Lisa Hendrickson-Jack is a certified Fertility Awareness Educator and Holistic Reproductive Health Practitioner who teaches women to chart their menstrual cycles for natural birth control, conception, and monitoring overall health. She is the author of three bestselling books The Fifth Vital Sign, the Fertility Awareness Mastery Charting Workbook, and her most recent book Real Food For Fertility, which she co-authored with Lily Nichols RDN. Lisa works tirelessly to debunk the myth that regular ovulation is only important when you want children by recognizing the menstrual cycle as a vital sign. Drawing heavily from the current scientific literature, Lisa presents an evidence-based approach to help women connect to their fifth vital sign by uncovering the connection between the menstrual cycle, fertility, and overall health. With well over 4 million downloads, her podcast, Fertility Friday, is the #1 source for information about fertility awareness and menstrual cycle health.   Fertility Friday: fertilityfriday.com Real Food For Fertility: realfoodforfertility.com The Fifth Vital Sign: thefifthvitalsignbook.com Instagram: @FertilityFriday Facebook: Facebook.com/FertilityFridays LinkedIn: Lisa Hendrickson-Jack     For more information about Michelle, visit www.michelleoravitz.com   The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/   Instagram: @thewholesomelotusfertility   Facebook: https://www.facebook.com/thewholesomelotus/         Transcript:   Michelle (00:00) So welcome to the podcast, Lisa.   Lisa Jack (00:03) Thanks so much for having me back.   Michelle (00:05) Yes. So having you back again, we had a little mishap, issue with the recording for some reason, but we are on a new recording software. So hopefully this is going to be great and I'm excited to pick your brain again.   Lisa Jack (00:21) Well, I'm happy to be here. I mean we can never anticipate the tax nafus. It's part of online business, I suppose.   Michelle (00:28) Oh, totally. 100%. So we had so many good things too. That's what's really frustrating. We had such a great conversation about so many things. But for people who are first hearing about this, I know that a lot of people think that there's certain textbooks like menstrual cycles, or they have like sort of an idea in their mind of what a perfect menstrual cycle looks like. And since this is...   your absolute specialty and you understand it from like A to Z, can you describe what a healthy menstrual cycle should look like?   Lisa Jack (01:06) Yeah, I mean, that's a great place to start. And just to put it out there when I'm working with clients and practitioners, I always say there's no such thing as a perfect menstrual cycle because you're a human, not a robot. And so when we look at what a healthy menstrual cycle looks like, we should be looking at a range. And basically, what I can lay out is the different parameters that we're looking at. Often when I talk about the menstrual cycle, people's minds will go straight to the period.   Michelle (01:17) Right?   Lisa Jack (01:34) and they'll kind of think, okay, well, what is a healthy period? But then they don't necessarily think about all the other parameters. So when we're looking at what makes a healthy menstrual cycle, we can look at the overall cycle length, which ideally would be somewhere between about 24 and 35 days. We can look at the pre -ovulatory phase in particular. So we can look at the period. So the period is its own category. We want to have a menstrual period that overall is somewhere between three to seven days with an average of about five days.   And I always say the period should be like a sentence. It should have a beginning, a middle, and an end, and then it should be over. So if it's like trailing on for days and days of bleeding, if you're getting bleeding throughout your whole cycle, as opposed to just when you have your period, these are things we should be looking at. And although it's really common to have several days of spotting before you start your actual bleed, it's not optimal. So it's helpful to understand that piece of it. And then in terms of pain,   Michelle (02:08) I love that, that's so good.   Lisa Jack (02:32) It's also extremely common for women to experience menstrual pain. And so there's always this question of like, is it normal or not? And there is debate. So there are definitely people who are more on the like, it's normal kind of, you know, because so many people have it. So it has to be normal. But, you know, outside of your period, pain is thought of as a problem. And so if you thought of any man in your life, anyone, your father, brother, cousin, whoever, friend, boyfriend, if he had pain in his period, in his penis for.   Michelle (03:01) in this period you imagine.   Lisa Jack (03:02) Right? But if he had pain in his penis for two to three days every month, such that he needed to take medication and possibly couldn't go to work if the medication didn't kick in, no one would think that that's okay. So that's also just a bit of an aside where when we look at what's happening during a menstrual bleed, it is a natural inflammatory process by which you shed that lining. And so in order for your uterus to shed that lining, there does have to be some inflammation. And we do have...   prostaglandins that we produce that help to induce those smooth muscle contractions to make this all happen. So what's interesting is that when we look at what the research says, women who have pain, they have a higher level of these prostaglandins. So they have a higher outside of normal inflammatory response. So at very least, pain with menstruation that's moderate to severe is a sign of increased inflammation, something we should be aware of. And at worst, it could be a sign of a more serious condition like endometriosis.   So as an aside, although common, we want to consider moderate to severe pain to be not optimal. And we want to be looking a little bit deeper into that. And for many women, they often need that nudge to do so, especially if they've had pain very consistently from their first period, for example. So outside of the period then, when we move into the actual, like the rest of the pre -ovulatory phase, we want to look at when ovulation is happening.   So in order to have a cycle that falls within that 24 to 35 day range, we do need ovulation to happen typically somewhere between days 10 and days 22 or days 23. So approximately. So we want to be looking at when ovulation is taking place. And as you approach ovulation, you're supposed to be making some healthy cervical fluid. And typically we would expect to see that for about two to seven days leading up to ovulation. So we want to look at the quality of that, how many days you're seeing. Like if you're not seeing any at all, that can be a sign of.   low hormones or an issue with your cervix. If you see it all the time, that can be a sign of something as simple as a yeast infection or something more serious potentially. So it's helpful to even know that that's a thing. And then after ovulation, that period of time, the post -ovulatory phase or luteal phase, as we call it, should be about 12 to 14 days. And so if it's, you know, seven days, that's a problem that could impede your chances of conception. It's a sign of extremely low progesterone. If you have...   moderate to severe PMS symptoms, if you have spotting, as I had mentioned previously before your period. So like interesting, right? Because you asked a pretty simple question, what does a healthy cycle look like? So I think what's good about this, just to kind of pull it back then, is that we're not looking for any one factor to be perfect. Within each of those factors I listed, there's a bit of a range. And so you could potentially have one of those aspects that's a little bit off, but overall, the rest of it is pretty strong.   