176. Dr. Labib Ghulmiyyah: What Fertility Can Reveal About Your Long-Term Health

When a couple is trying to get pregnant and it is not happening, the conversation can become very intense very quickly. Suddenly, you are hearing about IVF, egg freezing, AMH, sperm count, hormones, age, cost, and timing. But before the conversation jumps straight to the next procedure or the next number to panic over, there may be a deeper question worth asking: What is fertility trying to tell us about the health of the mother, the father, and the future child? In this episode of Extend, I sit down with Dr. Labib Ghulmiyyah to talk about fertility and pregnancy through a much bigger lens. This conversation looks at infertility not as a failure, but as information. It helps explain why fertility struggles, sperm health, ovarian reserve, placental function, and pregnancy complications can all give clues about metabolic health, inflammation, cardiovascular health, hormones, sleep, stress, toxins, and long-term risk. Dr. Labib Ghulmiyyah is an OB-GYN and residency director at Broward Health who brings together reproductive medicine, pregnancy care, longevity, and functional health. That combination matters because fertility is often treated like a separate category, when in reality, it is connected to the whole body. His approach helps couples think beyond "How do we get pregnant?" and start asking what their reproductive health may be revealing before, during, and after pregnancy. What's Discussed: (02:30) Why health optimization should happen before or alongside IVF. (04:55) How long couples may need to optimize health before fertility treatment. (07:17) Why the placenta may be one of the most overlooked biomarkers in pregnancy. (10:40) Why pregnancy complications should be debriefed after delivery. (18:40) Why the father's health matters far more than sperm count. (26:15) How testosterone therapy can affect sperm production. (41:29) Why low AMH does not automatically mean you cannot get pregnant. Listen to this episode of Extend to understand why fertility is not only about having a baby. It may be one of the earliest windows into your health, your partner's health, and the health of the next generation. Thank You to Our Sponsor: FunctionHealth: Learn more and join using my link. Visit functionhealth.com/drshah http://www.functionhealth.com/drshah and use gift code DRSHAH25 for a $25 credit toward your membership. Learn More About Dr. Darshan Shah: Website: drshah.com https://drshah.com Clinic: next-health.com https://next-health.com Instagram: @darshanshahmd https://www.instagram.com/darshanshahmd/ Learn More About Dr. Labib Ghulmiyyah: Website: drlabib.com http://drlabib.com Instagram: drlabibghulmiyyah https://www.instagram.com/drlabibghulmiyyah/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Darshan Shah?

  Before we get started with this episode, I'd like to invite all of you to the first ever Next Health Longevity Summit, happening in Nashville, Tennessee, at the Conrad Hotel on Saturday, September 12, 2026. This is an all-day summit where you're going to be hearing from some of the best speakers in longevity's medicine, including Dr. Vonda Wright, Dr. Luisa Nicola, many of the podcast guests that you've heard here on the Extend Podcast, and of course, I'm going to be there curating the entire day. We also have incredible vendors coming, so you can try the latest technologies in health, wellness, and longevity. Go to next-health.com/summit and buy your ticket today. We only have 400 spots and

• 0:39Dr. Darshan Shah?

  they're going quickly. That's next-health.com/summit. I look forward to seeing you all there. Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality.

• 1:22Dr. Darshan Shah?

  Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span. Today, we're diving into a crucial topic often overlooked in the longevity conversation: fertility and pregnancy. I am thrilled to be joined by Dr. Labib. He's a double-board certified OB-GYN and maternal fetal medicine specialist with more than 25 years of experience helping women optimize their health through a combination of evidence-based medicine, functional medicine, and patient-centered care. He's also the creator of the Vitality Formula, a framework designed to improve vitality, performance, and long-term well-being.

• 2:06Dr. Darshan Shah?

  He sheds light on why infertility can be a check-engine light for overall Health. We'll explore the critical importance of optimizing health before conception, how it impacts IVF success, and the profound role of placenta in both maternal and fetal long-term health. We're also going to discuss why longevity truly starts in the womb. This episode is packed with insights for anyone considering starting a family. We're simply interested in the foundational aspects of lifelong health.

• 2:36Dr. Darshan Shah?

  Hey, everyone. Before we dive into today's episode, I want to talk about something that you hear me talk a lot about, your biomarkers. And I want to tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day, patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog, and they see their doctor, and the doctor tells them all their blood work is normal. But the problem is this doctor usually is only checking about 10 to 15 biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running. Then all of these have blood tests that we can test on how effective they're working for you every single day. So if someone is not close to one of my clinics, one of my next health clinics,

• 3:20Dr. Darshan Shah?

  then I tell them, go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers, the same kind of comprehensive testing that we do at all of our next self clinics. And if you try to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They can even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements. They don't have pharmaceuticals they're trying to get you to take. You're just getting the data and you're getting insights from the data. And you can

• 4:02Dr. Darshan Shah?

  bring this data to a clinic like ours, and we then have the information that we need to tell you how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio or go to functionhealth.com/drschah and use the code DRSCHAH25 for a $25 credit towards your membership.

• 4:33Dr. Darshan Shah?

  Hello, Dr. Levee.

• 4:34Speaker 01

  Hello, hello, Dr. Shah. How are you?

• 4:35Dr. Darshan Shah?

  It's so great to be here with you.

• 4:37Speaker 01

  Same here. I'm very excited for today's discussion.

• 4:40Dr. Darshan Shah?

  Thank you. So, welcome to Extend. I'm so excited to talk to you because this is a topic that we don't normally address on this podcast, which is fertility and pregnancy. And, you know, from what I'm reading, a lot is happening in the fertility world right now, right? It seems like more and more people are having trouble getting pregnant.

• 4:59Speaker 01

  Yes, absolutely. We're seeing this more and more, commonly clinically speaking, you know, patients coming in with infertility issues, whether it's a female problem or a male problem. But definitely, we're seeing trends and issues with ovarian reserve, sperm counts. And as you know, this is probably from the way we're living and the lifestyle and the things we're getting exposed to in life. So definitely, there's a problem there. However, I like to look at infertility in a positive way. Because if somebody is infertile or couple is infertile, it's kind of a signal that there's something going on in their health. So, yes, it is, you know, the goal is to get them pregnant, but we want to get them pregnant in a healthy way.

• 5:42Speaker 01

  But at the same time, it's an opportunity to also fix their health because it can reflect their long-term health, too.

• 5:47Dr. Darshan Shah?

  Right, right. And that's such an important way of looking at it because I know that kind of what happens right now is someone tries to have a baby, they can't do it, and the next thing you know, they've signed up for some $30,000 in vitro fertilization package, right? I see that all the time right now. And it's like, what happened to everything else in between, right? It doesn't seem, I mean, is this true, like, most of the time? And I mean, there's a lot of money in this industry, as we know, right? Infertility and even surrogates and things. And it seems like there's a gap in health optimization before going that route.

• 6:21Speaker 01

  Yeah, I think IVF or, you know, assisted reproductive technologies, ART, are a great, you know, invention.

• 6:27Dr. Darshan Shah?

  Huge.

• 6:28Speaker 01

  Yeah, they save a lot of, you know, couples' hassles and a lot of people deserve to go through IVF. But a lot of times, sometimes, maybe we're too fast to go into IVF, maybe. But like you said, optimizing health could improve our fertility, but that will also improve the IVF success rate. It will improve the pregnancy outcomes. So definitely, they should be hand in hand. So before going into IVF, and most of the reproductive ophthalmologists will optimize their patients' health for better outcomes.

• 6:58Speaker 01

  So they should, you know, come together. But yeah, many people don't wait enough time. They just are in a hurry. But it all depends on the couple. Some women delay their child bearing to later in life because of their careers. And this is understandable. And they might not have a lot of time to optimize their health. And they jump directly into, you know, more effective ways of getting pregnant. So it's a case by case basis, but it's very important to optimize the health first for better outcomes.

• 7:25Dr. Darshan Shah?

  Yeah. So whether you're trying to get pregnant or you've already made the decision to undergo IVF.

• 7:31Speaker 01

  Exactly.

• 7:31Dr. Darshan Shah?

  It's still better to optimize your health, right?

