Gabriela Rosa - The Fertility Breakthrough

Stuart Cooke (00:01.126)
Hey guys, this is Drew from the Health Sessions and I am delighted to welcome Gabriella Rosa to the podcast. Gabriella, how are you?

Gabriela Rosa (00:08.134)
so well and very thrilled to be here. Thank you for having me.

Stuart Cooke (00:11.024)
Well thanks for sharing your time. I won't say good morning because you're on the other side of the globe and time differences and conversions are not my strong point. first, confusing. confusing. So thank you for sharing some of your time. But first up for our listeners that may not be familiar with you or your work, I'd love it if you could just share a little about yourself please.

Gabriela Rosa (00:20.334)
Neither am I.

Gabriela Rosa (00:32.91)
Yeah, absolutely. So I'm Gabriella Rosa and for the last over two decades, since 2001, I've helped couples overcome infertility and miscarriage, even when other treatments have failed. So it's been a little while and it's been many hundreds of thousands of people over that time. So I'm very privileged to be part of the most incredible time in people's lives and incredible for many reasons.

Lows are so low for people who have struggled to conceive or carry a healthy pregnancy to term. And sometimes my patients have been going through that for years and some even decades, believe it or not. And so you can imagine that when it's become a way of life to be infertile or to struggle with fertility challenges and miscarriages and failed treatments, which some of my patients unfortunately are burdened by.

it changes some things about who you are as a person and how you deal with life in your day to day. And so for me, the reverse of that is when we're able to create the incredible transformations that we are able to help deliver.

that whole picture transforms itself. It's the biggest thrill and it does not lose its luster. know, for me, even though I've been doing this for such a long time, each couple in each case is very different, even though they all seem to blend into the next almost because so many people that look for our service, they are the complex and difficult cases, you know, the things where nothing else has been really straightforward and it hasn't quite happened in the way that they envisioned.

So that's kind of where I come from, you know, in terms of my views, in terms of how I share the information that I share. you know, I think that it's important to highlight that that's a very different perspective as a fertility specialist, even from, you know, your average fertility specialist that might be seeing people who have been trying for six to 12 months and, you know, are going through treatment for the first time. We don't see those patients typically, sadly.

Stuart Cooke (02:44.814)
Yes. Yeah.

Gabriela Rosa (02:46.97)
It would be nice if this was the first resort, but typically, you know, people look for us when it's the last resort and that's really kind of my little corner of the universe.

Stuart Cooke (02:56.506)
Yeah, fantastic. Well, look, we're going to hopefully dive into a lot of your tools and tips and strategies as well to be able to.

to attack this with full force? Because I'm certainly surrounded by people who are confused, have tried and failed, repeat again and again, have gone into IVF and spent an absolute fortune. And I know that your thought process is a little bit different about that. So I thought we'd perhaps start at the beginning in terms of the most overlooked factors. What are the areas then perhaps people would never consider but perhaps should be right up there on the list?

Gabriela Rosa (03:34.242)
Look, I think that the number one thing that people sometimes, it's almost like, you know, fertility challenges and when it hasn't been easy, people sometimes lose... ...clarity about what is true, you know, and I think that... ...health care and the healthcare system around the globe, because we treat patients in every continent other than Antarctica.

So I see healthcare systems literally around the world and it makes it, know, healthcare systems don't make it easy for people who are in this kind of situation. They don't make it, they don't simplify the complex. They actually make the complex even more complicated. And there's a lot of misinformation and sometimes, you know, not willingly, but

disinformation that goes along with that. And one of the biggest things that I find that people miss is one of the most obvious things is that it's not normal if it hasn't actually happened in a have sex, get pregnant, have a baby kind of way. Right. I had a conversation. It's really interesting that we're having this conversation right now before this podcast interview.

Stuart Cooke (04:44.528)
Yeah.

Gabriela Rosa (04:55.117)
I was talking to a patient who was the first initial conversation and she was like, you know, I'm looking for you and I'm looking for this because I've just been, I've just had a failed IVF cycle and my doctor just told me that, well, you know, and you know, a failed IVF cycle. let's reframe that. She said, you know, it's, it's probably not like, I know that you're disappointed, but as far as we're concerned, and here's the bomb.

Stuart Cooke (05:13.296)
Yeah.

Gabriela Rosa (05:23.245)
It's actually not a bad result for a woman your age to have an embryo to transfer. And I'm like thinking, what? In what universe that a couple wants a baby are told that a failed IVF cycle is actually a great result? And this is the thing that often couples who are going through really challenging situations get told, oh, everything is normal, just keep trying or...

Stuart Cooke (05:29.02)
wow. Okay. Yeah.

Gabriela Rosa (05:48.838)
you know, it's okay, don't worry about that. We can bypass that with IVF and a variation of all of those things. And so what happens is that that in itself becomes a constraint to achieving a healthy pregnancy. Because how much longer does one continue going around in circles, getting the same results, spending, as you said,

thousands of dollars for an IVF cycle, which is not cheap. In Australia, the US is kind of a similar amount. Obviously, the conversion rates are a bit different. But you're looking at a $15,000 average cost for one IVF cycle that has close to 70 % failure rate across all ages. So if you think about it from that perspective, couples are literally herded down a path of

haven't been able to conceive, go to their GP, the next recommendation is here is a referral to an IVF clinic, good luck, right? And just keep trying. And it's like, well, but hang on a second, what is it that we need to understand? And often, and again, for structural reasons, you know, throughout healthcare systems and, you know, there's differentials in terms of like, you know, some places, the universal healthcare systems like the UK and Australia for the most part.

And then you have the U S that is more kind of privatized. But at the end of the day, unless you are going through, couples are going through an IVF cycle and there is an end game of how do we optimize the chances to have a baby to literally hold your baby at the end of this, it's not enough to just be told everything is normal. Just keep trying, or it's a numbers game. Just keep trying because that

wastes couples fertility potential along the way. You're much better off stepping off the wheel, know, the kind of, you know, going around in circles situation, understanding the underlying causes of what's not actually working. What are the gaps? Where are the places of opportunity? Where can we be optimizing function so that we can reverse and transform this function?

