Every month Dr. Ban does live coaching on weight loss, but today we focused on the topic of fertility.
Here is a recap of our discussion!
Dr. Ban: Tell us about the state of fertility for men and women
Dr. Aimee: I know it’s strange to say it’s an exciting time to be a fertility patient because nobody wants to be a fertility patient, but it’s true!
There are many relatively easy and affordable ways to get smart about your fertility. We will never eliminate all of the unknowns, but we can take some simple steps to understand our body and how it may impact our ability to get pregnant.
For example, there are sperm kits that you can get delivered to your home without even needing to see a doctor. There’s so much technology available now to improve treatment outcomes.
Yet, what I think is really important to note is that just because you see a fertility doctor it does not mean you want to do a treatment. I think that’s a big barrier for people.
What I tell people is to go see someone and get your TUSHY checked, get your sperm checked. Learn more about yourself so that you’re not wasting time or money doing something that’s not going to work.
Dr. Ban — I love that you’re making that point. By talking with you it does not mean treatment. So many people (my wife and I included) could benefit from talking to you or someone like you earlier. Future fertility planning is what it’s all about. It means getting ahead of any problems and understanding what fertility might look like for you.
Dr. Ban: Can you tell us more about egg freezing?
Dr. Aimee: Sure. I have to start by saying that it’s disappointing to see any marketing today about egg freezing that’s portraying it as a perfect option. Egg freezing can help secure your future fertility options, but it is not a guarantee.
As much as we may want to believe otherwise, there is no such thing as having it all. You can have it all at different times, but not at the same time. Egg Freezing is not a vehicle for having it all. It’s not a means of controlling your fertility 100 percent of the time.
I want everyone to learn about freezing their eggs. The reason being is that if you learn about egg freezing then you’re learning about your fertility and that’s a critical first step towards a future healthy pregnancy.
I want every woman to think about it by the time they’re 32 years old, especially if they want two kids. If you’re 37 and you want one kid then I want you to think about it. I also want to bring awareness to freezing embryos.
There are so many fertility myths. One of which is if you get pregnant with your first that the second will be easy. I see patients that have waited three years after their first because their OB said it would be easy. At your postpartum check talk about your future family planning goals.
Dr. Ban: Can you share with us what types of things impact our fertility?
Dr. Aimee:
Age, environment, and genetics are the three biggest factors affecting our fertility.
The age piece we can choose to control when it comes to having a baby, but many times we don’t have a say in it as much as we’d like.
Then there’s the environment and being mindful of what we put in our bodies and the toxins we might be exposed to in our daily life.
I’d love for people to get their fertility checked by the time they’re 25, or sooner if they have a medical reason for doing so.
Van: When it comes to age what are the hallmarks that mark certain declines in your fertility?
Dr. Aimee:
Let me just say that I blame BOTOX. Many women look young, yet fertility is not skin deep. It doesn’t matter how healthy you are, your fertility is declining each year with age. There is no BOTOX for your fertility.
It’s really hard to get pregnant over the age of 37. Each egg has a 25% chance of being genetically normal. That’s really low! At 40 each egg has about a 10% chance of being genetically normal. When I have a patient that’s 40 I am honest and tell them that 90% of women their age will not be able to have a pregnancy with their own eggs. This is shocking to people. People come to me and think that as long as they are doing IVF that they’ll be fine. IVF isn’t magical. We can’t create more eggs for women as they’re running out. There are even some women that run out even as early as 30. This is why I advocate for women to get their fertility levels checked before even thinking about having a family or starting birth control.
Once you’re on birth control I recommend checking fertility levels. Birth control tricks women into thinking they are fertile because their cycles are regular when they are on the pill.
At 30 years old each egg has a 50% chance of being genetically normal. This probability goes down as we get older. We test the anti-mullerian hormone (AMH) to get an idea for when women may go through menopause. It’s not a perfect test, but it’s the best we have available to us. We test this as we know that the closer you get to menopause the harder it is to get pregnant.
