Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode of the Conquer Your Weight podcast. I have a guest with me today, Dr. Erica Bove. She is an OBGYN and an REI, a Reproductive and Endocrinology Infertility Specialist, and she helps women to navigate their fertility journeys, both in the medical setting and then also as a coach, which is really cool because she helps women in this really emotionally fraught time to navigate what that looks like. And so Dr. Bove, I'm so excited to have you here today. We're going to talk a bit about the weight and how that plays a role in fertility and mindset. It's going to be a great conversation, so thank you for being here. Dr. Erica Bove: Yay. Thank you so much for having me. Dr. Sarah Stombaugh: Yeah. So tell us, I know I gave you a little bit of a brief introduction, but tell us a little bit about yourself, how you came to be here in this space, and we'll get talking from there. Dr. Erica Bove: Absolutely. So I actually went to med school to be a psychiatrist, which I think is so interesting because things have come a little bit full circle. When I went to med school and started doing my clinical rotations, I realized how much I loved women's health and how much I loved also working with my hands. And so I took a departure from my strong plan, which was a career in psychiatry, and I decided to go into OBGYN, and then I did a fellowship after that in infertility and endocrinology of reproductive systems. And as I got into practice, I was just seeing this huge gap between what patients were getting in the clinical setting in terms of like, okay, this is your diagnosis, these are your next steps, this is what you got to do. And it was almost like this analysis paralysis, all these strong, confident women were just debilitated by making their next choice, by having such intense feelings about the fertility journey in general. And I realized I think the mindset, the soul, the emotional aspect of this is just really not being served. So just like I found my way into coaching and kind of drank the coaching Kool-Aid with some parenting coaching and some relationship coaching, and then I thought to myself, I think my patients would really benefit from a lot of these tools. And so once I became a coach, I started experimenting with some coaching models and mindset work in the clinic, and all of a sudden patients were like, oh my gosh, that's just when I needed to make this decision, or I feel so much less anxious about this whole process, and I could see my patients actually being more well and more confident and more prepared in their journeys. And so that's when I decided that I was going to branch out and be a fertility coach, and now that's what I do for about half of my time. Dr. Sarah Stombaugh: I love that. And I think we think so much in medicine, there's this overlap of what is happening physiologically in your body, and while that's really important, when we don't address all of those underlying factors, our fears, the things that keep us from implementing these different goals, it makes it really fall flat. And so whether it's fertility, whether it's weight, that psychological piece is really important in being able to navigate that. So I absolutely love that you are doing that as part of your work. One of the conversations I have with people all the time, whether they are sort of actively in their fertility journey or decades later even, it's very common that women who are dealing with infertility deal with weight issues. And there's a lot that comes up in terms of body image, both in terms of sometimes this belief that our body is failing us, it's not functioning in the way that it needs to. And then also that sometimes these treatments can change a lot in terms of how our body processes energy. There can be some weight gain associated. So tell me a little bit about both the science of that and how you help people to address those. Dr. Erica Bove: Oh, that's such a great question, Dr. Stombaugh. So what I would say is I think the starting point is really shame, and I think the fertility journey involves so much shame in terms of shame is I am bad. And so I think a lot of people associate carrying extra weight with being bad, especially in the society that we live in. Similarly, a lot of people associate not being able to conceive with, I am bad. There is something fundamentally wrong with me. And so when I get to know my patients and my clients, I try to understand what their journey has been like with weight since they were a kid. Tell me about puberty. Tell me, were you an athlete in high school? What happened if you went to college? What has your whole journey been like? And if they've been pregnant before I say, tell me what you were doing at that time. What was your diet? What was your exercise patterns? The number is important. I do believe in a fertile zone for each person, but that's less important. It's more about, tell me about your practices when this happened, especially if we're trying to bring this about again, and even if they've been pregnant and ended in a miscarriage. So many things have to happen physiologically for even that to happen with ovulation and fertilizing of the egg and that embryo traveling down and implantation. So many things have to happen where I just ask those questions to really understand that person, their