Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / Pregnancy After 35: The Fertility Clock Myth, Egg Quality Truths, and How to Get Pregnant Without Panic with Dr. Lucky Sekhon

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Pregnancy After 35: The Fertility Clock Myth, Egg Quality Truths, and How to Get Pregnant Without Panic with Dr. Lucky Sekhon · hol+ with Dr. Taz MD | The Future of Medicine is Holistic

• [00:00:00] Dr. Taz: Before we get into today's topic, I just wanna say thank you to everyone who's been [00:00:05] listening and reaching out. Your dms mean the world. They tell me what's helping, [00:00:10] what's confusing, and what's next for you. So if you haven't yet, come connect with me on [00:00:15] Instagram at Dr. Taaz md. I'd love to hear your story and what brought you to Whole [00:00:20] Plus. [00:00:20] Dr. Taz: Now let's dive in. [00:00:21] Dr. Lucky Sekhon: It can't reverse the clock, but I can inform [00:00:25] people. Society has done a great job reminding women about, you know, the fragility of their [00:00:30] fertility. And I have people that come to me at 35 and they're like, oh my God, I'm turning 35 [00:00:35] tomorrow. Am I gonna fall off a fertility cle? Right? And that's not true either [00:00:38] Dr. Taz: with a worldwide [00:00:40] declining fertility rate. [00:00:41] Dr. Taz: I continue to meet patients every single day, struggling [00:00:45] to get pregnant, looking for answers and honestly feeling hopeless. That's [00:00:50] why I invited Dr. Lucky Sicon onto the show. She's a double board [00:00:55] certified reproductive endocrinologist and infertility specialist and an O-B-G-Y-N based [00:00:59] Dr. Lucky Sekhon: [00:01:00] in New York City. [00:01:00] Dr. Lucky Sekhon: There's a, an appropriate level of urgency because there is a [00:01:05] clock and contrary to what you might see in your Instagram feed, there isn't always a way to [00:01:10] reverse that, or, you know, there isn't like an easy supplement to take to fix that or freeze it at the same [00:01:15] time. It's on a continuum. It's not a cliff. [00:01:17] Dr. Lucky Sekhon: Yeah. So. I'll explain it this way. You're [00:01:20] born with all the eggs that you're ever gonna have. You don't make new eggs, you don't repair your eggs. I like to [00:01:25] use this analogy of like a pantry. Imagine at the core of both ovaries, you have this pantry, the [00:01:30] stockpile that you're born with, and every cycle you have a, an [00:01:35] unlocking of the pantry in it. [00:01:36] Dr. Lucky Sekhon: Situation that you can't control. I can't manipulate it as a fertility doctor, [00:01:40] but a few of those eggs escape and imagine they're like pulled outta the pantry into the kitchen [00:01:45] cabinets. That's what I can see on an ultrasound in bubbles of fluid that we call follicles. Each one [00:01:50] containing an egg. When I scan a person, I'm able to look at their ovaries and kind of get a count, and it's a [00:01:55] cohort that is easy to count. [00:01:56] Dr. Lucky Sekhon: It's like 10, 15, 20. It varies from person to person. Mm-hmm. [00:02:00] But it's like rationing, which is why I use this pantry analogy, because the more you have in your stockpile in a [00:02:05] given timeframe, the more you tend to bring to the surface and bring out. But [00:02:10] really matters is what is the chance of ovulating a healthy egg. [00:02:13] Dr. Lucky Sekhon: Mm. And. So much harder for people to [00:02:15] understand 'cause there's no direct way to test anyone's egg quality. Mm. [00:02:18] Dr. Taz: She helps [00:02:20] individuals and couples at every stage of their reproductive journey. She wrote The Lucky Egg, [00:02:25] understanding Your Fertility and How to Get Pregnant Now. A clear, compassionate [00:02:30] evidence-based guide designed to demystify fertility [00:02:33] Dr. Lucky Sekhon: for everyone and [00:02:35] help people make informed choices. [00:02:37] Dr. Lucky Sekhon: Please join me in welcoming Dr. Sicon to [00:02:40] the show. [00:02:40] Dr. Taz: Dr. Sicon, thank you for joining me today. This is such an [00:02:45] important issue. I'm dealing with it within my family. I was telling you about my sister and kind of her [00:02:50] journey to colleagues, to patients that are coming in every single day [00:02:55] really struggling with getting pregnant. [00:02:57] Dr. Taz: And it's not an age thing, it's, you know, these are [00:03:00] young women as well. Women in their twenties and, and such. What's going on? [00:03:05] Why is. Is fertility so challenging? When we look at statistics, we know that the fertility rate is [00:03:10] declining. Mm-hmm. Across the globe. And I know we can debate all the different reasons for that, but it seems like even [00:03:15] when there's the intention, right? [00:03:16] Dr. Taz: Yeah. To get pregnant, it's such a challenge. Yes. I am so [00:03:20] curious what you're seeing and what you think of all of this. [00:03:22] Dr. Lucky Sekhon: Well, when I first started out in my career, we used to [00:03:25] use this statistic. One in eight couples or individuals will have infertility, and [00:03:30] now it's actually been recently updated by the WHO to one in six. [00:03:33] Dr. Taz: Oh, wow. [00:03:34] Dr. Lucky Sekhon: And so I [00:03:35] think you're right that it does seem like it's getting more prevalent, and I do think a huge [00:03:40] factor is age for a lot of people because we're seeing a major societal shift. [00:03:45] Um, you know, even in my own life, and you know, my, my sisters, myself, [00:03:50] my friends, it's very normal and commonplace for people to really settle [00:03:55] down and start building their families more so in their thirties right and beyond. [00:03:59] Dr. Lucky Sekhon: Whereas our [00:04:00] parents' generation and definitely our grandparents' generation, it was. Unheard of to wait till you're [00:04:05] thirties, right? Mm-hmm. To start building your family. And there's some good things about it. I think it's great that people know [00:04:10] how to contracept and family planning is a thing. Um, I do think, [00:04:15] uh, people are, are not settling and they're waiting for the right relationship, the right [00:04:20] situation. [00:04:20] Dr. Lucky Sekhon: They're waiting to be financially stable. So all of that though does not line up [00:04:25] with our biology. [00:04:26] Dr. Taz: Right. [00:04:27] Dr. Lucky Sekhon: And it can make it harder and more challenging. But as you said, it's not [00:04:30] always age. And there can be other factors, like a common factor outside of age [00:04:35] is PCOS. Yeah. Polycystic ovary syndrome. I [00:04:37] Dr. Taz: have that. [00:04:38] Dr. Taz: Our whole family has that. [00:04:39] Dr. Lucky Sekhon: Lot of [00:04:39] Dr. Taz: [00:04:40] times and talking about it ad nauseum, but [00:04:41] Dr. Lucky Sekhon: Yeah. Yeah. A lot of times it's how you're genetically wired. Yeah. Right. And there are certain [00:04:45] populations, like I'm South Asian background. Mm-hmm. And so much type two [00:04:50] diabetes and insulin resistance in my family. Yeah. And so we do see certain, uh, [00:04:55] demographics have more. [00:04:55] Dr. Lucky Sekhon: Problems like PCOS and a lot of it is genetics. Some of [00:05:00] it's environmental, some of it has to do with how, you know, our, our, um, [00:05:05] bodies are wired from the diets that our ancestors had. Yeah. And now we can't adjust [00:05:10] as well to a western diet. So there's so many theories, but that can cause irregular cycles. [00:05:14] Dr. Taz: [00:05:15] Right. [00:05:15] Dr. Lucky Sekhon: And that is a major cause of infertility. If you're not ovulating or you're, you don't know when your next [00:05:20] ovulation is going to be, you're often not in the game when it comes to trying to conceive. And then [00:05:25] there's definitely environmental factors. We talk a lot about, you know, mi microplastics, [00:05:30] right? [00:05:30] Dr. Lucky Sekhon: There's a lot more awareness of how industrialization and has affected us. [00:05:35] Yeah. How we package our food and the things we're putting in and on our bodies. All of that [00:05:40] can impact our health. And I don't think that we're ever gonna have a full handle on. You [00:05:45] know, the, the gravity of all of these environmental exposures and how they can impact both [00:05:50] male and female fertility. [00:05:51] Dr. Taz: It's such an important conversation to have because I do feel like the landscape [00:05:55] of human biology not to be too, like theoretical is shifting. Right. You know, I feel [00:06:00] like when you talk about microplastics and you talk about some of these things and. We still don't [00:06:05] yet have all the information to be super tactical in the exam room. [00:06:09] Dr. Taz: Right? Yes. Yeah. [00:06:10] But we know we need to be aware of it. One of the things we can do you, you mentioned [00:06:15] like skipping periods or things like that, or you know, not having regularity is at least [00:06:20] educate young women to pay attention to that, right? Right. Yeah, I think so many young, there's [00:06:24] Dr. Lucky Sekhon: [00:06:25] so many red flags that go ignored. [00:06:26] Dr. Taz: What are some, let's go into that though, because I think, you know, for so long, you know, you're going [00:06:30] through your teenage years and your early twenties and you're busy. Yes. And you know, I wrote, you know, in the hormone shift I [00:06:35] called them, you know, the rock stars and the hustlers. 'cause you're all over the place and you're burning the candle at both ends [00:06:40] and you think you're kind of invincible. [00:06:41] Dr. Lucky Sekhon: Yeah. [00:06:42] Dr. Taz: And you're ignoring a lot of these red flags. Right. So if we can get on the [00:06:45] front end of that, what are some of the red flags that you would really, I [00:06:48] Dr. Lucky Sekhon: feel called out because that's how I'm [00:06:50] leading my life these days, you know? Yeah. Well I [00:06:52] Dr. Taz: did too. [00:06:52] Dr. Lucky Sekhon: Right? I know that's [00:06:53] Dr. Taz: how I got in trouble. But, [00:06:54] Dr. Lucky Sekhon: um, know, of course. [00:06:54] Dr. Taz: [00:06:55] But [00:06:55] Dr. Lucky Sekhon: I think your period is like a fifth vital sign, right? For people that don't know [00:07:00] what vital signs are. It's like your pulse. Your blood pressure. These are all considered objective [00:07:05] findings that you can gain some insights into someone's health, but people rarely [00:07:10] think about their periods in that fashion. [00:07:12] Dr. Lucky Sekhon: Right. And so if you have irregularity in your period, [00:07:15] that could be a sign of medical problems like PCOS, and that can often be associated with a [00:07:20] really ubiquitous problem with insulin resistance, which can lead to greater [00:07:25] incidence of heart disease and all sorts of medical problems that can affect not just your fertility, but your [00:07:30] overall general health and quality of life. [00:07:32] Dr. Lucky Sekhon: But what about painful periods? Right? Right. It takes about [00:07:35] eight to 10 years on average to be diagnosed with a condition called endometriosis. [00:07:40] Mm-hmm. And this is a common gynecological condition that affects up to 10% of women [00:07:45] that's probably under called. Yeah. 