The 8 Lessons I’ve Learned in Ten Years of Fertility Care
I started my medical practice ten years ago after graduating from UCLA School of Medicine, completing my OB-GYN residency at Harvard Medical School and a fellowship in Reproductive Endocrinology & Infertility at the University of Michigan. My sister always teases me that my job title means that I spent 15 years studying how a sperm and egg make a baby. It’s true!
With new tests, the diagnosis of “unexplained fertility” is really a thing of the past.
I’ve seen so much change in the field of fertility medicine in the past ten years. From transferring embryos during IVF day 3 to day 5 to Preimplantation Genetic Screening and frozen embryo transfers, the way we do IVF is continuously evolving and improving so I can help patients more than ever. Even diagnostic testing has changed. With new tests, the diagnosis of “unexplained fertility” is really a thing of the past. On the September 19th Egg Whisperer show, I shared the lessons I’ve learned in the last ten years.
Lesson One: Education is the Key to Your Best Fertility Choices
I first started throwing Egg Freezing Parties in 2014 because I wanted to empower women (and men) about their fertility in a fun way. Too many women in their late 30s and 40s were coming into my office struggling with fertility and wishing they had known more about it when they were younger. If someone had told them to get their fertility hormone levels checked or to consider the option of preserving their eggs, they most certainly would have made that choice.
I call it a party because fertility can be a heavy topic, so I create a light-hearted educational seminar that I host in a restaurant for people in their 20s and 30s to learn about their fertility, the basics of egg freezing and help them decide if egg freezing is the right choice for them. While egg freezing is not a guaranteed route to pregnancy, making the choice in your 20s, 30s, and even 40s can improve your chances for pregnancy. I have frozen the eggs of a number of women in their 40s who went on to have healthy pregnancies.
Get in touch if you want me to host an egg freezing party for your club, business or graduate school.
Lesson Two: Hormone Testing Helps You Track Your Fertility Over Time
I don’t want any woman to feel like she is standing at the edge of a fertility egg cliff or that she is a fertility time bomb. Your eggs just don’t run out overnight. It’s more like a slow wind down over decades. That’s why fertility testing, starting in your 20s, can help you and your doctor become more informed, which gives you more options. And it’s not true if your doctor tells you that you’re too young for fertility testing.
My Egg Whisperer Fertility Awareness Panel measures three critical hormones connected to your fertility. Antimüllerian hormone (AMH) is responsible for stimulating the growth of the ovarian follicles that hold your eggs. Follicle Stimulating Hormone (FSH) is produced by your pituitary gland and signals your ovaries to release an egg every month. E2 or Estradiol is another female sex hormone produced in the ovaries that regulates your menstrual cycle. Together, these three hormones regulate your reproductive system and while not perfect, they are the best we have when it comes to fertility indicators.
While age is the best indicator of your egg quality and ability to get pregnant naturally, fertility tests can provide you with a snapshot of the current state of your fertility. By continuing to take these tests over time, you’ll be able to paint a personalized picture of your fertility health. For example, the tests can tell you if you have any flags for early menopause, a high chance of having PCOS (See my article, Think Egg Count and Quality Doesn’t Matter? Think Again) and where you are on the fertility meter?—?high, medium or low fertility.
Fertility isn’t skin deep, so in order to be fully informed, you need: blood work, a consult with someone like me who will review your fertility history and goals, and then help you to create a personalized fertility care plan with full knowledge of your story.
Lesson Three: Pregnancy Starts at Trimester Zero
Trimester Zero is the three or four months before you get pregnant in which you prepare to get pregnant, and yes, this includes guys too. Recent research has shown that both the health of men and women before they conceive can profoundly influence a pregnancy, including being overweight or underweight.
It’s so important to quit smoking and decrease your drinking in these months. I always recommend that men get their sperm tested because if they’ve been on the pizza and beer diet, or they’re spending too much time in hot tubs, it can affect sperm quality. While women can’t improve the quality of their eggs, sperm actually regenerates every few months, so lifestyle changes can improve the quality of sperm.
Women can also use this time, to adjust their diets and start prenatal vitamins. (For more information, see Trimester Zero: Strategies for Your Best Preconception Health) Research has also shown that there’s a direct connection between your health and its impact on your growing baby, including birth weight, brain development and the long-term risks of a child developing cardiovascular, metabolic, immune and neurological problems.
Lesson 4: We can Start a Fertility Sharing Economy
Every since egg freezing became a viable option, a lot of women have come to me wanting to do the procedure. More companies are starting to cover egg freezing on their health insurances plans, but for those women who don’t have the coverage, the steep price tag makes it out of reach. Over the years, I’ve crossed paths with a lot of women who want to give the gift of life by donating their eggs. These two groups of women inspired me to start my Freeze and Share program.
