The Fertility Advice Women Need Earlier: Dr. Lucky Sekhon

Episode Transcript
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Speaker 1 (00:00):
The vast majority of assumptions that people make about their
body and how fertility works are often wrong.

Speaker 2 (00:06):
How early would you want women who want to eventually
get pregnant to start thinking about fertility. I think people.

Speaker 3 (00:12):
Should start thinking about fertility in their twenties.

Speaker 2 (00:14):
Doctor Lucky Secon, a board certified reproductive endocrinologist and fertility
specialist at RMA of New York, works with patients and
navigating fertility every day, and in this episode, she breaks
down how fertility actually works.

Speaker 1 (00:28):
Human reproduction is extremely inefficient. The amount of effort you
put in doesn't always equate to a better outcome. We're
only expecting like a twenty to twenty five percent max
chance per month. A lot of times people just kind
of chalk their periods up to this is the burden
of being a woman.

Speaker 3 (00:42):
They're being gas lit.

Speaker 2 (00:48):
Hi, guys, Kate here, thank you so much for tuning
into our conversation today with doctor Lucky. If you are
enjoying post run high, please be shared to follow wherever
you're listening, and we will be right back after this
short break. Doctor Lackysi Khan. I feel like fertility is

(01:10):
one of those things that we don't think about until
suddenly it's all we're thinking about, and in that moment
it can feel like there's a gap between what we
thought we knew and what's actually true. And you guide
people through this every day. So what are we most
commonly getting wrong about fertility before we even start trying.

Speaker 1 (01:31):
I don't mean to sound negative, because I'm actually a
very optimistic, positive person, but I'd say the vast majority
of assumptions that people make about their body and how
it works and how fertility works are often wrong, and
it comes down to just people lacking fundamental knowledge.

Speaker 3 (01:46):
I think it's because it's viewed as.

Speaker 1 (01:49):
Not relevant right for a large part of your adult life,
when you're nowhere near being ready to start trying to
get pregnant.

Speaker 3 (01:55):
It's like, well, why would I focus on that. I'll
worry about that.

Speaker 1 (01:57):
That's a later problem, right, And we think we got
some knowledge in school, but the focus was very different
in health class. It was about avoiding pregnancy, and there
wasn't a lot of focus on what is ovulation and
how do you track it? And what are the different
red flags that can appear over the course of your
life when it comes to your menstrual cycles, and what
could it mean, I mean it was really about contraception

(02:20):
and avoiding and unplanned pregnancy.

Speaker 3 (02:22):
That was really the focus.

Speaker 1 (02:23):
And there's no formalized education, and so people come to
me at all different stages. So people are like, I'm
just here for a fertility checkup. I'm just here because
I have no idea how I should feel about my body,
my fertility, how I should be planning things out for
the future, should I be thinking about egg freezing. And
then I have people who come to me and they're like,
I've been trying for two, three, four years and i

(02:45):
haven't seen anyone because I'm kind of nervous and I'm
afraid about what you're going to tell me and everything
in between, you know, And I think there's a lot
of fear and anxiety and the unknown makes it worse. Oftentimes,
I'd say majority of the time, I start every consultation
with like a full biology one oh one where I'm
drawing the reproductive tract. It's like being in grade school

(03:05):
and I'm teaching people what does ovulation actually mean, what's
happening in the background, and just explaining in a really easy,
accessible way so that they feel Okay, this isn't as complicated.
It doesn't have to be this scary, complicated thing. Even
the biological clock, it's not as scary and complicated as.

Speaker 3 (03:22):
What most people assume.

Speaker 1 (03:23):
It's not a cliff that you fall off of when
you turn thirty five. Your fertility is a continuum. And
I'm not saying that the biological clock isn't real.

Speaker 3 (03:32):
It is real. But I think if you know.

Speaker 1 (03:34):
About it, and you understand the accurate details about it,
you can make real decisions and plan around it.

Speaker 2 (03:41):
With the information that we have now, how early in
an ideal world would you want women who want to
eventually have babies and get pregnant to start thinking about fertility.

Speaker 1 (03:51):
I think people should start thinking about fertility in their twenties, honestly.
I mean, think about our parents' generation, Think about our grandparents'
generation when we're they having children, right, And we always
hear this narrative, and it's especially used to fear monger
on social media, that there have been all these things
in our environment that have shifted, and you know, fertility
as an all time low and we're seeing a lot

(04:12):
more people who need assistance than in prior generations. But
I think the fundamental shift is that people tended to
try earlier, and therefore they didn't really get confronted with
the same issues that we are, right, and so I
think that thinking about it doesn't have to be equal
to actually trying to get pregnant, but just having an understanding, well,

(04:32):
even in a subconscious way, it's going to inform your
decision making. I'll give you a personal example. When I
was a medical student, I thought I knew what I
needed to know to make basic decisions, and I kind
of had this really cocky attitude towards family building. I
was single, and I said to myself and I said
to my friends, I'm going to be one of those
people that starts having kids in their forties and I'll

(04:53):
just freeze my eggs or all freeze embryos with my
eventual partner.

Speaker 3 (04:56):
It'll be fine. And everyone's like, oh, okay, that's cool.
A lot of people weren't.

Speaker 1 (05:00):
Even familiar with what that was. But I knew I
wanted to go into this field. And once I actually
entered this field and started training as a fertility specialist
beyond my OBGYN training where I was delivering babies and
doing general GYN stuff, that's when I was like, you
know what, science is great, but I'm seeing a lot
of people that were really sure about certain plans and timelines.

(05:21):
And I'm understanding now from actually seeing these real life,
day to day examples of people struggling with different things
that you can't always control everything, and science isn't going to.

Speaker 3 (05:29):
Be a perfect solve for every case.

Speaker 1 (05:31):
And that's when I went home to my husband, because
at that point I had just gotten married, and I
was like, I think that I should get off of
the pill, and I think that we should change all
our plans, and like it's probably going to be harder,
and I just think it's better to start sooner rather
than later. We're already married, Like, what are we waiting for?
And he was like what, We had just bought a
one bedroom. He's like okay. And then I ended up

(05:52):
having luckily no difficulty having my first who's turning nine
this weekend. But then I realized in some of the
testing I had done, just being a fertility doctor and
wanting to be proactive, I had a lower egg count.
And even though I know that that has nothing to
do with my egg quality or my ability to ovulate
a healthy egg. We only ovulate one egg per cycle,
it still gave me pause because I thought to myself, well,

(06:13):
what if I run into trouble and I need IVF
and then my egg count's even lower later down the line.
And I also felt really overwhelmed by being pregnant and
then a new mom going back to work after seven
weeks after a C section. That's the life of an obgan,
and I was like, I can't do this anytime soon.
So I actually made the decision to be proactive and
freeze embryos with my husband. But my point in telling

(06:34):
you all of this is I know that my decisions
were shaped by my awareness and the fact that I
had the knowledge, and so I don't think that it's
ever too early to get the fundamental knowledge. I wrote
my book The Lucky Egg as kind of a fertility bible,
And my hope is this can be the thing that
fills the knowledge gap and can be the health class
two point zero and that formalized education that we've all

(06:55):
been missing.

Speaker 2 (06:56):
Yeah, and I think for those of you listening that
are in your twenties that maybe don't have a serious
partner yet but know that that is something that's coming
in your future. I hope that coming out of this conversation,
you can be a little bit more proactive about figuring
out what's going on in your body and getting to
know your unique situation.

Speaker 1 (07:13):
Yeah, and there's so many different ways to build a family.
Something I'm seeing a lot of nowadays is people coming
in and saying, you know what, I thought I needed
to wait for the perfect partner, perfect relationship, or situation.
And I've realized that it's a really important personal goal
for me, a life dream to have a child. And
I've realized that I'm enough. I don't need a partner

(07:33):
to do that with. And that's a really strong personal choice.
It's one that I respect immensely. It's one of the
most rewarding things that I've done in my career is
help women navigate that path. I've even helped men navigate
that path. And so I think the world has changed,
expectations have changed in society. Not everyone has to want
to have children, not everyone has to have a partner

(07:54):
to have children, And there's so many different ways that
it can look. But the key is you have to
have the right information so that you're making the right
decision for you.

Speaker 2 (08:01):
So, say somebody comes to you in their late twenties,
early thirties and they say, you know, I want to
get pregnant in the next three years, five years. What
can they start doing now, What can they start learning
about their cycle, about their body that will help them
in the long run.

Speaker 3 (08:16):
Well, that's a great question.

Speaker 1 (08:17):
I think there's a lot of anxiety around being on
birth control right now and a lot of misinformation about it.
There's nothing wrong with being on birth control. So if
you've been on long term birth control pills and IUD,
this is not something that's going.

Speaker 3 (08:29):
To affect your fertility.

Speaker 1 (08:31):
Once you remove that block to your ovulation, or you
remove the IUD, which is essentially working by preventing sperm
from getting to the egg, all of that effect is
reversed and your fertility is restored. But I think a
lot of people willy, Okay, should I be off of
the pill for years? Should I be tracking my natural ovulation?
A lot of people don't realize when they're on the pill,
that's not a real period, and that's okay.

Speaker 3 (08:52):
What you're doing is you're giving.

Speaker 1 (08:53):
Yourself small amounts of hormone and then you're taking it away.
If you're taking that week of placebo pills that aren't
actually medication and then your lining breaks down with the
withdrawal of those hormones, and so it's not coming from
ovulation like a regular period when you're not on the
birth control pill. Where that's coming from is you have
a bunch of eggs that kind of float to the
surface of the ovaries each month and a process we

(09:15):
cannot control, and your brain sends a signal to the
ovary and one of those eggs randomly gets selected to ovulate,
and that's your one shot at getting pregnant, and if
it doesn't happen, then that egg goes away, the hormone
levels drop, and you get a period.

Speaker 3 (09:27):
So if you're someone who's not on.

Speaker 1 (09:28):
The pill, it can be very useful to track your cycles.
If you're on the pill, it's not bad to track
your cycles, but it's less useful, right, because you're just
kind of tracking something that's an artificial phenomenon. But if
you're tracking your cycles and you're not on the pill,
there are things that you can learn, right just by
understanding the frequency of when you get a period, that's
going to tell you how often you ovulate, because that

(09:50):
period's coming on because you ovulated an egg in the
two weeks prior, and so if you're someone who's like
I never know when I'm going to get my period,
that's something you should figure out now in your twenties
and your thirties because the most common cause of that
are conditions like PCOS polycystic ovary syndrome. Ten percent of
the population has this, and it's an issue that can

(10:11):
also relate to your metabolic health. So it's not just
a fertility thing that you only need to worry about
when you're ready to start timing when to have sex
because you want to get pregnant. It also is something
that can increase your long term cardiovascular risk, your long
term risk of things like diabetes. It can often be
concurrent with symptoms like I keep gaining weight no matter

(10:32):
how hard I'm training or eating well, and it's a.

Speaker 3 (10:36):
Real source of frustration.

Speaker 1 (10:37):
There can be skin and hair changes, So paying attention
to your body and all the changes in your body,
not just with your period, but throughout the cycle. How
does it affect your mood, How does it affect you know,
your day to day ability to function? Are you having
painful periods? Are they heavy? All of these can be
underlying symptoms of major gynecologic conditions, whether that be PCOS

(10:59):
or endometrio. That's a big cause of pelvic pain, and
we're talking about it a lot more now, which I'm
very happy about. But it takes an average of eight
to ten years to get an accurate diagnosis. Every day
I talk to women where I'm like, has anyone ever
told you you might have endometriosis? Because they're just mentioning
it to me casually when I'm taking their medical history.

(11:19):
They've had these debilitating periods and that's why they started
the birth control pill.

Speaker 3 (11:22):
And then they went away.

Speaker 1 (11:24):
That's really relevant information. So not only should you pay
attention to what your cycle's doing now, but especially if
you are maybe inadvertently treating something by being on the
birth control pill, which is not a bad thing.

Speaker 3 (11:35):
It's good.

Speaker 1 (11:36):
You're inadvertently treating something, probably you need to think back
to why you went on it and what were your
symptoms back then, because that can unlock really important clues
to you know, things that could impact your future fertility.

Speaker 2 (11:48):
And I feel like there are so many people like myself.
I remember I went on birth control when I was
in high school. Yeah, and luckily I had wanted to
go off of it kind of post college. Yeah, for
no reason other than wanting to see if I could
regulate my hormones on my own, because I knew that
I had gone on it to kind of mask my
acne symptoms, right, And so then I went through this
process of getting off of birth control and just seeing

(12:09):
what would happen. But for people that maybe don't know
what symptoms are being masked, what would you say to them?

Speaker 3 (12:16):
I mean, I would say, look out for painful, heavy,
irregular periods.

Speaker 1 (12:21):
Also if you feel like you have hormonal acne, or
you start to feel like you're having hair growth in
places that traditionally women shouldn't have as much hair growth,
like on their face, on their chest, on their back.
And also hair thinning where you wouldn't traditionally have it.
They call it male pattern boldness. So having thinning in
the corners here, that can all be related to a
condition called PCOS right, And what that essentially is is

(12:45):
like your brain is trying to get your ovaries to
listen and they're not listening. And there's an overall theme
of resistance to signals, So also resistance to insulin, which
is how our body stores blood sugar effectively you end
up turning out more insulin, and that is the root
of a lot of problem. It's pro inflammatory. It can
cause your ovaries to overproduce testosterone and that's when you're
getting a lot of the skin and hair manifestations. And

(13:07):
it also can cause mental health issues too. A lot
of people feel so vindicated when I tell them this.

