I’m thrilled to share this conversation with my friend and colleague, Dr. Jaime Knopman, a reproductive endocrinologist and author of the newly released book Own Your Fertility: From Egg Freezing to Surrogacy, How to Take Charge of Your Body and Your Future. Dr. Knopman brings clarity, honesty, and courage to the conversations our patients need now more than ever.
In this episode, are talking fertility-doctor-to-fertility-doctor about egg freezing, IVF success rates, and fertility preservation strategies. If you’re wondering when to freeze your eggs, how age affects fertility, or what “fertility tests” actually tell you, this conversation is for you. We dive deep into the science of fertility decline, debunk common myths about getting pregnant, and discuss practical steps for fertility preservation. Dr. Knopman shares her powerful “fertility puzzle” and “fertility treatment ladder” frameworks that help patients understand their options. We also cover the emotional aspects of infertility, pregnancy loss, and how to build resilience through your fertility journey.
In this episode, we cover:
- Why fertility declines at age 32 and what AMH testing really tells you
- Egg freezing success rates and how many eggs you actually need
- The truth about monthly pregnancy chances (hint: it’s not 50/50)
- IVF treatment options explained: from IUI to embryo transfer
- Fertility myths debunked: hormone balancing, ovulation tracking, and the “fertility test”
- How to talk to your doctor about fertility preservation and family planning
- Real patient success story: 10 frozen eggs, 1 embryo, 1 healthy baby
Resources:
- Dr. Jaime Knopman’s book: Own Your Fertility (on Amazon)
- CCRM New York
- Dr. Jaime Knopman Instagram
- Dr. Jaime Knopman website
Full Transcript:
Dr. Aimee: Today, we look at ambition, timing, metabolic health, emotional resilience, modern family building, and what it means to truly plan your reproductive future. Today’s episode is titled Own Your Fertility: Why Planning Early is the new Standard of Care.
Our guest is my friend and colleague Dr. Jaime Knopman, reproductive endocrinologist and author of ‘Own Your Fertility,’ which was just released. She brings clarity, honesty, and courage to conversations our patients need now more than ever. I’m delighted to have her on so we can talk, fertility doctor to fertility doctor, about all of the behind the scenes of setting yourself for the best possible journey.
If you’re the kind of person who loves a good plan and wishes there was something straightforward to reference for your fertility journey, you’re going to want to tune in for this conversation with Dr. Jaime Knopman.
Jaime, thank you so much for joining me today.
Dr. Jaime Knopman: Thank you so much for having me. I appreciate it.
Dr. Aimee: You talk openly about when this all started for you. Specifically, you were inspired very early by Elizabeth Blackwell, who was the first woman to get a medical degree in the United States. I love this. I also knew from very early on that I wanted to go into fertility medicine. Can you tell us what Dr. Blackwell drew you in, and how it inspired you to become an REI doc?
Dr. Jaime Knopman: I wouldn’t have said these words back then, but I think I thought she was so empowering. She sort of was a badass. She knew what she wanted to do and she just did it. It didn’t matter that she was a woman and the standard of care was that physicians were male.
I really liked science. I know it sounds nerdy, but I did. Therefore, I went to college with a very linear path knowing that I wanted to go to medical school. Initially, I knew I wanted to do something in women’s healthcare, but I thought I wanted to be a surgical oncologist, perform mastectomies, lumpectomies, etcetera. Then, once I got to medical school, I realized that I actually wanted to do OBGYN.
Dr. Aimee: What a great story. Let’s talk about the first time you meet a patient. I think this helps patients know what to expect and can give other doctors good ideas, too. Obviously, we have to start with the basics. You say, “When I meet a new patient or couple, I go from nice to meet you to some version of what fears keep you up at night within the span of an hour.” What does this look like and why is this important to you?
Dr. Jaime Knopman: I always say I don’t want to be too intrusive, I’m not here to get your gossip, but I need to know what you want your future to look like, ideally, if I’m going to help you. Do you think you want four kids, but you don’t want to start until 40, or do you want one child and you’re going to start next year? Then I can guide you with what is the correct decision for your fertility. And I need to know if you have a partner or are you thinking of doing this on your own, is this partner the one you think you’ll have children with.
There are a lot of seemingly invasive questions, but they’re what we use to guide a patient to the right path.
Dr. Aimee: I’m super nosy, very nosy. You’re right. We get people to tell us things that sometimes they haven’t even told their partners.
Dr. Jaime Knopman: Correct.
Dr. Aimee: Explain the cleverly named “other Plan B.” What are some of the top things people need to know about preserving their fertility that seem to surprise them?
