The Romance Prescription: Exploring Love, Fertility and Preconception Health, with Dr. Kalea Wattles

On Tuesday, February 6th, FMCA hosted an Ask the Expert webinar with fertility expert Dr. Kalea Wattles. She joins us just in time for Valentine’s Day to share her expertise in love, fertility, and preconception health. The Ask the Expert series is offered to FMCA students and members of the Alumni Program.

Dr. Kalea is a naturopathic doctor, functional medicine practitioner, and fertility expert. To help her patients optimize their fertility, she uses both cutting-edge science and traditional approaches to help people conceive. By addressing the root cause of fertility struggles, patients can start restoring their health.

In this webinar, Dr. Kalea asks, does romance play an important role in fertility? She discusses everything from romantic love to menstrual health to natural aphrodisiacs. Learn about the Triangular Theory of Love, which includes passion, intimacy, and commitment, and how it relates to better fertility and successful relationships. Get tips on how to track menstrual cycles for better fertility. Finally, see what foods you can add to your diet to improve your preconception health and inspire romance.

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Ask The Expert: The Romance Prescription: Exploring Love, Fertility, and Preconception Health with Dr. Kalea Wattles:

Transcript

Dr. Wattles: I’m Dr. Kalea Wattles. I’m a naturopathic doctor and IFM-certified practitioner and a fertility specialist. My private practice is almost exclusively fertility at this point. I have a long-standing relationship and friendship with FMCA, so I’m really excited to be here today talking about… This has to be one of the most fun topics I’ve ever presented. It’s perfect for the upcoming Valentine’s Day, and that special topic is “The Romance Prescription: Exploring Love, Fertility, and Preconception Health.” If you happen to have any little takeaways or anything that you’re Instagramming or putting on threads or anything over the course of this presentation, use #RomanceRx so I can find it, and that’ll be really fun. But thank you all so much for joining. This will be fun and light-hearted, and I think we’ll have a great time together.

So, let’s dive in. Over the course of the next 40, 45-ish minutes, we’ll explore how romantic love influences our reproductive success. We’ll review how some specific nutrients can impact our hormonal and sexual health. We’ll talk specific aphrodisiac foods, which will be very fun.

And then I have a fun challenge for you at the end. The Romance Prescription Menu Challenge I have a goodie for you, so stick with me to the end, and we’ll talk all about that.

Throughout our time together, like I said, I’ll be mixing in a little science, a little history, a little of my own experience, but I had to start today with an ode to Aphrodite. I mean, we’re talking about aphrodisiac. And the Greek goddess Aphrodite, she presided over love, beauty, fertility, and she is also known as Venus in the Roman mythological tradition if that is what you’re most familiar with, but legend has it that Aphrodite was born in the ocean and she was transported to the shore in this giant shell. And there’s some debate over whether that was a clam shell or an oyster, and I don’t know the answer to that, but what I do know is that history is full of symbolism related to food, love, sexuality, fertility, and this is a prime example.

If you use your imagination, you can see this. The shell was actually thought to represent the female anatomy giving birth to the goddess Aphrodite, and the Greek name Aphrodite has been interpreted as meaning foam-born. And this partially explains why seafood has long been linked to love, to sexual function, to libido, and we’re going to talk about that a little bit more. And we’ll talk about how symbolism has played out across ancient civilizations.

So, this question that I’ve been asking myself as a practitioner is, what if love was the missing item on the treatment plan? In my fertility practice, I see so many women who have struggled with fertility, or they’ve been diagnosed with unexplained infertility, which is really frustrating. And we do a lot of work to evaluate them using a systems biology approach. So, we’re doing a full multi-system assessment that looks at metabolic health, hormonal health, inflammation, immune function, environmental and toxic exposures, nutrient sufficiency, gut health, their structural integrity. It’s really comprehensive. And from a medical management standpoint, it’s a very thorough evaluation.

But as you all know, at the center of the matrix is the mental, emotional, spiritual area. And as I grow and evolve as a practitioner, I’m feeling more comfortable and just more inclined to lean into that part of my patient’s history, and it’s really worthwhile to explore the context of their relationship: how they give love, how they receive love, if they feel loved. Especially when fertility issues have been ongoing, it can be really vital to reconnect to that source of love and lightheartedness that made you want to have a baby with someone in the first place, right?

So, throughout this talk, we’re going to talk about love. We’ll talk about how people can connect to the sources of love in their life. We’ll talk about how love shows up in our physiology, and I think it’ll be fun and informative.

If we look at human history, there are some interesting theories about how romantic love specifically is related to fertility and has shaped the evolution of social and family structures. And one theory is that one of the most important functions of romantic love is to increase reproductive success. And this makes sense, right? One of the only ways that we are going to be successful in protecting our offspring is if we have a lot of resources.

So, romantic love fosters deep relationships and closeness that would be necessary to raise a child, especially if there’s more than one, when there’s a lot of resources that we have a demand for. Romantic love is recognized as what we call a behavioral commitment device that leads to both the establishment and the maintenance of long-term partnerships.

And I’m going to underline and highlight that word commitment. That’s actually really important because this is the real love triangle: commitment, passion, intimacy. This is a model called the triangular theory of love. It was developed by a psychologist named Robert Sternberg. And essentially the theory goes that a relationship that’s based on just one of these elements is less likely to be successful long-term than a relationship that checks a few of these boxes.

So, if you feel very attracted to someone but you don’t feel comfortable being vulnerable with them, that’s probably not going to work in the long-term. Or, if you feel like you can be vulnerable with someone but you don’t feel very attracted to them, then that’s another scenario in which we might not have so much longevity in that partnership. So, let’s take these one by one and dive in and see how we can support ourselves and others in fostering these facets of a healthy, long relationship.

