transcript

Speaker 1:
[00:00] At Great Wolf Lodge, there's adventure for the whole family. Okay, I have to say this, I have never actually been yet. But every single person I know seems to be going, and their kids are obsessed with it, and so are the adults. And also, my kids just keep asking me to go to water parks with slides. And now I looked into this, and I get why. There's even one on the west coast of Florida, which is kind of close to me, like two hours, so hello, road trip. You and your pack can splash away in the indoor water park, where it's always 84 degrees. There's a wave pool, a lazy river, and a bunch of massive water slides, including ones your family can all enjoy together. They even have adventure-packed attractions from MagiQuest, a live action game kids can play throughout the lodge, to the Northern Lights Arcade. There's also a bunch of great dining options and complimentary daily events like nightly dance parties, all under one roof. With 22 lodges across the country, you're always only a short drive away from adventure. So bring your pack together at a lodge near you. Learn more at greatwolf.com. That's greatwolf.com. And strengthen the pack.

Speaker 2:
[01:05] People used to worry a lot about the health of children born from IVF. And I think it's because the way we used to do IVF was so much riskier. Now we're testing embryos. I mean, we are able to really reduce some of the risks, especially coming from obstetrical outcomes that were, you know, much more high risk with twin pregnancies. I think our protocols have gotten better. It's made it safer to go through these types of treatments as a patient and as a resulting child. And there really is nothing to this really harmful narrative that IVF children are, they look different or that their immune systems are compromised. I hear that a lot. But at the end of the day, our kids' health outcomes are a confluence of so many factors. And if we put it all on our bodies and our underlying issues and needing to go through fertility treatment, I mean, that's not accurate.

Speaker 1:
[02:02] Welcome back to The PedsDocTalk Podcast. I'm your host, Dr. Mona Amin, pediatrician, mom of two, and someone who loves conversations that close the gap between what we should know about our health and what we're actually taught. But before we get in today, you know what you need to do if you love the show. Subscribe, set up automatic downloads, and leave reviews. It's the only way the show can continue to grow. Okay, so for today's episode, as many of you know, I had secondary infertility, and that process was emotionally and physically draining, but it did bring me one of the biggest gifts in my life, my daughter. And I am immensely grateful for the technology, the doctors, everyone involved that makes IVF possible. But I also realized that I never had someone on the show to talk IVF, even though I've been there. So have you ever wondered how many of us reach adulthood without really understanding our own fertility? Have you ever thought why didn't anyone explain ovulation timing or what actually affects our chances of getting pregnant before we start trying? Or maybe you've heard people say things like, just keep trying, but no one really explains when it might be time to ask for help. Today we're talking about the fertility knowledge gap, the information many people wish they had earlier, and what actually matters when it comes to reproductive health. I'm joined by Dr. Lucky Sekhon, a board certified reproductive endocrinologist, infertility specialist, and OBGYN, author of the national bestselling fertility guidebook, The Lucky Egg. Dr. Lucky is widely recognized for her expertise in all things reproductive medicine. Through her clinical practice, research, and active online presence, she educates and advocates to close the fertility knowledge gap. She co-hosts Call Your Doctor, a podcast for all things women's health, from puberty to menopause. Dr. Lucky is also a regular contributor for today's show and NBC News, and has been featured in New York Times, 60 Minutes, Vogue and more. She's a busy woman, and she's here with me today. And this conversation is all about the fertility basics people often aren't taught, what actually helps from preparing for pregnancy, how ovulation works, and just de-stigmatizing IVF and talking about some myths. Thank you so much for being here, Lucky.

Speaker 2:
[04:16] Thank you for having me. It's so exciting to get to meet you because I've been your number one fan. I rely on your content as the mom of two young girls aged eight and five, and really admire what you do as a physician that creates content. I mean, I don't know when you started, but I started like four to five years ago, so I feel like I've learned a lot in a very quick amount of time.

Speaker 1:
[04:39] Yeah. I mean, being a creator online, obviously, your online social media, you have this book out, which I'm so excited for you. Like for most of my listeners, I am writing a book and the entire process, just at the beginning, is extremely daunting and tiring, but it's so worth it. So congratulations. And yeah, I started creating content, what, at the time of this recording, like seven years ago. And obviously, the opportunities, all the things I've done with it is obviously something I hold with a lot of gratitude. But I wanted you on, one, because congratulations on your book, and two, like I said in the intro, I have never had anyone on. Just talk about IVF. I've spoken about my IVF journey on YouTube channel only from my own perspective, right? And I'm very clear that there is so many different ways that you can use fertility treatments. And like I did IVF, but there's so many different things. So I think a lot of people don't realize how big the fertility knowledge gap actually is, but you do. Many adults reach the point of trying to have a baby and suddenly realize that no one ever really explained how their bodies work. So what are some of the most important facts about fertility and our reproductive biology that people are often surprised to learn and you wish people would know on this episode?

Speaker 2:
[05:53] Yeah, I mean, it's not surprising that there is a huge knowledge gap when you think about the fact that the main focus, when we learn in health class and grade school, it's all about contraception and avoiding unplanned pregnancies, important topics, obviously. But there is no formalized guidance as we enter our 20s, our 30s, and we're magically expected to just figure it all out and navigate the biological clock and also keep our eye on the prize in terms of our professional pursuits. And it's kind of unfair because it seems very much up to luck. Who is your OBGYN and are they going to educate you and take that extra time to kind of say, hey, what are your plans? Are you going to have a friend group that pays it forward and talks about it openly? And people are kind of left to their own devices. And so what I see day in, day out, I mean, I saw a patient today who just came in to talk about preventively freezing eggs. And often it morphs into a conversation of, hey, it sounds like you might have PCOS. It sounds like you could have endometriosis. So I think fundamentally, there's a lot of people walking around with underlying gynecologic issues or other predisposing factors in their health history that could one day relate to fertility issues. Doesn't mean they definitely will have it. But I find that a lot of people, by the time they come to my office and they are dealing with fertility, they're not only overwhelmed and feeling very upset by that, but they also sometimes feel very blindsided and upset that sometimes we're uncovering in the process of doing the basic testing that their painful periods, their heavy periods, their irregularities in their cycle, all along were kind of early clues that there was something going on that could impact their fertility. So not being aware of the signs to look out for with your menstrual cycle, that's number one, not understanding that there's a really narrow window of opportunity every time you ovulate, it's not like there's 30 days in the calendar month that you could be trying that are high yield. It's really confined to like two to five days in the lead up to ovulation. So people who come to me and they're like, I've been trying, sure, but they haven't been timing anything. They haven't really had any awareness about their cycle. People have a lot of preconceived notions. This might sound silly, but they assume that they're ovulating from one side and then the other side, and it alternates. And that can lead to misconceptions when problems arise. Like a person who has only one fallopian tube to work with automatically assumes, I have a 50% reduction in my chances. And I'm like, no, no, no, that's not true. It's actually like 20%. So I think the fundamental knowledge of just how our bodies work, what ovulation means and why it matters, that's probably like the biggest misconception, but it leads to so many problems downstream.

