Is it really as simple as “just lose weight”… or are we missing the bigger picture in fertility?
In this powerful episode of Cry It Out Loud, we’re joined by reproductive endocrinologist Nicole M. Marchetto to unpack one of the most misunderstood and oversimplified topics in infertility: weight, metabolism, and reproductive health.
For so many navigating infertility, PCOS, insulin resistance, or trying to conceive, the conversation around weight can feel frustrating, stigmatizing, and incomplete. Because fertility is not just about a number on a scale it’s about hormones, metabolic function, inflammation, stress, genetics, and how the body is actually functioning beneath the surface.
This episode goes beyond surface-level advice and dives into what people are actively researching and questioning right now.
In this episode, we explore:
• Why “just lose weight” is often incomplete and misleading• The connection between insulin resistance, hormones, and ovulation• How metabolism impacts egg quality, implantation, and pregnancy outcomes• PCOS, inflammation, and what’s really happening in the body• Why two people with the same weight can have very different fertility outcomes• The role of nutrition, stress, and environment in reproductive health• How to approach weight and fertility without shame or oversimplification
Whether you’re trying to conceive, navigating infertility, or feeling stuck in the “do everything right” cycle, this conversation offers science, clarity, and compassion.
Hosted by Chasing the Rainbows, a 501(c)(3) nonprofit providing free daily support for infertility, pregnancy loss, and pregnancy after loss. 👉 chasingtherainbows.org
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Episode Transcript
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(00:10):
Crying Out Loud, a podcast by Chasing the Rainbows with your
host Bernice Quisenberry. Today's conversation is one that
we approach with a lot of care and compassion.
When weight infertility come up in reproductive medicine, the
(00:33):
conversation often gets reduced to 1 oversimplified message.
Just lose weight. And for many people navigating
infertility, that advice can feel dismissive, stigmatizing,
and incomplete. Because the reality is far more
complex than just that. Weight is not simply a number on
a scale. It reflects a web of metabolic
health. Hormones, inflammation, stress
(00:54):
Physiology, along with other factors can ask us to care for
this. And for many individuals trying
to conceive, especially those navigating PCOS, insulin
resistance, or infertility, the question isn't just about
weight. It's about how the body is
metabolizing energy, regulating hormones and responding to the
environment that we live in. Our listeners know this well.
(01:14):
Many of you listening in today have already gone down the
rabbit hole of research, readingstudies, exploring nutrition,
learning about insulin singling,you know, inflammation, gut
health, all of it, and how we feel our bodies, you know, which
then can affect ovulation, egg quality, implantation and
pregnancy outcomes. So today, we're not staying on
(01:35):
the surface. We're diving into the whole
picture of weight, metabolism and reproductive health, not
through shame or simplistic advice, but through science,
compassion, understanding. We are joined today by Doctor
Nicole Marchetto, a board certified reproductive and
chronologist and infertility specialist.
Doctor Marchetto earned her medical degree from Drexel
(01:57):
University College of Medicine, where she also completed a
Master of Public Health. She then completed her OBGYN
residency at Mount Sinai Saint Luke's, Mount Sinai West in New
York, followed by her fellowshipand reproductive endocrinology
and infertility at Rutgers New Jersey Medical School.
She is also an accomplished researcher whose work has
(02:17):
explored pre implantation genetic testing, racial and
ethnic disparities in fertility care, and polycystic ovary
syndrome. As we all know, PCOS areas that
intersect deeply how wheat metabolism and systematic
factors influence reproductive health.
Doctor Marchetto, thank you for joining us today for what we
(02:38):
hope we will get, deeper and more thoughtful conversation
around health and nutrition and fertility.
Thank you so much, Bernice. I really, really appreciate the
opportunity to come speak with you and to your listeners.
I remember when we met several years ago at the Bereavement
conference, and I'll never forget that.
This is just such a great organization and so needed for
(02:59):
all of us who have gone through infertility and loss.
So thank you so much for having me.
Thank you, of course. And we're just so excited to
have you and to really talk through a lot of this.
You know, when I heard you speakat that conference, you spoke so
beautifully and the way that youreally broke things down just
gave us a huge understanding of,you know, different things.
So I'm really excited for you tobe on here for our listeners to
(03:21):
hear you share more. Thank you.
Yeah. So beyond the typical weight
conversation, we'll just dive right into these deeper
conversations. You know, many patients such as
myself, you know, feel the fertility conversation around
weight, it becomes very overly simplified, like just go lose
weight, Right. And from a reproductive
endocrinology standpoint, how doyou think we should reframe the
(03:44):
discussion, you know, away from BMI alone and toward metabolic
health? Yeah.
So I think that the first step is really speaking to a provider
really, you know, a physician orsomebody who is trained in
reproductive endocrinology and infertility to really figure out
what the person's diagnosis is. So many of our patients are
(04:05):
coming to us with recurrent pregnancy laws or infertility or
unexplained infertility. And really it's important to
kind of do a full work up and figure out if there is something
specific that we can identify asa cause for what they're coming
in for. Sometimes weight is playing a
role, but it's likely not the only role.
And it's important to understandexactly how it's playing a role
(04:26):
in their journey. We know that BMI is important
and we know that extremes of BMIdo play a role in miscarriage
and infertility. You know, at the very low end of
the spectrum, patients who are really underweight, the body
definitely needs more nutrients to be able to apply resources
directly to conceiving. But it's, it's many times more
(04:48):
than just ABMI factor that needsto be addressed.
So we do a full work up and we want to see exactly what is
happening with their hormonal communication from the level of
the brain down to the ovaries and how they're really
communicating directly with the ovaries and the uterus to be
able to address what the best next steps would be, what the
treatments are. And it's not simply going to be
(05:11):
gaining weight or losing weight depending on you know what what
their background is. Yeah.
Oh, that's great. Thank you for sharing it like
that. And you know, BMI is often used
as a screening tool in fertilitycare, but it doesn't always
reflect the insulin resistance or inflammation or metabolic
dysfunction. How do you evaluate metabolic
(05:31):
health more holistically when someone is trying to get.
