In this Week's episode host, Victoria, and Dr. Stephanie delve into the intricate world of fertility health, exploring essential topics such as egg freezing, IVF (In Vitro Fertilization), and natural ways to optimize reproductive well-being.
This episode serves as a guide for those who are navigating their fertility journey. We begin by defining fertility and shedding light on the various lifestyle factors that can impact reproductive health. From diet and exercise to stress management and environmental influences, we explore how everyday choices can influence fertility outcomes.
Next, we discuss the signs and symptoms that may indicate it's time to seek guidance from a gynecologist or fertility specialist. By recognizing the subtle cues of fertility issues early on, you can take proactive steps to address potential concerns and explore available treatment options.
Throughout the episode, we provide valuable insights into natural methods for regulating the menstrual cycle and enhancing fertility naturally. We highlight that in order to boost your fertility you may need to make some lifestyle modifications and find the best stress reduction techniques.
WE also delve into the fascinating realm of assisted reproductive technologies, including egg freezing and IVF. We unpack these procedures, discussing their potential benefits, considerations, and success rates. By providing a comprehensive overview of these options, we aim to empower everyone listening to make informed decisions about their fertility journey.
Whether you're considering egg freezing for future family planning, exploring IVF as a treatment option, or simply seeking ways to enhance your fertility naturally, this episode offers valuable insights and guidance to support you on your path to parenthood.
Join us as we embark on a journey of discovery and empowerment, unraveling the complexities of fertility health and celebrating the possibilities that lie ahead! Tune in to the full episode and be sure to share it with a friend!
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Connect w/ Dr. Stephanie Marshall Thompson on IG
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
So having a period every three months is not normal and will also decrease your
chances of getting pregnant because it decreases the amount of time that you
have to actually get pregnant because you're only ovulating a couple times a
year versus if you're ovulating and releasing an egg once a month.
Music.
(00:24):
Hello, Grown Girl Gang. Welcome back to the Girl We Grow Now podcast.
I am your host, Victoria, and I am so grateful that you are tuning back in and joining me this week.
If you are looking for tips, advice, and or inspiration, then you are in the right place.
This podcast was created to help you navigate life and live your most fulfilled and authentic life.
(00:48):
I am so, so excited for the month of April, even though I'm pretty sure Mercury
is in retrograde, I am still claiming a really good month for myself.
And I'm also sending you all those same vibes as well.
One thing that I'm so excited about this month is, well, I have a few things, but I'll share one.
So this month I'm headed back to Canada and anyone who knows me knows that I
(01:12):
literally love going to Canada and it's always something that I look forward to.
And I've actually been thinking that I want to share more of my trips with you
guys on here and some of the intros. So I'm going to try and start doing that.
So anyways, back to what we're here for. So today is the start of a new series for the month of April.
(01:33):
And the focus of this series is going to be on health.
And I'm so excited to say that we're starting this series with an episode on
fertility health, egg freezing, and IVF.
I know that this is a conversation that I've had with my friends now that I'm
in my 30s and thinking about whether or not I want to start a family.
And egg freezing is something that I've really been thinking about a lot and considering.
(01:56):
So I was really excited to get some more knowledge on what that process looks like.
And I know that it's something that I am hardcore thinking about for next year,
but I really want to see if my insurance covers any of it and really just have
that conversation with my gynecologist.
But whether or not you were thinking about starting a family,
(02:17):
this is a really good episode to listen to just to gain the knowledge of fertility
health and potential treatments and things that you may want to consider in
the future when you are ready.
So for today's conversation, I had the pleasure of having Dr.
Stephanie Marshall-Thompson join me to have this conversation.
Dr. Stephanie is a reproductive endocrinologist and infertility specialist at
(02:42):
the Institute for Reproductive Medicine and Science at St. Barnabas in Livingston, New Jersey.
She is an attending physician in the Department of Obstetrics and Gynecology at St.
Barnabas Medical Center, and she is board certified in both obstetrics and gynecology,
as well as reproductive endocrinology and infertility. In this episode, Dr.
(03:06):
Stephanie breaks down what fertility is, lifestyle factors that impact our fertility
health, signs and symptoms it may be time to see your gynecologist,
natural ways to regulate your menstrual cycle, and we talk about about egg freezing
and fertility treatments.
So go ahead, get your pen out, get your notepad or your notes app and really
(03:26):
take some notes because if this is something that you are considering or that
you might consider in the future,
there really are some great gems in here that you're going to want to remember
for when you're ready to pursue potentially starting a family or if you really
just want to know more about your fertility health. So with that, I'll see you in the next
With that being said, let's go ahead and get into the conversation with Dr. Stephanie.
(03:47):
Welcome, Dr. Stephanie. How are you? Thank you. Thanks for having me.
Very excited to join the conversation. Yes.
Okay, so I want to go ahead and get right into the conversation because I have a lot of questions.
So how does a woman's fertility change as we enter into our 30s?
Yeah, so I mean, just to kind of give you guys a little bit of background on
(04:08):
fertility fertility and what happens to our bodies from the very beginning.
We're born with all of our eggs. So over time, we lose the quantity and the quality of them.
The most amount of eggs that we're ever going to have is actually when we're in our mom's uterus.
And then when we go through puberty, we start to see a dramatic reduction in the number of eggs.
(04:30):
So by the time we actually get to puberty, we only have a couple hundred thousand
eggs down from millions when we're in our mom's uterus.
So as we get to our mid-30s, that decline gets to be pretty rapid.
It'll stay fairly steady throughout our late teens, 20s, and even into the early 30s.
But then we do start to see the decline around 35.
(04:53):
And I know it sounds crazy, but 35 really is a magic number where we start to see that decline.
And then 37 and on, it gets even more rapid.
So what we're really dealing with is decreases in egg quantity and quality.
That is so interesting. I didn't
realize that when we are basically babies is when we have most eggs.
(05:13):
I just thought like once you hit puberty is when you start to get like that egg production.
So that's actually really... Yeah, so now we have the eggs, but they're immature.
So when we hit puberty, what happens is every month, one of those little resting
eggs starts to grow and mature and then ovulate.
And then if you don't get pregnant, you end up getting a period.
And if you do get pregnant, obviously that continues, but the egg has to grow
(05:36):
and mature to ovulate. So we're dealing with
immature eggs previously. And then once you hit puberty, those eggs have the
opportunity to mature. Got it. That's so interesting.
So I know you mentioned that our eggs start to, we start to lose quantity and
quality. So are there any lifestyle factors that impact that?
Yeah. I mean, probably the worst thing that you can do for your egg quantity
(05:59):
and quality is smoking. We know that for sure.
You know, that is definitely a huge lifestyle factor. Smoking smoking nicotine.
As for marijuana, we don't have as much data on it, but we presume that it definitely
could impact your egg quality and quantity.
We know one of the largest factors as well as obesity and being overweight,
right? So it's been really important to maintain a healthy weight.
(06:23):
In this country, we have an obesity epidemic. So that is a challenge for many, many people.
And I think just basic lifestyle factors, you know, trying to get adequate amounts
of sleep, regular exercise, appropriate nutrition, all helps us with our future reproduction.