• 7:33Speaker 01

  Not only IVF, if you're, let's say, uh, want to donate your eggs. You wanna do, or you wanna freeze your eggs and for later on. Optimizing your health will give you a better quality eggs, more eggs for you wanna use in the future. So it's not only for the IVF itself. And it will tell a lot about, you know, how you are now. And it will probably be related to your longevity also. Uh, now, you know, we, we, we, our goal is to improve health span, lifespan. So that part of when you're infertile, it's a good clue, opportunity that it's like a check engine. That if there's something wrong, let me fix this for better, you know, health later on. Not only to get pregnant and have babies, which is super important, of course, but also to live longer and, and live healthier.

• 8:18Dr. Darshan Shah?

  Right, right. And then when you, um, say, you know, you mentioned earlier is both the woman and the man is not just one, right?

• 8:25Speaker 01

  Absolutely.

• 8:26Dr. Darshan Shah?

  And so we should go down each one of those pathways, what the woman can do, what the men can do. I'm sure it's, there's a lot of overlap there. But before we talk about that, if someone is listening to this and they're considering going through IVF, how much time should they spend optimizing their health before they write the check for the IVF treatment?

• 8:43Speaker 01

  That's a great question. I think it all depends where your baseline is.

• 8:46Dr. Darshan Shah?

  Hmm.

• 8:47Speaker 01

  So of course, we're gonna have to do a lot of, you know, baseline assessment through our, you know, history, our questionnaires, our interaction with the patient, and see where they are. And we look at multiple, you know, pillars of health that, you know, you love those, you know, the, the, the wheel of health that you, that you, you invented and you created. This is very important. So we go over every single thing from their sleep, their nutrition, their movement, uh, then look at their cardiovascular health. And so, and so we kind of follow a framework to make sure where is the weakness and where we can optimize. But it takes time. And if you've been, let's say, unhealthy for many, many years, and now you're twenty five or thirty, it's gonna take six months, sometimes a year to optimize.

• 9:26Dr. Darshan Shah?

  Sure.

• 9:26Speaker 01

  Some people are not patient enough to do it and some are. But I I think optimizing it is gonna give you a better, you know, return in your investment if you're gonna do IVF.

• 9:37Dr. Darshan Shah?

  Yeah.

• 9:37Speaker 01

  Uh, that's one. Plus, it's gonna be better return of investment on your health long term.

• 9:41Dr. Darshan Shah?

  Right.

• 9:42Speaker 01

  So it's kind of a window where it will, you know, I'm not healthy, let me improve my life. To get pregnant and then also to, for me to feel better. So it's a, it's a good opportunity for people to uh, kind of invest in their health because, you know, doing a sperm count on on a twenty five, thirty year old. If it's low sperm count or there's azospermia, it's a sign that there's something maybe wrong with his cardiovascular system. With his neural system, with his his hormones, and same thing for for for women. But yeah, it takes time. I would say three, six months, up sometimes up to a year, depending where you started.

• 10:17Dr. Darshan Shah?

  Sure, sure. And I think also, you know, the the other point here that you've told me before is that the health of the mom and the health of the father is transmitted through the DNA, through the methylation of the DNA to the kid, right?

• 10:31Speaker 01

  Right. So again, you know, when the egg and the sperm fertilize, they form the embryo and this embryo starts dividing. And yeah, so the, basically the fetal DNA is made of mom and and dad, uh, but there's something called genetic imprinting. So each of the parents will kind of reflect more in that DNA. Uh, and especially, and I, and there's an organ that I love and many people ignore and we know, we we we we throw it away after delivery. It's called the placenta.

• 11:00Dr. Darshan Shah?

  Yeah.

• 11:00Speaker 01

  The placenta is such an important organ that I think a lot of time, it can give us a lot of clues about what might happen to the pregnancy. Uh, what might happen to to the health of the fetus as well as the mom.

• 11:13Dr. Darshan Shah?

  Hmm.

• 11:13Speaker 01

  So if you look at, you know, the major complications that we see in pregnancy, like pre-eclampsia, preterm labor, uh, stillbirth, fetal growth restriction, they're all related to placenta. We call those like placental syndromes in a way. And that can tell us a lot about what could happen to the baby, of course. And if the baby is born small, for example, he or she are prone to develop chronic diseases later in life. That's called the. Marker theory or the fetal programming, we know this for for a fact.

• 11:40Dr. Darshan Shah?

  Really?

• 11:40Speaker 01

  But also the mom, if the mom develops preeclampsia, then she can, you know, have cardiovascular disease later in life. If she develops gestational diabetes, she can have diabetes later in life. So it's a it's a stressor to the mom's body that gives us a lot of clues. And a lot of things are in the placenta and this organ. I know it's a temporary organ that we, you know, delivered after, what's called the afterbirth. But the placenta is such a powerful marker, I'll I call it a biomarker, honestly, because it will help us a lot. The surfer like things in the mom's life, but the placenta is made of mom and dad. So also the dad contributes to the placental health.

• 12:20Dr. Darshan Shah?

  Ah.

• 12:21Speaker 01

  Uh, in a way, uh, and like I said, there depends on the genetic imprinting, how much his genes are expressing in the placenta. But his health is also important in the pregnancy.

• 12:31Dr. Darshan Shah?

  Right.

• 12:31Speaker 01

  So so so so that's why optimizing mom and dad before pregnancy is important.

• 12:37Dr. Darshan Shah?

  So before a baby is born, is there any way to evaluate the placenta? Um, or is this done after the birth?

• 12:44Speaker 01

  Yeah, a great question. Unfortunately, we don't have like great tools to evaluate the placenta, but like by using ultrasound.

• 12:51Dr. Darshan Shah?

  Yep.

• 12:51Speaker 01

  We can assess the shape of the placenta, the thickness of the placenta. We do check blood flow, whether to the uterus itself, and that that's one of the markers for preeclampsia, for example. Uh, we do sometimes check the blood flow in the cord.

• 13:04Dr. Darshan Shah?

  Mm hmm.

• 13:04Speaker 01

  Uh, to see how much the baby is getting, how much resistance there's in the cord, that will tell us about the health of the of the baby. But we don't have, I mean, of course, you can do very early on biopsies of the placenta, but these are more for genetic testing, like what we call CVS. But there are, you know, certain things that you can look at with ultrasound. And then there are some serum markers, for example, one of the serum markers we use to detect neural tube defects called AFP.

• 13:28Dr. Darshan Shah?

  Mm hmm.

• 13:29Speaker 01

  If it's elevated, uh, yes, it might tell us there's something in the spine of the baby, but a lot of times there's nothing in the spine, things look good. So if I have a high AFP level, then I know the placenta is not functioning well.

• 13:41Dr. Darshan Shah?

  Oh, really?

• 13:41Speaker 01

  Yes, it means it's leaky, the so those women are more prone to develop the baby developing growth restriction. So we follow those pregnancies closer because, so yes, there are some serum markers, including AFP. Uh, that will tell me about the health of the placenta and then ultrasounds.

• 13:56Dr. Darshan Shah?

  Mm hmm.

• 13:57Speaker 01

  And then measuring the baby and then all of those things, but. After birth,

• 14:01Dr. Darshan Shah?

  Yeah.

• 14:01Speaker 01

  you know, testing, doing some pathology or some testing on the placenta, on the cord, can give us clue what happens. Were there, were there any blood clots in that placenta that could explain what happened in, in, in the pregnancy?

• 14:12Dr. Darshan Shah?

  Is this routinely done, like the testing of the placenta after the birth or not? Or do you have to ask for it?

• 14:17Speaker 01

  Yeah, you have to ask for it. Most of the time in a normal delivery, you know, this placenta is thrown away.

• 14:22Dr. Darshan Shah?

  Right.

• 14:23Speaker 01

  But in pregnancies where you had the complication or you had a preterm delivery, yes, we do send the placenta to try to get clues. I think it's important, yes, to send it, get back the pathology, or you do any microbiology if there was any infections. But the most important part is sitting with the couple and debriefing after the pregnancy. I think that's what we miss a lot of times. Explaining what happened, of course, to give them support emotionally because they might have, you know, complications which are not easy, but also give them clues that, listen, your placenta wasn't functioning well. This might be an issue with your cardiovascular system. Continue to monitor things, not just, you know, deliver them and, you know, say goodbye to the next pregnancy.

• 15:02Speaker 01

  Yeah, so sending it is one thing, but following, and I, I call it the debrief of the, of the post, of the pregnancy, which unfortunately, and I'm guilty also, we don't have time to spend postpartum with patients. And I think we need to put a lot of effort in that, not just one visit. Multiple visits have a follow up because I think that could reflect a lot about, you know, our health, next pregnancy, next generation's health and, you know, longevity. I, I, I like to call, you know, I have this saying called longevity starts in the womb.

