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Infections: an overlooked factor in infertility with Elizabeth Mucci

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Infections: An Overlooked Factor in Infertility with Elizabeth Mucci

With 1 in 6 couples now struggling to conceive naturally, infertility is a massive and growing area within health care. The reasons why couples are becoming infertile are often multifactorial and in some cases, mystifying. Naturopath Elizabeth Mucci is at the coal-face of this every day and what she's finding is that there's an alarming trend being overlooked; and that is, underlying infections.

These infections are many, and varied, but in all cases, unresolved and by identifying them and supporting the body through healing, she is able to resolve infertility in many of her patients. Today she shares her experience in this crucial area of integrative medicine.

Covered in this episode

[00:42] Welcoming back Elizabeth Mucci
[01:49] What role do infections play in infertility?
[03:55] Endometritis vs. Endometriosis
[07:29] Cytomegalovirus
[10:09] Where to begin with therapy?
[12:16] The role of inflammation
[18:27] Endometriosis and autoimmunity connections
[19:52] Endometriosis: the inflammatory picture
[26:49] Bacterial vaginosis
[30:35] Topical treatment reccomendations
[32:34] The rise in STD incidence
[34:50] STD intervention options
[40:56] What else do we need to screen for?
[42:26] Rectification of gut health
[46:16] Group B strep
[49:50] Medical push-back in screening requests
[55:53] Thanks to Elizabeth 


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us in the studio today is Elizabeth Mucci

Elizabeth is a mentor, educator, and healthcare professional with over 17 years experience in integrative hormonal and reproductive medicine. As a scientist, nutritionist, and herbalist with a masters in reproductive medicine, Elizabeth is a passionate health advocate whose principles as a clinician and teacher have enabled her to help thousands of patients start their families both in Australia and overseas, including the U.S., U.K., Canada, China, and Japan.  
 
Prior to joining Elizabeth's fertility program, most of these patients have been facing particularly challenging fertility issues that have resulted in multiple miscarriages and repeat IVF failures. Elizabeth's greatest ambition is to provide both her patients and peers with the tools they need to enable more people around the world to build the happy, healthy families they've dreamed of. And I warmly welcome you back to FX Medicine, Elizabeth. How are you? 
 
Elizabeth: I'm well. Thank you. 
 
Andrew: Now, last time we spoke about fertility issues but we didn't get a chance to really delve into one of the major causes and that was infections. So, let's start off. How great an issue is infections as a cause of infertility? 
 
Elizabeth: Infections play a major role in infertility. And they know that things like, you know, herpes, even toxoplasmosis, cytomegalovirus, urea plasmas, the mycoplasmas, you know, the Chlamydias, the gonorrheas, the syphilis. They have all been implicated with infertility cases. 

And, you know, a lot of the time the obvious sort of thing that we think about is all of them are triggering inflammatory responses. And as a result, every time we tend to see inflammatory responses we tend to see some sort of alteration with our ability to attach a baby or to ovulate or, you know, depending on the mechanisms and the body and the genetics and, you know, because you'll have people that have had those infections falling pregnant. But what they tend to find is a lot of them fall… you know, they might fall pregnant but miscarry before they're 20 weeks, depending... And some of them, they're fine up until about 13 weeks and then they miscarry, the waters are getting infected and their waters break, and all the rest. 
 
Andrew: And does this answer the Th1/Th2 balance sort of theory, if you like, about pregnancy that, you know, immunity dampens to carry a baby which is really a parasite? Because it seems to be not really true. 
 
Elizabeth: It's more I would say, about a lot of these are encouraging endometritis. And therefore, as the baby is trying to attach it's struggling to attach and it's struggling to get good blood supply. And so, you know, and sometimes the baby itself is getting the infection. 
 
Andrew: Now you've mentioned endometritis and then there's endometriosis? 
 
Elizabeth: That's right. 
 
Andrew: Let's differentiate between those two first so that everybody's clear. Endometritis is obviously inflammation of the endometrium? 
 
Elizabeth: That's right. 
 
Andrew: From any cause? 
 
Elizabeth: That's right. 
 
Andrew: Which might include endometriosis or is that classified as different even though it's inflammatory in nature? 
 
Elizabeth: So, you could have both cases in the one person. But most of the STIs and the infections are going to encourage… the bottom line is like an endometritis. And therefore, you know, need to be treated either with an antibiotic or particular changes in lifestyle and/or both or whatever. And endometriosis is a little bit different. 

So endometriosis is still not 100% clearly understood. Because there are women with endometriosis that are falling pregnant and may never even know they've got it. And there's other people that might have the slightest amount and then they're feeling, you know, severe pain and all the rest. 

But they know that infertility rates in women with endometriosis, especially with IVF say for instance, is greatly decreased as a result of endometriosis. Endometriosis is harder to deal with than endometritis. Where you might just need an antibiotic, and then the endometrium recovers, and so on, and so forth. 
 
Andrew: So, with regards to endometritis, do you get permanent scarring like you do in, you know, salpingitis of the fallopian tubes being infected? Where you might get permanent scarring that has long-term effects on fertility or can it recover pretty quickly because it's a high turnover tissue? 
 
Elizabeth: I've seen it recover fairly quickly. And as far as women who have been exposed to things that may affect the tubes, I've also seen those recover. But often it depends on length of exposure, how many infections they've had, how they've been handled, you know, whether they've used the right antibiotic... 
 
Andrew: Or indeed, been caught. 
 
Elizabeth: Or even caught, exactly. 
 
Andrew: Because, you know, and that's one of the issues with any sort of STD is that very often they're insidious. 
 
Elizabeth: Oh, yeah. 
 
Andrew: And therefore, untreated. You know, do you find that it tends to be the most serious infections where they tend to get the more obvious symptoms like pain and fever? That they go, "Hang on, something is not right." They present to a GP. And then they find out that they've got an STD. How would you pick up somebody with endometritis as opposed to endometriosis? 
 