And so that can help you to understand that you don't need to have a perfect cycle for it to be healthy. We just need to have it for the most part fall into those parameters.   Michelle (05:58) For sure. And I also look at like, you know, as a practitioner, I look at like what's normal for you, because some people have always had a short cycle, but they're normal. Or, you know, it's usually when things become out of whack for you, or it's kind of like not like you're, they almost have like personalities, menstrual cycles, right?   Lisa Jack (06:17) Yes. Well, and I agree with you to a point because I used to be one of those people that was like, my cycles are long and that's normal because my cycles are always long. Right. So when I first started training, so I think there's a balance between understanding what the normal parameters are to make sure you're within them and then understanding what your normal is. And absolutely, when you're used to experiencing ovulation, you know, in a certain range and all of a sudden it's like 20 days later, yes, we need to be looking at that. But.   Michelle (06:27) Mm -hmm.   Right.   Lisa Jack (06:46) because of my own experience and what I've seen with many clients, there's a lot of things that we can experience a lot, like period pain is a good example, or even that pre -evaluatory spotting where we can just tell ourselves, well, I always experience that, that's totally normal, but it might not be. Yes. Yeah.   Michelle (06:58) I'm not talking about abnormal though. I'm talking about within like 26, like say you have a 26 day cycle and that just tends to be your thing. As long as it's not abnormal or within like sort of a more like red alarm position.   Lisa Jack (07:11) Yes. Yes. No, I tend to be I tend to be like, because I because this is what I do, right? Like I'm like lazery. So I'm like, well, the 20 days, 26 day cycle is within the normal range. But you could have a 29 day cycle or a 28 day cycle. That is actually problematic. Like you could let me give you an example. You could have a 28 day cycle where you're ovulating on day 20 with an eight day luteal. Right. So so this is why it's helpful to look at the whole picture.   Michelle (07:29) Right.   Bye.   100%. I think that what you do is very important. And, you know, looking at like the temperature, looking at the cervical mucus, looking at, well, possibly position, but like really understanding it in a way that has a different lens. Because for me, at least, I know that I really appreciate when patients come in and they do their BBT charting. Why? Because I look at the yin and the yang. And if it's too low, that tells me a lot. Usually when,   Lisa Jack (07:55) Yeah.   Michelle (08:09) The luteal phase, which is more of the yang part of the cycle, yang mean more heating. Yin is more cooling and moist. So that's kind of like more of the estrogen aspect of it. And it's pretty wild when you can actually see that. What we learned in textbooks actually being reflected in the menstrual cycle. But when we see that as practitioners and we can really look at it, I really appreciate being able to see that chart because it helps us.   see much more and a lot of other practitioners in the same boat, like they see what I'm talking about. It just helps you to understand it at a different And unfortunately, some people are very resistant to doing it because they say when I do my BBT, and I want to actually address it because I want to see what your thoughts on this. Sometimes people say that if they start to look and like kind of chart their cycle,   that it throws their cycle off and that they get really stressed out. Yeah. So then I'm like, okay, well, you know, what's the balance, you know, of trying it? And I say, just try it out. It's not forever. Like just see what it shows you. And then maybe it'll regulate as you're doing it. And I think that there's this resistance to it. Like they're almost overly focused on it and it stresses them out.   Lisa Jack (09:10) Interesting.   Mm -hmm.   Michelle (09:32) So I wanted to get your thoughts on that.   Lisa Jack (09:35) Yeah, well, I think the couple of things came to mind. So the first thing that came to mind when you said that, like, when I do it, it throws my cycle off. I think that that was interesting. That's interesting because that could be something a bit different. That could be that you thought your cycles were so, you know, perfect. And because people do like people think like my cycles are totally regular. Right. When you're not charting, you're like, yeah, it's always like 20 days. Like, yeah, because this is like how we think. But then as soon as you look at it, it's not it's not no one cycle is 20 days for a year.   I will put money on that. It's just not, if you're actually tracking.   Michelle (10:06) No, no, they still used like an app to track the numbers. So they knew what their numbers were, but they didn't do like the BBT and like a little bit more in depth.   Lisa Jack (10:15) Yep. Well, I guess what I'm, so I guess the thought that I had around that was that when you actually start to look, you see not necessarily that things are wrong, but you just see more of the nuance that you weren't looking for before. And so you may not have been aware of certain nuances that were happening because if you're not tracking it, you wouldn't be aware of those nuances. That was the first thing that came to mind. The second question I think is interesting.   For a couple of reasons. So now that I work with practitioners when you have your own modality as a practitioner, you know Then the people that are coming to you are coming to you for that particular modality and This whole charting thing is very niche. It's very specialized and not everybody wants to do it and that's totally okay I think that that's something that's important to remember So when you're as a practitioner seeing the value of charting and if there's a lot of value there   And it's really helpful. I mean, for me, that's all I do. So it's hard for me to imagine how I would support someone without seeing it, because it really is an integral part of everything that I do. But when you get all jazzed about something, it doesn't mean that everyone else is jazzed about it too. So when it comes to then encouraging your clients to chart, coming from all different walks of life and varying levels of interest in this topic, I think that it's important to kind of put that all into perspective. So.   Michelle (11:25) Mm -hmm.   Lisa Jack (11:40) You can lead a horse to water, but you can't make them drink. I think you can think about your messaging. One of the things that I learned, just because I've been in the field so long, I went through my initial, everybody needs to do this face, you know, 20 years ago, and, you know, trying to ram it down. And I'm not saying that's what anyone's doing. I'm just saying, like, when you first learn about this stuff, it's like you want to, like, literally, like, all your girlfriends, you have to, right? Like, you get into this energy, and some of your girlfriends are like, you need to leave me alone.   Michelle (12:03) Hahaha.   