Dr. Lucky Sekhon on What Every Woman Should Know About Fertility in Her 20s and 30s

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
I feel so privileged to be a fertility expert in
a time where success rates are at an all time high.

Speaker 2 (00:05):
Speaking as someone who is yet to go on this journey,
when do you feel like is the right time for
women to really start thinking about fatility?

Speaker 1 (00:14):
I think it's never too early.

Speaker 2 (00:15):
Doctor Lucky Second is a reproductive androcrinologist who's helping women
understand their fertility clearly, calmly, and proactively. She cuts through myths, pressure,
and online noise and focuses on what really matters. Do
you have any advice for women who are trying to
you know, we build trust with their own body after
they feel like their bodies failed them.

Speaker 1 (00:33):
It's not because of something you did or didn't do,
and you're definitely not alone. One in six couples have infertility.

Speaker 2 (00:38):
What if this time will be the time.

Speaker 1 (00:40):
There is some serendipity, there is some luck, and you
just need one egg to make it past all those hurdles.

Speaker 2 (00:46):
Welcome to a Really Good Cry podcast. A Really Good
Cry is here to help you understand your body, feel
confident in your skin, manage your emotions, and take back
control of your health. Because growth doesn't always start with answers,
Sometimes it starts with a really good cry Lucky thank
you so much for being here. I really really appreciate it.
I know you've flown in from New York and I'm

(01:06):
so grateful to have you on the podcast.

Speaker 1 (01:08):
Thank you for having me.

Speaker 2 (01:09):
We're gonna dive into your book, The Lucky Egg, Understanding
your Fertility and how to get Pregnant. Now, let me
tell you, this is one juicy book. There's so much
information in here. And what I loved about it was
you don't make it feel too scary.

Speaker 1 (01:23):
Yeah, that's really the goal.

Speaker 2 (01:24):
Yes, and I think that, you know, speaking as someone
who is yet to go on this journey, I definitely
feel overwhelmed by this whole space and it's a little
bit scary. Me and my friends talk about it and
we're like, I don't know, I'm avoiding it. I'm avoiding
thinking about it until I'm really ready to think about it.
And when we are, it feels really intense, especially when

(01:45):
you're over the age of thirty.

Speaker 1 (01:46):
Yes, it feels overwhelming. There's so much noise and advice
coming out you.

Speaker 2 (01:49):
A mile a minute, there is, And so I know
you've been doing this for nearly a decade. I would
have to start off with some beautiful success stories that
you've experienced.

Speaker 1 (01:58):
I mean so many, you know, I feel so privileged
to be a fertility expert in a time where success
rates are at an all time highly Yes. Yeah, if
you think about when IVF was first invented, and I'm
talking about IVF, but there are so many different ways
to help people get pregnant, but that's the one that
everyone associates with my job, right, But it is the
most striking change that in the nineteen seventies, when it

(02:20):
first came about and this technology became a thing, it
was like single digit success rates. And now every week,
you know, at least two thirds of my patients who
had an embryo transfer the week before, I'm calling them
to say, hey, you're pregnant. Oh my god. No. So
it's really something that I never take for granted because
I have predecessors, you know, mentors of mine that always

(02:40):
remind me of how lucky I am. When they were
coming up in their careers, They're like, it was really hard,
you know, to tell patients let's keep going in the
face of really low success rates compared to what we
can offer now.

Speaker 2 (02:53):
Yeah, when do you feel like is the right time
for women to really still think about the to like
your ideal puss. And if you're talking to them from
a young age, when would you say this is the
time we need to stop thinking about it. So.

Speaker 1 (03:07):
I know it might sound crazi or extreme, but I
think it's never too early. I mean, I have a
five year old and an eight year old daughter. Both
of them know how to correctly identify their body parts.
They know about the menstrual cycle. I think we need
to normalize this and make it so that people aren't
growing up afraid of their bodies or feeling that their
bodies are a mystery. I think it should be a

(03:28):
topic of conversation, maybe not with the lens of trying
to get pregnant necessarily, but just understanding your menstrual cycle,
understanding red flags and identifying things early instead of saying, Okay,
I'm only going to react after the fact once I'm
in a moment of crisis when it comes to my fertility.
I would love for everyone in their twenties to have
like a secondary formalized education, because high school health class

(03:50):
or junior high health class isn't enough. The goals are
very different, and then that's the last of our formative education,
and we go off into our twenties and our thirties
and we're expected to, you know, kind of strive towards
having it all and achieving our professional goals while navigating
our personal goals, and then magically trying to figure out
our biological clock, hoping to stumble upon the right obgyn

(04:12):
and the right Google search or the right group of
friends that are happening to share the good information. And
it seems a little bit too left up to chance.
And so that's really why I wrote this book. This
isn't for people who are only struggling in the trenches
of infertility, but it's really for people as they enter
their twenties and thirties to say, Hey, what should I
be thinking about? How should I be viewing, you know,

(04:33):
wellness and my overall habits day to day, and what
should I be thinking about as I embark on this
journey of trying to get pregnant so that I can
be as efficient and as effective as possible.

Speaker 2 (04:44):
I know you said that IVF. Obviously you're seeing so
many great success stories yeah happen and IVF, which is
so beautiful. What about when it comes to natural pregnancies.
Have you seen a trend in what's happening there? Is
it still the same? Well? Does it feel like it's
getting hot?

Speaker 1 (05:00):
I think that it's largely the same. I don't think
there's anything about our biology that has really changed, Right.
It takes a long time for evolution to actually take place,
but our behaviors are changing, and we're waiting longer to
have children, you know, And I shouldn't say it like
that because it makes it sound like it's an active choice.
I think it's a confluence of factors of how we're
living differently. It's taking longer to become financially independent and

(05:23):
feeling like you're in the right place in your life,
feeling like you have the right partner. I mean, there's
good things about that. Right. We now live in a
society where we're saying, let's not settle and let's not
stay in toxic relationships just for the sake of Hey,
I want to have children. And there's technologies to try
to work around that as well. Right, Like women can
freeze their eggs and say, I feel less pressured to

(05:44):
stick with something that's not right for me. I'm going
to listen to that voice inside my head and say
let me start fresh, and that would have been really
hard to do as someone in their mid thirties or
early forties, maybe twenty years ago, where certain things weren't options, right,
like egg freezing. But I think you know, the average
age of when we're starting to build our families has

(06:04):
definitely increased. Just think about our mother's generation, our grandmother's generation,
and there's good things about that, right, But our biology
hasn't kept pace, and we're not really giving women the tools,
the support, and the education or even the access to
certain techniques or strategies to try to work around that,
or even just policies that help us to create space

(06:27):
in our life so that we can achieve our dreams
professionally and personally alongside each other.

Speaker 2 (06:33):
You mentioned lifestyle quite a bit throughout this and the
things that we should be doing in our twenties and thirties.
Would you say that fertility from your experience is many genetics?
Is it mainly lifestyle? Is it? You know, what are
the main factors that are influencing fertility along our journey?

Speaker 1 (06:48):
So timing is really important on two different levels. One
is the effective age.

Speaker 2 (06:53):
Right.

Speaker 1 (06:54):
Age impacts our ability to ovulate a healthy egg and
it's not all doom and gloom. It's not like, oh,
over thirty five, all of your eggs go bad. That's
what society likes to tell people. But in fact, even
in our late thirties and early forties, you still have
normal eggs that you can ovulate, but the ability to
do that starts to shift where it takes many more
cycles for that egg that you need to ovulate to

(07:16):
be the one that's selected randomly, because it's a random
selection process that you cannot control, and it can take
longer to get pregnant, and there can be a higher
risks of things like miscarriage. So age is definitely a
big factor, but also timing with regards to knowing when
you're ovulating right, and so for people who aren't getting
regular periods and they never know when their next ovulation

(07:38):
is happening, or they don't ovulate regularly, that can make
it more challenging. And there are shifts in health in society.
The rise in obesity has led to more and more
people having a harder time ovulating regularly, so that indirectly
impacts fertility as well. Genetics is huge. A lot of
people aren't aware that if they have a first degree
relative with premature MENOPAUSEIDS, polycystic ovary syndrome which can lead

(08:03):
to regular cycles, problems like endometriosis. These are all major
gynecologic disorders that can relate to fertility issues, and there
can be a several fold increased risk of you yourself
having those issues if your mom or your sister first
degree relative also did so. Genetics can play a huge
role in fertility.

