Latest / Resiliency Radio with Dr. Jill Carnahan, MD / 330: Resiliency Radio with Dr. Jill: Perimenopause: The Silent Fertility Disrupter with Dr. Jaime Knopman

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330: Resiliency Radio with Dr. Jill: Perimenopause: The Silent Fertility Disrupter with Dr. Jaime Knopman · Resiliency Radio with Dr. Jill Carnahan, MD

• 0:01
  Dr. Jill Carnahan, MD: Welcome to Resiliency Radio, your go to podcast for the most cutting edge insights integrative and functional medicine.
• 0:07
  Dr. Jill Carnahan, MD: I'm your host Dr. Jaime and with each episode we dive into the heart of healing and personal transformation.
• 0:13
  Dr. Jill Carnahan, MD: Join me as I interview thought leaders, world experts, medical leaders, medical detectives and everyone in between just bringing you great practical information to help you on your journey to optimal health and healing.
• 0:26
  Dr. Jill Carnahan, MD: Today is no different.
• 0:28
  Dr. Jill Carnahan, MD: You are going to want to stay tuned as I talk to reproductive endocrinologist and fertility expert Dr. Jaime Notman.
• 0:35
  Dr. Jill Carnahan, MD: You're going to enjoy this interview if you're looking for options to help you have children in the future or now.
• 0:40
  Dr. Jill Carnahan, MD: If you're hitting per menopause and wondering can I still conceive?
• 0:43
  Dr. Jill Carnahan, MD: The answers to your questions are going to be captivating and will be inside this interview.
• 0:47
  Dr. Jill Carnahan, MD: If you stay tuned.
• 0:48
  Dr. Jill Carnahan, MD: I say stick around and you'll hear it all in just a few minutes.
• 0:52
  Dr. Jill Carnahan, MD: Before we jump in, I just want to remind you that we are accepting new patients at Flatiron Functional Medicine, my clinic in Lewisville, Colorado.
• 0:59
  Dr. Jill Carnahan, MD: I have a PA Fawn and a nurse practitioner, Hannah who are spectacularly intelligent for complex chronic illness.
• 1:06
  Dr. Jill Carnahan, MD: They are getting busy and getting full but we are still accepting new patients.
• 1:10
  Dr. Jill Carnahan, MD: If you want more information or want to schedule a free 10 minute call with one of them, you can call 303-993-7910.
• 1:18
  Dr. Jill Carnahan, MD: You can also email us at info@flatiron Functional Medicine.com we look forward to hearing from you.
• 1:25
  Dr. Jill Carnahan, MD: And guys, if you haven't yet checked out the website, Dr. Jaime health.com I've got products and services and our bestselling Dr. Jaime Beauty line.
• 1:33
  Dr. Jill Carnahan, MD: We have kits like the Mini Miracle Kit, the Hair regrowth kit and Dr. Jaime favorites.
• 1:38
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• 1:49
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• 1:50
  Dr. Jill Carnahan, MD: Okay guys, let's get to our show.
• 1:52
  Dr. Jill Carnahan, MD: Let me introduce our guest.
• 1:54
  Dr. Jill Carnahan, MD: Our guest is Dr. Jaime Notman.
• 1:55
  Dr. Jill Carnahan, MD: She's a double board certified reproductive endocrinologist and Infertility specialist serving as the Director of Fertility Preservation of CCRM Fertility in New York.
• 2:05
  Dr. Jill Carnahan, MD: Graduate of the University of Pennsylvania and INI School of Sorry I Can School of Medicine at Mount Sinai.
• 2:13
  Dr. Jill Carnahan, MD: She's completed her residency and fellowship at New York University Medical Center.
• 2:17
  Dr. Jill Carnahan, MD: She's nationally recognized for her expertise on fertility preservation, ivf, Egg freezing and reproductive endocrinology.
• 2:23
  Dr. Jill Carnahan, MD: You're going to love this interview.
• 2:24
  Dr. Jill Carnahan, MD: Let's let's join Dr. Jaime Notman.
• 2:27
  Dr. Jill Carnahan, MD: Dr. Notman, I'm super excited to have you on the podcast and talk about a very hot topic, but maybe a slightly different bent than we usually do.
• 2:35
  Dr. Jill Carnahan, MD: Our title is Perimenopause, the Silent fertility Disruptor.
• 2:38
  Dr. Jill Carnahan, MD: We're going to talk about how this might happen before you know it and all the things related that women want to hear or maybe their partners want to hear who are listening.
• 2:45
  Dr. Jill Carnahan, MD: but before we do, I always want to get to know my guests just a little bit more and tell me about your journey into medicine and then into this field.
• 2:52
  Dr. Jaime Knopman : Field, sure.
• 2:55
  Dr. Jaime Knopman : So thank you so much for having me.
• 2:57
  Dr. Jaime Knopman : My story is sort of, like, maybe typical.
• 2:59
  Dr. Jaime Knopman : I always knew I wanted to be a doctor.
• 3:02
  Dr. Jaime Knopman : I was in second grade.
• 3:03
  Dr. Jaime Knopman : I read a book about Elizabeth Blackwell, and I was decided that was what I was going to do.
• 3:08
  Dr. Jaime Knopman : I was going to become a physician.
• 3:10
  Dr. Jaime Knopman : And my path there was pretty linear.
• 3:12
  Dr. Jaime Knopman : I went to med school after college.
• 3:15
  Dr. Jaime Knopman : Between med school and college, I worked at Memorial Stone Kettering in their breast cancer department.
• 3:20
  Dr. Jaime Knopman : So I thought I wanted to be a surgical oncologist.
• 3:24
  Dr. Jaime Knopman : Once I got to med school, I realized that I didn't want to do that.
• 3:27
  Dr. Jaime Knopman : I really just wanted to take care of women.
