Liz Talks Podcast, Episode 24: Dr. Naomi Whittaker, OBGYN/NaPro fertility surgeon, talks progesterone, pregnancy loss, & NaPro technology!

Naomi Whittaker, MD, is an OBGYN and NaPro fertility surgeon specializing in the Creighton Model FertilityCare System and NaProTechnology, which works cooperatively with a woman’s body to treat the underlying cause of gynecologic issues and infertility, such as endometriosis and PCOS. 

TRANSCRIPT

Liz Talks Episode 24

  • Liz Talks Interviews Dr. Naomi Whittaker [2:50]
  • NaPro Technology and the Creighton Method [9:00]
  • Dr. Whittaker’s personal and professional journey into NaPro [21:39]
  • Supplemental progesterone [32:34]
  • Fertility issues and Dr. Whittaker’s Instagram posts [44:18]

Welcome to Liz Talks. I’m Liz, and I’m a nutritional therapy practitioner and best-selling author; but here, I’m 0% professional and 100% mom, spouse, friend, and over-analyzer. We’re going to talk food, beauty, family, fitness, mental health, friendship, marriage, and everything in between in this season of Liz Talks, and I’m so glad you’re along for the ride.

Remember; this is a podcast about thoughts, feelings, and opinions. And I definitely do not give individual, personal, or medical advice. 

This is episode 24, topic: Liz Talks to Naomi Whittaker, MD, NaPro fertility surgeon and expert in the Creighton method and NaPro technology.  

And in case you missed it, last weeks’ episode 23 was about exercising with your menstrual cycle, dragon’s blood skin care, and stem cell marketing. And, a diaper cream overshare. 

Before I begin, I want to quickly thank Arrowhead Mills for their generous sponsorship of this podcast. Next time you go to the store, I’d love to have you support a company that supports my work and look for Arrowhead Mills products. You can also find them on Vitacost.com. Arrowhead Mills pancake mixes are all we use for our Saturday morning pancake tradition, because I tried all the options, including homemade pancake mix, and none of them were as consistently good or as easy as Arrowhead Mills. So let me know if you try it by tagging me @RealFoodLiz on Instagram.

Time for a quick update. Since publishing last weeks’ podcast, I’ve heard back from a few folks about working out with the menstrual cycle. And since today’s podcast is also about the reproductive system, I wanted to pop in and share some of the feedback. So quite a few people were on a team “Can’t add one more thing to my plate” with me, and felt like syncing workouts to your cycle was just another layer between them and actually getting some movement in. 

A few others chimed in, though, with some interesting information including one gal who believes she extended her cycle from around 24 days to, I think, 28 solely through working out with her cycle. Now, there could be varying explanations for that; how mixing up movement stimuli might help achieve that, including just pulling back on too stressful training in favor of more gentle options more often. But it’s a really cool anecdote, and I wanted to share. 

So like I said last week; as long as it doesn’t become a barrier to movement, and as long as you want to do it, I think it’s great. But I don’t think it’s necessary or a should that people should feel compelled to do, or else. And of course, if I espoused more “or else” type stuff, I would probably get more traffic. But it’s just not how I roll. I can’t do it. 

  • Liz Talks Interviews Dr. Naomi Whittaker [2:50]

Liz Wolfe: Ok. Let’s move onto the podcast. I’m excited about all of my interviews, but I’m really excited to have Dr. Naomi Whittaker on this episode talking about NaPro Technology. (I always say it wrong). My friend Kristen, who Instagrams @VibrantLifeArmyWife and talks about her experiences with multiple miscarriages before finding NaPro first alerted me to Dr. Whittaker’s work. And I knew I had to reach out for an interview.

Now, if you’re like I was before I heard about NaPro, you either 1) thought it was a weird name and never really got around to looking into it. Or, 2) Looked it up, realized it was like a “catholic thing” and wrote it off. Both of those things were me. When I first heard of NaPro, I brushed it off. When I next heard of NaPro, I looked it up; saw it was in some way related to Catholicism, and then wrote it off again. There’s nothing wrong with a connection to Catholicism, but I’m not catholic so I just thought; meh. What does a church know that a highly trained OB/GYN doesn’t know? 

And wow, was that an incorrect assessment. So I finally came around to the idea sort of indirectly. I was studying some of the work of Ray Peat and Katharina Dalton; both of whom wrote incredible books on female hormones. And I realized that while I always thought my hormones were pretty balanced, that I actually very much needed to keep an eye on my progesterone. Not just because I suspected it was low, but because I was learning that “normal” on a conventional lab range is probably very inadequate. Not to mention some of what Peat has said about progesterone babies that was very interesting, and maybe I’ll talk about that eventually.

In any event; NaPro thresholds for adequate progesterone in pregnancy are higher than the conventional standard. And thanks to Peat, and Dalton, and my NaPro doctor, I became totally convinced and I understand why. So I experimented with some progesterone supplementation after my first daughter, maybe five or six years ago when I was first reading Peat and Dalton. But when it was time to get pregnant again, I didn’t want to mess with self-supplementation. I just wasn’t quite comfortable with it. And I wanted to work with a medical professional who could really assess and prescribe the right amounts of bioidentical progesterone should I need it. So I reached out to a local NaPro doctor in Kansas City, and worked with them on progesterone monitoring and management during my pregnancy. I had a fantastic experience. 

I was concerned going in for my consult with a very catholic medical practice that my personal history might preclude me from using this catholic centered; they call it technology. But I felt absolutely zero judgement. Just love. So that was great. 

So yes. NaPro is a technology, or a suite of medical principles that are rooted in Catholicism because; and this is where it got very interesting to me. The doctrine in place; at least within the St. Paul VI institute where NaPro, I believe, originated, is that so-called artificial reproductive technology, like IVF, is to be avoided. And this is not how Dr. Whittaker phrases it at all; she phrases it much more elegantly than I. So please go with what she has to say about it over what I have to say about it. This is kind of my clunky explanation. But we do touch on this briefly in our interview. 

