Episode 6: Dr. Annina Burns, PhD, RD: How You Can Support Your Fertility and Root Causes of Infertility

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SPEAKERS: Dr. Andrew Wong, Dr. Annina Burns

Dr. Andrew Wong

Welcome to the Capital Integrative Health podcast, a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. I am Dr. Andrew Wong, co-founder of Capital Integrative Health, an integrative practice committed to expanding access to holistic root cause medicine to the global community.

We are excited to have a conversation today with Dr. Annina Burns. Annina and I trained together in functional medicine and we’ve known each other for several years as friends and professional colleagues. Annina is the first Ph.D. and RD to be certified in functional medicine by the Institute for Functional Medicine and has over nine years of clinical experience. She is the CEO and founder of Simplina Fertility, an innovative fertility coaching program that helps couples improve their chances of a healthy pregnancy. She is most proud of being a mom and wants to give others who want to be parents the same opportunity to experience the joy of parenting, which is why she founded Simplina. Today we are going to dive into how you can support your fertility using nutrition, lifestyle, and functional medicine approach. Welcome, Annina to the podcast. Thank you so much for coming on today.

Dr. Annina Burns

Thanks for having me, Andy.

Dr. Andrew Wong

Yeah, so I just heard you moved into a great place that’s very much connected to the earth, more parking there and apple trees and why don’t you tell us about that first.

Dr. Annina Burns

Sure. So my family and I have been in this city is pretty much for the last 15 years and COVID really caused us to think twice about city living especially with a young child who can’t be vaccinated. And we decided to move out to Virginia, near my parents, so we have their help but we also now have access to apple pink picking, pumpkin patches, and we’re just out and about in the mountains and it’s really nice to be out with nature, especially during this time.

Dr. Andrew Wong

That’s so great. And then you probably also get to really breathe clean air and connect to the ground and do earthing and this type of things.

Dr. Annina Burns

Yeah, it feels really good. I mean, you really forget how far away from you are from nature when you’re in the city. So I was always gonna rush into the Metro trying to get to work and just having a chance to like, the air is cleaner and feels better to breathe out here. And I can also do social distancing safely and it’s not an issue so it is really nice to be out there at this time.

Dr. Andrew Wong

And you’re a registered dietician, functional and integrative nutritionist. So tell me about the Farmers Markets. Tell us about that. Farmers Markets, or do you shop at farms or grocery stores out there?

Dr. Annina Burns

We do. So we do a CSA in the summer to support a local farm. And then we also shop at Farmer’s Markets on weekends and it’s fantastic because by being further out in Virginia, we’ve got great access to produce that comes from both Pennsylvania and Virginia. Good apples, great berries, good veggies. It’s got a great bread.

Dr. Andrew Wong

Yeah, good soil quality there for sure. Yeah, I know a lot of the Virginia produce gets into Maryland too. And we see the produce from both Virginia and and Pennsylvania. So first, tell us about your background and intro to nutrition and holistic medicine. How did you get into into those fields, especially nutrition?

Dr. Annina Burns

Sure so I’m a Italian and American, and so food is everything in my family. It’s how I grew up. I mean, we celebrate with food, we eat over, good meals every single day. I mean, it’s always like what’s for dinner tomorrow. It’s just part of being a Italian-American. So food was a natural fit, but it’s always interested in biochemistry and the science of health and how you have optimum health and so nutrition is a perfect marriage of both together.

Dr. Andrew Wong

But first of all, I don’t know anyone who doesn’t like Italian food, food-wine pairings and you get the bread to start with and things like that often, but I know that you also are interested in fertility and that’s our main topic today but what got you interested in fertility and women’s health?

Dr. Annina Burns

Sure. So I’ve had a woman’s health practice for the last nine years where I help women throughout the lifecycle wherever they were. And then as I had my own struggles with fertility, and I saw my own clients have struggles with fertility. I really realized there’s a gap in health care. There is a need for women to get support before they want to get pregnant to improve their health but also for their male partners as well. So you have the best chance to conceive and also a healthier chance for a healthier baby. And so my own struggles and watching out in my clients that I want to create a service to be there for them. So they get that support and functional medicine and nutrition that they need.

Dr. Andrew Wong

And for your own kind of personal journey with fertility, what kind of barriers and also opportunities and breakthroughs to do kind of go through with them?

Dr. Annina Burns

Sure. So I mean, first of all, I tried to get pregnant after 35. So immediately the conventional medical system said, “Oh, you’re really high risk and you may not be able to get pregnant.” So then I was with a good lifestyle change and able to conceive my daughter, and I feel very, very fortunate. I have struggled with secondary infertility. And maintaining pregnancy and I have had repeated miscarriages. And so I know firsthand that loss and how hard it is, especially when you have had a child too and kind of dismissed by the conventional medical community as well. You already had one so you should be lucky with that. And so I know what my clients go through and I know that experience firsthand is I tried to solve my issues of like, How can I achieve pregnancy now that I’m in my 40s?

