February 27, 2025 • 57 mins
For many people, when we start thinking about a family, we assume it'll just happen nine months from the moment we start trying. But that isn't the way it happens for all of us. And fertility can often be a journey that's more winding and more complicated and more confusing than we expected it to be. That's why ParentData has launched a new content vertical, Trying to Conceive (TTC), covering everything from ovulation windows to donor eggs to infertility treatments, along with a newsletter all about infertility treatment in particular, which aims to answer all of your questions with data. It's our mission to provide real evidence-based information so you can make the best decisions for your family.
Today on ParentData, we're airing the audio from an event Emily did with three of the people who have contributed most to our new initiative: Dr. Breonna Slocum, a reproductive endocrinologist and fertility specialist, Marea Goodman, a licensed midwife and author, and Dr. Pooja Lakshmin, a perinatal psychiatrist. This roundtable of experts discuss about where to start with fertility, answer audience questions in real time, and consider what they all wish that they knew before starting the journey of trying to conceive.
Explore to Trying to Conceive on ParentData.org, where you can also access new articles every week on data-driven pregnancy and parenting.
This episode is generously supported by:
See omnystudio.com/listener for privacy information.
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Episode Transcript
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Speaker 1 (00:00):
This is parent Data. I'm Emily Oster.
Speaker 2 (00:07):
For many people, when we start thinking about a family,
we assume it'll just happen. We'll decide one day we
want to have a baby, and then nine months later
there'll be a birth. But that isn't the way it
happens for all of us, and fertility can often be
a journey that's more winding and more complicated and more
(00:30):
confusing than we expected it to be. And as I've
spent the last decade or so writing about pregnancy and parenting,
questions about fertility have come up all the time.
Speaker 1 (00:43):
People want to know.
Speaker 2 (00:45):
What is the data say. What is the data say
about when I should have sex? What is the data
say about when I should think about fertility treatments?
Speaker 1 (00:53):
What is the data say if I.
Speaker 2 (00:55):
Don't have any sperm in the relationship and I need
to have some donor sperm?
Speaker 1 (01:00):
How do I get that? These questions come up all.
Speaker 2 (01:02):
The time, and now parent Data has some answers. We
have recently launched a new content vertical in parent Data
on Trying to Conceive, covering everything from ovulation windows to
donor eggs to infertility treatment, along with a newsletter all
(01:23):
about infertility treatment in particular that aims to answer all
of the questions people ask, but answer them with data,
with science. One of the things that's really tough about
this space, especially if conception is a struggle, is that
we so much want hope, and that's an opportunity for
(01:44):
a lot of misinformation, and we're aiming to provide real,
evidence based information so you can make the best decisions
for your family, whatever is the fertility journey that you
are on. Today on the podcast, I'm airing audio from
an event I did with three of the people who
(02:05):
have contributed most to this trying to conceive content on
parent data.
Speaker 1 (02:10):
First, I've got doctor.
Speaker 2 (02:11):
Brianna Slocum, who's a reproductive endocrinologist and fertility specialist. I've
got Maria Goodman, who's a licensed midwife, author and the
founder of Pregnant Together. She specializes in caring for the
LGBTQ plus community from preconception to early parenting. And I've
got doctor Pooja Lakshman, who's been on here before, who's
a perinatal psychiatrist.
Speaker 1 (02:33):
The four of us.
Speaker 2 (02:34):
Talk together about where to start with fertility questions, about
what they all wish that we knew before starting to
try to conceive, and we answer a lot of listener
questions that come in through the zoom. This is a
really fun event and I'm really excited that we get
to share the audio with you and if you have
more questions, as people in the chat did, go to
(02:55):
parent data dot org see if we have answers and
if we don't, send your questions in just building out
what we want to do here, and we can't wait
to hear from.
Speaker 1 (03:03):
You after the break Office Hours on trying to conceive.
Speaker 3 (03:20):
So thank you all so much for joining us for
this month's office hours roundtable on trying to conceive.
Speaker 1 (03:28):
My name is Meg.
Speaker 3 (03:29):
I manage customer success here at parent Data, and I
am particularly excited for this conversation as trying to conceive
was just a huge part of my life in my thirties.
I experienced a number of pregnancy losses at topic pregnancy
surgeries and ultimately two rounds of IBF, which led me
(03:51):
to my two beautiful kids, Theo and Talia, and I
know firsthand how exciting, stressful, and really emotional this process
can be, and I just cannot wait for this team
of experts to discuss this really incredibly important topic this
discussion today and we put this in the event invite
(04:14):
as well, but it's going to reflect the wide range
of experiences that people have with fertility and family planning,
and we're going to leave plenty of time at the
end for audience Q and A. We had a lot
of interest in this event, a lot of questions came in,
so we'll definitely leave time for that. And you all
might know that today's theme is timed the launch of
a new section of parent Data on trying to conceive.
(04:37):
So we're just so excited to bring you high quality,
data driven information on this stage of life and it's
more important than ever and it's been something that the
whole team has been working on for over a year,
a really long time coming. So starting this week, you
can explore trying to conceive or TTC in two.
Speaker 1 (04:57):
Different ways on parent Data.
Speaker 3 (04:59):
So we've launched a new section of parent data dot
org dedicated to trying to conceive. So this includes articles
on topics like understanding your ovulation window, the two week wait,
pregnancy tests, and even miscarriage. You'll also find articles on infertility,
egg freezing, and LGBTQ plus conception. Second, we are starting
(05:23):
a weekly newsletter for anyone navigating fertility treatments or family
planning with donor sperm or eggs. So this is meant
for people who are looking for information to guide their
medical decisions. We'll be covering the latest research and headlines,
share one on one level guides, and answer reader questions.
And thanks to our sponsor Roe, you can actually access
(05:44):
all of the articles and the newsletter for free until
April eighteen. So this is obviously a celebration of that launch.
So now I am thrilled to introduce today's guests. As always,
today's event will be hosted by Emily Auster. Emily is
the founder and CEO of Parent Data, a professor of
economics at Brown University, and a mom of two. She
(06:07):
is also the author of four New York Times bestsellers,
Expecting Better, Cribsheet, The Family Firm.
Speaker 1 (06:13):
And The Unexpected. She will be joined.
Speaker 3 (06:16):
Today by three incredible Parent Data contributors who have years
of experience supporting people on their TTC's journey. So first
is doctor Brianna Slocum. She's a reproductive endocrinologist and fertility
specialist who treats patients navigating infertility and assisted reproductive technologies.
Speaker 1 (06:34):
Like IVF Next.
Speaker 3 (06:37):
Maria Goodman is a licensed midwife, author and the founder
of Pregnant Together who specializes in caring for the LGBT
plus community from preconception to early parenting. And finally, Doctor
Puja Lakshman is a perinatal psychiatrist and author who advocates
for women's mental health throughout their fertility journey. Without further ado,
(07:01):
welcome Emily, Brianna, Maria, and Poushia.
Speaker 2 (07:06):
Thank you Meg, and thank you everybody for being here.
We're incredibly excited to do this to talk all about
trying to conceive and Pujia, Maria, Rihanna, thank you guys
so much for writing all of these amazing things for
us and being here. And I am just thrilled to
get this information out. So we're going to start with
(07:29):
some discussion and then we'll open it up to questions.
But I want to kind of really start with the
question of normalizing trying to conceive infertility as a journey.
I think for a lot of us, you kind of
there's this narrative like you go off birth control and
then there's just a baby, and we often think about
it like, Okay, what's my ideal timing I'm going to
(07:50):
go off birth control and then like three months later,
you know it'll be ready, and nine months after that
I'll have a baby.
Speaker 1 (07:56):
And of course that is not true for everybody, And.
Speaker 2 (07:59):
I think it's it's really tough when you have that
expectation and it does not deliver in that way, and
people around you it seems like it's magic, and that's
not always happening for everyone. So this also leaves out
people who use a variety of other ways to grow
to grow their family. So let's just start there, and
(08:22):
I want it for each of you.
Speaker 1 (08:23):
I'm going to start with.
Speaker 2 (08:25):
Brianna, just ask what is one thing that you wish
everyone knew about trying to conceive if you had a
magic information Wand.
Speaker 4 (08:38):
I think that for a lot of reasons, there's this
real tendency to look inward for explanations for why a
fertility plan or journey maybe isn't happening the way that
you wanted it to. And oftentimes that really looks like
blaming yourself. So it's saying things like I wish I
had frozen my eggs earlier, or I wish I had
done this thing or not done that thing, or whatever,
(08:59):
And I find that it's really helpful to remember that
this is all happening in a context of a society
that really doesn't value women's reproduction. And so that's why
you didn't learn about fertility in school, for example, and
why fertility insurance coverage is not federally mandated, nor is
paid printal leave. So it's really not your fault, which
(09:19):
means that you're not completely in control of everything that happens,
But that doesn't mean that you don't have some power
and that you can't still feel good about the process
and kind of what's happening. And so if I had
like a magic wand I would really want everybody to
understand that, and to also just find a clinic or
doctor provider whoever who helps you feel some of that
power and you feel comfortable.
Speaker 1 (09:40):
With Maria, how about you? What would you tell people I.
Speaker 5 (09:47):
Love Rihanna that you started with that. I mean, what
I would say, which I think builds on that for
queer folks and solo parents and really anyone growing their
family outside of the traditional heterosexual model, is really just
that folks had access to the information and the choices
that they need and deserve. What I see so much
(10:08):
in these populations is overwhelm and not knowing where to start,
which I think is really it touches on that the
internalized there's internalized homophobia that can come up when growing
your family outside of the heterosexual model. And yeah, I
(10:31):
wish that as young people we knew what needed to
happen in order to be able to grow our families,
because I really see this as a reproductive justice issue
that we all have the right to grow or not
grow our families in the ways that we choose.
Speaker 6 (10:46):
Oh yeah, yeah, Well, first of all, I love Maria
and Brion, I love both of your points, and kind
of just I guess piggybacking a little bit. I think
one of the things that I wish we could bring
just more nuance to the emotional conversation because I think
so much of what we see on the outside is like, oh,
(11:09):
you know, I'm pregnant, and there's like this excitement emotion,
or at least that's what we're expected to feel, when
in reality, what I see in my practice as a
perinatal psychiatrist with patients is that it's rare for me
to have a patient where grief or ambivalence, loss conflict
(11:29):
is not part of their experience like that that thread
of grief or ambivalence or sort of feeling like lost
and confused. So it's I guess just normalizing that this
is this is not all like rainbows and unicorns, that
there's a real kind of process of acceptance that I
think happens, and I wish we talked more about that.
(11:49):
So I'm so excited for this space and for this
new newsletter.
Speaker 2 (11:54):
So I think what I'm hearing from from at least
Brian and Maria is this idea of of education. I
think for me, this is this is a core thing.
I think we spend an awful lot of time And
I say this as a parent of a teenager explaining
to people like how not to get pregnant and not
really expanding that out to like, why don't we help
(12:15):
you understand your fertility which or you know, how this
is all going to work and what are the different
ways that eventually if you want to have a child
you could which also, by the way, can help you
understand how to not have a kid now. And I
think this sort of like getting people to a place
where when they arrive at the moment of family building
they are in a better position to actually understand what's
(12:36):
what's going to come next.
Speaker 1 (12:37):
I think for me that's that's what it is, all right.
Speaker 2 (12:40):
So so I actually want to ask one more question
for Pooja in this in this space, which I think
gets a little bit more into the into the practical,
which is, you know, you talked a little bit about
mental health and some of the sort of mental health
stress stuff.
Speaker 1 (12:54):
I think one thing that's.
Speaker 2 (12:55):
Actually quite stressful for people is the idea that maybe
being stressed is the thing that's in the making them
not able to get pregnant. Then they're stress about being stressed,
And I think, so can you talk a little bit
about that and what do we know about the impacts
of stress on conception and how to sort of think
about that as a patient.