Whether I share this belief or not is irrelevant; because what I want to focus on here; and by the way, I know many catholic people that have used IVF; that have used assistive reproductive technology. This is not where I’m taking this. I just find it interesting. 

But what NaPro has done is absolutely drilled down to the deepest details of analyzing and correcting, sometimes surgically, and nurturing both male and female fertility in a way that no other branch of medicine has done. They’ve combined holistic approach of understanding your cycle, with just a deep understanding of everything. From natural fertility to hormones and even reproductive structure in a way that no other approach has. This is like root cause stuff. 

And because of that, they’ve literally worked miracles for people struggling with their fertility. Even those coming from failed IVF. And all of that, as Dr. Whittaker will discuss in the interview, they do with values of compassion and care. 

So a note; my familiarity with what Dr. Whittaker does really centers on NaPro and the small part of NaPro that I used to achieve a healthy pregnancy. There’s much more to NaPro and to the Creighton method than that. And much more than we talked about here. Dr. Whittaker also specializes in the Creighton method of fertility tracking, which we didn’t get into too much in this episode. I wish we had, but I’ll admit I was trying to simultaneously do too much and narrow down to one particular topic with this podcast. So I think we need just another interview or two with Dr. Whittaker to really cover our bases. So consider this an introduction. 

So let me read Dr. Whittaker’s official bio before we transition to the interview, because it describes all of this much more gracefully than I can. Dr. Naomi Whittaker is an OB/GYN fertility surgeon focused on women’s restorative reproductive medicine, compassionate healthcare, and education. Dr. Whittaker is a board-certified OB/GYN; she was not mine, but she is a board-certified OB/GYN and a fellowship trained surgeon who specializes in the Creighton Model Fertility Care System and NaPro Technology, which works cooperatively with a woman’s body to treat the underlying cause of gynecologic issues and infertility, such as endometriosis and PCOS.

Dr. Whittaker helps women improve their gynecologic health, and avoid or achieve pregnancy in accordance with their natural fertility using the latest research, medicine, and surgery. Dr. Whittaker earned her medical degree at Creighton University School of Medicine and completed her residency in OB/GYN at OSF Hospital in Peoria, Illinois She then completed the Saint John Paul II Fellowship in Medical and Surgical NaPro Technology at the Pope Paul VI Institute in Omaha, Nebraska. And Dr. Whittaker is currently practicing in Harrisburg, Pennsylvania.

Let’s move on to the interview! 

  • NaPro Technology and the Creighton Method [9:00]

Liz Wolfe: Dr. Whittaker; thank you so much for joining me on the podcast today. 

Dr. Naomi Whittaker: Thanks so much for having me. I’m excited. 

Liz Wolfe: I’m just so thrilled to talk about; am I saying it right? Is it NaPro?

Dr. Naomi Whittaker: Yeah, people say NaPro or NaPro. I say NaPro but either one is fine. 

Liz Wolfe: Either one works. Ok. I’ll probably say NaPro because I’m so used to it but I’ll try to remember NaPro. And the Creighton model. I talked a little bit in my introduction about how I came to find this information and I guess what you all call is this technology. So I talked a little bit about that previously; but what I would like to talk to you about and where I would like to start with you is just a broad overview of what is NaPro and also maybe wrap in the Creighton model a little bit. And let us know just a broad overview of what this technology is and why we’re talking about it.

Dr. Naomi Whittaker: Sure. So NaPro Technology stands for Natural Procreative Technology, in contrast to assisted or artificial reproductive technology. And NaPro really encompasses more than just infertility. But it’s an approach to women’s healthcare that works cooperatively with the menstrual cycle using a woman’s own knowledge of her biomarkers. Or signs and symptoms that her body is showing of what’s going on in real time. And how is that done? That’s done through the Creighton model system, which is a method of natural family planning. But it’s made in a medical minded way to teach women a standardized scientific way to chart her cycle that’s extremely accurate to have the woman describe her bleeding patterns. Her symptoms of ovulation with the mucus method of external observations. 

So a woman knows every cycle and every day what’s going on with her body. She’s educated through a course to be empowered with this knowledge. And that’s what makes us unique, in that we can use medicine to work cooperatively with this. Because the woman’s cycle is so complicated, typically doctors; when a woman walks in, they can’t really test. They don’t know where she is in her cycle or when she’s ovulating because the main event of the cycle is ovulation. That’s what everything goes around. Not every woman ovulates on cycle day 14. So we need to know in real time what’s going on.

A man is constantly fertile all the time; pretty much the same thing is going on. But for a woman, every single day of the cycle is unique. And for each unique woman, it’s different. And so we use the Creighton model to empower women with the education to know what’s going on. And we as physicians or providers, nurse practitioners, we use that data on that chart that a woman plots as a vital sign. If you go to a cardiologist, they look at an ECG. You go to an OB/GYN that knows NaPro, and we look at the Creighton chart to see what’s going on so we can use it to work with the body and see improvement in the chart. 

Liz Wolfe: So one of the things I love so much about this; it’s not just fertility charting. I think a lot of people in the holistic community talk about knowing your cycle. Knowing when you’re fertile and when you’re not. Tracking with body temperature and paying attention to the cervical mucus. And it feels like that’s wrapped into this, but that it’s also so much more. And what’s really cool about that to me is I feel like women have a right to this information! 

Half the time, when I was younger, I had no idea when my period was coming. I had no idea that I was fertile when I was fertile. Any of that. That information was just like, not available to me. And I had no idea. So not only is this; we have a right and we have a responsibility to know our cycles and know our bodies this way. But there are also so many questions around infertility, and struggles to get pregnant, and recurrent miscarriage, and all of these things that I feel like NaPro really has answers for that maybe we don’t find in the conventional system. Would you agree with that? 