Speaker 2 (08:20):
And not the specific tests that you recommend women do
to you know, let's say find out from a younger
age if these things are an issue for them, like
what would you recommend some of the symptoms out that
they should look out for, all tests that they should
be doing.

Speaker 1 (08:34):
So, starting with your period, if your periods are regular,
that's the first red flag that tells you that you're
not ovulating regularly. And if you're not ovulating, you're not
in the game, right. That means releasing an egg, so
there's a chance for that egg to get fertilized. And
so I've had women sometimes come to me and say,
I've been trying for a year, but I've only gotten
two periods in the last year, And I tell them, well,

(08:55):
then you really haven't been trying for the full year, right,
You've only had two attempts that entire time, and so
we need to do something to give you that opportunity.
I think the other major thing is it's never normal
to have debilitating periods, periods that are so painful that
you miss school or work. And it takes an average
of eight to ten years for someone to be diagnosed
with endometriosis because a lot of times women's pain has

(09:18):
been dismissed, overlooked, or normalized. It's just kind of told
to them, maybe by well meaning family members, that this
is just a burden that women have to bear, and
it's kind of a normal thing in our family. Heavy
periods that can be a sign that you have problems
like fibroids. So I think really tracking your cycle and
being intentional is important. You want to be in tune
with your body, right. And then besides that, I would

(09:41):
say other things to look out for. We know maintaining
a healthy body weight is really important for metabolic balance.
There is this concept of insulin resistance, which you may
have heard of. This is a major buzzword in the
wellness world, but it's actually a real issue that I
see play a role in many cases of infertility and
pregnancy loss. Insulin is basically a hormone that your body produces.

(10:03):
It's like a key that unlocks cells, that helps the
blood sugar get stored effectively in your cells. And a
lot of people's cells might not be listening to the
signal of insulin. There's like resistance to it and sometimes
weight gain, especially around the mid section, or having a
strong family history of type two diabetes. These are dead
ringers where you're like, okay, pcos someone having polycystic ovary syndrome.

(10:26):
There's a strong relationship. The reason why it matters is
that insulin gets produced at a higher level if your
cells aren't listening to that signal, and that can actually
cause your ovaries to overproduce testosterone and it can lead
to unhealthy balance imbalances where the eggs are being matured,
so it can affect our egg quality, the ability to
ovulate a healthy egg. It can also make it easier

(10:49):
to have problems like miscarriage. Most miscarriages are not within
our control. I want to make that clear. Most of
the time, this is just you ovulated an egg that
had a type BO or error. But those typos or
errors in the genetic code of those eggs are more
likely to happen if the environment around the egg when
it's maturing is affected by things like insulin resistance or imbalances.

(11:13):
So it's really important to think intentionally about how do
we make someone more responsive to the effects of insulin. Right,
if someone is overweight and they lose weight, that alone
can help, But building muscle can make you more sensitive
to insulin. The way we eat, the pattern that we
have in our diet in terms of fiber and protein,
and trying to avoid glucose spikes and really stabilizing your

(11:36):
blood sugar. All of this matters. And this is not
a moral feeling. There are a lot of people who
this is just genetically how they're wired, and it's not
always going to be possible to fix it with diet
and exercise. Sometimes you do need the help of certain medications,
whether that be metformin or GLP one agonists.

Speaker 2 (11:52):
Yeah, I was going to ask about GLP one's day
TIPA you mentioned them now, So why is that helping?
I've had a sage like people get being able to
get pregnant after they've been on GLP. Is that to
do with the weight loss or is there something else
that happens when people are on these peptides.

Speaker 1 (12:07):
It's both weight loss because weight is basically like that
fat can be like another organ that actually helps you
overproduce too much estrogen. So in our fat cells we
convert excess testosterone to estrogen, and so it's all related. Right,
Your ovaries will overproduce or have a tendency to overproduce testosterone,

(12:28):
maybe because insulin is causing that to happen, and then
that extra testosterone is getting converted in your fat cells
to estrogen. Estrogen is confusing your brain, which is listening
for the estrogen signal to see what your ovary is doing,
and then it's not sending the signals to the ovary
to tell it to ovulate effectively. And it's this vicious cycle.
And so a lot of people are having what they're

(12:49):
calling ozembic babies because yes, they've had this lifelong history
of irregularity in their ovulation. It's linked to insulin resistance.
Maybe they've struggled with their weight. Now they're correcting that
underlying disturbance, and all of a sudden, the signals from
their brain are getting through to the over and low
and behold, they're ovulating and that was the thing that
was making it harder for them to get pregnant. So

(13:10):
it's helping a lot of people because it's a very
potent way to help with weight loss and to make
someone more sensitive to insulin, especially certain formulations of GLP
one agonists.

Speaker 2 (13:19):
Does that have any benefit for people have endometriosis or
is that issue completely separate to this.

Speaker 1 (13:26):
I think we're still in the research phases of this.
You know, endometriosis is a different entity, but it is
related to inflammation and having too much insulin, and that
insulin resistance I'm talking about is also a pro inflammatory effect.
Enomeytriosis is a really important one because it's such a
quality of life issue and there's so many different ways

(13:46):
it can impact fertility, and no two cases of endometriosis
are going to be exactly alike. It's very unique per individual.
But it's basically a condition where the cells that act
like the innerlining of the uterus that are supposed to
build up and be hormonally responsive and then shed every
month when you get your period, are found in other
parts of the body that they shouldn't be, most often

(14:08):
the pelvic cavity, and we still don't really truly understand
the mechanism of why this happens to some people and
not to others. We know that we all sometimes menstrate
a little bit backwards. It's called retrograde menstruation through the
fallopian tubes. And our immune system is like a janitor
that goes around and kind of recognizes, oh, these cells
are foreign, let's clean them up. But some people's cells

(14:29):
may evade detection by their immune system, and it can
set up shop. And the lining of your uterus is
meant to be a little bit sticky and invasive. It's
meant to receive an embryo and allow it to kind
of burrow its way in, and it can really be
effective at creating new blood vessels. And so what can
happen is is if it's in the pelvic cavity, it
can start setting up shop and becoming hormonally responsive, and

(14:53):
every time you're getting a period, it's stimulating those implants.
And what's really mysterious is that it can be found
in remote locations, like it's been documented in the brain,
in the lung cavity, but most often it's like location,
location location, it's in the pelvic cavity causes really painful periods.
It can cause blockages in the fallopian tubes. It can
make it harder for an embryo to implant, It can

(15:14):
affect egg quality, it can cause your eggs to get
depleted faster. But there are many women that have endometriosis
that go on to have healthy pregnancies without any issue.
But there are some women with mouth cases that end
up having major problems with fertility. So there's a lot
we still don't understand about it. But we know that
a huge mechanism of how it affects fertility is through

(15:35):
inflammatory pathways, and we know there's a lot of information
now coming out about how GLP ones may help with
inflammatory issues in our body in general. So you may
have heard of people saying, you know, my eximo got
better while I was on a GLP one pagonist. They're talking,
you know, about so many different potential off target health effects,
and I wouldn't be surprised if we find out that

(15:57):
there could be a benefit for women with enomytriosis.