Right. So I think, I think you know,
taking a full history and understanding the patient's
journey so far. So any medications that they're
on, if they've had any drastic changes in weight, weight loss
or weight gain that coincided with their, their history, if
they, if they, you know, recently have had a change in
(05:53):
their menstrual cycles that werealso reflective of what that
change in weight has been. We want to know, you know, did
they recently are, are they struggling with depression and
that their weight gain has been associated with depression and
trying to figure out if there's anything else that might be
going along side of the weight gain or weight loss.
We know that really BMI is, is like you said, it's a number,
(06:18):
right? So it's BMI is a a calculation
of the height and the weight andhow it it's sort of supposed to
reflect the person's overall risk for other diseases.
But it's not perfect. So we really can't rely on that
alone. And so we want to do other tests
to see, you know, do they have any evidence, lab based evidence
(06:38):
of insulin resistance or pre diabetes or diabetes?
We know that that weight that has hormonal impacts, so excess
body fat can have estrogen effects.
We know that adipose tissue can directly turn into estrogens in
the body with different hormone pathways that we have.
We know that that weight can also directly impact the level
(06:59):
of inflammation in the body and that inflammation crosstalks
with insulin resistance. Now it's not super
straightforward in terms of how to be able to test somebody for
insulin resistance. There are a couple of gold
standard measurements that we can use, but are often, you
know, not not as straightforwardto actually measure.
So often we'll get a summary hormone, which is the hemoglobin
(07:20):
A1C, which is kind of like your,your glucose summary of the
control over the last three months.
That's a good place to start. I also like to get fasting lab
values on a comprehensive metabolic panel as well as a
fasting insulin level and a fasting glucose level.
There are some other labs, like I said that that may be
described more eloquently in theliterature that may not be as
(07:41):
practical for our patients to begoing and doing all the time.
But we want to get a sense of what is happening sort of in
their day-to-day life, their nutrition, their habits and
other medical conditions and other medications that may also
be playing a role in that risk. Are they on Prednisone for an
autoimmune condition? Because that can impact your
your resistance to insulin and glucose intolerance.
(08:04):
So and any other risk factors, you know, if they have
polycystic ovarian syndrome. So this is going to come out
when we do their full history and physical exam.
We're going to evaluate how regular their cycles are, what
their ovaries look like. Some of the other hormone values
that we're going to be checking.Patients with polycystic ovarian
syndrome also have an increased risk for metabolic syndrome.
(08:26):
These are two conditions that that really go hand in hand.
And so we have to assess for thepatient's overall risk for
cardiovascular disease later in their life and really both
within a pregnancy, you know what their risks are as well as
post pregnancy and and how to make sure that we can keep them
healthy and safe long, long term.
I think taking that overall approach too, I mean, with
(08:46):
looking at medications, because I know sometimes the one
medication I was put on caused waking and things like that too,
which also was then affecting because it was very rapid
increase things like that. So I think mentioning Dr.
Marchetto that, you know, looking at everything, OK, let's
like look at this and see what'scausing it, you know, root cause
and really evidence based than just, you know, trying to to
(09:10):
guess at it. Right, I think too, I mean, I, I
see patients all the time and we, we do talk about weight and,
and how hard it is to lose weight.
And I think that it's, you have to also be practical.
And I think leaving a patient with the instructions to just go
lose weight is, is like the least helpful thing that we
could do. So I think, you know, having
(09:30):
some tools, we often will work with a nutritionist.
We also have been starting to use more of the new medications
that focus on the GLP one receptor agonists and what role
they may play in helping patients who are at particularly
high risk of weight gain becauseof the Physiology of their their
(09:51):
their ovaries. And so there's a lot of other,
you know, multi pronged approachthat is is needed in these kind
of conversations. Absolutely.
And I think too, you know, taking in all the stressors,
everything that you're dealing with when you're on an
infertility journey and sometimes food is comfort,
right? And then to, you know, try to
create another new routine on top of, or, you know, trying to
(10:14):
readjust your, you know, food and, and intake and, and all of
that is so difficult in those moments when you're already
trying to navigate so many otherthings.
So I, you know, love that you say from this compassionate
approach, you know, we work witha nutritionist, we help you,
we're here for you, We're alongside of you.
It's not like we're just going to leave you high and dry and
figure it out on your own. Right, exactly.
(10:36):
I think that's that's really valuable.
And I think we've learned a lot as a field to to really
understand that it's not a blamesituation.
And this is really you, you haveto understand that.
And I think we're starting to now that there's a lot more data
and more discussion on it. But but yeah, I mean, the the
worst thing that we can do is just kind of abandoned a patient
and, and expect them to kind of be able to handle all of this
(10:57):
without any kind of other help when it's really their their,
you know, hormones and Physiology that are affecting
it. Yeah.
Well, and the other factors, youknow, let's talk through
inflammation, for example, and how that, you know, can affect
egg quality and, you know, implantation, so many different
things as well. And it's really hard to
sometimes get that under controlor regulated too.
(11:19):
Yeah. So the the tough thing and I
talk about this a lot with my patients, especially in the
first visit is there is a whole lot that we don't understand
about the body and about reproduction.
And I think that understanding that that sort of lack of
knowledge is crucial in our approach because we have to be
open to the idea that there may be something happening on a
(11:40):
molecular level that we have notyet diagnosed or figured out.
And so many times when we are working with patients who either
have recurrent pregnancy laws orinfertility who are going
through maybe the IVF journey and, and maybe, you know, we're,
we're struggling with miscarriages with IVF, we have
to think that there is more happening than what we can just
detect and measure. And being open to understanding
(12:02):
those other pathways and, and sort of trying different things
is important. We do know that that high weight
and obesity does create a chronic inflammatory state.
And there's a host of cytokines,inflammatory cytokines that are
up regulated that function to dysregulate hormone secretion
(12:23):
and metabolism. And we know that this can affect
egg quality, it can affect embryo implantation, it can
affect the the environment and the uterus.
And again, we don't fully understand all of it.
And so there's sort of a different approach for every
patient and trying to figure outwhat they've tried before and
really what some of these other conditions that are might be
(12:43):
playing a role could be and whatwe can do to help address each
of those conditions along the way.
Oh my goodness. Yeah.
And right. So when you were saying about
like the macro nutrients, the micronutrients, the, you know,
what do we know from research with that and the influence it
has on egg quality and you know,the ovarian function?