Gabriela Rosa (08:00.076)
And that's one of the things, like honestly, I see this more often than I would love to be able to report, where sometimes couples have been going through years of infertility and still don't have their full tests and workups and, you know, really a proper diagnosis. That is a fallacy that in reproductive medicine is totally acceptable. When was the last time?

that you were recommended to go down a very expensive, very high intervention treatment path with an unexplained diagnosis. Right? And just be told that you should be happy with that. Well, it's unexplained, you know, just keep trying. So I could talk about this all day and get on my little soapbox, but I'll get down from it now and just say that I think that there's a lot that people leave to chance because they don't know what they don't know.

Stuart Cooke (08:33.253)
Yeah.

Stuart Cooke (08:42.364)
You

Stuart Cooke (08:52.838)
So what should they know? Because I'm thinking about that. You're talking about IVF and obviously, IVF is a financial model as well. And it's a very successful financial model. totally. And the closer we get to success, the more we feel, I mean, there'll be a sunk cost fallacy in there as well, right? So I've put 50 grand in there, like we gotta keep going. That's right.

Gabriela Rosa (09:02.817)
Yeah, it's a multi-billion dollar industry. Absolutely.

Gabriela Rosa (09:13.515)
huge.

It's going to work next time. And it doesn't. And then we've spent a hundred thousand and it's like, well, hang on. Yeah.

Stuart Cooke (09:22.446)
Yeah, I have a friend who has put in almost, I think, $300,000. So it's very, very hard to imagine the gravity of what this would have on your emotional well-being, obviously your financial well-being. Why do we need...

Gabriela Rosa (09:42.155)
Yeah, yeah. It's a huge financial burden as well, of course.

Stuart Cooke (09:46.46)
Totally. So what do we need to do just in terms of, mean, thinking of it in a different way. So the analogy is, you know, I want to grow a plant. I want to grow some tomatoes in the garden and I'm going to scrape around in winter and plant that seed and the ground is hard and it's dry and the conditions are just against me. I'm not going to be eating tomatoes any time soon.

Gabriela Rosa (10:05.836)
Yeah.

Gabriela Rosa (10:10.861)
Yeah, in Boston you're going to be fighting the snow so it's not going to be good idea.

Stuart Cooke (10:16.216)
Yeah, that's right. You know, is it as simple as checking all of the important boxes in terms of understanding timing, understanding nutrient requirements, understanding the impact of emotional stress on the nervous system, understanding perhaps our own physical background in terms of health and genetics and things like that? Where would we start?

Gabriela Rosa (10:44.301)
All of those things are true and so, and more. so, you know, it's a great way to, the way that I like to say this is there's two things here that are going to make a huge difference. One is that you cannot continue making adjustments and treatment decisions based on unknown information, right? Because part of the reason as to why you have cycles fail for example, or even conception or miscarriages occur.

Stuart Cooke (10:45.956)
Right. Yeah.

Stuart Cooke (11:06.202)
Right.

Gabriela Rosa (11:13.809)
is that we don't know why it's happening. That's the first thing. Right? And so the first step, as obvious as it might seem, is actually do proper, full, thorough, comprehensive investigations. Understand that if your doctor refuses for you to do certain tests that are going to be important for you to have the knowledge that you need, that you will need to invest out of pocket money to do those tests. Because if you don't,

Stuart Cooke (11:17.372)
Mm. Mm.

Gabriela Rosa (11:42.508)
you are actually leaving your solutions on the table or your potential solutions on the table. Right. And so it's going to be extremely important to be able to understand, first of all, what are we doing where, you know, it's almost, I always say this analogy because this happened to me. I had a leaking toilet one time in my house and I basically got a plumber in and they did, and I had had it in another part of the house previously.

And this was a different bathroom and I got the plumber in and they did all the things, know, I took the toilet off, resealed the silicone, whatever it is that plumbers do amazingly. And 24 hours later, he said, you can use the toilet. It's going to be fine. 24 hours later, there was water again. Like, but actually the first time that we use the toilet was fine. The second time there was water again. And I'm thinking, okay, this is very strange. This didn't happen last time. Last time it worked. Let's use the analogy there of, you know,

whatever treatment worked the first time, the second time, secondary infertility, it's not working, or even any combination of that, right? But it's a similar kind of thinking process that goes on. So I called the plumber back about four times, the same plumber, and he suggested this and did that and did whatever, but really didn't fix the problem and was out of ideas as to what to do. And so I called another plumber, right? It was my second opinion. And so I get the last, the next plumber, said, look,

Stuart Cooke (12:40.572)
Yeah.

Gabriela Rosa (13:04.939)
These are all the things that were done by the previous plumber. Clearly we still have a problem. So can you please do your diagnosis and assessments of what's going on so that I can understand what we need to do about this? So after literally two hours looking at this whole situation, they come back to me, they say, we're going to have to bring this really expensive machine. It's $3,000. We're going to have to take tiles off the wall. I'm like, okay, that's where you lost me. Tiles off the wall is a no go.

Stuart Cooke (13:32.053)
right. No.

Gabriela Rosa (13:34.446)
because I have no tiles to replace the tiles on said wall. So the $3,000 machine, could kind of like, okay, fine. It's an investment in my solution, but you know, the tile in the wall is like, yeah, no. So then I said to him, I was going on holidays. I said to him, look, just leave the toilet off because it was off the ground already because we couldn't find the solution. So leave the toilet off. I'll go on holidays. I'll come back. I'll review it again and decide what to do from there.