Speaker 2 (16:00):
Hearing people or friends coming out with telling me that
they've got endometriosis more than I've heard, you know, in
the past. Maybe just because they're more open about talking
about it. But what are some of the tools, techniques,
the medications, or the holistic treatments that people can do
that you've seen have really helped them.

Speaker 1 (16:17):
Yeah, I think you know, the key is really trying
to lead an anti inflammatory lifestyle. And I know that
sounds kind of woo woo, but it is a real thing.
I've had many patients with endometriosis, and I do think
it's amazing that we're having this conversation. And that's why
you're hearing about it more because more and where women
are going to their doctors and saying, you know what,

(16:37):
I am going to keep probing and asking questions because
it just doesn't feel right that it's so painful. And
I think a huge red flag or hallmark sign that
you could have endometriosis is a history of really painful
periods and then you went on the birth control pill,
you shut down ovulation, you shut down that stimulation, and
all of a sudden that pain went away. That is

(16:57):
really endometriosis until proven other wise. So I have had
many patients who've tried different ways of eating, trying to
adopt a more pro antioxidant type diet like a Mediterranean
style diet. There are some supplements that have been touted
as having anti inflammatory effects and maybe being helpful, and

(17:19):
a lot of this has been studied, but the reality
is is that a lot of the data on supplements
is not from well designed studies, and you're looking at
different types of patient populations, and you don't always know
what you're getting in each bottle of supplements. So I
think it's harder to really put a finger on exactly
what supplements are better for endometriosis. I think when it

(17:39):
comes to medical management, that's usually the mainstay is, well,
let's stop what's driving this, right, And so if someone
says I have debilitating cramps, I've been diagnosed with endometriosis.
And by the way, the diagnosis, the gold standard way
is kind of invasive. You have to have a surgery
where they go through the belly button with a camera
and actually visualize and take a sample of the tissue

(18:01):
that they think looks like endometriosis and send it off
for analysis. That's not very practical to send everyone to
the operating room just to get a diagnosis. And I
think that you can make the diagnosis clinically and say, listen,
it's probably endometriosis. Sometimes you can see it on ultrasound,
But even if you have a clean looking ultrasound with
no signs of it, it doesn't mean it's not there.

(18:21):
It can be insidious in the pelvic side wall. But
a lot of times if someone's not trying to get pregnant,
stopping their ovulation. And I know that's not a popular answer,
and I think a lot of women are very angry
and bitter, and rightly so about maybe ten years prior
twenty years prior, being in their teens and it not
being explained to them clearly. You know, we think you

(18:43):
of endometriosis. This is why we're advising going on the pill.
So I've had a lot of patients who are like,
I went on the pill in my teens. I don't
know why. I've never explained, and now I'm coming off
of it and I'm having trouble with my ability to
get pregnant, and I'm the one diagnosing them with endometriosis,
when in reality, whoever put them on the pill likely

(19:03):
suspected that that was what was going on. So I
think it's about education and trusting women, even at a
young age. To understand complicated things about their body and
making sure people are as informed as they possibly can be.
Sometimes medications isn't going to cut it, and that's where
surgery could have a role to say, Okay, let's have
you go see an endometriosis expert. This is what they

(19:26):
do all day, every day, and they can do it
via a minimally invasive approach and remove those metriosis lesions
and it may help to improve your pain and even
help to improve your fertility.

Speaker 2 (19:36):
Wow, And I know you mentioned regular periods being such
a good sign of you know, good fertility. So is
regular periods? Say? Would you say that if you have
a regular period, you have regular ovulation?

Speaker 1 (19:47):
Pretty much? Yes, But sometimes it can be tricky because
some women will have problems like polyps in their uterus
where they're getting cyclical bleeding or regular bleeding and maybe
mistaking that to be their period. So I think it's
really about having that regular, characteristic period, like you know,
three to five days of bleeding. It's different for different people,

(20:08):
but I think it's not always clear to every patient,
and so I think keeping a menstrual diary and really
writing everything down so you can go to your doctor
with objective data. In general, though, what goes up must
come down. And I always say when you ovulate, your
progesterrial levels rise, and then when they drop, your lining
breaks down. So that's usually why you're bleeding, is because

(20:30):
you ovulated in the preceding cycle. But bleeding can happen
for a variety of reasons. So if anything feels off
or it feels like it's not a normal period, it's
possible that it isn't. And I'd say the first step
is getting a pelvic culture sound to investigate, well.

Speaker 2 (20:43):
The kind of test you think that women should be
doing regularly. Should they be getting the homeless checked regularly,
and if so, what kind of homeland level should they
be asking to get checked.

Speaker 1 (20:53):
I'm not a big believer in you need to go
in every year and check your egg count, but I
think everyone one could benefit from getting it checked at least,
you know, once or twice in their twenties or early thirties.
I am a big believer in getting at least one
pelvic ultrasound, And this is not a guideline based recommendation.
This is just my observation as a fertility doctor who

(21:15):
has seen so many women of varying ages where I'm
often the first one diagnosing problems like fibroids or that
they were born with a uterus that has a different
shape than the average person. And I think that all
too often this is only coming up because they're coming
to me with a fertility issue, and then I'm investigating.
And you see a lot of variation across the board.
You see some women who are going to their OBGN

(21:38):
and every once in a while they get a public
ultrasound because sometimes you have problems going on that you're
only going to see if you do imaging and they
haven't manifested as physical symptoms yet. And then there are
some women that up until they're forties, you know, they've
never had one and I'm the first one doing it.
So it's just not standard across the board. And sure,
maybe it's not practical for everyone to get one ultrasound

(21:59):
per year, but I think at least once in your
twenties or thirties just to say that you've taken a
look at the uterus, at the ovaries and there aren't
any major red flags.

Speaker 2 (22:08):
Yeah, because if you, let's say you're a woman who
has decided to freeze her eggs, and the eggs are
good and good quality, they've said they're fine, But what
other I guess there's so many other aspects of you
may have the egg, but the size, the shape or
size of the vehin of your muterus and all of
that must also impact. And then does it also change

(22:29):
as you get older? Because obviously frozen the eggs, so
that's great, that's there. But does the women's body shift
and change that makes it harder to get pregnant as
we get older?

Speaker 1 (22:39):
To for sure? I mean, every time you ovulate, you
have a cyclical exposure to higher estrogen, and then the
cycle begins again when you go through your next ovulation.
And the more ovulations you have in your lifetime, the
more opportunity for fibroids to grow, for endometriosis to grow.
So it is definitely something that can change over time.

(22:59):
And there is this concept of secondary infertility, which we
don't talk about enough. A lot of women think, Okay,
I didn't have any issues getting pregnant with baby number one?
Why is it so difficult now?

Speaker 2 (23:10):
Right?

Speaker 1 (23:11):
And just because it was easy once doesn't mean it
will always be easy because things can change and evolve
with your body. We know there's the biological clock right
as we get older, it becomes harder and more challenging
to ovulate that healthy egg, and that in and of
itself might be the reason why it's just taking longer.
But of course things can change with your uterus, even
your fallopian tubes. You can develop inflammation where they become

(23:33):
blocked over time even though they previously weren't blocked. So
it's always really important to never take anything for granted
and always reevaluate. If more than a year has passed,
it's time to get a reevaluation if there's a problem,
if you're trying to get pregnant and it's.

Speaker 2 (23:46):
Not happening, and with regass of testing. Obviously this is
a smaller type of test. But do these ovulation kits?
Are they quite accurate for people to use if they
are on the pregnancy journey.

Speaker 1 (23:56):
Yes, they can be. I mean, I think they work
really well for people that have regular periods. What they
are detecting is basically when you ovulate. What's happening is
you have a stockpile of eggs that you're born with
like one to two million, and at any given time point,
a very small subset of them get recruited to the
surface of the ovaries in a process I can't control,
and neither can you. Then your brain, like a lottery,

(24:19):
sends a signal and randomly chooses one of those eggs
to mature and ovulate, and that's your one shot at
getting pregnant. That egg lasts for twelve to twenty four hours,
and if it's not fertilized in that timeframe, it basically
disintegrates and goes away and you have to wait till
the next cycle.

