Natural Infertility Treatments, part 2 of 2

Iva King
Dr. Iva Keene

This is my interview with Dr. Iva Keene. She’s a Fertility Specialist and Doctor of Naturopathic Medicine. Find her on Facebook as “Natural Fertility,” and see her website natural-fertility-prescription.com. Please point your friends suffering with infertility to my last blog post (as well as this one). Last time I posted the flier on the upcoming Fertility Retreat at Sanoviv in Mexico, where I will be for a few days, and Dr. Keene will be instructing.

GSG:  What do you think of the current medical model for fertility? Twenty years ago, it was testing, drug approaches to hyper-ovulation or Lupron for manipulating hormones, IVF, lots of surgeries. It was a nightmare for me personally. Has it gotten better?

DR. KEENE: While I think the testing, procedures and drugs have improved somewhat, the general approach to treating infertility hasn’t changed significantly. It’s still focused on the reproductive system alone. The treatment aim is to jump over the problem, force a conception and then hope the pregnancy will be successful.

While in some cases, like severely blocked fallopian tubes, retrograde ejaculation, or missing Vas Deferens, the medical model is the only option available, my experience has been that most cases of infertility respond better to a holistic approach.

PCOS, endometriosis, unexplained infertility, recurrent miscarriages, irregular periods, ovarian cysts, and sperm abnormalities are all symptoms of some other imbalance in the body, which usually affects multiple systems such as the endocrine system, the immune system, liver and the digestive system.

fertile questionOur reproductive system is not crucial for our body’s survival. As such, in terms of the body’s priorities it is last on the list when it comes to nutrient and energy distribution. The heart, lungs, brain, kidneys etc are more important for your survival because if one of those organs had a problem, your life would be at stake.

Infertility should always first be treated holistically and IVF, ICSI etc. be reserved as the last options once the natural approaches have been exhausted and everything has been done to bring the body into equilibrium. Not only does this holistic approach reduce the need for those technologies, but it also increases their chances of success if they have to be used.

For this reason, I don’t see our approach as an alternative to IVF, ICSI etc., but rather as complementary to them.

GSG:  Do “standard of care” infertility treatments cause permanent or debilitating side effects?

DR. KEENE:  They can. This will very much depend on the treatment used, the individual, their underlying health and the number of times the treatment was used in close succession. In rare cases, some women develop life threatening conditions such as Ovarian Hyper Stimulation Syndrome.

Some studies suggest that repeated use of fertility drugs predisposes women to breast and ovarian cancer later in life. Unfortunately, many of my patients come to me once they’ve been through multiple IVF treatments. And because most clinics urge patients not to waste any time, the treatments are used repeatedly, sometimes for a year or longer.

Some of the more immediate side effects I’ve observed in some of my clients are hormone irregularities, irregular cycles, shorter cycles, cysts, thyroid problems, weight gain and mood disorders.

GSG:  What kind of natural treatments for infertility are effective?

circle and bloomDR KEENE: The approach I use has been shown to have an over 80% success rate when used for a minimum of 4 months and maximum of 2 years. The effective treatments focus on identifying systemic imbalances and correcting those with dietary and lifestyle changes as well as supplementing with nutrients that have been shown to be effective.

This treatment approach also relies on tests for toxicities and immune imbalances, as the two are linked, and when the immune system is out of balance, pregnancy is much harder to achieve. Acupuncture is also a great adjunct therapy to this approach, as are mind-body programs like those produced by Circle and Bloom.

GSG:  What book or resources should a couple read who are struggling with infertility?

DR. KEENE: We recommend Circle and Bloom mind/body programs in conjunction with our Natural Fertility Prescription program which is a step-by-step system explaining in great detail what practical steps a couple should take over a period of 120 days to maximize their chances of getting pregnant naturally. In addition to our core Natural Fertility Prescription (NFP) program, we also offer protocols specifically designed to address egg and sperm health issue as well as a program for IVF preparation to help couples who have decided on that path.

GSG:  Does diet influence fertility? What about consumption of animal flesh and milk that has hormones in it, if it’s not organic? What kind of diet do you recommend for couples wishing to conceive, and deliver a healthy baby?