'cause so many people are walking around normalizing their [00:07:50] pain and saying, yeah, I might have missed a lot of work and maybe growing up I missed school [00:07:55] because of my period. [00:07:55] Dr. Lucky Sekhon: And I always have to tell them that's not normal. [00:07:57] Dr. Taz: Right. [00:07:58] Dr. Lucky Sekhon: Right. It is normal that you're gonna have [00:08:00] some cramps. But I think it's hard for people to differentiate what's normal and what's [00:08:05] not. [00:08:05] Dr. Taz: Is there a way to like help people with because for, okay. First question. [00:08:10] Why does it take so long to diagnose endometriosis? [00:08:12] Dr. Taz: And I know, okay. The conventional [00:08:15] answer is that you have to do a laparoscopic yes. Surgery. Yes. Right. But has [00:08:20] technology evolved at all? Has laboratory, like I read somewhere, doing a CA 1 25 might be [00:08:25] helpful. Mm-hmm. Is there a way to get an earlier diagnosis? Because I know this is coming up over and over [00:08:30] again, [00:08:30] Dr. Lucky Sekhon: right? [00:08:30] Dr. Lucky Sekhon: So endometriosis for anyone that might not be familiar, right? [00:08:33] Dr. Taz: Yeah. [00:08:33] Dr. Lucky Sekhon: Is a condition [00:08:35] where cells that behave like the cells that that typically line the inner cavity of the [00:08:40] uterus. So they're dynamic, they build up with estrogen stimulation and then they break [00:08:45] down and you get a period. For some reason, cells that behave that way are found in other parts of the [00:08:50] body. [00:08:50] Dr. Lucky Sekhon: There used to be, you know, the top theory of how this happened is that women, [00:08:55] obviously, when they menstruate. They have vaginal bleeding, but this can actually go backwards through the fallopian [00:09:00] tubes and land in the pelvic cavity. And we know that all women have retrograde [00:09:05] menstruation. That's what we call it. [00:09:05] Dr. Lucky Sekhon: To some degree, your immune system should recognize when cells are [00:09:10] in parts of your body that they shouldn't be. Mm-hmm. And it's like they come through like the janitor and clean them up. Right. [00:09:15] But. We think about, you know, endometriosis as being this perfect storm. [00:09:20] Not only might there be be mechanical reasons like retrograde menstruation, and sometimes people with [00:09:25] uterine different shaped, shaped uterus or uterine anomalies are more prone to that, [00:09:30] right? [00:09:30] Dr. Lucky Sekhon: Right. So you do see an association, but why isn't their immune system recognizing these foreign cells? And [00:09:35] sometimes it evades the immune system. So there might be an autoimmune component to this. See [00:09:39] Dr. Taz: that right. [00:09:39] Dr. Lucky Sekhon: [00:09:40] And it allows these cells to kind of set up shop. And if you think about what the lining of your uterus [00:09:45] is supposed to do, when a pregnancy is established, they're sticky and they're kind of invasive and [00:09:50] they work with the embryo to allow it to burrow within and you know, turn into a pregnancy and [00:09:55] they can become sticky and invasive in other places. [00:09:57] Dr. Lucky Sekhon: Mm. And they set up shop and turn into these, what we call [00:10:00] implants, and they are able to respond to hormones. So every month, if someone's not [00:10:05] on the birth control pill, if someone's able to ovulate, they have these monthly hormonal [00:10:10] fluctuations that feed these implants. And then you also have, you know, breakdown [00:10:15] and bleeding and inflammation and it can lead to scar tissue formation. [00:10:18] Dr. Lucky Sekhon: So I always say [00:10:20] no two patients with endometriosis are exactly alike. One of the reasons why it's hard to diagnose [00:10:25] is it manifests in so many different ways. For some people, it means you see cysts on the [00:10:30] ovaries very clearly that look like endometriosis. [00:10:32] Dr. Taz: Interesting. [00:10:33] Dr. Lucky Sekhon: For some people, their ovaries look perfect.[00:10:35] [00:10:35] Dr. Lucky Sekhon: It might be in the muscle wall of the uterus. These are examples where it might be obvious if you're [00:10:40] doing a scan, but not everyone gets a scan, a pelvic ultrasound as standard of care, which [00:10:45] is a, a bone issue that I have to pick. [00:10:46] Dr. Taz: Me too, [00:10:47] Dr. Lucky Sekhon: right? Because you can learn a lot, [00:10:49] Dr. Taz: right? [00:10:49] Dr. Lucky Sekhon: But. [00:10:50] The absence of those findings doesn't mean you don't have endometriosis because it can be really insidious. [00:10:54] Dr. Lucky Sekhon: It can be [00:10:55] in the side pelvic wall. Yeah, and this is really weird. It can show up in your, [00:11:00] the cavity that surrounds your lungs. It can even show up in the brain that's not as common. It can show up in [00:11:03] Dr. Taz: your lungs. [00:11:04] Dr. Lucky Sekhon: Yes. [00:11:05] There are some people when they get their period every month, they'll have like a lung [00:11:10] collapse. [00:11:10] Dr. Lucky Sekhon: Like this is very rare, but it's Right, right. Not a common [00:11:12] Dr. Taz: one, but, [00:11:12] Dr. Lucky Sekhon: but it is a type of endometriosis, so [00:11:15] it can look very different for different people. It doesn't always cause infertility. [00:11:20] Not every person with endometriosis is gonna have trouble getting pregnant. But for some people it can [00:11:25] cause blocked tubes. [00:11:26] Dr. Lucky Sekhon: For some people, it can cause them to lose their eggs at a faster rate, [00:11:30] or it can affect their egg quality or even the ability for the embryo to implant, especially if it's [00:11:35] infiltrating the muscle of the uterus. Hmm. So I think because it can manifest in so many different ways, [00:11:40] it's hard to kind of pin down. [00:11:41] Dr. Lucky Sekhon: I think also as a society and you know, the, the [00:11:45] field of medicine has a longstanding. Dark history of, you know, [00:11:50] minimizing women's pain and not adequately treating it. [00:11:52] Dr. Taz: Mm-hmm. [00:11:53] Dr. Lucky Sekhon: And I think women, ourselves, we've [00:11:55] internalized a lot of that. And, you know, don't often speak up for ourselves. Right. And even [00:12:00] when we do, sometimes it's dismissed. [00:12:01] Dr. Lucky Sekhon: So I think it's this vicious cycle that has led to this real delay in [00:12:05] diagnosis. [00:12:05] Dr. Taz: Can we dial into the pain for just a second? I have a 17-year-old daughter and I'm pretty [00:12:10] convinced. In fact, I think we have our ultrasound appointments coming up, but I'm pretty convinced she's got [00:12:15] endometriosis, just the way she presents. [00:12:17] Dr. Taz: But there is pain that is crampy [00:12:20] pain. You don't ki you know Right. You don't feel great, you know, the week before your cycle or whatever. But then [00:12:25] there's pain that is severe and sometimes even signs. I always educate my patients [00:12:30] like rectal pain and some of those things during your period or, or big warning signs or big red [00:12:35] flags. [00:12:35] Dr. Taz: Mm-hmm. Where is that like. Pain crossover where, okay, these are not just [00:12:40] cramps. Yeah. We need to think a little bit more. Is there any kind of tactical or like Yeah, more [00:12:45] like a less emotional, more logical way to like identify that [00:12:49] Dr. Lucky Sekhon: there are [00:12:50] validated pain questionnaires that researchers have used. [00:12:53] Dr. Lucky Sekhon: Because otherwise it seems like a [00:12:55] subjective thing. Right? [00:12:55] Dr. Taz: Right. [00:12:56] Dr. Lucky Sekhon: If you're trying to study different interventions, it's hard to compare and it's not a [00:13:00] perfect tool and not everyone's gonna have access to or, or know which ones to to [00:13:05] use. But I think the simplest thing for any lay person is, you know, just keep a [00:13:10] menstrual diary. [00:13:10] Dr. Taz: Right? [00:13:11] Dr. Lucky Sekhon: And a lot of times people will come to me and they're charting their [00:13:15] information and kind of saying like, this is when I feel this pain, this is, and it gives you a lot more objective information to go [00:13:20] off of versus just depending on recall and being able to think back to, well how painful was it? [00:13:24] Dr. Lucky Sekhon: [00:13:25] Because psychology is a weird thing where you can kind of minimize, you know, past experiences [00:13:30] and it's almost like a defense mechanism. So I think keeping a diary. [00:13:33] Dr. Taz: Okay. [00:13:34] Dr. Lucky Sekhon: Um. But [00:13:35] it's, it's a really challenging thing because everyone has a different pain tolerance or threshold. [00:13:40] Right. But I think if it comes down to interfering with your day-to-day ability to [00:13:45] function, so that's why I always ask about like attendance when it comes to school or you know, calling out of work. [00:13:49] Dr. Lucky Sekhon: [00:13:50] Of course. Yeah, yeah. Or having to modify your activities, like having to change your plans around your [00:13:55] period. I don't think that's ever considered normal. And to go back to your original question. [00:14:00] Yes, the standard way to diagnose and the standard teaching has been, [00:14:05] you should do a laparoscopy, which is, you know, it's invasive, right? [00:14:08] Dr. Lucky Sekhon: It's doing a small incision in the [00:14:10] belly button and going in with a camera and looking directly, instead of using ultrasound or other indirect [00:14:15] ways of assessing and being able to even, not just see an implant, but [00:14:20] to take a small biopsy, even send it off and say, okay, is this endometriosis? Mm-hmm. Does this look like [00:14:25] the lining of the uterus instead of what it's supposed to be? [00:14:28] Dr. Lucky Sekhon: And I don't [00:14:30] think that that is always necessary as a fertility specialist. Our field, I can tell you, [00:14:35] we used to do laparoscopies on so many people, and then they had these big studies that [00:14:40] came out that were like. You know, we're taking a lot of people for laparoscopy. Statistically speaking, [00:14:45] you probably have to take like 30 women to surgery to improve, you know, the fertility of one [00:14:50] person. [00:14:50] Dr. Lucky Sekhon: Mm. Okay. And that might not make, make sense. It might not be, you know, the [00:14:55] safest approach for something that is technically invasive. It might not be a good use of resources. [00:15:00] And I think that we can make the diagnosis clinically. Mm. Right. If someone says to me, I have [00:15:05] painful periods, here's my menstrual diary. [00:15:07] Dr. Lucky Sekhon: This is how it's affected my life. And by the way, [00:15:10] when I was on the pill for five years, all of this went away. [00:15:13] Dr. Taz: Wow. [00:15:13] Dr. Lucky Sekhon: And now I'm off and it's kind of [00:15:15] back. I'm like, okay, well that is a telltale sign. Mm-hmm. What else could that be? Right? You don't always need the [00:15:20] proof and you don't always necessarily have to have surgery. [00:15:23] Dr. Lucky Sekhon: There's a role for [00:15:25] surgery, but I don't think every single person that thinks they have endometriosis necessarily needs it. [00:15:29] Dr. Taz: I [00:15:30] think that's pretty hopeful to so many people. Yeah. Listening today. 