Dr. Ban: What are some of the main fertility issues that men and women need to think about?
Dr. Aimee:
Aside from age, your lifestyle is an important factor. From a medical standpoint, I like to understand things like your blood pressure, blood sugar (hemoglobin a1c) and cholesterol levels. Once you’ve checked these things it’s wise to set goals with your doctor on if and how you will improve.
For men, a semen analysis is like a vital sign. You can look at a semen analysis and sometimes determine if other medical problems might exist.
For women things like fibroids, endometriosis and tubal blockages are the big issues that I encounter with my patients, along with recurrent pregnancy loss.
Women who have multiple miscarriages should have a work-up to see if there’s a genetic reason, it can be from an anatomic reason like an abnormality in the uterus. All of these things can be seen with imaging studies or a blood test.
Dr. Ban: Can you tell us more about the process of freezing an embryo?
Dr. Aimee:
Sure. IVF is the process of collecting eggs, making embryos by fertilizing each egg with sperm, and then you grow the embryos, and then you freeze them.
A bit of myth-busting here. There is no such thing as freezer burn when it comes to your embryos (or eggs). I’ve had families that I’ve worked with for ten years that have come to me several times to have several children, all using the batch of embryos frozen at one point in time.
I always like to ask people what family size they want and then work together to determine what it’s going to take to get that family size. Then it’s up to them to decide if it’s something they’re willing to do.
For some of my patients, their own eggs aren’t an option so we consider other great paths for them such as egg donation, embryo donation, or adoption.
It’s really important to know what your fertility diagnosis is because without that you can’t answer any of these questions.
Dr. Ban: What’s a cycle of retrieving eggs entail?
Dr. Aimee:
It’s a two-week process. It’s an injection of hormones during that time every single night. This also includes about five visits to my office. The first visit is when your period starts. The last visit is for the egg retrieval procedure which is done while you’re asleep in an operating room. In between these visits are ultrasounds and a blood draw.
During the egg retrieval, there is a needle puncture done on one side, right and left, in the vagina to aspirate the follicles. I like to say it’s popping bubbles. I put the needle into each follicle or fluid-filled sac that contains each egg. Egg freezing is just like IVF without the F because there is no fertilizing that takes place.
So for IVF, you go through the same process. After the egg retrieval, your period starts, but you can also choose to transfer an embryo and there are three options when it comes to IVF.
- IVF with a fresh transfer which means putting an embryo in five days later
- IVF with a frozen transfer which means freezing the embryo and putting the embryo in at a later time
- IVF with a frozen transfer and genetic testing and that’s where you can test the embryos, learn more about the chromosomes, and then pick the embryo that has normal chromosomes to transfer
Dr. Ban: Tell us about the different methods you have?
Dr. Aimee:
Yes, I call it the Egg Whisperer Method
Step 1 is to get your TUSHY checked.
The T is for tubes as Fallopian tubes, they are the embryo transport system. If the tubes are blocked then pregnancy naturally may not happen and you’ll be at a higher risk for an ectopic pregnancy.
The U is to serve as a reminder to get an ultrasound of the uterus. That’s how you determine if a woman has fibroids or a way to learn about endometriosis or polyps in the uterus.
The S is for semen as we look at the sperm through a semen analysis.
H is for Hormones and a preconception panel to make sure thyroid and vitamin D levels are normal. Finally, Y stands for your genetic profile. I like to look at chromosome analysis and a carrier screen for certain genetic diseases. The other test I like to do is a cancer carrier screen as well.
If insurance doesn’t cover any of these things you’re looking at spending around $2,000. Many times insurance covers these things, but if they don’t and $2,000 is too much for you there are even some direct kits or tests you can order directly without going to a lab that can save you money too.
Once you get your TUSHY checked you know more about your diagnosis and can get a customized fertility plan.