That makes sense. So what about alcohol? Does that have any kind of impact? Yeah.
(06:44):
So I think if you are a moderate drinker, a social drinker, then you generally
should not see much of an impact.
Of course, heavy alcoholism will be an issue.
Okay. And I know you mentioned obesity and keeping a healthy weight.
So if say we are trying to get pregnant and we're thinking about our fertility,
is it the healthy weight that our doctor tells us when we go in for a physical
or is there something that we can like use to measure what's healthy for us?
(07:06):
Yeah, we want to be a normal BMI, right? So underneath the BMI of 25 is considered normal weight.
I know there are flaws to BMI, to body mass index, which is a measure of our
height versus weight, but realistically it's the best measure that we probably do have right now.
So that's what we use, you know, to maintain a healthy weight.
(07:27):
I know a lot of women will say, well, I know I'm overweight,
but I don't have high blood pressure. I don't have diabetes.
I don't have heart disease.
Unfortunately, those things will come. You just may not have developed them yet.
But if your weight is, especially in the obese categories, then you're at very
high risk of developing these diseases and they affect your reproduction.
(07:49):
They affect everything.
Yeah. So just talking about obesity, I did hear women talking about how being
on Ozempic helped help them overcome infertility.
I don't know if you've seen results with that, but is that because it is known
to help you lose weight? Is that why?
Exactly, yep. So Ozempic, Manjaro, those can all help you lose weight.
And I think for a lot of women, what it does is help to regulate their menstrual cycle.
(08:12):
Because one of the things that we know is that being overweight can cause you
to have irregular menstrual cycles and can cause you to have an excess of estrogen
because fat actually converts to estrogen.
So when we lose weight.
It will regulate our menstrual cycles so that we can have a period more regularly
and then it's easier to get pregnant.
(08:33):
I think we forget or we don't really know that it's not normal to not have a
regular menstrual cycle.
You know, a regular menstrual cycle is anywhere between 21 to 35 days from the
start of one period to the start of the next period.
So having a period every three months is not normal and will also decrease your
chances of getting pregnant because it decreases the amount of time that you
(08:57):
have to actually get pregnant because you're only ovulating a couple times a
year versus if you're ovulating and releasing an egg, you know, once a month,
then it's going to be easier for you to get pregnant. That makes a lot of sense.
And even just thinking about regulating periods, I know. So I've always been
regular, but I remember when I was younger, I would have, I mean,
I still have them like period cramps and I would go in to the doctor.
(09:19):
I know I've had some doctors really push birth control.
So does that, like how does birth control affect our fertility?
Birth control does not hurt your fertility at all. If anything, it helps.
It's very helpful for conditions like endometriosis and pelvic pain.
It's very helpful for women who do have irregular menstrual cycles,
who aren't ready to become pregnant because remember, not having a period is abnormal.
(09:41):
And if you don't have a period regularly, the cells from the inside of the uterus
can grow and become abnormal.
And we don't want that to happen. A birth control pill will prevent that from
happening. Now, if you're on a birth control pill and you're not getting a period, that's okay.
It's supposed to be that way. Some women will have light periods,
some will have normal, some will have none. But if you're on a birth control pill, that's okay.
(10:05):
Naturally, it's not okay to not get a period. So the birth control thing is
a great thing for maintaining our reproductive health.
It does not decrease the number of eggs you have.
It does not put you at higher risk of cancer, which I know is a common misconception.
And it does not decrease your fertility in the future. Yeah,
I think that is good to know because I have known like family friends who've
(10:26):
had fertility issues and they wondered if it was because they were on birth
control for over a decade. And so they really questioned it.
Not at all. It may take a few cycles to get your period back in a normal fashion,
but does not affect your future fertility.
That is good to know. But I do want to ask, are there any natural methods or
practices that can help us regulate menstrual cycles if we're not ready to be
(10:48):
on birth control? Yeah, I mean, I think probably the biggest factor is weight, right?
So, you know, most women will have regular menstrual cycles if they're a normal weight.
You know, there are women who suffer from things like polycystic ovary syndrome
who are in a normal weight range as well, too.
And they can use things such as ovacetol, which is a supplement that can help
to regulate menstrual cycles.
(11:10):
I've had women who use acupuncture and find that helpful, too. you.
Right. So those are just some suggestions. But, you know, the majority of women
who are in normal weight will ovulate regularly.
That is good to know. So I feel like lately I've been hearing a lot about cortisol and weight gain.
So how like how does cortisol and those kind of hormones play a factor in fertility?
(11:31):
Yeah. So, I mean, I think that for cortisol to truly cause weight gain,
it is one of those more rare problems.
Things, right? We really want, there are certain conditions where that happens
and most people are not affected with that, right?
So just measuring baseline cortisol levels kind of just because we're gaining
weight doesn't give you any information from an endocrinologic standpoint.
(11:54):
That's for people who have things like Cushing syndrome and things that are more rare.
So, you know, truly, of course we want to have stress reduction as much as possible, right?
Not not have this sort of fight or flight response that's going on constantly,
you know, that can elevate cortisol.
But, you know, those are normal things for the most part.
(12:15):
So I think just overall trying to reduce stress is helpful.
And that's why, you know, I bring that up with cortisol because cortisol is
the quote unquote stress hormone.
But, you know, truly just checking cortisol levels because we've gained weight
is not helpful for the majority of people.
Again, there are some conditions where that is, but not for the majority of people too.
So I wish I could quantify what stress really looks like in terms of its impact on reproduction,
(12:40):
fertility, and weight, but there's really not a lot of good correlations to
say, well, if your stress level is an eight, you're going to,
you know, have this much difficulty, et cetera.
You know, we just want everyone to live as healthy a lifestyle as possible.
I mean, things that do help with those sort of regulations are sleep,
as well as getting outside in nature, sunshine, which, you know,
(13:03):
know, can be kind of hard in the winter and also depending on where you live.
But those are natural methods that help with cortisol levels.
Yeah, I think sunshine and getting in nature are a huge one because I know if
I've had a stressful day and I go for a walk, I feel so much better by the time I get home.
So I think that's a really important one to mention. So what are some of the
warning signs that indicate potential fertility issues and when should someone seek help?
(13:27):
That's a great question. I think, again, not getting a regular period can really
lead to future fertility issues because again, you're just not ovulating regularly.
You have to ovulate for the sperm and the egg to meet. I think pelvic pain is
something that we shouldn't ignore.
If you feel like your pain may be out of the ordinary or it's just so severe
that you've gotten used to it, you should be worked up.
(13:47):
We're looking for things like endometriosis, which is when the cells from the
inside of the uterus can go outside and then implant on the fallopian tubes.
It can implant on your uterus, can cause future fertility issues.
And I think Let's not forget the guys too, right?
Yes. It's very important that men maintain normal health practices as well.
(14:09):
Other signs, you know, I mentioned the pelvic pain, have fibroids worked up.
If you do feel like you may have fibroids, you know, it's not normal to have
extremely heavy periods.
That could be a sign that something's inside the uterus and could prevent implantation
of an embryo, something like a polyp or a fibroid as well. So when you say pelvic
(14:31):
pain, are you talking about period cramps or a different kind of pain? Everything.
