Podcasts about Reproductive endocrinology

Send us a textIn this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols breaks down one of the most commonly overlooked causes of infertility: elevated prolactin levels, also known as hyperprolactinemia.If you've ever been asked about nipple discharge at a fertility consult and thought, “What does that have to do with getting pregnant?”—this episode is for you.Dr. Amols dives into:What prolactin is and why your body produces itHow elevated prolactin shuts down ovulation by disrupting GnRH, FSH, and LHThe connection between dopamine and prolactin controlCauses of high prolactin—including prolactinomas, medications, thyroid issues, and even stress or exerciseDiagnostic steps: when to repeat the test, when to order an MRI, and how to rule out macroprolactinFirst-line treatments (cabergoline, bromocriptine) and what to expect during recoveryHow untreated hyperprolactinemia affects IUI, Clomid, Letrozole, and IVF outcomesLearn how to identify this hormone imbalance, when to treat it, and how correcting it can restore ovulation and dramatically improve your chances of pregnancy.Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform. Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com. Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com. Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Amanda Kallen is an associate professor in the Division of Reproductive Endocrinology and Infertility at the University of Vermont Larner College of Medicine and an adjunct professor at the Yale School of Medicine. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A.N. Kallen and Others. Undermining Women's Health Research — Gambling with the Public's Health. N Engl J Med 2025;392:2185-2187.

Dr. Lowell Ku, MD, RE is a Reproductive Endocrinologist who is board-certified in Reproductive Endocrinology and OBGYN. He is the senior physician at Dallas IVF, and recognized by numerous organizations and publications as a top Dallas physician. In this episode, Dr. Ku provides essential information that all those trying to conceive will want to know. Hear about: What happens when a man goes to a fertility clinic. What potential testing can find. Suggestions to improve sperm quality. And more!

Send us a textThis week Fertility in Focus is thrilled to welcome Jullin Fjeldstad from Future Fertility and Dr. Sony Sierra from Evolve Egg Freezing Clinic, who sat down with us to discuss how they're bringing their unique expertise to the forefront of reproductive technology. These esteemed guests illuminate how AI is reshaping fertility preservation, specifically through the lens of egg freezing. Dr. Sierra provides a compelling overview of how egg freezing empowers individuals to align their reproductive plans with personal and professional aspirations, amidst a growing trend on social media. As more people turn to fertility preservation, understanding its benefits and implications becomes paramount. With insights from both of our guests this week, we explore how AI not only improves clinical outcomes but also offers patients unprecedented control and understanding over their fertility journeys.More about our guest speakers: Jullin Fjeldstad is the Head of Clinical Embryology and Scientific Operations at Future Fertility. Throughout her career, she has always held a passion for innovative ART technologies aimed at improving the fertility journey and IVF outcomes. In her current multi-faceted role, Jullin draws upon her experience as a seasoned embryologist and former lab director to navigate partnering clinics through seamless adoption of Future Fertility's AI-powered oocyte quality assessment tools, as well as overseeing Future Fertility's scientific project collaborations. With her extensive IVF experience and comprehensive understanding of the laboratory operations, she also provides invaluable input to the company's product development processes. Jullin holds a BSc. in Biology from the University of Victoria, Canada and a MSc. in Clinical Embryology from the University of Leeds, UK, where she achieved distinction in both areas.  Dr. Sony Sierra, MD, FRCSC, REI (She/Her), serves as a distinguished Reproductive Endocrinology & Infertility Specialist (REI) and Deputy Medical Director and Partner at TRIO. With nearly two decades of experience, she specializes in reproductive health, recurrent pregnancy loss, and early Recurrent Pregnancy Loss (RPL) programs. As the Medical Director at EVOLVE Egg Freezing Clinic and an Associate Physician at Women's College Hospital, she contributes significantly to advancing reproductive medicine. Dr. Sierra's research interests include infertility, implantation failure, and PCOS, reflected in her publications and conference presentations. Passionate about patient care, she approaches her practice with compassion and dedication, guided by her belief in excellence and empathy. Dr. Sierra's commitment to ongoing education and involvement in esteemed societies ensures her patients receive the most up-to-date care and expertise. She finds immense fulfillment in helping individuals and couples achieve their dreams of starting a family, making her a valued asset in the field of fertility medicine.For more info about Dr. Sierra, you can check out the TRIO Fertility Website: https://triofertility.com/team-member/sony-sierra/ or you can follow her on Instagram @drsonysierra. https://futurefertility.com/https://instagram.com/futurefertilityaihttps://www.youtube.com/@futurefertilityIf you or your organization would like to sponsor educational episodes just like this, please contact us at podcast@fertilitymatters.ca. Follow Fertility Matters Canada at @fertility_canada on Instagram and TikTok.

