Dr. Christine Maren on The Egg Whisperer Fertility Expert Q&A Series (Thyroid Health and Fertility)

[Music] Welcome to the Egg Whisperer Show, a podcast exclusively designed to create more reproductive health awareness and discuss your fertility preservation options. Here's your host, the Harvard Educated Fertility Specialist, Dr. Amy. [Music] Hi everyone, I hope you're all having a great Saturday. So there's one thing that I wanted to talk about on my show for a really long time, and that's thyroid and fertility. And I finally met someone who's just as passionate about it as a thyroid as I am about fertility. That's pretty cool. So her name is Dr. Christine Marin, and she has a podcast called Hey Mommy, M-A-M-I. And I'm so happy that she's available today, and she's going to chat with us about fertility and thyroid. So I hope you'll listen in on this conversation right now. She is wonderful. Hi Christine. Hi. So good, how are you? I'm doing great. Yeah. Awesome. So tell us about yourself, and why you went to medicine and why are you so passionate about the thyroid? Yeah. I went into medicine because I wanted to help people. As cliche as it sounds, that was my thing. I was in undergrad at the University of Colorado Boulder. I was doing a finance degree, which I finished, but I studied abroad in Mexico, and I also did a program called Presidents Leadership Class. And both of those things really just instilled the sense of service in me. And I found that I also was just really drawn to the sciences. Like I had a friend who he sat down next to me in finance class and opened up the newspaper and was reading about stocks. And I was like, I could really care less about that. Like literally I had no care in the world. And I taught group exercise classes at the time, which was like an awesome job in college. And I was really into fitness and nutrition and all of that. So I really, I knew that my calling was more in the health sort of realm. I love that. I would roll my eyes at the stocks too. Yeah. And then what about fertility? Do you have a fertility story that you wouldn't mind sharing with us? Yeah. Yeah. So I struggled with pregnancy complications throughout all three of my pregnancies, really, mostly my second, but with my first child, it took not long to get pregnant, but I had gestational diabetes and I just fell. There was something wrong. What is that about? It had zero traditional risk factors. And that's when I really dove into nutrition, but fast forward a couple years, I tried to get pregnant with my second. My husband had just returned home. He was deployed as a military surgeon. And we were on a timeline and ready for our second baby. And I had a miscarriage. It took me a while to get pregnant at that time. And then I had a miscarriage. And then I had another one. And I saw a fertility specialist. And ultimately my diagnosis was unexplained in fertility. And I felt like there was an explanation there had to be what I just knew there was something wrong. And then I had symptoms going on and I just felt like they were all connected. And so I took a deep dive at that point into my own health and discovered a lot of things, including thyroid dysfunction. And I had a successful pregnancy and I had my son. And after that I got really healthy and I felt really good. And then I had my spiced third. So then tell us more about your connection to thyroid and why you're just as passionate about the thyroid as I am about fertility. Yeah. So I'm a thyroid patient. I'm a thyroid medication change my life, my sister's a thyroid patient, my other sister's a thyroid patient, my mother-in-law, my mom. I mean, all the people who are close to me are thyroid patients. And I see so many people and I work with so many people who get on the right dose of thyroid medication. It's literally life-changing for themselves and for their family. As a mom, I work with lots of moms. And like, our energy trickles down into the household. I would say as a mom, I was at a point in my life when my thyroid was off and I felt like I short-circuited. It was like I couldn't multitask. I had like all these people ask me for stuff all the time and it's hard. And so I think you can change people's lives with proper thyroid management. And then what symptoms should someone look out for that could be a sign of having a thyroid problem? Yeah. So if you're super exhausted, fatigue, feel like you've short-circuited, those are things to watch out for. It can also really influence mood for some more than others, depression, anxiety, that sort of thing or just having a flat mood. Fertility is a symptom, so is having your regular periods. So if you're not ovulating regularly and you have irregular cycles, it's something to look at. Got dysfunction, especially constipation, but there could be other kinds of issues going on as well. Signing hair, hair loss, thinning of the outer third of the eyebrow, feeling really cold, like cold to the bone. If you wear a wearable, like I wear my aura ring, your body temperature is really low. That can be thyroid-related or low heart rate pulse. It can also be very metabolic. So having high blood sugar, high cholesterol, having problems losing weight, unexplained weight gain, that sort of thing. And so if you have any of those symptoms, what kind of test should you ask your doctor for? So I'm a big advocate for a full thyroid panel. So that means TSH, free T4, free T3, reverse T3, thyroid peroxidase and thyroid glybulin antibody. So that's six tests. It's not typically what a doctor orders. Typically your doctor will look at a TSH. Sometimes they'll order a TSH with a reflex to free T4. But what that means is only if your TSH is very abnormal or very high, will you actually get to see what your free T4 looks like. I think not only ordering those labs, but also making sure they're in optimal ranges is really important. So not just like in the normal range. Yeah. Just look at the whole pattern. Look at the whole pattern. So if your TSH is like four and your free T4 is like 0.9 and your free T3 is like 2.5, I think I would give that person thyroid hormone. And of course it always depends on symptoms and how somebody feels. But generally that sort