Speaker 6 (13:11):
Yeah, yeah, this is this is a topic that can
be a little bit triggering, So I'll just caveyat it
with that, And also just to give everybody kind of,
you know, some of the numbers. So like in general,
like in a normal pregnant or a normal situation where
there's not any other confounding variables or other medical situations
(13:32):
going on, ten to twenty percent of early pregnancies and
in miscarriage, Like that's just normal, right, and that's the
body's way of working and making sure that the eggs
and the ambrews that are the healthiest kind of move
through and are picked. But in we know that about
(13:53):
ten to fifteen percent of couples are going to struggle
with infertility and are not going to be able to
conceive naturally. And there is research to show that when
there is environmental stress. And when we're talking about environmental stress,
it really it's just such a broad range of things.
So it could be you know, being but not having support, right,
(14:14):
being in a situation where you're a solo caregiver and
you're experiencing stress from that standpoint, or being in a
relationship that is fraught and has a lot of conflict,
or being in a socioeconomic demographic where you're experiencing stress
and you don't have access to healthcare. Race and identity
(14:35):
plays into this too. We know that there is a
link between stress and having difficulty getting pregnant. And this
is something that's really hard to talk about because at
least with my patients, like and this was my experience
as well, Like I I went through IVF to conceive
my son, who's now two and a half. Telling a
stressed person not to be stressed probably one of the
(15:00):
things that you can do. So I really I try
and with my patients when I'm when when they're gearing
up for whether it's IVF or IUI or even in
there in the beginning stages of like starting to think
about conceiving, I say to them, Look, this could be
a long process, Like we don't know what it's going
(15:20):
to look like, and so we need to get your
support system in place. We need to figure out who
is your team, Like who is going to be there
for you? Who are the friends that you can lean
on that you can text? Can we start a group chat? Right?
Do you know anybody else that's done IVF or that's
done EUI that you can reach out to, So like
(15:41):
kind of thinking of it as more of a p
in a proactive way of like, what are the levers
that we can pull so that we don't feel so
out of control when it comes to chronic stress.
Speaker 1 (15:54):
All right, let's get into the details. Rihanna, I'm starting
with you.
Speaker 2 (15:59):
Tell us about age and fertility and in particular, what
you'd like people to know as we age into what
you people in the reproductive space would call advanced maternal age.
Speaker 4 (16:15):
Well, I think it's really important to understand that age
is the single best predictor of a woman's ability to
get pregnant. And the reason why is that age corelates
best with a quality or the ability of that ache
to make a healthy baby, and that goes down with age,
I'm sure as we all know. So to put some
(16:36):
numbers on it, a healthy thirty year old woman has
about a twenty percent chance of getting pregnant per cycle.
The number goes down to five percent by the time
she's forty, And unfortunately there's no test for equality. There
are tests for a quantity, or to get a sense
of roughly how many eggs your bodies releasing each cycle,
and those are tests like AMH, which I'm sure many
(16:58):
of you have heard of, go down with age. But
because quality is more important, tests like AMH do not
correlate well with your ability to get pregnant.
Speaker 2 (17:08):
So the AMH is going to tell me how many
eggs I have, but not whether they're good. Roughly, it's
a metric of how many, but not whether they're good.
I think this is quite an important point, because I
think we often conflate those people have this idea that
AMH is going to tell me, like is it going
to work? And that's not to what extent does it?
Like if I have a good AMH, is that tell
(17:30):
me it's going to work?
Speaker 4 (17:33):
No, it tells you how you're going to respond to
IVF or IVF meds. So egg freezing IVF and certainly
numbers are important. You'll often hear IVF in particular referred
to as a numbers game. So I don't want to
say it doesn't matter. But if you're looking at it,
just got in the dark to see, like can I
get pregnant? Yes? Or no? AMH is not going to
(17:54):
help you there.
Speaker 2 (17:56):
So you said that age is the most important determinant
of fertility. Is there are there ways to youth in
my eggs too?
Speaker 1 (18:05):
Are there you know?
Speaker 2 (18:06):
Ways to make my eggs? We hear a lot of
about supplements. You talk a little bit about supplements that
could or could not lower your egg age.
Speaker 5 (18:17):
Yeah.
Speaker 4 (18:18):
Well, first, I love the verb youthin. I'm gonna write
that down and take it with me. But this is
really tough for many people A year but no, and
that's because we really don't completely understand ovary and aging,
although the ovary is really interesting in the sense that
it is one of the first organs that we can
appreciate its aging in this way, but we don't understand
(18:41):
it completely, and so that means that there are interventions
that we can offer. At this point. We do know
that have the alcohol use, for example, or tobacco use
like smoking, that certainly can worsen your equality. But most
of the women who I'm saying already know that. I'm
sure most of you all do too, So yeah, not really.
There are two supplements that you hear about THHA and
(19:04):
Q ten or like the two, which we have articles
on about those specifically in the data behind it.
Speaker 2 (19:10):
Let me ask one other thing here, which is about
secondary infertility. And I think for a lot of people
that's something that sneaks up because you may get pregnant
the first time and then because of age or because
of randomness in the process. So is this a common
reason you see people and how would you suggest people
(19:31):
navigate that medically?
Speaker 1 (19:33):
Is it different than if it were primary infertility.
Speaker 4 (19:36):
So it's super common, it's super common. And with that specifically,
I mean it is important to go and see a provider,
because we are looking at what changed, because as you mentioned,
obviously they were able to get pregnant the first time,
you know, something must have changed. So what I'm looking
at specifically is a really detailed history to see us,
for example, where there are there any hormonal changes result
(20:00):
from complications from birth for example, or things like that.
Are there differences maybe that we're going to see on
the semen analysis, But most of the time it is
age kind of as you alluded to, And so this
is actually my research interest. But in kind of thinking
about it and approaching it is just kind of when
you think about when you are ready to start your
family and kind of doing that math about how many
(20:21):
children you want Roughly, you know, things change like how
many children you want, how far out do you want
to space them, how willing are you to use IVF
to achieve your pregnancy goals family goals? Those are my
research interests, But that's kind of how I would think
about it on this end.
Speaker 2 (20:36):
All right, Maria, I want to turn to you and
I want to ask you just very basically the patients
that you see, why are people, why are people coming
to you? And how is it maybe different than how
people are coming to Brehanna or how is it not different?
Speaker 5 (20:49):
Yeah, great question. I would say I primarily work with
people who are either at the very beginning of the process.
Speaker 1 (20:56):
Who are like, where do I start?
Speaker 5 (20:58):
I know I need to choose a donor, I have
no idea idea how to go about that, or maybe
folks that have been trying at home with a directed
known donor or sperm Primum Bank for a few rounds
and need to kind of reassess their choices. I also
(21:18):
run a virtual community for queer folks and solar parents
that bring people together for that mental health community support piece,
which is really a huge thing that I see people
just feeling alone throughout the process. I think everyone struggling
with any sort of infertility feels that way. What's tricky
and unique about queer family building or solo parent family
(21:42):
building is that a huge majority of the data that
we have on infertility is based on heterosexual people. So
they've been trying to conceive either for six months at
home if they're over thirty five, one year at home
if they're under thirty five, and then and medically kind
of they achieve that infertility diagnosis and get support there
(22:08):
are some new studies that are coming out on the
different considerations for queer folks and solo parents when the
issue is really just access to the gam meats, the sperm,
or the eggs or the uterus that they needn't. We
don't always need infertility support, but sometimes we do so,
(22:30):
so it's it's a complex decision making process. It's also
influenced by the cost. There's a different financial burden placed
on queer folks and solo parents when you have to
buy sperm from a bank. That's really changed post pandemic.
A vial of sperm used to be like six hundred
to eight hundred dollars and now can be fifteen hundred
(22:53):
or two thousand per vile.
Speaker 1 (22:55):
Why is that now?
Speaker 7 (22:56):
I'm interested, as again, I don't understands yet, you know,
I think I think a lot of there were a
lot of issues, a lot of social interruptions, you know,
during the pandemic, And I don't fully know why it
is so much more expensive, but it is, and it's
(23:17):
really influenced how I advise folks on the choices that
they make, because.
Speaker 5 (23:22):
Most people don't have the luxury of trying at home
with previously frozen sperm for six to twelve months, and
I don't necessarily recommend it because of the financial and
emotional burden. So it's it's sort of a combination of
looking at people's values and preferences than assessing age and
(23:44):
other fertility predictors, and trying to forge a path that
will reduce their time as much as possible and also
reduce like the emotional and financial burden. And it's it's
a complex process.
Speaker 2 (24:00):
Yeah, it's almost like there's too many choices. There's too
many choices and too many ways to go into it.
And somehow that like so many choices, but also.
Speaker 5 (24:09):
And we don't really know are you do you have
been fertility or do you just not have access to
sperming your relationship? And then how do you know? There
are different recommendations medically for how to get pregnant, and
sometimes it's hard to know what is ideal.
Speaker 2 (24:26):
Pooja, I want to come back in asking you to
to something.
Speaker 1 (24:31):
Brianna said about age.
Speaker 2 (24:32):
So I think one of the things that's so tricky
is navigating what we think of as this sort of
age readiness trade off between you know, I want to
wait because that's good for other aspects of my life.
But then I'm worried about about fertility, and I think
the mental health burden.
Speaker 1 (24:49):
There is actually pretty significant.
Speaker 2 (24:51):
Because it stresses you out, but also because then you
you know, end up on the other end thinking, well,
I waited too long because of this other trade off.
So I'm like to ask how you think about people
navigating that and what you'd how you'd counsel someone with
that kind of kind of concerns in your practice.
Speaker 6 (25:10):
Yeah, yeah, I think that this is this is sort
of like the million dollar question. I think, especially in
my practice, where I'm taking care of women who generally
are professionals, high achieving, you know, have gone to graduate school,
have put in a lot of time and energy into
their career, and so that means that they are delaying
(25:34):
child bearing. And I personally went through that experience too.
I actually wrote about it for The New York Times
a couple of years ago that I was thirty eight
and a half when I had my son, and and
that kind of winding backwards didn't start. Didn't feel ready
to become a mother until I was like thirty five,
thirty six, and so had that conversation to look into
(25:57):
egg freezing and then started trying and then had a
carriage and then right, So it's like it takes time.
So I think, you know, I guess a couple things
on the readiness question. I think one, it's so easy
to play Monday morning quarterback with your decisions and your
life in general, and so I really try and encourage
(26:19):
my patients like, no, you, at each step of the way,
at each stage, you are making the best decisions for
yourself with the data that you have, and there's a
reason that you make choices at any given time, and
it's not fair to sort of go back and beat
yourself up. The other thing that I would say is,
like one of the things talking about the stress piece
(26:41):
Emily is like, yeah, like we as women, we as
people that have uteruses, Like oftentimes, especially if you're in
a heterosexual relationship, we're the ones that are constantly doing
this calculus and doing this math like oh, okay, I'm
thirty five right now, and like if I wait till
I'm thirty seven, like this is what the numbers are. Right,
And you have a male partner, usually it's like completely
(27:02):
foreign to them to be thinking in this way and
they're not sitting here some of them actually are on
this zoom call, which is great, but most of them
are not, right, Like they're not reading about this thought,
they're not thinking about it. So it's interesting because I
think we are often bearing this burden even before you
(27:22):
start trying to conceive and talk about queer couples, right,
Like it's such a it's like years before there's even
like a baby or thinking about a pregnancy. So just
naming that and like giving yourself some compassion there because
it is such a heavy load. The other thing that
I would say is that, like I think this is
a little bit similar to what you say, Emily, Like
(27:43):
there's no secret option. See, Like there's no secret option. See,
there's no like perfect decision, there's no perfect time. It's
just weighing for yourself, like all of the different pros
and cons. Babies are expensive, Like babies are freaking expensive.
Speaker 1 (27:59):
Kids are expensive, right, so like.
Speaker 6 (28:01):
You know, just like the financial side, like the relationship side,
like all of these things, and and kind of that's
why it's kind of the first thing I mentioned was grief,
because I do think that so much of this is
about like making peace with yourself and coming to a
place of acceptance and it take a long time to
(28:22):
get there. You know, I think a lot of folks
here on this call, I know I'm seeing like people
want practical information about like what to do and how
to get the best chance of success. And like, one
of the things that's so hard about the infertility journey
is like there's no one hundred percent like we There's
never like if you do this, then definitely you will
(28:44):
go home with a baby. There's there's just like shades
of gray and optimizing, but there's never like that feeling
of certainty that you could hang on to that if
you're somebody who got pregnant easily, that that you just
innately have. When you're somebody who has struggled with infertility,
you you unfortunately, you never get back that feeling of certainty.