Welcome back to another expert minisode! Today Ali is talking to Dr. Molly Quinn, is a Reproductive Endocrinology and Infertility specialist with HRC Fertility. Dr, Quinn prioritizes direct communication with patients and will always make herself available to patients for any questions, and today, she is answering ALL the things about Recurrent Pregnancy Loss, or "RPL." Ali and Dr. Quinn talk about how recurrent pregnancy loss is medically defined, how common it is, who is most at risk, what the most frequent causes of recurrent miscarriage and so much more. You do not want to miss this one! If you know anyone who has experienced or is experiencing RPL, please pass this episode on to them! Follow her on IG: @mollyquinnmd @hrcfertilitypasadena @hrcfertilityTOPICS COVERED IN THIS EPISODE:Recurrent pregnancy loss; miscarriage; fertility tests; infertility; IVF; genetic testing; chromosomal issues; mental health support; Support this podcast at — https://redcircle.com/infertile-af/donationsEPISODE SPONSORS:WORK OF ARTAli's Children's Book about IVF and Assisted Reproductive Technologyhttps://www.infertileafgroup.com/booksDo not miss Ali's children's book about IVF! It's been getting rave reviews. “Work of ART” is the story of an IVF kiddo the day he learns he is a “work of ART” (born via IVF and ART). For young readers 4-8. Hardcover. Written by Ali Prato; Illustrated by Federico Bonifacini.Personalized and non-personalized versions are available. Order yours now at https://www.infertileafgroup.com/booksFor bulk orders of 10 or more books at 20% off, go to https://www.infertileafgroup.com/bulk-order-requestFERTILITY RALLYIG: @fertilityrallywww.fertilityrally.comNo one should go through infertility alone. Join the Worst Club with the Best Members at fertilityrally.com. We offer 5 to 6 support groups per week, three private Facebook groups, tons of curated IRL and virtual events, and an entire community of more than 500 women available to support you, no matter where you are in your journey.Join today at link in bio on IG @fertilityrally or at www.fertilityrally.com/membership BELIIG: @belibabywww.belibaby.com Are you thinking about growing your family? Whether you're just starting to plan or are actively trying to conceive, preconception health is key. Beli has vitamins to help both women and men optimize their health before pregnancy. With essential nutrients like Folate, Iodine, and Zinc, Beli ensures your body is ready for this exciting next step. Give yourself and your future baby the best foundation for a healthy start.Visit Belibaby.com today and use code IAF15 for 15% off your first order. Our Sponsors:* Check out Happy Mammoth and use my code INFERTILEAF for a great deal: https://happymammoth.comSupport this podcast at — https://redcircle.com/infertile-af/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

I'm honored to have Dr. Jie Deng  as a guest on The Egg Whisperer Show podcast today. She is not only an Obgyn and Maternal Fetal Medicine specialist (did extra training studying high risk pregnancies), she is also a fertility doctor at Stanford University finishing up her Reproductive Endocrinology and Infertility Fellowship. We are talking about the risks of birth defects, autism and cancer with IVF treatment. She's also answering questions about whether ICSI increases the risk of birth defects as well as: should all IVF pregnancies have a fetal echocardiogram? Dr. Deng is so well versed in the topic IVF risks and high risk pregnancies, and I am excited to talk to her! 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, April 22, 2024 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