Speaker 1:
[08:38] You said it beautifully, that there's so many experiences that people will go through and unless they have the access to that person educating them, right? Like, I think about friend groups, like in a friend group, there may be people who never have to use IVF. And then you have one friend in that group who feels very isolated, like, hey, how come it seems so easy for everyone else to conceive naturally? And I'm struggling and it's been months. And we'll get into like that sort of timeframe when you want people to sort of consider a reproductive endocrinologist or fertility specialist. And I had a story where one of my friends, who is married and wants to start a family, I was talking to her about ovulation and I was explaining to her, she's on the medical field and she was using an aura ring to track her fertility. And I'm like, well, that's not very accurate. And we can talk about that in a little bit. And I'm like, that's not very accurate. You need a better monitor. And I talked to her about what I used and what I learned from other docs. And I'm like, you're really not getting good data there. I told her and then I also gave her some guidance on when she should see a fertility doc, given her age. But that's because I'm a doctor, but also I went through it and I gave her resources like yourself. I gave her resources like other fertility doctors. And I'm like, hey, I don't want you to be stressed about this, but I want you to know that it's important to seek help. You know, and like, when is that coming for you? So, you know.

Speaker 2:
[09:55] It's not always easy to share information to because it's such a sensitive area of life. And I think sometimes depending on how the message is delivered and received, it can feel very judgmental or someone could say like, I don't really want your advice. So, it's kind of this like fine line of, you don't want to give unsolicited advice, but you also do want to pay it forward and say, there's this crucial time-sensitive knowledge that I want to be able to spread to everyone around me because we all recognize that most people don't know everything that they need to know about their fertility.

Speaker 1:
[10:25] Yeah. And your book, The Lucky Egg, really aims to close that knowledge gap and help people better understand their reproductive health. So who is this book really for and who do you hope will read it?

Speaker 2:
[10:37] So this is a book for everyone, right? I know that's kind of an annoying answer, but it's the truth. And I wrote this with the lens of like, this needs to meet people wherever they're at. My hope, my dream would be that this is like required reading for every woman in her 20s, right? So it's to fill the knowledge gap, as you said, it's to really point out. I start out the book by talking very generally about what are the things that most people don't realize? And I would challenge anyone listening who hasn't read the book, read it, and I guarantee you'll learn something new that you thought that you knew, but you didn't know the right thing. How to prepare for pregnancy, right? There's all these things that you're seeing online now about like trimester zero, and it almost feels overwhelming, like all these influencers are saying, there's a 20-step routine I do every morning. I'm having this tea, I'm doing affirmations. And it's like, what are the simple things that as a fertility doctor, I know actually move the needle and help you prepare your body for pregnancy and optimize your fertility as much as you can. I also wanted to deliver the message that prior guidebooks before me, often not written by actual experts, really emphasize the role of things like supplements, and you can do this and you can do that, and you follow this really strategic thing, and therefore, it's going to guarantee success. And that's not true. And I think the backlash to that is people blame themselves and automatically say, I'm in this predicament of infertility because I didn't do all these things, and that's not true. How to track your cycle, when and where to seek help, that's not as straightforward as it might sound. All of the different testing and treatment options, because it can feel like there's a zillion, when in reality, I like to keep it simple and very evidence-based. And then for the people in the trenches, like the last quarter of the book is for you, if you are going through IVF, IUIs, whatever treatments, and they're not working, what should you consider? What's fact, what's fiction? There's so many add-ons and things that are outed to help, but what should you really be asking your doctor? And I'm like, your REI, your fertility doctor friend in the corner, that's kind of taking notes for you at the consult and helping you every step of the way.

Speaker 1:
[12:39] And okay, my question is, if you and other reproductive endocrinologists were not writing these books, who was writing these books? Like, what training did they have to be able to give that information? I'm just very curious from the market perspective of these, yeah.

Speaker 2:
[12:52] I didn't want to write a book, right? I feel like now it's like there's a lot of doctors writing books and it's wonderful to see. I was not one of the ones that was like, this is a mission I'm going to fulfill. It found me and it just happened very naturally. And part of it was from the annoyance that was growing year after year of being in practice and people coming to me with this one particular book, which I will not name because I do not seek to get into any sort of legal squabbles. But it was not written by a doctor. It's written by someone who went through like three rounds of IVF herself. She's not a doctor at all and decided, hey, I have a biochemistry degree or something along those lines from like undergrad. I'm going to just do a deep dive on PubMed and go through all the studies and synthesize it. And she wrote it up in a really compelling way, but it really makes people feel anxious because it's very, very focused on supplements and what you can do. And it makes sense that she would focus on that because she doesn't have the ability to really focus on anything else. And so a very lopsided view and I as a result, I've seen tons of people come to me where they're like taking 20 different types of supplements and they're trying to live in a bubble and they feel very much like they're not able to live their lives. And you know from going through this and many people who've gone through a fertility journey or even trying on your own when it does happen successfully, it can take time and you burn yourself out unnecessarily. And sometimes you go on detours and totally waste time, which is in my opinion, the most valuable resource that we have. So that was the most popular book before mine came along and it's still very popular. But I think that we need more resources from doctors who are actually treating patients and actually diagnosing different forms of infertility, to be the ones that are actually giving out this advice.

Speaker 1:
[14:36] Well, I'm glad you did it, even though it wasn't in your cards, but it obviously is so important and coming from someone, not only experience from understanding the literature, from experience that you've had as a practicing clinician, and what I love, which I always like having these kind of people on my show is the understanding of the balance. Like you're not saying you can't use anything like supplements, like maybe there are some that are useful, but you're in that middle. You're like, I want to help support this naturally, quote unquote, but I also am not going to throw things at you. And so I think this leads perfectly into the next question is like, when someone starts trying to have a baby, you can feel like there are aura rings and apps and tracking tools and supplements coming from every direction. So what would be your simple fundamentals that people should understand about ovulation timing when trying to conceive? And are there certain diet supplements slash ovulation tools that you love the best or think that are important?

Speaker 2:
[15:36] Yeah, definitely.