Speaker 2 (24:33):
Right.

Speaker 1 (24:33):
So, when you PI on a stick an ovulation predictor kit,
what you're looking for when it lights up or whatever
the indicator is, is that you're about to ovulate. It's
actually detecting a signal from your brain, your putuitary gland
called LH. So that signal initially will cause you to
mature an egg. It's called follicle stimulating hormone. And then
a second signal goes out called lutinizing hormone or LH,

(24:56):
and that gets into your urine very quickly, and so
that's why we have EP these ovulation predictor kits. Day,
ok And if you see that signal light up, you're like, Okay,
this gives me a twenty four to thirty six hour window,
and it's very beneficial to know about ahead of time
because sperm will wait in the reproductive tract for three
to five days, and so you really want to be
having sex in that three to five day window before

(25:18):
you actually ovulate any attempts after the egg is already
released or lower yield. So it's basically giving yourself a
warning or heads up pay ovulation is about to happen. Now.
The tricky thing is especially for women with polycystic ovary
syndrome PCOS. That's a condition where your ovaries, just like
the insulin resistance we were talking about, there's this overall

(25:38):
theme of resistance where your ovaries are a bit stubborn
and resistant to those signals from the brain, and so
your brain ends up kind of shouting at the ovaries saying, hey,
I need you to work, and that high LH can
become this constant force, and so you might get positive
ovulation predictor kits throughout your cycle and come to me
and say, I don't understand what's going on. Says I'm

(26:00):
ovulating all the time, but I'm not getting my period.
So it might not be the best idea for someone
who knows they have PCOS, who has irregular or confusing
cycles to try diy ovulation predictor kids or ovulation monitoring,
because it could end up being inaccurate and really frustrating.

Speaker 2 (26:18):
Let's get into peacos a little bit, because again, something
that I hear constantly that people around me end up
finding out that they've got. I would love to start
off with what have you found has helped people in
that situation, because the people like I've got family members
and friends with it, and they're on their pregnancy journey
and they're really struggling, and it's a very defeating process. It's,

(26:39):
you know, lose weight, lose weight. They go to the doctor's,
everyone's like, just lose weight, just lose weight, and being
told that even if they try, sometimes it's really difficult
to use the way. And so I would love to
hear from your experience, what has helped people that you've
seen with pea COSS and one of the main changes
that people should be making.

Speaker 1 (26:56):
Yes, So, there are so many different types of polycystic
over e syndrome. There are some women who have just
a smidge of it, but their brain is able to
get through to the over eventually, and they still kind
of ovulate regularly. I will say for most women with pcos,
if they're able to ovulate regularly, then it probably isn't
going to be a huge hindrance to their fertility, right.
But it's for the people that hardly get a period

(27:18):
or they never know when their next period's coming. It
could be every forty five days, could be up to
every seventy days. That's when it becomes really unfair and
unpredictable because you're not getting as many shots on goal
as the person with the twenty eight day ovulation, right,
And so you never know when it's going to happen.
And even if you're someone who could have sex every day, right,
I don't know who those people are, but apparently they exist,

(27:41):
it's still not fair because you're not getting as many tries.

Speaker 2 (27:44):
Right.

Speaker 1 (27:44):
So that's probably the biggest mechanism when we think about
the link between pcos and infertility. But then you also
have this association with ovulation at sorry insulin resistance and
how that may affect in subtle ways and sometimes more
drastic ways, egg quality and the environment being more inflammatory
making it harder for an embryo to implant and stay implanted.

(28:06):
So there's multiple ways that this can affect fertility. But
for the person with really irregular cycles, often, yes, we'll
talk about lifestyle changes, but if you're overweight, you're not
at your healthy set point. Yes, losing weight might make
you more sensitive to insulin, and that might reduce the
interference of the signals to the ovary and help you

(28:28):
to ovulate more readily, but it's often not enough, and
sometimes you do need medication, and there's a medication called letrosol.
It's a pill that basically fools your brain into thinking
there's no estrogen and it cranks out an even stronger
signal and we force the ovary to listen. But it's
frustrating for people, even though I tell them, hey, PCOS
is one of the easiest problems that I treat, because

(28:49):
it's not that you don't have the eggs. It's that
your body doesn't know how to access the eggs, and
we do have ways to force it to access the eggs.
But it seems really unfair that you have to take
a pill for five days, come in for an all ultrasound,
maybe some blood work to kind of gauge what's actually
happening with your body and your ovulation, and it's like,
you know, work to do something that a lot of
people take for granted, being able to on their own

(29:11):
track their ovulation do this without intervention. So something I'm
constantly saying to my patients with PCOS because they get
very worn down very quickly, where they're like, I just
started my journey, and I've been on this journey now
for five months, and you've made me ovulate five months
in a row. That's great, but nothing's happening. What's wrong.
I'm starting to panic. And I always explain to them

(29:33):
human reproduction is so inefficient. When you ovulate one egg,
it's a long shot. We all need to think about
it that way, even in our twenties, not every egg
is going to fertilize, turn into an embryo, and actually implant.
So if I'm just giving you the opportunity to release
that egg, I'm giving you, let's say, a twenty percent
chance of pregnancy each month. I'm just presenting the option.
But whether it actually all happens after the fact after

(29:56):
you ovulate, is largely out of our control. So it's
going to take persistence in time, and eventually if someone
gets really tired by it. We can always say, let's
bypass ovulation. You know, we can do things like IBF,
or we have to take some shots. We extract eggs,
we put the eggs and sperm together outside the body,
We put one embryo in at a time, and we
just say, forget about the ovulation piece, let's just get

(30:18):
you pregnant. But there's a step wise approach, and I
think it's really about educating my patients and arming them
with all of the tools to be resilient because a
lot of this is just like persistence paying off, but
you have to stay in it to win it.

Speaker 2 (30:32):
Yeah, I think it's so difficult for women when you're
really trying and you just don't know when do I stop.
You always, you know with some of my friends that
you just think, well, what if this time will be
at the time totally and it's so hard for them
to know, Okay, well maybe this is the time I
should give up, like five years, ten years, however long
you're trying for. It's so hard to put a stop

(30:55):
to it because you're always live in that hope, because
you also want to believe that your body's capable of.

Speaker 1 (30:59):
That, right and I've seen such miraculous things happen. You know,
when you were asking me earlier, what are some of
your favorite fertility stories. I mean, I was talking to
one of my dear friends today. She's publicly shared her journey,
and I told her I was going to give her
a shout out. But Jordana Abram, she has her own
podcast about, you know, infertility, in her journey with infertility,

(31:20):
and she just had twin girls after a really harrowing
journey with infertility and pregnancy loss. And you know, she
actually kind of gave up on the idea of trying
to carry on her own and pivoted to surrogacy, and
the surrogate got pregnant, and then she wasn't even really trying,
wasn't in the midst of IVF for her own journey,

(31:42):
and miraculously got pregnant. So she just had two babies,
like within the span of weeks, two baby girls, and
they call I guess they're called like twibblings because they're
kind of like twins. But she carried one and the
surrogate carried the other, and it was just so fertuitous.
And it's actually why I called my books Lucky egg
is stories like this that even when the stats are

(32:04):
stacked against you, the odds are stacked against you, You've
tried everything. Sometimes you know, science can get you very far,
but at the end of the day, there is some serendipity,
there is some luck, and you just need one egg
to make it past all those hurdles. And despite all
of the science and the predictions, at the end of
the day, it worked for her. And I think that
those stories give a lot of hope.

Speaker 2 (32:25):
They really do. I think people need to hear those
because there are so many of the other stories and
you need those little glimpses of hope that kind of
get you through the next You know, if you're doing IVF,
the next cycle and the next cycle, there's.