DR. KEENE:  Diet is very important for fertility! Both organic and non-organic animal food products will have the hormones from the animal in them. One of the largest studies conducted on women, the Nurse’s Health Study by Harvard, with 17,544 participants over eight years, found that women who ate more plant proteins rather than animal proteins had better fertility overall and fewer problems with ovulation and infertility due to anovulation.

milk infertilityMilk, strictly speaking, is the breast milk of another species. And while you’ll find lots of information on the nutritional benefits of raw unpasteurized milk, the three main issues with milk for fertility are as follows:

  1. Milk is mucous producing and can predispose to blocked fallopian tubes.
  2. Milk is loaded with estrogen as cows are milked during their second trimester of pregnancy. In someone who already has estrogen dominance, like women with fibroids, polyps, endometriosis and PCOS, milk is only making the problem worse. Similarly, milk and all dairy products contain insulin growth factor, which is great for the young of the species as it helps them grow big and strong. In adult humans, it only makes us fat, predisposes us to acne, and in women with PCOS, where insulin resistance is already present, dairy only makes the condition worse.
  3. A very large portion of the population is lactose intolerant. We stop producing the enzyme lactase at the age of two, needed for breakdown of the main sugar molecule in dairy, lactose. If you are intolerant to dairy but keep eating it anyway on a regular basis, you are not only damaging your digestive system and preventing nutrients from being absorbed, but you are also setting up your immune system to become overly aggressive and predispose to miscarriage and ‘unexplained infertility’.

So while raw dairy products may be a source of nutrition for some people, like those who want to build muscle and who are not intolerant to lactose, it’s not a good idea for those wanting to get pregnant, and those who already have weight issues or hormonal imbalances.

This applies to both men and women, since in men, excess estrogen causes testosterone to be converted to estrogen, which negatively impacts sperm quality and quantity.

foods for fertilityOur fertility diet essentially focuses on fresh vegetables, especially dark leafy greens, nuts and seeds, legumes and beans, green smoothies, fresh fruit, wild fish and some lean protein from grass-fed animal sources for those who don’t wish to give up meat. And we emphasize the food being as fresh as possible and organic where possible. Eggs and meat should be grass-fed, organic and free range. Hormones, oocytes and sperm need good quality fats and protein. And this is the main focus of this diet, as well as providing high levels of vitamins, minerals, other nutrients, and fiber from plant sources. Fiber helps mop up excess estrogen and environmental toxins from the diet before those toxins get a chance to absorb into our bloodstream.

GSG:  You’ve said that the greatest gift you can give your baby is robust health, and this starts with the quality of the sperm and eggs at conception. How does one achieve healthy sperm and eggs?

fertility eggDR. KEENE:  Women are born with all their eggs. In fact, the eggs are older than the woman! However these egg cells are not mature. They are in their primordial form. From the onset of puberty, every 120 days, 5-6 of those primordial egg cells will be selected for maturation. At the end of this cycle, 1-2 of the best formed eggs will be selected for ovulation.

And while it’s true that you are born with a finite number of eggs, it’s not true that the quality of the eggs you ovulate each month can’t be made better or worse depending on your dietary and lifestyle choices. The Natural Fertility Prescription (NFP) program and the Egg Health program focus on providing your eggs with all the nutrients which have been shown to improve egg quality as well as removing/minimizing exposure to all the toxins shown to negatively impact your egg quality and hormone balance.

Similarly with sperm, men produce new batches of sperm approximately every 90 days. So it’s possible to improve the quality and quantity of the sperm in as little as 3 months, providing there are no congenital anatomical malformations or genetic abnormalities present, which are rare and do not apply to majority of men. We also created a Sperm Health program, which can be used in conjunction with the NFP program for improving sperm health.

Even if a couple have no fertility issues, we advise everyone planning children to prepare for pregnancy at least 120 days before conception. This ensures that you are conceiving with the best quality eggs and sperm, which means you are passing on the best of your genetic material to your child.

GSG:  What’s the best and worst part of your job as a naturopathic physician working with infertility?

body intelligenceDR. KEENE:  What I love the most about my work is empowering people and educating them about how their bodies work, how everything is interrelated, and showing them how a seemingly harmless dietary or lifestyle habit or nutrient deficiency can have wide-reaching effects over time.

I have great respect for, and am in awe of, the inherent intelligence and perfection of our human body. Trillions of cells working 24/7 enable us to have the life experience we enjoy. Our body is the most intelligent pharmacy in the world, and it is programmed to strive for balance and health. Which it will achieve, given all the right elements and an environment to thrive.