Speaker 3 (13:12):
I'm like the depression and.

Speaker 1 (13:14):
Anxiety and the sleep disturbance because it can also be
associated with sleep apnea.

Speaker 3 (13:18):
So it's so much more than fertility. I mean, people always.

Speaker 1 (13:21):
Say your period is your fifth vital sign when you
think about pulse, blood pressure, temperature, your respiration rate, and
I do think there is something to that. I think
a lot of times people just kind of chalk their
periods up to this is the you know, this is
the burden of being a woman. This is just how
it's always been, and they're normalizing it for themselves.

Speaker 3 (13:38):
And they're also sometimes having their symptoms and complaints. They're
being gas lit. They're not always being listened to.

Speaker 1 (13:45):
And I think that the medical field needs to do
better in terms of listening to women and really prioritizing
not just you know, diagnosing them and treating their pain
and their quality of life issues, but also putting real research,
heft and effort behind getting ants and finding better ways
to treat women.

Speaker 2 (14:02):
So when somebody comes to you and they're looking to
start their fertility journey, what is step one for you?

Speaker 1 (14:08):
So usually they're coming to me either if they aren't
trying yet but they want to think about fertility preservation
for the future, or if they've been trying on their
own and it's not happening. And so usually the guidance
is track your cycle, figure out when you're ovulating. If
you have a regular interval between your periods, it's going

(14:28):
to be easier to kind of predict when your ovulation
is coming and you don't have to do all the guesswork.
You could plug it into an app, right, and it's
going to kind of model out, Okay, this is when
you're typically ovulating in the next cycle, so that you
can actually know, all, I have this runway of time
to put an effort, and let's try to have sex
in that five to six day window leading up to ovulation,
and that's going to give me the best chance of

(14:50):
sperm and egg meeting. And knowing that it's very much
like playing slots, right, like pulling the lever of the
slot machine is akin to timing when you're ovulating and
having sex right before that time. The rest of all
of that is left up to chance. We don't know
if every egg that you ovulate is we know not
every egg that you ovulate it's going to fertilize successfully.

(15:11):
We don't know if that fertilized egg is capable of
turning into an embryo and traveling to the uterus, and
if it's a healthy embryo. There's a lot of what ifs,
and it's like everything has to line up. And this
is one of the fundamental things that people don't realize,
and they often get very dejected very early in the
process of trying to get pregnant. Human reproduction is extremely
inefficient at best in your twenties. And if you're in

(15:32):
your twenties and you're hearing this, know that you are
presumed to be in the it's as good as it
gets phase of your fertility and your egg quality. But
even still, when you pull that lever of the slot machine,
we're only expecting like a twenty to twenty five percent
max chance per month.

Speaker 3 (15:48):
This is why it is normal.

Speaker 1 (15:49):
It is the one time, we'll all say, you know
that saying the definition of insanity is doing the same
thing over and over and expecting a different result. That's
actually not applicable here. That's my whole life as a
fertility doctors, encouraging people and saying, listen, it's only been
three months. You can't expect a twenty percent chance per
month to finally, you know, to hit the jackpot after
three times. So it might make sense if you're under

(16:11):
thirty five, especially if you're in your.

Speaker 3 (16:13):
Twenties, I think you have time to be persistent.

Speaker 1 (16:15):
And I think if it's been longer than a year,
that's when it's the official guideline that you need to
see an expert like me. And if you're thirty five
and older, don't wait longer than six months. And if
you're in your forties, I don't think that this is
overly proactive. You should see someone at the three month mark, right.
The reason that that guidance exists, those guidelines exist is
because we know that our ability to randomly ovulate, because

(16:36):
it is very random, like a lottery, you ovulate one egg,
the chance of that egg being genetically normal and healthy
and having what it takes to turn into a baby
starts to dramatically shift in a negative direction over the
age of thirty five, but.

Speaker 3 (16:49):
It's never perfect for anyone.

Speaker 1 (16:50):
So like in our twenties, even then, some eggs that
we ovulate just don't have what it takes. But that
becomes a more prevalent issue, and it becomes kind of.

Speaker 3 (16:58):
The exception to the rule to ovulate a healthy egg
as we enter our forties.

Speaker 1 (17:03):
Having said that, we still do have normal eggs in
our forties, and so it's kind of like when people say,
what do people need to know about their fertility, I
always say, it's never the extreme thing that you know,
you should get pregnant in the first couple of tries,
or you know, if you're in your forties you don't
have any good eggs left. It's the truth is somewhere
in between. People get pregnant and ovulate a healthy egg in.

Speaker 3 (17:26):
Their late thirties their forties.

Speaker 1 (17:28):
But it's important to have a plan and give yourself
a shorter runway of time so you can be really proactive.

Speaker 2 (17:32):
And I feel like sometimes like I know for myself,
when I first went to my doctor and I said, Okay,
we're going to start trying to get pregnant, and she
kind of gave me that year marker two, as you know,
you're going to try for the year, see what happens. Yeah,
I remember thinking, oh my god, a year I now.

Speaker 3 (17:46):
Yeah. I mean, it's never wrong to see someone sooner.

Speaker 1 (17:50):
And I always say you don't have to follow any
rule book, and if you have irregular cycles, I mean
you should skip all those steps because if you don't
know when you're ovulating, you're not really in the game.
What I mean when I say that is when you ovulate,
that egg lasts for twelve to twenty four hours, and
if it's not fertilized in that timeframe, it basically goes
away and then you have to wait.

Speaker 3 (18:07):
Till the next attempt.

Speaker 1 (18:09):
So if you never know when that's about to happen,
even if you're someone who has sex every day, which
I don't know who those people are, but even if
that was true, this is still extremely less efficient because
you're not getting as many shots on goal as the
person with the clockwork every twenty eight.

Speaker 3 (18:25):
To thirty day cycle.

Speaker 1 (18:27):
So if that's you, you should go straight to a
fertility doctor because we need to a figure out why
your cycles are irregular.

Speaker 3 (18:33):
Correct those underlying disturbances.

Speaker 1 (18:35):
However, we can, whether that be through recommended lifestyle changes
or with the help of medications right and come up
with a strategy or an approach, because otherwise you're just
you're going to end up wasting a lot of time
and you're going to be very frustrated and at home
trackers like peeing on the ovulation predictor kits, You're going
to get a lot of false positives because you're picking

(18:56):
up this false signal where your brain's just yelling at
your ovary telling it to hey, I want you to ovulate.
I want you to listen, and you're going to often
pick that signal up and think you're ovulating when you're not.
So I think get plugged in with experts early if
anything is off about your cycle, whether it's whether it's
a regular, whether it's painful, and not only if you
have a diagnosis of problem like endometriosis, because a lot

(19:18):
of people go undiagnosed. Oftentimes, I as the fertility expert,
the specialist, am the first person to tell someone that
they have something going on with their uterus or their ovaries,
something that could be the underlying cause of their infertility.
We're not doing a standard ultrasound on all women as
they enter their twenties. It's just not a standard of
care thing. And maybe my perception is skewed from all

(19:39):
the things that I see, but I'm kind of like,
what's the harm? Why aren't we doing that? And there's
such a variation, like some women are like, yeah, I
get one of these every year when I go for
my annual or I've had one one or two, you know,
in the past five to six years. Whenever I had
a complaint, my doctor would do it. And then there
are some women that come to me in their forties
and they're like, oh, I've never had this time.

Speaker 3 (20:00):
What is this? And I'm like, no one's ever looked
at your universe or your ovaries. That's kind of crazy
to me.

Speaker 2 (20:15):
I was somebody that had, you know, all these weird symptoms,
like I've always had acne, I had irregular hair on
my chest, Like I had all of these signs of
what is PCOS, Yes, but I had never gotten tested
for it. And I remember I had been on acutane
twice and my dermatologist had said, like, after the acutine
kind of failed a few times, she was like have
you ever gotten tested for PCOS? And of course, like

(20:37):
I just kind of said no and almost like shrugged
it off and was like, Eh, I don't know what
that means. I'll deal with that at some point. But
it wasn't until starting my fraternity journey that I realized, oh,
I actually have PCOS and this probably is something that
I'm going to have to figure out in order to
have a healthy pregnancy.

Speaker 1 (20:52):
I think the important thing to know about PCOS is
that anytime in medicine you have something that requires nuance,
where there's a spectrum of ways that it could present,
it's always going to be more likely to fly under
the radar, right, and it's more insidious. And it's because
I think it's human nature to be like, Okay, this
is what I learned in medical school. This is what
the textbook picture of PCOS looks like. It's someone who

(21:14):
struggles with their weight. And a lot of women with
lean PCOS are misdiagnosed as a result. And you know,
as a fertility doctor, I'm much more familiar with pcos
than the average clinician, and so I think it is
a major source of frustration. A lot of women come
to me to talk about egg freezing, and then they
leave and they have a new diagnosis of PCOS or

(21:35):
fibroids or endometriosis. But it's really important. And I always say,
if I see something, I'm going to say something. I'm
not going to just focus on the reason that you
came to see me, because this is fundamental information about
your body that you should have already had.

Speaker 2 (21:46):
Are there any wearables that you recommend people to kind
of start wearing or using when they're trying to get pregnant?

Speaker 1 (21:52):
Wearables are tricky because most of them are detecting temperature changes, right,
So when your temperature rises by like half a degree,
what that's telling you is now you have gone from
estrogen dominance.

Speaker 3 (22:04):
In the first half of the cycle. Your ovaries are.

Speaker 1 (22:07):
Pumping out estrogen and increasing amounts starting from when you
get your period, and then you start recruiting a new follicle,
which is a bubble of fluid that contains a maturing egg,
and then that's the one that bursts and releases the
egg that you ovulate. That's when you have like peak estrogen,
and only after ovulation is progesterone starting to rise, and
that progesterone actually causes your blood vessels to.

Speaker 3 (22:27):
Dilate or relax.

Speaker 1 (22:29):
Your body temperature changes just in a subtle way. And
so when you have a wearable or you're doing the
basal body temperature tracking, that's another form of cycle tracking.
You're detecting that rise in estrogen, and that's telling you.
It's like a confirmatory sanity check of source where you're like, okay,
this means that now my body is.

Speaker 3 (22:46):
Being affected by progesterone. But remember what I said.

Speaker 1 (22:49):
You really need to concentrate your attempt of when to
have sex and when to try in a given ovulatory
cycle in the two to three day window that's like
the tighter window, but even the five to six day
windows leading up to ovulation, because sperm gets into the
reproductive tract and we'll sit around and linger for like
three to five days. The egg will not wait around
for the sperm. So in order to get maximum chance

(23:12):
for a meeting to take place, it's really about doing
it before. So if you are detecting your temperature rise,
that's not super helpful to be like, okay, in this cycle,
now it's going to inform when I should try. It's
already too late, so I think if you have a
really regular cycle and you're always knowing your temperature goes
up during a certain part of the cycle, then you
can kind of use that information to understand when you
generally are ovulating. But I find it less helpful. I

(23:35):
think that, you know, wearables can make you more aware
of your habits, and if I think we're so busy
and we're in such a state of just like rushing
to the next thing, that it's very easy to forget
about some of the basic things that we know have
a major impact on our health, like getting enough sleep.
So like for me, wearing an aura ring was helpful

(23:56):
to kind of be more mindful about my sleep patterns,
and I could kind of also start to see a
pattern between like when I was looking at my screen
right before bedtime, or I drink you know, caffeine later
in the day and then I had a more fitful sleep.
So that's how I think of trackers in terms of
fertility tracking. It if it is plugged into like those
apps that you're also plugging in the first day of

(24:18):
your menstrual cycle, maybe like in a layered effect, it
can give you more accurate information that's a little bit
more granular but I think it depends if you're a
data person. I have some patients that come to me
and they're like, honestly, I'm getting driven crazy by the
data overload, and they feel so relieved when I tell them, listen,
I can just do monthly you know, blood work and
ultrasounds because your case is a bit more complicated. You

(24:40):
have pcos and these home trackers are probably not great
for you because you're getting a lot of false signals.

Speaker 3 (24:45):
And they're like, thank God, because this is too much
for me, you know.

Speaker 1 (24:47):
So I think if it's overwhelming you, then you don't
need to incorporate it into your regimen.

Speaker 2 (24:52):
When it comes to cycle tracking, Yeah, I like that.
I think of that too with fitness. Sometimes it's like
either you're a data driven person when it comes to
like cutting Macro's micros, or you're somebody that just wants
to be told, like how many minutes a day do
I have to work out?

Speaker 3 (25:05):
What should I be doing? I'm in the ladder camp.

Speaker 2 (25:08):
I always feel like people that are more sciencey too,
are like the what they would be the more data?
Are you not more data driven with like how you
work out?

Speaker 1 (25:16):
I am, but I feel like I'm so cynical about
like I feel like I have. We all are overloaded
all the time with information, and so I'm kind of
like a less less is more type person. I'm like,
just show me what's relevant, you know, And I think
all of the excess noise, I find it frustrating.

Speaker 2 (25:35):
Also, it's figuring out what works for you and you
know your body.

Speaker 1 (25:38):
Yeah, I think with the ORR ring, for me, like
the sleep was the most illuminating part of it.

Speaker 3 (25:43):
But I don't know.

