Fertility Specialist: Understanding female & male fertility, when to get help & how treatments work (with Dr. Lucky)

23:09Like this is all common sense, but it's important to hear from a fertility doctor that we see that make a meaningful difference. Really? You see diet make a meaningful difference? Yes.

23:18Two Parents & A Podcast Hosts:In men and women fertility? Yeah. It's not to say that if you're suffering with infertility, it's because you're not eating healthy. No. But I have seen patients longitudinally say, okay, I have made an effort to do X, Y, Z, and we have seen better outcomes. And that sounds really anecdotal. So I will say there's lots of data and studies looking at this, looking at dietary patterns and outcomes, whether you're trying on your own and you're just getting started out versus going through treatment. Wow. And what are other things that men may be doing that hurt their sperm health? And we were with a friend a month or two ago and he was telling us about uh him and his partner's fertility journey and when he went and his sperm quality got checked his sperm counts were incredibly low and uh i think that what they tapped into is the driver of that uh was he's hot tubbed every morning sauna he was a big sauna hot tub and sauna and he cut it he stopped hot tubbing and and they went back six months later six months later thank you and things got back to healthy levels so what are other things like that that that should be on i'm so glad you brought that up because that often sounds like a myth but sperm are really uh sensitive to extreme temperature especially heat so you know being in a hot tub once on vacation it's no big deal men are always making you sperm and it's not going to kill off all your sperm right but if you're one of those people that's like, I'm doing a cold plunge and then a hot tub and I'm doing that every morning.

24:51I'm going to spend like 30 minutes in this extreme heat and think about how the male body is built, right? The scrotum, going back to that like Seinfeld episode, shrinkage, right? It is actually, there's a muscle that helps bring it closer to your body. If you need heat and further from your body, if you need to cool down because there's an optimal temperature for sperm production. And if you're surrounded by boiling hot water, you're doing extreme hot yoga or saunas for hours at a time, you don't have enough of an ability to regulate your temperature, at least where the sperm is being produced.

25:29So it can actually, in a chronic way, negatively impact fertility. But the good news is it's not a permanent effect because you're always making new sperm. So like you said, there's ways to kind of counteract that. And I usually ask both partners about their lifestyle at length. But then I always say, like, let's do the semen analysis. And, you know, let's see if there's any indicator or red flag. And if there is, then we can kind of work backwards to think, okay, how can we be optimizing what you're doing? Another example, which is often thought of as a myth, and maybe it's not as extreme as people make it out to be, but wearing really, really tight underwear.

26:06And it's the same thing. It's counteracting your natural mechanism to cool the area where sperm is being produced. a rare example and this is not going to be applicable to the large proportion of people listening to this but it's an interesting case I had a patient whose husband was like a professional biker and he was biking for like hours and hours a day and it was causing this like repetitive stress or trauma to the area and he had major issues so you know there's so many different ways that it can be affected but the good news is there's always room for improvement

26:36Two Parents & A Podcast Hosts:that's really the good news yes yeah the sauna thing to me it's fascinating like you you stop and then it can improve yeah the next round it's about improving the environment yeah definitely we're getting ready for baby boy next year and i'm stocking up on so many magnetic me outfits because i always say changing a newborn is like changing a cat and when there are zippers and buttons you guys it's basically impossible and that's where magnetic me comes in because their magnetic closures make dressing time quick and easy. I'm telling you, you just change the baby, get the outfit on and boom, you magnet one clothes and then they all pop into place.

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27:48Two Parents & A Podcast Hosts:Don't wait. Order today at magneticme.com. Okay, questions from the audience. All right. What are the most common causes of infertility in women and in men? So I would say in women, a lot of times age is a huge factor for the women I'm seeing. But I also think that it is important to highlight that there are many people in their 20s that might have infertility. And it's interesting because a lot of people in their 20s who go through infertility feel extremely frustrated because there's less of a narrative about it. And therefore there's a lot of dismissing. And a lot of them are coming to me after seeing their OBGYN or other doctors who are like, you're okay, you have time.

28:32And they're like, what are you talking about? I've been trying for four years, you know? So there's less urgency in how they're treated and addressed. And there's more stigma because most of their peers maybe aren't dealing with that. But issues like PCOS, which means a tendency to ovulate irregularly. And if you're not ovulating or you never know when you're about to ovulate, it makes it way less efficient because of everything I explained about the timing, right? This is why you start with a biology 101 and then everything else makes sense. Endometriosis is a condition that you might have heard of.