Lisa Jack (12:06) right? Because like, I've got this, like, I'm good with the birth control pill, and you need to stop. And that's okay. So the way that I have approached that in my life is that, I mean, now I have my own podcast, right? Like, I talk to people who want to hear about it. And in my personal life, I don't necessarily talk about it. And I have not, I typically don't have the experience where a person is not necessarily at all coming to me for charting, because usually people are coming to me for charting.   Michelle (12:21) Yeah.   Lisa Jack (12:34) but I have had varying levels of interest within that. So I've had a lot of clients who are coming to me for conception and they really do want to know what's going on in their cycle. But sometimes the charting does cause a lot of stress, especially depending on what a person is going through. So I've had clients who are super motivated, like dotting all the, you know, eyes, crossing all the T's, writing every little notation and notes and like really, really detailed. And I've also had clients who resist that a bit and they...   They don't necessarily get into the notations a whole lot. And so a lot of what I do in those situations is we have a conversation and talk through it. It's the same stuff. They're just not writing it down. And I try to help them achieve their goals, meeting them where they're at. Like I can think of several clients who weren't necessarily super into those notations, but through our conversations, like they were still checking. They were still observing their cervical fluid. They were still able to time sex accordingly.   And they got a lot out of it. And I really tailored what I was presenting to them to what they needed. And I was always having those check -in conversations. And this is something I talk about with my practitioners, like the whole coaching aspect of it, where you can have your goals. You want to have this person chart, but they can have their own goals. And so sometimes it's like, well, what would success look like for you? You know, I see that you're not really that into the charting or I see that the charting is causing a lot of stress. We don't want more stress. We definitely don't want that. What would make you happy?   Like what would success look like after, you know, our several weeks of working together? And maybe she says, I just wanted to understand how to pick up when like which days I'm fertile. Like I don't want to like write it all down or anything. I just want to be more confident in identifying that. And so, you know, my comment on that is there are lots of ways that we can improve our clients' education and confidence without necessarily going all the way down the charting rabbit hole. So we have to be flexible as practitioners with where our clients are at with these things.   Michelle (14:30) No, I'm with you and I actually tell them There's a lot of other ways to figure out if you're ovulating. However, I always really enjoy being able to look at the charts because it on a different level.   Lisa Jack (14:44) as a practitioner, when you have that knowledge, you can still, like it still comes through and they're still getting so much from you.   And I think sometimes it's interesting hearing the charting instructor saying, you know what, if this is stressing you out, then just stop. I've had that conversation with a number of clients over the years where it's like, if this is too much for you, then just stop. Just stop charting for a month or two and see how you feel. And the interesting thing is you stop writing it down. But after you've learned all the stuff about how to identify the fertile, it's not like you're going to stop going pee. So you're going to see your mucus.   and you're still going to have that knowledge and information. You're just finding a way to dance with that information that does not cause more stress.   Michelle (15:28) Absolutely. So as far as birth control pills,   I know this is another topic you talk about a lot and also just like how that impacts the body. So I'd love for you to talk about like how it impacts the body. And then if somebody's been taking it for a really long and wants to get pregnant after stopping, what are some of the things they should be thinking about?   Lisa Jack (15:52) Mm -hmm. Love that question because not a lot of We're just not told how the birth control pill works. I was actually listening to someone Kind of a prominent person talk about the birth control pill Yesterday and it was really great because a lot of what she said was on point but she did say, you know, well, you know the pill tricks your body into thinking that you're pregnant and and so these are some of the myths that we still have Today about how the birth control pill works in the body. I   So it's interesting because if we were to compare the state of a woman on birth control, so the state of her natural hormones, the most compatible or comparable state would actually be to a woman in menopause. That makes terrible PR and marketing, so they're not gonna tell you that. And so essentially, the pill, the main mode of action for the most common pill, which is the combined oral contraceptives, so it has a combination of synthetic progestin and synthetic estrogens,   is to suppress ovulation. So that's the main mode of action. And that's really helpful when you're trying to avoid pregnancy, because if you're not ovulating, you can't get pregnant. So in order for it to suppress ovulation, then, it interferes with the conversation that is typically happening between your hypothalamus, pituitary gland, and ovaries. And as a result, the ovaries then become kind of dormant. And so that's why we can think of the menopause as a similar comparison, not pregnancy. Because in pregnancy, we're actually making ridiculous amounts of   progesterone. So compared to the progesterone you make in your menstrual cycle, by the time you're 40 weeks pregnant, you're making 11 times the amount of progesterone. So it's not the same when you're on the pill. It's not a comparable state. And so when women are on the pill, if we were to measure their natural estrogen and progesterone, they would be very low and flat, very consistent. So the first main mode of action is to suppress ovulation.   And then there are other modes of action that work in conjunction. One is to maintain a very thin, flat endometrial lining. And so they measure it with ultrasound and, you in my books, I kind of share some of those numbers because it's quite, quite thin. So even if something were to happen, then there's less of a chance of conception because the endometrium is so thin. And then it also prevents the production of fertile quality cervical fluid. So the sperm then theoretically, like they can't go anywhere because the, the cervix is blocked with this mucus plug all the time.   And those are the modes of action that work together. So when a woman is then on contraceptives for a long time, and, excuse me, interestingly in the research, they define long -term as two years or more. And when you think about most of the women in your life or yourself, many women have used birth control for two years, five years, eight years, 10 years, 15 years, 20 years. So this whole concept of long -term is pretty.   