Stuart Cooke (13:38.468)
Ha

Gabriela Rosa (14:03.329)
So when I left, was still water and puddles and all the things and I came back, everything completely dry, which told me that the water was not leaking from the wall. So, because that was the, that was the idea of this machine and the tiles and you know, all these things. So I'm like, okay, the water, my ignorant, you know, assessment of the situation is that the wall is dry. It's not coming from there. Fine. Still didn't know what the solution was, but

Stuart Cooke (14:13.05)
Yes. Yeah.

Stuart Cooke (14:18.232)
crikey.

Stuart Cooke (14:23.481)
Hahaha

Stuart Cooke (14:28.123)
Yes.

Gabriela Rosa (14:32.333)
went along with my day and went into the shower. Literally as the water in the shower is coming down onto the floor, I see on the other side of the shower screen, the water bubbling in from the ground. So I realized my problem there and then I had a shower proofing problem which required a $30,000 bathroom renovation, not a $3,000 machine. But at least I knew what my problem was, you see.

Stuart Cooke (14:51.355)
Yes.

Gabriela Rosa (15:01.069)
And so that enabled me to fix it as opposed to palliate this forever to a leaking toilet that would have happened if I was just trying to just, you know, keep spending money on getting different plumbers to give me the same solution without the actual results that I was looking for, which is one, a usable toilet and two, one that's on the ground actually sealed properly and you know, no major disasters going on after that.

Stuart Cooke (15:05.617)
Mm.

Gabriela Rosa (15:29.591)
So I think that that analogy, you know, it always comes to my mind when I'm talking about this because it's the perfect analogy to understand what ends up happening in fertility treatment when things have not been straightforward for people. And it's also an analogy for all of the things that you said, the cost-sunk fallacy, the fact that, the next time this is going to be it, you know, let's just, we don't know, the problem is unknown, but let's just keep going.

Eventually we should find a solution. Maybe the next plumber, he'll be able to seal it better than the last one. You know, all of those things. And so from my perspective, you know, when I'm looking at the situation, that proper diagnosis is going to be where we start. That's the first thing. The second thing, and this is where people can actually take charge of, you know, perhaps they don't know what they don't know at this point, but there are many things they already know. And that is this, when I say to you, Stuart,

and indulge me for a moment here. I know that this is going to be a difficult thing for you to imagine, but imagine for a second, right, that you were pregnant. Not your partner, but you. Okay. You are going to gestate this baby inside of you. Let's not think about how it's going to come out yet, but let's just imagine that you are gestating this baby and it's your responsibility to bring it to life.

Stuart Cooke (16:30.651)
You

Stuart Cooke (16:38.416)
Yes. Yep.

Stuart Cooke (16:49.052)
You

Gabriela Rosa (16:57.195)
Okay? And as difficult as it might seem to or feel to imagine this, but just imagine all the things that you would immediately start doing or stop doing if that baby was inside your belly right now and you really were just adding that child to viability and to turn and to be able to actually bring it to the world. If I said to you, what are those things? What are the things that you would

start doing or stop doing to ensure the healthiest possible baby for your child. What are those things? Give me like a top five.

Stuart Cooke (17:36.688)
Those things, if in the instance I was smoking and drinking I'd stop. I would want to research the most nutrient dense requirements from a food standpoint for a growing embryo. And then I would ensure that I've got all my nutritional bases met.

I would think about my emotional wellbeing, I'd think about my physical wellbeing, I'd work on sleep and I'd just dive myself into the world of pregnancy, like what are the things that I need to do. And then you mentioned previously about, we need to first get a measurement on where we are from a health perspective. So I'd want to know what those markers were. So what's my baseline? It's like anything, if I want to lose weight, I want to know how much I'm

Gabriela Rosa (18:10.785)
Yeah, yeah, yeah.

Gabriela Rosa (18:24.109)
and

Stuart Cooke (18:27.064)
now. So I've got a target, so I know what I need to do. So I'd start there and then would then dive into listening to people like yourself, because I want to know what people who have dedicated their lives to this one particular driving passion to be able to create a legacy and cure a problem. Like, what have they found?

Gabriela Rosa (18:27.935)
Okay. Yeah, yeah, yeah.

Gabriela Rosa (18:50.667)
Yeah. So, and let me ask you, so in terms of like, and you've mentioned some of these already, but like, what about your exposures? What about things in your day to day? What would you come in contact with and what would you avoid coming in contact with? Were there things that come to mind?

Stuart Cooke (18:56.252)
Hmm.

Stuart Cooke (19:06.746)
Yeah, totally. So it would be personal healthcare products. It would be environmental toxins and pollutants. I'd be looking at drinking water. I would be thinking about everything under the sun, the deodorant, spray in my body, the clothes that I'm wearing, the places that I visit.

Gabriela Rosa (19:25.429)
Yeah. And you know, this is amazing because you you, you, you have a very, obviously you're an educated person and you know, the reality of it is that a lot of us already have all of these inklings either because we've absorbed it from society. We've read an article here. We've watched something on TV there. We've listened to a podcast episode. You know, we have these understandings. Now, let me say it to you this way. Right now.

Stuart Cooke (19:38.236)
Hmm.

Gabriela Rosa (19:54.494)
no matter who you are or what you do, you are already carrying 50 % of that little baby that you want to create inside of you. And so the reality is that the act pregnant now to get pregnant later starts way before a conception is even in place. And this is one of the principles, the foundational principles that I teach my patients is that if you are not sure,

Stuart Cooke (20:03.162)
Yeah.

Gabriela Rosa (20:23.317)
What to do to optimize your fertility, reverse engineer the process and ask yourself, what would you do to have the healthiest possible baby? And that includes whether you're gestating that child now or whether that child is already here. You know, think about it. What are the things that you would absolutely ensure that your baby, your brand new newborn baby was away from or had to be able to be the healthiest it could be? And so we, from that reverse engineer.