• 3:29
  Dr. Jaime Knopman : And ob GYN seemed like a more fluid path there.
• 3:32
  Dr. Jaime Knopman : So I became an obstetrician, gynecologist, and from my ob GYN residency, was fascinated by hormones and subspecialized in reproductive endocrinology and infertility.
• 3:44
  Dr. Jill Carnahan, MD: Wow.
• 3:44
  Dr. Jill Carnahan, MD: Very, very cool.
• 3:45
  Dr. Jill Carnahan, MD: It's so interesting, too.
• 3:46
  Dr. Jill Carnahan, MD: Like you with medicine, we go into that thinking this one thing, and then we kind of see, you know, like, oh, maybe that's not exactly the kind of thing I want to do.
• 3:53
  Dr. Jill Carnahan, MD: And I love hearing about the journeys and then how we up where we're at.
• 3:56
  Dr. Jill Carnahan, MD: And, yeah, really interesting.
• 3:59
  Dr. Jill Carnahan, MD: So fertility has been a defining topic of conversation in the last decade and.
• 4:03
  Dr. Jill Carnahan, MD: And becoming more and more important because the rates of infertility are climbing, and that might be a good place to start.
• 4:10
  Dr. Jill Carnahan, MD: Do you know any basic statistics on what we're seeing for both men and women?
• 4:13
  Dr. Jill Carnahan, MD: And obviously, we're going to be focusing on women's health, but why is this becoming much more of an issue than it was, say, 20, 30, 50 years ago?
• 4:21
  Dr. Jaime Knopman : So now one in six individuals worldwide will struggle with infertility.
• 4:26
  Dr. Jaime Knopman : And the reason that the rates have risen so dramatically, really, number one, number two.
• 4:30
  Dr. Jaime Knopman : Number three.
• 4:31
  Dr. Jaime Knopman : Number four is age.
• 4:32
  Dr. Jaime Knopman : Right.
• 4:32
  Dr. Jaime Knopman : We are no longer having children at the same ages that we once were.
• 4:37
  Dr. Jaime Knopman : We were meant to have babies, meaning, like our ovaries and sperm and our reproductive organs are at their prime in their.
• 4:45
  Dr. Jaime Knopman : In our 20s.
• 4:46
  Dr. Jaime Knopman : But people don't have babies in their 20s anymore.
• 4:49
  Dr. Jaime Knopman : In many developed countries, they're pushing having children into their 30s.
• 4:53
  Dr. Jaime Knopman : And because of this, we're seeing higher and higher rates of infertility.
• 4:57
  Dr. Jaime Knopman : Now, I'm always asked, do you think there's an impact of toxins or environmental factors?
• 5:02
  Dr. Jaime Knopman : Probably there are.
• 5:04
  Dr. Jaime Knopman : We just don't know what those are specifically today.
• 5:07
  Dr. Jaime Knopman : So I would say age is the primary driving factor.
• 5:10
  Dr. Jaime Knopman : And as we get older, having children, we're just going to see the rates of infertility continue to soar.
• 5:16
  Dr. Jill Carnahan, MD: Yeah, that makes a lot of sense because really, people are delaying pregnancy, delaying marriage, delaying cohabitation and things that lead to fertility issues.
• 5:25
  Dr. Jill Carnahan, MD: so that makes a lot of sense.
• 5:27
  Dr. Jill Carnahan, MD: And then all women are also getting pregnant later with the help of infertility clinics and interventions and things.
• 5:33
  Dr. Jaime Knopman : Yeah.
• 5:33
  Dr. Jill Carnahan, MD: Talk about fertility as a vital sign.
• 5:36
  Dr. Jill Carnahan, MD: I like that framework and I think it's important because I think there's a lot of women that don't think of it that way.
• 5:41
  Dr. Jill Carnahan, MD: Do you want to frame it that way?
• 5:43
  Dr. Jill Carnahan, MD: And.
• 5:43
  Dr. Jill Carnahan, MD: And why it's actually much more than just getting pregnant?
• 5:48
  Dr. Jaime Knopman : Yeah, I mean, I have thought about this for a while.
• 5:50
  Dr. Jaime Knopman : We go to our ob GYN and he or she talks to us about contraception and breast health and cervical and STD screening.
• 5:58
  Dr. Jaime Knopman : But we need that fifth pillar, and that fifth pillar should be talking about your fertility.
• 6:04
  Dr. Jaime Knopman : Right.
• 6:04
  Dr. Jaime Knopman : And what do you plan to down the road?
• 6:06
  Dr. Jaime Knopman : And how can you significantly decrease the incidence of infertility?
• 6:12
  Dr. Jaime Knopman : It's always been fascinated me that infertility is the.
• 6:15
  Dr. Jaime Knopman : One of the only diseases we wait for you to have before we treat you.
• 6:20
  Dr. Jaime Knopman : Right.
• 6:20
  Dr. Jaime Knopman : Like, we don't wait for you to have breast cancer and then, you know, like, treat you.
• 6:25
  Dr. Jaime Knopman : I mean, we do, but, like, we try and prevent breast cancer.
• 6:28
  Dr. Jaime Knopman : We try and prevent cervical cancer.
• 6:30
  Dr. Jaime Knopman : Why don't we try and prevent infertility?
• 6:33
  Dr. Jaime Knopman : Because we have a lot of diagnostic technologies and capabilities and treatment options that could do that.
• 6:40
  Dr. Jill Carnahan, MD: Makes so much sense.
• 6:41
  Dr. Jill Carnahan, MD: And so why per menopause is kind of the topic.
• 6:45
  Dr. Jaime Knopman : I'm just turning off my heat.
• 6:46
  Dr. Jaime Knopman : Sorry.
• 6:46
  Dr. Jaime Knopman : It was so cold in my office and now it's so hot.
• 6:49
  Dr. Jaime Knopman : So there you go.