'cause I think that's a big block. Like, I don't wanna [00:15:35] go for surgery. Let me just put up with this for longer. [00:15:37] Dr. Lucky Sekhon: Right. [00:15:38] Dr. Taz: What about the CA 1 [00:15:40] 25, which. Is a marker, you know, that I've seen some recent reports or literature on is [00:15:45] maybe using that and following and tracking that. Yes. To see what's going on there. I love that you [00:15:50] talked about sort of the autoimmune component of that. I think that's a lot of how I think [00:15:55] about mm-hmm. [00:15:55] Dr. Taz: Both PCOS and endometriosis. Like, we need to stop thinking about these as hormone diseases and think [00:16:00] about them more as autoimmune diseases and look at things like inflammation. You know, [00:16:05] curious if. If there's any marker or tracker mm-hmm. That a clinician could, [00:16:10] could use Yeah. Or a patient could use to sort of understand what's going on. [00:16:14] Dr. Lucky Sekhon: Yeah. [00:16:15] So ca 1 25, uh, is a test that scares a lot of people, right? [00:16:20] Because the way it's traditionally been used is as a marker for certain types of ovarian [00:16:25] cancer, but really it's a marker of inflammation. So if you have inflammation of your ovaries, [00:16:30] often you're gonna have really high levels. And it's used as a a way to screen people. [00:16:34] Dr. Lucky Sekhon: It's [00:16:35] not the perfect screening tool. Ovarian cancer is a very difficult gynecologic, yeah. Cancer, [00:16:40] because it's often picked up at later stages. But for people with a strong family history, often they're getting. [00:16:45] You know, yearly or bi, you know, biannual, uh, pelvic ultrasounds and getting these [00:16:50] levels checked. [00:16:50] Dr. Lucky Sekhon: Mm-hmm. And if there's a rise, then maybe they, you know, are watched more carefully. But [00:16:55] we also know you can get these false positives and especially at lower level elevations, there is an [00:17:00] association between that and endometriosis. Mm-hmm. Now, I don't wanna scare people who are listening to [00:17:05] this and who are thinking, Hey, I might have endometriosis, but it is a known fact that, [00:17:10] um, people with endometriosis can have a slightly increased risk of a specific type of [00:17:15] ovarian cancer called clear cell carcinoma. [00:17:17] Dr. Taz: Okay. [00:17:18] Dr. Lucky Sekhon: But it makes sense because it can [00:17:20] involve the tissue of the ovary. And so you know, you can test a CA 1 25, but if it's [00:17:25] normal, that doesn't mean you don't have endometriosis. Gotcha. So I think that markers, there [00:17:30] have been a lot that have been studied, like even BCL six, that's another inflammatory marker that a lot of [00:17:35] fertility doctors nowadays are doing biopsies of the inner lining of the uterine cavity [00:17:40] and looking for a certain level elevation in this marker. [00:17:42] Dr. Lucky Sekhon: In some studies, not all, it hasn't really been [00:17:45] validated. What's [00:17:45] Dr. Taz: the number? What's the [00:17:46] Dr. Lucky Sekhon: BCL six? [00:17:47] Dr. Taz: BCL six. And can we routinely test that or not? [00:17:50] [00:17:50] Dr. Lucky Sekhon: You can. I mean, there's a company that will run it on a biopsy of the lining of the uterus. Okay. [00:17:55] But there have been many cases of people that have said, yeah, mine was negative. [00:17:58] Dr. Lucky Sekhon: And then I ended up [00:18:00] going for a laparoscopy because I had all the signs and symptoms, and guess what? I had stage four [00:18:05] endometriosis. So these markers are not perfect. Right. And they aren't as sensitive or as [00:18:10] specific as we need them to be. To truly say this can be part of the diagnostic criteria. [00:18:14] Dr. Taz: [00:18:15] Gotcha. [00:18:15] Dr. Taz: So there's still so much more work to do. So between endometriosis and PCOS, [00:18:20] are those the two primary blocks to fertility that you are [00:18:25] seeing in your practice? [00:18:26] Dr. Lucky Sekhon: I mean, we also see people with blocked tubes. Mm-hmm. Right. And sometimes [00:18:30] it's because they have conditions like endometriosis, right? Sometimes it's because they had a ruptured [00:18:35] appendix when they were younger, and it led to like a local inflammatory reaction. [00:18:39] Dr. Lucky Sekhon: So these [00:18:40] are the things I ask people about when, when I talk about their surgical history and they'd say, oh, I had [00:18:45] appendicitis. I always ask, was it ruptured or not, right? Mm-hmm. Um, I always ask [00:18:50] about chronic medical conditions. There are some uncontrolled chronic medical [00:18:55] conditions that can run concurrently alongside infertility or even recurrent [00:19:00] pregnancy loss. [00:19:00] Dr. Lucky Sekhon: So people with really, um, poorly controlled autoimmune conditions where they're [00:19:05] constantly having flares. That's not great for your general health. It's not gonna be great for your fertility either. [00:19:09] Dr. Taz: Yeah. [00:19:10] [00:19:10] Dr. Lucky Sekhon: Deficiencies. A lot of people don't realize that iron deficiency anemia can make it [00:19:15] harder to get pregnant. [00:19:16] Dr. Taz: Are there other nutritional deficiencies that you've seen? [00:19:18] Dr. Lucky Sekhon: Vitamin D is [00:19:20] a little bit harder to nail down the exact role. Yeah. But there's many different proposed ways that it [00:19:25] could impact fertility and pregnancy health. So I check everyone for vitamin D deficiency, and [00:19:30] if I detect it, it's quite common, you know, being in the Northern hemisphere. [00:19:33] Dr. Lucky Sekhon: Yeah. Especially going into [00:19:35] the winter. It's something that I really keep my eye on and I always replete it because you just don't wanna have [00:19:40] any unchecked. Deficiencies. [00:19:42] Dr. Taz: Are there genomics that you are tracking as [00:19:45] well, or, or not necessarily? I don't know if you get into M-T-H-F-R or any of these sort of [00:19:50] genomics that might have a higher risk. [00:19:52] Dr. Lucky Sekhon: So yes, we do. I mean, when I, [00:19:55] when I am working up cases of recurrent pregnancy loss, meaning two or more [00:20:00] miscarriages, I often will look at, again, an immune marker that can also affect [00:20:05] your, uh, risk of blood clotting. Mm-hmm. These are called antiphospholipid syndrome [00:20:10] antibodies. [00:20:10] Dr. Taz: Okay. [00:20:10] Dr. Lucky Sekhon: Um, and if those are elevated, there could be a role for giving baby aspirin while trying to [00:20:15] conceive an even a, a more potent injectable, blood thinner called Lovenox once pregnant.[00:20:20] [00:20:20] Dr. Lucky Sekhon: Um, sometimes part of that panel, you know, will look for other blood clotting disorders. Even [00:20:25] though blood clotting disorders are not really an established risk factor for recurrent [00:20:30] losses, they're often. Are on the panel that we use to run for, uh, ruling out [00:20:35] antiphospholipid syndrome. [00:20:35] Dr. Taz: Mm-hmm. [00:20:36] Dr. Lucky Sekhon: Which are three specific markers. [00:20:38] Dr. Lucky Sekhon: And M-T-H-F-R comes up on that [00:20:40] panel a lot. Mm-hmm. So, um, you know, this is a, an enzyme that helps us break [00:20:45] down folate. Mm-hmm. [00:20:46] Dr. Taz: And. [00:20:47] Dr. Lucky Sekhon: There are many people, it used to be called a [00:20:50] mutation, but now we talk about it more like a variant. Interesting. Okay. And there are many people that have this variant. [00:20:55] Yep. [00:20:55] Dr. Lucky Sekhon: And it's not necessarily a problem if you ask me or my colleagues, like [00:21:00] 10, 20 years ago, people would be like, oh my gosh, if you have this variant, like you need a different type of folic acid, you need [00:21:05] to do this. Mm-hmm. Um, you know, you need to be on baby aspirin. Nowadays we recognize that up [00:21:10] to 30 to 40% of the population has a variant. [00:21:12] Dr. Lucky Sekhon: Has that, [00:21:12] Dr. Taz: right? Mm-hmm. [00:21:12] Dr. Lucky Sekhon: And there's so many different pathways for folate to [00:21:15] be broken down, that it's usually not a problem for people. Now, if there's a [00:21:20] specific block that leads to backup of, you know, one of the things that's supposed to [00:21:25] be broken down, backup of something called homocysteine. Mm-hmm. [00:21:27] Dr. Lucky Sekhon: That can actually be a problem. So [00:21:30] anytime someone has M-T-H-F-R tested for, there's always usually [00:21:35] reflexive testing to look at homocysteine levels. And if those are normal, this is not considered clinically relevant [00:21:40] in most cases. And it's a source of confusion because. Really and truly, we want people [00:21:45] to take folic acid in their prenatal vitamin right. [00:21:47] Dr. Lucky Sekhon: To, to prevent neural tube defects problems like spina [00:21:50] bifida. But there has been a lot of this like legacy information that is [00:21:55] very hard to uncouple from this issue where people feel very worried about taking folic [00:22:00] acid. They wanna take a very specific type. [00:22:01] Dr. Taz: Right? [00:22:02] Dr. Lucky Sekhon: But that's usually not relevant. So if you have the [00:22:05] M-T-H-F-R mutation or variant, then get your homocysteine level check. [00:22:08] Dr. Lucky Sekhon: That's the takeaway. [00:22:09] Dr. Taz: And follow that. [00:22:10] That might be the big thing. And we've seen that in practice as well with homocysteine being high. Yes. Or [00:22:15] inflammation in the body. [00:22:16] Dr. Lucky Sekhon: Right. [00:22:16] Dr. Taz: You know, we don't necessarily track that in the cases of [00:22:20] PCOS and endometriosis, but it is interesting to look at as well. [00:22:23] Dr. Lucky Sekhon: For sure. [00:22:23] Dr. Taz: You know, one of the things I, [00:22:25] I saw recently, and you probably saw the study too, is, and this is where it's so [00:22:30] confusing. For our women and for younger women. I'm all about having a career. I'm all [00:22:35] about getting out there and doing what you're meant to do in the world. Yes. Right. And I don't want women to think [00:22:40] that they have to, to necessarily choose, but one of the things I saw recently was a study [00:22:45] that talked about the rising rates of prenatal androgens in [00:22:50] moms, you know, in moms, like from a preconception standpoint and from a early kind of [00:22:55] embryonic standpoint, and some of that being connected to, you know, the early onset of [00:23:00] PCOS and endometriosis and those type of things. [00:23:02] Dr. Taz: I'm only bringing that up because if you could wave a magic [00:23:05] wand, and I know we're gonna get into more fertility stuff, but if you could wave a wand and [00:23:10] say, I wish that teen girls, children, teen girls, and young women [00:23:15] in their early twenties knew this. [00:23:17] Dr. Lucky Sekhon: Mm-hmm. [00:23:17] Dr. Taz: What would you say to them? [00:23:19] Dr. Lucky Sekhon: I [00:23:20] mean, how many, how many answers do I get? [00:23:22] Dr. Taz: You get five, you know. [00:23:23] Dr. Lucky Sekhon: Okay. I will [00:23:25] say, uh, smoking is always a bad idea. Right. We know that there are certain [00:23:30] things that are fearmongering and then there are certain things that we know are exposures that truly can have [00:23:35] a negative impact on. Our fertility can accelerate how quickly we go into menopause, which [00:23:40] technically means, you know, how quickly our egg supply runs low. [00:23:43] Dr. Lucky Sekhon: Right. To a point where our ovaries stop [00:23:45] functioning. Smoking is one of those things, so this isn't to shame anyone, but it's to give you [00:23:50] motivation that there's so many. And does [00:23:50] Dr. Taz: that include vaping? Right. [00:23:52] Dr. Lucky Sekhon: So we don't have all of the studies that we [00:23:55] do on tobacco and cigarette smoke, but it makes sense. [00:23:58] Dr. Lucky Sekhon: Yeah. That there's an extension. Right, right. Yeah. And [00:24:00] I, I think that this idea that e-cigarettes and vaping are like a healthier form of smoking, [00:24:05] I don't think you can say that. Yeah. I think you're, you're inhaling, you know, combusted [00:24:10] chemicals, there's all sorts of toxins and things that you are ingesting that just aren't good for your general health and they're [00:24:15] not gonna be good for your fertility. [00:24:16] Dr. Lucky Sekhon: Yeah. Um. I think something else that people really need to [00:24:20] recognize, not even just young people. Everyone needs to be a little bit more aware of the role that [00:24:25] insulin resistance can play. Mm. It's a big one in our health and in our fertility and you [00:24:30] know, when we talk about, um, how to make our egg quality better, it seems [00:24:35] like this magical concept and often it is kind of used that way to market certain things like [00:24:40] supplements. [00:24:41] Dr. Lucky Sekhon: But the one meaningful thing you can really do to improve the [00:24:45] environment where the eggs are maturing inside your ovaries, that's where all the genetic [00:24:50] reorganization is happening. When an egg is maturing. Becoming ready to ovulate, actually going through [00:24:55] ovulation and then fertilizing. Those are moments where your chromosomes are being [00:25:00] duplicated, rearranged, and they can be more error prone those eggs if they're in an environment [00:25:05] that doesn't serve them. [00:25:06] Dr. Lucky Sekhon: So if there's excess androgens, like excess [00:25:10] testosterone, and a lot of that people don't realize can be linked to the role of high insulin [00:25:15] levels. Interesting. 