Stuart Cooke (20:47.676)
you

Gabriela Rosa (20:52.043)
what we need to do in order to optimize fertility as a foundation to overlay effective treatment. And that's the critical nature, particularly when we are dealing with situations where it hasn't been straightforward. The majority of the population out there and the reason why we have, you know, such one of the reasons there are many other reasons, but one of the reasons why we have such disregard.

for the treatment of infertility in the grand scheme of health conditions around the world is that the majority of the population in the world conceive without trying. That's why we hear so many people like, know, such a South Sheik had a one night stand, got pregnant. they weren't trying. Oops, got pregnant. You know, I'm one of those babies. My parents weren't trying to have me. I just decided it was my time. Right. And so the reality of it is that those,

Stuart Cooke (21:34.927)
Yeah.

Gabriela Rosa (21:46.926)
Most couples who can see without three attempts, it's literally have sex, get pregnant, have a baby. When that has not happened, it is not a situation of just keep trying, everything is normal. Even if the preliminary test results have come back as normal. Because you see, in every healthcare system around the world, the mandate because of guidelines is.

To assess infertility or fertility parameters, we need to know is the woman ovulating, she have a uterus and is it normal in its shape and size? Is she ovulating, does she have a uterus and do we have sperm? That's not a lot of things. And they look at a patency of fallopian tubes, obviously. So, are the fallopian tubes actually clear and do they work? Those are four things.

Stuart Cooke (22:29.179)
No.

Gabriela Rosa (22:42.461)
that essentially couples go through as a matter of general process when they go to a GP after those tests are assessed. For the most part, doctors are like, everything is normal. Just keep trying until the next step, which is the referral to an IVF clinic. And then when you get there, the thing that is actually being done at that point of triage is not understanding more about what's not working.

Stuart Cooke (22:56.272)
Hmm.

Gabriela Rosa (23:12.159)
It's actually doing a workup to see if there are any major issues, i.e. sexually transmitted infections or any other major reason as to that would impact a pregnancy from developing and creating a baby. If those very beginning answers are so to speak clear, then there's not a lot more investigation that goes on there unless a patient is educated enough to say, all right.

I've done this, this, this, this, this. These are the things that are going on. I've had these results and everything there is normal, but I need these additional results and these other things looked at because unfortunately, unless you're coming to a service like us, that that's our job. will literally like be working with a patient to go, right. You need to go to your doctor and say, this is this. You need to get these tests. These are the things that you need to get done and we need the results. Right. And so we basically are doing that unless

Stuart Cooke (23:56.348)
Mm.

Gabriela Rosa (24:09.289)
you're coming to someone who is doing that, you're on your own. And that's where it becomes very difficult.

Stuart Cooke (24:15.984)
What are the markers? You mentioned testing and obviously we need to ensure that you're in range for X number of markers. What is your perspective on the range? Because I know at the moment if I go into the doctors and get my cholesterol checked then I'm going to be in a certain range supposedly, right? But that range, yes it may be normal for a population of very sick people but it's not optimal for me.

Gabriela Rosa (24:36.802)
Yes.

Gabriela Rosa (24:42.401)
Yes. Yes.

Stuart Cooke (24:43.482)
Are you looking at slightly different scale, a different range?

Gabriela Rosa (24:48.161)
That's a really great question. The answer is yes and yes. And there's more. So basically, yes, there's a huge difference between optimal ranges and lab ranges. And you've touched on that really nicely. And the reality of it is that for couples who are going through infertility with lots of things that haven't worked,

Stuart Cooke (24:51.544)
Right.

Stuart Cooke (25:01.69)
Yeah. Right.

Gabriela Rosa (25:13.619)
Lab ranges are never going to actually be the thing that you should look at because there are optimal ranges. Now we have a program that is a free program for people who all over the world who if they have that kind of question and they're interested in what are the tests that I should do and what are the reference ranges that I should be looking at that are ideal not average they can take that program which like I said it fertility challenge is what it's called.

Gabriella Rose's fertility challenge. can Google it. You can just go to my website and find it. But basically what it does is exactly that. It helps people to understand what are the ranges that you should look at, but also what are the tests? Let me give you an example. Semen analysis are a really good example. The majority of semen analysis and you never, if you have a fertility challenge of any kind, you never want to go to a general lab.

to do a fertility analysis through a semen analysis because general labs aren't specialist labs. They have even more lax reference ranges than andrology labs, which are done through IVF clinics that are more rigorous in terms of their ranges. So the first thing that you need to look at as a man doing a semen analysis is to go to an andrology lab. Okay.

get a referral to an andrology lab to have a semen analysis. But most doctors, when they request a semen analysis, they're requesting a standard semen analysis, which has count, concentration, typically morphology, motility, and that's pretty much it. So how well does it swim? How well is it shaped? And how many are there is essentially the kind of three major questions.

Stuart Cooke (26:58.256)
Yeah.

Gabriela Rosa (27:01.717)
That's not always going to be enough to pinpoint the problem that a couple has in terms of male factor fertility or if there have been miscarriages or if there has been difficult, like failed fertilization or failed implantation. There's more that you need to understand, not just those parameters are going to be enough for us to know if there's other things we need to look at. We need to look at a semen culture. Are there infections that are silent? Because very often there are.

in this kind of subpopulation of people who are having difficulty, is there a DNA fragmentation issue? Because again, the DNA, the mitochondria within the sperm that make it swim really fast and be able to actually be powerful enough to penetrate the egg and create an embryo fertilization to occur, it requires these proper parameters to be able to be working effectively. So basically,

we have then immune antibodies. Also immune antibodies in sperm will make a huge difference in whether a conception is even possible. And if we don't know it's there, it might actually be something that might be a constraint of natural conception and sometimes even for couples undergoing IVF because we don't like, you essentially unless we take that sperm and we put it into the egg through ICSI.

we're not going to be able to have implantation, fertilization occur. It's usually going to fail if we have sperm antibodies that cause a lot of clumping of the sperm. So those are just some things and it's not enough for us to just go, well, let's just bypass all of that. Let's just go and get an egg and a sperm and let's just put it in and everything is going to be fine. Why? Because there is a certain kind of biological component of conception that

Stuart Cooke (28:43.152)
Yeah.