Speaker 1 (29:09):
Yeah.
Speaker 2 (29:10):
Yeah, And I think you know part of what's what's tough.
And I sort of see this in a lot of
your guys comments, it's like, well does this matter?
Speaker 1 (29:17):
Does this matter? Does this matter?
Speaker 2 (29:18):
And you know, we can look at those things in data,
and a lot of times for a lot of the
questions you're asking, the answer is no. So we know
age matters, that's pretty clear. But a lot of these
other things. You know, I have a few extra pounds here.
I had one glass of wine day four. You know,
I exercised too much.
Speaker 1 (29:37):
This stuff is.
Speaker 2 (29:38):
Not mattering in an important way in our chances of conception,
but it's the piece of feeling like, well, there's got
to be something I can control, Like what if I
did everything perfectly, Well, I didn't do everything perfectly, and
now it's my Now it's my my fault. And I
think that's I think that's really that that's that's really
hard because the loss of control is I think some
(29:58):
of the hardest pieces pieces here. So I want to
do one more sort of like questions for you guys,
and then we're going to get to people's individual questions.
And so I know you guys have already put a
bunch in, but you can think think more about what
you what you.
Speaker 1 (30:17):
Want to ask.
Speaker 2 (30:19):
But I want to the question I want to ask
here is is kind.
Speaker 1 (30:22):
Of where where to start. So just in like a
brief way, Uh, let's start with you, Maria.
Speaker 2 (30:28):
You know if you people come they say, I'm looking
to build my family in a I'm a queer couple,
I'm solo parent. I'm looking to build for some other
reason in a non traditional way. Where would you recommend
they start their thinking?
Speaker 5 (30:44):
Well, I wrote a bunch of articles that will be
helpful for starting that process. I like to separate the
the beginning approach into two parts, so the emotional part
and the logistical part. Under emotional, I would include like
values and know that that emotions often come in ways
(31:07):
waves throughout this process. Under logistical, I'd include your access
to fertility providers that have experience working with somebody in
your situation and finances, all of those sorts of things,
and sort of seeing those as two separate but interconnected processes. So,
(31:27):
as Pooja said, there's often grief, there's often ambivalence. I
think overwhelm is us feeling flooded by these emotions. So
it's really important to have a space for that, and
then also getting clear on the logistical side of things,
your preferences. When it comes to either choosing a directed
(31:49):
or known donor or unidentified donor from a bank, I
recommend choosing that first because your type of don't or
sperm and how easy it is for you to get
it will influence your conception, options and choices, and so
so that's generally where where I encourage people to start,
(32:12):
like get that emotional support piece in order figure out
where you're getting your sperm, and then and then you
can either you know, trying at home. I read an
article about at home incuminations for queer folks and solo parents.
Maybe you're making an appointment with a reproductive endocrinologist and
going straight to reciprocal IVF or IVF. We've got resources
(32:33):
on all of that, but I would say that that's
a good place to start aesome.
Speaker 2 (32:39):
All right, Brianna, For you, when do you seek help
from a doctor?
Speaker 1 (32:43):
Started? Very practical. When should I start? When should I
look for a doctor's help with conception?
Speaker 4 (32:49):
Yeah, well, ideally you would have some sort of visit
preconception to just run down your med list, history, all
of that, to make sure that all of that's compatible
with the pregnancy and make sure you're up to day
on your vaccines like all of that. But yeah, when
you're actually ready to get started, I would definitely just
check to see if you have any red flags. We
(33:10):
actually have an article on this, but red flags would
be things like if you aren't having regular periods, you're
not having periods at all, If you have a history
of endometriosis or ever having received chemo or radiation specifically
to the pelvis, things like that. We have a whole
article on it. In those cases you should seek help
(33:31):
right away. Otherwise it really goes by age of the
woman for the reasons we've been discussing, and so if
you're less than thirty five, it's a year of trying.
If you're over thirty five.
Speaker 1 (33:41):
It shorty tell us why? Sorry, can you tell us
why this is? Why is it?
Speaker 4 (33:45):
Yeah?
Speaker 1 (33:45):
Why is it different in different ages?
Speaker 4 (33:48):
It's different because on fertility outcomes correlate best with age.
So it's just shortened because your fertility starts to decline
a little bit more rapidly between thirty five thirty seven,
and so we really want to get you and you
as possible, just for equality reasons.
Speaker 2 (34:04):
All right, poojia, how should people prepare for fertility treating?
Speaker 6 (34:11):
I actually, can I ask Brianna follow up question or
ye go into more detail about when we say trying,
what does that mean?
Speaker 4 (34:20):
Yeah, so sometimes people take it to mean like doing
all the things like ovulation predictor kids all of that. No,
it's just having unprotected intercourse regularly. So ideally are having
it regularly.
Speaker 2 (34:34):
Wait, now I have a follow up, which is, yeah,
someone has been trying, like really trying, like I'm ovulation testing,
I'm doing it, Like should I cut it off earlier
because like, I'm trying hard. I've been trying harder, and
so I should have learned more from like three months
rather than six months.
Speaker 4 (34:51):
No, not necessarily. No, it's still you know, this is
just kind of a statistics kind of map probability thing.
It's it's not necessary really like you're trying harder, so
that means something's really wrong. There could still be other
things that it just takes time. But yeah, no, I
just mean having regular unprotected intercourse.
Speaker 1 (35:12):
Awesome, thank you.
Speaker 6 (35:15):
So what so my question was what would I say
to patients like as they're starting to prepare or get.
Speaker 1 (35:20):
Ready for fragility, Yeah, fertility, Yes, so a couple of things.
I think.
Speaker 6 (35:27):
First, if if you're going down the IVF path or
even the EUI path, I'm like really honest with my
patients and usually they like this, sometimes they get mad
at me, but think that it is going to be
kind of another full time job in terms of the
blood draws, the testing that you need to get done
when you're in the midst of the cycles where they're
(35:49):
monitoring your follicles to see how they're growing. Like it's
a lot of time. For about like two weeks or so,
you'll kind of be living at the office. And and
the thing is that there's just so much information and
it's kind of like learning a new language that you
do really sort of end up. It's like by the
end of it, you'll kind of feel like you have
a PhD in IVF because you're kind of just like
(36:11):
learning all of this information.
Speaker 1 (36:12):
So one is just to be prepared for that.
Speaker 6 (36:14):
And I like that Brand mentioned that overwhelmed, Like it
is overwhelming. It's overwhelming, and that's normal, and like it
sucks that it is this way. The reason is because
what things that we've talked about, like we should be
learning about this in school, we should have this vocabulary,
but we don't, so it can feel really overwhelming. And
so again like leaning on your support system, having other
people in your life who have been through it that
(36:35):
you feel comfortable talking about your situation with. It doesn't
need to be like ten people, it could literally just
be one or two people. And then just being prepared
for the uncertainty. I think so much of this.
Speaker 1 (36:48):
I know it.
Speaker 6 (36:48):
It's annoying that I keep mentioning that because there's like
not a lot of like tangible stuff that you can
do to deal with uncertainty. But really, like the marker
of an infertility journey really is that you're it's just
one hurdle after the next, you know where you first
you get the eggs, and then and then you're waiting
to see like how many how many get fertilized, and
(37:10):
then maybe you're doing genetic testing, and then you're waiting
to find out like is how is your uterine lining?
And I don't say this to like freak anybody out,
but more just to say like, it's a long process,
and so you have to kind of think of it
as like a marathon as opposed to a sprint, and
you really want to be giving yourself all of the
same like care and attention and love as much as
(37:32):
possible as you would give to that little baby that
you're hoping to bring home.
Speaker 2 (37:44):
More parent data after the break, we're in turn to question,
So if you have a question, raise your hand.
Speaker 1 (38:03):
We'll get to as many as we can.
Speaker 2 (38:05):
You can go on camera or just in audio, and
I saw Katie m had her hand up before.
Speaker 1 (38:11):
It's not up anymore.
Speaker 2 (38:12):
But Katie, if you still want to ask your question,
I'm going to go with you.
Speaker 1 (38:15):
First, let me give you a second. Hey, I appreciate that.
Speaker 8 (38:19):
My question was just going back to Brianna's guidance about
when to seek medical help when you're trying to conceive.
It sounded like you said that before thirty five there
was a pretty clear guideline, and then that between thirty
five and thirty seven or so there's maybe another sort
of general drop off infertility at that point. Are there
(38:40):
guidelines you could provide sort of all other factors being
equal of between thirty five and thirty seven and then
thirty seven and you know, maybe forty about when you
would see someone if you're having trouble conceiving.
Speaker 1 (38:54):
I just want it. Can I just say?
Speaker 2 (38:56):
This is why I love people a parent who are
Parent Data subscribers so much, because we need like by month, Rihanna,
thirty seven or so does not work over here, And
thank you Katie for.
Speaker 1 (39:07):
Calling that out. I appreciate it.
Speaker 2 (39:08):
Rihanna.
Speaker 1 (39:09):
Let's go with precision.
Speaker 4 (39:11):
So unfortunately, there really aren't by month guidelines it's over.
Thirty five is six months of trying, and then a
lot of fertility providers will say when you get to
forty you should seek help right away, but I mean
it's totally individual. And this is kind of what I
mean too about like ideally you'd have a physician who
(39:33):
can talk to you, and like you just feel like
you could go to them and ask them all these questions, like, oh,
I'm thirty six and I've been trying for three months,
but I really want to start the work up now,
Like I think I think that's where you can talk
to your provider and they can give you like look
at your specific scenario and give you more specific kind
of month to month guidance. But generally speaking about thirty
(39:56):
five is all kind of lumped into the six months
and then forty you can go right away.
Speaker 1 (40:00):
Does that help?
Speaker 9 (40:02):
Yeah?
Speaker 1 (40:02):
Thank you, Sarah. What do you get hey?
Speaker 9 (40:08):
I had a question about that five percent number or
the kind of idea of you know, five percent likelihood
to get pregnant each cycle when you're you know, forty,
and just how does that impact like your past history,
Like I had my first baby really easily at thirty seven.
Now my mom got pregnant, you know, very easily throughout
her life into her forties. Like, what are the factors
(40:30):
that kind of tell you is my likelihood maybe a
little bit higher than five percent every month given that
I had, you know, a baby easily in my late thirties.
That's kind of my overall question.
Speaker 4 (40:42):
Yeah, it's really hard to apply these kind of population
level statistics to your individual situation. So I love that
your question kind of addresses that. I would say, having
been able to conceide for four is certainly certainly a
good prognostic indicator, as we would say, I like, it's
certainly something good in your favor. Certainly, I think to
(41:05):
some extent kind of like the fertility of your family.
So if you have a very long family history of
women being able to conceive into their late age, that's
certainly not going to hurt you. But I think kind
of with that five percent number overall, I think that's
why a lot of fertility specialists just say, go seek
help right away. But yeah, there really isn't This is
(41:28):
a great question, and there's not like more data than
that other I mean, because we don't see the people
who are able to conceive easily, so I'm biased in
that way too.
Speaker 2 (41:37):
We don't see them much in data either, right, I
mean it's hard to like it's that kind of really
detailed data where we would actually actually kind of have
like how long did your mom take and how long
did you take for the first one, you know, and
we're how hard were you trying?
Speaker 1 (41:53):
And so on. I think is not is I don't know,
not not easy Ellen, Oh yeah, poo Je.
Speaker 6 (42:02):
Sorry, well, I just wanted to jump in and Brianna,
you can correct me if this is if you don't agree.
But I think for the folks that are kind of
asking like should I go in to see the doctor
or should I wait, I think it's always I always
err on the side of just going, you know, because
a lot of times for the first part of the
workup is going to be lab tests that are time
(42:22):
to your cycle as well, so it's going to take
a little bit of time to do whatever work up
is needing to happen. And I think just having that
conversation with your ob can help alleviate a lot of
anxiety too, and just lay out a map for you
in terms of like the next six months, because right
now when you're just kind of questioning to yourself, should
(42:43):
I go or should I not go? It's already taking
up a lot of mental space. So might as well
take an action and do something and then go have
a conversation where you so you feel like you have
a little bit of agency there, Mary, when you have
to be like I've never had an ob be like,
oh my gosh, I can't believe you came to see
me at like four months instead of six months.