'cause your body's trying to get your cells to store sugars so the insulin levels [00:25:20] go up if your body tends to be resistant to those signals. And insulin can act like a [00:25:25] growth factor on your ovaries. [00:25:26] Dr. Lucky Sekhon: So I see it all the time where people are like, I've been tested for that. [00:25:30] My hemoglobin A1C is normal. Normal. Oh yeah. Or my insulin levels. All of these things are normal, but they have these [00:25:35] indirect signs like high testosterone. [00:25:37] Dr. Taz: Yeah. [00:25:37] Dr. Lucky Sekhon: And we know where that's coming from. And then when we. [00:25:40] Correct. The insulin resistance, all of that seems to normalize. [00:25:42] Dr. Lucky Sekhon: And I've had patients go through more [00:25:45] than one attempt. Maybe they're coming to me for a second opinion, and they do seem to do a lot better when [00:25:50] we get those things under control. [00:25:51] Dr. Taz: And as you mentioned, there's a huge, you know, if you're of South [00:25:55] Asian descent [00:25:55] Dr. Lucky Sekhon: Yeah. [00:25:56] Dr. Taz: Even Hispanic descent. Yes. I think there is a huge [00:26:00] epidemic. [00:26:00] Dr. Taz: I don't know why, I don't know if you have any explanation, but there's an epidemic of insulin [00:26:05] resistance. Yes. At a young age. Yeah. Not even like, you know, later we can blame diet and this and that, but there is an [00:26:10] epidemic of, of insulin resistance for sure. Yeah. So I think it's so important to be aware of that. [00:26:14] Dr. Lucky Sekhon: [00:26:15] One of the greats in the field of reproductive endocrinology. I'm proud to say that he was my [00:26:20] mentor. He was at Mount Sinai, he actually passed away recently, within the past year. His name's Nathan [00:26:25] Case. [00:26:25] Dr. Taz: Okay. [00:26:25] Dr. Lucky Sekhon: And he's an endocrinologist. Um, who. Did so much work. He did a lot [00:26:30] of menopause work, but he also focused a lot on trying to understand the [00:26:35] origin, the etiology of PCOS. [00:26:37] Dr. Lucky Sekhon: Yeah. And he talked a lot about these [00:26:40] certain populations. Yeah. And he talked a lot about immigration. [00:26:43] Dr. Taz: Mm. [00:26:44] Dr. Lucky Sekhon: And how I [00:26:45] was, I alluded to it earlier, like our ancestors were in a different environment, [00:26:50] eating a different diet, and that genetic. Wiring still exists in us today. Mm. [00:26:55] And our bodies maybe aren't as equipped to deal with the Western diet. [00:26:58] Dr. Taz: Interesting. [00:26:59] Dr. Lucky Sekhon: As [00:27:00] someone whose ancestors grew up in this environment. Right? Yeah. So could this shift over time as we have now [00:27:05] settled here and will have generations and generations follow us, you know, in this [00:27:10] environment? We don't know. I mean, there's so many other factors, but I think that is a, a prevalent [00:27:15] the, that is a major theory as to why it's so prevalent in certain populations. [00:27:18] Dr. Lucky Sekhon: That's [00:27:18] Dr. Taz: so [00:27:20] interesting. Anything else you would. Tell you I love the insulin resistance piece. I think if we could get [00:27:25] everybody to dial into that mm-hmm. How would, how would you have them look at that? 'cause I've had those [00:27:30] conversations with patients and they're like, same, A1C is fine. Fasting insulin's fine. [00:27:34] Dr. Taz: What's a better [00:27:35] way? Yeah. To understand if you, if that might be your block. Right. That might be your fertility block. [00:27:39] Dr. Lucky Sekhon: So [00:27:40] other labs that are kind of objective findings, like I mentioned, um, high testosterone. Yes. [00:27:44] Dr. Taz: [00:27:45] Okay. [00:27:45] Dr. Lucky Sekhon: High D-H-E-A-S, which is another testosterone like hormone mm-hmm. That a lot of people [00:27:50] don't know about. [00:27:50] Dr. Lucky Sekhon: It's not as familiar as testosterone. Um, there's another one that sometimes is [00:27:55] elevated depending on the functioning of your adrenal glands. Your adrenal glands are little glands that sit on top of your [00:28:00] kidneys on either side, kind of back here, and they, they make androgens. Mm-hmm. [00:28:05] And so sometimes you can have this other androgen elevated called androstenone. [00:28:08] Dr. Lucky Sekhon: Mm. [00:28:09] Dr. Taz: Mm-hmm. [00:28:09] Dr. Lucky Sekhon: Some [00:28:10] people are born with, you know, a problem with one of the enzymes in their adrenal gland. And this can lead to an [00:28:15] abnormal buildup of androgens. So there's a lot of different. Reasons or causes behind it. But we know [00:28:20] insulin resistance can be a cause of a buildup of androgens. And so you can measure those. [00:28:24] Dr. Lucky Sekhon: You [00:28:25] can also do, um, what's even better than a hemoglobin A1C, which is really just kind of a, [00:28:30] a overall, an an overview of your sugar control over the past 90 [00:28:35] days, which a lot of people who have insulin resistance are churning out enough insulin at a [00:28:40] higher level that they're able to compensate. Yeah. So it's not that you're gonna see an elevation in their blood sugar, [00:28:45] but you might uncover it by giving them a glucose challenge. [00:28:48] Dr. Lucky Sekhon: Yeah. And doing something called an oral [00:28:50] glucose tolerance test, where, you know, two hours later you're measuring their levels and seeing how did they handle [00:28:55] that glucose load. And if it's kind of elevated, even if it's not diabetic range, that can also be a [00:29:00] clue. But then other things that are kind of more insidious is. [00:29:03] Dr. Lucky Sekhon: Asking about family history. [00:29:05] [00:29:05] Dr. Taz: Mm. [00:29:05] Dr. Lucky Sekhon: So, you know, I have patients that'll say, oh yeah, everyone in my family has type two diabetes. Yeah. And you're like, [00:29:10] okay, there you go. Or I've been gaining weight and especially in my midsection, and it's been really hard. [00:29:15] No matter what I do, I just can't take it off. I have acne that seems [00:29:20] hormonal. [00:29:20] Dr. Lucky Sekhon: Like there's all these things that are tied together. Symptoms. Yeah, exactly. [00:29:23] Dr. Taz: Yeah. So [00:29:25] interesting. And I really hope, you know, if you're watching and listening that you're spreading this information [00:29:30] because I think there's just so much heartache and frustration and I feel like if we got again, on the front end [00:29:35] of it Yes. [00:29:35] Dr. Taz: Then it would prevent some of the journeys I've seen so many different people take. [00:29:39] Dr. Lucky Sekhon: And [00:29:40] sometimes there's a lot of really simple lifestyle measures. Like we know having built up, [00:29:45] building up muscle in your body can promote being more sensitive to [00:29:50] insulin. Mm-hmm. And conversely, having more fat deposition on your body, especially around the [00:29:55] midsection, kind of opposes the effects of insulin. [00:29:57] Dr. Lucky Sekhon: So just in our day-to-day behaviors [00:30:00] and how we work out and treat our bodies, we can make a meaningful [00:30:05] difference and we can prevent these things, which. Seem to get more common as we get older, but [00:30:10] it's not always your fault. Sometimes you can do all the right things and you, it's doesn't be wired [00:30:13] Dr. Taz: just the way you're wired. [00:30:14] Dr. Taz: Right. And [00:30:15] literally within our family, everyone's got high insulin. [00:30:18] Dr. Lucky Sekhon: Yep. [00:30:18] Dr. Taz: It shows up differently. Right. You [00:30:20] know, my, I have one sister that has trouble with weight, another one that has trouble with like acne. [00:30:25] I had trouble with hair. Like, everyone's different, you know? [00:30:27] Dr. Lucky Sekhon: Yep. [00:30:28] Dr. Taz: So I think it's really important to [00:30:30] understand and dial into that concept, you know, aggressively to, to get a handle on it. [00:30:34] Dr. Taz: I'm [00:30:35] curious, are you like an advocate for medications like metformin or the [00:30:40] GLP ones? Absolutely. Absolutely. Where, where do they fit into the conversation around fertility? [00:30:44] Dr. Lucky Sekhon: I think [00:30:45] lifestyle changes are important and great, and they're not mutually exclusive with medications. I [00:30:50] think sometimes people can find it really hard, especially to kind of kickstart the [00:30:55] process. [00:30:55] Dr. Lucky Sekhon: Um, it's almost like. You know, you need some help. Yeah. Especially at the beginning and then it [00:31:00] becomes easier, um, to see, you know, changes with lifestyle Right. Measures. [00:31:05] Um, so I think that it's a wonderful thing, especially in light of the fact that fertility is so time [00:31:10] sensitive. Mm-hmm. I don't think it's a realistic goal to just say, you know, eat, try to eat [00:31:15] healthy, right? [00:31:15] Dr. Lucky Sekhon: Try to avoid insulin, calories, calories out, and all that stuff. Right. Sometimes it's really difficult [00:31:20] because you're already wired in such a way where high insulin levels can really bottom you out and make [00:31:25] you have these periods of low blood sugar where not only are you having major pangs of [00:31:30] hunger. [00:31:30] Dr. Lucky Sekhon: But you're feeling sick, right? You're feeling nauseous. It's, it's sometimes really hard. You have to [00:31:35] break this vicious cycle and sometimes medication can be the best tool to do so. I have a [00:31:40] lot of patients who take metformin. [00:31:41] Dr. Taz: Yeah. [00:31:41] Dr. Lucky Sekhon: And I tell them, you know, let's be doing all the things all at [00:31:45] once because we wanna make the most impact in the shortest amount of time because we don't wanna [00:31:50] be, you know, only doing this and not focusing on the fertility. [00:31:53] Dr. Lucky Sekhon: A lot of people are, [00:31:55] are, you know, dealing with other time sensitive issues, right? Like a lower egg count and so, and, and age and [00:32:00] the effect it can have on their egg quality. So you really wanna try and. And be as efficient as [00:32:05] possible. [00:32:05] Dr. Taz: I like that. And some of the blocks that I've heard from folks too is like, well, I don't wanna be on a medication [00:32:10] forever, or I'll become [00:32:11] Dr. Lucky Sekhon: dependent on it. I'll [00:32:12] Dr. Taz: become dependent on it. I, those are the two things I hear. But that's not [00:32:15] the case. [00:32:15] Dr. Lucky Sekhon: No. [00:32:15] Dr. Taz: Like it's not the case. [00:32:16] Dr. Lucky Sekhon: It's not like your pancreas becomes lazy or pancreas is what turns out [00:32:20] insulin. It's not like, oh, it becomes lazy because, you know, now you're just helping it along. [00:32:25] That's not really true. I think your overall health can improve dramatically because insulin [00:32:30] can be very pro-inflammatory. [00:32:31] Dr. Lucky Sekhon: Yeah. Um, and so, and I think it makes [00:32:35] it easier to exercise. It makes it easier to, uh, be conditioned in a way where [00:32:40] you can actually maintain a healthier lifestyle. So, um, that's something that I really [00:32:45] think is a huge mental block for a lot of people. Like, how long am I gonna have to be on this? And I always say, right. [00:32:49] Dr. Lucky Sekhon: I'm trying to get you [00:32:50] pregnant or I'm trying to improve your outcome, you know, for egg freezing or Right. Making [00:32:55] embryos, and you don't have to stay on this long term, but I have some patients that are like, I feel so much better, better [00:32:59] Dr. Taz: on it [00:32:59] Dr. Lucky Sekhon: than hear about. Yeah. But [00:33:00] I actually do wanna stay on it long term, even though I'm done with whatever I was doing with you. [00:33:03] Dr. Lucky Sekhon: Yeah. Can you please gimme some [00:33:05] refills? [00:33:05] Dr. Taz: Yeah. And I think these are all like, actionable things that people watching and [00:33:10] listening can take advantage of. [00:33:11] Dr. Lucky Sekhon: Yes. [00:33:11] Dr. Taz: Right. Yeah. So, you know, but that brings us now, [00:33:15] okay, that's the preventive stuff. That's what you should be dialing into maybe early on. What [00:33:20] about those people who have now entered the conversation around, I'm ready to get pregnant. [00:33:24] Dr. Taz: Mm-hmm. [00:33:25] And are