• 6:51
  Dr. Jill Carnahan, MD: We can edit Easy peasy.
• 6:53
  Dr. Jaime Knopman : As we're on the topic of menopause.
• 6:55
  Dr. Jaime Knopman : Yeah.
• 6:55
  Dr. Jaime Knopman : I was like, it is so cold.
• 6:58
  Dr. Jaime Knopman : I feel like my mom, who back in the 80s used to like, scream at us, open the window.
• 7:02
  Dr. Jaime Knopman : Close the window.
• 7:03
  Dr. Jaime Knopman : Yeah, yeah.
• 7:05
  Dr. Jill Carnahan, MD: So.
• 7:05
  Dr. Jaime Knopman : So because women are having their children later when Frequently it's sort of this clash between perimenopause, menopause and trying to conceive all at the same time.
• 7:15
  Dr. Jaime Knopman : But it's like a trifecta.
• 7:16
  Dr. Jaime Knopman : It's an unhappy sort of trifecta.
• 7:19
  Dr. Jaime Knopman : So the only thing you can do right is frequently, hopefully have done some form of fertility preservation before so that the chance of this is lower makes.
• 7:32
  Dr. Jill Carnahan, MD: A lot of sense.
• 7:33
  Dr. Jill Carnahan, MD: So often we're seeing women who come in, they're like 35 and they want to get pregnant.
• 7:37
  Dr. Jill Carnahan, MD: And you're seeing, oh wait, there's AMH issues and whatever else.
• 7:41
  Dr. Jill Carnahan, MD: How would women, first of all, how would we reframe that?
• 7:44
  Dr. Jill Carnahan, MD: If someone says, you know, they're in their late 20s, but they know in a decade they want to get pregnant, what would you recommend to that person?
• 7:51
  Dr. Jill Carnahan, MD: And when should we start thinking about this?
• 7:53
  Dr. Jaime Knopman : I mean, I think we need to start thinking about in our early 20s, right.
• 7:57
  Dr. Jaime Knopman : We should go in and say, hey, like I think I want kids or I'm not sure if I want kids or if I'm not sure if I don't want kids.
• 8:04
  Dr. Jaime Knopman : But I know I want the opportunity.
• 8:07
  Dr. Jaime Knopman : So I want to at least check my ovarian reserve today.
• 8:10
  Dr. Jaime Knopman : Right.
• 8:11
  Dr. Jaime Knopman : And that doesn't mean that you have to freeze eggs or if that you freeze eggs, you have to use those eggs, but it gives you the opportunity to potentially have genetic children.
• 8:22
  Dr. Jaime Knopman : I mean, I am now like a flood with stor women who come in who are having fertility struggles in their 40s.
• 8:28
  Dr. Jaime Knopman : And we turn around and we look at their eggs and we use their eggs and the eggs are, you know, I say eggs for the win.
• 8:35
  Dr. Jaime Knopman : Those eggs are coming in and serving woman is serving as her own egg donor.
• 8:39
  Dr. Jaime Knopman : Right.
• 8:39
  Dr. Jaime Knopman : Her 30, 20 year old self is being the egg donor now at 40 something.
• 8:44
  Dr. Jill Carnahan, MD: Wow.
• 8:44
  Dr. Jill Carnahan, MD: So if they think ahead, there's this real big opportunity for them to do something later that they had.
• 8:49
  Dr. Jill Carnahan, MD: Now you'll understand this completely, Dr. Notman.
• 8:52
  Dr. Jill Carnahan, MD: But back I was diagnosed with breast cancer at 25, very aggressive.
• 8:56
  Dr. Jill Carnahan, MD: And of course I'm 25.
• 8:57
  Dr. Jaime Knopman : Right.
• 8:57
  Dr. Jill Carnahan, MD: No children.
• 8:57
  Dr. Jill Carnahan, MD: Yeah.
• 8:58
  Dr. Jill Carnahan, MD: And I was offered that egg retrieval and freezing and what ended up happening.
• 9:02
  Dr. Jill Carnahan, MD: Because my cancer was so aggressive and I was so young, they thought that the potential process of, and I'd love to know your opinion because now it's plus years.
• 9:11
  Dr. Jill Carnahan, MD: But the process of, you know, inducing ovulation and getting eggs might even be risky.
• 9:16
  Dr. Jill Carnahan, MD: And because I was unsure, I decided not to.
• 9:18
  Dr. Jill Carnahan, MD: Now because I made the decision at 25 very clearly, I don't have regrets, but it's Interesting.
• 9:23
  Dr. Jill Carnahan, MD: Because a lot of women, I mean, because of the breast cancer, I was offered that, but I've never had children.
• 9:29
  Dr. Jill Carnahan, MD: And part of the infertility has been because of the chemo and the radiation that they thought, what would you have said to my 25 year old self back then?
• 9:37
  Dr. Jill Carnahan, MD: Would you have been pro or con for egg retrieval or what?
• 9:41
  Dr. Jill Carnahan, MD: Would you have any thoughts on that?
• 9:43
  Dr. Jaime Knopman : I would have been pro for egg retrieval.
• 9:45
  Dr. Jaime Knopman : Yeah.
• 9:46
  Dr. Jaime Knopman : Because you.
• 9:47
  Dr. Jaime Knopman : Yes.
• 9:48
  Dr. Jaime Knopman : Like theoretical risk exists.
• 9:50
  Dr. Jaime Knopman : Right.
• 9:50
  Dr. Jaime Knopman : We all fear an will this make my cancer worse?
• 9:55
  Dr. Jaime Knopman : Will the delay for two to three weeks make it worse?
• 9:58
  Dr. Jaime Knopman : You know, but we know that does not appear to be the case.