29:04It's getting a lot more airtime because there's a lot of outrage over the fact that it's traditionally taken a long time for women to get a diagnosis. But it's typically this condition that's chronic and can be associated with chronic pelvic pain, really painful periods. And it's basically very fascinating. No one really truly still understands why it happens, but it runs in families. And it's a situation where the tissue that lines the inner cavity of the uterus that builds up and sheds whenever you get a period, for some reason, cells that act like that tissue are found in other parts of your body.

29:37Most often, your pelvic cavity. And so that's where the pain usually predominates. And it's fed by the hormonal changes of your menstrual cycle. But I've had patients who have it in their lung cavity, who have a collapsed lung every time they get a period. You know, that's an extreme example. People have found it in the brain. People have found it in the abdominal wall. So it's a really weird, mysterious illness that is debilitating for so many, and it can cause infertility through a variety of mechanisms. So a lot of the young patients I see with infertility have endometriosis. About a quarter of my patients, up to a third of my patients, have endometriosis.

30:10They just don't know it yet. And you can't really always diagnose it on imaging. So it's like taking a good history. the gold standard way is to do a minor minimally invasive procedure to visualize it directly but it's something that if anyone listening has painful periods please talk to your doctor and know that many people have had to speak to multiple doctors and really self-advocate to get a proper answer on that that's really important to know okay i'm really glad you said

30:35Two Parents & A Podcast Hosts:that um it's it's it's i just the the part where you say you have to talk to multiple doctors and self-advocate but it's important that you're saying that so they can hear that and they can know that they need to do that. Okay. Why does it seem like so many people in their twenties and thirties are dealing with infertility today? And, and is anything, are things different today than they were 20 years ago? Fertility wise? Yes. I mean, you specified twenties and thirties. I will say in general, the, the feeling that it's more prevalent, a huge part of it is, is that a lot of of us are waiting longer to have kids, right?

31:11Like I started trying in my mid thirties. My mom was already married. My mom was married in her like late teens.

31:21Two Parents & A Podcast Hosts:Okay. A lot of our friends have, you know, have kids at 21, 22. I mean, they just do. Yeah. She had four kids, but she started in her early twenties. Right. And I here started in my mid thirties. And so when we're starting at a later age and we're trying to have multiple children, there's just an increased tendency that you may need some help in getting there to overcome the biological clock. But there's also other shifts, right? The increasing incidence or the rise in obesity. And with that comes something called insulin resistance, which is like a big buzzword right now in the wellness space.

31:55But it is a real problem. And it's something I diagnose multiple times a week. And it can affect not only egg quality. And let me explain what insulin resistance is. It's basically insulin is a hormone that is like the key that unlocks the cell and allows sugar from the bloodstream to be stored in cells. That's important because anything you eat gets broken down and processed as energy and sugar is a major source of that. But a lot of people are resistant to the effect of insulin. And so their pancreas makes more insulin and insulin is very pro-inflammatory and it can actually drive the production of testosterone in our ovaries.

32:35A lot of people don't even know that women produce testosterone. Throws off the balance of hormones, can throw off the ovulation and make your cycles irregular, can create a more inflammatory environment. It can also make it less likely for an embryo to successfully implant. Sometimes I see it being related to miscarriages. And so these are the things I think about when I'm like, okay, why am I telling a patient that she could benefit from altering her diet or trying to exercise, especially weight bearing exercise? Because when you build muscle, it actually sensitizes your body to insulin. When you have more fat, especially in the central area, that makes you more insulin resistant.

33:12So it's all related. And we are seeing more and more obesity. And it's, you know, just the difference in how we eat nowadays and the types of foods that are available and their socioeconomic factors like the crappier foods that cause more insulin resistant tend to be cheaper and more readily available and you know all of that in combination with us having kids at an older age not to mention you know the things we put on our body and the things in our environment everyone's talking about microplastics we didn't have an awareness and now we're in this time frame we're in this generation where we're like, oh, we all have microplastics in our body, right?