Speaker 1:
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Speaker 2:
[19:32] I always like to start with keeping it simple. I think first of all, do-it-yourself ovulation tracking is something everyone should do if they see wanting to have a baby on the horizon, even if they're not actively going to be trying now, because it's all about gathering data. And once you start tracking your cycle, I believe it takes about three to four months, three to four cycles to really establish a pattern. And that's what it is, it's pattern recognition. And if you are someone with a regular cycle, just the simple fundamental act of writing down when you get day one of full flow of your period, right? And then writing down the next one, and along the way, other things to chart are, are you noticing symptoms around your cycle, like when are you having the most pain, how heavy is your bleeding, what are the heavy days, and are there any other associated symptoms? Just track it all, but at the very simplest level, just tracking day one of your cycle, and then establishing what the cadence is, because you can use that if it's regular to try to kind of model out prospectively when does your ovulation typically happen in the cycle. But I like to layer that on top of actual dynamic testing, meaning ovulation predictor kits. So when you pee on a stick, an ovulation predictor kit, and it lights up, there's different, you know, brands and different types of signals. But there's some that have like the flashing smiley face and then the solid, right? Those are measuring the rise of estrogen that's happening as you're getting a mature egg that's about to get released. And then the solid smiley face is actually picking up the definitive signal called luteinizing hormone or LH that filters out through your kidneys into the urine very quickly. And once you start detecting that on the ovulation predictor kits, it's basically giving you a heads up of 24 to 36 hours that you are going to ovulate. And so the key is to have sex in the two to five day window in the lead up to ovulation. Any attempts after you've already released the egg are much more low yield because an egg only lasts for 12 to 24 hours, sperm will last and wait around for up to three to five days. So you're just trying to line up those chance encounters, those meetings happening. And it's all about tracking your cycle, understanding if there's any sort of variation or irregularity. I would say if you really feel like it's erratic and you don't know what's going on, that means you shouldn't be trying on your own for up to a year or at six months, and then seeing a doctor. Because if you're not ovulating or you never know when you're going to ovulate next, you're not in the game.

Speaker 1:
[22:06] I use one of those kits. Again, this is not sponsored. I want to be very clear here, and neither one of us are sponsoring anything. But I did use the clear blue one that was the advance monitoring one. So there's so many different ones, but the one that you have to pee on the stick, it was a smiley face. And I used it for my son. I didn't have infertility with my son. But I did months without it. And I want to be clear because I'm giving the example of my friend who used the aura ring. She's like, oh, it just checks body temperature. And I think you agree that that's not enough. You need, if you're going to use a kit, you have to pee on a stick and it has to tell you your estrogen and LH rises.

Speaker 2:
[22:43] Well, it's picking up that signal, that warning of when you're going to ovulate. Once your temperature rises by half a degree, that's too late. That's happening because you already ovulated and you're making progesterone. And once you've ovulated, that is the wrong time to be trying. So a lot of confusion around that. I think it's because of Hollywood. I mean, we've all grown up watching movies where people are trying to get pregnant and they're like, my temperature's up. It's time to try. And it's like, no, that's actually wrong.

Speaker 1:
[23:09] No, I think that's such a useful thing. And again, I felt like it was so simple to use. I mean, it was so easy and it was very, I mean, in my personal experience with him, we got pregnant two months after using the ovulation, but we had been trying just with other methods that didn't have that window. There's so many other trackers. For five months, we were planning. And then finally, my friend was like, hey, you need to try this. This is what I used. And I'm like, this makes sense. But then we're gonna get to the point where, when it's not, you need to go see somebody else, because that's what happened for my daughter. For my daughter, we had my son. We were trying for my daughter. I was using the same monitor, because it was still useful. And I was like, interesting. It's nothing's happening after six months. And we'll get into the timing of that and a little bit of my story for anyone who's not familiar. But are there anything else that we can do besides this really important education you just gave about understanding ovulation and timing in terms of the supplement realm, or in terms of what you're eating, things like that?

Speaker 2:
[24:09] Yes. I mean, I would view lifestyle as a holistic thing, right? I think the simplest way to not feel overwhelmed is think about this. And this is true in every arena that you just asked me about. When you think about lifestyle and the levers that we have the ability to pull. Anything better for heart health tends to be better for fertility. So that is true when you think about maintaining a healthy weight. When you think about controlling and combating something called insulin resistance, which is like a mechanism by which we can have metabolic dysfunction, meaning you might not store blood sugars as effectively in your cells. And ways to combat that naturally are building muscle because that naturally will make you more sensitive to the effects of insulin, which is a hormone. Losing weight if you need to, especially around the midsection, that's better for heart health and it's better for fertility because insulin resistance can directly impact our fertility in a negative way. And for women with conditions like PCOS or strong family history of type 2 diabetes, if you're struggling with weight, all of these things can kind of play into that. When you're thinking about diet, really trying to think holistically about eating the rainbow. The Mediterranean style diet is the one that's often touted, but there's a lot of similar diets and we all know what a healthy diet is, right? It's rich in fruits and vegetables, lean proteins, healthy sources of fats like nuts, seeds, avocado. You know, trying to reduce ultra-processed foods. And when you think about caffeine, it's not really about getting pregnant, but once you are pregnant, we really want you to reduce your caffeine, your daily caffeine intake to less than 200 to 300 milligrams per day. Very excess amounts of caffeine. I'm talking like four or five cups of coffee. Some studies have shown an association with an increased risk of miscarriage. And so it's, you know, the data on it's not perfect, but if you don't know yet that you're pregnant, it's like really it makes sense as you're trying to get into a pattern of behaviors that you would want to be doing once you are pregnant. So drinking is another example. You know, there is data to suggest that excessive alcohol intake, we know it's not good for your general health, right? But it's definitely correlated with lower fertility outcomes, lower pregnancy rates. And so less than four drinks in a given week is what the American Society of Reproductive Medicine says. But I don't think it's a bad thing to really try to minimize alcohol intake. Never smoking. Smoking is bad for our fertility, and it can put people into earlier menopause. There's an association. What else? Supplements-wise. I mean, this is going to sound really simple and straightforward, but believe it or not, everything's controversial when you look online. Prenatal vitamins containing folic acid. There is a lot of misinformation that you should be on a specific type of folic acid or folate called methylfolate. There's no such thing as this. You really should be on folic acid because it's the one form of folate that's been proven to prevent neural tube defects, which is things like spina bifida. Ideally, you should have that on board, ideally three months pre-conception. Correcting underlying nutritional deficiencies like vitamin D, ferritin, that can be associated with subfertility, especially iron deficiency, anemia, things like that, and you're trying to optimize your body for being pregnant. So it's better to really address these things beforehand. Now, in terms of the fertility supplements, I have a whole chapter in the first half of my book about how to prepare your body. And I created these crazy tables that are very detailed, but it was the best way that I knew how to sort through all the noise. I've listed every single supplement that's been talked about when you think about male and female fertility. Love it. The name of the supplement, I've identified it. The typical dosage that is taken, what people talk about and what's been studied. And then the potential side effects and adverse consequences of being on certain supplements and interactions, because they're not just all natural and completely benign, and it's important to point that out. And then talking about the trials and the data, is it animal model, human model? So the best supplement that fits into that category, if it's not a prenatal, you're taking it for the sole purpose of trying to improve your fertility that has the most data behind it, and I think is relatively benign, is coenzyme Q10. And 600 milligrams per day has been associated in several different trials as well as meta-analyses where they pool the data from multiple studies, so they have like larger numbers with better outcomes if you're going through IVF in terms of the number of eggs retrieved, the quality of the embryos resulting from those eggs. And there's also some compelling data in mainly the mouse model and the animal model that suggests mechanisms behind which it's helping. So it is one of the main factors in our mitochondria, which is the powerhouse of our cells. And our mitochondria play an important role in egg health. So the idea is maybe the antioxidant pathways and also helping to support the energy required in the egg cell, you are helping to support better egg quality, you're creating a healthier environment around where the eggs are being matured, and therefore they're less prone to errors. So I definitely tell my patients, you know, there's no harm and it could help, so why not?