• 15:35Dr. Darshan Shah?

  Yeah.

• 15:35Speaker 01

  Because tells me about the mom and the baby. And whatever the mom is doing in her pregnancy, whether she developed, you know, hypertension, the baby can have, you know, long term secretly. So longevity should not start fifty.

• 15:50Dr. Darshan Shah?

  Yeah.

• 15:50Speaker 01

  Uh, we should start way early in our teens and maybe even in utero or in the womb.

• 15:55Dr. Darshan Shah?

  Right, right. No, that makes total sense.

• 15:57Speaker 01

  Yeah.

• 15:58Dr. Darshan Shah?

  So if you're a couple and you're delivering a baby, you know, you have options now to either save the cord blood, the cord and the placenta, right? You can do all three of those. And I know there's different, it's expensive. To do this, but it's more expensive, the more you're kind of refrigerating and putting away, right?

• 16:14Speaker 01

  Correct.

• 16:15Dr. Darshan Shah?

  What do you think is the utility of saving this, these?

• 16:17Speaker 01

  Well, you know, there's a big debate about this topic. Uh, now I know there's a huge market for stem cells that are extracted from cord, from zinkymel cells, or what we call the Wharton's jelly. They used to, you know, do it for from the cord blood, but now we know you can get more cells from zinkymel cells and stuff. Again, today, we don't have a lot of diseases that we can treat with those stem cells. So, you know, following the evidence and the guidelines, it's not something that, you know, we push for, or we're not supposed to push for, unless the couple wants to do it as a safety banking. But today, it's not something that we would, you know, recommend every couple to do it. Yes, if they want to do it, there are options. There are public banks, there are private banks.

• 16:59Speaker 01

  Again, it's, it's their health, it's their, it's their organ, basically. So they, they're, they're free to do whatever they want, but following guidelines, we should not be pushing people do it, do it.

• 17:10Dr. Darshan Shah?

  Right.

• 17:10Speaker 01

  Unless you have a very strong family history of a certain, you know, like Fanconi's anemia, or a lot of, you know, cancers in the, in the family that potentially those stem cells could treat in the future.

• 17:21Dr. Darshan Shah?

  What type of cancers?

• 17:23Speaker 01

  Usually like blood, uh, blood, yeah, these are the most ones. If you have a strong family history of that, maybe do it as a safety net.

• 17:30Dr. Darshan Shah?

  Yes.

• 17:31Speaker 01

  But, you know.

• 17:32Dr. Darshan Shah?

  Otherwise, you don't see a lot of utility there, right?

• 17:35Speaker 01

  Some, a lot of people do it, yes, and, and they're free to do it, but medically speaking, evidence based, we should not, you know, push people, you know.

• 17:41Dr. Darshan Shah?

  Right, right. You know, I, I know OB GYNs don't normally push people to do it. I think people are mainly asking for it.

• 17:48Speaker 01

  Yeah, exactly, exactly. I mean, and it's nice to know what's out there and then, you know, weigh your options. But yeah, we should not be pushing today, maybe in, in a year or two, when we do another podcast, I might tell you, listen, bank your, you know, bank your, your, your, your cells. And I get this question all the time. And they ask me, you know, I tell them what the evidence is and, and, and they will, they will pick and choose what they want.

• 18:08Dr. Darshan Shah?

  Right, right. I think there's this thought out there that maybe one day the stem cells will be useful. So to your point with the blood cancers, sometimes people have to have treatment for blood cancer using. Radiation therapy, chemotherapy, and then they're it basically eliminates their blood cells that are cancers from their body. And then those stem cells can then be used to replace those, right? And so if you have them banked, you're lucky. Otherwise, you have to go on a big search for someone that has

• 18:35Speaker 01

  Exactly.

• 18:35Dr. Darshan Shah?

  Matching. Matching stem cells to you, which is a huge other industry, right?

• 18:39Speaker 01

  Exactly.

• 18:40Dr. Darshan Shah?

  That's the only, to my knowledge, that's the only real current use of those banked stem cells, is that correct?

• 18:46Speaker 01

  Today, yes, yes. But as you know, also, you know, people are using stem cells for other things.

• 18:50Dr. Darshan Shah?

  Right.

• 18:50Speaker 01

  Wellness, longevity, and, you know, other things which also, you know, as, you know, we're, we're learning every day more and more like how effective they are, how safe they are. Who are the candidates, where to inject them, how to inject them, how much to inject them.

• 19:02Dr. Darshan Shah?

  Yes.

• 19:02Speaker 01

  So you're more of an expert in those, but, but as far as the, the, those fetal cells, yes, of course, they are. Uh, you know, in, in their infancy still, they have a good potential to differentiate into better cells. So the theory is beautiful, but I think the application is still a bit.

• 19:18Dr. Darshan Shah?

  Yeah, there's still a lot of research that needs to be done. The, the way I look at it personally is that, you know, a lot of people right now are injecting stem cells. And they're either taking their old stem cells from their fat or their bone marrow and injecting it. Or they are getting, um, mesenchymal cells from donated umbilical cord from babies, right? And so these are someone else's cells. Obviously, there's a lot of testing that happens to make sure they're disease free, et cetera. But there's also like, this is not your DNA. So there's this like theory of chimerism that can happen. Like you get someone else's DNA and your DNA.

• 19:50Speaker 01

  Exactly.

• 19:50Dr. Darshan Shah?

  But no one knows, I mean, there's so much more research that needs to be done, right?

• 19:53Speaker 01

  I know, yeah. That's why it's so regulated and in multiple places in the world, in the US, just few, few states have, you know, strict regulations and indications when to use it, how to inject it, whether locally or systematically.

• 20:07Dr. Darshan Shah?

  Systemically, right?

• 20:07Speaker 01

  Yeah, I mean, it's a very interesting field, um, you know, I'm, I'm, I'm trying to learn more and more every day, uh, in it. Because I think it has a huge potential, uh, to help, uh, people, uh, feel better and, and treat a lot of diseases.

• 20:20Dr. Darshan Shah?

  Yeah, I always think that, you know, if I, back when I was born, you know, many years ago, th- this was not even an option to stay, save your stem cells. So I always imagined that if my stem. Cells are saved somewhere. Maybe now if I'm doing stem cells for wellness or I need an injection in my knee or my shoulder. I would just go to the bank and say, hey, I need some of my stem cells now. They can be taken out of the bank.

• 20:41Speaker 01

  Yeah.

• 20:41Dr. Darshan Shah?

  Maybe they're multiplied. I don't know, you know, they're so, they'd be in the freezer for fifty years. I don't know how valuable they are.

• 20:48Speaker 01

  I mean, you know, theoretically, you know, they've had stem cells, you know, banked from the early eighties.

• 20:54Dr. Darshan Shah?

  That's true, right?

• 20:55Speaker 01

  You know, probably still potentially viable.

• 20:57Dr. Darshan Shah?

  Right.

• 20:57Speaker 01

  So by definition, they can stay infinitely. So, yeah.

• 21:02Dr. Darshan Shah?

  So interesting. So one of our kids, I didn't have any of this knowledge for my son.

• 21:05Speaker 01

  Yeah.

• 21:06Dr. Darshan Shah?

  Um, and so he was born twelve years ago and we did not save the stem cells. But then my daughter, I started learning about this and I said, let me just save it just in case. And who knows?

• 21:14Speaker 01

  Exactly. It's like buying them an insurance or a college fund or, you know, it's, it's again, but medically speaking, you know, it's very important to, you know, know that we're still at the infancy of that technology, but it's going fast.

• 21:27Dr. Darshan Shah?

  Yeah, it is going really fast. I think during the course of our lifetimes, especially our kids' lifetime.

• 21:32Speaker 01

  Yeah.

• 21:33Dr. Darshan Shah?

  Um, there'll be a lot of determinations made about the utility of these stem cells. So definitely something to consider. Okay, going back to healthy babies and creating healthy babies and infertility. I think, you know, those two things come hand in hand, right? Whether you're infertile or you're trying to make a healthy baby. It's the same things that you have to do to optimize your health and the health of the father. The health of the father, I think, is important because the healthier the father is, the more sperm they're making, right?

• 21:59Speaker 01

  Of course.

• 21:59Dr. Darshan Shah?

  To get pregnant, but it goes beyond that, doesn't it? The health of the father?

• 22:03Speaker 01

  Of course. I mean, it's not only the amount of sperm.