Everything so you know our periods yes we will
have cramps but you know we shouldn't have cramps to the
point that it's not controlled with an over-the-counter
medication you know it's not normal for cramps to cause
you to not be able to go to school or work that's what's out of the realm of
normal okay that may be normal for you but that also should you should see your
(14:55):
doctor you know that can be a concern that makes sense and when and you also
mentioned heavy periods so how do we know it's heavy especially say like we
just assume our periods heavy but we don't really have anything to compare it to.
Right. You can do a pad or tampon count and keep track of it so that you can
know. Also, it can cause anemia.
So if you're seeing your doctor and your blood count is low,
then it's very possible that heavy periods could be causing you to be anemic.
(15:18):
Okay. And is there, I mean, I know this is a weird question,
but is there like a certain pad count that we should kind of be like, okay, this is too many?
Yeah. You really shouldn't be soaking more than a pad per hour during a regular menstrual cycle.
And even that is a lot. Okay. Okay. That's good. Really good to know.
And I know you mentioned the men, which I actually did want to ask you about
because I know we hear all the time, women, we talk about our fertility,
(15:40):
but like, how does age impact the male fertility?
Yeah, they're a little bit luckier than us. You know, men produce sperm until
they die. And they produce sperm every three months.
So we actually don't consider advanced paternal age until over the age of 50.
And that even has more to do with spontaneous issues that can happen with the
baby. me, but they're still making sperm and they can still have very easy,
(16:03):
healthy pregnancies after that age.
So, you know, the guys have it a lot easier than we do.
Yeah, that makes sense. I just thought I'd ask because I know a lot of times,
usually if there's a fertility issue, we usually look at the woman,
but I'm sure there are other things outside of age, like you mentioned,
that would impact men. Well, we look at the men too.
You know, in our practice, you know, if you're seeing a fertility specialist,
we do it concurrently. Okay, that's good.
(16:25):
Because I think a lot of men don't really know because I think within a relationship,
usually it's like, oh, it must be the woman if you don't know.
But that is really good to know. So I want to talk a little bit about egg freezing.
This has definitely been a topic of conversation for my friends and I.
So what are some of the misconceptions about egg freezing?
Yeah, I think some of the common misconceptions are that it will decrease the
(16:45):
amount of eggs you have overall, which is not true.
It's actually sort of saving some of your eggs.
And then also that it takes a really long time. Lots of people People are shocked
when I talk to them and I tell them it takes about two weeks.
They think it may take three or four months, but the process is actually about two weeks.
The other one is that it is a guarantee. You know, it is not.
(17:05):
But success rates are very high depending on how old you are.
So age is the most important factor when it comes to fertility treatment success
rates and when it comes to egg freezing success rates.
So what is the specific age that we are most optimal when it comes to freezing
our eggs? Ideally under the age of 35. Okay. And so...
(17:27):
What are the different options or can you even walk us through the process of egg freezing?
Yeah. So I'll say, you know, in relationship to age, I think that everybody
always deserves a consult. You know, you should have the conversation.
We do have plenty of successful pregnancies from women in their late 30s and
early 40s with egg freezing as well. It will just take more eggs.
So there are a lot of factors to weigh in terms of getting an appropriate number
(17:50):
of eggs, you know, that can lead to a good chance of a baby in the future.
The actual process of egg freezing, like I said, takes about two weeks.
The concept is that we're trying to grow as many eggs as possible in one menstrual cycle.
You know, I mentioned to you before that we grow one egg a month.
So we're trying to get, you know, 5, 10, 15 eggs to grow in that cycle.
(18:12):
We do that by having you take injectable follicle stimulating hormone.
So follicle stimulating hormone is a hormone that your brain normally makes
to tell your ovaries to grow an egg.
Now, instead of your brain making it to make one egg, you take in the injections
to try and grow multiple.
So the injections are subcutaneous. They're underneath the skin and you take
(18:33):
several of them a day and you take them for about eight to 10 days.
During that process, we're using vaginal ultrasounds and hormone testing to
watch the growth of the eggs. When the eggs get to the point that we think they're
mature, which means that they could eventually be fertilized,
we have you take something called the trigger shot that makes you ovulate.
But before you actually release the eggs into your abdomen, we take you for
(18:56):
an egg retrieval and remove those eggs surgically.
So you do get anesthesia for the procedure.
It is a surgical procedure and we use a vaginal ultrasound.
It has a needle attached to it. It goes through the vagina into the ovary and
removes the eggs and then we would freeze them. So the procedure takes about
30 minutes and then it's a day procedure. So recovery is about two hours.
(19:19):
So the entire process is about two weeks, about eight to 10 days of the hormone
injections that you take at home, including the monitoring in your doctor's
office and then the egg retrieval at the end.
Wow. So what are the risks associated with that? The greatest risk are the surgical risks.
So there's always the risk of any surgery, things like infection,
bleeding, damage to the area that we're working on. The other side effects that
(19:42):
are common are bloating because, you know, instead of making one egg,
you may be making multiple or you should be making multiple.
And some women complain of it being like a bad PMS. They may feel emotional.
So I always tell people not to have any major life decisions going on at that
time and pick, you know, two weeks of time where they don't have too much going
on. Obviously, you can go about your daily life.
(20:03):
You know, you're in and out of the office. But, you know, realistically,
a time when you can focus and relax and be stress free.
Yes. OK, so when the eggs are removed, you freeze them. And so we just keep
them in like your facilities wherever you freeze them until we're ready to use them. Yes, correct.
So is there a time limit on how long you could keep your eggs frozen?
(20:23):
Yeah, I mean, the eggs can technically be frozen indefinitely,
right? They're flash frozen in liquid nitrogen.
Okay. So it's definitely easy to keep them for a while. The main issue becomes pregnancy.
And there are different age cutoffs depending on which clinic you go to.
Our age cutoff at CCRM New Jersey is 50.
So we want you to create embryos and implant them before that age.
(20:48):
At age 45, you know, is really when I would prefer you to do it before.
And that's just because the risk to pregnancy get to be higher the older you
get. But the eggs themselves are okay.
Okay. So you mentioned embryos. So can you tell us the difference between egg
freezing and creating embryos? Yeah. So eggs are yours.
You know, you grow an egg, you create multiple eggs, and they belong to you alone.
(21:13):
So it's a single gamete. To make a baby, you need an embryo.
So you need sperm and the egg together, and that creates the embryo.
So IVF technically is with embryo.
Embryo. Egg freezing is essentially the same thing as IVF in the process to
make the eggs, but the difference is with IVF, now we're going to fertilize
(21:35):
that egg with the sperm and create the embryo.
And then we grow the embryos in the laboratory prior to transfer back into you, into your uterus.
So we can do both egg freezing and embryo freezing depending on the situation.
And many women who are doing IVF will have leftover embryos that we can keep
frozen as well. Oh, okay.
(21:57):
So is there any cases where you go to fertilize the egg and then an embryo just
can't be created for whatever reason?
Yes, it does happen that sometimes the egg won't fertilize. Okay.
And that's why we need multiple eggs in IVF, right?
The point of IVF is the point of trying to select the best embryo.