Gabriela Rosa (28:52.809)
optimises itself. you know, when it comes to the egg that is going to be fertilised in any given month, it sends out these enzyme reactions and these kind of enzyme signals to the sperm that most complements its own DNA. So that in itself is a way in which we have a better ability to be able to have conception occur.

So if we're trying to just bypass that by picking a sperm that we can see in the microscope that's swimming, rather than allowing the process to happen as naturally as possible, we may also be missing a step that's actually going to enable us to be able to create a healthy pregnancy to term and a healthy baby, rather than just have an embryo that then does an implant because of those

preliminary issues that are going on and that create a failed cycle. I always say if you have an egg and a sperm together, you should end up with a baby. And if you don't, then it's really the cue to ask more questions and deeper questions. So coming back to results and coming back to these parameters that we look at. In semen, it's going to, that's a classical.

you know, example, because it's a really easy example for basically anybody who's trying to get pregnant to understand. You need to have more clarity about all of the different components of the sperm and the semen analysis, not just come some high level understanding, because the more that you know, and you understand about the situation, then the more that you can intervene with the specific thing that's going to make a difference, like the bathroom renovation situation, you know, like there are some couples.

who will need IVF and that's going to be a wonderful thing and a wonderful step in the right direction after everything else has been optimized. But if we don't, for example, find that there is some silent infection and we go and create an embryo because we can bypass everything, that embryo is less likely to not end up in a miscarriage or a failed cycle. So these are all of the things that we need to take into account and

Stuart Cooke (30:51.76)
you

Gabriela Rosa (31:10.413)
Testing, always say there's bit of, there's art and science to it because you know, there's thousands of tests out there. There's many things you could do and you can go down rabbit holes around testing that are most unnecessary and that waste time, money and energy of couples who are already exhausted and overwhelmed. So you don't want to be, you know, doing all of the tests just because you can. You know, sometimes those things are most unnecessary if we...

Stuart Cooke (31:21.36)
Yeah.

Gabriela Rosa (31:39.192)
you know, in cost effectiveness analysis, and this is, you know, this is credit to Harvard here on all of my healthcare system lessons. But, you know, we have, there's a thing in cost effective analysis in terms of healthcare systems that says, if you are going to treat by test, and as much as sometimes that is what ends up leaving a lot to chance.

When you are looking at an entire picture and you're looking at a holistic process, that is true. If you are going to treat and the treatment and intervention is going to be that 20 % of the effort that gives you 80 % of the result and that's going to resolve a lot of these issues, I agree, why test? But what happens is when we don't test because we think...

Stuart Cooke (32:24.604)
Hmm.

Gabriela Rosa (32:29.323)
that whatever strategy is the treatment and it's not, and it keeps failing over and over and over again, then we need to rethink that assumption and we need to restate it and we need to then address it in a different way. Does that make sense?

Stuart Cooke (32:44.124)
It does, yeah, absolutely. Ultimately, I think I love to use the minimal effective dose analogy for lots of things in life. Just tell me what I need to do. How can I get into the gym? And I don't want to spend three hours in gym. I want to spend 45 minutes, want the biggest bang for buck, and then I'm out again. so yeah, I... Yeah. Yeah.

Gabriela Rosa (32:51.917)
Absolutely.

Gabriela Rosa (33:01.933)
Yeah, absolutely. And that's my approach to fertility treatment. You know, like you've nailed it in one. Because, for a lot of my patients, like they don't have time. They don't have time for it not to be that way because they've already wasted all their time for 10 years trying the way that didn't work. So by the time they come to me, it's like we have five minutes, you know, we don't have the same amount of time that they've spent up until now.

Stuart Cooke (33:13.402)
No.

Mm.

Stuart Cooke (33:24.23)
Yeah. Yeah.

Stuart Cooke (33:31.004)
I've got a question then that plays on my mind because of one of the businesses that I'm in at the moment. So it's supplement related. So a foodie question. Vitamin A, right? So this is a bugbear for us because we, I'm in the freeze dried beef organ supplements as well. That's one of the businesses that I'm working in at the moment. And the common question that we get is,

Gabriela Rosa (33:56.557)
Thank you.

Stuart Cooke (34:00.558)
I would love to take your supplements, it contains vitamin A, so retinol from food. We've been told I must avoid this like the plague because it's terrible for pregnancy. But I'm thinking, hold on a minute, terrible for pregnancy? I think it's crucial for pregnancy. So I would love to know your thoughts, not just on vitamin A, but how diet impacts fertility. Because much like my frozen tomato garden scenario, minimum effective dose. Just tell me the nutrients I need to put in the soil and the

Gabriela Rosa (34:25.901)
Thank

Stuart Cooke (34:30.522)
strategies that I need to be all over to get those tomatoes to grow.

Gabriela Rosa (34:34.955)
Yeah, yeah. Look, that's a great question. And I wish that the answer to that question was as simple as me writing a book about it. You know, there are books out there about it. I just like, literally like, I think about it every day how again, this is another thing that often wastes people's time on this journey, because they think like, well, this is what I need to do. It's simple, it's easy. Let's just implement it. But there is so much more that goes on to answer that question. But here's the thing.

Stuart Cooke (34:42.576)
Yeah.

Stuart Cooke (34:53.884)
Hmm.

Stuart Cooke (34:59.643)
Yeah.

Gabriela Rosa (35:04.097)
And actually, this person that I was speaking to this afternoon as well, one of her biggest concerns was the fact that she's a vegan. And so she was saying, she actually, surprise, surprise, heard me on a podcast saying that, if you're a vegan, you need to eat meat. And I didn't actually say that. But the message is kind of like that a little bit. And here's the thing.

Stuart Cooke (35:21.508)
Right. Yeah.

