Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / An Expert Roundtable on Trying to Conceive

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An Expert Roundtable on Trying to Conceive · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:00
Speaker 1: This is parent Data. I'm Emily Oster.
0:07
Speaker 2: For many people, when we start thinking about a family,
0:11
Speaker 2: we assume it'll just happen. We'll decide one day we
0:15
Speaker 2: want to have a baby, and then nine months later
0:18
Speaker 2: there'll be a birth. But that isn't the way it
0:21
Speaker 2: happens for all of us, and fertility can often be
0:24
Speaker 2: a journey that's more winding and more complicated and more
0:30
Speaker 2: confusing than we expected it to be. And as I've
0:35
Speaker 2: spent the last decade or so writing about pregnancy and parenting,
0:40
Speaker 2: questions about fertility have come up all the time.
0:43
Speaker 1: People want to know.
0:45
Speaker 2: What is the data say. What is the data say
0:47
Speaker 2: about when I should have sex? What is the data
0:50
Speaker 2: say about when I should think about fertility treatments?
0:53
Speaker 1: What is the data say if I.
0:55
Speaker 2: Don't have any sperm in the relationship and I need
0:58
Speaker 2: to have some donor sperm?
1:00
Speaker 1: How do I get that? These questions come up all.
1:02
Speaker 2: The time, and now parent Data has some answers. We
1:08
Speaker 2: have recently launched a new content vertical in parent Data
1:13
Speaker 2: on Trying to Conceive, covering everything from ovulation windows to
1:18
Speaker 2: donor eggs to infertility treatment, along with a newsletter all
1:23
Speaker 2: about infertility treatment in particular that aims to answer all
1:27
Speaker 2: of the questions people ask, but answer them with data,
1:31
Speaker 2: with science. One of the things that's really tough about
1:34
Speaker 2: this space, especially if conception is a struggle, is that
1:39
Speaker 2: we so much want hope, and that's an opportunity for
1:44
Speaker 2: a lot of misinformation, and we're aiming to provide real,
1:49
Speaker 2: evidence based information so you can make the best decisions
1:53
Speaker 2: for your family, whatever is the fertility journey that you
1:56
Speaker 2: are on. Today on the podcast, I'm airing audio from
2:03
Speaker 2: an event I did with three of the people who
2:05
Speaker 2: have contributed most to this trying to conceive content on
2:08
Speaker 2: parent data.
2:10
Speaker 1: First, I've got doctor.
2:11
Speaker 2: Brianna Slocum, who's a reproductive endocrinologist and fertility specialist. I've
2:16
Speaker 2: got Maria Goodman, who's a licensed midwife, author and the
2:19
Speaker 2: founder of Pregnant Together. She specializes in caring for the
2:23
Speaker 2: LGBTQ plus community from preconception to early parenting. And I've
2:27
Speaker 2: got doctor Pooja Lakshman, who's been on here before, who's
2:30
Speaker 2: a perinatal psychiatrist.
2:33
Speaker 1: The four of us.
2:34
Speaker 2: Talk together about where to start with fertility questions, about
2:38
Speaker 2: what they all wish that we knew before starting to
2:41
Speaker 2: try to conceive, and we answer a lot of listener
2:44
Speaker 2: questions that come in through the zoom. This is a
2:48
Speaker 2: really fun event and I'm really excited that we get
2:50
Speaker 2: to share the audio with you and if you have
2:52
Speaker 2: more questions, as people in the chat did, go to
2:55
Speaker 2: parent data dot org see if we have answers and
2:58
Speaker 2: if we don't, send your questions in just building out
3:01
Speaker 2: what we want to do here, and we can't wait
3:02
Speaker 2: to hear from.
3:03
Speaker 1: You after the break Office Hours on trying to conceive.
3:20
Speaker 3: So thank you all so much for joining us for
3:24
Speaker 3: this month's office hours roundtable on trying to conceive.
3:28
Speaker 1: My name is Meg.
3:29
Speaker 3: I manage customer success here at parent Data, and I
3:33
Speaker 3: am particularly excited for this conversation as trying to conceive
3:37
Speaker 3: was just a huge part of my life in my thirties.
3:42
Speaker 3: I experienced a number of pregnancy losses at topic pregnancy
3:47
Speaker 3: surgeries and ultimately two rounds of IBF, which led me
3:51
Speaker 3: to my two beautiful kids, Theo and Talia, and I
3:56
Speaker 3: know firsthand how exciting, stressful, and really emotional this process
4:02
Speaker 3: can be, and I just cannot wait for this team
4:04
Speaker 3: of experts to discuss this really incredibly important topic this
4:10
Speaker 3: discussion today and we put this in the event invite
4:14
Speaker 3: as well, but it's going to reflect the wide range
4:18
Speaker 3: of experiences that people have with fertility and family planning,
4:21
Speaker 3: and we're going to leave plenty of time at the
4:23
Speaker 3: end for audience Q and A. We had a lot
4:26
Speaker 3: of interest in this event, a lot of questions came in,
4:28
Speaker 3: so we'll definitely leave time for that. And you all
4:32
Speaker 3: might know that today's theme is timed the launch of
4:34
Speaker 3: a new section of parent Data on trying to conceive.
4:37
Speaker 3: So we're just so excited to bring you high quality,
4:41
Speaker 3: data driven information on this stage of life and it's
4:45
Speaker 3: more important than ever and it's been something that the
4:48
Speaker 3: whole team has been working on for over a year,
4:50
Speaker 3: a really long time coming. So starting this week, you
4:54
Speaker 3: can explore trying to conceive or TTC in two.
4:57
Speaker 1: Different ways on parent Data.
4:59
Speaker 3: So we've launched a new section of parent data dot
5:02
Speaker 3: org dedicated to trying to conceive. So this includes articles
5:07
Speaker 3: on topics like understanding your ovulation window, the two week wait,
5:11
Speaker 3: pregnancy tests, and even miscarriage. You'll also find articles on infertility,
5:17
Speaker 3: egg freezing, and LGBTQ plus conception. Second, we are starting
5:23
Speaker 3: a weekly newsletter for anyone navigating fertility treatments or family
5:27
Speaker 3: planning with donor sperm or eggs. So this is meant
5:30
Speaker 3: for people who are looking for information to guide their
5:33
Speaker 3: medical decisions. We'll be covering the latest research and headlines,
5:37
Speaker 3: share one on one level guides, and answer reader questions.
5:40
Speaker 3: And thanks to our sponsor Roe, you can actually access
5:44
Speaker 3: all of the articles and the newsletter for free until
5:47
Speaker 3: April eighteen. So this is obviously a celebration of that launch.
5:52
Speaker 3: So now I am thrilled to introduce today's guests. As always,
5:57
Speaker 3: today's event will be hosted by Emily Auster. Emily is
6:00
Speaker 3: the founder and CEO of Parent Data, a professor of
6:03
Speaker 3: economics at Brown University, and a mom of two. She
6:07
Speaker 3: is also the author of four New York Times bestsellers,
6:10
Speaker 3: Expecting Better, Cribsheet, The Family Firm.
6:13
Speaker 1: And The Unexpected. She will be joined.
6:16
Speaker 3: Today by three incredible Parent Data contributors who have years
6:20
Speaker 3: of experience supporting people on their TTC's journey. So first
6:24
Speaker 3: is doctor Brianna Slocum. She's a reproductive endocrinologist and fertility
6:29
Speaker 3: specialist who treats patients navigating infertility and assisted reproductive technologies.
6:34
Speaker 1: Like IVF Next.
6:37
Speaker 3: Maria Goodman is a licensed midwife, author and the founder
6:41
Speaker 3: of Pregnant Together who specializes in caring for the LGBT
6:45
Speaker 3: plus community from preconception to early parenting. And finally, Doctor
6:50
Speaker 3: Puja Lakshman is a perinatal psychiatrist and author who advocates
6:55
Speaker 3: for women's mental health throughout their fertility journey. Without further ado,
7:01
Speaker 3: welcome Emily, Brianna, Maria, and Poushia.
7:06
Speaker 2: Thank you Meg, and thank you everybody for being here.
7:09
Speaker 2: We're incredibly excited to do this to talk all about
7:13
Speaker 2: trying to conceive and Pujia, Maria, Rihanna, thank you guys
7:17
Speaker 2: so much for writing all of these amazing things for
7:20
Speaker 2: us and being here. And I am just thrilled to
7:24
Speaker 2: get this information out. So we're going to start with
7:29
Speaker 2: some discussion and then we'll open it up to questions.
7:32
Speaker 2: But I want to kind of really start with the
7:35
Speaker 2: question of normalizing trying to conceive infertility as a journey.