Speaker 1 (43:02):
You know.
Speaker 2 (43:04):
Yeah, people, when you see people, Maria, do you do
you basically tell them to go right right away.
Speaker 5 (43:13):
That's generally my recommendation. I do work with a fair
amount of people that are like, I want to stay
outside of the Western medical system as much as possible.
I want this to be as like quote unquote natural
as possible. And so the personal preference is a factor,
is an important factor. And for those folks, depending on
(43:34):
their menstrual cycle, their ovulation signs and symptoms, how old
they are, you know, that can be really reasonable to
to not get that work up right away. But yes,
for the people that are over thirty five, don't really
have those same qualms about accessing care in the Western
medical system. It's it's never it's never a bad idea,
(43:57):
although I will say, and Brianna mentioned this at the beginning,
like even when you get that work up, it's not
necessarily going to tell you that you will get pregnant
easily or you won't. There are a lot of factors
that go into that.
Speaker 1 (44:11):
Ellen, Hi, Hi, thank you guys. This is great.
Speaker 4 (44:18):
Just wondering.
Speaker 10 (44:19):
So it's kind of too full to question if you
are like looking at that year or six month window
and in that time you do conceive and you have
an early loss, do you consider like do you have
to bump that time before somebody is usually willing to
see you, or like does that count? So that's like
(44:44):
part one, and then the other piece of it is like,
what are like some of the first steps before IVF
or IUI or some of the more intensive things are
like the little things you can do.
Speaker 4 (44:58):
No, no, no, you don't have to reach Are the clock?
Please still come in? Yeah? Please still come in? And
then the second question about what to do kind of
prefertility treatments is how I understand it kind of how
to optimize natural conception, which we do have an article on,
but there's quite a few things. I mean, we can
(45:19):
first of all, understanding that you really do need to
be having a lot of intercourse, not just right around
the time of ovulation. So a lot of people will
just use, well they consider trying to be using ovulation
predictor kits, and then they have intercourse the day of
a positive ovulation kit and maybe like the next day
when ideally you should ideally have sperm mixtos, you're kind
(45:40):
of before that. So a lot of it would be
kind of understanding your fertility window, what test you're using,
and just making sure you're having enough sex, and then
kind of eliminating the things that we know are harmful,
so just heavy alcohol, use tobacco. You would look at
your medlist just to make sure that's okay. Yeah, stuff
like that. But we have a whole article that goes
(46:01):
into more detail.
Speaker 2 (46:02):
What do you mean, like a lot of sex, like
multiple times every day, every other day every day?
Speaker 1 (46:08):
How much sex is enough? People would like.
Speaker 4 (46:09):
To know ideally daily, but you can stretch it to
every two.
Speaker 1 (46:14):
Every other every other day. Yeah, exactly, Bill, is a lot.
I mean, I'm just saying it is a lot.
Speaker 2 (46:19):
I say that because I think But one thing I
think is worth naming is like people think it's going
to be it's not as fun to have sex when
you're trying to conceive, maybe Pooja. I'm sure you have
thoughts on this also from your things, but it's like
not as it gets boring.
Speaker 6 (46:37):
No, no, nobody reports it being fun.
Speaker 2 (46:42):
I had a man I've been I want to understand
there's no men on this, but I had a man
in my office the other day who explained to me, like,
it's not fun to have sex this much to trinye.
So I don't think this is a gendered I don't
think this is gendered as much as we might think.
Speaker 5 (46:55):
It also takes about twenty four hours for people with
to regain their sperm count and motility, so waiting those
twenty four hours is helpful to make sure that Lisa
wasting your attempts.
Speaker 2 (47:08):
Yeah, okay, Emily with it.
Speaker 1 (47:14):
There are like four thousand Emily's.
Speaker 2 (47:15):
Thank you for everyone having the same name Emily with
a lowercase.
Speaker 11 (47:19):
It's me, thank you, Good afternoon, everybody. I'm trying to
focus on the data part of this question because I'm
not asking you to tell me why I had a miscarriage.
Speaker 1 (47:28):
Don't worry, But.
Speaker 11 (47:29):
The question is I got pregnant very easily the first
time actually also the second time, which is what ended
up in a sixteen week mixed carriage. I have done
every test under the sun, both on myself and on
the fetus, and they can't find anything wrong.
Speaker 1 (47:43):
So the question is a two parter.
Speaker 11 (47:45):
Number one is with unexplained. I am assuming there's something chromozotal, obviously,
but my issue is like why did my body I
understand why you have a miscarriage, and my body did
what it needed to do, but like why did it
not happen at eight weeks or I could have maybe
like blood at home didn't require surgery, Like why did
it take so long for my body to recognize that
this was like not healthy?
Speaker 1 (48:06):
Number one?
Speaker 11 (48:06):
And number two I was told that I could start
trying again right away, which is I'm in three months though,
and it's and they say, like, you actually are more
fertile the six months after a miscarriage. But I feel
like I know a lot of people once they had
one miscarriage, they had several, so kind of like a
multipart question on the unexplained part, like why did my
body not handle this earlier in the pregnancy? And then
(48:29):
number two is the statistics I'm getting pregnant again and
ending in a healthy pregnancy, and like, don't I'm in
therapy to find out, like, how do you not stress
for them in the forty weeks so the next pregnancy.
I don't expect you to answer that part of it,
but more of the science part of it.
Speaker 4 (48:44):
So first, I'm really sorry to have a sixteen week loss.
It sounds really tough, so I'm glad that you have.
It sounds like a community of people who are kind
of helping you process that. And I will also kind
of say, as a caveat, I don't know your specific history,
so it's going to be hard to get into as
much nuance as I normally would if I was seeing
(49:05):
a patient, and kind of the other nuances that second
trimester losses generally have different etiologies compared to first trimester losses.
I see a lot of patients for recurrent pregnancy loss,
which it sounds like you're alluding to, which is multiple
losses within that first trimester. I don't see as many
(49:26):
patients who have had second trimester losses, at least compared
to the ones I see with first trimester. And it's
primarily because and this may answer your question. Those second
trimester losses, usually there's it's something like structural infectious, maybe
achord accident. Like it's usually something that's not at risk
(49:49):
of repeating itself per se. And that's me saying that
without knowing anything about your history or kind of seeing
the test results. But I hope that kind of gives
you some in in the sense that having one second
trimester loss, I mean, having one loss generally does not
necessarily mean that you're going to have another one. But
second trimester losses are in a kind of different category
(50:12):
compared to the first trimester losses.
Speaker 2 (50:15):
I think you can also see from the JAD here
Emily that people are thinking about you.
Speaker 1 (50:21):
Monica.
Speaker 12 (50:22):
Hi, So I had a question about seeing an Obie
Guinde versus a reproductive endocrinologist and making that decision Pope,
like after you've after you've hit the six book mark
depending on your age, early one year mark. So I'm
just curious about that. And then a second part, which
is actually not related, but I'm just curious, like when
(50:45):
we say five percent or like twenty percent of being
able to conceive, like what has to go right or
like what is going wrong that like leads to the
other eighty percent or the other ninety five percent. I
think I've just been really curious about what actually happens.
Speaker 1 (50:59):
Maria.
Speaker 2 (50:59):
I'm going to pass that on to you to start,
because I think you probably deal with people who think
more about this choice between providers.
Speaker 5 (51:07):
Yeah, I would. I would recommend if you are having
any fertility issues to go straight to seeing a reproductive endocrinologist.
They specialize in assessing hormone levels and medications, and obe's
can do kind of that initial workups, the lab test.
Sometimes there's ultrasounds involved with that and that can be helpful.
(51:30):
But I do think a reproductive endocrinologist is your best
support person for the trying to conceive period.
Speaker 2 (51:40):
Yeah, and then the second part of that What was
the second part of that question, Monica, I'm sorry.
Speaker 12 (51:44):
Yeah, it was like the what's what's the a percent
that's going wrong or the ninety five percent that's going wrong?
Just like what is or what has to go right
for that leads to those percentages?
Speaker 4 (51:54):
Great question, so many things. It's kind of crazy how
inefficient human reproduction is. This is what we've evolved to do,
I guess, But yeah, so I mean you have to
you have to have a follicle with an egg in it,
So it can't be like an an ovulatory cycle where
you're not releasing an egg. So that has to happen.
The egg has to release, it has to be picked
(52:16):
up by the Filippian tube. Sometimes that doesn't happen. Then
it has to like travel its way too, from the
Filippian tubes to the uterus, and the Filippian tubes is
where it gets fertilized. So ideally sperm is already there waiting.
That kind of factors into all of the things we've
been talking about about how much how much sex do
you need to have? So ideally the sperm is there waiting.
(52:38):
And then yeah, it has to travel from the Philippian
tubes to implant, and then of course it's just to
say nothing about the genetics behind. It has to be
a genetically normal egg, genetically normal sperm, all of that,
and you know there's still factors now we don't completely understand.
But yeah, not very unefficient process.
Speaker 5 (52:58):
I just want to briefly say we've been chatting about
it a little bit in the chat, but getting a
semen analysis for your partner or donor is really important.
I think you know.
Speaker 4 (53:09):
Yes, we've spoken.
Speaker 5 (53:10):
There's a lot of women and female Boddy people here,
and I think often that like burden of infertility is
on the person with the uterus, so assessing male factor
infertility is really important. There are some easy ways to
do that. There's even at home mail and tests these
days that have some decent assessment tools. So just putting
(53:33):
that out there, all.
Speaker 2 (53:36):
Right, I'm going to take one more question and then
we're going to end. But when we end, we will
put up a slide which has links to sign up
to the newsletter and which is all on infertility, and
will also have a place for you guys to send
in your questions because I know from the chat that
there are a tremendous number of incredibly specific questions. Is
(53:58):
exactly what we're intend the newsletter for, so we really
want to hear those questions. We can get into this
kind of detail in a way that it's hard on
a that's hard on a big zoom.
Speaker 1 (54:08):
So Emily, you're up. You're the last one.
Speaker 2 (54:12):
Okay, you know other sorry, others, there's another Emily.
Speaker 1 (54:15):
I'm sorry, Emily. So is it me?
Speaker 3 (54:18):
Emily?
Speaker 1 (54:19):
Yes, it is you, Emily. Okay, Hi, So my question.
Speaker 13 (54:23):
I might not be in exactly the right room for this,
but it's such a smart room. I'm hoping you can
tell me where the right room to go is.
Speaker 1 (54:28):
If this is not.
Speaker 13 (54:29):
It, mine's about X topic pregnancy, which I have not
found good information about anywhere. I've had two, with a
healthy daughter born in between those two, and what I
seem to find is like just test early and hope
it's not a topic again, And that's a terrible answer,
and I'm like coming up on thirty nine and so
(54:52):
like everyone delays the next thing. Just wondering if anyone
has anything to say or directions to point me related
to ex topic pregnancy.
Speaker 4 (55:00):
Thank you. I think this could be the right root.
Maybe I certainly treat topic pregnancies do surgery on them.
I would say, yeah, I have a lot of questions
I guess about your specific history, and I would want
to see your uterine imaging. So I'd suppose a good
place to start is go to your OBGI N and
(55:22):
kind of start there, or if you've already been to
your OB do I N. Maybe single fertility specials actually
maybe get you a little bit closer. But yeah, certainly
this is a very individual question. But I would want
to look more closely at your history.
Speaker 1 (55:40):
Okay, guys, we're going to end there.
Speaker 2 (55:42):
Thank you so much, Brianna, Maria Pooja for being here,
for writing for us, for answering questions in the chat.
I think this is There is so much should be
said on this space, and there are so many specific
questions and somebody general questions.
Speaker 1 (56:00):
And I'm hoping that we will continue to grow this.