Once the mechanics of this wonder machine are understood, most of my clients are full of vigor again and ready to try for a baby again. Their faith in their bodies is restored and they feel much more empowered about their fertility. And this is key. After many failed fertility treatments, people often start to doubt themselves and their bodies because they are told by the medical profession that their eggs are old, their sperm is no good, they are too old, or their bodies are in some way ‘broken’.

And while it may be true that the body is currently in a state of imbalance, that does not mean one should give up on it, give up hope. It does not mean that the issues cannot be resolved and fertility restored without medical intervention. Instead, the traditional drug and procedural methods used so far should be questioned and doubted, because these methods are not providing the body with what it needs to fix itself! It’s not drugs or doctors who ‘cure’ the body—it’s the body itself that repairs itself when given the right materials to do so.

What I find most frustrating is the misinformation which is often propagated by the mainstream infertility treatment approach. Namely, that time is running out already at age 37, that the egg and sperm quality can’t be improved, and that if your AMH is low you should opt for donor eggs immediately.

These misconceptions and ‘fear tactics’ cause so much stress and despair, which is unnecessary, not to mention counter-productive to any fertility treatment. And while it’s true that fertility will decline with age and the risks of miscarriages due to chromosomal abnormalities are higher, if dietary and lifestyle factors are ignored and nutritional deficiencies remain unaddressed, the fact is that most of these factors can be addressed.

fertility loveIf they properly prepare for pregnancy, it is possible for women in their mid- to late-forties to have healthy pregnancies with their own eggs and give birth to healthy children.

GSG:  Dr. Keene, I hope those who read this will have renewed hope. Like you, I believe in the miracle of the human body, and I marvel at its innate ability to correct imbalances. We need to get heavy metals, chemicals, and toxic foods out of its way. Thank God there are practitioners like you helping people get on the right track. Thank you very much for serving my readers with this information and encouragement!

DR. KEENE:  Thank you so much, Robyn, for the opportunity to share this information with your readers. I hope more couples will look to natural infertility treatments first after reading this interview. It would be a great pleasure to meet some in person at our upcoming fertility retreat at Sanoviv in Rosarito, Mexico.

Natural Infertility Treatments, part 1 of 2

infertility sucksAs I started blogging nearly 6 years ago, one of my first topics talked about my struggle for over 5 years with infertility, in my 20’s. In fact, my oldest son arrived after five courses of artificial insemination, and I was taking hyper-ovulation drugs too. (Bad idea—it made hormonal issues worse.)

So technically, my son was an immaculate conception. My husband was there at the hospital several hours before I showed up by myself, to deposit a “sample” for “spinning.” I then had an encounter with a turkey baster.

(They don’t really use a turkey baster. Kinda like that, though.)

IVFIt was a hellish five years, with a lot of roller-coaster ride (I was pregnant once during that time and miscarried, and thought I was pregnant, other times). Hopes dashed, hormones manipulated, expensive and invasive tests administered.  I cried almost every month I learned I would not be a mother. I withdrew from normal social activities because I didn’t want to be around the pregnant women and young mothers, who just reminded me of what I didn’t have.

Those five years did make me deeply grateful to be a mother, when it finally happened. Those five years gave me an advanced degree, a chance to travel in Europe, and a jump start on a career that would have never happened if things had happened the way I planned them. (And that education and career start would prove helpful later, when I became a single mother.)

As with many things in life, I’m glad that things didn’t go according to MY plan. I would have been a VERY young mother and would have, I believe, been chomping at the bit, later, to experience the life I didn’t have a chance to when I was young. This whole experience taught me to float in the stream a bit, rather than try TOO hard to force agendas.

I’m always glad when I remember that, and stop pushing sometimes when things just aren’t working. Maybe something better is just around the corner? Maybe the time isn’t right?

I miscarried my son’s twin. And endured a very difficult pregnancy. The delivery was terrible, 27 hours, and 2.5 hours of pushing, as the early morning of my second night of no sleep dawned. I was falling asleep between contractions. When I talk about being 206 lbs., that was the day I delivered Kincade. (I’d gained 62 lbs. during the pregnancy! And I started the pregnancy at a higher weight than I have been, the past 10 years.) I had massive edema, major blood sugar problems, and looked and felt awful.