Speaker 1:
[29:19] I love that, and my favorite thing so far of that is that anything good for your heart is good for fertility. I think it just really makes it a basic understanding, because what I saw happen so much with a lot of my friends going through infertility, whether it was secondary infertility or not, was this sort of extreme stress around what they're eating, what they're not drinking, to the point where they would go out and drink like two drinks, and they would panic, like I've just ruined my chances. And I'm like, as long as you-

Speaker 2:
[29:46] I shouldn't try this month. I'm like, no, try.

Speaker 1:
[29:48] No, I'm like, as long as you're not a raging alcoholic, and you are doing things in moderation, like you just said, is drinking two drinks on a night out bad for your heart? Probably not. If you're drinking two drinks every night for the whole life, okay, maybe we need to talk about that. But I love that you brought that in, because I hope for anyone on that journey, they hear that and they buy your book, and they understand that we create so much more stress by thinking about all the things we should and shouldn't do. And then that doesn't help getting pregnant either. I mean, the stress we carry of like, oh my god, I shouldn't do this and I shouldn't do that. It's just become so not fun anymore.

Speaker 2:
[30:27] Being stressed about being stressed is such a thing in my patient population. And I spend a lot of time talking people down from that, because I think when you think about stress, you have to define it very carefully. There is a different stress surrounding the day to day work stress, running around. And I talk to a lot of stressed out type A New Yorkers, as you can imagine, being in New York City. And that is different than chronic, long-term stress where maybe you're not expending as many calories or you're expending more calories than what you're taking in. So certain types of stress, like marathon runners and things like that, where it's like a repetitive stress, where it's just like an extreme, that might cause your cycle to be irregular. So it might indirectly impact your fertility, right? But mental stress in terms of just the day-to-day psychological stress that we face in our lives because life is always lifing, that's not causing you to have infertility. I've seen online so many things about relating that type of stress to, this is why you have a low egg count, diminished ovarian reserve. And there's no data or evidence to support that. I just want to go on the record and say that.

Speaker 1:
[31:41] I love that. And also, I think that leads in to my next one, which is what we're talking about when people are like, maybe well-meaning family members are noticing someone trying, meaning that they're reporting that. And a lot of those spaces will say, just keep trying, you got to relax, it's going to happen. When is it time for someone to stop listening to that person? But more importantly, when is it time for someone to say, hey, I have been trying, it's now time to see a fertility specialist?

Speaker 2:
[32:11] Yeah, and the reason why this is such a good question is because I also see the opposite where people come in after two months of trying and they're crying and panicking and I'm like, no, no, no, no, no. Human reproduction is inefficient. Even if you are considered quote unquote young, you're in your 20s or early 30s, every time you ovulate one egg in your 20s, there's like a 20 to 25% chance that it could result in a pregnancy. And that number, that statistic or figure changes as we age because the ability to randomly ovulate a healthy egg is, that's our biological clock, right? That definitely starts to shift, especially more rapidly at 35 and older. But even in our late 30s and early 40s, just to be devil's advocate, you still have normal eggs. It's just what's changing is that it may take more random ovulations because it's very much like a lottery of an egg for that to actually be a healthy egg for things to line up downstream of that, for that egg to fertilize and turn into an embryo and so on and so forth. So you never expect the first one to actually work. The first time, and everyone who gets pregnant on the first time they try tends to be the people that are shouting it from the rooftop. So I do think there's this like skewed perception of reality. The reality is, is though it's like playing the slots. You can pull the lever and make sure that you're timing things correctly, but whether everything lines up after that is so out of your control. So you have to play the slot machines over and over. You're not encouraging gambling behaviors, but you get the analogy. Eventually, hopefully things will line up. So you have to know when to fold them, when to hold them and when to fold them, right? Just to follow through the analogy. I mean, at the six-month mark, if you're approaching your mid-30s, the rule book says 35 and older, if it's been six months, seek help. If you're under 35, you could play around for up to 12 cycles a year. Now, I would say it also depends on how stressed you're feeling about this and what your level of urgency is. You should also be thinking, how many kids do I want to have? Because if you're 33 and you want to have three kids, actually kind of think it's bad advice to wait a whole year, like maybe closer to the six-month mark. But the guidelines say under 35 a year, over 35, six months. And if you're in your 40s, not a bad idea to see an expert even at the three-month mark.

Speaker 1:
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Speaker 1:
[36:48] And part of that is what you had said earlier in that you're doing the month marks, but you're also correctly monitoring ovulation, correct?

Speaker 4:
[36:56] Yes.

Speaker 2:
[36:56] If you don't have a regular cycle, you go straight past go and you see a fertility doctor because if you're not ovulating, you're not in the game. And also, if you have any concerns, like if you're like, I have debilitating periods, you don't need to have the label or diagnosis of endometriosis. Maybe it hasn't been diagnosed. I think if anything concerns you about your cycle, or you have a family history that concerns you, it always is wise to go in earlier rather than later.

Speaker 1:
[37:23] So my story here quickly was that I had no problem getting pregnant with my son. And again, when I started doing correct ovulation monitoring, I had a very traumatic delivery for anyone who's not familiar, a lot of scar tissue, repeat surgery after the delivery. And we started trying again when my son was about a year old. And I was like, interesting, because it just wasn't happening. I was ovulating. My periods were very regular. And the monitors were telling me. And I was like telling my husband at the four month mark. I was like, hmm, something's not right. Like I'm ovulating, it's all happening. Something's not right. And I worried that was something with my delivery, because it was so traumatic, did that cause something? I ended up going to the fertility doctor. It takes a while to get into the one I wanted. So it was like two months after that. So now it was six months of trying. And I saw her. And in my situation, I had developed a hydrosalp ink. So one of my fallopian tubes had so much scar tissue, for anyone listening, that it was creating a fluid overflow back into the uterus. And so it's an inhospitable environment. So even if I was ovulating off my right side, even if it fertilized, it wouldn't attach. It wouldn't attach and grow into an embryo. And so basically, we had to remove the fallopian tube, try timed ovulation, see what side I was ovulating on. And I just kept ovulating off the left side where I had no fallopian. So then my doctor, after three months of that, was like, what do you want to do? And I'm like, let's do the IVF, which was get the embryos or get the egg out, fertilize it with my husband's sperm. And then we had our one embryo. And I say that story because for two things, one, it's exactly what you said about something didn't feel right to me and I didn't follow the exact guideline of six months. I was 35 at that point, but I was like, you know what? Like something's not right. And I'm gonna make the appointment, I'm gonna go, and something was wrong. And I got that fixed. And then the other comment is the fact that, there are so many different ways that we do fertility treatments. I already just mentioned that they removed the fallopian tube and we were doing timed ovulations of like ultrasounds looking at what side they were releasing on. So my question, my next question is, IVF is a term people hear constantly and they always think that, and the other misconception is that all fertility treatments are IVF. So many people don't actually know what the process involves or why someone might need it. Can you walk us through exactly what IVF is and the situations where it becomes part of someone's path? And if you want to explain how it may differentiate than other common procedures like maybe IUI.