fertility history and their weight loss journey as one journey. And then once I understand that, then I ask them, how do you feel about this right now? Is optimizing your weight something that you're interested in? We talk about the data between carrying extra weight, high BMI, and ovulation issues. Even if somebody is ovulating, there's lower pregnancy rates per cycle actually in terms of fertility. And so I will say probably 90% of my patients are like, yes, I've been trying to lose weight this whole time and I've hit a plateau, or I just feel so busy and stressed and then I stress eat and then it makes it worse. You kind of uncover all of these different cycles, and so whatever that common goal is for that person, a lot of times we actually press the pause button on fertility treatments and we say, you know what? Let's invest three months in this process, in this weight optimization journey. I usually work with somebody like you who really understands the intricacies of all of this. Sometimes it's even six months, especially if they're young and we have time, oftentimes they don't even need my help. It is so wild. They call back, they're like, Hey, Dr. Bove, guess what? Well, that was awesome. That was easy. Dr. Sarah Stombaugh: I love that. Dr. Erica Bove: That was not easy for them, but I'm like, okay, well, less is more sometimes, but I think it's really about empowerment, and I think a lot of people feel disempowered by their journey with weight struggles and also by their journey with infertility and trying to understand where the overlap is, how the mindset shifts can affect both, and then how we can help people bring about their goal. And I realize that was only your first question. I can answer your second question, but those are some of my thoughts for the first question. Dr. Sarah Stombaugh: Absolutely. I love that because it's really about getting to reconnect with your body and looking at how your weight and your health is impacting all these other areas of your life, whether it's for fertility or just in general, sort of healing that relationship with food and with your body. I love that. Dr. Erica Bove: Yes. And then your second question. Dr. Sarah Stombaugh: Go ahead. Dr. Erica Bove: Yeah, I think in terms of the fertility journey and the different treatments that are involved, and sometimes it's like, I mean, if people don't know and they're listening to your podcast, sometimes it's like months and years. It's not just like, I'm going to do this for two or three weeks and then I'm going to get pregnant. It's like, let's try this for four months, and if that doesn't work, then we're going to get you into on different train tracks to try this other treatment. And so sometimes people conceive, I mean, my goal is as quickly as possible, but it can take years. And so it is really complex. And one thing that I like to do is I like to normalize that there will be some side effects from the medications. There will be some bodily changes that are associated with this. Sometimes it's weight gain from progesterone, extra progesterone, or even water weight from some of the fertility treatments that we use. And so I just say, your body is going to feel different. Your body is going to change. You may not how you feel in your body some days. And just know that this is a chapter in the whole picture, and there are things that you can do every single day that will make you feel better in the context of this journey. And so gentle exercise most days of the week, even if it's walking, getting outside, I always encourage my patients and my clients, they're like, oh, I'm so busy. And I say, okay, do this. Don't look at social media until you've met your exercise goal and then give yourself permission because we all have time to go social media for 45 minutes or an hour. And then it's like, oh, but I don't have time to exercise. And I mean for me, exercise is medicine. It's like brain chemistry. So that's what I tell my people to do and they think they don't have time. I think it's really powerful. Dr. Sarah Stombaugh: Yeah, I agree. So tell me some of the other things. So you feel like your body's not really working, you feel like, oh, I'm getting weight. I'm really out of control, which is very common during this journey. So exercising can be helpful. Are there other things that even if it feels sort of small at the time that help people feel a little bit more in control or help them feel like they're moving their health in a positive direction? Dr. Erica Bove: Yes. I think for me, sometimes it's actually looking at the statistics and so saying, because each month in and of itself has a low probability of working. But if you look at, say I'm helping somebody ovulate and they're not ovulating, I might say, okay, you have about a 10% chance of conceiving this month, which sounds abysmal. So I'm like, just expect you're not going to be pregnant the first month because it's like a 90/10 chance. But if you stick with this, if you give it the good college try over four to five months, you have about a 45% chance of being pregnant. That sounds much better. I think a lot of this is the rollercoaster of intervening and expecting that something is going to be different because we're intervening. Even in that first month, I ovulated fantastic. Every ovulation, most ovulations actually don't end in a