Fertility Acupuncture with guest Judy Tognetti

Judy Tognetti joins me today from Nurture Acupuncture. She is one of my most favorite acupuncturists, I’ve been working with her for over 10 years now. Judy has been doing acupuncture for over 16 years now, mostly in the fertility arena.

Dr. Aimee: Welcome, Judy. How did you get started in acupuncture?

Judy Tognetti: I started out training as an OBGYN, and then decided to leave medical school for some personal reasons.

Dr. Aimee: Shut the door. I did not know that.

Judy Tognetti: I did, I left, and my mother was not very happy. It took me a couple of years, and then I got introduced to acupuncture.

Dr. Aimee: I’d be kind of mad, too, if I was your mom.

Judy Tognetti: She was, I almost got disowned. Anyway, I went on to find acupuncture and decided that I could take it into the gynecology area. I did some fertility work with it and found it to be really effective. I still got the benefit of what I was wanting to do educationally. I love it. I wouldn’t change anything in the world for it.

Dr. Aimee: Well, I have you here because I want you to needle me. Will you needle me?

Judy Tognetti: Okay. I will.

Dr. Aimee: Let’s do it. Show me, how do these needles work? I’m just going to let you do your thing.

Judy Tognetti: These are always sealed, so we have sealed needles. We use something called a guide tube so that it’s cleaner, so that our skin and our bodies never touch at the insertion site. The needle is threaded through this little tube into there like so.

We normally will clean the skin with some alcohol, obviously. We’re going to push the guide tube down onto the skin. When we push it down, usually you feel no pain or anything. We just insert like this.

Dr. Aimee: I felt nothing.

Judy Tognetti: Then the needle sits there. It doesn’t usually go any further than through the main level of the derma. It can go a little bit deeper.

Dr. Aimee: Got it. I’m feeling really positive right now. Just kidding. I feel blood flow to my uterus, my ovaries, better eggs.

Judy Tognetti: Better eggs, exactly. Normally, they’re retained about 25 to 30 minutes.

Dr. Aimee: I actually do feel something.

Judy Tognetti: You can. It’s on the lymphatic system right there, so you might.

Dr. Aimee: I actually feel a dull sensation in my hand.

Judy Tognetti: Then obviously we dispose of them. These are now just for Aimee. These would go into a hazmat container and we would not autoclave them.

Dr. Aimee: How exactly does that work when it comes to fertility? How does fertility acupuncture work?

Judy Tognetti: Fertility acupuncture is based on the concept of using the nervous system, lymphatic system, and balancing hormones. By utilizing certain points in the body, we’re able to adjust the hormones. If we use electrical stimulation, we’re able to secrete neurotransmitters. At certain amplitudes, we can secrete serotonin, dopamine, whatever it is that we’re trying to secrete.

Other than that, we’re using needle points that are selected over the ovaries or over the uterus to drive blood flow, increase lymphatic circulation, and balance the hormones. Basically, in a nutshell, that’s what it’s doing while we’re doing it.

Dr. Aimee: What happens when someone goes to a fertility acupuncturist like yourself for the very first time? What can someone expect at the first appointment?

Judy Tognetti: At the first appointment, you should really be interviewing your acupuncturist to make sure that they actually know what they’re talking about. There are a lot of people doing acupuncture for fertility that may or may not understand exactly how to do it. For example, if you’re down regulating their cycle, meaning with Lupron or birth control pills, then we should also be downregulating with the needle.

I have seen variations of downregulation not occurring, and then that can cause problems when you go to rescan, now they have cysts or formations of fibroids or anything that could be formatting that we don’t want to have happen in the downregulation. Definitely interview them, make sure they know what medications are, how the medications are used, what to do with the needle during your cycle.

Dr. Aimee: And they can communicate with the fertility doctor. You and I email all the time.

Judy Tognetti: That is correct.

Dr. Aimee: I send you calendars and say, “This is the patient’s calendar. Make me look good, work your magic.”

Judy Tognetti: That’s right. Definitely interview them, pick the right person, or get a referral from your MD like Dr. Aimee. That way you’ll know that you’re in the right place and you’re not wasting your time, money, and efforts. More of it is about your efforts than it is about any of the other things. We can make more time and we can make more money.