mainstream if they're defining it as two years. So there's a couple different ways that the pill affects the body then. One is that it does have an effect on the menstrual cycle. So when women are coming off the pill, research has shown that it takes anywhere from nine to 12 cycles for all cycles, not months, for all of those menstrual cycle parameters to normalize post -pill. So that includes everything we just talked about, like the overall cycle length, the cervical mucous production,   you know, the luteal phase length. And so it's really common to come off the pill and to have a short luteal phase for it to take several months before the cycle either returns or normalizes. So some women do get their, they start ovulating and having their periods pretty, pretty quick. Others might take a couple of months and then on the, you know, a smaller percentage might take quite a while, but generally speaking, a lot of women get their cycles back within the first few months. But then those first few cycles, often ovulation is delayed. And so some of those cycles,   are quite a bit longer. And then it's also quite common to have a short luteal phase for those first few cycles and to have abnormal cervical amicus patterns. So that's one way that the pill affects the body. Another thing to be aware of is it's well known that when women are on contraceptives, so if you were currently on contraceptives and you did an ovarian reserve test, for example, it suppresses ovarian function. I just said it makes the ovaries dormant. So then it's logical that those...   ovarian reserve parameters are going to be suppressed. And that's what we find in the research. So I think one of the scary stats when women engage with my books is that stat on how when women are on the pill, ovarian volume shrinks by 50%. So it's saying that the pill shrinks your ovaries while you're on them. That sounds awful, right? And then the AMH is low and antral follicle count is low. And what the research tells us...   is that when a woman comes off the pill, it takes about a minimum of six to seven months before those parameters start to normalize again. And interestingly then, why are we not told to come off the pill? Six to a minimum of six months or so before we start trying, we're not, but that's something important to know as well. So I don't see these things to scare you because obviously some women do come off the pill and get pregnant right off the bat. So it's not even to say that you can't.   Michelle (20:46) Right.   Lisa Jack (21:01) but we want to acknowledge that there's a temporary period of subfertility post -pill. And so the other way, so I talked about kind of these three ways that the pill affects the body. So I mentioned the menstrual cycle effects on the menstrual cycle. I mentioned the effects on the ovaries and then there's the effect on fertility itself. And so those are the time to pregnancy studies where they look at how long it takes a person to conceive.   And so there was this interesting study that compared women who were using condoms, so non -hormonal methods, to a variety of hormonal methods, including the birth control pill, the shot, the hormonal IUD, and a few others. And in that study, the women who came off the pill, it took them an average of eight months to conceive. The ones who were using the pill, quote, long term, so two years or more, compared to the women who were using condoms, who took an average of four months to conceive. And the shot...   users were the worst offenders and they took an average of about 18 months to conceive after coming off of the shot. And the IUD was about eight months as well, eight to 10 months. So that is interesting information because we're not told that. So it doesn't mean that we need to be afraid that the pill is going to impair our fertility forever, but it does mean that we need to be aware that there's a temporary period of subfertility. So then the recommendation out of that,   Michelle (21:52) Mm -hmm. Wow.   Right.   Lisa Jack (22:19) that Lily and I make in real food for fertility is that you should consider coming off of birth control a minimum, I would say a minimum of six to 12 months before you start trying to conceive. And I would add in a caveat that if you did go on the pill because you had menstrual cycle problems, like because you actually knew that there was something wrong, you had long irregular cycles, you never knew when your next period was coming, you had extreme pain with menstruation.   you had extreme mood swings or like, right, like there was some sort of kind of medical reason why you were put on birth control, then you'd want to extend that period. And I would go as far to say 18 months to two years because not because we think you won't be able to get pregnant, but because if there's an underlying issue, the pill doesn't solve it. It masks it. So when you come off of it, you still have to figure out what's going on there if you wanted to conceive naturally. So if you come off well before you're ready, so you're still.   Michelle (23:06) Mm -hmm.   Lisa Jack (23:16) Actively avoiding like you have to figure out your birth control and I would recommend a non hormonal birth control option So you still have to be on top of your birth control game? But during that time if your cycle is kind of wonky if things are going awry You actually have time to fix it. You have time to make your appointments You have time to normalize your hormones without the added pressure of also trying to conceive at the exact same time   Michelle (23:40) Yeah. I mean, it's crazy to me because I have, I can't tell you how many people I've had come in and say, oh, my doctor said the second you get off your birth control pill, even if they've been on it for like 15 to sometimes 20 years, the second you get off, you can get pregnant. You don't have to do anything. And you're telling me the science, you know, it's crazy because they say that they're very based in science and the evidence, but.   Nobody seems to be looking at that   Lisa Jack (24:09) Well, and there's a couple things I can mention about the science that I think are really interesting. So, I mean, one of the ways, one of the reasons that I am digging into the weeds about this is because often when I'm working with women in real time, I'm seeing this stuff. I'm seeing the menstrual cycle regularities and it's consistent. I've worked with hundreds of women at this point who've come off of birth control in my various programs and you see it. You see these abnormal mucous patterns. You see that it takes time for the cycle to normalize.   Michelle (24:26) Yeah.   Lisa Jack (24:38) And so then when you see that stuff, you want to know why. And so that's part of my motivation to look at the research to kind of get that explanation. Because sometimes you see things in clinical practice before you understand why you're seeing them. And then when you actually dig into the research, you're like, OK, this is why. Because the pills, you know, suppressing ovarian function and it takes seven months minimum for that ovarian function to normalize. You know, I had this woman reach out to me. She's like a listener of the podcast.   Michelle (24:49) Right.   Lisa Jack (25:06) And she kind of independently had this experience. She came off the pill, she was in her late thirties, and then she got her AMH and her ovarian reserve parameters tested right off the bat because her and her husband wanted to conceive. And they came back so low that they told her, and this is a whole other topic if you want to go into it, because we can, but they told her, okay, your AMH is so low, you won't be able to conceive and all that kind of stuff. And so then she was devastated. It was like a whole thing. She was like, what's going on? And she was trying to do her research. And again, she was listening to the podcast.   