Dr. Andrew Wong

Yeah, and I think you know, 35 is considered advanced maternal age, but certainly in the DC areas as people get more educated and I think even generations people are tending to have trying to have kids a bit later now in life too. So it’s not uncommon.

Dr. Annina Burns

It’s not uncommon at all and it’s the trend. So more and more people are having children later. So you want to have a good financial footing and want to have their careers in a place where you can bring a child into the world. It’s a good time to bring a child into the world, and there’s a lot to be said for that. It’s just how do we help Mother Nature and help your body also coincide with those goals?

Dr. Andrew Wong

What do you enjoy most about your work at this point?

Dr. Annina Burns

I just love working with clients. I love getting on to Zoom. Now I see everybody virtually. And having them say “I have never slept this well in my life. I have never felt so good in my life. I’ve been struggling 10 years with this gut issue and this is the first time I feel normal.” When you hear those words as you know as a provider, Dr. Wong, it’s just so heartwarming, it feels wonderful and you want more people to have that experience.

Dr. Andrew Wong

And that’s awesome. As we both know, and even in functional medicine, the body is connected, everything’s connected. So they may be coming into you with fertility issues, but it may be a gut issue or hormone issue or a detox issue, etc. So they’d like you just said they may be coming to you and then they end up sort of, “oh, this is the best I’ve felt in such a long time,” because you’re working on the whole system with them. That’s right. How does your approach differ from a conventional approach to women’s health?

Dr. Annina Burns

Sure. So I think particularly in the fertility world, if you want to get pregnant they say just try and if that doesn’t work after a year if you’re under 35 or six months if over 35, go to IVF.

Dr. Andrew Wong

Okay, so that’s the definition of infertility

Dr. Annina Burns

Yes, that’s the definition of infertility but that’s also the conventional path of “you can’t get pregnant you go to an OB, OB says wait and try. You’ve waited and tried try go to IVF.”

Dr. Andrew Wong

Nothing in between.

Dr. Annina Burns

Right. So usually nothing in between. Sometimes they’ll do STD testing. They might do some basic bloodwork looking at your thyroid status, but that, there’s not a lot of answers provided in that process. And in a functional medicine practice and in Simplina, we really look for those underlying health conditions. Why are you not able to conceive and so functional medicine is different because we’re looking at the root cause for infertility instead of just saying, “Okay, this is the way it is, this is what your option is.”

Dr. Andrew Wong

So we’re gonna go now with kind of this female fertility and male fertility kind of diet there. We’ll start with female fertility. What’s the role of female fertility in the whole fertility process?

Dr. Annina Burns

Right. So I think women get a disproportionate amount of the weight and fertility cycles. So we often say, well, it’s a woman’s issue, and it is 50%. Often women so we say about 30% are women 30% men, 30% unexplained but often that unexplained is equally divided between men and women.

Dr. Andrew Wong

That leaves another 10% which is another, who knows?

Dr. Annina Burns

Another conventional medical doesn’t answer for, right? But the role of women is very much, not only do they have to produce good quality eggs, your uterus has to be such that you can have implantation and you can actually hold an embryo and then grow an embryo. So they have a key role in fertility.

Dr. Andrew Wong

Yeah, there’s multiple steps. It sounds like. But it sounds like what you said in some of it are known but the ones that are known, it’s kind of like half and half, terms of sometimes it’s more the female sometimes, or the male, or both maybe. And what about what do we know about male fertility? What role do men play in this process?

Dr. Annina Burns

Sure. So I think male fertility is kind of the big unanswered question and in the IVF world we really don’t look enough. We know that sperm counts are declining. They’ve declined about 50% in the last 40 years. It’s pretty dramatic. We’re also seeing more abnormal sperm so you can have sperm but that abnormal sperm leads to infertility and also is more likely to lead to miscarriage or issues in pregnancy and after when a child is born. So we know that men are a key part of the equation and we actually have good data on the decline of sperm quality. And so often in an IVF setting, we just look at motility and we’re looking whether or not they move and quantity. You know how much you have, but we’re not looking at quality. And that’s key.

Dr. Andrew Wong

Are there tests out there that can look at sperm quality as well?

Dr. Annina Burns

There are so there’s a DNA fragmentation test. Which looks at how broken up the DNA is of the sperm. And there’s also one I’m increasingly using, which is DNA methylation, right? So before that DNA is actually broken, or you can start to see it methylate- uncoil, which means that it’s starting to be damaged, but it also means that the male has perhaps a higher biological age than their chronological age, right? So a guy might be 35 or 40, but he might have sperm of a 45 year old.