• 22:06Dr. Darshan Shah?

  Right.

• 22:06Speaker 01

  Of course, you want them to be motile, active and healthy, but also you want the DNA inside of them also to be healthy.

• 22:12Dr. Darshan Shah?

  Exactly.

• 22:12Speaker 01

  And not fragmented and not exposed to toxins or smoking or drugs or, you know, so. And even, even like, we, we always talk about like stressful life, lack of sleep, you know, our exposures, our daily exposures are, these are all play a role in our health. So.

• 22:28Dr. Darshan Shah?

  Yes.

• 22:28Speaker 01

  A sperm analysis actually is not a bad test to do to kind of know what's happening in your, in your health.

• 22:34Dr. Darshan Shah?

  Right.

• 22:34Speaker 01

  So even at twenty-five, thirty-year-old, he can do a sperm test and it will tell you. It's one of the vital signs. Let's say it's like, you know, a period with, you know, adolescent girls that tell us a lot about their, you know, endocrine life, about their fertility. So I kind of divide, especially, you know, women's health into like several P's. You know, you have the puberty or periods, and then you have pregnancy, placenta, and then you have the perimenopause, menopause. So those three P's are super important. They're connected. So if a girl has issues with her period, uh, what we used to call PCOS, and a couple of days ago, they changed the nomenclature into, and it makes so much sense that this is an endocrine metabolic problem. It tells us a lot about her fertility, what's gonna happen with her fertility.

• 23:14Speaker 01

  Her fertility will tell us about her long-term health, how she goes through menopause, also tell us about her, you know, chronic diseases. So they're all related.

• 23:23Dr. Darshan Shah?

  Yes.

• 23:23Speaker 01

  So we should not ignore, you know, a girl that's having painful periods, irregular periods. It tells us a lot about her hormones. Maybe she's having, you know, stressful things in college and school. Uh, she's not sleeping well, she's not exist, she's not eating healthy. So it's a continuum of things, and same thing for a man.

• 23:41Dr. Darshan Shah?

  Yeah.

• 23:42Speaker 01

  Okay, yeah, we don't have the periods and stuff, but again, we have to assess men, their sperm count, their blood pressure, their weight. So all of those play a role, absolutely.

• 23:52Dr. Darshan Shah?

  Yeah, and I think like you mentioned, like, stress plays a huge role in not just in the number and quality of your sperm, but also in what switches are turned on and off in the DNA.

• 24:01Speaker 01

  Absolutely.

• 24:02Dr. Darshan Shah?

  That is then put into the sperm, right? So I think the sperm, how, how many months does sperm last?

• 24:07Speaker 01

  Well, the sperm can last up to like three months.

• 24:09Dr. Darshan Shah?

  Three months, right?

• 24:10Speaker 01

  And then every like one twenty days or so, it can, you know, you know, re- replenish. But like I said, definitely the, the, the, what you call epigenetics.

• 24:17Dr. Darshan Shah?

  Right.

• 24:18Speaker 01

  Cause you, we have a certain genes that are expressing, but depends what we give them as information, they will, you know, kind of express those proteins or those RNAs prior to the protein, depends on our exposure.

• 24:31Dr. Darshan Shah?

  Right.

• 24:31Speaker 01

  So epigenetics play a role, and then, you know, eventually, the day the fertilization happens, you know, it depends on what sperm fertilizes, what egg.

• 24:40Dr. Darshan Shah?

  Right.

• 24:41Speaker 01

  You will get, you know, those, uh,

• 24:43Dr. Darshan Shah?

  Yeah.

• 24:43Speaker 01

  those things that will either get you pregnant, and if it gets you pregnant, you know, the, the pregnancy itself.

• 24:48Dr. Darshan Shah?

  Exactly. So I think. You know, the important point is like the sperm lasts three months. So for at least three months, you should be healthy before you're trying to get pregnant, but hopefully even longer than that. Right. And so what switches are turned on and off in the DNA depends on, like you said, what are you exposed to? Are you exposed to a lot of stress? Are you exposed to metabolic disease? Are you exposed to toxins, like even smoking and alcohol, right? So, you know, women pretty much automatically, they they have an intuition to not drink as they're trying to get pregnant for the most part, right? But I think men almost drink more sometimes.

• 25:21Speaker 01

  So go, I'm having twins. Yeah, I think there's this thing when we are maybe a bit, you know, young and you feel nothing's gonna happen to me. It's okay if I smoke, you know, the mom is carrying the pregnancy and she has to be healthy. I don't need to be healthy. And it's absolutely wrong because yes, prior to the to the pregnancy, you're contributing half of the DNA.

• 25:43Dr. Darshan Shah?

  Right.

• 25:43Speaker 01

  So that's gonna play a huge role. But then also you want to be in in a good shape. When you're living with someone, you know, for for you to be a role model. And then also to take care of your kids when they they grow up. So, yeah, it has to be both both ways. And and like you're mentioning, like moms automatically stop smoking or drinking. And that's intuition, but this is also biology.

• 26:05Dr. Darshan Shah?

  Right.

• 26:06Speaker 01

  They will start not liking the smell of smoke or the smell. So it's kind of a defense mechanism where their body is saying to stay away from those things.

• 26:13Dr. Darshan Shah?

  Right.

• 26:15Speaker 01

  But we also know that some men also actually develop symptoms of pregnancy. It's called Kuva syndrome where they will, you know, gain weight, they will get nauseated. Actually, there are reports of men having contractions, you know, close to the labor time. So and it can tell you there's so much like relation between between between the couples that whatever she's feeling could reflect on on the other person.

• 26:37Dr. Darshan Shah?

  Yeah. You mentioned getting a sperm test done. I think these are available now on the internet, right? Where you can just order at home test kit. It's not as complicated anymore, right?

• 26:47Speaker 01

  It's not complicated. They will send you the kit. Depending, there's multiple ways. They will send you the kit. You will, you know, produce the sperm, put it back into that kit with the return label. And they will send you in a few days, they will send. You the the results and there are actually other smaller devices where you can do the test at home.

• 27:05Dr. Darshan Shah?

  Yes.

• 27:06Speaker 01

  You just plug it into a certain thing and and from your phone you can see your sperm and then it will give you kind of a count and.

• 27:12Dr. Darshan Shah?

  Oh wow.

• 27:12Speaker 01

  So it depends and then some labs go a little bit further. They give you maybe more fragmentation percentage and then you can they can even bank or like freeze your sperm if you want automatically. So there's multiple ways of of doing it. So it's an easy test. It's not complicated.

• 27:26Dr. Darshan Shah?

  Right, right. It's all available now direct to your home.

• 27:29Speaker 01

  It makes more sense to, you know, produce the sperm at home than going to a lab, you know, it's not it's not easy. So we tell all the men out there that, you know, it it could be one of their annual checkups.

• 27:40Dr. Darshan Shah?

  Yeah.

• 27:40Speaker 01

  Maybe starting at the age of thirty or thirty five. I mean, there's no recommendations. I'm I'm not putting out recommendations, but it makes sense maybe at thirty, thirty five, because that's where we're seeing the numbers drop. Uh, it could be an eye opener for for him to improve his health.

• 27:54Dr. Darshan Shah?

  Yeah, I'm sorry. I mean, there's such a great point because like what we should maybe look at our sperm, even if we're not trying to get pregnant as a young person.

• 28:02Speaker 01

  Yeah.

• 28:02Dr. Darshan Shah?

  Because that the health of the sperm tells you a lot about your physical health. So what if that did become like a biomarker until obviously, you know, you're done with childbearing.

• 28:12Speaker 01

  If you think about it, to produce sperm, you need good blood flow to the testicles. So it means you have to have a good cardiovascular system. Uh, you need good neuronal also innervation to your testes or also on the female to the ovaries. Uh, so if you are stressed and you're under, you know, high, you know, cortisol levels, you know, you might not innervate your testicles well. And then you want the mitochondria or those engines in the sperm to produce. It's a very dynamic organ, uh, the testicles and the ovaries. They're actually probably the most dense organs in the body with mitochondria. So you need all of those. Uh, so if the sperm count is low, it means you have an issue in one of those. You're either too stressed or uh, exposed to too a lot of toxins or you're not giving blood to that area and then it's it's an eye opener. Absolutely.

• 28:57Dr. Darshan Shah?

