What Every Woman Needs to Know About Fertility with Dr. Carolina Sueldo, MD FACOG

Fertility, Self Development

You will never go to a doctor without these tips!

In this episode of the Carolina Sotomayor Podcast, Carolina will be diving deep into what you need to know now about your fertility to conceive your baby. If you need to know more about your body and what to expect in a fertility doctor appointment, this episode is for you.

In this episode, you’ll hear:

1:10 Who is Carolina Sueldo?
2:10 What does a woman need to know about fertility
3:39 Number 1 infertility issue
10:35 Different types of infertility
12:24 Unexplained infertility and how to cope with it
14:25 “Your uterus and your mind are equally important” – Carolina Sotomayor
14:42 How to optimize fertility outside of medical treatments
17:25 When is the right time to consult a specialist

Professional bio
The Carolina Sotomayor Podcast is brought to you by Carolina Sotomayor and the Fertility Foundation.


Carolina Sotomayor is an Expert Womb Healer who helps women conceive by removing physiological blockages with Reiki. She is the host of the Carolina Sotomayor Podcast, a show that covers everything from fertility to postpartum to motherhood, and the creator of Fertility Foundation Collective, an online membership that helps women heal at their own pace to boost their fertility.


Carolina has served over 500 women from around the world to heal. She is passionate about helping women create their families. As a result, there are over 60 reiki babies in the world.

Fertility Foundation Collective: https://carolinasotomayor.com/membership
Carolina Sotomayor Reiki: https://carolinasotomayor.com/
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Full episode transcription:

Hi, I’m Carolina, your podcast host and womb healer, and today we’re having a very special guest. This is Dr. Carolina Swo, and I’m gonna go ahead and hand her introduction over to you. Thank you so much for being here. Thank you for taking the time to speak to.

Absolutely. Thank you so much, Carolina. I’m so excited to be here today. So as she mentioned, I am a doctor. I’m actually a double board certified OB G Y N and fertility specialist. So what that means is after medical school I did four years of OB, B G Y N training. . I then did three more years of reproductive endocrinology and infertility.

And then for both specialties you have to take a written exam and an oral exam. So lots of lots of training to get to get to this spot. That’s so impressive, . Thank you. Thank you. I’m so grateful that we were able to connect because you are exactly who I would want on this podcast because you’re everything that we wanna know and get everything to know about fertility straight from.

The authority, the person that makes it happen. A lot of our listeners struggle with fertility, are trying to conceive, uh, trying to fall pregnant. Whether they’re using pharmaceuticals, they’re wanting to achieve that naturally, or they actually need to seek the help of modern medicine. What does a person, what does a woman need to know about her fertility?

Yeah. So part of the reason that I’m so passionate about this is because, you know, growing up and a lot of my girlfriends, right, cause I’m, I’m that, I’m that patient. I am that person. I am that client where my friends, they’re in reproductive age and they’re starting to ask me all these questions and I realize that there’s just such a lack of awareness and such a lack of education as a society.

We just do not do a good job of educating and informing, and I would say even in the healthcare system. , non women’s health professionals also have a tough time, right? Because you’re seeing it for like one module in medical school and then that’s it. You never saw it again. So I talk about like the fertility 1 0 1.

Like what are the few basic things that women need to know about their reproduction? So I think one thing that’s like key is that a healthy reproductive age female should be having on average a monthly cycle. Now it doesn’t have to be the exact same day every single month, but they should be having a predictable, regular monthly period.

And if that is not happening, as fantastic as it is to not get bleeding every month, that is not. and that warrants an evaluation. So if you’re skipping three, four months, or if you’re going, you know, every other month, or let’s say you’re bleeding with ovulation or you’re bleeding more in the month. So any alteration of that regular, predictable monthly bleed is not normal.

And warrants investigation, A lot of our listeners have P C O S or endometriosis. That’s like the number one thing is like trying to conceive with those ailments is a number one thing I see. Come. , right? And we know that P C O S is the number one cause for irregular cycles in, in reproductive aids women.

And there’s a whole, like, I won’t get into it today, but there’s a whole nitty gritty in terms of the testing and the evaluation that goes into that. You can’t just call somebody P C O S without, without testing, but it is the number one cause. So if you’re not having predictable monthly periods, you need to see, uh, Either an ob gyn or a fertility specialist for further evaluation.

The second thing I would say is that a lot of times women don’t have a clear understanding on when they ovulate. And so really when you talk about ovulation, and this is whether you’re trying to get pregnant or whether you’re trying to avoid pregnancy. So for both, both times, it’s useful. And the idea is that.