Speaker 1 (25:45):
I think that there's good and bad to it. I
think a lot of times people get really fixated, and
there's a huge mental health component to the trying to
conceive journey, and I think sometimes we can get mentally
very fatigued, and we should probably overestimate that from the
get go to avoid even hitting that wall, because that's

(26:06):
what leads to a lot of people dropping out of trying,
whether they're trying on their own, and then.

Speaker 3 (26:10):
They're like, Okay, I just need a break, right, And
I think breaks are good for you.

Speaker 1 (26:14):
But sometimes people go away for like a year or
two when they had complicated issues and they actually needed
treatment for really legitimate problems that we knew were at
the root of their infertility and the reason for you know,
those long pauses are mental burnout. And you know people
sometimes drop out of treatment and don't return, and you know,
as a fertility expert, this is a couple or this

(26:37):
is an individual that could very likely be successful. We
just need to be more persistent. And so I think
protecting your mental health is important.

Speaker 3 (26:44):
So I talk about that a lot in my book
and with my patients.

Speaker 1 (26:47):
You know, I think about the patient that has thirty
different supplements like littered all over their bathroom counter. I mean,
that's exhausting. Can you imagine taking that many supplements per day?

Speaker 2 (26:56):
I can, because I did do it for a PCOS
and I do think it worked.

Speaker 1 (27:01):
Yeah, I mean there can be something to certain supplements,
for sure, But I think a lot of times people
grind their gears and it's like, I think keeping things
simple and really trying to focus on the big picture
is so helpful to your mental health. And I think
if you're someone where the data makes you feel more relaxed,
because you're like I just need more to feel like
I'm as informed as.

Speaker 3 (27:21):
Possible than great.

Speaker 1 (27:22):
I think whatever works for you, but you don't have
to do all the things I think when you enter
the world of trying to conceive, especially if it's been
a while, if things are starting to get more complex,
if you're going on Reddit, you're starting to enter the forums,
it can feel like everyone's speaking a different foreign language
and there are all these people that you are using jargon,
and you feel like you're like an alien, you know.

(27:44):
And I think that a lot of patients feel that way.
They're like, oh my gosh, I feel like I should
be doing like fifty different things and I'm not doing anything.
But this is one of those areas where the amount
of effort you put in doesn't always equate to a
better outcome. And that doesn't mean we throw up our
hands and don't try, but I think we really have
to be mindful about where we put our efforts because
there's only so many hours in the day and only

(28:05):
so many things we can be focusing on. And it's
like a marathon, right if we're talking about running today,
It's like, this is not a sprint. This is, for
so many people, a marathon, and you need to be
able to stay in.

Speaker 3 (28:16):
It to get to the finish line.

Speaker 2 (28:17):
Yeah, And I think it's so important to remind people
that because I mean, I have so many friends that
are on different varying fertility journeys, from people that get
pregnant in the first month to people that have endometriosis,
and it is taking a little bit longer. But everybody's
journey is different. So I'm curious from that perspective, what
advice do you give to patients to manage kind of
the mental stress of it, because I feel like so

(28:40):
much of even being pregnant and trying to get pregnant
for a woman is having to like compartmentalize it.

Speaker 3 (28:47):
Oh one hundred percent.

Speaker 1 (28:48):
Yeah, I mean, and especially if your journey is more
complicated and it involves fertility treatments, compartmentalization is your friend,
because I think it's like looking at a whole mountain
and being like, oh my.

Speaker 3 (28:59):
God, there's the peak of everest.

Speaker 1 (29:00):
It's like, that's so daunting. I think to say, like,
this is where I need to sum it. I need
to get through the retrieval and then I'm going to
have a little rest stop and then I'm going to
wait for these results and then the next step is
preparing for the transfer or maybe do we need to
do another egg retrieval?

Speaker 2 (29:15):
Right?

Speaker 1 (29:15):
So I think just kind of having like your small
baby steps type goals. Also, I love what you said
about everyone's on their own journey. I think comparison is
the thief of joy. That is a very true statement
when it comes to fertility journeys. And I think there's
something great about people sharing their story. I think it
helps others feel seen and less alone, and it's.

Speaker 3 (29:35):
A wonderful community.

Speaker 1 (29:36):
It's like the worst club with the best members because
everyone shows up for each other, strangers on the internet
who will never meet in real life. People really care
about everyone's success in journey. But I think there is
a double edged sword to that because it's always like, well,
why did you know? Why did it work for them?
And I did all these things.

Speaker 3 (29:54):
I did these surgeries, I did these procedures, and I'm
still kind of stuck in the same place.

Speaker 1 (29:59):
So it's a little tricky and it requires so much
mental fortitude, and I always say over prepare.

Speaker 3 (30:05):
I have a whole.

Speaker 1 (30:06):
Mental health tool kit in my book. I talk about
mental health through every chapter because I believe the mental
health struggle and journey.

Speaker 3 (30:12):
Associated with issues like a.

Speaker 1 (30:14):
Pregnancy loss is very different from someone who's like I'm single,
I've been told I just have endometriosis and I have
a lower egg count, and you know, there's different stressors
in all of that, and I think those mental health
aspects have to be addressed.

Speaker 3 (30:28):
In a very unique way.

Speaker 2 (30:29):
Mm hmm. Yeah. And I feel like women we need
to we need to just be comforted in those situations too,
and just feel like we're not alone, because I feel
like pregnancy can feel so alone and there's so much
blame involved, like we everybody. It's like somebody has a miscarriage,
and then I feel like, what I do?

Speaker 3 (30:47):
Right, what did I not do?

Speaker 1 (30:49):
I mean, I hear my mom talk about all the
time she had my brother at twenty.

Speaker 2 (30:52):
Five weeks, oh wow, and it was you.

Speaker 3 (30:55):
Know, he's my younger brother.

Speaker 1 (30:56):
It was her last child, so she was older, she
was almost forty. I'm sure her age was a risk factor, right,
But she's always like I was working too much, Like
she still talks about it. I think there's so much
trauma and self blame and shame, like there's so much
to unwrap, and we just as women need to be
easier on ourselves. I mean, so much of the locus

(31:16):
of responsibility in control is placed on us because we're
often the one carrying the pregnancy. Also, we have this
pesky biological clock where everyone knows we're not making new
eggs and that there's this age related decline in egg
quantity and quality.

Speaker 3 (31:30):
Men don't have.

Speaker 1 (31:31):
They don't fall under that same scrutiny because there is
this feeling that they're invincible. Right, They're always making new sperm.
Every seventy four days, new sperm cells are generated. This
is why we know older men can fother children. But
is it benign? No, there are risks associated with it,
and fifty percent of couples who have infertility there's a
male factor. And so I think that so much of

(31:54):
the focus tends to be on what can a woman do.
Everyone's talking about trimester zero on social media right now,
which which is this concept of you need to concentrate
for about three months the length of a trimester before
getting pregnant. I'm being perfect, and it's just not realistic.
I think it's a good goal to be the healthiest
version of yourself, to control chronic medical conditions, to switch

(32:15):
from any pregnancy unsafe medications to alternatives that are treating
any underlying chronic medical conditions that we know are safer
in pregnancy and get stable on that before getting pregnant, right,
So always better to kind of prepare ahead of time,
you know, getting healthy in terms of our behaviors and
the things we're avoiding, eating well, exercising more. Pretty much,
anything better that's better for your heart health is better

(32:37):
for fertility. I'm not discounting all of that. I think
that's really critical. But I think feeling like you have
to live in a bubble, that you can't use deodorant,
that you have to switch every cleaning product in your house, like,
I think that a lot of that is based on
magical thinking. A lot of it's based on junk science
or you know, salacious clickbait headlines, and it's making people

(33:00):
afraid to live their lives and it's robbing them of joy.
And I think it's the wrong thing to focus on,
you know. I think it's tricky because I'm not saying, like,
you know, warm up your food and plastic it doesn't matter.
I think that we do need to be mindful of
our environment, but we cannot control everything, and I think
that you do have to relinquish some control and realize

(33:20):
what levers like which levers to pull that are actually
going to make a difference that are worth concentrating your
effort on.

Speaker 2 (33:27):
If that makes sense, Let's talk about trimester zero, because
you're so right, it is taking on a life of
its own on social media. I've heard it referred to
as trimester zero and then also training for pregnancy. So

(33:48):
what should a man and a woman both be doing
in trimester zero?

Speaker 1 (33:52):
I actually like the concept of training for pregnancy because
it's exactly what it is.

Speaker 3 (33:58):
Right.

Speaker 1 (33:58):
Like when I think about a patient who sits in
front of me and a lot of people come to
me and we have these like preconception counseling moments where
I'm like going through their medical history and trying to
understand is there any chronic health issue that a hasn't
been diagnosed and isn't under control or that could be
optimized better. Oftentimes I'm talking to their specialists, Like I
think that it's a really good thing before you start

(34:20):
trying to get pregnant, to ask yourself, are you up
to date on all your cancer screening? Right because pregnancy
hopefully is a nine month long process, and during that
time there can be limited options in terms of certain
tests that can be done. For instance, you're not going
to do a biopsy of the inner part of the cervix, right,
So if someone has an admirable PAP smear before I'm

(34:42):
doing any sort of fertility treatment to get them pregnant,
I'm like, Hey, if you're due for a PAP shortly, like,
let's just get that done now to make sure. If
there's any intervention that we otherwise wouldn't be able to
do or wouldn't be recommended or safe from pregnancy, I'd
rather get that out of the way now so that
we know you're safe.

Speaker 3 (34:57):
Right.

Speaker 1 (34:57):
So, really prioritizing the person who's going to be caring
their health above all and making sure that they're good,
you know, and that all issues are kind of tucked,
and then like what is the lifestyle?

Speaker 2 (35:09):
You know?

Speaker 3 (35:09):
And I think people don't talk enough about sleep. The
role of sleep.

Speaker 1 (35:13):
Sleep plays a huge role in our hormone health, and
I think it's really important to be consistent with sleep.
A lot of people have sleep disorders that have yet
to be dealt with. I think, you know, what we
eat matters, and so really trying to clean up our
diet and eat more of a variety of you know, vegetables,
and fruits the cell sounds very common sense, but I

(35:33):
think it's important to cut down on processed foods and
foods that are inflammatory and focus on a Mediterranean style diet.
A diet that would be better for heart health is
always going to be better for fertility. Not drinking, you know,
because this is something you're not supposed to be doing
during pregnancy and for a good reason, and so kind
of cutting down on that and really minimizing alcohol intake

(35:54):
while you're trying to get pregnant. Can you have a
glass of wine here? They're sure fine, but we usually
say less than for drains in a given week. And
it is kind of like training for pregnancy, because once
you're pregnant, you shouldn't be drinking at all.

Speaker 3 (36:05):
There isn't an.

Speaker 1 (36:05):
Established safe level of alcohol that we know for a
fact isn't going to affect fetal development. Not smoking, right,
Smoking is terrible for our fertility.

Speaker 3 (36:13):
It causes us to deplete our eggs.

Speaker 1 (36:16):
Faster, you can go into menopause earlier. It can affect
your egg quality, and it's obviously very dangerous in pregnancy.

Speaker 3 (36:22):
And so if you're someone who is.

Speaker 1 (36:25):
Addicted to nicotine or you're vaping, like these are things
that you should really be training for pregnancy and cutting
down and really eliminating eventually by the time you're pregnant.
Weight management this is a huge hot button topic, but
we know that every outcome in pregnancy that we want
to avoid, the risks are elevated by two factors excessive

(36:45):
weight and advanced age. And there's one of those things
that we can actually try and control. And this is
not coming from a place of shaming anyone, but it's
to say do your best, you know. And I've had
some patients who have really struggled with their weight and
it's not a moral fail. It's just how their body
is genetically wired. We're metabolically wired. Sometimes they have insulin resistance.

(37:05):
A lot of times they do, and sometimes it makes
sense to even get the help of experts to maybe
rest on the help of certain types of medications like
GLP one agonists are a big topic right now.

Speaker 3 (37:18):
You can't be on them when you're pregnant.

Speaker 1 (37:20):
Because we don't have the safety data to say that
that's okay. And there are some studies that have shown
lower birth weight in babies that were born when their
moms were on meds like ozebic and even some abnormalities
or birth defects. So we're not there yet where we
can say it's totally safe. We say you should have
a wash out period where you should be off of
it for at least two months. So sometimes optimization in

(37:44):
that trimester zero might look like taking a pause and
doing something first and optimizing your health in some way
and then saying, Okay, now I'm in a better place
to start trying. But it's tricky because you also have
to contend with the biological clock.

Speaker 3 (37:59):
So, you know, studies have tried to look.

Speaker 1 (38:01):
At this, like in women who are approaching or are
in their forties but also are struggling with their a
high BMI or being overweight, does it make sense to
take three to six months and wait to reduce their
weight if they can, or is the biological clock more
of something that we should be you know, focused on,
And so you know, there isn't a clear answer, and

(38:23):
I think you really have to be mindful of all
of the things. Sometimes I see a lot of people
telling patients to kick the can down the road because
they're like, you know, you have to be a perfectionist
and you should be on a supplement regimen for three months,
because that's the amount of time it takes.

Speaker 3 (38:36):
To improve egg quality.

Speaker 1 (38:37):
You hear a lot of that it's not actually rooted
in science, and sometimes I think it's bad advice, particularly
for older women or women who have a very low
egg count.