So just because you make 10 eggs doesn't mean you're going to have 10 embryos
(22:20):
or 10 chances of pregnancy. and say, when we fertilize the eggs,
they're not all going to fertilize. That's normal.
And they're not all going to grow into embryos. That's also normal.
And then, you know, we can do other things like genetic screening on embryos,
looking for chromosome abnormalities, and they're not all going to be genetically normal either.
You know, that's why this is a process of selection. And that's why the more
(22:44):
eggs you have, the more likely it is you'll end up with a good embryo,
you know, for a successful pregnancy.
Okay, that makes a lot of sense. So I want to get your thoughts on the law that
passed in Alabama classifying embryos legally as children, because I know I
mentioned my family friend, so she still has embryos left.
And she was kind of thinking about what she should do with them now that this law passed.
(23:05):
So she's kind of nervous. So I mean, most women will keep their embryos frozen
until they have completed their family.
And then most women will choose to either discard them or donate them to science.
So you know, The law in Alabama basically saying that embryos are children and
criminalizing any discarding of embryos really does change the point of IVF.
(23:29):
It affects the point of IVF.
We are supposed to create multiple embryos. That's what makes it so efficient.
There's no scientific basis that an embryo is a child, and you can debate that
all you may, but it cannot live outside of a uterus nor outside of the freezer.
Right so you know you can't thaw an embryo and it becomes a person it doesn't
(23:52):
work like that there has to be a vessel or a vehicle so it is not a child it
has the potential to be a child the potential to be a human being but that's
that's all it is so do you think like
IVF will change if this gets passed more, like more widespread?
IVF won't be available in states.
Oh, okay. So they just won't have it at all. No, it won't be available because
(24:14):
if there's a law that criminalizes discarding of embryos, it defeats the purpose of what we do in IVF.
I'll give you some history with the reason that egg freezing was developed in
Italy is because they didn't allow you to fertilize more eggs then you are going
(24:34):
to transfer into a woman's uterus.
So, you know, again, I was describing the process where you're making multiple eggs.
So if a woman has more eggs, we're not going to fertilize 10 eggs and then put
those embryos back into someone.
You know, at most we want to put back in one embryo, ideally,
maybe two, you know, in the right situation.
(24:55):
So what they did was developed a way to freeze the excess eggs so that they
wouldn't fertilize more eggs
than they were actually planning to transfer back into a woman's uterus.
So that's how we got good at the technology, at least the beginnings of it.
That's how, you know, the technology started.
But, you know, one of the other advancements in IVF has been the advancement
(25:17):
of doing genetic testing and screening on embryos.
And we routinely discard embryos
that do not have all the proper DNA to make a healthy a human being.
So IVF will not be available in those states where discarding an embryo is considered criminal.
Also in the Alabama case, I mean, that was intentional, but it's possible if
(25:39):
an embryo is dropped, nobody wants to be criminalized, you know,
for those things. So it won't be available.
Wow. So can you explain the role of genetic infertility and how does that affect fertility treatments?
Yeah. So, you know, as I mentioned that all women are born with our our eggs,
right? So our eggs, we don't make new eggs. They age with us.
So what happens as we get older, as many of you know, there's a higher chance
(26:04):
of miscarriage and a higher chance of just not getting pregnant overall.
And that generally has to do with our eggs and the age of the eggs.
So even naturally, when the egg is fertilized or an attempt to be fertilized,
the older you are, the less likely your egg is to be fertilized,
the less likely that egg is to to create an embryo, and then once it becomes
(26:25):
an embryo, again, naturally and in IVF, it has to grow and divide properly.
And if it's not growing and dividing properly, it gets abnormal numbers of chromosomes.
You need 23 pairs of chromosomes to create a human being, you know,
who has all the proper DNA.
And when you're older, there's a much greater likelihood that your embryos are going to be abnormal.
(26:48):
So we do have the opportunity to screen the embryos beforehand and make sure
that all of the DNA that's supposed to be there is present and in the right place.
Say if your mom had infertility issues, it doesn't necessarily mean that you will?
Not at all. Infertility is generally not genetic. There are some things that
are genetic that we see more of, like endometriosis, but that doesn't mean that
(27:09):
if your mom had it or didn't have it, then, you know, you won't or will have those things.
Also, if your mom, you know, got pregnant later on in life, it doesn't mean
that you will get pregnant later on in life.
You know, fertility is generally related to the individual.
So what are some of the different testing options available for fertility for both men and women?
So for women, we usually start with egg count testing. So we look at how many
(27:33):
eggs you have in relationship to what it should be for your age.
There's no test that we have that tells us you have like a million eggs, right?
But we are able to see if your egg count is age appropriate by ultrasound and by hormone test.
We also need to look at your anatomy. So we check that the fallopian tubes are
open and that the uterus doesn't have anything that could prevent implantation of an embryo.
(27:58):
The fallopian tubes are very important in natural conception because they need
to be open and free and clear of any blockages or fluid or anything that could be damaging.
Because the sperm and the egg meet in the fallopian tube. The egg is released
from the ovary, travels to the fallopian tube.
The sperm goes through the cervix and uterus up into the fallopian tube, meets the egg there.
(28:21):
That's where the embryo is created and then grows for a few days.
And then that embryo has to go into the uterus for implantation.
For men, we do a semen analysis. So we look at the count of sperm.
We look at the morphology, which is the percentage of normally shaped sperm.
And then we look at the motility, which is the amount of sperm that are swimming
(28:41):
and available to fertilize an egg.
Oh, okay. So for the egg count, that sounds like it maybe could be a first step
if you're considering having children.
Is that something you can get from your family doctor or is that something you
need to see a fertility doctor? Yeah, I mean, your OBGYN can order it, too.
We start with something called an anti-malarian hormone level,
and that gives us a general idea of if your egg count is age appropriate.
(29:04):
Nothing predicts fertility, though, like age and pregnancy, right?
So that's the most important predictor. And even if your egg count is high,
and even if it is lower than it should be, your age still trumps everything.
So is it true that once you have one pregnancy, you're more likely to have another,
or is that a misconception? conception? Not necessarily.
(29:24):
We see lots of secondary infertility and it's generally related to age.
So what advice would you give to women in their 30s who are considering their
options for fertility treatment or just starting that journey?
Yeah, I think it's important to just sort of see where you are in terms of your
relationship to your egg count again and age.
(29:44):
Considering egg freezing, if it's available to you, it really is a great way
to try and preserve your eggs for the future and just have a consult with a fertility specialist.
Or you could start with your GYN and talk to them about the antimalarian hormone
level and checking your hormones on the third day of your menstrual cycle and
just make sure you're optimizing your health.
(30:05):
Yeah, I really like that. And I think, so is this something that we should probably not wait for?
Because I know people like me who are single, we kind of don't really think
about it as much as far as getting the testing, but is this something we should
just go ahead and take Yeah, absolutely.
There's no reason not to. It's always better to be informed.
And if you choose not to proceed with egg freezing or some women will even decide
(30:25):
that they want to become a single mother by choice, then at least you have the
information and you know what the processes look like.
Yes. All right. Well, thank you so much, Dr. Stephanie. Thank you for coming
on. Can you tell us? Welcome. Happy to be here.