Dr. Ban: Can you help us understand more about the thyroid and vitamin D testing? Which tests are you looking for and why?
Dr. Aimee:
Sure, for me the TSH is what I use as a screening test for the thyroid. If the TSH level is close to four, or above four, or if she has a family history of thyroid issues then I’ll do a full panel of testing.
This full panel will involve testing for thyroid antibodies, total t4, total t3, and then for vitamin D I just check for vitamin D. I like to see vitamin D above 30, but ideally between 40 and 50.
If the sperm count is found to be on the low side then we implement the BALLS method.
I see guys come in all of the time and they’re told their sperm count is low but really good.
This statement just doesn’t make sense to me, and so I have found myself saying the same things over and over again to patients. Finally, I’m putting it into a mnemonic that’s easy for guys or their partners to remember.
Background genetics, Anatomy, Lifestyle, Labs, and Sex.
Background genetics: The sperm DNA fragmentation test, chromosome analysis, carrier screen and y chromosome microdeletion (talk to your doctor about which tests apply to you).
Anatomy check. This is not something I do, but send patients to a urologist. We do this to make sure the guy doesn’t have a varicocele for example.
Then we talk about Lifestyle. This would include things like not smoking, exercising most days of the week (including weight training), no THC at all, and moderate to low consumption of alcohol. This is especially true if someone’s BMI is high.
As far as Labs I like to test the same types of hormones on men that I do on women. So we check testosterone and estrogen. Then we look at vitamin D, and thyroid levels. We even check prolactin, FSH, and LH. If the count is really low then sometimes you might learn that the man might be going through something similar to what women do with menopause.
The final thing I talk about with patients is Sex and just finding out how it’s going in the bedroom. I bring that up because a lot of the times people aren’t getting pregnant because they aren’t having sex anymore. There are medications you can take, home insemination kits you can use, and therapists to talk to so you can help solve the problem.
Once you have your TUSHY checked and your BALLS checked, then you’re ready for the Egg Whisperer D.I.E.T.
It’s not a meal plan or a diet in the way we typically think about it. Rather it’s my formula for IVF success if you need IVF.
In order to have the D in the Egg Whisperer D.I.E.T, you need to learn about your fertility diagnosis. You want to have as much information as you can before pursuing a specific treatment option. This will help give you the highest chance of pregnancy.
I is for IVF, E for endometrial testing, and T for transfer.
Within this is your fertility team. Your fertility TEAM is therapy, exercise, acupuncture, and meditation.
These are the things that I talk about with my patients on a daily basis. I thought it would be helpful to put it all together for people that I don’t get the chance to see.
Dr. Ban: I want to go back to something you said about prolactin. Can you help me understand why that’s important to test?
Dr. Aimee:
An elevated prolactin may interfere with signal pathways between the brain and testicles needed to create sperm (spermatogenesis). This could cause a lower sperm count. Similarly, with women, it may impact how they ovulate. Low vitamin D in guys might cause lower sperm quality too. I also check vitamin D in women as lower vitamin D is linked to early-onset dementia and a higher risk of autism for offspring.
Dr. Ban: I want to share something personal. I think the BALLS method is so important and I want all guys to know how easy it is to test their sperm. I learned that for us our fertility issues were related to my sperm. I thought I was in shape and so that meant my sperm had to be good too!
Dr. Aimee:
Yes. Your fertility isn’t skin deep and getting a fertility test today is as easy as ordering a kit for your phone and having it sent to your home. It’s so important to know the count and quality of sperm as it’s an equal part of the baby-making equation.
Dr. Ban: How do people get in touch with you?
I make it very easy for people to get in touch. I am on social media and have a website and email.
I also have an app coming out called The Egg Whisperer app. You can take a fertility quiz and I can guide you through the questions that make sense to ask your doctor. The goal is to help make your interaction with your doctor more effective vs. to replace your doctor.
Thank you for reading this recap of my conversation with Dr. Ban!
You can catch more of me and fertility topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!