Gabriela Rosa (35:30.123)
We don't make people who are vegetarian or vegan start eating animal products or meat. We do, however, need to then understand much more about where the imbalances are, because it is not a matter of whether there will be imbalances, it's where are they? That's the thing. And so organic acids becomes really important to test, looking at all the amino acid profiles and all of these things so that we understand. And we don't do that as a matter of course. If you're a meat eater, it's very unlikely that we're going to go down that very focused and

Stuart Cooke (35:39.024)
Yeah.

Stuart Cooke (35:43.036)
Hmm.

Gabriela Rosa (36:00.11)
very deep analysis task because we don't need to. For the most part, you're going to get most of your amino acids and it's going to be okay. Supplementation is a little bit different. It's a little bit the same, but a little bit different. And let me answer the vitamin A question first and then I will come back to how I approach supplements. The World Health Organization actually has a guideline of every pregnant and breastfeeding woman should take no more, but no less than 10,000 IU

Stuart Cooke (36:12.24)
Hmm.

Stuart Cooke (36:16.462)
Okay.

Gabriela Rosa (36:29.833)
of vitamin A from all sources. So that includes supplements, food, you know, whatever sources. We don't tend to overeat our foods that are high vitamin A sources. And so the TGA has limitations on their labels about two and a half thousand IU because they're very conservative, but that's not actually the limit. And that's certainly not the limit that comes, you know, from the World Health Organization guidelines.

Stuart Cooke (36:32.251)
Right.

Stuart Cooke (36:41.937)
Yep.

Gabriela Rosa (36:58.249)
And you are absolutely right that vitamin A, many other essential nutrients, vitamins and minerals and amino acids are going to be the essential foundation for optimum health and optimum fertility. So there is no doubt that you need these nutrients. What often can be a bit of an issue here is that people then start taking single nutrients and that can be a trap.

Stuart Cooke (37:21.53)
Yes. Yeah.

Gabriela Rosa (37:23.851)
And the reason that that is a trap is because you can over absorb certain nutrients. can take other nutrients out of balance. You can, there's lots of different variations of what can happen as a result of taking these imbalanced kind of nutrient concoctions and or single nutrient supplementation. The best approach, and this is why literally in 24 years of doing this work, we have done a study through my, my MPH was a study of our results.

and at Harvard. And we saw that amongst this population that had been on average trying to get pregnant for four years, plus or minus two and a half, had previously, 51.5 % had previously had miscarriages, that decreased 13.5 % after our treatment. And the overall live birth rate of the program is 78.8%. Now, why and how when

so many other things aren't effective. How is it that this works so well? Well, one aspect is that there is selection bias. We know the kinds of patients that we can get a good result for and we optimize for that. So that's why I always do a complementary fertility assessment when I talk to somebody to see, are we a good fit for each other? You know, because unless I know that, then I don't know if this is going to be a good fit for someone or not.

The second thing about that is that we use supplementation heavily, but we tailor and customize our recommendations for that individual. So that's where it becomes a really kind of distinctive process in a way, because we're not just going, here's a list of all the things you should take. I don't know if that person actually needs to take those things. That's why I have never in 24 years, you will not find me.

Stuart Cooke (38:56.038)
sure.

Gabriela Rosa (39:16.365)
writing books and I've written four books, writing books about supplements, writing papers about supplements or doing specific supplementation recommendations or any of those things because in my view, when it comes to fertility and the very specific subset of the population of infertile couples that I treat, they really need tailored. They really need very highly personalized advice for them.

It's not the same for everybody in the general population. It's not the same for the people who it's been easy to overcome infertility. But for the types of patients that I treat, it's crucial. And so that's where the conversation distinction is. We have to delineate that because in general, say, absolutely go and have a multivitamin. Everyone should have a really good quality multivitamin. Everyone should have a really good quality DHA supplement. That's really high DHA.

Stuart Cooke (39:53.67)
Yeah.

Gabriela Rosa (40:09.565)
everyone should have good nutrition, good amino acids intake, 130 grams of protein per day. Mind you, that's per kilogram, that's a blanket recommendation that's not the same for everyone. But I'm just saying, in my own case, being 169 centimeters, 70 something kilos, that's my amount, and my patients will have their own.

Stuart Cooke (40:20.122)
Yeah.

Gabriela Rosa (40:35.297)
But the thing about here is that we really are looking at how do we tailor the advice to the problem that we have, the leaking toilet analogy, you know, as opposed to just using some kind of blanket recommendation. But yes, I think vitamin A, I'm a fan.

Stuart Cooke (40:44.188)
Totally.

Stuart Cooke (40:50.021)
Hey.

Yeah, it's interesting because I recently tested DNA and I've done this for the best part of a decade but as tests get more more more, absolutely, it just gives us...

Gabriela Rosa (41:02.029)
and and granular.

Stuart Cooke (41:05.92)
way more insight into what we really should be doing to try and optimise my health. And again, I'm in this minimum effective dose scenario. Just tell me what the things I need to do, because I know that my diet and supplementation plan will be different to yours. And the results came back and it was a game changer. was like, wow, I didn't ever think that I'd need to be doing these.

Gabriela Rosa (41:19.819)
Yeah, absolutely.

Gabriela Rosa (41:24.781)
Isn't that interesting? Absolutely. And isn't that fascinating? Because that's the thing that I often try and get people to understand. And it's sometimes difficult for people to understand that sometimes it's the 2 % that you're missing that actually still means 100 % no baby. It's not the 98 % that you are already doing. You know, when people come to me and they say things like, I've tried everything. I'm like, no, you haven't. If you haven't done this, you haven't.

Stuart Cooke (41:35.42)
Hmm.

Stuart Cooke (41:39.9)
Mm.

That's right.

Yeah.

Stuart Cooke (41:50.638)
Yeah, I bet you haven't. Yeah.