just struggling and kind of the mind game, you know, is [00:33:30] like, oh my God, you know, this is how old I am, I gotta hurry up. If I don't hurry up, then [00:33:35] X, y, Z is gonna happen. [00:33:36] Dr. Lucky Sekhon: Yeah. [00:33:36] Dr. Taz: So the ticking clock, the time [00:33:40] bomb that damn clock, you know, help us with that. [00:33:44] Dr. Lucky Sekhon: Yeah. [00:33:45] I mean. Uh, the best way that I can help. [00:33:48] Dr. Lucky Sekhon: I can't make it go [00:33:50] away. I can't reverse the clock, but I can inform people because, you know, I think [00:33:55] society has done a great job. Maybe they've, it's overperformed at reminding women [00:34:00] about, you know, the fragility of their fertility. And I have people that come to me at, you know, [00:34:05] 35 and they're like, oh my God, I'm turning 35 tomorrow. [00:34:07] Dr. Lucky Sekhon: Am I gonna fall off a fertility cliff? Right. And that's not [00:34:10] true either. Yeah. Right. So I, I think that I have a very balanced view. There's a, an [00:34:15] appropriate level of urgency because there is a clock and, you know, contrary to [00:34:20] what you might see in your Instagram feed, there isn't always a way to reverse that. [00:34:24] Dr. Lucky Sekhon: Or, you know, there isn't [00:34:25] like an easy supplement to take to fix that or freeze it, but at the same [00:34:30] time it's, it's, um, on a continuum. It's not a cliff. Yeah. So I'll explain it this [00:34:35] way. You're born with all the eggs that you're ever gonna have. You don't make new eggs, you don't repair your eggs. [00:34:40] Right. I told someone that earlier today. [00:34:42] Dr. Lucky Sekhon: Who's in her late thirties, and she was like, oh my God, I've never heard that [00:34:45] before. Mm-hmm. So I feel like even though it's not the, the most fun fact to share, it's an important one [00:34:50] to be real about, that we just have different biology. You know, men have a biological [00:34:55] clock too, right? But they're always able to make new sperm, right? [00:34:57] Dr. Lucky Sekhon: Every 74 days or so, and new [00:35:00] sperm cell is generated, we don't make new eggs. So we're born with a stockpile. And I like to use this analogy of [00:35:05] like a pantry. Imagine at the core of both ovaries, you have this pantry, the stockpile that you're born [00:35:10] with, and every cycle, you know, you have a, an unlocking of the [00:35:15] pantry in a. [00:35:15] Dr. Lucky Sekhon: Situation that you can't control. I can't manipulate it as a fertility doctor, but [00:35:20] a few of those eggs, a very limited subset kind of escape and imagine they're like pulled outta the pantry [00:35:25] into the kitchen cabinets. Mm-hmm. And their's see-through. Right. That's what I can see on an ultrasound in [00:35:30] bubbles of fluid that we call follicles, each one containing an egg. [00:35:33] Dr. Lucky Sekhon: I am able, at any given [00:35:35] time point, when I scan a a, a person, I'm able to look at their ovaries and kind of get a count. And [00:35:40] it's a count a, a, a size of a cohort that is easy to count. It's like 10, [00:35:45] 15, 20. It varies from person to person. [00:35:47] Dr. Taz: Mm-hmm. [00:35:47] Dr. Lucky Sekhon: But it's like rationing, which is why I use this pantry [00:35:50] analogy, because the more you have in your stockpile in a given timeframe, the more you tend. [00:35:54] Dr. Lucky Sekhon: Bring to [00:35:55] the surface and bring out, and then what your body does naturally. Once you go into [00:36:00] puberty and you start being someone that can ovulate, your brain sends a signal called [00:36:05] follicle stimulating hormone, where basically it sends a signal out and like a [00:36:10] lottery, one of these eggs is selected to mature and it's a random selection, right? [00:36:14] Dr. Lucky Sekhon: And [00:36:15] then it gets matured and you're able to kind of open one cabinet or the other and access just one [00:36:20] egg. Mm-hmm. One egg gets ovulated, everything else is a perishable item in those cabinets and gets thrown away. [00:36:25] And then a new set come outta the pantry. Right? So that is always kind of depleting our stockpile. [00:36:29] Dr. Lucky Sekhon: We're [00:36:30] losing hundreds to thousands of eggs each month in these waves of recruitment, and we don't [00:36:35] really know why this system exists. And the reason why it's important to understand that this is happening in all of [00:36:40] our ovaries, and people are walking around with no idea about this magic that's happening in our bodies.[00:36:45] [00:36:45] Dr. Lucky Sekhon: But you have to understand it because this explains why when you ovulate one egg. [00:36:50] In your fertility is so inefficient. Yeah, right. That one egg is a long shot. It's [00:36:55] not that you're ovulating. If people see 20 eggs on their ultrasound, they're like, oh, I'm so fertile. 'cause they're assuming [00:37:00] that now they have more chances to ovulate, but you're only ovulating one. [00:37:04] Dr. Lucky Sekhon: And not every egg [00:37:05] is going to be healthy and actually fertilize and grow into an embryo and implant. [00:37:10] And you know, when we talk about numbers, the only reason it matters is because [00:37:15] I, as a fertility doctor, do have the knowledge and technology and knowhow to open [00:37:20] both kitchen cabinets and try to the best of my ability to remove everything before it [00:37:25] perishes and goes away. [00:37:25] Dr. Lucky Sekhon: I can actually remove. And so the more you have available in the [00:37:30] stockpile, the more you have available for me to take out. [00:37:32] Dr. Taz: Right. [00:37:32] Dr. Lucky Sekhon: And the more eggs you freeze or the more eggs you [00:37:35] try to turn into embryos, the better treatment outcomes tend to be, the more efficient treatment [00:37:40] tends to be. But ultimately, whatever egg count you have is not gonna determine your natural [00:37:45] fertility, your ability to get pregnant from one egg that's ovulated. [00:37:48] Dr. Lucky Sekhon: So that's [00:37:50] quantity, right? And why it matters. It only matters if you need treatment, which you, you don't have a crystal ball, right? Maybe if you do, [00:37:55] it's nice to know, hey, you have a lot of eggs that we can stimulate and access. But [00:38:00] really matters is what is the chance of ovulating a healthy egg. Mm. And that's so much harder for people to [00:38:05] understand 'cause there's no direct way to test anyone's egg quality. [00:38:08] Dr. Taz: Mm. [00:38:08] Dr. Lucky Sekhon: I wish there was a blood test. I know. [00:38:10] Where we could say, okay, 30% of eggs that you have at this current state could turn unhealthy into healthy [00:38:15] embryos. Right. That would be so helpful. [00:38:16] Dr. Taz: Yeah. [00:38:17] Dr. Lucky Sekhon: And we also don't have a test that tells us how quickly we're [00:38:20] gonna lose our eggs. We know that we tend to lose them at a faster rate as we approach 35 and [00:38:25] older. [00:38:25] Dr. Lucky Sekhon: So this is why that number is in everyone's, you know, at the forefront of their consciousness. They're like, [00:38:30] oh God, I'm turning 35. Right. It doesn't mean you're gonna lose all your eggs. But you will start to lose them [00:38:35] faster. [00:38:35] Dr. Taz: Mm. [00:38:36] Dr. Lucky Sekhon: But the other thing that also happens at 35 is it's never perfect for [00:38:40] anyone in your twenties. [00:38:41] Dr. Lucky Sekhon: If I was to take all the eggs that I could get from the kitchen cabinets and [00:38:45] turn them into embryos and tested them, even then 20 to 25% of them are gonna have typos or [00:38:50] errors that don't allow those eggs to turn into babies. Right? That number rises to about [00:38:55] 35% at 35, but then by the time you get to 37, 38, it's like 50, 50, 40. [00:38:59] Dr. Lucky Sekhon: [00:39:00] It's more like 70% of embryos tend to be abnormal. Mm-hmm. And not have reproductive potential, and [00:39:05] 30% will be normal. So that's why turning 35 matters. It's not that. [00:39:10] All of a sudden you're destined to have infertility age related problems with egg quality and [00:39:15] quantity. It's that it can become more challenging to have randomly hope to ovulate a [00:39:20] healthy egg. [00:39:20] Dr. Lucky Sekhon: And this means it often takes many more ovulations to get to a pregnancy and there's a higher [00:39:25] risk of miscarriage when pregnancy does occur. But I always say, because I'm an optimist, you [00:39:30] know, this also explains why some people. We'll say I got pregnant on my own without a fertility. [00:39:35] Doctor's help at 42 because hey, there's still 20% of embryos that could be normal at that age, actually could be that [00:39:40] age. [00:39:40] Dr. Taz: Do you believe we can reverse the ovarian age? I know there's a lot of work around PRP [00:39:45] and stem cells and I don't know what you think about that science since I know it's probably [00:39:49] Dr. Lucky Sekhon: I want to [00:39:50] Yeah, I, I I would love that. I I would love that. Unfortunately, you [00:39:55] know, this is something I'm very much abreast of and constantly reading new, right, right. [00:39:59] Dr. Lucky Sekhon: New data [00:40:00] that comes out. Um, currently there's no convincing evidence mm-hmm. That [00:40:05] any of those things work to do that. [00:40:06] Dr. Taz: Gotcha. [00:40:07] Dr. Lucky Sekhon: I think it's great that we're continuing to study it though. 'cause [00:40:10] PRP can work in many different fields of medicine. Right. Especially like, you know, for joint [00:40:15] issues. Like we know there are certain tissue in our body that you can actually cause [00:40:20] regeneration of cells and there, there is a real role for regenerative medicine, right? [00:40:24] Dr. Lucky Sekhon: Mm-hmm. The [00:40:25] ovaries are tricky because we just don't have that same ability to make new eggs. And [00:40:30] so I'm not saying it's not gonna be possible, but right now that is still very much in the [00:40:35] experimental research phase, and right now all of the data that has ever [00:40:40] shown like a small associated rise in a MH level or egg count markers, [00:40:45] it's probably more because of the disruption of the follicles. [00:40:47] Dr. Lucky Sekhon: When you're piercing it with a needle and [00:40:50] injecting it, you're creating an inflammatory response and then releasing more A MH. Mm-hmm. Coming from those [00:40:55] follicles. Interesting. We're not really seeing, there's two major randomized control trials, which is like the data [00:41:00] we want. Right. That came out in 2024. [00:41:03] Dr. Lucky Sekhon: Before that we didn't really have [00:41:05] much to go off of, and both of them failed to show any sort of difference. Yeah, [00:41:09] Dr. Taz: Uhhuh. [00:41:09] Dr. Lucky Sekhon: [00:41:10] So I, I hope so. I think what would really be an amazing breakthrough, if any scientists are listening [00:41:15] and are wanting to work on this problem, I would love if I could somehow [00:41:20] program the ovaries to say, you know what? [00:41:21] Dr. Lucky Sekhon: I know there's a low number in the pantry and we're bringing [00:41:25] fewer to the surface as a result, but I'd like you to recruit more because then I could tell someone [00:41:30] who's 40 and maybe dealing with a lower egg count, but also egg quality issues. Yes, I'm gonna [00:41:35] deplete your stockpile faster. 'cause right now people worry about like an egg retrieval, right? [00:41:39] Dr. Lucky Sekhon: Am I gonna go into [00:41:40] menopause sooner? And the, the, the reason why I go into this analogy is when you realize [00:41:45] that whatever we are getting to would've been thrown out anyway. Yeah. That alleviates that concern. [00:41:49] Dr. Taz: Yeah. [00:41:49] Dr. Lucky Sekhon: But [00:41:50] sometimes I wish that I could say, Hey, this might actually deplete your egg count faster, your [00:41:55] overall supply, but let's just for this moment. [00:41:58] Dr. Lucky Sekhon: To make sure that your [00:42:00] cycle is successful. Like let's start out with 30 eggs. [00:42:02] Dr. Taz: Yeah. [00:42:02] Dr. Lucky Sekhon: I wish I could do that. Mm. You know, and I feel [00:42:05] like that's probably a more realistic path forward just from what, what I know about the science of the ovaries [00:42:10] and [00:42:10] Dr. Taz: regenerating the, [00:42:11] Dr. Lucky Sekhon: yeah. Yeah. I think like just being able to access more would be a game changer.