Speaker 2 (38:46):
Yeah. I feel like there's a lot of misinformation out
there too, and then there's a lot of personal experiences
that might not be rooted in facts that are out
there on the internet.

Speaker 3 (38:53):
Totally.

Speaker 1 (38:54):
I think that's probably one of the most difficult challenges.
I talked about how great the community is, but I
think people sharing their personal stories it can also lead
to these like anecdotes and oftentimes it's like, Okay, someone
who might have had a long journey where they did
multiple egg retrievals and then they're like, and then I
added in this supplement and then I had a much
better retrieval outcome. Well, your doctor was probably tweaking things

(39:17):
along the way as well, right, And so I think
it's not always scientific the information that we're getting or
that's being shared online. And you know, it's not always
a harmful thing, but I think that it can be
harmful because it can waste people's time it can waste money,
it can waste their most valuable resource, which really is time,
and it can burn them out.

Speaker 3 (39:36):
I think that's the biggest thing.

Speaker 2 (39:38):
How can you know, if we're talking now too about
like physical training, how can overtraining physically affect your fertility?

Speaker 3 (39:46):
So it can?

Speaker 1 (39:47):
You know, it has to be often extreme, and sometimes
it's the combination of overtraining and not taking in enough calories,
and so what happens. It makes sense when you think
about the fact that your brain is like the central
command tower, right, It's controlling a lot of the major
hormones in our body. And so your pituitary glen, which

(40:08):
sits right here in the front of your brain, is
basically sending signals to the ovary and then you know
one of those signals is going to hit a follicle
and get you to ovulate. If your brain is detecting
that there is a caloric deficit or an energy deficit,
it's going to shut those signals down and say we
don't have enough energy to keep functioning just ourselves, Like

(40:30):
we don't. We have no business trying to support another
human being growing inside of you, right, And so that's
kind of like an evolutionary protective mechanism where you stop ovulating,
and so I see this a lot in people who've
had disordered eating, and sometimes you see it in athletes,
like I'm talking people training for the Olympics, people that are,
you know, training and doing high intensity things for like

(40:52):
eight to ten hours a day. I don't see it
in a lot of people that are like training for
a marathon, because I feel like it's like a temporary thing,
and most people aren't doing things in an extreme way.
So I think all too often people hear this and
become very afraid of moving their body and they think
that it's dangerous.

Speaker 3 (41:08):
I've heard a lot of people say, like.

Speaker 1 (41:09):
I'm trying to get pregnant now, so I was told
by this person.

Speaker 3 (41:13):
Sometimes it's an expert.

Speaker 1 (41:14):
Oftentimes it's not that I should be avoiding high impact workouts.
I shouldn't raise my heart rate above a certain level.
I should really aim to keep my body temperature. And
I'm like, your body is smart, it knows how to
self regulate, and so I think there's a lot of
bad advice. And I think that movement is such an
amazing form of medicine for our mental health, and so

(41:36):
telling people when they're already in an anxious state because
they're trying to conceive, they're trying month after month, or
they're pregnant, and there's so many things to be anxious
about when you're pregnant, and I'm.

Speaker 3 (41:45):
Sure you can relate to that.

Speaker 1 (41:46):
Taking away a major tool that they have in their
toolkit to manage that anxiety is not helping them. And
there's so much data now that your pregnancy is always
going to be healthier if you're incorporating movement. And it
gets harder as you know, when you get into the
later stages of pregnancy. I remember I loved pilates, and
you know, even by the time I was like twenty weeks,

(42:09):
it kind of felt weird to do some core exercises,
so you make modifications, but it's really important to keep moving.
It leads to better obstetrical outcomes. It leads to better
delivery outcomes. I mean, it's always a plus. And you
think nothing you're doing should be extreme, and you know,
if you're training and you're training for marathon, you need
to be appropriately eating and taking in the right amount

(42:29):
of calories to support.

Speaker 2 (42:30):
All of that, right, so it's really meet your exercise
with proper fuel, yes, and you'll be okay exactly. I
also felt too, like when I got pregnant, what I
was really happy that I was doing prior to becoming
pregnant was keeping up a consistent workout regimen because it
might easier. It makes it easier. And my doctor did say,
obviously now he's a little bit more resistant on all
the running, but he did say, whatever you were doing

(42:54):
pre pregnancy, you can continue to do.

Speaker 1 (42:56):
Always say that, yeah, yeah, And I you know, have
told to pause for short periods of time, particularly during
certain treatments, whether you're freezing eggs or you're trying.

Speaker 3 (43:06):
To get pregnant. If you're going through an.

Speaker 1 (43:07):
Egg retrieval process, it involves your ovaries getting enlarged, so
there are exercise restrictions.

Speaker 3 (43:13):
They're very temporary.

Speaker 1 (43:14):
Usually it's like a few days into your shots, and
some doctors, just to be on the safe side, we'll
say the day you start your shots, like stop doing
any high impact workouts or anything that's core intense, like
anything that could bounce or twist your ovaries around. I
would say, don't jostle your ovaries. That's how I always
describe it to my patients and that restriction goes into effect,
you know, in an early stage, once we start stimulating

(43:34):
the ovaries, and after the egg retrieval, it's not like
magically the ovaries shrink right away.

Speaker 3 (43:39):
It takes a week or two.

Speaker 1 (43:40):
For them to kind of go down to their normal size,
and that's when the concern is no longer there and
the restrictions are lifted, and we usually a good rule
of them is like wait till you get your period
one to two weeks after an egg retrieval, when you're
ovulating and you're just trying on your own, or even
if you're doing more laid back treatment options, like there's
something called medicated EUI where people are taking medications to

(44:00):
boost their population.

Speaker 3 (44:01):
Your overs aren't getting big, and so I.

Speaker 1 (44:04):
Really don't think that you need to be restricting you know,
what exercises you're doing. Obviously, talk to your doctor, but
I think if you get the sense that there's this
overarching recommendation to cut out exercise and it seems overly restrictive,
don't be afraid to advocate for yourself and ask the why,
because sometimes I think in medicine we don't trust patience
enough and maybe it's like we're airing on.

Speaker 3 (44:25):
The side of safety.

Speaker 1 (44:26):
We're like, well, if we give nuanced information, people are
going to get it wrong, and then someone might try
to run when they're over is enlarged, and we worry
about the overtwisting.

Speaker 3 (44:34):
Right. It's a very rare.

Speaker 1 (44:35):
But painful complication, and I think people are like, let's
just air on the side of caution.

Speaker 3 (44:40):
But again, I don't know.

Speaker 1 (44:41):
As a woman who's gone through their journey of trying
to conceive, getting pregnant on my own, trying to conceive
with the help of IVF, having gone through all the
different types of cycles, movement was a very important thing
for me to deal with the anxiety and the ups
and downs that came with those hormonal changes. And so
as a doctor, I've made a huge commitment to really
being nuanced in my guidance. I put together a program

(45:03):
with Megan Roop from Sculpt Society. I love her too,
She's so wonderful, and she had this great, you know,
prenatal series because she's had two babies, and she shared
her journey and her fitness journey throughout all of that
and also postpardon. But she and I paired up because
she was like I want to be able to come
up with a doctor approved program for how people can
move their body, whether they're going through an egg retrieval,

(45:25):
they're recovering from a miscarriage, not saying that you can't
take a break and you have to keep working out.
But for some people it helps them right, and they're
worried about like how does your body change and all
of these different things that can happen as you're trying
to get pregnant, and so we came up with, you know,
all these like fertility safe workouts, and it was funny
because for some of them, she's like, wait, you mean

(45:46):
I can only do arms and walking, Like what do
you mean? And like there were some you know, restrictions
even with her program. But I think there's a way
that we can give women the tools so that they
can make better decisions for themselves and take care of
their mental health. I don't think we need to be
overly restrictive.

Speaker 2 (46:00):
That's great that you guys did that, because that is
so helpful for somebody that you know is listening to
this and they're like, Okay, I still want to air
on the side of caution, go straight to scold society
and check that out.

Speaker 3 (46:10):
Yeah, I think it's fantastic.

Speaker 2 (46:12):
Also, I love Megan because she on her app does
a lot of pregnancy safe workouts, which is another really
overwhelming space. I'm like, what Core can I do? What
can I not do? And it's really helpful. And I
also do have to say I think your body tells
you what you can and can't do. Like I was
somebody early on that had to cut out CORE when
I got pregnant because it just didn't feel right. Yeah,

(46:34):
and that's it.

Speaker 3 (46:35):
I get that.

Speaker 1 (46:35):
And there's some people that are like front and center
at the pilates and yoga studio and I'm like, how
are you doing.

Speaker 3 (46:40):
That at thirty weeks?

Speaker 2 (46:41):
Apparently there's people that do Tracy Anderson the heated workout
all the way through their pregnancy.

Speaker 3 (46:45):
That's crazy. I would vomit.

Speaker 2 (46:47):
I say, how do you feel about heated workouts when pregnant?

Speaker 1 (46:50):
I think you know, define heated because there's some that
are like super intense. And I think the problem with
an overly heated room, like I'm like, a close to
one hundred degrees is it you don't have the ability
to regulate your body temperature?

Speaker 3 (47:03):
Like I think it's crazy.

Speaker 1 (47:03):
When people are like, you're working out in a normal
temperature room or outside, but don't let your body temperature
get above a certain level. It's like, that's what sweating
is for. That's your body's natural mechanism to shed heat.

Speaker 3 (47:13):
But if you're in a.

Speaker 1 (47:14):
Really hot room, like that's not going to help very much.
It's like being in a hot tub, right. So there's
certain extreme temperature environments that we advise pregnant women to
stay out.

Speaker 3 (47:24):
Of in terms of your fertility. I don't think it's
going to impact anything.

Speaker 1 (47:28):
But just as a precaution, if I've just done an
embryo transfer on someone, I'm going to say to them, yeah, like,
let's avoid saunas and hot tubs or anything extreme. I
think our body knows how to do its job and
regulate itself more than people give it credit for. But
you know, I think once you're at a certain point
in pregnancy, you do have to think about how that
extreme heat could affect.

Speaker 3 (47:48):
Fetal development and things like that. This is why we
are very proactive.

Speaker 1 (47:52):
About treating fevers, especially in the first trimester, because we
know not controlling the maternal temperature can actually lead to
a higher of problems in the development of a fetus.
So I don't think people should feel worried if it's
like hot outside, but I think being in an environment
where everything is hot, your body's going to have a
harder time regulating, right.

Speaker 2 (48:13):
And then you're on top of that, you're doing an
intense workout.

Speaker 1 (48:15):
And you're prone to low blood pressure just because of
the natural changes in blood volume and pregnancy and how
your blood vessels behave, and so you just don't want
to predispose yourself to fainting and things like that. And
even if you're going through a fertility journey, some of
the medications that you're on, those hormone changes can have
a profound effect on your blood pressure and your ability
to kind of recover from workouts and things like that.

Speaker 2 (48:37):
So I like that we referenced a few treatment options.
So far. We've talked about EUI, We've talked about IVF. Yes,
let's dive a little bit deeper into those because for me,
for example, like I am not as familiar with IVF
or IQUI just because I haven't been through the process yet.
I of course have seen people document it on social media,
and I love when I see people documenting their egg retrievals.
I love when I see somebody documenting their IVF journey

(49:00):
because I think it's really important and it's cool to
get a little inside look.

Speaker 1 (49:04):
So personal and so much a privilege that they're letting
all of us in their journey.

Speaker 2 (49:08):
It is such a privilege. And also, so many of
us are going to have to go through one of
the treatment options at some point, So let's talk about
the different treatment options available. What do you typically recommend
patients start with, and then what can they progress to.

Speaker 1 (49:23):
I love this question because this is like the fun
part about my job. I'm a very strategic person and
I love planning, and so I do love helping quiet
the noise and redirecting focus. And so when someone comes
to me, if they're a couple and they've been trying
to get pregnant for a certain period of time, first
step is testing, and we're testing for core things. One

(49:44):
is the sperm, because fifty percent of couples will have
some sort of sperm quality issue. So we look at
it under the microscope and we're like, is there enough sperm?
Can its women afford direction? Is there enough normally shaped sperm?
And we're looking at all of those parameters in totality,
and if it's above a certain threshold, we're we're like, okay,
there's at least ten million total modal sperm, it's called
the total modal count. Then we're like, okay, then you

(50:07):
have either option, Like we can rely on sperm being
able to travel and get to where they need to go.
If it's lower than that, that's when we might need
to kind of take the reins and say there's probably
not enough to get to the egg. And even like
inseminations where we're dropping sperm off at the top of
the uterus, that isn't enough of a shortcut. We might
need to take the eggs out of the body IVF

(50:28):
and put them with sperm directly, maybe even inject one
sperm into each egg. That's a very successful way to
overcome a lot of forms of male infertility that can't
be overcome by just lifestyle changes or certain medications on
the male partner. And so we're testing the sperm. We're
testing to see are the Philippian tubes blocked.

Speaker 3 (50:46):
This is where the sperm and the egg are supposed
to meet.

Speaker 2 (50:48):
Right.

Speaker 3 (50:48):
If you think about the diagram we've all seen about.

Speaker 1 (50:51):
Our female reproductive tract. It's like you have a uterus,
you have Philippian tubes, and then they connect the.

Speaker 3 (50:55):
Uterus to the ovaries. So there's a test.