Speaker 1 (32:37):
More than one way to get there. Yeah, And I think,
you know, while you don't always have a clear defined
path and I don't have a crystal ball, trust me,
it would make my job so much easier if I did.
I think that the key thing that I can do
is really coach and guide my patients and give them
my honest, professional opinion about when it's time to pivot,
but also leave the door open for you know, there
is no finality in all of this, Like, you can't

(32:59):
always pret what's going to happen. All we can do
is make the next best take the next best step
based on the information we have at hand.

Speaker 2 (33:06):
Yes, I'd love to get into natural fertility for a
bit and then move on to IVF. But what would
you say, because obviously there's so many things that out
there if you should try this for fertility, and you
should be eating this and doing this. But as some
of the lifestyle changes you think that matter the most,
if there's any that you haven't already mentioned, and which
ones do you think are overrated and don't really make
much of a difference.

Speaker 1 (33:26):
Yeah, I think lifestyle plays a huge role in our
general health and in our fertility. And I think the
best way to think about it is in simple terms,
whatever is better for heart health tends to be better
for your fertility. Right, So when you think about exposures
to avoid, that's the easy place to start. Smoking is
never good for fertility, right, And it's not good for
your health in general. We know that it depletes your

(33:48):
eggs at a faster rate, It is associated with going
into early menopause, and if you're in menopause, it means
you run below a critical threshold of eggs, you're not
able to ovulate. And if you're not ovulating, you're not
in the game. And if it's because of a quantity issue,
there isn't very much that I can do to work
around that. I need eggs to work with, right.

Speaker 2 (34:06):
And you're just born with the amount of eggs that
you keep the whole life.

Speaker 1 (34:09):
Right, correct, and things like genetics age. We know as
we get older we lose eggs at a faster rate,
but also toxic exposures including smoking, can accelerate that process. Drinking, right, alcohol,
especially the threshold that has been kind of looked at,
and the overall pattern that has been establ established is
that less than four drinks in a given week is

(34:31):
kind of associated with better outcomes versus more than four
drinks moderate to heavy drinking. When it comes to diet,
the best diet for fertility is usually the boring one.

Speaker 2 (34:42):
Right.

Speaker 1 (34:42):
There are all these bad diets out there about, you know,
keto or carnivore diet. Anything that's extremely restrictive or very
one sided and doesn't involve a lot of variety is
not something that I would ever recommend to my patients.
And it's shocking how much that is pushed and recommended. Yeah,
you look online, a Mediterranean style diet is always going

(35:05):
to serve your health better, whether it be your heart
health or your fertility. So that means, you know, lean proteins,
healthy sources of fats like nuts, seeds, avocado, eating the
rainbow like this is such common sense stuff, but it's
actually been proven in the data that this seems to
be associated with better pregnancy rates, whether trying on your
own or looking at women who are undergoing treatment. Exercise

(35:27):
is so important, you know, movement is medicine and one
hundred and fifty minutes of cardiovascular exercise per week, but
also resistance training and doing kind of a mix of everything.
But I think building muscle because again that makes you
more resistant to the effects of insulin, which is really
important for your overall health and fertility. Sleep we know
that if you're consistently getting less than seven hours, that

(35:50):
can lead to menstrual disturbances, so it's really important to
be consistent with your sleep routine. And then stress is
a big one, right I'm here to actually tell you
that the day today's stress, you know, the boardroom meeting,
that big deadline. Those aren't affecting your fertility in a
negative way, and we need to stop blaming ourselves.

Speaker 2 (36:07):
Right.

Speaker 1 (36:08):
So many women who go through miscarriages or failed cycles
or they're not getting pregnant trying on their own, they'll
often say, you know, I really need to clean up
my lifestyle. I need to like clear my life of stress.
And I just think that that is a losing battle.
You know, living a stress free life is not really
the goal. I think it's about setting up coping mechanisms

(36:30):
and being able to build resilience so that you can
handle stress effectively and that you don't have unhealthy coping mechanisms.
That's really the key.

Speaker 2 (36:38):
I think, even though you said, oh, you know, it's
all the basic things that we already know. Even if
it is basic, it's so needed to be reminded of
every single day, because yes, of course we're told eating vegetables,
but all we eat all vegetables, And yeah, we're told
to exercise for this many hours, but are we actually
doing it right? A lot of the time, it's the
simple stuff that people struggle with the most. Right is

(36:59):
getting a takeaway and eating something deep fried might be
a lot more convenient but all we thinking on a
daily basis about our hot health, are we thinking about
all fertility and so yes, it sounds really simple, but
if we actually affect on it. Sometimes I think we
hear things over and over again, but oh we've heard that,
but all we actually doing it?

Speaker 1 (37:18):
No, and there's opposite advice out there. R exactly the
number of times I've sat across my desk from a
couple and you know, either partner will be like, well,
he or she exercises five days a week, and I'm like, bravo,
Oh that's a good thing. But there is this narrative still,
and I feel like this was a really really prevalent
narrative like ten twenty years ago, that when women are

(37:40):
trying to get pregnant they should be treating their bodies
so delicately, and especially when you are pregnant, oh god
forbid you exercise. I think we're moving away from that,
and now it's understood that, you know, our bodies are amazing,
and when you are pregnant, it's actually advised that you
should exercise regularly. But there's still this idea of like, well,
you don't want to toast you too much exercise and

(38:03):
that's actually bad advice. You know, being sedentary is actually
so bad for our health, and it's not great for
our fertility either. So movement is good. Movement is medicine,
and we shouldn't be afraid of it. I mean there
are extremes. You know, if someone's training for the Olympics
and in combination, you know, eating very little and there's
a major imbalance in the amount of energy they're taking

(38:23):
in and what they're expending. That can affect your fertility
because it can shut down ovulation. It's almost like your
brain is saying, we're too stressed out, we don't have
enough resources to just keep you alive, Like we're not
going to shunt energy towards ovulation because we don't want
to support a baby right now. That's a very extreme example.
But for someone who's exercising three to five days a week,

(38:44):
that's a good thing and we shouldn't be afraid of that.

Speaker 2 (38:47):
And should women be avoiding high intensity exercises during the
prices of trying to get pregnant.

Speaker 1 (38:53):
I don't think so. I think exercise is better than
no exercise. Maybe, you know, in early pregnancy, it's not
lies to be like, now's a great time to take
up CrossFit. You know, I've never worked out before, but
now I'm gonna enjoin the CrossFit cults. Like I don't
necessarily think that's a good idea, but that's because physiologically,
in the early steps of pregnancy, especially in the first trimester,

(39:14):
your body is adjusting and you have a lot of
progesterone and that can cause your ligaments to be more
relaxed and you're more prone to injuries. So I always
tell patients to be careful when they're doing new things
or easing back into an exercise routine. But the earlier
you get back into it, the easier it is. I
think the longer you go without exercise, it's easier to
become deconditioned, and it's much harder to kind of pick
up in the second and third trimester.

Speaker 2 (39:35):
Because I always hear about how for women, you know,
especially recently Expects saying avoid any woman should be avoiding
high intensity training because it really throws off your hormones
and your courts all. And I guess I was wondering,
what is too intense exactly? Is it breaking a sweat
like she's breaking a sweat? Should we not be out
of breath when we're walking out by now it's really

(39:58):
hard because then as soon as you're told that, yeah,
you think, oh so I should stick to pelosis, Yeah,
stick to going on wolves.