Dr. Naomi Whittaker: Absolutely. Yeah, I do plan on teaching my daughter when she becomes closer to puberty. I want to teach her the basics of her menstrual cycle, and how to see signs of ovulation so she can predict her irregular period. Because of course, we know it’s irregular at first. And that’s normal. So it can be used throughout a woman’s reproductive life. So I have patients that are teenagers and not sexually active, just doing it for health. I have young women who are using it for PMS, painful periods. All of this helps me understand what’s going on. Because it’s not just, for example, endometriosis. But it’s always tied to hormones. It all is so intertwined and important. 

So then I have women using it to achieve pregnancy. I have women using it to avoid pregnancy. There are even ways to do it in a very effective, nearly 100% effective way for woman to seriously avoid pregnancy without using synthetic hormones. I have women whose husbands have had vasectomies that come to me for PMS management. Or perimenopausal management. So especially; women who have been charting for years, they have watched their entire cycle for decades transform, and they completely understand it. It’s just incredibly knowledgeable.

And of course, if they go to another doctor that’s not trained, they’re teaching this doctor about the menstrual cycle. And it’s pretty funny to hear their stories when they go to the doctors. Like, psychiatrists. I have patients educating psychiatrists about the 101 about the menstrual cycle. Which is kind of sad in a way that doctors don’t understand; but what can you do but laugh.

Liz Wolfe: Right. So, something that’s really interesting about this. I had an OB/GYN that I absolutely loved for my second. And folks that have listened to my podcast; I have told my birth stories in earlier podcasts. Basically I ended up birthing at home. We don’t have to talk about that. But all the way up until around the time I was to deliver, I was with an OB that I absolutely loved that was also very conventional. She was wonderful, very conventional. And I was also seeing a NaPro doctor about my progesterone levels. And you know; both doctors were aware of each other and everything like that. 

But I chose to go ahead and go to a NaPro doctor because I had been told in the past that my progesterone in early pregnancy was within range. And from what I knew of NaPro, the progesterone levels that you guys like to see in pregnancy are actually higher. So I decided; I was already fascinated with progesterone from some of the Ray Peat/Katharina Dalton stuff I had read long before I ever heard of NaPro. But NaPro really helped me put it all together. And I had a great experience seeing a NaPro doctor just for progesterone monitoring, so that was great. 

But I also want to talk about; I’m going to jump around a little bit here. But before we get more into this, we talked about this a little bit before we started the podcast. But I want to talk quickly about where NaPro and the Creighton model came from. It’s very interesting to me; and like we said as we were talking before, I’m not catholic. But it has always been very interesting to me that this; did this arise out of the catholic church? Can you tell me a little bit more about it’s origins? 

Dr. Naomi Whittaker: Sure. So Dr. Thomas Hilgers is who developed the NaPro technology and Creighton model systems. He is a catholic, personally convicted catholic. And he had a big population of catholic patients who happened to be charting their cycles with natural family planning; probably the Billings method, I would guess be the most used method. I’m not sure. 

So what he noticed is these women would come to him with these charts, and he would look at them. And the ones who tended to have fertility issues; PMS, and whatnot, he would look at their charting and see big abnormalities. They wouldn’t look like the normal healthy women. In addition, his mother had severe PMS that interfered with her ability to be a mother, and he talks about that as well. So he had a very personal conviction for this. And he saw how hard it can be on women, as his mother. And he saw directly with his patient population; this link between these abnormal bleeding or menstrual cycle patterns to fertility issues. 

So he designed this Creighton model system to be more standardized, scientific version similar to the Billings method. It uses just the cervical mucus; no basal body temperatures. It’s very doable. And he developed a standardized scientific way to plot this. In that way, it’s reproducible, so you can use it with studies. So he would study these charts and assign mucus cycle scores and see what a normal luteal phase length was and associate it with certain medical issues based on the chart. 

This is how this one physician became very curious about what this charting means. Otherwise, women weren’t charting and regular medicine didn’t really think about this as a tool. But he was able to use this as an extra tool to delve into these women’s health issues. 

Liz Wolfe: And I suppose, as people sort of delve into this that are maybe hearing about this for the first time on this podcast, my journey in kind of learning more about it was someone; I can’t remember who, years ago, alerted me to this idea. Maybe on someone else’s behalf, or maybe someone had asked a question in my parenthood Facebook group, and somebody popped on and was like; look into this! And I looked into it for just a second and was like; oh it looks like it’s just a catholic thing. Maybe it’s just natural family planning; catholic thing. Whatever. And I kind of honestly brushed it off.

And then as I started to learn more about progesterone; which it seems like an important part of the NaPro system when you are working with women, especially maybe with recurrent pregnancy loss or maybe with luteal phase defects, that type of thing. And you can obviously correct me on that. But it started to kind of come together for me. And I headache sort of dismissed it as this thing that Catholics use when they want to avoid IVF or reproductive technology that is, for example; against your religion is not the right way to say it. But is that kind of in the ballpark? 

Dr. Naomi Whittaker: Yeah. 

Liz Wolfe: Yeah, ok. So I had sort of dismissed it for that reason. And coming back to it, and realizing how scientific this system is. And also the melding of sort of a holistic integrative and respectful view of the female menstrual cycle and integrating that with actual medical science to help bring the body back into alignment for whatever it might be. For overcoming PMS or for overcoming infertility and all that stuff. Would you say a lot of women come to you having had experiences with, say failed IVF or recurrent pregnancy loss that’s not addressed properly in the conventional system? 

Dr. Naomi Whittaker: Yeah, that’s very common, unfortunately.

  • Dr. Whittaker’s personal and professional journey into NaPro [21:39]

Liz Wolfe: Ok. So on that note, will you sort of describe your professional or your personal journey, and how you came to utilize this technology in your practice. 