• 10:01
  Dr. Jaime Knopman : And that's why we offer egg freezing electively to so many patients, because we now know that really can come in and be the savior frequently down the road after surgery or chemo or whatever it may be.
• 10:17
  Dr. Jill Carnahan, MD: Yeah, that makes so much sense.
• 10:19
  Dr. Jill Carnahan, MD: And again, I just had to decide and I've always learned in my medical history that I, when I made a decision, I always just felt like I'm doing the best with have and I'll never look back and regret.
• 10:27
  Dr. Jill Carnahan, MD: So I don't have regrets.
• 10:28
  Dr. Jill Carnahan, MD: But I also have never had a biological child and part of that is because of my journey.
• 10:32
  Dr. Jill Carnahan, MD: So I understand this so well in a different lens because I've been through it and I want for women to have that opportunity, especially if they're facing something and they don't know about their future.
• 10:42
  Dr. Jill Carnahan, MD: So super important.
• 10:43
  Dr. Jill Carnahan, MD: I love that you answered that so clearly.
• 10:48
  Dr. Jill Carnahan, MD: What?
• 10:48
  Dr. Jill Carnahan, MD: Oh, here's the other thing I want to mention.
• 10:50
  Dr. Jill Carnahan, MD: So a lot of women I'm just finding out that are in my practice are like, my insurance covers this.
• 10:54
  Dr. Jill Carnahan, MD: How often?
• 10:55
  Dr. Jill Carnahan, MD: That surprised me when I first heard that.
• 10:57
  Dr. Jaime Knopman : So we're seeing it more and more.
• 10:58
  Dr. Jaime Knopman : I mean, this when people ask me what's the biggest game changer?
• 11:01
  Dr. Jaime Knopman : Of course it's improvements in technology and awareness, but more than that is access to care.
• 11:07
  Dr. Jaime Knopman : Right.
• 11:08
  Dr. Jaime Knopman : More and more women are being able to do this because their employer is going to foot the bill.
• 11:15
  Dr. Jaime Knopman : So I just sat with a woman who's going to leave.
• 11:18
  Dr. Jaime Knopman : You know, I joke around, I'm like, I know things before anyone else does because patients will be like, I'm going to leave my job.
• 11:23
  Dr. Jaime Knopman : And I'm like, okay, don't worry, I'm not going to tell anyone.
• 11:25
  Dr. Jaime Knopman : Right.
• 11:26
  Dr. Jaime Knopman : But I want to access my benefits before I leave.
• 11:29
  Dr. Jaime Knopman : And that is why people are doing this, are able to do this when previously they may not have been.
• 11:35
  Dr. Jill Carnahan, MD: Is it true?
• 11:36
  Dr. Jill Carnahan, MD: I mean, in my recollection this was rarely covered.
• 11:40
  Dr. Jill Carnahan, MD: Is this pretty new in the last?
• 11:41
  Dr. Jaime Knopman : Yeah, I'd say in the last.
• 11:43
  Dr. Jaime Knopman : I think Covid was a real big turning point.
• 11:45
  Dr. Jaime Knopman : The numbers of women freezing their eggs went up dramatically in 2020.
• 11:50
  Dr. Jaime Knopman : Not only here, abroad as well.
• 11:53
  Dr. Jaime Knopman : And now it's.
• 11:53
  Dr. Jaime Knopman : I mean, it's like 800 fold greater.
• 11:56
  Dr. Jaime Knopman : Right.
• 11:56
  Dr. Jaime Knopman : And.
• 11:57
  Dr. Jaime Knopman : And with that rise, really what was paralleled was the rise in coverage from employers.
• 12:05
  Dr. Jill Carnahan, MD: Okay, amazing, because that should surprise me.
• 12:07
  Dr. Jill Carnahan, MD: When I heard, I thought, oh, it is more common.
• 12:09
  Dr. Jill Carnahan, MD: And again, that's not my area of expertise, but.
• 12:11
  Dr. Jill Carnahan, MD: So you mentioned that this may or may not be as known as some of the basic factors of aging.
• 12:16
  Dr. Jill Carnahan, MD: But what are your thoughts around endocrine disrupting chemicals, poor sleep, poor diet, insulin resistance?
• 12:23
  Dr. Jill Carnahan, MD: Are there other factors that have evidence based that could be contributing to infertility as well?
• 12:28
  Dr. Jaime Knopman : I mean, we definitely know insulin sensitivity.
• 12:30
  Dr. Jaime Knopman : Right?
• 12:31
  Dr. Jaime Knopman : Women who are not ovulating at regular intervals because of insulin sensitivity, obesity.
• 12:38
  Dr. Jaime Knopman : That is definitely contributing to fertility struggles.
• 12:41
  Dr. Jaime Knopman : Right.
• 12:42
  Dr. Jaime Knopman : The impact of toxins and disruptors.
• 12:45
  Dr. Jaime Knopman : I don't think there's clear data on that yet.
• 12:48
  Dr. Jaime Knopman : I think we all surmise that there probably is an impact, but to what degree?
• 12:54
  Dr. Jaime Knopman : And these are incredibly hard studies to do.
• 12:57
  Dr. Jaime Knopman : Meaning, like, how do you parse out, you know, the impact of equal or a sweetener, you know, sweet low on that versus this or phones or, you know, laptops or whatever it is.
• 13:09
  Dr. Jaime Knopman : I think it's.
• 13:10
  Dr. Jaime Knopman : It's very challenging.
• 13:13
  Dr. Jaime Knopman : I think we have all recognized that there is a need to lead a clean and healthy lifestyle, if possible.
• 13:19
  Dr. Jaime Knopman : And that is going to benefit every organ in your body, including your ovaries, including.
• 13:25
  Dr. Jaime Knopman : Right, all of those organs.
• 13:26
  Dr. Jaime Knopman : So I would advocate for a healthy lifestyle as opposed to going sort of rogue and doing, you know, and doing a variety of diets and exercise.