We’ll start with passion because I think that’s the one that most people would consider to be fun and lighthearted. It pertains to romance, to physical attraction, sexual attraction. It’s usually what initially brings someone together. It initiates that relationship of varying degrees of seriousness, and it stimulates proximity-seeking. When you are passionate about someone, you want to be around them. You want them in your space. You want to be in their space. And it also causes you to idealize your partner. It might be what one calls the rose-colored glasses where you really put this person on a pedestal. They can do no wrong, they are everything that’s good in the world, and they’re just so beautiful to you. It also deters you from seeking out other potential mates, right? Because when you feel really passionate about one particular person, you tend to feel less passionate about others. And that’s helpful if you’re trying to have just a monogamous relationship.

Now remember that we’re trying to fulfill as many of the criteria on our love triangle as possible. So, when you’re working with someone, or maybe this is you, or maybe it’s your best friends or someone you know, you can ask them, “Do you find yourself thinking about your partner frequently during the day?” Because actually, in the research setting, when researchers are trying to establish or assess the level of passion in a relationship, they will ask them, “Do you think about this person regularly during the day?” That is one of the hallmarks of a passionate relationship. And if not, if they don’t think about their partner during the day, can they? Can they take a few minutes and think about them in a loving way or maybe even journal a couple things, a couple points about their partner that they find that they love or that makes them feel excited? I think that’s a good way to connect back to the pieces that maybe made you feel passionate in the beginning and have faded long-term.

If they can’t, if it’s not possible to journal these things, that’s okay, because we have intimacy, right? Intimacy refers to the more emotional aspects of love. It’s emotional involvement, emotional intelligence. It’s a closeness and a warmth that can sustain long-term partnerships. Intimacy is what creates a sense of interdependence that binds couples together. It’s that feeling, you might describe it as, “It’s me and you against the world,” or, “Nobody knows me like you do.” That’s intimacy.

And to be intimate by this definition, a couple of things have to happen. You have to be willing to be vulnerable, which is scary for many of us. And you also have to be willing to create space for someone else’s vulnerability, which is a skill.

One way to assess intimacy in a relationship is to ask someone, “Do you agree with this statement—I share deeply personal information about myself with my partner?” If they don’t, what’s the catch? What’s the obstacle? What’s that about? Is it that they don’t trust their partner to protect that personal information? Is it that they anticipate they won’t be understood or is it that they’re worried to share that information because they think it might be interpreted as a weakness and that that doesn’t feel safe? Obviously, there’s so much to unpack here, but thinking about all of these things about, what is the obstacle to your willingness to share? And then what could your partner do to make you feel more safe? Just putting words to these obstacles can be so helpful so that couples and individuals can communicate with each other. It helps to foster.

And in my world, working with couples who are on the verge of becoming parents together, this is really important, because intimacy plus commitment, which we’ll talk about next, was found to promote the greatest bi-parental support of the offspring, so that means that both parents are showing up in a collaborative spirit to care jointly for their children. That’s really important and something that I have been incorporating more and more into my preconception counseling.

So, let’s talk about commitment. Commitment pertains to the more cognitive piece about making decisions and starting and maintaining a long-term relationship. It’s centered around caregiving, about shared decision making, teamwork. What’s interesting is that when someone is in a committed relationship, they often have a positively biased perception towards their partner. So, we find that committed individuals will see their partner as more attractive than other people. And sometimes that means they even view their partner as being more attractive than their partner views themselves or as other people might view their partner. Their partner is so beautiful to them because they feel committed. They also might view their relationship as better than other relationships. My marriage or my relationship is the absolute best partnership there is.

And to get to the root of whether someone is committed or feels commitment from their partner. We can ask, “Do you view your relationship with this person as permanent?” And if not, there’s all these reasons, all these things that we can talk about. Do you want your relationship to be permanent? Is this forever for you? Do you feel uncertain about your partner’s perspective here and you need some dialogue to help to make that connection or to open the door or to understand where they’re coming from? So, these are all great opportunities to check in because hopefully we all can have a love that is passionate, it is committed, and it is intimate, and we’re checking all these boxes or ideally at least more than one, if we’re looking at longevity.

And now that we know that we’re feeling real love, let’s answer this question. Can being in love make you more fertile? And to answer this, I just want to take a minute and briefly review female reproductive physiology I think because I love the menstrual cycle as a fertility specialist and I’m always just looking for ways to walk you through this process and to talk hormones.

So, I have this beautiful graph and I’m going to walk you through. If you haven’t taken anatomy and physiology for a while, this is going to be a refresher, so get ready. I’m going to take you all the way to the beginning of the cycle. We’re here at Cycle Day 1. Cycle Day 1 is the first day of full flow of your menses, of your period.

So, in the very beginning of the menstrual cycle, follicle stimulating hormone, or FSH, is stimulating and signaling our follicles, which are egg sacs within the ovary, to mature. It is telling our follicles to mature a healthy, wonderful, beautiful, golden egg. And those follicles are growing and growing. And as they’re growing, they are producing estradiol.

So, estradiol is increasing over the course of the cycle as our follicles are getting bigger and bigger. And then at a point that’s roughly mid-cycle, estrogen is going to reach a point that is high enough that it is going to tell the brain there is a big, juicy egg that is mature enough to ovulate. So, the brain is going to detect this level of estrogen that tells us we have an egg that is big enough to ovulate, and it is going to release a big surge of the hormone, luteinizing hormone, or LH. And if anybody has ever taken ovulation predictor kits, it’s the urinary test strips for luteinizing hormone, which tell you that you’re about to ovulate.

So, the brain is going to release luteinizing hormone. Luteinizing hormone is going to send out a big surge, and it is going to cause this egg cell—you can see down here—to rupture from its follicle. And that is ovulation. So exciting. It’s like the main event of the whole cycle. It’s what we’re building up to.