33:52That's changed over time. But like, there's a lot of good things that have happened. I don't want to be all doom and gloom. Now we have vaccines, like women aren't having 10 kids and only expecting half of them to live, you know? So there's a lot of improvements. And we are also seeing massive improvements in the past two, three decades in the success of fertility treatments like IVF. So we're able to push the limits of our biological clock a little further. So there's just so many different things happening good and bad that have led us to the place that we're in right now that makes a lot

34:22Two Parents & A Podcast Hosts:of sense um okay so after 30 is there a really steep fertility cliff how does age realistically impact fertility for both women and men so it's the two things we talked about but just to recap because i gave you the foundation right i said nobody has perfect eggs even in your 20s when you think my fertility must be as it is as good as it can get right a lot of people think it's perfect, right? The best way to think about the quality aspect is when you have an embryo that forms from your eggs, what is the chance that that embryo has all of its DNA and therefore has a high reproductive potential ability to implant and stay implanted, right?

35:00At baseline in your 20s, when it's as good as it gets, 20 to 25 percent embryos are going to be abnormal, but the large majority, 75 to 80 percent, will be healthy. So shouldn't take too many ovulations to get there, hopefully right at 35 that figure changes to one-third abnormal two-thirds chance of an embryo being normal okay so still love those odds right when we get to like 37 38 it's 50 50 okay and at 40 it's two-thirds abnormal one-third normal and at 45 it's like 90 95 percent abnormal right

35:31Two Parents & A Podcast Hosts:so i heard a statistic that after the age of 30 12 of your eggs are viable that's wrong i don't think that's correct yeah that's what you're saying is a lot better odds than that yes and and i think a lot of people hear this message and feel nervous or anxious and i always say like i'm a glass half full girly so i'm looking at a 37 38 year old patient i'm like yeah there's still a 50 chance that an embryo that forms is normal there's a lot of people walking around that never make it through my clinic door that were able to get pregnant in their late 30s or their early 40s totally but you don't want to sugarcoat things and be overly reassuring and that's why you say okay try on your own you know I had someone come in today who was like I'm 42 and you know I she froze eggs with me and then she actually came back with a partner she froze eggs at 38 and she froze a good number like 20 or more and she came back with her partner a few years later and was like we're not ready yet but I really would like to know if those eggs are viable because an egg is a single cell and you can't test it you can't really assess you're just hoping for the best as long as you have enough you're doing the math and thinking how many normally thaw how many normally fertilize how many we went through that like that exercise of talking about how inefficient everything is and she froze enough but she didn't really know but then she had a partner and she was like i'm ready to commit to the sperm and turning the eggs into embryos and we did it and there was a lot of attrition but we ended up with like four or five normal healthy embryos and i said well now that we know they're healthy because they've been tested because you can actually biopsy and remove some of the outer cells without hurting it and we can get that definitive information and an embryo thaws really well like 98 percent of the time and a 60 to 70 percent chance of live birth is pretty good yeah and you have enough that i think you're in a good position and we were talking about that and she said well now i'm 42 she came back in today and she said we're probably going to start trying like next year she was 41 going to be 42 next year should i just come back and use these embryos right away and i was like listen why don't you just try on your own and if after three months it hasn't happened then we'll talk about it and then And then maybe we used an embryo.

37:35And I said these words. And the husband laughed out loud. And I was like, maybe I shouldn't have said that. But I was like, maybe at that point, we just get out of Dodge and get you pregnant. And I'm like, that's how I think. That is the mind of a fertility doctor. But I didn't tell her to go straight to it. And I don't think it would have been unreasonable for her to say, hey, I really want to avoid the elevated risk of miscarriage. But it could also work. Right. And then she could keep those embryos for baby number two or three, if that's what she wants to do. Because guess what? this is the best piece of uplifting information that I want to share is that your uterus doesn't really age.

38:07Two Parents & A Podcast Hosts:Oh, that's amazing. So the age you are when you come back to use your frozen eggs or embryos doesn't factor into the equation as much. Of course, we're up against, you know, being older and having maybe a higher risk of certain complications. And we have to be watched more carefully by our OB when pregnant. But your ability to get and stay pregnant is not linked to the age of your uterus. It's really linked to the age of your eggs and the resulting embryo quality. Isn't that fascinating? That's fascinating. And I did, we were talking about, I think, some golfer's wife who had carried, she had frozen eggs really young and then came back and carried them, I don't know, I want to say 60.

38:42Two Parents & A Podcast Hosts:Yeah. And they had said that she could still house the eggs was the term that they had used. Yeah. I mean, 60 is pretty extreme. Every program, this is kind of interesting, every IVF center may have its own kind of internal guidelines and there's ethical things that have been written about this to help guide decision making. But you do have to think about having a healthy baby and also thinking about what is the goal here and some of the ethical guidelines written by the American Society of Reproductive Medicine, right? Those are the types of societies we look to for guidance on these things because it's so not black and white.