conception even in people who don't have infertility. So just sort of normalizing that, but then saying, if I can get you to ovulate for four to five months in a row, you might get pregnant on the second one. You might get pregnant on the third one, stay the course. Because I think what happens is people get so frustrated with it, and this probably happens in your work as well, that they just decide to throw in the towel. They're like, this is too hard. I can't do this. Forget it. I don't even know why I started this during the first place. And then they stop maybe after cycle number two, whereas maybe they would've even gotten pregnant on cycle number four. You just don't know. So I say, let me do the worrying. Let me be the one who kind of guides with the plan in this, but trust the process. And I think that helps people relax a little bit because even if they're not controlling it directly themselves, they're like, somebody has my back. Somebody is navigating this with me, somebody's in my corner and I do believe it can happen. Dr. Sarah Stombaugh: Yeah, I love that answer. And I think knowing that you have someone who's a professional who's supporting you in this and really in a really comprehensive way being able to support patients in this, I think that that's just so valuable. And tell me a little bit, we think about this, I talk about forest and trees all the time. Sometimes when we're walking through the forest and we just see tree, tree, tree, it's hard to step back and think about the whole forest, think about the whole journey. Sometimes in weight loss, we're looking at the scale and that ideally is moving in the direction that we want it to. But in fertility, I think a lot of times there are changes that are happening behind the scenes on a lower physiological level that we're not always directly aware of. And so month after month, even if those changes are happening, if the pregnancy hasn't occurred, it feels like nothing is happening and that is stressful. So tell me a little bit. A lot of times we have built these different things that we do when we respond to stress. If we feel like we've had a really difficult day at work, if we haven't made the sports team in school, if we've had a fight with our significant other or with friends, we have things that we do to respond to our stress. And in a journey like infertility and working through that, I imagine that stress comes up frequently. So tell me, we talked about exercise, we talked about sort of letting you do the worrying. Are there other things that you recommend so that people can manage their stress beyond eating, which certainly with my patients comes up a lot, that emotional eating component? Dr. Erica Bove: Yes. So I think there are many layers to this question. I think the first layer is learning how to feel our feelings, and that's not something that we're taught how to do generally speaking. Actually in medicine, we're actually kind of taught to suppress our feelings and to ignore them to focus on the task at hand. And so I think there's a lot of feelings involved in infertility. There's a lot of feelings involved in the weight loss journey, and it's really tuning in to say, okay, what am I feeling in this moment? Because our feelings drive our actions and our actions drive our results in the world. And so if we have this subconscious tape of what we're feeling and we're not even aware of it, then that comes out sideways in terms of actions maybe we don't want to have and just sort of maybe we are stressed out about the fertility journey and then we stress eat. But if it's like, oh, I think I'm feeling shame, I think I'm feeling inadequate, I think I'm feeling unworthy of this. I hear that a lot too or even guilty that I can't make my husband a father. And that comes up a lot too, right? I've had so many women say to their husbands, you need to divorce me and marry somebody else because you would be such a good dad, and I just feel so horribly guilty that I can't do this for you. And I mean, it is so much more complex than that, but I think people really struggle with navigating this whole landscape. So when we can learn how to feel the feelings and let them go, then they don't sabotage our behavior because we're like, oh, that was just shame. Shame. And I had a conversation, I felt the shame, and then I let him go. Dr. Sarah Stombaugh: I love that. Dr. Erica Bove: So that's really helpful is feeling feelings in terms of just understanding our own inner landscape in terms of the stress, I think a lot of this, especially in infertility is the isolation of it all because nobody talks about it. And so a lot of this is helping people understand that they're not alone and that if one in six couples is dealing with this and one in four female physicians, that it's super common. Personally, I find the support groups to really be really helpful because people see their stories and other people's stories, and people can offer each other guidance and support in a way that is really healing and really powerful. And so that isolation piece, I think that can increase the stress. And when you can help connect people to other people who are dealing with similar things, a lot of that just melts away. Dr. Sarah Stombaugh: Yeah, I love that. Thank you for sharing it. Tell me a little bit when you think about food, because that's always