Dr. Andrew Wong

DNA methylation.

Dr. Annina Burns

That’s exactly right.

Dr. Andrew Wong

Got it. And do conventional fertility specialists test these kind of tests?

Dr. Annina Burns

Not in this area. And generally they don’t.

Dr. Andrew Wong

Generally not. Okay. Why is that?

Dr. Annina Burns

I think we just kind of go by the book, right? Like, this is our protocol. We’ve been doing this a long time. And this is what we do.

Dr. Andrew Wong

It’s in the box is the answer that is sort of conventionally,

Dr. Annina Burns

Right? It’s how we’re training and what we’ve been doing.

Dr. Andrew Wong

Alright. And what are some of the fundamental nutrition tips for supporting fertility?

Dr. Annina Burns

So I think the big thing is that people often say when you’re pregnant, “Oh, I can’t drink I need to eat better. I need to exercise.” You need to think like you’re pregnant before you’re pregnant. When you’re trying to get pregnant right. So you need to be eating a good variety of fruits and veggies. Low toxin. Organic, avoiding the Dirty Dozens and things that have high pesticides in them. Low glycemic, it’s gonna keep that blood sugar nice and low, so higher in the protein and the fat. A little bit lower on the complex carbs. You still need carbs. And getting the right supplementation to support your body. Those are just some really basic nutrition tips.

Dr. Andrew Wong

How about organic foods if people cannot afford organic foods and then what would you recommend there?

Dr. Annina Burns

Right, so I think the key thing is avoiding the foods that are the highest pesticides right. So the Environmental Working Group has something called the Dirty Dozen, which I just mentioned. So strawberries are one thing that if you can’t buy them organic, just don’t eat. Blueberries actually are much lower in pesticides, so that’s a good option. Eating in the season is cheaper. So if you’re having apples in the fall, it’s cheaper than having raspberries in the fall. Because we’re bringing those raspberries in from far away because it’s not growing locally. So you don’t need to be 100% organic. You just need to really avoid those high-pesticide, high-toxic foods.

Dr. Andrew Wong

On the local farms- we just went apple picking recently too. Do they use pesticides a lot on their crops?

Dr. Annina Burns

They generally do. And apples are actually one of the more high-pesticide fruit so it’s really important as well, I think you brought up a good point, to wash your veggies and fruits, that’s key before eating them.

Dr. Andrew Wong

How do you wash them? Is it like water with the vegetable cleaner or is there some other way?

Dr. Annina Burns

So I actually just use the 7th generation dish soap and you dilute it and you wash all your veggies and you’ve rinse it off with that.

Dr. Andrew Wong

But you can still eat with skin?

Dr. Annina Burns

You can still use your skin but another option would be like to take the skin off to reduce the pesticide for apples.

Dr. Andrew Wong

And then another random question I had about strawberry since you mentioned it. You know those little wild strawberries you see everywhere on the grass. Are they safe to eat?

Dr. Annina Burns

I always tell people, “No.” Mushrooms, berries. There’s actually a lot of ones that are poisonous in our area. So I think it’s just better not to have them.

Dr. Andrew Wong

Yeah, and they may be picking up a lot of pesticides on the road or whatever.

Dr. Annina Burns

Who knows? There could be dog waste and that makes you sick as well.

Dr. Andrew Wong

Okay. That makes sense. And are there any essential nutrients that people should be aware of? I guess we can talk about maybe macro and micronutrients, but in terms of augmenting or improving fertility.

Dr. Annina Burns

Sure. So there are quite a few. So vitamin A is very important for the corpus luteum. Iron is really important to help that placenta grow. Your B vitamins are very important in this process. Folate, as many people know and the methylated form is very key. Fat is actually important. So a lot of times people overlook fat, but you need fat to produce your hormones. Hormones are produced from cholesterol. So you need to have good quality fats in your diet.

Dr. Andrew Wong

You’re saying fats are not bad?

Dr. Annina Burns

So fats are not bad. At least healthy fats. Healthy fats. That’s right. You don’t have any need for trans fat, but you know eating eggs, having steak, or chicken, olive oil, avocado, those are all healthy fats.

Dr. Andrew Wong

Got it. Okay. And obviously, we know that brain tissue is mostly fat. So for the fetal brain development, they’re going to need those fats.

Dr. Annina Burns

It’s absolutely important. So that’s why we talk about fish oil and fish, and protein, it’s very key.

Dr. Andrew Wong

And for vegetarians, where would they get the healthy fats from?

Dr. Annina Burns

So I highly encourage eggs because that’s a great source. And if they are pescatarian, to have fish in moderation and that’s low-toxin fish. Some fish are highly toxic like sword fish or tuna, where as wild salmon is a better choice. And then to get fish oil or DHA, is a supplement is good for vegetarians.