Speaker 2 (56:03):
Space over the next whatever period it is so people
can get all of their questions answered. Send in your
questions and thank you again for being here. Parent Data
(56:26):
is produced by Tamar Avishai with support from the parent
Data team and PI Rex. If you have thoughts on
this episode, please join the conversation on my Instagram at
prof Emily Ostar, and if you want to support the show,
become a subscriber to the parent Data newsletter at parentdata
dot org, where I write weekly posts on everything to
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(56:49):
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Speaker 1 (56:51):
There are a lot of ways you can help people
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Speaker 2 (56:54):
Leave a rating or a review on Apple Podcasts, text
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Speaker 1 (57:04):
From what she did.
Speaker 2 (57:05):
Close the story to your Instagram debunking a panic headline
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Rite Penelope, right, mam. We'll see you next time.
This is parent Data. I'm Emily Oster.
Speaker 2 (00:07):
For many people, when we start thinking about a family,
we assume it'll just happen. We'll decide one day we
want to have a baby, and then nine months later
there'll be a birth. But that isn't the way it
happens for all of us, and fertility can often be
a journey that's more winding and more complicated and more
(00:30):
confusing than we expected it to be. And as I've
spent the last decade or so writing about pregnancy and parenting,
questions about fertility have come up all the time.
Speaker 1 (00:43):
People want to know.
Speaker 2 (00:45):
What is the data say. What is the data say
about when I should have sex? What is the data
say about when I should think about fertility treatments?
Speaker 1 (00:53):
What is the data say if I.
Speaker 2 (00:55):
Don't have any sperm in the relationship and I need
to have some donor sperm?
Speaker 1 (01:00):
How do I get that? These questions come up all.
Speaker 2 (01:02):
The time, and now parent Data has some answers. We
have recently launched a new content vertical in parent Data
on Trying to Conceive, covering everything from ovulation windows to
donor eggs to infertility treatment, along with a newsletter all
(01:23):
about infertility treatment in particular that aims to answer all
of the questions people ask, but answer them with data,
with science. One of the things that's really tough about
this space, especially if conception is a struggle, is that
we so much want hope, and that's an opportunity for
(01:44):
a lot of misinformation, and we're aiming to provide real,
evidence based information so you can make the best decisions
for your family, whatever is the fertility journey that you
are on. Today on the podcast, I'm airing audio from
an event I did with three of the people who
(02:05):
have contributed most to this trying to conceive content on
parent data.
Speaker 1 (02:10):
First, I've got doctor.
Speaker 2 (02:11):
Brianna Slocum, who's a reproductive endocrinologist and fertility specialist. I've
got Maria Goodman, who's a licensed midwife, author and the
founder of Pregnant Together. She specializes in caring for the
LGBTQ plus community from preconception to early parenting. And I've
got doctor Pooja Lakshman, who's been on here before, who's
a perinatal psychiatrist.
Speaker 1 (02:33):
The four of us.
Speaker 2 (02:34):
Talk together about where to start with fertility questions, about
what they all wish that we knew before starting to
try to conceive, and we answer a lot of listener
questions that come in through the zoom. This is a
really fun event and I'm really excited that we get
to share the audio with you and if you have
more questions, as people in the chat did, go to
(02:55):
parent data dot org see if we have answers and
if we don't, send your questions in just building out
what we want to do here, and we can't wait
to hear from.
Speaker 1 (03:03):
You after the break Office Hours on trying to conceive.
Speaker 3 (03:20):
So thank you all so much for joining us for
this month's office hours roundtable on trying to conceive.
Speaker 1 (03:28):
My name is Meg.
Speaker 3 (03:29):
I manage customer success here at parent Data, and I
am particularly excited for this conversation as trying to conceive
was just a huge part of my life in my thirties.
I experienced a number of pregnancy losses at topic pregnancy
surgeries and ultimately two rounds of IBF, which led me
(03:51):
to my two beautiful kids, Theo and Talia, and I
know firsthand how exciting, stressful, and really emotional this process
can be, and I just cannot wait for this team
of experts to discuss this really incredibly important topic this
discussion today and we put this in the event invite
(04:14):
as well, but it's going to reflect the wide range
of experiences that people have with fertility and family planning,
and we're going to leave plenty of time at the
end for audience Q and A. We had a lot
of interest in this event, a lot of questions came in,
so we'll definitely leave time for that. And you all
might know that today's theme is timed the launch of
a new section of parent Data on trying to conceive.
(04:37):
So we're just so excited to bring you high quality,
data driven information on this stage of life and it's
more important than ever and it's been something that the
whole team has been working on for over a year,
a really long time coming. So starting this week, you
can explore trying to conceive or TTC in two.
Speaker 1 (04:57):
Different ways on parent Data.
Speaker 3 (04:59):
So we've launched a new section of parent data dot
org dedicated to trying to conceive. So this includes articles
on topics like understanding your ovulation window, the two week wait,
pregnancy tests, and even miscarriage. You'll also find articles on infertility,
egg freezing, and LGBTQ plus conception. Second, we are starting
(05:23):
a weekly newsletter for anyone navigating fertility treatments or family
planning with donor sperm or eggs. So this is meant
for people who are looking for information to guide their
medical decisions. We'll be covering the latest research and headlines,
share one on one level guides, and answer reader questions.
And thanks to our sponsor Roe, you can actually access
(05:44):
all of the articles and the newsletter for free until
April eighteen. So this is obviously a celebration of that launch.
So now I am thrilled to introduce today's guests. As always,
today's event will be hosted by Emily Auster. Emily is
the founder and CEO of Parent Data, a professor of
economics at Brown University, and a mom of two. She
(06:07):
is also the author of four New York Times bestsellers,
Expecting Better, Cribsheet, The Family Firm.
Speaker 1 (06:13):
And The Unexpected. She will be joined.
Speaker 3 (06:16):
Today by three incredible Parent Data contributors who have years
of experience supporting people on their TTC's journey. So first
is doctor Brianna Slocum. She's a reproductive endocrinologist and fertility
specialist who treats patients navigating infertility and assisted reproductive technologies.
Speaker 1 (06:34):
Like IVF Next.
Speaker 3 (06:37):
Maria Goodman is a licensed midwife, author and the founder
of Pregnant Together who specializes in caring for the LGBT
plus community from preconception to early parenting. And finally, Doctor
Puja Lakshman is a perinatal psychiatrist and author who advocates
for women's mental health throughout their fertility journey. Without further ado,
(07:01):
welcome Emily, Brianna, Maria, and Poushia.
Speaker 2 (07:06):
Thank you Meg, and thank you everybody for being here.
We're incredibly excited to do this to talk all about
trying to conceive and Pujia, Maria, Rihanna, thank you guys
so much for writing all of these amazing things for
us and being here. And I am just thrilled to
get this information out. So we're going to start with
(07:29):
some discussion and then we'll open it up to questions.
But I want to kind of really start with the
question of normalizing trying to conceive infertility as a journey.
I think for a lot of us, you kind of
there's this narrative like you go off birth control and
then there's just a baby, and we often think about
it like, Okay, what's my ideal timing I'm going to
(07:50):
go off birth control and then like three months later,
you know it'll be ready, and nine months after that
I'll have a baby.
Speaker 1 (07:56):
And of course that is not true for everybody, And.
Speaker 2 (07:59):
I think it's it's really tough when you have that
expectation and it does not deliver in that way, and
people around you it seems like it's magic, and that's
not always happening for everyone. So this also leaves out
people who use a variety of other ways to grow
to grow their family. So let's just start there, and
(08:22):
I want it for each of you.
Speaker 1 (08:23):
I'm going to start with.
Speaker 2 (08:25):
Brianna, just ask what is one thing that you wish
everyone knew about trying to conceive if you had a
magic information Wand.
Speaker 4 (08:38):
I think that for a lot of reasons, there's this
real tendency to look inward for explanations for why a
fertility plan or journey maybe isn't happening the way that
you wanted it to. And oftentimes that really looks like
blaming yourself. So it's saying things like I wish I
had frozen my eggs earlier, or I wish I had
done this thing or not done that thing, or whatever,
(08:59):
And I find that it's really helpful to remember that
this is all happening in a context of a society
that really doesn't value women's reproduction. And so that's why
you didn't learn about fertility in school, for example, and
why fertility insurance coverage is not federally mandated, nor is
paid printal leave. So it's really not your fault, which
(09:19):
means that you're not completely in control of everything that happens,
But that doesn't mean that you don't have some power
and that you can't still feel good about the process
and kind of what's happening. And so if I had
like a magic wand I would really want everybody to
understand that, and to also just find a clinic or
doctor provider whoever who helps you feel some of that
power and you feel comfortable.
Speaker 1 (09:40):
With Maria, how about you? What would you tell people I.
Speaker 5 (09:47):
Love Rihanna that you started with that. I mean, what
I would say, which I think builds on that for
queer folks and solo parents and really anyone growing their
family outside of the traditional heterosexual model, is really just
that folks had access to the information and the choices
that they need and deserve. What I see so much
(10:08):
in these populations is overwhelm and not knowing where to start,
which I think is really it touches on that the
internalized there's internalized homophobia that can come up when growing
your family outside of the heterosexual model. And yeah, I
(10:31):
wish that as young people we knew what needed to
happen in order to be able to grow our families,
because I really see this as a reproductive justice issue
that we all have the right to grow or not
grow our families in the ways that we choose.
Speaker 6 (10:46):
Oh yeah, yeah, Well, first of all, I love Maria
and Brion, I love both of your points, and kind
of just I guess piggybacking a little bit. I think
one of the things that I wish we could bring
just more nuance to the emotional conversation because I think
so much of what we see on the outside is like, oh,
(11:09):
you know, I'm pregnant, and there's like this excitement emotion,
or at least that's what we're expected to feel, when
in reality, what I see in my practice as a
perinatal psychiatrist with patients is that it's rare for me
to have a patient where grief or ambivalence, loss conflict
(11:29):
is not part of their experience like that that thread
of grief or ambivalence or sort of feeling like lost
and confused. So it's I guess just normalizing that this
is this is not all like rainbows and unicorns, that
there's a real kind of process of acceptance that I
think happens, and I wish we talked more about that.
(11:49):
So I'm so excited for this space and for this
new newsletter.
Speaker 2 (11:54):
So I think what I'm hearing from from at least
Brian and Maria is this idea of of education. I
think for me, this is this is a core thing.
I think we spend an awful lot of time And
I say this as a parent of a teenager explaining
to people like how not to get pregnant and not
really expanding that out to like, why don't we help
(12:15):
you understand your fertility which or you know, how this
is all going to work and what are the different
ways that eventually if you want to have a child
you could which also, by the way, can help you
understand how to not have a kid now. And I
think this sort of like getting people to a place
where when they arrive at the moment of family building
they are in a better position to actually understand what's
(12:36):
what's going to come next.
Speaker 1 (12:37):
I think for me that's that's what it is, all right.
Speaker 2 (12:40):
So so I actually want to ask one more question
for Pooja in this in this space, which I think
gets a little bit more into the into the practical,
which is, you know, you talked a little bit about
mental health and some of the sort of mental health
stress stuff.
Speaker 1 (12:54):
I think one thing that's.
Speaker 2 (12:55):
Actually quite stressful for people is the idea that maybe
being stressed is the thing that's in the making them
not able to get pregnant. Then they're stress about being stressed,
And I think, so can you talk a little bit
about that and what do we know about the impacts
of stress on conception and how to sort of think
about that as a patient.
Speaker 6 (13:11):
Yeah, yeah, this is this is a topic that can
be a little bit triggering, So I'll just caveyat it
with that, And also just to give everybody kind of,
you know, some of the numbers. So like in general,
like in a normal pregnant or a normal situation where
there's not any other confounding variables or other medical situations
(13:32):
going on, ten to twenty percent of early pregnancies and
in miscarriage, Like that's just normal, right, and that's the
body's way of working and making sure that the eggs
and the ambrews that are the healthiest kind of move
through and are picked. But in we know that about
(13:53):
ten to fifteen percent of couples are going to struggle
with infertility and are not going to be able to
conceive naturally. And there is research to show that when
there is environmental stress. And when we're talking about environmental stress,
it really it's just such a broad range of things.