Yes. Can you tell us where we could follow you and where we could potentially
work with you? Absolutely.
So I'm at Colorado Center for Reproductive Medicine in New Jersey,
(30:48):
also known as IRMS, the Institute for Reproductive Medicine and Science.
I practice out of our Jersey City and Teaneck locations.
I mean, you can find me on Instagram as Dr. underscore SM Thompson.
Perfect. I will make sure that I link your links in the show notes.
And again, thank you. And thank you.
(31:09):
Thank you all for tuning into this week's episode. If you really loved the episode
and you felt like it resonated with you, be sure to share the love and share
the episode with a friend.
Also, if you could take a minute and head to the review section wherever you
listen to your podcast and leave me a review, letting me know what you're loving
about these episodes and which topics you want to hear next.
That way I can make sure that i continue creating episodes that you love also
(31:31):
make sure you hit the subscribe button so that you don't miss an episode until next.
Music.
So having a period every three months is not normal and will also decrease your
chances of getting pregnant because it decreases the amount of time that you
have to actually get pregnant because you're only ovulating a couple times a
year versus if you're ovulating and releasing an egg once a month.
Music.
(00:24):
Hello, Grown Girl Gang. Welcome back to the Girl We Grow Now podcast.
I am your host, Victoria, and I am so grateful that you are tuning back in and joining me this week.
If you are looking for tips, advice, and or inspiration, then you are in the right place.
This podcast was created to help you navigate life and live your most fulfilled and authentic life.
(00:48):
I am so, so excited for the month of April, even though I'm pretty sure Mercury
is in retrograde, I am still claiming a really good month for myself.
And I'm also sending you all those same vibes as well.
One thing that I'm so excited about this month is, well, I have a few things, but I'll share one.
So this month I'm headed back to Canada and anyone who knows me knows that I
(01:12):
literally love going to Canada and it's always something that I look forward to.
And I've actually been thinking that I want to share more of my trips with you
guys on here and some of the intros. So I'm going to try and start doing that.
So anyways, back to what we're here for. So today is the start of a new series for the month of April.
(01:33):
And the focus of this series is going to be on health.
And I'm so excited to say that we're starting this series with an episode on
fertility health, egg freezing, and IVF.
I know that this is a conversation that I've had with my friends now that I'm
in my 30s and thinking about whether or not I want to start a family.
And egg freezing is something that I've really been thinking about a lot and considering.
(01:56):
So I was really excited to get some more knowledge on what that process looks like.
And I know that it's something that I am hardcore thinking about for next year,
but I really want to see if my insurance covers any of it and really just have
that conversation with my gynecologist.
But whether or not you were thinking about starting a family,
(02:17):
this is a really good episode to listen to just to gain the knowledge of fertility
health and potential treatments and things that you may want to consider in
the future when you are ready.
So for today's conversation, I had the pleasure of having Dr.
Stephanie Marshall-Thompson join me to have this conversation.
Dr. Stephanie is a reproductive endocrinologist and infertility specialist at
(02:42):
the Institute for Reproductive Medicine and Science at St. Barnabas in Livingston, New Jersey.
She is an attending physician in the Department of Obstetrics and Gynecology at St.
Barnabas Medical Center, and she is board certified in both obstetrics and gynecology,
as well as reproductive endocrinology and infertility. In this episode, Dr.
(03:06):
Stephanie breaks down what fertility is, lifestyle factors that impact our fertility
health, signs and symptoms it may be time to see your gynecologist,
natural ways to regulate your menstrual cycle, and we talk about about egg freezing
and fertility treatments.
So go ahead, get your pen out, get your notepad or your notes app and really
(03:26):
take some notes because if this is something that you are considering or that
you might consider in the future,
there really are some great gems in here that you're going to want to remember
for when you're ready to pursue potentially starting a family or if you really
just want to know more about your fertility health. So with that, I'll see you in the next
With that being said, let's go ahead and get into the conversation with Dr. Stephanie.
(03:47):
Welcome, Dr. Stephanie. How are you? Thank you. Thanks for having me.
Very excited to join the conversation. Yes.
Okay, so I want to go ahead and get right into the conversation because I have a lot of questions.
So how does a woman's fertility change as we enter into our 30s?
Yeah, so I mean, just to kind of give you guys a little bit of background on
(04:08):
fertility fertility and what happens to our bodies from the very beginning.
We're born with all of our eggs. So over time, we lose the quantity and the quality of them.
The most amount of eggs that we're ever going to have is actually when we're in our mom's uterus.
And then when we go through puberty, we start to see a dramatic reduction in the number of eggs.
(04:30):
So by the time we actually get to puberty, we only have a couple hundred thousand
eggs down from millions when we're in our mom's uterus.
So as we get to our mid-30s, that decline gets to be pretty rapid.
It'll stay fairly steady throughout our late teens, 20s, and even into the early 30s.
But then we do start to see the decline around 35.
(04:53):
And I know it sounds crazy, but 35 really is a magic number where we start to see that decline.
And then 37 and on, it gets even more rapid.
So what we're really dealing with is decreases in egg quantity and quality.
That is so interesting. I didn't
realize that when we are basically babies is when we have most eggs.
(05:13):
I just thought like once you hit puberty is when you start to get like that egg production.
So that's actually really... Yeah, so now we have the eggs, but they're immature.
So when we hit puberty, what happens is every month, one of those little resting
eggs starts to grow and mature and then ovulate.
And then if you don't get pregnant, you end up getting a period.
And if you do get pregnant, obviously that continues, but the egg has to grow
(05:36):
and mature to ovulate. So we're dealing with
immature eggs previously. And then once you hit puberty, those eggs have the
opportunity to mature. Got it. That's so interesting.
So I know you mentioned that our eggs start to, we start to lose quantity and
quality. So are there any lifestyle factors that impact that?
Yeah. I mean, probably the worst thing that you can do for your egg quantity
(05:59):
and quality is smoking. We know that for sure.
You know, that is definitely a huge lifestyle factor. Smoking smoking nicotine.
As for marijuana, we don't have as much data on it, but we presume that it definitely
could impact your egg quality and quantity.
We know one of the largest factors as well as obesity and being overweight,
right? So it's been really important to maintain a healthy weight.
(06:23):
In this country, we have an obesity epidemic. So that is a challenge for many, many people.
And I think just basic lifestyle factors, you know, trying to get adequate amounts
of sleep, regular exercise, appropriate nutrition, all helps us with our future reproduction.
That makes sense. So what about alcohol? Does that have any kind of impact? Yeah.
(06:44):
So I think if you are a moderate drinker, a social drinker, then you generally
should not see much of an impact.
Of course, heavy alcoholism will be an issue.
Okay. And I know you mentioned obesity and keeping a healthy weight.
So if say we are trying to get pregnant and we're thinking about our fertility,
is it the healthy weight that our doctor tells us when we go in for a physical
or is there something that we can like use to measure what's healthy for us?
(07:06):
Yeah, we want to be a normal BMI, right? So underneath the BMI of 25 is considered normal weight.
I know there are flaws to BMI, to body mass index, which is a measure of our
height versus weight, but realistically it's the best measure that we probably do have right now.