  Right. You know, one other thing I think about a lot too for men is health especially is that a lot of men now are doing testosterone replacement therapy and they're also waiting until later in life to get uh, have babies and get pregnant, right? So we see a lot of men that are already doing testosterone replacement therapy. A lot of people are just buying testosterone, unfortunately, online or they're not seeing a doctor. And they're not told of the risks that this will eliminate your sperm production, right?

• 29:23Speaker 01

  Yes, of course. And the fourth layer I want to talk about, other than the innervation and blah, is the hormones, of course, that you need to produce those. And testosterone is one of the most important, you know, hormones in men. And yeah, if you take testosterone like exogenously, like from the outside, without, of course, any guidance from a physician, you might overdose on that. It's gonna shut down your own testosterone production and sperm production.

• 29:46Dr. Darshan Shah?

  Right.

• 29:46Speaker 01

  It's usually reversible, but still it can take six months to a year to reverse sometimes. I've seen that happen. There are other ways of, you know, increasing your testosterone with other medications, either naturally. But going to the gym, lifting weights, sleeping well will raise your testosterone.

• 30:01Dr. Darshan Shah?

  Yes, for sure.

• 30:02Speaker 01

  So you don't always have to take TRT. I like how we move from a woman to men, but they're connected.

• 30:08Dr. Darshan Shah?

  They're so connected, right?

• 30:09Speaker 01

  They're so connected, yeah. So and even testosterone now, I know it can be given in different trouts, like nasally. It will affect your sperm less than if it's given IM or, you know, through pellets. So, yes, you could benefit from it, but if fertility is a priority in your life, then you have to be careful with TRT. And you'll see a TRT specialist, a hormone specialist that, you know, will take care of that problem for you.

• 30:33Dr. Darshan Shah?

  And I also, you know, I recommend to a lot of young people that are wanting to do TRT, like bank your sperm as well, right?

• 30:39Speaker 01

  That's a great idea.

• 30:39Dr. Darshan Shah?

  Test and banker sperm. Like you mentioned, some of these companies that do the testing, they will bank it too. And so it's always good to have that just as a backup, right?

• 30:48Speaker 01

  Why not? Yeah, yeah. Because, you know, you never know what could happen later in your life. You know, the sperm can drop.

• 30:54Dr. Darshan Shah?

  Right.

• 30:55Speaker 01

  And then, of course, if you're not feeling well and you're tired and your testosterone is low, first try to find the cause.

• 31:00Dr. Darshan Shah?

  Yes.

• 31:01Speaker 01

  And then if you want to replace it, that's, you know, it's gonna improve a lot of your life. And then you have banked sperm. So it's a good idea, I think, to think about it that way.

• 31:10Dr. Darshan Shah?

  And then also, I think, men, if you're wanting to have children in the future and your testosterone is low and you've tried everything and it's just not getting to where you want. To be and Clomiphene is probably a really good choice because this pushes your natural production testosterone. And does it help with sperm production too?

• 31:29Speaker 01

  It could help with the sperm production and also it's used in women also to help them, you know, for ovulation. So yeah, that's one of the things if you want to improve your sperm count or your testosterone levels without affecting your sperm count. Mclofin, Clomiphene is one, ACG also is another one, injections or a combination of those. It will raise a little bit your testosterone without affecting your sperm count.

• 31:50Dr. Darshan Shah?

  Got it.

• 31:51Speaker 01

  That's one option, but of course TRT is way better to, you know, optimize your testosterone level, but it has that, you know, side effect.

• 31:58Dr. Darshan Shah?

  Right, absolutely. Okay. And then I know some people that when they're on TRT and they come off of it, they sometimes take ACG and Clomiphene to push their testosterone and their sperm production again.

• 32:09Speaker 01

  Exactly, exactly.

• 32:09Dr. Darshan Shah?

  It's something you've really got to work with a skilled hormone replacement doctor.

• 32:12Speaker 01

  So this, I think this is the message, don't just, you know, go buy testosterone and inject it because plus, you know, you have to, like we said, like optimize the other parts of your health. You have to be on certain supplements so that the testosterone will work, make sure you're not inflamed because I see a lot of people, even women, they go on HRT or men on testosterone that are inflamed, they have gut issues. It's not gonna work.

• 32:36Dr. Darshan Shah?

  Right.

• 32:36Speaker 01

  I mean, it might work for a short period of time and then they're gonna crash again.

• 32:39Dr. Darshan Shah?

  Yeah.

• 32:39Speaker 01

  So going back to the basics, to the wheel is so important, like in anything you do.

• 32:45Dr. Darshan Shah?

  Yeah, it's all interrelated. Yeah.

• 32:47Speaker 01

  Absolutely.

• 32:47Dr. Darshan Shah?

  I was thinking about when I was in high school, I can say this now because it's been such a long time, but I'm such an idiot. I remember I bought testosterone at the gym.

• 32:56Speaker 01

  Wow.

• 32:57Dr. Darshan Shah?

  Someone gave it to me in a vial. I had no idea what it was. I had no idea what the dose was. I injected it. It's such a dumb thing to do, you know, to just buy it at the gym or buy it online without the medical care with someone that knows, not just giving you advice on the testosterone, but also knows your overall health. I think that's so important because it's so, like you said, it's interrelated to everything, right?

• 33:17Speaker 01

  And we're seeing now this more with, you know, peptides now, you know? People are getting it from, you know, gray markets, from gyms.

• 33:24Dr. Darshan Shah?

  Yeah.

• 33:25Speaker 01

  I mean, I have nothing against, you know, coaches and a lot of them are very knowledgeable in the, you know, physical. Conditioning of people and athletes. But when it comes to, you know, peptides, you have to be, you know, kind of have some medical background, you know, know. Uh, you know, how those peptides or anything you're injecting in your body, how it works.

• 33:42Dr. Darshan Shah?

  Right.

• 33:43Speaker 01

  Pros and cons, are there any human studies? So I think always, you know, consult with physicians. I think this bypassing physicians today has become kind of fashionable.

• 33:53Dr. Darshan Shah?

  Yeah.

• 33:54Speaker 01

  Uh, yes, people have to be their own, and you, I, I think you say this about your own CEO of your health, yes. No, no question. And if you're not satisfied with what your physician is telling you, go find someone else. But always, you know, get tested, make sure what you're taking has, you know, benefits, not, you know, drawbacks. But yeah, I, I think start with the basics and then you add those things as a second layer.

• 34:17Dr. Darshan Shah?

  Yep, for sure.

• 34:18Speaker 01

  Yeah.

• 34:19Dr. Darshan Shah?

  And then can I ask you two, just to kind of tie a bow around this topic around men and their role in pregnancy? Obviously, they want to be as healthy as possible.

• 34:27Speaker 01

  Hmm.

• 34:28Dr. Darshan Shah?

  One of the things that I've been reading a lot about now too is like the, the use of GLP ones in getting healthy, both for men and women. And you know, there's this whole thing about Ozempic babies now.

• 34:37Speaker 01

  Right.

• 34:38Dr. Darshan Shah?

  Where women are getting pregnant after they take Ozempic. And I think there's also a similar effect, like men are becoming more fertile with taking Ozempic too, right?

• 34:46Speaker 01

  Sure.

• 34:46Dr. Darshan Shah?

  Or any GLP one.

• 34:47Speaker 01

  Yeah, yeah, yeah.

• 34:48Dr. Darshan Shah?

  And, and how closely related is your metabolic health and your ability to achieve a pregnancy?

• 34:54Speaker 01

  It is so related. I mean, you know, and having insulin resistance or full-blown diabetes is gonna affect your cardiovascular health, it's gonna affect, you know, your sperm production, your hormone production. So definitely by lowering, you know, your weight by itself and, and decreasing the amount of fat, whether it's, you know, fat that you see or visceral fat, which is more important.

• 35:16Dr. Darshan Shah?

  Right.

• 35:17Speaker 01

  You're gonna improve your metabolic health and therefore you're gonna produce more sperm. And we come back to the same idea that it's a vital sign.

• 35:24Dr. Darshan Shah?

  Yeah.

• 35:24Speaker 01

  And that's why we were getting those Ozempic babies, because women that, let's say, have the, you know, P O M S or previously PCOS. When they go on it, they're gonna lose some weight, they're gonna decrease inflammation, all their inflammatory markers will improve, they will start ovulating.

• 35:38Dr. Darshan Shah?

  Right.

• 35:39Speaker 01

  So very. Important metabolically, you know, tho- those drugs are are great, but they're not for everyone.