Speaker 2:
[39:59] Yeah, for sure. Basically, let's start with the fertility workup. The big things you look at, like you said, are the fallopian tubes, the shape of the uterus. So you're trying to rule out blockages or things like fibroids that could be getting in the way or taking up real estate from an embryo where it's trying to implant. A lot of people have fibroids, so if anyone's listening and feeling nervous that I'm bringing this up, the location and the size matter, and there's a lot of people walking around with fibroids that will never impact their fertility. Okay? Also, we talked about the ovulation pieces, the irregularity there. If it's regular, then the next question is, what is your egg quality? What is the chance of ovulating a healthy egg? There's no test for that. So that's a huge blind spot in my field, but we have a lot of data and understanding of how female age can affect egg quality and the resulting quality of an embryo. And then also the sperm. That's a huge one, right? Because 50% of couples with any form of infertility have a male factor, some sort of component that is affecting the sperm quality. And men are always making new sperm. So there's always ways to try to improve it, whether it be with lifestyle changes alone, or even the help of a urologist, maybe prescribing certain medications. So let's say you do the whole work up, and you're like, okay, the tubes are open, uterus looks good. From what we can tell, like there's a good number of eggs, not that that counts for your fertility, but that's just nice to know in the background. In case we need to rely on IVF, it tells me how many eggs I can work with. And the sperm looks good. Okay, great. Well, why are you not getting pregnant? Some of it may be chalked up to the inefficiency of human reproduction because we have no test for egg quality. And especially as we enter our late 30s and beyond, there could be an overwhelming number of ovulations where you just ovulated the wrong egg and it's super annoying and even more inefficient, right? So there's that. There's also things that aren't always easy to diagnose directly or accurately like endometriosis. And then sometimes people have other metabolic things going on like insulin resistance. So all these things can kind of all play a role collectively. But we do the standard workup and it's all normal. In that scenario, you have options. And there are really two buckets of treatments that we can utilize to just make this really inefficient process more efficient. One bucket is the laid back approach, which it sounds like you started with a variation of it, right? You can track someone's ovulation. If it's unexplained and you don't really know what's going on, it actually is evidence-based and recommended to do a combination of two things. Boost things on the egg side and boost things on the sperm side. This is called medicated IUI. So you're taking usually an oral pill of Clomid or Letrazole. These are medications that fool your brain into thinking you're not making enough estrogen. And so it causes you to actually over-stimulate your ovaries, where there's an opportunity or chance to release two or three eggs, because one egg is a long shot, remember, for everybody. And at the same time, you're putting sperm at the top of the uterus in a procedure that feels like a pap smear. So you're augmenting what someone's trying to do on their own at home before they even come to you. But it's like, instead of one egg hopefully meeting a sperm, you're kind of doing what I like to call speed dating for the reproductive tract. Hopefully, if more eggs and more sperm can meet, there's a better chance that that meeting will be successful, and it's not going to get you there overnight. It might be something you try for three to six rounds, and studies have shown if it hasn't worked after that sixth round, there's diminishing returns and it's time to move on. A lot of my patients in their mid-30s are like, I'll try three of these and then I'm going to move on. There's also IVF. That's the second bucket of treatment, right? So if the first bucket is laid back, it's kind of doing something that's not that different from what you were doing. There's no major procedure or anesthesia. It's kind of out of pocket, much less expensive than IVF, right? But you're introducing the risk of twins because you might ovulate two or three eggs and you can't control what actually implants. And you're not controlling the risk of miscarriage, right? Because it's all just happening inside of your body, and that's just a natural part of our biology, that we can ovulate an unhealthy egg that results in an unhealthy embryo and eventually stops growing after it implants. This is in contrast to IVF. IVF is much more controlled. It is more aggressive. It is more expensive. There are more people and technologies involved. You're starting out with the egg retrieval process. That's the first step. Eight to ten days of shots. Usually they're superficial in the lower abdomen, right? And you're basically injecting the same signal your brain normally sends to randomly select one egg to mature at a higher level to try to get everything that's there. And that's when egg count matters. You're coming in for lots of monitoring visits during the eight to ten days of shots. It culminates in an egg retrieval procedure that takes about 10 to 15 minutes. You're put to sleep under light sedation. It's all done vaginally. We're extracting as many eggs as we can. These are all eggs that would have been transient and thrown out anyway, and then a new set of recruits will come up to bat in the next cycle. So this is where how many eggs I have access to can matter. This is the only place that egg count really matters. And then the more eggs we have, the more eggs we have a chance to fertilize. So we would take a partner sperm or donor sperm, right, depending on the situation, put sperm and eggs together in the lab, and then we would grow them for a week into embryos. And not all of them will make it, just like in our body. There's a lot of drop off and attrition and inefficiency. That doesn't magically go away just because you're doing this expensive, high tech process. But you're starting out with multiple eggs, and that's where numbers can be helpful. And then you see survival of the fittest a week later, like half of them might drop off or more. And then whatever turns into an embryo, you can put it into the uterus right away. A lot of times now, majority of cycles, we're testing the embryo and then freezing it, waiting for the results. And then in a subsequent cycle, we take one embryo usually at a time, and we thaw it out and place it at the top of your uterus. And we do it with the timing around your menstrual cycle, or we give you medications to emulate the menstrual cycle. And it works really well if you have a high quality embryo. You mentioned having one embryo. I mean, I have patients in that situation all the time, and I'm like, it's worth trying, because it's a 60 to 70% chance of live birth if it's tested and looks good under the microscope.

Speaker 1:
[45:59] We had only one embryo at all fertilized at day five. You know how you're talking about watching that? And so when you think about all the stats, everyone's like, okay, we had this many and this many. We had one that fertilized, we got it sent off for genetic testing, and it was viable, and there was genetically normal, and we're like, this is our only shot. She was literally our miracle embryo. You talk about the lucky egg, she was our lucky embryo. I mean, I get teary-eyed thinking of her, because we would not have done this more. It was an emotionally draining process for us, and financially, it was really hard, that I had told my husband. He was like, I don't know if I can do years and years of this. And he's like, we have our son.

