Latest / Beek on being / Beek on being FERTILE

Transcript

Beek on being FERTILE · Beek on being

• 0:00
  Melissa Shere Beek: Hi. I hope you are well. This podcast is a place for people to share personal and professional perspectives, talk openly, and ask questions. From serious to silly to sublime, it's all about communication and connection. Always coming from a place of kindness and curiosity, we talk about shared humanity, discuss ideas, and highlight people creating a better world.
• 0:23
  We've got to keep learning, keep growing, keep being. I'm Melissa Beak, and this is Beak on Being. Today's episode is Beak on Being Fertile. So many factors go into a person's decision to reproduce, when to reproduce, as well as the factors that affect their ability to reproduce, such as age, genetic issues, and disease. People may delay having children and choose egg retrieval as an option because they may have health issues they need to prioritize.
• 0:50
  They may delay for preventative measures because of genetic issues. They may want to wait until they have more financial security focusing on career first and family second. Their age and amount of egg production, or even because egg retrieval is an option now when maybe previously it wasn't an option at all. There are so many personal and medical reasons. Today we will talk about fertility, the population experiencing fertility issues, the factors and decisions that go into choosing egg retrieval, and what the process of egg retrieval entails.
• 1:22
  We have two incredible board certified physicians in studio today to talk about it all. So please introduce yourselves and tell our listeners a little bit about you.
• 1:33
  Dr. Rebecca Karsenti: Okay, great. Hi, I'm Doctor Rebecca Karsenti. I'm a Miami native. I went to Palmetto High School here in Miami and then went to Duke University for college. I then came back to Miami for medical school and did my training in Boston at Tufts University and OB GYN.
• 1:55
  I am a general obstetrician gynecologist, which means I do a lot of things for all for women. I serve all ages. I love seeing teenage girls and being their first introduction often to medicine outside of the pediatrician's office. And I go up to older age as well. I'm doing a lot of menopause treatment, a lot of talk about perimenopause, and lots of infertility, and fertility in general.
• 2:26
  It I I love all things women's health, and really excited to be here and talk about fertility today.
• 2:32
  Melissa Shere Beek: Excited to have you on.
• 2:34
  Dr. Armando Hernandez-Rey: And I'm Armando Hernandez-Rey. I'm a board certified OBGYN and reproductive endocrinologist and fertility specialist. I mainly focus on infertility, basically taking everything comprehensively and what's relating to the infertility, as well as the endocrinologic aspects of it, which are just basically dealing with hormones. I'm a professor at both medical schools, I have the residents in the medical schools that do rotations with me and shadow me. And I'm, know, I think kind of a dinosaur in the fact that I'm one of the few infertility specialists today that does quite a bit of surgery, both minimally invasive robotic surgery and open procedures, anything that's relating to the care of a infertility patient.
• 3:23
  And I'm happy to be here, and I really thank you for the invitation to contribute to this incredible podcast.
• 3:30
  Melissa Shere Beek: Aw, thank you. I'm honored to have you both. I know you spoke a little bit about your population. Can you tell us a little bit about your population too that you serve?
• 3:37
  Dr. Armando Hernandez-Rey: Basically, I see patients from puberty to menopause. Got it. Today, actually, coincidentally, I saw a patient from Israel who has complete androgen insensitivity, so that means that she's a pseudo hermaphrodite and was born, is an XY, but was born with a vagina. And, you know, that, creates a lot of complexity both from a health standpoint, as well as obviously from a reproductive standpoint because she has no uterus and or ovaries. So it's the gamut of patients.
• 4:17
  Melissa Shere Beek: You get it all.
• 4:18
  Dr. Armando Hernandez-Rey: Yeah, yeah. But obviously the focus is infertility or as it relates. Today's world is different than what it was when I was a fellow, and we're seeing patients up to their early 50s using donor egg and or surrogacy and even donor sperm
• 4:37
  Melissa Shere Beek: Amazing.
• 4:38
  Dr. Armando Hernandez-Rey: As it relates to their their particular issues.
• 4:41
  Melissa Shere Beek: So, yeah. That's awesome. How did you both get into this profession?
• 4:45
  Dr. Armando Hernandez-Rey: Please.
• 4:46
  Dr. Rebecca Karsenti: Okay. I can start. So my dad is an OBGYN, so I watched for years as women would come up to us everywhere. And oh, doctor Strassberg, you're so amazing. You delivered my child.
• 5:00
  You mean so much to me. And I just I loved the connection that he had with his patients. But at the time, I thought that I would be a pediatrician. Because I loved the idea of continuity of care, but I wasn't sure that I wanted to do OB GYN. But then when I went through medical school, I realized I loved it the the day I delivered my first baby.
• 5:20
  Dr. Armando Hernandez-Rey: I was
• 5:20
  Dr. Rebecca Karsenti: like, this is amazing, of course. I haven't looked back. I actually thought I might do infertility at some point, but the way life took me, I ended up staying and doing general obstetrics and gynecology. I delivered babies for about seventeen years, which was amazing. And then now I've been focusing more on women's health.
• 5:41
  Melissa Shere Beek: Got it.
• 5:42
  Dr. Armando Hernandez-Rey: So I wanted to be an orthopedic surgeon.
• 5:44
  Dr. Rebecca Karsenti: Really? I didn't expect that.
• 5:47
  Dr. Armando Hernandez-Rey: Yeah. I went to medical school, was sure that I was gonna be the Dolphins team doctor and I was gonna be the guy that was gonna run out to the and get the wounded.
• 5:59
  Melissa Shere Beek: Right.
• 6:01
  Dr. Armando Hernandez-Rey: But I unfortunately had a really bad fracture when I was in high school and I got sort of PTSD, but I was always inclined to take more of the surgical approach. I went into OB GYN to be a GYN oncologist and pivoted shortly thereafter to infertility because it's just, what an amazing field and the amazing things that you can do for patients and it's so cutting edge. And two years ago when I was a fellow, things have changed
• 6:33
  Melissa Shere Beek: Completely different.
• 6:34
  Dr. Armando Hernandez-Rey: Dramatically.
• 6:35
  Melissa Shere Beek: Yeah.
• 6:38
  Dr. Armando Hernandez-Rey: No looking back, I couldn't have made a better choice for myself and extremely happy.
• 6:43
  Dr. Rebecca Karsenti: Well, I'm sure both of
• 6:44
  Melissa Shere Beek: your patients are beyond thrilled.
• 6:46
  Dr. Armando Hernandez-Rey: And I can attest to her dad who was my professor and was an amazing amazing mentor for me.
• 6:52
  Melissa Shere Beek: Yeah. Oh, he's amazing.
• 6:54
  Dr. Rebecca Karsenti: Thank you.
• 6:54
  Melissa Shere Beek: Got a fan club here, so . When we talk about fertility, we're talking about a person's biological ability to reproduce, to make healthy eggs and then of course sperm, so it can be fertilized, they can be implanted and developed. When we talk about infertility and needing egg retrieval, it's because this concept isn't this conception isn't occurring. So many factors are involved in affecting our reproductive systems disorders, disease, age related societal or environmental factors. Is there a specific medical definition on infertility as far as time period of trying or a person's age more specifically?
• 7:31
  Dr. Armando Hernandez-Rey: Yeah. Mean, the classic definition is anybody less than 35
• 7:34
  Melissa Shere Beek: Less than 35.
• 7:36
  Dr. Armando Hernandez-Rey: Should, if trying for over a year, then should look to her OBGYN for guidance and if not, infertility specialist.
• 7:47
  Melissa Shere Beek: Okay.