Dr. Jaime Knopman: We were just chatting about this before. I think women are often surprised at how impactful their age is going to be on their fertility. I think that’s because for most of us we assume our fertility is a given, so we don’t think about it until sometimes it’s too late. You and I have seen a lot of women come into our offices in their mid-forties saying, “I think I’m going to start to try to have a baby,” and we are like wait a second, where have you been for the past 10 or 20 years. It’s not to be insensitive, but it’s: “Wow, people really don’t know what’s going on in their bodies.”
Dr. Aimee: People think that we’re being mean to them when we say things like, “You’re in perimenopause right now,” but that’s just normal human biology. There was a study that just came out showing that it’s actually age 32 that we see a bigger decline. You probably saw that as well. I think so many women think it’s 40 or 50.
Dr. Jaime Knopman: Correct. We came up with this slogan in med school for an abstract we submitted for ASRM: “Menses does not equal motherhood.” Just because you’re getting your period, it doesn’t mean the quality and quantity of your eggs is able to make a healthy pregnancy. I think we’re often misled by this concept.
It doesn’t mean we want to scare women or make people think that they’re all going to be infertile when they hit 32. But it does mean that we have to think about that in order to plan for our future.
Dr. Aimee: There’s nothing wrong with being hopeful at the same time, if let’s say for example, you are 45. You and I both want all of our patients to succeed the way they want to. We don’t want them to have to use an egg donor, but sometimes we have to have those hard conversations with patients.
You describe the puzzle as your go-to metaphor to explain infertility. What are the five pieces of the infertility puzzle? I really like that analogy. What are the basics that patients need to know about each of the puzzle pieces?
Dr. Jaime Knopman: Two pieces come from your ovaries, because you need to ovulate or release an egg, and the quality and quantity of your eggs has to be adequate. Your fallopian tubes, your uterus, and then sperm. I say there’s probably multiple more pieces that we will discover as fertility as a field of medicine grows.
You and I have both sat with many couples who have what we call unexplained infertility where all the pieces of the puzzle seem to be checking out but they’re not getting pregnant. There’s probably a lot of other pieces, we’re just unaware of what those pieces are today.
Dr. Aimee: You learn so much as you put someone through an IVF cycle. You learn about their egg quality in ways that an FSH and AMH level just don’t tell you. You have this analogy that I also love, it’s called the “fertility treatment ladder.” That’s a brilliant way to explain how many doctors and patients approach the fertility treatment plan, often from an organic standpoint. If one treatment doesn’t result in a pregnancy, then another option may present itself.
How do you phrase this with patients to help them understand the different types of treatment from the start?
Dr. Jaime Knopman: I explain to them at the base of the ladder or the lowest rung, it’s just unprotected intercourse, if you’re having heterosexual sex and your partner has sperm. As it doesn’t work, we need to go up step by step to become more aggressive in our treatment modalities. You and I both know, just because you get to the top, which a lot of people consider to be IVF, it doesn’t mean that you can’t do it again. I think there’s a fear sometimes of, “If I do IVF and it doesn’t work, then there’s nothing else you have to offer.” Well, there’s a lot of things we have. We can do it again with a different protocol. We can change some other things in the lab. But I think it’s easier to think about things in a stepwise fashion than a huge leap to the end, because that can be overwhelming.
Dr. Aimee: A lot of what we do can seem overwhelming, especially with a lot of the things that patients read in Facebook Groups or on Reddit where people have gone through IVF that doesn’t work, and it makes them feel like they just don’t want to have those experiences. That’s a good point.
One of my favorite things about doing these shows and being on social media is fertility myth busting. You do a lot of that in your book, in Chapter 7. I know that helping people understand the differences between fact and fiction helps them plan for a much smoother journey. Let’s do some fertility myth busting with some of these misconceptions that I haven’t tackled on the show before…
“You’re able to get pregnant until you hit menopause, which is when your fertility comes to an end.”
Dr. Jaime Knopman: That’s sort of like the “menses doesn’t equal motherhood” slogan. We will get our periods. I’m an open book, so I’m 47-and-a-half, I still get my period, but I certainly don’t have good eggs, so I’m not getting pregnant. It doesn’t mean that if you are still menstruating the quality of the gamete is able to develop into a healthy pregnancy.
Dr. Aimee: Right.
“A period is your egg coming out. If you look closely enough, sometimes you can even see a tiny egg in the blood. That’s why you’re most fertile during menstruation.”
Dr. Jaime Knopman: I have heard this so many times. The first time, I thought it must be a one-off. Then when patients said it to me repeatedly, I was like no, this is incorrect.
Your period marks the beginning of the next cycle. There is no egg. What you’re seeing come out is just tissue from the uterine cavity. You’re most fertile, usually, two weeks after that.
I was struck by the unawareness of a lot of people.