[00:42:15] [00:42:15] Dr. Taz: Do you still like A MH and F-S-H-L-H ratios? Yeah. And all that [00:42:20] stuff is markers, yeah. Of equality. [00:42:22] Dr. Lucky Sekhon: I love the information I can get. [00:42:23] Dr. Taz: Maybe explain what those [00:42:25] are. Fsh. [00:42:26] Dr. Lucky Sekhon: Yes. [00:42:26] Dr. Taz: Do you like the ratio to lh and why is that relevant? [00:42:30] Yeah. And do you still like a MHI [00:42:31] Dr. Lucky Sekhon: use all the information I can get, right? So a MHI love [00:42:35] a MH. [00:42:35] Dr. Lucky Sekhon: Anti-malaria hormone is a hormone that's produced by [00:42:40] all the little, uh, cells that line each of the bubbles of fluid that we call follicles. So I was [00:42:45] mentioning how a bunch of eggs come out of the stockpile and they're visible each in bubbles of fluid. [00:42:50] Um, so the number that come out, obviously that's going to correlate with how much a [00:42:55] MH is being produced by all the little cells that line each of those bubbles, right? [00:42:58] Dr. Lucky Sekhon: Mm-hmm. So it's not. Telling you [00:43:00] anything that different, but it's a different way of looking at egg quantity. Why do I like [00:43:05] it? I think it helps me more than it helps my patients. It's harder for them to kind of interpret it, it with, with the [00:43:10] right context, but for me it really helps me figure out the right dose of medication to use to best [00:43:15] stimulate their ovaries and how they might respond. [00:43:17] Dr. Lucky Sekhon: Ah, [00:43:17] Dr. Taz: okay. [00:43:18] Dr. Lucky Sekhon: Um, it's also just nice to kind of [00:43:20] compare if someone has a lower, lower response, you have this objective data point to say, oh, well your A [00:43:25] MH is different now. This is how it's kind of shifted. Um, and so I do think it's a [00:43:30] helpful thing because unlike FSH and some of these other markers that come from the pituitary gland, [00:43:35] those get shut off. [00:43:36] Dr. Lucky Sekhon: Mm-hmm. If people are on the pill. Right. A lot of people are coming to me, not [00:43:40] necessarily with infertility, but for fertility checkups or to talk about egg freezing and when they're on the [00:43:45] pill. I can't necessarily check those other levels accurately, but a MH doesn't [00:43:50] really get affected. [00:43:50] Dr. Taz: Gotcha. [00:43:51] Dr. Lucky Sekhon: Okay. We, long, long-term pill use sometimes can falsely suppress a [00:43:55] MH, but that's not always the case. [00:43:56] Dr. Lucky Sekhon: And in general, the teaching is, is you can kind of check it at any point in the [00:44:00] cycle whether or not they're on the pill and you can get a gauge of their egg count. [00:44:05] FSH is helpful because it tells us how hard your brain is working to stimulate the ovaries. And that's why [00:44:10] as we approach perimenopause and menopause, we see much higher levels of FSH 'cause [00:44:15] essentially it's like your brain yelling at the ovary, telling it, come on, do your job, make [00:44:20] estrogen. [00:44:20] Dr. Lucky Sekhon: LH is another hormone that's produced by your pituitary, and it's the secondary [00:44:25] signal. Once you have that mature egg that's been selected and grown by the FSH, it's the the [00:44:30] signal that really makes you release. The egg. But a lot of women with PCOS tend to have [00:44:35] higher LH levels, much higher LH levels than FSH. [00:44:38] Dr. Lucky Sekhon: And while it's not part of the diagnostic [00:44:40] criteria, I use it to, to figure out the right relative doses of certain [00:44:45] medications. Women with PCOS going through an egg retrieval cycle [00:44:50] typically need less LH and more FSH. Mm-hmm. And there are some women that have a [00:44:55] different type of problem with their ovulation. [00:44:57] Dr. Lucky Sekhon: Often it's women who've had histories of [00:45:00] eating disorders or maybe they're competitive athletes. Any sort of situation where the [00:45:05] pituitary might be a little bit stressed because of lack of energy or an energy [00:45:10] deficit, it doesn't produce those same hormones and you typically have too low of an LH and [00:45:15] you actually need more lh. [00:45:16] Dr. Taz: Interesting. [00:45:17] Dr. Lucky Sekhon: So I use this information to tailor my [00:45:20] treatments on, on how to best stimulate someone's ovaries. [00:45:22] Dr. Taz: Such important information. I think this [00:45:25] we've. Sort of established, but I wanna make sure we drive it home. We know we can [00:45:30] improve the eggs environment or its home. Right. Right. Or where, where it's [00:45:35] living. [00:45:35] Dr. Taz: Yeah. Right. We've talked about insulin resistance. I know nutrients are a big part of that. Yeah. I've talked [00:45:40] about prenatal androgens. Can we really improve egg quality? [00:45:44] Dr. Lucky Sekhon: I think you [00:45:45] can improve the environment where the eggs are being matured, and therefore you could [00:45:50] potentially neutralize external sources of external [00:45:55] exposures that would contribute more errors. [00:45:59] Dr. Lucky Sekhon: I don't [00:46:00] necessarily think, I think the background risk associated with age is just, it is what it [00:46:05] is. Right? Right. We're all subject to the effects of aging. You know, human beings have a [00:46:10] specific lifespan, like there's certain things that just can't be avoided. Right. But [00:46:15] we can live our lives in different ways that influence our lifespan. [00:46:18] Dr. Lucky Sekhon: Mm-hmm. So that's the best analogy that I can [00:46:20] think of. Right? Yeah. Like there are certain behaviors that definitely can lead to poorer egg quality or accelerated [00:46:25] changes in egg quality. We've already talked about some of 'em, like smoking, [00:46:27] Dr. Taz: right? [00:46:28] Dr. Lucky Sekhon: And then therefore, there [00:46:30] are things that you can do. On the side of being healthier and sometimes, you know, [00:46:35] there could be a role for supplements. [00:46:36] Dr. Lucky Sekhon: I definitely think correcting any nutritional, nutritional deficiencies. Yeah. And then [00:46:40] there is some good data on coq 10. It's not the most perfect data that we want, [00:46:45] but enough observational studies and a lack of harm that [00:46:50] kind of brings more comfort to say, you know what, there's some animal data. [00:46:52] Dr. Lucky Sekhon: There's even some human studies that have been pooled and looked [00:46:55] at where there seems to be a trend towards better outcomes, potentially better response to stimulation, [00:47:00] potentially better quality of the eggs turning into embryos. And maybe it's a subtle [00:47:05] change, but hey, let's do anything in everything that could help. [00:47:07] Dr. Lucky Sekhon: So a lot of my patients take coq 10. [00:47:10] They usually take it at a dose of about 600 milligrams per day. Okay. But it, I don't. I don't [00:47:15] think it should be touted as like the end all be all. Right. Right, right. It's like it's part of a larger [00:47:20] strategy of just saying whatever we can do. Antioxidants, what do, what do we mean when we talk about [00:47:25] antioxidants, we talk about molecules that protect us from free radicals, which is one of the [00:47:30] mechanisms of aging and cellular breakdown. [00:47:33] Dr. Lucky Sekhon: Whether it be because of [00:47:35] radiation, you know, toxic exposures. Cigarette smoke, like things like that. [00:47:40] So I think it's a, a protective mechanism. Our body naturally knows what to do a lot of the [00:47:45] time. Like we naturally all produce antioxidants, but you know, maybe some people [00:47:50] are a little bit deficient, right? [00:47:51] Dr. Lucky Sekhon: It could use more. And I think if it's not gonna do any potential harm, [00:47:55] then you know, if there could be a potential benefit, why not add it to your regimen? [00:47:59] Dr. Taz: I love that, [00:48:00] and that's something that we see in practice a lot too. That, again, that environment, whether it's insulin [00:48:05] resistance, the high androgens, you know, nutritional deficiencies, those are things that we can [00:48:10] actively work on. [00:48:11] Dr. Taz: Yes. While you're working on your fertility journey simultaneously, [00:48:15] and many people finally arrive at that point where they decide to step into your office, right? Mm-hmm. Mm-hmm. [00:48:20] You know, they've tried for a year. I think that's the standard. Yeah. It doesn't happen for them, you [00:48:25] know? What are some of the biggest fears, misconceptions. [00:48:28] Dr. Taz: Myths [00:48:30] around what happens next. Yeah. Whether it's IUI or IVF or some of those things. [00:48:34] Dr. Lucky Sekhon: [00:48:35] Yeah. I mean, first big misconception is when they walk through my door and they're looking to [00:48:40] find a reason, is, you know, there is gonna be a reason that we identify very [00:48:45] clearly and objectively, and then we'll have a targeted treatment plan. [00:48:48] Dr. Lucky Sekhon: I think that's the biggest source of [00:48:50] frustration in a lot of, uh, patients who are dealing with infertility. Mm-hmm. Not really having [00:48:55] closure or some sort of clear answer, but I always explain to them, there is no test for egg [00:49:00] quality. Right. And there could be something going on even at a younger age. [00:49:02] Dr. Lucky Sekhon: Mm-hmm. We don't know for a fact that you're gonna follow [00:49:05] all of the standard statistics. [00:49:06] Dr. Taz: Right. [00:49:07] Dr. Lucky Sekhon: And there could be other aspects of your partner's [00:49:10] sperm quality that aren't necessarily picked up on a standard semen analysis, which is [00:49:15] very basic. It's just saying you have enough sperm, there's a, a high enough proportion of [00:49:20] sperm that can swim in a forward direction and that are shaped normally. [00:49:23] Dr. Lucky Sekhon: But that doesn't mean it's [00:49:25] perfect in all the ways that it needs to be. And so it's minimal [00:49:27] Dr. Taz: requirements just, just swim in one direction. [00:49:29] Dr. Lucky Sekhon: [00:49:30] Exactly. Right. But we know chronic medical conditions, obesity, which can also [00:49:35] throw off the testosterone, estrogen balance in men. All these things can have [00:49:40] indirect impacts on sperm quality that you don't see, you know, directly under the microscope when doing a semen [00:49:45] analysis. [00:49:45] Dr. Lucky Sekhon: So, um, you know, I always explain that. Not getting an [00:49:50] explanation. Unexplained infertility. Right. It's not a lazy diagnosis, it's just we don't [00:49:55] have all of the tools necessary to really know everything there is to know. And a big blind [00:50:00] spot is egg quality. [00:50:01] Dr. Taz: Yeah. [00:50:01] Dr. Lucky Sekhon: Right? [00:50:01] Dr. Taz: Yeah. [00:50:02] Dr. Lucky Sekhon: But it doesn't mean that there isn't a solution, just 'cause we didn't [00:50:05] find a problem. [00:50:05] Dr. Lucky Sekhon: So the standard workup is check to make sure there's no blockages in the tubes. Check to make sure there's no, [00:50:10] you know, mechanical things that could get in the way of an embryo implanting in the uterus, like [00:50:15] fibroids or scarring or polyps. Make sure someone is ovulating, you know, [00:50:20] and make sure the sperm is healthy. [00:50:21] Dr. Lucky Sekhon: Those are the four major components you're addressing. But if everything comes back [00:50:25] normal. There are things that could be going on that you're not directly seeing [00:50:30] Endometriosis. Mm-hmm. Not always obvious on imaging. Right. Not always obvious, even taking a history from a [00:50:35] person because they've kind of normalized what their pain is. [00:50:37] Dr. Lucky Sekhon: Right. And there's some cases where you don't have so much [00:50:40] pain. Yeah. And that's