• 13:38
  Dr. Jill Carnahan, MD: Well, we do have evidence on the epigenetic expression of methylation on the ovary quality in that.
• 13:44
  Dr. Jill Carnahan, MD: So I think that we're going to probably have more and more.
• 13:46
  Dr. Jill Carnahan, MD: And as an environmental toxin expert, I do see that there are studies that show some correlation.
• 13:51
  Dr. Jill Carnahan, MD: But like you said, we just need a lot more evidence.
• 13:54
  Dr. Jill Carnahan, MD: But the truth is, avoiding chemicals is never going to hurt you, so.
• 13:57
  Dr. Jaime Knopman : Correct.
• 13:58
  Dr. Jaime Knopman : Right.
• 13:59
  Dr. Jaime Knopman : But the one thing I say to patients is like, we can see people clean up their life and go, you know, really hardcore and all that, and still have bad IVF outcome.
• 14:09
  Dr. Jaime Knopman : Right.
• 14:09
  Dr. Jaime Knopman : Like, I think probably a lot of this is genetics, that we just don't know genes yet as they relate to fertility.
• 14:15
  Dr. Jaime Knopman : But I do think that's probably a big contribution.
• 14:19
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• 14:21
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• 14:25
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• 14:30
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• 14:35
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• 14:41
  Dr. Jill Carnahan, MD: Okay, let's get back to the show.
• 14:42
  Dr. Jill Carnahan, MD: Absolutely.
• 14:44
  Dr. Jill Carnahan, MD: So when someone comes in, say they're 27, they're like, I don't know now, but I think I want to have children.
• 14:49
  Dr. Jill Carnahan, MD: I want to do, you know, freezing my eggs.
• 14:51
  Dr. Jill Carnahan, MD: What are some of the markers you do to test?
• 14:53
  Dr. Jill Carnahan, MD: What would be like a typical lab order of the basic.
• 14:55
  Dr. Jill Carnahan, MD: Sure.
• 14:56
  Dr. Jaime Knopman : So we do ovarian reserve testing and that includes ultrasound, which is a way to look at ovarian reserve, antral follicle count, and then we look at blood testing called amh, anti mullerian hormones.
• 15:08
  Dr. Jaime Knopman : And these parameters are used to analyze ovarian reserve or egg quantity.
• 15:14
  Dr. Jaime Knopman : Now it's very important to remember that one's egg quantity does not tell us about one's egg qual.
• 15:23
  Dr. Jaime Knopman : My egg quantity testing is abnormal, does not mean my egg quality is going to be abnormal.
• 15:28
  Dr. Jaime Knopman : It means that if I do egg freezing, I'm not going to get 20 eggs.
• 15:34
  Dr. Jaime Knopman : Right.
• 15:34
  Dr. Jaime Knopman : And if I do egg freezing, I might need to do more than one round of egg freezing to get to an ideal number.
• 15:42
  Dr. Jaime Knopman : But it does not mean that I am infertile.
• 15:46
  Dr. Jaime Knopman : Right.
• 15:47
  Dr. Jaime Knopman : Or that my egg quality is subpar.
• 15:50
  Dr. Jill Carnahan, MD: Okay, that makes sense.
• 15:51
  Dr. Jill Carnahan, MD: Can you give us some basic numbers as far as what ideally AMH should be and how many follicles should be counted approximately?
• 15:58
  Dr. Jaime Knopman : That is a hard question because it's not a one to one linear transition.
• 16:02
  Dr. Jaime Knopman : Right.
• 16:03
  Dr. Jaime Knopman : So I would say if I see a 25 year old and her AMH level is 1.5, that is not normal.
• 16:09
  Dr. Jaime Knopman : Right.
• 16:10
  Dr. Jaime Knopman : At 25, we're going to want to see that at least in the threes.
• 16:13
  Dr. Jaime Knopman : But if I see a 42 year old and her AMH is a 1.25, I'm going to say that is great.
• 16:18
  Dr. Jaime Knopman : Right.
• 16:19
  Dr. Jaime Knopman : Like, yeah, it is going to be largely driven by patient age and then there will be certain factors that I would anticipate the AMH being low.
• 16:28
  Dr. Jaime Knopman : So if I see a woman who has had ovarian surgery, let's say for ovarian cyst and her AMH level is low, I'm not going to be surprised.
• 16:38
  Dr. Jaime Knopman : Right.
• 16:38
  Dr. Jaime Knopman : I'm going to say that's probably where I would expect it to be.
• 16:43
  Dr. Jaime Knopman : So there's factors that sort of tip me off for what may happen.
• 16:47
  Dr. Jaime Knopman : But it's, you know, I've never been a fan of these ovarian reserve calculators.
• 16:51
  Dr. Jaime Knopman : People will say like, oh, put my AMH into a computer and it'll spit out how many eggs I need, et cetera.
• 16:57
  Dr. Jaime Knopman : Because we're so much more than a number.
• 17:00
  Dr. Jaime Knopman : It's just like people are like, is AI going to replace embryologists?
• 17:03
  Dr. Jaime Knopman : Is AI going to replace physicians?
• 17:06
  Dr. Jaime Knopman : No, because there's the human side and the art of everything we do.
• 17:09
  Dr. Jaime Knopman : Will it enhance what we do?
• 17:11
  Dr. Jaime Knopman : Of course.
• 17:12
  Dr. Jaime Knopman : Hands down, we know that.
• 17:14
  Dr. Jaime Knopman : Right.
• 17:14
  Dr. Jaime Knopman : Does AMH help us dose our patients?
• 17:17
  Dr. Jaime Knopman : Of course it.
• 17:19
  Dr. Jaime Knopman : But it doesn't take away our clinical judgment.