So, the egg is going to rupture from the follicle. That’s ovulation. And then under luteinizing hormone signaling, this egg sac, where the egg used to live, is going to fill with fat, and it is going to become a structure that we call the corpus luteum. And the corpus luteum is going to pump out progesterone. Progesterone will sustain the endometrium, which is that inner lining of the uterus, in the hopes that an egg is going to be fertilized and will have a nice cushy landing spot for that little developing embryo to, kind of, burrow in and grow and develop.

In the case that the egg does not fertilize, the egg sac, this corpus luteum, is going to wither away, it’s going to atrophy, and progesterone production will cease. That endometrium will no longer be sustained. It will shed. That is menses. The cycle starts all over again.

So, the first half of the menstrual cycle from Day 1 of your period until ovulation, that is called the follicular phase, and the predominant hormone is estrogen. Following ovulation until the next period, that is the second half of the cycle. It is called the luteal phase, and the predominant hormone is progesterone.

And I promise I’m building and building, and now I’m going to tell you how this relates to love and all these fun things that we’re talking about because there was a really fun study that happened in 2019. And it found that women who reported being in love had higher levels of the gonadotropin hormones. So, follicle stimulating hormone and luteinizing hormone are known as the gonadotropins. And women who were reportedly in love had higher levels of FSH and LH, so they were maturing more eggs, and they were signaling those eggs to be ovulated, when we compared their levels to single women.

So, this suggests that romantic love can influence hormonal profiles related to fertility, which I think is so fun. And I’m obviously just making the case for being in love, and I think it’ll show up a couple of different places. Let’s look at the menstrual phases and libido specifically. And I’m going to tell you some fun facts about estrogen, and we’re going to walk through how our desire and our arousal might change over the course of the cycle.

When we look at studies examining libido specifically during the menstrual cycle, we see that many women experience a boost to their libido around ovulation. This makes perfect sense, right? This is when the probability of conception is the greatest. They tend to feel more attractive, less depressed, less lonely. In the research, they call this increased erotic motivation that happens around ovulation time.

So, now I’m about to tell you some even more fun facts about estrogen. And before I do that, I want you to commit this chart to memory, how we have this rise of estrogen that’s mid-cycle. And you’ll see about halfway through the cycle is when estrogen is at its highest point, and I want you to keep this mental model as I walk you through the next couple of fun facts.

So, around ovulation, estrogen is going to cause the cervix to produce a very specific cervical fluid. It is different than normal vaginal secretions, and it is designed to support fertility. And this is one of my favorite subjects ever. We could probably have a webinar only about this, but I had to tell you some of the most amazing functions of this, what we call, fertile quality cervical fluid, because it’s so fun and it’s so amazing and it makes me feel like humans are so magical.

Under estrogen’s signaling, that increase of estrogen because our follicles are getting bigger and bigger, our fertile cervical fluid creates a sperm superhighway. And what I mean by that is that estrogen causes the fibers in our cervical fluid to straighten out, and it creates a path right through the cervix. When I’m talking to patients about this, I say, “Have you been bowling? And did you ever put up the bumpers on your bowling alley so when you put your ball down the lane, it causes your ball to go perfectly down and hit the pins at the end?” That is exactly what it’s like.

It also, this very special cervical fluid, protects sperm from a more acidic vaginal environment. The vagina is healthy when it’s a little bit acidic to protect us from vaginal infections. But this fertile quality cervical fluid is considerably less acidic than the vagina, so it can protect sperm from that acidic environment. In the research, they say it protects them from the hostile vaginal environment, which is funny language but I get the point. It’s because it’s acidic.

This cervical fluid also serves as sperm food. In the research, they say that it biochemically nurtures the sperm, which is fancy terminology for sperm food, because it contains the ions and the enzymes and the, kind of, immune cells that are important for keeping the sperm healthy. It also stores sperm for later release. It acts as a sperm lobby. We want sperm to be waiting for when an egg is released. It comes down the female reproductive tract. We want sperm to be waiting. And in these perfect conditions of this beautiful cervical fluid, sperm can live up to five days in the female reproductive tract. So, this is really helpful when someone’s trying to get pregnant because we have that sperm just hanging out in the lobby ready to do their job.

And then finally, this fertile cervical fluid, it has a really high mucin content, so it forms a gel, and that keeps the cervical canal open. So, basically, it’s opening the door for the sperm, it’s inviting them right in on that sperm superhighway, and that’s great if you’re trying to get pregnant to know these things.

So, we’ll pause and we’ll just have a little coaching moment, because sometimes when I’m working, we don’t talk about this. We didn’t learn this in school. Our friends aren’t talking about this. Our mom didn’t teach us. So, I wanted to make sure that everybody had some tools to help people actually monitor their cervical fluid.

I tell my patients start tracking the first day after your period ends, and you’re going to check at multiple points during the day. It’s fine. You’re going to the bathroom anyway, so it just makes sense that, when you go use the restroom, you’re going to check for cervical fluid.

If you want to get really into the specifics, I have some instructions here. You’re going to wipe front to back. Of course we all know to do that. And fluid tends to collect at the perineum, so it’s like there’s, kind of, a bulge, a space between the vaginal opening and the anus, and fluid will collect there. So, I have my patients wipe all the way back. They’ll collect fluid on the tissue. And then I have them look at it. They’re paying attention to the sensation as they wipe. Is there resistance? Does it feel slippery? Does it feel like gel? And then I ask them to actually observe the fluid on the tissue. And this is a totally new experience for a lot of people, but it’s a way that we are engaging in our body and our fertility and getting to know ourselves in the deepest way possible.

So, I have my patients observe with their eyes. What does it look like? Does it look like raw egg white? That is what we’re looking for, egg white cervical mucus, people will call it. And then I want them to rub it like get some in between your index finger and your thumb. Rub your fingers together. Does it feel slippery? Does it slide easily? And then we’ll actually stretch it between our fingers, and fertile quality cervical fluid will stretch, I mean, inches.