Dr. Naomi Whittaker: Sure. So I always wanted to be a physician, from when I was 8 years old. My parents fled communism, and inspired me to dream big and reach for the stars, you know, in America, this land of opportunity. I didn’t know that would lead me to where I am at all. The only exposure I had to medicine was with my family practice doctor. And I saw that he helped our family emotionally, physically, and spiritually. So that really drew to me. 

I was motivated to go to medical school. I ended up at Creighton University in Omaha. Just on accident; totally. I applied to many medical schools, and that was the one I went into. I am catholic, but honestly that was not the main reason I went to Creighton; it was where I got in. 

Liz Wolfe: {laughs} 

Dr. Naomi Whittaker: Of course it all worked out. It led to this. My husband deployed my first year of medical school to Afghanistan. And at that time, he was like; hey, let’s start a family; because, I don’t know. {laughs} I guess, you know, experiencing a lot of things at the time. 

Liz Wolfe: Yeah. There’s a lot of things that happen in a military family. Where you’re like; YOLO! {laughing} 

Dr. Naomi Whittaker: Yes! So when he got back, we started our family. But through that time, I was on the pill and I had a lot of my own GYN issues. Painful periods. Heavy periods. Migraines. And I was still put on the pill; which you shouldn’t be if you have migraines. It’s a risk factor for stroke.

Liz Wolfe: Oh, wow.

Dr. Naomi Whittaker: Didn’t even know that at the time. So I was looking, from my faith perspective at that point, for an alternative to birth control. And I was looking through different natural family planning methods. A lot of them; like, basal body temperature, I couldn’t do. I’m not a morning person. I couldn’t wake up at the same time.

Liz Wolfe: {laughing} 

Dr. Naomi Whittaker: That didn’t work for me. Anyway, I eventually found the Creighton model; being at Creighton University, of course it was a lot easier for me to find it. And was taught how to chart with the Creighton model system. I didn’t even realize there was a medical component yet. This was slowly coming to me. I finally learned about the science of the menstrual cycle much more in depth than I did in medical school; at the same time, had my son. Had not the best experience with my OB/GYN, and went through my OB rotation soon after. And I saw it from the other side. From the provider perspective. And I saw very much of the standard approach to OB/GYN medicine. Perhaps it was a little more callous than usual, being at an academic center. But I didn’t see a lot of compassion for mom and baby. 

You know; one thing that NaPro does, because of the faith-based background, is it has a big reverence for both mom and baby. And the catholic church sees the mom as a sacred vessel, as well. So both mom and baby are very respected. And I saw that contrast, which I was drawn to, as well as the science. Really it was the science first, and then it was the compassionate care for both mom and baby. It kind of happened a lot at the same time, as well as my own personal experience. It was all intertwined. 

So, I also saw the good signs that complicated surgeries to treat the underlying cause was really fascinating versus the quick fixes that I saw with the standard approach. So as a medical student, when I was in labor and told I needed a C-section, that really impacted my family. Because my grandmother had died after a C-section in Poland. And the approach wasn’t really gentle. He didn’t really warn us that a C-section was coming, and it was very abrupt. It wasn’t an emergency, but it was done pretty quickly. He even; oh man, it was just a lot. But he kind of screamed during the C-section. Like, ah! 

Liz Wolfe: Oh my goodness. 

Dr. Naomi Whittaker: There was just; {laughs} I had some issue afterwards with fevers and, anyway. It was a really, really hard experience.

Liz Wolfe: So your care, even as a resident was actually less than you would have hoped as someone who was going into this exact field? That must have been a really twilight zone experience for you. 

Dr. Naomi Whittaker: It was. It was really eye opening. It was great as a medical student to see both approaches side by side, basically. Which; you know, who else gets to see that? You don’t get to see a lot of NaPro doctors. Especially the NaPro fellowship trained surgeons that I was exposed to. They had the training program there where I was. So I was able to see; ok. Patient A goes into this clinic, and gets the IUD. Patient B, same complaint, goes to the NaPro doctor, gets this whole workup and finds all these issues and corrects them. And so I saw that. 

And people were flying in from Poland for these surgeries. It was clearly a big difference between the draw of one to the other. And just the approach; the compassionate approach. A woman came in with a miscarriage when I was on my rotations. And it was her second or third miscarriage. And she had high blood pressure and she wasn’t taking her medicines. And they were just like; “ugh. Why is she crying. She was only 11 weeks.” And I was just like; oh my! This was in the hallway. That really struck me. 

I really wanted to give that compassionate care. You know; while in a labor. When a woman is experiencing a miscarriage. And how much of a difference that makes for that woman. 

Liz Wolfe: Mm-hmm. Ok, so on that note. What you do; you do so many other things besides just; I mean, your Instagram is like a wealth of knowledge. So we’re only talking about a very small proportion of what NaPro and the Creighton model actually do for women in this podcast. And I have to say; when I talked about interviewing you on Instagram, I had multiple people, even people I know that are close to me reach out and say; this changed my life. This is why my third baby is here in the world. This changed my cycle. I was shocked at how many people have taken advantage of this; I’ll call it technology. 

You know; when you say technology, you think of computers and machines and scientific innovations, where really what a lot of what this is is just knowing each individual woman’s cycle, and identifying their individual issues and addressing them in a gentle, biologically appropriate way. So identifying issues and dealing with them, rather than saying; you have this issue so let’s put you on birth control. Or let’s give you an IUD. Or whatever it may be. 

Liz Wolfe: So there’s a lot more to this than what we’re going to be able to talk about today, but one of the things I really wanted to talk about is recurrent pregnancy loss. When women come to you with multiple losses; or even one loss, how do you feel like maybe the conventional system has failed them, and what do you do differently? How can you help? 

Dr. Naomi Whittaker: Sure. So I’ll start with one loss. If a woman comes to standard OB/GYN practice, the way we were taught in our general residency training is; one loss is normal. Probably with some random mutation, genetic issue. Probably nothing will happen. You don’t need to do anything. Everything’s fine. Just try again. 