Ronit Menashe and Vida Delrahim are the visionary co-founders of WeNatal, a pioneering prenatal supplement company dedicated to supporting both women and men on their fertility journeys. Their partnership began over 15 years ago at Nike, where they forged a deep friendship that would later evolve into a shared mission. After experiencing miscarriages just a week apart, Ronit and Vida were struck by the lack of guidance and the absence of male-focused fertility support in traditional prenatal care. This realization propelled them to create WeNatal, aiming to shift the conversation from "me" to "we" in reproductive health. Backed by leading functional medicine doctors and nutritionists, WeNatal offers science-backed, clean, and bioavailable supplements designed to optimize fertility and overall health for both partners from preconception through postpartum. You can connect with Ronit and Vida via Instagram @we_natal Related Episodes: Ep 291 - Nutrition for Pregnancy with Brigid Titgemeier Ep 304 - Reproductive Endocrinology and Infertility Treatment with Dr. Lauren Rubal If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating or share your feedback on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health. Disclaimer: This podcast is for general information only, and does not provide medical advice.  I recommend that you seek assistance from your personal physician for any health conditions or concerns.

On this episode of Talking Away The Taboo, Estie Rose, MS, CGC, Heather Hipp, MD, and Gail Heyman, join Aimee Baron, MD for the second episode of our 5-part IWSTHAB x JSCREEN Podcast series is all about Fragile X. When people think of genetic testing before pregnancy, they often think of Tay-Sachs or cystic fibrosis—but Fragile X is just as important and far less understood. In this episode, Estie Rose and Dr. Heather Hipp explain the difference between recessive and X-linked conditions, what it means to be a Fragile X carrier, and how it can affect fertility and family planning. We also hear from Gail Heyman, who shares her deeply personal journey navigating Fragile X in her own family—and how that led her to advocacy. Whether you're building your family or supporting someone who is, this episode is filled with insight, honesty, and heart. -Click here to watch Part 1: Introduction to Genetics and Infertility More about Estie:  Estie Rose is a certified genetic counselor at jscreen. She has a special interest in community education and serves as a resource for individuals who are facing genetic health issues. Connect with Estie:  -Follow her on Instagram More about Heather: Dr. Heather Hipp is a Reproductive Endocrinology and Infertility (REI) physician and an Associate Professor at Emory University School of Medicine. She earned her undergraduate degree at Duke University and then her MD degree at Emory University, where she continued her training in residency and fellowship. She is the Program Director for the REI fellowship at Emory and serves as chair for the American Society for Reproductive Medicine Education Committee. Her profession memberships include American College of Obstetrics and Gynecology, American Society for Reproductive Medicine, Alpha Omega Alpha Honor Society, and American Gynecological & Obstetrical Society. She is also on the National Fragile X Foundation Scientific and Clinical Advisory Committee. Her research focuses on women who are carriers for the fragile X mutation and their risk of premature ovarian insufficiency, as well as trends and outcomes of in-vitro fertilization (IVF) in the United States. More about Gail:   Gail Heyman is a passionate advocate and leader in the Fragile X community. After her son was diagnosed in 1989, she co-founded the Fragile X Association of Georgia and has served as its director ever since. Her family's experience—spanning three generations affected by Fragile X conditions—fuels her tireless work to raise awareness, promote research, and support others navigating similar challenges. Gail also serves on JScreen's advisory board and has received national recognition for her leadership in genetic advocacy and inclusion. -Click here to learn more about Gail's story -Check out Carly Heyman's book, My eXtra Special Brother -Learn more about Fragile X here Connect with JScreen:  -Visit their website -Coupon Code: IWSTHAB18 for $18 off initial testing (no expiration date on this offer) -Follow JScreen on Instagram Connect with us:  -Check out our Website - Follow us on Instagram and send us a message -Watch our TikToks -Follow us on Facebook -Watch us on YouTube