Dr. Aimee: Right. How many sessions does a patient on average need? I’m going in, I’m seeing if I’m ready to do IVF, I’m seeing you. What do I do, how many office visits?

Judy Tognetti: Normally, for IVF, a thorough history should be done. If you’ve had a lot of complications and you’re age 45, then obviously you’re going to need a few more treatments than somebody who is 22 that has undiagnosed infertility. Normally, we say to people come about three months before, let’s evaluate whether we need to start ASAP or we can have you start another month from now or two months from now. That way we can evaluate what we need, how we need to do it, and if we need to institute any kind of supplementation or any kinds of herbs, etcetera, into the protocol for you.

Dr. Aimee: The other acupuncturists at your center, there are several wonderful acupuncturists there. What if someone sees you one session and sees someone else in another session, is that detrimental at all for their care or their progress?

Judy Tognetti: Not so much. In our business, the three main doctors have been practicing. I’m the most junior at 16 years, the other person is at 30 years, and another one at 25 years, so we’re a very senior team. Anyone that has worked with us or is working there as an associate has been trained by us for several years, so there should be no variation in the protocol that’s being instituted.

It just may be a personality thing, maybe you want to talk to a female versus a male, or you like to come on Friday. We have that open so that you can come six days a week, so that it’s easy for your travel during the week or the weekend, whatever you prefer. You can definitely see any of us, we’re very interchangeable.

Dr. Aimee: I hope you’re not going to be insulted if I call the herbs that you give patients fancy dirt.

Judy Tognetti: No. It is fancy dirt. It smells like dirt, it looks like dirt.

Dr. Aimee: Tastes like dirt.

Judy Tognetti: Tastes like dirt. It’s medicine. People think it’s a tea. It’s no Lipton tea. It’s medicine. It’s composed of bark, seeds, flowers, etcetera, so there’s roots in there. It does smell and look like dirt. We use a freeze-dried granulation that is easier to take than something that has to be cooked.

Dr. Aimee: Tell me about dirt. Don’t be insulted, but when I tell patients about Chinese herbs, I’m just thinking about oh my goodness they’re going to be eating dirt. What’s the deal?

Judy Tognetti: The deal is it’s granulated herbs and they do look like dirt. It actually looks like sand. It can be shaken like sand. It’s composed of roots, barks, flowers, seeds, nuts, a bunch of different things. It is freeze-dried and then it’s granulated, and you take it by the teaspoon full. When you do that, you put it in some warm water, shake it up, and then shoot it down. Don’t take time and make a big glass of tea.

Dr. Aimee: Can you mix it with vodka?

Judy Tognetti: You can mix it with vodka when you’re not trying to get pregnant. It would taste much better with vodka, that would be correct, but no.

Dr. Aimee: Do you give everyone the same formulation of Chinese herbs, or do you change the prescription depending on what they’re going through?

Judy Tognetti: The prescription is based on your medical history, it’s also based on our analysis of what we find by palpating the abdomen to see what areas in Chinese medicine.

Dr. Aimee: You have to tell me about the whole palpation thing. We’re going to get to that.

Judy Tognetti: We’ll come back to that. We palpate the abdomen to decide what channels in Chinese medicine or what organ pathways are not correct, and then we use herbs to adjust for that. We also look at the tongue and the pulse, and then decide what we need to do based on the medical history.

Dr. Aimee: Okay. How long is a patient typically on Chinese herbs for?

Judy Tognetti: Some clinics allow Chinese herbs to be taken all the way through the retrieval, and some have it shut down as soon as the gonadotropins or the stimulation medications begin.

Dr. Aimee: What do you think is best? Based on your 16 years of experience, I’m sure you have an opinion.

Judy Tognetti: Based on my experience, they do best if they continue through the retrieval. But if I’ve had you for three or four months already on the same herbs, then I don’t really care about 10 days. By then my job has been done anyway. But we do see some improvement with the size of the follicle and the tracking of the follicles being about the same size with the herbs in general.

Dr. Aimee: One of the things that I’m concerned about is if someone starts something new, all of a sudden, right around their transfer day, and then they might develop an allergic reaction. I don’t mind if patients are on the Chinese herbs. I actually prefer if they start before treatment to see if they’ll develop an allergy, because like all things, people are allergic to some things, and you wouldn’t know until you’ve tried them.