(13:04):
Yeah. So I think, I think that the
important thing is making sure that we understand what, what
nutrients our bodies need to develop a healthy pregnancy,
right? So we, we, we need all of them,
but in different amounts, right?So I think, I think protein we
know is really important. Sugars are important too.
(13:26):
Just, you know, understanding the the the sugars that are
gonna up regulate your glucose system quicker and less
efficiently are probably not as helpful.
And and again, some patients aremore sensitive to certain
nutrients than others. And certain patients may have
conditions that we have to thinkabout.
They may not be absorbing certain nutrients or macro
(13:47):
nutrients as well as others. So if a patient has come to us
with a history of the gastric sleeve or bypass surgery, we
have to think about how are they're going to get, get all of
the, the important vital nutrients they need to, to
become pregnant. It's again multidisciplinary,
you know, working with their, their, their bariatric doctors
(14:07):
and, and nutritionists and, and kind of giving them the tools to
be able to, to feel their best as well.
Absolutely, yeah. And that's, you know, that's
right. Like when you're on this
journey, it's self-care, taking care of yourself and having the
right people in your corner and the right team really is is so
vital. During all of this, right.
(14:28):
I mean, I think I think all of us have been been in some part
of a journey in our life where we feel like we're kind of lost.
And it's so important to have, you know, someone in your court
to help figure out some of thesethese questions that come up.
Yeah. I think mental health providers,
nutritionists, also friends, networks, support groups because
(14:50):
nobody is alone. And I know myself sitting in
this seat as a physician sees see patients all the time that
are going through difficult scenarios.
And I've also been on the other side of the table where I'm in
the patient. And yeah, I mean, it's it's hard
to to kind of navigate when you think you're doing this by
yourself. But that's why support groups
are so vital. Yeah, yeah.
(15:10):
Thanks, Doctor Marcheto for that.
Yeah. And emphasizing Exodus, it
really is, especially, you know,when you're feeling like you're
getting hit at all angles, you know, and, and trying to
navigate and figure it out. So, you know, and then this
really brings up and what's interesting is gut health and
microbiome, you know, and the evidence of around that with
reproductive hormones and fertility outcomes.
(15:33):
You know what a lot of people have questions around that gut
health is it's almost like a a word now that's like going
buzzword that's just going around.
Yeah, that's so true. And I think that's an area of
research that that is blooming and is getting a lot more
attention now. And, and I think that we're
understanding that the gut Biomeplays a really important role
(15:55):
in, in our hormone access. So as women, you know, our
hypothalamic pituitary ovarian access in terms of modulating
different pathways, men too, youknow, in terms of, of their
reproductive pathway, how, how certain microbes and how, yeah,
really what is going on again atthe molecular level is playing a
(16:18):
role in, in your hormone level. I don't know that we have really
reached the surface. I think we're almost at, you
know, the tip of an iceberg whenwe get down to what is happening
and, and the disk biosis. You know, we know that patients
with PCOS have really a different microbiome than
patients without PCOS and that'sprobably true for a lot of other
(16:39):
conditions as well. But yeah, I think when we look
at the link between the the gut Biome and infertility and
inflammation, it's all probably along the same sort of
continuum. So I think, you know, we are
constantly looking for new areasof research and this is really
just just hitting the, the top of the, the beginning of the
(16:59):
understood mechanisms related again to inflammation and and
really oxidative stress and injury.
Yeah, absolutely. And you know, I just kind of
want to circle back and, and forthis, you know, when we talk
about like GLP ones, you know, and utilizing different things,
you know, cycling through dieting, weight, metabolic
(17:21):
stress, all of that. How might like that, you know,
repeated weight fluctuations like really affect this as well,
'cause I think trying to keep with a routine or stabilizing
because, you know, I, I'm one that's guilty of a crushed diet,
right? Like I'll change it for a little
bit. And I feel like because I'm so
regiment with it, then I real quick go back to how I was
(17:43):
eating 'cause it's frustrating if I break it for a couple of
days or something like that. So love your opinions about that
as well. Yeah, I think, I think that the
the GLP ones are one of those like sort of huge once in a
lifetime discoveries that I meanof course they came out a
couple, you know, at least a decade ago.
But I think that the, the impactthat these medications are
(18:06):
having on so many different bodysystems is, is huge.
And I think that we we really know that obesity and weight
health is probably a lifelong chronic disease that is likely
not something that can just be treated and left alone without
chronic medications. I mean, we kind of see it like a
(18:27):
blood pressure. I mean, yes, your blood pressure
is probably under control. If you have hypertension, you're
on antihypertensives. But when you go off the
medication, the disease likely is going to resurface.
So that's kind of likely how this is going to be sort of
addressed long term. And so the question is, OK, well
then how do we, how do we managethis in the the preconception
and prenatal time frame? And I don't know that we have an
(18:51):
answer for that yet, but, you know, we do know that a lot of
patients with PCOS who are goingon the GLP ones and are
achieving pregnancy because their cycles have become a
little bit more regular and they're ovulating more
regularly. We're starting to gather more
data on what the role of those medications will be in the
pregnancy. You know, obviously right now
our recommendation is for patients to come off really when
(19:11):
they're trying to conceive or atthe very least as soon as they
find out they're pregnant. But I think long term the
question is, you know, will willthere be a world where patients
can stay on AGLP 1 during pregnancy to help maintain that
symbiosis and homeostasis in theinsulin resistance during
pregnancy. But right now, I don't know that
we have any any good data, Not good.
(19:33):
I'm not an expert on the GLP ones, but this is just something
that we're seeing, you know, patients coming in with with
lots of questions. Absolutely, 'cause it is, it's,
it's now that it's easily accessible for people through
insurance, things like that, it's getting covered.
More people are seeing the need for it and to really help it.
It's interesting, especially with, you know, looking that as
(19:53):
an option to really help controlyour weight or, you know, lose
weight. Exactly.
Yeah, Yeah. So, so much research in my, you
know, fertility world of what these medications can do for our
patients. It's really just we're just at
the beginning. So yeah.
Yeah, it's fantastic. I know science.
(20:13):
It's always, you know, evolving and I feel like more rapidly
over these last couple of years in the fertility space and just
hoping that continues. Yeah, I know we, we really, you
know, as as women, we're, we're always looking for more research
to be dedicated to what's happening in, in our patients
and in our lives. And I think a lot of fear of
(20:34):
math research and, you know, pregnancy and rightfully so.