7:40
Speaker 2: I think for a lot of us, you kind of
7:43
Speaker 2: there's this narrative like you go off birth control and
7:45
Speaker 2: then there's just a baby, and we often think about
7:48
Speaker 2: it like, Okay, what's my ideal timing I'm going to
7:50
Speaker 2: go off birth control and then like three months later,
7:52
Speaker 2: you know it'll be ready, and nine months after that
7:55
Speaker 2: I'll have a baby.
7:56
Speaker 1: And of course that is not true for everybody, And.
7:59
Speaker 2: I think it's it's really tough when you have that
8:03
Speaker 2: expectation and it does not deliver in that way, and
8:08
Speaker 2: people around you it seems like it's magic, and that's
8:11
Speaker 2: not always happening for everyone. So this also leaves out
8:15
Speaker 2: people who use a variety of other ways to grow
8:19
Speaker 2: to grow their family. So let's just start there, and
8:22
Speaker 2: I want it for each of you.
8:23
Speaker 1: I'm going to start with.
8:25
Speaker 2: Brianna, just ask what is one thing that you wish
8:29
Speaker 2: everyone knew about trying to conceive if you had a
8:33
Speaker 2: magic information Wand.
8:38
Speaker 4: I think that for a lot of reasons, there's this
8:40
Speaker 4: real tendency to look inward for explanations for why a
8:44
Speaker 4: fertility plan or journey maybe isn't happening the way that
8:47
Speaker 4: you wanted it to. And oftentimes that really looks like
8:50
Speaker 4: blaming yourself. So it's saying things like I wish I
8:53
Speaker 4: had frozen my eggs earlier, or I wish I had
8:55
Speaker 4: done this thing or not done that thing, or whatever,
8:59
Speaker 4: And I find that it's really helpful to remember that
9:01
Speaker 4: this is all happening in a context of a society
9:05
Speaker 4: that really doesn't value women's reproduction. And so that's why
9:08
Speaker 4: you didn't learn about fertility in school, for example, and
9:11
Speaker 4: why fertility insurance coverage is not federally mandated, nor is
9:15
Speaker 4: paid printal leave. So it's really not your fault, which
9:19
Speaker 4: means that you're not completely in control of everything that happens,
9:22
Speaker 4: But that doesn't mean that you don't have some power
9:25
Speaker 4: and that you can't still feel good about the process
9:28
Speaker 4: and kind of what's happening. And so if I had
9:30
Speaker 4: like a magic wand I would really want everybody to
9:32
Speaker 4: understand that, and to also just find a clinic or
9:35
Speaker 4: doctor provider whoever who helps you feel some of that
9:38
Speaker 4: power and you feel comfortable.
9:40
Speaker 1: With Maria, how about you? What would you tell people I.
9:47
Speaker 5: Love Rihanna that you started with that. I mean, what
9:50
Speaker 5: I would say, which I think builds on that for
9:53
Speaker 5: queer folks and solo parents and really anyone growing their
9:56
Speaker 5: family outside of the traditional heterosexual model, is really just
10:01
Speaker 5: that folks had access to the information and the choices
10:05
Speaker 5: that they need and deserve. What I see so much
10:08
Speaker 5: in these populations is overwhelm and not knowing where to start,
10:14
Speaker 5: which I think is really it touches on that the
10:19
Speaker 5: internalized there's internalized homophobia that can come up when growing
10:24
Speaker 5: your family outside of the heterosexual model. And yeah, I
10:31
Speaker 5: wish that as young people we knew what needed to
10:35
Speaker 5: happen in order to be able to grow our families,
10:38
Speaker 5: because I really see this as a reproductive justice issue
10:40
Speaker 5: that we all have the right to grow or not
10:42
Speaker 5: grow our families in the ways that we choose.
10:46
Speaker 6: Oh yeah, yeah, Well, first of all, I love Maria
10:49
Speaker 6: and Brion, I love both of your points, and kind
10:53
Speaker 6: of just I guess piggybacking a little bit. I think
10:57
Speaker 6: one of the things that I wish we could bring
11:01
Speaker 6: just more nuance to the emotional conversation because I think
11:06
Speaker 6: so much of what we see on the outside is like, oh,
11:09
Speaker 6: you know, I'm pregnant, and there's like this excitement emotion,
11:12
Speaker 6: or at least that's what we're expected to feel, when
11:14
Speaker 6: in reality, what I see in my practice as a
11:17
Speaker 6: perinatal psychiatrist with patients is that it's rare for me
11:21
Speaker 6: to have a patient where grief or ambivalence, loss conflict
11:29
Speaker 6: is not part of their experience like that that thread
11:32
Speaker 6: of grief or ambivalence or sort of feeling like lost
11:35
Speaker 6: and confused. So it's I guess just normalizing that this
11:39
Speaker 6: is this is not all like rainbows and unicorns, that
11:42
Speaker 6: there's a real kind of process of acceptance that I
11:46
Speaker 6: think happens, and I wish we talked more about that.
11:49
Speaker 6: So I'm so excited for this space and for this
11:52
Speaker 6: new newsletter.
11:54
Speaker 2: So I think what I'm hearing from from at least
11:58
Speaker 2: Brian and Maria is this idea of of education. I
12:01
Speaker 2: think for me, this is this is a core thing.
12:03
Speaker 2: I think we spend an awful lot of time And
12:05
Speaker 2: I say this as a parent of a teenager explaining
12:07
Speaker 2: to people like how not to get pregnant and not
12:11
Speaker 2: really expanding that out to like, why don't we help
12:15
Speaker 2: you understand your fertility which or you know, how this
12:18
Speaker 2: is all going to work and what are the different
12:19
Speaker 2: ways that eventually if you want to have a child
12:21
Speaker 2: you could which also, by the way, can help you
12:24
Speaker 2: understand how to not have a kid now. And I
12:26
Speaker 2: think this sort of like getting people to a place
12:29
Speaker 2: where when they arrive at the moment of family building
12:32
Speaker 2: they are in a better position to actually understand what's
12:36
Speaker 2: what's going to come next.
12:37
Speaker 1: I think for me that's that's what it is, all right.
12:40
Speaker 2: So so I actually want to ask one more question
12:45
Speaker 2: for Pooja in this in this space, which I think
12:47
Speaker 2: gets a little bit more into the into the practical,
12:49
Speaker 2: which is, you know, you talked a little bit about
12:51
Speaker 2: mental health and some of the sort of mental health
12:53
Speaker 2: stress stuff.
12:54
Speaker 1: I think one thing that's.
12:55
Speaker 2: Actually quite stressful for people is the idea that maybe
12:58
Speaker 2: being stressed is the thing that's in the making them
13:00
Speaker 2: not able to get pregnant. Then they're stress about being stressed,
13:03
Speaker 2: And I think, so can you talk a little bit
13:04
Speaker 2: about that and what do we know about the impacts
13:06
Speaker 2: of stress on conception and how to sort of think
13:09
Speaker 2: about that as a patient.
13:11
Speaker 6: Yeah, yeah, this is this is a topic that can
13:14
Speaker 6: be a little bit triggering, So I'll just caveyat it
13:18
Speaker 6: with that, And also just to give everybody kind of,
13:22
Speaker 6: you know, some of the numbers. So like in general,
13:24
Speaker 6: like in a normal pregnant or a normal situation where
13:27
Speaker 6: there's not any other confounding variables or other medical situations
13:32
Speaker 6: going on, ten to twenty percent of early pregnancies and
13:35
Speaker 6: in miscarriage, Like that's just normal, right, and that's the
13:39
Speaker 6: body's way of working and making sure that the eggs
13:44
Speaker 6: and the ambrews that are the healthiest kind of move
13:46
Speaker 6: through and are picked. But in we know that about
13:53
Speaker 6: ten to fifteen percent of couples are going to struggle
13:56
Speaker 6: with infertility and are not going to be able to
13:59
Speaker 6: conceive naturally. And there is research to show that when
14:03
Speaker 6: there is environmental stress. And when we're talking about environmental stress,
14:06
Speaker 6: it really it's just such a broad range of things.