what we're trying to get pregnant, or if we are pregnant, there's so many conversations about what I should eat, what I shouldn't eat. How do you help patients to navigate that, whether they are struggling with their weight or not? Is there sort of a best diet for trying to conceive? What are your recommendations there? Dr. Erica Bove: Such a great question, and I literally, I get asked this question every single day, so it's super relevant. I think the thing to realize is that there's not one size fits all when it comes to a diet for fertility. I think people have even looked at a diagnosis of polycystic ovarian syndrome where maybe there's some insulin resistance and maybe there's some other things going on. Even in that situation, there's not one size fits all. There's certain guidelines that are helpful that I think it can help people and we can talk about those, but I think that a lot of this is helping each person understand what foods make them feel satiated, what foods make them feel healthy and strong. Trying to have a balance of the different food groups I think is really helpful. And so what I tell my patients, the simple carbohydrates, the processed food, try to eat from the outside of the grocery store, not the middle where all the processed food is. That's a good general rule of thumb. And try to get veggies like you talk about on your podcast all the time, veggies in your diet, some fruits, and if you're going to have carbohydrates, try to make them complex carbohydrates and not something that is just super easy to store. Because I think that just the nutrition, if it can stay around a little bit longer, it usually goes farther for many people. So there's the people with PCOS who talk about trying to increase protein intake, which I love protein. I think protein is good for all of us. And really just being mindful of what foods make somebody feel healthy and strong. For me, it's almonds. If I carry almonds with me and I get hungry and I have a handful of almonds, I feel like I'm on top of the world. If I eat a piece of pizza, I feel like I've swallowed a brick. So over time I have learned this intuitive eating for myself, and I try to help my patients and my clients do the same thing so that they can choose foods ahead of time that they know are going to make their bodies feel good. There is a lot written about, well, infertility is inflammation and we need these anti-inflammatory diets. And people talk about going gluten-free and dairy free. And I mean if you look for anything on the internet, you can find it, which is the scary part. And people literally, I mean they just drive themselves crazy because they are like, it's my diet. That's the reason why I'm not getting pregnant, and it's all my fault. If I don't eat the exact specific foods I'm supposed to, then that's why it's not working. And so I think there's a middle ground where we realize that food is medicine. We need healthy food to be healthy and strong for our immune systems, for our fertility. I always say growing eggs, growing embryos takes energy. So we have to be mindful of that, but by the same token, not become so obsessed with it that we then use it as a weapon against ourselves that we're like, oh, it's because I'm not doing all the right things that this is failing. So I think unless somebody has a diagnosis of celiac disease, there's not really any evidence that going gluten-free is the answer. So similarly, the whole dairy thing, it is really controversial, but I would just say I would caution people against thinking there's one way to do it. I think if somebody needs way optimization, then they should work with you or somebody locally who can help them because that really is going to help provide a tailored plan for them that keeps in mind that they're trying to get pregnant. Because a lot of things that a lot of obesity medicine doctors offer are not compatible with pregnancy. So we have to think keep that in mind as well. And there's just also a lot, we just dunno either about the GLP-1s and early pregnancy. And so hopefully with time we'll have more data, but I think a tailored approach is the best way and helping people figure out what feels good to them personally, what successful for them personally, and then go from there. Dr. Sarah Stombaugh: Yeah, absolutely. And I think to sort of add to that, when I work with my patients, they sometimes get really frustrated because they're like, well, what diet should I follow? And I'm like, you should follow that. Let's say their name is Erica, right? You should follow the Erica diet. And they're like, well, what the heck is the Erica diet? And so we designed that diet and the reality is there are certainly principles that are going to carry through for many of my patients, we're emphasizing lots of whole foods where we can, lots of vegetables, lots of food fruits, lots of grains in their whole form meat that is coming from high quality sources. But as you said, when you look at some of these diets, gluten-free diets, a lot of people who improve on a gluten-free diet may have actually eliminated just bread out of their diet completely, whether that's a traditional wheat bread or even a non wheat bread. And so they're really just eliminated a lot of processed foods. And a lot of times we realize we feel better when we have more stable sources of energy, when we