But I think, you know, the more creative ways of addressing some
of these questions in the lab are.
Are vital. Agreed.
Agreed. And so you know, when, when they
are using assisted programs or things like that, also a lot of
times, you know, patients are told you also need to look at
how you're fueling your system, like what you're consuming and
(20:56):
all of that. Like what would your, what would
it mean to actually like fuel the body for fertility, if that
makes sense. I know you touched on a little
bit with protein and things, butif we could even go into a
little bit deeper with that. Yeah.
I mean, I definitely don't thinkthat there is a single diet that
is right for somebody who's trying to conceive, but I think
making sure that you're getting the specific nutrients such as
(21:19):
folic acid. So we know that that's a
nutrient that's required for thebeginning of the baby's
development of the neural tube. And and many times we're not
getting that enough in our diet alone.
And so the general recommendation across the board
is if you're of reproductive age, even if you're on birth
control, to be on some form of aprenatal vitamin that has folic
acid in it. So that in the event of a, a
(21:41):
spontaneous, you know, unintended pregnancy, that that
early time frame is protected. So folic acid is a nutrient that
is in it should be in every prenatal vitamin.
You should be on at least 400 micrograms a day.
And there are certain populations that may need to be
in a slightly elevated dose, forexample, for twin gestations or
a history of a neural tube defect.
(22:02):
So that's like the most vital thing that we can recommend
across the board that everybody should be on.
And then outside of that, you know, in in our patients, we're
worried about egg quality and we're always looking for any
kind of nutrients, vitamins or supplements that might be
helpful for egg quality. The only real one that we have,
you know, right now that I can say, you know, with certainty is
(22:23):
Co enzyme Q10, which is an antioxidant that is really
great. It's it's marketed for like
heart health, but it's somethingthat can help improve egg
quality. And, you know, it's not a magic
pill, but this is one of those things that people are always
looking for something extra thatthey can take.
And there's some other other supplements out there that, you
know, are still being studied, but that one we're pretty
(22:45):
clearly recommending across the board, along with the folic
acid. Otherwise, you know, I think I
tell my patients that, you know,we see, we see a lot of these
things as inflammatory disorderswhere you know, if you're kind
of looking at ways of life, anti-inflammatory type of
approaches is always gonna be great.
So, you know, avoid any kind of toxins like tobacco, chew
(23:08):
tobacco, smoking cigarettes, vaping, nicotine, you know,
anything that is gonna increase risk for oxidative damage is
probably not going to be great for egg health and sperm health
and for, you know, pregnancy. We have a lot of data, you know,
that that is all true. So I think just trying to lead a
(23:28):
cleaner lifestyle in terms of avoiding some of those those
modifiable risk factors, it's helpful.
And again, there's no magic bullet.
Sometimes there are things that we really cannot avoid.
Sometimes there are genetic predispositions to conditions
that we we can't really address.But but it to the much of the
ability of being able to kind ofavoid some of those things, you
(23:49):
know, binge drinking and and youknow, some of the things that we
know probably aren't great for your overall health.
Absolutely. Doctor Marchow Yeah.
And well, that leads into, you know, what out things outside of
significant weight change do yousee to like sleep patterns, you
know, rhythms, things like that that can maybe be changed in
(24:11):
someone's lifestyle or, you know, life to help with
fertility. Yeah, I mean, again, I think, I
think some of this is what we have control over and some of it
is not. So if you're, you know, an RN
working night shift, you know, that's your, that's your job in
your life. And so you know, that's not,
that's not one of those things that you can necessarily change.
(24:31):
And we don't really know the overall impact and it it
probably does not have the same impact on one patient over
another. But sleep is important and
having some sort of a routine with sleep is, is good.
What I can say is that some patients, you know, if you're
worried that you're not getting restful sleep or you feel like
you're somebody that snores or you're waking up in the middle
of the night gasping for air, you know, I would definitely
(24:53):
recommend a sleep study or seeing or asking your doctor
about, you know, whether or not you are a candidate for work up
for obstructive sleep apnea. We know that sleep apnea is a
condition that can limit your oxygenation overnight.
It can definitely affect, you know, your blood vessels can put
you at risk for blood hypertension and pulmonary
hypertension, both which are big, big precursors for
(25:17):
cardiovascular disease, probablyhas an impact on egg quality and
sperm quality as well. So, you know, we we will often
as part of our assessment when when we're kind of evaluating a
patient, talk to patients about,you know, their overall patterns
of, of their day-to-day life. And if they're really not
getting a lot of sleep because of something like this, that
might be something that you could be addressing with an
(25:38):
intervention like a CPAP machine.
This again, you know, something that you would talk to with your
primary care doctor. But but yeah, sleep is sleep is
crucial. We can't all sleep all the time
as much as I'm sure many of us would like to.
But but yeah, to the best of your ability, you know, knowing
that everybody has busy, hectic lives, be sure that when you are
sleeping, you're getting some some rest.
Quality, yeah. Quality sleep.
(25:59):
Absolutely. Wow, thank you so much.
And I would love for us to closewith if someone listening feels
like they've tried everything, changing diet, exercising, doing
all the research and still feel stuck in their fertility.
You know, what would you want to, you know, leave with them
with and any advice that you have also Doctor Marchetto.
(26:20):
I think knowing that you're not alone is always a really
important message. So, you know, I have the benefit
of of, like I said, seeing patients every day that that I
know that, you know, as a patient myself that I am not
walking alone through any of this because I see how many
people are affected by all thesedifferent things every day.
But I know that patients are notso aware because this is
(26:41):
something that not everybody talks about.
So just just know that you're not alone.
There are support groups out there such as chasing the
rainbows and, and you know, really seeking out help and
seeing a reproductive endocrinology and infertility
specialist. You know, we are our physicians
who are, are trained in OBGYN that then sub sub specialized in
(27:02):
reproduction and fertility. And really it's it's important
to kind of have somebody who hasthat background be able to
assess what what's going on and how we can help you.
Great. Thank you so much, Doctor
Marchetto, for being on here, for sharing your expertise, your
perspective and a deeper understanding all around this.
Thank you very much. Thank you.