14:09
Speaker 6: So it could be you know, being but not having support, right,
14:14
Speaker 6: being in a situation where you're a solo caregiver and
14:18
Speaker 6: you're experiencing stress from that standpoint, or being in a
14:21
Speaker 6: relationship that is fraught and has a lot of conflict,
14:25
Speaker 6: or being in a socioeconomic demographic where you're experiencing stress
14:32
Speaker 6: and you don't have access to healthcare. Race and identity
14:35
Speaker 6: plays into this too. We know that there is a
14:38
Speaker 6: link between stress and having difficulty getting pregnant. And this
14:42
Speaker 6: is something that's really hard to talk about because at
14:44
Speaker 6: least with my patients, like and this was my experience
14:46
Speaker 6: as well, Like I I went through IVF to conceive
14:50
Speaker 6: my son, who's now two and a half. Telling a
14:53
Speaker 6: stressed person not to be stressed probably one of the
15:00
Speaker 6: things that you can do. So I really I try
15:05
Speaker 6: and with my patients when I'm when when they're gearing
15:08
Speaker 6: up for whether it's IVF or IUI or even in
15:12
Speaker 6: there in the beginning stages of like starting to think
15:14
Speaker 6: about conceiving, I say to them, Look, this could be
15:18
Speaker 6: a long process, Like we don't know what it's going
15:20
Speaker 6: to look like, and so we need to get your
15:23
Speaker 6: support system in place. We need to figure out who
15:27
Speaker 6: is your team, Like who is going to be there
15:29
Speaker 6: for you? Who are the friends that you can lean
15:31
Speaker 6: on that you can text? Can we start a group chat? Right?
15:34
Speaker 6: Do you know anybody else that's done IVF or that's
15:37
Speaker 6: done EUI that you can reach out to, So like
15:41
Speaker 6: kind of thinking of it as more of a p
15:43
Speaker 6: in a proactive way of like, what are the levers
15:47
Speaker 6: that we can pull so that we don't feel so
15:49
Speaker 6: out of control when it comes to chronic stress.
15:54
Speaker 1: All right, let's get into the details. Rihanna, I'm starting
15:58
Speaker 1: with you.
15:59
Speaker 2: Tell us about age and fertility and in particular, what
16:03
Speaker 2: you'd like people to know as we age into what
16:09
Speaker 2: you people in the reproductive space would call advanced maternal age.
16:15
Speaker 4: Well, I think it's really important to understand that age
16:19
Speaker 4: is the single best predictor of a woman's ability to
16:21
Speaker 4: get pregnant. And the reason why is that age corelates
16:27
Speaker 4: best with a quality or the ability of that ache
16:30
Speaker 4: to make a healthy baby, and that goes down with age,
16:33
Speaker 4: I'm sure as we all know. So to put some
16:36
Speaker 4: numbers on it, a healthy thirty year old woman has
16:38
Speaker 4: about a twenty percent chance of getting pregnant per cycle.
16:42
Speaker 4: The number goes down to five percent by the time
16:44
Speaker 4: she's forty, And unfortunately there's no test for equality. There
16:49
Speaker 4: are tests for a quantity, or to get a sense
16:52
Speaker 4: of roughly how many eggs your bodies releasing each cycle,
16:55
Speaker 4: and those are tests like AMH, which I'm sure many
16:58
Speaker 4: of you have heard of, go down with age. But
17:01
Speaker 4: because quality is more important, tests like AMH do not
17:05
Speaker 4: correlate well with your ability to get pregnant.
17:08
Speaker 2: So the AMH is going to tell me how many
17:11
Speaker 2: eggs I have, but not whether they're good. Roughly, it's
17:14
Speaker 2: a metric of how many, but not whether they're good.
17:16
Speaker 2: I think this is quite an important point, because I
17:18
Speaker 2: think we often conflate those people have this idea that
17:22
Speaker 2: AMH is going to tell me, like is it going
17:24
Speaker 2: to work? And that's not to what extent does it?
17:28
Speaker 2: Like if I have a good AMH, is that tell
17:30
Speaker 2: me it's going to work?
17:33
Speaker 4: No, it tells you how you're going to respond to
17:35
Speaker 4: IVF or IVF meds. So egg freezing IVF and certainly
17:39
Speaker 4: numbers are important. You'll often hear IVF in particular referred
17:43
Speaker 4: to as a numbers game. So I don't want to
17:45
Speaker 4: say it doesn't matter. But if you're looking at it,
17:48
Speaker 4: just got in the dark to see, like can I
17:51
Speaker 4: get pregnant? Yes? Or no? AMH is not going to
17:54
Speaker 4: help you there.
17:56
Speaker 2: So you said that age is the most important determinant
17:58
Speaker 2: of fertility. Is there are there ways to youth in
18:04
Speaker 2: my eggs too?
18:05
Speaker 1: Are there you know?
18:06
Speaker 2: Ways to make my eggs? We hear a lot of
18:10
Speaker 2: about supplements. You talk a little bit about supplements that
18:13
Speaker 2: could or could not lower your egg age.
18:17
Speaker 5: Yeah.
18:18
Speaker 4: Well, first, I love the verb youthin. I'm gonna write
18:21
Speaker 4: that down and take it with me. But this is
18:24
Speaker 4: really tough for many people A year but no, and
18:28
Speaker 4: that's because we really don't completely understand ovary and aging,
18:31
Speaker 4: although the ovary is really interesting in the sense that
18:34
Speaker 4: it is one of the first organs that we can
18:36
Speaker 4: appreciate its aging in this way, but we don't understand
18:41
Speaker 4: it completely, and so that means that there are interventions
18:44
Speaker 4: that we can offer. At this point. We do know
18:47
Speaker 4: that have the alcohol use, for example, or tobacco use
18:51
Speaker 4: like smoking, that certainly can worsen your equality. But most
18:54
Speaker 4: of the women who I'm saying already know that. I'm
18:56
Speaker 4: sure most of you all do too, So yeah, not really.
19:00
Speaker 4: There are two supplements that you hear about THHA and
19:04
Speaker 4: Q ten or like the two, which we have articles
19:06
Speaker 4: on about those specifically in the data behind it.
19:10
Speaker 2: Let me ask one other thing here, which is about
19:13
Speaker 2: secondary infertility. And I think for a lot of people
19:18
Speaker 2: that's something that sneaks up because you may get pregnant
19:22
Speaker 2: the first time and then because of age or because
19:24
Speaker 2: of randomness in the process. So is this a common
19:28
Speaker 2: reason you see people and how would you suggest people
19:31
Speaker 2: navigate that medically?
19:33
Speaker 1: Is it different than if it were primary infertility.
19:36
Speaker 4: So it's super common, it's super common. And with that specifically,
19:41
Speaker 4: I mean it is important to go and see a provider,
19:43
Speaker 4: because we are looking at what changed, because as you mentioned,
19:46
Speaker 4: obviously they were able to get pregnant the first time,
19:49
Speaker 4: you know, something must have changed. So what I'm looking
19:53
Speaker 4: at specifically is a really detailed history to see us,
19:56
Speaker 4: for example, where there are there any hormonal changes result
20:00
Speaker 4: from complications from birth for example, or things like that.
20:03
Speaker 4: Are there differences maybe that we're going to see on
20:05
Speaker 4: the semen analysis, But most of the time it is
20:08
Speaker 4: age kind of as you alluded to, And so this
20:11
Speaker 4: is actually my research interest. But in kind of thinking
20:13
Speaker 4: about it and approaching it is just kind of when
20:16
Speaker 4: you think about when you are ready to start your
20:18
Speaker 4: family and kind of doing that math about how many
20:21
Speaker 4: children you want Roughly, you know, things change like how
20:24
Speaker 4: many children you want, how far out do you want
20:26
Speaker 4: to space them, how willing are you to use IVF
20:28
Speaker 4: to achieve your pregnancy goals family goals? Those are my
20:31
Speaker 4: research interests, But that's kind of how I would think
20:33
Speaker 4: about it on this end.
20:36
Speaker 2: All right, Maria, I want to turn to you and
20:38
Speaker 2: I want to ask you just very basically the patients
20:41
Speaker 2: that you see, why are people, why are people coming
20:44
Speaker 2: to you? And how is it maybe different than how
20:46
Speaker 2: people are coming to Brehanna or how is it not different?
20:49
Speaker 5: Yeah, great question. I would say I primarily work with
20:53
Speaker 5: people who are either at the very beginning of the process.
20:56
Speaker 1: Who are like, where do I start?