So that's what we use, you know, to maintain a healthy weight.
(07:27):
I know a lot of women will say, well, I know I'm overweight,
but I don't have high blood pressure. I don't have diabetes.
I don't have heart disease.
Unfortunately, those things will come. You just may not have developed them yet.
But if your weight is, especially in the obese categories, then you're at very
high risk of developing these diseases and they affect your reproduction.
(07:49):
They affect everything.
Yeah. So just talking about obesity, I did hear women talking about how being
on Ozempic helped help them overcome infertility.
I don't know if you've seen results with that, but is that because it is known
to help you lose weight? Is that why?
Exactly, yep. So Ozempic, Manjaro, those can all help you lose weight.
And I think for a lot of women, what it does is help to regulate their menstrual cycle.
(08:12):
Because one of the things that we know is that being overweight can cause you
to have irregular menstrual cycles and can cause you to have an excess of estrogen
because fat actually converts to estrogen.
So when we lose weight.
It will regulate our menstrual cycles so that we can have a period more regularly
and then it's easier to get pregnant.
(08:33):
I think we forget or we don't really know that it's not normal to not have a
regular menstrual cycle.
You know, a regular menstrual cycle is anywhere between 21 to 35 days from the
start of one period to the start of the next period.
So having a period every three months is not normal and will also decrease your
chances of getting pregnant because it decreases the amount of time that you
(08:57):
have to actually get pregnant because you're only ovulating a couple times a
year versus if you're ovulating and releasing an egg, you know, once a month,
then it's going to be easier for you to get pregnant. That makes a lot of sense.
And even just thinking about regulating periods, I know. So I've always been
regular, but I remember when I was younger, I would have, I mean,
I still have them like period cramps and I would go in to the doctor.
(09:19):
I know I've had some doctors really push birth control.
So does that, like how does birth control affect our fertility?
Birth control does not hurt your fertility at all. If anything, it helps.
It's very helpful for conditions like endometriosis and pelvic pain.
It's very helpful for women who do have irregular menstrual cycles,
who aren't ready to become pregnant because remember, not having a period is abnormal.
(09:41):
And if you don't have a period regularly, the cells from the inside of the uterus
can grow and become abnormal.
And we don't want that to happen. A birth control pill will prevent that from
happening. Now, if you're on a birth control pill and you're not getting a period, that's okay.
It's supposed to be that way. Some women will have light periods,
some will have normal, some will have none. But if you're on a birth control pill, that's okay.
(10:05):
Naturally, it's not okay to not get a period. So the birth control thing is
a great thing for maintaining our reproductive health.
It does not decrease the number of eggs you have.
It does not put you at higher risk of cancer, which I know is a common misconception.
And it does not decrease your fertility in the future. Yeah,
I think that is good to know because I have known like family friends who've
(10:26):
had fertility issues and they wondered if it was because they were on birth
control for over a decade. And so they really questioned it.
Not at all. It may take a few cycles to get your period back in a normal fashion,
but does not affect your future fertility.
That is good to know. But I do want to ask, are there any natural methods or
practices that can help us regulate menstrual cycles if we're not ready to be
(10:48):
on birth control? Yeah, I mean, I think probably the biggest factor is weight, right?
So, you know, most women will have regular menstrual cycles if they're a normal weight.
You know, there are women who suffer from things like polycystic ovary syndrome
who are in a normal weight range as well, too.
And they can use things such as ovacetol, which is a supplement that can help
to regulate menstrual cycles.
(11:10):
I've had women who use acupuncture and find that helpful, too. you.
Right. So those are just some suggestions. But, you know, the majority of women
who are in normal weight will ovulate regularly.
That is good to know. So I feel like lately I've been hearing a lot about cortisol and weight gain.
So how like how does cortisol and those kind of hormones play a factor in fertility?
(11:31):
Yeah. So, I mean, I think that for cortisol to truly cause weight gain,
it is one of those more rare problems.
Things, right? We really want, there are certain conditions where that happens
and most people are not affected with that, right?
So just measuring baseline cortisol levels kind of just because we're gaining
weight doesn't give you any information from an endocrinologic standpoint.
(11:54):
That's for people who have things like Cushing syndrome and things that are more rare.
So, you know, truly, of course we want to have stress reduction as much as possible, right?
Not not have this sort of fight or flight response that's going on constantly,
you know, that can elevate cortisol.
But, you know, those are normal things for the most part.
(12:15):
So I think just overall trying to reduce stress is helpful.
And that's why, you know, I bring that up with cortisol because cortisol is
the quote unquote stress hormone.
But, you know, truly just checking cortisol levels because we've gained weight
is not helpful for the majority of people.
Again, there are some conditions where that is, but not for the majority of people too.
So I wish I could quantify what stress really looks like in terms of its impact on reproduction,
(12:40):
fertility, and weight, but there's really not a lot of good correlations to
say, well, if your stress level is an eight, you're going to,
you know, have this much difficulty, et cetera.
You know, we just want everyone to live as healthy a lifestyle as possible.
I mean, things that do help with those sort of regulations are sleep,
as well as getting outside in nature, sunshine, which, you know,
(13:03):
know, can be kind of hard in the winter and also depending on where you live.
But those are natural methods that help with cortisol levels.
Yeah, I think sunshine and getting in nature are a huge one because I know if
I've had a stressful day and I go for a walk, I feel so much better by the time I get home.
So I think that's a really important one to mention. So what are some of the
warning signs that indicate potential fertility issues and when should someone seek help?
(13:27):
That's a great question. I think, again, not getting a regular period can really
lead to future fertility issues because again, you're just not ovulating regularly.
You have to ovulate for the sperm and the egg to meet. I think pelvic pain is
something that we shouldn't ignore.
If you feel like your pain may be out of the ordinary or it's just so severe
that you've gotten used to it, you should be worked up.
(13:47):
We're looking for things like endometriosis, which is when the cells from the
inside of the uterus can go outside and then implant on the fallopian tubes.
It can implant on your uterus, can cause future fertility issues.
And I think Let's not forget the guys too, right?
Yes. It's very important that men maintain normal health practices as well.
(14:09):
Other signs, you know, I mentioned the pelvic pain, have fibroids worked up.
If you do feel like you may have fibroids, you know, it's not normal to have
extremely heavy periods.
That could be a sign that something's inside the uterus and could prevent implantation
of an embryo, something like a polyp or a fibroid as well. So when you say pelvic
(14:31):
pain, are you talking about period cramps or a different kind of pain? Everything.
Everything so you know our periods yes we will
have cramps but you know we shouldn't have cramps to the
point that it's not controlled with an over-the-counter
medication you know it's not normal for cramps to cause
you to not be able to go to school or work that's what's out of the realm of
normal okay that may be normal for you but that also should you should see your
(14:55):
doctor you know that can be a concern that makes sense and when and you also
mentioned heavy periods so how do we know it's heavy especially say like we
just assume our periods heavy but we don't really have anything to compare it to.
Right. You can do a pad or tampon count and keep track of it so that you can
know. Also, it can cause anemia.
So if you're seeing your doctor and your blood count is low,
then it's very possible that heavy periods could be causing you to be anemic.