You know, a dominant follicle or egg is recruited, and typically around day 14 is when the follicle ruptures and the egg is released into the pelvis. But that day 14 is predicated on a 28 day cycle. So if your cycles are 34 days, or if your cycles are 21 days, both are considered, you know, normal variants, but your ovulation is not gonna be day 14.

So the key there, oh, Right. So the key there is to do menstrual tracking, and you wanna get kind of three, four months of information to see how long your cycles are. So let’s say you have a 34 day cycle. We know the ovulation is gonna happen two weeks before your next period, so you’re probably ovulating around day 16.

that’s mindblowing because it’s really mindblowing. So one, we need to make sure we’re having a reoccurring regular cycle. Two, we need to be tracking our cycles, and that is, I guarantee you, most women I know that stopped having babies or or not interested in having babies at this time. They’re not tracking their cycle.

Yeah, like they have no idea, you know, if you’ve had a tubal lation or if you’ve had, I don’t know, you know, if you’re on the birth control or something. I mean, obviously those are different scenarios, but for an average reproductive age female who’s not on anything, these are really key things to know. So if you have a 28 day cycle, then yes, your ovulation is gonna be day 14.

But if you have a 34 day cycle, 34 minus two weeks, I’m sorry, so your ovation’s gonna be closer to day 20. And then if you have a short cycle, let’s say your cycles are 22 days minus two weeks, so you’re gonna be ovulating around cycle day eight. So ovulation can be extremely variable depending on your cycle length.

That’s so valuable to know. That’s like literally mind blowing because Yeah, I never accounted to think about how long the cycles. And like just having that massive of information so you can also take some action, right? And being proactive, right? Like, so my whole thing is I’m like super passionate about empowering women in that way.

So if you hundred percent have a, a more clear understanding of your menstrual cycle in your body, that’s only gonna empower you when you’re then facing these challenges or questions or. Oh my goodness. I love that so much. What’s a third tip that, what do we need to know about our fertility? Regular, predictable monthly periods.

Number two, understanding when ovulation happens typically two weeks before your next period. And then number three is the concept of ovarian aging. So what most women don’t know is that we are born with a set number of eggs. So we are born with all the eggs that we’re ever gonna have in our lifetime, and we lose those eggs progressively and continually as we age.

So generally speaking, until about age 35, we know that the number of eggs and then the quality of those eggs remains fairly. But after age 35, we do begin to see a very real, very continual decline in the woman’s fertility. After age 40, that decline becomes much more dramatic. So think of a diagonal line versus a vertical line after age 40.

And it’s not like something magical happens on your birthday. It’s not like, like you turn 35 and all. Right, exactly. So you know what, what we’re talking about here, it’s, it’s all a continuum, but patients need to understand, women need to be knowledgeable in that after age 35 year over year, it absolutely matters.

And after age 40, gosh, it matters even more. So. So really important from a reproductive planning standpoint. Do you wanna have children? Yes or no? How many children do you wanna have? And then based on those two question. Really being thoughtful and intentional about that reproductive planning journey. I love that.

When do my eggs go bad? So I actually get that question a lot, which is funny because I think of like all of a sudden they’re rotten or they’re spoiled. Like, I don’t know why I know hard boiled eggs. Yes, yes. So I get this visual, um, and again, it, it’s a continuum, right? Like there is not. Sort of magic number or magic date or magic time where the eggs actually go bad.

What happens is that with the decline in the quantity and the quality of the eggs, you begin to see that becoming pregnant becomes more difficult, the risk of miscarriage becomes higher, and then ultimately the risk of a b, a baby with fetal anomalies as well. So women who are older absolutely can get pregnant, absolutely can have beautiful, healthy babies.

But the statistics on a general population scale reflect this decline in fertility that happens with age. So if I had to say, I would say the decline in fertility or the change in egg quantity and quality becomes more obvious after age 35 and much more dramatic after age 40. Wow. What is the average age?

that you’ll see of a patient. , so our patients are all over the place. That’s also sort of a, a myth is that only older women go to a fertility specialist, and that could not be further from the truth. Yes, we know that in our modern society, women are delaying childbearing, and so with that comes the aging factor, but we definitely have a lot of young patients who come in.

You mentioned P C O S, you mentioned endometriosis. . Those are super common diseases that we see on on the younger patient side. Let’s not forget the guys. So if she has a male partner, and if that male partner has a sperm issue, she might be young and healthy, but they may still have to see a fertility. Oh, it’s true.

I always forget about the guys. Yeah, I know , but that is true. You know, there’s so many things to the male infertility journey as well. Can you talk about the different types of infertility? Like there’s secondary infertility? Yeah. Can you talk about what different types of infertility there are? Sure. So let’s start with the definition of infertility, which the textbooks typically will say, define it based on time.