Now, if you go to a NaPro doctor, such as myself when I add this additional training, I ask them first if they’re charting. Hopefully they are, because I can immediately tell them some feedback if they’re charting. What does their luteal phase look like? Do they have signs or symptoms of low progesterone? Do they have signs of inflammation in their uterus? 

So we’re able to talk about these things. Talk about potential testing, if they desire to pursue that. And what options they have. What red flags they have on their chart. So I’m able to offer them, especially progesterone testing would be the main one. But also, what if their cycles are extremely off? A lot of brown or black bleeding at the end of the cycle. At the end of their menses, actually. Is a big red flag as well.

So just looking at all these patterns. Do they have severe PMS? All these are red flags telling you we need to correct something that’s going on. And we could potentially prevent it. Which standard medicine is more about all or nothing. Is this going to risk the mother’s life? No. So they can try again. But NaPro is more proactive and preventative in diagnosing these issues. 

Liz Wolfe: Mm-hmm. So without violating privacy issues or anything like that. If a woman came to you with multiple losses; often times do you see it’s one particular thing over and over again? Or is it a spectrum of things? 

Dr. Naomi Whittaker: Yeah, recurrent pregnancy loss is a whole nother; is usually more complicated. Usually multiple issues are going on. Whether it’s endometriosis, autoimmune. Some septum or some physical barrier in the uterus. It’s usually more things are going wrong to cause more losses. So the workup is a lot more for that, as far as the blood tests. Strongly recommend charting. Strongly recommend being on progesterone, even before implantation. Definitely even more aggressive or proactive with that. Because they’re much higher risk for miscarrying again. Obviously women do not want to go through that trauma again. Because statistically they’re more likely to miscarry again, and obviously more things are going wrong for it to happen over and over. The workup is much more thorough. And there’s usually a lot more; progesterone may be all they need, but it’s usually more than that. 

  • Supplemental progesterone [32:34]

Liz Wolfe: Mm. So, let’s talk some more about progesterone. First of all, when the NaPro physician put me on progesterone, it was; I had to get it from a compounding pharmacy. So it was progesterone dissolved in like sesame oil or something like that. But there are different types of progesterone replacement that are out there. Right? And one in particular; I can’t remember what the brand name was, but I think it’s being recalled because it actually didn’t do anything for, maybe preterm labor, or something like that. I can’t remember what type that is. 

But do you have a type that you generally lean towards, or does it depend on the person? Are there types of hormone replacement out there that are just not great that you don’t like to use? 

Dr. Naomi Whittaker: Sure. So what we use is bioidentical progesterone. 

Liz Wolfe: Bioidentical. Ok.

Dr. Naomi Whittaker: Yeah, so the chemical structure is exactly the same as what the body naturally produces. So there are different versions of bioidentical progesterone. You can get the shot, which is absorbed the best. 

Liz Wolfe: That’s what I did. 

Dr. Naomi Whittaker: If a woman is extremely low, we usually do the shot plus or minus vaginal. Vaginal is the second best absorbed. And the third best is oral, because it’s broken down by the liver, so not as much is absorbed. So the first is shot, then vaginal, then oral. And we give all bioidentical.

The one that; it’s not recalled; Makena.

Liz Wolfe: Makena. 

Dr. Naomi Whittaker: It’s just not; so instead of doing something, which was 17-hydroxyprogesterone, which is a subtype of bioidentical progesterone. It’s not quite as potent, actually.

Liz Wolfe: Oh.

Dr. Naomi Whittaker: It has to do with patents, I’m sure. And what they can make money off of, as far as what chemical structure they use. But Makena is what the name brand is; 17-hydroxyprogesterone. And the only way standardized medicine was using some form of progesterone in pregnancy was that kind. And you had to have a preterm birth before. So what I think; they’re just saying that the data isn’t as robust anymore to support that use. So they say; well, you don’t have to use it. So it’s either doing nothing, or using that. 

Liz Wolfe: I see.

Dr. Naomi Whittaker: Which; because it’s not as potent as the regular progesterone, it’s not working as effectively; and number two, they aren’t addressing all the risk factors. I don’t know how they chose their at-risk population, but I think it’s the study design that’s the issue, not the progesterone. If that makes sense. 

Liz Wolfe: Yeah.

Dr. Naomi Whittaker: I do think it works. I just think the data, when they repeated it, they changed; I’d have to look at it. But my suspicion is; I believe I did look at it. This was a few years ago when that data came out. It’s either the study design or the patient population that they used. Also; again, we look at all the issues. So it’s usually not just progesterone that’s the issue. It’s usually multiple things that we need to address to get them a term healthy pregnancy. Some case progesterone alone helps. But most of the time, multiple issues are associated with low progesterone. 

Liz Wolfe: Mm-hmm. Ok, so that was a misinformation, but you corrected me, so thank you. I’m not going to get in trouble about what I said about Makena, since you fixed it. But my question is why; is there this idea that versions of progesterone that can be synthesized that are more effective in some way or another than what you use, which is bioidentical? What’s the point of using anything other than bioidentical? 

Dr. Naomi Whittaker: Sure. Well, they can patent it and make more money.

Liz Wolfe: Ah! 

Dr. Naomi Whittaker: That’s the main reason they have other versions. {laughs} Also it’s technically much more potent than nature on certain receptors. For example, some of the birth control pills, synthetic progestins is what we call them, or artimones as Dr. Hilgers calls them. Not hormones, but artificial hormones; artimones; act very differently. There are tons of receptors on almost every tissue on the body. The brain, bone, breast tissue. So these receptors are especially potent on the brain, for example, to suppress normal endometrial development or preventing ovulation, for example. Shutting down the brain. That’s what they’re meant to do.