of person would benefit from a little bit of thyroid hormone replacement. Right. And then what if you're a patient you're trying to advocate for yourself and the doctor will not order the full panel and they'll just do TSH and you have symptoms looking at you to advocate for herself or himself. So there is this misperception that lab testing is really expensive and some lab testing is expensive, but a free T3 is like 20 bucks or less. That's really obviously check with your insurance. Labs aren't transparent about what things cost, but I have cash pay rates for my patients. We don't have insurance and it's literally like $20. So it's not an expensive lab. So there's this misperception that it's expensive. I will say also if your doctor doesn't know how to interpret these labs, they might not be comfortable ordering them. And I can understand that. But I think you have to advocate for yourself. You can order them yourself. There's a lot of different ways. You can go online and just literally direct to consumer lab testing. So you can do that. But I think best option is to work with a professional who really understands thyroid because there's a lot of idiosyncrasies in terms of timing and then if you actually do need treatment, what does that look like? And then what's the connection between thyroid and fertility? So thyroid infertility is a big deal. Your thyroid, I mean the reason people have irregular periods when they have thyroid disorders because they're not ovulating. And so you got to ovulate to get pregnant. So that's a big deal. It's also important for maintaining pregnancy, especially in the first trimester. So first trimester, why is it a big deal in the first trimester? Especially in the first trimester, we have a big change in sex hormone binding globulin, which is totally natural. We know that a pregnant woman will have sky-high, maybe not sky-high. But we know it increases a lot when we get pregnant and that's totally natural. But we also know that our need for thyroid hormone replacement increases by probably at least 30% when we get pregnant. So in your first trimester, if you're working with a thyroid doctor and trying to get pregnant or your primary care doctor, make sure they know that if you're trying to get pregnant, soon as you have a positive thyroid pregnancy test, your medication should increase. And then how often should a patient ask that her levels get checked if it's not being done already? So I would, if pregnant, I would check every four weeks, which is quite often, but it's a big deal in pregnancy. So I think that's important. If not pregnant and just trying to get to a good level, if you switch thyroid hormone replacement around, I would do about every six weeks. If you're changing the dose. Got it. And so let's say you were diagnosed with a thyroid problem. Do you have to wait a certain period of time once it's normalized before you should start getting pregnant? I would. Yeah. I would say make sure that you have a stable and optimal TSH, T4, T3, that you get what dose you need and you get on that dose because as soon as you're pregnant, you got to increase that dose by 30%. And it's helpful to know what dose that it's right. So as long as your TSH is like all over the map and you haven't figured out your dose, give it some time so you can get even. Right. And then what about after delivery? What happens postpartum to the thyroid function? So postpartum, your dose will drop again and that's natural because our sex hormone binding glowy and go back down. And we just have to be really aware. Like postpartum thyroid issues are very common. First of all, we know that postpartum is an independent risk factor for autoimmune disease. And so Hashimoto's, which is an autoimmune disease that attacks the thyroid, can come up postpartum in the first year. That's a big deal, something I would screen for. But also just like postpartum depletion and really just this adrenal demion from being up all night and nursing and all of these things add up and put people at high risk for having thyroid disorders postpartum. The other big one is postpartum thyroiditis. And so somebody's like feeling like super revved up and like maybe around four months, the classic sort of symptom would be like four months. They're feeling super revved up. They can't sleep even though they're exhausted. Their heart rates like really fast, they're anxious, they're just postpartum anxiety that comes up and then they like crash and they're so tired. That sounds like postpartum thyroiditis. So getting that full thyroid panel, including the antibodies is a big deal. And when postpartum should someone have those levels checked? So I like to check them six weeks, six months and a year, unless somebody's having symptoms. So if there's symptoms that come up around three months, I would check them in three months. Right. And then if someone has been diagnosed with a thyroid problem, is there a cause for concern? Should they worry about things long term for themselves? I think long term if it's not controlled or not treated appropriately. differently than yeah. Some of the, I mean thyroid just guides or metabolism overall. There are long-term sort of risk factors if you're hypothyroid with all sorts of things. Blood pressure, cholesterol, depression, infertility, all these kinds of things come up. And so having your thyroid hormone regulated in the right ways is a really big deal. I just think of it like any other hormone replacement. We've got to replace that hormone too if it's under functioning. - Awesome. And then what do you think the ideal TSHs? And is it really just the TSH for fertility or is it the TSH with everything else? - Yeah, I think it's the TSH with everything else. I say ideal TSH is about one. We know that the upper limit when we're talking about fertility is two and a half. On your lab order, you might see a four and a half. Again, it's not like, it might be in a normal range by the labs, but really think about that optimal range is a big deal. So I would say ideally getting your TSH close to one between one and two would be ideal. Getting your free T4 above one. So maybe around 1.1 to 1.4 and getting your free T3 in the threes. A