Speaker 2:
[46:39] It's a roller coaster too, like getting those updates. I mean, I've gone through IVF too. I did it as a form of fertility preservation at 34, and then I had secondary infertility at 37, 38. But when I went to go preserve my fertility, I did it because my numbers were looking low, and I just was like, I'm not worried that that means I'm infertile, because listen, I tell my patients that all day, every day, but I'm not ready to have another baby anytime soon. I was really overwhelmed coming back to work trying to juggle it all. So I just knew if I do need IVF in the future, my numbers are already low, let me just do it. And I had some cycles where I only got two eggs and nothing turned into an embryo. And it's like being the patient on the other side is so tough. It gave me a newfound appreciation.

Speaker 1:
[47:20] Oh, absolutely. And I also respect and understand how it's such a world, and I'm sure you see this in your patients. Even though I did IVF, and I know many people who had fertility issues and did IVF themselves, the reality is that it's still very isolating, even though you have people in the world, because there's no two experiences that are exactly the same. Like, I relatively had a very lucky situation. I'm putting that in quotes, right? I had one embryo, it transferred on my first time. And other people have been trying for seven, eight years that I know, you know? And so it can feel so lonely. And at the same time, feel good hearing the stories. Do you feel that from your patients? Like, hey, I love being informed, but I also feel a little sad, like, in the IVF community.

Speaker 2:
[48:06] Yeah, I think people have an obsession with hearing other people's stories. And for me, that was actually a hard thing when I was writing the book, because my editor kept being like, more patient stories. And I'm like, it feels like a HIPAA violation, but it's not, you know? It's just like, we're not used to as doctors. I don't think it's a natural tendency for us to be like, let's talk about a patient that I just saw, you know? But I do think it helps people, because it humanizes the issue. I think talking about it like a textbook, people feel far removed from it. I think when you put a face to it, even if it's not identifying the person, but you know what I mean? Putting it into context, I think that it makes people feel way less alone, and I think that they learn little nuggets of information along the way. It's a fine line, as you said, because you also are in your own situation, and especially those long shot stories, I think they can be hopeful. But I also think that they can, it's a double edged sword, because sometimes it just feels like, well, why isn't it happening for me like that? Like, it's so unfair. And I think comparison is the thief of joy. And it is important, a good point that you said, like everyone's situation is so individual. But all we have to go off of is statistics and what we're learning from each other. And the stories that people are sharing online are helping a lot of people. And there's great communities online for anyone that feels alone and feels like they can't open up to the people in their lives.

Speaker 1:
[49:29] And so I think, you know, when I started vlogging my secondary infertility journey, it was twofold. It was one because emotionally, it helped to vlog. Like it helped me from a therapy standpoint, write it down, videotape it, get it out there almost as how someone would journal. And then the second component is when people hear the story, I served a really greater purpose of like helping people feel supported. And I made it very clear on that vlog because I'm like, this is my story. This is not everyone's story. And what it did do is that so many people who are going through this journey sent the series to their friends or family just so that they can hear someone else. Because I cried in the vlogs, you know, I'd be like, this is so freaking frustrating. Like I have to push back my transfer. There was something wrong with my uterine lining. And I told them all those ups and downs. And I said, I really appreciate that it served those two purposes because I don't expect anyone to go online and share their journey if they don't feel comfortable. But what I did do is help people just feel like, you know what, Dr. Mona had this really great vlog series. Like just watch it because it really represents the struggle. Like even if it's not my exact struggle, it's the fact that this was a really hard, emotionally draining process. And then you factor in the money, you factor in getting time off of work. Like all of those layers of things that people don't realize. It's not, yeah.

Speaker 2:
[50:51] But also I love that you shared your journey with secondary infertility because what I have observed, and we talk about this online sometimes, there's certain pockets of the infertility community that are quieter. And secondary infertility, and I've been through this myself, and I actually didn't share my journey in real time. You'd think I would as a fertility doctor. But I think there is a sense of, at least for me, there was like this guilt. I'm like, I have a daughter. I'm so lucky. I'm seeing all these cases of patients that are just struggling to get to baby number one. And it feels like even if you feel like you are struggling, obviously, your struggle is valid. I felt very concerned about how it was going to make other people feel. I didn't want to be perceived as someone that was complaining about my situation because I should just be happy I have one. And I think it's actually one of the more lonelier forms of infertility because there's less of a community. There might be a little bit less compassion. And people feel guilt for, quote unquote, complaining. And I want that to go away because I think infertility is hard, whether it's primary or secondary, and every situation is very unique.

Speaker 1:
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Speaker 1:
[53:34] Oh, this is so, so true. And I, again, I'm so happy that you're here to chat about that. And I think you've already discussed, you know, obviously what happens, the different types of IVF. When someone does make that initial appointment with a fertility specialist, it's a reproductive endocrinologist is that doctor, correct?

Speaker 2:
[53:52] Yes. Yeah. Reproductive endocrine and infertility, which means we did three additional years of subspecialty training after becoming an OB-GYN.

Speaker 1:
[54:01] Amazing. Thank you so much for explaining that because many people who aren't familiar may not know that you all are OB-GYN residency trained, fellowship trained, and obviously to get even more training in what you are experts at. So if someone's going to that appointment for the first time, what sort of information should they be prepared to give to that doctor? What sort of basic things may happen on that first initial evaluations? And again, we don't have to get so much into like all the little, all the imaging and stuff because there's so much nuance, but what should they expect from that first visit?

Speaker 2:
[54:29] Yeah, so when I see a new patient, I spend about an hour with them. The first 45 minutes is all talking in my office. Understanding what are your goals? Where have you been? What's your situation? What's your relationship status? Because remember, some people are coming to me for fertility preservation. You know, some people are coming to me wanting to do this on their own without a partner using donor sperm. There's so many different ways to build a family. But I understand, I want to understand where you're coming from, how long you've been trying, what are your periods like, whole medical history. Sometimes people are like, oh, well, that part's not relevant. I'm like, actually, no, it is. Your family history and understanding if you're at a risk of any sort of hereditary syndrome or conditions, because that might be something that you could test embryos for. So every question I ask is very detailed, but there's a purpose behind it. And then after getting a detailed history from one or both partners, if it's a couple, then I do an ultrasound, and I look at the ovaries, I look at the uterus, and I'm basically just screening for things, and I'm just counting the number of eggs in case this is a person that needs to do IVF, that that's helpful to know how many tools do I have in my toolkit. And then we do blood work, and often we'll do hormone testing. We may do genetic carrier testing on both partners to understand if they have any reproductive risk. And we'll schedule the partner for a semen analysis. That's not something I like to spring on someone just there at that first visit. I like them to come in mentally prepared. And then, you know, the results come back. And I always at that first visit say, like, if everything comes back normal, Medicaid, IUI versus IVF, you know, I talk about the ability to potentially reduce the risk of miscarriage by doing genetic testing of embryos. That's particularly helpful in older patients or people who are coming, you know, after a string of losses that we think might have been age-related, embryo quality-related. I talk about, you know, the risks of things like twins, the risks associated with certain treatments. And let people really be in the driver's seat. I mean, I give them my opinion based on what their goals are and their age and their tests and the things that I see at that first visit. But once the results come back, we often have a follow-up conversation and it becomes very clear what the right plan is. And I believe in doctors and patients being partners in that decision-making because oftentimes there's more than one potential right answer and it comes down to what is important to the patient and what their risk tolerance is and how quickly they want to be pregnant and how important it is to freeze for the future.