• 17:22
  Dr. Jill Carnahan, MD: Yeah, that makes so much sense and I really love that because there isn't even in functional and integrative medicine, there's not these hard and fast guidelines.
• 17:29
  Dr. Jill Carnahan, MD: It's this spectrum of illness and wellness and everything that we see.
• 17:33
  Dr. Jill Carnahan, MD: So you've become kind of a national leader in fertility for preserving for fertility preservation for cancer patients.
• 17:39
  Dr. Jill Carnahan, MD: Like my story.
• 17:40
  Dr. Jill Carnahan, MD: I want to know a little bit more about that.
• 17:41
  Dr. Jill Carnahan, MD: Would you expect post chemo for that AMH to be affected by that?
• 17:47
  Dr. Jill Carnahan, MD: And then we already talked a little bit about this, but what's your general approach to a woman who's facing, you know, significant therapy that could affect ovarian function?
• 17:56
  Dr. Jaime Knopman : Yeah, so.
• 17:57
  Dr. Jaime Knopman : So definitely the chemotherapy can reduce amh.
• 18:01
  Dr. Jaime Knopman : Because chemotherapy is designed to kill rapidly dividing cells.
• 18:04
  Dr. Jaime Knopman : Right.
• 18:04
  Dr. Jaime Knopman : That's why it works against cancer.
• 18:06
  Dr. Jaime Knopman : But women who are given chemotherapy, it doesn't just treat their cancer, it also can reduce their eclipse quantity.
• 18:15
  Dr. Jaime Knopman : So we would be expected to see the AMH levels decline in a woman who's gotten chemotherapy.
• 18:21
  Dr. Jaime Knopman : Now there's some data to suggest that it will rebound.
• 18:24
  Dr. Jaime Knopman : Right.
• 18:24
  Dr. Jaime Knopman : That your AMH may be low and that it may get better as you're sort of further away from the chemo.
• 18:31
  Dr. Jaime Knopman : But unfortunately there is going to be an impact that is going to arise from getting that chemotherapy.
• 18:38
  Dr. Jill Carnahan, MD: Yeah.
• 18:39
  Dr. Jill Carnahan, MD: Is there a certain age?
• 18:40
  Dr. Jill Carnahan, MD: Obviously I was 25, so there's a no brainer if I'm that young, it would make sense.
• 18:44
  Dr. Jill Carnahan, MD: Right, but what about a 40 year woman or a 42 or 37 or is there a, for you as an expert there is there a certain age within what they are wanting that you'd be like, it's probably not worth it if you're going to go into chemo and you're 42.
• 18:58
  Dr. Jaime Knopman : I don't know if there's I don't know if there's ever it's not worth it moment.
• 19:02
  Dr. Jaime Knopman : Right.
• 19:03
  Dr. Jaime Knopman : Like, I think a lot of what we do is about patient choice and reproductive autonomy.
• 19:07
  Dr. Jaime Knopman : Right.
• 19:08
  Dr. Jaime Knopman : So I think that we have to sit with patients and educate them on the chances of something happening, the chances of success, and then let the patient meet, make the decision for what's best for them, if that makes sense.
• 19:21
  Dr. Jaime Knopman : Right.
• 19:21
  Dr. Jaime Knopman : Like, absolutely.
• 19:22
  Dr. Jaime Knopman : I am a guide, but I'm not the end all, be all.
• 19:25
  Dr. Jaime Knopman : So I may say to you, like, I don't think it's more than 10% chance of success, but if you are aware of that 10 and you want to take that's on you.
• 19:36
  Dr. Jaime Knopman : Right.
• 19:36
  Dr. Jaime Knopman : Where I think we run into problems is when patients are like, wait, I thought my chance of success was 40%, but it's actually 4%.
• 19:46
  Dr. Jaime Knopman : Right.
• 19:46
  Dr. Jaime Knopman : They're not well counseled.
• 19:48
  Dr. Jaime Knopman : That, to me, would be a different situation.
• 19:51
  Dr. Jill Carnahan, MD: So you probably find in your practice, calculating at least an estimate of where that is helpful for some of their decisions.
• 19:56
  Dr. Jill Carnahan, MD: Are you giving them that?
• 19:57
  Dr. Jill Carnahan, MD: Yeah, that makes perfect Completely.
• 19:59
  Dr. Jaime Knopman : Yeah.
• 19:59
  Dr. Jaime Knopman : Because that's also like, I mean, our job in many ways as physicians is we.
• 20:03
  Dr. Jaime Knopman : We guide people.
• 20:05
  Dr. Jaime Knopman : Right.
• 20:05
  Dr. Jaime Knopman : We don't.
• 20:06
  Dr. Jaime Knopman : I think medicine has gone away from the hierarchical.
• 20:09
  Dr. Jaime Knopman : You know, this is what you must do.
• 20:11
  Dr. Jaime Knopman : And I think, to be honest, it's largely due to the influx of women, which I think is great.
• 20:16
  Dr. Jaime Knopman : But I don't think that there is one right answer.
• 20:20
  Dr. Jaime Knopman : I think there's a myriad of right answers, and patients have to make that decision about what's best for them.
• 20:26
  Dr. Jill Carnahan, MD: I couldn't agree more.
• 20:27
  Dr. Jill Carnahan, MD: We're much more, much less patriarchal, which is.
• 20:29
  Dr. Jill Carnahan, MD: Thank goodness.
• 20:30
  Dr. Jaime Knopman : Yeah, yeah.
• 20:31
  Dr. Jill Carnahan, MD: Goodbye to that.
• 20:32
  Dr. Jill Carnahan, MD: Now, obviously you treat women, but men are involved as partners.
• 20:36
  Dr. Jill Carnahan, MD: Do you typically to have the partner do sperm counts or do any assessment, or are you just focused on if they want a future, but to, like, where does that land?