Speaker 1 (50:57):
You can go and get a test where they put
die in the uterus and basically watch it spill out
of either tube to prove.

Speaker 3 (51:04):
That it's open and there's no blockages.

Speaker 1 (51:06):
There's a lot of reasons why women might have blockages,
like enemytriosis is a risk factor for that, having prior
infections you didn't know about our surgeries and things like that,
So we want to make sure they're not blocked. If
they're blocked, then we should do IVF because taking this
process outside the body allows us to bypass that blockage.
We create the embryos outside the body. We put an
embryo inside the uterus, and it doesn't matter. You know,

(51:26):
we've addressed it and worked around it. I care about
the uterus. Are there any things that are getting in
the way, taking it valuable real estate from where an
embryo would want to implant.

Speaker 3 (51:35):
That's more. If we find something like that, is there
a role for surgery to correct it right?

Speaker 1 (51:39):
And then the last component, which is the more complicated one,
is the ovaries and the eggs they contain.

Speaker 3 (51:44):
Can you ovulate regularly?

Speaker 1 (51:46):
Are you someone that has problems with ovulating because of underlying.

Speaker 3 (51:49):
Pcos like we need to figure that out. Or is
it more that your brain stops.

Speaker 1 (51:53):
Sending the signals out because of a prior eating disorder,
or you are training really hard, Like these are the
things that I'm thinking. Now, let's say all those tests,
including hormone tests, which we won't get into all the
nuances and details, but let's say we do all the
battery of tests. In my book, actually the diagnostic chapter,
I have like tables and tables that are like, if
this is your situation, these are the basic tests, because

(52:14):
I think a lot of times we just need to
simplify things for people. Right, But let's say you do
all the tests and they're normal, that doesn't mean I'm
going to say, Okay, good luck, keep trying. We have
to do something to make this really inefficient process more efficient,
and that can be two different buckets of treatment. The
first one is called medicated EUI, and I always say,
think of it like speed dating for your reproductive tract. Right,

(52:36):
you're not doing anything that different from what the couple
has already been doing on their own, which is ovulating
one egg, hoping for the sprim the egg to meet
and for something to happen. But you're giving both things
a boost. You're saying, Okay to the female partner, take
this pill for five days meds like Clona or electrosol.
This is going to fool your brain into thinking there's
not enough estrogen, and it's going to send a stronger

(52:57):
signal and it could give you the opportunity to release
two or three eggs. And then at the same time,
let's place the sperm at the top of the uterus,
wash it, concentrate it, and really put the best swimmers
right at the top of the uterus. So there's more
eggs and more sperm meeting, and that's going to increase
the chance that there'll be a successful meeting that takes place.

Speaker 3 (53:16):
It's not that different from what.

Speaker 1 (53:18):
You're doing on your own, so it might improve your
overall chances by like five percent. So if at thirty
five every month when you ovulate, there's like a fifteen
percent chance that all those things will line up when
you pull the slot machine lever. If you're doing a
medicated IUI each cycle, it's improving your chances by maybe
a few percentage points, like five percent or so. So
it might take you from like you know, ten to

(53:38):
fifteen percent or fifteen to twenty percent. It's not going
to be an overnight success. I don't ever expect the
first one to work. This is like the long game.

Speaker 3 (53:46):
I usually say, Okay, we're going to do this. Great.

Speaker 1 (53:48):
Maybe we try it for three or four months, and
then we regroup and see how you're feeling, because oftentimes
people are like, oh, this has to be easier than IVF.
I'm just taking a pill, coming in for an ultrasound.
You're putting sperm at the time my uterus in a
procedure that feels like papsmir It seems pretty low key.

Speaker 3 (54:03):
But I think doing the same thing.

Speaker 1 (54:05):
Over and over and feeling like I'm doing an intervention,
why am I not getting pregnant and hearing your doctor
say well, we don't expect it to work, like this
is going to take time, and then it might still
not work.

Speaker 3 (54:15):
That can be very difficult.

Speaker 1 (54:16):
So I usually say, like, let's check in after three
or four months. You know you're coming in periodically throughout
these cycles. You're also trying on your own on top
of it, because the more sperm, the better. Right, So
this doesn't mean there isn't a way for you to
get pregnant from having sex, Like you're incorporating that that
option can take time to get there, it may not work,
and at a certain point you have to know when

(54:36):
to pivot. It does introduce the risk of twins because
you're releasing more than one egg. Oftentimes people think IVF
is is more aggressive, so there's more twins and triplets.

Speaker 3 (54:45):
It's actually the opposite.

Speaker 1 (54:47):
IVF has gotten so much more successful that now it's
not justifiable to put in more than one embryo, so
there's a much lower risk of twins.

Speaker 2 (54:53):
I like that you say the risk of twins because
I'm like a seven and a half sorry at eight
months pregnant. Now I'm eight months pregnant. I wish I
was pregnant with twins. So really, oh my god, two
done in one pregnancy.

Speaker 1 (55:05):
But imagine how you're feeling now and how that would
be compounded by carrying two babies. Right, True, it's really tough,
but it's not even just your quality of life and
how you're feeling.

Speaker 3 (55:14):
There's a six times higher rate of preterm labor.

Speaker 1 (55:17):
And as someone who had a premie brother who spent
the first five years of his life in the hospital.
I know all too well all of the other complications
that that can cause, and also anything that happens in
pregnancy that you want to avoid, like diabetes, pre acclampsia,
preterm labor.

Speaker 3 (55:33):
All of that is heightened by twins.

Speaker 1 (55:34):
So I don't want to scare anyone who's listening who
might be carrying twins. I mean, it can be very safe,
and it can be something that is a beautiful thing,
but you usually want to see a high risk specialist
who's managing you and monitoring you closely for complications.

Speaker 3 (55:48):
So if we can avoid it, we do.

Speaker 1 (55:49):
And that's why, as a fertility doctor, I say it
it's a risk. Even though twins are super cute.

Speaker 2 (55:54):
Yeah, that's interesting. I'm a twin. Oh you are identical,
not identical and.

Speaker 3 (56:00):
Bro that means your mom ovulated two eggs.

Speaker 1 (56:03):
Yeah, that's very interesting. Yeah, so that can happen on
its own. By the way, this is an interesting tidbit.
As we approach as we enter our forties and as
our egg count typically gets lower, your brain detects that
and start sending stronger signals each month and sometimes that
leads to this phenomenon where women as they age are
more likely to ovulate more than one egg.

Speaker 3 (56:23):
How old was your mom when she had.

Speaker 1 (56:24):
You, guys, I feel like she was thirty. Okay, so
it doesn't apply there. I mean it can happen for
other reasons too, but yeah, So the risk of twins
with medicated EUI is approximately three to eight percent. And
then the other thing is is like, this is all
just happening inside your body, so there's no Unlike with IVF,
where there's ways to test the embryos, you're not able
to do that.

Speaker 3 (56:44):
You're just hoping for the best.

Speaker 1 (56:45):
And we know that one in four pregnancies can end
in miscarriage, especially in the first trimester, because a lot
of us, all of us, have the ability to ovulate
an unhealthy egg an error a typo, right, and this
means it turns into an embryo that has missing our
ex DNA. That's a number one cause of first trimester
miscarriages and it can happen to anyone. And that's why
I always say it's not your fault. It's most likely

(57:08):
something that you had no control over and something that
you couldn't have done.

Speaker 3 (57:13):
Nothing to avoid.

Speaker 1 (57:14):
Right, sometimes you just ovulate the wrong egg, and that's
what it comes down to, and that becomes more prevalent
as we get older.

Speaker 3 (57:20):
But even in your twenties that can happen.

Speaker 1 (57:22):
And that can happen with a medicated EUI. There's nothing
we can do about it. It's just like what naturally
can happen.

Speaker 3 (57:26):
Right.

Speaker 1 (57:27):
And the other thing when you compare it to IVF
is there's no opportunity.

Speaker 3 (57:30):
To freeze for the future.

Speaker 1 (57:31):
So it's just about getting you to baby number one
or the next baby, and you're going to be pregnant,
hopefully for nine months and then you're maybe breastfeeding or
just kind of like recovering, and so you have to
think about the big pictures. So when someone comes to
me and they're like, I'm thirty eight and I want
to have two children, I'm thinking about the biological clock.
And I don't think it's unreasonable or overly aggressive to say,

(57:53):
you know, it may make sense to go straight to
IVF because IVF is a different ballgame. This is more complicated,
it's more expensive than IUI. If you have no insurance
coverage and you're paying out a pocket, it's more intense
there's more things that you need to do.

Speaker 3 (58:07):
It's a two step process.

Speaker 1 (58:09):
You're taking shots for eight to ten days to try
to Basically, you're injecting the same hormone signal your brain
sends to you're over to get it to ovulate. At
a higher level, you're trying to get whatever eggs are available.
Every month, a certain wave of eggs get recruited, and whether.

Speaker 3 (58:23):
You use them or not, you're going to lose them.

Speaker 1 (58:25):
Like you either ovulate one and then the rest go away,
or you can do a process like egg freezing or IVF,
where we're stimulating the ovaries and we're saying, let's capture
and salvage all of those eggs before your body would
waste them. Let's take advantage of this wasteful system. And
having more is always better because it means that I
have more chances to turn those eggs into embryos. So

(58:46):
that's the only instance where your egg count really matters,
is if you're doing egg freezing or you're doing the
first part of IVF, the egg retrieval. It's going to
dictate how efficient that process will be and how well
you might respondwise when you're ovulating, it's not a numbers game, right.
So the first part is the stimulation, having an egg retrieval,
which is done under sedation. You're watched by an nisesiologist.

(59:09):
It's a very minor procedure. It takes ten minutes, but
it's a day you.

Speaker 3 (59:11):
Take off of work.

Speaker 1 (59:12):
And all the while in the lead up to the
egg retrieval, you are coming in for lots of monitoring visits,
so there's a lot more poking and prodding, you're getting ultrasounds,
you're getting blood work usually like every other day, so
five or six early morning visits, and then you're getting
the procedure, and then we're waiting to see how many
of those eggs were fertilized, how many turned into embryos,
which takes about a week.

Speaker 3 (59:32):
By that point, you're getting your period.

Speaker 1 (59:34):
And then if we have embryos to work with, and
by the way, we can genetically test them without harming them.
They have one hundred to two hundred cells. They separate
out into cells that become the baby and cells that
become the placenta that kind of line the.

Speaker 3 (59:46):
Periphery of the embryo.

Speaker 1 (59:47):
And now in almost like ninety nine percent of the
cycles we do, we remove some of those outer cells
that want to become the placenta and and that offer
genetic testing. So many misconceptions about that. The genetic testing,
its main role is to identify which.

Speaker 3 (01:00:01):
Embryos have those typos or errors that I was talking.

Speaker 1 (01:00:03):
About, which ones don't, which ones have forty six chromosomes,
which is what they're supposed to have. And so the
idea is to be able to select the healthy embryo
one at a time and know that if it's healthy
and it looks great and it's tested, it could have
up to a sixty to seventy percent chance of a
live birth. So the advantage of IVF is you tend
to get pregnant quicker. It's not a guarantee, and for
some people it can still be a struggle because a

(01:00:24):
it might be harder to make those healthy embryos if
you have a lower egg count, or if you have
a hard time because egg quality is an issue for you.

Speaker 3 (01:00:31):
You might get a lot of eggs at.

Speaker 1 (01:00:33):
Retrieval and a lot of them don't make it to
that embryo stage or they're not normal and you have
to do another round to get that normal embryo.

Speaker 3 (01:00:39):
And some people have issues like fibroids, or.

Speaker 1 (01:00:41):
They've had surgeries on their uterus where we have the embryos,
but it's really hard to make that environment ideal for
the embryo to actually stick and implant. So there's so
many different ways that it can be challenging, but in
general it tends to get people pregnant faster than medicaid EUI.

Speaker 3 (01:00:56):
It allows you to test.

Speaker 1 (01:00:57):
The embryos and reduce the risk of miscarriage. This is
a huge game changer for women who are trying to
conceive in their forties. A big thing that's been in
the media lately is, you know, the CDC reported their data.

Speaker 3 (01:01:09):
Saying more women than ever are getting pregnant in their forties.

Speaker 1 (01:01:12):
There's been a massive increase up to seventy percent in
some states in the birth rate in forty plus women,
and there have been dramatic declines in women getting pregnant
under thirty five. And part of this is the rise
in this technology and leveraging this technology and being able
to say, you know, now you can have a forty
something year old patient who normally would have had like

(01:01:33):
a forty to fifty percent chance of miscarriage if they
had just ovulated.

Speaker 3 (01:01:37):
On their own.

Speaker 1 (01:01:37):
That's not to say you shouldn't try on your own, right,
but this is why we say don't try for longer
than three months without seeking intervention. Now we can say,
you know what, we can test all these embryos and
dramatically lower your chances, and your.

Speaker 3 (01:01:48):
Uterus doesn't really age.

Speaker 1 (01:01:50):
So your chance of getting pregnant from an embryo that's
transferred in your uterus is somewhat equivalent to that of
a twenty something year old.

Speaker 2 (01:01:59):
Right.

Speaker 3 (01:01:59):
You're kind of taking age out.

Speaker 1 (01:02:00):
Of the equation, at least when it comes to getting
and staying pregnant. When you're doing IVF and doing the
genetic testing, and because it works so well for so
many people, we're only putting back one embryo at a time,
So unless the embryo splits, you're not having twins. There's
usually like a two percent chance of that happening. And
I think the biggest thing is also being able to
freeze the extra embryos that you create from one round,
because you might have multiple eggs that turn into multiple embryos.