Dr. Andrew Wong

Alright, so we talked about how we define infertility. Let’s talk about some common root causes that you see in the functional medicine space in terms of what causes infertility, what are some of those root causes you’re working up when you see a client?

Dr. Annina Burns

Sure. So there are a number of issues that I’ve found. So PCOS and endometriosis are some of the classic ones. Autoimmunity, thyroid antibodies, gut dysbiosis, nutrient deficiencies and even bacterial overgrowth- Candida, BV, and so forth that can upset the vaginal biome- are all root causes. And then the male side, you look at low testosterone, low DHEA, the hormonal levels, as well as poor sperm quality.

Dr. Andrew Wong

Got it. So we’re talking at a pretty high level here. I know, some listeners may not know all these acronyms, so let’s kind of dive back in if you don’t mind to PCOS.

Dr. Annina Burns

Polycystic Ovarian Syndrome, and that’s when you have cysts on your ovaries. And I find many of my clients have had this throughout life. And then they go to get pregnant and they can’t. And it’s like, well, maybe that’s part of the problem because PCOS, the polycystic ovarian syndrome has been linked to having high blood glucose and poor blood glucose control. So there are things you can do with nutrition to reduce those cysts that can improve your chances of fertility.

Dr. Andrew Wong

Now, is it the hormonal imbalances or the blood sugar imbalances that kind of lead to infertility for PCOS women?

Dr. Annina Burns

It’s both. So blood sugar drives things because it creates inflammation in the body and it upsets the hormonal balance, and then you have that cascade effect and one of the symptoms that you get is PCOS.

Dr. Andrew Wong

Right. So is that correct to say that PCOS kind of stems from insulin resistance? Mostly or are there others a lot?

Dr. Annina Burns

There are other reasons, but we really think the root cause for PCOS is insulin resistance.

Dr. Andrew Wong

So it goes back to a lot of, we know that from studies that up to 88% of Americans had metabolic syndrome, insulin resistance, prediabetes, diabetes, and I wonder how many people you know of that group have more fertility issues?

Dr. Annina Burns

Right. Absolutely.

Dr. Andrew Wong

It sounds like that’s an issue, and then back to the thyroid, too. Autoimmune conditions in general would increase the risk of inflammation oxidative stress and fertility, but we know that we probably both see a lot of women with with autoimmune thyroid. Have you found that improving their thyroid hormone helps with fertility as well?

Dr. Annina Burns

It definitely helps. In functional medicine, we like to see that TSH between 1-2, and so it’s a really narrow range- 2.5 kind of being a maximum area whereas normal thyroid would be you know, 2 to 4.5 different range for fertility, but I have seen a difference. So conventional range versus an optimal range for fertility is narrower, right? Much tighter.

Dr. Andrew Wong

I found that too. It seems to be people are more successful at that range. That’s great. And have you found herbs and nutrition to be helpful with lowering that TSH down to a 2 let’s say or do they need medications or what are your experience with that?

Dr. Annina Burns

So it really depends where it is. Right? So if they’re at a 3 or a 2.8, we just really try to have good cortisol controls, we might use Rhodiola or ashwagandha, to kind of control the cortisol which can help control the thyroid. We can also use selenium and zinc and other nutrients to help that T4 and T3 conversion. However, if someone you know is over 4.5 or 5, and they’re looking to get pregnant, we absolutely want them to get thyroid medication if they’re looking to get pregnant soon because we do know if that TSH is elevated, more likely to miscarry even though you do get pregnant.

Dr. Andrew Wong

Yeah, and I feel like more people are having TSH and thyroid issues now than before, and I’m not sure if it’s just because we’re diagnosing it more if there are more environmental toxins out there, or are there gut dysbiosis, etc.

Dr. Annina Burns

Right. And we are seeing a rise in thyroid-related disorders. I do think there’s a rise in it.

Dr. Andrew Wong

And then you talked about methylation a bit earlier like DNA methylation how does that how does that exactly cause or contribute to infertility and what do you do about methylation?

Dr. Annina Burns

Right? So the key thing with methylation, is you have the uncoiling of the DNA, and what you want for fertility is optimum half. You want your DNA to be really strong and really healthy. And the way you do that is with nutrition. You do that with exercise, you do that with sleep, and targeted supplementation to really kind of prevent that methylation from happening. So basically, when you methylate, when you think about it as you’re aging faster, that’s another way to think about methylation. One thing is also to make sure you’re getting methylated supplements, so I know both you and I use those; methyl tetrahydrofolate, methylated, B six, and methyl B12. Those are important because you have more methyl donors we know about 40 to 60% of the population has genetic snips related to MTHFR. And that’s important for fertility.