Speaker 1:
[56:59] You're making me want to cry and call my fertility doctor. Like, it's like, like that relationship. And I know you know that so well. Like, this is someone that I hope people would find they trust, because it's not, you know, you mentioned so much about the, there's research and stuff, but so much of it is just stall, right? Meaning you're kind of also just like looking at the unique characteristics of that patient, looking at what therapies are in the literature and kind of saying, okay, like I felt that was happening with my amazing doctor. Like she was so knowledgeable, but there was like, hey, Mona, I think we should try this. Like you only have one embryo. I need to monitor this. Like there was just so much care and attention. Like it was the first time in my life as a patient that I felt like there was so much attention on me. And I say that after going to so many different doctors. And I thank you so much for that work because it is this amazing partnership that should feel like that.

Speaker 2:
[57:49] It is a very sensitive area. It's very unique because it's like you're not just dealing with one patient. Sometimes you are dealing with a couple. They may process information differently. There's just so many different variations of each. Every day I walk into my office, I'm like, I have no idea what to expect today. And it makes it interesting and I'm passionate about it. And I just see such a need. I mean, I think that my love of education and kind of explaining complex things in a simple way didn't start with doing content creation on social media or writing this book. It's really from the individual one-to-one conversations I have had with thousands and thousands of patients.

Speaker 1:
[58:30] And that's me too. My last topic of conversation is, again, just only we're touching the tip of the iceberg of this book. So already, if you're interested, you're going to have to get the book. We'll be linking all of that. My next thing is about stigmas, myths, misconceptions. So there's two things that come to my mind. So one, when I started doing IVF, I got a lot of this response, congratulations, like when they found out that I was doing IVF. And I said, interesting. Like why congratulations? They're like, it means you're going to have a baby. So there's one misconception is that people think IVF means you are going to have a baby. It's a guarantee, which we'll talk about. And then the second thing, which I will add and then I want you to go go forth, is I don't know if you know, right now on social, there's this trend saying that people can tell if you are an IVF baby by your face. And I mean, I'm like, this is such interesting commentary, like my kid looks like my kid because she has my genetic features and my husband's, but there's no, I'm just curious about your thoughts on those two things.

Speaker 2:
[59:31] Yeah, oh my gosh.

Speaker 1:
[59:32] And more, and more, yeah.

Speaker 2:
[59:34] Okay, the first one was about IVF not being a guarantee. Yes. It's not. I mean, I try to give a very balanced view. When you compare the efficacy between medicated IUI and IVF, you can imagine why it tends to be more successful, and there is a shorter time to pregnancy for the average patient. Because instead of working with just one, two, or three eggs, you're able to, as if someone has a good egg count, be able to work with multiple and then you're able to weed out, they weed out on their own, the ones that don't make it to the embryo stage, right? So you're kind of able to hone in on the ones that have the highest reproductive potential. But I already said it, it's like 60 to 70% is the best case scenario, live birth rate we can offer per one embryo transferred if it looks great and it's tested and normal, not 100%. So sometimes it takes multiple transfers, and sometimes people have challenges with their lining. Sometimes they have scar tissue in their uterus. Sometimes getting that normal embryo is the challenge. So in my book, actually, the troubleshooting chapter, I struggled with, you know, and you're gonna see like writing this book, I don't know how far into the process you are, but just like sitting down and strategizing, like how am I going to attack the level of information? And my strategy was I'm gonna go based on the information that I deliver to patients. So I actually put like quotes, like the first problem is I didn't get as many eggs as I wanted, or a lot of my eggs were retrieved, or I had a very low fertilization rate. It's like I went through each pitfall at every step of the process, and then talked about like, well, here are the things that we can address and think about. So think about it as a series of potential places where things can go wrong, right? That sounds terrible and pessimistic, but that's where my brain is thinking in terms of troubleshooting. So you might have trouble responding to the egg retrieval process and not being able to get enough eggs because your egg count is on the lower end. Okay, that's one reason why someone might need to do multiple rounds and not get there the first time they try. Or you might have drop off at the fertilization step. A lot of times it's getting the fertilized eggs to turn into embryos like what you experience, that attrition is so real and a challenge for so many. And then sometimes you get the embryos, but all of them test abnormal or you don't get what you need. And then if you surpass that expectation, a lot or that hurdle rather, a lot of people are like, okay, well, now it's solved, right? But it's like, okay, it best to two-thirds chance. And so it might take multiple transfers to get there. And I think people do have this misconception that IVF can overcome all. Listen, I thought that when I was a medical student and I was like, I'm single, there's like probably no end to that insight. I'll just do IVF in my 40s, it'll be fine. I used to think that way and then only when I became a fellow training in REI, I was like, I told my husband because at that point I was with him, I was like, never mind, scrap my plan, I think I should get off of the pill and start trying. And he was like, what? We just bought a one-bedroom apartment. Are you crazy? But your perception gets skewed. So I think the truth is somewhere in between. Not everyone is going to struggle, but not everyone is going to have a guarantee of success the first time they try or go through IVF and be successful the first round, right? And it's important to be open-minded to that possibility that it may, it often can take multiple rounds to get there for many people. And I don't think that we talk about that enough. And then the second thing that you talked about. I mean, my second child is from IVF. And like, I haven't had any comments like that, probably because people know better than to say something like that to me, a fertility doctor and an IVF mom. But I'm here to tell you there's no such data that shows anything of the sort. And people used to worry a lot, especially like 20 to 30 years ago, about the health of children born from IVF. And I think it's because the way we used to do IVF was so much riskier, right? We weren't good at growing eggs into embryos. We didn't know how to genetically test them in the early days of IVF. What were we doing as a result? Well, patients were most often paying out of pocket. There was no such thing as insurance coverage back then. They're taking this crazy leap of faith. Of course, you're going to put back multiple. People were putting back four, five, six embryos at a time because they all had such a low probability of success that collectively you were giving the patient a better chance. What happened? Tons of twins, even triplets, higher order multiples, which you know the consequences of that, higher risk of preterm delivery. With that comes a whole host of medical issues. So nowadays, we've really vectored towards 99% of the embryo transfers in my practice are single embryos at a time. Now we're testing embryos. I mean, we're able to really reduce some of the risks, especially coming from obstetrical outcomes that were, you know, much more high risk with twin pregnancies and also putting back embryos a week after the egg retrieval, because we didn't know how to freeze and thaw them well. That putting that embryo back into a very unnatural environment has been associated with preterm labor, growth restriction, things like that. So I think our protocols have gotten better. It's made it safer to go through these types of treatments as a patient and as a resulting child. And there really is nothing to this really harmful narrative that IVF children are, they look different or that their immune systems are compromised. I hear that a lot. Like, you know, they're gonna have all these problems. Like I've seen it on these like crazy podcasts. I think I've sent you a few clips where I'm just like, we need to attack this, you know, because it's just not founded in any sort of data. And it's terrible because think about how terrible a patient feels if they're like, I needed to rely on this technology to overcome infertility. And now you're telling me I might have put my future child at a disadvantage. It's just not true.