39:20Right. And it's very hard to tell someone, no, you're too old. Like, we can't do this. but we have to think, is there a reasonable chance, looking at the combined age of both parents or the support system, that this child can be raised to adulthood? Right. Because we don't want to set people up for situations. Because there's so much science can do now, but should we be doing it? Right. And we have to constantly ask ourselves those questions. Totally. Totally reasonable response. Yeah. Yeah.

39:47Two Parents & A Podcast Hosts:And I can't remember if she was the wife or if she carried them for somebody. I don't remember that. I bet she carried them for someone else. I think now that you're saying this, I think that's what it was. but I don't know. Okay. I have one child and want a two-year age gap, but I'm nervous about my fertility changing in the meantime. I'm still under 35. What is the fertility cost of waiting a little longer? I think it depends on where you're at. So it's not a linear thing. It's not like every year you lose X percent of eggs and your egg quality decreases by X percent. The good news for someone who it sounds like she said she was in her 20s.

40:19No, she said I'm still under 35, which I'm guessing between 30 and 35. Okay, fine. When you're in your 20s and very early 30s, that, if you're looking at it as like a line on a graph, it's kind of flat. Yes, there's always a decrease in egg count and quality over time. That's just a fact. But it's a pretty gradual, slow decrease. And then it speeds up as we approach our mid-30s. So there's an uptick maybe at like 32 and then 33 and then even more so at 35. And then it's like a sharper rise. Remember we talked about the 25%, the 35%, the 50%, and then it goes to 70, it's like things start to move along more quickly.

40:58But it's not a fertility cliff. It's a continuum. And I think it's actually healthy to take a little bit of time between pregnancies. This is something we don't talk about enough, the concept of a short interpregnancy interval. I have patients who come back to me and I'm like, you just delivered your baby. What are you doing here? And they're like, I'm ready. Let's do this. I want to have lots of kids. And I'm like, your uterus needs time to heal. And, you know, taking a year or a year and a half between pregnancy or delivery and the next pregnancy is actually something we advise, especially if you had a C-section.

41:32But even if you had a vaginal delivery, it takes time for your uterus to regain its strength, for your body to feel back to a place where it's healthy to have another baby. And there's actual risks associated with not waiting long enough, like higher risk of preterm labor, growth restriction or growth issues. And so you just want to be really careful. It's not that it's not possible to have another pregnancy six months later, but I usually don't advise. I usually say, wait at least a year.

41:56Two Parents & A Podcast Hosts:Okay. And so on this second, can you explain secondary infertility? Yes. So things can change over time, right? It's not always going to be static. The number one thing that I see as a cause of secondary infertility is you started at 32, 33, and now you're over 35 for baby number two or baby number three. And so just naturally, it's a little bit harder. But also everything we talked about holds true. Like sperm quality can change over time. You know, as we all get older, we might be more prone to certain chronic medical conditions. We might be a little bit more overweight and maybe our habits have changed.

42:34Life is stressful. Maybe we're not coping as well or sleeping as well. All of these things can holistically impact our fertility. But also the more and more ovulations a woman has in her lifetime, the more opportunity for fibroids to grow because that's hormonally driven. the more opportunity for endometriosis to worsen and spread. So these are all factors that explain why you see an increased prevalence of infertility. It's not just age. It's all of those other things as well.

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44:12Two Parents & A Podcast Hosts:That's right, 55 % off plus free shipping. Once again, that's nurturelife.com slash two parents. And make sure you use our promo code two parents. Even if you aren't a parent with young kids, you might have a parent friend who struggles with mealtime. This would be a great gift. Make sure to share our code so our show gets the credit. Remember, put your little ones first with healthy meals from Nurture Life. Okay, how long should people try naturally before seeking help? In parentheses, my first took a year. Terrified it'll take just as long again. Yeah. So the reason why I named my book, The Lucky Egg, a lot of people think it's just like good marketing because my name is crazy, lucky.

44:50But it's actually to illustrate and to admit that, well, I like to think of everything as being scientific and have an explanation for everything. There are so many things we don't have an explanation for. There are some people that have that history and then they try for baby number two and it happens on the second round, right? Because it's like a lottery. There is an element of luck and there's so much lack of control that we have to admit. There are people that have had failed IVF cycle after IVF cycle and then randomly on a break between cycles, they were able to get pregnant. We hear those stories all the time.