(15:18):
Okay. And is there, I mean, I know this is a weird question,
but is there like a certain pad count that we should kind of be like, okay, this is too many?
Yeah. You really shouldn't be soaking more than a pad per hour during a regular menstrual cycle.
And even that is a lot. Okay. Okay. That's good. Really good to know.
And I know you mentioned the men, which I actually did want to ask you about
because I know we hear all the time, women, we talk about our fertility,
(15:40):
but like, how does age impact the male fertility?
Yeah, they're a little bit luckier than us. You know, men produce sperm until
they die. And they produce sperm every three months.
So we actually don't consider advanced paternal age until over the age of 50.
And that even has more to do with spontaneous issues that can happen with the
baby. me, but they're still making sperm and they can still have very easy,
(16:03):
healthy pregnancies after that age.
So, you know, the guys have it a lot easier than we do.
Yeah, that makes sense. I just thought I'd ask because I know a lot of times,
usually if there's a fertility issue, we usually look at the woman,
but I'm sure there are other things outside of age, like you mentioned,
that would impact men. Well, we look at the men too.
You know, in our practice, you know, if you're seeing a fertility specialist,
we do it concurrently. Okay, that's good.
(16:25):
Because I think a lot of men don't really know because I think within a relationship,
usually it's like, oh, it must be the woman if you don't know.
But that is really good to know. So I want to talk a little bit about egg freezing.
This has definitely been a topic of conversation for my friends and I.
So what are some of the misconceptions about egg freezing?
Yeah, I think some of the common misconceptions are that it will decrease the
(16:45):
amount of eggs you have overall, which is not true.
It's actually sort of saving some of your eggs.
And then also that it takes a really long time. Lots of people People are shocked
when I talk to them and I tell them it takes about two weeks.
They think it may take three or four months, but the process is actually about two weeks.
The other one is that it is a guarantee. You know, it is not.
(17:05):
But success rates are very high depending on how old you are.
So age is the most important factor when it comes to fertility treatment success
rates and when it comes to egg freezing success rates.
So what is the specific age that we are most optimal when it comes to freezing
our eggs? Ideally under the age of 35. Okay. And so...
(17:27):
What are the different options or can you even walk us through the process of egg freezing?
Yeah. So I'll say, you know, in relationship to age, I think that everybody
always deserves a consult. You know, you should have the conversation.
We do have plenty of successful pregnancies from women in their late 30s and
early 40s with egg freezing as well. It will just take more eggs.
So there are a lot of factors to weigh in terms of getting an appropriate number
(17:50):
of eggs, you know, that can lead to a good chance of a baby in the future.
The actual process of egg freezing, like I said, takes about two weeks.
The concept is that we're trying to grow as many eggs as possible in one menstrual cycle.
You know, I mentioned to you before that we grow one egg a month.
So we're trying to get, you know, 5, 10, 15 eggs to grow in that cycle.
(18:12):
We do that by having you take injectable follicle stimulating hormone.
So follicle stimulating hormone is a hormone that your brain normally makes
to tell your ovaries to grow an egg.
Now, instead of your brain making it to make one egg, you take in the injections
to try and grow multiple.
So the injections are subcutaneous. They're underneath the skin and you take
(18:33):
several of them a day and you take them for about eight to 10 days.
During that process, we're using vaginal ultrasounds and hormone testing to
watch the growth of the eggs. When the eggs get to the point that we think they're
mature, which means that they could eventually be fertilized,
we have you take something called the trigger shot that makes you ovulate.
But before you actually release the eggs into your abdomen, we take you for
(18:56):
an egg retrieval and remove those eggs surgically.
So you do get anesthesia for the procedure.
It is a surgical procedure and we use a vaginal ultrasound.
It has a needle attached to it. It goes through the vagina into the ovary and
removes the eggs and then we would freeze them. So the procedure takes about
30 minutes and then it's a day procedure. So recovery is about two hours.
(19:19):
So the entire process is about two weeks, about eight to 10 days of the hormone
injections that you take at home, including the monitoring in your doctor's
office and then the egg retrieval at the end.
Wow. So what are the risks associated with that? The greatest risk are the surgical risks.
So there's always the risk of any surgery, things like infection,
bleeding, damage to the area that we're working on. The other side effects that
(19:42):
are common are bloating because, you know, instead of making one egg,
you may be making multiple or you should be making multiple.
And some women complain of it being like a bad PMS. They may feel emotional.
So I always tell people not to have any major life decisions going on at that
time and pick, you know, two weeks of time where they don't have too much going
on. Obviously, you can go about your daily life.
(20:03):
You know, you're in and out of the office. But, you know, realistically,
a time when you can focus and relax and be stress free.
Yes. OK, so when the eggs are removed, you freeze them. And so we just keep
them in like your facilities wherever you freeze them until we're ready to use them. Yes, correct.
So is there a time limit on how long you could keep your eggs frozen?
(20:23):
Yeah, I mean, the eggs can technically be frozen indefinitely,
right? They're flash frozen in liquid nitrogen.
Okay. So it's definitely easy to keep them for a while. The main issue becomes pregnancy.
And there are different age cutoffs depending on which clinic you go to.
Our age cutoff at CCRM New Jersey is 50.
So we want you to create embryos and implant them before that age.
(20:48):
At age 45, you know, is really when I would prefer you to do it before.
And that's just because the risk to pregnancy get to be higher the older you
get. But the eggs themselves are okay.
Okay. So you mentioned embryos. So can you tell us the difference between egg
freezing and creating embryos? Yeah. So eggs are yours.
You know, you grow an egg, you create multiple eggs, and they belong to you alone.
(21:13):
So it's a single gamete. To make a baby, you need an embryo.
So you need sperm and the egg together, and that creates the embryo.
So IVF technically is with embryo.
Embryo. Egg freezing is essentially the same thing as IVF in the process to
make the eggs, but the difference is with IVF, now we're going to fertilize
(21:35):
that egg with the sperm and create the embryo.
And then we grow the embryos in the laboratory prior to transfer back into you, into your uterus.
So we can do both egg freezing and embryo freezing depending on the situation.
And many women who are doing IVF will have leftover embryos that we can keep
frozen as well. Oh, okay.
(21:57):
So is there any cases where you go to fertilize the egg and then an embryo just
can't be created for whatever reason?
Yes, it does happen that sometimes the egg won't fertilize. Okay.
And that's why we need multiple eggs in IVF, right?
The point of IVF is the point of trying to select the best embryo.
So just because you make 10 eggs doesn't mean you're going to have 10 embryos
(22:20):
or 10 chances of pregnancy. and say, when we fertilize the eggs,
they're not all going to fertilize. That's normal.
And they're not all going to grow into embryos. That's also normal.
And then, you know, we can do other things like genetic screening on embryos,
looking for chromosome abnormalities, and they're not all going to be genetically normal either.
You know, that's why this is a process of selection. And that's why the more
(22:44):
eggs you have, the more likely it is you'll end up with a good embryo,
you know, for a successful pregnancy.
Okay, that makes a lot of sense. So I want to get your thoughts on the law that
passed in Alabama classifying embryos legally as children, because I know I
mentioned my family friend, so she still has embryos left.