• 7:48
  Dr. Armando Hernandez-Rey: And after the age of 35, it's six months. That's a very old, very dated definition. And today's world, the generations today that are looking to conceive for the most part are very much instant gratification. Nothing wrong with that I am too. And I think people have a timeline, particularly now that women are waiting longer because they're pursuing careers that take a little bit of more time.
• 8:19
  Melissa Shere Beek: Right.
• 8:20
  Dr. Armando Hernandez-Rey: They're professionals. They wanna take their you know, enjoy their lives post graduate school or whatever endeavor they're they're pursuing, and and then but they are very much aware as opposed to twenty two, twenty five years ago that there is a biological clock and that biological clock is very important.
• 8:37
  Melissa Shere Beek: Yeah.
• 8:37
  Dr. Armando Hernandez-Rey: So I you know, that's still the traditional teaching, but I I think the the lines are blurred a little bit in today's clinical practice.
• 8:46
  Melissa Shere Beek: Right. You touched upon a few things. People waiting, maybe establishing themselves first, finding a partner or just having financial security, but what other factors go into infertility issues? Is it just because they're waiting longer, or you see more of a population that's related to disease, or maybe someone who has tested positive for a genetic?
• 9:12
  Dr. Armando Hernandez-Rey: All of the above. All of I I could cast a very wide net as to what that encompasses. I would say that primarily the main cause of infertility is age, both for male and for female. Obviously, for females, the reproductive aging occurs earlier than it does in the male, But it's certainly age. There are other things that go with the aging process separate from that.
• 9:46
  For example, things like endometriosis have a more significant impact if you're 35 and have had endometriosis your entire life, as opposed to being 20, as opposed, as the same way that if you smoked for fifteen or twenty years, but nobody smokes anymore, very few people smoke, but just the example that I always give
• 10:13
  Melissa Shere Beek: Right.
• 10:14
  Dr. Armando Hernandez-Rey: Has a more pronounced effect than if you smoked for three years when you're in high school and have your first kid at 21.
• 10:21
  Melissa Shere Beek: Right. Got it.
• 10:22
  Dr. Armando Hernandez-Rey: So it's cumulative, essentially. Got
• 10:24
  Melissa Shere Beek: it. Doctor. Karsenti, when you're talking about your population too, do you find that there's an increase in fertility issues with your patient population?
• 10:36
  Dr. Rebecca Karsenti: I mean, yes and no. I mean, I think there's a lot of women who I wouldn't say they're misinformed, but they're like, oh, well my friend got pregnant in their late thirties and didn't have a problem, So I'll be fine. Mhmm. There's definitely a population of that. And I talked to them about fertility and how it goes down after your late twenties and try to provide education.
• 11:00
  Because the the last thing I want is for a patient to kind of arrive in her late thirties, and then be like, I'm And having then say, oh my god, I wish I had known. So I feel like my job is to talk about that, and educate them so they know their options. I think that's one thing. And then I also think there is a subset of patients also who are just generally unhealthy. Right.
• 11:25
  Like I think there's a lot of women in Miami, I mean, who take care of themselves and are exercising and all the things. But there's other people who still are just not in that healthy lifestyle. They have hormonal imbalances, know, and we try to work on that. But I I I think I sit still see a fair amount of that in my practice. People who just aren't taking care of themselves and then
• 11:49
  Melissa Shere Beek: they wonder why they can't get pregnant. So is there something that if someone's trying to get pregnant or thinking about getting pregnant that you could tell them to do to increase their fertility health? Like, what to plan beforehand? What you should be doing? Are there extra vitamins?
• 12:03
  Are there like, what do you advise them to do?
• 12:06
  Dr. Rebecca Karsenti: I mean, I try to address healthy lifestyle all the time with my patients. And that's really, I think, number one is minimizing processed foods. Mhmm. I think they're probably in the in the space of infertility. There probably is some kind of environmental factors that contribute to endometriosis Right.
• 12:25
  And all the hormonal imbalances that we see. I think our our foods are not the same foods that they were twenty years ago.
• 12:32
  Melissa Shere Beek: Oh, yeah. No. My kids are in their early thirties and around 30. And the only thing we were told was, make sure you get folic acid. That was the advice.
• 12:43
  Dr. Rebecca Karsenti: Right. Which is still really important. It's important. Right.
• 12:46
  Melissa Shere Beek: But nobody ever thought about environmental things or processed foods that we were eating or anything else that we were Yeah. Taking in.
• 12:52
  Dr. Rebecca Karsenti: So I I try to talk to my patients about healthy lifestyle, healthy eating, exercising, a good multivitamin, something with folic acid like And you then, sometimes we'll talk about the environmental factors, like cutting back on the plastics, you know. Yeah. Just being aware of what they're putting in their body and their partner, what their partner's putting in their body too.
• 13:15
  Melissa Shere Beek: Right. And what they're exposed to too, where they go and what they do. Yeah. Is what is, I don't know the statistics on this, but what is the size of the population that's experiencing fertility issues, and how does that compare to the percentage in your practice that you're seeing?
• 13:33
  Dr. Armando Hernandez-Rey: Infertility affects one in six couples.
• 13:34
  Melissa Shere Beek: Okay.
• 13:38
  Dr. Armando Hernandez-Rey: I would tell you that it probably affected less couples thirty years ago or forty, fifty years ago, the baby boomers, but that's because they were having kids at 20.
• 13:48
  Melissa Shere Beek: Right.
• 13:49
  Dr. Armando Hernandez-Rey: So we don't really have great statistics. And remember that infertility and IVF is really pretty new.
• 13:56
  Melissa Shere Beek: Right.
• 13:59
  Dr. Armando Hernandez-Rey: I think the more people wait, the more difficulty they will have. There's absolutely, as Rebecca said, so many different factors that are involved, PFAS, forever chemicals, leaching from water bottles, all of these things that we're taking into account for longevity, which has a lot of overlap with infertility and general health. Age still seems to be the predominant factor
• 14:25
  Melissa Shere Beek: that affects
• 14:25
  Dr. Armando Hernandez-Rey: everything, the biggest factor that we see when we say aging is what's called premature ovarian insufficiency or diminished ovarian reserve, which is kind of an old moniker. And there's 13 reasons why this happens. Cocaine use, alcohol abuse, smoking, secondhand smoking, radiation, chemotherapy, autoimmune disorders, infectious disorders, which doesn't happen in first world countries. Genetic disorders, spontaneous and or familial, and then idiopathic. Oh, sorry, endometriosis, surgery to one or both ovaries, and idiopathic, which means
• 15:07
  Melissa Shere Beek: we don't know where it comes from.
• 15:08
  Dr. Armando Hernandez-Rey: And we think either you were born with less eggs, you consumed them faster in isolation, or in conjunction with any one of the other 12 that I just mentioned.
• 15:17
  Melissa Shere Beek: And
• 15:18
  Dr. Armando Hernandez-Rey: in my world, like an oncologist, an oncologist sees every woman as cancer, and I see every woman as infertile. Infertile. Yeah. And Rebecca sees 45 year olds get pregnant and, you know
• 15:32
  Melissa Shere Beek: Whoopsie.
• 15:33
  Dr. Armando Hernandez-Rey: Right. And so their perspective is different. The lens they're looking at, things are different. But I see 25 year olds in menopause and 30 year olds in menopause, and I see men who are 30 with azoospermia, no sperm, because they were doing testosterone for ten years and they burn their testicles out.
• 15:54
  Dr. Rebecca Karsenti: So
• 15:56
  Melissa Shere Beek: it's a lot.
• 15:57
  Dr. Armando Hernandez-Rey: It's varied.
• 15:58
  Melissa Shere Beek: It's very varied.