So it could be you know, being but not having support, right,
(14:14):
being in a situation where you're a solo caregiver and
you're experiencing stress from that standpoint, or being in a
relationship that is fraught and has a lot of conflict,
or being in a socioeconomic demographic where you're experiencing stress
and you don't have access to healthcare. Race and identity
(14:35):
plays into this too. We know that there is a
link between stress and having difficulty getting pregnant. And this
is something that's really hard to talk about because at
least with my patients, like and this was my experience
as well, Like I I went through IVF to conceive
my son, who's now two and a half. Telling a
stressed person not to be stressed probably one of the
(15:00):
things that you can do. So I really I try
and with my patients when I'm when when they're gearing
up for whether it's IVF or IUI or even in
there in the beginning stages of like starting to think
about conceiving, I say to them, Look, this could be
a long process, Like we don't know what it's going
(15:20):
to look like, and so we need to get your
support system in place. We need to figure out who
is your team, Like who is going to be there
for you? Who are the friends that you can lean
on that you can text? Can we start a group chat? Right?
Do you know anybody else that's done IVF or that's
done EUI that you can reach out to, So like
(15:41):
kind of thinking of it as more of a p
in a proactive way of like, what are the levers
that we can pull so that we don't feel so
out of control when it comes to chronic stress.
Speaker 1 (15:54):
All right, let's get into the details. Rihanna, I'm starting
with you.
Speaker 2 (15:59):
Tell us about age and fertility and in particular, what
you'd like people to know as we age into what
you people in the reproductive space would call advanced maternal age.
Speaker 4 (16:15):
Well, I think it's really important to understand that age
is the single best predictor of a woman's ability to
get pregnant. And the reason why is that age corelates
best with a quality or the ability of that ache
to make a healthy baby, and that goes down with age,
I'm sure as we all know. So to put some
(16:36):
numbers on it, a healthy thirty year old woman has
about a twenty percent chance of getting pregnant per cycle.
The number goes down to five percent by the time
she's forty, And unfortunately there's no test for equality. There
are tests for a quantity, or to get a sense
of roughly how many eggs your bodies releasing each cycle,
and those are tests like AMH, which I'm sure many
(16:58):
of you have heard of, go down with age. But
because quality is more important, tests like AMH do not
correlate well with your ability to get pregnant.
Speaker 2 (17:08):
So the AMH is going to tell me how many
eggs I have, but not whether they're good. Roughly, it's
a metric of how many, but not whether they're good.
I think this is quite an important point, because I
think we often conflate those people have this idea that
AMH is going to tell me, like is it going
to work? And that's not to what extent does it?
Like if I have a good AMH, is that tell
(17:30):
me it's going to work?
Speaker 4 (17:33):
No, it tells you how you're going to respond to
IVF or IVF meds. So egg freezing IVF and certainly
numbers are important. You'll often hear IVF in particular referred
to as a numbers game. So I don't want to
say it doesn't matter. But if you're looking at it,
just got in the dark to see, like can I
get pregnant? Yes? Or no? AMH is not going to
(17:54):
help you there.
Speaker 2 (17:56):
So you said that age is the most important determinant
of fertility. Is there are there ways to youth in
my eggs too?
Speaker 1 (18:05):
Are there you know?
Speaker 2 (18:06):
Ways to make my eggs? We hear a lot of
about supplements. You talk a little bit about supplements that
could or could not lower your egg age.
Speaker 5 (18:17):
Yeah.
Speaker 4 (18:18):
Well, first, I love the verb youthin. I'm gonna write
that down and take it with me. But this is
really tough for many people A year but no, and
that's because we really don't completely understand ovary and aging,
although the ovary is really interesting in the sense that
it is one of the first organs that we can
appreciate its aging in this way, but we don't understand
(18:41):
it completely, and so that means that there are interventions
that we can offer. At this point. We do know
that have the alcohol use, for example, or tobacco use
like smoking, that certainly can worsen your equality. But most
of the women who I'm saying already know that. I'm
sure most of you all do too, So yeah, not really.
There are two supplements that you hear about THHA and
(19:04):
Q ten or like the two, which we have articles
on about those specifically in the data behind it.
Speaker 2 (19:10):
Let me ask one other thing here, which is about
secondary infertility. And I think for a lot of people
that's something that sneaks up because you may get pregnant
the first time and then because of age or because
of randomness in the process. So is this a common
reason you see people and how would you suggest people
(19:31):
navigate that medically?
Speaker 1 (19:33):
Is it different than if it were primary infertility.
Speaker 4 (19:36):
So it's super common, it's super common. And with that specifically,
I mean it is important to go and see a provider,
because we are looking at what changed, because as you mentioned,
obviously they were able to get pregnant the first time,
you know, something must have changed. So what I'm looking
at specifically is a really detailed history to see us,
for example, where there are there any hormonal changes result
(20:00):
from complications from birth for example, or things like that.
Are there differences maybe that we're going to see on
the semen analysis, But most of the time it is
age kind of as you alluded to, And so this
is actually my research interest. But in kind of thinking
about it and approaching it is just kind of when
you think about when you are ready to start your
family and kind of doing that math about how many
(20:21):
children you want Roughly, you know, things change like how
many children you want, how far out do you want
to space them, how willing are you to use IVF
to achieve your pregnancy goals family goals? Those are my
research interests, But that's kind of how I would think
about it on this end.
Speaker 2 (20:36):
All right, Maria, I want to turn to you and
I want to ask you just very basically the patients
that you see, why are people, why are people coming
to you? And how is it maybe different than how
people are coming to Brehanna or how is it not different?
Speaker 5 (20:49):
Yeah, great question. I would say I primarily work with
people who are either at the very beginning of the process.
Speaker 1 (20:56):
Who are like, where do I start?
Speaker 5 (20:58):
I know I need to choose a donor, I have
no idea idea how to go about that, or maybe
folks that have been trying at home with a directed
known donor or sperm Primum Bank for a few rounds
and need to kind of reassess their choices. I also
(21:18):
run a virtual community for queer folks and solar parents
that bring people together for that mental health community support piece,
which is really a huge thing that I see people
just feeling alone throughout the process. I think everyone struggling
with any sort of infertility feels that way. What's tricky
and unique about queer family building or solo parent family
(21:42):
building is that a huge majority of the data that
we have on infertility is based on heterosexual people. So
they've been trying to conceive either for six months at
home if they're over thirty five, one year at home
if they're under thirty five, and then and medically kind
of they achieve that infertility diagnosis and get support there
(22:08):
are some new studies that are coming out on the
different considerations for queer folks and solo parents when the
issue is really just access to the gam meats, the sperm,
or the eggs or the uterus that they needn't. We
don't always need infertility support, but sometimes we do so,
(22:30):
so it's it's a complex decision making process. It's also
influenced by the cost. There's a different financial burden placed
on queer folks and solo parents when you have to
buy sperm from a bank. That's really changed post pandemic.
A vial of sperm used to be like six hundred
to eight hundred dollars and now can be fifteen hundred
(22:53):
or two thousand per vile.
Speaker 1 (22:55):
Why is that now?
Speaker 7 (22:56):
I'm interested, as again, I don't understands yet, you know,
I think I think a lot of there were a
lot of issues, a lot of social interruptions, you know,
during the pandemic, And I don't fully know why it
is so much more expensive, but it is, and it's
(23:17):
really influenced how I advise folks on the choices that
they make, because.
Speaker 5 (23:22):
Most people don't have the luxury of trying at home
with previously frozen sperm for six to twelve months, and
I don't necessarily recommend it because of the financial and
emotional burden. So it's it's sort of a combination of
looking at people's values and preferences than assessing age and
(23:44):
other fertility predictors, and trying to forge a path that
will reduce their time as much as possible and also
reduce like the emotional and financial burden. And it's it's
a complex process.
Speaker 2 (24:00):
Yeah, it's almost like there's too many choices. There's too
many choices and too many ways to go into it.
And somehow that like so many choices, but also.
Speaker 5 (24:09):
And we don't really know are you do you have
been fertility or do you just not have access to
sperming your relationship? And then how do you know? There
are different recommendations medically for how to get pregnant, and
sometimes it's hard to know what is ideal.
Speaker 2 (24:26):
Pooja, I want to come back in asking you to
to something.
Speaker 1 (24:31):
Brianna said about age.
Speaker 2 (24:32):
So I think one of the things that's so tricky
is navigating what we think of as this sort of
age readiness trade off between you know, I want to
wait because that's good for other aspects of my life.
But then I'm worried about about fertility, and I think
the mental health burden.
Speaker 1 (24:49):
There is actually pretty significant.
Speaker 2 (24:51):
Because it stresses you out, but also because then you
you know, end up on the other end thinking, well,
I waited too long because of this other trade off.
So I'm like to ask how you think about people
navigating that and what you'd how you'd counsel someone with
that kind of kind of concerns in your practice.
Speaker 6 (25:10):
Yeah, yeah, I think that this is this is sort
of like the million dollar question. I think, especially in
my practice, where I'm taking care of women who generally
are professionals, high achieving, you know, have gone to graduate school,
have put in a lot of time and energy into
their career, and so that means that they are delaying
(25:34):
child bearing. And I personally went through that experience too.
I actually wrote about it for The New York Times
a couple of years ago that I was thirty eight
and a half when I had my son, and and
that kind of winding backwards didn't start. Didn't feel ready
to become a mother until I was like thirty five,
thirty six, and so had that conversation to look into
(25:57):
egg freezing and then started trying and then had a
carriage and then right, So it's like it takes time.
So I think, you know, I guess a couple things
on the readiness question. I think one, it's so easy
to play Monday morning quarterback with your decisions and your
life in general, and so I really try and encourage
(26:19):
my patients like, no, you, at each step of the way,
at each stage, you are making the best decisions for
yourself with the data that you have, and there's a
reason that you make choices at any given time, and
it's not fair to sort of go back and beat
yourself up. The other thing that I would say is,
like one of the things talking about the stress piece
(26:41):
Emily is like, yeah, like we as women, we as
people that have uteruses, Like oftentimes, especially if you're in
a heterosexual relationship, we're the ones that are constantly doing
this calculus and doing this math like oh, okay, I'm
thirty five right now, and like if I wait till
I'm thirty seven, like this is what the numbers are. Right,
And you have a male partner, usually it's like completely
(27:02):
foreign to them to be thinking in this way and
they're not sitting here some of them actually are on
this zoom call, which is great, but most of them
are not, right, Like they're not reading about this thought,
they're not thinking about it. So it's interesting because I
think we are often bearing this burden even before you
(27:22):
start trying to conceive and talk about queer couples, right,
Like it's such a it's like years before there's even
like a baby or thinking about a pregnancy. So just
naming that and like giving yourself some compassion there because
it is such a heavy load. The other thing that
I would say is that, like I think this is
a little bit similar to what you say, Emily, Like
(27:43):
there's no secret option. See, Like there's no secret option. See,
there's no like perfect decision, there's no perfect time. It's
just weighing for yourself, like all of the different pros
and cons. Babies are expensive, Like babies are freaking expensive.
Speaker 1 (27:59):
Kids are expensive, right, so like.
Speaker 6 (28:01):
You know, just like the financial side, like the relationship side,
like all of these things, and and kind of that's
why it's kind of the first thing I mentioned was grief,
because I do think that so much of this is
about like making peace with yourself and coming to a
place of acceptance and it take a long time to
(28:22):
get there. You know, I think a lot of folks
here on this call, I know I'm seeing like people
want practical information about like what to do and how
to get the best chance of success. And like, one
of the things that's so hard about the infertility journey
is like there's no one hundred percent like we There's
never like if you do this, then definitely you will
(28:44):
go home with a baby. There's there's just like shades
of gray and optimizing, but there's never like that feeling
of certainty that you could hang on to that if
you're somebody who got pregnant easily, that that you just
innately have. When you're somebody who has struggled with infertility,
you you unfortunately, you never get back that feeling of certainty.
Speaker 1 (29:09):
Yeah.
Speaker 2 (29:10):
Yeah, And I think you know part of what's what's tough.
And I sort of see this in a lot of
your guys comments, it's like, well does this matter?
Speaker 1 (29:17):
Does this matter? Does this matter?
Speaker 2 (29:18):
And you know, we can look at those things in data,
and a lot of times for a lot of the
questions you're asking, the answer is no. So we know
age matters, that's pretty clear. But a lot of these
other things. You know, I have a few extra pounds here.
I had one glass of wine day four. You know,
I exercised too much.