(27:23):
Thank you so much. It was so good to see you again,
but hopefully we'll talk again soon.
Absolutely so great to have you on.
To everyone listening to maybe navigating infertility or still
birth, infant loss, any type of pregnancy loss, please know your
story matters, your baby matters, and your grief matters.
Healing doesn't follow a timeline.
Trauma and loss don't have a schedule, and you deserve
compassionate care through everystep of this journey.
(27:46):
If this conversation resonates with you, please share this
episode with someone who may need to hear it as well.
And if you are looking for support, want to volunteer,
donate, host an event in honor of your baby, you can learn more
at Chase and the rainbows.org. Thank you for being here, for
listening, and for continuing tobreak the silence around
infertility and baby loss. Until next time this is cried
out loud.
Crying Out Loud, a podcast by Chasing the Rainbows with your
host Bernice Quisenberry. Today's conversation is one that
we approach with a lot of care and compassion.
When weight infertility come up in reproductive medicine, the
(00:33):
conversation often gets reduced to 1 oversimplified message.
Just lose weight. And for many people navigating
infertility, that advice can feel dismissive, stigmatizing,
and incomplete. Because the reality is far more
complex than just that. Weight is not simply a number on
a scale. It reflects a web of metabolic
health. Hormones, inflammation, stress
(00:54):
Physiology, along with other factors can ask us to care for
this. And for many individuals trying
to conceive, especially those navigating PCOS, insulin
resistance, or infertility, the question isn't just about
weight. It's about how the body is
metabolizing energy, regulating hormones and responding to the
environment that we live in. Our listeners know this well.
(01:14):
Many of you listening in today have already gone down the
rabbit hole of research, readingstudies, exploring nutrition,
learning about insulin singling,you know, inflammation, gut
health, all of it, and how we feel our bodies, you know, which
then can affect ovulation, egg quality, implantation and
pregnancy outcomes. So today, we're not staying on
(01:35):
the surface. We're diving into the whole
picture of weight, metabolism and reproductive health, not
through shame or simplistic advice, but through science,
compassion, understanding. We are joined today by Doctor
Nicole Marchetto, a board certified reproductive and
chronologist and infertility specialist.
Doctor Marchetto earned her medical degree from Drexel
(01:57):
University College of Medicine, where she also completed a
Master of Public Health. She then completed her OBGYN
residency at Mount Sinai Saint Luke's, Mount Sinai West in New
York, followed by her fellowshipand reproductive endocrinology
and infertility at Rutgers New Jersey Medical School.
She is also an accomplished researcher whose work has
(02:17):
explored pre implantation genetic testing, racial and
ethnic disparities in fertility care, and polycystic ovary
syndrome. As we all know, PCOS areas that
intersect deeply how wheat metabolism and systematic
factors influence reproductive health.
Doctor Marchetto, thank you for joining us today for what we
(02:38):
hope we will get, deeper and more thoughtful conversation
around health and nutrition and fertility.
Thank you so much, Bernice. I really, really appreciate the
opportunity to come speak with you and to your listeners.
I remember when we met several years ago at the Bereavement
conference, and I'll never forget that.
This is just such a great organization and so needed for
(02:59):
all of us who have gone through infertility and loss.
So thank you so much for having me.
Thank you, of course. And we're just so excited to
have you and to really talk through a lot of this.
You know, when I heard you speakat that conference, you spoke so
beautifully and the way that youreally broke things down just
gave us a huge understanding of,you know, different things.
So I'm really excited for you tobe on here for our listeners to
(03:21):
hear you share more. Thank you.
Yeah. So beyond the typical weight
conversation, we'll just dive right into these deeper
conversations. You know, many patients such as
myself, you know, feel the fertility conversation around
weight, it becomes very overly simplified, like just go lose
weight, Right. And from a reproductive
endocrinology standpoint, how doyou think we should reframe the
(03:44):
discussion, you know, away from BMI alone and toward metabolic
health? Yeah.
So I think that the first step is really speaking to a provider
really, you know, a physician orsomebody who is trained in
reproductive endocrinology and infertility to really figure out
what the person's diagnosis is. So many of our patients are
(04:05):
coming to us with recurrent pregnancy laws or infertility or
unexplained infertility. And really it's important to
kind of do a full work up and figure out if there is something
specific that we can identify asa cause for what they're coming
in for. Sometimes weight is playing a
role, but it's likely not the only role.
And it's important to understandexactly how it's playing a role
(04:26):
in their journey. We know that BMI is important
and we know that extremes of BMIdo play a role in miscarriage
and infertility. You know, at the very low end of
the spectrum, patients who are really underweight, the body
definitely needs more nutrients to be able to apply resources
directly to conceiving. But it's, it's many times more
(04:48):
than just ABMI factor that needsto be addressed.
So we do a full work up and we want to see exactly what is
happening with their hormonal communication from the level of
the brain down to the ovaries and how they're really
communicating directly with the ovaries and the uterus to be
able to address what the best next steps would be, what the
treatments are. And it's not simply going to be
(05:11):
gaining weight or losing weight depending on you know what what
their background is. Yeah.
Oh, that's great. Thank you for sharing it like
that. And you know, BMI is often used
as a screening tool in fertilitycare, but it doesn't always
reflect the insulin resistance or inflammation or metabolic
dysfunction. How do you evaluate metabolic
(05:31):
health more holistically when someone is trying to get.
Right. So I think, I think you know,
taking a full history and understanding the patient's
journey so far. So any medications that they're
on, if they've had any drastic changes in weight, weight loss
or weight gain that coincided with their, their history, if
they, if they, you know, recently have had a change in
(05:53):
their menstrual cycles that werealso reflective of what that
change in weight has been. We want to know, you know, did
they recently are, are they struggling with depression and
that their weight gain has been associated with depression and
trying to figure out if there's anything else that might be
going along side of the weight gain or weight loss.
We know that really BMI is, is like you said, it's a number,
(06:18):
right? So it's BMI is a a calculation
of the height and the weight andhow it it's sort of supposed to
reflect the person's overall risk for other diseases.
But it's not perfect. So we really can't rely on that
alone. And so we want to do other tests
to see, you know, do they have any evidence, lab based evidence
(06:38):
of insulin resistance or pre diabetes or diabetes?