• 20:44
  Dr. Jaime Knopman : No, I think if there's a partner in place who the patient believes they're going to have children with, we would want to assess their sperm quantity.
• 20:52
  Dr. Jaime Knopman : We have to, you know, listen.
• 20:54
  Dr. Jaime Knopman : Like, I'm not a dating coach or anything, but I think you have to tread lightly.
• 20:58
  Dr. Jaime Knopman : Like when.
• 20:59
  Dr. Jaime Knopman : If I'm sitting with a patient and she's like, oh, I've been with this guy for four months.
• 21:03
  Dr. Jaime Knopman : I'm not calling him in for semen analysis.
• 21:05
  Dr. Jaime Knopman : Right.
• 21:05
  Dr. Jaime Knopman : Because I'm like, whoa, pump the brakes.
• 21:07
  Dr. Jaime Knopman : Right?
• 21:07
  Dr. Jaime Knopman : Yeah, yeah.
• 21:08
  Dr. Jaime Knopman : If you're still with this person in a year and we feel it's going the right way and we Want to go and get a semen analysis.
• 21:15
  Dr. Jaime Knopman : Great.
• 21:15
  Dr. Jaime Knopman : But we also want to avoid, like, the anxiety that may be brought on by saying, like, oh, let's, you know, let's do this asap.
• 21:23
  Dr. Jaime Knopman : So I think we have to.
• 21:25
  Dr. Jaime Knopman : We have to.
• 21:26
  Dr. Jaime Knopman : My job is to be a good guide in that area.
• 21:31
  Dr. Jill Carnahan, MD: Okay.
• 21:32
  Dr. Jill Carnahan, MD: Makes perfect sense.
• 21:33
  Dr. Jill Carnahan, MD: And I couldn't agree more.
• 21:34
  Dr. Jill Carnahan, MD: If a woman in their 30s and 40s wants to optimize fertility hormone health or longevity, what are the three highest impact things that they could do right now?
• 21:42
  Dr. Jaime Knopman : Number one, don't smoke.
• 21:44
  Dr. Jaime Knopman : I think, you know, we've known this for years how bad smoking is for our lungs and our vessels and our brain, but it's equally as bad for our ovaries.
• 21:53
  Dr. Jaime Knopman : Number two, be aware of what's going to happen to your body.
• 21:56
  Dr. Jaime Knopman : Right?
• 21:56
  Dr. Jaime Knopman : Like, I'm not saying that you have to do fertility treatment, but know that your ovarian reserve is going to decline.
• 22:02
  Dr. Jaime Knopman : So have, get educated, have knowledge.
• 22:05
  Dr. Jaime Knopman : And number three, if your periods are so bad, so painful that you can't go to work or school, or if you bleed, I had a friend of a friend text me yesterday being like, I've soaked through, like, you know, my clothes five times over.
• 22:23
  Dr. Jaime Knopman : What should I do?
• 22:24
  Dr. Jaime Knopman : I'm like, you should see your doctor.
• 22:26
  Dr. Jaime Knopman : Like, that's not normal.
• 22:27
  Dr. Jaime Knopman : Right?
• 22:28
  Dr. Jaime Knopman : So we have to recognize that we're not just supposed to, like, tough it out and be like, okay, I'll bring seven changes of clothes and get an ulcer from all the Advil.
• 22:37
  Dr. Jaime Knopman : Like, like, that's not normal.
• 22:38
  Dr. Jaime Knopman : Use your voice, speak up and get yourself treatment.
• 22:43
  Dr. Jill Carnahan, MD: Love that.
• 22:43
  Dr. Jill Carnahan, MD: Because, yeah, there are women suffering.
• 22:45
  Dr. Jill Carnahan, MD: I feel like the hormonal issues, the infertility, everything is increasing because of stress, environmental exposures and all these things.
• 22:51
  Dr. Jill Carnahan, MD: What's the biggest myth about perimenopause?
• 22:54
  Dr. Jill Carnahan, MD: Like, what are people not thinking about that they should be thinking about?
• 22:58
  Dr. Jaime Knopman : I guess the biggest myth.
• 23:00
  Dr. Jaime Knopman : I mean, you can get pregnant in perimenopause, right.
• 23:02
  Dr. Jaime Knopman : You're not in menopause.
• 23:04
  Dr. Jaime Knopman : So once you, if you're still ovulating, still releasing eggs.
• 23:08
  Dr. Jaime Knopman : Yeah.
• 23:09
  Dr. Jaime Knopman : The chances go down, but the chances still exist.
• 23:12
  Dr. Jaime Knopman : So you have to be aware of that.
• 23:14
  Dr. Jaime Knopman : Not because, again, that nobody's trying to scare you and tell you, like, oh, my God, like, you know, you're never baby.
• 23:20
  Dr. Jaime Knopman : But the point is, be aware that it can happen.
• 23:23
  Dr. Jaime Knopman : And if you don't want it to happen, you should use contraception.
• 23:27
  Dr. Jill Carnahan, MD: Yes.
• 23:27
  Dr. Jill Carnahan, MD: I'll never forget one of my first or second years of practice.
• 23:30
  Dr. Jill Carnahan, MD: I had a lovely woman in her 40s and we treated her autoimmunity and her gut health and all of her good stuff got her eating right and sleep well.
• 23:37
  Dr. Jill Carnahan, MD: And she came back very angry because we had fixed her irregular cycles and she was pregnant at 42 with twins.
• 23:44
  Dr. Jill Carnahan, MD: Now, in the hindsight, best thing that ever happened, of course, in the end.
• 23:47
  Dr. Jill Carnahan, MD: But it was so funny because at first she was so angry, like, why don't you tell me that changing my lifestyle could affect fertility?
• 23:53
  Dr. Jill Carnahan, MD: And I didn't even think of it because it was so obvious.
• 23:55
  Dr. Jill Carnahan, MD: And I learned.