Joelle Taylor, MD, FACOG is a board-certified Reproductive Endocrinologist and a Diplomate of the American Board of Obstetrics and Gynecology. She is an active member of several leading scientific societies, including the American Society for Reproductive Medicine (ASRM), the Society of Reproductive Endocrinology and Infertility (SREI), the Society of Assisted Reproductive Technology (SART), and the American Congress of Obstetricians and Gynecologists (ACOG).   Dr. Taylor earned her medical degree from the University at Buffalo School of Medicine and Biomedical Sciences in 2006. As a recipient of the Howard Hughes Medical Institute Scholar Award, she dedicated a year to research at the National Institutes of Health during her medical training. She went on to complete her residency in Obstetrics and Gynecology at Wake Forest University in 2010, followed by a fellowship in Reproductive Endocrinology and Infertility at the renowned Jones Institute for Reproductive Medicine in Norfolk, Virginia—home to the first IVF baby in the United States.   Throughout her career, Dr. Taylor has been recognized with multiple research grants, has published extensively, and has presented her work at national conferences.   Outside of her professional pursuits, Dr. Taylor lives in Jupiter with her family and their Australian Labradoodle. She enjoys weightlifting, yoga, playing pickleball, and cooking for family and friends.

Order my new book: Finally F**kn Fertile Using Yoga Meditation & Breathwork to Conceive! https://www.lisapinedayoga.com/store/p1/FINALLY_F%2ACKING_FERTILE_Using_Yoga%2C_Meditation_%26_Breathwork_to_Conceive.htmlDID YOU KNOW PCOS can be managed by some medications and even improve egg quality? In the latest episode of The Dismantling You Podcast I interview Dr. Cary Dicken  Topics we discussed:*PCOS*Endometriosis*Egg Freezingand so much moreCary L. Dicken, MD, joined RMA of New York – Long Island in the fall of 2020. She comes to us from the Sher Institute for Reproductive Medicine in New York City, where she served as Associate Medical Director for over six years. Dr. Dicken is board certified in both Obstetrics & Gynecology and Reproductive Endocrinology & Infertility. She has been recognized by her peers and patients as an outstanding and compassionate physician. Dr. Dicken is a caring and warmhearted fertility specialist while still being honest and upfront with her patients. She is proud to be a reproductive endocrinologist and loves spending her days helping individuals/couples create the families they want.Contact Dr. Cary DickenWebsite: https://www.rmalongislandivf.com/physicians/cary-l-dicken-mdInstagram: @dr.cary.dicken

In this episode of Better Edge, Christina E. Boots, MD, MSCI, associate professor of Reproductive Endocrinology and Infertility at Northwestern Medicine, discusses the impact of obesity on reproductive outcomes and the promising role of GLP-1 agonists in treating obesity and infertility. Discover how these groundbreaking medications are reshaping reproductive health, offering hope for patients with higher BMIs. Learn about the latest insights and clinical considerations for their use in preconception care plans.