And then she ended up independently requesting her ovarian reserve parameters tested several times during the first year after the pill. So I don't have the data in front of me because she actually sent it to me and I invited her on the podcast and we talked about it was a really interesting episode. But so she tested it independently, like whatever it was, four months, six months, like in 12 months, whatever, right? So you get my point. And interestingly, by the 12 month mark, you know, the AMH was...   like rebounded quite well to the doctor's astoundment, if that's a word. And I, it aligns with the research study that I cited in that book. Now in that study, they only went to the six to seven month mark. You know, in her case, she just independently chose to demand these tests and saw the results for herself. And so again, this is, it's really interesting information. So what I wanted to say about the research and what's interesting about it is that,   It's harder to find studies that actually break down the data like month to month, or even just not just at the year mark. Most of the studies, if you look, because I did, and a lot of the newer studies that are coming out, they just tell you at the year mark. And so when you have a study that's saying X percentage of women conceived at the year mark, the pill is a reversible contraceptive method, it's all good. Goodbye, get out of my office. Then that's...   If that's all you're looking at, you're not asking these questions, but it's when you look at the studies that actually break this stuff down, like how things are at the beginning, after two months, three months, five months, six months, eight months, 12 months, that you actually see that, yeah, sure, if we just skip to 12 months, it looks great and it sounds great in a study, it's very succinct. But the emotional damage, my kids always, they have all their slang, emotional damage. So if anyone has like 10 year olds, they're gonna be laughing with me. And everyone who doesn't is like, what is she talking about?   But like the emotional issues that like the very real challenges for a woman in her, you know, let's say late 20s, early 30s, mid 30s, whatever, who has been avoiding pregnancy like the plague her whole life, who's told that she can get pregnant on every day of her cycle, terrified all the time is so scared to come off the pill that she probably delayed it as long as humanly possible because she thought she was going to get pregnant immediately. The amount of stress it causes her.   two months later to still not be pregnant, three months later to still not be pregnant. That is the reason that I look at this research and talk about it in this way. And that is one of the reasons why maybe the medical professionals are not talking about it this way because most of the research just looks at the year mark and says X percent of women conceived, end of story, you're good to go, come off the pill, you'll get pregnant, it's fine.   Michelle (28:19) really is crazy if you think about it. And because people are really not getting the full picture and they're not getting enough information to really go on. And another thing is also just the nutrient deficiencies, which I know that you guys address in the book. So I want to talk about that as well and why that's so important. What are some of the things that you guys see and like how to address it?   Lisa Jack (28:43) Mm -hmm. I mean, I think that's such a good question as well because I had thought of it when you were talking before You know just come off the pill and you'll get pregnant, right? That's what your practitioner says and Interestingly, I mean, yes, the goal is to get pregnant but like for me I have three children by this point So it's not just to get pregnant because you could get pregnant and miscarry you can get pregnant have an awful pregnancy It could be a very difficult time where you're feeling really ill and sick and therefore you you're not even able to eat the best   Michelle (29:02) Right.   Lisa Jack (29:11) You know, have these plans to eat all this good food during pregnancy. And then for many of us, including myself, I had a lot of nausea. I didn't have a lot of vomiting, but I had a lot of nausea in the like, especially my last pregnancy in the first several months. And so you don't always have the opportunity to eat all the good food you were planning to eat. So when it comes to what the goals are, I would say on my client's behalf that, yes, the goal is to conceive, but it is to have a healthy child. It is to be a healthy parent.   It is hard to parent even if you are nourished. If you are, like most women, deficient in iron going into pregnancy, studies show as few as 20 % of women go into pregnancy with sufficient iron stores. I mean, it's even harder to parent when you're nutrient deficient at the end of this process and you're low in iron and every other nutrient known to human beings and your thyroid is acting up and whatever. So...   I would go further and say, okay, it's not just about getting pregnant. It's about having a healthy child. And if we have the opportunity to optimize, it's not just going to help the child, it's going to help us as well. So some of the nutrients that are depleted by hormonal contraceptives, it's like the exact ones we need to make healthy babies. It depletes our B vitamins, particularly folate, and B12, and B6 is particularly bad.   It depletes our coenzyme Q10, which anybody who's in the fertility space knows is essential for optimal egg and sperm quality and overall health. And it does this by disrupting nutrient metabolism. When I was talking about the B6 depletion in the fifth vital sign, I gave the analogy of like a hole in a bucket. Because in order to get enough B6, for example,   to offset the deficiency, it's like you had to take 38 times the recommended RDA, right? So it's showing you that it's changing the way you're metabolizing these nutrients. So just by coming off of it, your body would then start metabolizing those things normally. And so maybe like the hole stops, like you stop up the hole in the bucket, but you would still want a period of time of focused nutrition so that you can actually build back.   up those stores and there's other nutrients including zinc and magnesium, selenium, phosphorus, it increases your requirements for vitamin A and vitamin C. Like it's interesting and this is well known and you know even I had an interesting pharmacist on my podcast years ago and like pharmacists are super interesting because like they study all the drug interactions and I mean he wrote a whole book on how   you know, the pill depletes all these nutrients and he's kind of arguing like, why aren't we telling them to take a vitamin or something like we know that this is happening and the vitamin doesn't make everything better either. It just like puts a little like it's like damage control until we get off of it. So so then the recommendation out of that is not only do we want to take the time.   Michelle (32:02) Right. Yeah.   Right.   