Speaker 1 (40:03):
No, you need to work your heart out right. And
I don't think when people are I think when people
are saying that, what they're really referring to is like
Olympic level training, like where you're really doing something repetitive
and it's not in balance. But I think for someone
who's just like I want to go for a run
for half an hour to an hour a day, not

(40:24):
only is that so good for your physical health and
your fertility, but it's also great for your mental health too.
So this narrative of women, you know they're going through
fertility treatments or they're trying on their own, and now
maybe they're in early pregnancy, and telling them to be
so careful and that they are these delicate beings and
they shouldn't be exercising, it's doing a major disservice to
them because it's not actually rooted in scientific evidence. We

(40:47):
know the scientific evidence actually is saying it's better to
be someone that exercises regularly. But I think it's a
huge problem when it comes to taking away a tool
that so many use for their mental health.

Speaker 2 (40:59):
Yes, and if you think about it tribally, like even
if you go back culturally, back in the day, women
were grinding, like, they were really out there. They were
picking the they were picking the fruits, they were going out,
they were foraging.

Speaker 1 (41:10):
They were doing so much, not working desk jobs.

Speaker 2 (41:13):
Yeah, exactly, they were sitting around for that long. So
I imagine moving your body. All you're really doing is
a one hour to maybe two hours.

Speaker 1 (41:21):
Work, counteracting all of the sedentary other hours of the day.
It's really important. I'm here to say that that's not
a thing.

Speaker 2 (41:28):
Okay, good to know. Are there any foods that you
recommend when someone is starting to try and get pregnant.
Are there any foods that you're like, you know what,
this has actually been found to really help on this
journey or is it generally just the Mediterranean diet.

Speaker 1 (41:43):
It's more the pattern of eating there isn't. I think
one of the biggest fertility myths is that there's this
set formula, whether it be a superfood or you know,
a particular set of supplements that are guaranteed to reverse
the biological clock or a guarantee that you're going to
get pregnant faster than the next person that's not doing
those things. That's not true, right, There isn't a single
thing that falls within that bucket. I think it's more

(42:05):
of a dietary pattern. I think variety is always good,
you know, when you think about the major top nutrients,
like folate is really important from leafy green vegetables. We
also say to take folic acid as part of your
prenatal vitamin because it's actually very important for preventing a
certain type of birth defect that affects the spinal canal.

(42:26):
And that's why a lot of the American diet is
actually fortified with fullic acid. But taking you know, folate
through diet as well as a follic acid in your
supplement Omega threes. These are fatty acids, healthy sources of
fats that you don't produce naturally in your body, and
you can get them from nuts, seeds, salmon. It's anti

(42:46):
inflammatory and it is known to be better for fertility
and for pregnancy health.

Speaker 2 (42:51):
Anify greens for the pholin and healthy fats exactly.

Speaker 1 (42:55):
And then iron, I would say iron and protein are
really important as well. There are many people that are
undiagnosed with iron deficiency and there can be an association
with it making it harder to get pregnant. So it's
something that I screen all my patients.

Speaker 2 (43:06):
Especially in all culture iron and I just had got
some of my block tests back and I was like, oh,
my iron has gotten so low. Iron invismin dy Yeah,
like every time I stopped taking it.

Speaker 1 (43:17):
It just do you live in LA I don't want
to know what my vidy swinter.

Speaker 2 (43:22):
I really need to get back to it. So I
took my IES supplement this morning for you. I wanted
to ask about supplements because you just mentioned them prenatals.
Do you have anyones that you recommend and what's your
view on them?

Speaker 1 (43:36):
So I try to stay away from recommending any particular
brand as a doctor, Okay, okay, because I think it's
important for me to not be biased in that regard.
But always, you know, I think one that contains fulloic acid.
If you go to the American College of Obgyn website,
there's actually a list of nutrients and amounts of nutrients
that are the daily recommended amount for women who are

(43:56):
trying to get pregnant or in the first trimester, and
so whether you're getting that for diet or from supplementation,
I think it doesn't matter how you're doing it, but
it's really important to try to hit on all of
those major vitamins and micronutrients. When you think about other
supplements that have been looked at, first of all, correcting
any known deficiencies. We already talked about it a little

(44:17):
bit like iron. Vitamin D is another one that plays
an essential role in many aspects of human reproduction as
well as early pregnancy health, and so many of us
are vitamin D deficient. So I would say start by
correcting deficiencies. You know, if you have a B twelve deficiency.
A lot of times the earliest sign of these things
is looking at a complete blood count and seeing, okay,

(44:38):
some of your levels are off, and you can indicate
whether you know whether that's actually causing anemia or whether
there's just subtle changes in your complete blood count that
may lead down a further line of investigation to say, hey,
are you deficient in fold eate vitamin B twelve? Are
these things that we can correct with supplementation or changes
in your diet. Coenzyme Q ten is probably one of

(45:00):
the more studied vitamins when we think about supplements for
fertility and it's an antioxidant. It doesn't have the perfect
data that I would love to recommend it wholeheartedly, but
it definitely has a pretty favorable side effect profile, doesn't
seem to have a lot of interactions with medications or
major side effects, and there are some pretty well designed studies,

(45:23):
large scale studies that have shown a relationship between taking
six hundred milligrams of coenz im Q tena day and
higher pregnancy rates and women undergoing treatment. So it's specifically
been looked at for a lot of women who may
be older or are dealing with diminished to varying reserve.
But it's not the end albeit at all, And it's
not something that I'm like, this isn't going to work
if you don't take this, But it's probably got the

(45:45):
most evidence behind it versus some of the others. And
in my book, I have a whole table where and
this was the chapter that the writing almost killed me
because it's really depressing as a doctor, as someone who's
scientifically minded to comb through so much bad data, you know,
I was just like, I can't believe this is touted
to be like the end all, be it all of supplements. Meanwhile,
there's like hardly any human studies, right, So this table

(46:08):
goes through all of the different types of supplements that
have generated any buzz when it comes to improving male
or female fertility, And I put, how is this proposed
to actually help? Because a lot of people are taking
these things without even knowing what is today the proposed benefit.
What is the typical dosage that's been taken and recommended.
What do the studies actually show a lot of the

(46:28):
studies shown really little effect, or you know, are really
poorly designed or have really small numbers. So when you
actually look through it, I think that that gives you
the necessary context and information to make informed decisions. I
will say, there isn't one single supplement that I'm like,
this is vital and if you don't take it, you
know your fertility is going to be doomed. That just

(46:48):
isn't a thing in my field.

Speaker 2 (46:50):
Okay, good to know. I think that'll help with other people.
Do that ease about it?

Speaker 1 (46:53):
Yes?

Speaker 2 (46:54):
I definitely move on to egg freezing, and then we
mentioned it earlier. But first of all, there's obviously egg
freezing and then there is embryo freezing. Now, are is
it two different processes that a woman has to go
through or is it pretty much the same process that
both in tail.

Speaker 1 (47:09):
So it's same, it looks same for the female partner. Okay,
So the first step to egg or embryo freezing, and
these are the two methods that we know of that
are effective at trying to preserve someone's fertility for the future.
The first step looks the same and it involves trying
to go in and capture a bunch of eggs, basically
salvaging them. Remember I said at the beginning that there's

(47:29):
a stockpile of eggs that you're born with. At any
given time point, only a very limited subset of eggs
are allowed to escape from that pantry, so to speak.
And it's almost like rationing. That's why I use the
word pantry, because it's like your body allows you to
release only as many as you can afford to release.
So earlier in your life, when you have more in
your stockpil, you bring more to the surface, and later

(47:50):
in life when you have less than your stockpile. Because
we don't make new eggs over time, you can't regenerate eggs,
then you bring fewer to the surface. Now, when I
do an ultrasound on someone and I'm looking at through
ovaries and I'm counting those bubbles of fluid that we
call follicles, those are the eggs that we're pulled out
of the stockpile, and so counting them only matters if
you're going through a process like an egg retrieval for

(48:10):
fertility preservation or for IVF to overcome in fertility, And
the first step is taking shots. The shots that you
take for eight to ten days approximately are mimicking that
same signal your brain sends to the ovary to get
one of them to normally mature and then later ovulate.
But we have you take those shots at a slightly