• 15:59
  Dr. Armando Hernandez-Rey: Yeah.
• 15:59
  Melissa Shere Beek: And also the combination of all of those factors. Okay. So when you talked about different ages and and different things, I hear a lot of discussion among women, particularly young women in their twenties and thirties about egg retrieval. And they talk about the many factors that go into wanting or needing to do egg retrieval. They may be concerned about their age and the amount of egg reproduction, which is production which we just talked about.
• 16:24
  And some are just not ready for children yet, either emotionally or economically or for whatever the reasons. But they want to secure the possibility of carrying a child or children in the future. Some may be positive for genetic issues, and need to remove their ovaries, so they too want to secure the possibility for future pregnancies. What factors go into the decision to do egg retrieval? Or what are you seeing besides these contributing factors as the point that they have this discussion with you and say, okay.
• 16:59
  Or when do you say to your patients, this is something you should consider? AgriTrip.
• 17:04
  Dr. Rebecca Karsenti: I mean, as my patients between, I would say, like 30 and 35, when I see a single patient who is not thinking at this time that she's ready to get pregnant, I'll address it, we'll talk about it. And as they kinda creep closer to 35, I'd say, okay, well what are your plans? Do you want to have children in the future? Is this something that you would regret if it doesn't happen? And then, when they say that they want kids and it doesn't seem to be on the horizon, I do encourage them to see doctors like Doctor Hernandez Ray.
• 17:43
  Because I think and I always say to patients, it's information. Right. I think it's great to be educated. Yes. And like that that's the great thing about doing a podcast like this is that I think women just need to educate themselves.
• 17:55
  And I always say, you're not committing, you're not putting the money down No. But the knowledge to do the egg freezing, but learn about it. Learn about the process. Learn about what it would look like, and also from a cost perspective. Right.
• 18:08
  Because thankfully, we are seeing some insurance coverages, Not so much in Florida, but in other states. So maybe as things evolve and there's better coverage, you know, even if you learn about the process now, and then you're not ready now, maybe you'll be ready in a year. Right. Maybe you'll be ready
• 18:24
  Melissa Shere Beek: in the But the knowledge and information about that.
• 18:26
  Dr. Rebecca Karsenti: Yeah. I think I think it's important to be to be educated.
• 18:30
  Melissa Shere Beek: Doctor Hernandez-Rey , can you break down what IVF entails? Like the whole process?
• 18:36
  Dr. Armando Hernandez-Rey: Yeah. Sure.
• 18:37
  Melissa Shere Beek: Like what do your patients have to do beforehand to prepare and how all of that.
• 18:42
  Dr. Rebecca Karsenti: Well, egg I think egg freezing. Right? You wanted to talk about Well, what all the process of egg freezing is?
• 18:46
  Melissa Shere Beek: Well, all of it because I mean, there's the process of egg retrieval. You'd have to tell your patients that they're going to be boosting up with shots to increase egg production, and then you'd have to tell them there's options afterwards, right? So when you're doing egg retrieval, my understanding is that you could either freeze the eggs or you could fertilize the eggs and implant them, but I've also heard discussion about freezing embryos.
• 19:11
  Dr. Armando Hernandez-Rey: Mhmm.
• 19:12
  Melissa Shere Beek: Okay. So can you break down everything for us?
• 19:14
  Dr. Armando Hernandez-Rey: Yeah, sure. So essentially, IVF as a whole is four phases. Obviously, before those four phases begin, which is the therapeutic aspect of this, there's an evaluation portion.
• 19:27
  Melissa Shere Beek: Right.
• 19:28
  Dr. Armando Hernandez-Rey: Which generally is predicated on the cycle of a woman where we do things like cycle day three labs, cycle day two, three, four labs, which are baseline laboratory that assess a woman's ovarian reserve. As you know, women are born with a finite number of eggs and the consumption of those eggs, however it happens, the 13 ways that I just mentioned, it happens, and that's what we're trying to assess, including a hormone called an anti mullerian hormone, which has got a lot of notoriety because it's basically probably the most sensitive marker that we can use. It's generally not perfect.
• 20:03
  Melissa Shere Beek: Right. It's a gauge.
• 20:04
  Dr. Armando Hernandez-Rey: It's a gauge. And then we do a uterine assessment, which is either hysterosalpingogram, which checks fallopian tubes and or the uterus, or a hysteroscopy or saline sonogram to look at the the the
• 20:17
  Melissa Shere Beek: The lining.
• 20:18
  Dr. Armando Hernandez-Rey: The lining. The the the contour
• 20:21
  Melissa Shere Beek: Mhmm.
• 20:21
  Dr. Armando Hernandez-Rey: Of the uterus itself, more than just the lining. And then, obviously, the male is involved and we do a semen analysis, which we're like amoebas, we can do this at any time, single celled organisms, while these women are very complex.
• 20:35
  Dr. Rebecca Karsenti: Right.
• 20:36
  Dr. Armando Hernandez-Rey: A lot of things that we're monitoring, including an entire hormonal panel for assessment of hormonal imbalances as Rebecca or Doctor. Carcenti spoke about, which in general, when we talk about in this world today, it's either polycystic ovaries or perimenopause. Right. Essentially. Prolactin, thyroid, all of those things
• 20:58
  Melissa Shere Beek: are Do you see a lot of PCOS?
• 21:01
  Dr. Armando Hernandez-Rey: Sure. Especially in this population here in South Florida, but generally the numbers are about a third of the patients who are seeking infertility care. I would say we're probably about a fourth. Okay. Sorry, not a fourth, but not thirty three percent, but forty, forty five percent.
• 21:18
  Melissa Shere Beek: Oh, so even bigger populations.
• 21:19
  Dr. Armando Hernandez-Rey: Got it.
• 21:20
  Melissa Shere Beek: That's
• 21:20
  Dr. Armando Hernandez-Rey: what I meant. I'm sorry.
• 21:23
  Melissa Shere Beek: No. No worries.
• 21:24
  Dr. Armando Hernandez-Rey: And and then we begin the the IVF portion. Right. If if that's the the route that they wanna take, and and and that also incorporates the egg freezing or the fertility preservation portion. But essentially, we're talking about four phases. The first phase is the preparation phase, which generally is some sort of hormonal manipulation that severs the connection between the pituitary and the ovary, which allows us to be able to control the stimulation portion, optimize it, maximize the results.
• 21:55
  During the second phase, which is the stimulation, where women are injecting themselves on a daily basis for the most part for
• 22:01
  Melissa Shere Beek: For how long?
• 22:02
  Dr. Armando Hernandez-Rey: Generally ten to twelve days, and that will culminate eventually after very intense monitoring with blood work and ultrasound to get to the extraction or the egg retrieval or the harvesting, which is a minor surgical procedure under anesthesia with an anesthesiologist. They generally don't feel a thing, obviously during the procedure, they're asleep.
• 22:25
  Melissa Shere Beek: How many eggs are you able to retrieve?
• 22:27
  Dr. Armando Hernandez-Rey: Well, that depends. It depends on the age, the women's ovarian reserve, the stimulation protocol that's chosen. Like everything in life, too little is too little and too much is too much. Too much, right. There's a sweet spot that for the most part, say anywhere between twelve and sixteen eggs should be reasonable, and then that's begins the fertilization process if we're moving on to in vitro fertilization.
• 22:55
  Mhmm. If we're freezing eggs, we freeze eggs right there. We freeze not the total number, but the mature number of eggs, which means that they've gone through the meiotic processes that constitute the maturation of an egg Mhmm. Which can then be fertilized to complete the maturation of that of that egg.
• 23:14
  Melissa Shere Beek: Got it.