Elizabeth: So a lot of the time, it's interesting because when women come to me, I ask for extensive screening because of this very reason. Because often what's happening is it's hidden. They're not getting any symptoms at all, and they've already gone through lots of IVF, and infections haven't been… particular infections like the general screening, the obvious ones, like the gonorrheas, the syphilis, the Chlamydias have been done, the HPV, you know, that sort of thing. But not the other ones. So often, herpes simplex, cytomegalovirus, toxoplasmosis, they might just sit there quietly and not be detected.  
 
And I've done that where I've actually picked up say, for instance, both. Actually, cytomegalovirus or toxoplasmosis because we've done some screening and gone, "You need to not go and either do either transfer that you thought you wanted to do with that embryo, just wait," or, "I can't have you trying yet. We've got to clear this out of your system because some of them are causing blindness, some of them are causing brain damage," you know, all that sort of thing. 
 
Andrew: Has that got to do with load when we're talking about these, you know, devastating effect with foetuses? Because what is it? 92%, 95% of us are infected with... 
 
Elizabeth: CMV. 
 
Andrew: …cytomegalovirus, CMV. But for most of us, this doesn't cause issues. And there seems to be this perfect storm that happens. Where I don't know about the load but it seems to be multi-factorial. And as soon as you get this other factor, whether it be hormones or stress, or something, bang, you've got a really acute infection going on. Rears it’s ugly head.
 
Elizabeth: So, yeah. So you're looking at, you know if their IgG levels are positive but IgMs are negative, that's fine. But when you look at the avidity or how long they've had it for. So some of the girls we sort of, you know, I can see that it's there right now. So I wait, we test, and we retest and, you know, all that sort of stuff. How they're feeling, all the rest. 

And some of them, you know, three months down the track, they're still showing positive but we know three months has gone past. And we know that that's okay for them to actually if they've had it in their system for that long, they may have had it much longer and that's okay. It's just really the initial, you know, activity of it. 
 
Andrew: And with CMV, forgive me for harping on but it really interests me this virus… Do you tend to do, you know, palpation of the parotid glands or do you tend to look more locally? 
 
Elizabeth: With me personally? No. Usually, I just send them to the GP. I get blood test results. We get to find out what it is and we will… I’ll get them to recheck. If it's just been that they're unwell and it's all happening right now, I focus on that way before we even start trying. 

I do know there are some doctors who won't test the CMV because if they do come up positive some people will choose to actually abort their baby because they don't know if they've affected the baby. 
 
Andrew: All right. Gotcha. 
 
Elizabeth: And so they can be in this dilemma. But that's the way I generally do it. Is I don't want a positive when they're actually trying and then I work on that, and I'll wait at least three months, maybe six before I, you know, depending how unwell they are. 
 
Andrew: So prevention rather than treatment during? 
 
Elizabeth: Exactly. 
 
Andrew: And treatment during, oh, sorry, treatment as a prevention. What sort of herbs, nutrients do you tend to employ? 
 
Elizabeth: Usually, actually, with a lot of my patients to start with, I'm always working on the immune system. So I always go in and strengthen the immune. Because one, I don't want a hiccup down the track. I don't know really where they're at as I first meet them. I don't know what's happening in the uterus. I don't know what their natural killer cells are doing. I don't know their inflammatory markers. So as I sort of start I think, well, I want a really healthy immune. So I work on building that. 

So a lot of antimicrobials, you know, and looking at things that actually weaken your immune system, so we, you know, that sort of activity. So we're sort of building the immune on one sense so you might use things like goldenseal, you know, sage, depending on what area they're sort of at. Or anti-inflammatory markers could be raised so you're using a lot of anti-inflammatory herbs, which we've got some beautiful ones. 
 
And so I tend to start off with doing a lot of that antimicrobial work, looking at getting the uterine lining functioning a lot better and just their body in general. So, you know, are they needing higher doses of say, vitamin C? Is that what they're needing? Are they rundown? Are they commonly catching colds one after the other? You know, there are all sort of clues of where their body's at. And I want them at a point where they're pretty strong. 

The other thing I have found is women that tend to have asthmas and eczemas, and that sort of stuff. 
 
Andrew: Yeah, atopic conditions, too. 
 
Elizabeth: Exactly. I sort of work on that because I don't want them to be super sensitive. If they're actually doing that, they're weakening in the cold or as soon as they've got a cold and they're rundown. I find that their fertility is compromised. 

So, yes, so we work on those. I always work on that. Even though people might think that's really got nothing to do with fertility. Actually, it has quite a large role because it's inflaming the system. 
 
Andrew: Do you ever have an issue with anti-inflammatory-type nutrients and herbs used with immunostimulant, and I think that's a little bit simplistic. But immunomodulatory herbs and nutrients, or herbs mainly, modulation. Do you ever have an issue with that? You get some people saying, "Oh, you shouldn't be dampening the immune system because you want an immune response which is inflammatory in nature." But they're different sides of the coin. 
 
Elizabeth: Oh, yeah, totally. So you've got, you know, you've got the immune system that's fighting obviously, you know, colds, and flu's, and all the things that they’re sort of having impact. And then you've got your own little internal world that's going on and inflammatory sort of responses. And that's where I have found they work beautifully together, actually. I haven't found that an issue at all. 

So, for me, it's more about what is causing inflammation and I do get the markers looked at. So I will do the CA 125 to see if women have maybe got endometriosis or pelvic inflammatory disease. That does tend to rise in those situations, not all the time though. And, you know, the C-reactive protein and ESRs. And I want to see is there any inflammation stirring? That's really, really important to me. Because it's giving me a clue that something is not happy internally. And then have a look at, yeah, the external world and have a look at, you know, how do I build a strengthening immune system for that sort of response but I haven't found them contraindicating at all. 
 
Andrew: Let's just delve a little bit into CA 125. I do wanna finish off a little bit on endometriosis after that. But CA 125, you know, there was this thing probably around a decade now it seems to have petered out largely. But there's probably some people out there they're going, " Oh, CA 125 is the marker for ovarian cancer." Can we please discuss this? What's CA 125? What's its relevance? 
 
Elizabeth: So it's an antigen. And basically, what it has been used for ovarian cancer, that's... 
 
Andrew: But to track it, not to screen it? 
 
Elizabeth: Yeah, that's right. That's right, exactly, you can’t. So that's the obvious one. 