• 35:45Dr. Darshan Shah?

  Yeah.

• 35:45Speaker 01

  So if you're infertile, don't go take GLP one. You're not gonna get pregnant based on that. You have to have, you know, insulin resistance or diabetes or something causing that infertility, because there's many causes of infertility.

• 35:57Dr. Darshan Shah?

  Sure, sure.

• 35:57Speaker 01

  Uh, but yeah, I think these drugs are a good tool to help this patient optimize the health uh before they get pregnant. We still don't know a lot about the use in pregnancy. Of course, there are reports of women or mostly women getting pregnant while they were taking it, what we call Ozempic babies. So far, we haven't seen any patogenesis from those or or cause of malformations in the baby. Of course, we stop it once we know they're pregnant. Ideally, you like to stop it eight weeks before a pregnancy. Um, that's what the label says, but probably nothing bad will happen if you get pregnant on a GLP one. But yeah, it's not a drug to be used in pregnancy.

• 36:35Dr. Darshan Shah?

  Got it. So yeah, if you, a lot of women are concerned about weight gain during pregnancy. You're supposed to gain weight during pregnancy. Do not take a GLP one because.

• 36:44Speaker 01

  That's the other also thing that even during pregnancy, we should keep an eye on the metabolic health of women.

• 36:49Dr. Darshan Shah?

  Yeah.

• 36:50Speaker 01

  Even now, you know, a lot of these women that are at very high risk of developing, let's say, gestational diabetes, they're already like overweight. Uh, they've had a previous baby that was huge and they had gestational diabetes. We start telling them, even do put CGMs, continue growth early on in the pregnancy to work on their diet. Ideally, you like to do it before. Uh, but now we even sometimes tell them to do it early in the pregnancy to kind of adjust their diet so that they will gain weight, but in a healthy way.

• 37:17Dr. Darshan Shah?

  Right.

• 37:18Speaker 01

  Uh, so that they'll be able to lose it because too much fat that's not needed will cause inflammation. Inflammation will increase the markers of inflammation that will go through the placenta. The placenta is kind of a gatekeeper.

• 37:29Dr. Darshan Shah?

  Right.

• 37:29Speaker 01

  But it can do so much. It can filtrate so much toxins that sometimes it gets overloaded.

• 37:34Dr. Darshan Shah?

  Gets overwhelmed, yeah.

• 37:35Speaker 01

  So yeah, very important to see where the person started as far as their weight is concerned. There are guidelines to know how many pounds to gain through every trimester or total of a pregnancy. Uh, but I think educating women about nutrition. And then maybe showing them data like CGMs or other other device wearables that are out there could be a good tool to, you know, and give them an incentive to improve their health.

• 38:00Dr. Darshan Shah?

  Yeah, yeah, I think I think what you're trying to say is that, you know, that you're supposed to gain weight during pregnancy, but you wonder what gain the right type of weight.

• 38:06Speaker 01

  Exactly.

• 38:07Dr. Darshan Shah?

  You don't want it to be inflammatory visceral lot of inflammatory visceral fat. That then creates more consequences to the baby, but also you don't want to screw up your metabolic health too while you're.

• 38:20Speaker 01

  If you look at all the complications of pregnancy, pre-eclampsia, preterm labor, stillbirth, there's an inflammatory marker going on right there because women that develop the say gestation diabetes, they're more prone to develop at the end of the pregnancy, for example, pre-eclampsia, which is high blood pressure. So and then the women that develop pre-eclampsia are more prone to have a smaller baby, what we call FGR. Sometimes actually we detect FGR early on, let's say at thirty, thirty two weeks. And then those women will develop pre-eclampsia or high blood pressure. So all these are interrelated and I think a lot of it is related to inflammation. Probably the same process as what happens with aging. We know aging is inflammatory kind of status.

• 39:00Speaker 01

  So I think the same thing happens in in in pregnancy when you're prone to develop these complications. And yeah, we should use pregnancy as kind of a window that as if the mom instead of going and running on the treadmill to do a stress test, this was the perfect stress test.

• 39:16Dr. Darshan Shah?

  Yes.

• 39:16Speaker 01

  And then, like we said, in the postpartum phase, start working on those areas.

• 39:22Dr. Darshan Shah?

  Got it.

• 39:22Speaker 01

  For them, yeah.

• 39:23Dr. Darshan Shah?

  Yeah, so so for the mom then to optimize their health for pregnancy. Number one thing that we talked about is metabolic health and making sure like using a continuous glucose monitor.

• 39:33Speaker 01

  That's yeah.

• 39:34Dr. Darshan Shah?

  Optimizing your diet, right, yeah. Maybe even using GLP ones if you do need to fix your metabolic health and maybe lose some visceral fat before the pregnancy. But to your point, eight weeks before pregnancy, try to get off of it and definitely not during the pregnancy, right? The second thing we talked about is lowering inflammation as much as possible, right? And so that that involves gut health, right? Making sure your gut is healthy, making sure you don't have a lot of visceral fat. What are some other things women can do to reduce inflammation?

• 40:02Speaker 01

  Well, I, you know, kind of the two things that I think are so important is movement, exercising. Then sleep. Sleep is such a powerful, you know, tool that we kind of. Think, oh, I don't want to, I don't need to sleep now.

• 40:18Dr. Darshan Shah?

  Yeah.

• 40:19Speaker 01

  I think if one, I had to pick one thing, you know, work on your sleep. I think that's, that's a very powerful uh tool, cause it's gonna clean up your body, decrease inflammation. Uh but like you said, there's multiple sources of inflammation.

• 40:32Dr. Darshan Shah?

  Mm hmm.

• 40:33Speaker 01

  So gut, sleep and movement, I think these are the three things that will give you the best, you know, return on investment, let's say, and you'll see good results. And it will make a difference in your, in your health.

• 40:43Dr. Darshan Shah?

  Yeah.

• 40:44Speaker 01

  So, but and then, of course, we have to make sure the nutrients are, are, are good, you know, their, their vitamin D. For example, there's a lot of data on vitamin D now, and then pregnancy outcomes. Make sure their iron levels are good, because they consume a lot of iron, you need to give the baby iron, the placenta. Your own blood needs iron, so those are very important to optimize before the pregnancy. And then, of course, making sure that reproductive organs are healthy.

• 41:07Dr. Darshan Shah?

  Right.

• 41:08Speaker 01

  Their uterus doesn't, there's no, you know, adenomyosis, adenomyriosis, any polyps, any septums. So we have to make sure that where the baby's gonna be sitting is also, you know, in good health.

• 41:19Dr. Darshan Shah?

  Yes.

• 41:20Speaker 01

  Uh whatever the, the baby is getting, like, you know, the placenta should be in good health, therefore mom and dad. And then throughout the pregnancy, you know, get the prenatal care that's important to you and monitor things. And keep doing what you were doing before the pregnancy and the pregnancy.

• 41:35Dr. Darshan Shah?

  Right.

• 41:35Speaker 01

  Exercising, continue exercising in pregnancy, do not stop. Try to sleep as much as possible throughout pregnancy also. So anything you were doing before, continue to do it and try to do it in a better way, of course, during the pregnancy.

• 41:49Dr. Darshan Shah?

  Yeah, and then, I mean, the, the other thing I wanted to also mention here is that um women should also be, you mentioned some supplements.

• 41:57Speaker 01

  Hmm.

• 41:57Dr. Darshan Shah?

  One of the ones that they're all told to take is folate, right?

• 42:00Speaker 01

  Yes.

• 42:01Dr. Darshan Shah?

  What, can you, I know there's some debate around the folate, can you talk about it?

• 42:04Speaker 01

  There's a huge debate, there's a huge debate, okay, like, if you wanna dissect the literature and be, you know, an evidence-based, you know, physician. Today, folic acid, which is the synthetic form, which eventually, you know, your body will change into folate. Is the one proven by studies, by huge epidemiologic studies, that it will decrease the risk of neurotub defects.

• 42:25Dr. Darshan Shah?

  Right.

• 42:26Speaker 01

  So we should still give folic acid.

• 42:28Dr. Darshan Shah?

  Hmm.

• 42:28Speaker 01

  Yes, there are women that have some mutations in the gene called MTHFR, where they will not kind of, you know, convert it to the folate or this active form that they will directly take folate. I don't think there's anything bad about it, but again, there's no studies done on folate to decrease neurotubefin.

• 42:47Dr. Darshan Shah?

  Right.