• 23:16
  Dr. Armando Hernandez-Rey: The limitation with egg freezing
• 23:18
  Melissa Shere Beek: How long can they be stored?
• 23:20
  Dr. Armando Hernandez-Rey: In in In perpetuity.
• 23:22
  Melissa Shere Beek: Wow.
• 23:22
  Dr. Armando Hernandez-Rey: The the the limitation of an egg, and and this is a very sensitive topic for women who are moving on or have decided to freeze their eggs, is is a couple things. Number one, we can't stick a probe in in it and say it's a good egg or a bad egg.
• 23:38
  Melissa Shere Beek: Right.
• 23:38
  Dr. Armando Hernandez-Rey: Number one. Number two, with the aging process, there's a lot of inner cycle variability. And so when a woman is 18, 11 out of the 12 of the year, it's a perfect egg and they have a three percent chance of miscarriage. When a woman is 40, there's only one or two out of the twelve months Unviable. That are good eggs.
• 23:57
  Yeah. And when they're 18, they'll recruit a thousand eggs and 950 are good and 50 are bad. By the way, I'm just making these
• 24:03
  Melissa Shere Beek: little jokes. No. I get the I get it.
• 24:05
  Dr. Armando Hernandez-Rey: And when they're 40, it's a 100 eggs of which 90 are bad and 10 are good.
• 24:11
  Melissa Shere Beek: Right.
• 24:12
  Dr. Armando Hernandez-Rey: So in today's world, there's they're stuck in this very nebulous zone where there's more information out there, they're more in control, women are empowered. But any woman who sits in front of my office, I think it took a long a lot to get there. Yeah. Because it's not what they planned for themselves. This generation still believes that they have this this lofty goals of, you know, being together, having kids, all that, for the most part.
• 24:40
  Obviously, there's exceptions with everything. And so when I can't deliver what they expect, which everybody expects nothing but absolute
• 24:47
  Melissa Shere Beek: A 100% perfect results.
• 24:49
  Dr. Armando Hernandez-Rey: Perfect results, That's where the communication comes into play. And so you have Instagrammers now who are infertility specialists who are actually telling them I received multiple calls from friends who have daughters roughly in their college years, who are like, I just saw this woman, for example, and no critique.
• 25:10
  Melissa Shere Beek: Right.
• 25:11
  Dr. Armando Hernandez-Rey: I'm I'm just stating the facts, who are I just saw this woman, and she's an infertility specialist, and she's saying that she's going to freeze her daughter's eggs at 22. And she's not wrong. You know, biologically speaking, Now, she's not if I tell Rebecca, who's an OBGYN and incredibly gifted and talented woman that I'm going to recommend to her daughter
• 25:38
  Melissa Shere Beek: Right.
• 25:38
  Dr. Armando Hernandez-Rey: To freeze her eggs. She's you're you're you're absolutely nuts. Right? And and that's where that's where the problem comes because then you have a 34 year old woman who's she's having that perfectly sane conversation, take your time, go and have a conversation. But if her AMH is 0.3, she's like, well, why didn't I do this earlier?
• 26:00
  Melissa Shere Beek: Yeah. Why didn't I? I think that's why I hear a lot of 20 and 30 discussing, I wanna do this now even before they have, like, a significant other in their life just to ensure the possibility of having children.
• 26:12
  Dr. Armando Hernandez-Rey: The same way if I tell a 39 year old. Rebecca sends me a patient, let's say, and and she's 39, she has no children, and I have a conversation about IVF. Mhmm. She'll go back to Rebecca, and she said, what? He said, what?
• 26:28
  Why IVF? And and she'd be totally right. She's like, why would I be talking about IVF at 39?
• 26:34
  Melissa Shere Beek: Right.
• 26:35
  Dr. Armando Hernandez-Rey: Well, the the practical standpoint is that most couples want more than one kid. Mhmm. And at 39, if she's been trying or just starting to try, who knows if we don't have a crystal ball how long it's gonna take. And by the time she's ready to be mother again, it may be too late. Right.
• 26:51
  And so that's the only way that we can Ensure. Well, not insure, but do the best we can to preserve the fertility now as opposed to later because yesterday's better than today and today's better than tomorrow.
• 27:02
  Melissa Shere Beek: Right. Got it. And I
• 27:04
  Dr. Rebecca Karsenti: think it's interesting to note too that measuring the AMH for fertility or like as a proactive measure
• 27:12
  Melissa Shere Beek: Will you tell us what AMH is?
• 27:14
  Dr. Rebecca Karsenti: That's the anti Mullerian hormone Right. Okay. That he referred to
• 27:17
  Melissa Shere Beek: Right.
• 27:18
  Dr. Rebecca Karsenti: Which is part of our testing that we do as part of the infertility workup.
• 27:23
  Dr. Armando Hernandez-Rey: Mhmm.
• 27:23
  Dr. Rebecca Karsenti: Because AMH was not created, but was discovered and utilized for the IVF process. And to see which patients they think would do well or have a good outcome with multiple eggs or live birth. AMH was used was developed for that purpose. And not for what we are using it today, which is a I get asked all the time, younger twenties, can you measure my fertility? I wanna do the fertility test.
• 27:56
  And there's a lot of companies now who are doing this and offering this test online that patients can do a fertility test, which is the AMH in a vacuum. But the American College of Objoin and the Menopause Society actually says we shouldn't be doing that. Don't I don't know if you have an opinion about that.
• 28:15
  Dr. Armando Hernandez-Rey: I do.
• 28:16
  Dr. Rebecca Karsenti: I I do it.
• 28:17
  Dr. Armando Hernandez-Rey: I don't I don't agree.
• 28:18
  Dr. Rebecca Karsenti: Right. I I actually do right. I don't agree either. I measured for my patients for exactly the reason that Armando referred to and you said, because if you're thinking about your fertility and you're 24 and you want an idea, then let's check it.
• 28:35
  Melissa Shere Beek: Why not?
• 28:35
  Dr. Rebecca Karsenti: But I I think it I think doing it online in a vacuum is not the right way to do I think it should be done
• 28:42
  Melissa Shere Beek: With your doctor.
• 28:43
  Dr. Rebecca Karsenti: Someone who's educated, and who could give the appropriate counseling. Right. Because it's not a perfect test. It could give us an idea of what's going on, but it doesn't tell us the whole story. I'm sure I've sent patients with a low AMH to Armando saying, okay, I think you should go see the specialist, and maybe they didn't have a problem, and and vice versa.
• 29:04
  So I think, you know, it it is a nebulous time. And it's a it's a difficult subject because we wanna try to capture these patients when they're fertile, but at the same time, doing I agree, egg freezing at the age of 22 doesn't necessarily sound correct either.
• 29:23
  Dr. Armando Hernandez-Rey: I mean, it's invasive and all of that.
• 29:25
  Dr. Rebecca Karsenti: Right. And
• 29:26
  Melissa Shere Beek: how many 22 year olds are thinking about it too at that time? Not I mean, not many.
• 29:32
  Dr. Armando Hernandez-Rey: No? Like like, we're planning for a kid's college nowadays where my parents just said, here's a number two pencil and take take your SAT.
• 29:39
  Melissa Shere Beek: Right.
• 29:40
  Dr. Armando Hernandez-Rey: The same thing is happening with the infertility because it's it's very prevalent in in the in the in the media.
• 29:45
  Melissa Shere Beek: Right.
• 29:46
  Dr. Armando Hernandez-Rey: And and and again, biologically speaking, they're not wrong. Yeah. But nothing is perfect. Nothing is binary.
• 29:53
  Dr. Rebecca Karsenti: Right.