Send us a textYou've done the ultrasounds, the shots, the bloodwork — and then retrieval day comes, and... nothing. Zero eggs. What just happened?In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols dives into one of the most confusing and emotionally crushing outcomes in IVF: Empty Follicle Syndrome (EFS). But before you panic, know this — most cases aren't what they seem.We'll break down:The difference between true vs. false EFSWhy true EFS is rarer than a unicorn eating tacosHow trigger shot timing and hormone levels can lead to confusionWhat doctors actually mean when they say “empty follicle”Real strategies for preventing and managing this situationWhether you've heard the term before or are just trying to understand your IVF journey better, this episode will give you clarity, peace of mind, and as always — a side of science and salsa.Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform. Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com. Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com. Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Text me to ask a question, leave a comment or just say hello! Hey doc! In this episode of ✨Stethoscopes and Strollers✨, I'm having a vulnerable conversation with Dr. Erica Bove, a Reproductive Endocrinology and Infertility Specialist and fertility coach who shares her powerful journey through motherhood during medical training, unexpected divorce, and rebuilding her life and career.Dr. Erica opens up about:Having her first child during residency and navigating early motherhood with limited supportExperiencing a dramatic birth during Hurricane Sandy and a challenging unmedicated delivery with her second childDiscovering her husband's affair with their nanny and rebuilding her life as a single momFinding her path to fertility coaching after realizing clinical medicine wasn't serving her familyKey takeaways:The critical importance of trusting your intuition, even when it's telling you something you don't want to hearHow finding the right support system can transform your experience as a Physician momThe power of boundaries and self-advocacy, especially during life's hardest momentsLearning to rebuild your identity after divorce or other major life transitionsDr. Erica shares why she created Love and Science Fertility, a coaching practice specifically for female physicians navigating fertility journeys, including those experiencing secondary infertility.Remember, doc, your intuition is a powerful tool - both in medicine and in life. Trust yourself.Erica Bove, MD, is the mother of two boys who are 12 and 10. At times, she prefers to be called "Mama Bear." She is a double board certified OB-GYN and Reproductive Endocrinologist (REI) physician at the University of Vermont, as well as a certified life coach through The Life Coach School. She is also the founder of Love and Science: Thriving Through Infertility. She has a keen interest in marrying an evidence-based approach with intuitive knowing in the context of a trusting relationship. She empowers physician women to build their families with confidence, compassion and community. Her mission is to heal and support the healers and to create a legacy she is proud of.For more information about Dr. Erica Bove, you can visit her website and connect with her on Facebook, follow on Instagram, and listen to the Remember to subscribe to "Stethoscopes and Strollers" on your favorite podcast platform so you never miss an episode of encouragement and empowerment. Apple Podcast | Spotify | YouTube Connect with me. Website | Instagram | Facebook Join my Email list to get tips on navigating motherhood in the medical field. If you feel you need direct support or someone to talk through the unique challenges of being a physician mom, schedule a free coaching session. Free Coaching Session with Dr. Toya

In this episode of the SART Fertility Experts Podcast, Dr. Susan Nasab and Dr. Dan Williams discuss the egg retrieval process, a key step in IVF and egg freezing. They explain candidate criteria, procedural details, anesthesia, recovery expectations, and potential complications. The conversation highlights the importance of setting realistic expectations, post-op care, and choosing an experienced fertility team. Dr. Williams reassures listeners that egg retrieval is a safe and effective procedure, with most patients achieving successful outcomes through modern fertility treatments. Find the #StartwithSART Fertility Experts series wherever you get your podcasts. Looking for advice on building a family? Ask the experts and #StartwithSART. For more information about the Society for Assisted Reproductive Technology, visit our website at https://www.sart.org Have a topic you'd like to hear? Tell Us!  

Send us a textIn honour of Endometriosis Awareness Month, tune in to this republished, intriguing episode with Dr. Sony Sierra, a renowned reproductive endocrinologist at TRIO Fertility in Toronto and a past president of the Canadian Fertility and Endocrinology Society. Dr. Sierra takes us deep into endometriosis, shedding light on this misunderstood condition.Dr. Sony Sierra unpacks the realities of endometriosis—its overlooked symptoms, diagnostic challenges, and misunderstood impact on fertility. She breaks down the three key ways it affects conception, the best treatment options, and what patients need to know at every stage of their journey. This episode is a must-listen for anyone seeking clarity, support, and empowerment in the fight for endometriosis awareness.More About our Guest Speaker:Dr. Sony Sierra, MD, FRCSC, REI (She/Her), serves as a distinguished Reproductive Endocrinology & Infertility Specialist (REI) and Deputy Medical Director and Partner at TRIO. With nearly two decades of experience, she specializes in reproductive health, recurrent pregnancy loss, and early Recurrent Pregnancy Loss (RPL) programs. As the Medical Director at EVOLVE Egg Freezing Clinic and an Associate Physician at Women's College Hospital, she contributes significantly to advancing reproductive medicine. Dr. Sierra's research interests include infertility, implantation failure, and PCOS, reflected in her publications and conference presentations. Passionate about patient care, she approaches her practice with compassion and dedication, guided by her belief in excellence and empathy. Dr. Sierra's commitment to ongoing education and involvement in esteemed societies ensures her patients receive the most up-to-date care and expertise. She finds immense fulfillment in helping individuals and couples achieve their dreams of starting a family, making her a valued asset in the field of fertility medicine.For more info about Dr. Sierra, you can check out the TRIO Fertility Website: https://triofertility.com/team-member/sony-sierra/ or their Instagram at @triofertility. Follow Dr. Sierra directly at @drsonysierra.If you or your organization would like to sponsor educational episodes just like this, please contact us at podcast@fertilitymatters.ca. Follow Fertility Matters Canada at @fertility_canada on Instagram and TikTok.