Judy Tognetti: That’s right. I wouldn’t even give them to you if it was the first time I saw you and you were doing a transfer. There are some different herbs though. The ones that are used post-IVF transfer have very low allergens in them. They’d be less likely to have an allergy or allergic reaction to them versus the ones that are made to go in the follicular phase of a stimulation.

Dr. Aimee: You’re saying a lot of fun words like stimulation.

Judy Tognetti: The stimulation would be what Aimee is having you do with the medications that you’re injecting, or if you’re doing an oral Clomid, for instance, then these medications, the herbs could technically counter-indicate with them and you may get some response with them.

Dr. Aimee: You’re saying herbs can’t hurt if you don’t have a bad reaction to them.

Judy Tognetti: That is correct. Herbs cannot hurt. Usually, we have you start slower than average and then work up to the full dose so that we can monitor any kind of symptoms.

Dr. Aimee: You brought up something post-transfer. One of the things everyone asks me about is the darn pineapple core. My joke is to soak the core in some nice rum and the next morning you can suck on it. But core to me is really bitter. That doesn’t sound like fun. You just had a transfer, you want to be relaxed, you want to eat things that you’re used to eating, and now you’re going to eat the core of a pineapple. What’s that all about?

Judy Tognetti: I tell people just take the core, divide it into two or three doses, depending on what day of the transfer.

Dr. Aimee: Pineapple core is really hard. How are you supposed to cut the pineapple? You might cut yourself.

Judy Tognetti: You just buy it cut up at Whole Foods. Then you take the core, divide it, and I personally just chew it and then spit out the core itself. It’s very fibrous. There are people that enjoy eating the core, and I say go for it.

Dr. Aimee: Chew it and suck on it.

Judy Tognetti: Chew it, suck on it, get the juice out of it, and then spit it out. That will give you the bromelain, which is what we’re looking for.

Dr. Aimee: Suck and spit, don’t chew and swallow.

Judy Tognetti: Correct.

Dr. Aimee: I need a picture of a pineapple with that hashtag for everyone.

Judy Tognetti: We’re looking for that bromelain to inhibit any kind of inflammation that could occur.

Dr. Aimee: Inflammation is bad, obviously, because when an embryo is going to get all snuggly inside the uterus, you want it to continue to stick and grow, not be attacked by inflammatory cells. You want a nice anti-inflammatory type of environment.

Judy Tognetti: Correct.

Dr. Aimee: Okay. There are all sorts of other recommendations that acupuncturists make and I’m just like, “Seriously?” One of them is you can’t eat or drink anything that’s cold, everything has to be warm. In the Summertime, that’s really hard. Why do you do that to my patients?

Judy Tognetti: Well, it’s not my rule. Chinese medicine believes that things that are raw or cold take longer to digest in the body and therefore can influence the way hormones are producing. For instance, if you eat something really cold like ice cream, your body then has to heat itself up to digest it. By doing so, it can impact the thyroid possibly or change the way the hormones are.

The other thing with ice cream, even though it tastes really great, is it’s very sugary. Not so awesome for fertility in general. When you do that, it’s junk food, empty calories, etcetera, it will shoot your cortisol and your insulin, and then that will change the way your hormones are producing.

Dr. Aimee: That sounds like no fun. I don’t want ice cream anymore now.

Judy Tognetti: When you’re done having babies, you can have all the ice cream you want.

Dr. Aimee: What about alcohol and coffee? I tell my patients alcohol in moderation is okay. Most Americans, when you look at a wine glass, they’re basically pouring an entire bottle or half a bottle into a glass. I’m telling them four ounces, and four ounces is half a cup.

Judy Tognetti: Four ounces, most Americans don’t know what that is, so four ounces would not occur.

Dr. Aimee: You say basically no?

Judy Tognetti: We say alcohol is okay in moderation. During the stimulation, if you’ve had issues, you may not want to do that because it may affect the way that your follicles are producing. But if you’re doing IUI or trying naturally, or any of these other methods, then red wine in particular is better than any form of white wine can be, because white wine will turn into sugar very quickly, where red wine has some antioxidant properties, technically.

Dr. Aimee: If you have four liters of it.