Lisa Jack (32:17) for our menstrual cycles to normalize, right? And our ovaries to just get, and again, it's not to say that you can't get pregnant. Like if your body is ready, then plenty of women come off the pill and get pregnant, but we're saying, let's take it a step further and optimize this. So during that, let's say minimum period of six to 12 months, we are also encouraging you to really focus on incorporating the foods that contain those nutrients that are depleted on the pill, the same ones we need to optimize our chances of conception so that when we're ready to conceive, ideally,   Our bodies are ready, ideally we're able to conceive quicker, more easily, and our pregnancies, the pregnancy outcome, the health of our babies and our own health is better. I mean, why not?   Michelle (33:00) Totally. And then also the gut health, like the gut microbiome gets impacted, which can impact also how we're absorbing those it's important to also get that back so that you're able to like reabsorb nutrients.   Lisa Jack (33:16) Yeah, I mean, I think that it's just, this is the information that we need. It's a piece of it. And it's crazy to think that it's just not a standard practice. So I've spoken to so many women who they had it in their mind, you know, I've been on the pill for 10 years and my husband and I are planning to start trying to conceive in the fall, you know? And so she calls her doctor, makes her appointment, takes a shower, gets in her car, drives across town.   to ask this doctor if she should come off the pill, you know, even a few months before. And the doctor says, no, you're good. But I always say like your intuition got you to like get out of bed, like do all this stuff. Like something's up. Listen to it. You know what I mean? It's just we just live in an upside down, ridiculous place where, you know, after we hear this stuff, it feels like common sense. But before, you know, you're questioning yourself. And that's how the medical system is. It's very paternalistic. Not to like.   Michelle (33:56) Yeah, yep, totally.   Lisa Jack (34:13) totally rag on it. But we can't always depend on these so -called professionals for all of these answers because at the end of the day, doctors are busy and they don't necessarily have time to read all of this research. So they don't know everything.   Michelle (34:27) 100%. I think that that is the key phrase is nobody knows everything. That's why you need a team. And it's important to ask a lot of people. And also you are part of that team. Your own internal intelligence is a thing. Yes. And you got to listen to your gut. Like your intuition is a real thing. So, um,   Lisa Jack (34:39) You're the head of the team.   Michelle (34:48) And I think there have been studies on that too. So yeah, people have like intuitive intuition and they can feel their body from within because if you think about survival, you even look at animals, they'll know what to eat. They just are guided by what is good for their body. That is a real instinct that we have and I think very, very important that you touched upon that. as one of the questions,   Lisa Jack (34:51) Hahaha!   Michelle (35:16) about or is it true that we are born with all the eggs we'll ever have?   Lisa Jack (35:21) Yeah, for sure. I mean, I think it's so interesting because we live in just such an interesting time. So there are these like talks about stem cell research and, you know, people are starting to say like, it's a myth and all this kind of stuff. But when we're looking at natural conception, like birds and the bee stuff, we are for all intents and purposes born with all the eggs that we'll ever have. So it's really interesting numbers. When we're in utero, you know, we have several million eggs in there.   And by the time we're born, we have an estimated number of 500 ,000 to a million eggs, which is wild if you think about it. And to go a step further too, so I mentioned like my, I have three children and so I have a, my youngest is 19 months old as we're recording this and it's a she. So I had a girl after 10 years of being a boy mom, which is fun. But fun fact, you know, when I was pregnant with her, you know, she then had all her eggs in there.   And so theoretically, I was carrying the egg that could turn into a grandchild in the future. So all that fun information, fun facts. And so as we then go through the process of aging, as we go through our reproductive years, and we then at the time of menopause, when we have our last period, they say we have about 1 ,000 eggs left.   So from that perspective then, we can't really control the natural kind of, because there is this natural over time, they call it follicular atresia. They say we ovulate, the research says if you're ovulating normally throughout your reproductive life, you're going to release anywhere from 400 to 500 eggs. So assuming you're not on the pill for 20 years, you're not necessarily releasing all those eggs. During ovulation, that's how much you're releasing, which is interesting.   But it's not to say that you have a million eggs and then you're releasing one at a time. And so it's like going down like that. What happens is every time you go through a menstrual cycle, you have a cohort of follicles that develop and they prepare for ovulation. And then one is chosen to ovulate, but the majority of them, they just, you know, again, they call it follicular atresia. Like the majority of them just kind of like go away.   And interestingly, the question comes like, well, if I'm on the pill and I'm not ovulating, does that mean that I get all these extra eggs? And it's like, have you ever known anyone who was on the pill for 20 years to then go through menopause at 70? No, you haven't. That's not a thing. So even though you're not ovulating, cycle to cycle in the same way, that process of follicular atresia is still taking place. So I think that what's scary about that is that we have this finite number and there's an end date.   Michelle (37:52) laughs   Lisa Jack (38:10) Whereas men don't have a firm end date. They do go through aging. So their sperm quality changes over time. Like, listen, they make no mistake. But they still continue to produce sperm all their lives. Whereas we have this end date. So then when we're looking at supporting egg quality, when we're looking at optimizing our chances of fertility, then what we're looking at is to support egg quality. You know, we're looking to understand the different ways that we can test for   are over in reserve and understand those interactions, but we really want to focus on that quality. Because even though there's this cool research that talks about the stem cells, and I don't know if your listeners have heard this, maybe you've heard it, Michelle, but it's like people are talking about this now, like, oh, it's a myth. But that all requires artificial reproductive technology. Like there's no scenario where whatever they're talking about happens naturally. So if we're looking at natural conception, then that's really where our focus has to be, which is on supporting egg.   quality and one fun fact I want to share about egg quality that I think is kind of mind -blowing. Okay, so Michelle, do you remember high school, you know, high, junior high or high school bio class like biology class where they used to tell us about the cells or whatever and like in my textbook they would have a picture of the cell and it had all the like organelles and stuff and there would be like a couple like maybe one or two mitochondria in the picture, right?   Michelle (39:34) Yes.   Lisa Jack (39:35) So how many, I don't know if we've had this conversation specifically, so how many mitochondria do you think are in an egg cell?   Michelle (39:43) I know there are hundreds of thousands.   