free T3 in the twos is maybe the reason that you feel like garbage. So even if your T4 looks normal and your T3 looks low, there's a conversion disorder. Infl medical literature, we know this is like youth thyroid, six syndrome. It's really just T3 conversion disorder 'cause there's inflammation, toxins, infections, whatever. If you're not converting and you don't have an F2-3, you can feel functionally hypothyroid. And that's not always the problem with the gland because your gland might be producing an F2-4, but you might not be converting it to T3. If someone just wants to maybe try to control their thyroid naturally, is that really a thing? Are there things that you can do naturally to control it or should you really consider medications and natural or things like lifestyle changes? What is your opinion on that? I'm a fan of natural lifestyle changes, nutrition combined with medication. I think some people can achieve that. And I think definitely if there's an autoimmune component to the thyroid problem, that is definitely more of a natural approach to treating Hashimoto's. So there's really it's like a two-pronged thing. It's number one is treating that the autoimmune component number two is treating the hormone replacement. Eye-dying can be used sometimes, but it's quite tricky. It's, I think, more of a medication than a supplement because when you use too much iodine, you can give yourself a goiter and mess up your thyroid. But it's like, it's in our hemony literature we call it the Goldilocks hormone because it's like too little snack good, but too much isn't good either. So I'm pretty conservative with iodine. I don't like to use anybody who has Hashimoto's or an autoimmune disease, but using low conservative supplementation like a milligram is pretty safe in people who don't have Hashimoto's. Nonetheless, it's not gonna be like an overnight change for a thyroid most of the time. So I think that nutritional changes, lifestyle, sleep, certain nutrients, all these things can influence thyroid function in a big way, but ultimately most people benefit from thyroid hormone replacement. Of course, it depends on how bad their hypothyroidism is. - And then can you tell us a little bit more about what specifically are the nutritional lifestyle changes that you would recommend to someone? - Yeah, so in terms of nutrients, some of the most important ones are iron, selenium, zinc, vitamin A, some of the B vitamins are a big deal too. What am I missing? Tyrosine versus amino acid is a big one too. And exercise, actually, exercise influences your thyroid hormone receptor sensitivity as does vitamin A. Note to people who are trying to get pregnant don't take a bunch of excess vitamin A. That's not safe, but it is an important nutrient for a thyroid and something you can get safely through foods. So those are all important. I think also good quality. Sleep is a big deal. So when we talk about HPA access dysfunction and adrenal health and stress and cortisol, all of these things are gonna be really influenced by sleep and overall stress. Bar parasympathetic or sympathetic nervous system are fight and flight response. We wanna really get into this place of not sympathetic dominance, but have some balance there where our parasympathetic nervous system is really on fire. - And how do you measure your quality of sleep? - I use this as my or a ring. Oh, you are a, this tells me what my REM sleep, my deep sleep, my light sleep, how many times I wake up all of that. So that's what I use. I love it. My husband has one too now. That's my go-to. That's usually what I recommend for patients. And put it on airplane mode, by the way, when you're wearing it. - Okay. - Why airplane mode? - Oh, we won't keep diving EMFs, but I feel like just to be, the literature is out there on EMFs, but I just play it safe. - And EMFs is electromagnetic frequencies? - Yeah, from cell phone and all these things. So I usually counsel my patients, like just do simple things. Like you don't have to put foil on your windows. Just keep your phone on airplane mode and you're wearing on airplane mode and shut off your Wi-Fi at night. That's not gonna hurt anybody. It might be a good idea. - That's a very good tip. I think I might need to be telling patients that, along with checking your TSH free T4 and free T3. - Yes. - Not just TSH and free T4, that's your recommendation. - Yeah. - For sure. - Perfect. Well, thank you, Christine, for joining us today. I really appreciate the time. Can you tell us more about you, your upcoming podcast and more about your current website? - Yes. Seem you're right here on Instagram at Dr. Christine Marin, my website's the same. And I have a new project called, Hey Mommy. It's M-A-M-I, my colleague and friend, Dr. Alex Carrasco. And we are launching a podcast very soon where we interview you and all things, fertility and infertility sort of work up. And we'll have a lot of great interviews there. Our goal is really just to help women have a healthier and happier momy hood. So everything from preconception through pregnancy and postpartum and beyond, really. - Okay. - Thank you for your time. I really appreciate all the wisdom. Thank you for sharing personal stuff about yourself and telling us why we should be very passionate about our thyroid as well. - Of course. - Thank you. - All right. - Thank you, Christine. - Thank you. - Thank you for listening and making the "Egg Whisperer Show" a part of your weekly routine. As always, you can read more about each episode at drammy.org under the blog tab. You can also find the "Egg Whisperer Show" on Spotify, Apple Podcasts and Google Podcasts. While you're at drammy.org, you can find a link to the "Egg Whisperer School," which houses Dr. Amie's online classes about fertility. And you can sign up for the "Egg Whisperer Newsletter" to get by weekly updates. So you can stay in the know about your fertility. You can also tune into the "Egg Whisperer Show" and watch Dr. Amie as she goes live on Facebook, Twitter and YouTube each week on Wednesday at 7 p.m., Pacific Time. The "Egg Whisperer Podcast" has new episodes each week on Thursday. And we hope to see you again next week. Have a great day. [MUSIC PLAYING]