Gabriela Rosa (41:53.71)
But it's exactly what you're saying. Sometimes it's that 1 % that either you don't know or that you're missing that will still mean 100 % no result or a subpar result at best.

Stuart Cooke (42:08.602)
Yes, totally, absolutely. And I'm blown away by the nuance of the detail that was personal just to me. It was unique to me that I hadn't thought of before because we are surrounded now by this digital world where everyone's an expert on social media and you follow this diet, follow that diet, take this supplement. And it's just like, this is just... No, I know. But...

Gabriela Rosa (42:31.317)
I'm not rolling my eyes as you're saying this, I promise I'm not.

Stuart Cooke (42:35.942)
How would you know? How would you know unless you want to decades and decades of guesswork, which ultimately doesn't serve anybody? So I...

Gabriela Rosa (42:43.371)
Yeah, No, you're right. And it's very frustrating. I think it's very frustrating from a consumer perspective as well, because, you know, I get this all the time. It's like, my god, this is what you do for free. I imagine what you know, going through your program is like, and I'm like, yeah, but the reason that I do that for free is because I understand that there is so much more and this is like the amazing foundation that you need for us to be able to find the, you know, minimum effective dose and sometimes

Stuart Cooke (43:07.228)
tightly.

Gabriela Rosa (43:12.415)
that is the minimum effective dose, you know, and that's wonderful and that's great and that just benefits, you know, my, my mission really, when I first started doing this work was that I wanted to help make the world a better place, one healthier baby at a time. You know, it was my very kind of naive thought about how I would impact the world or the legacy that I would leave. And of course the work just becomes bigger and bigger and bigger than you, bigger than you ever imagined because obviously

Stuart Cooke (43:14.362)
Yep.

Stuart Cooke (43:24.764)
Hmm.

Stuart Cooke (43:29.126)
Yeah.

Gabriela Rosa (43:41.806)
There's so many layers to that. When you're first starting out, there's the polyanna glasses that go on and you kind of go, of course, this is the path. But then obviously, I'm still here 24 years later. So that has to mean something and it could mean that I'm crazy. But I kind of think that I'm pretty sane. So the other possibility here is that there is definitely more that needs to be done and the world needs to understand all of this.

Stuart Cooke (44:02.556)
Hmm.

Gabriela Rosa (44:11.629)
The reality of it is that when you're really busy doing this kind of work at a really deep level, it's so easy for someone who has no experience or has a couple of years of experience to go on social media and proclaim themselves as an expert and think that they're going to solve the issues, but then that ends up wasting people's time even more. So I get your frustration in terms of that because it's a very challenging issue.

Stuart Cooke (44:27.568)
Yeah.

Stuart Cooke (44:37.308)
It is challenging, and especially working in social media because unfortunately, and most people won't want to hear this, but the green smoothie very rarely fixes everything. that... Yeah.

Gabriela Rosa (44:48.169)
If you're talking about thyroid and infertility, actually worsens it. Just so you know. Let's put that out there.

Stuart Cooke (44:54.33)
Yeah, Oxalate Bomb. I'm fascinated by this. I'm mindful of time as well, so I had a whole heap of questions that I would love to ask you, but maybe we'll schedule a round two for the...

Gabriela Rosa (45:05.293)
We'll have to do a ta- exactly, we'll have to do a part two.

Stuart Cooke (45:08.442)
Have to, have to. I was just gonna jump in perhaps just for you to explain a little bit about the holistic fertility clinic because I know it's groundbreaking, it's the benchmark for, and I guess the home for all of your knowledge and resources that help so many people. So I wondered if you could just give us a little recount of what to expect if we were A, wanting to get pregnant in the future and wanna optimize the tomato garden, right?

for future growth, or struggling because it's winter and the tomatoes aren't growing. So what would we expect if...

Gabriela Rosa (45:39.029)
Yes. Yes.

Absolutely. Look, I think the first place that people can go and find more information, one of my books called Fertility Breakthrough, Overcoming Fertility and Recurrent Miscarriage when other treatments have failed is free online. So on actually on YouTube and Spotify, the audio version. So you actually have my voice reading the book for you, putting you to sleep at night. That might be a good thing or a bad thing. But

Stuart Cooke (46:08.518)
Hahaha.

Gabriela Rosa (46:08.651)
But it's there, it's available free online. And the reason that I did do that and made it available free online is because I really wanted it to reach as many people as possible that needed the information and that wouldn't necessarily come across it in any other way. So it's absolutely free. It's there, just go find it. Just Google my name, Gabriella Rosa, G-A-B-R-I-E-L-A with one L and R-O-S-A is the surname.

And that actually will probably take you to most places where you need to go in order to get the process started. mentioned through the conversation about the fertility challenge. The fertility challenge is a program that's very close to my heart. It's a program that I've been running for about 10 years and it has just gotten an entire new facelift. It used to be a 14 day kind of little tasks every single day and educating people on things. It's just became a 30 day program that is really in depth and

multiple sessions in the week and people can catch up on replay and you know, they can really go and dive deep into understanding. I'm just not okay with people not knowing what they need to know. You know, I don't even care if we work together, if we're not a good fit in the future, whatever, just go and learn, go and find out, go and understand the things that are getting in the way because that's usually the biggest unlock that someone

Stuart Cooke (47:21.307)
Yeah.

Gabriela Rosa (47:28.479)
on journey can have is actually understanding what they don't know they don't know. So I highly encourage people to take on the fertility challenge and conquer it as I always say because that's going to give people a new level of confidence you know on their journey and then of course through our website which is fertilitybreakthrough.com and if you can't spell that just try Google these days will fix it for you.

Stuart Cooke (47:52.464)
Yeah, you'll get there.

Gabriela Rosa (47:55.22)
Exactly, but fertilitybreakthrough.com is the website where they can, you know, all the information is there.