Dr. Aimee: Also, the egg white cervical mucus, people think that’s like a cracked egg, like a chicken egg. In a way, it is a sign the egg is coming out in a few days, but it’s not anything related to your egg, meaning it’s not the actual follicle with cervical mucus coming out.
“You have a 50/50 chance of getting pregnant every month.”
Dr. Jaime Knopman: You and I see this a lot. Patients will say, “I don’t understand. I started to try, I had sex on the right day, I’m not pregnant.” I’m like, of course you’re not. Most of the time, we know you’re only your most fertile in those first few months of trying, your fecundability is 25% max. Most of the time, you’re not going to get pregnant. I think people are so surprised by that statistic.
Dr. Aimee: Yes. Humans are not very good at getting pregnant. We’re just not as efficient as other animals.
Dr. Jaime Knopman: Human reproduction is inefficient, yes.
Dr. Aimee: I wish we were like bunnies, I wish we could ejaculate like men every day and have eggs come out. The wait for it, you have to wait two weeks, ovulate, wait another two weeks to find out if it happened. If we could figure out a way to ovulate every day, don’t you think that would be pretty amazing?
Dr. Jaime Knopman: Yes. Then you would up the odds significantly.
Dr. Aimee: I know. Maybe an invention for me. Okay, next myth…
“Out of balance hormones are why you’re having a hard time getting pregnant.”
Dr. Jaime Knopman: The hormone topic has become really mainstream. People come in, I see a lot of women who say, “I want to balance my hormones.” What I say is hormones are never balanced. That’s what happens in the menstrual cycle, there’s a natural fluctuation and cadence. You’re going to see a rise of estrogen, a rise of progesterone, but that is normal.
Are there situations where you’re not having this regular fluctuation and that’s abnormal? Sure. PCOS or hypothalamic amenorrhea. But balancing your hormones is not going to make you more fertile, per se.
Dr. Aimee: When I see a patient who has a high FSH, she wants me to help her lower it. FSH being high isn’t something that we necessarily treat. It’s just something we use to help understand what’s going on with you. There are certain things that might help, like supplements and a couple of other things that may help lower the FSH, but overall, you’re right, balancing hormones is something that, I totally agree, is very much trending on social media.
Dr. Jaime Knopman: It’s very en vogue now. Everyone is like, “I want to balance my hormones.”
Dr. Aimee: Okay, next myth.
“Your infertility is in your own hands, or somehow because of something that you did.”
Dr. Jaime Knopman: Again, we see this all the time. I want to control it, it’s my fault, I ran across the street after my embryo transfer and that’s why it didn’t work, or I ate pasta for dinner and that’s why my egg quality is bad. I always say I wish it was that simple. Unfortunately, most of the time, it’s not.
In trying to control it, what I think happens to women is they become a tight grip on trying to control, and it makes the process even more untenable because they can’t pull through because they’re trying so hard to grip it and to control it.
Dr. Aimee: The take control of your own fertility, you can take control of the knowledge that you gain about your fertility, but it’s just one of those things that it doesn’t matter how hard you work, there’s little that we have control over, except the doctors we see, how we take care of ourselves, how much sleep we have at night.
Next myth…
“There is a test that measures how fertile you are. Just ask your doctor for the fertility test.”
Dr. Jaime Knopman: You probably see this, too. All the time, people are like, “I’m here because I want the fertility test.” I’m like, “What test is that? If you figure it out, let me know.”
There is no test for one’s fertility other than your ability to conceive.
It really started with the influx of egg freezing patients who wanted to know what their eggs were like. What I say until I’m blue in the face is we know your egg quantity based on your AMH and your antral follicle count, but we don’t know the quality of those eggs until they are fertilized by a sperm. Saying, “I’m here for the fertility test,” is an incorrect way to assign validity to that test.
Dr. Aimee: It’s not as accurate as we would like it to be. We can forecast. I call myself a fertility fortune teller, but fortune tellers are not very good.
Dr. Jaime Knopman: That’s a great way of putting it. We’re saying we believe your AMH is low, you may have an early menopause or difficulty conceiving, but we don’t know for certain.
Dr. Aimee: Let’s talk about resilience. The last section of your book, it’s so funny because I always say just keep swimming, I have that in my mind and it’s always a tune in my ear. You tell a story of a patient facing loss. This is one of the things that we can never really plan for. We don’t want it to happen to any of our patients. How do you approach this with patients, what do they need to know after a difficult cycle or a loss?
Dr. Jaime Knopman: I think these are the hardest conversations that I have. I’m sure you’re the same. We want it so badly for patients, sometimes I think I might want it more than they do. Then to have to be the one to break that news is difficult.