Judy Tognetti: If you have four liters of it, you might get that resveratrol to help with your egg quality.

Dr. Aimee: What about coffee, any recommendations on that? Anytime I have patients and I’m like you can drink one cup of coffee a day, they’re like, “Judy told me I can’t.” Well, I don’t want to piss Judy off.

Judy Tognetti: I say 25 milligrams or less.

Dr. Aimee: That’s like two sips of coffee. Are you serious?

Judy Tognetti: You can have a tall Starbucks or Peet’s, that’s about 25 milligrams. You just don’t want to go over that. Number one, it affects the way your blood sugar is handled. Number two, the caffeine isn’t very helpful for the body in general.

Dr. Aimee: I think it puts people in a good mood and helps with their metabolism.

Judy Tognetti: It does do that, but it also makes them shaky, over hungry, overeating, nervous, panic attacks.

Dr. Aimee: You have pros and cons.

Judy Tognetti: Pros and cons, yes.

Dr. Aimee: So, you can have a cup, and you won’t get mad at my patients?

Judy Tognetti: A cup is good. I tell them all a cup.

Dr. Aimee: I’m going to send everyone this video after this.

Judy Tognetti: Go ahead. Send this video.

Dr. Aimee: I’m going to send this to everybody.

Judy Tognetti: On that, we need to talk about green tea.

Dr. Aimee: Okay. Tell me about green tea.

Judy Tognetti: A lot of people are doing that because they think it has all these great antioxidants. The problem with green tea is it’s extremely cold to your body whether you drink it hot or cold.

Dr. Aimee: Really?

Judy Tognetti: One of the greatest studies came out showing that it actually impacts in great volume the lining of the uterus.

Dr. Aimee: Interesting. I had no idea.

Judy Tognetti: So, we stay away from all green teas as well. You can have black teas, which have caffeine, so you have to monitor that 25 milligrams.

Dr. Aimee: Okay. I’ll be sure to tell patients to go easy on the green tea, if not cut it out all the way. A little coffee, a tiny bit of alcohol, no green tea, no ice cream. What can I eat or drink? What do you tell patients?

Judy Tognetti: Some women are trying to diet while we’re trying to make a baby, and the decision is we’re either making a baby or we’re on a diet. We need to eat at least 1,500 calories a day, nothing below or that, or we don’t produce the great hormones that we need.

The other thing that we push is good sources of fats so that the hormone chain is actually working effectively.

Dr. Aimee: A good source would be similar to Mediterranean diet, probably.

Judy Tognetti: Mediterranean diet is very similar. Also, kind of like a Paleo diet a little bit. We push the salmon, the avocado, and the nuts, for instance, for the good fats. We also ask you to eat about 50 to 60 grams of protein. We ask you to eat good grains. The grains that we typically recommend are going to be things like millet, quinoa, things that are gluten free but also have protein content to them.

Dr. Aimee: What’s millet?

Judy Tognetti: Millet is a small little grain that tastes like almonds. A lot of women will eat that. It looks like couscous, kind of.

Dr. Aimee: A lot of? I’ve never even heard of it.

Judy Tognetti: You’re going out tonight, we’re going to have some millet. It’s a lot in the Italian diet. You’re not Italian, but I am, and we eat that.

The diet would consist mostly of fruits and vegetables. A lot of dark green leafy vegetables so that we can build up the body correctly. A lot of good proteins, a lot of good grains, small amounts of dairy. We’re not very big fans of dairy in Chinese medicine, especially if they’re not organic. We do allow one item of dairy a day, meaning one piece of cheese, one yogurt, one glass of milk.

Dr. Aimee: Got it. Can acupuncture help PCOS patients?

Judy Tognetti: Yes. Acupuncture can help PCOS. The number one thing that we do is we look at the diet. We start implementing the diet where you’re eating every two to three hours so that we can maintain the insulin levels. We also use points in the abdomen to help with ovulation if you’re not currently ovulating as a PCOS patient.

Dr. Aimee: That stuff works, I’m telling you. I’ve had patients where I’m just so scared to transition them to gonadotropins only for their stimulation because they haven’t responded to Femara or Clomid, and then acupuncture works.

