Podcasts about mullerian

In this episode, I'm sharing all of the details about IVF, including debunking some of the common misconceptions about it. (like the myth that it causes early menopause or is linked to birth defects, cancer, or autism). I also walk you through the IVF process step by step, from egg retrieval to embryo transfer, and share insights on what really impacts success, like antral follicle count (AFC), anti-Mullerian hormone (AMH) levels, and sperm health. I also talk about how IVF can impact future fertility and share tips to help you ask the right questions during your fertility consultations. If you've ever felt overwhelmed or unsure about IVF, this episode is for you. Tune in now to feel informed, empowered, and ready to take the next step on your fertility journey!" Read the full show notes on Dr. Aimee's website   Do you have questions about IVF? Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, January 13, 2025 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom. Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org.   Other ways to connect with Dr. Aimee and The Egg Whisperer Show: Subscribe to my YouTube channel for more fertility tips! Subscribe to the newsletter to get updates

Dr. Natalie Crawford addresses a listener's question about primary amenorrhea, discussing the absence of periods despite typical puberty signs and normal hormone levels. She explains the difference between primary and secondary amenorrhea, potential causes like ovarian failure, Mullerian aplasia, androgen insensitivity syndrome, and more. Most importantly, she emphasizes the importance of thorough evaluation and testing to determine the underlying cause. Want to receive my weekly newsletter? Sign up at nataliecrawfordmd.com/newsletter to receive updates, Q&A, special content and my FREE TTC Starter Kit and Vegan Starter Guide! Don't forget to ask your questions on Instagram for next week's For Fertility's Sake segment when you see the question box on Natalie's page @nataliecrawfordmd. You can also ask a question by calling in and leaving a voicemail. Call 657–229–3672 and ask your fertility question today!      Thanks to our amazing sponsors! Check out these deals just for you: Quince- Go to Quince.com/aaw for free shipping on your order and 365-day returns Ritual-Go to ritual.com/AAW to start Ritual or add Essential For Women 18+ to your subscription today. Calm - Go to calm.com/aaw for 40% off a Calm premium subscription. Air Doctor - Go to AirDoctorPro.com and use code AAW to get up to $300 off! If you haven't already, please rate, review, and follow the podcast to be notified of new episodes every Sunday. Plus, be sure to follow along on Instagram @nataliecrawfordmd, check out Natalie's YouTube channel Natalie Crawford MD, and if you're interested in becoming a patient, check out Fora Fertility. Learn more about your ad choices. Visit megaphone.fm/adchoices