Once you see it, you’ll never miss it again. It’s so obvious, but I think this is really important to learn how to take these cues that your hormones are giving you in real-time and you can respond by timing intercourse appropriately. It allows you to be proactive and to identify patterns. And then you’ll know to talk to your doc if you’re not seeing these things, do we need to do an assessment of your hormones?

Let me just tell you really quick about some other added benefits of estrogen that are so cool and so fun. As you get closer to ovulation, estrogen will cause your uterine ligaments to lift the cervix higher into the pelvis. So, monitoring cervical position is another tool that I teach my patients for identifying when they’ll ovulate, because a cervix that is… When we’re getting close to ovulation, the cervix will SHOW. That means it’s soft, which makes it easier for sperm to enter. It’s higher in the pelvis. It’s open because of that mucin content in the fluid we talked about. And it’s wet because it has that fertile quality cervical fluid. So, a fertile cervix will SHOW.

And like I said, estrogen is going to cause the uterine ligaments to pull that cervix higher into the pelvis. And not only is this important for cycle monitoring, but it can also give some insight into sexual preferences over the course of the cycle because some women will find that certain positions that allow for deeper penetration are just going to be more comfortable closer to ovulation because the cervix is physically higher in the pelvis, so there’s not so much friction with deeper penetration. And it might be more painful at other times of the month, but isn’t that helpful if you just know that about yourself?

My final fun fact…well, maybe I shouldn’t say final, because I might have more. But one additional fun fact about estrogen is that it causes dilation of the blood vessels in the face. And so researchers have theorized that this flushing effect is what makes women appear so luminous and glowy right before they ovulate. It’s like real-time information about…so, you can let your mates know that you’re nearing ovulation because you’re looking so goddess-like and glowy. And I just think that’s a really fun piece of information. So, you’ll all have to tell me on Instagram, if you notice that about yourself. Please watch your skin in your next cycle and around ovulation. I want to know if you’re feeling more glowy and luminous.

I also wanted to highlight this really interesting work out of Indiana, where they looked at the immune function and sexual health in women. And they found that in sexually active women, which was different than women who were abstinent, they experienced marked changes in their immune function over the course of their menstrual cycle.

So, they looked at things like antibody production and immune cells, and they found that roughly mid-cycle, when ovulation was occurring, there was some modulation of the immune system that might make it more likely that sperm or an embryo could survive without an attack from the immune system, which would allow pregnancy to occur.

And if you think about it, sperm are interesting, right, because they are a non-self-entity that we are bringing into our physical body, and we’re asking our immune system, like, “Look the other way. Nothing to see here.” Our immune system has to have some tolerance, and then we fertilize an egg, we have this developing embryo that is also non-self but is in our body and needs to be protected from the maternal immune system.

So, there’s some immune modulation that has to take place, and it looks like there’s a shift mid-cycle that allows this to happen. This is really preliminary research. I think that this institution is going to explore this quite a lot more.

But I’ve been thinking about this so much because I would say immunologic infertility is something I’m seeing more and more. And it’s not just anti-sperm antibodies, but it’s just autoimmune disease in general or a hyperactivated immune system in general as a cause for unexplained infertility or early pregnancy loss. So, I’m really thinking about how we can tone the immune system to prepare during our preconception planning. Interesting studies to follow.

All right, I hear from so many of my patients who they have low progesterone and it’s either causing them to have a short luteal phase, so that time from ovulation to when your next period begins, I like to see that about 14 days. When it’s less than 11 days, I’m getting worried about the endometrium’s ability to sustain a pregnancy.

So, my patients are always asking me about progesterone. Do they have enough progesterone and what can we do to support it? Do I need to take an actual either oral or vaginal progesterone medication? Wouldn’t it be so amazing if I could just prescribe therapeutic snuggle time?

And there’s a really fun paper that came out in 2009, and I’ll tell you it showed that social closeness was associated with elevated levels of progesterone. And then I have personally translated that to be snuggle time, but I’ll tell you the details of the study and then you tell me if you think that the snuggling would be appropriate.

First of all, progesterone is really important. This is, like I said, the main hormone in the last half of the menstrual cycle. It’s calming to the nervous system. It encourages sleep. It prepares the uterus for an embryo if baby making is in the cards. And the findings of this study showed that progesterone is also involved with bonding, motivation, and satisfaction from relationships.

So, the set up was that researchers paired two female sets of participants. So, they paired up two females, and they asked them to play a partner game that involved answering deeply personal questions about themselves. So, going back to the intimacy part of will you share information, it was creating intimacy between these two partners. And these were people…they didn’t know each other before. They just randomly paired them.

So, then after they did that activity, they measured their salivary progesterone, and they also gave them a survey asking about their willingness to risk their life for that partner. And then they compared them to a control group of female pairs who were just asked to edit research papers together. No intimacy there. It was not partner building, not bonding. And they measured their salivary progesterone and willingness to sacrifice themselves for their partner again a week later. And the women who played the partner game had increased levels of progesterone and they were more willing to risk themselves for their partner.

Now, this study, absolutely not a homerun in terms of methodology, right, because hormones can fluctuate for a variety of reasons. Not everyone in the study was on the exact same cycle day, but it’s so fun for me to read papers like this sometimes because I’m always looking for reasons to recommend more social closeness.

And I think what we can take away from this is possibly there was a hormonal outcome, but we also see that there seems to be some connection between intimacy and progesterone. So, my recommendation is snuggle up with your partner or spend some quality time with your friends or do whatever it is that you do to connect with your community for progesterone’s sake.

We’ve talked about all kinds of cycle changes, and I think Step 1 is people just getting to know their cycle. So, I wanted to share some of my favorite cycle trackers. There’s lots to choose from, and it’s dependent upon if you just want to enter in like, “Yes, I started my period today,” or if you also want to track cervical fluid and cervical position and take your hormones.