20:58
Speaker 5: I know I need to choose a donor, I have
20:59
Speaker 5: no idea idea how to go about that, or maybe
21:02
Speaker 5: folks that have been trying at home with a directed
21:08
Speaker 5: known donor or sperm Primum Bank for a few rounds
21:12
Speaker 5: and need to kind of reassess their choices. I also
21:18
Speaker 5: run a virtual community for queer folks and solar parents
21:21
Speaker 5: that bring people together for that mental health community support piece,
21:25
Speaker 5: which is really a huge thing that I see people
21:28
Speaker 5: just feeling alone throughout the process. I think everyone struggling
21:32
Speaker 5: with any sort of infertility feels that way. What's tricky
21:38
Speaker 5: and unique about queer family building or solo parent family
21:42
Speaker 5: building is that a huge majority of the data that
21:46
Speaker 5: we have on infertility is based on heterosexual people. So
21:51
Speaker 5: they've been trying to conceive either for six months at
21:55
Speaker 5: home if they're over thirty five, one year at home
21:58
Speaker 5: if they're under thirty five, and then and medically kind
22:01
Speaker 5: of they achieve that infertility diagnosis and get support there
22:08
Speaker 5: are some new studies that are coming out on the
22:11
Speaker 5: different considerations for queer folks and solo parents when the
22:15
Speaker 5: issue is really just access to the gam meats, the sperm,
22:20
Speaker 5: or the eggs or the uterus that they needn't. We
22:24
Speaker 5: don't always need infertility support, but sometimes we do so,
22:30
Speaker 5: so it's it's a complex decision making process. It's also
22:34
Speaker 5: influenced by the cost. There's a different financial burden placed
22:40
Speaker 5: on queer folks and solo parents when you have to
22:43
Speaker 5: buy sperm from a bank. That's really changed post pandemic.
22:48
Speaker 5: A vial of sperm used to be like six hundred
22:50
Speaker 5: to eight hundred dollars and now can be fifteen hundred
22:53
Speaker 5: or two thousand per vile.
22:55
Speaker 1: Why is that now?
22:56
Speaker 7: I'm interested, as again, I don't understands yet, you know,
23:02
Speaker 7: I think I think a lot of there were a
23:05
Speaker 7: lot of issues, a lot of social interruptions, you know,
23:09
Speaker 7: during the pandemic, And I don't fully know why it
23:13
Speaker 7: is so much more expensive, but it is, and it's
23:17
Speaker 7: really influenced how I advise folks on the choices that
23:21
Speaker 7: they make, because.
23:22
Speaker 5: Most people don't have the luxury of trying at home
23:26
Speaker 5: with previously frozen sperm for six to twelve months, and
23:30
Speaker 5: I don't necessarily recommend it because of the financial and
23:32
Speaker 5: emotional burden. So it's it's sort of a combination of
23:37
Speaker 5: looking at people's values and preferences than assessing age and
23:44
Speaker 5: other fertility predictors, and trying to forge a path that
23:52
Speaker 5: will reduce their time as much as possible and also
23:55
Speaker 5: reduce like the emotional and financial burden. And it's it's
23:58
Speaker 5: a complex process.
24:00
Speaker 2: Yeah, it's almost like there's too many choices. There's too
24:02
Speaker 2: many choices and too many ways to go into it.
24:05
Speaker 2: And somehow that like so many choices, but also.
24:09
Speaker 5: And we don't really know are you do you have
24:12
Speaker 5: been fertility or do you just not have access to
24:14
Speaker 5: sperming your relationship? And then how do you know? There
24:19
Speaker 5: are different recommendations medically for how to get pregnant, and
24:23
Speaker 5: sometimes it's hard to know what is ideal.
24:26
Speaker 2: Pooja, I want to come back in asking you to
24:30
Speaker 2: to something.
24:31
Speaker 1: Brianna said about age.
24:32
Speaker 2: So I think one of the things that's so tricky
24:36
Speaker 2: is navigating what we think of as this sort of
24:39
Speaker 2: age readiness trade off between you know, I want to
24:43
Speaker 2: wait because that's good for other aspects of my life.
24:45
Speaker 2: But then I'm worried about about fertility, and I think
24:48
Speaker 2: the mental health burden.
24:49
Speaker 1: There is actually pretty significant.
24:51
Speaker 2: Because it stresses you out, but also because then you
24:54
Speaker 2: you know, end up on the other end thinking, well,
24:56
Speaker 2: I waited too long because of this other trade off.
24:58
Speaker 2: So I'm like to ask how you think about people
25:03
Speaker 2: navigating that and what you'd how you'd counsel someone with
25:06
Speaker 2: that kind of kind of concerns in your practice.
25:10
Speaker 6: Yeah, yeah, I think that this is this is sort
25:15
Speaker 6: of like the million dollar question. I think, especially in
25:20
Speaker 6: my practice, where I'm taking care of women who generally
25:23
Speaker 6: are professionals, high achieving, you know, have gone to graduate school,
25:27
Speaker 6: have put in a lot of time and energy into
25:29
Speaker 6: their career, and so that means that they are delaying
25:34
Speaker 6: child bearing. And I personally went through that experience too.
25:38
Speaker 6: I actually wrote about it for The New York Times
25:39
Speaker 6: a couple of years ago that I was thirty eight
25:43
Speaker 6: and a half when I had my son, and and
25:46
Speaker 6: that kind of winding backwards didn't start. Didn't feel ready
25:50
Speaker 6: to become a mother until I was like thirty five,
25:53
Speaker 6: thirty six, and so had that conversation to look into
25:57
Speaker 6: egg freezing and then started trying and then had a
26:00
Speaker 6: carriage and then right, So it's like it takes time.
26:04
Speaker 6: So I think, you know, I guess a couple things
26:07
Speaker 6: on the readiness question. I think one, it's so easy
26:12
Speaker 6: to play Monday morning quarterback with your decisions and your
26:16
Speaker 6: life in general, and so I really try and encourage
26:19
Speaker 6: my patients like, no, you, at each step of the way,
26:22
Speaker 6: at each stage, you are making the best decisions for
26:25
Speaker 6: yourself with the data that you have, and there's a
26:29
Speaker 6: reason that you make choices at any given time, and
26:33
Speaker 6: it's not fair to sort of go back and beat
26:36
Speaker 6: yourself up. The other thing that I would say is,
26:39
Speaker 6: like one of the things talking about the stress piece
26:41
Speaker 6: Emily is like, yeah, like we as women, we as
26:44
Speaker 6: people that have uteruses, Like oftentimes, especially if you're in
26:47
Speaker 6: a heterosexual relationship, we're the ones that are constantly doing
26:51
Speaker 6: this calculus and doing this math like oh, okay, I'm
26:54
Speaker 6: thirty five right now, and like if I wait till
26:56
Speaker 6: I'm thirty seven, like this is what the numbers are. Right,
26:58
Speaker 6: And you have a male partner, usually it's like completely
27:02
Speaker 6: foreign to them to be thinking in this way and
27:04
Speaker 6: they're not sitting here some of them actually are on
27:07
Speaker 6: this zoom call, which is great, but most of them
27:10
Speaker 6: are not, right, Like they're not reading about this thought,
27:13
Speaker 6: they're not thinking about it. So it's interesting because I
27:16
Speaker 6: think we are often bearing this burden even before you
27:22
Speaker 6: start trying to conceive and talk about queer couples, right,
27:25
Speaker 6: Like it's such a it's like years before there's even
27:28
Speaker 6: like a baby or thinking about a pregnancy. So just
27:32
Speaker 6: naming that and like giving yourself some compassion there because
27:35
Speaker 6: it is such a heavy load. The other thing that
27:38
Speaker 6: I would say is that, like I think this is
27:41
Speaker 6: a little bit similar to what you say, Emily, Like
27:43
Speaker 6: there's no secret option. See, Like there's no secret option. See,
27:46
Speaker 6: there's no like perfect decision, there's no perfect time. It's
27:51
Speaker 6: just weighing for yourself, like all of the different pros
27:54
Speaker 6: and cons. Babies are expensive, Like babies are freaking expensive.
27:59
Speaker 1: Kids are expensive, right, so like.
28:01
Speaker 6: You know, just like the financial side, like the relationship side,
28:04
Speaker 6: like all of these things, and and kind of that's
28:09
Speaker 6: why it's kind of the first thing I mentioned was grief,
28:12
Speaker 6: because I do think that so much of this is
28:14
Speaker 6: about like making peace with yourself and coming to a
28:18
Speaker 6: place of acceptance and it take a long time to
28:22
Speaker 6: get there. You know, I think a lot of folks
28:24
Speaker 6: here on this call, I know I'm seeing like people
28:27
Speaker 6: want practical information about like what to do and how
28:30
Speaker 6: to get the best chance of success. And like, one
28:34
Speaker 6: of the things that's so hard about the infertility journey
28:36
Speaker 6: is like there's no one hundred percent like we There's
28:41
Speaker 6: never like if you do this, then definitely you will
28:44
Speaker 6: go home with a baby. There's there's just like shades
28:48
Speaker 6: of gray and optimizing, but there's never like that feeling
28:52
Speaker 6: of certainty that you could hang on to that if
28:54
Speaker 6: you're somebody who got pregnant easily, that that you just
28:58
Speaker 6: innately have. When you're somebody who has struggled with infertility,
29:02
Speaker 6: you you unfortunately, you never get back that feeling of certainty.
29:09
Speaker 1: Yeah.
29:10
Speaker 2: Yeah, And I think you know part of what's what's tough.