Listen to ASCO's Journal of Clinical Oncology essay, “It Mattered Later: A Patient Turned Doctor's Perspective on Fertility Loss” by Dr. Margaret Cupit-Link, who will be a clinical oncologist at Cardinal Glennon Children's Hospital in St. Louis, MO. The essay is followed by an interview with Cupit-Link and host Dr. Lidia Schapira. Dr Cupit-Link shares her personal experience with childhood cancer and the importance of educating patients on the known and unknown consequences of their therapies so they can, when possible, participate in fertility preservation. TRANSCRIPT Narrator: It Mattered Later: A Patient-Turned-Doctor's Perspective on Fertility Loss, by Margaret Cupit-Link, MD   I was 19 years old when I had to make one of the most important decisions of my life. The problem was, at 19 years, it was not important to me—yet. With piercing clarity, I recall the very first time I heard the word sarcoma. My leg had been hurting, and I had just undergone magnetic resonance imaging. The doctor spoke of abnormal tissue. As a pre-med student, I blurted out the words, “it's cancer, isn't it,” and waited for him to reassure me. He did not—he could not—reassure me. The days and weeks that followed are still a blur. There was more diagnostic imaging, a biopsy of my tibia, and placement of a subcutaneous port in my chest. When we learned that the Ewing sarcoma growing in my leg was not metastatic, my family celebrated; meanwhile, I struggled to eat, sleep, and breathe, unable to accept the reality that I was no longer a healthy college student. I was a patient with cancer. Before my chemotherapy would begin, my mom and I had to give legal consent. Technically, I had to give consent—as if I would choose to say, “no thanks,” to the only treatment that could give me a fighting chance to keep living. With each potential side effect that was mentioned, I felt a piece of my morale slip away. Was I going to die? Maybe. Regardless, I would lose my hair, my appetite, my immune system, and my independence. Should I be lucky enough to live through it, I would be susceptible to a host of late effects from chemotherapy, one of which was infertility. Infertility, I felt, was the least of my worries; it paled in comparison with heart failure, secondary malignancies, and death. As a 19-year-old, I did not want children. My career goals were my priority, and I had yet to be in a serious romantic relationship. Starting a family was not on my agenda. So, on the worst day of my life, when all I cared about was staying alive, I was told I could choose to undergo ovarian stimulation to harvest follicles in a somewhat experimental process that would delay the start of my chemotherapy by several weeks. Without hesitation, I said no. At the time, I did not realize I was lucky to have had time for such a conversation. My diagnosis and presentation allowed for a small delay before treatment; I would later learn that many patients do not get that luxury. A little over a year after completing therapy and returning to college, I developed hot flashes, night sweats, and mood swings. On the basis of the levels of luteinizing hormone, follicular stimulating hormone, and anti-Mullerian hormone in my blood and an ultrasound showing ovaries without follicles, I was diagnosed with premature ovarian insufficiency and told it was unlikely my ovaries would recover. I was not heartbroken or even disappointed; I was still so thankful to be alive. I did worry, however, what this would mean for my boyfriend, the person I wanted to marry. To this day I am amazed that he, as a 20-year-old man, was completely accepting of me and my infertility and that never changed, even after he became my husband. Near the end of my pediatrics residency, I came to understand the term baby fever. My coresidents were getting pregnant, my sister was having a baby, and my husband and I were settled down in our very first home. I visited a reproductive endocrinologist. It had been 9 years since I had completed chemotherapy, and I learned my ovaries were not functioning at all. I was told to plan on adoption—of an embryo or a baby—as I was not a good candidate for fertility treatments. At first, I did not allow myself to react to this news. How could I mourn something like fertility when I was a 10-year survivor of childhood cancer, had exceeded my career goals, and was married to a wonderful person? Most of the time, and on the outside, I was unphased. I spoke about my desire to adopt with enthusiasm. I was honest about my ovarian failure and made jokes about being in menopause. I celebrated my friends' pregnancies and came to love my nephew as if he were my own.  I considered the many ways in which I could become a parent, each with its own barriers. Because I had not undergone oocyte or embryo cryopreservation before chemotherapy, having a genetic child was simply not an option for me. I could adopt a baby in need through the foster care system, which would not require monetary payment. However, I knew then and now that the goal of the foster care system is to eventually reunite children with their families; although I was strong, I could not risk falling in love with a child and losing them to reunification. Private adoption was another option. While it felt unethical to pay a large sum of money in exchange for someone else's baby, I would one day have the luxury of being able afford the price tag (at least $20K US dollars [USD] to $100K USD in the United States, depending on the state and organization). Then, there were the options offered by modern medicine—embryo adoption or in vitro fertilization using a donated oocyte and my husband's sperm. In these cases, even if my body was unable to sustain an embryo, I could use a gestational carrier (surrogate mother). While I knew that having a baby the old-fashioned way was not without its own costs and risks, it was undoubtedly easier than any of my options. I did not admit—until now—that it hurt to know I would never experience the miracle of pregnancy. It hurt to know that I would never have a child that was half of me and half of my husband. It hurt to know that, even now, my cancer had taken something from me that I could never get back. My experience with infertility has made me thoughtful about how infertility may affect my patients. As a pediatric oncologist, I am painfully aware that many of my patients who lose their fertility from the drugs I prescribe them will travel the same road of grief I have traveled. I am even more aware, however, that most of my teenage patients are not ready to make decisions about fertility—even when they are forced to do so. In my desire to counsel my patients on this topic, I have tried to imagine a scenario in which the advice of a doctor might have prompted me to prioritize fertility preservation. Perhaps I should have been told that delaying cancer-directed therapy by several weeks would be unlikely to affect my disease outcome. Perhaps I would have benefitted from knowing the complexities of the foster care and private adoption systems. Perhaps fertility preservation should not have been a choice at all, but a standard of care, as it is now.1 What I think I needed to hear, above all, was that I did not understand the gravity of my decision. I did not and could not understand the desire to become a parent that would one day overcome me. If I could go back in time and speak to my 19-year-old self, I would say, “it might not matter to you now, but it will matter to you later.” Just days before I originally planned to submit this article, after 12 years of menopause, I experienced the unexpected. Seven positive urine pregnancy tests later, my doctor sent me for an urgent ultrasound, and it was confirmed: I was 6 weeks pregnant. At first, I felt I was no longer worthy of writing this article: how could I speak up about infertility from cancer therapy after having miraculously conceived a child? However, I eventually realized my pregnancy was yet another reason I should write on this topic. Only now, as I hold my daughter in my arms, do I fully understand how much my fertility would come to matter to me. Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Professor of Medicine at Stanford University. Today we are joined by Dr. Maggie Cupit-Link, a third year Pediatric Hematology Oncology Fellow at St. Jude Children's Research Hospital, Maggie will graduate from fellowship and receive her Master's in Clinical Investigations in June. She will then begin a position as a clinical oncologist at Cardinal Glennon Children's Hospital in St. Louis, Missouri.  In this episode, we'll be discussing her Art of Oncology article, “It Mattered Later: A Patient Turned Doctor's Perspective on Fertility Loss.” Our guest disclosures will be linked in the transcript.   Maggie, welcome to our podcast and thank you for joining us. Dr. Maggie Cupit-Link: Thank you so much for having me. It's an honor to be here. Dr. Lidia Schapira: It's lovely to have you. I'd love to start just by asking a little bit about your motivation to write and share this piece. It's such an important piece and you really have shown us what was deep in your heart. And then there's this sort of unexpected resolution. Tell us a little bit about what led you to finally finish the piece and share it with the world. Dr. Maggie Cupit-Link: So I've been writing for a lot of my life as a way to express myself and cope with emotions. And I had cancer when I was 19 and 20, Ewing sarcoma. And during my treatment, I found writing was very therapeutic for me and very healing. So that's when I got really into writing about my personal experience and actually published a book after I finished treatment. But then writing more recently, I was writing about my infertility, which I had from chemotherapy. And I would write about it and journal about it here and there because it was really challenging. And for a long time, I suppressed a lot of those emotions because I didn't think they were helpful. And I felt, I guess, ashamed and embarrassed to feel so upset about infertility as a cancer survivor who has so much in life. So many parts of my life are so normal and full and even more full than the average person so I felt like I wasn't really allowed to grieve my fertility.  And I started to write a piece because I'm part of a working group, a group of physicians working together to learn more about fertility and pediatric cancer survivors, particularly those who have received immunotherapy, because there are a lot of new agents that we don't know as much about when it comes to fertility. And as I was working with this group, I started writing this piece on my own. And then I was about to submit the piece just to the group to show them my personal reflection when I took a pregnancy test and it was positive. So then I took seven– Dr. Lidia Schapira: -other ones Dr. Maggie Cupit-Link: I was not, I didn't believe any of them. Then finally I called my sister, and she told me that I was not acting like a doctor, that it was very obvious I was pregnant. And so then I went to see my doctor, but I found out I was six weeks pregnant right at the time of finishing this piece. And at first I thought, “Well, I can't write this piece anymore.” But the more I thought about it, the more I thought, “Well, either way, it shows that us oncologists really need to learn more about fertility.” And I'm very blessed and lucky to have this ending in my story, but it shows that there's a lot of missing information out there. Dr. Lidia Schapira: That was an amazing answer, and I have about five different topics now that I want to discuss with you. But let's start with the end. And that is your baby. How old is your baby now? Dr. Maggie Cupit-Link: So her name is Lila Jude. Two days from now, she'll be seven months on June 12. Her name comes from the family name Carlisle. That's where we got Lila. And then Jude comes from the Patron Saint of Hopeless Causes, St. Jude, but also the hospital that treated me and where I've trained, St. Jude Children's Hospital. So that name was very significant for us. Dr. Lidia Schapira: So I'm getting goosebumps and teary just to hear you tell the story. Let's start a little bit with some of the themes that you touched on. The first is when you've said that you've always used writing as a way of processing emotionally complex situations as a patient, now, perhaps as an oncologist. Tell us a little bit about the book that you wrote about your experience. Dr. Maggie Cupit-Link: Sure. When I was in treatment, I wrote a lot of entries in my journal, and it was just a way for me to process things. I think sometimes, for me, I don't know exactly what I feel until I write it down and make myself reflect on it, because I'm a busy body. I'm constantly going and doing. And so during chemo, I couldn't really do it. I had a lot of time to sit, and so I needed to write. And my grandfather is a retired Professor of Christian Philosophy. And during my year of cancer therapy, he and I started writing letters to each other because I had a lot of questions, understandably, about God. So the title of the book is actually “Why God?: Suffering Through Cancer into Faith.” And it's a lot about doubt and my anger towards God and what I would see in the hospital around me, the children who were dying from cancer, who even had it worse than me. It felt very impactful to my faith.  But ultimately, through my conversations with my grandfather, he taught me a lot about another way to understand God, another way to understand faith in spite of horrible suffering, which I think is a thing for a lot of people because a lot of people in this world suffer. And so eventually we published a book. During medical school we published it, and it was a compilation of my journal entries intersected with his letters. And so part of it was really personal and raw and journal entry, and part of it was Christian philosophy. So it was an interesting combination. Dr. Lidia Schapira: Well, Maggie, I will definitely now have to get your book and it'll be on my list for summer reading. So you touch on some of the fundamental, sort of ethical, moral principles of our profession, which is suffering and how we deal with suffering. And you've had a lot of time to reflect and philosophize and also experience this, as well as loss. Can you tell us a little bit about how your experience of loss has evolved over the decade of survivorship?  Dr. Maggie Cupit-Link: I think initially, loss, for me, meant a lot of different things than it does now. I felt like I lost a lot when I was sick because I had to give up a year of college. I lost my tibia and knee bones. I have a prosthetic knee and tibia now, internal, and they function very well, but I don't have a real leg. I lost, of course, in chemo, you lose your hair. I lost a lot of tooth enamel. I lost a lot of friends because I was a teenager, and teenagers don't handle illness very well. People were afraid to talk to me. And then, of course, I lost my ovarian function. For a while, I think I focused on that a little bit more than what I had gained. But over time, it became very obvious to me that despite all the loss that I had during my year of cancer therapy, I gained a lot more. I gained a lot of perspective and a lot of emotional depth. And then ultimately, what directed me to my career decision. I knew I was wanting to be a doctor before I had cancer, but then after that year, I knew exactly what kind I would be if I got through the year.  But I think one thing I've had to learn apart from that is being able to feel loss, even when you have so much. Because I have a lot of gratitude and I have so many good things in my life now with my health and my husband and now my baby and this wonderful career. Even though I have all those wonderful things, I'm still allowed to feel loss sometimes because I will be susceptible to late effects and there will be things in my life that are not quite normal because of going through cancer therapy. And then, of course, the other layer of loss is the people that we lose along the way. If you see behind me in my office, there's a picture of a little boy on the shelf up there. He was my good friend when I was sick. His name is Odie, and he died from hepatocellular carcinoma. When we were sick, he was a good bit younger than me. He was like a little brother to me during therapy.  The loss of his life definitely propelled me forward to try to change more for other kids. And I think one thing I struggle with now as an oncologist and I'm still learning to do, is process the loss of my patients as it happens. I think I'm lucky that when I lose a patient, when a patient loses their life, I still see the beauty in what I was able to provide for them and their family. That's still a gift. I feel that it's important for me to grieve the loss of their lives, and I'm working on finding, like, the best way to do that for me over time.  Dr. Lidia Schapira: You will find a lot of reflections on this topic in the pages of Art of Oncology over the last 20 plus years. I think that is a very, very common theme. I'm really impressed with how well you just understand the importance of this, to stay emotionally healthy and resilient.  My next question addresses that a little bit, and it has to do with processing the early experience of being a cancer survivor. As a young medical student and as a young physician, what was that like for you?  Dr. Maggie Cupit-Link: I think early on, I had a lot of guilt when it came to being a survivor. This concept of survivor guilt, I think you can read about it as well, and I'm sure there are some articles in the Art of Oncology about it. But the idea that, like, ‘why me?' and when I encounter patients who go through similar diseases or experiences that won't have good outcomes, ‘why? Why me? Why did I get a good outcome and they didn't?' And so early on, I struggled with that more. I felt guilty about it. I think over time, I recognized that the guilt– I mean, I always knew it was illogical. That doesn't mean we don't feel it. I think over time, I've recognized the guilt as unproductive. And so I tried to empathize with myself about it and acknowledge that I feel guilty. But then instead, what can I do with this feeling that's helpful? So where can I put this? What can I do to make things better for somebody with it? And I think that I've been able to do that better as time has gone along.  I also think that early on in my survivorship, I thought that I had even more ability to understand patients' perspectives than I did. And I learned quickly that everybody's experience, even another 19-year-old with Ewing sarcoma who had to leave college, is so different. And so I've been humbled along the way in learning that just because I understand part of their experience does not mean I understand their experience all the way, and that I should never assume that I do. I should always listen and wait to try to understand more about what's different about their perspective.  Dr. Lidia Schapira: I'm surprised a little and maybe delighted to hear the wisdom in your words. You are so young and yet you know so much. Did you have any mentors during medical school and residency who helped you process this? And then playing it forward, how do you imagine now that you're going to be an attending, mentoring others who may be the young Maggie and come under your tutelage? Dr. Maggie Cupit-Link: I've had a lot of mentors, for sure, in life. I've been in therapy pretty much my whole life. I'm really lucky that my grandmother is a PhD psychologist and she's a clinical counselor. And so from the time I was a child, if there was ever a problem, I would go see a therapist. There was no exception to that, especially when I became sick. And then in the aftermath of that, I've frequently been seeing a therapist, and that really helps me gain wisdom. I think that's been one big source of mentorship.  But there have been other providers that have been big sources of mentorship for me for this. One was actually a good friend of mine. Her name is Beth. She's a physician, a clinical research physician scientist at St. Jude, and she was a fellow when I was a patient. And we became friends back then. And then when I went back to college afterwards and then medical school, I shadowed her a few times. I did an away rotation with her once at St. Jude while I was in medical school, and during that time, I remember meeting a boy with Ewing sarcoma. And I remember walking into the room thinking, “Oh, this is great. I totally get this. I'm going to be so helpful to his mom.” And I quickly learned that he had metastatic disease, which meant, really, we had a different disease entirely. And that when I told his mother about me, I almost felt like it made things worse because she knew that my outcome was different than her son's was going to be. And I remember Beth afterwards reflecting with me, saying like, “Yeah, it is true. Everyone will have a different story, even if you understand a lot.” I think she told me, “You don't always have to tell people your experience in order to use your experience.” And so that was one of the ways that I learned. I don't have to share everything upfront in order to still have so much empathy and compassion.  And then I've also had the honor to work with many doctors who have just role modeled, listening really well and really good bedside manner and compassion. The physician who treated me, Dr. Pappo, still works at St. Jude, and so I've gotten to work with him a little as well, and he role modeled wonderful bedside manner. And then my primary research mentor as well, Dr. Federico has taught me a lot. And just watching her with our shared patients and the way she tells family news and the way she explains things has been really helpful to me, too. So I would say a lot of mentors and a lot of therapy.   Dr. Lidia Schapira: I like that combination. Clearly, it's been very productive and useful for you. Tell us a little bit about choosing to work in this field after your personal experience. I mean, it sounds like you were headed to St. Jude's to a laboratory to do research even before the diagnosis, but one could easily imagine that you would have chosen to become a dermatologist after this, or somebody who was not totally immersed in this culture of cancer and also a lot of grief and suffering, as we've just said before. Tell us a little bit about your research passion and how these two themes in your life, your personal experience of cancer and survivorship and your research, have meshed. Dr. Maggie Cupit-Link: Well, I think I knew that I was going to do this career in some capacity when I was watching the kids around me during my treatment. And I think this is one of the reasons why it was so important for me to be treated at a pediatric institution. I know that the AYA population is sometimes treated with adults and sometimes children, and I would advocate that being treated with children is helpful because children are miraculous, resilient creatures. And I remember deciding that I was going to have to fix my attitude during chemo because I was very depressed and very angry and deciding that maybe it would help me if I could just play with the kids in the waiting room and try to distract them and make them have a better day. And so I decided I would try to do that for myself, but ultimately they distracted me and made me have a better day. And so the more I was around the kids, the more I knew that they just hold so much optimism and innocence and light that I feel that we lose as adults. And I wanted to be around it. So in a way it was selfish that I would choose this career because I just wanted to be with them, but also knew that if I was going to go through all this nonsense, I better use it. That was very motivating for me.  And I think it has been a gift from my experience and maybe my therapy and who knows what else that I'm able to take the bad and the grief that I experience personally and use it to feel differently about the grief that I feel as a doctor. I think I feel differently about loss than my colleagues. It's still hard when I see patients suffer, when patients lose their lives, it's still hard. But I think it's hard in a different way than it is for some of my colleagues. And for some reason, I think I feel more comfortable in that space. I think I feel comfortable around that. Dr. Lidia Schapira: Tell me a little bit more by what you mean by saying that it is hard, it has to be hard, but it's hard in a different way because of your lived experience. Tell me a little bit more. Dr. Maggie Cupit-Link: I think I'm not uncomfortable around suffering and death. I think I feel very comfortable around children who are suffering and children who are dying, doesn't scare me and doesn't make me feel like I need to turn away, because I feel it's familiar in a sense. And I think I also, having been the patient who received so much comfort and support and love from providers, should I have died, I still would have valued all of that support so much that allows me to value the support that I'm giving, even in the face of death. Dr. Lidia Schapira : Maggie, you're amazing. Tell us a little bit about your research and your plans now that you're going to be finishing your formal training? Where will we find Maggie in a few years? What will you be doing? What will we be reading? Dr. Maggie Cupit-Link: Well, I have really enjoyed doing clinical research. Back in college, after I finished therapy and went back to school, I did join a couple different St. Jude labs and did a variety of different things. But I was not a natural in bench research. I broke a lot of things. I'm very clumsy. It was not my area. I was not good at it. And that's okay. I've decided to come to terms with that. I love science itself and it's been really wonderful to get this Master's in Clinical Investigations throughout fellowship because I could directly apply a lot of those skills to my research in clinical research. And so I'm really passionate about writing and helping with trials, clinical trials, but specifically would like to help with trials that focus on acute and late effects of toxicities. One of my major research projects has been creating a prospective study to evaluate the early late effects in high risk neuroblastoma survivors. And I chose that population because they receive all the therapies that you can imagine, the kitchen sink, and some novel immunotherapies that we don't really understand fully yet in mechanism of action, and so things like that, as well as evaluating acute toxicities and interventions for those. I distinctly remember every inpatient chemo that I experienced turning to my mom and saying, “There has to be a better way,” because my burden of side effects was really high. And I just remember saying, “There has to be a better way.” And my mom would say, “Yes, there has to be. You can figure that out one day.” So I do, I hope I can make some small changes in the way we give conventional therapy and the way we handle side effects as well as prevention of late effects.  I am currently collaborating with  Children's Oncology Group on one of their projects in the late effects of neuroblastoma, and I hope to continue collaborating with that group as well as my career advances. I'll be an attending physician at Cardinal Glennon Children's Hospital, which is a part of St. Louis University. And I have family here in St. Louis. My husband is a dentist here with his dad. They have a practice together, so it was really important for us to be here. And this hospital is a charity hospital as well, which I really think is a wonderful thing. And that makes me feel a little bit tied to St. Jude, since it's a charity hospital as well. And so I hope to be able to continue some of the clinical projects and some collaborations with the COG as I take care of patients. And I do hope to continue writing other stuff as well.  Dr. Lidia Schapira: Maggie, I have to ask you one last question, and that is that in your piece you say you were 19 and fertility didn't matter to you then, and you couldn't have understood then or couldn't make space for the later. Now that you are where you are and you're dealing with young adults who may be your patients in similar situations, tell me a little bit about how you think about involving the parents perhaps in this conversation or sort of making space to attend to some of these very thorny issues that may have so many repercussions on future health. Dr. Maggie Cupit-Link: I think it depends on the patient of course. Because, as you know, some patients can't have a conversation about fertility based on medical acuity. But when a patient has the luxury of time, I think that that's just not a discussion I rush through. And I agree with you that using the parents perspective would be incredibly helpful. I think, I've had a few older patients that I discuss this with, and they're all different because I even had a 17-year-old patient who told me she wanted to be a mom for sure. And so she was different than me and that she already knew that was important to her. But when people think it's not important, I just encourage them to think about it more and talk to their parents about it and to remember that who they are today is not who they were 10 years ago, and who they're going to be 10 years ago is not who they were today. And that this is something you can't time travel with. This is your chance to make a decision. And really, the fertility preservation methods, generally, they're pretty safe and not traumatizing. And so it's sort of like, why not just go ahead and do it? Especially if the institution you're a part of is offering it. And I think there are a lot of ways to get funding for that, too. Dr. Lidia Schapira: Well, you are definitely a champion. Dr. Maggie Cupit-Link: Thank you.  Dr. Lidia Schapira : I know that our readers and our listeners are going to follow your career, and I thank you so much for your thoughtful essay and for agreeing to this conversation. It's been a real pleasure. Dr. Maggie Cupit-Link: Well, thank you. I have one more thing to tell you before we end. Dr. Lidia Schapira: Yes, tell me.  Dr. Maggie Cupit-Link: So after I had the baby, my doctor and I decided we would wait to get on birth control until we saw if I was going to go back into menopause or not. We waited, and then I got pregnant again. And so I am 16 weeks pregnant with a baby boy this time. And so I'll have my second child 12 months after the first. Dr. Lidia Schapira: Oh, my goodness. Dr. Maggie Cupit-Link: It is a blessing. But after that, I might have to consider birth control to space some- plan, space some people out a little bit. But we're very excited. Dr. Lidia Schapira: The gift of your survivorship is now in your 30s. You need to have that conversation about family planning that most people and couples have earlier on. So congratulations. Congratulations.   Dr. Maggie Cupit-Link: Thank you so much. Dr. Lidia Schapira: Beautiful way to end. And to our listeners, until next time. Thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all of the ASCO shows at asco.org/podcasts.    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.   Like, share and subscribe so you never miss an episode and leave a rating or review.   Guest Bio: Dr. Maggie Cupit-Link will be a clinical oncologist at Cardinal Glennon Children's Hospital in St. Louis, Missouri.   Additional Reading:Why, God?: Suffering Through Cancer into Faith, by Margaret Carlisle Cupit, et al        