But what they found and actually it does change throughout the cycle. So the best time to check your CA 125 is in that mid-follicular to preovulatory phase. Because when you've got your menses, it will rise. So at different times of the cycle do that. 

But really what's happening is it can rise when there's inflammation in that area. So it's giving us a clue that hang on, you could have PID, you know, the pelvic inflammatory disease. You could have endometritis, you could have endometriosis. I've seen it where any sort of infection if it's bad enough, can sort of put it on the higher ends of that. 

So I use it as… I test it as just another clue that something is going on but heaps of the girls come up with low CA 125 and have had Stage 4 Endometriosis. So it's not a definite marker by any means. 
 
Andrew: But does it give you a clue as a screening tool or as a tracking tool? 
 
Elizabeth: As in for... 
 
Andrew: Anything. 
 
Elizabeth: At which for anything? 
 
Andrew: Like for anything. Like obviously, it's not a screening tool for ovarian cancer? We know that. 
 
Elizabeth: No. 
 
Andrew: But you're saying it rises during the menses? 
 
Elizabeth: Yeah. 
 
Andrew: To me, you know, you wouldn't have really any relevance of testing at least not during that period of the cycle. But if you are in another period of the cycle you said the pre-follicular phase? 
 
Elizabeth: Yeah. 
 
Andrew: Then you screen and it's high, does that tell you that there is definitely something going on or are there some ladies that just have high CA 125 for, you know, they're just one of those people that's more inflamed? 
 
Elizabeth: Well, I'm sure they're there out there. I wouldn’t doubt that. 
 
Andrew: But you don't find that. 
 
Elizabeth: But I don't find that. I tend to find it's more the...but that might be just the women that I'm dealing with because I'm dealing with a lot of the infertile women. 

So, for me, it's more about if I see that it's on the higher end, then I will keep an eye out for other things that could be telling me, it's just like another thing in the box. It's just another one that goes, "Okay, this person's got really high estrogens but they're not displaying a healthy fertility. They've got some higher CA 125, so what's going on there?" "Okay, some inflammation markers are coming up." So it's just part of the story. You know, they've got endo in the family, endometriosis in the family. You know, we know that it's 6% to 7% higher in first-degree relatives. 

Andrew: Gotcha.

Elizabeth: So we've got some genetics… 

Andrew: Clues… 
 
Elizabeth: There’s clues. You’re sort of putting all your clues together. Because really, the only way to find endometriosis is via laparoscopy. 

So, you know, I get so many people saying to me, "Oh, I've had a HyCoSy, so therefore, I don't have it," you know? And so then they go down the road of IVF. And actually it's making the endometriosis much worse, you know. 

But it's more about, you know, it is more commonly found often in PCOS, so polycystic ovarian syndrome. And there's multiple reasons for that actually with endometriosis. There's actually a lot of things going on with endometriosis. It's probably pretty poorly understood.  
 
So when you're sort of putting that picture together, and you've taken the time to get to know your patient, and there is a family history, and there are some markers. And then you're looking at their lifestyle. 

And there are things that we can do to one, quickly drop those inflammation markers. One is really watch your sugar intake. You know you eat your sugar, your interleukin 6 gets triggered in the brain, inflammation markers, cytokines go up, everything goes haywire. And then you're sort of dealing with that. Where if we can just keep a lot of those inflammation markers down in the first place as well as maybe using an antibiotic then they might only need to use that antibiotic once, instead of over, and over, and over again. If we can sort of help with herbs that fight the bugs as well, you know, that sort of thing. 
 
Andrew: Let's delve into this extremely controversial area of endometriosis being an autoimmune disease. 
 
Elizabeth: Right. 
 
Andrew: Now, I remember some people taking umbrage to a comment that was made by Stacey Roberts in a previous podcast on endometriosis. But when we reviewed the transcript, she actually said that there are researchers looking at it, as though it's an autoimmune disease. 
 
Elizabeth: Right. 
 
Andrew: Which is true, indeed I think that is. Indeed afterwards, I saw a paper that was using an autoimmune panel to try and see if it was feasible to use as a screening tool. But when I looked at the panel that they used, it was not looking for antibodies, it was looking for inflammatory markers. 
 
Elizabeth: Yeah, right. 
 
Andrew: So, one, is I think Stacey Roberts was correct in saying there are some people who are looking at it. But it is not an autoimmune disease. 
 
Elizabeth: No, definitely not an autoimmune disease. 
 
Andrew: Because there's no antibody. 
 
Elizabeth: No, that's right. That would be very easy to, oh, my god, could you imagine? 
 
Andrew: Otherwise we’d be using… we’d be putting more and more ladies on methotrexate. 
 
Elizabeth: Oh, my god, that would be an easy one. 
 
Andrew: No, it wouldn't. 
 
Elizabeth: No, in as far as go, “let's test for antibodies. Right, you've got it.” You know, we can't find endo that easily. And yeah, then again, you've got the methotrexate treatment. 
 
Andrew: Can you imagine that? 
 
Elizabeth: Yeah, that glorious treatment, yeah. 
 
Andrew: Yeah, lovely. So let's talk about the inflammatory aspects. You said CRP, ESR, what other inflammatory markers do you tend to look for with endo? 
 
Elizabeth: Well, pain. 
 
Andrew: TNF, ILB, Interleukin 1B? 
 
Elizabeth: I don't actually check for those. Actually no, no. But I'm sure they would come up in those cases. But I don't. I mean I suppose because I would find it very difficult to find doctors that would feel okay with doing this, like a lot of the time they've... 
 
Andrew: And where would you get it checked? 
 
Elizabeth: Yeah. 
 
Andrew: I don't know TNF alpha... 
 
Elizabeth: That's exactly right. You see what I'm saying. Like as from a practicality point of view, so far I've picked up endo in almost 100% of women and... 
 
Andrew: That's from a bias sample, obviously, they come and see you for fertility issues. 
 
Elizabeth: Exactly. 
 
Andrew: But wow, 100%. 
 
Elizabeth: Nearly 100%. So, and actually, the professor I worked with has said that to me. He said, "You know, we need to do something because you're picking it up.” 