Judy Tognetti: A lot of it is just listening to the diet, changing things. We do ask you to exercise with moderation, too, and try to lose a little bit of weight if you’re overweight, and that helps the estrogen come out of the fat cells. When the estrogen comes out of the fat cells, it’s more usable to the body hormonally and we tend to see more pregnancies occur.

Dr. Aimee: That sounds like a win-win all the way around. What’s the regimen around transfer day? Transfer day, you want to do pre- and post-transfer acupuncture. What’s the best protocol, what’s your protocol?

Judy Tognetti: Our protocol is based on your history. There was a study done in 1998, it’s a little bit outdated, on how they did it and what points they used. We use that as a basis, but we also modify it specifically to you and your history.

On that day, we usually have you come about 45 minutes before your transfer time. That way you have plenty of time to get comfortable, stop being so nervous, we’ll administer your valium for you if you’ve been given valium. We’ll check the bottle to make sure it’s really diazepam or valium, whatever you gave us.

Dr. Aimee: Not doxycycline.

Judy Tognetti: Not doxycycline, which I have seen. We make sure that everybody is on time. If they’re not on time, we go ahead and hold back on the valium and just keep you laying down in our office until the doctor is actually ready for you, so that you don’t get nervous.

The points that are used in the pre-transfer are things to encourage blood flow to the uterus. They also relax the cervix so that it’s a little bit easier when we’re using the instrumentation to go in, so it aids the implantation.

When you come back afterward, usually you’re back about 30 to 45 minutes, depending on how long it takes the doctor. Speedy Gonzalez over here is really quick, so I know her patients will be back very quick. When you come back, the treatment is very different.

Dr. Aimee: How did you know that’s my nickname?

Judy Tognetti: You are Speedy Gonzalez because trust me, I know, your patients come back about half an hour later.

Dr. Aimee: I want them in your office doing their thing, getting their uterine relaxation on.

Judy Tognetti: Right. That’s right, got to relax that uterus. It helps a lot of people. They feel really comfortable, they are more relaxed when they leave to go get their embryos. I think that actually helps the more that we’re nervous, and the reason we use the valium is to stop any uterine contractions, so the acupuncture is also there as an assistance.

Dr. Aimee: I’ve had patients say, “Judy checked my pulse.” You also see patients after the transfer, and they say, “She thinks that I might be pregnant.” How does that work, what’s the mechanism there?

Judy Tognetti: It depends on the amount of days after the transfer. We can pick up the pregnancy pulse in Chinese medicine. The unfortunate part is that it sits on the same channel as if you ate food, so we have to make sure you’re not having a food baby, but you’re having a baby baby. We always ask if you have eaten so that we know if it’s food related or baby. Usually, about six to seven days, depending on how many treatments I’ve actually worked with you, I can tell immediately if you are in fact pregnant, especially if you’ve conceived twins.

Dr. Aimee: Can you tell if it’s a boy or a girl?

Judy Tognetti: Yes, we can tell if it’s a boy or a girl.

Dr. Aimee: How? Really? You’re right like 50% of the time.

Judy Tognetti: More than that, actually. We average in the 80% range for success on gender. Unless you’ve already tested it for us, then we’re very accurate at 100%. But the pulse will change bilaterally when the woman is about nine to ten weeks pregnant and we can tell what the gender should be.

Dr. Aimee: How?

Judy Tognetti: On one side of the body is stronger than the other. If it’s on one side, it indicates a boy, if it’s the other side, it’s a girl, so we can tell based on that.

Dr. Aimee: Why do you get so mad at patients when they walk in with heels on? I see patients that are like, “I have a secret pair of shoes that I take off and put back on before I go in to see Judy so she doesn’t get mad at me for wearing heels into her office.” What is the story behind that?

Judy Tognetti: It’s not so much Judy, it’s George that does not like that. It’s very traditional. What he thinks is that the higher the high heel, it tilts the pelvis, and when it tilts the pelvis, it changes the blood flow into the uterus and the ovaries and shunts it off, basically. When we do that, we have less likelihood of good nutrition to the ovaries and the uterus, and then therefore our outcome might not be what we’re looking for. Especially when pregnant, we do not want to see a lot of high heels, or overly high heels. If you’re wearing a two-inch heel, it’s not really an issue. It’s the spiked larger three and four inch heels that are the issue here.