We're digging into what you need to know if you have low AMH and want to get pregnant this year. Most people I speak with have their AMH (anti-Mullerian hormone) biomarker memorized. A low result can have you feeling confused and panicked about your next steps. But what if we are focusing on the wrong biomarker? After all, AMH does not predict egg quality or your body's ability to get pregnant naturally. It's a marker of your ovarian reserve and does not determine your ability to get pregnant. We've helped women with AMH as low as 0.02 ng/ML get pregnant naturally. So, what can you do to get pregnant this year when you have low AMH? In this episode, you'll learn: 1) What the studies are telling us about AMH and fertility (i.e., AMH is not a predictor of pregnancy success) 2) What to focus on instead of AMH that improves your reproductive health (i.e., themes we see with low AMH and action steps to help you get pregnant this year) 3) The biggest barriers we see with low AMH and how to improve egg retrievals/transfers and implantation with IVF   --- RESOURCES: Fab Fertile Method https://www.fabfertile.com/what-we-do/   Ultimate Guide to Getting Pregnant This Year If You Have Low AMH/High FSH - https://fabfertile.clickfunnels.com/optinvbzjfsii   --- Vitamin D deficiency may be linked to decreased ovarian reserve, as indicated by higher serum FSH, low AMH and low antral follicle count. In simpler terms, ensuring adequate vitamin D levels could potentially boost your fertility odds. We see low vitamin D levels all the time with our clients. Check out our Fab Vitamin D3/K2 supplement https://fabfertile.com/products/vitamin-d3k2-supplement Use code “GPN15” for 15% off your order at FFLNaturals.com   --- Remember, AMH is NOT a predictor of natural pregnancy. It can't tell you about the health of your eggs or predict if you can get pregnant. The AMH level does not need to define your chances. So, how do we fast-track pregnancy success? What you place on your fork every day matters. And no, you don't need to try the latest dietary fads such as: ❌ Carnivore ❌ Keto ❌ Vegan It's not about following generalized dietary guidelines. Because that only wastes precious time. The most important factor is consuming the diet that is right for YOU. I'm excited to announce that our Summer Fertility Recipe Guide is ready! Go to FertilityDietFreebie.com to grab your copy. In this 5-day challenge, you'll learn how food impacts your body and enjoy delicious, nutrient-dense recipes designed to enhance fertility (especially if you have low AMH and/or high FSH). The guide includes a meal plan and grocery shopping list. Start this challenge with your partner.   --- Join my FREE Facebook group and get my training on HOW to improve pregnancy success with your own eggs. https://www.facebook.com/groups/451444518397946   --- Check out https://www.fabfertile.com/blogs/podcasts/why-amh-is-the-wrong-biomarker-to-focus-on-and-what-to-do-instead-to-get-pregnant-this-year/   ---   Please note when promoting a product, we only select products that either Sarah Clark or her team has tried and believe are beneficial for someone who is TTC. We may receive a small commission.

Dr. Daisy Robinton, co-founder and CEO of Oviva Therapeutics, discusses the company's innovative approach to improving women's healthspan by targeting the biology of ovarian aging. Motivated by her personal experiences and the realization that female physiology is underserved by research and medicine, Daisy outlines how menopause is a key inflection point in the acceleration of aging in women. She explains the central role of anti-Mullerian hormone (AMH) in regulating ovarian function and fertility. Oviva's lead program, a recombinant enhanced AMH protein, aims to improve IVF outcomes by synchronizing follicle growth. Excitingly, this approach could also preserve ovarian reserve to delay menopause onset, thereby extending female healthspan.Key Topics Covered:Pivoting from developmental biology to found a women's health startupOvaries as central regulators of female healthspan beyond reproductionAMH as a brake on follicle activation and loss of ovarian reserveUsing enhanced AMH to improve egg yield in poor-responding IVF patientsPotential of AMH-based therapy to delay menopause and slow agingMenopause as the single greatest known accelerator of agingEconomic and societal impact of extending female healthspanDistinguishing reproductive longevity from overall women's healthViewing fertility as a marker of overall health and wellbeing

Join Dr. Monica Minjeur as she explores the intricate web of hormones impacting menstrual cycles and fertility. In this episode, Dr. Minjeur discusses the roles of cortisol, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and anti-Mullerian hormone (AMH). Through client stories and expert insights, discover how these hormones interact and influence reproductive health. Learn practical strategies for optimizing hormone balance and enhancing fertility naturally. Tune in for a comprehensive guide to understanding the complex world of hormones.Link to hormone graphic discussed in episode: https://radiantclinic.com/podcast

For our Season 3 finale, MS3 students Darby Billing and Elise Kao host an episode on disorders of sexual development. They'll cover topics such as 5-alpha reductase deficiency, Mullerian agenesis, androgen insufficiency, and more in our usual question-and-answer style format. Never feel bad for not knowing the answers when you're listening to SoS! The point is to miss questions now so you'll never miss them again.

In this Healthed lecture, endocrinologist, Professor Helena Teede AM provides an update on the changes to clinical practice that are recommended in these new guidelines, including where and when testing for anti-Mullerian hormone is most appropriate.See omnystudio.com/listener for privacy information.

In this episode we get the chance to sit down and speak with board-certified, practicing OB/GYN, wife, mom, podcast host, and course creator, here to help you have your most beautiful pregnancy and birth experience: Dr. Nicole Rankins! Dr. Nicole explains what is considered a geriatric pregnancy and where the term originated from, how aging affects fertility, how many eggs we are born with and when a woman turns 30 how many eggs she's left with?!She shares some things that women should be aware of when they get pregnant after 30 and healthy tips for women who may be getting pregnant after 35! Listen to This Episode to Learn About: -guilty pleasures of having a podcast -the change from geriatric pregnancy to advanced maternal age  -Emily and her simulation theory  -how many eggs are we born with? How many eggs are we left with after 30? And after 35? -what makes up a “good” egg? -anti-Mullerian hormone  -freezing your eggs  -what to know if you are waiting to get pregnant (complications) -the spread of false information through social media  -warning signs that you should be aware of  -the importance of childbirth education  -tips for how to stay healthy during and before pregnancy  Sync Up With Dr. Nicole: Instagram:@drnicolerankins Website: www.drnicolerankins.com

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Elvio Silva to discuss precursors of ovarian cancer. Dr. Silva received a medical degree from the Universidad de La Plata and has been a faculty member at M.D. Anderson Cancer Center since 1980. He had pathology residences in Buenos Aires, Argentina, and University of Toronto, Canada and is the former President of the International Society of Gynecological Pathologists. Highlights: - Most ovarian serous tumors originate in the ovarian stroma. - Ovarian serous tumors originate in the epithelium of inclusion cysts or in epithelial areas that appear in the stroma due to mesenchymal-epithelial transition. - Mesenchymal-epithelial transition in serous tumors mimics the development of the Mullerian duct from the celomic mesenchyma.

Have you ever heard a mockingbird imitate a blue jay? How about a seal imitating a Maine fisherman? This month, the guys explore what happens when animals make sounds they're not supposed to: the wild world of vocal mimicry. Birds imitate chainsaws and car alarms, elephants speak Korean; what's going on? With a special focus on one of the bird world's best known mimics - the northern mockingbird (Mimus polyglottos) - the guys delve into the research trying to explain why animals - especially birds - feel the need to engage in the wildlife equivalent of, “I know you are, but what am I?” Episode NotesSteve wondered about the similarity between the scientific names of the northern mockingbird (Mimus polyglottos) and monkeyflowers (in the genus Mimulus). Turns out that both refer to mimicking; the mockingbird (whose scientific name means ““many-tongued mimic”) imitates the sounds of other species, and the monkeyflowers have flowers that, at least to some, seem to have grinning faces resembling those of monkeys.Bill mentioned that the viceroy butterfly (Limenitis archippus) is often mistakenly cited as an example of Batesian mimicry. What's up with that? Here's what the University of Wisconsin has to say about it: “Ecologists have long preached that Viceroys have enjoyed a Batesian “Get-out-of-Jail-Free” card due to their resemblance to the toxic Monarch butterfly (Batesian mimicry—the harmless imitating the harmful). Monarchs are poisonous because their caterpillar host plant, milkweed, contains harmful cardiac glycosides. Recent research suggests that because willow leaves are very bitter, the Viceroy may be almost as distasteful as Monarchs. In that case, Monarchs and Viceroys are mimicking each other, each cashing in on the other's bad reputation (Mullerian mimicry).”Check out episode 34: The Downy-Hairy Game for more info on Batesian and Mullerian mimicryThe guys wondered, “Are there any large passerines (songbirds/perching birds)?” The largest seem to be in the raven family; “The heaviest and altogether largest passerines are the thick-billed raven and the larger races of common raven, each exceeding 1.5 kg (3.3 lb) and 70 cm (28 in). The superb lyrebird and some birds-of-paradise, due to very long tails or tail coverts, are longer overall.” (Source: Wikipedia)The guys briefly discussed mobbing behavior in birds, and Bill mentioned a couple of suspected reasons behind the behavior. He regretted not mentioning what is accepted as the most likely reason: to drive away predators! Steve wondered, “Did mimicry evolve independently?” According to a 2018 study, “Vocal mimicry evolved independently at least 237 times and was lost at least 52 times.”Since brown headed cowbirds are nest parasites and don't raise their own young, how do their young learn the brown headed cowbird song? Turns out that the good people at BirdNote did an episode on this very topic in 2021! Here's the takeaway from the episode transcript” “Scientists think that when a young cowbird hears the “chatter call” of an adult cowbird, something is triggered in its brain, and it begins to learn the song of its own species. Like a kind of “password,” the chatter call guides the young bird in recognizing what species to identify with. Then, when the young cowbird is ready — probably when it's two years old — and hears an adult male Brown-headed Cowbird sing, it will imprint on that song. It's a remarkable adaptation, even more so when you consider that cowbirds are fostered by as many as 220 different species. And they still wind up learning their own song.”LinksFind out more about Hoover, the talking seal.A clip of the superb lyrebird from the incomparable David Attenborough and his series Lives of BirdsHead down a fascinating rabbithole and explore the world of mimicryMeet Koshik, the elephant that speaks Korean SupportThe Field Guides PatreonMake a onetime Paypal donation.The Field Guides Merch ShopOur SponsorsGumleaf Boots, USAAlways Wandering ArtPhoto Credit(c) bluewing – some rights reserved (CC BY-NC)Works CitedAncillotto, L., Pafundi, D., Cappa, F., Chaverri, G., Gamba, M., Cervo, R. and Russo, D., 2022. Bats mimic hymenopteran insect sounds to deter predators. Current Biology, 32(9), pp.R408-R409. Gammon, D.E. and Altizer, C.E., 2011. Northern mockingbirds produce syntactical patterns of vocal mimicry that reflect taxonomy of imitated species. Journal of Field Ornithology, 82(2), pp.158-164. Howard, R.D., 1974. The influence of sexual selection and interspecific competition on mockingbird song (Mimus polyglottos). Evolution, pp.428-438.Owen-Ashley, N.T., Schoech, S.J. and Mumme, R.L., 2002. Context-specific response of Florida scrub-jay pairs to northern mockingbird vocal mimicry. The Condor, 104(4), pp.858-865.

Periods can be a pain, disrupting your plans, pimpling your face, and REALLY messing with your moods. But if they're causing a lot of actual pelvic pain, or if the pain is persistent and not only cyclical, that may indicate a problem that's more than "normal" cramps. Müllerian anomalies and endometriosis are common causes for pelvic pain, but because people with uteruses are told that pain is "normal," it can take years to get a proper diagnosis and treatment. Yeah.... no. Fortunately, getting the right diagnosis for pelvic pain can mean finding solutions to help with the pain and heavy bleeding. Solutions now may also help preserve fertility in the future. In this episode Ruby and Anne are talking with Dr. Angela Hernandez, Pediatric and Adolescent Gynecologist at Seattle Children's Hospital, about pelvic pain, why it happens, what we can do about it, and how far someone who says "suck it up, it's normal," can shove it.  Are you or someone you know concerned about pelvic pain? Learn more from the resources below: The Center for Young Women's Health: https://youngwomenshealth.org/gynecology-index/#a-gyn-guides-E The Journal of Pediatric and Adolescent Gynecology: https://www.jpagonline.org/article/S1083-3188(19)30365-1/fulltext Or check out the Adolescent Medicine department at Seattle Children's at 206-987-2028.  More about Dr. Angela Hernandez: Dr. Angela Hernandez is a Pediatric and Adolescent Gynecologist at Seattle Children's Hospital. She completed OB/GYN residency at Baylor College of Medicine and PAG fellowship at Texas Children's Hospital in Houston, Texas. Her clinical interests include Mullerian anomalies, multi-disciplinary care, complex contraception and chronic pelvic pain in adolescents. When she is not at work, she enjoys going to Orange Theory fitness classes and exploring the PNW with her partner, James, their two dogs, and their foster child.

In this episode we will discuss the rate, diagnosis and treatment of Mullerian anomalies in patients with anorectal malformation. Dr. Levitt and Dr. Frischer invited special guests from the gynecology site: Dr. Lesley Breech from Cincinnati Children's Hospital, and Dr. Veronica Gomez-Lobo from Children's National.

A subset of clinically benign uterine polyps shows atypical morphologic features worrisome for, but not diagnostic of, Mullerian adenosarcoma. The guest, Dr Marisa Nucci discusses her team's finding in their recently published study in Modern Pathology. The authors propose the term “atypical uterine polyps” for these lesions, which show biologic overlap with early Mullerian adenosarcoma but lack molecular alterations characteristic of clinically aggressive adenosarcoma. Study by Nucci et al. Atypical uterine polyps show morphologic and molecular overlap with mullerian adenosarcoma but follow a benign clinical course. Modern Pathology, 35, 106-116. See acast.com/privacy for privacy and opt-out information.