have more fiber or when we have more protein, things that have these sort of staying power and meals that make us feel good for hours later and that, like you said, maybe feel like you have a brick sitting in your stomach or sometimes we have foods that make us feel really crashy afterwards, so they give us this sort of surge of energy and then an hour or two later, we're ravenous, we're hangry, we're kind of hypoglycemic. And we actually sometimes are. It's been interesting, even patients who track their blood sugar see that it's wild, they've eaten something that is really carbohydrate dense, especially more processed, carbohydrate dense, and then an hour or two later they're actually hypoglycemic because their body has sort of gone overboard with storing that. And so it feels, I think especially in the infertility journey, it feels like I have to do everything right now. You don't feel like you have the luxury of time of let's slowly build these changes. But the reality is when we think about our entire lives and we think about what are the things that we can do, not just to support our fertility journey, but to support our overall long-term health goals. A lot of times it's just making these small and incremental changes and paying attention, as you said, the foods that make me feel good right now, they sit in my body well, I feel good for hours afterwards. And then thinking about too, what can I do sometimes just 1% better. A lot of times patients will say to me, are grapes healthy? I heard grapes are really high in sugar. I'm like, okay, if we're going to lay out all of the fruits, for example, are grapes higher in sugar compared to a lot of other fruits? And yeah, they are. But when you compare them to chips or you compare them to popcorn or you compare them to a pastry, that is not going to be a better choice. And so instead of just, is this good for me? Is this bad for me actually stopping to see what is the role that it's feeling? Is it better compared to what I was doing before and not in imal way, but A, does it serve my needs more efficiently? Is it a better fit for what my body needs? And just sort of 1% better each day moving in the direction of your goals can really be a lot better than just being sort of all in or all out, which a lot of times we're really inclined to do. Dr. Erica Bove: That is such a good point. That is such a good point. And I think, do you help people get in touch with their hunger signals? Dr. Sarah Stombaugh: Oh, a hundred percent. Yeah. Dr. Erica Bove: Let's talk about that because I think people just don't even understand that that's a thing. Our bodies actually tell us what they need. Dr. Sarah Stombaugh: Our bodies have gotten really disconnected from it. And when we think about this intuitive eating, for example, the interesting thing about intuitive eating is I believe it only really works when we're eating real food. So a lot of times when we look at more processed foods, a lot of those have been designed truly in a lab, they're designed in food labs in order to hit all of these different taste buds, to have us wanting more of them. And it makes it really challenging for us to feel the appropriate, maybe not hunger, but especially satiety after we eat satiety does not come in on the same way when we've eaten some of these more processed foods. And so I have all my patients logging food and I have them do the numerical scale where they're paying attention to what is my hunger, what is my satiety? Always checking in at the beginning of a meal, at the end of a meal, but sometimes even halfway or two thirds of the way through a meal, it's a great place to check in and say, okay, have I had enough? Do I need to eat more? What is my body saying right now? Because they think a lot of us have gotten used to feeling sort of uncomfortably full as the norm. We're eating at times where we're just not hungry at all. So we walk by the break room at work or someone offers us something and it's in our mouth before we even have stopped to say, Hey, am I actually even hungry right now? And there may be other reasons that you're deciding to eat besides just hunger, but at least that check-in to say, well, is my body even hungry? Is a really great way to start paying attention to what's going on. So yeah, that's a little bit about how I counsel about it. Tell me how you utilize some of those same strategies. Dr. Erica Bove: Yeah, very similarly, and I think just the act of tuning into your own body and listening and just asking it what it needs. I think so often we're not taught how to do that, and maybe it's like, I'm actually thirsty. I'm not hungry. Maybe I'm actually tired and I think I actually need a nap and I'm looking to food because it'll give me a temporary dopamine hit and I'll feel a little bit better. But it's almost like the AA, hungry, angry, lonely, tired. I think about that sometimes like, oh, maybe I'm just lonely and that's why I want to go to the pantry. So I think a lot of this comes back to feelings. When we can have a better roadmap and understanding of the inner landscape of our feelings, then we can actually probe that and say, how am I feeling right now? And is that feeling driving me to want this external thing, i.e., food or is it, oh, do I need to meet that need and then that's actually going to help me in a way that doesn't sabotage my