Dr. Aimee: Got it. In pregnancy acupuncture, I tell my patients that patients who do acupuncture actually have less nausea, less vomiting, their first trimester is a lot smoother for them. I think that’s definitely well proven in the literature.

Judy Tognetti: Yes. The literature will show it can stop bleeding, especially if it’s a subchorionic hematoma, which is just a small bleed that has nothing to do with your baby, but yet you’re seeing blood, so you’re a little bit nervous. Acupuncture in fact can stop that. We use something called moxibustion that we show you what to do, you do it at home, and it actually aids and stops any kind of bleeding.

Dr. Aimee: Is that where people burn pieces of their hair off?

Judy Tognetti: Yes, if they don’t do it right, you may burn your hair.

Dr. Aimee: I’ve seen some bald spots.

Judy Tognetti: When you’re pregnant, you don’t care that you have a bald spot. If you’ve been trying for 10 years and you have a baby, you don’t really care that it’s bald there.

Dr. Aimee: I know.

Judy Tognetti: We do show you how to do that. It has great research on that. We have you do that moxi at least through the first trimester to prevent miscarriage. It also increases blood flow, so sometimes when she would scan you, your baby is actually a little bit ahead of target, and that’s due to that diet that we give you, the acupuncture itself, and the moxi bringing more blood flow.

Dr. Aimee: Do the babies come out really loving salmon and millet?

Judy Tognetti: Usually they don’t. Most babies that have had acupuncture through the entire course of the pregnancy are actually very calm babies.

Dr. Aimee: And they’re smarter.

Judy Tognetti: They have shown a little bit of increase in brain activity, but mostly they show that they are not as colicky and they actually have good birth weight.

Dr. Aimee: I wish I had known that back in the day.

Judy Tognetti: Me too.

Dr. Aimee: So, what we have planned today is that Judy is going to give me a uterine massage in front of everybody right now.

Judy Tognetti: Sure we are. No.

Dr. Aimee: What’s the story with the uterine massage? And the Maya massage? What’s the difference? Are you really manipulating patients’ uteruses? You were in medical school, and I know you know what you’re talking about.

Judy Tognetti: We’re not actually touching the uterus through the vaginal canal. We’re not going this way in there. It’s always done externally.

It’s done from the breastbone to the pubic bone. It’s about 45 minutes of work, it’s very finite movement. The Maya massage is just another name for it. We call it by its Chinese name, which is [chaanutsan 0:22:16], it’s exactly the same method.

The purpose of that is going to be to open up the fascia or the abdominal wall and get blood flow to move down into the ovary and the uterus. What they can feel is any kind of nodulations or possible cysts, some fibroids if they’re large, we can feel those externally. They’re using this method to break down those things and encourage blood flow.

It also helps get rid of stress. Most women store all of their emotional baggage through the abdomen, so a lot of people have abdominal releases for emotions, especially if there has been any trauma sexually or any kind of miscarriages. This helps us be able to move forward into another cycle and be well grounded for it.

Dr. Aimee: Do you think the abdominal massage also helps with stress and relaxation, do people leave the Maya massage feeling more relaxed?

Judy Tognetti: Yes, they do. Once you get over the idea that somebody is actually touching your abdomen — most of us don’t want a massage there, we like it on our back or our neck — once they get used to that idea, everything feels really warm. It can change your libido very quickly. It increases the cervical mucus, so they feel more grounded in general.

Dr. Aimee: Whoa. You said libido.

Judy Tognetti: Yes. It will change your libido.

Dr. Aimee: Can you teach partners how to do the Maya massage so they can get it on at home, does that help at all?

Judy Tognetti: You can teach it. We do teach it to some patients. It’s also on YouTube. Everything is on YouTube, so you definitely can look on there to figure out how to do that.

What I find with most IVF / IUI patients, anybody in the reproductive field, there is so much stress and so much anxiety associated with when do we have to have sex, hurry home, today is the day, there’s so much pressure that these things are actually techniques that will help relax them so that it now becomes enjoyable, you’re making love to your husband versus it’s my job today.

Dr. Aimee: Yes. If you took my ice cream away.

Judy Tognetti: Took your ice cream and your coffee, and no alcohol, then there’s no fun anymore.