Have you heard of having a double uterus or double cervix?  The term is Uterine didelphys is a rare condition that happens when you grow two uteruses instead of one. This happens when you are a developing baby. You are born with it. ‌ While developing as babies, girls typically grow a uterus from two channels called the Mullerian ducts. Today's guest was born with a didelphys uterus after 3 laparoscopic surgeries it was confirmed she also had endometriosis, fibroids, and polycystic ovarian syndrome.  That did not stop today's guest from trying to conceive.  La-Anna Douglass began fertility treatments with drugs and still was unable to conceive.  She decided to try IVF and IVF did not work for her leaving her depressed and heartbroken.  In today's episode La-Anna shares her journey to conceiving a baby naturally after 8 years of trying to conceive and her current journey through secondary infertility. This podcast is for you to listen to to learn more about a double uterus and double cervix, but also if you have any underlying conditions like endometriosis, fibriods, and pcos. Listen to this episode here: sistersinloss.com/ep242 Become a Sisters in Loss Birth Bereavement, and Postpartum Doula Here Living Water Doula Services Book Recommendations and Links Below You can shop my Amazon Store for the Book Recommendations You can follow Sisters in Loss on Social Join our Healing Collective Online Support Group Join the Sisters in Loss Online Community Sisters in Loss TV Youtube Channel Sisters in Loss Instagram Sisters in Loss Facebook Sisters in Loss Twitter You can follow Erica on Social Erica's Website Erica's Instagram Erica's Facebook Erica's Twitter

Take a sneak peak at this month's Fertility & Sterility! Topics this month include mosaic embryos diagnostics and counseling (02:40), machine learning for personalized cycles (10:41), a look at ASRM's new practice committee documents on the new Mullerian classifications and the general fertility evaluation, as well as their committee opinion on obesity and reproduction (26:11), sperm DNA fragmentation (38:47), aneuploidy in recurrent implantation failure (43:10), BMI and recurrent pregnancy loss (50:26), maternal morbidity in infertile patients (54:14). View Fertility and Sterility November 2021 Volume 116 Issue 5 View Fertility and Sterility at https://www.fertstert.org/  

Dr. Allison Rodgers joins me to discuss different uterine cavity abnormalities that can affect women. These types of abnormalities can increase risk of miscarriage and why I wanted to share this episode during miscarriage and infant loss awareness month. You can find Dr. Allison Rodgers on IG and tiktok at @dr.allison.rodgers. Are you craving better sex? Not sure what that even looks like for you? Get The Sex You Desire is NOW enrolling! Join HERE! Follow Jordan D'Nelle on Facebook and Instagram Email: JordanDnelle@VaginasVulvasandVibrators.com Support the Vaginas, Vulvas, and Vibrators podcast! Leave an honest review on iTunes. Your ratings and reviews help this podcast impact more lives! Subscre to Vaginas, Vulvas, and Vibrators on iTunes if you haven't already! *Disclaimer: This podcast is for informational and/or entertainment purposes only and is not a substitute for medical advice, diagnosis, or treatment. www.jordandnelle.com 

In this episode, Xavier Bonilla has a dialogue with Carole Hooven about the hormone Testosterone and its impact on men and within society. They discuss her new book and reasons for writing the book. They talk about sex hormones and the sexual reproductive system as well as the impact of sexual selection on both. They provide definitions of male and female within a biological framework including discussions on the genetics, hormones, and gametes. They talk about the impact of culture and environment on gender expression and biological sex. The talk about how hormones are distributed throughout the body and the importance of secondary sex characteristics. They talk about the Mullerian and Wolffian ducts and also give different examples of how hormones interact with the environment. They discuss the complexities of discussing biology and environment in current society and many other topics.  Carole Hooven is a Lecturer and Co-Director of the undergraduate program in the Department of Human Evolutionary Biology at Harvard University. She has a Bachelors in Psychology from Antioch College and a PhD from Harvard University. Her main research areas are sex differences, testosterone, and hormones interaction with behaviors. She is the author of T: The Story of Testosterone, the Hormone that Dominates and Divides Us which you can purchase here. You can find her at her website. Twitter: @hoovlet

Polycystic Ovarian Syndrome (PCOS) and fertility coach Sujatha Gopalakrishnan discuss some hard truths about what many women suffer from when it comes to infertility. The challenges include PCOS and endometriosis, frequently associated with being overweight or morbidly obese. In this episode, Sujatha shares her own personal experience of being diagnosed with PCOS and the fascinating journey she went on after making massive lifestyle changes which resulted in her falling pregnant successfully. It was her documentation of this journey that led her to become a PCOS and fertility coach, in which she developed a brilliant program focusing on the 5 aspects of a woman's journey to fertility and motherhood. From nutrition and eating habits, activity level, movement tracking, supplements, detox and distressing, this episode gives you incredible insights and practical knowledge to help manage fertility problems. For full episode details, go to www.felicitycohen.com Show Notes: 1:00 – Sujatha Gopalakrishnan went on a journey herself trying to conceive, soon discovering that she had PCOS. We dived into the realities for women who suffer from Polycystic Ovarian Syndrome (PCOS), a common issue is being overweight, whereby losing the excess weight is the first step to improving the condition. 4:06 – Suffering from malnutrition and low progesterone, Sujatha made some lifestyle changes and 6 months later, she finally fell pregnant, with a healthy daughter who is now 3 years old. 5:03 – Sujatha shares how she first discovered she had PCOS. From mood swings, weight gain, mental health issues and irregular period cycles. She was fortunate to have a doctor (GP) that was concerned with women's health, noting that one of the biggest issues is lack of diagnosis. 8:38 – After making some significant lifestyle changes, Sujatha shares how her period cycle changed to become more regular and naturally knew when she was ovulating. As she is still practising living a healthier lifestyle, 3 years since having her baby, she still has the same cycle.  11:28 – Sujatha shares how she suffered from inflammation which is a common issue associated with infertility and losing weight. We discuss the importance of losing weight to prevent infertility and metabolic diseases and how a poorly managed PCOS diagnosis can lead to other diseases like steatosis (fatty liver) mental health issues and vitamin deficiency. 15:52 – We get to know a bit more about Sujatha's background growing up in India with an orthodox brahmin family. She moved to the Middle East for 7 years to start her career in advertising. Eventually moving back to India, Sujatha met her husband through an arranged marriage. Progressing in her career, they moved to Australia where she worked as an accountant. 21:59 – Sujatha shares how it was her husband who suggested she track her journey to fall pregnant. It was from that documentation that led her to become a PCOS and fertility coach. Noting she had a smooth pregnancy except for gestational diabetes, which after the lifestyle changes she had made she only had to have the least amount of insulin. 25:00 – We discuss in detail about the anti-Mullerian hormone (AMH) and how that affects a babies predisposition to PCOS, and the importance of regulating those levels of AMH in women. 28:01 – Sujatha tells us about her process as a PCOS and fertility coach, focussing on the 5 aspects of a women's journey towards fertility and being a mom. From food, activity, tracking, supplements, detox and destress. 33:07 – Sujatha shares her parenting tips since conceiving, like giving them the attention they need and developing healthy food habits from a young age. We also discuss the issues with addiction to technology, with Sujatha sharing limiting her daughter's usage by limiting screen time and not allowing access to those devices, but also focussing on sharing more educational content. 37:02 – Wellness for Sujatha is to be able to have the best health to live life to the fullest and to have the confidence to face what life throws at you.

Endometriosis & imaging modalities And more endometriosis discussion with letter to editor & reply from authors. Mullerian anomalies in patients with known renal anomalies

What are the first line tests essential in the female fertility work-up? Join Dr. Neil Chappell and Fertility Answers physicians assistant Grace Pitt, PA, as they discuss anti-Mullerian hormone testing (AMH) and the hysterosalpingogram dye test (HSG) as the first two essential tests for diagnosing female infertility. AMH testing gives us clues to your remaining supply of eggs and fertility potential while an HSG tells us whether your fallopian tubes are open, an essential criteria for fertilization. Learn more about how these tests are conducted, what the numbers mean, and how the results can refine treatment options and timelines.

In this episode, Adina shares her full experience as a childless woman from shocking experiences being stigmatized to multiple health issues to medical procedures to unknowingly early signs of infertility.Terms used: Uterine Fibroids: abnormal benign growth in the uterine wall. Partial Hysterectomy: partial hysterectomy removes the uterus including, in some cases, the cervix. Myomectomy: a surgical procedure to remove uterine fibroids.Misshapen uterus: a malformation of the uterus that females are born with, meaning it develops during embryonic life. In technical terms: the Mullerian ducts, which are the initial development of the fallopian tubes, uterus, the uterine cervix, and the superior aspect of the vagina, fail to form a normal uterine cavity.Thyroid disorder: also called hypothyroidism or under-active thyroid is a condition in which a thyroid gland doesn't produce enough of certain crucial hormones.Pituitary gland tumor: abnormal growths that develop in your pituitary gland. Some pituitary tumors result in too much of the hormones that regulate important functions of your body. Some pituitary tumors can cause your pituitary gland to produce lower levels of hormones.Anemic: a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Birth control pills: a daily medication that contains 2 hormones (estrogen and progestin) to prevent pregnancy — or manage and suppress heavy periods.Watch this interview on YouTube.com/ChildlessWomenTo support our series, visit www.AsToldByChildlessWomen.com

It's no secret that in the animal kingdom big, bold colors attract attention. This can be to attract a mate or even blend into one’s surroundings. It could also signify that that animal is extremely dangerous - even toxic. But how did this trait first emerge and are there only certain species that do so? Dr Frank Rheindt, Associate Professor and Dean’s Chair in the Department of Biological Sciences National University of Singapore joined Jonathan to discuss. Listen and subscribe to Futureproof with Jonathan McCrea on Apple Podcasts and Spotify.    Download, listen and subscribe on the Newstalk App.    You can also listen to Newstalk live on newstalk.com or on Alexa, by adding the Newstalk skill and asking: 'Alexa, play Newstalk'.

The world of reproductive medicine has a lot of confusing terms, and “Mullerian anomalies” is one of them. Join Dr. Carrie Bedient from The Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center as they discuss Mullerian anomalies, specifically uterine abnormalities. Listen as the Fertility Docs review the different types of anomalies, why they occur, the ways these anomalies can affect fertility and how our doctors can treat these issues. Have questions about infertility? Visit FertilityDocsUncensored.com to ask our docs. Selected questions will be answered anonymously in future episodes.

In BONUS Episode 260 of Beat Infertility, Dr. Allison Rodgers answers six listener questions (egg quality, Asherman's syndrome, PCOS, and more) and then we discuss Mullerian anomalies. If you need additional support, consider joining Hope University or our Infertility Warrior Tribe. For details on both, please visit https://beatinfertility.co/hopeu.  

In BONUS Episode 260 of Beat Infertility, Dr. Allison Rodgers answers six listener questions (egg quality, Asherman's syndrome, PCOS, and more) and then we discuss Mullerian anomalies. Infertility coach Heather Huhman helps warriors like you make scientifically-based, well-informed decisions about your next steps. To schedule your free 30-minute call, go to https://beatinfertility.co/hope.  

Today, we have two special guests with us to talk about this wonderful topic. Dr. Margie Thorsen is a PGY-1 at Brown/Women and Infants Ob/Gyn residency and Dr. Emily Seidler from Beth Israel Deaconess to talk about treatment of infertility. Twitter: @creogsovercoff1  Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