The Right Reverend Rose Hudson-Wilkin, the Bishop of Dover, is a trailblazer, who has been right at the heart of a changing nation for over 40 years. Despite discrimination due to her gender and ethnic minority background, Bishop Rose has never wavered from the call she received to enter ministry at the age of 14. She joined Nuala McGovern to discuss her memoir, The Girl from Montego Bay.A Royal College of Nursing report, On the Frontline of the UK's Corridor Care Crisis, which came out this week, found that the situation in A&E is the worst it has ever been and that a lack of hospital beds means corridor care has been "normalised". One nurse described caring for a 95-year-old woman dying with dementia who had spent eight hours lying on a trolley in a crowded corridor next to a drunk person who was vomiting and being abusive. Others describe women having a miscarriage in side rooms. Professor Nicola Ranger, Chief Executive of the Royal College of Nursing joined Anita Rani to discuss what is going on.Holly Bourne, bestselling author of How Do You Like Me Now? and the Spinster Club series, is back with So Thrilled For You, her most personal novel yet. It's a story about four friends navigating motherhood, career ambition, and societal pressures, all unfolding during a sweltering summer's day at a baby shower. Holly joined Nuala and explained what inspired this book. Can AI improve the success rates of women undergoing fertility treatment? Anita discusses the impact of AI on IVF with Dr Cristina Hickman, an embryologist, co-founder of Avenues, and Chair of the Global AI Fertility Society, and Dr Ali Abbara, a Clinician Scientist at Imperial College London, and Consultant in Reproductive Endocrinology at Imperial College Healthcare NHS Trust.Hermine Braunsteiner was the first person to be extradited from the US for Nazi war crimes. She was one of a few thousand women who had worked as a concentration camp guard and was nicknamed ‘the Mare' by prisoners because of her cruelty; she kicked people to death. In 1964, Hermine's past was unknown: She was living a quiet existence as an adoring suburban housewife in Queens, New York when she was tracked down by a reporter from The New York Times who exposed her past. Angharad Hampshire, a Research Fellow at York St John University, joined Nuala to talk about The Mare, her novel based on Hermine's life.The all-female, Welsh-language, post-punk trio Adwaith are the only band to have won the Welsh Music Prize twice, for their first two albums. They are about to release their third album, Solas, all about returning to their hometown in Carmarthen. Band members Hollie Singer, Gwenedd Owen and Gwen Anthony performed live in the studio. Presenter: Anita Rani Producer: Annette Wells Editor: Rebecca Myatt