also kind of a mystery too, that the severity of disease doesn't always [00:50:45] correlate with symptoms. [00:50:45] Dr. Taz: Mm-hmm. [00:50:46] Dr. Lucky Sekhon: And then another big one is, like I said, egg quality. Right. [00:50:50] And then I always look at the person as a whole, like is there something else going on with their health [00:50:55] that needs to be addressed that could be indirectly impacting their fertility? [00:50:58] Dr. Lucky Sekhon: And if we find nothing. [00:51:00] We're just trying to improve the inefficiency of human reproduction. There's really [00:51:05] medicated IUI, which is essentially like speed dating for your reproductive tract. [00:51:09] Dr. Taz: Mm-hmm. [00:51:09] Dr. Lucky Sekhon: You're [00:51:10] saying, okay, if one egg is expected to hopefully meet the perfect sperm, and they get together, and the odds of all these things [00:51:15] lining up is about, you know, 15, 20%, even in your twenties, early thirties, it's not that efficient [00:51:20] and you've already kind of given a, a good run. [00:51:22] Dr. Lucky Sekhon: Now let's bump it up a little bit. Let's give you a [00:51:25] medication, an oral medication to improve the odds or the chance that you could release [00:51:30] more than one egg or more than one long shot. And [00:51:32] Dr. Taz: that's the Clomid [00:51:33] Dr. Lucky Sekhon: or, yeah, ch Clomid or Letrozole. Okay. [00:51:35] But then also on the sperm side, let's deliver the sperm closer to where the eggs are being released. [00:51:39] Dr. Lucky Sekhon: So it's like speed [00:51:40] dating, there's more eggs, more sperm, and you're hoping for an interaction. But anyone who's gone to a speed dating event [00:51:45] knows you're not destined to meet the one the first time you go. Right. It just might improve the odds of [00:51:50] meeting that person, but it might take several cycles. So it's not the most efficient. [00:51:54] Dr. Lucky Sekhon: And while [00:51:55] it's. Not as burdensome on your body as you know, head-to-head comparison, one [00:52:00] IUI cycle versus one IBF cycle. It can get fatiguing in terms of the mental game of doing something [00:52:05] over and over and expecting a different result. So at a certain point, if that doesn't work, you move on. Or [00:52:10] for some people, especially if they're starting their family at an older age or they have specific challenges, they [00:52:15] might just go straight to IVF, right? [00:52:16] Dr. Taz: Mm-hmm. [00:52:17] Dr. Lucky Sekhon: And IVF is a different ball game. A lot more work. You're taking [00:52:20] shots for eight to 10 days. You're trying to get all of those eggs in the kitchen cabinets to grow [00:52:25] and mature because like a banana when it's ripe is easier to peel a bubble of fluid, a [00:52:30] follicle that's expanding. It's easier to pierce and it's easier to remove the egg from each one when you're doing an [00:52:35] egg retrieval procedure. [00:52:36] Dr. Lucky Sekhon: So eight to 10 days of shots coming in for lots of [00:52:40] check-ins. So there's a lot of poking and prodding. Yeah, you're coming in for like five or six blood draws ultrasounds during the eight to 10 [00:52:45] days, and then you're having a procedure, which is very minor. I've undergone an egg retrieval. [00:52:50] More than once. [00:52:51] Dr. Lucky Sekhon: Um, you know, it's a great nap. You do feel crampy. You do feel groggy [00:52:55] and out of it for the rest of the day. And it is normal to feel bloated and everyone's different. But the large majority of [00:53:00] patients, it's like that. It, it's a one day thing, and the next day you can go to work, right? But what we're doing is [00:53:05] we're extracting as many eggs as we can vaginally. [00:53:07] Dr. Lucky Sekhon: And then that part is done, and then you're just [00:53:10] waiting for updates. Maybe we freeze the eggs if you're doing egg freezing. But if we're trying to create embryos the [00:53:15] next day, you'll know how many of those embryos actually fertilize successfully. It's typically like 70 to [00:53:20] 80% a week later, we'll know how many turned into embryos. [00:53:22] Dr. Lucky Sekhon: It might be like half, maybe 60%. [00:53:25] And an embryo has many cells. So you can remove some of the outer cells without harming the embryo. [00:53:30] They would one day become the placenta and you can genetically test them and freeze them and get a report [00:53:35] back about two weeks later that iden identifies which ones are healthy and which ones are not. [00:53:39] Dr. Taz: Hmm. [00:53:39] Dr. Lucky Sekhon: And that's one of [00:53:40] the things that has made IVF much more successful. Yeah, even just putting one [00:53:45] embryo back at a time, it's like a 60 to 70% chance of life birth, and it allows you to freeze [00:53:50] extra embryos for the future. [00:53:51] Dr. Taz: Right. [00:53:51] Dr. Lucky Sekhon: And come back at any age. Your uterus doesn't really age. [00:53:54] Dr. Taz: Mm-hmm. So [00:53:55] you could potentially do, uh, an IVF or an [00:54:00] embryo transplant. [00:54:00] Dr. Taz: Up to what age? Where would you, I [00:54:02] Dr. Lucky Sekhon: mean, there are no [00:54:05] hard and fast rules or limits, but every clinic kind of has their own ethical guidelines. Yeah. [00:54:10] And we do look to the American Society of Reproductive Medicine and they do give some guidance, but there [00:54:15] isn't like a black and white because patient care should be individualized. [00:54:18] Dr. Lucky Sekhon: Right. I wanna make that clear. But in [00:54:20] general, you know, yes, we can get people pregnant and their ability to get pregnant and stay [00:54:25] pregnant, meaning the risk of miscarriage should not be affected by the age of their uterus. Mm-hmm. Which is pretty [00:54:30] miraculous, but. The obstetrical risks, meaning like the risk of [00:54:35] delivery and Yeah. [00:54:35] Dr. Lucky Sekhon: Yeah. The risk of high blood pressure, the risk of diabetes in pregnancy, risks to the [00:54:40] fetus. All of these things are heightened as we get older. [00:54:43] Dr. Taz: Yeah. [00:54:43] Dr. Lucky Sekhon: That risk [00:54:45] starts to set in at 35 and older. Mm-hmm. But it doesn't mean every person over 35 who's pregnant is [00:54:50] gonna have a complication. But your, your chances increase and you're watched more carefully. [00:54:54] Dr. Lucky Sekhon: And [00:54:55] that becomes even more true in our forties. And definitely even more true over 45 like that every [00:55:00] five years is a very significant increment of time. [00:55:02] Dr. Taz: Gotcha. [00:55:03] Dr. Lucky Sekhon: But if you're someone that [00:55:05] is not overweight, you have well controlled conditions, or you're healthy, you don't have any [00:55:10] medical conditions. [00:55:11] Dr. Lucky Sekhon: Those are all things that are in your corner to promote, you [00:55:15] know, being able to have a healthier pregnancy. Yeah. But age in and of itself can cause wear and [00:55:20] tear, especially to your blood vessels. Right? Right. And so you're more prone to things like high blood pressure. Do you know [00:55:24] Dr. Taz: 50 year olds [00:55:25] who have [00:55:25] Dr. Lucky Sekhon: Yeah. [00:55:25] Dr. Taz: Carried? [00:55:26] Dr. Lucky Sekhon: Yeah. I mean, I would say most practices will say 50 [00:55:30] might be the limit, or even up to 55 if you're in perfect health. [00:55:33] Dr. Taz: Gotcha. [00:55:34] Dr. Lucky Sekhon: But you will hear [00:55:35] crazy headlines that are true in other countries where there's less regulatory oversight of [00:55:40] women having children in their seventies. Wow. But you know, you have to think about the ethical dilemmas surrounding [00:55:45] that. [00:55:45] Dr. Lucky Sekhon: I, I think the guidelines from the as m is very much, you know, [00:55:50] surrounding not just the health of the mom and the health of the child, but also. Can you [00:55:55] reasonably as a couple, or as an in individual be around to raise your child to adulthood, [00:56:00] like age 21? [00:56:00] Dr. Taz: Right. What does the future look like for IVF and assisted [00:56:05] reproduction? [00:56:05] Dr. Taz: Is there anything on the horizon? Is there anything new developing? [00:56:09] Dr. Lucky Sekhon: Well, I think [00:56:10] we've made remarkable strides. You know, my mentors who were around [00:56:15] when IVF was invented, which was really in like the seventies, which is crazy to think of, that's not that [00:56:20] long ago. Back then they used to say, oh, there was like a 5% or less [00:56:25] chance of calling a patient with a positive pregnancy test after doing IVF. [00:56:29] Dr. Lucky Sekhon: And they were putting in [00:56:30] multiple embryos. Okay. And they didn't know how to freeze and thaw them. Well. They did not know how to do genetic [00:56:35] testing. And now we're at a place where. I'm hardly ever putting in more than one embryo because the success rates are so [00:56:40] high. It would just really increase the risk of twins. [00:56:41] Dr. Lucky Sekhon: Yeah. Which is a high risk pregnancy, and we're [00:56:45] able to say, okay, within three transfer attempts of one embryo at a time, if it's [00:56:50] genetically tested, there's a 92% chance of live birth. [00:56:52] Dr. Taz: That's incredible. [00:56:53] Dr. Lucky Sekhon: Yes. It [00:56:55] is. And hopeful. Very hopeful. Yeah. So I think we've already made a lot of progress. Progress. I think [00:57:00] what's gonna close the gap, why do one third of high quality, seemingly perfect, [00:57:05] genetically tested embryos not implant because the testing is not exactly perfect. [00:57:09] Dr. Lucky Sekhon: The testing is very [00:57:10] good, but right now we're just sampling a small number of the cells that actually make up the embryo. And I think if we could [00:57:15] find a way to like collect some of the media around the embryo and get a more holistic view, and [00:57:20] you know, once the resolution of the testing gets even deeper, we're going to know more and be able [00:57:25] to better select which embryo to transfer. [00:57:27] Dr. Taz: Mm-hmm. [00:57:27] Dr. Lucky Sekhon: Um, so I think that will probably close the [00:57:30] gap and make success even better. I think finding ways to overcome some of the [00:57:35] difficult problems, like I said. Being able to make more eggs come to the surface. [00:57:40] Like right now that feels like sci-fi, but it doesn't seem like that crazy of a thing for us to figure out.