Let's talk about Endometriosis... On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Anila Ricks-Cord, a wife, mother of 3 hilarious children and a board-certified obstetrician-gynecologist. She is a motivational speaker, a 2-time bestselling author of The New Laws of Mommyhood & Marriage: From A New School Mom With An Old School Hustle and the co-author of The Making of a Medical Mogul. She is a media personality whose passion is to encourage women to address their health care concerns and fears, giving them a voice and empowering their best lives, mind, body, and spirit. This week she is on the show to talk about endometriosis, a disease that affects 11% of women, can responsible for painful menstrual cycles and even infertility. Listen to how Dr. Ricks-Cord has to deal with this problem in her current practice. Text LUNCHLEARNPOD to 44222 to join the mailing list. Remember to subscribe to the podcast and share the episode with a friend or family member. Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify Sponsors: Lunch and Learn Community Online Store (code Empower10) Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you) Dr. Pierre's Resources – These are some of the tools I use to become successful using social media My Amazon Store – Check out all of the book recommendations you heard in the episode Links/Resources: Facebook Instagram Twitter Social Links: Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/ If you are looking to help the show out Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod Download Episode 132 Download the MP3 Audio file, listen to the episode however you like. Episode 132 Transcript... Episode 132 Transcript...  Introduction   Dr. Berry:  Welcome to another episode of the Lunch and Learn with Dr. Berry. I’m your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of DrBerrypierre.com as well as Pierre Medical Consulting. Helping you empower yourself with better health with the number one podcast, for patient advocacy. Today I get to bring you a special guest today Dr. Anila Ricks-Cord which is a good friend of mine and an expert in women's health and what she calls vagina land. She is hilarious, first of all. But she is really an expert because you guys know I'm not the biggest women's health discussion, right? Because there was a reason why I went into medicine but so I figured. Let's bring someone on who can kind of help me, kind of grasp what is knowledge and I really kind of avoid it when I was a medical student in medical resident. So today we're gonna be talking about endometriosis which depending on when you listen to gets its entire month of awareness March is Endometriosis Awareness Month. So I figured if a disease gets a whole entire month, it has to be important. And if it has to be important let's bring an important guest on. So I just want to talk. I'm just gonna give a little bit of a bio just so you can kind of understand exactly the person we gonna talking to. First of all she’s hilariously funny. You definitely gonna enjoy today's episode. Dr. Anila Ricks-Cord is a wife, mother three hilarious children. She's a board certified obstetrician gynecologist. She's a motivational speaker. She's a two time bestselling author.  She's a media personality whose passion is to encourage women to address their health care concerns and fears giving them a voice in empowering their lives, mind, body and spirit. Can you know the theme: Empower yourself a Better Health. She currently resides in Texas where for loving spouse, three children and two lizards. She attended college at Indiana University. While there she performed research and published articles on rats in order to help curb alcohol behaviors in humans which is absolutely hilarious. She did move to Baltimore to perform research and publish articles at John Hopkins University. This time investigating acute respiratory distress random at the molecular level. She attended graduate school at Johns Hopkins and pursue a master's degree in biotechnology. She was accepted at the University of College Medicine. Experience significantly shaped how she practice medicine culminating her receipt of the Leroy Week's Award for Outstanding clinical skilled bedside manner and commitment to service.  Again, she is absolutely amazing and I get again especially from my fellows who are probably not sure this is a podcast. I listen to this is a disease process that could affect your mom, could affect your sister, it could affect your cousins. So this is something you may well listen to just be able to kind of pass it on, right? Especially if you have a female friend or spouse or a wife or a sister who has these very vague complaints and no one seems to know what's wrong with her. And then you start kind of attributing it to maybe in her head. This is a disease process that may make you think different right. So sit back for another great episode again if you have not had a chance, make sure you subscribe to the podcast. Leave a five star review for the podcast. So we are on the radar of everybody so everyone can be empowered for better health. So again thank you. Let's listen to another amazing episode this week with Dr. Dr. Anila Ricks-Cord. Episode   Dr. Berry: All right. Lunch and Learn community. So you heard that amazing intro with Dr. Anila and we're gonna, you know, really let her speak and introduce yourself to the community. And of course, you know guys, I've said this before, I am not no women's health expert. One of the reasons why I went and turned on medicine is because I kept getting kicked out of their rooms when I was a medical student, right? So I figured if we're going to be talking about women's health, especially disease course like endometriosis, right? I figure let's get the expert to talk and I'm just going to sit here and listen. So really, I'm actually going to be listening along with you guys and you know this, this expert kind of expand her knowledge on this and tell us what endometriosis in the show. But first and foremost, Dr. Anila, please again, thank you for coming to the Lunch and Learn with Dr. Berry. Dr. Anila Ricks-Cord Thank you Dr. Berry so much for allowing me to be able to be graced by your presence and share a little bit of knowledge. Dr. Berry: Just the feeling is, oh, a hundred percent mine. I've told Dr. Anila, a friend of mine and I told her, I said, I'm gonna get you on a podcast. Like you can't be given all that amazing information out to the community on Facebook and everywhere else and not give it to Lunch and Learn community. So I already, I had already pre-warn she would be on the show. Dr. Anila Ricks-Cord That’s you did, that’s you did. And I'm honored to be here. So. Dr. Berry: For those who may not know, you may not be following you, you give a little bit, you know, outside of the bio, little bit about yourself. Tell us why you do what you do and you know, kinda how you got to where you at now. Dr. Anila Ricks-Cord Sure. So I am a board certified obstetrician/gynecologist. I'm a wife of 22, going on 23 years. Praise God, Lord willing. I’m a mother of three awesome kids and I'm a two time best-selling author and a speaker. So through my books, my patient care, and my coaching programs, I encourage women to address their health care concerns and fears, giving them a voice and empowering them to live their best lives, mind, body, and spirit. So I'm originally east coast native. I'm the eldest of three children and a big science geek. I openly where their pin. I attended school in Indiana University, Purdue University at Indianapolis. And that was where I met my love and my biggest cheerleader perform research at Hopkins before having the privilege of attending Howard University College of Medicine and then completed my residency at WellSpan York, Pennsylvania. So I was inspired to practice medicine and led to become an obstetrician gynecologist secondary to the death of my mom. She was last 22 years old. She was misdiagnosed with the flu and subsequently died of Septicemia. For those who don't know what that is, it's essentially a bacterial infection in the blood, which basically causes massive organ failure and death. So this is why I do what it is I do. So. Dr. Berry: I love it. And you know, thank you for sharing that story with us because I think a lot of times people outside of in fact very, you know, full disclosure, we're actually recording this on like, you know, national doctor's Day, right? And I love this day. Because a lot of times physicians really aren't getting a lot of the fanfare and the good light that they should be getting. Right? You know, a lot of times there's a lot of misconceptions of why we became physicians. For some reason people think it's all about the money. I keep trying to tell you, trust me. (Most assuredly is not. Fannie Mae, Sallie Mae, she visits me on a regular). Can you chat and tell folks that, and it's really the love of wanting to see that next person get better. Right? And understanding that is, you know what, I wasn't there. I wasn't able to maybe make the steps I wanted to. It's like for my mom. Right? But maybe I can do for someone else. Right. And I, I'm, you know, I'm totally feeling that because I remember being a second year medical student and getting a phone call that my father was in the hospital and again, I'm a second year medical student. I didn't even know my dad had like medical problems. But you know, that's a whole another discussion. They don't, you know, patient guys don't like to talk about nothing. Right? And you know, subsequently from that he passed away and I said, you know what, there's no way that I'm not going to let people know, like, hey I only, I’m physician but I can't help you right from that day forth, I just kind of took that man once again, thank you for kind of taking your mantle and kind of really running with it. Dr. Anila Ricks-Cord It is what I was called to do. I feel like knowledge is power and my angelus says, when you know better, you do better. And my goal is to make it so that people know better so they can do better. Dr. Berry: I love it. So the topic at hand today is endometriosis. And I could tell you from a, I'll be honest, I'm an internist. I take care of patients than I used to take care of patients outpatient where I knew a little bit about it. But once I went inside the hospital, you know, my knowledge of it was very, very weak. Right? So I know that again in March where it's actually National Endometriosis Month, right? So any disease process that gets a whole month is one that I feel like the Lunch and Learn community needs  to know. Dr. Anila Ricks-Cord So I happily, I will tell you about endometriosis. So before I can tell you what it is, allowing me to describe what's normal. First told you I'm a big fan of that Geek and women who become their menstrual cycles every month. The body attempts to get itself ready for the possibility of pregnancy. So I like to describe it as your brain calls her ovaries and says, hey girl, we're trying to get pregnant this month. Under the influence of your brain. Your ovaries make estrogen and progesterone, which causes the lining of your uterus to get nice and thick and fluffy, and it causes you to ovulate. The thickness of this lining. This thing happens every single month where every month we get nice and thick and fluffy, so we actually do get pregnant. There's a nice and nourishing space for a fertilized egg to implant and grow. If you don't get pregnant, that lining dies and peels off. And that peel, that lining is actually your menstrual blood, and so if you don't get pregnant, it starts all over again. Better luck next month. Maybe it'll work out next month. Exactly. Just like we bleed out of our uteruses and out of our vaginas and owns or whatever, you know, products you used. There's also something called the theory of retrograde flow where we actually need backwards too. So if you imagine that this uterus has like this cavity on the inside, and whenever I talked about my lives, whenever I do them, I use my face as the uterus and I take my laps and I separate and pull them up to the side and said this is the fallopian tubes. You bleed backwards into the uterus are actually from the uterus into the fallopian tubes and into the pelvis. You know, this is where it's an issue and some of us, that tissue, that lining, endometrial lining, the supposed to regenerate itself every month. Some of that tissue takes residents actually in your pelvis and your abdomen and so come next cycle, the tissue does what it does and it sickens to try and make a lining where it is, but it's in the wrong place.  Yes, exactly right. Right. So you've got this out of bounds, bleeding going on, which triggers inflammation. Kind of like if you hit your elbow, you hit your knee and it swelled up. Right. Nice. And is sore. Your body responds to this perceived injury and your immune system kicks in and gets involved. And this is where scarring happens. So what is endometriosis is when you have your period in places other than in your uterus. And these endometrial cells, once they get access to your pelvis, they can then travel to other places and get access to your blood vessels and your root system and go outside your covas, to other places. So it is primarily a disease of your pelvis, but because they don't have any limitations and they don't know down, they can go other places too.  Dr. Berry: So once that I retrograde bleeding happens. There's really like, oh all fair in love and war pretty much. Dr. Anila Ricks-Cord Yes. For some of us, we all do it. Not all of us, we all have this, this retrograde flow, but not all of us have tissue that are like boundaries. I don't know things like no boundaries. And so there's a, there's a thought that there's a genetic predisposition where there's a subset of people who have tissue that decides, Oh yeah, I'm going to be a topic, I'm going to grow wherever it is I wanted to go. Maybe, maybe it's like living in a large city, you need to get to some places not so highly populated. So you decide, a lot of people live like on the pelvic. The actual prevalence of endometriosis is not exactly known. So they say that you see it in between 25 to 38% of adolescents that have chronic pelvic pain and in 10 to 15% of women that are reproductive age. And so there's a substance and we talk about this theory of retrograde flow and then there's also a thought process to or told you big baggy claim. I apologize. I put disclaimer on it. Dr. Berry: We trust. We're just, we're all here for this. I'm sitting there, I'm listening. I'm like, okay. Okay. All right. All right. Dr. Anila Ricks-Cord Cool beans. So from an embryo logic perspective, I know you remember, you don't tucked it back in the rule that dig somewhere because it doesn't serve you anymore. But those of us who are women, when we actually go about being formed in our mother's womb, we have got a fallopian tube and a uterus and another fallopian tube and a uterus. And what happens is these two halves come together to make a hole. The center hollows out. And you've got, if you're lucky, you have one normal functional cavity. There's a subset of people who have what are called Mullerian anomalies where the two little pieces and uterus don't get together where they're supposed to. It doesn't hollow out the center and become one. And so these people are also a set up for endometriosis because they have topic endometrial tissue that ends up in other places. And so about 40% of these children that have these genital check defects will have issues with individuals. As they say, 50% of women that have infertility's had endometriosis and 70% of women and adolescents that have pelvic pain actually have endometriosis. Dr. Berry: And because we don't know the true figures, do you feel like the figures maybe higher than what we're even picking up? Dr. Anila Ricks-Cord I would say so because unfortunately it takes about nine years to diagnose endometriosis because it's a disease of exclusion. And so when people present, so you have a patient that will come and see you in and they've got these vague multitude of symptoms. So like in women in grownups, people who are not adolescents and adolescents have defined 10 to 19 years old. So reproductive age women, you can have a lady that comes to see you with a complaint of pelvic pain either with her periods or with sex. And so if it's pelvic pain with her periods and call a dysmenorrhea, which is this dull crampy pelvic pain, that might start about two days before your cycle starts last. The entire length of cycle might occur a couple of days afterwards. Or if it's chronic, we're, it's been present for more than six months. It can be dull or throbbing or sharp or even in one of my patients, she has a burning sensation every month on her cycle shows up. She's got a spot in her left lower quadrant or her anterior abdominal wall where it's like a hot poker. That's how hers that she has pain all the time, but when her period's shows up, it just burns in this one little spot. So that's what cycle you're paying with your period. If you have pain with sex, you will have patients that have complaints of pain with penetration, particularly deep penetration, and so when you go see your Ob-Gyn, one of the ways that you can kind of mimic this is the thought is when you get these endometrial implants in such a personal space, you can get these. It starts off as a microscopic disease and you can get nodules or uterus has got this support system inside our pelvis is kind of like the ladies who wear bras, kind of like a bra strap. So you've got the same call, uterine staples that supported on the inside of your pelvis. You can take your fingers in a lady who has endometriosis, put them in the back part of her vagina, separate them like a peace sign and stroke and practically make her leap off the table because she has nodular implants in the back. So you can simulate this, this pain with sex when you stroke on these easier to cycles on the back issues that nodules implanted inside. Ladies who present with infertility and so infertility technically is defined is a chick, is less than 35 years old, has been trying for a year to have, has been having regular sex for a year and trying to get pregnant and hasn't. If you're over 35 is six months essentially, but they say the 30 to 50% of women who have infertility had endometriosis. If you have a lady that presents and she has an incidental finding on ultrasound which has got some pain and you do an ultrasound, she's got a mass on her ovaries, there's a particular. Endometriosis implants can actually implant anywhere inside your pelvis, on your bow, on your bladder, inside the wall of the uterus to, and I'll come back to that one. And inside the ovary you can get what it called Endometrioma where when you look at them on an ultrasound where essentially the equivalent of blood clots inside the ovary, a lady that's got an ovarian mass and is an Endometrioma, if you have a high index of suspicion that she has endometriosis, you know, also present in ladies and have bladder issues. Like if you have a feeling like when you do not have a UTI but you feel like you go into the bathroom all the time or you feel like you've got to go right now or you have pain when you go to the bathroom. That could be a sign of endometrial implants in your bladder. If you have bowel issues where you have issues with diarrhea or waxing and waning diarrhea and constipation or pain when you desiccate or colicky bow, that can be a sign of endometrial implants in your bow. There is a version of endometriosis called adenomyosis. Which is what Actually Gabrielle Union had. Heavy menstrual bleeding is is a possible sign of endometriosis and by heavy menstrual bleeding. Allow me to clarify. A regular period is supposed to be no more than 80 cc's so in simple terms in an English Dr. Berry: Talk to the men. I hear. Dr. Anila Ricks-Cord Right. I'm about to say so. A normal period is for hotel bottles of lotion. That’s 2.7 fluid ounces or it's about a third cup. That Mixing Cup that you have in the kitchen when you make us up on one third cup size, that's ATC seats. Anybody who has more than that and some of the patients that don't have had that have had heavy menstrual bleeding, they making crosses and ease and the underpants they've got multiple two, three second. I'm like mattresses. Or they're use tampons. If you can use a super plus tampon and that thing falls out in an hour or two you have heavy menstrual bleeding. For Gabrielle Union. When she was talking about her fertility struggles, what she suggested was that she was in it to her doctor with heavy menstrual bleeding. Traditionally put her on OCP is birth control pills in order to be able to regulate her flow.  