And she was kind of thinking about what she should do with them now that this law passed.
(23:05):
So she's kind of nervous. So I mean, most women will keep their embryos frozen
until they have completed their family.
And then most women will choose to either discard them or donate them to science.
So you know, The law in Alabama basically saying that embryos are children and
criminalizing any discarding of embryos really does change the point of IVF.
(23:29):
It affects the point of IVF.
We are supposed to create multiple embryos. That's what makes it so efficient.
There's no scientific basis that an embryo is a child, and you can debate that
all you may, but it cannot live outside of a uterus nor outside of the freezer.
Right so you know you can't thaw an embryo and it becomes a person it doesn't
(23:52):
work like that there has to be a vessel or a vehicle so it is not a child it
has the potential to be a child the potential to be a human being but that's
that's all it is so do you think like
IVF will change if this gets passed more, like more widespread?
IVF won't be available in states.
Oh, okay. So they just won't have it at all. No, it won't be available because
(24:14):
if there's a law that criminalizes discarding of embryos, it defeats the purpose of what we do in IVF.
I'll give you some history with the reason that egg freezing was developed in
Italy is because they didn't allow you to fertilize more eggs then you are going
(24:34):
to transfer into a woman's uterus.
So, you know, again, I was describing the process where you're making multiple eggs.
So if a woman has more eggs, we're not going to fertilize 10 eggs and then put
those embryos back into someone.
You know, at most we want to put back in one embryo, ideally,
maybe two, you know, in the right situation.
(24:55):
So what they did was developed a way to freeze the excess eggs so that they
wouldn't fertilize more eggs
than they were actually planning to transfer back into a woman's uterus.
So that's how we got good at the technology, at least the beginnings of it.
That's how, you know, the technology started.
But, you know, one of the other advancements in IVF has been the advancement
(25:17):
of doing genetic testing and screening on embryos.
And we routinely discard embryos
that do not have all the proper DNA to make a healthy a human being.
So IVF will not be available in those states where discarding an embryo is considered criminal.
Also in the Alabama case, I mean, that was intentional, but it's possible if
(25:39):
an embryo is dropped, nobody wants to be criminalized, you know,
for those things. So it won't be available.
Wow. So can you explain the role of genetic infertility and how does that affect fertility treatments?
Yeah. So, you know, as I mentioned that all women are born with our our eggs,
right? So our eggs, we don't make new eggs. They age with us.
So what happens as we get older, as many of you know, there's a higher chance
(26:04):
of miscarriage and a higher chance of just not getting pregnant overall.
And that generally has to do with our eggs and the age of the eggs.
So even naturally, when the egg is fertilized or an attempt to be fertilized,
the older you are, the less likely your egg is to be fertilized,
the less likely that egg is to to create an embryo, and then once it becomes
(26:25):
an embryo, again, naturally and in IVF, it has to grow and divide properly.
And if it's not growing and dividing properly, it gets abnormal numbers of chromosomes.
You need 23 pairs of chromosomes to create a human being, you know,
who has all the proper DNA.
And when you're older, there's a much greater likelihood that your embryos are going to be abnormal.
(26:48):
So we do have the opportunity to screen the embryos beforehand and make sure
that all of the DNA that's supposed to be there is present and in the right place.
Say if your mom had infertility issues, it doesn't necessarily mean that you will?
Not at all. Infertility is generally not genetic. There are some things that
are genetic that we see more of, like endometriosis, but that doesn't mean that
(27:09):
if your mom had it or didn't have it, then, you know, you won't or will have those things.
Also, if your mom, you know, got pregnant later on in life, it doesn't mean
that you will get pregnant later on in life.
You know, fertility is generally related to the individual.
So what are some of the different testing options available for fertility for both men and women?
So for women, we usually start with egg count testing. So we look at how many
(27:33):
eggs you have in relationship to what it should be for your age.
There's no test that we have that tells us you have like a million eggs, right?
But we are able to see if your egg count is age appropriate by ultrasound and by hormone test.
We also need to look at your anatomy. So we check that the fallopian tubes are
open and that the uterus doesn't have anything that could prevent implantation of an embryo.
(27:58):
The fallopian tubes are very important in natural conception because they need
to be open and free and clear of any blockages or fluid or anything that could be damaging.
Because the sperm and the egg meet in the fallopian tube. The egg is released
from the ovary, travels to the fallopian tube.
The sperm goes through the cervix and uterus up into the fallopian tube, meets the egg there.
(28:21):
That's where the embryo is created and then grows for a few days.
And then that embryo has to go into the uterus for implantation.
For men, we do a semen analysis. So we look at the count of sperm.
We look at the morphology, which is the percentage of normally shaped sperm.
And then we look at the motility, which is the amount of sperm that are swimming
(28:41):
and available to fertilize an egg.
Oh, okay. So for the egg count, that sounds like it maybe could be a first step
if you're considering having children.
Is that something you can get from your family doctor or is that something you
need to see a fertility doctor? Yeah, I mean, your OBGYN can order it, too.
We start with something called an anti-malarian hormone level,
and that gives us a general idea of if your egg count is age appropriate.
(29:04):
Nothing predicts fertility, though, like age and pregnancy, right?
So that's the most important predictor. And even if your egg count is high,
and even if it is lower than it should be, your age still trumps everything.
So is it true that once you have one pregnancy, you're more likely to have another,
or is that a misconception? conception? Not necessarily.
(29:24):
We see lots of secondary infertility and it's generally related to age.
So what advice would you give to women in their 30s who are considering their
options for fertility treatment or just starting that journey?
Yeah, I think it's important to just sort of see where you are in terms of your
relationship to your egg count again and age.
(29:44):
Considering egg freezing, if it's available to you, it really is a great way
to try and preserve your eggs for the future and just have a consult with a fertility specialist.
Or you could start with your GYN and talk to them about the antimalarian hormone
level and checking your hormones on the third day of your menstrual cycle and
just make sure you're optimizing your health.
(30:05):
Yeah, I really like that. And I think, so is this something that we should probably not wait for?
Because I know people like me who are single, we kind of don't really think
about it as much as far as getting the testing, but is this something we should
just go ahead and take Yeah, absolutely.
There's no reason not to. It's always better to be informed.
And if you choose not to proceed with egg freezing or some women will even decide
(30:25):
that they want to become a single mother by choice, then at least you have the
information and you know what the processes look like.
Yes. All right. Well, thank you so much, Dr. Stephanie. Thank you for coming
on. Can you tell us? Welcome. Happy to be here.
Yes. Can you tell us where we could follow you and where we could potentially
work with you? Absolutely.
So I'm at Colorado Center for Reproductive Medicine in New Jersey,
(30:48):
also known as IRMS, the Institute for Reproductive Medicine and Science.
I practice out of our Jersey City and Teaneck locations.
I mean, you can find me on Instagram as Dr. underscore SM Thompson.
Perfect. I will make sure that I link your links in the show notes.
And again, thank you. And thank you.
(31:09):
Thank you all for tuning into this week's episode. If you really loved the episode
and you felt like it resonated with you, be sure to share the love and share
the episode with a friend.
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(31:31):
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