Dr. Andrew Wong

Right. So the conventional maybe unmethylated folic acid supplementation would not be necessarily good for someone with that MTHFR mutation. What about gut dysbiosis? How would you treat that in this situation with infertility?

Dr. Annina Burns

Right? So we want to make sure we treat gut dysbiosis before we actually try to conceive. That’s why there’s simply no functional fertility program. We have four months where we’re really detoxing cleaning up your System Optimum Health before you go to conceive. You can’t be detoxing or treating a gut issue without trying to get pregnant because a lot of those herbs or if you use antibiotics are toxic when trying to conceive. But if we look at we do a GI MAP test, we’re looking for our gut dysbiosis the presence of h pylori, the presence of Candida really the hue that because when your gut is inflamed, and there’s dysbiosis we know that that can also lead to vaginal dysbiosis and upset the bathroom biome. So you could get pregnant but not be able to maintain that pregnancy and still have a harder time getting pregnant as well. So I use herbs. I use diet to really try to do that. And then I also refer out to a physician if they really need antibiotics. They have really high h pylori account before they try to conceive. What

Dr. Andrew Wong

What about insufficiency? dysbiosis where it’s like low levels of lactobacillus Bifida bacteria, how does that kind of play in what is your role? What are your thoughts about probiotics in regards to I guess, supporting healthy initiation of pregnancy?

Dr. Annina Burns

Right. So we really want a good healthy gut biome right? Because that’s important for nutrient absorption. It’s also important for detoxification and those are two things you really need. So if you have insufficiency, we also want to treat that before you try to conceive. So we want to use probiotics. We also want to use fermented foods, if it’s right for that particular person because you want to colonize that gut. So it’s not just about taking one pill but it’s also eating in a way that supports your gut health.

Dr. Andrew Wong

What are your favorite fermented foods?

Dr. Annina Burns

Sauerkraut? I actually really do like sauerkraut and kombucha tea is an all time favorite.

Dr. Andrew Wong

Nice. Yeah, I’m starting to get into sauerkraut. And then, I guess in terms of the other thing I wanted to ask about infertility, we know that a lot of people are, there might be working moms or working dads or working people in general, I guess I’d say or they’re just running around like stressed out and so what is the role of stress with infertility, how do you see stress and the mind-body connection play a role in this.

Dr. Annina Burns

So stress plays a key role. We actually have a mental health component in Simplina that we address stress because if that cortisol level is too high or too low, we know that impacts your blood glucose, and that in turn impacts fertility, and infertility, let me just say this is a major stress. So studies have shown that chronic infertility, miscarriages, have the same PTSD disorders as having a cancer diagnosis or an HIV diagnosis and people have chronic stress and fear of what’s going to happen next. What is my health going to look like going forward is a real stressor. So it’s a bit of a Catch-22 when you’re dealing with infertility, but we try to break that cycle as best as we can; get people the mental health support that they need, but also really try to support your lifestyle in a way that can reduce stress.

Dr. Andrew Wong

I’ve definitely seen that where people have been trying for so many years and they’ve had years of infertility and that in itself, as you said, becomes trauma; becomes almost like fear, limbic system activation kind of thing.

Dr. Annina Burns

That’s right.

Dr. Andrew Wong

And of course, then the flip side is, they do get pregnant. That’s there’s so much joy and so much gratitude, and it’s great to see people get pregnant.

Dr. Annina Burns

Absolutely right. We want to do everything we can to make that possible.

Dr. Andrew Wong

Now, once someone has, I’m not sure if there’s research on this or not, but if once someone has one child, are they more likely to have another child, just based off on that, just statistics basically, are about the same in terms of infertility for the second child?

Dr. Annina Burns

You are more likely so I think a lot of times with traditional IVF clinics, they say, “Oh, you’ve had one child, so you should be able to have another” right? So it’s not an issue. But we do know, that secondary infertility is real. The numbers are valid and whether or not it’s about equal to primary or secondary. I’m not exactly sure when but secondary infertility is a problem.

Dr. Andrew Wong

Can you just describe to everyone what that means?

Dr. Annina Burns

So secondary infertility is just you’re able to conceive your first child but you’re unable to conceive a child after the first child. So it’s called secondary infertility.

Dr. Andrew Wong

Thank you. And then we talked about the role of insulin resistance and maybe being overweight metabolic syndrome, this blood sugar kind of condition, creating this inflammatory in a way kind of like where everything is kind of not safe to have child so then someone’s maybe a bit more having trouble with fertility. What about the opposite sort of where people are underweight? Where they’re maybe don’t have the raw material to make the hormones based on that. Do you see that much in your practice? And how does the role of being underweight or maybe not eating enough or not, not maybe not weighing enough in a way?