She subsequently was found after having her struggles with fertility so she could, she had gone through some ivs cycles. She got pregnant a couple of, actually, she’s pregnant more than a couple of times. I think she suggested maybe nine times. She got pregnant, something along those lines, seven to nine times. But with her, she has endometriosis in the walls of her uterus. And so you've got this glandular tissue that's supposed to do right and be nice and fluffy like a comfort in the winter time for this egg that's on fertilizer on the wall. But it has a place where it's supposed to be. It's only supposed to be on the lining of the inside of the shoe is not deep with them. A muscle for people who have the endometriosis inside the wall of the uterus or the Adenomyosis. They actually have bleeding that occurs within the muscle itself. And this leads to inflammation and issues with fertilization and implantation and being able to carry a pregnancy. So again, heavy menstrual bleeding was also a sign as well as irregular menstrual bleeding. Endometriosis can also make itself manifest in the form of low back pain or chronic fatigue. This is why it's so nondescript and it takes forever to diagnose. Dr. Berry: That’s I think about. Nine years? Dr. Anila Ricks-Cord Nine years. Yeah. In adolescence, which is that group between ages 10 to 19 and there had been some documented cases of little girls who didn't have Mullerian anomalies I talked about what you just didn't come together. Right. They had the babies that have been documented to have endometriosis as young as eight and a half years old. Those little girls will have symptoms that are, that can be cyclic, like only a time with your pain and not having anything to do a period. But they can get pain that gives worsening and more severe when they actually start having periods and they can have rectal pain, they can have constipation, they can have pain with defecation when they go to the bathroom associated with their cycle. Rectal bleeding, pain with urination, and even blood in the urine or that need to go right now and so is so nondescript. You can see how a physician would run through a litany of tests before finally getting to the point where you even considered endometriosis at all. Dr. Berry: Nine year seems so long. (It is). Should it not be like more ahead of the line or do you really have to kind of rule out some big stuff first before you can say like, okay, let me let's think about endometriosis inside of them. No, cross my t's of everything else. Dr. Anila Ricks-Cord So I think that because it was a diagnosis of exclusion for the longest time to truly diagnose it, you need a tissue staff and so the thought process, (Tissue it's in the muscle. How do you get, wow, okay). Right and endometriosis, you only get, if you have a uterus of the path lab, that's how you diagnose that otherwise is I take you to the operating room. I do a diagnostic laparoscopy where I poke a hole inside your belly button, do you up the carbon dioxide, took another two holes inside your belly in order to be able to get camera inside there and some graspers to move around and look to see if I can see signs of disease. And it's not four stages to what you could have minimal disease, which is microscopic, and you don't see nothing to stage four disease where you have everything stuck like chuck on the inside. But ideally if you get to the point where you have to do laparoscopy, then you go inside and you biopsy this different parts of the pelvic sidewall underneath the uterus cycles. If it's on the ovary where ever you see there'll be, sometimes it looks chocolate, sometimes it looks white, and so any abnormalities you see you're biopsying them in order to be able to confirm the presence of disease and that's part of it. A lot of us who are conservative would want to try. I think old school thought was if you had endometriosis, let me try all these other things to make sure it's not that before I'd used last resort and take you to the operating room. (Which is operating room. When I talked to some people and say operating room, what? ). Exactly and yes, just when you think about that, if at any time you poke a hole inside anybody, anytime you performed surgery, there's a risk of it. It’s a disease thereafter and so it's a risk versus benefits kind of thing. But I think that the thought process, I think more people are becoming more aware about how much of a big deal this is. Because you think about how often do when you were seeing patients that were women, you joked that you got put out of the room all the time, that it's a comfort level that's got to exist between you and your physician and I'm sure you've seen the commercials talking about the meds and the chick the study have had endometriosis. When people don't feel comfortable talking about what's going on with their period, how much they bleed. Like you'd be surprised the number of women that have gotten Menorrhagia or heavy menstrual bleeding where they practically write their name on the floor in blood and cursing every time their period shows up and they think it's normal and they ask anybody about anything.  Dr. Berry: Wow. Have you have trouble in the past and tried to even pull that type of information out of your patients? Dr. Anila Ricks-Cord You know, I think for me I'm fortunate in that I laugh and joke with my patients and then because I have also had issues with Menorrhagia like so black people are real good at making fibroids. Sidebar, I have a fibroid. Uterus is about the size of a 12 week pregnancy. And as a consequence, I think God has got a funny sense of humor cause at the Ob-Gyn, if somebody thinks that I have experienced it, I can relate to with my patients. And having been one of those chicks that has been a Menorrhagia without, not that people want to know what my contraceptive option is, but I use a Mirena IUD in order to control my Menorrhagia. Without my Mirena IUD, I can use a super plus tampon and it falls out every two hours. And I could write my name on the floor of blood curse using a regular tampon. Using a regular tampon, about Mirena. I don’t know what that was.  And so I use humor in what are the bridge the gap in order to be able to ask those kinds of questions. So tell me about your menstrual cycle. How long does it last? What products do you use, how often do you change them? Because a large number of these people who have, who should have hemoglobin hematocrit of six. They eyeball rolling because they believe, they think that's absolutely normal. They think that's absolutely normal. And then because it's, it's your period and you're not comfortable talking about that stuff anyway. It's a don't ask, don't tell, unless you have the kind of relationship with your physician where you feel like you can talk about.  Dr. Berry: Can you talk about it and if you can't, if I want to say you can't take their relationship isn't there to talk to it with your OB, you definitely not talking to the hospitalist. Dr. Anila Ricks-Cord Of course not. If the person see it on the bottom, you can to the physician. Why talk to people that you are not close? Exactly.  Dr. Berry: Okay. All right. All right. So let's see. So you mentioned liking me and I told you I was going to get some learning today. I already let her know, oh we're going to do some learning today. Cause again this is, I'm taking those right along, which I'll be going again. I've experienced in taking care of patients with this disorder. But of course you know me, I'm referring out to the OB clinic when I, well I think is what you got. Go ahead. See my OB friends, see if that's the case. So definitely. Wow. Okay. So what about, so we talked about it. I, I hear somebody, you know, some of the signs and symptoms kind of really associated with it. Now, is there anything that these patients are doing that may have attributed to getting any endometriosis? I mean because I guess they have to have a menstrual cycle, right? So it's not all about the retrograde bleeding, but is there… Dr. Anila Ricks-Cord Well in theory, remember there are some babies eight and a half and haven't had periods that have issues with the document in endometriosis. Wow. The vast majority of us have this menstrual, heavy menstrual cycle related signs and symptoms. We were, we're cycling and we've got this retrograde flow, but you don't necessarily have to have a period. You can have these, these girls. So when you're talking about risk factors for it in the materials, as we talked again about the, the developmental conditions that predispose you to basically having your belly tampered with endometrial tissue. We talked also about the fact that there are some people who are believed to have the genetic predisposition. So if you have a first degree relative that has endometriosis and by first degree relative is either your mom or your sister or your children, if you have a first degree relative that has endometriosis, you have an increased likelihood of having it too. And there's a thought process that, and these people who have a genetic predisposition for endometriosis, there's something about the way their cells signal that they don't respect boundaries and go from one place to another. Like tutors, I'm going to the pelvic. And then there's also a thought to that if you started your period early, like 10 or less that you're an increased risk for endometriosis. And then it has unfortunately has awful side effects too. Awful side effects. Dr. Berry: Now are, those are the, especially because we would kind of lean on, they're kind of starting to period early. So of course, you know, we're talking about like kids and then obviously this is an issue that a dose deal with as well. But I'm always kind of fascinated, especially as I'm an internist, I really only see 18 and up, you know, as an OB, you know, you're seeing all kinds of ranges. Do the complications associated with it? Like are they much worse off in the child than adult or is it still kind of tight? I gets bad either way. Like we know the rectal bleeding, we know the urinated, we know all this. But like if you, if you had to I guess choose, right? Like when would you rather start dealing with these problems? Would you rather deal with it as you know, in, in the younger age or more of that old, they're 35 40? Dr. Anila Ricks-Cord Well, oh, sorry. That's interesting. Thank you for reminding me. I forgot about that. One might tell you a little sidebar about that one. So in theory with children, the thought process is again, 40 days, 40% of adolescents with general tract anomalies, 50% of them have issues with infertility and 70% of women and adolescents with pelvic pain, it's got it. But the thought is that you've got longer in, would it be repetitive or your belly with these things? And so as a child, outside of the symptoms that we discussed beforehand, okay, the issue is think about all the years particularly undiagnosed, that you've got your belly, your abdomen, and your pelvis, your bowel, your bladder being peppered by these implants inside your personal space that then may not reflect or respect boundaries. Hop a ride on your vasculature or in your lymph system and go to other places. You can actually have endometriosis implants in your chest. Dr. Berry: The chest wall? Dr. Anila Ricks-Cord Yes, you can actually, it's this thing with, with so you know, cells and how they're supposed to respect boundaries and go to confluence and owning by protein signaling. Endometriosis implants can end up inside your lungs. You can actually get a collapsed lung as a consequence of endometrial implants. You can actually have Hemolysis when you cough blood for people don't know where that is. Yes. Or you can actually have, what is the other one is there's the collapsed lung, this coughing up of blood. And there's one other, I'm gonna circle back. When you talked about the difference between adults and children from the standpoint of what it is they have, you think about you have longer to be able to develop the side effects which are infertility. And if he's a disease which distorts the tubes and the ovaries, you have inflammation which is going to cause scarring and you've got pain and so you've got a longer time in order to be able to do this. So yeah, it can give you chest pain, collapsed lung, a blood in the lungs and coughing up few months. And then also with endometriosis, which I'm a sidebar in people who don't have one, you talked about the difference between adult versus children. You can be a perfectly normal lady who went to go have a C section. And as a consequence of having a c section because the uterine lining was disrupted, you can get into endometriosis impulse anywhere along that incision line. So where when I do C section, so we, after the scan we cut that we cut through the Fascia, separate the muscles cut. So the organs are online with this peritoneum is what he's got his own thought casing. Your bladder sits on top of your uterus and there's this thing called the physical uterine peritoneum that you cut your, put some letter out of the way you cut inside the uterus, you deliver the humans, you close uterus one layer and then folded back on itself. You can get into the endometriosis implants from the opening of that uterus being out in the abdomen, in the Fascia, in the anterior abdominal wall, and in the incision site. In my residency program, we had a lady who had a complaints of pain every single time her periods showed up. And actually when we imaged her, you found what looked like a small little one meter hole and it was actually much larger when you got inside her and started dissecting out where it could be. Endometrial lining had implanted in her incision and every single time she had a period it would bleed in her anterior wall and that incision site. I had a lady who when she was a child she had, I can't remember what her particular condition was. She had some kind of condition where she ended up having anomalies with her legs. One was rotated backwards, the other was rotated in a strange way and so she ended up having to have one of an amputated and was a compromise. Actually had that, she had booked a mandated bilateral amputees and there was something going on with her belly when she had some kind of surgery or maybe there was a challenge or something that was playing. She presented with complaints of belly button pain at one point in time and on further inquiry when you talked to her, she said that she could milk her belly button around the time of her period, showed up and get a round discharge to come out. And sure enough she had endometrial implants in her belly wall were when she started cycling because she had surgery when she was a child. It was enough to disrupt stuff and literally she blown through her interior wall where there was a defect of a wall with the implants would bleed right inside there. She'd get a little know what’s inside. Another chick who came to office, same kind of thing, complaints of just barely walk. She had an endometrial coma in her anterior wall as well. And so you, you go to the treatment modalities for endometriosis cause she's got endometriosis. And then outside of what it does from a standpoint of being a child and you having all this time to pepper your belly and being able to get it being a normal chick who just had a c section or a disruption in the lining of the uterus. Now you have it causes all kinds of pregnancy complications. We causes miscarriage, increased restricts topic pregnancy. You can get bleeding during pregnancy and hemorrhage afterwards sets you up for Preeclampsia. You can have a Placenta Previa where ideally placement of the placenta is hanging from the top of the readers like a chandelier. It increases your risk for a preview where it covers the opening of your cervic for a c section, such your upper preterm labor and delivery, a c section and low birth weight babies. So it's just all unpleasant. (Oh Wow. Okay).  And the thought is that because you have got these ectopic implants, this endometrial tissue inside your pelvis within triggers an inflammatory response. As women when we get pregnant. So we have relations, the sperm travels up of vagina for the rest of, it's through our uterus, Fallopian to define the egg, fertilizes the egg, and then the Fallopian tube pulls the egg, desperate lives towards itself. And then in the tube you got these hairs, these silly or that kind of push the egg through the tube and into the wall of the uterus. It is a thought process that with people who have endometriosis, that'd be inflammatory. Mediators are chemicals and their pelvis are so high that it's toxic to sperm. And that's part of the compromise with your fertility too, that this from getting sad then go. Dr. Berry: It's just not the place for me. Right? Dr. Anila Ricks-Cord No, I can't work on these conditions. I cannot be. So, no, it's crazy. Dr. Berry: That's and I guess the question is like, especially in your stance, like how, what's the likelihood that you're going to, you know, you see a young who is complaining of a lot of these issues and say, you know what, let me let, let's open you up and see. Right? Like let's do a laparotomy, right? Like is that, does that also ate into it as well that you know maybe the surgeons aren't likely to open them up to check because of like I don't want to put a surgeon. I don't want to put a kid through that. Dr. Anila Ricks-Cord And you think about the fact that if it's a child, some of us are comfortable with adolescents, some of us are not. There is a branch of gynecology that is specific to pediatrics and so you think about asking about whether or not people are even listening to what the complaints are. How many people with a child who complains of having constipation would ever think that has endometriosis and that you just eat too much junk or you need to drink some more water. I think that there's such a vague complaints that unless the child has been complaining about them the entire time and you've done a complete workup and I can't tell you the number of times where we'd endometriosis, it comes down to the gastroenterologist and the Ob-Gyn they've been sent and would it be able to get a colonoscopy in order to be able to be assessed to see what's going on with this presumed abdominal pain that once they ruled them not that is not GI in origin. Then it becomes, well the only other thing you got left down there is your reproductive organs. So it's either your guts or your uterus, which is where the attachments to it. Dr. Berry: I'm scared, scared for you. I don't have any of those issues with it being clearly, clearly this is why the disease process like this needs whole month. Right? Because it average nine years to like that, we got to move this out, right? We got to move this up quickly. That should not be the case. I'm sorry. I'm so sorry for you. Dr. Anila Ricks-Cord I think things are getting better. Again, we used to treat it like it was a zebra and you go through everything before you, and even from the same point of you ask about what's the like of somebody performing surgery. So ideally the founder to do laparoscopic surgery, but you think about people who manage conservatively, they would put you on everything first. Exactly. Birth control down to see what exactly you would. You would go through all the other conservative options before definitively going to surgery and, and the data suggests that even if you do surgery alone and that’s it, there are people who have defended over get relief with surgery, particularly if you have adhesions where you imagine that you've got with a good example of an adhesions? Where you have an abnormal connection of one thing to another. Maybe like imagine a ribbon and not inside your uterus but still if you had a connection between your uterus and your bowel or your uterus was stuck to your anterior abdominal wall because this inflammation causes this scarring and this is music disease that take place. If you want surgery, you just… Dr. Berry: Almost like a fly trap where like it's like it's stuck to that. Dr. Anila Ricks-Cord Yes. That’s a good analogy. Yes. Minus the dead flies. Exactly. Well you have things sticking from one point to another and it causes for the people who have chronic pelvic pain and have that disease, just going to the bathroom causes them problems. If they have issues with constipation and near bowel is stuck to the anterior abdominal wall or stuck to their uterus. A contorted in some way, shape or form. Can you think about how though the bow has got this motion where kind of squeezes fecal matter from one point to another? Just being constipated is enough to cause you wicked pain. And so people who have chronic pelvic pain secondary to disease, secondary to endometriosis, have to do things to alter their lifestyle to make it so the consistency of their stool is more like saucers. So the bowel doesn't get over distended and pissed off and cause pain. Dr. Berry: Wow. So we didn't scared Lunch and Learn community enough. They want to hear now. Like all right, you scared us. We believe you. We notice issue. Please tell me how to treat it or at least prevent it, right? Because I guess that's a two part question, right? Is this a way? Again, little kids is getting even before there, you know, they're menstruating, right? Is there an actual way that you could do anything about this? And if there is like how do I treat it? Like I, I know we've mentioned a little bit about the oral contraceptives, which again, I'm an internist. I don't know none of those things.   