29:14
Speaker 2: And I sort of see this in a lot of
29:15
Speaker 2: your guys comments, it's like, well does this matter?
29:17
Speaker 1: Does this matter? Does this matter?
29:18
Speaker 2: And you know, we can look at those things in data,
29:21
Speaker 2: and a lot of times for a lot of the
29:23
Speaker 2: questions you're asking, the answer is no. So we know
29:27
Speaker 2: age matters, that's pretty clear. But a lot of these
29:30
Speaker 2: other things. You know, I have a few extra pounds here.
29:32
Speaker 2: I had one glass of wine day four. You know,
29:36
Speaker 2: I exercised too much.
29:37
Speaker 1: This stuff is.
29:38
Speaker 2: Not mattering in an important way in our chances of conception,
29:42
Speaker 2: but it's the piece of feeling like, well, there's got
29:44
Speaker 2: to be something I can control, Like what if I
29:46
Speaker 2: did everything perfectly, Well, I didn't do everything perfectly, and
29:48
Speaker 2: now it's my Now it's my my fault. And I
29:51
Speaker 2: think that's I think that's really that that's that's really
29:56
Speaker 2: hard because the loss of control is I think some
29:58
Speaker 2: of the hardest pieces pieces here. So I want to
30:05
Speaker 2: do one more sort of like questions for you guys,
30:08
Speaker 2: and then we're going to get to people's individual questions.
30:12
Speaker 2: And so I know you guys have already put a
30:13
Speaker 2: bunch in, but you can think think more about what
30:17
Speaker 2: you what you.
30:17
Speaker 1: Want to ask.
30:19
Speaker 2: But I want to the question I want to ask
30:21
Speaker 2: here is is kind.
30:22
Speaker 1: Of where where to start. So just in like a
30:25
Speaker 1: brief way, Uh, let's start with you, Maria.
30:28
Speaker 2: You know if you people come they say, I'm looking
30:31
Speaker 2: to build my family in a I'm a queer couple,
30:34
Speaker 2: I'm solo parent. I'm looking to build for some other
30:37
Speaker 2: reason in a non traditional way. Where would you recommend
30:41
Speaker 2: they start their thinking?
30:44
Speaker 5: Well, I wrote a bunch of articles that will be
30:47
Speaker 5: helpful for starting that process. I like to separate the
30:54
Speaker 5: the beginning approach into two parts, so the emotional part
30:58
Speaker 5: and the logistical part. Under emotional, I would include like
31:03
Speaker 5: values and know that that emotions often come in ways
31:07
Speaker 5: waves throughout this process. Under logistical, I'd include your access
31:14
Speaker 5: to fertility providers that have experience working with somebody in
31:18
Speaker 5: your situation and finances, all of those sorts of things,
31:22
Speaker 5: and sort of seeing those as two separate but interconnected processes. So,
31:27
Speaker 5: as Pooja said, there's often grief, there's often ambivalence. I
31:31
Speaker 5: think overwhelm is us feeling flooded by these emotions. So
31:37
Speaker 5: it's really important to have a space for that, and
31:41
Speaker 5: then also getting clear on the logistical side of things,
31:45
Speaker 5: your preferences. When it comes to either choosing a directed
31:49
Speaker 5: or known donor or unidentified donor from a bank, I
31:56
Speaker 5: recommend choosing that first because your type of don't or
32:00
Speaker 5: sperm and how easy it is for you to get
32:03
Speaker 5: it will influence your conception, options and choices, and so
32:08
Speaker 5: so that's generally where where I encourage people to start,
32:12
Speaker 5: like get that emotional support piece in order figure out
32:15
Speaker 5: where you're getting your sperm, and then and then you
32:18
Speaker 5: can either you know, trying at home. I read an
32:21
Speaker 5: article about at home incuminations for queer folks and solo parents.
32:26
Speaker 5: Maybe you're making an appointment with a reproductive endocrinologist and
32:30
Speaker 5: going straight to reciprocal IVF or IVF. We've got resources
32:33
Speaker 5: on all of that, but I would say that that's
32:36
Speaker 5: a good place to start aesome.
32:39
Speaker 2: All right, Brianna, For you, when do you seek help
32:42
Speaker 2: from a doctor?
32:43
Speaker 1: Started? Very practical. When should I start? When should I
32:46
Speaker 1: look for a doctor's help with conception?
32:49
Speaker 4: Yeah, well, ideally you would have some sort of visit
32:54
Speaker 4: preconception to just run down your med list, history, all
32:58
Speaker 4: of that, to make sure that all of that's compatible
33:00
Speaker 4: with the pregnancy and make sure you're up to day
33:02
Speaker 4: on your vaccines like all of that. But yeah, when
33:04
Speaker 4: you're actually ready to get started, I would definitely just
33:08
Speaker 4: check to see if you have any red flags. We
33:10
Speaker 4: actually have an article on this, but red flags would
33:13
Speaker 4: be things like if you aren't having regular periods, you're
33:17
Speaker 4: not having periods at all, If you have a history
33:19
Speaker 4: of endometriosis or ever having received chemo or radiation specifically
33:26
Speaker 4: to the pelvis, things like that. We have a whole
33:29
Speaker 4: article on it. In those cases you should seek help
33:31
Speaker 4: right away. Otherwise it really goes by age of the
33:35
Speaker 4: woman for the reasons we've been discussing, and so if
33:37
Speaker 4: you're less than thirty five, it's a year of trying.
33:40
Speaker 4: If you're over thirty five.
33:41
Speaker 1: It shorty tell us why? Sorry, can you tell us
33:44
Speaker 1: why this is? Why is it?
33:45
Speaker 4: Yeah?
33:45
Speaker 1: Why is it different in different ages?
33:48
Speaker 4: It's different because on fertility outcomes correlate best with age.
33:51
Speaker 4: So it's just shortened because your fertility starts to decline
33:55
Speaker 4: a little bit more rapidly between thirty five thirty seven,
33:57
Speaker 4: and so we really want to get you and you
34:00
Speaker 4: as possible, just for equality reasons.
34:04
Speaker 2: All right, poojia, how should people prepare for fertility treating?
34:11
Speaker 6: I actually, can I ask Brianna follow up question or
34:14
Speaker 6: ye go into more detail about when we say trying,
34:18
Speaker 6: what does that mean?
34:20
Speaker 4: Yeah, so sometimes people take it to mean like doing
34:24
Speaker 4: all the things like ovulation predictor kids all of that. No,
34:27
Speaker 4: it's just having unprotected intercourse regularly. So ideally are having
34:33
Speaker 4: it regularly.
34:34
Speaker 2: Wait, now I have a follow up, which is, yeah,
34:36
Speaker 2: someone has been trying, like really trying, like I'm ovulation testing,
34:40
Speaker 2: I'm doing it, Like should I cut it off earlier
34:43
Speaker 2: because like, I'm trying hard. I've been trying harder, and
34:46
Speaker 2: so I should have learned more from like three months
34:49
Speaker 2: rather than six months.
34:51
Speaker 4: No, not necessarily. No, it's still you know, this is
34:54
Speaker 4: just kind of a statistics kind of map probability thing.
34:57
Speaker 4: It's it's not necessary really like you're trying harder, so
35:02
Speaker 4: that means something's really wrong. There could still be other
35:05
Speaker 4: things that it just takes time. But yeah, no, I
35:09
Speaker 4: just mean having regular unprotected intercourse.
35:12
Speaker 1: Awesome, thank you.
35:15
Speaker 6: So what so my question was what would I say
35:18
Speaker 6: to patients like as they're starting to prepare or get.
35:20
Speaker 1: Ready for fragility, Yeah, fertility, Yes, so a couple of things.
35:27
Speaker 1: I think.
35:27
Speaker 6: First, if if you're going down the IVF path or
35:31
Speaker 6: even the EUI path, I'm like really honest with my
35:34
Speaker 6: patients and usually they like this, sometimes they get mad
35:36
Speaker 6: at me, but think that it is going to be
35:40
Speaker 6: kind of another full time job in terms of the
35:44
Speaker 6: blood draws, the testing that you need to get done
35:47
Speaker 6: when you're in the midst of the cycles where they're
35:49
Speaker 6: monitoring your follicles to see how they're growing. Like it's
35:52
Speaker 6: a lot of time. For about like two weeks or so,
35:54
Speaker 6: you'll kind of be living at the office. And and
35:58
Speaker 6: the thing is that there's just so much information and
36:01
Speaker 6: it's kind of like learning a new language that you
36:03
Speaker 6: do really sort of end up. It's like by the
36:05
Speaker 6: end of it, you'll kind of feel like you have
36:07
Speaker 6: a PhD in IVF because you're kind of just like
36:11
Speaker 6: learning all of this information.