But it's just that process, it's that funnel effect. When you're putting the story together it becomes a little bit more obvious. You know, you're making these women and couples very fertile but still, they're not falling pregnant. So, you know, you think "Okay, well, how much of this is going to be to chance. You know this is a really perfect set up here."  
 
And that's where a lot of the women have already done IVF, they've already done all that, they haven't fallen pregnant. And then so I know that they've made these eggs to the right size and they've made these A-grade embryos, and then they've gone and plunked them in and they can't fall pregnant. You know? So we deal with all the other things that could be going on and usually there are other things at the same time, usually, there will be infections.  
 
So often I'll see that an infection again could be a precursor to… it's a chicken and the egg thing, which one came first? Was there an infection there for ages and then encouraged the lining to break away, and then retrograde up and through the tubes and then stick out?

Andrew: Ahh. 

Elizabeth:  You know, is that happening? The breakdown of the cells. I'm sure that I've tend to found women with infections tend to be at higher sort of chance that they've got endometriosis as well. Is there a family history, you know, is that happening? But they have found endometriosis in men. They have found it in other... 
 
Andrew: And in the eye and brain. 
 
Elizabeth: Yeah, oh, 100%. So they're found in other areas, thoracic and stuff like that. So they know it's not just the retrograde theory. They know that it's not just the case. But it's probably a few things that are actually happening here but, you know, they do know it's estrogen-dependent, they do. 
 
Andrew: And humankind isn't very good at looking at multifactorial things. 
 
Elizabeth: Yeah, exactly, exactly. 
 
Andrew: We want the one thing. So, is anybody doing any work on embryological issues? 
 
Elizabeth: I'm not sure if… you know, the studies, I know they found the studies. There were some studies showing that the egg quality can drop when you've got endometriosis. Because… and that was fairly recent. Which is what I had sort of thought. Because I kept thinking this is strange, these women are removing endometriosis, you know, a lot of the doctors are going to rush out there and start trying straight away, you know. But what a lot of the time I'm finding is it's not until about the fourth to sixth month after the laparoscopy that they are falling pregnant.  
 
So, to me, logic was, well, hang on, if you've got all this disease state hanging around, you've got a lot of inflammation markers there. Often you've got damaged cells, you need those cells to die off, new cells to grow, and all the rest, and they’re a three-month turnaround, right? 

And so then you've got the eggs that are forming three in a row, you know, as in month-by-month before, you know, three months before you're even ovulating those eggs are developing. So, if that endometriosis was around the ovaries or whatever. You've got blood in an area that shouldn't be there. So you've got this oxidation happening. 
 
Andrew: Yeah, so you get rid of those eggs before you start looking at the… 
 
Elizabeth: Exactly. So what I tend to see is all of a sudden… So, some of the girls were actually falling pregnant because the doctors were putting them in a panic, some of these doctors. Going, you know, "Now, right now before the endo comes back. You know, go start trying," and then they'd miscarry. So and then three months later as that's gone past, on the fourth month, bingo, they're having really healthy babies and off they go. 

So, the impact of endometriosis as far as to the egg quality, I have seen it but...  

Andrew: Ranging…really ranging…

Elizabeth: Yeah, but it's not always. But usually, the women that have successfully in my clinic, successfully fallen pregnant in a very short period of time within six weeks of the laparoscopy and continued the pregnancy to full-term, I could count on like two hands. And that's in 18 years of practice. 

So what I found most of the time is that times needing to go past. And so in just with what I'm seeing I can see it's having an effect on the embryos. When women have done IVF that have come to me going, "Well, they said they're A-grade," or they might even say the opposite. They've done IVF and they've gone “Look you need donor eggs. You do need donor eggs because we can see they're pretty poor.” And then they've come through the system, we've got rid of endometriosis and bingo, they’ve got great quality eggs. 
 
Andrew: Once you wait for a while? 
 
Elizabeth: Once we wait, once we fix everything, once we get inflammation markers down, get the body repairing. You know? Because the endometriosis, because it is inflammatory, it sets the body up and you're living with an inflammation, like living with that inflammatory disease for years. 

So the body is sort of has worked out all its biochemistry and buffers, and things all around that. Then you've removed the disease. The body's got to have time to readjust and, you know, recalibrate all that sort of stuff. So that's what I sort of find, that's why I get them tested after the laparoscopy to go, "Now, you're a new person. Let's have a look who are you hormonally, progesterones, estrogens, you know, and things like that." 
 
Andrew: Long-term effects from surgery including adhesions driven by matrix metalloproteinases, you know, that sort of cross-linking of tissue, that sort of stuff. Can you track that? Can you see who is more likely or indeed who's might have active, you know, adhesion formation? 
 
Elizabeth: For me, the way I prefer, if someone is going to try and fall pregnant, this is in this case, right? If someone is not going to fall pregnant, normally, I sort of say, "Look, hold off on having the laparoscopy until you are getting close to wanting to fall pregnant," unless, of course, they're in excruciating pain. But if they're… Just because the closer we get to pregnancy and then you fall pregnant a lot of the adhesions break as a result of the pregnancy. 

Andrew: Ahh, okay, right. 

Elizabeth: So it's like your pregnancy served you a purpose. That's why I tend to do it that way if I can, you know. 
 
Andrew: So, let's get back into the active infections and the resultant things that happen. So, bacterial vaginosis has an obvious deleterious impact on fertility. I’ve podcasted with Moira Bradfield about this. 

Tell me more about bacterial vaginosis, what you use to treat? Do you encourage the use of antibiotics for these infections as the first line in all cases, because of the long-term potential deleterious effects to let's say gonorrhea and Chlamydia, we know that there's scarring that can occur with the fallopian tubes, it's unethical and probably I would say illegal to not encourage antibiotics in that thing. 
 
Elizabeth: Oh, 100%. 
 
Andrew: Are there any cases where you think, "Oh, we can treat this naturally?" 
 
Elizabeth: So, I do. What I tend to do is, again, I'm having a look at the timeline. I'm having a look at the bug that I'm dealing with. So that.. it all is relative. 
 
Andrew: So confirm the bug? 
 