• 29:53
  Dr. Armando Hernandez-Rey: And and women, as I said, and I wasn't joking, women are very complex. Yes. And one semen analysis, we know of a man is fertile or infertile.
• 30:01
  Melissa Shere Beek: Right.
• 30:01
  Dr. Armando Hernandez-Rey: With women, it's not just the AMH. It's it's an AMH. It's an ultrasound that says ovarian volumes or antral follicle counts. So it's an amalgamation of these all these different aspects of the fertility process. But I don't agree with the American College of OBGYN because the same way that I said the American College is as I used to be Right.
• 30:21
  A fellow of the American College when I was a fellow, and their lens is different.
• 30:26
  Melissa Shere Beek: Yeah.
• 30:27
  Dr. Armando Hernandez-Rey: And menopause, I agree with the menopause society, which shouldn't be used to predict menopause either, or perimenopause. Right. But in my world, if you have a 28 year old who has an AMH of point eight, and I see it all the time, then we should act.
• 30:44
  Dr. Rebecca Karsenti: Yeah. Let's get going. Yeah.
• 30:46
  Dr. Armando Hernandez-Rey: Right. We should act. So in that way, it is an important marker be taken into consideration.
• 30:54
  Melissa Shere Beek: Do you discuss this with all your patients no matter their age?
• 30:57
  Dr. Rebecca Karsenti: I do. I do. Okay. Yeah.
• 31:01
  Melissa Shere Beek: And there's gotta be other factors for screening too. An emotional level, psychological level, do your patients go through that?
• 31:09
  Dr. Rebecca Karsenti: Yes. Definitely. And I think when I say that I discuss it, I mean, I it depends on the patient and where she is also in her in her life Right. Cycle.
• 31:19
  Melissa Shere Beek: Right. You
• 31:20
  Dr. Rebecca Karsenti: know, there are 22 year olds that are ready to talk about, you know, maybe they're exploring couples or, you know, moving in that direction, and then there's very young 22 And year same thing in their late sixties.
• 31:34
  Melissa Shere Beek: Same thing with the thirties.
• 31:35
  Dr. Rebecca Karsenti: Right. And and it's also what's going on with their lives professionally and kinda where they're headed and
• 31:41
  Melissa Shere Beek: Right. All of those factors go into it.
• 31:44
  Dr. Rebecca Karsenti: Yeah. But education is super important.
• 31:45
  Melissa Shere Beek: I think so too. And I've heard a lot about not just personal decisions for doing it, but I've heard a lot of people who have medical issues or have tested positive for different diseases or genetic things, and and for preventative measures have removed their ovaries, and so they want to have the opportunity to have children in the future later. I know very little about your lab, but I've heard amazing things. Can you tell us about your lab and your success rate?
• 32:12
  Dr. Armando Hernandez-Rey: Yeah. Sure. Well, I'm I'm a big believer in surrounding myself with smarter people than I am. And so, I mean, we started our lab about thirteen, fourteen years ago. Actually, our lab director who's in town right now is her name is Sangeeta Jindal, and she's a past president of Society for Assisted Reproductive Technology.
• 32:34
  So extremely well known. She's the one that helped me build the lab and create the protocols that were necessary to create our success, humbly speaking, but proudly, honestly, these are publicly available stats. We are very close to the top in the country.
• 32:52
  Melissa Shere Beek: Amazing.
• 32:55
  Dr. Armando Hernandez-Rey: We fly two embryologists from out of state because they're that good, and there's, you know, with private equity involved very much in our space, in the infertility space, there's been an incredible growth of practices.
• 33:15
  Melissa Shere Beek: Wow.
• 33:16
  Dr. Armando Hernandez-Rey: And when I was a fellow, when I first started in private practice here in South Florida, we were basically three practices, and now there's over eight, nine practices.
• 33:28
  Dr. Rebecca Karsenti: Wow.
• 33:30
  Dr. Armando Hernandez-Rey: So I think, doing things right, keeping your head down and don't worry about anybody else is what's key. And so great embryologist, a great lab director, and also we installed LifeAir, which is
• 33:46
  Melissa Shere Beek: Yeah, tell me about a little bit
• 33:47
  Dr. Armando Hernandez-Rey: more LifeAir about is a I wish I had any financial interest in it. Unfortunately, I do not. But basically, it's it's a ultra purification system where it removes the VOCs or volatile organic compounds that are in the atmosphere. Mhmm. Basically reducing it to point zero zero zero zero zero one because of the sensitivity of embryos, eggs, and sperm.
• 34:17
  Melissa Shere Beek: Right.
• 34:17
  Dr. Armando Hernandez-Rey: Particularly eggs and embryos that are more sensitive to the atmosphere. And so, you know, we have a no perfume policy, no deodorant policy, no fragrance policy. And literally, if you come in with any fragrance, we do a Zoom call or we reschedule you.
• 34:39
  Melissa Shere Beek: Okay.
• 34:39
  Dr. Armando Hernandez-Rey: That that's how strict we are. It's a pain for patients because I I don't use perfume cologne or anything, usually, but I can see how Effects. It's part of
• 34:47
  Melissa Shere Beek: your Yeah.
• 34:48
  Dr. Armando Hernandez-Rey: It's part of your daily routine
• 34:50
  Dr. Rebecca Karsenti: Sure.
• 34:51
  Dr. Armando Hernandez-Rey: And it happens. But if it were your embryos, you wouldn't want anybody screwing
• 34:55
  Melissa Shere Beek: up Messing your with it. No.
• 34:57
  Dr. Armando Hernandez-Rey: So I think we we go the extra step. I I don't pretend to be better than anybody else. You know, I think I'm we are obsessive compulsive about those things, but so are other infertility Again
• 35:10
  Melissa Shere Beek: I think you'd have to be.
• 35:11
  Dr. Armando Hernandez-Rey: Just doing
• 35:11
  Melissa Shere Beek: Just to make sure
• 35:13
  Dr. Armando Hernandez-Rey: You know
• 35:13
  Melissa Shere Beek: integrity of all of these Building
• 35:15
  Dr. Armando Hernandez-Rey: multiple layers to try to produce the best results possible because, you know, I mean, as good as we are, pregnancy rates are not great. Yeah. You know? And so if you went to your plastic surgeon and said and and he tells you that you're about you're gonna have a seventy four percent chance of liking the results of your breast augmentation or your you probably wouldn't do it. Right?
• 35:42
  Well, this is the best that we've gotten in seventy percent with our donor egg program. We're very successful, mid eighties, but still fifteen percent that don't get pregnant. Yeah. And and primarily, that's beyond that is because there's three aspects to a pregnancy, which a lot of people, you know, sometimes forget, which is there's egg, sperm, and embryo, which is one unit. Right.
• 36:04
  Then there's the uterus, and then there's any external factors, whether it's obesity or the PFAS chemicals that you're surrounded with. Right. Firefighters as one occupational hazard where they're involved with incredible toxins in
• 36:17
  Melissa Shere Beek: Right, in the environment.
• 36:18
  Dr. Armando Hernandez-Rey: Yeah. Or you're obese or diabetic or hypertensive, or you have some autoimmune complex that can affect you keeping a pregnancy.
• 36:27
  Melissa Shere Beek: That's a lot of factors.
• 36:28
  Dr. Armando Hernandez-Rey: Multifactorial.
• 36:29
  Melissa Shere Beek: I hear sometimes that after people have done IVF, they get pregnant on their own without it. Is that a fairy tale? Does it happen? Do you have a percentage of people?
• 36:41
  Dr. Armando Hernandez-Rey: What do you think, Rebecca?
• 36:42
  Dr. Rebecca Karsenti: I don't think it's a fairy tale. I see it all the time.