36:12
Speaker 1: So one is just to be prepared for that.
36:14
Speaker 6: And I like that Brand mentioned that overwhelmed, Like it
36:17
Speaker 6: is overwhelming. It's overwhelming, and that's normal, and like it
36:20
Speaker 6: sucks that it is this way. The reason is because
36:22
Speaker 6: what things that we've talked about, like we should be
36:24
Speaker 6: learning about this in school, we should have this vocabulary,
36:27
Speaker 6: but we don't, so it can feel really overwhelming. And
36:30
Speaker 6: so again like leaning on your support system, having other
36:33
Speaker 6: people in your life who have been through it that
36:35
Speaker 6: you feel comfortable talking about your situation with. It doesn't
36:39
Speaker 6: need to be like ten people, it could literally just
36:41
Speaker 6: be one or two people. And then just being prepared
36:45
Speaker 6: for the uncertainty. I think so much of this.
36:48
Speaker 1: I know it.
36:48
Speaker 6: It's annoying that I keep mentioning that because there's like
36:52
Speaker 6: not a lot of like tangible stuff that you can
36:54
Speaker 6: do to deal with uncertainty. But really, like the marker
36:58
Speaker 6: of an infertility journey really is that you're it's just
37:02
Speaker 6: one hurdle after the next, you know where you first
37:05
Speaker 6: you get the eggs, and then and then you're waiting
37:07
Speaker 6: to see like how many how many get fertilized, and
37:10
Speaker 6: then maybe you're doing genetic testing, and then you're waiting
37:12
Speaker 6: to find out like is how is your uterine lining?
37:15
Speaker 6: And I don't say this to like freak anybody out,
37:17
Speaker 6: but more just to say like, it's a long process,
37:20
Speaker 6: and so you have to kind of think of it
37:22
Speaker 6: as like a marathon as opposed to a sprint, and
37:25
Speaker 6: you really want to be giving yourself all of the
37:30
Speaker 6: same like care and attention and love as much as
37:32
Speaker 6: possible as you would give to that little baby that
37:35
Speaker 6: you're hoping to bring home.
37:44
Speaker 2: More parent data after the break, we're in turn to question,
38:00
Speaker 2: So if you have a question, raise your hand.
38:03
Speaker 1: We'll get to as many as we can.
38:05
Speaker 2: You can go on camera or just in audio, and
38:08
Speaker 2: I saw Katie m had her hand up before.
38:11
Speaker 1: It's not up anymore.
38:12
Speaker 2: But Katie, if you still want to ask your question,
38:14
Speaker 2: I'm going to go with you.
38:15
Speaker 1: First, let me give you a second. Hey, I appreciate that.
38:19
Speaker 8: My question was just going back to Brianna's guidance about
38:23
Speaker 8: when to seek medical help when you're trying to conceive.
38:27
Speaker 8: It sounded like you said that before thirty five there
38:29
Speaker 8: was a pretty clear guideline, and then that between thirty
38:32
Speaker 8: five and thirty seven or so there's maybe another sort
38:37
Speaker 8: of general drop off infertility at that point. Are there
38:40
Speaker 8: guidelines you could provide sort of all other factors being
38:43
Speaker 8: equal of between thirty five and thirty seven and then
38:47
Speaker 8: thirty seven and you know, maybe forty about when you
38:50
Speaker 8: would see someone if you're having trouble conceiving.
38:54
Speaker 1: I just want it. Can I just say?
38:56
Speaker 2: This is why I love people a parent who are
38:58
Speaker 2: Parent Data subscribers so much, because we need like by month, Rihanna,
39:02
Speaker 2: thirty seven or so does not work over here, And
39:06
Speaker 2: thank you Katie for.
39:07
Speaker 1: Calling that out. I appreciate it.
39:08
Speaker 2: Rihanna.
39:09
Speaker 1: Let's go with precision.
39:11
Speaker 4: So unfortunately, there really aren't by month guidelines it's over.
39:18
Speaker 4: Thirty five is six months of trying, and then a
39:21
Speaker 4: lot of fertility providers will say when you get to
39:23
Speaker 4: forty you should seek help right away, but I mean
39:26
Speaker 4: it's totally individual. And this is kind of what I
39:28
Speaker 4: mean too about like ideally you'd have a physician who
39:33
Speaker 4: can talk to you, and like you just feel like
39:36
Speaker 4: you could go to them and ask them all these questions, like, oh,
39:39
Speaker 4: I'm thirty six and I've been trying for three months,
39:43
Speaker 4: but I really want to start the work up now,
39:45
Speaker 4: Like I think I think that's where you can talk
39:47
Speaker 4: to your provider and they can give you like look
39:49
Speaker 4: at your specific scenario and give you more specific kind
39:52
Speaker 4: of month to month guidance. But generally speaking about thirty
39:56
Speaker 4: five is all kind of lumped into the six months
39:58
Speaker 4: and then forty you can go right away.
40:00
Speaker 1: Does that help?
40:02
Speaker 9: Yeah?
40:02
Speaker 1: Thank you, Sarah. What do you get hey?
40:08
Speaker 9: I had a question about that five percent number or
40:11
Speaker 9: the kind of idea of you know, five percent likelihood
40:14
Speaker 9: to get pregnant each cycle when you're you know, forty,
40:18
Speaker 9: and just how does that impact like your past history,
40:21
Speaker 9: Like I had my first baby really easily at thirty seven.
40:24
Speaker 9: Now my mom got pregnant, you know, very easily throughout
40:27
Speaker 9: her life into her forties. Like, what are the factors
40:30
Speaker 9: that kind of tell you is my likelihood maybe a
40:32
Speaker 9: little bit higher than five percent every month given that
40:35
Speaker 9: I had, you know, a baby easily in my late thirties.
40:38
Speaker 9: That's kind of my overall question.
40:42
Speaker 4: Yeah, it's really hard to apply these kind of population
40:45
Speaker 4: level statistics to your individual situation. So I love that
40:50
Speaker 4: your question kind of addresses that. I would say, having
40:53
Speaker 4: been able to conceide for four is certainly certainly a
40:57
Speaker 4: good prognostic indicator, as we would say, I like, it's
41:00
Speaker 4: certainly something good in your favor. Certainly, I think to
41:05
Speaker 4: some extent kind of like the fertility of your family.
41:09
Speaker 4: So if you have a very long family history of
41:11
Speaker 4: women being able to conceive into their late age, that's
41:14
Speaker 4: certainly not going to hurt you. But I think kind
41:17
Speaker 4: of with that five percent number overall, I think that's
41:20
Speaker 4: why a lot of fertility specialists just say, go seek
41:24
Speaker 4: help right away. But yeah, there really isn't This is
41:28
Speaker 4: a great question, and there's not like more data than
41:31
Speaker 4: that other I mean, because we don't see the people
41:32
Speaker 4: who are able to conceive easily, so I'm biased in
41:36
Speaker 4: that way too.
41:37
Speaker 2: We don't see them much in data either, right, I
41:39
Speaker 2: mean it's hard to like it's that kind of really
41:43
Speaker 2: detailed data where we would actually actually kind of have
41:48
Speaker 2: like how long did your mom take and how long
41:50
Speaker 2: did you take for the first one, you know, and
41:52
Speaker 2: we're how hard were you trying?
41:53
Speaker 1: And so on. I think is not is I don't know,
41:57
Speaker 1: not not easy Ellen, Oh yeah, poo Je.
42:02
Speaker 6: Sorry, well, I just wanted to jump in and Brianna,
42:04
Speaker 6: you can correct me if this is if you don't agree.
42:08
Speaker 6: But I think for the folks that are kind of
42:09
Speaker 6: asking like should I go in to see the doctor
42:11
Speaker 6: or should I wait, I think it's always I always
42:14
Speaker 6: err on the side of just going, you know, because
42:16
Speaker 6: a lot of times for the first part of the
42:19
Speaker 6: workup is going to be lab tests that are time
42:22
Speaker 6: to your cycle as well, so it's going to take
42:25
Speaker 6: a little bit of time to do whatever work up
42:28
Speaker 6: is needing to happen. And I think just having that
42:31
Speaker 6: conversation with your ob can help alleviate a lot of
42:35
Speaker 6: anxiety too, and just lay out a map for you
42:39
Speaker 6: in terms of like the next six months, because right
42:41
Speaker 6: now when you're just kind of questioning to yourself, should
42:43
Speaker 6: I go or should I not go? It's already taking
42:45
Speaker 6: up a lot of mental space. So might as well
42:48
Speaker 6: take an action and do something and then go have
42:50
Speaker 6: a conversation where you so you feel like you have
42:53
Speaker 6: a little bit of agency there, Mary, when you have
42:56
Speaker 6: to be like I've never had an ob be like,
42:58
Speaker 6: oh my gosh, I can't believe you came to see
43:00
Speaker 6: me at like four months instead of six months.