Elizabeth: That's right. So confirm the bug first. Then have a look at, "Okay, in this timeline of when this person is either wanting to fall pregnant or whatever, what's the best approach?" Because they know things like say the contraceptive pill decreases vaginosis, they know that. And that would have a lot to do with now, you've got a decreased amount of mucus, you've got a decreased amount of blood flow that might be flowing around and causing these things. 

So out of the two evils, if you sit there and just think of it that way, what's better in this case? How long? Are we better off putting them on the pill? Which I don't like to encourage. But if that's going to mean that they don't take lots and lots of antibiotics that might be a better approach. Or do we just encourage really strong immune systems and have a look at what's going on with their practice? What are they actually doing to encourage this bacteria and, you know, encourage better sort of behaviour or whatever? 
 
Andrew: But you're alluding to the ping-pong infection? 
 
Elizabeth: Exactly, exactly. 
 
Andrew: So let's go, let's explain that. 
 
Elizabeth: Yeah. So if you only treat…and I've had doctors do this. So they’ve found an infection and they'll only treat the woman. She goes back home and gets reinfected. And this can happen with UTI sort of stuff. It goes on, and on, and on. 

And so really, it's about both of you have to be looking at your immune systems. You both have to be treated. You both, you know, change behaviour. That might be things like wearing different underwear, you know, you could be wearing things that are helping grow this bacteria in large amounts, all sorts of things like that. 

And so, yeah, you definitely need to be treating both partners otherwise yeah, you’ve got the ping-pong effect going on, and on. And on, and that's with candida and all that sort of stuff as well, yeah. 
 
Andrew: Oh, well, there's a whole host of infections. I was going to also make the point about uncircumcised men being a source of infection. It's dark, it's warm, it's moist. You should be treating yourselves. You know, we know that uncircumcised men are at increased risk of HIV, for instance. And HPV? I think so. 
 
Elizabeth: I think probably lots of the infections, yeah. 
 
Andrew: Yeah, yeah. So they should definitely be treating themselves as well as the partner because you're just going to be transferring from a reservoir to…

Elizabeth. Yeah, exactly. 

Andrew:  You know, a newly naked, you know, tissue that you've just treated. If you're going to be using antibiotics. 
 
Elizabeth: Exactly. Exactly. And then the more antibiotics you use, the more resistance and it goes on. And then you…

Andrew: On and on….

Elizabeth:  You know, I've got some patients that are needing to use IVs and stuff like that. Just to try and treat these bacterial infections. 
 
Andrew: Topical treatment, do you ever use, you know, douches and? 
 
Elizabeth: I do actually. I tend to use vinegar and tea tree oil in some water. 
 
Andrew: Ooh, what strength? 
 
Elizabeth: Yeah, just two drops. In a whole cup.

Andrew: Yeah..

Elizabeth: Yeah. It works like magic. And so, in some water, and then use an ultra-thin tampon, insert it overnight. And you've got that whole antifungal thing happening with the tea tree but you've also got the pH that's corrected. And a lot of the bugs can't live in that pH. So it's a really nice way. The women find that it fixes it really quickly. 
 
Andrew: Helps with the itching as well? 
 
Elizabeth: Yeah, all of that. Like within a day or two. 
 
Andrew: Oh, wow. 
 
Elizabeth: And so then I say, "Look, you got..." 
 
Andrew: That's a welcome relief? 
 
Elizabeth: Yeah, yeah, yeah, exactly. So then I go, look, especially if you've got… you know, you tend to see things also like women have been using condoms the whole time so they've been fine. Then they start trying to fall pregnant. And if the guy is his pH is really alkaline, you might have this encouragement of bacterias. That's what I have found. So all of a sudden there, they’re having sex... 
 
Andrew: Because sperm is... 
 
Elizabeth: Is alkaline. 
 
Andrew: A higher pH? 
 
Elizabeth: Yeah, and the vagina is acidic. So you've got that sort of…so that's where the guy's health can actually impact. So if he is eating…if he's quite acidic in nature, lots of alcohol, and, you know, huge amounts of red meat or whatever. It could actually be encouraging his sperm pH to change. And so, therefore, the bacterial infections also change your pH. So you've got all that mess happening. 
 
Andrew: Yeah. Yeah. 
 
Elizabeth: And so it's just, you know, it's that ticking off the box of what's all the little things that we can do here to balance that pH in the area? 
 
Andrew: You'd be great as a detective. 
 
Elizabeth: Oh, yeah, yeah. I love it. That is actually part of this actually. 
 
Andrew: Well, it is. Absolutely, it is. 
 
Elizabeth: Yeah, yeah. 
 
Andrew: Let's talk about other infections. You know, there's herpes, gonorrhea, and Chlamydia. I mean gonorrhea and Chlamydia, there was a massive spike. And just recently I saw it again. What's going on? Is it.. are we getting complacent? You know, I remember with the…there was an initial concern about when the HPV vaccination became available, Gardasil in Australia. That there was a concern that it might promote promiscuity, and therefore, you know, not enough attention or care being given to other STDs. There was a more recent study saying no, that's not the case. 
 
Elizabeth: I've actually been surprised at how many of my patients are totally unaware of these other bugs that are out there. And I'm like, you know, often you'll see them talking about, you know, one partner and the other partner. And they're being really slack with their use of condoms and things. And I'm saying to them things like, "Oh, so contraception. You're using condoms in these cases?" And they'll go, "Oh, no, because I'm on the pill." 
 
Andrew: Oh, yeah. 
 
Elizabeth: And then okay. And I don't know what happened with the HIV sort of thing scare. But I say to them, "There's actually, there's all these other ones that are really common. So herpes simplex and Chlamydia, or any of that." 
 
Andrew: Herpes and Hep C, they're really easy... 
 
Elizabeth: Oh, yeah they're everywhere. So and, you know, the wart virus and on and on. But it's just more the fact that I think a lot of it is ignorance or they've just, when they've had pap smears that have come back clear and maybe they're looking at the behavior that they've had so far hasn't gotten sick, so, therefore, they must be doing the right thing instead of... 
 