(01:02:23):
Not all of them will get there, but if you
end up with multiple embryos from one or multiple rounds,
they don't change over time. Once they're frozen, you can
come back at any age. I've had patients freeze at
thirty nine they had their first baby, they froze some
extra embryos, and they've come back at forty five for
their third baby and gotten pregnant on the first transfer.
I mean, that is the reason behind the headlines.

Speaker 2 (01:02:44):
I mean, it seems like such a miracle that IVF exists, right,
I mean, and so I'm curious too. I love knowing
that it decreases the chance of miscarriages, because that was
going to be one of my questions.

Speaker 3 (01:02:55):
Yes, and can because of the genetic testing, And then.

Speaker 2 (01:02:57):
With the genetic testing, does it also limit your risk
factor of rare diseases?

Speaker 1 (01:03:03):
So that's a great question and a common misconception. A
lot of people that have frozen eggs with me come
back years later now that they're married, ready to start trying,
and they're like, why wouldn't I just use my eggs
because then you can just test them and then we're
going to have less chance of having a child with
a medical problem. And I'm like, not really, we're testing
to just count the number of chromosomes, the amount of

(01:03:23):
DNA it's just looking.

Speaker 3 (01:03:24):
For those typos or errors.

Speaker 1 (01:03:26):
Right, there is something that you should know about which
is called carrier screening, where you can do blood work
or even a cheek swab on both members of both
prospective parents, both members of the couple and basically see
is there any risk of an overlap, like what mutations
do you carry? What mutations does he carry? Could there
be any common mutations? And going back to high school

(01:03:49):
biology Punnett squares, right, there are certain mutations where if
you have both gene copies are mutated, then you have
the actual disease. And so if you know that there's
a chance of overlap, where one and four chance of
having a child with two copies of the mutation for
major diseases like cystic fibrosis, that is a major lung
disease that can affect your ability to live past your thirties. Right,

(01:04:10):
there are a lot of major diseases on these panels,
like four hundred, five hundred conditions, And so it's routine
now to do this preconception. All too often people don't
know about it. They get pregnant and then they go
to their obgyn and then they get tested and it
usually is that you don't overlap. But I'd say two
to four percent of the couples that I see and
test will find that they do overlap for something. And

(01:04:31):
what that means is they have options. Now they can say,
all right, well we'll roll the dice and know that
by the end of the first trimester we can test
the fetus if we want to and see is this
baby going to be affected. That's a really anxiety provoking weight.
Or you could say, you know what, I don't want
to be in that situation. I want to create embryos.
I want to genetically test them, and because we know
what to look for, we can also test the embryos

(01:04:52):
for that set of mutations. I have patients and this
is something I love doing. Patients who have a strong
family history of cancers. They find out that they are
our carrier of the Broca.

Speaker 3 (01:05:02):
Mutation, like a gene that predisposes.

Speaker 1 (01:05:04):
Them to a higher lifetime risk of developing certain cancers.
And they've had this painful family history, They've lost loved ones,
often apparent and they're like, you know what, I don't
want to have this cloud hanging over my head. I
know I have a fifty percent chance of passing this
on to a future child. If there's something I can
do to stop that, I want to do that.

Speaker 3 (01:05:23):
And I have patients who.

Speaker 1 (01:05:24):
Come to me to freeze their eggs because they're like,
I know, I'm going to do IVF to want to
stop the propagation of this gene one day. So why
didn't I start with younger, more plentiful eggs, right. I
think it's a really special thing that this technology has
afforded us the ability to halt and to give people
peace of mind.

Speaker 2 (01:05:41):
Absolutely. And Jeremy and I did the testing before we
tried to get pregnant, and by the way, I came
back with like six things that I carry. He carried none.
So he always like jokes with me about that. He's like,
there's definitely some imbread stuff happening with your ancestors, but
definitely get the test because you never know.

Speaker 1 (01:05:59):
Yeah, knowledge is power, and listen, you don't have to.
It doesn't mean, oh, you find out you're a match
and you have.

Speaker 3 (01:06:04):
To do IVF.

Speaker 1 (01:06:05):
No, I mean I think it's just about again making
decisions with information. My goal in writing my book and
how I counsel my patients is I'm not trying.

Speaker 3 (01:06:15):
To get them to do anything.

Speaker 1 (01:06:17):
You know, if they come in to talk to me
about egg freezing, or they come in to talk to
me about future family planning and they decide never to
freeze their eggs, or they ultimately make a decision that
they don't want to have children, I think that's great
for them. What I don't want is someone to look
later on in life back and say, you know what,
I would have made different decisions if I had access
to better information.

Speaker 2 (01:06:36):
One hundred percent. I like that we talked about embryo
freezing because it is something that's been top of mine
for me. I'm, you know, currently eight months pregnant. We're
about to have our first baby. But I've definitely been
thinking I want to take a significant amount of time,

(01:06:59):
maybe years, three years, four years before trying to get
pregnant with my second. You know, I live in New
York City. I want to be focused on my career
for the next three or four years. Having a baby does,
you know, not derail your career, but it definitely sets
certain things aside for a little bit of time. As
a woman, And I think this is something that a
lot of women think about, even when it comes to
getting pregnant. In the first place. So let's talk about

(01:07:21):
secondary infertility, what people should know and what proactively we
should be thinking about. If you know somebody's in the
same situation that I'm in.

Speaker 1 (01:07:29):
Yeah, I think secondary infertility is such a great topic.
It's not talked about nearly enough, and I think that
has led to a lot of social isolation for people
who are going through it. Adding to the fact that
they also feel guilt. It's almost like survivor's guilt. They're like,
how can I complain that I'm having problems, you know,
having baby number two when I have baby number one.

Speaker 3 (01:07:49):
A lot of people are struggling even to get there.

Speaker 1 (01:07:52):
But I'm here to tell you that your visual journey
matters and your pain is valid. And I think people
really need to fight that narrative. And I'm talking from
experience because I'm someone that had secondary infertility and because
I was.

Speaker 3 (01:08:07):
I'm so thankful.

Speaker 1 (01:08:08):
I was a fertility doctor and I was actually in
training subspecialty training, so I was already in obgin. But
being in this environment of a fertility clinic and seeing
everything that I was seeing, I decided to proactively freeze.

Speaker 3 (01:08:20):
My my embryos.

Speaker 1 (01:08:21):
And I didn't know if I would ever need to
use them, and so it was less stressful for me
because it was still distressing that I wasn't able to
get pregnant at thirty seven when I was trying, but
it was kind of like, well, I had planned for
this and I ended up using what I froze. But
for a long time I didn't share that journey because
it felt like it was coming from a place of privilege,
like I had the knowledge, I made.

Speaker 3 (01:08:42):
A proactive decision.

Speaker 1 (01:08:43):
Therefore, my secondary infertility journey was way less stressful than
it could have been. Versus if I had to start
from scratch, maybe I would have needed to do Undoubtedly
I would have needed to do multiple cycles because it
took me multiple cycles to be able to free the
number of embryos I wanted because I had a lower
egg count. So I think, you know, a lot of
peop people feel like less inclined to.

Speaker 3 (01:09:02):
Share and it's more isolating for them.

Speaker 1 (01:09:04):
But secondary infertility is also one of those things that
is rooted deeply in denial because people find it so
hard to understand. I spoke to someone today about it, actually,
who was thirty five when she had her first and
now she's thirty seven thirty eight, and she's like, I
just don't understand it was so easy for me to
get pregnant with baby number one. I just feel like
there's something deeper and we're not getting to the root

(01:09:25):
of it. And I was like, our bodies change, right,
our bodies change in so many different ways.

Speaker 3 (01:09:29):
And we've already talked about the biological clock.

Speaker 1 (01:09:32):
If in our mid thirties, there's a one in three
chants that an embryo that randomly forms from an ovulated egg.

Speaker 3 (01:09:38):
Could have those typos.

Speaker 1 (01:09:39):
Or errors, that rises to about one half in our
thirty seven thirty eight, you know age range, and so
it takes many more ovulations to get there. So, just
by virtue of the biological clock, secondary infertility is a thing.
But also the more ovulations we have in our life,
the more opportunity for underlying guy niccologic issues that can
sometimes predece posed to.

Speaker 3 (01:10:00):
Infertility that they have to thrive.

Speaker 1 (01:10:02):
Right, Like, the more ovulations you have, the more chances
for enomytriosis to flourish, for fibraids to grow over time,
and sometimes there can even be things that happen during
the delivery that can result in.

Speaker 3 (01:10:14):
A predisposition to fertility issues.

Speaker 1 (01:10:17):
You know, some women can have these these structures called
isthmasiles form in the C section scar.

Speaker 3 (01:10:22):
So I am a big believer.

Speaker 1 (01:10:24):
In preconception testing, getting a scan before you're ready to
start trying, because you need to know how your body,
especially your uterus, has changed in the process of growing
a baby delivering a baby. Sometimes that involves surgical intervention,
and I think it's really important to take a second
look and look at your body.

Speaker 3 (01:10:40):
From a different lens.

Speaker 1 (01:10:41):
Years later, you know, things could be different with your fertility.

Speaker 3 (01:10:45):
And I think the biggest thing that I.

Speaker 1 (01:10:47):
See as a barrier to treatment for women with secondary
infertility is their denial.

Speaker 2 (01:10:52):
This is kind of a sidebar, but when you said
surgery made me think of this because I've been seeing
stuff on this and now I'm seeing everywhere because of
course I clicked on like one video and I've seen
and I'm having a baby soon, and now I'm like stressed.
It's a true that your placenta can sometimes not come
out at birth.

Speaker 3 (01:11:06):
It is.

Speaker 1 (01:11:07):
It's not the most common thing, so I wouldn't worry
about it needlessly. But yeah, for some women it could
be like sticky, especially if they've had surgeries on their uterus,
Like there's you know, a higher chance of that happening,
but it's not. I wouldn't say it's like the most
likely thing. I don't want anyone to feel anxious, but
these are the types of things I ask about.

Speaker 3 (01:11:27):
So people come back to have baby number two, baby
number three.

Speaker 1 (01:11:30):
Maybe they were able to get pregnant with EUI, or
maybe they did IVF and they're coming back to use
more frozen embryos to have more children. I always do
such a thorough history of how did the pregnancy go,
Were there any complications?

Speaker 3 (01:11:42):
Were you know?

Speaker 1 (01:11:43):
I think that pregnancy is almost like a stress test
for your body. For women that develop gestational diabetes in pregnancy,
or they develop high blood pressure, that can be a
sign that there's something that they're predisposed to from a
cardiovascular standpoint or an insulin resistant standpoint, there are reasons
for me to do further testing even after they're done

(01:12:03):
with their postpartum phase, right because those things could impact
their future fertility, especially insulin resistance.

Speaker 2 (01:12:10):
Okay, I have a specific one because I found out
throughout this pregnancy that I have a low platelet count. Okay,
have you heard of that before?

Speaker 1 (01:12:16):
Yeah, I mean it can be autoimmune. Do you know
the cause of it or no yet. Sometimes it's more
just related to the changes in your blood volume and
how your body changes in pregnancy. But sometimes it's an
autoimmune condition and sometimes it just develops in pregnancy. So
it's something that they'll monitor and recheck your levels.

Speaker 2 (01:12:36):
But it's scary too, because it's like if your levels
drop you below a certain number, you can't have an epidural, yes.

Speaker 1 (01:12:43):
And so this is something that's kind of monitored and watched.
And sometimes steroids can play a role if they think
that it's autoimmune, and that can actually help mitigate things.
But there's so many different things that can happen to
our bodies in pregnancy. It's wild, you know. And I
spent years delivering babies and taking care of pregnant women
and beyond the first trimester, and now my focus is
more preconception and first trimester.

Speaker 3 (01:13:04):
But everything's all related.

Speaker 1 (01:13:06):
Like never ever omits something when you're talking to your
doctor and giving your medical history, because I think that
there's a lot of connections that people don't make where
I'm like, oh, you never mentioned that, Like this is
a major factor that I'm going to dig into deeper
and they're like, oh, okay, it's really like putting puzzle
pieces together. But I really do think how our bodies
behave in pregnancy can relate to our general health, and

(01:13:28):
our general health can.

Speaker 3 (01:13:29):
Greatly relate to our fertility.

Speaker 2 (01:13:30):
It's all related, right, So, I know we talked about
how the example of freezing embryos if you want to
be somebody that you know doesn't have a baby right
away post having your first, right, that's kind of the
situation that I'm in. But I know a lot of
my friends are in the mindset of I want to
bang out all of my kids right in a row.
So I'm twenty eight, you know, So I'm going to
speak from the perspective of my friends for twenty eight,

(01:13:51):
twenty nine, thirty. If we have our first baby at
twenty nine or thirty, how long do you recommend waiting
in between the first baby in the second?