But these are some of my favorites. Read Your Body is great. Natural Cycles can link to your Oura ring. So, for all of our Oura ring users, that’s a good add-on. Mira and Inito both include urinary hormone testing so that you can watch and track your hormones over time. Kindara is another great app. So, just ask people, do you feel comfortable and confident to track your cycle? And if not, there are many tools available.

I wanted to highlight a couple nutrients to focus on. And these are really important. I would say, in my fertility practice, most of my patients who… I’m in Seattle, so that’s not helping, but a lot of my patients who have unexplained infertility, endometriosis, even just a lot of period pain have a low vitamin D. So, really important for fertility because of the way that vitamin D helps those follicles, those egg sacs to develop, but we also see some implications in libido specifically.

The connection…it seems evident in various aspects of sexual health, including desire, arousal, lubrication, the ability to orgasm, and then pain with intercourse. And also, if you think about it, it’s not just those direct sexual symptoms but low vitamin D also has some implication in depressive symptoms and mental health, which can further contribute to our sexual well-being.

So, maintaining vitamin D is an important factor in promoting sexual function and just overall well-being, overall fertility. So, let’s ask our clients and ourselves, “When was the last time you had your vitamin D tested?” And let’s make sure that this is at least an annual venture.

I also wanted to talk about iron status. I see low iron quite often in my patients who have really heavy menstrual bleeding, or they have anovulatory cycles, or they have unexplained infertility. And if you think about it, iron is responsible for delivering oxygen throughout the entire body, including to our reproductive organs. So, when I have patients who are anovulatory, meaning they’re not ovulating regularly, I’m thinking about iron because iron is very impactful to our ovarian health. And when we see, for example, low ferritin, we also see more anovulatory sites.

Iron is also responsible or contributes to building up that nice fluffy endometrium, that inner lining of the uterus. So, when we have lower iron, we have a thinner endometrium. There’s not as much for our little developing embryo to grab onto.

And there’s implications in sexual health as well. And in fact, iron deficiency anemia can significantly impact sexual function and satisfaction, especially in women of reproductive age. Iron deficiency anemia has been associated with decreases in all aspects of sexual function and satisfaction when compared to women that have sufficient iron levels.

So, I think this information really underscores the importance of doing your routine blood work, including a complete blood count to look at your red blood cells, looking at a serum iron, a ferritin, which is a really important storage form of iron, and just doing our anemia screen. And then we could ask our clients, “Are you eating iron-rich foods?” Maybe doing a dietary recall, looking at food sources of iron and then asking, “Are you pairing those with food sources of vitamin C?” which can really enhance the absorption of iron.

And I’ll actually take this a step further as someone who has had iron deficiency in the past, and it was because I had low stomach acid or hypochlorhydria. So, I now ask all of my patients that have low iron, I say, “Are you eating while you’re distracted? Are you eating in the car at the office? Are you eating while you’re stressed out?” because that can really impact the secretion of our gastric acid, which is so important for pulling the minerals from our food. So, you can actually ask about the context of eating as well, which will give you some insight into things like digestive function.

And then before we look at specific aphrodisiac foods, which is really fun, I have to mention the Mediterranean diet. And I think the Mediterranean diet comes up in really a broad spectrum of conditions: cardiovascular disease and cognitive function, fertility certainly. But it’s increasingly evident that our dietary choices influence our sexual health. And the Mediterranean diet has received considerable attention related to sexual function, and we know why. The Mediterranean diet has this focus on fruits and vegetables and nuts and whole grains and olive oil and fish and all of these things that can support healthy vasculature, and healthy lipid levels, and healthy hormones.

And we see this in the research that there’s enhanced sexual function in both men and women. So, for women, it likely increases pelvic blood flow, so more easily aroused, more powerful orgasm, and then reduce risk for erectile dysfunction in men. If you use IFM food plans, the Cardiometabolic Food Plan is my choice as a Mediterranean diet, kind of, derivative. So, lots of good choices, but really it just focuses on the pillars of healthy eating, which are important for a variety of reasons.

So, now let’s talk about aphrodisiac foods. Aphrodisiac, especially in foods, have a long history of, kind of, intriguing humans with their ability to boost desire and enhance sexual performance. And then the use of foods and plant-based remedies I think has been referenced throughout time and all over the world. We see references to things like the ground, the powdered horns of animals, and all kinds of dried botanicals for use in the royal family so that they would have the libido to perpetuate the royal line. I mean, there’s a lot of history and lore about this.

And while some aphrodisiac foods are rooted solely in mythology, evidence shows that libido is shaped by overall health, and that is definitely affected by what we eat. And foods that have historically been used as aphrodisiacs, they often do have a nutritional composition that supports the physiology of sexual health and vitality. So, let’s talk about some of the most important ones. And I want you to pay special attention to these foods because I’m going to ask you to call upon them for a challenge that I’ll describe at the end.

So, first let’s talk about foods that support pelvic blood flow because they promote nitric oxide. So, remember, nitric oxide helps your vessels to dilate so that you can have excellent blood flow. It’s one of the reasons why we focus on this for hypertension, for example. But I use this for a couple different reasons in my practice.

I might incorporate foods like beets, watermelon, garlic, leafy greens, pomegranate, nuts, and seeds because they promote nitric oxide. So, number one, for men who have erectile dysfunction, supporting nitric oxide can be very helpful to get that healthy flow of blood into the pelvic region. Similarly, for female sexual function, we want the pelvis to be engorged with blood when we are aroused because it increases sensation, more powerful orgasm.

And then I’ll also link this to fertility. So, I have patients who they’re trying to conceive and they will enter into the infamous, what we call, the two-week wait. So, they ovulate mid-cycle, right? And then they have about two weeks where they’re waiting to either get their period again or get a positive pregnancy test.