Andrew: Are we now not are longer going to be doing pap smears? 
 
Elizabeth: So, yeah. 
 
Andrew: What's going to happen here? 
 
Elizabeth: Yeah. So it's interesting because I'm still surprised at the lack of education that's out there. I'm actually quite surprised thinking it's being taught in schools, you know, all that sort of stuff. But they're not ever thinking even, they're just not thinking things like HPV. And they're not thinking like I'm going to be living with maybe herpes for the rest of my life. They're just not thinking like that. 
 
Andrew: Crazy thoughts. 
 
Elizabeth: Crazy. 
 
Andrew: So let's talk about treatment though when this rears its ugly head. Do you encourage the use of antivirals to get the disease under control and then look at natural things to keep it under control or do you treat? 
 
Elizabeth: So it will depend on the severity. It will depend on how sick they're getting with it as well, how, the malaise. And as well as where they're at in the whole scope of fertility because you can't birth, when you've like, naturally, if you've actually got some herpes sores there. So normally, I will get them on the L-Lysine and I'll say, "Now, this is, you know, we need to have this more long-term." And elderberry has been shown to dismantle the reaction of the herpes virus which is fantastic, that's all later sort of stuff. Later studies. So that's a nice one, Thuja. I've just found... 
 
Andrew: St. John's Wort? 
 
Elizabeth: I don't use St. John's as much because it can then alter their mood. Some people don't do very well with St. John's. So I tend to sort of... 
 
Andrew: Forgive me for interrupting. I think it's interesting, it's the high-hypericin that's used for envelope viruses and yet it's… if you look at the evidence it's low hypericin extracts of St. John's Wort that work in depression. So it's not an antidepressant if you're going to use this for an antiviral. 
 
Elizabeth: Yeah, yeah, yeah. So I've not found that I've needed to. So I've used a lot of the antiviral sort of herbs and then as... 
 
Andrew: Forgive me, I'm interrupting you. But how about Melissa officinalis? Do you use that? 
 
Elizabeth: No, I don't tend to actually. I just found I haven't needed to do that like, you know, Pau d'Arco, you know, those sort of things. And usually we get under control. Pretty quickly actually. And it might be more the fact that I'm dealing with a whole heap of other things with their immune, so you're strengthening the immune system, yeah. 
 
Andrew: And what about topical doses, topical application? I'm sorry, intravaginal use. 
 
Elizabeth: Yeah. You can use elderberry topically. 

Andrew: Okay. 

Elizabeth: So that works really quite well. But I've not really found that I've needed to do that. 

Usually, what happens, women come back saying… or men, they come back saying, "Actually, I haven't had a breakout for ages now." Reducing sugars, you know, you'd really trying to strengthen the immune system. Looking at encouraging liver function because you've got the liver involved in the immune. So you're doing all the other stuff and just making a healthier body. And I have found L-Lysine to work really, really well. So a lot of the women just hardly get a breakout during pregnancy. None of them that I can think of have had a breakout during the time they're birthing.  
 
Andrew: Okay. 
 
Elizabeth: Yeah, I haven't needed that. But otherwise, if they did they'd use the drug. Right then and there. Because, you know, that's what I'm saying. Out of the two, you want to birth naturally you'll have to… 
 
Andrew: And we mentioned before gonorrhea and chlamydia. Let's talk about the treatment of those because this is critical. You know, chlamydia can lead to some... 
 
Elizabeth: Serious stuff. 
 
Andrew: Serious stuff. So let's talk about ethics and even legalities about treatment. 
 
Elizabeth: First of all, you know, all my women have been screened for it. And, you know, I straight away want an antibiotic used here. I think it's negligence not to do that. And at the same time, use stuff that, you know, herbally that will support that. And then you do all the gut health at the same time and all the gut repair. And, you know. 

It's interesting I've actually come across a small amount of patients that will try and resist antibiotics when there is something quite serious there.

Andrew: Yeah.   
 
Elizabeth: And with I've actually been a little bit at war with them where I've said, "When you look at this, if you look at the two evils, that bug is doing a lot of destruction, very quickly. You need to actually deal with this. I'll deal with your gut, don't worry about it. That's sort of can repair very easily. Those tubes get wrecked. You end up with fluid in your tubes, they're going to have to be removed. They end up blocked or whatever. They're going to have to be, you know, removed. If they’ve been scarred by these diseases." So, you know, and then your only option is IVF once they're removed. 

So, to me, that's way more dramatic than being able to just use an antibiotic and don't treat it. Yeah, and then you want to re-test to make sure it's gone. You've got to test both partners obviously and make sure that they're gone in both. 
 
Andrew: What about syphilis and even some of the more uncommon bacterial or indeed viral, hey, let's go fungal as well, if there are culprits for infections that impede fertility? 
 
Elizabeth: As in do I, would I want them treated? I mean syph…oh, my god. Yeah, of course. 
 
Andrew: But, you know, prevalence, like I know nothing about the prevalence of syphilis in the Australian community? 
 
Elizabeth: I know it's on the rise. I know it's on the rise in the States. And I think because a lot of people sort of think of it as an old disease. Like it's something of the past. It's just an STI and it needs to be screened for and, you know, it's really that ping-pong idea again. Because you may be meeting somebody that you're thinking or, you know, that they're not cheating. It's not about a cheating thing, it's who did they sleep with and who did those people sleep with. And that's where you may be literally sleeping with... 
 
Andrew: The community. 
 
Elizabeth: The community, exactly. That's exactly right. So you want to be screening. And a lot of people have fear around screening, you know, there's all that as well. So some people will be, you know, jump up and, yeah, find anything because I want to treat it? 

Other people are putting their head in the sand and it depends on what they associate with these diseases and, you know, what they're being brought up with and all the rest. 
 
Andrew: I do want to cover up on a couple of the other culprits. What else do you look at? What other bacterial diseases do you look at? 
 
Elizabeth: So I will screen for urea plasma and mycoplasma. To me, the anaerobes which actually.. so someone, for instance, decides to put in an IUD, usually, within the first 20 days, you're going to see an increase in infections, PID really. They need to be looked at, and treated, and all the rest. You don't have to remove the IUD but you need to treat it. And I would be treating them with an antibiotic. 