Dr. Anila Ricks-Cord Oh that's hilarious. So I'm trying to be really, really good. But all I could hear you say…Nope, and I don't do that. So treatment options and prevention, unfortunately at this point, because we understand its mechanism of action, but we don't really understand what causes it. So because we don't really understand what causes it, we've seen the clusters of people that look like this and clusters of people that look like that, we don't know how to prevent it. And so the thought now is with treatment options, there are a couple. They thought ideally as you want to decrease your inflammation, and initially I didn't mean to scare anyone. Knowledge is power. I wouldn’t scaring anybody at all.  Dr. Berry: Lunch and Learn community knows that you know, we're going to talk about a lot of disease courses. That you know what, if you're not, if it's not taken care of, it can cause a lot of problems. Yes, yes. Yeah. Take care of the problem. If you don't know that the problem is out there. Dr. Anila Ricks-Cord This is true. You're absolutely correct. And so with treatment, so ideally, first line is nonsteroidal anti-inflammatories, Ibuprofen and Naproxen. Back in the day we used to give people for chronic pelvic pain narcotics. And unfortunately we turned them into crack heads. So ideally the goal is to stay away from opioids. You want to do what you can do to increase, decrease, I'm sorry, inflammation. That's first one. Second is you use hormones. So you either have a couple of choices. You can either use birth control for non-birth control reasons. If you're not sexually active and you just have wicked pain or you get a two for trying to decrease your pain and make it said that you don't get any unplanned babies. The thought as you can use birth control pills, you can use injectable, which would be depot, you can use the implant, which is the next one on the ring. Do you either use them continuously when you get on a method and you stay on a method or use it cyclically in order to be able to make them. Dr. Berry: And from a, you know, from a non OB, I'll even talk about the guy on the guy's perspective, right? When y'all take birth control pills, so that it bleed less? So, yeah. Dr. Anila Ricks-Cord So yes. Ok I got you. Thank you for asking. In my case, I can write my name on the floor in blood and curse if mine is definitely about, not having or bleeding less. And so earlier when we talked before about how the brain calls the ovaries and tells the ovaries, we tried to have a baby and the ovaries go about thickening of the lining of the uterus and making it so you ovulate. Your body doesn't care how the hormones are made. You can either make them or take them. Your body just wants them to be present. And so the thought with the use of birth control pills or contraception, depending on which condom use is to thin the lining of the uterus. So you don't have a nice fluffy learning for an egg to implant. And some of them that modalities actually shut your ovaries down so you don't ovulate. In this case, the goal is to be able to thin the lining of the uterus and if you're using it continuously to shut down those ovaries so that that you don't have that tissue, that's another places. It's getting nice and thick and then after it gets nice and thick, it dies and you've got all this inflammation. You're trying to stop that process. Just shut it down. Thank you very much. Where you, you're in these other locations. Yes. Where you're living, where you've traveled abroad with this issue… Dr. Berry: We trying to starve those areas off. (That is exactly right). All right. All right guys, trust me guys. I got, y'all are here. I know. This is a woman's cell phone. Trust me. Dr. Anila Ricks-Cord Yes. From the standpoint of endometriosis, the goal is to starve that estrogen sensitive tissue that sitting out in the periphery. So you can either use hormones in the form of birth control or they're another batch of medicines you can use called GNRH agonist. I'm not going to have moment over this cause this term too much. But old school, there was a medicine called Lupron, which was a shot that you could get. New school, is this the one that you've seen on TV called Orilissa. They're both GRNH agonist and what they do is they cause the equivalent of a medical menopause. They shut you down, allow the implants to starve and die. But they can only be used short term, like the Orilissa. Depending on what your symptoms off, you can only use a six months to 24 months. And the same with Lupron because there's some side effects that go with it because it puts you into a medical menopause. It can actually decrease your bone mineral density and make it like a little old lady. The snap. Exactly. So those are treatments and if you do hormones that thought as if you do hormones, you do insets to so hormones and insets. And the goal was if you use the hormones when the same one of the contraception, the goal is to trick your body into this sort of false pregnancy state. Shut down your ovaries and make the implants die or go into a coma and decrease that inflammation. The next option would be surgery. Like we talked about laparoscopic. Laparoscopic surgery where you fill the belly up with carbon dioxide, drop the camera on the inside, put in some graspers in order to move things around. See if you can find some tissue to biopsy to confirm the diagnosis. If there adhesions, you disconnect those adhesions. And then if there are lesions that you can see, you do what's called ablation, you literally go and you burn these adhesions on the inside of the belly. Now, the lovely thing about surgery, but the bad thing about surgery is that anytime you have surgery, God makes all of our organs have their own organ case to them. Even your belly, it's got aligning cause like the inside of your mouth, anytime you pop inside somebody's belly, you risk the possibility of causing them adhesions as a consequence of the surgery. And if the surgery alone… Dr. Berry: With a c section? Dr. Anila Ricks-Cord Yes. Well, the endometriosis actually tracks. So all of these layers that you put together, it actually tracks into all of these. So imagine anywhere your nice touch, your skin fat Fascia, peritoneum, the endometrial cells can be in any of that line. From the inside of the uterus all the way out from the incision site in the uterus to the peritoneum, to the Fascia and the muscle wall in the back, all the way through in the skin itself, all the way through. And the lady I was talking about in residency, she had a tiny little lesion in her skin. But when you went to go dissect this thing out, it was huge. And it was in her Fascia. So it was like a mountain top. You just saw the top of the mountain. And when he got up on the news, right, you saw the rest of this mountain down inside, they were like icebergs. Now that…so. Dr. Berry: I'm not gonna lie, I might not wish endometriosis as my enemy. That's what I'm hearing. Dr. Anila Ricks-Cord It’s not a pretty thing to have at all. And the problem with surgery is that if you just do surgery here within a year, you've got symptoms that returned. Yeah, definitive treatment for endometriosis once you have done having your baby. So ideally for ladies who are reproductive age, the goal is to shut you down so you're ready to get pregnant, you get pregnant, then we shut it back down again. And then when you're done, depending on the severity of your disease process, some people respond well to hormones, some people don't. And definitive treatment for endometriosis is removing your uterus, tubes and ovaries being without hormone for a period of time to allow the implants to die off. And then restarting the hormones afterwards because you really need to be on hormones. Still menopause up in this country and average age is 52 otherwise you look like a man about to blood vessels and you snap crackle, pop in, all kinds of stuff. So outside of that, there's a thought process that there are some alternative medicine options that may or may not work. Now traditional data says it doesn't work. But you have to bear in mind that we are unique individuals. We have bio individuality. And so what works for one person may not work for somebody else but may work for the person that's using it. So this on is that acupuncture, herbal remedies and homeopathic May. I worked for some people outside of that. From the standpoint of you asked if there's anything you can do to prevent it. No. The thought process is to try and make yourself as healthy as you can be and to have coping mechanisms for the pain. So exercise. Dr. Berry: Health wise, you're talking about food or? Dr. Anila Ricks-Cord Right. We talking about food. We talking about balanced diet with very little processed food in it. We thought, I'm like getting enough sleep because you feel yourself when you sleep at night. We're talking about exercise and what it be able to decrease inflammation and meditation in order to be able to help cope with the pain. There's also in the DDA goes a suggestion to they're people who have endometriosis are deficient in vitamin D and so when we talk about how this tissue response and how we can say, Oh, you have to say the curb, but I'm going to go outside the boundaries and do other stuff. And these people who have endometriosis and are found to have vitamin D deficiencies. Folks believe this supplementation of vitamin D you might make a difference in any woman who is of reproductive age needs 800 international units of vitamin D a Day. Anyway, some of US Brown people don't spend a whole lot of time in the sun and don't generate the vitamin D and I'll give you an example. A lot of people who drink milk, they get milk and eat cheese. Drink milk and eat cheese. They get all the calcium and vitamins they need, I don't drink milk because I'm lactose intolerant. The last time I had my labs on, I'll tell you my vitamin D level with 17.  I'm the surprised Dr. Berry laughing at me. Normal is considered to be normal to be 30 and in Vagina land as the OB Gyn. We lasted to be around 6. And so vitamin comes supplement outside of of finding that people who have endometriosis are deficient in vitamin D. There's also a thought process that vitamin D and depression have a role with deficiencies in vitamin D and colon cancer. There are deficiencies in vitamin D, so just bone up on your vitamin D. Dr. Berry: Get your Vitamin D. Right. Like I say that again. I kind of scoffed at first. I was like, what is this little thing had his own month? This ain't heart disease. This ain't, you know, verbally like, okay, all right. Dr. Anila Ricks-Cord It affects quality of life. Talked about seriousness of disease. The reality is the endometriosis isn't going to kill anybody at all. There's a thought process that when I talked earlier about the ovarian masses that you can get the Endometriomas. The endometrial tissue that invades into the ovary and obviously takes residents can actually give you so with ladies who held a Sidebar, I'm making a correlation. I apologize, I coming back. For the Ovarian Syndrome who don't have regular menstrual cycles are at increased risk range and mutual cancer because at lining become can become atypical and find it. That same kind of thing can happen in the ovary where the endometrial tissue that is implanted in the ovary this now cause this chocolate fiscal of blood, which is the endometriomas. He can take on abnormal qualities just like the lining of the uterus when it is a typical he ladies are at PCOS.  They haven't found words actually become for lung cancer, but it has the capability to change cause it's inter-mutual tissue crazy stuff. Right. The bad thing about endometriosis is, like I said, if you, if you have it, it's everything. Unfortunately it can cause infertility. It can dictate whether or not you can move your house and function without pain. The patients that I have had that have had chronic pelvic pain secondary to endometriosis sometimes have to be selective about the kind of jobs that they take. Because if you have a pain syndrome that's present, say 21 days out of the month where you might have eight had a 10 pound most days. But maybe you get a break in on some other days, you've got five out of 10 pain interferes with your ability to be able to live. If you can’t get up to bed and get functioning because your belly is his feels like his demonically possessed and it's telling you all kinds of things from a pain standpoint and you can't function.  Pain was, and how can you hold a decent job? There are people who, because they have issues with endometriosis and the pelvic pain is exacerbated when they have relations. If you are single and not all of you in an intimate relationship, you have a difficulty with engaging in relationships and if you're married, it can interfere with your ability to be able to have an intimate relationship with your spouse. And then that over time leads to depression because is a chronic pain syndrome. Intimacy is a huge part of having relations or we're having a relationship and imagine not being able to be intimately associated with the person that you've vowed to spend the rest of your life with because it hurts so bad you can't stand it, but it's like having a nails in the back of your personal space and so you'd much rather that than have an intimate relationship. Dr. Berry: Wow. Okay. All right. You and Endometriosis. Before we let you go. Right. I got a couple more questions are, you know, but more on a, on a lighter note, right. Because endometriosis is scary. Again, I might have to tell my residents like hey, that patient who comes in for this vague abdominal pain. We might've needed to move it up a couple notches on the differential. Now can you talk about how what you do can help women take just take better control? Not necessarily just for this show, but it's just in general. Right? And this is a question I like to ask. I just want to, and I want to kind of get my guesses thoughts on like what do they do to help people empower, especially in your world, women empower themselves for better health.  Dr. Anila Ricks-Cord Sure. So what I like to do with all of my encounters be an individually as a patient, either in the hospital or in coaching or when I was in private practice in private practice is I encouraged them to be their own healthcare advocate. When you're looking for a physician, the purpose is to find somebody that you can partner with, with the ultimate goal of optimizing your health. Medicine is no different than customer service. It actually is like customer services for women. For those of us who like to drop some coins every now and then in places like say Nordstrom. Nordstrom is pricey as all get out, but the one thing that you can bank on with Nordstrom is they have customer service on luck. You know, they're rumored to have taken back a tire from somebody who said that they bought it there even though they don't feel tight. Medicine is no different than that. If you don't have a relationship with someone who listens to you and is genuinely vested in you being successful, you being healthy and your money someplace else, this also puts the onus of your health care on you. So I think when I think about my patients and they come and they talk to me, they say that nobody has listened to them and I think that's crucial. I think that you have to bear in mind that however old you are, you have had that body and know how that body works for however many years God has allowed you to live on the face of the earth.  Dr. Berry: No one gonna knows better than you. Dr. Anila Ricks-Cord Right. You are your own healthcare advocate. You got this on lock. If you go see somebody and you were trying to talk to them about what you're experiencing and then listen to what it is you say, go ahead and pick up and walk right on out the door and take you off your money and your insurance card with you. Because you wouldn't take bad customer service at a restaurant. You wouldn't take bad customer service in a product that you purchased. (Nope). So why would you take it with your health care, which is more important and lasting than product you going to buy, meal that you eat and pass on through it. Dr. Berry: Please tell Lunch and Learn how can they find you? Right? Because I know some people are probably energized right now. You know, and I kind of alluded to your Facebook, like give them all the ditails because I need people to be able to kind of track you. Dr. Anila Ricks-Cord Sure. On the sly, I'm a firm believer that food is medicine that tells the body what to do. And so I have invested in becoming a health coach. So in addition to being an Ob-Gyn, I'm a health coach. And with that said, I love answering questions that Dr. Berry's alluded to. So on Wednesday evening, 7:00 PM CST cause I'm in Texas, I do Facebook live on women's health topics and you can find me across all social media At D R A N I L A O B Gyn, that’s Doctor Anila OB Gyn. You can also find more information on my website, which is also www.drnilaobgyn.com. That's D R A N I L A O B G Y N.com. And if you tune into any of my lodge will find that I love answering questions. I think that as I alluded to earlier, my mom died because there was nobody there to advocate for her. And at 22 years old I didn't know the questions to ask. My goal as a health provider is to make it so that you know what I know. So your arm to take better care of yourself. Dr. Berry: I love it. Absolutely love it. And of course Lunch and Learn community, like always, if you're running out, you're in the car, you're driving, wherever you doing, you don't have to worry. All the, all of her information will be in the show notes. So you we will make sure and, and you really just got to watch one of her Facebook lives because she gets very animated, right? Like she really make like, okay, yeah, this one was health really is, that's why I say that, you know, you're going to be on my show because I need someone animated to educate me. A women's health to really educate y'all. So again, she is always, which she seems to be when you listen to her and you could just tell the love that's there. I like that and have everything right. You could just tell the love that is there to educate, to help you. Right? Get to where you need to be. And that's what I love about her. Right. She's absolutely amazing. Again, we're going to make sure she will be a repeat regular on this show, especially again at ya'll. Y'all ask me a lot about women's health stuff and I'd be like, I'd be like, hey they, and this, I know what I know and I know that I don't know. Once I realized I know what I don't know. That's when I get the console. Dr. Anila Ricks-Cord It has been my privilege and it would most assuredly be my pleasure for wherever it is you'd like for me to talk about from vagina land cause I have it on low. Dr. Berry: All right. Again, I appreciate everything that you do for your community. Appreciate everything you do for just the world and allowing you to take your amazing talents outside of the clinic and outside of the one on one and being able to talk to the master. So again, thank you Dr. Anila for coming on the show this week. Dr. Anila Ricks-Cord Thank you so very much Dr. Berry. I appreciate it.