45:21And as doctors, if we don't acknowledge that, that unknown, and we have to, how could we not? I mean, there isn't even a test for me to look at someone's individualized egg quality. We're making a lot of guesstimates. And the science is great, but it's not everything. and there is an element of serendipity and luck. And so what I would tell this person is stay on top of it because it's normal for it to take a year. It's like a 15 % chance or 20 % chance, even in your late 20s per month, that that one randomly ovulated egg will actually line up and turn into a pregnancy. So your cumulative probability gets to a more acceptable level, like maybe 85 % of couples are pregnant after one year of trying.

46:01So it might've just been that. But obviously if you're under 35, and it's been over a year, go see a doctor, get tested, and then talk about treatment. If you're over 35, don't wait longer than six months. If you're in your 40s, it's good to go even after three.

46:15Two Parents & A Podcast Hosts:Okay. Okay. If you're in your 40s. Wow. Okay. Thoughts on hormonal birth control pills and how they affect fertility short-term and long-term. So short-term, while you're on it, the whole idea is for you to not get pregnant, right? So hormonal birth control pills specifically work by shutting that signal that I was talking about from your brain that normally gets sent to your ovary to get one of those eggs to ovulate, just shuts it off. It's fooling your brain into thinking there's already enough estrogen and progesterone being produced, so it doesn't need to do its job. It's like, okay, I'm going to take a vacation.

46:45And so then you're not ovulating. And if you're not ovulating, you can't really get pregnant, right? Now, if you miss a few pills, then your brain wakes up and starts sending signals and you might ovulate. And that's how accidents can happen, right? So with perfect use, hormonal birth control is really effective. Now, if you've been on it for a really long time, your brain might be like, oh, I don't need to like think about when to go off of my vacation. And it might take a few months for it to wake up and start sending that signal out. But that's not a big deal. And we usually say, give it three to six months.

47:17If after six months, you still haven't started ovulating and getting a period, that's the number one clue that you're ovulating is that You're getting a period because that's happening because the hormone changes from ovulation. And when the hormones drop, if you don't get pregnant from an ovulation, then the lining breaks down and you get a period. So if you're not getting a period and it's been six months, it's time to see a doctor. And it's never wrong, even at the three-month mark, to just get checked out. Now, some women feel very convinced that the pill caused problems for them. And something I see every day in my, not every day, but like every week in my practice is women that went on the pill because they were in their teens and they weren't trying to get pregnant and maybe their periods were kind of annoying or heavy and so their doctor said go on this and they they liked it it was great maybe they're even skipping their periods because they're not taking the placebo week in the pack totally fine then they get off of it because they're like oh i'm 31 i'm in a relationship i want to start tracking my cycles i'm thinking about trying to get pregnant cycle doesn't come they come to me at the three to six month mark and i do a scan and i recognize hey it looks like you have pcos polycystic ovary syndrome based on how your ovaries look and your hormone profile.

48:24And they feel really betrayed by the birth control pill. They're like, oh my God, this whole time I had this thing and I can't believe I didn't know about it. I feel so blindsided. They're just not mentally prepared. And what I explained to them is, yeah, it's not great to not know what's going on with your body. A lot of times they're like, I don't even remember the conversation clearly, but now I'm remembering my periods were kind of irregular and all over the place. And I was trying to, you know, I was, it was interfering with school and stuff. So the doctor put me on the pill. So I'm kind of like, that was an early clue or sometimes it's something that emerges in our bodies.

48:54It increases with insulin resistance. So there's environmental and genetic factors, but it was masking it because when you're on the pill, you're not actually seeing what your ovulation can do. But I always explain to them when people have PCOS and they're not having a regular ovulation, I always say you have this unhealthy balance, imbalance of never making progesterone because you're not ovulating and that's actually not good for you. It's bad for the lining of your uterus, not to scare people, but if left unchecked for too long, that can actually cause like early forms of uterine cancer. So when women come to me with known PCOS where I diagnose it, I'm usually like, if the goal isn't to get pregnant, I'm not going to try to make you ovulate.

49:34I might put you on birth control pills because that will help to balance out the lack of progesterone. It also helps you create more of this protein called sex hormone binding globulin. And basically it's like a sponge that soaks up all the extra testosterone because a lot of women with PCOS are prone to insulin resistance. They make more testosterone than they should be and they get acne. They get hair loss where they should be having hair. They get hair growth in places where they shouldn't have hair. I know that this is probably speaking to tons of people listening right now because it's so common.