So those artimones also have nasty side effects such as depression when bioidentical has a more relaxing effect on the brain receptors and actually affects GABA effectors, which is what narcotics actually affect GABA receptors. So they have a very different mechanism of action on different tissues. But they keep changing different patents every, what, 10 years or so when the patent expires. And so different versions have different side effects. Some cause more blood clots, like the third generation of birth control pills. And some cause more testosterone side effects. It just depends on the generation of what side effects you want to choose that go with that synthetic version.

Liz Wolfe: So I’ve talked about this before on previous podcasts, but I was on a new birth control. This was like 15 or more years ago; probably even more than that. I was on this new birth control and I noticed that I was getting literally whiskers around my chin.

Dr. Naomi Whittaker: Yes. 

Liz Wolfe: And my neck. And I was like; what is the deal? And this wasn’t before Google, but it was certainly before it was so easy to find information about anything. Now I could just Google chin whiskers birth control and something would come up explaining what happened. But I had to really, really dig to finally find out that I was on a high androgen birth control. And there are all these different side effects and things that could happen; and they were happening to me. But it was really, really difficult to figure that out. Whereas now it might be potentially a little bit easier. 

But as far as side effects go, I can definitely give a plus-one on that one. 

Dr. Naomi Whittaker: Yeah, so exactly. The artificial progestin; in certain generations it’s much closer in chemical structure to testosterone than progesterone. 

Liz Wolfe: Wow that’s fascinating. Ok, so what; and I keep talking about progesterone probably because that’s where I plugged into this technology. So I have another question about progesterone. Are there other benefits besides potentially being one piece of the puzzle in overcoming recurrent pregnancy loss that additional progesterone can do? It was very interesting to me to see that the threshold for progesterone levels in pregnancy are higher when you talk to a NaPro doctor than when you talk to; I don’t like using the word conventional doctor, but for lack of a better term; a conventional doctor. 

Dr. Naomi Whittaker: Sure. Yeah. 

Liz Wolfe: Why are they so different and are there other benefits that you might experience on supplemental progesterone? 

Dr. Naomi Whittaker: So the standard approach to medicine teaches that progesterone over 3 means someone ovulated. I’ve looked at different fertility textbooks to see kind of their thought process. And other texts say progesterone over 10 is a good sign of ovulation. And that’s about where they keep it. They don’t really talk about progesterone in pregnancy, except they say progesterone under 5 is a risk factor for ectopic. 

Other than that, they do not test levels in pregnancy, at all. They have no idea what’s normal. So what Dr. Hilgers did is he had 50 women without a history of miscarriage, without a history of fertility issues or anything, and he plotted their progesterone levels throughout their whole pregnancy and used that as a standard. So we base our progesterone levels based on that standard that he made. We monitor every two weeks progesterone levels, and we adjust treatment accordingly.

Liz Wolfe: So, I think this is really interesting, and it probably has nothing to do with the progesterone. But based on other stuff that I’ve read about progesterone {laughs}. My first baby, I had some bleeding at the beginning and was told everything was normal, everything was fine. So wonderful, yay. And she was born at 41 and 3, at like 7 pounds 6 ounces or something like that. And then my second I was on progesterone, and some of the things. This might not be your wheelhouse, but some of the things I had learned about progesterone is it basically increases the delivery of nutrients through the placenta and it promotes a healthy metabolism and all of that stuff. 

I cannot explain that scientifically, at all. I’m going to have somebody on the podcast eventually, we’ll talk more about generalized benefits of progesterone. But my second baby was born at like barely 38 weeks, and she was like 8 pounds. So I was like; it must be that great progesterone oxygenating the placenta and doing all of that stuff. Is there anything to that? {laughs} You can say no. 

Dr. Naomi Whittaker: Yeah. I’m sure there is. Is it robustly studied; not that I’m aware of. But I do see a big difference when women have better hormone levels, better ovulation, and implantation. So that’s going to promote a healthier connection between mom and baby; that placenta. A healthier placenta, potentially a healthier sac to be stronger. That’s theoretical.

There is data showing that it is neuroprotective for the brain cells; progesterone is. So I think there is data to show it helps with brain development; at least protection, if not brain development, as well. So it makes sense that it helps with many other things. It helps relax the uterus. I would love to see that data. I don’t know how much has been done because, again, a lot of big studies are done by pharmaceutical studies and they aren’t making a lot of money off of this. 

Liz Wolfe: Right.

Dr. Naomi Whittaker: So the data we have is going to be limited and hard to find. So I should find some time to look up data on that. I think it would be really interesting. It would be hard to prove. 

Liz Wolfe: Definitely. Yeah. It definitely would. And a lot of the resources that I enjoy going through are old. {laughs} And there are, of course, problems with that. But this idea that before we really had this; not to sound conspiratorial, but there was a time before the pharmaceutical industry was mostly responsible for these types of studies and grant money was allocated differently. I think there was actually a time in history where the United States military was actually doing a lot of medical studies. At least it was funded in that way. I’ll have to go back and look at that. We’re getting way far afield at this point. But there was a time where people were talking about these things in a very different way than they talk about them now. And it was kind of more the idea that biologically, this makes sense. And this is what we have observed. And that type of thing. So I don’t know that I’m actually pulling from any real data on that. But like you said, who knows if we would ever have that data anyway.

Dr. Naomi Whittaker: Yeah. Follow where the grant money is going. That helps.

  • Fertility issues and Dr. Whittaker’s Instagram posts [44:18]

Liz Wolfe: That helps, for sure. I’m not going to keep you too much longer. But I know that there are going to be a lot of women listening who are maybe struggling with getting pregnant or struggling with recurrent loss. And one of your most recent posts on your Instagram talked about the different tests that you run for recurrent pregnancy loss. Acquired blood disorder antiphospholipid antibody syndrome. Inherited blood clotting disorder. Anatomic issues. Hormonal or metabolic and medical issues. Male factor infertility. Infectious or inflammatory endometriosis. Autoimmune. And then there’s the environmental, occupational, personal habits, and whatnot. And psychological. And then of course, the unexplained and further testing that you could consider. 