Speaker 1 (29:37):
This stuff is.
Speaker 2 (29:38):
Not mattering in an important way in our chances of conception,
but it's the piece of feeling like, well, there's got
to be something I can control, Like what if I
did everything perfectly, Well, I didn't do everything perfectly, and
now it's my Now it's my my fault. And I
think that's I think that's really that that's that's really
hard because the loss of control is I think some
(29:58):
of the hardest pieces pieces here. So I want to
do one more sort of like questions for you guys,
and then we're going to get to people's individual questions.
And so I know you guys have already put a
bunch in, but you can think think more about what
you what you.
Speaker 1 (30:17):
Want to ask.
Speaker 2 (30:19):
But I want to the question I want to ask
here is is kind.
Speaker 1 (30:22):
Of where where to start. So just in like a
brief way, Uh, let's start with you, Maria.
Speaker 2 (30:28):
You know if you people come they say, I'm looking
to build my family in a I'm a queer couple,
I'm solo parent. I'm looking to build for some other
reason in a non traditional way. Where would you recommend
they start their thinking?
Speaker 5 (30:44):
Well, I wrote a bunch of articles that will be
helpful for starting that process. I like to separate the
the beginning approach into two parts, so the emotional part
and the logistical part. Under emotional, I would include like
values and know that that emotions often come in ways
(31:07):
waves throughout this process. Under logistical, I'd include your access
to fertility providers that have experience working with somebody in
your situation and finances, all of those sorts of things,
and sort of seeing those as two separate but interconnected processes. So,
(31:27):
as Pooja said, there's often grief, there's often ambivalence. I
think overwhelm is us feeling flooded by these emotions. So
it's really important to have a space for that, and
then also getting clear on the logistical side of things,
your preferences. When it comes to either choosing a directed
(31:49):
or known donor or unidentified donor from a bank, I
recommend choosing that first because your type of don't or
sperm and how easy it is for you to get
it will influence your conception, options and choices, and so
so that's generally where where I encourage people to start,
(32:12):
like get that emotional support piece in order figure out
where you're getting your sperm, and then and then you
can either you know, trying at home. I read an
article about at home incuminations for queer folks and solo parents.
Maybe you're making an appointment with a reproductive endocrinologist and
going straight to reciprocal IVF or IVF. We've got resources
(32:33):
on all of that, but I would say that that's
a good place to start aesome.
Speaker 2 (32:39):
All right, Brianna, For you, when do you seek help
from a doctor?
Speaker 1 (32:43):
Started? Very practical. When should I start? When should I
look for a doctor's help with conception?
Speaker 4 (32:49):
Yeah, well, ideally you would have some sort of visit
preconception to just run down your med list, history, all
of that, to make sure that all of that's compatible
with the pregnancy and make sure you're up to day
on your vaccines like all of that. But yeah, when
you're actually ready to get started, I would definitely just
check to see if you have any red flags. We
(33:10):
actually have an article on this, but red flags would
be things like if you aren't having regular periods, you're
not having periods at all, If you have a history
of endometriosis or ever having received chemo or radiation specifically
to the pelvis, things like that. We have a whole
article on it. In those cases you should seek help
(33:31):
right away. Otherwise it really goes by age of the
woman for the reasons we've been discussing, and so if
you're less than thirty five, it's a year of trying.
If you're over thirty five.
Speaker 1 (33:41):
It shorty tell us why? Sorry, can you tell us
why this is? Why is it?
Speaker 4 (33:45):
Yeah?
Speaker 1 (33:45):
Why is it different in different ages?
Speaker 4 (33:48):
It's different because on fertility outcomes correlate best with age.
So it's just shortened because your fertility starts to decline
a little bit more rapidly between thirty five thirty seven,
and so we really want to get you and you
as possible, just for equality reasons.
Speaker 2 (34:04):
All right, poojia, how should people prepare for fertility treating?
Speaker 6 (34:11):
I actually, can I ask Brianna follow up question or
ye go into more detail about when we say trying,
what does that mean?
Speaker 4 (34:20):
Yeah, so sometimes people take it to mean like doing
all the things like ovulation predictor kids all of that. No,
it's just having unprotected intercourse regularly. So ideally are having
it regularly.
Speaker 2 (34:34):
Wait, now I have a follow up, which is, yeah,
someone has been trying, like really trying, like I'm ovulation testing,
I'm doing it, Like should I cut it off earlier
because like, I'm trying hard. I've been trying harder, and
so I should have learned more from like three months
rather than six months.
Speaker 4 (34:51):
No, not necessarily. No, it's still you know, this is
just kind of a statistics kind of map probability thing.
It's it's not necessary really like you're trying harder, so
that means something's really wrong. There could still be other
things that it just takes time. But yeah, no, I
just mean having regular unprotected intercourse.
Speaker 1 (35:12):
Awesome, thank you.
Speaker 6 (35:15):
So what so my question was what would I say
to patients like as they're starting to prepare or get.
Speaker 1 (35:20):
Ready for fragility, Yeah, fertility, Yes, so a couple of things.
I think.
Speaker 6 (35:27):
First, if if you're going down the IVF path or
even the EUI path, I'm like really honest with my
patients and usually they like this, sometimes they get mad
at me, but think that it is going to be
kind of another full time job in terms of the
blood draws, the testing that you need to get done
when you're in the midst of the cycles where they're
(35:49):
monitoring your follicles to see how they're growing. Like it's
a lot of time. For about like two weeks or so,
you'll kind of be living at the office. And and
the thing is that there's just so much information and
it's kind of like learning a new language that you
do really sort of end up. It's like by the
end of it, you'll kind of feel like you have
a PhD in IVF because you're kind of just like
(36:11):
learning all of this information.
Speaker 1 (36:12):
So one is just to be prepared for that.
Speaker 6 (36:14):
And I like that Brand mentioned that overwhelmed, Like it
is overwhelming. It's overwhelming, and that's normal, and like it
sucks that it is this way. The reason is because
what things that we've talked about, like we should be
learning about this in school, we should have this vocabulary,
but we don't, so it can feel really overwhelming. And
so again like leaning on your support system, having other
people in your life who have been through it that
(36:35):
you feel comfortable talking about your situation with. It doesn't
need to be like ten people, it could literally just
be one or two people. And then just being prepared
for the uncertainty. I think so much of this.
Speaker 1 (36:48):
I know it.
Speaker 6 (36:48):
It's annoying that I keep mentioning that because there's like
not a lot of like tangible stuff that you can
do to deal with uncertainty. But really, like the marker
of an infertility journey really is that you're it's just
one hurdle after the next, you know where you first
you get the eggs, and then and then you're waiting
to see like how many how many get fertilized, and
(37:10):
then maybe you're doing genetic testing, and then you're waiting
to find out like is how is your uterine lining?
And I don't say this to like freak anybody out,
but more just to say like, it's a long process,
and so you have to kind of think of it
as like a marathon as opposed to a sprint, and
you really want to be giving yourself all of the
same like care and attention and love as much as
(37:32):
possible as you would give to that little baby that
you're hoping to bring home.
Speaker 2 (37:44):
More parent data after the break, we're in turn to question,
So if you have a question, raise your hand.
Speaker 1 (38:03):
We'll get to as many as we can.
Speaker 2 (38:05):
You can go on camera or just in audio, and
I saw Katie m had her hand up before.
Speaker 1 (38:11):
It's not up anymore.
Speaker 2 (38:12):
But Katie, if you still want to ask your question,
I'm going to go with you.
Speaker 1 (38:15):
First, let me give you a second. Hey, I appreciate that.
Speaker 8 (38:19):
My question was just going back to Brianna's guidance about
when to seek medical help when you're trying to conceive.
It sounded like you said that before thirty five there
was a pretty clear guideline, and then that between thirty
five and thirty seven or so there's maybe another sort
of general drop off infertility at that point. Are there
(38:40):
guidelines you could provide sort of all other factors being
equal of between thirty five and thirty seven and then
thirty seven and you know, maybe forty about when you
would see someone if you're having trouble conceiving.
Speaker 1 (38:54):
I just want it. Can I just say?
Speaker 2 (38:56):
This is why I love people a parent who are
Parent Data subscribers so much, because we need like by month, Rihanna,
thirty seven or so does not work over here, And
thank you Katie for.
Speaker 1 (39:07):
Calling that out. I appreciate it.
Speaker 2 (39:08):
Rihanna.
Speaker 1 (39:09):
Let's go with precision.
Speaker 4 (39:11):
So unfortunately, there really aren't by month guidelines it's over.
Thirty five is six months of trying, and then a
lot of fertility providers will say when you get to
forty you should seek help right away, but I mean
it's totally individual. And this is kind of what I
mean too about like ideally you'd have a physician who
(39:33):
can talk to you, and like you just feel like
you could go to them and ask them all these questions, like, oh,
I'm thirty six and I've been trying for three months,
but I really want to start the work up now,
Like I think I think that's where you can talk
to your provider and they can give you like look
at your specific scenario and give you more specific kind
of month to month guidance. But generally speaking about thirty
(39:56):
five is all kind of lumped into the six months
and then forty you can go right away.
Speaker 1 (40:00):
Does that help?
Speaker 9 (40:02):
Yeah?
Speaker 1 (40:02):
Thank you, Sarah. What do you get hey?
Speaker 9 (40:08):
I had a question about that five percent number or
the kind of idea of you know, five percent likelihood
to get pregnant each cycle when you're you know, forty,
and just how does that impact like your past history,
Like I had my first baby really easily at thirty seven.
Now my mom got pregnant, you know, very easily throughout
her life into her forties. Like, what are the factors
(40:30):
that kind of tell you is my likelihood maybe a
little bit higher than five percent every month given that
I had, you know, a baby easily in my late thirties.
That's kind of my overall question.
Speaker 4 (40:42):
Yeah, it's really hard to apply these kind of population
level statistics to your individual situation. So I love that
your question kind of addresses that. I would say, having
been able to conceide for four is certainly certainly a
good prognostic indicator, as we would say, I like, it's
certainly something good in your favor. Certainly, I think to
(41:05):
some extent kind of like the fertility of your family.
So if you have a very long family history of
women being able to conceive into their late age, that's
certainly not going to hurt you. But I think kind
of with that five percent number overall, I think that's
why a lot of fertility specialists just say, go seek
help right away. But yeah, there really isn't This is
(41:28):
a great question, and there's not like more data than
that other I mean, because we don't see the people
who are able to conceive easily, so I'm biased in
that way too.
Speaker 2 (41:37):
We don't see them much in data either, right, I
mean it's hard to like it's that kind of really
detailed data where we would actually actually kind of have
like how long did your mom take and how long
did you take for the first one, you know, and
we're how hard were you trying?
Speaker 1 (41:53):
And so on. I think is not is I don't know,
not not easy Ellen, Oh yeah, poo Je.
Speaker 6 (42:02):
Sorry, well, I just wanted to jump in and Brianna,
you can correct me if this is if you don't agree.
But I think for the folks that are kind of
asking like should I go in to see the doctor
or should I wait, I think it's always I always
err on the side of just going, you know, because
a lot of times for the first part of the
workup is going to be lab tests that are time
(42:22):
to your cycle as well, so it's going to take
a little bit of time to do whatever work up
is needing to happen. And I think just having that
conversation with your ob can help alleviate a lot of
anxiety too, and just lay out a map for you
in terms of like the next six months, because right
now when you're just kind of questioning to yourself, should
(42:43):
I go or should I not go? It's already taking
up a lot of mental space. So might as well
take an action and do something and then go have
a conversation where you so you feel like you have
a little bit of agency there, Mary, when you have
to be like I've never had an ob be like,
oh my gosh, I can't believe you came to see
me at like four months instead of six months.
Speaker 1 (43:02):
You know.
Speaker 2 (43:04):
Yeah, people, when you see people, Maria, do you do
you basically tell them to go right right away.
Speaker 5 (43:13):
That's generally my recommendation. I do work with a fair
amount of people that are like, I want to stay
outside of the Western medical system as much as possible.