Lisa Jack (39:45) Yeah, so when I asked this question to someone who's not heard this before, you know, it's kind of like, I don't know, right? Because in the picture, yeah. Yeah. So you were in the know. But like, when you think about it, so the range of mitochondria in your average cell could be from like a few, a handful to a few hundred, like liver cells, heart cells have a few thousand mitochondria, which is even mind blowing in and of itself. Because like in the picture, in the textbook, there was like one.   Michelle (39:49) I heard it on your podcast years ago. Yeah.   I know. It's like one lonely mitochondria just floating in the cytoplasm.   Lisa Jack (40:13) Right? There was not a thousand. You're just like, how does what do you mean there's a thousand? What does the cell look like? Exactly. But in the human egg cell. So the human egg cell is the largest cell of all the cells in the body. It is a cell that is visible to the naked eye. It is the size of a period in a piece on a piece of paper. So you can actually see it with the naked eye. And there are anywhere from 100 ,000 to 600 ,000 mitochondria in one egg cell.   Oh my gosh. And mitochondria are what determine there are energy producers. And then if you think about it logically, it's like, well, yeah, we're building a whole human. So yes, that makes sense. Right. But until you break it down, you don't think about it. So then how do we support egg quality? Well, we do everything we can to support our mitochondrial health. So to really support those mitochondrial cells, we also do what we can do to reduce what they term.   Michelle (40:43) Yup.   Right?   Lisa Jack (41:07) oxidative stress, which is damaged to oxygen. So I was thinking the example of like, if you peel a banana and it turns brown, but if you dip the banana in, you know, lemon juice or vitamin C water, then it doesn't turn brown. So it's that those two things are play a big role in supporting mitochondrial and overall egg quality.   Michelle (41:28) Yes, yeah, 100%. I also talk about plugging the energy leaks in your life because man, even emotions can drain your energy. So they're just like everything, all the aspects, all the things. And I want to talk really quickly because I know we're kind of running out of time about sperm health because we had a really good conversation on the recording that didn't work out. And I want to talk about that, about the parameters of sperm health today.   what they used to be and how they've changed and what we're seeing just overall, like now versus before.   Lisa Jack (42:02) Yeah, I mean, I always get excited to talk about all of these topics, really, like the egg quality piece is super interesting and then the sperm quality. But particularly with sperm, when it comes to fertility, we're still somehow in this place where we think of fertility as a woman's health issue and we don't really think about the contribution of the male. And so the statistics tell us that 20 to 30 percent of all cases of infertility are solely related to male factor.   and 50 % of the time male factor plays a role. So that means half of the time when you're dealing with a fertility issue, his contribution is playing a role, it's a factor. So the odds are pretty good then that if you're dealing with infertility or struggling to conceive that there's something going on with his sperm. And then there's a few other studies that I found really interesting just collectively where...   when they look at different populations. So if they're doing a study, they might have a group of people who's trying to conceive and some of them conceive within the first six months or the first year and then others conceive within year one or year two. And statistically speaking, if you're taking more than a year or two to conceive, his sperm is not optimal. So on average, when they separate it out,   the sperm quality of the groups of men who are part of that cohort that it took a year or two years to conceive or more, the overall average is a lot lower. Statistically, hello, this is something we should be aware of. Getting back to what you were alluding to, when we look at older studies, the average man in the 40s had a sperm concentration of something like 113 million sperm per milliliter, which sounds like a lot.   The average man today has an average of about 50, 50 million sperm per milliliter. So there's a lot of different studies. It's widely known. It's been talked about quite a bit. It's a topic that comes up every now and then because there is this trend, this downward trend when we look at sperm counts where it's declining and it's declined anywhere up to 70%.   you know, within the last few generations. And it's a concern because what happens in 40 years, like if we continue on this downward spiral, what literally will happen? Because how much further down can we go? Right? So this highlights that it's not just an issue with your partner. It's not just these people. This is an overall trend that's affecting men on a large scale. And arguably, it's affecting us too. We just don't have the ability to test eggs like they do sperm. Like we can't just provide an egg sample.   So it's a little bit more difficult for us to kind of provide that type of information. But arguably there's something going on. And I mean, naturally the question is, well, why is this happening? And I think there's a variety of factors. So I think overall diet quality has declined. There's a huge influx in the consumption of ultra processed foods. So an ultra processed or processed food is something where you look at it and you literally can't even tell what it came from. So if you look at white, that too.   Michelle (45:01) Mm -hmm.   You can't even pronounce it.   Lisa Jack (45:10) But if you look at like white sugar or white flour, like you don't know if it came from a beet. You don't know what it came from, right? And then when you take those materials that have already been processed, lots of the nutrients, a huge portion of the nutrients that were in whatever the original food was are lost in that processing. And then you make foods with it. I mean, their solution is to fortify it back with some nutrients. But what you have is a far inferior product that is far less.   nutrient dense. And so that's a part of it. When you're consuming ultra processed foods, you're also often consuming a higher portion of carbohydrates as opposed to getting a good healthy balance of protein and fat. I mean, the 80s and 90s were all about not eating the fat, right? The fat phobia, cholesterol is bad, all the things. And what do you need for optimal fertility? Well, you need sufficient protein as the backbone that we require to make enough hormones. We need sufficient cholesterol specifically.   Michelle (45:56) All right. Yeah.   Lisa Jack (46:09) because cholesterol is a precursor for our steroid hormones. And when we consume this off balance, really high carbohydrate diet, we end up with metabolic issues and what's on the rise, right? Obesity, metabolic issues, diabetes. There's all these issues that contribute to poor sperm parameters and poor egg quality, poor fertility and reproductive outcomes. So there's a lot of different factors. And then we did even talk about the toxins, you know, every year thousands and thousands of new chemicals are created.   Michelle (46:09) Yeah.   Lisa Jack (46:38) A lot of them are similar in structure to estrogen. And in order for men to make sperm, they need testosterone. So anything that's pouring estrogen into all of their skin and all of the scented things and all the stuff we put on our body and all the chemicals and in the environment, all that stuff, none of that helps the sperm. So there's a lot of different factors we can look at that are contributing. So, I mean, this is a big topic. And one thing I just wanna make sure to mention is that...   