Dr. Annina Burns

That’s right. So I do see that in my practice, and the issue of being underweight is it impacts as you said, so clearly, your hormonal levels so you can have depressed hormonal levels and you cannot ovulate. Women need a certain amount of fat in their bodies to ovulate and also to produce hormones. So you really want to be right in between like you want a healthy body weight to conceive. Being underweight is a risk factor.

Dr. Andrew Wong

Obviously, there are a lot of people out there with eating disorders, body dysmorphic disorders, it’s not their fault. It’s like almost like society’s message of you got to be thin; you got to look at this model and the glossy magazine cover, right, and so I feel like a lot of people are coming into it with that. And they’re like, “Well, why can I get pregnant?” But then their BMI is really low, and then their hormones are low. So that’s that’s kind of answer. What do you do in that situation? Are you referring out to a mental health therapist to help with that or what?

Dr. Annina Burns

Yeah, so I do think with eating disorders like it really is best addressed by psychologist who has expertise in eating disorders, because it’s its own kind of classification and you want to address it before you’re trying to get pregnant not just to maintain that health to try to get pregnant and through pregnancy but also after birth, to be a healthy mom and to be a healthy family and model those people.

Dr. Andrew Wong

Maybe seeing a therapist before working on the nutrition or concurrently?

Dr. Annina Burns

Yes, but I am a big fan of mental health professionals really playing a key role in their fertility process.

Dr. Andrew Wong

Yeah. So I think we could talk about your coaching program you have your founder of the Simplina Fertility Coaching Program and you work exclusively with clients that are wanting to get pregnant essentially, right, which is great. I guess who can use it? Why should people useyour pro gram in terms of fertility program? I think maybe starting with a patient experience would be great because I think listeners out there may want to kind of hear that story of someone, especially if you’re out there listening and you’re wondering, well, when is it my turn to get pregnant?

Dr. Annina Burns

Right? Absolutely. So I think a good patient experience story is I had a patient who is in her early 30s. And she wasn’t unable to get pregnant. She went through IVF and they found a high level of abnormal eggs, right? So she didn’t have good quality eggs. She successfully was able to conceive on a transfer and then she went to get pregnant again and she had secondary infertility. She couldn’t get pregnant the second time and she had even higher number of abnormal eggs and she’s under 35. And so then she started to ask what more? IVF just said you have a high number of abnormal eggs, the clinic said it’s a chance- your chances are lower. And she said “What more can I do?” And when she came to me, and I described what we do in Simplina, how we look at underlying health conditions. We improve egg and sperm quality and really improve your health to increase your chances whether you go to IVF or not, or try to conceive naturally. And she said “I’m so glad I found you because this is exactly what I’m looking for.” And it’s that sort of statement that really explains what Simplina does. We are that other where that support base that you don’t get and she went through our program with her husband. She had a successful egg retrieval, and she is now five months pregnant, and she had successful transfer and higher number of high quality eggs after completing our programs.

Dr. Andrew Wong

So what is the program consists of at least for her, you know, what was that kind of method of success for her?

Dr. Annina Burns

Right so we in our something a program, we meet every two weeks with a couple for a course of four months. So there are eight sessions and it starts with diagnostic testing from the beginning and a really thorough intake and also listening to the patient experience and the client experience where people have been, I think a lot of times they walk into a new practice and they have to start over- shouldn’t have to start over. They know what they’ve been through and then we can look at their existing labs after we do some diagnostic testing or refer them out for diagnostic testing. Then we start the program of detoxing to really kind of clean up the body and in building egg health and sperm health. As we get results back from functional tests and conventional tests, we personalize that further, right so that that program is personalized for their particular needs. And you build two eggs every three months, that 90 days and you generate new sperm every 64 days. So we have a chance to have this brand new opportunity to produce good eggs and sperm at the end of our program.

Dr. Andrew Wong

I just had some laughing because of the 64-days sperm building I wonder if there is some mathematical reason or something.

Dr. Annina Burns

Very particular. I always tell people to wait until the four months; you gotta wait to the women’s ready so the guy’s got to wait.

Dr. Andrew Wong

Ladies first and the husband participates as well in the program; has to be two people’s tango with this. Right?

Dr. Annina Burns

Absolutely. And they are an equal part of the equation and equal player.

Dr. Andrew Wong

So for everyone, all those guys listening out there, if they’re dragging their feet, they probably wouldn’t be a good fit for this kind of program. They would have to be really all in as well.

Dr. Annina Burns

We really want them all in. I do see women if their husbands don’t want to because I don’t believe in not providing care because your partner is not on board, right? So we want to increase your chances regardless of where you are. But I really want to have the couple there.