• 36:44
  Melissa Shere Beek: You do?
• 36:45
  Dr. Rebecca Karsenti: And probably because there's probably some factor of anxiety that goes into especially with the first pregnancy, seeking a first pregnancy
• 36:56
  Melissa Shere Beek: Stress and
• 36:56
  Dr. Rebecca Karsenti: all the anxiety and the stress and, you know, and I often, even before they get to Armando will say, oh, you've been trying for, you know, more than six months, you know, are you using ovulation kits? Yes, I'm
• 37:09
  Dr. Armando Hernandez-Rey: doing this.
• 37:10
  Dr. Rebecca Karsenti: This is okay. Well, maybe you guys should take a vacation
• 37:13
  Melissa Shere Beek: Right.
• 37:13
  Dr. Rebecca Karsenti: And relax and just have fun. And sometimes they get pregnant. So I think there is which is hard to tell people, just relax. Yeah. But there is definitely When
• 37:23
  Melissa Shere Beek: they're focused. Hyper focused on a goal.
• 37:25
  Dr. Rebecca Karsenti: There's definitely that little something that sometimes when they're not looking for it, hey, here it
• 37:30
  Melissa Shere Beek: is. It happens.
• 37:31
  Dr. Rebecca Karsenti: Yeah.
• 37:32
  Melissa Shere Beek: In the Egg retrieval process, does it cause epigenetic changes or changes to gene activity that become inherited? What are the risks?
• 37:45
  Dr. Armando Hernandez-Rey: It's a loaded question.
• 37:47
  Melissa Shere Beek: I'm sorry.
• 37:48
  Dr. Armando Hernandez-Rey: No. No. It's okay. I love the challenge.
• 37:51
  Melissa Shere Beek: I wanna know it all.
• 37:53
  Dr. Armando Hernandez-Rey: So the answer is we don't really know.
• 37:57
  Melissa Shere Beek: Okay.
• 37:59
  Dr. Armando Hernandez-Rey: It must not because we have perfectly normal children
• 38:04
  Melissa Shere Beek: There that are born from
• 38:09
  Dr. Armando Hernandez-Rey: are circumstances where we think we do, which is what's called a hyper stimulation, where you have a patient who, as I said to you, the sweet spot is 12 to 16, right? But you have patients who are overstimulated just because inherently there's something like a patient with polycystic ovaries,
• 38:28
  Melissa Shere Beek: or
• 38:30
  Dr. Armando Hernandez-Rey: the clinician will overstimulate for whatever reason. That's something that happens very often in Latin America. Again, not a criticism, just an observation. And so we definitely see that there's a larger attrition when you have Sorry.
• 38:44
  Melissa Shere Beek: No, it's okay.
• 38:46
  Dr. Armando Hernandez-Rey: 39 eggs. Right. You you go from 39 eggs in a young woman to three embryos. Well, that doesn't really happen.
• 38:54
  Melissa Shere Beek: Yeah.
• 38:54
  Dr. Armando Hernandez-Rey: Unless there's something that you've done to cook the eggs, as they say. And the best example that we have of this is ten years ago when these egg banks started popping up. You know, if you and I started a business together, well, what do we do? We take a young woman and stimulate her ovaries like she was 40 just because more bang for your buck, right? Right.
• 39:18
  22 year old, you stimulate her like she's 35, you get a 100 eggs, well, now that's at least 10 couples as opposed to doing the right way and getting two couples out
• 39:28
  Melissa Shere Beek: of Right.
• 39:29
  Dr. Armando Hernandez-Rey: You know, two sales. And the pregnancy rates were abysmally poor, and they had to sort of, like, you know, pivot to like what was actually physio as as close to physiologic as possible. Because what we're trying to achieve with IVF is a super physiologic approach, but again, like everything in life, extremes are bad.
• 39:49
  Melissa Shere Beek: Right.
• 39:50
  Dr. Armando Hernandez-Rey: So So those are the epigenetic changes that we think occur.
• 39:53
  Dr. Rebecca Karsenti: Okay. But also pregnancies from IVF often require more monitoring because there could be more complications, differentiated birth rate, cardiac issues. So often those pregnancies are monitored just because
• 40:09
  Melissa Shere Beek: Is that because of age or because of IVF or both? Both. Okay. Yeah. Alright.
• 40:15
  And we touched upon the emotional aspect of this a little bit, but what are the emotional, physical, and financial? Because you said a little bit about insurance tolls egg retrieval takes.
• 40:29
  Dr. Rebecca Karsenti: I mean, I think a lot of it depends on insurance coverage. If there is, there are companies that are covering egg freezing for their employees, which is amazing. I think from a psychological perspective, I mean, I think, look, I think I start the conversation or they might start the conversation, but we have the conversation about their plans as far as the future and children, and when that will be, where the and where they're gonna be. And so I think that moment to me is is quite a psychological journey. Yeah.
• 41:09
  And Armando referred to that too, that by the time they get in front of him, they've done a lot of soul searching. Sure. And are really trying to figure out what to be doing. I think, don't know if you have in your practice a protocol for patients to do any therapy or if you have a counselor.
• 41:31
  Dr. Armando Hernandez-Rey: Yeah, we have. There's counselors that we work with. For sure.
• 41:35
  Melissa Shere Beek: Is it just for screening purposes beforehand or throughout the process?
• 41:40
  Dr. Armando Hernandez-Rey: A lot of people are different. I think nowadays they're more open to the concept of sitting in front of somebody. Certainly you get a lot more pushback from the male than you do the female. At the end of the day, you're paying a lot of money for the possibility of something happening. And so the anxiety that's created is the unknown.
• 42:03
  Melissa Shere Beek: For the
• 42:04
  Dr. Armando Hernandez-Rey: root, What's for gonna happen? Yeah. Which is awful for couples. Thankfully, just because I'm knee deep in it, thankfully, there is a lot more insurance penetration in South Florida now. Right.
• 42:18
  Okay.
• 42:18
  Melissa Shere Beek: Was just gonna ask you about that, about the accessibility and affordability of fertility.
• 42:23
  Dr. Armando Hernandez-Rey: I mean, like everything Insurance. The problem with fertility and insurance coverage is that it's potentially two ships going in opposite directions.
• 42:38
  Dr. Rebecca Karsenti: Right.
• 42:38
  Dr. Armando Hernandez-Rey: And I'm sorry, I keep hitting this.
• 42:40
  Melissa Shere Beek: That's okay.
• 42:42
  Dr. Armando Hernandez-Rey: Problem is that technology is growing so quickly. Mhmm. And, you know, without We're completely powerless because these companies are charging a lot of money
• 42:55
  Dr. Rebecca Karsenti: Mhmm.
• 42:56
  Dr. Armando Hernandez-Rey: For this new technology, which then should increase your pregnancy rates. But the insurance is another behemoth that wants to make money.
• 43:03
  Melissa Shere Beek: Right.
• 43:04
  Dr. Armando Hernandez-Rey: I mean, they're not everybody's in the in the in the business of So making money, right, for reimbursements are less.
• 43:10
  Melissa Shere Beek: Mhmm.
• 43:10
  Dr. Armando Hernandez-Rey: So then practices, and this is global.
• 43:14
  Melissa Shere Beek: Okay.
• 43:16
  Dr. Armando Hernandez-Rey: Don't have the means for not research and development, but just development
• 43:23
  Melissa Shere Beek: Right.
• 43:24
  Dr. Armando Hernandez-Rey: To get the better scopes, the better, you know, particularly the smaller practices. And then and then you have the private equity part, which they're all about cost cutting. So they're they run very lean. So then you have the customer service aspects, which are completely decimated, and if anybody needs customer service, everybody needs customer service.