efforts on the weight loss journey? Dr. Sarah Stombaugh: Yeah, absolutely. Yeah, I love that explanation. And it's so important because our hunger scale, it's going to change over time. And when we look at things like even the COVID pandemic for example, and we were a lot less active, a lot of people gained weight during that time for a multitude of reasons. Things like feeling stress and eating more or having more sedentary behavior, and so therefore, their calic needs were different. And so when we look at something like a hunger and satiety scale and starting to pay attention to on a day when you're more active, you're going to have more hunger, and that's okay. Your body needs that energy. Your body needs that fuel. And on the day where you're less active or in a period of your life where your metabolism has changed for whatever reason, being able to be in touch with that is really best skill, whether it's fertility, whether it's menopause, being able to hone in on what does my body need right now and the stage of life that I'm in is probably the most important tool for long-term weight loss success. Dr. Erica Bove: I think that makes so much sense because it's not going to be the same every single day. It's not going to be the same in every season. I think for me, one thing that's really helped me as I dealt with an eating disorder as a competitive runner back in the day, and so I really had to relearn how to eat almost like someone who's paralyzed has to relearn how to walk. So it was this very intensive, intentional process of how do I have a healthy relationship with food? How do I have a healthy relationship with my body? And it's been years since I did all that really hard work, but I think sometimes a lot of those ways of thinking about it come up, which I think is helpful and that I can help other people with that was this notion of never too hungry, never too full. For me personally, if I get so hungry, then it's so easy to yo-yo one extreme or if I'm so full. So I think that there's that moderation piece, like you said, checking in halfway, two thirds through the meal saying, do I really need this? Or even having smaller plates. That's something that I think is really helpful is just if you have a bigger plate at home, you're probably more likely to put more food on that plate. And so if you have a smaller plate that fits less food, you're like, okay, well then am I really hungry for more? Or is this just because it's here and it tastes good? And all those things. So just little things that I've learned along the way too. But I think just really emphasizing that this is a journey and that a lot of it is based in our mindset and just like the fertility journey is a fertility journey. The weight loss journey is a weight loss journey, and it's not going to look linear. The progress there's going to be sometimes there's going to be leaps ahead, sometimes there's going to be steps backwards, but just honoring the whole process I think is really important. Dr. Sarah Stombaugh: Well, I love that because what is happening when you take a step back, because there's always, I have this graph that I draw every day at least, and I'll send it home with my patients or email it to them if I'm meeting with them virtually. And it is this up and down that we see. And sometimes it feels like no change is happening, but when you step back and you can draw a graph and say, okay, what is actually happening? We see that there is a demonstrable change, whether it's weight or whether it's whatever else your goals are in life in weightlifting or in fertility, that over time sometimes we don't see the little changes, but they add up in a really significant way. And so I think it's probably true in every area of life, right? Dr. Erica Bove: Yeah, absolutely. And even for my patients thinking about things like, okay, you figured out what a cycle looks like in terms of treatment. You showed up for your blood draws and your ultrasounds, maybe they're getting injections. You figured out how to give yourself an injection, and I'm sure for your patients too, giving themselves injections, all those things that they need to be celebrated because when you enter this new world, it's like a whole new set of skills and language and things that maybe people have never done before. And it's like, this is the investment in yourself, this is the investment in the process. And then finding ways to celebrate the big and the small milestones I think is really important. Dr. Sarah Stombaugh: Yeah, absolutely. You said something about giving injections that made me think about, you mentioned earlier the GLP-1 receptors, and I feel like that is the topic of the day. Everybody is constantly talking about the Wegovy, the Zepbound, and some of the other medications like Ozempic, how we utilize these medications to support weight loss. And they've been a major game changer. And so for many people who have struggled with chronic excess weight, that is an amazing skill or tool that's available for people. But one of the challenging things is that, as you said, we don't know a lot about fertility, and a lot of the guidelines will say that you should stop about two months before trying to conceive. And so for people, especially when they feel like, Hey, my timeline's really tight here, whether it's just based on known ovarian reserve or