50:06And a lot of it is just genetic. Some of it's environmental. But I would have probably recommended the pill anyway. So what I always tell patients is, I probably would have had you on this anyway. It just sucks that you didn't know about it.

50:18Two Parents & A Podcast Hosts:Right, right. So the pill's not always the enemy at all. And now they're seeing me and they're trying to get pregnant. So the mechanism of what we're doing changes because now I care about them actually ovulating. Right. So there's meds that I can use, oral medications. They're called like letrozole or clomid, where you take it for five days and it fools your brain into thinking there's no estrogen. So it wakes your brain up and it makes it send a stronger signal to the ovaries. because what PCOS is is broken telephone for your ovaries. Your ovaries are getting the signal, but they're kind of not listening.

50:50And so they need the brain to shout at it. Like, you know, that Kim Kardashian quote that went viral, which was like, people just don't want to work. Like, that's what your brain's saying to your ovary when you give them letrozole. It's saying, okay, you got to get up and work.

51:03Two Parents & A Podcast Hosts:Okay, so PCOS is broken telephone. That is such a good way to describe it. And so there are pills that can wake up your brain and say, no, we do have to ovulate. And lifestyle changes too. Because anything you can do to counteract insulin resistance, that's why weight loss can help people with PCOS who are overweight. Because it can make the noise that's preventing the signal from being received go away. Okay, okay. That is fascinating. Okay, and then for those people that are struggling with fertility, what are treatment options like? So there's really two buckets, and I think we have to address this and talk about it.

51:37Let's say you do the workup we talked about. You do the imaging, uterus looks good, tubes look normal, sperm looks great egg count not that it really matters for your ability to get pregnant with one egg each month but egg count looks good you're able to ovulate no test for egg quality remember okay well why isn't it happening then well about 15 i'd say as little as 15 percent of cases of infertility are unexplained a lot of times there's actual endometriosis lurking in the background it's just like you just don't know about it or it's egg quality which there's no direct test for or a combination of just the inefficiency of all the different parts that have to come together.

52:15So you don't find a target to treat. Like if you find blocked tubes, then we do IVF, right? We take the eggs out of the body. We take the sperm and the eggs, create embryos, and we bypass the blockage and put the, we put an embryo at the top of the uterus and we go vaginally, so we're avoiding the blockage. There's a really low sperm count. In extreme cases, we could do IVF where we put one sperm into each egg and bypass that issue. If there's a blockage in sperm getting into the reproductive tract, we can do a minor procedure to extract sperm directly from the testes. So there's a lot of like solves if you know what you're trying to solve for.

52:49But if there's nothing that you can solve for, you still need to rectify the inefficiency of human reproduction. And there's two buckets of treatment. One is like gambling or like speed dating for the reproductive tract. You're doing something to increase the odds just by a bit on the egg side and the sperm side. So what that looks like for someone with ovaries is taking a medication like clomid or letrozole to force your brain to send a stronger signal because now it might help you release two or three eggs. One egg is a long shot, two or three long shots in play. It improves your odds by a bit.

53:19And on the sperm side, you can put sperm at the top of the reproductive tract. Give it a shortcut. It's like sperm delivery, right? And you're washing it, you're concentrating it, and you're just trying to get more sperm and more eggs to interact. So it's like speed dating for the uterus. Okay. Instead of two people meeting and finding each other and being like, you're the one, you're going to an event, you're meeting a bunch of people, and you're hoping that that improves the odds of a connection taking place. But anyone who's gone to a speed dating event knows that that is not destined to work the first time.

53:44So it's like the long game. You might try medicated inseminations or IUI, intrauterine insemination. In combination, you might do that and also keep trying on your own during that time for like three to six months. Now, the other option is much more direct. It's IVF. So medicated IUI is laid back. It has laid back treatment success rates. It has laid back prices. Like it's cheaper. It's not high tech. IVF is much more controlled. It involves having a team of embryologists in a lab who you never meet doing like micro procedures with your eggs and sperm. And basically you're taking shots. You're trying to get multiple eggs to grow.