If you’re a young woman who is considering freezing your eggs, through Freeze and Share we will cover all the medications, fees, travel and five years of storage if you are open to donating half of your eggs to a woman or couple in need of donor eggs. You’d have to go through a meticulous counseling process and give legal consent. You would get to meet the family to whom you donate your eggs (this is optional), and also get to decide with them what kind of relationship you will have with the child in the future. (See The Extended Donor Family: It’s All About Connection) I’m sure you’ve read stories in the news about people finding their donors and donor siblings through DNA tests, so it’s important to understand that there’s no such thing as an anonymous donation anymore. But if you’re a willing egg donor who feels comfortable with this kind of open future family, and you want to preserve your fertility, then Freeze and Share could be the right choice.
Lesson 5: Everyone Deserves Access to Fertility Medicine
There are over 20 million people in the United States who don’t have access to fertility treatment. That’s why I started The Egg Whisperer YouTube show so that anyone with an Internet connection can learn about their fertility and get access to my tests and my care.
Fertility should not be a taboo topic. I want to teach everyone about their fertility and fertility medicine so that no matter where you are, you can take this information to your local doctor and talk to them about the necessary tests that you might need. If you have a question or a topic that you want me to address on the show, just email me. I look forward to hearing from you.
Lesson 6: Diagnosis Before Treatment
I’m not a chef, but as a fertility doctor, I use special techniques to help cook up the right environment for an embryo. If you follow my Egg Whisperer D.I.E.T, I can guarantee that you’ll never look back and feel like you missed a chance for your very best chance for pregnancy. It’s a simple four-step approach:
D is for Diagnosis: If we know why you need IVF in the first place, then we’ll be better prepared for the number of cycles you’ll need and have a better understanding of the right protocol for you. We do this by testing your hormones, antral follicle count and genetic profile.
I is for IVF: After your diagnosis, I always plan an IVF cycle in a way that we can thoroughly test your embryos for chromosome issues and their mitochondrial DNA count (Mitoscore) which predicts an embryo’s implantation rate. Together with the embryo quality, Mitoscore and chromosome information, I can rank embryos in order from highest to lowest pregnancy rates.
E is for Endometrial Receptivity: I call this testing the Evite to your embryo party. Just like a party, you don’t want your embryos to show up in your uterus too early or too late. To test for endometrial receptivity, I always run my patients through a rehearsal cycle during which they take the same medications they would take for an actual embryo transfer. Instead of doing the transfer, I perform a gentle endometrial biopsy by removing a tiny amount of cells to make sure your lining is ready to receive your embryo.
T is for transfer: Finally, I help my patients best prepare for their transfer, which means going into your embryo transfer with a clear mind and an open heart. If it doesn’t work, we need to be ready for that and will do everything in our power to understand why and discuss what we can do next time.
Lesson 7: Build Your Fertility Team
Depending on your diagnosis, whether it’s PCOS, secondary infertility or repetitive abnormal pregnancies, everyone is going to have a different team that they’ll need to support them through their fertility care. No matter the case, I always ask my patients to find a mantra or a superhero alter-ego that they can focus on to help them feel inspired. When you’re going through fertility care, it’s so important to find joy every day, so I always recommend building your fertility team with that in mind.
T is for Therapy: Since IVF can be emotionally challenging, it’s always good to have someone to talk to throughout the process. IVF can also make you more susceptible to depression and anxiety, especially if you have a prior history. It’s easy to find a therapist online these days?—?I often recommend an online platform called OOTify to find the perfect fit for you.
E is for Exercise: Try to get enough of it, mainly because exercise can help raise your serotonin levels to minimize anxiety and depression. Talk to your doctor about what they recommend for your particular situation. Eating well is also part of a healthy exercise routine, so remember: proteins shakes, Mediterranean diet and healthy meal delivery kits to take the hassle out of your IVF weeks.
A is for Acupuncture: Research has shown that fertility acupuncture has many benefits. A key advantage is that it helps to improve physical symptoms such as nausea and soreness in your belly. I’ve also seen that patients who continue acupuncture into their first-trimester experience less nausea and generally feel better.
M is for Mindfulness: Today, many apps can guide you through short meditations that help to clear and focus your mind on the present moment. Because there are so many unknowns in the IVF process, it can feel stressful. I always tell my patients to use mantras like “I’m going to be a parent one way or another.”
Lesson 8: Fertility Care Should be Comfortable
A few years ago, I realized that a lot of my patients felt uncomfortable continually having to sit half-naked during their many appointments. I decided to create my Egg Whisperer fertility pants as a simple way to make my patients feel more comfortable and cozy during their fertility treatments. Made from 100% high-quality stretch cotton, the pants have a secret hole in the crotch, so your doctor has easy access for ultrasounds, exams, IUIs and transfers. I know that fertility care can be stressful, so I thought these pants could bring more comfort, ease, and privacy to your experience.
It’s been a fantastic experience to be able to help my patients for the past ten years. The babies who are part of this community aren’t babies anymore—they’re in 4th and 5th grade. I know that I can’t help everybody get pregnant, but I always tell my patients that there are many ways that they can become parents, and they’ll never look back and say that they could have done more with the science.