Speaker 1 (01:14:01):
So it's usually recommended to wait like a year and
a half. Anything shorter than that is considered a shortened
interpregnancy interval. And there have been some studies, and this
is controversial and not well established, that I've associated that
with a higher risk of growth issues in subsequent pregnancies
if you don't wait long enough to allow your uterus
and your body to really heal and even like a

(01:14:23):
heightened risk of things like pre term delivery. As a
fertility doctor, I don't always tell people, hey, you just
had your baby, you know, a year ago. You need
to wait an additional six months and then we'll do
an embryo transfer, because a lot of my patients have
started at an older age and I'm also trying to
weigh the obstetrical risks of another year or two. It's like,

(01:14:44):
I think that there has to be a balance that
you strike, and you have to look at all of
the different competing interests. I would say no one should try,
you know, shorter than six to six months to one year.
I usually recommend that my patients wait at least a year,
especially if you had a ce section. Right, you need
to give your uterine scar time to heal and regain

(01:15:04):
its strength before stretching your uterus out again and then
going through labor.

Speaker 2 (01:15:08):
Right, I didn't even think about that, but yeah, they
cut into it.

Speaker 1 (01:15:11):
So yeah, so I think it's important. And also, you know,
it takes everyone's different. For me personally, I had two kids.

Speaker 3 (01:15:19):
I had two s sections.

Speaker 1 (01:15:20):
I had the first sea section because my daughter was
breach and she just would not budge, and they were like,
do you want us to try to turn her? And
I'm like, she's been breached since I was twenty four weeks.
I don't think she's like gonna move anytime soon, so
let's just do the sea section. And then I contemplated
whether to try for a vaginal delivery. It was twenty
twenty when I had my second, so I was like,
I'm going to try to minimize my time in the
hospital and just like schedule the second sea section because

(01:15:42):
they give you an option, do you want to do
a repeat sea section or I had two sea sections.
For me, I think like going back to work very
quickly after influenced how I felt.

Speaker 3 (01:15:51):
And how quickly I recovered.

Speaker 1 (01:15:52):
I see a lot of articles online that like, your
body doesn't go back to normal for X number of years.
It's like, no, for some people it's going to be faster,
and for other people it's going to take longer. Just
like anything in life, it's we're all individuals. For me,
it was interesting both times. It took me exactly eighteen
months to feel like all of a sudden, I had
this moment of clarity where I.

Speaker 3 (01:16:11):
Was like, I feel like myself again.

Speaker 1 (01:16:13):
I feel like my body's mine, you know, And I
felt better at like three month intervals, like the first
three months were the hardest, and then at six months
I was like, Okay, I feel better, and then at
twelve months, I was like, I'm not quite myself, but
I feel better. And it was really eighteen months for me.
But I think everyone has like their set point when
they get back to feeling like themselves again, and I

(01:16:33):
think that should be factored into decision making too, when
you're thinking about when to come back and when to
try for another child.

Speaker 2 (01:16:39):
Like you would recommend somebody go into pregnancy having felt
like their self. Yeah, yeah, I.

Speaker 3 (01:16:45):
Think that's ideal.

Speaker 1 (01:16:46):
A big one is like people wanting to try to
get to their pre pregnancy weight. I don't think we
should put so much pressure on ourselves, but certainly, you know,
if you feel like I think one of the advantages
of giving yourself enough time is you're optimizing your ability
to do that versus you know, not being in a
great place, which may predispose you to things like insulin resistance,
and it may compound your risk going into the next

(01:17:09):
pregnancy a little bit more overweight than you normally would
be of things like gestational diabetes. Right, So, I think
there's somebody to be said about, you know, balancing all
the priorities. And I think a lot of women have
this sense of urgency around their fertility, which rightly so,
but then also like preconceived notions about how close they
want their children to be in age and things like that,

(01:17:29):
and you can't control everything.

Speaker 3 (01:17:31):
I think we have to let go of some of
that because.

Speaker 1 (01:17:33):
You know, you have your plan, and then it's like
your biology may have a different plan.

Speaker 2 (01:17:37):
It's so true, and I think about that all the time.
I'm always like, I, you know, I have a twin
and then I have a brother that's eighteen months older.
And I loved growing up so close in age because
we had the same friends and it was so fun
and our like our parents' friends overlapped and yeah, all
of that, and I feel like a lot of my
friends also had siblings close in age, so I always
kind of saw myself doing that. Yeah, and then it
is so true you really have to do like release

(01:17:59):
control on certain things because it's like, well, maybe that's
just not what works for your lifestyle.

Speaker 1 (01:18:05):
Yeah, my kids are three and almost three and a
half years apart, and it didn't bother me so much.

Speaker 3 (01:18:10):
But it started to bother me as I.

Speaker 1 (01:18:12):
Wasn't getting pregnant, and I was like, Okay, now I
have a sense of urgency, like thank god I have
these embryos, because it just felt like, wow, I envisioned
them being two years apart. But I didn't get too
hung up on it. I think something that I've learned
as a fertility doctor from my profession is you kind
of have to.

Speaker 3 (01:18:26):
Roll with it.

Speaker 2 (01:18:26):
Mm hmm. It's so true. Yeah, it's even like the
gender of kid that you have. Yeah, like you can't
control it, oh my god.

Speaker 3 (01:18:32):
Yeah.

Speaker 1 (01:18:32):
And there's a lot of people wanting to control a
lot of things. And again this is a no judgment zone,
but I think your life and gets easier and your
mental health is always going to be in a better
place the less you try to control, especially the less
irrelevant things like the big picture things. Of course, you know,
but I think priorities are really important. I have a website,

(01:18:53):
the luckiegg dot com, where I put like a IVF
pregnancy due date calculator. But then I went one step
further because I'm like, I'm inside the brain of all
my patients, and I also it spits out all of
the dates of the major things, the major milestones. First
genetic tests that you can do CVS or amniosynthesis, the
first growth scan. Because for me, as an obgyan, with

(01:19:15):
all that knowledge, I was always like, Okay, that was great. Okay,
now you got to get to twenty four weeks, and
now I got to get to thirty four weeks. You know,
there was always a milestone that I would get past
and breathe a little bit easier and then focus on
the next baby step.

Speaker 2 (01:19:28):
What is the thirty four week milestone.

Speaker 1 (01:19:30):
It's kind of like sometimes where they do like a
growth scan, Like you know, I had just stational diabetes,
so I had a growth scan at that point. It's
also like where lung maturity. So for me, I was like, okay,
now I know like if God forbid, I went into
labor a little bit on the earlier end, like the
lungs are quote unquote mature.

Speaker 3 (01:19:47):
Before thirty four weeks.

Speaker 1 (01:19:48):
They give you steroids if they think that you're going
to go into labor early because that can try to
hasten or speed up that lung maturity process. I think
I'm extra sensitive about that milestone because my brother had
major long issues because he was born so early. But
as an obgan, that's how your brain thinks. You're just like, Okay,
I got to get to this milestone because then I
can put all of these other worries aside, and now

(01:20:09):
I can worry about the next milestone. But I don't
think it's I don't think it's unhealthy to think that way.
I think it goes back to what you said about compartmentalization.

Speaker 3 (01:20:17):
It helps, Yeah, for sure.

Speaker 2 (01:20:19):
Okay, let's talk about miscarriages, because, as we've said, it's
one in four pregnancies end up in a miss with
a miscarriage. So you know, I've had friends recently go
through miscarriages, so they specifically want me to ask you
these questions. Yeah, of course, when it comes to having
a miscarriage, how long do you recommend waiting to try
to get pregnant again?

Speaker 1 (01:20:39):
So there's no specific amount of time the markers I
look for. Basically, if if patient of mine has a miscarriage,
I will bring them in for blood work.

Speaker 3 (01:20:48):
You know, a few weeks later to just see.

Speaker 1 (01:20:50):
Where their hCG their pregnancy hormone level is at. And
hCG has a very long half life, meaning it takes
a long time to clear out of your system. So
depending on how that level looks, I might bring them
back in another two weeks and then, you know, just
periodically check in versus giving them some kind of like
fake deadline of okay, you know when you get your

(01:21:10):
next period. Because what people don't realize is that when
you're pregnant, your body is not sending that signal to
you're ovary to ovulate anymore. But once you're in this
state of recovery after a miscarriage, your brain starts to
send signals to the ovary and so in the background,
you could be ovulating as your hCG level is still
kind of trending in this downward direction, so you could

(01:21:31):
get pregnant. I think it's clinically a little confusing if
you have an elevated level and then you ovulate and
you get pregnant. So we normally recommend let's get to
a resolution negative pregnancy test at home. I often will
do blood work to just kind of check in, and
I try to be proactive about it, because every once
in a while the blood work starts kind of plateauing,
and you're like, oh, maybe we need to do imaging.

(01:21:51):
I like to stay on top of things, and so
this is not the most common thing to happen, but
sometimes tissue can be retained where you're like, oh, that's
why the hCG levels not drop right, or that's why
you're having a regular spotting, and that needs to be
treated so that we can get you on the path
to resolution, so you can get back on the road
of trying again. And so once someone has a negative
hCG level a negative home test, if they're testing and

(01:22:12):
just tracking on their own and they're not under the
care of a fertility doctor who's being super vigilant, at
that point, you know, it's like, okay, you'll get a period.
You might be in the middle of ovulating, and so
your period even after your levels negative.

Speaker 3 (01:22:24):
Like you'll get a period two weeks later. Just start trying.

Speaker 1 (01:22:27):
You know, you don't have to have a certain number
of periods. There isn't like a three month waiting period.
There's all these like, you know, recommendations I see online
that are just made up. I don't think there's a
reason to delay. I think also your mental health. When
do you feel mentally ready to get back on the
path of trying. I think if you check all three
of those things, like you've gotten your it's not even

(01:22:48):
that you have to get your period, but I think
you know, that's when you can start cycle tracking again
and establish okay, like this is my baseline, and you
have a negative hCG test, the pregnancy hormones out of
your system, and you feel mentally ready.

Speaker 2 (01:23:00):
And what do you say to patients that recently had
a miscarriage and obviously it's something that's extremely upsetting, what
do you say to kind of re encourage them, you know,
let them know that it's okay, this is a normal
thing to go through. Well.

Speaker 1 (01:23:14):
I often think to myself that there's some evolutionary benefit
to the fact that hCG lingers for so long and
it's like takes time to get out of your system.
It's very frustrating, don't get me wrong, but oftentimes the
state that a patient's mental health is in when they
first discovered that they have a miscarriage, and we're going
through the miscarriage management, there's different ways to manage it.

Speaker 3 (01:23:35):
You can kind of wait and watch. Not usually my style.

Speaker 1 (01:23:37):
So usually I use medications or I'll do a dnc
AT procedure, and there's pros and cons to either, but
we manage it. And it's a really sad time and
they might just feel like so shut down mentally. It's
not even really possible to have like a proper conversation
sometimes because I know they're not retaining a lot of information,
they're just in the state of trauma. I find that

(01:23:59):
by the time you know their HGG level is negative,
it's like that built in break I think does wonders
for people. I mean, don't get me wrong, it's still difficult,
it's still hard, but I feel like people are like
they have more mental strength and fortitude at that point
where they've picked themselves up off the floor.

Speaker 3 (01:24:17):
Right. Obviously we're supporting them as much as we can.

Speaker 1 (01:24:19):
But I think time does heal all wounds, and while
there might be some trauma that's still there, I think
you need to give yourself a necessary waiting period to
feel ready again. I think something to over anticipate is
this like PTSD like phenomenon where you may walk if
you're going to fertility clinics, or even your ogi, and
when you walk back in that first time, you might

(01:24:40):
start to feel like, Okay, my pulse is racing or
I'm feeling upset. I think it's a really good idea
to not do that alone, you know. I think like
those are the things that people don't realize until they're
in it. That I often will warn my patience. I'm like,
when you come back here, you're probably going to feel
a certain way, right, And it's like desensitization therapy. Enough
visits back where you can associate this place with not

(01:25:02):
that negative event that happened in your life.

Speaker 3 (01:25:04):
That's going to help work through this, right.

Speaker 1 (01:25:07):
But I think that pregnancy loss oftentimes can manifest as
a form of PTSD for a lot of women.

Speaker 2 (01:25:12):
Oh yeah, and I completely agree. I am the women
that are able to go to pregnancy appointments on their
own have a different type of thick skin because I
cannot go without a friend or my husband.

Speaker 1 (01:25:25):
Yeah, it's good because you don't know what you may learn,
and it's just like an anxiety provoking time. And oftentimes
you know you're when you're the subject, right and everyone's
doing the tests and you're being poked in products not
always easy to remember all your questions.

Speaker 3 (01:25:40):
I think it's really a good thing in.

Speaker 1 (01:25:42):
Terms of self advocacy to have someone there to help
keep you on track.

Speaker 2 (01:25:46):
Yeah, all right, so you mentioned the amniocentesis. Yeah, I
want to talk a little bit about this from your perspective,
because I was very I got offered the amniocentesis after
my twenty week anatomy scan.

Speaker 3 (01:25:57):
Yeah.

Speaker 2 (01:25:57):
Basically, the situation that we have with our daughter is
that one of her kidneys is polycystic. They think that's
like what it's potentially going to be, but the other
ones functioning normally. A lot of people have one kidney
or one functioning kidney. I actually have a cousin that
has a pelvic kidney, so it's probably a genetic thing
in my family. I'm like, of course I got it
out of all of the siblings. But regardless, I got

(01:26:20):
offered the amniocentesis test, and we're you know, obviously Jeremy
and I aren't in the healthcare world. We were very
overwhelmed by the stats of it because one in three
hundred people can have a miscarriage from doing it. So
what are your thoughts around the amniocentesis? Would you recommend it.
What do you tell patients that get offered it.