based on age, you feel like they may not have many months or years in order to dedicate to their weight loss. And so what can they do both while trying to conceive and while working through this weight loss journey? And so one of the things I will say is that there's a lot of options that are really available that are safe in pregnancy. Certainly when we think about some of the dietary changes and we think about some of the stress management, we think about exercise, of course all of that is on the table. But even from a medication standpoint, we can sometimes do things like using metformin medication or using certain medications for the treatment of mood. I really like Bupropion, which the medication that decreases cravings and medications that you maybe safe to continue even throughout a pregnancy journey. That would be a discussion between your prescribing provider, between your REI or your OBGYN. But that there may be options available that are not the traditional like, oh gosh, I'm not a candidate for Wegovy, not a candidate for Zepbound? Is there something available to me? And the answer is maybe yes. And so whether that is your OBGYN or your REI or someone like your primary care physician or someone like myself in obesity medicine to reach out and ask, is there something that I can be doing right now? Because the answer might be yes, Dr. Erica Bove: That's right. And alongside with that, I want to mention that sometimes people think they have diminished ovarian reserve if they also have chronic excess weight because that physiological state does lower the anti-me Lian hormone. And as people do start to lose weight, that number comes up. It gets complicated with PCOS, but sometimes people think they have a diagnosis of diminished air reserve and they actually don't. And so there may be options. I think from my perspective, and for education, the most important thing in terms of fertility is still age. It's not any lab result, it's not any test. It's really like, what is your age? And so if you're 38 and you have a low A MH and you're worried about your timeline, it still may make sense to take a pause whether it's three months, six months to invest in this because it's all risk benefit conversation. But I think a lot of people don't think they have the time to invest. And oftentimes they do. And like you said, adjuncts are amazing. I love metformin, I love all these things. But even sometimes with the stronger medications, they are available and people may not think they're candidates. Dr. Sarah Stombaugh: And I think too, to add on, they're safe, especially in the IVF journey when you are using these medications. It's safe during egg retrieval. It's safe during all of these things. And so there may not be a reason to pause during that process, but rather to pause upon the actual conception. Dr. Erica Bove: Yes, exactly. Dr. Sarah Stombaugh: Cool. Well, as we wrap up the conversation today, Dr. Bove, anything else that you wanted to make sure to add for my listeners? Dr. Erica Bove: Oh goodness. I mean, I think it comes back to our self-image. It comes back to our worthiness as people. It comes back to who we truly are. And so I think as we're on these journeys, I think remembering our why we're doing this, our deepest why is really important. And I think understanding that our worth is actually internal. A lot of these things come in terms of externals, like, okay, am I pregnant? Am I losing weight? Am I not? These different things. But I think if we can hold onto that worthiness that is not based on anything external and then understand why we're doing this in terms of having a healthier life, having a better life, I think separating those two things can make it such that sometimes the day-to-day shifts in the data points, they may not rock us so hard when we can connect with our core and we can also understand, like you said, the forest and not so much the trees. Dr. Sarah Stombaugh: I love that. Well, and let me, my listeners may be wondering, oh my gosh, she sounds amazing. I want to learn more about her. I know that you've recently launched a podcast, and so I would love for you to share a little bit about that so people can find you and work with you if they're interested. Dr. Erica Bove: Well, thank you so much. So I love coaching my clients, the people who work with me are professional women who are undergoing their fertility journey and it's taking a little bit longer than they expected, or their mindset is just really, really suffering from this process. And so I have my website, which is love and science fertility.com. I have my podcast, which is everything's the same name, love and Science Fertility, which you can find on all the different podcasts comes out on Thursdays. And I also have my social media pages on Facebook and Instagram under the same name. So I would absolutely, if you're listening to this and you're like, oh my goodness, I would just love some help with the fertility journey, those are my people. That's who I love to serve. Dr. Sarah Stombaugh: Yeah, absolutely. And I believe very strongly in the work that you do and how you support your patients and your colleagues. And so I think that's really just so cool. So thank you so much Dr. Bove for joining us today. This has really been a pleasure. Dr. Erica Bove: Thank you, Dr. Stombaugh. So nice to be with you.