54:19The shot mimics that signal your brain normally sends to get one egg to mature and ovulate. But you take it at a higher level to get all of them to kind of plump up and mature. then we go in and we do a very simple procedure that takes 10 minutes but you're asleep so you don't feel anything or remember anything and we extract the eggs vaginally okay and we do it with a needle and you don't feel it and you wake up in the recovery room kind of surprised it's over and I'm speaking from experience because I did IVF to have my second and basically we take the eggs out you go home you go back about your business you're going to sleep that day off and the next day you can go to work so it's very minimal okay but there's a lot of bloating and I I don't want to overly minimize it.

54:55Like it's kind of an annoying process to go through. My friends were definitely like bloated

54:57Two Parents & A Podcast Hosts:and it was hard on them. Yeah, and then it kind of dissipates after a week or two you get your period. Totally. We get a sample of sperm from the partner that day and we put sperm and eggs together in the dish. We grow them for a week. We grow them into embryos and we see the survival of the fittest. The drop off still happens. The inefficiency doesn't magically go away but we counteract it by working with not just one, two or three eggs but hopefully multiple and that's why egg count matters. The more you start with, the more you end up with. at the embryo stage you can put the embryo in the uterus right away you could freeze the embryos you can test the embryos which is what i do in majority of cases because it's nice to be able to say okay we froze these embryos now the report comes out a week or two weeks later which ones are healthy and which ones oh these would not implant or would maybe result in a miscarriage we're not going to use these okay and we use one embryo at a time nowadays that's modern ivf and we thaw it out 98 will survive the thaw we place it at the top of the uterus in a procedure that feels easier than a pap smear it takes five minutes and eight days later we get a lot of positive pregnancy tests but sometimes it takes more than one to get there and so after three consecutive transfers of a high quality genetically tested normal embryo you have a 92 cumulative live birth rate now a lot of people struggle with ivf because it's hard to get that normal healthy embryo because they have a low egg count okay or they have a lot of egg quality issues so that's when you hear about people doing multiple rounds and some people have fibroids or uterine factor issues that are really hard to overcome and it's hard to get the embryo to implant but in general those are the stats that we're working with now which is it's a great time to be a fertility doctor no question and the fact that we're this we have this much education around it now yes and that we can do this much absolutely that's awesome that's wow that's it's just incredible to hear you say that so a lot of your how many of your patients do IVF oh I mean I'd say like just under half my practice are people that are freezing eggs or like me wanting to freeze embryos for the future because they're in their mid-30s and they're like thinking I want two to three kids and I have a career and I don't want to have kids back to back that's why I did it at 34 sorry 33 and then no 34 I did it at 34 I had already had my first and I was like there's no way I can do this anytime soon this is so overwhelming for me and I care about my career but I know I want to be a mom of more than one child if I can.

57:18So then I froze and then lo and behold at 37 everything I thought might happen happened and then I ended up relying on what I froze. So wait, what was your question?

57:27Two Parents & A Podcast Hosts:Just how, no, that's really interesting because I'm glad you're saying this because I'm 32 right now and I think a lot about we want more than two kids and I do think a lot about this break that's going to happen next and I have some friends we talk about it and we're like, you know, do we freeze our eggs because maybe I'll get to 37 and what I think will happen will happen, like you're saying. The question was how many patients. Oh, yeah, now I remember. Yes. So more than half are dealing with a variety of causes of infertility, male, female, sometimes a combination of both. A lot of them decide to start with medicated IUI.

57:59I think it depends. Some people go straight to IVF, especially if they're starting their journey in their mid to late 30s and they know they want to have multiple children. I'm like, you know, you might get away with doing medicated IUI, the easy, low-tech treatment option, but then what happens when you're back for baby number two and then if we need to resort to IVF at that point it might be harder and take more cycles because we have less eggs to work with and they have a lower conversion rate so just do it some people will go straight too because they're like you know in the American Society of Reproductive Medicine at says at 38 anyone who's starting their family that wants two kids should consider IVF right the first step so it's more about the the fact that you can preserve your fertility and that whole idea of your uterine age not really being a huge factor.

58:41So if you could free some embryos, that's really strategic. But I'd say it's a mixed bag. There's no one size fits all. I can't even give you a stat because I've never really looked at that. Yeah, OK. But I'd say people that come to me at 38 and they're like, I just want one. I'm like, then let's try to make it work with IUI. I'm like, let's have a low threshold to move on to IVF if we need to, especially if they have a decent egg count. If they have a low egg count, I'm like, do I really want to spend time doing something with a lower success rate because there's a high chance we might need IVF?

59:08So it's all about being strategic.