We know that that weight that has hormonal impacts, so excess
body fat can have estrogen effects.
We know that adipose tissue can directly turn into estrogens in
the body with different hormone pathways that we have.
We know that that weight can also directly impact the level
(06:59):
of inflammation in the body and that inflammation crosstalks
with insulin resistance. Now it's not super
straightforward in terms of how to be able to test somebody for
insulin resistance. There are a couple of gold
standard measurements that we can use, but are often, you
know, not not as straightforwardto actually measure.
So often we'll get a summary hormone, which is the hemoglobin
(07:20):
A1C, which is kind of like your,your glucose summary of the
control over the last three months.
That's a good place to start. I also like to get fasting lab
values on a comprehensive metabolic panel as well as a
fasting insulin level and a fasting glucose level.
There are some other labs, like I said that that may be
described more eloquently in theliterature that may not be as
(07:41):
practical for our patients to begoing and doing all the time.
But we want to get a sense of what is happening sort of in
their day-to-day life, their nutrition, their habits and
other medical conditions and other medications that may also
be playing a role in that risk. Are they on Prednisone for an
autoimmune condition? Because that can impact your
your resistance to insulin and glucose intolerance.
(08:04):
So and any other risk factors, you know, if they have
polycystic ovarian syndrome. So this is going to come out
when we do their full history and physical exam.
We're going to evaluate how regular their cycles are, what
their ovaries look like. Some of the other hormone values
that we're going to be checking.Patients with polycystic ovarian
syndrome also have an increased risk for metabolic syndrome.
(08:26):
These are two conditions that that really go hand in hand.
And so we have to assess for thepatient's overall risk for
cardiovascular disease later in their life and really both
within a pregnancy, you know what their risks are as well as
post pregnancy and and how to make sure that we can keep them
healthy and safe long, long term.
I think taking that overall approach too, I mean, with
(08:46):
looking at medications, because I know sometimes the one
medication I was put on caused waking and things like that too,
which also was then affecting because it was very rapid
increase things like that. So I think mentioning Dr.
Marchetto that, you know, looking at everything, OK, let's
like look at this and see what'scausing it, you know, root cause
and really evidence based than just, you know, trying to to
(09:10):
guess at it. Right, I think too, I mean, I, I
see patients all the time and we, we do talk about weight and,
and how hard it is to lose weight.
And I think that it's, you have to also be practical.
And I think leaving a patient with the instructions to just go
lose weight is, is like the least helpful thing that we
could do. So I think, you know, having
(09:30):
some tools, we often will work with a nutritionist.
We also have been starting to use more of the new medications
that focus on the GLP one receptor agonists and what role
they may play in helping patients who are at particularly
high risk of weight gain becauseof the Physiology of their their
(09:51):
their ovaries. And so there's a lot of other,
you know, multi pronged approachthat is is needed in these kind
of conversations. Absolutely.
And I think too, you know, taking in all the stressors,
everything that you're dealing with when you're on an
infertility journey and sometimes food is comfort,
right? And then to, you know, try to
create another new routine on top of, or, you know, trying to
(10:14):
readjust your, you know, food and, and intake and, and all of
that is so difficult in those moments when you're already
trying to navigate so many otherthings.
So I, you know, love that you say from this compassionate
approach, you know, we work witha nutritionist, we help you,
we're here for you, We're alongside of you.
It's not like we're just going to leave you high and dry and
figure it out on your own. Right, exactly.
(10:36):
I think that's that's really valuable.
And I think we've learned a lot as a field to to really
understand that it's not a blamesituation.
And this is really you, you haveto understand that.
And I think we're starting to now that there's a lot more data
and more discussion on it. But but yeah, I mean, the the
worst thing that we can do is just kind of abandoned a patient
and, and expect them to kind of be able to handle all of this
(10:57):
without any kind of other help when it's really their their,
you know, hormones and Physiology that are affecting
it. Yeah.
Well, and the other factors, youknow, let's talk through
inflammation, for example, and how that, you know, can affect
egg quality and, you know, implantation, so many different
things as well. And it's really hard to
sometimes get that under controlor regulated too.
(11:19):
Yeah. So the the tough thing and I
talk about this a lot with my patients, especially in the
first visit is there is a whole lot that we don't understand
about the body and about reproduction.
And I think that understanding that that sort of lack of
knowledge is crucial in our approach because we have to be
open to the idea that there may be something happening on a
(11:40):
molecular level that we have notyet diagnosed or figured out.
And so many times when we are working with patients who either
have recurrent pregnancy laws orinfertility who are going
through maybe the IVF journey and, and maybe, you know, we're,
we're struggling with miscarriages with IVF, we have
to think that there is more happening than what we can just
detect and measure. And being open to understanding
(12:02):
those other pathways and, and sort of trying different things
is important. We do know that that high weight
and obesity does create a chronic inflammatory state.
And there's a host of cytokines,inflammatory cytokines that are
up regulated that function to dysregulate hormone secretion
(12:23):
and metabolism. And we know that this can affect
egg quality, it can affect embryo implantation, it can
affect the the environment and the uterus.
And again, we don't fully understand all of it.
And so there's sort of a different approach for every
patient and trying to figure outwhat they've tried before and
really what some of these other conditions that are might be
(12:43):
playing a role could be and whatwe can do to help address each
of those conditions along the way.
Oh my goodness. Yeah.
And right. So when you were saying about
like the macro nutrients, the micronutrients, the, you know,
what do we know from research with that and the influence it
has on egg quality and you know,the ovarian function?
(13:04):
Yeah. So I think, I think that the
important thing is making sure that we understand what, what
nutrients our bodies need to develop a healthy pregnancy,
right? So we, we, we need all of them,
but in different amounts, right?So I think, I think protein we
know is really important. Sugars are important too.
(13:26):
Just, you know, understanding the the the sugars that are
gonna up regulate your glucose system quicker and less
efficiently are probably not as helpful.
And and again, some patients aremore sensitive to certain
nutrients than others. And certain patients may have
conditions that we have to thinkabout.
They may not be absorbing certain nutrients or macro
(13:47):
nutrients as well as others. So if a patient has come to us
with a history of the gastric sleeve or bypass surgery, we
have to think about how are they're going to get, get all of
the, the important vital nutrients they need to, to
become pregnant. It's again multidisciplinary,
you know, working with their, their, their bariatric doctors
(14:07):
and, and nutritionists and, and kind of giving them the tools to
be able to, to feel their best as well.