So in a patient under the age of 35, we talk about more than a year of trying in a patient over 35, it’s more than six months, and then infertility. So that’s the definition based on time and age. And then infertility gets divided up into primary infertility if the patient has never been pregnant. Or secondary infertility, if she does have a history of previous pregnancies, whether or not they were live births, they’re still considered, uh, secondary infertility.

And so that’s with regards to pregnancy versus no pregnancy. So primary versus secondary. And then you have sort of the distribution of causes, right? So we know that female infertility, so whether it’s, uh, an issue with the uterus, an issue with the fallopian tubes, an issue with the ovaries, we see that about 30% of the time.

Um, we talked about the guys so you know, an issue with them 30% of the time, 20% of the time. It’s actually something in both partner. and then 20% of the time the evaluation comes back negative. And the term used for that is unexplained infertility. Yeah. Um, which is actually a term I hate because it’s unexplained just sounds so frustrating to the couple.

And so I really much prefer the term undiagnosed. And essentially what I tell patients is that the testing available today is not finding whatever it is that’s going on. And so 20% of couples or one in five couples that I. Will have undiagnosed infertility. Can you talk about the unexplained fertility?

How does one cope with like these heavy diagnoses? It’s so difficult to already have, you know, the negative. Pregnancy test, then go to the doctor, and then all of this has the potential to create fertility trauma. So what is your best advice when someone gets unexplained infertility or P C O S or whatever the diagnosis of the ailment is?

What are like some next steps for that patient to move forward with to cope with this new journey? Yes. I think when you’re talking about the infertility journey, A huge piece of this is mental, right? Mental is sort of all-encompassing, sort of emotional, psychological mindset. There’s, there’s so much that goes into this right journey that it’s not just, and the biggest thing I think for patients is.

Loss of control. They don’t feel in control of their bodies. They don’t feel in control of the situation because the question that I always get from patients, what can I do? Right? The question is, what can I do? What can I take, what can I, whatever to, you know, correct this problem. And so it’s really understanding that infertility is a medical disease.

It’s nothing that you did to cause it. It’s nothing. You know, it’s not your fault. This is something. we have to confront and face, but I spend a lot of time counseling my patients about the psychological branch or the psychological arm of this journey, and really trying to be proactive about seeking out help and sort of taking ownership of that, right?

Like understanding, acknowledging, and verbalizing that is just as much a mental journey as it is a physical journey. And so what am I doing? to take care of that piece and to address that piece, right? Mm-hmm. , because that is such a huge predictor of, you know, sticking with treatment, the likelihood of, you know, pursuing further treatment, not dropping out, et cetera.

So yeah, it’s super, super important. So let’s say it for the pupil in the back, your uterus and your mind are equally important. So, Yes. So taking care of both. It’s so important for sustaining this journey. So one thing that I would love to ask you is how do we optimize fertility? How does a person optimize their fertility outside of medical treatment?

Because some people wanna do this naturally, or continue naturally, or maybe I hear all the time I try to do ivf, but I couldn’t do the needles, or I couldn’t do the hormones. It was really difficult. What do you re. Yeah. When I talk about treatment, I always talk about a three armed approach, and so I talk about the medical treatment, I talk about supplements, and then I also talk about lifestyle, and I don’t think that they are mutually exclusive.

I think they are complimentary to each other. So I never want to minimize the medical aspect or the supplement aspect, but I want to emphasize the lifestyle aspect because that’s what patients can take control over and take ownership of. So when you talk about lifestyle, , it’s so many things and I’m gonna start in no particular order.

So one would be work. So we know that, for example, night shift workers have increased risk of irregular cycles, increased risk of infertility. Oh wow. We know our, um, our guys who are expo well and women too who are ex. Exposed to environmental toxins such as our painters, our hair stylists, our long distance truck drivers, et cetera.

They have higher rates of infertility. Um, so job related can definitely be something. Now job related, stress is a little bit harder to quantify because sort of all of us have stress and you know, whose stress is more than other. But I think there are very real job issues when it comes to, for example, the night shift workers or these environmental exposure.

The second thing we talk about is sleep. So we know that good sleep, and it sounds so basic, but most of us don’t get good sleep. And good sleep is so important for fertility because that’s when so many things are happening at a hormonal level. Um, and so sleep is super important. Addressing that and, and being on top of that.

Um, and then I talk about, you know, the exercise piece and the nutrition. Um, and for both of those, what I would definitely say is that accountability matters. Accountability counts, if you will. Um, most of us know what we need to do, but the actual implementation, the actual, actual execution is very, very few percentage of people are actually doing it.