(48:30):
higher level in an effort to select everything that's been
pulled out of the stockpile. So the first step is
you want to mature them. And just like when you
have a banana that ripens, it's easier to appeel. When
a follicle becomes larger, the egg inside of it is
more likely to be mature and capable of being fertilized
by sperm one day. So we're bringing you in during

(48:50):
the course of these eight to ten days of shots,
which you're typically taking at home on your own or
the help of a nurse. Right, and then you're coming
in for periodic monitoring visits. These are usually done early
in the morning so that we can get same day
results where we're doing a scan and blood work, engaging
how is your body responding, And at a certain point
we'll say, Okay, it looks as good as it can
possibly get. I think we're going to capture as many

(49:11):
of the eggs as we can. Let's go in and
get them out. And that is a very minor procedure.
It takes ten minutes or less. You're put to sleep
with light sedation through an IV. An antithesiologist is watching
the entire time, and all we're doing is if this
is the vaginal canal going to the uterus, right, the
ovaries sit very low down on either side. Under ultrasound guidance,

(49:31):
we kind of angle the ultrasound this way and we
use a long, thin needle. Under ultrasound guidance, we're basically
popping each bubble and just draining the fluid to pick
up the egg from each one on either side. So
there's no incisions on your abdomen. This is not a
major surgery, and you wake up in the recovery room.
And I'm speaking from experience having gone through this. I
did embryo freezing with my husband at thirty four. I

(49:52):
woke up in the recovery room like I can't believe
it's over, you know, And it felt like the best
nap of my life. I woke up crampy, kind of tired,
went home and slept for five six And that day
they can take the eggs out and we can either
freeze them as eggs, which are as single cells, so
you can actually test the quality. You can just know, hey,
I have some mature eggs, okay, and you can freeze them.

(50:12):
Or if you have a partner or you want to
do this with a sperm donor, we can take sperm
and we can inseminate those eggs. We can put them
with the eggs and fertilize them, let them grow for
a week. And as they're growing, they're separating into two
cell types, cells that become the baby and cells that
would one day become the placenta. That's an embryo that
in plants. We can even remove some of those outer
cells and send them off for genetic testing or not

(50:35):
and freeze them at the embryo stage. But embryos you
can assess the quality because you can do that genetic testing. Okay,
you know that anyone can have an embryo form from
their eggs, even in their twenties that has missing or
extra DNA. These are typos and errors that happen as
part of human biology, and they become more prevalent as
we get older. But that's the advantage of embryo freezing

(50:55):
is that you're further along in the process. Not every
egg that you eventually saw fertilize and try to turn
into an embryo. We'll get there, because again, human reproduction
is inefficient, and that inefficiency isn't magically solid for just
because you're doing this high tech process. So when you
think about freezing eggs, I wouldn't even call it an
insurance policy or a backup plan. I would call it
a head start if and should you ever need IVF

(51:17):
in the future. How lovely is it to be able
to say, well, we have a larger cohort of eggs
and what I'm typically going to be able to get
in one round of effort now at this older age,
and they should have a higher conversion rate from eggs
to healthy embryos because they were from when you were
in your twenties or early thirties versus now, And so
it's not to say every egg will be guaranteed to

(51:38):
be successful. So having enough eggs based on the age
you are when you freeze your eggs is really essential.
And there's a lot of unknowns that you're willing to
accept for flexibility though, because you can come back and
use those eggs with whichever partner once you turn them
into embryos, you're not able to undo that, so you're
kind of committed.

Speaker 2 (51:54):
So you make it sounding much more of an easier
process than I feel, because so many of my friends
have been considering it. But I'm not sure, and it
feels like a scary process. But it's essentially a fifteen
day ish period that you're going through.

Speaker 1 (52:07):
Yeah, and I don't want to sugarcoat it. I mean,
was it the most favorite thing that I ever did?

Speaker 2 (52:11):
Yeah?

Speaker 1 (52:11):
I mean you feel bloated, You definitely have some side effects.
You have some cramps even a few days after the procedure,
but it's not the months and months of shots that
a lot of people assume.

Speaker 2 (52:21):
And there's no negative effects on the body after you've
done it.

Speaker 1 (52:25):
It's no, It's very transient because remember the eggs that
come to the surface, they're always getting thrown away at
the end of the cycle. So this isn't depleting your
egg count, this isn't putting you into menopause faster. This
is us just salvaging what would have already been wasted
in that cycle. And it's not something that is ever
going to affect your future fertility. Even if you feel

(52:47):
bloated and you have some water weight gain, all of
that will dissipate as the hormones leave your body about
two weeks later. You get a period about one to
two weeks after the egg retrieval and everything resets.

Speaker 2 (52:56):
Okay, oh my god. Yeah. Definitely put people to ease
their minds, to ease that this process, because I feel
like it feels like such a big decision to make,
but actually it's just safeguarding as all.

Speaker 1 (53:07):
Yeah, I'm just gaving myself to you to think it's
a big decision, and it's also a big cost, right.
Not everyone has insurance coverage to do this, So I
do think it's a big decision. But I think it's
an important thing to consider and at least learn about
if and should you ever find yourself or if you
think you're someone who might find yourself realistically in a
place where you're trying to build your family in your
late thirties, forties and beyond, then it's a smart thing

(53:30):
to do. I mean, I did this at thirty four.
I had already had a child, but I just felt
really overwhelmed getting back into work and trying to balance
it all. And I said to myself, as a fertility doctor,
I'm going to take my own advice because I don't
see myself being in a place where I'm ready to
try again for another two to three years, and inevitably
I'm going to be thirty seven thirty eight, it could
be a little bit harder to ovulate that healthy egg

(53:51):
that I need to ovulate. So let me do this.
And I'm so glad I did, because I did end
up having secondary infertility. It was harder for me to
get pregnant, and it wasn't surprising as to why, but
I was so I was less stressed, and I felt
really at ease with the fact that I already had
done the hard work of creating the embryos.

Speaker 2 (54:10):
Yes, I would have to move on to IVF. What
do you feel is the biggest misconception that people have
about IVF.

Speaker 1 (54:17):
I think there's a lot of fear. Right so you
already talked about, oh my gosh, how long is this
going to take, how evasive is it, how hard is it?
I think people overestimate that. I think this is there's
this idea of like IVF long haulers, Like there's all
these people that you hear these nightmare stories of oh
my gosh, they've done so many cycles, and sometimes I

(54:37):
think patients feel my patients will say like I want
to try this, but I don't want to be someone
that's doing cycle after cycle left and I'm like, you're
not signing up for that. I mean, you're going to
try this and then let's see what the outcome is
and then make a thoughtful decision depending on how you
felt going through the process, what the results were, how
much progress we made. Is this something we need to

(54:57):
try again. Yeah, some people get what they need out
of the first round off IBF. There are many people
where it takes more than one round because not every
egg that they extract is going to fertilize, grow into
an embryo, and sometimes if you're starting with a small
number or you have significant egg quality issues, you may
end up in a position and I did for one
of my cycles when I was trying to do this
just preemptively where I only had two eggs retrieved and

(55:20):
none of them turned into embryos. And that was a
cycle where I had nothing to show for it. So
that can be really difficult. And I think people sometimes
go into IVF thinking the success rates are really high,
so this is going to be the solve, and they
might be blindsided to find out, hey, it didn't work,
and I need to try this more than once. So
I think it's a balance of don't be so overly
pessimistic and assume you're going to be sucked into this

(55:42):
IVF world where you're just going on this non stop
train of IVF. No, you can make thoughtful decisions. There's
no like you're not like a past exactly, and there
should be an ongoing conversation with your doctor, not just
something that you're like a passive passenger and all of this.
But also it's not always rosy like. Sometimes it takes
time and it's and while science has gotten us very far.