Absolutely, yeah. And that's, you know, that's
right. Like when you're on this
journey, it's self-care, taking care of yourself and having the
right people in your corner and the right team really is is so
vital. During all of this, right.
(14:28):
I mean, I think I think all of us have been been in some part
of a journey in our life where we feel like we're kind of lost.
And it's so important to have, you know, someone in your court
to help figure out some of thesethese questions that come up.
Yeah. I think mental health providers,
nutritionists, also friends, networks, support groups because
(14:50):
nobody is alone. And I know myself sitting in
this seat as a physician sees see patients all the time that
are going through difficult scenarios.
And I've also been on the other side of the table where I'm in
the patient. And yeah, I mean, it's it's hard
to to kind of navigate when you think you're doing this by
yourself. But that's why support groups
are so vital. Yeah, yeah.
(15:10):
Thanks, Doctor Marcheto for that.
Yeah. And emphasizing Exodus, it
really is, especially, you know,when you're feeling like you're
getting hit at all angles, you know, and, and trying to
navigate and figure it out. So, you know, and then this
really brings up and what's interesting is gut health and
microbiome, you know, and the evidence of around that with
reproductive hormones and fertility outcomes.
(15:33):
You know what a lot of people have questions around that gut
health is it's almost like a a word now that's like going
buzzword that's just going around.
Yeah, that's so true. And I think that's an area of
research that that is blooming and is getting a lot more
attention now. And, and I think that we're
understanding that the gut Biomeplays a really important role
(15:55):
in, in our hormone access. So as women, you know, our
hypothalamic pituitary ovarian access in terms of modulating
different pathways, men too, youknow, in terms of, of their
reproductive pathway, how, how certain microbes and how, yeah,
really what is going on again atthe molecular level is playing a
(16:18):
role in, in your hormone level. I don't know that we have really
reached the surface. I think we're almost at, you
know, the tip of an iceberg whenwe get down to what is happening
and, and the disk biosis. You know, we know that patients
with PCOS have really a different microbiome than
patients without PCOS and that'sprobably true for a lot of other
(16:39):
conditions as well. But yeah, I think when we look
at the link between the the gut Biome and infertility and
inflammation, it's all probably along the same sort of
continuum. So I think, you know, we are
constantly looking for new areasof research and this is really
just just hitting the, the top of the, the beginning of the
(16:59):
understood mechanisms related again to inflammation and and
really oxidative stress and injury.
Yeah, absolutely. And you know, I just kind of
want to circle back and, and forthis, you know, when we talk
about like GLP ones, you know, and utilizing different things,
you know, cycling through dieting, weight, metabolic
(17:21):
stress, all of that. How might like that, you know,
repeated weight fluctuations like really affect this as well,
'cause I think trying to keep with a routine or stabilizing
because, you know, I, I'm one that's guilty of a crushed diet,
right? Like I'll change it for a little
bit. And I feel like because I'm so
regiment with it, then I real quick go back to how I was
(17:43):
eating 'cause it's frustrating if I break it for a couple of
days or something like that. So love your opinions about that
as well. Yeah, I think, I think that the
the GLP ones are one of those like sort of huge once in a
lifetime discoveries that I meanof course they came out a
couple, you know, at least a decade ago.
But I think that the, the impactthat these medications are
(18:06):
having on so many different bodysystems is, is huge.
And I think that we we really know that obesity and weight
health is probably a lifelong chronic disease that is likely
not something that can just be treated and left alone without
chronic medications. I mean, we kind of see it like a
(18:27):
blood pressure. I mean, yes, your blood pressure
is probably under control. If you have hypertension, you're
on antihypertensives. But when you go off the
medication, the disease likely is going to resurface.
So that's kind of likely how this is going to be sort of
addressed long term. And so the question is, OK, well
then how do we, how do we managethis in the the preconception
and prenatal time frame? And I don't know that we have an
(18:51):
answer for that yet, but, you know, we do know that a lot of
patients with PCOS who are goingon the GLP ones and are
achieving pregnancy because their cycles have become a
little bit more regular and they're ovulating more
regularly. We're starting to gather more
data on what the role of those medications will be in the
pregnancy. You know, obviously right now
our recommendation is for patients to come off really when
(19:11):
they're trying to conceive or atthe very least as soon as they
find out they're pregnant. But I think long term the
question is, you know, will willthere be a world where patients
can stay on AGLP 1 during pregnancy to help maintain that
symbiosis and homeostasis in theinsulin resistance during
pregnancy. But right now, I don't know that
we have any any good data, Not good.
(19:33):
I'm not an expert on the GLP ones, but this is just something
that we're seeing, you know, patients coming in with with
lots of questions. Absolutely, 'cause it is, it's,
it's now that it's easily accessible for people through
insurance, things like that, it's getting covered.
More people are seeing the need for it and to really help it.
It's interesting, especially with, you know, looking that as
(19:53):
an option to really help controlyour weight or, you know, lose
weight. Exactly.
Yeah, Yeah. So, so much research in my, you
know, fertility world of what these medications can do for our
patients. It's really just we're just at
the beginning. So yeah.
Yeah, it's fantastic. I know science.
(20:13):
It's always, you know, evolving and I feel like more rapidly
over these last couple of years in the fertility space and just
hoping that continues. Yeah, I know we, we really, you
know, as as women, we're, we're always looking for more research
to be dedicated to what's happening in, in our patients
and in our lives. And I think a lot of fear of
(20:34):
math research and, you know, pregnancy and rightfully so.
But I think, you know, the more creative ways of addressing some
of these questions in the lab are.
Are vital. Agreed.
Agreed. And so you know, when, when they
are using assisted programs or things like that, also a lot of
times, you know, patients are told you also need to look at
how you're fueling your system, like what you're consuming and
(20:56):
all of that. Like what would your, what would
it mean to actually like fuel the body for fertility, if that
makes sense. I know you touched on a little
bit with protein and things, butif we could even go into a
little bit deeper with that. Yeah.