59:11Two Parents & A Podcast Hosts:Okay, that's fascinating. Wow, I mean, your patients are lucky to have you. Thank you. No pun intended. No, that is right now. And of course, I'm sitting here like, what a great name. So for people that are struggling with fertility issues, what are some ways that you suggest that their friends and family support them? I think you need to be a good listener. Okay. Stop the knee-jerk human nature tendency to put a Band-Aid on it and say like, but at least you don't or you know it's going to be okay stay positive just relax like those are the things that are very triggering to people even though it's seemingly helpful um educate yourself I always say when I'm talking about my book that I didn't just write it for people that are trying to get pregnant or thinking about pregnancy for themselves but also I wrote it for the moms the uh you know partners the friends the community around people going through this so that you can unburden the person that's dealing with enough on their own and say, okay, you just share this book because it's so easy to understand that you don't have to be in the trenches of infertility to care enough to read it.

1:00:15You can learn a lot. And I think when people educate themselves and show, that's a way of showing up that is so meaningful and helpful versus platitudes or not showing up at all because you're like, oh, this is awkward. I don't even know what to say. That's the worst thing you can do right and the worst worst thing you can do is if you are lucky enough to not experience this but your friend is going through infertility don't like not tell them that you're pregnant okay don't not invite them to your baby shower and treat them differently because that's even just more isolating than it needs to be no question okay so tell tell us about where they

1:00:53Two Parents & A Podcast Hosts:can find the book where they can find you on social plug yourself okay i'm really bad at plugging myself it's okay but uh okay I'm on Instagram um at lucky.ccon and I'm also on TikTok I'm better on Instagram though but TikTok Dr. Lucky Egg because someone took lucky.ccon believe it or not um I have a website that I started so long ago I think it was like during COVID and it's called theluckyegg.com and that's where the idea for the book came from because I just started putting out articles answering the questions of the day that were coming to me and if I see like common things that are coming up I'm like oh this must be like some trendy thing on social media because everyone's asking me about it then I would address it and myth bust and I also put some calculators so I have an egg freezing calculator based on my real life experience with people coming back to thaw out their eggs oh that's genius you've got egg freezing yeah like put your age that you were when you froze your eggs and how many mature eggs you froze and I'll give you the probability of success obviously you can't predict with 100 % certainty but it's at least giving someone some tangible idea of what to expect.

1:01:55There's also like an AMH calculator. We didn't even talk about that, but that's a blood test that everyone does to look at their egg count. And it's basically just plotting you on a graph using real-world data from 17 ,000 patients and showing you where does yours fall. And it's not a comparison game, but it's more about just being able to conceptualize because there's so much that people are like, I don't even know what to think about this information. And so it tries to put it into context. And so now the book came from me doing little social media posts and blogs and seeing how that was really helping people.

1:02:26They're walking through my door being like, I found you on Instagram and I already feel so much better about my situation because you've educated me. But me understanding that the grid is very fragmented and wanting to have an all-encompassing resource with an index, a glossary of terms. and it's really an easy read but it's like my conversational voice on instagram but it's in a format that is taking you through the education that i just took you through like the basics how to prepare your body for pregnancy when to seek out help how to even find a good clinic like these are things you can't google easily and also if you're deep in the trenches of treatment and it's not going well how to troubleshoot you know and and also a huge mental health aspect to it because people don't talk about mental health.

1:03:09They over, and including myself, I over-anticipated my ability to handle failed cycles. And as a professional, I was like, if this blindsided me and it was hard for me, how does someone who has no knowledge of this deal?

1:03:22Two Parents & A Podcast Hosts:Totally. So it's everything. It's really a fertility Bible is how I'm describing it. And I hope it helps a lot of people. I do too. I do too. So it's called The Lucky Egg, you guys. Can they get it on Amazon? Everywhere. Amazon, Barnes & Noble. There's going to be an audio book. Great. Yeah, it's coming out January 13th. January 13th. Okay, amazing. Thank you so much, Dr. Lucky, for being here. This was a very, very valuable episode. So thank you. Thank you. Thank you very much. Thanks for listening to another episode of Two Parents and a Podcast powered by Just Media House. If you enjoyed the show, don't forget to like, subscribe, comment, rate, and review.

1:03:54Two Parents & A Podcast Hosts:Stay connected on Instagram, TikTok, YouTube, and Facebook at Two Parents and a Pod. Welcome to our home. Sorry it's so messy. New episodes Mondays and Thursdays.