(56:04):
It's not the solf you know, sometimes it takes more
than one round to get there. There's a lot of
fear around IVF and this misconception that it could cause
breast cancer. That's a huge one as well, and that's
just not a thing. You know that the data shows
that there isn't a relationship between women who have done
a round of IVF, even several rounds of IVF, who

(56:24):
have been followed for decades in their lives, they don't
have a higher risk of developing breast cancer. There is
an underlying risk factor where we know that the more
ovulations you've had in your lifetime is related to risk
of breast cancer. And so I think there might be
with a without iv ACT, right, But I think when
people initially used to ask this question, you know, if

(56:46):
you're looking at a population of patients going through IVF,
they might be older at time of first time that
they're trying to get pregnant. So there's a lot of
like confounding variables and things. And when we've looked into
the data, and we've looked to countries like Denmark that
have done a good job of keeping registries and following
long term outcomes. IVF is very safe in the long term.

(57:07):
It's not going to impact your fertility, and it's not
going to impact your risk for things like breast cancer.

Speaker 2 (57:12):
Okay, And are there any helistic treams that you recommend
alongside when people getting IVF, like acupuncture or anything that
you've noticed has helped along that journey.

Speaker 1 (57:21):
I think acupuncture has been a wonderful tool for a
lot of my patients. Now I'm going to be forthcoming
and say that there isn't one singular study that's well designed,
large that's like this really moved the needle and intended
in pregnancy rates for women. But it's certainly not harmful.
And I do know that a lot of my patients

(57:42):
find it very relaxing. They feel like it helps with
stress relief, It helps them feel less anxious. Maybe some
of it is placebo, but you know, the idea is
that it can improve blood flow to certain areas of
the body. This is an ancient form of Chinese medicine.
You don't always know everything there is to know. I've
gone to acupuncturists for migraines, you know, as a Western

(58:04):
medicine doctor. So I don't think there's a downside. I
think if there are things that aren't going to hurt
and could be helpful, even if it's like on a
mental health front, then I'm all for it.

Speaker 2 (58:14):
And why not? Yeah, exactly talking about mental health, I
feel like, you know, we mentioned the women who have
tried and tried and they just feel really betrayed by
their own bodies. Yes, do you have any advice for
women who are trying to you know, we build trust
with their own body after they feel like their bodies
failed them, Like how to rebuild that relationship with their
body off to something like this?

Speaker 1 (58:36):
Yeah, I mean I think the first thing is and
you have to drill this into your brain because trust
me as an expert who tells women this all day
every day. When I went through my own fertility journey,
it was such a human nature knee jerk reaction to
automatically look inward and blame myself. And so I'm here
to tell you it is not your fault. You know,
whatever you're experiencing, it's not because of something you did

(58:58):
or didn't do. And that maybe confusing coming off of
you know, our conversation about lifestyle, but in reality, age
timing genetics play have much more of a weighted role
in all of this than the things that you can control,
and it's not fair. This is a hard thing to
uncouple in our mind because so much of our life
is about the effort we put in and then seeing

(59:19):
the product right, and fertility is not one of those things.
And I think you can set the conditions as much
as you can, you can put your best fit forward
as much as you can, but it can be really
unfair and it doesn't discriminate. So it is not your
fault and you're definitely not alone. One in six couples
have infertility. There are so many women. At least ten
percent of women have endometriosis, ten percent of women have pcos.

(59:44):
There's a reason why we're talking about this so much,
and it's because we're blowing the lid off of all
of these issues. Because I think there's a revolution where
women are like, we're tired of being you know, so
secretive about something and feeling ashamed of our bodies. It's
time for us to openly share and change their because
it really isn't our fault, and I think there shouldn't
be pressure or a rush to heal. It's going to

(01:00:07):
be a natural process. And I think something we don't
talk about enough is, you know, the journeys that don't
end in a baby. Right. We've seen people like Jennifer Anison,
high profile people share that they went through their own
fertility journey where they tried and despite all of their
access and the resources that they had, it wasn't successful.

(01:00:28):
And I think people really lauded that and thought, wow,
if this can happen to her, And this really shed
light on this issue because there is a bias towards
sharing the positive endings, the happy endings, and those stories
because that's uplifting and what people want to hear. But
this doesn't always work for everyone. And I think there
is often a way to overcome issues if you're willing
to pivot, you know, there's usually a way for us

(01:00:50):
to help you get there. But sometimes there can be
really difficult circumstances, and sometimes people aren't open to all
of the different options. You know, it's really your choice,
and you're entitled to the vision of what you wanted
for your family building journey. And I don't think that
it's helpful to tell people, well, you can always use
donor egg, or you can always adopt or you can

(01:01:12):
do surrogacy. It's easier, said, than.

Speaker 2 (01:01:14):
Such an emotional tie to It's so much deeper than
just the baby itself. It's like how you feel about
your own body. It's exact how woman feels her responsibility
is or her duty is. Like there's so much identity.

Speaker 1 (01:01:27):
Yeah, and sometimes you have to do a lot of
work to undo that yes, and realize that you're more
than your fertility.

Speaker 2 (01:01:33):
I think that's really hard, especially in certain cultures, but
just the culture of women, like in society even now,
it's so hard to for women who have been brought
up thinking that this is the n actual progression of
life and this is how it should be, to really
uncouple themselves from.

Speaker 1 (01:01:49):
Them absolutely, and I think the burden shouldn't be on them.
I think it needs to be on society. Right, when
are we going to stop asking women? Are you trying?
So when you start trying, it's like you don't know.

Speaker 2 (01:02:00):
That probably like every time I post it, Oh my god,
I'm not okay, I get it. Yeah, you guys want
to see a baby have your own. Now.

Speaker 1 (01:02:06):
I've become so hyper sensitive working in this field that
sometimes I'm in the line at Starbucks and I'm like
overhearing someone's conversation, just cringing. You know, I think that people,
even who aren't in the fertility journey could benefit from
reading my book because there's a whole section on how
to be a sensitive partner or family member or friend.
Had the best show up for the people in your

(01:02:27):
life that are facing this challenge.

Speaker 2 (01:02:30):
Thank you so much. This has been amazing. I really
appreciate all the insight that you've given, but also just
the hope that you've probably shared with so many people
that are on this journey of whether it's fertility, whether
it's trying to get pregnant. You know, there's so many
steps to this, and I think you've really helped not
just you know, go through it here, but in your book.
It's such a I mean it's a hefty book and

(01:02:51):
it's just filled with so much goodness that's so useful.

Speaker 1 (01:02:53):
I promise it's an easy read.

Speaker 2 (01:02:55):
No it is. It's such an easy wead, but I
really appreciate how in detail it is, Like we need
this because there is so much to it, and I
think it's really important to have all the knowledge you
can possibly have then feel empowered like knowledge is power,
and to have that about your own body as a
woman is just so important.

Speaker 1 (01:03:14):
Absolutely, something we see a lot online is like click beat,
you know, feeling like what the video you're about to
watch is going to answer her and solve all your problems.
And I really wanted to create a resource that actually,
in detail answered people's questions right, And this is this
goes beyond the character limit on a caption or the

(01:03:35):
three minute limit on an Instagram reel. You just can't
give that level of nuance in detail. So that's why
I wrote this book.

Speaker 2 (01:03:42):
Aways a way too precious and complicated to be able
to do it in that amount of time.

Speaker 1 (01:03:46):
Exactly. I think this is like a health class two
point zero and I hope it'll help a lot of people.

Speaker 2 (01:03:49):
Thank you so much, Lucky, I think really appreciate it.
And if anyone listening, go get your copy of The
Lucky Egg Understanding Your Fertility, How to Get Pregnant Now
by Doctor Lucky Second.

Speaker 1 (01:03:59):
Thank you, thank you, thank

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Radhi Devlukia

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Dr. Lucky Sekhon on What Every Woman Should Know About Fertility in Her 20s and 30s