I want this to be as like quote unquote natural
as possible. And so the personal preference is a factor,
is an important factor. And for those folks, depending on
(43:34):
their menstrual cycle, their ovulation signs and symptoms, how old
they are, you know, that can be really reasonable to
to not get that work up right away. But yes,
for the people that are over thirty five, don't really
have those same qualms about accessing care in the Western
medical system. It's it's never it's never a bad idea,
(43:57):
although I will say, and Brianna mentioned this at the beginning,
like even when you get that work up, it's not
necessarily going to tell you that you will get pregnant
easily or you won't. There are a lot of factors
that go into that.
Speaker 1 (44:11):
Ellen, Hi, Hi, thank you guys. This is great.
Speaker 4 (44:18):
Just wondering.
Speaker 10 (44:19):
So it's kind of too full to question if you
are like looking at that year or six month window
and in that time you do conceive and you have
an early loss, do you consider like do you have
to bump that time before somebody is usually willing to
see you, or like does that count? So that's like
(44:44):
part one, and then the other piece of it is like,
what are like some of the first steps before IVF
or IUI or some of the more intensive things are
like the little things you can do.
Speaker 4 (44:58):
No, no, no, you don't have to reach Are the clock?
Please still come in? Yeah? Please still come in? And
then the second question about what to do kind of
prefertility treatments is how I understand it kind of how
to optimize natural conception, which we do have an article on,
but there's quite a few things. I mean, we can
(45:19):
first of all, understanding that you really do need to
be having a lot of intercourse, not just right around
the time of ovulation. So a lot of people will
just use, well they consider trying to be using ovulation
predictor kits, and then they have intercourse the day of
a positive ovulation kit and maybe like the next day
when ideally you should ideally have sperm mixtos, you're kind
(45:40):
of before that. So a lot of it would be
kind of understanding your fertility window, what test you're using,
and just making sure you're having enough sex, and then
kind of eliminating the things that we know are harmful,
so just heavy alcohol, use tobacco. You would look at
your medlist just to make sure that's okay. Yeah, stuff
like that. But we have a whole article that goes
(46:01):
into more detail.
Speaker 2 (46:02):
What do you mean, like a lot of sex, like
multiple times every day, every other day every day?
Speaker 1 (46:08):
How much sex is enough? People would like.
Speaker 4 (46:09):
To know ideally daily, but you can stretch it to
every two.
Speaker 1 (46:14):
Every other every other day. Yeah, exactly, Bill, is a lot.
I mean, I'm just saying it is a lot.
Speaker 2 (46:19):
I say that because I think But one thing I
think is worth naming is like people think it's going
to be it's not as fun to have sex when
you're trying to conceive, maybe Pooja. I'm sure you have
thoughts on this also from your things, but it's like
not as it gets boring.
Speaker 6 (46:37):
No, no, nobody reports it being fun.
Speaker 2 (46:42):
I had a man I've been I want to understand
there's no men on this, but I had a man
in my office the other day who explained to me, like,
it's not fun to have sex this much to trinye.
So I don't think this is a gendered I don't
think this is gendered as much as we might think.
Speaker 5 (46:55):
It also takes about twenty four hours for people with
to regain their sperm count and motility, so waiting those
twenty four hours is helpful to make sure that Lisa
wasting your attempts.
Speaker 2 (47:08):
Yeah, okay, Emily with it.
Speaker 1 (47:14):
There are like four thousand Emily's.
Speaker 2 (47:15):
Thank you for everyone having the same name Emily with
a lowercase.
Speaker 11 (47:19):
It's me, thank you, Good afternoon, everybody. I'm trying to
focus on the data part of this question because I'm
not asking you to tell me why I had a miscarriage.
Speaker 1 (47:28):
Don't worry, But.
Speaker 11 (47:29):
The question is I got pregnant very easily the first
time actually also the second time, which is what ended
up in a sixteen week mixed carriage. I have done
every test under the sun, both on myself and on
the fetus, and they can't find anything wrong.
Speaker 1 (47:43):
So the question is a two parter.
Speaker 11 (47:45):
Number one is with unexplained. I am assuming there's something chromozotal, obviously,
but my issue is like why did my body I
understand why you have a miscarriage, and my body did
what it needed to do, but like why did it
not happen at eight weeks or I could have maybe
like blood at home didn't require surgery, Like why did
it take so long for my body to recognize that
this was like not healthy?
Speaker 1 (48:06):
Number one?
Speaker 11 (48:06):
And number two I was told that I could start
trying again right away, which is I'm in three months though,
and it's and they say, like, you actually are more
fertile the six months after a miscarriage. But I feel
like I know a lot of people once they had
one miscarriage, they had several, so kind of like a
multipart question on the unexplained part, like why did my
body not handle this earlier in the pregnancy? And then
(48:29):
number two is the statistics I'm getting pregnant again and
ending in a healthy pregnancy, and like, don't I'm in
therapy to find out, like, how do you not stress
for them in the forty weeks so the next pregnancy.
I don't expect you to answer that part of it,
but more of the science part of it.
Speaker 4 (48:44):
So first, I'm really sorry to have a sixteen week loss.
It sounds really tough, so I'm glad that you have.
It sounds like a community of people who are kind
of helping you process that. And I will also kind
of say, as a caveat, I don't know your specific history,
so it's going to be hard to get into as
much nuance as I normally would if I was seeing
(49:05):
a patient, and kind of the other nuances that second
trimester losses generally have different etiologies compared to first trimester losses.
I see a lot of patients for recurrent pregnancy loss,
which it sounds like you're alluding to, which is multiple
losses within that first trimester. I don't see as many
(49:26):
patients who have had second trimester losses, at least compared
to the ones I see with first trimester. And it's
primarily because and this may answer your question. Those second
trimester losses, usually there's it's something like structural infectious, maybe
achord accident. Like it's usually something that's not at risk
(49:49):
of repeating itself per se. And that's me saying that
without knowing anything about your history or kind of seeing
the test results. But I hope that kind of gives
you some in in the sense that having one second
trimester loss, I mean, having one loss generally does not
necessarily mean that you're going to have another one. But
second trimester losses are in a kind of different category
(50:12):
compared to the first trimester losses.
Speaker 2 (50:15):
I think you can also see from the JAD here
Emily that people are thinking about you.
Speaker 1 (50:21):
Monica.
Speaker 12 (50:22):
Hi, So I had a question about seeing an Obie
Guinde versus a reproductive endocrinologist and making that decision Pope,
like after you've after you've hit the six book mark
depending on your age, early one year mark. So I'm
just curious about that. And then a second part, which
is actually not related, but I'm just curious, like when
(50:45):
we say five percent or like twenty percent of being
able to conceive, like what has to go right or
like what is going wrong that like leads to the
other eighty percent or the other ninety five percent. I
think I've just been really curious about what actually happens.
Speaker 1 (50:59):
Maria.
Speaker 2 (50:59):
I'm going to pass that on to you to start,
because I think you probably deal with people who think
more about this choice between providers.
Speaker 5 (51:07):
Yeah, I would. I would recommend if you are having
any fertility issues to go straight to seeing a reproductive endocrinologist.
They specialize in assessing hormone levels and medications, and obe's
can do kind of that initial workups, the lab test.
Sometimes there's ultrasounds involved with that and that can be helpful.
(51:30):
But I do think a reproductive endocrinologist is your best
support person for the trying to conceive period.
Speaker 2 (51:40):
Yeah, and then the second part of that What was
the second part of that question, Monica, I'm sorry.
Speaker 12 (51:44):
Yeah, it was like the what's what's the a percent
that's going wrong or the ninety five percent that's going wrong?
Just like what is or what has to go right
for that leads to those percentages?
Speaker 4 (51:54):
Great question, so many things. It's kind of crazy how
inefficient human reproduction is. This is what we've evolved to do,
I guess, But yeah, so I mean you have to
you have to have a follicle with an egg in it,
So it can't be like an an ovulatory cycle where
you're not releasing an egg. So that has to happen.
The egg has to release, it has to be picked
(52:16):
up by the Filippian tube. Sometimes that doesn't happen. Then
it has to like travel its way too, from the
Filippian tubes to the uterus, and the Filippian tubes is
where it gets fertilized. So ideally sperm is already there waiting.
That kind of factors into all of the things we've
been talking about about how much how much sex do
you need to have? So ideally the sperm is there waiting.
(52:38):
And then yeah, it has to travel from the Philippian
tubes to implant, and then of course it's just to
say nothing about the genetics behind. It has to be
a genetically normal egg, genetically normal sperm, all of that,
and you know there's still factors now we don't completely understand.
But yeah, not very unefficient process.
Speaker 5 (52:58):
I just want to briefly say we've been chatting about
it a little bit in the chat, but getting a
semen analysis for your partner or donor is really important.
I think you know.
Speaker 4 (53:09):
Yes, we've spoken.
Speaker 5 (53:10):
There's a lot of women and female Boddy people here,
and I think often that like burden of infertility is
on the person with the uterus, so assessing male factor
infertility is really important. There are some easy ways to
do that. There's even at home mail and tests these
days that have some decent assessment tools. So just putting
(53:33):
that out there, all.
Speaker 2 (53:36):
Right, I'm going to take one more question and then
we're going to end. But when we end, we will
put up a slide which has links to sign up
to the newsletter and which is all on infertility, and
will also have a place for you guys to send
in your questions because I know from the chat that
there are a tremendous number of incredibly specific questions. Is
(53:58):
exactly what we're intend the newsletter for, so we really
want to hear those questions. We can get into this
kind of detail in a way that it's hard on
a that's hard on a big zoom.
Speaker 1 (54:08):
So Emily, you're up. You're the last one.
Speaker 2 (54:12):
Okay, you know other sorry, others, there's another Emily.
Speaker 1 (54:15):
I'm sorry, Emily. So is it me?
Speaker 3 (54:18):
Emily?
Speaker 1 (54:19):
Yes, it is you, Emily. Okay, Hi, So my question.
Speaker 13 (54:23):
I might not be in exactly the right room for this,
but it's such a smart room. I'm hoping you can
tell me where the right room to go is.
Speaker 1 (54:28):
If this is not.
Speaker 13 (54:29):
It, mine's about X topic pregnancy, which I have not
found good information about anywhere. I've had two, with a
healthy daughter born in between those two, and what I
seem to find is like just test early and hope
it's not a topic again, And that's a terrible answer,
and I'm like coming up on thirty nine and so
(54:52):
like everyone delays the next thing. Just wondering if anyone
has anything to say or directions to point me related
to ex topic pregnancy.
Speaker 4 (55:00):
Thank you. I think this could be the right root.
Maybe I certainly treat topic pregnancies do surgery on them.
I would say, yeah, I have a lot of questions
I guess about your specific history, and I would want
to see your uterine imaging. So I'd suppose a good
place to start is go to your OBGI N and
(55:22):
kind of start there, or if you've already been to
your OB do I N. Maybe single fertility specials actually
maybe get you a little bit closer. But yeah, certainly
this is a very individual question. But I would want
to look more closely at your history.
Speaker 1 (55:40):
Okay, guys, we're going to end there.
Speaker 2 (55:42):
Thank you so much, Brianna, Maria Pooja for being here,
for writing for us, for answering questions in the chat.
I think this is There is so much should be
said on this space, and there are so many specific
questions and somebody general questions.
Speaker 1 (56:00):
And I'm hoping that we will continue to grow this.
Speaker 2 (56:03):
Space over the next whatever period it is so people
can get all of their questions answered. Send in your
questions and thank you again for being here. Parent Data
(56:26):
is produced by Tamar Avishai with support from the parent
Data team and PI Rex. If you have thoughts on
this episode, please join the conversation on my Instagram at
prof Emily Ostar, and if you want to support the show,
become a subscriber to the parent Data newsletter at parentdata
dot org, where I write weekly posts on everything to
do with parents and data to help you make better,
(56:49):
more informed parenting decisions.
Speaker 1 (56:51):
There are a lot of ways you can help people
find out about us.
Speaker 2 (56:54):
Leave a rating or a review on Apple Podcasts, text
your friend about something you learned from this episode, bit
your mother in law about the merits of something parents
do now that is totally different.
Speaker 1 (57:04):
From what she did.
Speaker 2 (57:05):
Close the story to your Instagram debunking a panic headline
of your own. Just remember to mention the podcast too.
Rite Penelope, right, mam. We'll see you next time.
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