• 23:55
  Dr. Jill Carnahan, MD: I'm like, wait, we have to talk about these things.
• 23:58
  Dr. Jaime Knopman : Yeah, exactly.
• 23:59
  Dr. Jill Carnahan, MD: It's so funny.
• 24:00
  Dr. Jill Carnahan, MD: Yeah, I'm sure you've had cases like that too, where they not expecting.
• 24:04
  Dr. Jill Carnahan, MD: And then.
• 24:05
  Dr. Jaime Knopman : Well, you know what I've seen a bunch is our women who I've said, oh, your egg quantity is low.
• 24:09
  Dr. Jaime Knopman : Women who are coming to egg freeze.
• 24:10
  Dr. Jaime Knopman : And I say, doesn't mean you're infertile.
• 24:12
  Dr. Jaime Knopman : It means your quantity is low.
• 24:14
  Dr. Jaime Knopman : And then they call me the couple months later and they're like, I got accidentally pregnant.
• 24:18
  Dr. Jaime Knopman : And I'm like, well, what happened?
• 24:19
  Dr. Jaime Knopman : They're like, you told me my eggs were bad.
• 24:21
  Dr. Jaime Knopman : I was like, no, I did not tell you that.
• 24:23
  Dr. Jaime Knopman : I said your egg quantity was low.
• 24:25
  Dr. Jaime Knopman : I never said your quality.
• 24:26
  Dr. Jaime Knopman : This is not on me.
• 24:27
  Dr. Jill Carnahan, MD: Yeah, exactly.
• 24:28
  Dr. Jill Carnahan, MD: Exactly.
• 24:29
  Dr. Jill Carnahan, MD: It is funny.
• 24:29
  Dr. Jill Carnahan, MD: And then usually it's a good thing, but not, you know, it's so interesting.
• 24:34
  Dr. Jill Carnahan, MD: What is the most exciting breakthroughs in fertility medicine?
• 24:37
  Dr. Jill Carnahan, MD: What's up and coming?
• 24:37
  Dr. Jill Carnahan, MD: What are some things that are maybe still in the pipeline?
• 24:41
  Dr. Jaime Knopman : I think the influx of AI in the fertility landscape is going to be pretty exciting, and I'm excited to see where that goes.
• 24:48
  Dr. Jaime Knopman : I would say probably the biggest advancements are genetic screening of embryos.
• 24:52
  Dr. Jaime Knopman : We've gotten really good at it, such that we have a lot of success in identifying what eggs, you know, what embryos are healthy and which ones are not.
• 25:03
  Dr. Jaime Knopman : And I think that's very exciting for the future.
• 25:06
  Dr. Jill Carnahan, MD: Oh, I can agree more.
• 25:07
  Dr. Jill Carnahan, MD: And would you say that there's a certain percentage predictability of, like, having a good.
• 25:12
  Dr. Jill Carnahan, MD: Like, can you, with the data that we have now, give a ballpark estimate of how successful that will be?
• 25:17
  Dr. Jaime Knopman : Yeah.
• 25:18
  Dr. Jaime Knopman : So embryos that are high quality, like genetically tested, beautiful morphology, they can have a live birth rate of 70%.
• 25:25
  Dr. Jaime Knopman : I mean, it doesn't get better than that in fertility medicine.
• 25:28
  Dr. Jaime Knopman : At least nothing we've seen.
• 25:30
  Dr. Jaime Knopman : So I think that's incredibly exciting.
• 25:32
  Dr. Jaime Knopman : And I can only imagine where we're going to be in, you know, 10 years from now.
• 25:36
  Dr. Jill Carnahan, MD: Amazing how Cool.
• 25:37
  Dr. Jill Carnahan, MD: Well, if people want to find out more about you, about what you do, about your practice, where can they go to find out more?
• 25:43
  Dr. Jaime Knopman : Sure.
• 25:43
  Dr. Jaime Knopman : So I work at a fertility clinic called CCRM New York.
• 25:47
  Dr. Jaime Knopman : We're located on 53rd and 7 in Manhattan.
• 25:50
  Dr. Jaime Knopman : I also have an Instagram page where I try and give good information.
• 25:54
  Dr. Jaime Knopman : It's Dr. Jaime J A I M E Notman.
• 25:58
  Dr. Jaime Knopman : I also have a website and I wrote a book called own your fertility.
• 26:02
  Dr. Jaime Knopman : It came out this year, January 2026.
• 26:04
  Dr. Jaime Knopman : And I think it's a really good resource for anyone who's thinking of having a baby, has a baby, doesn't want a baby.
• 26:12
  Dr. Jaime Knopman : All things reproduction.
• 26:14
  Dr. Jill Carnahan, MD: Amazing.
• 26:14
  Dr. Jill Carnahan, MD: Well, thank you for the brilliant work you've done in the world and thank you for coming on Resiliency Radio.
• 26:19
  Dr. Jaime Knopman : Thank you so much for having me.
• 26:21
  Dr. Jaime Knopman : Have a wonderful day.
• 26:22
  Dr. Jill Carnahan, MD: Hey guys, thanks for joining me for another episode of Resiliency Radio.
• 26:26
  Dr. Jill Carnahan, MD: As you know, we have new episodes coming out every single week on Wednesdays, so you can stay tuned if you want to hit the like or subscribe button and the bell to be notified of future episodes.
• 26:35
  Dr. Jill Carnahan, MD: That way you won't miss any one of these, hopefully.
• 26:38
  Dr. Jill Carnahan, MD: Enjoy this impactful, inspirational interview with Jaime Notman about fertility and how you can change that course if you act early.
• 26:47
  Dr. Jill Carnahan, MD: If you have any questions or comments, leave them below or anywhere you're watching or listening to this podcast and I will see you again next week for another episode of Resiliency Radio.