As a surgeon, can you tell me about the top maybe three issues that you address with women who are experiencing pregnancy loss. Whether that’s surgically or nutritionally or supplementally. Just give us a little bit of a feel about what your day to day looks like. 

Dr. Naomi Whittaker: Sure. So one of my biggest suspicions when a woman walks in that she may not know about is endometriosis. And that often is associated with low progesterone; they often go together. And endometriosis is a very inflammatory condition. And perhaps that’s why there’s low progesterone. Or maybe low progesterone causes endometriosis to go more out of control. Not sure. It’s kind of a chicken or egg hypothesis with that. So that; one of my biggest enemies is endometriosis. And it can be “silent”, they call it. But I don’t see it as silent, because I see the chart and the symptoms of infertility or recurrent pregnancy loss. Those two things together help me home in on that. So that’s a big enemy.

Another one is PCOS; often has low progesterone. And I can treat that surgically. Another one is just a hostile uterine environment. It could be infection. Inflammatory. It could be a septum or polyps. Those would be my top issues that I find at surgery. 

Liz Wolfe: So one of the things that I found interesting that you said earlier was the way women are treated. And that you wanted to do things differently than maybe you had experienced them as a mother. And what I think is really interesting about that is yes, you are a fertility surgeon. And that is your purview; all of the things that you just said. 

But you also list psychological as something that maybe is worth evaluating. And I know you’re not a psychiatrist. But at the same time, just being able to come to a provider who is listening to you. Who is really trying to get to know you. And who is treating you; you and your journey as sacred, probably has a really profound effect on the women you see in your practice. Would you consider that to be the case? And beyond that; when do you refer out for psychological care for women that come to see you? 

Dr. Naomi Whittaker: That’s definitely my goal, to be supportive and empathetic as much as I can to a woman’s history, even if I haven’t experienced such a deep loss. For example, some women have been through so incredibly much. But I do hope that just even that appointment itself is hopefully healing and bringing hope for them. And that’s a huge part of what I do. And I do think that helps probably with outcomes. I mean, there’s data on that. Not in the fertility population I’m aware of, but in other health issues. Even being listened to and having that compassionate care improves outcome. So I do hope that is the case. It sure seems that it does, at least, improve quality of life as they’re going through such a hard time. 

What was the other question again? 

Liz Wolfe: Oh shoot, I don’t even remember.

Dr. Naomi Whittaker: Oh, it was good. 

Liz Wolfe: Because the whole time you’re talking, I’m jotting down all these million other questions that I want to ask you. Maybe it was, when do you refer out for psychological care? 

Dr. Naomi Whittaker: Oh yeah. Yeah. So I often; I have so little time in each visit, and I could spend so many hours. And that’s part of the reason I’m making Instagram pages, so they have more resources to be their own doctor and get the help that they need, as much information as possible. But there’s a lot. We do talk about certain self-help programs. Like organic conceptions. That’s kind of a self-guided couples program for couples struggling with infertility. There’s springs in the desert support group. We talk about that versus some women do need antidepressants, if they have a lot of anxiety and depression. Which is basically almost everyone has that, dealing with infertility.

We do talk about; I think everyone struggling with it should consider therapy, counseling, self-help, and/or psychiatry. Because it’s just so much. And everyone has some component. It’s just part of the journey. So I do think everyone needs something. I hope that they help pursue it. But of course, it’s hard. Because especially; I mean, men I think it’s hard to get them to open up. And there is a stigma. And I think that just makes it hard for people to have that. It kind of acts as a barrier, that stigma. But I think it’s extremely beneficial, and everyone should consider it. 

Liz Wolfe: I agree. And even as someone who hasn’t necessarily experienced pregnancy loss, or recurrent pregnancy loss. Even just being pregnant can be so stressful. Not for everyone. But there’s a lot of fear that comes up around losing your baby, or what might be wrong, and all of that stuff. So I love therapy. It’s helped me so immensely in my life. And self-help has, as well. I also have a podcast about that; when I’ve seen a therapist and when I’ve done things at home that have been really helpful. But I couldn’t agree more. And I think it’s so wonderful that that’s part of how you operate your practice and how you work with people. Because I don’t think anyone has ever referred me to therapy or to psychology or anything like that in any of the medical appointments that I’ve been to. It was something that I really had to come upon myself. So I think that’s wonderful.

Ok. Before I let you go, is there anything else that has been on your mind lately around your practice, around family planning, fertility, NaPro, whatever? 

Dr. Naomi Whittaker: Oh my goodness. I’m not good at open-ended questions. {laughs} 

Liz Wolfe: I know. Putting you on the spot. I’m not either. But maybe if I put it this way; you’re active on your Instagram page. You’re telling people’s stories. A friend of mine is on your Instagram page right now telling her story. And she’s wonderful. And I’ll give all your information to your Instagram page to where people can find you.

But you’re talking about; the last few posts have been about recurrent pregnancy loss. And there has been one about; I will totally butcher this. Uterine cesarean scar niche surgery. You’re obviously posting these things because they’re on your mind; or do you just have a list of things that you want to talk about that you want to educate people on? 

Dr. Naomi Whittaker: Yeah, I have a long, long, long list. And people are always messaging me questions, and sometimes that needs a post. I have way more ideas than I do have posts. I’m trying to get to. For example; the reason I posted that one is because that one is on almost no OB/GYN or even infertility doctors radar. And it’s pretty; somewhat rare. But I get it. So it can’t be that rare. {laughs} 

Liz Wolfe: Right.