This week we talk to Dr. Moira Kyweluk, a postdoc at University of Pennsylvania School of Medicine and recent Northwestern PhD/MPH grad. She talks to us about trans* reproductive health, anti-Müllerian hormone, and assisted reproductive technologies. Tune in to today's episode to learn more about Moira's research, placenta fetching, and more! Moira can be found at:https://www.moirakyweluk.com/ Twitter: https://twitter.com/eggsovarieasy Connect with us! Twitter: twitter.com/endocrinepod Instagram: instagram.com/endocrinepod Facebook: facebook.com/endocrinepod Don’t forget to support us on Patreon at patreon.com/endocrinepod. For as little as $1 a month, you can know about upcoming interviews and episodes, as well as ask guests questions about their work!

Episode 46: Tara Follum In this episode: Mullerian Anomolies Tara's instagram: https://www.instagram.com/tfollum88 Life After Miscarriage Connections: Instagram: www.instagram.com/shellymettling/?hl=en www.instagram.com/lamfampodcast/?hl=en Youtube: www.youtube.com/c/SHELLYMETTLING Ebook: www.amazon.com/dp/B07KZMBSJN #LAMFAM Merch: shop.spreadshirt.com/life-after-miscarriage

The Anti-Mullerian Hormone (AMH) Test by Women's Health Melbourne

In an exclusive interview with TheRightDoctors on Emcure AICOG tv, Dr. Hiralal Konar, professor, Calcutta National Medical College and Hospital in Kolkata spoke about Mullerian Malformation, its causes & cure. This is what he said: ' Mullerian malformations is specialized tissue in the embryonic life meaning that when we are within the womb during our conception time 5-6 weeks so early and this is the tissue Mullerian tissue that differentiates, that divides in the different segments. We have got different tissues like Mesonephric tissue or Wolffian tissue in male. The problem of un differentiation or mal development creates all the problem meaning that the birth passage or the vagina is not developed or partly developed. We examine the girl clinically and take the history, sonography and there are other investigations including the magnetic resonance imaging. We come to know which area is defected where is mal agenesis or maldevelopment If the uterus is partially developed then we can construct it, if the uterus has got some mal development we can unify, if there is septum or partition between the two, we can remove the partition.' TheRightDoctors, a Google Launchpad Digital Health StartUp, is one of the leaders in production and dissemination of Medical Information. We bring Insights from the World's Best Medical Minds to digital audiences worldwide across leading digital and social media platforms. Subscribe for more videos: https: https://goo.gl/BDq1gL Our Social Media Links : Facebook - https://goo.gl/YO1oel Google + - https://goo.gl/ImMXq5 Twitter - https://goo.gl/J1gtvw LinkedIn - https://goo.gl/FClkyl

The Immune team reveals how γδ T cells that synthesize interleukin-17A regulate adipose regulatory T cell homeostasis and thermogenesis. Hosts: Vincent Racaniello, Stephanie Langel, and Cynthia Leifer Become a patron of Immune! Links for this episode γδ17 T cells, T cell homeostasis and thermoregulation (Nat Immunol) γδ17 T cells cells at epithelial barriers(Nat Rev Immunol) Image credit Letters readon Immune 8 Weekly Science Picks Steph- Polycystic ovary syndrome and anti-Mullerian hormone Cindy- Foldscope(Ted talk) Vincent- Virology Lectures 2018 Music by Steve Neal. Immune logo image by Blausen Medical. Send your immunology questions and comments to immune@microbe.tv

Listen in to this episode to learn more about Mullerian mimicry, it's role in the evolution of bumblebees, and why it is the subject of Briana's research. “Depending on where you are, you might have the same species with completely different color patterns, and this is fairly common in Oregon.“ - Briana Ezray. Learn more about this episode of PolliNation at http://bit.ly/PN-Briana-Ezray

Thanks to Dollar Shave Club for sponsoring this video. Get your first month of the Executive Razor with Dr. Carver’s Shave Butter for only $5 at http://www.dollarshaveclub.com/minuteearth It can be hard to distinguish bees from all the other insects out there that look like bees. Thanks also to our supporters on https://www.patreon.com/MinuteEarth ___________________________________________ If you want to learn more about this topic, start your googling here: Mullerian mimicry: a type of mimicry in which two or more animals with defenses develop similar appearances as a shared protective device Batesian mimicry: a type of mimicry in which an animal with no defenses is protected by its resemblance to an animal capable of defense ___________________________________________ Credits (and Twitter handles): Script Writer: Kate Yoshida (@KateYoshida) Script Editor: Alex Reich (@alexhreich) Video Illustrator: Ever Salazar (@eversalazar) Video Director: Kate Yoshida (@KateYoshida) Video Narrator: Kate Yoshida (@KateYoshida) With Contributions From: Henry Reich, Emily Elert, Peter Reich, David Goldenberg Music by: Nathaniel Schroeder: http://www.soundcloud.com/drschroeder _________________________________________ Like our videos? Subscribe to MinuteEarth on YouTube: http://goo.gl/EpIDGd Support us on Patreon: https://goo.gl/ZVgLQZ Also, say hello on: Facebook: http://goo.gl/FpAvo6 Twitter: http://goo.gl/Y1aWVC And find us on itunes: https://goo.gl/sfwS6n ___________________________________________ If you liked this week’s video, we think you might also like: A collection of "bees" that aren't bees: http://notabee.tumblr.com/ ___________________________________________ References: Brower J.V.Z. & Brower L.P., (1965). Experimental studies of mimicry. 8. Further investigations of honeybees (Apis mellifera) and their dronefly mimics (Eristalis spp.). American Naturalist 99:173–187. https://www.jstor.org/stable/pdf/2459113.pdf Dyer, F., Jan 2017, personal communication. Franks, D. W. and Noble, J., (2002). The origins of mimicry rings. Standish, R. K., Bedau, M. A. and Abbass, H. A.(eds.) In Artificial Life VIII: Proceedings of the Eighth International Conference on Artificial Life. MIT Press., pp. 186-191. http://alife8.alife.org/proceedings/sub2852.pdf Pasteur, G., (1982). A classificatory review of mimicry systems. Annual Review of Ecology & Systematics, 13: 169–199. http://www.annualreviews.org/doi/abs/10.1146/annurev.es.13.110182.001125?journalCode=ecolsys.1 Rettenmeyer, C.W., (1970). Insect Mimicry. Annual Review of Entomology 15: 43-74. http://dx.doi.org/10.1146/annurev.en.15.010170.000355. Wilson, J., Jan 2017, personal communication. ___________________________________________ Image Credits: Honey bee (Apis mellifera) - Charles James Sharp https://commons.wikimedia.org/wiki/File:Honey_bee_(Apis_mellifera).jpg Sugar bag bee - Graham Wise https://en.wikipedia.org/wiki/File:Tetragonula_carbonaria_(14521993792).jpg Agapostemon virescens - Susan Ellis https://commons.wikimedia.org/wiki/File:Agapostemon_virescens.jpg Amegilla cingulata bee - Chiswick Chap https://commons.wikimedia.org/wiki/File:Amegilla_cingulata_on_long_tube_of_Acanthus_ilicifolius_flower.jpg Drone fly (Eristalis tenax) - Francis C. Franklin https://commons.wikimedia.org/wiki/File:Eristalis_tenax_and_flowers.jpg Eumeninae Wasp - Joaquim Alves Gaspar https://commons.wikimedia.org/wiki/File:Wasp_August_2007-3.jpg Sesia apiformis - Gyorgy Csoka https://commons.wikimedia.org/wiki/File:Sesia_apiformis_adult1.jpg Lunate Blister Beetle - Bernard DUPONT https://www.flickr.com/photos/berniedup/12748380493/ Plain Lacewing (Cethosia hypsea) caterpillar - Bernard Dupont https://www.flickr.com/photos/berniedup/22723162703 Nymph of Green Milkweed Locust (Phymateus viridipes) - Bernard DUPONT https://commons.wikimedia.org/wiki/File:Nymph_of_Green_Milkweed_Locust_(Phymateus_viridipes)_(13983971884).jpg Eristalis tenax - Wilder Kaiser https://commons.wikimedia.org/wiki/File:Eristalis_tenax_01Aug2009.jpg Yellow Jacket Wasp - Wikimedia user Bombman356 https://commons.wikimedia.org/wiki/File:Yellow_jacket_wasp.jpg

In this show, Dr. Adrian Queseda and Dr. Matthew K. Hoffman discuss the Quantification of the Familial Contribution to Mullerian Anomolies, ( A. Hammoud et. al., Obstet Gynecol 2008, 111:378-384). This paper was published in Obstetrics and Gynecology in February, 2008 and reveals level II evidence of an increased risk of inheritance of mullerian anomilies, based on data from the Utah Population Database.Click here to listen or download Mullerian Anomolies