Speaker 1 (01:26:40):
I mean, I don't think it's something that everyone has
to do across the board. I guess, just like backing
up the whole purpose of tests like choreonic villas sampling CBS,
which is done at the end of the first trimester,
or an amniocentesis, which is basically drawing up amniotic fluid,
and it is kind of scary when you think about
how it's done. It's like with a long needle and

(01:27:02):
it goes through the abdomen under ultrasound guidance, and then
you're piercing the amniotic sack and drawing up.

Speaker 3 (01:27:07):
Some fluid because the fetus.

Speaker 1 (01:27:09):
Is surrounded by fluid, the amniotic fluid in the sack,
and it's constantly shedding its cells into that fluid. And
so you're able to actually sequence the DNA and get
a really comprehensive look at the genetics of a fetus,
and so you know, the first step doesn't have to
be one of those invasive tests. The CBS is where
they're actually going in with a needle and taking a
small part of the placenta that's just developing, you know,

(01:27:32):
in the first trimester. So they're both invasive, they both
come with certain risks, but they're done because you're able
to at that stage of pregnancy get enough tissue to
have enough DNA to go deeper and ask you know,
more detailed questions. And so for anyone who may have
something that comes up as a red flag, which initially
I mean the standard test is really a non invasive

(01:27:53):
pre needle test, which is a blood test, and the
earliest that can be done is like at the tail
end of the first trimester. So most people as a
standard will get that done because it's just a blood test.
And then if there's a marker that's elevated that's like, hey,
you look like you could be at an increased risk
of down syndrome where there's three copies of chromoson twenty one,
or there's something else going on that's maybe a red
flag or inconclusive. At that point, you can choose do

(01:28:15):
you want to do a CBS get earlier information, or
do you want to wait and do the amniocentesis and
do this a little bit later. There's pros and cons
to either, but I think you know, if there's something
that comes up as a question or a red flag,
it might be worth doing it, but again you're going
to be counseled that there can be certain risks because
it's an invasive procedure, and so I think the decision.

Speaker 3 (01:28:36):
Is deeply personal.

Speaker 1 (01:28:38):
I recommend amniocentesis to my patients when they do genetic
testing for a specific gene mutation, because the genetic testing
of embryos works really well, but there's always with any test,
a rate of error.

Speaker 3 (01:28:51):
And if you went out of your way.

Speaker 1 (01:28:52):
To test these embryos and you were desperately trying to
avoid something, I was to think that it's a good
idea to do confirmatory testing.

Speaker 3 (01:28:58):
It's standard of care and record mended.

Speaker 1 (01:29:00):
There is this misconception that women that did IVF and
genetically tested their embryos don't need to do any prenatal
genetic testing, and that's actually terrible advice because it's so
little DNA that you're able to collect from just a
few cells from an embryo that you could be missing
a lot of information. I always say, pretend as if
you didn't do IVF, Pretend as if you didn't do
the genetic testing, and do the level of genetic screening

(01:29:23):
or diagnostic testing that you would have done otherwise, but
most people take a step wise approach. And then obviously
it can come up if things come up on the
anatomy scan that suggests, hey, there could be something genetic
going on. But I think it's really a risk benefit
calculus and what you're comfortable with. You know, it's not
something that everyone needs to do. As an OBGYN, I'm
the worst patient and I knew too much and there

(01:29:44):
are things that you can pick up on CVS and
amniosynthesis that you can't get from just the non invasive prenatal.

Speaker 3 (01:29:50):
Test blood test.

Speaker 1 (01:29:51):
So I wanted to know everything, and they were like,
do you even want to know the variance of undetermined significance?

Speaker 3 (01:29:56):
And I was like, yes, give.

Speaker 1 (01:29:57):
It to me straight, even though I knew that would
drive me nut because I'd be like, what does this
gene variant mean? I'd be looking it up like till
two am. I was very lucky it came back normal.
So it's one of those like you know, you could
be your own worst enemy. But as an obg wyan
and even as a fertility doctor, which is why I
was so you know, cautious and frozembryos, which I'm glad
I did, but it could have worked out that I

(01:30:18):
didn't need them, right, And so I think as a doctor,
I tend to be like overly vigilant for myself and
my own healthcare journey, overly cautious. And sometimes I'm glad
that I'm like that, and sometimes I'm like, Okay, you
need to calm down and not drive yourself nuts.

Speaker 2 (01:30:32):
But it is so good that you're because I would
look at the result of an amniosynthesis and if I
was to see anything that was it's like cause for concern. Yeah,
I would probably send myself into a spiral without having
needed to.

Speaker 1 (01:30:45):
I agree, And I think that's like one of the
big criticisms is totally off topic. But like those full
body MRIs, you know, people are like, well, why would
you do that? It causes like undo, you know, anxiety.
But I'm like, I can kind of interpret if a
cyst is benign or if it's not relevant or doesn't
need follow up.

Speaker 3 (01:31:02):
So I don't know.

Speaker 1 (01:31:03):
Maybe I'm being cocky, but I tend to like more information,
not when it comes to wearables, and when it comes
to diagnostic it makes sense. I mean, you are a doctor, Okay,
all right, so we're gonna do some bonus questions. First
one is what myths do you see on social media
that you find to be especially harmful when it comes
to getting pregnant. Yeah, I mean, I think the biggest

(01:31:23):
myth is we have a formula, a program, a supplement,
a tincture, a tea, something that's going to fix all
your problems. I have seen the craziest things I have people.
I've seen people promote supplements to unblock tubes. I'm like,
how does that work? You know, like that doesn't even
make sense. I saw something today, and you know, a

(01:31:45):
lot of this is like my followers on Instagram. Every day,
I get flooded with at least fifty different dms from
different people, and it's usually like is this legit? And
then sending me a post and I've seen a major uptick.
I'm like, what is going on with the misinformation cycle
right now? But I saw one today of a woman
that was wearing this like red light device but on
her abdomen, and it's like this will help your egg quality,

(01:32:07):
And I'm like, scientifically, that just does not make sense.

Speaker 2 (01:32:10):
Right.

Speaker 1 (01:32:10):
It might help the skin of your abdomen look like
more youthful and tighter, but like it's not going to
get to your ovaries and do anything to fix your
egg health. And so there's a lot of magical thinking
and marketing and targeted ads, and they're targeting us, specifically
women and those who are trying to conceive or already

(01:32:31):
pregnant or postpartum, because it's so easy to manipulate our
fear and our desperation to want to control things and
do right by our future child, and it's like so
easy to manipulate that for their financial gain, and it's
really really infuriating, and it's the thing that really motivates
me to be chronically online and making videos till all
hours of the night outside of my day job, because

(01:32:52):
I just feel like if I'm not going to use
my voice and expertise to quiet that type of noise
and nonsense, who will It will be just running rampant and.

Speaker 3 (01:33:00):
It already is.

Speaker 1 (01:33:02):
And I'm seeing more and more experts get online, which
makes me happy, but it's just like a never ending problem.
And I think what we can really do is educate
people on how to examine these things critically and look
at things with a certain lens of skepticism. We need
more skepticism and cynicism in the world of social media.

Speaker 2 (01:33:19):
Right now GLP one's Is it true that being on
a GLP one can increase your chance of getting pregnant?

Speaker 3 (01:33:26):
Yes, they call this ozembic babies.

Speaker 1 (01:33:29):
It can help, especially if women have underlying insulin resistance.

Speaker 3 (01:33:33):
Insulin resistance is this like, you.

Speaker 1 (01:33:35):
Know, throwaway term that you hear like a lot of
wellness podcasters talking about. But it is a real problem
and I diagnose it in a large proportion of patients
with infertility. It's not always just women with PCOS. It
can be you know, associated with excess body weight.

Speaker 3 (01:33:51):
Insulin is a hormone that.

Speaker 1 (01:33:53):
Helps you store blood sugars effectively, and having excess weight,
especially around the mid section, family history of type two diabetes,
having PCOS. There's all these like clues in clinical markers
that kind of like smell of insulin resistance, and you
can do blood work to rule it in or out.
You can look at body composition, there's those scans that
you can do and basically it is a condition that

(01:34:15):
is like a vicious cycle where your body's not listening
to insulin, it's not storing blood sugars effectively, and then
it makes you churn out more insulin, because that's what
hormones do. If they're not getting listened to, they yell,
they create a higher signal, and that can, as I
said earlier, affect how our ovaries behave.

Speaker 3 (01:34:32):
It can make your ovaries overproduced.

Speaker 1 (01:34:34):
Distaster, and it can create an unhealthy environment around the
ovaries or around the eggs within the ovary so that
they're more error prone. So even if you're young and
you're like, wait, why am I having you know, poor
results with egg retrievals. A lot of my eggs aren't
turning into healthy embryos, or I'm having miscarriages, and they
tested the miscarriage.

Speaker 3 (01:34:52):
I did a DNC and it was genetically normal. How
do you explain that.

Speaker 1 (01:34:55):
It's like, well, maybe we need to correct the insulin
resistance because that could be an underlying factor for not
just egg quality issues, but also things like miscarriage or
not having embryos implant, whether you're trying on your own
or through treatment. So this is a very real thing.
It's very prevalent because we live sedentary lives. A lot
of us are sitting at a desk twelve hours a day,
not prioritizing movement in the way we should, not building

(01:35:18):
muscle the way we should, because muscle building is like
the antidote, It actually makes you much more sensitive to
insulin and helps correct a lot of that metabolic dysfunction.
So glp ones are very very good at treating insulin
resistance and therefore if you're correcting that underlying problem. Oftentimes
women who haven't been ovulating regularly can start ovulating, especially
if they're overweight and they've lost some of the weight.

Speaker 3 (01:35:39):
That can be really helpful correct all of those.

Speaker 1 (01:35:42):
Underlying disturbances that I mentioned. But glp ones are not
safe in pregnancies, so it's really tricky because there are
women that are like, oh, I don't need to be
on contraception, I never ovulate. That's not a great plan, right,
especially if you're doing something that's changing your metabolism, you
might start ovulating, so you want to beware of that.
And there are potential risks in pregnancy that have been documented,

(01:36:03):
growth restriction, lower birth weight, even certain birth defects, and
so we really want to be careful.

Speaker 3 (01:36:09):
To have a wash out period of ideally.

Speaker 1 (01:36:10):
Two months before getting pregnant, and maybe make sure you're
going to a reputable source to get it from. Yes,
Oh my gosh, I mean you really have no reason
to go to like compounding pharmacies. Like now there isn't
a drug shortage, and you can get this through reputable
sources and know that you're getting the same type of
formulation every time you're taking it.

Speaker 2 (01:36:29):
And also your insurance might cover it. So I feel
like that's also a good thing for book.

Speaker 1 (01:36:33):
Yes, and now there's oral forms so it doesn't have
to be injectable. I mean that can reduce the rate
of side effects potentially.

Speaker 2 (01:36:39):
So Doctor Lucky, your book is now for sale. Everybody
can pick it up. It's called the Lucky Egg. What
is one thing you want everybody that reads this book
to take away from it?

Speaker 1 (01:36:51):
I want them to feel like it's not so complex
and scary the issue of their fertility and what they
need to know. I want them to walk away feeling
calm and confident and just sure of themselves and what
their next step should be. I think it's a really simple,
easy to access roadmap. I always say, it's like, you know,

(01:37:13):
the idea of just going through life and not getting
this formalized education feels very much like driving on a freeway.
And not having looked at GPS or plugged in my
destination and just relying on, you know, going so fast
and having to navigate like here are the signs, let
me just swerve, you know, lanes because I actually need

(01:37:33):
to get off at this exit. That's how you make
bad decisions. And so I just want.

Speaker 3 (01:37:37):
People to be really thoughtful about what.

Speaker 1 (01:37:40):
They want out of life and understand a better strategy
that's logical, that's not rooted in fear mongering or misinformation
or trying to sell people things.

Speaker 3 (01:37:49):
That's just giving them all.

Speaker 1 (01:37:50):
The facts so that they can make an informed decision
for themselves.

Speaker 2 (01:37:53):
And where can everybody follow you to stay connected with
everything you've got going on.

Speaker 1 (01:37:57):
I'm most active on Instagram at Lucky dotz con sekho n.
I'm on TikTok at doctor Luckyegg because Lucky dot ce
com was taken apparently. I have a website, the luckyegg
dot Com. I have a lot of cool calculators, like
an egg freezing calculator, an AMH tool, lots of interactive tools,
even that pregnancy due date calculator that gives you the
milestone dates for your pregnancy. And then my book's everywhere,

(01:38:19):
and there's an audio book, there's an ebook, and I'm
based in New York City. I work at a practice
called Armay of New York and I'm still a full
time doctor that' sees patients.

Speaker 2 (01:38:28):
Thank you so much for being on post rend HIKEDEG.
Thank you for having me Hi, guys, Kate here. If
you made it this far, thank you so much for
being here. This is one of those conversations I will
definitely be listening back to the next time I'm trying
to conceive. Fertility is something so many people assume they
understand until they're in it, and my hope is that

(01:38:50):
this gave you a clear, more honest picture of what
conception actually looks like and the proactive measures we can
take going into our fertility journeys. If you're enjoying post
rerend High, please be sure to follow this show wherever
you're listening and share this episode with someone who might
need to hear it. I'll see you guys next week.

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Kate Mackz

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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;}The Fertility Advice Women Need Earlier: Dr. Lucky Sekhon