Dr. Naomi Whittaker: It’s just something that’s easily overlooked. Again, the charting is my big neon sign telling me that that’s there. So what I see is this pattern where they have their period and maybe have some brown bleeding at the end. They have a couple of dry days, and then they bleed again. It’s this very characteristic pattern, and it has to do with blood pooling in that cesarean scar defect. So a lot of the posts, when I’m really motivated, are because women have suffered that come to me. And they’ve suffered for so long. And no one knows about it. So it’s to kind of put it on people’s radar so they can kind of investigate for themselves; maybe that’s something. That’s my unexplained. 

That’s I guess kind of the whole goal of my account. Hopefully women can empower themselves to not walk away with an unexplained infertility diagnosis. Because I see women; when they have that diagnosis, they blame themselves. They don’t blame the person who can’t figure it out, or medicine. Because that’s either a fault of just medicine, we either don’t have the right technology to figure it out or the doctor didn’t look hard enough. They blame themselves. So, yeah. I hope that helps. 

Liz Wolfe: Well it’s on my radar now. It absolutely helps. And my question, too, would be; from pregnancy to pregnancy. Pregnancy obviously changes your body in so many ways. But can somebody be dealing with one thing; whether physical. For example, issues from a previous cesarean scar. Or cycle-wise, based on hormones, whatever it is. From pregnancy to pregnancy, can those things show up? Like; didn’t have to struggle with this before. It wasn’t a problem. But then I was pregnant, and then now you know it’s been a couple of years, whatever it is, and I’m having this issue. Can these things kind of show up? It’s not necessarily we’re dealing with the same thing throughout our entire lives until you correct it. These things can pop up from pregnancy to pregnancy. And from year to year. Right? 

Dr. Naomi Whittaker: Yes. So usually; yeah, I see a lot of secondary infertility. And this is often due to advancing age. Right? As we age, autoimmune conditions worsen. Our weight goes up often either after pregnancy or just with time. Stress may worsen. Any health issue can worsen as we get older. Insulin resistance, for example. So, especially less than 25, our fertility can overcome a lot of health issues or our health issues aren’t bad enough. Even endometriosis is there, and women overcome it relatively easy less than 25. But as we get older, these manifest more strongly. So women may have secondary infertility.

I have some after four or five kids that want to come to me for secondary infertility. And I think that also is important to add; all these women have different stories, and backgrounds. It’s important not to judge women based on their family size, right? It’s not only the women that have no children that feel judged. It’s the women that have; everyone feels judged. Whether you have too big a family, too small. And I think it’s important; you never know anyone’s story. And I think that’s one thing to take, too, from this fertility perspective.

Liz Wolfe: Well just that you recognize that everybody has a story is certainly a step forward for medicine. That the people that come to you aren’t just numbers. Things that you have to figure out based on whatever the standard of care is in that moment. But that people actually come to you with diverse stories, with diverse needs. I mean, out of all of the research I did throughout my pregnancies and when we were researching fertility for our Baby Making and Beyond; these things that you’re talking about on your Instagram page, I had never heard of any of them before. And it just makes me so excited to follow you, and to learn more, and to be able to say; hey, maybe go check out this page. Because there might be something here for you that’s going to resonate. That you’ll see yourself in one of these posts, and know what questions to ask.

Dr. Naomi Whittaker: You have no idea how happy that makes me. {laughs} That’s my exact goal.

Liz Wolfe: No, I love it! And I wish that I could keep you on the podcast for hours and hours. I hope you’ll come on again, because at some point I’d love to talk about PCOS, about endometriosis, and just give people some of these resources that you’re bringing to the forefront so they know, you know, that they’re not crazy. Or that if there’s something wrong, it could be much more treatable than they ever thought. 

Dr. Naomi Whittaker: Exactly. 

Liz Wolfe: Yeah. So I’m really excited about this. Alright, we’ll close it down for today. But I will do my best to wrangle you back on the podcast. I know you have a brand new baby! So it was amazing for you to spend this time with me today. I can’t tell you how much I appreciate it. 

Dr. Naomi Whittaker: Oh my gosh, my pleasure. Thanks for having me on. 

Liz Wolfe: Absolutely. Can you tell folks where to find you and where their best resources to start off with for NaPro and the Creighton model would be? 

Dr. Naomi Whittaker: Sure. You can go to my Instagram page, @NaPro_fertility_surgeon or search my name; Naomi Whittaker on Instagram. I have a lot of links on my bio to NaPro resources, including the main NaPro technology website by the institute where I did my fellowship training. Also a NaPro eBook that my husband and I designed to help make it understandable in a simple way. So I would start there.

Liz Wolfe: Perfect. And I will tell folks; I did not do your work justice with this podcast. But I really hope folks will; who have not already heard of you, of course. Because one of my friend’s and members of my community actually let me know about you. So it may be that everybody already knows who you are. But if they don’t, I really hope they go check out your stuff. Learn a little bit more about what you’re doing, and potentially about themselves. And again, note I did not do your work justice with this interview, but I do hope it helps a couple of people discover what it is you’re doing and how profoundly helpful it is for so many women, and families. So thank you so much for coming on. 

Dr. Naomi Whittaker: Aww. Thank you. Thank you for supporting what we do and spreading the word, and just helping other women. And couples. 

Liz Wolfe: I’m thrilled to be able to do it. 

Alright, my friends. No overshare today. So that’s it for episode 24. A big thank you to Dr. Naomi Whittaker, who you can find @NaPro_Fertility_Surgeon on Instagram. Big thanks to her for coming on the show. And a big thanks to Arrowhead Mills for making this episode possible. I hope you all enjoyed it! Remember, you can ask me anything at www.RealFoodLiz.com/ask; what do you want me to cover? What do you want to know? Is there a question that I can answer for you, or is there something I can take to my research team? Let me know. 

I also need reviews, folks! If you love the podcast, consider leaving me an iTunes review or a Spotify rating, pretty please. And if you don’t like, just skip that part. Don’t tell anybody. 

I appreciate you guys; I’ll see you next week. 

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