43:02
Speaker 1: You know.
43:04
Speaker 2: Yeah, people, when you see people, Maria, do you do
43:08
Speaker 2: you basically tell them to go right right away.
43:13
Speaker 5: That's generally my recommendation. I do work with a fair
43:16
Speaker 5: amount of people that are like, I want to stay
43:18
Speaker 5: outside of the Western medical system as much as possible.
43:21
Speaker 5: I want this to be as like quote unquote natural
43:24
Speaker 5: as possible. And so the personal preference is a factor,
43:30
Speaker 5: is an important factor. And for those folks, depending on
43:34
Speaker 5: their menstrual cycle, their ovulation signs and symptoms, how old
43:38
Speaker 5: they are, you know, that can be really reasonable to
43:41
Speaker 5: to not get that work up right away. But yes,
43:44
Speaker 5: for the people that are over thirty five, don't really
43:49
Speaker 5: have those same qualms about accessing care in the Western
43:52
Speaker 5: medical system. It's it's never it's never a bad idea,
43:57
Speaker 5: although I will say, and Brianna mentioned this at the beginning,
43:59
Speaker 5: like even when you get that work up, it's not
44:02
Speaker 5: necessarily going to tell you that you will get pregnant
44:06
Speaker 5: easily or you won't. There are a lot of factors
44:08
Speaker 5: that go into that.
44:11
Speaker 1: Ellen, Hi, Hi, thank you guys. This is great.
44:18
Speaker 4: Just wondering.
44:19
Speaker 10: So it's kind of too full to question if you
44:23
Speaker 10: are like looking at that year or six month window
44:26
Speaker 10: and in that time you do conceive and you have
44:30
Speaker 10: an early loss, do you consider like do you have
44:35
Speaker 10: to bump that time before somebody is usually willing to
44:38
Speaker 10: see you, or like does that count? So that's like
44:44
Speaker 10: part one, and then the other piece of it is like,
44:47
Speaker 10: what are like some of the first steps before IVF
44:51
Speaker 10: or IUI or some of the more intensive things are
44:56
Speaker 10: like the little things you can do.
44:58
Speaker 4: No, no, no, you don't have to reach Are the clock?
45:00
Speaker 4: Please still come in? Yeah? Please still come in? And
45:05
Speaker 4: then the second question about what to do kind of
45:09
Speaker 4: prefertility treatments is how I understand it kind of how
45:12
Speaker 4: to optimize natural conception, which we do have an article on,
45:16
Speaker 4: but there's quite a few things. I mean, we can
45:19
Speaker 4: first of all, understanding that you really do need to
45:22
Speaker 4: be having a lot of intercourse, not just right around
45:26
Speaker 4: the time of ovulation. So a lot of people will
45:29
Speaker 4: just use, well they consider trying to be using ovulation
45:33
Speaker 4: predictor kits, and then they have intercourse the day of
45:35
Speaker 4: a positive ovulation kit and maybe like the next day
45:37
Speaker 4: when ideally you should ideally have sperm mixtos, you're kind
45:40
Speaker 4: of before that. So a lot of it would be
45:43
Speaker 4: kind of understanding your fertility window, what test you're using,
45:46
Speaker 4: and just making sure you're having enough sex, and then
45:49
Speaker 4: kind of eliminating the things that we know are harmful,
45:53
Speaker 4: so just heavy alcohol, use tobacco. You would look at
45:57
Speaker 4: your medlist just to make sure that's okay. Yeah, stuff
45:59
Speaker 4: like that. But we have a whole article that goes
46:01
Speaker 4: into more detail.
46:02
Speaker 2: What do you mean, like a lot of sex, like
46:04
Speaker 2: multiple times every day, every other day every day?
46:08
Speaker 1: How much sex is enough? People would like.
46:09
Speaker 4: To know ideally daily, but you can stretch it to
46:13
Speaker 4: every two.
46:14
Speaker 1: Every other every other day. Yeah, exactly, Bill, is a lot.
46:18
Speaker 1: I mean, I'm just saying it is a lot.
46:19
Speaker 2: I say that because I think But one thing I
46:23
Speaker 2: think is worth naming is like people think it's going
46:26
Speaker 2: to be it's not as fun to have sex when
46:29
Speaker 2: you're trying to conceive, maybe Pooja. I'm sure you have
46:32
Speaker 2: thoughts on this also from your things, but it's like
46:34
Speaker 2: not as it gets boring.
46:37
Speaker 6: No, no, nobody reports it being fun.
46:42
Speaker 2: I had a man I've been I want to understand
46:44
Speaker 2: there's no men on this, but I had a man
46:46
Speaker 2: in my office the other day who explained to me, like,
46:48
Speaker 2: it's not fun to have sex this much to trinye.
46:50
Speaker 2: So I don't think this is a gendered I don't
46:52
Speaker 2: think this is gendered as much as we might think.
46:55
Speaker 5: It also takes about twenty four hours for people with
47:00
Speaker 5: to regain their sperm count and motility, so waiting those
47:03
Speaker 5: twenty four hours is helpful to make sure that Lisa
47:07
Speaker 5: wasting your attempts.
47:08
Speaker 2: Yeah, okay, Emily with it.
47:14
Speaker 1: There are like four thousand Emily's.
47:15
Speaker 2: Thank you for everyone having the same name Emily with
47:18
Speaker 2: a lowercase.
47:19
Speaker 11: It's me, thank you, Good afternoon, everybody. I'm trying to
47:23
Speaker 11: focus on the data part of this question because I'm
47:26
Speaker 11: not asking you to tell me why I had a miscarriage.
47:28
Speaker 1: Don't worry, But.
47:29
Speaker 11: The question is I got pregnant very easily the first
47:33
Speaker 11: time actually also the second time, which is what ended
47:36
Speaker 11: up in a sixteen week mixed carriage. I have done
47:38
Speaker 11: every test under the sun, both on myself and on
47:41
Speaker 11: the fetus, and they can't find anything wrong.
47:43
Speaker 1: So the question is a two parter.
47:45
Speaker 11: Number one is with unexplained. I am assuming there's something chromozotal, obviously,
47:49
Speaker 11: but my issue is like why did my body I
47:52
Speaker 11: understand why you have a miscarriage, and my body did
47:55
Speaker 11: what it needed to do, but like why did it
47:57
Speaker 11: not happen at eight weeks or I could have maybe
47:59
Speaker 11: like blood at home didn't require surgery, Like why did
48:02
Speaker 11: it take so long for my body to recognize that
48:04
Speaker 11: this was like not healthy?
48:06
Speaker 1: Number one?
48:06
Speaker 11: And number two I was told that I could start
48:09
Speaker 11: trying again right away, which is I'm in three months though,
48:12
Speaker 11: and it's and they say, like, you actually are more
48:14
Speaker 11: fertile the six months after a miscarriage. But I feel
48:17
Speaker 11: like I know a lot of people once they had
48:18
Speaker 11: one miscarriage, they had several, so kind of like a
48:21
Speaker 11: multipart question on the unexplained part, like why did my
48:24
Speaker 11: body not handle this earlier in the pregnancy? And then
48:29
Speaker 11: number two is the statistics I'm getting pregnant again and
48:32
Speaker 11: ending in a healthy pregnancy, and like, don't I'm in
48:35
Speaker 11: therapy to find out, like, how do you not stress
48:37
Speaker 11: for them in the forty weeks so the next pregnancy.
48:39
Speaker 11: I don't expect you to answer that part of it,
48:40
Speaker 11: but more of the science part of it.
48:44
Speaker 4: So first, I'm really sorry to have a sixteen week loss.
48:49
Speaker 4: It sounds really tough, so I'm glad that you have.
48:52
Speaker 4: It sounds like a community of people who are kind
48:54
Speaker 4: of helping you process that. And I will also kind
48:57
Speaker 4: of say, as a caveat, I don't know your specific history,
49:01
Speaker 4: so it's going to be hard to get into as
49:03
Speaker 4: much nuance as I normally would if I was seeing
49:05
Speaker 4: a patient, and kind of the other nuances that second
49:09
Speaker 4: trimester losses generally have different etiologies compared to first trimester losses.