Dr. Andrew Wong

And just to be clear, we’re talking about males and females but but it could be any partners or any people without any partner or anyone.

Dr. Annina Burns

patients who are doing IUI with sperm donors and they’re single, and that’s totally fine you can have regardless of the type of relationship you’re welcome, great.

Dr. Andrew Wong

Thank you so much for that and for what kind of testing to use with your clients. You talked about functional medicine testing, getting to the root cause getting to more precision medicine.

Dr. Annina Burns

Right. So I do some basic blood testing looking at cardiovascular risk profile, looking at thyroid, looking at nutrients, looking at blood glucose and then on the functional side, I look at hormonal balance. I look at gut health. I look at nutrient deficiencies and I also look at sperm health and DNA methylation.

Dr. Andrew Wong

Nice. Yeah, that’s really all great. We had Dr. Carrie Jones on here to talk about the DUTCH test. So we’re big fans of that. I don’t know if you use the DUTCH? Both the cycle mapping or?

Dr. Annina Burns

Yes I do the cycle mapping and often I’ll do the cortisol on top of it.

Dr. Andrew Wong

Yeah, well, that plays a huge role and you know, the stress, of course, is a mediator in that. And is Simplina a functional medicine coaching program done with IVF or separately? In other words, do people need to choose between a sort of functional medicine approach and IVF? Or can they be synergistic?

Dr. Annina Burns

No. Simplina is there to support you regardless of what path you choose to parenthood and so we are here for you if you want to pursue IVF and IUI. We’re here for you if you want to conceive naturally, and we’re also here for you if you don’t know and you’re just going along the fertility journey and you’re going to see what happens because having better health, having better egg health and better sperm health can only help you regardless of the path.

Dr. Andrew Wong

How do you collaborate if that is done with the fertility specialist? Like I know a lot of times in our practice, people will be like, can you collaborate with my other doc, my other practitioners because there may be some things that it’s better if practitioners talk together to collaborate on their care plan.

Dr. Annina Burns

Right. So I’m always available to collaborate. I do work with a couple of reproductive endocrinologists regularly. Okay, we share patients and so I often refer to those reproductive endocrinologists because I know that they’re on board, with nutrition, and lifestyle change. But I’m also always available. I tell my patients, and I write letters to physicians when suggesting labs and diagnostic testing. Because I do think it’s important that providers talk to each other.

Dr. Andrew Wong

I love what you said about nutrition and I think what’s so important to emphasize here today is that food is information. And food can actually cause basically an epigenetic change in the expression of the genes.

Dr. Annina Burns

That’s right. Absolutely. So how your lifestyle can influence your genes.

Dr. Andrew Wong

Can we talk about epigenetics a bit and kind of what that means? And how nutrition can impact fertility that way?

Dr. Annina Burns

Right. So I think it’s good to step back with genetics because a lot of times when people hear genetics, they think, “Oh, I’m at high risk for heart disease because that’s what is in my family, and therefore I might have heart disease.” And the key thing with epigenetics is that expression of the gene, right, so the environment can change your genes to then express something so you could not have heart disease risk in your family, but the environment in which you’re living and the lifestyle can actually express genes and change your team so that you could be more likely to have heart disease.

Dr. Andrew Wong

Got it. So an environment could be like food you take in, the air you breathe, the toxins or the stress, the sleep.

Dr. Annina Burns

Every way in which you live in. What we do with Simplina Fertility Program is we focus on the full lifestyle, right? So it’s not just about nutrition and food. It’s about targeted supplements. It’s about exercise. It’s about sleep. It’s about your home environment, and exposure to toxins that can actually inhibit fertility- it’s changing all of that, to try to improve your epigenetics so that you have a better chance, better eggs, and better sperm.

Dr. Andrew Wong

And we would also be remiss without mentioning Liz Baer who we both are friends with and Liz, actually, I believe you kind of introduced us. Thank you for making CIH a reality because we met and we co-founded CIH. CIH was born so you played a big role on the fertility of CIH. Thank you, Annina. And you know speaking of Liz, of acupuncture, so I’m wondering about your experience. Have your clients relate to the impact of acupuncture on fertility as well?

Dr. Annina Burns

Yeah so I think acupuncture is a great resource for fertility. Eastern medicine has a different way of looking at the body as you’re very familiar with, and it can really support the body in addition to whether you’re doing IVF or eating well, exercising, it also helps balance the body in a way that supports fertility. So I’m a big fan of acupuncture and I encourage my patients to use it.

Dr. Andrew Wong

So I think the take home so far for this, what I’m getting is that there’s many paths to fertility. And a lot of times it’s being synergistic about it can be really helpful.