• 42:47Speaker 01

  So a lot of times, you know, I get patients that ask me, I say, take folic acid three months before the pregnancy. If they have the MTHFR mutation, we might add the folate form.

• 42:56Dr. Darshan Shah?

  So you could take both.

• 42:57Speaker 01

  Yes.

• 42:58Dr. Darshan Shah?

  Right.

• 42:58Speaker 01

  During pregnancy, if they, you know, wanna continue with. But the important part of folic acid and what it does is actually even before you find out you're pregnant, the neurotube is starting to form. So once you discover you're pregnant and you're like a few weeks, then the, the, the work of folic acid stops there. Cause the neurotube have, so maybe women that have MTHFR mutation, they will benefit from folate throughout the pregnancy. We don't know. It doesn't hurt. Uh, it's a water soluble vitamin. It's a B nine and it's a B nine, I call it. So it's right in the gray zone, but if we wanna follow the guidelines still, folic acid is the way to go. I know a lot of people will not like what I say now, but I, a lot of times I do, I give both honestly.

• 43:40Dr. Darshan Shah?

  Yeah.

• 43:41Speaker 01

  So that, you know, we bypass if there's any obstruction in, in that mutation. But, but today, folic acid is still what in the American College of OB GYN recommends and most of our inner societies. But folate is not out. I, I still think it's okay to take it. And then of course it depends on each patient.

• 43:57Dr. Darshan Shah?

  Right, right. Okay. Thank you for breaking that down for us and what you recommend. Um, and then, you know, there's this marker that a lot of people that are trying to get pregnant are checking called AMH. Can you tell us what that is and, and the utility of that and how women should think through that?

• 44:10Speaker 01

  Yeah. So first of all, your antiemotional hormone is one of the markers we use to tell us about ovarian reserve or how much reserve they have. One, it doesn't tell us about the quality of your eggs. So this is very important. Second, it doesn't tell us if, what are your chances of getting pregnancy? If you check an AMH and it's low, it doesn't mean you're not gonna get pregnant.

• 44:28Dr. Darshan Shah?

  Hmm.

• 44:29Speaker 01

  So this is so important. I get so many patients coming in crying, my AMH is so low. And then a few months later, they're, they're. They're pregnant with twins. I've seen this so many times. So AMH doesn't mean you're not gonna get pregnant. AMH is one of the markers used to tell us about your ovarian reserve. It's very helpful if you're gonna go through IVF for the physicians to know how to stimulate your ovaries. You might need more stimulation when your AMH is low. So it's not a standalone marker. You have to combine it with other markers, your ultrasound, your egg count, your FSH day two. And then, of course, your your overall health is and your age is actually probably the best marker for fertility. We know that. But AMH is a good marker, but it doesn't tell us the whole story.

• 45:11Dr. Darshan Shah?

  Got it.

• 45:12Speaker 01

  So very important, don't freak out when your AMH is low and it's not the only marker.

• 45:16Dr. Darshan Shah?

  Got it. And I think AMH is a good number to follow as you're trying to improve your chances of having a healthy baby. So maybe something can follow along as.

• 45:25Speaker 01

  Absolutely. It might be a like a clue that, you know, maybe my ovarian reserve is low. Let me work out my and I've seen so many patients coming back three to six months later. After optimizing their sleep, their exercise, their diet, their AMH goes up.

• 45:40Dr. Darshan Shah?

  Yeah.

• 45:41Speaker 01

  And they're happy and.

• 45:42Dr. Darshan Shah?

  Right.

• 45:42Speaker 01

  And yes, it's a perfect marker to give us incentive to to work, but it's not the whole picture. So I think people, you know, are afraid of AMH and they worry a lot about it.

• 45:53Dr. Darshan Shah?

  Well, to your point, I think a lot of people get their marker done if it's low, they think I'm screwed. I'm not gonna get pregnant and it's not true, right?

• 46:00Speaker 01

  Yeah, yeah, yeah, yeah, yeah.

• 46:01Dr. Darshan Shah?

  And and so you mentioned some other markers, you said AMH, ultrasound of your ovaries to check the the number of eggs. And how do you check the quality of the eggs?

• 46:11Speaker 01

  You cannot check the quality. It's based on your age. So that's probably the the strongest marker. Of course, the older the person is, the you know, the the quality of the eggs and the DNA fragmentation is gonna be higher. And the risk of what we call aneuproidy and those eggs are gonna be less, that's, you know, we cannot change it. But we can delay it as much as possible by optimizing our health.

• 46:33Dr. Darshan Shah?

  Right.

• 46:33Speaker 01

  And I think by the time you will improve your ovarian reserve. But actually, this is so important too, not only to get pregnant, but also it'll tell us when you might become menopause and your ovarian age. And I know. You're gonna have quite many talks about this ovarian age tell us a lot about our longevity.

• 46:51Dr. Darshan Shah?

  Right.

• 46:51Speaker 01

  So improving your AMH, let's say, is not only to get pregnant, but also to, you know, delay menopause. And when you delay menopause, you're gonna improve your health span.

• 47:01Dr. Darshan Shah?

  Right.

• 47:01Speaker 01

  So it's kind of a continuum. We cannot divide women's health into, you know, puberty, pregnancy, menopause. They have to be one continuum because, you know, it's a one, one, one body.

• 47:12Dr. Darshan Shah?

  Yeah.

• 47:12Speaker 01

  And it tells us, you know, at every stage of life, we can get clues from, from that.

• 47:17Dr. Darshan Shah?

  Yes.

• 47:17Speaker 01

  But back to AMH, it is not the only thing that will tell you about, you know, your ovarian reserve. Quality is difficult to know, the quality of the eggs.

• 47:26Dr. Darshan Shah?

  Sure, sure.

• 47:27Speaker 01

  Before, you know, retrieving them and then fertilizing them and, and know if the embryos are healthy or not. You cannot know about your.

• 47:31Dr. Darshan Shah?

  Yeah.

• 47:32Speaker 01

  But maybe in the near future, we'll be able to do some sort of, you know, DNA testing that could tell us about, about it. But we're not there yet. We cannot know about the quality of the eggs.

• 47:41Dr. Darshan Shah?

  Right, right. Last question is a tough one for you.

• 47:44Speaker 01

  Let's see.

• 47:45Dr. Darshan Shah?

  So if you're a thirty year old woman and you still are, um, you know, you don't have a child yet and you have, maybe you're not in a relationship yet and you're thinking like, what should I do at this point in time?

• 47:58Speaker 01

  Hmm.

• 47:58Dr. Darshan Shah?

  The reason I ask you this question is I, I get this question a lot and it's all around. Do I, um, freeze my eggs now? Especially when you turn like thirty five.

• 48:07Speaker 01

  Yeah.

• 48:08Dr. Darshan Shah?

  And above, women are really looking to freeze their eggs.

• 48:12Speaker 01

  Yeah.

• 48:12Dr. Darshan Shah?

  What is your advice to these women, um, as far as, um, how should they think about timing of egg, of freezing eggs?

• 48:18Speaker 01

  I think this is a great question and I think every woman deserves to know about this technology. Uh, and then they can decide, you know, if they wanna do it, pursue it or not. But, you know, the overall idea is the earlier you freeze your eggs, the more eggs you're gonna get and better quality. But do you really wanna freeze your eggs at twenty five? You might not be in that mindset and yes, you might, of course, you know, find a partner and have a kid. But the earlier you do it, the better. I think the age of thirty, thirty two is a great time. Because that way you will get a good amount of eggs and good quality at the same time.

• 48:52Dr. Darshan Shah?

  Hmm.

• 48:53Speaker 01

  But yeah, there's nothing wrong with doing it at twenty eight, thirty five. Even at thirty seven, when you're just, I mean, women have now careers. Uh, you know, their, their, their, their health in the workplace is so important. And I, I love to talk about this because we ignore their health when they're in the workplace. They have pains and endometriosis and menopause and they're still producing and, and have high levels and, and their COs and their teachers and their doctors. So this is another topic to talk about, but I think freezing your eggs, putting them on the side is like uh freezing the sperm like we just talked about. So I think the earlier the better, but thirty, thirty two, if you're in good health is a perfect time. And there are actually calculators that will tell you, you know, how many eggs you need to freeze to end up with a pregnancy later on.

• 49:36Speaker 01

  Because when you freeze, let's say eighteen eggs and you thaw them now and you wanna use them, some of them will die.

• 49:41Dr. Darshan Shah?

  Hmm, okay.