So, everybody wants to know, what can I do during the two week wait to support my fertility? So, I’ll say focus on these foods that promote nitric oxide because it will help to nourish the endometrium with fresh blood to help thicken, to help vascularize the endometrium so that if you do fertilize an egg, again, there’ll be a nice, healthy endometrium for that little developing embryo to burrow in. So, lots of implications both in sexual health and infertility.

I have to highlight pomegranate. This is a superstar. We know it’s packed full of antioxidants, which can help to maintain egg and sperm quality. Packed full of minerals. It has vitamin C. It has folate. It has all these vitamins and minerals, which are super important for a preconception diet. Pomegranate juice, like I said, supports the action of nitric oxide.

And there were all of these studies that I didn’t talk about because they were sponsored by the company POM, which is a very popular pomegranate juice. But they had interesting results. Lots of pelvic blood flow, increased circulation to those pelvic organs. Pomegranate juice in the prenatal timeframe has also been shown to reduce markers of oxidative stress and inflammation in the placenta. So, if we’re thinking about reducing risk for things like preeclampsia, pregnancy induced hypertension, pomegranate juice might be a good addition. And then like I said, pomegranate juice in men has been shown to improve erectile dysfunction.

So, a fun fact is that pomegranate has been recognized as a symbol of fertility across many cultures perhaps due to a resemblance to an ovary. I should have put a picture of an ovary in here, but you can use your imagination. It’s round. It has little egg-like structures within. It’s red. It’s juicy. It’s luscious. It’s beautiful. So, you can draw these connections here, and I think that’s a really fun form of symbolism.

On that note, let’s talk about avocado, because I have to tell you there is a long-standing story that avocados were called testicle trees by the Aztecs. And I don’t think you have to use your imagination too much to see it–the texture of the fruit, the shape of the fruit, the fact that they grow in pairs. And I’ve heard, I’ve done some research, and it seems like historians have largely debunked this myth, which I’m actually so disappointed about because I thought that was so fun.

But there’s no doubt that avocado is a great source of nutrients that can support healthy sexual function. They have monounsaturated fatty acids, dietary fiber, antioxidants. We know that avocado intake has been inversely associated with cardiovascular disease, which is a leading cause of erectile dysfunction in men. So, I definitely think avocado is a great choice for your preconception and your libido-boosting food plan.

Let’s talk about oysters because we already introduced Aphrodite, and we know that, according to ancient Greek legend, Aphrodite, the goddess of love and beauty and fertility, she was born from the sea and then she arrived on shore translated by some, kind of, shell. I want to say it’s an oyster shell. And Roman emperors would pay the finders of oysters, they would pay them in gold that was equal to the weight of the oysters because of their supposed aphrodisiac capabilities. They were so treasured that they were worth their weight in gold literally.

There is an abundance of research looking at zinc specifically. So, oysters are a great source of zinc. That’s what makes them so important in a fertility food plan. And zinc insufficiency can significantly increase serum testosterone in men. It can also cause lower sperm volume, lower sperm motility, which is how sperms swim, lower percentage of normal sperm. And in many cases, these parameters are actually improved with zinc supplementation.

Zinc is an important component of the outer membrane of sperm cells that allows them to undergo the acrosome reaction, which is the event that allows the sperm to fertilize an egg. Zinc has antioxidant power. It protects sperms against damage by free radicals, especially in those who are smokers or they might have some heavy metal exposure.

And then another fun fact about zinc is before ejaculation, the prostate gland secretes a zinc-rich fluid that mixes with the seminal fluid. And some research indicates that this zinc boost might give sperm some extra stability and protection to survive within that fairly acidic vaginal environment. So, oysters are on the menu for your libido-boosting, fertility-boosting, testosterone-boosting menu.

I also want to mention apples. Apples are rich in antioxidants. They have polyphenols, phytoestrogens, and they seem to have some anti-inflammatory and anti-atherogenic action. And there was one study that was really fun, and it was looking at apple intake in sexually active Italian women. And they found that daily apple consumption was associated with increased vaginal lubrication and just general sexual function was improved. So, that whole saying like, “An apple a day keeps the doctor away,” it’s the opposite for your sexual partner. So, apples are a great addition to the menu as well.

Continuing along the fruit train, we have watermelon, which is a rich source of citrulline. The body readily converts citrulline to the nitric oxide precursor, arginine. So, sometimes with my patients, I’ll just give them an arginine supplement, but let’s eat watermelon. That’s a great choice. You can either eat the watermelon, drink the watermelon juice. You can freeze the watermelon juice into ice cubes that make your drinks look beautiful, or you can make popsicles with the watermelon juice. So, there’s all kinds of ways, depending on the season, that you can utilize watermelon in your aphrodisiac food plan.

And then the final food I will highlight, which it had to happen, it’s chocolate. Derived from the cacao bean, it’s rich in flavonoids. It’s been found, again, to increase nitric oxide mediated vasodilation. So, again, with the nitric oxide and supporting the healthy pelvic blood flow, promising for supporting sexual function. So, it makes so much sense to me that we would all have Valentine chocolate boxes, hopefully dark chocolate, 70% or higher so we get lots of antioxidants.

So, now you know all of these aphrodisiac and libido-boosting foods, and I want to put them together in a fun Valentine food plan. So, we’ve developed something for you. It’s The Romance Prescription libido-boosting valentine menu. This is two different appetizers, a main course, two different sides, two different drinks, and a dessert. And it’s all planned out for you in a menu that is utilizing so many of the aphrodisiac foods that we’ve talked about. And this is really designed to help get your creative energies flowing.

So, I really want you all to head to drkaleawattles.com/romanceprescription where you’ll be able to enter your email and download this whole PDF menu. And you can see here there’s this gorgeous, bright pink beet dip that is the perfect for your Valentine menu. It’s the perfect color. It’s very Instagrammable. I want to see your creations, whether you use the recipes that I’m suggesting or you combine all these aphrodisiac foods that we’ve talked about at this presentation and you make your own, I want you to take pictures of it and show us what you’re making. On Instagram, tag me @functionalfertility, tag FMCA @functionalmedcoach and we want to see your creations. So, please make your Valentine menu, capture your photos, share them. I’ll share them, and we really want to see what you’re making. This is our Valentine Recipe Challenge with all of your aphrodisiac creations.