[00:57:45] [00:57:45] Dr. Taz: Yeah. [00:57:45] Dr. Lucky Sekhon: Um, so I hope that that becomes something, and I hope, you know, for women that have scarring in their [00:57:50] uterus, [00:57:50] Dr. Taz: right. [00:57:50] Dr. Lucky Sekhon: Going back to the idea of regenerative medicine, like finding ways to help them regrowth [00:57:55] their lining up and clean the [00:57:56] Dr. Taz: lining up. [00:57:56] Dr. Lucky Sekhon: For sure. Preventing problems like being able to prevent [00:58:00] fibroids, being able to better prevent, you know, things like PCOS and [00:58:05] endometriosis from getting worse. [00:58:06] Dr. Taz: Do you want women there? This is a debate, but do you [00:58:10] want women to make decisions like, [00:58:15] okay, I'm busy right now, I'm focused on something else right now, I'm gonna freeze my [00:58:20] eggs for later. [00:58:22] Dr. Lucky Sekhon: It's not that I want them to do that. I [00:58:25] want everyone to think about their li their life goals. And I know that sounds so [00:58:30] like wishy-washy, but as a professional woman. [00:58:33] Dr. Lucky Sekhon: As someone that [00:58:35] actually did take a moment and froze embryos. You know, I froze embryos with my husband at 34 [00:58:40] after having my first, and I know for a fact I know myself well enough to know that [00:58:45] I never would've done that or made the effort to do it had I not been in this field. [00:58:48] Dr. Taz: Mm-hmm. [00:58:49] Dr. Lucky Sekhon: I was just too [00:58:50] busy. [00:58:50] Dr. Lucky Sekhon: Yeah. It would've been like such a like peripheral thought to me and I would've been like, ah, it's probably all gonna work [00:58:55] out even if I was in medicine. I can admit that to myself. Yeah. Right. [00:58:58] Dr. Taz: Yeah. [00:58:58] Dr. Lucky Sekhon: But because it was in my [00:59:00] face, I was like, oh, I need to really strategize this. And even still, I was kind of in denial. [00:59:04] Dr. Lucky Sekhon: I was like, I [00:59:05] probably will never use this. And guess what? At 38 it was a lot harder to get pregnant. I ended up [00:59:10] needing to rely on what I froze. Mm-hmm. So I was really happy that I did this proactive thing. [00:59:14] Dr. Taz: Mm-hmm. [00:59:14] Dr. Lucky Sekhon: Um, [00:59:15] I know that in my career and just how busy, you know, you were saying like, I can't believe you [00:59:20] just came from seeing patients. [00:59:21] Dr. Lucky Sekhon: It's like, yeah, we're running around on empty a lot of the time. Right. [00:59:25] I think it's very easy, and I see it in a lot of my patients that are in high powered careers to just go, [00:59:30] go, go, right? And never really take a, a beat to think, Hey, what am I doing in my life? [00:59:35] What do I want out of life? Uh, is, are my actions aligning with what I [00:59:40] actually want? [00:59:41] Dr. Lucky Sekhon: It's really easy to be the goes by in the wheel. [00:59:43] Dr. Taz: Yeah. [00:59:43] Dr. Lucky Sekhon: Yes. And time goes by and you [00:59:45] get another promotion and then like, it just slips away from you. So I think people need to a, [00:59:50] take the time to think about their goals and prioritize them. I think b, they [00:59:55] should learn about the option to freeze eggs or freeze embryos. [00:59:59] Dr. Lucky Sekhon: Um, and [01:00:00] you know, sometimes it's just having the conversation that opens their mind up to even the possibility. There's a [01:00:05] lot of preconceived notions, right? Sometimes people come in and they're like, I know egg freezing doesn't really work. And I'm like, what are you [01:00:10] talking about? Yeah. It can work really well. [01:00:11] Dr. Taz: Yeah. [01:00:12] Dr. Lucky Sekhon: It's just never a guarantee because an egg is a single [01:00:15] cell, [01:00:15] Dr. Taz: right, [01:00:15] Dr. Lucky Sekhon: and you're freezing potential, but it can give you a massive head start if and should you ever need IVF. [01:00:20] [01:00:20] Dr. Taz: I think that's incredible. And I do think, you know, you know, I talk about the [01:00:25] Superwoman syndrome and, and I agree. I want women to be out there doing what [01:00:30] they wanna do. [01:00:30] Dr. Lucky Sekhon: Yeah. [01:00:31] Dr. Taz: I think one of the things that at least our generation has learned is [01:00:35] that we have to balance our energies and that includes our feminine for fertile energy, [01:00:40] right? Yeah. With all the goal setting and all the things that we wanna accomplish in the world. And I think that [01:00:45] it's incredible that. Women have options today, but I think it begins with thinking about your health [01:00:50] and it begins with thinking about all the determinants of your health and how that ties to fertility and [01:00:55] then what you're gonna do from an actionable standpoint. [01:00:58] Dr. Taz: Right. In terms of safeguarding your [01:01:00] health and safeguarding your fertility, and then knowing what you're gonna do next. Yes. And I think that's just a [01:01:05] really important conversation to have with yourself, you know? Yeah. [01:01:07] Dr. Lucky Sekhon: I think a lot of people suppress thoughts [01:01:10] about fertility because it brings up anxiety. [01:01:12] Dr. Lucky Sekhon: Yes. And it also brings up like an existential [01:01:15] crisis, and often people feel very helpless 'cause they're like, well, only when [01:01:20] the relationship comes. Correct. Yeah. Then this becomes a priority and I. Don't think that [01:01:25] that's how it has to be. [01:01:26] Dr. Taz: And that can also feel like failure, right? Yes. Well, I'm not able to find [01:01:30] the person, or I'm not able to do whatever. [01:01:32] Dr. Taz: Right. And then there's just this, again, that shame that [01:01:35] women already have had to live with for centuries. Yeah. Like I think it just, you [01:01:40] know, emphasizes that feeling again. Totally. Again, you know, and there's no reason like, you know, be [01:01:45] logical about your fertility and your health just like you would about your career. [01:01:49] Dr. Lucky Sekhon: Yeah. [01:01:49] Dr. Taz: And [01:01:50] let your relationship grow emotionally and maybe illogically like it's [01:01:55] supposed to. Yes. You know what I mean? So it's, I think understanding that there's a difference [01:01:58] Dr. Lucky Sekhon: Yeah. [01:01:58] Dr. Taz: Between those two [01:02:00] determinants of, of your life. You know, [01:02:01] Dr. Lucky Sekhon: there's also a huge difference, um, you know, [01:02:05] in what we're taught growing up and what we see happen when it comes to education and our [01:02:10] career goals where the amount of effort you put in equals the result. [01:02:14] Dr. Taz: Correct. [01:02:14] Dr. Lucky Sekhon: When it comes [01:02:15] to relationships, it takes two and like you can't control everything that happens in that arena. [01:02:20] And same with fertility. There's so much that's out of our control that it's not a meritocracy. It's not [01:02:25] like you put in the effort, you get an A, you did the work. Exactly. And that's hard for people like us. [01:02:29] Dr. Lucky Sekhon: Right. [01:02:30] Yeah. You know, that's like what our career has been built on. [01:02:31] Dr. Taz: Yeah. Very much. Well, your book is coming out, [01:02:35] the Lucky Egg. [01:02:35] Dr. Lucky Sekhon: Yes. [01:02:36] Dr. Taz: Talk to us about that. [01:02:37] Dr. Lucky Sekhon: So this is a book that was born [01:02:40] from years in practice of patients asking me is there like a one [01:02:45] stop shop resource that I can go to, which will. Help me navigate this crazy [01:02:50] 180 shift that only women it feels like are expected to do. [01:02:53] Dr. Lucky Sekhon: Like you go through your life, like, [01:02:55] I don't wanna get pregnant. And now all of a sudden you're not equipped with any information and it's like, [01:03:00] okay, bye ovulation predictor kits and figure out your cycle. And everyone's like, oh my God, I have no idea what's going on. And [01:03:05] I meet women who are so smart, so talented, so successful. [01:03:09] Dr. Lucky Sekhon: They're in [01:03:10] their thirties, they're in their forties, and they don't know the basics. Yeah. And so this is to fill that knowledge [01:03:15] gap. Love it. But it's also to provide like a dictionary. There's even a glossary at the end, because I [01:03:20] always say, getting into the world of fertility, if you do start running into trouble, like what are these [01:03:25] tests mean? [01:03:25] Dr. Lucky Sekhon: What are the treatment options? It feels like learning a new language. Yeah. And so it's almost [01:03:30] like, you know, a fertility English dictionary of sorts to help people just really [01:03:35] navigate. You know, this transition from not thinking about it to all of a sudden it becoming really important to [01:03:40] them and knowing that it's time sensitive and you wanna be efficient with your time and not get pulled [01:03:45] in all these different directions and you know, with all the noise and bad information. [01:03:48] Dr. Lucky Sekhon: So it's [01:03:50] evidence-based, it's warm. It's not gonna make you feel like a science experiment. [01:03:54] Dr. Taz: [01:03:55] Yeah. [01:03:55] Dr. Lucky Sekhon: It is going to make you feel like you have a best friend that is also a [01:04:00] fertility doctor. Love it. That's here to hold your hand and guide you through every step of the process. And there's [01:04:05] also a really huge part of it that is about mental health. [01:04:07] Dr. Taz: Mm. [01:04:08] Dr. Lucky Sekhon: Because one of the major, [01:04:10] um, uh, the major contributions, I should say to people not getting to the [01:04:15] success, to the, to. The finish line, especially in a time where IVF [01:04:20] can be successful for a lot of people is often dropout, premature dropout. [01:04:25] And they've even looked at this and looked at like, is it financial? [01:04:28] Dr. Lucky Sekhon: Obviously there can be financial barriers, [01:04:30] but the number one contributor to premature dropout is psychological, the mental [01:04:35] burden. Mm-hmm. So I think, uh, really paying attention to your mental health alongside your physical health [01:04:40] so that you can stay in it to win it. And then also there's a whole section on troubleshooting [01:04:45] because I think that's where people really get tripped up, get frustrated. [01:04:46] Dr. Lucky Sekhon: Yeah. When they have a field cycle and they're like, now what do I do? [01:04:49] Dr. Taz: Yeah. [01:04:50] I love that it's such an important resource. I know so many of you will benefit from it. Where can [01:04:55] people find you or find the book or Yes. Where would you direct everybody to? [01:04:58] Dr. Lucky Sekhon: So the book is going [01:05:00] to be sold wherever you can find books. [01:05:01] Dr. Lucky Sekhon: Right? Okay. Yeah. Um, and you can go to my website, the lucky [01:05:05] egg.com, um, and the landing page, you know, you can pre-order it at various places. [01:05:10] Um, that website is also a great resource. I have a lot of like a MH calculators, egg freezing [01:05:15] calculators, really practical tools alongside blogs and content that will help kind of [01:05:20] explain a lot of important things, um, about testing and treatment. [01:05:24] Dr. Lucky Sekhon: And then I'm on [01:05:25] Instagram and TikTok, so you can find me there. Um, I try to, you know, make light of things and [01:05:30] bring a lot of levity to something that can traditionally feel very anxiety provoking or fearful, [01:05:35] um, because I think that, you know, education is at the core of what we really need to be pushing forward. [01:05:39] Dr. Taz: [01:05:40] Yeah. Well, thank you so much for taking time out today. This has been such an incredible [01:05:45] conversation. I'm gonna ask you one final question. [01:05:47] Dr. Lucky Sekhon: Sure. [01:05:47] Dr. Taz: What makes you whole. [01:05:49] Dr. Lucky Sekhon: What [01:05:50] makes me whole, um, honestly, I would have to say. I [01:05:55] think having a purpose. I love it in life. I love it. Having a mission, and I know that sounds so [01:06:00] general, but I really do feel gratitude every day knowing [01:06:05] that I'm doing exactly what I'm meant to be doing. [01:06:06] Dr. Lucky Sekhon: I feel so driven and passionate about this [01:06:10] mission. I grew up in a matriarchal household. Mm-hmm. And in a culture where, you know, [01:06:15] women didn't necessarily get prioritized. Right. And so for me, it feels so gratifying to [01:06:20] be in this role, educating women, empowering them, giving them options that, like my [01:06:25] grandmother, we could never have dreamt of. [01:06:26] Dr. Lucky Sekhon: Right. Um, and just making people feel like less [01:06:30] afraid, more seen, and more in control. [01:06:32] Dr. Taz: I love that. Purpose is, I can [01:06:35] resonate with that so much. So thank you again for. Taking time to be here today. I really [01:06:40] appreciate it, and for everybody else watching and listening to this episode, please remember to share it with your [01:06:45] friends. [01:06:45] Dr. Taz: And if you have somebody in your life who is in that space, right, that space where they're [01:06:50] feeling discouraged, shameful, hopeless, please share this episode with them. I know I have [01:06:55] met so many people in my journey who have been there, and I wish I could have shared this with them earlier. [01:07:00] Thank you, and I'll see you guys next time [01:07:01] Dr. Lucky Sekhon: before you go take a second to reflect on what [01:07:05] stood out for you today. [01:07:06] Dr. Lucky Sekhon: Then if you can leave a quick review wherever you're [01:07:10] listening, it really helps other people discover Whole Plus and start their own healing [01:07:15] journey. And don't [01:07:16] Dr. Taz: forget to follow me on Instagram at Dr. Taz md. I love [01:07:20] hearing how these episodes are supporting you.