Stuart Cooke (48:01.456)
Fantastic, fantastic. We'll put all of those URLs and links in the show notes that we've spoken about today. I've got one wrap-up question, which is more personal to you. And ultimately, it would be great. The fertility queen, right? Gabriella Rosa, what do you do every day? What are your daily non-negotiables that allow you just to win the day? Anything, wild and wacky.

Gabriela Rosa (48:24.653)
Yeah, look, I have always, this is one thing that has never ever shifted my entire life. My sleep. I prioritize my sleep every single day. Like you can imagine, I have two Harvard degrees, have, you know, like I've got two masters, one doctorate on the way. Like, you know, I'm busy. I run a clinic which serves people all over the world. Like I'm a very, very busy person and you know, I have a team of 40 people.

But one thing that I will never, never do is fit more things into my day than it enables and allows me to have quality sleep for the amount of time that I need to feel at my best. Because I know that if I get enough sleep and if I prioritize quality sleep, everything else in my life will be better. You know, my energy levels, my patience.

Stuart Cooke (49:14.48)
Yeah, totally.

Gabriela Rosa (49:18.441)
my ability to show up for the people that I need to show up for in every area of my life. So my sleep is like the one thing. And then a few years back, I think that probably I'm in my eighth year of bodybuilding and I went through a really big phase of like really focusing on completely transforming my body through, you know, heavy weights training, like literally bodybuilding and weightlifting.

And that transformed me in more ways that I can describe. Yes, the body was a side effect of, you know, essentially how it changed the way that I do things. But I think that training, physical training, I'm not talking about physical activity, which is the amount of activity that you do in your day to day, not being sedentary, blah, blah, blah. I'm not talking about exercise, i.e. exercising three days a week to prevent cardiovascular disease.

Stuart Cooke (50:01.628)
Hmm.

Gabriela Rosa (50:12.801)
I'm talking about progressively overloaded physical training from a weights training resistance point of view to a cardio perspective and actually combining all of those different types of training. actually, you know, I'm at a phase of my life now where I'm really looking at longevity and quality of life. You know, I've been my own patient through infertility and having been diagnosed with polycystic ovarian syndrome very early on.

in my teen, well actually I was 18 at the time, being told that I would never have a baby. And so, you know, I have two healthy boys, one is 13, the other one's 10 this year. So that didn't quite come true and I conceived naturally and you know, all of that. And I did it by exactly implementing the things that I tell my patients to do. In fact, I have a personal rule and a rule for all of the clinicians in my clinic, which is we don't tell people that I would not do. The things that I would not do.

Stuart Cooke (51:08.912)
Great. Yeah. Walk the talk.

Gabriela Rosa (51:11.489)
So if I wouldn't do it, we're not going to recommend it. But if I would do it, well, you better be damned that it is going to be the line, you know, because I'm not superhuman. I'm not special in any way. If I can manage, my expectation is that my patients are going to be able to as well because they want to be healthy. They want to have the outcome that they're looking for. So that's the idea.

Stuart Cooke (51:14.405)
Yeah, perfect.

Stuart Cooke (51:34.938)
Yeah. that's excellent. And I interviewed a very well-known longevity expert three or four years ago, and I asked him this golden question. Like, everything that you know in your knowledge base for longevity, like, what's the one thing that we could be doing to try and reach the golden years, thinking that he was going to...

Magic supplement, resveratrol, rapamycin or any of the above. And he just, he thought about it for a while, then he leaned into the microphone and he said, lift weights. And the downstream effect of everything that provides.

Gabriela Rosa (52:00.035)
Mm-hmm.

Gabriela Rosa (52:12.577)
Look, and I tell you, and I think that that and the sleep, because you only build muscle recovering, right? So that's really the big thing. But the really interesting thing about that, and I think that it's so valuable, is that more and more, the science is catching up as to why this is the case. And we know that just, and we could be here for another two hours talking about this, but we're not going to, but the reality of it is that, you know, I think that there is so much

Stuart Cooke (52:17.424)
Yeah. Mm, mm.

Stuart Cooke (52:36.687)
No.

Gabriela Rosa (52:41.389)
opportunity left on the table just for vitality and good health to really embark on these habits that are actually going to ensure that we get the outcomes for our later years that we want to. You know, I often joke with my friends and my family that my goal is actually being able to sit and get up from the toilet at age 90. And I might be stretching that age a bit more as I get older, but you know, age 90 and be able to wipe my own bottle.

Stuart Cooke (53:04.955)
Mm-hmm.

Gabriela Rosa (53:09.973)
That is my life goal.

Stuart Cooke (53:10.736)
Well, well then you better be doing squats in your 70s. Right? Yeah. Yeah.

Gabriela Rosa (53:15.053)
You know, I like I'm learning those babies, you know right now But yeah, but that's because you see in order to be able to do that. You have to have good memory You have to have dexterity you have to have the ability to you know, good cognition You have to be able to actually fit and get up you need to like you need to have core strength You need to have leg strength. You need to have glute strength you have to have all of the things working for you to be able to

Stuart Cooke (53:42.417)
Yes.

Gabriela Rosa (53:43.701)
sit and get up from the toilet and wipe your own bottom. So that's my life goal.

Stuart Cooke (53:46.16)
Totally. Good on you. I love it. I love it. We have to do a part two. In the future we have to. So many things that I didn't touch on today that I really, really want to. But fantastic conversation. Just remind our listeners again, best place to go to get more of you in all of your communications.

Gabriela Rosa (54:05.805)
Absolutely, fertilitybreakthrough.com. I'm in every social media platform pretty much. so, but fertilitybreakthrough.com is where people need to go.

Stuart Cooke (54:14.18)
Wonderful, wonderful. will share the link and share the love to our audience because I'm sure they will get so much out of this conversation. Really, really appreciate it and look forward to round two at some stage soon. Thank you so much.

Gabriela Rosa (54:21.943)
Thank you.

Absolutely. Thank you so much for having me. This was a lot of fun. Thank you. All

Stuart Cooke (54:28.272)
Thank you.