep, obviously. It’s because some people will be like, I get like eight and I feel great. And then I get like eight and a half and I feel terrible. I’m like, honestly, because you’re out of your, your sleep sweet spot.

Samantha Briguglio  40:10

So I really emphasize that. And obviously, like just finding what’s going to work best for you. A lot of times I talk about sleep hygiene habits, they’re gonna be really important. Even if you fall asleep easy, but I tell people like to emphasize that because your cortisol levels can still be messed up, even if you just like fall asleep. If you’re waking up in the middle of the night, or, I mean, if you drink a lot of water at night, you’re gonna wake up to go to the restroom. But other like, it’s going to be important. So I have for example, I’ll put my phone in a completely different room. So I lay in bed with like out my phone in that room, I highly recommend that one for everyone. People get worried about an alarm. I’m like, you can get an old fashioned alarm clock or honestly just put the phone on our mind, turn it up, then you have to get out of bed. Turn it off anyway, so you’re already up. So that’s gonna be important, you know, drinking some tea, maybe doing some light stretching. If you do have an issue falling asleep, I definitely recommend people like go to a practitioner and really get that figured out. Because insomnia is going it’s going to be in my opinion, that can be a root to everything first. Because it’s so big. You can only clean your cerebrospinal fluid, which I basically say is like the gas that makes the car go right, like at the end of the day can only clean that while you’re sleeping. That’s the only time so if you’re not sleeping, you’re running off dirty gas or dirty cerebrospinal fluid. And how was anything supposed to function right after that? So I feel like I could talk about sleep forever and ever, but…

Lindsey Lusson  41:38

I think it’s like one of the most under recognized lifestyle habits that has such a trickle down effect on of course our fertility, but our overall health too. And I think that that’s a message that listeners need to hear too because a lot of my HA clients are waking up at 4 or 5am to get that workout in because they’re trying to be so healthy, but that might interfere with them getting their 7 to 8 and so when we start talking about fertility, like it might be better to hit the snooze button or to really focus on your sleep quality over the workout. 

Samantha Briguglio  42:14

100% I tell people do not wake up early to get that workout in like if you’re like sacrificing sleep to get the workout in the workout is not benefiting you, right? Like it’s just not going to. Also to the point of just because you said snooze button. I know what the point you’re making, but I actually am like I’m a non snoozer. So I tell people like only set your alarm to when you need to get up and then get up at that time. Because that helps you like your circadian rhythm. If you’re like snoozing, that’s like throwing it off. 

Lindsey Lusson  42:43

That’s so good. I think people need to hear that. I am actually not a snoozer. So I’m like you’re preaching to the choir over here. But I know that there are a lot of people who like snooze for like half hour. And yeah.

Samantha Briguglio  42:59

Well, that then that goes to another point, just putting your phone in the other room, so you have to get up to get it.

Lindsey Lusson  43:04

Yeah, now, I think that these are all such such wonderful tips. Well, if somebody wants more info from you, because I know that you share a lot on social and there’s like, you’re always like sharing new things, like so many different topics, like, what’s the best way for someone to be engaged with you? Or maybe even take next steps. Do you do virtual consults with people? Tell us a little bit more about that. 

Samantha Briguglio  43:25

Yeah. So on Walk the Natural Path on Instagram, honestly, I’m super active on there. So you’ll always learn something new. I pretty much post every single day. And then I’m very open in my DMs. I love when people message me. So if you have like any questions, I have people reach out. Obviously, I can’t give specific medical advice on there. But I do love when people reach out. And if I feel like I can also help with their case, I usually direct you towards my consultations. Or you can just book an appointment and all that infos on my Instagram. So that’s probably the easiest place to go.

Lindsey Lusson  43:58

I love it. Well, that’s super helpful. And we’ll link that in the show notes. So thanks so much for your time today and sharing some of your information and tips with us and you guys be sure to reach out to Dr. B if you have more. Thank you.

Samantha Briguglio  44:09

Bye. Thanks for having me.


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I’m a fertility nutritionist and registered dietitian who specializes in hypothalamic amenorrhea. My passion is helping women trying to conceive find freedom with food and exercise, so they can recover their period, and get pregnant naturally.

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Jan 19, 2022

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