Can AI improve the success rates of women undergoing fertility treatment? Anita Rani discusses the impact of AI on IVF with Dr Cristina Hickman, an embryologist, co-founder of Avenues, and Chair of the Global AI Fertility Society, and Dr Ali Abbara, a Clinician Scientist at Imperial College London, and Consultant in Reproductive Endocrinology at Imperial College Healthcare NHS Trust.The second reading is due today of a private members bill that seeks to ban first-cousin marriage. It's particularly prevalent among Pakistani and Muslim communities. But what would this mean for women? And how would genetic testing to enforce the ban work? Anita Rani speaks to CEO of Karma Nirvana Natasha Rattu and Emeritus Professor of Health Research at Bradford University, Neil Small. The award winning documentary Sugarcane follows an investigation into the Canadian Indian residential school system, and the attempts of survivors and their descendants to try to understand what happened in them. Emily Kassie is the film's producer and co-director and joins Anita on Woman's Hour. Mark Zuckerberg says companies need to embrace more “masculine energy”. The Meta boss told a podcast that instead of trying to get away from it, corporate culture should celebrate the positive side of things like “aggression”. But what even is ‘masculine energy'? And do we really need more of it? Anita talks to Josh Smith, contributing editor of Glamour magazine and Becky Hewitt, Chief Exec of culture change company Kin&Co.Presenter: Anita Rani Producer: Laura Northedge

Idaho lawmakers were unable to reach an agreement last year on legal protections for in vitro fertilization, or IVF. Associate producer Logan Finney discusses how the procedure works and the legal landscape around fertility with Dr. Emily Jungheim, Chief of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine.

In this episode of the Conscious Fertility Podcast, host Lorne Brown speaks with Dr. Elizabeth Stener-Victorin about polycystic ovarian syndrome (PCOS), a complex endocrine and metabolic disorder affecting many women worldwide. Dr. Stener-Victorin, joining from Sweden, discusses the prevalence, symptoms, and ongoing research on PCOS, focusing on its root causes and effects. The conversation emphasizes the importance of preconception care, healthy lifestyle choices, and holistic management of PCOS. Dr. Stener-Victorin shares her research on the impact of acupuncture, diet, and lifestyle changes on women with PCOS, covering metabolic, reproductive, and psychological aspects. The discussion also explores the benefits of integrating acupuncture and the challenges of clinical trials, offering valuable insights for those dealing with or supporting someone with PCOS. Key Topics: Preconception Care: Lifestyle changes, exercise, and a balanced diet boost fertility in women with PCOS. Acupuncture's Role: Helps regulate ovulation and improve insulin sensitivity, especially with other treatments. Transgenerational Impact: PCOS can affect the metabolic and reproductive health of offspring. Holistic Approach: Management includes diet, exercise, acupuncture, and possibly medications like Metformin. Research: Studies are exploring immune function and the effects of acupuncture and lifestyle changes in PCOS.   About Dr. Elisabet Stener-Victorin: Dr. Elisabet Stener-Victorin, a physiotherapy graduate from Lund University (1985), earned her doctorate from the University of Gothenburg in 2000 and was a postdoctoral researcher in Japan. In 2015, she founded the Reproductive Endocrinology and Metabolism research group at the Department of Physiology and Pharmacology. Her research focuses on polycystic ovary syndrome (PCOS), exploring its pathophysiology and the effects of acupuncture and exercise on reproductive function, hyperandrogenemia, and insulin resistance. She also studies molecular pathways and epigenetic changes in tissues. She enjoys kitesurfing. Where To Find Dr. Elisabet Stener-Victorin    Website:  Reproductive Endocrinology and Metabolism (REM) Group : https://ki.se/en/research/research-areas-centres-and-networks/research-groups/reproductive-endocrinology-and-metabolism-elisabet-stener-victorins-research-group Twitter: @ElisabetStener // https://x.com/ElisabetStener Publications: https://ki.se/en/people/elisabet-stener-victorin#publications LinkedIn: https://www.linkedin.com/in/elisabet-stener-victorin-8a181814/?originalSubdomain=se How to connect to Lorne Brown online and in person (Vancouver, BC) Acubalance.ca book virtual or in person conscious work sessions with Dr. Lorne Brown  Lornebrown.com   Conscious hacks and tools to optimize your fertility by Dr. Lorne Brown: https://acubalance.ca/conscious-work/   Download a free copy of the Acubalance Fertility Diet & Recipes and a copy of the ebook 5 Ways to Maximize Your Chances of Getting Pregnant from Acubalance.ca Connect with Lorne and the podcast on Instagram:   @acubalancewellnesscentre @conscious_fertility_podcast @lorne_brown_official Youtube: The Conscious Fertility Podcast   DISCLAIMER: By listening to this podcast, you agree not to use it as medical advice to treat any medical condition in either yourself or others. This podcast offers information to help the listener cooperate with physicians, mental health professionals or other healthcare providers in a mutual quest for optimal well-being. We advise listeners to carefully review and understand the ideas presented, and to consult your own physician for any medical issues that you may be having. Under no circumstances shall Acubalance, any guests or contributors to the Conscious Fertility podcast, or any employees, associates, or affiliates of Acubalance be responsible for damages arising from the use of the podcast.