When Kincade was a year old, I learned about the way our diet was impacting our health. Both of us were in terrible health, my baby and me, and my husband was overweight, too. After I radically changed our lifestyle, especially our diet, I got pregnant three more times, without intervention, and had easy, normal pregnancies where I gained much less weight.

Taking Charge fertilityI also had an ectopic pregnancy nine months after Kincade’s birth, before the lifestyle changes. It was discovered only when it ruptured and required emergency surgery to cut off an ovary. I had bled out half my blood supply at the time that this occurred, while I was in another state and did not have a blood donor. I spent weeks recovering enough to even stand up. I flew home to Utah after two weeks, pushed in a wheelchair onto the plane.

The removal of my right ovary likely reduced my fertility by half, in some ways. But I had three more healthy children AFTER that, without incident. I believe that providing my body appropriate fuel, consistently, allowed my body to heal and solve problems.

I did read a great book towards the end that I believe helped solved my problems. (None of the testing revealed what our fertility problem was.) It is called Taking Charge of Your Fertility by Toni Weschler, MPH. I learned in her book to tune into the female body’s signals, mid-month, that fertility is highest. I learned that what the OB/GYN’s I had been working with were telling me was probably WHY I didn’t get pregnant for five years! They were having me take my temperature every morning. We were told to abstain until right when my temperature went up. At that time, though, I learned from this book, the window to get pregnant had just barely passed.

Ignoring what the drug-specialized OB/GYN’s had told me to do, for five years, and doing what Toni Wechsler taught me in that book, plus improving my health with diet, gave me three more beautiful healthy babies.

Sanoviv Clinic
Sanoviv Campus

I am speaking at Sanoviv, in Mexico just across the border from San Diego, in September at an infertility retreat there. The photos here are of the gorgeous Sanoviv campus. For more information about the retreat, see the flier below.

Dr. Iva Keene will be there as the specialist, and I interviewed her for this blog series. She’s a naturopathic physician and a specialist in natural treatments for infertility. My

Sunset over the pool at the Savinov campus
Sunset over the pool at the Sanoviv Campus

next post is my written interview with Dr. Keene that I hope will help others struggling to conceive, with ideas of interventions that don’t involve drugs and surgery, that help the body correct itself. I wish I had known more, when I was 22 years old and began infertility treatments for a problem that wasn’t likely a problem. I was just impatient (sought treatment after 6 months of “trying”), and suffering from years of eating a processed, chemical diet soaked with salt, sugar, MSG, and aspartame.

Link to the flier about the infertility retreat in September HERE.

PLASTICS: which ones to avoid, and why!

You’re likely aware that plastics are harmful to your health. They have phenomenally long half-lives, and don’t break down in the body, causing ongoing damage.

Look on the bottom of your bottle, and see the number in the little triangle. Look carefully at this graphic, because the  numbers aren’t consecutive. The worst grades of plastic are 6, 3, and 7.

A 7 is the worst grade of plastic, and most labeled 7 contain the most infamous chemical in plastics: Bisphenol A (BPA).

Water and other liquids leach BPA. This endocrine-disruptor chemical can do crazy things to your hormones. The U.S. finally banned the chemical in baby bottles, after the European Union and Canada did. Wiki says a study found BPA in 96% of pregnant women. It’s been linked to obesity, breast and prostate cancer, and ADHD.

Please don’t use old baby bottles or any other plastic that isn’t BPA free that comes into contact with your food or water. More and more companies are making their plastics without BPA, including Blendtec’s blender jars. But our FDA continues to support the use of BPA in cans, including drinks, and infant formula!

Another chemical to avoid is PVC (polyvinyl chloride), known as vinyl, which contains phthalates, known to cause birth defects in baby boys, testicular cancer, infertility, and asthma. PVC plastics are labeled with the 3 triangle.

So, anything you use that’s plastic, make sure it’s labeled 1, 2, 4, or 5.

Our GreenSmoothieGirl bottles, of course, are BPA free, vinyl free, and phthalate free.

Thyroid—you might have a problem and not know it

All estimates I’ve read are that 25 to 50 percent or more of American women have significant thyroid issues. Possibly over half of women over 40. Most of these women are undiagnosed. If you have low thyroid, which is the most common thyroid problem, symptoms may be low energy, slow metabolism / weight gain, dry skin, bags under your eyes, fatigue, hair loss, depression, poor circulation, low immune function, and insomnia.