And so having a dietician or having a trainer or having somebody that can work with you and really keep you accountable is gonna make you more successful. And then lastly, I’ll come back to what we were talking about earlier, which is the mindset piece. And so whether that is working with a coach, working with a therapist, working with a support group, um, whatever that looks like for you, I think it’s important to incorporate that as part of your management plan, as part of your treatment plan.

Wow, that’s so much. When does a person see a specialist? When is the right time and what? What is the title of that specialist? So they, the regular doctor would be an ob gyn, so then they would go to a fertility specialist. Is that the correct name? Yeah, so we, we like our acronyms in medicine, and so the, the medical term is an re ei or a reproductive endocrinology and infertility specialist, aka a fertility specialist.

So, um, r e i is kind of the, the short. For it. Um, but it’s got a very long name behind it cuz really we do all things hormone, right? Like it’s, it’s all things to do with reproduction and hormones are a big part of that. Um, what I would say is start with your ob gyn. You’re already seeing them once a year anyway for your annual.

And so just start with them. Check in with them, let them know what your concerns are or what you, what you’re thinking. And then, you know, they may feel comfortable addressing or they may. Depending on their training experience and comfort level. And so you always have the possibility of seeing a fertility specialist afterwards.

Um, in terms of when to see somebody, I would say, you know, we went by the definition in the textbooks according to time. So under 35, trying for over a year, over 35, trying for more than six months. But I would say that that’s maybe incomplete. I would add. If a patient has extremely painful periods or known endometriosis, they definitely wanna seek out help sooner.

Um, those are patients that I always try to encourage to consider fertility treatment sooner rather than later. Um, if it’s somebody who has a known, like known risk factors, so. For example, they have fibroids in the family or they have a history of STDs and you know, the tubes might be blocked or the husband has, you know, or the male partner has some sort of, you know, male factor or concern for male factor issue.

So, you know, longstanding diabetes or something like that. So I would say the time piece is one variable. . But I would say if you are anxious enough or if you are curious enough to ask the question, then you should be asking the question and getting your answers addressed. Because I can’t tell you how many women I see in my office who say, I wish I would’ve started this sooner.

I wish I would’ve asked somebody earlier. I wish I would’ve, coulda, shoulda. You know, all these things. Um, so if you’re, if you’re anxious about it or if you have questions about it, I would say, I would argue that that is the right time to be asking and seeing someone. , what are some questions that they should be asking in a new relationship with an r e I.

So, you know, I think, and it’s so funny you asked this cause I actually had a great discussion earlier this week about, um, bias and like its role in medicine and healthcare and all this. So I think that, you know, so much of your fertility journey revolves around your relationship with your provider, with your physician, and so true.

So the first thing is just that initial. Feel or gestalt or whatever you wanna call it, do you connect with your physician? Do you feel heard? Um, you know, do you feel like they’re asking a lot of questions? Do they do, you know, do you feel that they’re engaged, et cetera. Um, and then I think some of the questions to ask are really gonna be related to, okay, you know, do I have normal periods?

Um, is there any risk factors that are coming up in my history as you’re reviewing my. What tests can I expect in this journey? So what is the testing and what is it looking for? And then based on my case, what are the treatment options available to me? Right? Because every patient’s, um, treatment plan is gonna be managed a little bit differently.

And so I think those are some great starter questions, but I always tell people when you’re going to see a specialist, it is almost like this information overload, right? Because we cover so much in one visit. So I always recommend if you can have a second person at the appointment. If visitors are not allowed because of covid still, you can always have somebody on speaker phone or FaceTime during the appointment.

Um, and then the other thing is take a notebook, like old school pen and paper. I’m old school that way. And really just write things down, take notes, you know, we’re all used to it. We know that what we’re saying, what the information that we give at a visit is a lot even. Somebody who is in healthcare. So for a lay person sometimes who it can be just completely overwhelming.

So taking those notes is so important because then you can go back, look at it and then say, oh man, I forgot to ask about this. Or, oh man, what did she mean by that? Or whatnot. So you can ask, you can write down those questions for your follow up visit. I love that. Thank you so much for your time today.

And can you tell our listeners, are you on social? How can they follow you? How can they learn more about. Yeah, yeah, absolutely. So I have a YouTube channel. I drop episodes there weekly. They’re just quick 10 minute clips of those little blurbs that you wish you knew. And it’s my name Dr. Carolina sdo. So very easy to find.

And then I’m also on social. I’m on Instagram and Facebook. I would love for you to send me a DN after this episode and let me know what you thought about it, and if you have any questions, I would love it to work with you. I would love that. I love also that we’re twinning with our first. Yes, the two.

Carolina. Carolina, the two Carolinas. So I’m so blessed to have had you here today and thank you so much for your time. Absolutely. Thank you so much for having me. This was so fun. Awesome. I hope you have a good day.