A lot of them are the anaerobes. So you're looking at doxycycline sort of treatment instead of…and that's the other thing too, a lot of people think, "Yeah, I took some amoxicillin." 

Andrew: Wrong antiobiotic. 

Elizabeth: And you're going, "Yeah, that's okay but that's not for this." That's, you know, I already had lots of antibiotics and they never use doxycycline. 
 
Andrew: It's like saying “I've had all the tests.” 
 
Elizabeth: Yeah, yeah, that's right. Exactly. 
 
Andrew: There's more tests. 
 
Elizabeth: I hear that every day, every day. 

Anyway, so they're quietly sitting there causing that endometritis a lot of the time. And again, they just get passed on from one person to the other. Or, you know, they could be happily living in the bowel. And so you might have a really bad gastro, it's come across to the other side. So you might not even be sleeping with anybody and actually, it's gone up into the uterus where it doesn't belong causing some issues and stuff like that. 
 
Andrew: You mentioned your treatment about balancing all of the gut health. And there's the obvious thing there with terrain, diet, lifestyle, even sleep can affect the microbiota. But we all like to think about an active agent and the one that always comes to mind is probiotics. So what sort of probiotics do you tend to employ and why? 
 
Elizabeth: So I often will change up my probiotics. So I might use the more the merrier basically for me. So the higher the doses, the more the merrier. Change up the ones I'm using just so that you're not always using the same probiotic. 

But really important because every time you've used your antibiotic, you know, you've made your gut just a little bit more leaky. And then you've got that cascade so you're then now more susceptible to infections, so you're going round, and round, and round in circles. 

So definitely probiotics. Most of my women will be on probiotics. And often throughout pregnancy as well. Because it will help the baby get the probiotic health, as well as reduce the chances of the waters becoming infected, and so forth. So that is, yeah, definitely very important in this whole process. 
 
Andrew: But always with prebiotics? 
 
Elizabeth: No. No, I don't. And actually, if they're showing any signs of SIBO, I won't be using prebiotics. 
 
Andrew: Gotcha. 
 
Elizabeth: Yeah. Yeah. But, you know, gut plays a major role in the whole fertility thing for me. Because you're wanting a good absorption of calcium, healthy absorption of iron throughout pregnancy, you know, so always work on the gut. Get that really, really strong, always work on the immune system. So there are two areas for fertility that are vital. 
 
Andrew: Well, it's the seat of the triggering of the immune system, the Treg. 
 
Elizabeth: Exactly. 
 
Andrew: And obviously nutrition, and dare I say supplements. Do you find that most people you can treat by tweaking or concentrating on their lifestyle, their diet. Or do you find that you really need to punch them with some supplements for a little while? 
 
Elizabeth: I always give them supplements. Because, as well as, you know, obviously there's a problem there. When they've come to me they're already coming with a problem. Or I mean, even at sometimes, you know, people might say, "Look, I just want the best pregnancy that I can have." So and they might be in really good health, I'll still use general things to sort of help. Because of along the way I want them to be stronger.  
 
But, you know, the first three months of pregnancy, a lot of the women are feeling quite ill or at least until 12 weeks, some until 16 weeks and they're struggling to take any vitamins at all. So if you've done that preconception sort of stuff with them, at least they've got some sort of, you know, higher amounts of nutrients in their systems with, you know, obviously not the water-based ones but the, you know, the omegas, and that sort of stuff. And worked on their gut health so that they're at least absorbing from the foods that they are eating and able to hold down.  
 
So, for me, it's like I don't know what's going to happen around the corner as they fall pregnant. And, you know, the baby is at its most vulnerable stage at that state, for the first 12 weeks of the pregnancy. A lot of women have really low iron to start with. They might have really low iodine to start with. And they're just taking, you know, they go and get their multi, their pregnancy multi thinking that's enough. And then their thyroid function could be thrown out because their iodine… all of that sort of stuff. So I just want to make sure they're in perfect nic, vitamin D levels and all the rest before we're starting. And then try to maintain it, just makes it easier to maintain in pregnancy. 
 
Andrew: So we've spoken about mainly infections that tend to affect ‘down there’. They tend to affect the vagina, and the uterus, and the tubes. But what about things like, you know, flu? What about things like Group B Strep? Tell me what you do here. 
 
Elizabeth: So the Strep B is an interesting one. It happens often that the women will come up positive when we're doing some screening. And doctors will say, you know, "They might have a heavy growth," and doctors will say, "We're not going to treat it now because we'll treat it when you're birthing, if it's still there." It's a hard one because you don't necessarily want to use an antibiotic.  
 
However, what I’ve found was often when you're using the antibiotic at the end, you know, if that's what ended up happening and it actually happened to me personally. Then that can encourage weakness in the baby. And so out of four children that I've had, that one baby where I actually did get treated and, you know, often they'll say, "Look, you don't really need…" because I didn't want to be treated. So I said, "Look, you know…" I said, "Look if your waters don't break until the end you're fine." My waters didn't, actually, she was born in the sac. 
 
Andrew: Right, wow. 
 
Elizabeth: This particular child. It was really interesting. She was born in the sac. And they still pressured me the whole time. And I was saying, "But the waters haven't broken yet." And they're saying, "Yeah, I know but if you don't actually use this, they're going to take the baby away." 
 
Andrew: You're not covered. 
 
Elizabeth: Yeah, that's exactly right. They're going to now put a lot of pressure on you, they're going to take that baby away. They're going to put it under monitoring. And so it was awful being in that situation. So I really feel for women in that situation. 

But it's just that they did use the antibiotic and she ended up with lots of candida problems to the point where there was candida all over. Like nappy rash but it was candida nappy rash, she had oral thrush, she had it all. And in a very short period of time. So I could see the impact of and I'm not somebody to really use antibiotics. So it wasn't like I'd been using lots of antibiotics, I hadn't. It was the first dose. It was just one shot through that whole laboring, you know like I think they gave it to me two times or something. 
 