Patty: Yes, thank you so much, Kalea. This is excellent. I want to talk more about this recipe challenge.

Dr. Wattles: Yes, please.

Patty: We want to see how creative we can be with things like that. But let’s go back. Thank you so much for all of these great resources and amazing examples of coaching questions. I hope everybody, as they were going through that, understood the role of the coach in that. If you have questions about it, they’ll put them in the Q&A box because we can definitely flesh that out a little bit.

Going back and talking about… Because we were talking about fertility and sexual health through here, so those not only looking to get pregnant. So, you were talking about the hormones and cervical fluid. Would that be comparable for both issues? So, looking at it for fertility, does sexual health equate to that? So, in terms of best time intimacy and areas like that, you’re going to see those ideal times around the hormones in that area. Is that right?

Dr. Wattles: That’s absolutely right. I mean, it’s kind of a beautiful design that when we are most fertile, we also tend to have the highest libido. And there’s lots of hormonal players. It’s estrogen. It’s also testosterone. So, for example, when I’m doing my preconception lab work, I have a pretty hefty preconception panel that I’m looking at. And I’m looking at estrogen, and luteinizing hormone, and follicle stimulating hormone, but I’m also looking at androgen hormones, so testosterone-like hormones, testosterone, DHEA sulfate, all of these things that can contribute to our sex drive, the maintenance of our lean muscle mass, our metabolism, the way we feel healthy in our body.

And so I think we need to consider the hormones certainly but also there’s all of these other players. The context of our relationships going back to the passion, intimacy, and commitment, when we feel multiple facets of that love triangle, we tend to feel safer, have less inhibition in our sexual relationships. There’s obviously a mental health component. When we have more depression or more anxiety, we have less arousal or less sex drive. So, I think we are looking at hormones. We’re looking at the context of someone’s relationship. We’re looking at their mental, emotional, spiritual health. And then also just things like stressors.

And there’s this great book by the author, Emily Nagoski, and it’s called “Come as You Are.” And she talks about all of these different inputs and how they influence your libido. And there’s this funny illustration where she’s describing a couple, and the husband, he is ready to go. He has his blinders on and nothing in the house is bothering him. But the wife, she hears the dishwasher running. She can hear somebody’s phone beeping in the other room. She hears the dog getting into something. And her filtration system is just so much more sensitive, and she has all these inputs that are influencing her ability to get in the mood. So, there’s all kinds of things that we can think about in terms of what is influencing our sexual function.

Patty: Yeah. No, that’s great. So, I just want to point that out, especially for coaches, that it’s not… So, some coaches here might be working in the area that you do, infertility, but they also may want to be working with perimenopausal women. And they can talk about snuggling and how that may increase their progesterone, especially in the second…

Dr. Wattles: Please talk about snuggling.

Patty: Yes, right? Yeah. Or, that part of intimacy, right, or connection with things that you can do. So, that’s great. The other way, when you were talking, is really foods. Coaches can support through food, so creating meals and the given ideas with the needed nutrients for that, but also making dinner and that’s what’s going to take us back around to this really fun recipe challenge. So, how to make time to connect? So, you could really check a lot of boxes there, right?

Dr. Wattles: Yes. And maybe this is getting a little abstract, but I’m going to say it anyway, that I think when you’re working on your fertility, I always encourage my patients to get creative because isn’t growing a human, that’s the ultimate creative process, right? And so especially when someone is struggling with fertility or they’re feeling frustrated, we’ll look for what are the other creative outlets you have in your life? Is it art? Is it dancing? Is it music? Is it cooking?

And so I think creating meals, number one, is a creative outlet, especially if you’re putting meals together and getting really creative with the foods that you’re pairing. But then, like you said, there’s this opportunity to do it with your partner. And we talked about commitment being an intentional spending of your time. So, that’s one way that we can I think foster commitment in our relationship, but then also intimacy because you’re doing something together. It’s working towards a share goal. So, yeah, let’s create your menu plan. Use the aphrodisiac foods. Do it together. That’s multiple facets of your healthy relationship.

Patty: Absolutely. And we’ll get back to that in a minute. But in terms of… There was one other area, because I know coaches are so helpful in this area of stress and you mentioned how stress can affect stomach acid. But does stress affect other aspects of fertility and sexual health? Obviously, the dog barking in the background is something, but can you go into a little bit more of those areas so that coaches can maybe get some ideas of questions they can ask their clients around stress, and fertility, and sexual health?

Dr. Wattles: Mm-hmm. So, I want everyone to remember in their mind when I showed the graph of all the hormones and I said, “Love can increase your FSH and your LH,” which are gonadotropins. So, again, these are the hormones that are coming from the brain that tell our ovary to start maturing an egg and then to ovulate an egg.

When we are under chronic stress and we have elevated cortisol, cortisol can, kind of, inhibit those gonadotropins. So, we might see that there… We just struggle a little bit more to mature an egg, and we struggle a little bit more to ovulate because cortisol’s effect is at the level of the brain.

So, stress absolutely plays a role in fertility, in our sexual health, in our motivation to want to connect with our partner. And I have all kinds of different stress transformation strategies. And I found that everybody prefers something different. That’s why coaching is so beautiful because some people, they want breathing exercises. Other people want guided meditation. Other people want compassion meditation. Other people will exercise. And some of us don’t even know that about ourselves.