• 43:49
  Melissa Shere Beek: Right. Right. Right.
• 43:49
  Dr. Armando Hernandez-Rey: But a lot of handholding is infertility patients. Yeah. So we're kind of in a in in a difficult situation right now with regards to infertility, and I think the dust will eventually settle and and good always wins over evil.
• 44:07
  Melissa Shere Beek: Yes. It has to.
• 44:08
  Dr. Armando Hernandez-Rey: But but it's it's a it's very difficult. And to I'm sorry to be so so verbose, but
• 44:14
  Melissa Shere Beek: No. I love it.
• 44:16
  Dr. Armando Hernandez-Rey: You know, the accessibility is is much better. Mhmm. I would say ten years ago, it was about 15% insurance. Now, I think we're closer to 50%.
• 44:26
  Melissa Shere Beek: Oh, no. That's great. I didn't I didn't even think you were gonna say it was that high.
• 44:30
  Dr. Armando Hernandez-Rey: Yeah. Yeah. It's about 45 to 50%. I'm sending you
• 44:34
  Dr. Rebecca Karsenti: a lot more patients. Right? Great.
• 44:37
  Melissa Shere Beek: Yeah. What do your patients say is the most difficult thing for them? Is it the cost? Is it time? Is it money?
• 44:42
  Is it the emotional toll? Do you have the discussion with your patients or you?
• 44:47
  Dr. Rebecca Karsenti: I mean, I do, I guess, because I'm vetting them often his way. I mean, plenty of people go his way without me.
• 44:54
  Melissa Shere Beek: But what are they saying to you as patients? They're saying what what is the most difficult thing?
• 44:58
  Dr. Rebecca Karsenti: Well, I mean, we talk about what the process entails, and that often there is a cost. Right. You know, if it if there is insurance coverage or not. And also, is a big time commitment and a physical commitment.
• 45:13
  Melissa Shere Beek: Right.
• 45:14
  Dr. Rebecca Karsenti: You know, I just had a conversation with somebody this week about possibly pursuing egg freezing. And I said, you know, there's a lot of different offices in the city and, you know, this is my favorite, of course. But if you live in this part of town, you know, you have to make sure, are you willing to drive to Coral Gables Right. Every day, because often you're getting blood work, ultrasound
• 45:38
  Melissa Shere Beek: Right. Day.
• 45:38
  Dr. Rebecca Karsenti: So, you know, just to manage expectations and have them know that they're expectations. You know, it is a commitment.
• 45:46
  Melissa Shere Beek: But they don't come back to you and say, the most difficult thing is
• 45:49
  Dr. Rebecca Karsenti: I think the most difficult thing is is, you know, doing the process
• 45:53
  Melissa Shere Beek: Right.
• 45:53
  Dr. Rebecca Karsenti: And the unknown of what what's gonna happen.
• 45:56
  Melissa Shere Beek: Yeah. Well, that's Right. A big
• 45:58
  Dr. Rebecca Karsenti: Whether it be IVF and, you know, hoping for a baby in a short period, or the process of egg freezing and, you know, having those eggs stored for for when you're ready. And then that the unknown that that I don't really address, but that unknown of what what their future is gonna be, what their who their partner's gonna be, and and all that.
• 46:20
  Melissa Shere Beek: It's a lot.
• 46:21
  Dr. Rebecca Karsenti: It's a lot.
• 46:22
  Melissa Shere Beek: Is there anything you wish my listeners knew about the egg retrieval process that maybe they might be misinformed about? Because we touched about a lot of misinformation things, but is there anything else we left out? Or anything else you think
• 46:33
  Dr. Armando Hernandez-Rey: Yeah. I mean, the the most important thing is that there's a lot of inner cycle variability. Mhmm. And your ovarian reserve may be normal or age appropriate, but on any one given cycle, you may hit it out of the park, and on any given cycle, we may not. And again, I have never seen one woman who doesn't expect anything but success.
• 46:57
  Melissa Shere Beek: Right.
• 46:58
  Dr. Armando Hernandez-Rey: And getting the optimal number, that sweet spot on one given cycle.
• 47:02
  Melissa Shere Beek: One go, yeah.
• 47:04
  Dr. Armando Hernandez-Rey: And that's really a challenge because as I said, I think there's no woman that I've met thus far that's said when she was 18 or 20 or whatever, number one, have to egg freeze my eggs, and number two, that when I do it, I may not get and I may need a second cycle, or they may not work. I mean, I always tell them, like, this is only insurance policy. The goal is for you to conceive naturally Right. And just to feel more comfortable, less anxious about
• 47:35
  Melissa Shere Beek: Right.
• 47:35
  Dr. Armando Hernandez-Rey: Oh my god, am I aging? Yeah. But, you know, we've had situations where, unfortunately, the eggs didn't survive Right. Or didn't lead to a viable pregnancy.
• 47:47
  Melissa Shere Beek: Crushing. Crushing.
• 47:50
  Dr. Rebecca Karsenti: And also that every woman is different. Yes. I think that I mean, there's so many people say, oh, well, my friend, my sister, my cousin, you know, had
• 47:57
  Melissa Shere Beek: this Or even your mother,
• 48:00
  Dr. Rebecca Karsenti: you know, or your sister. Think even a a close relative, their experience is not necessarily yours. Right. Because we are all so individual. And as Armando put, you know, we're complex creatures.
• 48:13
  We you know, women are beautiful complex creatures. Yes. And so much goes in to that egg that's going to then go and be fertilized for a baby. You know, it's had a whole life. It's a that egg has lived a whole life from when you were inside your, you know, your mother's belly.
• 48:34
  Like and so everybody is so different. Yeah. And and and for good or for bad. Right. But I but I always try to to have people feel reassured and positive.
• 48:46
  Good. There's so much talk on the media about infertility.
• 48:49
  Melissa Shere Beek: But what I think you said information is key.
• 48:51
  Dr. Rebecca Karsenti: Yeah. You know, and and get educated. And and if you're interested in doing testing with your OB GYN, ask your OB GYN to do it. Some might say no, and say, oh, no. It's not recommended.
• 49:03
  But but many will say yes. And I think it's good to be educated and and knowledge is power. Yeah.
• 49:09
  Melissa Shere Beek: Oh, a 100%. Yeah. What's the future of IVF? Because I've heard some things about AI.
• 49:15
  Dr. Armando Hernandez-Rey: Yeah. There's a lot of AI is nowhere where it needs to be. Although, if you speak to the companies, they'll tell you that it's there. It's not there yet, but certainly things like prediction models for assessing the best quality embryos, That's in the pipeline.
• 49:33
  Melissa Shere Beek: That's cool.
• 49:34
  Dr. Armando Hernandez-Rey: Number one. Number two, standardization of protocols. I'm not clear as to what benefit there is in that, but I mean, KPIs and data analysis is always essential. Mean, I see three Excel spreadsheets a day, literally, about our KPIs, about whether it's patients or protocols or success rates or lack thereof.
• 50:02
  Melissa Shere Beek: Right.
• 50:02
  Dr. Armando Hernandez-Rey: So I think data is important. I think what's more in the pipeline is, it's gonna be relevant, is automation of the Embryo Lab. We have now Conceivable as a company.
• 50:17
  Melissa Shere Beek: Automation?
• 50:18
  Dr. Armando Hernandez-Rey: Yeah, like elimination essentially of an embryologist. Can do essentially what an embryologist does, and they've already done it in Mexico.
• 50:31
  Melissa Shere Beek: Wow.