But yeah, it really had a major impact on her and affected her gut, and all the rest. And so there was all this... So, for me, I prefer it to be treated with an antibiotic. To cut the long story short. I prefer to be treated when we find it especially in heavy growth as well as use a strong probiotic. Because the probiotics actually work really well with this one. And yes, if it comes back, well, it came back and you use probiotics all through pregnancy. But then at least there's a chance that it wouldn't…even if you've got a heavy growth it may disappear. But it's really unlikely in my opinion, you've got estrogens that are really high. You know, that's encouraging moisture, and it's encouraging mucous, and it's encouraging all that sort of stuff. And so yeah, I just sort of, I prefer it. So often I say to people, you know, "If you're okay doing this that's what I prefer." And but yeah, the doctors really resist that with that, yeah. 
 
Andrew: You do a hell of a lot of screening because you want to know exactly what you're dealing with. Do you find as a naturopath that you find resistant in screening or are you in that team that are well-versed with your knowledge and so they are more likely to be open to your requests? 
 
Elizabeth: So this is a really good question. And it's one that really annoys me, the answer to this question. The doctors that know me and know my background, they will test. Because they know how thorough I am, and they know how successful my pregnancy rates are. They know the women I have already done IVF for years and years, you know, or they may be really struggling with say vulva dermatitis that's come from years and years of maybe candida exposure and all the rest. 

And so, for them, they've seen the suffering of their patients. So they're just happy to go, "If you find something else we're happy to look for it."  
 
And then they've also seen the healing of it all. So I've got this group of people that surround me that have seen the progress, and seen all that happen so they're great. Where it's tricky is where you, the patient will go back either to their doctor, and the doctor has no idea of this area. And so then they come back, and they've gone, oh, they were really reluctant to do this. They decided to do this, this, and this, but not this. 
 
Andrew: But not that, no, not that. 
 
Elizabeth: Or they've gone and taken a swab and they've not done a high vaginal swab where I needed it to go right up near the cervix because that's where urea plasma or mycoplasma live. They’ve done a low vaginal swab so now the results aren't accurate. So they've had…and I've had those cases where I've sent them back and said, "No, it's actually a high vaginal and it's come up positive." I've had... 
 
Andrew: How great you would have taught them. 
 
Elizabeth: Oh, it's so frustrating. It's frustrating for the patient. 

So other times are I've had one incident, the patient said, "The doctor is screaming at me right now. I'll let you have a listen." And the doctor was going, "You cannot get these infections unless you've had it sexually transmitted." Screaming on the phone saying that urea plasma and mycoplasmas were STIs. And the person had just had a laparoscopy. And so whenever there's a procedure involved I want them screened again. Because I want to know did they get anything in that laparoscopy and that has come up positive so many times. 

So they were negative to start with, they've had their procedure which might be they've had a miscarriage, and so they've had D&C. And then in that D&C, they've actually contracted a bacteria. 
 
Andrew: There's an issue for the SSSD department. 
 
Elizabeth: That's exactly right. And then what's ended up happening is we've gone and rechecked and gone, "Yep, there it is. There's a bacteria." So because I've seen this over and over I don't want them then to be trying. And then we've got the same. 

So often, you'll see women will come and say, "Look, I had a laparoscopy about a year and a half ago." And then they've contracted or they'll say things like, "I fell pregnant straight away first go and then had a baby, and I haven't been able to fall pregnant for the last seven years." And so my first question is, "Did you have an episiotomy or did you have a Caesar?" And they'll go, "Yeah, I had a Caesar. Yeah, you're right." 
 
I'll go, "Right. let's check for it," and bang, urea plasmas, mycoplasmas are there. And so they've been living really with like either a mild endometritis or an infection. And so whenever there's…that's definitely a take-home message for all the praccies out there. When there's been a procedure, retest for some of these things. And so some of the doctors will say, "No, I've already tested for this." And this particular doctor was screaming on the phone retested and it was positive. And so... 
 
Andrew: So at least they had the... 
 
Elizabeth: So at least they could see actually procedures can do this as well. It's not that you've got a partner that might be sleeping around on you. 
 
Andrew: At least they had the humility and the common sense to retest at the end. 
 
Elizabeth: Yeah. 
 
Andrew: So, would the magic sentence, therefore, be something like, well, “Doctor, seeing as the treatment that's gone before hasn't worked. Perhaps it would be medically prudent to look at some other tests that might help the patient.” 
 
Elizabeth: Yeah. However, I've even had GPs that have done the tests, found positives, treated my patients. We've had sensational stories where, you know, women have fallen pregnant on the withdrawal method, trying not to fall pregnant while I've done six years of IVF and failed because we got rid of the mycoplasma. 
 
Andrew: Yeah. 
 
Elizabeth: Right. Have seen this and something has happened whether then said, "Oh, look, actually there's not enough evidence to show that there's so I'm not going to test anymore." 

So I've had that thing too which is really frustrating. When I was doing the Masters, they know that part of the list of recurrent miscarriages was urea plasmas and mycoplasmas. They know they often will give you a dose of doxycycline maybe five days before, before you do a transfer because that reduces your chances. 
 
Andrew: Right. But even the professor that you worked with whose very well-known in Australia is frustrated by his medical counterparts. So, you know, I guess where I'm going here, I don't want our listeners to feel like we're doctor-bashing today. This is a real issue. 
 
Elizabeth: This is real. 
 
Andrew: And it's even an issue within the medical profession, within their peers saying, "Guys and Gals, why aren't you doing things?" So I think, you know, hopefully, some of these professionals will be listening and hopefully, they'll start to question. Well, I think that's the beginning, at least start to question. 

Elizabeth, I can't thank you enough personally. And I know our listeners will thank you for taking us through the myriad of things that you have to look at with infections and infertility. You always give me and I'm sure our listeners, too, these clinical tips to go, "Oh, my goodness. I never thought about testing for that." I've got to say though, you always leave me wondering, "What else is there?" And so I can't wait to welcome you back to FX Medicine and delve into some other issues with infertility and pregnancies. 
 
Elizabeth: I look forward to it. 
 
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.

Additional Resources

Elizabeth Mucci
Life on the Inside

Other podcasts with Elizabeth include:


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FX Medicine Podcast
FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.