49:16
Speaker 4: I see a lot of patients for recurrent pregnancy loss,
49:19
Speaker 4: which it sounds like you're alluding to, which is multiple
49:22
Speaker 4: losses within that first trimester. I don't see as many
49:26
Speaker 4: patients who have had second trimester losses, at least compared
49:31
Speaker 4: to the ones I see with first trimester. And it's
49:33
Speaker 4: primarily because and this may answer your question. Those second
49:37
Speaker 4: trimester losses, usually there's it's something like structural infectious, maybe
49:45
Speaker 4: achord accident. Like it's usually something that's not at risk
49:49
Speaker 4: of repeating itself per se. And that's me saying that
49:52
Speaker 4: without knowing anything about your history or kind of seeing
49:55
Speaker 4: the test results. But I hope that kind of gives
49:58
Speaker 4: you some in in the sense that having one second
50:02
Speaker 4: trimester loss, I mean, having one loss generally does not
50:05
Speaker 4: necessarily mean that you're going to have another one. But
50:08
Speaker 4: second trimester losses are in a kind of different category
50:12
Speaker 4: compared to the first trimester losses.
50:15
Speaker 2: I think you can also see from the JAD here
50:16
Speaker 2: Emily that people are thinking about you.
50:21
Speaker 1: Monica.
50:22
Speaker 12: Hi, So I had a question about seeing an Obie
50:27
Speaker 12: Guinde versus a reproductive endocrinologist and making that decision Pope,
50:33
Speaker 12: like after you've after you've hit the six book mark
50:36
Speaker 12: depending on your age, early one year mark. So I'm
50:38
Speaker 12: just curious about that. And then a second part, which
50:42
Speaker 12: is actually not related, but I'm just curious, like when
50:45
Speaker 12: we say five percent or like twenty percent of being
50:48
Speaker 12: able to conceive, like what has to go right or
50:51
Speaker 12: like what is going wrong that like leads to the
50:53
Speaker 12: other eighty percent or the other ninety five percent. I
50:55
Speaker 12: think I've just been really curious about what actually happens.
50:59
Speaker 1: Maria.
50:59
Speaker 2: I'm going to pass that on to you to start,
51:00
Speaker 2: because I think you probably deal with people who think
51:02
Speaker 2: more about this choice between providers.
51:07
Speaker 5: Yeah, I would. I would recommend if you are having
51:11
Speaker 5: any fertility issues to go straight to seeing a reproductive endocrinologist.
51:15
Speaker 5: They specialize in assessing hormone levels and medications, and obe's
51:22
Speaker 5: can do kind of that initial workups, the lab test.
51:26
Speaker 5: Sometimes there's ultrasounds involved with that and that can be helpful.
51:30
Speaker 5: But I do think a reproductive endocrinologist is your best
51:33
Speaker 5: support person for the trying to conceive period.
51:40
Speaker 2: Yeah, and then the second part of that What was
51:41
Speaker 2: the second part of that question, Monica, I'm sorry.
51:44
Speaker 12: Yeah, it was like the what's what's the a percent
51:46
Speaker 12: that's going wrong or the ninety five percent that's going wrong?
51:48
Speaker 12: Just like what is or what has to go right
51:51
Speaker 12: for that leads to those percentages?
51:54
Speaker 4: Great question, so many things. It's kind of crazy how
51:58
Speaker 4: inefficient human reproduction is. This is what we've evolved to do,
52:02
Speaker 4: I guess, But yeah, so I mean you have to
52:05
Speaker 4: you have to have a follicle with an egg in it,
52:09
Speaker 4: So it can't be like an an ovulatory cycle where
52:12
Speaker 4: you're not releasing an egg. So that has to happen.
52:14
Speaker 4: The egg has to release, it has to be picked
52:16
Speaker 4: up by the Filippian tube. Sometimes that doesn't happen. Then
52:20
Speaker 4: it has to like travel its way too, from the
52:23
Speaker 4: Filippian tubes to the uterus, and the Filippian tubes is
52:26
Speaker 4: where it gets fertilized. So ideally sperm is already there waiting.
52:30
Speaker 4: That kind of factors into all of the things we've
52:32
Speaker 4: been talking about about how much how much sex do
52:35
Speaker 4: you need to have? So ideally the sperm is there waiting.
52:38
Speaker 4: And then yeah, it has to travel from the Philippian
52:41
Speaker 4: tubes to implant, and then of course it's just to
52:44
Speaker 4: say nothing about the genetics behind. It has to be
52:46
Speaker 4: a genetically normal egg, genetically normal sperm, all of that,
52:50
Speaker 4: and you know there's still factors now we don't completely understand.
52:53
Speaker 4: But yeah, not very unefficient process.
52:58
Speaker 5: I just want to briefly say we've been chatting about
53:01
Speaker 5: it a little bit in the chat, but getting a
53:03
Speaker 5: semen analysis for your partner or donor is really important.
53:08
Speaker 5: I think you know.
53:09
Speaker 4: Yes, we've spoken.
53:10
Speaker 5: There's a lot of women and female Boddy people here,
53:14
Speaker 5: and I think often that like burden of infertility is
53:17
Speaker 5: on the person with the uterus, so assessing male factor
53:22
Speaker 5: infertility is really important. There are some easy ways to
53:24
Speaker 5: do that. There's even at home mail and tests these
53:27
Speaker 5: days that have some decent assessment tools. So just putting
53:33
Speaker 5: that out there, all.
53:36
Speaker 2: Right, I'm going to take one more question and then
53:38
Speaker 2: we're going to end. But when we end, we will
53:41
Speaker 2: put up a slide which has links to sign up
53:44
Speaker 2: to the newsletter and which is all on infertility, and
53:49
Speaker 2: will also have a place for you guys to send
53:52
Speaker 2: in your questions because I know from the chat that
53:56
Speaker 2: there are a tremendous number of incredibly specific questions. Is
53:58
Speaker 2: exactly what we're intend the newsletter for, so we really
54:02
Speaker 2: want to hear those questions. We can get into this
54:04
Speaker 2: kind of detail in a way that it's hard on
54:06
Speaker 2: a that's hard on a big zoom.
54:08
Speaker 1: So Emily, you're up. You're the last one.
54:12
Speaker 2: Okay, you know other sorry, others, there's another Emily.
54:15
Speaker 1: I'm sorry, Emily. So is it me?
54:18
Speaker 3: Emily?
54:19
Speaker 1: Yes, it is you, Emily. Okay, Hi, So my question.
54:23
Speaker 13: I might not be in exactly the right room for this,
54:25
Speaker 13: but it's such a smart room. I'm hoping you can
54:27
Speaker 13: tell me where the right room to go is.
54:28
Speaker 1: If this is not.
54:29
Speaker 13: It, mine's about X topic pregnancy, which I have not
54:33
Speaker 13: found good information about anywhere. I've had two, with a
54:38
Speaker 13: healthy daughter born in between those two, and what I
54:42
Speaker 13: seem to find is like just test early and hope
54:45
Speaker 13: it's not a topic again, And that's a terrible answer,
54:49
Speaker 13: and I'm like coming up on thirty nine and so
54:52
Speaker 13: like everyone delays the next thing. Just wondering if anyone
54:55
Speaker 13: has anything to say or directions to point me related
54:58
Speaker 13: to ex topic pregnancy.
55:00
Speaker 4: Thank you. I think this could be the right root.
55:04
Speaker 4: Maybe I certainly treat topic pregnancies do surgery on them.
55:09
Speaker 4: I would say, yeah, I have a lot of questions
55:12
Speaker 4: I guess about your specific history, and I would want
55:14
Speaker 4: to see your uterine imaging. So I'd suppose a good
55:18
Speaker 4: place to start is go to your OBGI N and
55:22
Speaker 4: kind of start there, or if you've already been to
55:24
Speaker 4: your OB do I N. Maybe single fertility specials actually
55:27
Speaker 4: maybe get you a little bit closer. But yeah, certainly
55:31
Speaker 4: this is a very individual question. But I would want
55:34
Speaker 4: to look more closely at your history.
55:40
Speaker 1: Okay, guys, we're going to end there.
55:42
Speaker 2: Thank you so much, Brianna, Maria Pooja for being here,
55:47
Speaker 2: for writing for us, for answering questions in the chat.
55:52
Speaker 2: I think this is There is so much should be
55:55
Speaker 2: said on this space, and there are so many specific
55:58
Speaker 2: questions and somebody general questions.
56:00
Speaker 1: And I'm hoping that we will continue to grow this.
56:03
Speaker 2: Space over the next whatever period it is so people
56:08
Speaker 2: can get all of their questions answered. Send in your
56:11
Speaker 2: questions and thank you again for being here. Parent Data
56:26
Speaker 2: is produced by Tamar Avishai with support from the parent
56:29
Speaker 2: Data team and PI Rex. If you have thoughts on
56:32
Speaker 2: this episode, please join the conversation on my Instagram at
56:36
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56:39
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56:43
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56:51
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