I think I’ve gotten better as I’ve gotten older. I think when I was a younger physician, I was so uncomfortable that I would say it really fast and sort of run out of the room. I didn’t know what to do. Now, I’ve grown up a bit. I’ll sit down to make sure I’m on the same level as the patient. If I’m calling, I’ll say, “Is this a good time? Do you want me to call you back?” That’s just more to allow the patient to have some control, but also to slowly process the information because it’s really hard to take in.
Dr. Aimee: It really is. I agree. I feel like as I’m getting older, I’m able to handle these conversations myself. I used to overeat just to self-soothe because those conversations were so hard, I would be a disaster, a total mess.
Dr. Jaime Knopman: I agree. I think one thing I learned was I had a lot of problems separating myself from the patient. I was so in it with them that I then was like, “What did I do? What can I do?” Now, oftentimes I’m like it’s nothing we did, we have to find a way.
I had breast cancer in my late thirties, early forties. I often say that was probably one of the most formative experiences for me as a physician. To have the script flipped and I became the patient, it showed me what was good as a physician and what was not always great as a physician. Meaning, “You have breast cancer, this is all the information,” and I’m like oh my god, I can’t process this right now, I’m going to need you to call me back in a couple of days, because I wasn’t ready to get the news even though that person was ready to call and tell me.
Dr. Aimee: You share a lot of patient POVs, point of views, in your book. Is there one story that stands out to you that you might want to share with us today?
Dr. Jaime Knopman: It’s so funny, because that patient just texted me a few hours ago. She was a woman who decided to go back to medical school in her thirties. She had been in finance and thought, “This is not what I want to do.” She came in to freeze eggs, she had very low egg quantity, her AMH was low. She got one to two eggs per egg freezing cycles, we got a total of 10 eggs frozen. She goes on, completes med school and residency, she becomes an orthopedics resident, meets a partner and wants to thaw her eggs.
She told me this, I wasn’t aware that orthopedic residents actually have the highest rate of infertility, above that of even just women in medicine. She was concerned about carrying herself because it’s a very physical residency with a lot of exposure to radiation. She thawed her eggs, we got one healthy embryo, a female, a day six euploid embryo. She found a surrogate, and the surrogate got pregnant on the first transfer. I’ll never forget, she was on call, so her mom came to the transfer. It was so beautiful.
She just texted me. She actually was not only in the delivery room, the OB let her deliver the baby with her. They had a nine-and-a-half-pound baby girl. I was like, this is so beautiful. I said to her, “Are you willing to share your story before I talk about it?” She was like, “I want to share with everyone. Had I not frozen my eggs, I don’t actually know if I would have ever had a genetic child.”
Dr. Aimee: If she hadn’t come to you to get that encouragement to do so, because I think a lot of doctors it wouldn’t be worth it to them to put someone through that many cycles for 10 eggs.
Dr. Jaime Knopman: The thing was I kept saying to her, “We don’t actually know the quality of your eggs. If you can physically, emotionally, and financially keep going, let’s try to get to 10.” At the end of the day, someone might say she has 10 eggs and only one good embryo, but she has a baby now. That is a win.
Dr. Aimee: Right. It’s a huge win. What do you hope doctors and patients will take from your book?
Dr. Jaime Knopman: That’s a good question. I think what I hope the most is just awareness about your body. I think we know because this is what we do every day in and day out, we know so much about what happens to women and couple’s fertility, but so many people don’t. I want to bring awareness to this because as we continue to push when we have children to later and later ages, we need to know this. Otherwise, the rates of infertility will only continue to soar.
Dr. Aimee: The thing is I feel like there’s this pushback on us as fertility doctors by educating patients about this, because there’s this whole other side where people are saying things like it’s not true, your eggs don’t age, and it’s just so unfair to people out there who believe that.
Dr. Jaime Knopman: Because we see this every day, we live it day in and day out, we also know what will happen if you ignore this and you come to us in your late thirties wanting to have a large family. It is unlikely to happen, and it would have been more likely had you addressed it earlier.
Dr. Aimee: Jaime, where can people find you and your book?
Dr. Jaime Knopman: The book is available now on Amazon and Barnes & Noble. I work at CCRM New York, which is the Colorado Center for Reproductive Medicine. I work at the office that’s located in New York City. I also have an Instagram handle @DrJaimeKnopman and a website at DrJaimeKnopman.com.
Dr. Aimee: Thank you. Is there anything else you want to add before we sign off?
Dr. Jaime Knopman: I’m so grateful for you having me here. Also, you do amazing work, so thank you.
Dr. Aimee: Thank you for saying that. Dr. Jaime, thank you for this thoughtful conversation and for the work you are doing to expand access, autonomy, and clarity for anyone planning their reproductive future.