Dr. Aimee: I guess the abdominal massage will have to be it.

Judy Tognetti: The abdominal massage is worth trying. It is a little weird at first, and then most people actually prefer it.

Dr. Aimee: Great. Judy, it has been so fun having you on the show tonight. You’re just such a breath of fresh air.

Speaking of breath, before we end the show, I just want to ask you what kind of suggestions do you have for your patients? We both see a lot of the same patients and they’ve gone through so much, so much trauma. What kind of recommendations do you make to them about how to deal with stress? We all have stress, so the real strategy is how to cope with it.

Judy Tognetti: How to cope with it. We use a lot of relaxing music inside the clinic. I also refer them to some stress and meditation things. There are a lot of meditations that are done for IVF associated to that, you can purchase those. A lot of times we’re playing them in the clinic. We also teach something called bottle breathing, because most women breathe very shallow from the chest.

Dr. Aimee: Bottle breathing? Can you do it with me, can you teach us?

Judy Tognetti: Yes. Basically, you make sure that you’re sitting upright so that you’re relaxing the pelvis. You breathe in through the nose, and when you breathe in through the nose you want to feel the breath come all the way down into the lower part of your abdomen. Then when you go to exhale, you exhale from the bottom and all the way up through the top, so you’re exhaling from the bottom of the bottle. When you do that, it relaxes the whole entire nervous system, resets the sympathetic nervous system, so that you are in fact more relaxed in general.

Dr. Aimee: So, you’re inhaling from the top of the bottle.

Judy Tognetti: From the top of the bottle down, so you’re filling the bottle up. Then you’re draining it from the bottom to the top. When you do that, you’ll feel a release of all of your muscles.

Dr. Aimee: Oh. It works. It takes a couple breaths to kind of imagine it. I like it. Bottle breaths. I’m going to use that.

Judy Tognetti: The other thing I teach is body scan meditation. I think that women have a lot of things going on, we have work stress, commute stress, etcetera. I teach what’s called body scan meditation where you focus on a body part, you breathe through that body part, you move to the next part. When you do that, it’s keeping your focus on that foot or on that leg, instead of on the laundry that needs to be done or something else.

It gives you 30 full minutes of just relaxing and it keeps you focused, your mind doesn’t tend to wander, versus just trying to do meditation that doesn’t work when you’re a very busy person. These body scan meditations, you can purchase them or you can YouTube them.

Dr. Aimee: And you can do them while you’re driving.

Judy Tognetti: You can do them when you’re driving, that’s right. I always tell people why don’t you sit upright and for the next five stop lights you do the bottle breathing and then you just forget about it again, and then you just go on to the next whatever you want to do. You can wear a rubber band and remember at 12:00 every day you do this breathing. It just helps relax you, and the more relaxed you are the easier it is to conceive.

Dr. Aimee: Yes. We learned a lot about you today. We learned that you went to medical school. I think there’s some fertility stuff that we talked about before we started the show that a lot of people would be surprised about. Surprised in a really good way. Tell us?

Judy Tognetti: My original journey into why I came into the more reproductive part of medicine versus gynecology is that I was asked to be a donor. So, I was an egg donor when I was 23 years of age, and we produced a very beautiful son for this woman. Later on, I was asked to be a gestational carrier for another friend, and we produced another beautiful baby boy.

Dr. Aimee: That’s wonderful.

Judy Tognetti: So, technically I’ve had some great experiences with that. I love being on that journey. It’s just the best gift to give someone a child.

Dr. Aimee: It absolutely is. You’re just such a blessing to so many of my patients. Thank you for all of your work, 16 years of it and more.

Judy Tognetti: And more to come.

Dr. Aimee: We’ll be doing the same thing for years to come and won’t stop doing what we do because we absolutely adore our patients and we love helping them.

Judy Tognetti: That’s right.

Dr. Aimee: Thank you, everyone, for joining the show tonight. You can find Judy at NurtureAcupuncture.com. What cities are you in, Judy?

Judy Tognetti: We are in San Ramon, San Francisco, San Jose, Orinda, and soon to be Foster City.

Dr. Aimee: That’s very exciting. That’s awesome. Thank you for everything.

Judy Tognetti: Thank you. It was a pleasure.

Dr. Aimee: Have a great night, everybody.

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