My best friend since childhood, on the other hand, has the “auto-immune” condition of hyperthyroidism, which is just as miserable. Her thyroid is always revved and overproducing. She goes the drug route. The symptoms are a racing heartbeat, weight loss, increase or decrease in appetite, insomnia, fatigue, diarrhea, mental disturbance, infertility, thinning hair, itching and hives, heat intolerance, and tremors / shakiness.

All the endocrine disruptors in the environment and food supply affect thyroid function. Don’t eat soy! Don’t expose yourself to pesticides, or plastics, or heavy metals. Avoid drugs, alcohol, and unchecked stress.

Doctors will likely put you on synthetic hormone. Remember that the drug thyroid is not bioidentical to the thyroid produced in your body. It’s been molecularly altered, each drug different from each other, to earn a patent.

If you find a clinic that specializes in bioidentical hormone, the cost is far less, and your body can assimilate and utilize the hormone effectively, like the hormone your own thyroid produces.

I spent four years on a synthetic thyroid drug, many years ago, before I knew any better. It helped me drop the 40 lbs. I’d gained in a year since I became hypothyroid. But it increased my risk for cancer. I happily transitioned to bioidentical and have been on it ever since. Recently I went completely off thyroid to test whether perhaps my good diet compensated, and maybe I could produce hormone effectively by myself.

The good news is, my baseline was much better than it was 10 years ago when I first was tested. The bad news is, I got ugly bags under my eyes. I made some videos last summer in Denver when I was completely off thyroid, and I can’t even look at them. Ugly. My body makes about 60% of the thyroid I need. I take a few drops of nascent iodine each day, now, and my bioidentical thyroid keeps me happy and balanced.

You can read whole books on the thyroid phenomenon by Mary Shomon, a bestselling author. Too many women are hypothyroid and going without treatment. Remember to google “bioidentical hormone” rather than starting with the standard M.D.’s practice of automatic drug-oriented HRT (hormone replacement therapy).

And remember, having an M.D. check you for T3 will not give you the whole answer. When I gained 40 lbs. because I was very hypothyroid in my mid-30’s, I was tested for that and the doc told me it was “normal.” I knew I was NOT feeling normal, but what was I to do?

You must get the full blood panel and have a highly specialized bioidentical practitioner look at the interplay of T3, T4, progesterone, estrogen, testosterone, and a variety of co-factors. When I did that, my life changed dramatically because they could treat my whole body, rather than just drug one element, throwing other critical elements into imbalance.

If you’re feeling healthy but want to make sure you’re getting enough iodine, using refined salt with chemical, synthetic iodine enrichment, is harmful. If you want ways to get more natural, bioavailable iodine in your diet, to enhance your body’s ability to make and utilize thyroid hormone?

Talk to your holistic practitioner about whether you should take nascent iodine (available online, google it) or Lugol’s solution (prescription). My practitioner had me paint a 1”x1” patch of my inner forearm with drugstore iodine, and if it disappeared in an hour, she said that was a sign my body needs iodine. (However, I believe others dispute this test as valid.)

Food-based sources are kelp (which you can take in tablets, or it’s a wonderful salt replacement seasoning), or dulse, or nori sheets (seaweed). Those are high-iodine sea vegetables. If you take too much, you would notice being jittery, anxious, shaky, so if so, you could back off those foods. But generally, you’d have to eat an awful lot of sea vegetables to create an imbalance.

Seven reasons not to drink soda, part 2 of 2

Here are seven kicks in the pants, to help you quit the soda habit:

1. SODA BRAIN! Brominated vegetable oil, or BVO, is added to soft drinks. It’s an industrial chemical used in plastics as a flame retardant. (It’s also in sports drinks.) It is known to cause nerve disorders and memory loss. It builds up in body fat and causes behavioral and mood problems, infertility, and heart problems.

2. FAT ON THE INSIDE! Researchers in Denmark found that those who drink soda have fat stores around their liver, other organs, and skeletal muscles, which leads to diabetes. Soda drinkers in the study also had much higher triglyceride blood fats and cholesterol than non-soda drinkers.

3. HORMONE UPSET! Aluminum cans are coated with BPA, which interferes with hormones and causes obesity, diabetes, cancer, and infertility. Neither Pepsi nor Coke has been willing to switch to BPA-free, while everyone else in America is doing so.