I mean, I definitely don't thinkthat there is a single diet that
is right for somebody who's trying to conceive, but I think
making sure that you're getting the specific nutrients such as
(21:19):
folic acid. So we know that that's a
nutrient that's required for thebeginning of the baby's
development of the neural tube. And and many times we're not
getting that enough in our diet alone.
And so the general recommendation across the board
is if you're of reproductive age, even if you're on birth
control, to be on some form of aprenatal vitamin that has folic
acid in it. So that in the event of a, a
(21:41):
spontaneous, you know, unintended pregnancy, that that
early time frame is protected. So folic acid is a nutrient that
is in it should be in every prenatal vitamin.
You should be on at least 400 micrograms a day.
And there are certain populations that may need to be
in a slightly elevated dose, forexample, for twin gestations or
a history of a neural tube defect.
(22:02):
So that's like the most vital thing that we can recommend
across the board that everybody should be on.
And then outside of that, you know, in in our patients, we're
worried about egg quality and we're always looking for any
kind of nutrients, vitamins or supplements that might be
helpful for egg quality. The only real one that we have,
you know, right now that I can say, you know, with certainty is
(22:23):
Co enzyme Q10, which is an antioxidant that is really
great. It's it's marketed for like
heart health, but it's somethingthat can help improve egg
quality. And, you know, it's not a magic
pill, but this is one of those things that people are always
looking for something extra thatthey can take.
And there's some other other supplements out there that, you
know, are still being studied, but that one we're pretty
(22:45):
clearly recommending across the board, along with the folic
acid. Otherwise, you know, I think I
tell my patients that, you know,we see, we see a lot of these
things as inflammatory disorderswhere you know, if you're kind
of looking at ways of life, anti-inflammatory type of
approaches is always gonna be great.
So, you know, avoid any kind of toxins like tobacco, chew
(23:08):
tobacco, smoking cigarettes, vaping, nicotine, you know,
anything that is gonna increase risk for oxidative damage is
probably not going to be great for egg health and sperm health
and for, you know, pregnancy. We have a lot of data, you know,
that that is all true. So I think just trying to lead a
(23:28):
cleaner lifestyle in terms of avoiding some of those those
modifiable risk factors, it's helpful.
And again, there's no magic bullet.
Sometimes there are things that we really cannot avoid.
Sometimes there are genetic predispositions to conditions
that we we can't really address.But but it to the much of the
ability of being able to kind ofavoid some of those things, you
(23:49):
know, binge drinking and and youknow, some of the things that we
know probably aren't great for your overall health.
Absolutely. Doctor Marchow Yeah.
And well, that leads into, you know, what out things outside of
significant weight change do yousee to like sleep patterns, you
know, rhythms, things like that that can maybe be changed in
(24:11):
someone's lifestyle or, you know, life to help with
fertility. Yeah, I mean, again, I think, I
think some of this is what we have control over and some of it
is not. So if you're, you know, an RN
working night shift, you know, that's your, that's your job in
your life. And so you know, that's not,
that's not one of those things that you can necessarily change.
(24:31):
And we don't really know the overall impact and it it
probably does not have the same impact on one patient over
another. But sleep is important and
having some sort of a routine with sleep is, is good.
What I can say is that some patients, you know, if you're
worried that you're not getting restful sleep or you feel like
you're somebody that snores or you're waking up in the middle
of the night gasping for air, you know, I would definitely
(24:53):
recommend a sleep study or seeing or asking your doctor
about, you know, whether or not you are a candidate for work up
for obstructive sleep apnea. We know that sleep apnea is a
condition that can limit your oxygenation overnight.
It can definitely affect, you know, your blood vessels can put
you at risk for blood hypertension and pulmonary
hypertension, both which are big, big precursors for
(25:17):
cardiovascular disease, probablyhas an impact on egg quality and
sperm quality as well. So, you know, we we will often
as part of our assessment when when we're kind of evaluating a
patient, talk to patients about,you know, their overall patterns
of, of their day-to-day life. And if they're really not
getting a lot of sleep because of something like this, that
might be something that you could be addressing with an
(25:38):
intervention like a CPAP machine.
This again, you know, something that you would talk to with your
primary care doctor. But but yeah, sleep is sleep is
crucial. We can't all sleep all the time
as much as I'm sure many of us would like to.
But but yeah, to the best of your ability, you know, knowing
that everybody has busy, hectic lives, be sure that when you are
sleeping, you're getting some some rest.
Quality, yeah. Quality sleep.
(25:59):
Absolutely. Wow, thank you so much.
And I would love for us to closewith if someone listening feels
like they've tried everything, changing diet, exercising, doing
all the research and still feel stuck in their fertility.
You know, what would you want to, you know, leave with them
with and any advice that you have also Doctor Marchetto.
(26:20):
I think knowing that you're not alone is always a really
important message. So, you know, I have the benefit
of of, like I said, seeing patients every day that that I
know that, you know, as a patient myself that I am not
walking alone through any of this because I see how many
people are affected by all thesedifferent things every day.
But I know that patients are notso aware because this is
(26:41):
something that not everybody talks about.
So just just know that you're not alone.
There are support groups out there such as chasing the
rainbows and, and you know, really seeking out help and
seeing a reproductive endocrinology and infertility
specialist. You know, we are our physicians
who are, are trained in OBGYN that then sub sub specialized in
(27:02):
reproduction and fertility. And really it's it's important
to kind of have somebody who hasthat background be able to
assess what what's going on and how we can help you.
Great. Thank you so much, Doctor
Marchetto, for being on here, for sharing your expertise, your
perspective and a deeper understanding all around this.
Thank you very much. Thank you.
(27:23):
Thank you so much. It was so good to see you again,
but hopefully we'll talk again soon.
Absolutely so great to have you on.
To everyone listening to maybe navigating infertility or still
birth, infant loss, any type of pregnancy loss, please know your
story matters, your baby matters, and your grief matters.
Healing doesn't follow a timeline.
Trauma and loss don't have a schedule, and you deserve
compassionate care through everystep of this journey.
(27:46):
If this conversation resonates with you, please share this
episode with someone who may need to hear it as well.
And if you are looking for support, want to volunteer,
donate, host an event in honor of your baby, you can learn more
at Chase and the rainbows.org. Thank you for being here, for
listening, and for continuing tobreak the silence around
infertility and baby loss. Until next time this is cried
out loud.
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