And I’ll use myself as an example. When I first kind of entered into the world of mind-body medicine, I didn’t know that I actually don’t love deep breathing exercises. It, kind of, makes me feel anxious, which is maybe something I need to work on personally. But a guided meditation gets me there instantly. I will instantly relax when I can anchor into someone’s voice. So, I love the idea of having someone who can guide you through some options or even just letting you know that there are different options that stress management doesn’t mean that you have to sit there in silence in your own thoughts and stare at the wall. There’s so many things that we can do.

Patty: Yeah, great. And like you said, you just pointed out the perfect role of a coach, especially in that situation. All right, there’s a few questions we can get to. So, Kim is asking, do you suggest comprehensive nutrient level testing? And do you have a particular test or lab that you like?

Dr. Wattles: Yeah, so I always start with my preconception panel, which is just pretty standard bloodwork that’s well-covered by insurance. I try to tier my blood work just depending on honoring finances and honoring people’s goals. So, on my just standard bloodwork, I’ll look at a couple nutrients. I’ll do an iron, a total iron binding capacity, and a ferritin to assess iron stores. I’ll do vitamin D. I’ll do folate in the blood. But then sometimes I’ll look at vitamin A.

But then if someone wants to do a really thorough nutritional assessment, I use Genova Diagnostics, so I’ll either use the NutrEval or the Metabolomix assessment. I have a fully virtual practice now, so I’m using Metabolomix more because it doesn’t require a blood draw. It’s urine, and then it’s a finger prick test. It looks at I think 125 different nutritional markers.

And sometimes I try to guess people’s nutritional sufficiency, but what I will say is I did a nutritional test on myself. I have a whole nutrition degree. I definitely know how to eat. And mine was horrible because I was eating while I was distracted and I wasn’t focusing on my food and I wasn’t experiencing my food, the colors, and the taste and the sense to get my stomach acid and to get my digestive enzymes flowing. So, that was a big wakeup call for me.

So, yes, I will do nutrient testing. It is expensive, so it’s always just a shared conversation about what our goals are. The other place where I think it can be really helpful is people, especially in preconception, will come to my office and they’re on 15 different supplements. And they’re like, “Do I even need this?” So, we can do some nutritional testing to tailor and pare down their supplements so that they don’t get pill fatigue.

Patty: Great. And what do you consider to be an optimal level of vitamin D?

Dr. Wattles: I want it for fertility at least above 50, but 80 to 100 would be great. But in Seattle, I’m happy if I can get it above 50.

Patty: Okay, great. So, location-dependent, too, sometimes, right?

Dr. Wattles: Well, sometimes people [inaudible 00:55:09] Seattle, and it’s, like, 5 to begin with. So, we have quite a journey.

Patty: Got it. Yeah, for sure. There’s another question. Does stress affect implantation?

Dr. Wattles: This is a great question. I would say that it’s indirect in that stress can increase inflammation and inflammation in the endometrium can impact what we call endometrial receptivity. So, we ant our endometrium to be receptive, meaning it doesn’t have a lot of inflammation. It does have a lot of progesterone. It does have a lot of healthy blood flow.

And when we have a lot of stress, we can have more inflammation. I can’t directly say, “Your stress is making your endometrium less receptive,” but of course especially for my patients who are doing something like IVF where there’s a lot of investment of time, energy, money, and we’re doing everything possible, we’re definitely going to call upon those stress transformation strategies to support their endometrium. But nothing I know of that’s a direct effect, but of course, everything’s connected so we can make a case for it.

Patty: Great. And how about the connection there between menopause and reduced libido? Would some of these strategies also help with increasing libido during that time?

Dr. Wattles: I certainly think so, especially I think this one goes to more of the mental, emotional, spiritual component of connecting with your partner, of navigating… We just know that when we’re in perimenopause, it also tends to be the time, right, where kids are teenagers and our parents are aging and our careers are changing. And there’s lots of other contextual factors. So, even just beyond the hormonal piece, focusing on that mental, emotional, spiritual component, and then supporting vaginal health.

As estrogen is decreasing, we have more vaginal dryness which may… Even if we have desire to have sex, it may make us less motivated because we know it will be less comfortable. So, using some hormones if you need or I really love to use… I have a prescription-strength, through a compounding pharmacy, a vaginal hyaluronic acid that can just help to plump the tissue. I love the company Good Clean Love. They also make a vaginal moisturizer that has hyaluronic acid. I think it has vitamin E. But it’s very effective and it’s just over-the-counter. You can order it online, so there’s lots of products that can help, too.

Patty: Yeah. No, that’s great. So, that just brings me back to the recipe challenge. So, it sounds like this could really benefit so many from young to older. And so let’s definitely check that out. Do you want to pull that back up and have like the…

Dr. Wattles: Mm.

Patty: Yeah, you want to pull that up and you could just… So, we want you guys to make a recipe, share it. We would love to see some different… I mean, Dr. Kalea has some really great recipes on those cards, but also we would love to see your creativity and just, given Valentine’s Day, we’re, kind of, in that mindset already, so we would really… Yeah, definitely tag us, share it. I’ll be making something. I’m going to share it. And we would love to see what you guys do as well.

Dr. Wattles: Please do. I think the foods just… It’s funny, they inherently just look good on a Valentine menu, because they’re already pink and beautiful and have all these textures. So, very photographable and I think will be beautiful in photo evidence. And we can’t wait to see.

Patty: Yeah, thank you so much. Well, as always, I know everybody in the FMCA community already knows you and loves you and appreciates all the amazing information that you have and really your understanding of the coach approach and what coaches can offer. So, thank you so much for being with us here today and giving us some more clear-cut examples of how coaches can work in this area with providers like you. And, yeah, I can’t wait to see everybody’s Romance Prescription Valentine’s Day meals.

Dr. Wattles: Don’t forget to use #RomanceRx so that we can find you and tag our accounts.

Patty: That’s right. That’s right. All right, everybody.

Dr. Wattles: Thank you so much, everyone.

Patty: Thank you. All right, take care. Bye-bye.