The most common thing that I've experienced as a practitioner is that when I'm working with a client who's been trying to conceive or working on the charting and everything, I'm asking, has your partner been tested? And if he has, then it's like, yeah, but he's fine. I always say that. My favorite way, right? He's fine. We were told he was fine. He's good. But no one ever went through his analysis with you. So in the book, we actually put a table in there. We have some drawings of what sperm looks like and all this stuff. We're equipping you with all this information.   because what happens is the guidelines that they use are based off of this 2010 World Health Organization document. And in that document, they're telling you that normal parameters are a sperm concentration of 15 .15 million sperm per milliliter. I just finished telling you that the average amount of the 40s had like 10 times that amount of sperm. And so they're telling you that if his sperm is 15 .15 million,   sperm per milliliter or higher that he's fine. The motility 40%. So motility means the sperm that are moving. So does that mean 60 % aren't moving? And then the morphology being 4 % or higher. So again, morphology means if you look at it, if you think of sperm, it looks like a little circle oval head and tail. So when it doesn't have normal morphology,   Michelle (48:05) Mm -hmm.   Lisa Jack (48:29) It means that the head could be squashed. There could be no head. There could be two heads. There could be no tail, like all that kind of stuff. And so they're saying four out of every hundred look like a normal sperm and 96 don't. And you're good to go. So what those what's important to realize about those numbers is that those normal numbers do not represent what would be optimal for conception naturally. Those numbers represent a point that below which.   Michelle (48:44) Yeah. Yeah.   Lisa Jack (48:57) there's a problem and we need to look at it. So it's a very different way of looking at it. So what we talk about in the book, there's a different study that looked at, at what point do the numbers start to have a negative impact on fertility to try to define an optimal level. And those research defined optimal as sperm concentration of 48 million sperm per milliliter or higher.   they defined a normal motility of 63 % and a normal morphology of 12%. So that's a lot higher than the World Health Organization. So what I'm saying is for couples who have been struggling to conceive, you know, if your partner hasn't been tested yet, you know, we're saying get them tested as soon as you can. Because even if you want to, if you identify an issue, it takes anywhere from a minimum of three to four months.   Michelle (49:36) Mm -hmm.   Lisa Jack (49:55) to start to see an improvement because when your partner ejaculates today, count back three months. So we're recording this in like end of February, so let's say March. So count back three months, February, January, December. So whatever he was doing in December, that determines his printout today. So whatever he does today, we're not gonna see the printout until April, May, June, right? So just to put it out there. And that's only the beginning of it, because it's not like everything's just amazing in three months. Like it can take several months for all of those changes to kick in. So.   Michelle (50:11) Right.   Lisa Jack (50:25) You know, what we're talking about then is that there's a range, a sub -fertile range that is not being looked at. Men are just being told that they're either good to go or they're not, and they're not being told that, you know, you might have, you know, beat the WHO criteria, but that doesn't make you optimal, and you still have a whole ways to go. And as long as you're not in that optimal range, it's going to mean, statistically, that it's going to take you longer to conceive.   Michelle (50:55) Oh my God, it's crazy because this information, especially if you're really actively trying to conceive, you could be wasting a lot of time not really getting the right information. Lisa, as always, you're a wealth of information, super, super smart. I really admire your brain. I'm very excited. Well, it's good to read.   Lisa Jack (51:15) I read a lot.   Michelle (51:22) And I'm very excited. I actually haven't seen your book yet. I read the first chapter. I did opt in for that. So I'm very excited because it is so rich with the information. I feel like it's really going to benefit the community in such an empowering way. So I think it's amazing that you guys did this. Really, it's such a contribution. Because a lot of people don't really know all those details. And I know that you really went into deep.   studies and presenting people with information that is not something that they're going to get presented with by mainstream. Let's just say mainstream. I feel mainstream is just not as, you're not going to get the quality from mainstream. You almost have to dig deeper to get the quality of the true real information that's going to help. So I know we're running out of time and I know that you have to go. So I just want to thank you so much for coming on. Before we,   I want you to share with the listeners how they can find the book, how they could find you, work with you, all the stuff.   Lisa Jack (52:29) Well, thank you again. Thank you so much. This is a great conversation. You had great questions. So the newest book is Real Food for Fertility and it's available on Amazon. It's currently available in our paperback and ebook formats. And Lily and I are planning to record the audiobook later this year. So we're really excited about that. So for all of the podcast listeners, it's like, when's the audiobook coming out? Like soon, soon. We're doing it as soon as we can.   Michelle (52:50) The audio people.   Lisa Jack (52:53) Yes, but we wanted to do it ourselves. I always think it's fun when the authors are able to do it themselves. So we're really looking forward to that. You can also go over to realfoodforfertility .com. You mentioned the, you know, you opted in for the first chapter. So for anyone who wants to dive into the first chapter, you can grab that over there and also find more information about Lily and myself.   And you can find me if you like podcasts, if this topic interests you, you can type Fertility Friday into your favorite podcast player and you'll find my podcast. I'm in my 10th year of podcasting. We've released over 500 episodes, which is totally wild. And so lots of lots of fun and info to be had over there. And you can find me on Instagram at Fertility Friday. That's my favorite place on the socials to hang out. And I'll just make one more note for any practitioners who are listening.   You know, this whole topic of charting, we talked about it a little bit, incorporating charting into what you're doing and using it as a vital sign for your clients. I created this resource, How to Interpret Virtually Any Chart Your Client Throws at You, that I made specifically for practitioners, and you can get that over at fertilityfriday .com slash chart.   Michelle (54:01) Fabulous. Lisa, it's always a pleasure talking to you. I really admire your   thank you so much for coming on today.   Lisa Jack (54:09) Thank you so much for having me.