Dr. Annina Burns

It’s absolutely the case, right? So we know like the data shows that certain supplements help for fertility, a certain level of exercise and type of exercise helps. But the question is you want everything to help right when you’re trying to get pregnant, you need everything and so it’s how do we bring all those pieces together to optimize your health so that you have the best chance.

Dr. Andrew Wong

Let’s go into that if you don’t mind. What are your top three supplements not to be cookie-cutter but like if you had to just say okay, what are the top three, you know, pretty big target supplements that would likely be helpful for someone that’s trying to get pregnant.

Dr. Annina Burns

Sure. So I would say a prenatal and a good quality prenatal. So that prenatal is got to have methylated folate in it and methylated B vitamins and a good mixture and also be free from contaminants. So that’s number one. I would say Coenzyme Q 10 is really important for egg and sperm health in ATP in the Ubiquinol form, the reduced form is key.

Dr. Andrew Wong

One thing, sorry, back to the methylation, if someone had MTHFR, would it be okay to use the adenosyl hydroxy forms or the methyl form is what you typically recommend?

Dr. Annina Burns

No, I’m doing adenosyl hydroxy form for B12 also the MTHFR. Okay, so and that’s where personalized nutrition comes in. Right? That’s where you want to actually be working with a condition. So you get that diagnosis and you’re taking the right supplement for your body type.

Dr. Andrew Wong

Got it. So some form of B 12. That is sort of intelligent for the MTHFR gene variation if people have that to help with with methylation process as well as you said reduced CoenzymeQ10 content, which is Ubiquinol. And then what is it what is another one that you might?

Dr. Annina Burns

I would say fish oil to reduce the inflammation. You don’t want to it too high of a dose anyway to make sure it’s a toxin- free, reduced, but really want to anti-inflammatory, good fat and the bad.

Dr. Andrew Wong

Yeah, how much fish could someone eat? If they’re like, Well, I don’t want to do the fish oil pills or you know, things like that. What would you say?

Dr. Annina Burns

Two to three times a week really. And again, that’s low toxin, no mercury fish, right. So you need to look at your fish charts and what you’re eating.

Dr. Andrew Wong

Got it. Okay, great. And then I think let’s go with some other questions that we kind of ask all of our guests. We can go with your morning routine. If you have a favorite morning routine and if you could describe it for us.

Dr. Annina Burns

Sure. So I’m so proud of myself because I did it this morning. Awesome. I will be honest, I don’t do my morning routine every single morning.

Dr. Andrew Wong

I don’t think anyone does.

Dr. Annina Burns

Sometimes I just need to sleep in. But what I do is I get up and I have warm water and lemon. I stretch- feels really good to stretch. I actually write, sort of free write on one page, everything whether it’s dreams or thoughts for the day or just get stuff out on paper. And then I do a guided meditation.

Dr. Andrew Wong

That’s awesome. Have you heard of the Miracle Morning book? I’m kind of getting an atlas- it incorporates a lot of that. I’ve been doing that too. Not every morning but I’ve been trying to. You know, sleep is really so important. And we touched on that but how much sleep do you think people need? Let’s just get back to the second how many hours you think people need to like to support a healthy pregnancy?

Dr. Annina Burns

You really need seven to eight hours of undisturbed sleep. So that’s the key thing. So if you’re waking up in the middle at three, or four hours, that’s not undisturbed sleep, and you definitely need over six hours.

Dr. Andrew Wong

Okay, got it. Thank you. And then what book or podcast you’re enjoying the most right now?

Dr. Annina Burns

So I really like the Functional Medicine Radio Show with Dr. Carri. I’m enjoying that pretty well. And I also like a lot of startup podcasts, so Rock Health, and Masters of Scale by Reed Hoffman.

Dr. Andrew Wong

Great. And what do you do every day to cultivate joy besides your morning routine and playing with your daughter and the apple picking and pumpkin taking?

Dr. Annina Burns

I really would say playing with my daughters. Yeah, just really enjoyed that time. She’s five years old. It’s such a precious time. Also just observing children and how they just find joy, and they’re so present in the moment and so curious and so just to spend that undivided time with her really cultivates great joy.

Dr. Andrew Wong

I feel like children are the best teachers really.

Dr. Annina Burns

They really are so intuitive.

Dr. Andrew Wong

Yes, exactly. And they love play and they know how to manage stress really well. Through play.

Dr. Annina Burns

They and they break down and cry when they need to.

Dr. Andrew Wong

Right releasing the toxins that way and the emotions etc. How can listeners get in contact with you, more about your practice and work with you and etc?

Dr. Annina Burns

So we have a website (Simplina.com) and you can actually book directly online, just hit the “Book now” button. You can also contact us through that website and we’ll get right back to you.

Dr. Andrew Wong

Great. Well, thank you so much, Annina, for joining us today.

Dr. Annina Burns

I’m so happy to be here. Thanks.