• 49:42Speaker 01

  There's certain calculator that can estimate, you know, how many eggs you want. Let's say at thirty, I need to, let's say, bank twenty eggs so that I will end up with one or two pregnancies later on. You might use them at the age of forty or forty five.

• 49:54Dr. Darshan Shah?

  Right, right, right.

• 49:55Speaker 01

  So, yeah, I think everyone deserves to know about egg freezing and we should be discussing with them. And if they are and they're ready to do it, go ahead and do egg freezing.

• 50:05Dr. Darshan Shah?

  Right. How safe of a procedure is it to extract the eggs?

• 50:08Speaker 01

  It's a very safe procedure. Usually it's done by reproductive endocrinologists, which are OB G O A Ns trained in fertility. Um, they take, you know, some, you know, stimulation hormones or injections for, you know, a week or ten days. And then they get that very easy procedure that's done, kind of the sim- similar to the first part of an IVF.

• 50:25Dr. Darshan Shah?

  Right.

• 50:26Speaker 01

  And then that's it. And the recovery is fast, the complications are very minimal. So, yeah, I mean, I definitely open up the subject and talk to my patients about it. But, you know, some don't wanna do it, some wanna do it, but yeah, it's a good thing.

• 50:40Dr. Darshan Shah?

  The procedure, just so people know that are listening to this podcast, uh, if you're curious, it's, it's an ultrasound guided and you just put a needle in, in the ovary.

• 50:47Speaker 01

  Yes.

• 50:47Dr. Darshan Shah?

  And remove it using an ultrasound.

• 50:49Speaker 01

  Correct.

• 50:49Dr. Darshan Shah?

  And you're not asleep for it.

• 50:50Speaker 01

  You're a little bit sedated, yes.

• 50:52Dr. Darshan Shah?

  You're sedated, okay, and local anesthesia.

• 50:54Speaker 01

  Local anesthesia and you're sedated.

• 50:56Dr. Darshan Shah?

  Thirty minutes or so, an hour?

• 50:57Speaker 01

  Yeah, much less.

• 50:58Dr. Darshan Shah?

  Much less, so just a quick procedure.

• 51:00Speaker 01

  The longer process takes is to prepare the ovaries, to stimulate them, and then, you know, you can, you can extract those. X to that, you know, minor egg retrieval process, which is quick and easy.

• 51:11Dr. Darshan Shah?

  And the and the stimulation of the ovaries is done by taking like oral enclomiphine?

• 51:15Speaker 01

  Usually it's given, you're given injections.

• 51:17Dr. Darshan Shah?

  Injection, okay.

• 51:18Speaker 01

  Injectables, stimulation drugs like ACG and FSH.

• 51:22Dr. Darshan Shah?

  Got it.

• 51:22Speaker 01

  That way it will produce more eggs so that they can, you know, extract them.

• 51:26Dr. Darshan Shah?

  But I think you're.

• 51:26Speaker 01

  Those are done by reproductive endocrinologists.

• 51:29Dr. Darshan Shah?

  Right.

• 51:30Speaker 01

  Um, and like it's a very easy procedure.

• 51:33Dr. Darshan Shah?

  Got it.

• 51:33Speaker 01

  Yeah.

• 51:33Dr. Darshan Shah?

  And when you say make more eggs, you're talking about stimulating the eggs.

• 51:37Speaker 01

  The ovaries.

• 51:38Dr. Darshan Shah?

  The ovaries, right, to release the eggs, right? Because you're born with a certain number of eggs.

• 51:42Speaker 01

  You're born with a certain number and then you just make them grow to a stage. And then, of course, you know, whenever you do that, usually in a normal cycle, you overlay it from one.

• 51:51Dr. Darshan Shah?

  Yeah.

• 51:51Speaker 01

  Sometimes two and you get twins. But when you have multiple eggs that are stimulated, then they kind of reach, reach the same stage. And then the doctor will decide based on their size when to extract them. So they are in a good, you know, phase of of of the egg.

• 52:04Dr. Darshan Shah?

  Makes makes sense.

• 52:05Speaker 01

  Yeah, yeah, yeah. It's a, it's a, of course, it's a, it's a science by itself.

• 52:09Dr. Darshan Shah?

  Well.

• 52:10Speaker 01

  But, and you know, it's a bit expensive to to to do the procedure. But it might, you know, be worth for certain people depending on, you know, their life stage and life career and decisions.

• 52:21Dr. Darshan Shah?

  Very good.

• 52:21Speaker 01

  Yeah.

• 52:22Dr. Darshan Shah?

  Well, Dr. Labib, it's been such an amazing.

• 52:24Speaker 01

  Thank you so much for having me.

• 52:25Dr. Darshan Shah?

  Time talking to you here and I mean, you're, you have such an incredible career. You're the residency director now, right? Is that?

• 52:31Speaker 01

  Yes, yes, yes.

• 52:32Dr. Darshan Shah?

  At which which hospital?

• 52:33Speaker 01

  At Broward Health.

• 52:34Dr. Darshan Shah?

  Uh huh.

• 52:35Speaker 01

  Yeah, we have a new OB GYN residency, so I'm excited about that. You know, teaching residents is such a passion for me. So I always love to do that because, you know, whoever taught us medicine, you know, it's our mission to, you know, teach back the new generation.

• 52:49Dr. Darshan Shah?

  Right.

• 52:49Speaker 01

  And I see so many things now changing in medicine, whether, you know, how we look at things, how we treat things. Even also like the business part of medicine, which no one taught us about. I think my goal is to kind of put this in the minds of, you know, the new generation of physicians. Uh, because things are changing today. So, so yeah, thank you for having me. I think I'm so excited, you know, to to to be on the podcast and it was such a. Short, I think, I don't know how long we talked, but I felt it was so short.

• 53:20Dr. Darshan Shah?

  I know, I know. I feel like I could talk to you for hours and hours about this. But I did want to give my listeners, because this is a frequently asked about topic. And I did want to give my listeners some information coming from you. Because you are bringing together these two worlds of longevity and functional medicine with OB-GYN and bringing it together, which is how I wish everything was taught in medicine, right?

• 53:43Speaker 01

  Yeah, yeah, because I think the longevity, functional medicine, whatever you want to call it, root cause medicine, and I know there's a lot of things out there. But it makes so much sense to add to any specialty. Whether you're a surgeon, an OB-GYN, dermatologist, a radiologist, I mean, everybody should know those things. And yeah, I think combining them is such a powerful tool that can make patients more powerful and their health better. And that's our goal at the end, yeah.

• 54:11Dr. Darshan Shah?

  Where can people find you on social media and anywhere else?

• 54:14Speaker 01

  My name, and my name is not very, I think it's a bit unique. So like if you just put my name, you will, you know, find me on social media. And, you know, I'll be more than happy to answer, you know, questions. And there's also my email and contact information on that. So again, I thank you so much for this opportunity.

• 54:31Dr. Darshan Shah?

  Thank you so much.

• 54:31Speaker 01

  And hopefully we'll have, you know, part two and part three.

• 54:34Dr. Darshan Shah?

  Let's keep doing it. I can't wait.

• 54:36Speaker 01

  And then also thank you for what you're doing in the space and like, you know, relaying those messages to people and, you know, all what you're doing on social media, on the website, even at Next Health. I see so much, you know, difference and you're making difference in people's lives.

• 54:52Dr. Darshan Shah?

  Thank you. I appreciate that. Thank you. Thank you.

• 54:58Dr. Darshan Shah?

  That was a great recording with Dr. Labib. Here are the top five things I learned on this episode. Number one, infertility is a health signal. Infertility isn't just a reproductive issue. It's often a check engine light indicating underlying health problems that need to be addressed for overall well-being. Number two, optimize health before IVF. Before committing to expensive IVF treatments, dedicate three to 12 months to optimize health for both partners, which significantly boosts. Success rates and long-term health. Number three, dad's health matters significantly. A father's health, including sperm quality and DNA integrity, is just as crucial as a mother's, influencing not only conception, but also the child's genetic programming.

• 55:41Dr. Darshan Shah?

  Number four, the placenta is a biomarker. The placenta, often discarded, is a powerful temporary organ that offers critical clues about pregnancy, health, and potential future complications and future health risks for both mother and child. Number five, sperm count is a vital sign. Regular sperm analysis, even for young men not actively trying to conceive, can serve as an early biomarker for cardiovascular, hormonal, and overall systemic health.

• 56:11Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.