4. FRANKENFOOD! Lots of soda ingredients are corn-derived, and nearly 90 percent of the corn grown in the U.S. is now genetically modified. The U.S. government isn’t particularly interested in testing this horrible social experiment, but we know that genetically modified crops are linked to rapid aging, infertility, and gastrointestinal tract damage. Not that those ingredients really resemble corn by the time you drink them….but you get none of the fiber and other nutritional benefits of corn (which are limited anyway) and all of the downside of the GMO “frankenfood.”

5. CARAMEL CANCER! Two chemicals with reeeealllly long names are known to cause cancer in animals, and they make the lovely brown color in colas. Center for Science in the Public Interest tried unsuccessfully last year to get the FDA to ban them. The chemicals are just cosmetic, but of course Coke and Pepsi aren’t gonna back down. (Look how big the experiment went over when Pepsi tried to make a clear cola called Crystal Pepsi in 1992. All they care about is what sells.)

6. DIET AIN’T ANY BETTER! Even diet soda makes you fat. A study in Texas found that those who drink diet soda gained 70 percent in waist circumference in 10 years, compared with people who don’t drink soda. Those who drank more than two per day? They had a 500 percent waist expansion! The culprit is the neurotoxin aspartame. It actually raises your blood glucose levels, even though it contains chemicals rather than sugar.

7. GET OLD FASTER! Phosphates in cola extend their shelf life and improve taste. But they rob your bones and blood of desperately needed minerals. That leads to kidney problems, osteoporosis, heart disease, and rapid aging. It stops children and teens from building bone mass, in the critical period they are developmentally meant to do so. (After 30, we generally lose bone mass.) Soda manufacturers have increased phosphate levels higher and higher—but a medical journal article two years ago showed that lab rats with elevated phosphates died much earlier than normal.

natural infertility treatments

One of my first blog entries when I put this site up two years ago was about my infertility story. I forget about it sometimes, since I have four wonderful children ages 9 to 16 and that trial is behind me. But what a hard time that was. All the infertility treatments and drugs are things I wish I didn’t do. I didn’t know better at the time.  

Recently Craig and I and my girlfriends went to Utah’s figure and bodybuilding (female and male) competition at Cottonwood High School, to support my friend Jamie.   Jay Cutler, three-time and current Mr. Olympian, was a “guest poser.”  We were in Las Vegas two months ago when he won his third title (he had lost, in 2nd place, many times, to the same guy).

My goodness! Mr. Cutler is a freak of nature–or steroids–probably a combination of both!   People are not meant to be that huge. Craig says Cutler wakes up every two hours during the night to drink/eat protein powders / bars.   You’d have to, to support such massive muscle weight. This is not healthy–you probably already know if you read this site what I think about processed / fractionated soy and whey protein powders. I have hemp protein powder and SunWarrior raw fermented brown-rice protein powder for my teenage son, who asks for a protein shake every night at 10 p.m. For the rest of us, I believe we should trust nature to provide the right amounts of protein/carbs/fats in natural, whole foods, primarily from plants.

My two girlfriends I work out with, Jamie and Kristi, trained hard for a few months prior to Jamie’s competition. They ate nothing but protein (virtually no vegetables or fruits, even) for quite some time. It’s a way to bulk up, lean out, and cut up, but it’s not healthy to cut out complex carbohydrates with all their nutrition and fiber.

Jamie  and her husband have been going to Vaughn Johnson in Provo, Utah for natural-method infertility treatments.   I love that he told them, “You don’t need drugs–you need to address both of your hormone imbalances [Jake is a former competitive bodybuilder]. And we can do that naturally.”

I am very impressed than a local M.D. isn’t sucked into the pressure to promote drugs and surgery as a way to address infertility issues. I wanted to pass that name along to anyone local who is struggling with infertility.

I also found this Toni Wechsler’s book Taking Charge of Your Fertility extremely helpful in solving my own problems 15 years ago. They never found anything wrong with me or him, and  having read the book, I  believe it was the medical intervention, ironically enough, that was sabotaging our efforts to start our family.   (I wish I’d found the book a few years earlier, before lots of drugs and 4 artificial inseminations and losing my oldest son’s twin.) I highly recommend it to anyone struggling to conceive.