Speaker 1:
[65:18] And I can say from the pediatric side, I have so many different patients I see, right? And I, yes, I may know that they were conceived through IVF if it's in the chart, but from a physical standpoint, there is not a facies, which means like a facial expression thing of someone who was born via IVF. And I thank you for giving the historical context because that makes sense where that sort of stigma and fear may have rooted from. But I agree. I mean, there is nothing from a health perspective in terms of what I didn't even know that immune system thing that people were concerned about. I guess the biggest question I get is about the development of the child. Like, are they going to develop milestones wise? And I'm like, I can say from my experience too, that I don't see any different outcomes. And is there any data to support the developmental outcomes of a baby via IVF, like milestones and things like that or not really?

Speaker 2:
[66:06] Again, I think it comes down to two things, and it's kind of like obstetrical risks and some of the things that come along with that. And also I should mention age, right? We can overcome a lot of the age related changes to our fertility, but our body is still different. And when we're carrying a pregnancy in our 40s, mid 40s, late 40s, you're at a higher risk of certain outcomes during pregnancy, including things like growth restriction. And that can have an impact on later health outcomes, and it's not a certainty or an absolute risk. It's something where you're like, okay, yeah, we have to be responsible and counsel our patients that because of age, even over 35 and then over 40 and over 45, there's incremental increases in certain risks. And your OB-GYN is going to be aware of that and monitor you more carefully. And maybe there are certain indications for as things come up to induce earlier. We can't say that age doesn't matter to the health of pregnancy. And as a result, there can be an association when we look at IVF data, especially historically, a lot of patients are older. And so sometimes that plays a role. And when you look at the advanced paternal age, there is some data to suggest associations between very advanced paternal age, like men having babies in their 50s and 60s, and potential certain health outcomes in children, like neurodevelopmental outcomes. There has been a link to autism. Again, it doesn't mean every father in their 50s or 60s is going to have a child with those issues, but there's an association. And when you think about underlying infertility diagnoses, like if you have PCOS and insulin resistance, yes, there may be some relationship to potential metabolic health issues in future children. But this is why we talk about preconception counseling and trying to control these things and really optimize your health as much as you can. But at the end of the day, our kids' health outcomes are a confluence of so many factors. And if we put it all on our bodies and our underlying issues and needing to go through fertility treatment, I mean, that's not accurate. And that's putting way too much on one factor. I mean, there's a culmination of factors. And I think the reason why there's been such an emphasis and worry about this traditionally has been because of, you know, who is mostly doing IVF, especially, I mean, now it's changing, but I think before it was like something that you were just looking at a skewed population that at baseline may have some elevated risks. These aren't risks that can't be managed. And it's not to say that you should feel worried if you're in that category. But it's just important to look at the data with a really balanced view of like, this is the culmination of so many different variables.

Speaker 1:
[68:47] Lucky, this was such an amazing conversation. Like I said, in the middle of the convo, I feel like our conversation just touched the tip of the iceberg of your book. I mean, you have so much more in your book, and I'm so grateful. The book is out, guys. You have to get it. You have to share it with anyone going through this journey. But even if people are not going through this journey, I want you to read it so that you can educate yourself. That's the point. Where can people go to stay connected, to get the book and learn more about all the work you do and you continue to do?

Speaker 2:
[69:15] Thank you so much. I'm on Instagram mainly. I'm on TikTok as well, but on Instagram, I'm at lucky.secon, S-E-K-H-O-N. My TikTok is DrLuckyEgg. I am also on my blog. I've been doing longer form content on that for quite some time, theluckyegg.com, and there's a lot of calculators and cool dynamic tools that you can play around with. And then my book is everywhere, and there's an audio book narrated by me, so you can buy it on Barnes and Noble, Amazon, wherever you get books.

Speaker 1:
[69:42] Yes, I'm going to be linking everything. And then my final question for all of my guests is nothing related to this topic of IVF or maybe it is. What is making you happy right now and bringing you joy in your life?

Speaker 2:
[69:54] Connections, I think connections to you. Like look at this, this is amazing. We've never met in real life. We are Instagram friends by definition, and it's been such a wonderful conversation and so inspiring. I've had so many great connections over the past couple of months because I've had a reason to want to talk about my book. But that's like the most gratifying thing that's come out of all of this is like having an excuse to basically be like, Mona, I want to talk to you and have this one-on-one conversation. And I think that's what's really filling my cup right now. Am I tired? Am I a little run down? Sure. But that's what's really keeping me going is the motivation to be connected and also hearing from followers or people that read the book who reach out to me. That's such a magical part of this journey.

Speaker 1:
[70:40] And I want to thank you. So for those of you who are not familiar, obviously, Dr. Lucky is of Indian origin, like myself, and there's still so much stigma around fertility issues, not only in the Indian community, but elsewhere too. But it was just so nice seeing an Indian woman, fertility specialist, online, sharing the information. She was a source of a lot of the resources and information. When I was going through my own journey, I followed a few different fertility specialists, and she was one of them. So Lucky, thank you so much for all of that work that you do. And I know you said this book wasn't in your plan, but it now is. And I'm just so grateful that it can live on people's bookshelves and people can feel supported and not scared, because that's what I think more people need in this IVF and fertility journey. So thank you for being here today.

Speaker 2:
[71:23] Oh, my gosh. Thank you for sharing your platform to talk about this important issue. And congratulations on your successful journey. And I really do admire how much you've shared it so openly and vulnerably. So thank you for everything you've done.

Speaker 1:
[71:39] Thank you. And for everyone tuning in, thanks for being here. What I really took home today from this episode, I mean, it was wonderful. And as someone who's gone through the journey, I was just nodding along. But I love what she said about anything good for your heart is gonna be good for fertility. I mean, that to me, if I had that message when I was going through the journey, I think it would have made my stress a lot better in terms of stop the overthinking and stop the, well, I can't have this and I can't have this. And thank you so much. So if this conversation helped clarify something about fertility or reproductive health, please share with someone who might need it. Make sure you share the book, The Lucky Egg with people who might need it. These are topics that deserve more open, educated, compassionate conversation like we had today. And you can continue the discussion with me on Instagram at PedsDocTalk, at The PedsDocTalk Podcast, and make sure you tag DrLucky at lucky.sekhon. So we can see that you're listening and we can reshare it. And again, if you love the show, subscribe, follow all of the things. I cannot wait to chat with another guest next time on the show.

Speaker 8:
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