• 50:32
  Dr. Armando Hernandez-Rey: Yeah. And I think in the world of the area of genetics, and I'm not talking about designer babies,
• 50:43
  Melissa Shere Beek: and
• 50:44
  Dr. Armando Hernandez-Rey: it's a very toxic word, but design can mean a lot of things and editing certain genetic mutations that are not necessarily incompatible with life, but compatible with a horrible life.
• 51:06
  Melissa Shere Beek: Right.
• 51:07
  Dr. Armando Hernandez-Rey: And if it's okay to fix a heart valve in utero or a ureter, then why is it not okay to fix a gene that could mean a reasonable quality of life for that So human again, I'm not making any judgments here, I'm just putting it out
• 51:25
  Melissa Shere Beek: there for
• 51:27
  Dr. Armando Hernandez-Rey: comparison. So I think that's very much on on the horizon.
• 51:34
  Melissa Shere Beek: Wow. Is there anything you think we left out? Covering?
• 51:39
  Dr. Rebecca Karsenti: No? I
• 51:41
  Melissa Shere Beek: think we covered a lot.
• 51:42
  Dr. Armando Hernandez-Rey: Think we
• 51:42
  Melissa Shere Beek: covered a We covered a lot. Yeah. Well, I can't thank you both enough for being here today. This was beyond incredible and informative, and I'm I really appreciate it. I hope our listeners have gained great insight on their reproductive options, and how lucky are your patients?
• 51:57
  Really amazing. Listener links, I'll be adding them all to everything that I post, so you can give me all those information. I do one thing at the end of my podcast before I sign off with my guests. You game? It's called Quickie Questions.
• 52:13
  Sure. Okay. And they're just sort of little fun things. What are you most proud of?
• 52:19
  Dr. Rebecca Karsenti: My kids. Mhmm.
• 52:20
  Dr. Armando Hernandez-Rey: God. You beat
• 52:21
  Dr. Rebecca Karsenti: me too.
• 52:21
  Melissa Shere Beek: Sorry. You can say the same. Your kids.
• 52:26
  Dr. Armando Hernandez-Rey: Yeah. My kids.
• 52:27
  Melissa Shere Beek: Yeah. Of course.
• 52:27
  Dr. Armando Hernandez-Rey: Absolutely.
• 52:28
  Melissa Shere Beek: Okay. What inspires you?
• 52:33
  Dr. Rebecca Karsenti: So many things. I think little things every day. I love looking at the moon at night. Yeah. The full moon this week.
• 52:43
  Walking the dog last night, looking up at the moon always reminds me of, well, you know, when I was delivering babies that I'd see the full moon and it was gonna be a busier night on the Labor Floor.
• 52:52
  Melissa Shere Beek: Really?
• 52:52
  Dr. Rebecca Karsenti: Yeah.
• 52:53
  Melissa Shere Beek: Oh, well, now that I look at the moon every night, I'll be thinking differently about what the full moon means. Yeah. And what about you?
• 53:00
  Dr. Armando Hernandez-Rey: So many things, honestly. I mean, you can gain inspiration from the moon or anything that surrounds you. My job, I love my job. I really love what I do. I love my family, my kids, my friends.
• 53:11
  I'm surrounded by incredible friends.
• 53:13
  Melissa Shere Beek: That's wonderful.
• 53:15
  Dr. Armando Hernandez-Rey: My life, you know, everything is a reason for getting up in the morning and and making it a better day than it was the day before.
• 53:23
  Melissa Shere Beek: Yeah. It's a blast. When was the last time you really laughed hard?
• 53:33
  Dr. Rebecca Karsenti: I was laughing pretty hard. I'm trying to remember. My perimenopausal brain doesn't remember.
• 53:39
  Melissa Shere Beek: It's
• 53:39
  Dr. Rebecca Karsenti: okay. But I was watching a movie with my kids and we were all crying laughing.
• 53:46
  Melissa Shere Beek: I love that.
• 53:48
  Dr. Armando Hernandez-Rey: This Yeah. Weekend remember which one. Yeah. This weekend, my my kids were and my wife were making fun of me for something that I totally cringe at. Cringe And at and and totally fine with making fun of my laughing at myself.
• 54:02
  Yeah. So I laughed crazy. I don't remember what it was exactly, but it was something, like like, out of the '80 an eighties, like, really weird movie, and I said it
• 54:14
  Melissa Shere Beek: Like a good John Hughes quote or something? Probably. Yeah.
• 54:17
  Dr. Armando Hernandez-Rey: They were like like like rolled their eyes and
• 54:19
  Melissa Shere Beek: were like, dude,
• 54:20
  Dr. Armando Hernandez-Rey: seriously. Yeah.
• 54:21
  Melissa Shere Beek: Bro. Bro.
• 54:22
  Dr. Rebecca Karsenti: Bro. Right. Right.
• 54:24
  Dr. Armando Hernandez-Rey: Come on.
• 54:26
  Melissa Shere Beek: Alright. So you give so much to your patients gift wise. What is the greatest gift that you've gotten from your profession?
• 54:35
  Dr. Armando Hernandez-Rey: I'm gonna say this one first. Go ahead. Dissatisfaction. I mean, honestly,
• 54:38
  Melissa Shere Beek: like Yeah.
• 54:39
  Dr. Armando Hernandez-Rey: I I was in
• 54:40
  Melissa Shere Beek: Can only imagine.
• 54:40
  Dr. Armando Hernandez-Rey: I was on an airplane on a couple a couple weeks ago from New York, and there was three kids that I had on that flight at 11:00 at night that I had helped bring into this world. World. Oh. One of them it's like 11:00. The flight is delayed.
• 54:57
  The the light the the dark the lights have been turned off, so, like, whoever wants to sleep while we're waiting on on the tarmac to to push off. And the kid says to me as he's walking to his seat, he's like, hey, my mom said you made me. And everybody woke up and and laughed.
• 55:14
  Melissa Shere Beek: Oh, that's so beautiful.
• 55:16
  Dr. Armando Hernandez-Rey: Anyway, that's amazing. Yeah.
• 55:17
  Melissa Shere Beek: That's beyond. Yeah.
• 55:19
  Dr. Rebecca Karsenti: Yeah. So you know, because I could say the babies I delivered. But I I love because I I am in the legacy of my dad. Yeah. I I happen to love when I see his patients now that he retired and I see them in my office and say, your dad is such an incredible The continuity.
• 55:39
  And yeah. It makes me makes me feel good every time.
• 55:43
  Melissa Shere Beek: That's really awesome.
• 55:44
  Dr. Armando Hernandez-Rey: He should be. He's a great guy. He's a great guy.
• 55:46
  Melissa Shere Beek: Yeah. Oh, well, thank you guys again. I really appreciate you being here. It really was an education and I'm honored to have you both.
• 55:53
  Dr. Armando Hernandez-Rey: No. Thank you for the invitation. That
• 55:54
  Dr. Rebecca Karsenti: was very awesome.
• 55:55
  Dr. Armando Hernandez-Rey: Appreciate the time.
• 55:56
  Melissa Shere Beek: Oh, I appreciate the time too. To our listeners, thank you so much. So grateful you're here. Keep listening. Keep learning.
• 56:02
  Keep laughing. Keep up with Beak on Being, and stay well, everyone. Listen to Beak on Being wherever you get your podcasts. All episodes are automatically transcribed. A big shout out and a huge thank you to Steven Chan at Penthouse Studios.
• 56:16
  Thank you. Awesome. We good? Thank you, guys. This was amazing.
• 56:24
  Dr. Rebecca Karsenti: That was great.
• 56:24
  Melissa Shere Beek: I hope you had fun too. Yeah. I learned a lot. Can't