Two Passionate experts debate nutrition. Simon Hill is a physiotherapist and nutrition scientist, and host of The Proof Podcast, with a best selling book The Proof is in the Plants. With a masters degree in nutrition, he has a healthy obsession with nutritional science. He began his career interested in the physiology and anatomy related to optimal athletic performance. Then, encouraged by his Dad's heart attack, he turned his attention to nutrition's role in preventing disease and optimizing health. Dr Robert Kiltz is a Diplomat of the American Board of Obstetrics and Gynecology and Fellowship trained and Board Certified in Reproductive Endocrinology and Infertility. He is the Founder and Director of CNY Fertility, one of the largest and most innovative fertility practices in the country, and a thought leader in the keto carnivore movement. Dr. Kiltz believes that an animal-based diet dramatically improves mental clarity, fertility, and health Robert and Simon have very different perspectives on the hierarchy of evidence. Will they be able to see eye to eye on anything? SPONSORS: Cymbiotika: Enter code ELLEN for 20% off + free shipping on your subscription order OSEA: Enter code ELLENF10 for 10% off your order Sayu: get 15% off with code ELLEN Anima Mundi Herbals: Get 20% off with my code ELLENFISHER20 WHERE TO FIND DR KILTZ website Instagram YouTube WHERE TO FIND SIMON website The Proof Podcast Instagram WHERE TO FIND ME The Empowered Pregnancy & Birth course My ebooks My instagram Elevate your videos with record-label quality music from Musicbed

Joining Rena and Dara on the Fertility Forward podcast today is Dr. Erkan Buyuk, who is a board-certified reproductive endocrinologist, infertility specialist, and OB-GYN practicing at RMA of New York's Eastside office. He currently serves as the Director of the Reproductive Endocrinology and Infertility (REI) Fellowship Program and as an examiner for the REI Division of the American Board of Obstetrics and Gynecology. Before joining RMA of New York in 2019, Dr. Buyuk was the Director of the Fertility Preservation Program and Reproductive Tissue Bank and the Director of the REI Fellowship Program at Einstein/Montefiore Medical Center. We are very excited to have Dr. Buyuk share a fascinating abstract presented at the most recent American Society for Reproductive Medicine Conference in Denver. Join the conversation to hear from Dr. Buyuk about why their research topic is important, why they chose to do this study, how they completed it, the results, and much more. Be sure not to miss out on this very insightful episode!  

Robert Kiltz, MD, is the Founder and Director of CNY Fertility. He is a Diplomate of the American Board of Obstetrics and Gynecology and fellowship trained and Board Certified in Reproductive Endocrinology and Infertility. He has been on the carnivore lifestyle for 15 years now and resolved issues like bleeding bowels, psoriasis, arthritis, migraines, ADHD amongst others. Had a fantastic chat with him and learnt a lot! Find him here - IG and X - @doctorkiltz YT - https://www.youtube.com/@doctorkiltz Websites - ketoforfertility.co doctorkiltznutritionalsolutions.com Spotify - Carnivore Conversations

Welcome to Episode 147 of The “So Now What?” Podcast with Lana Manikowski. In this special episode, Lana dives deep into the often-overlooked journey that follows fertility treatments for women who leave without a child. Whether you're a fertility doctor, clinic staff, mental health provider, or a woman navigating life after infertility, this episode highlights the unmet needs and real stories from women who feel unseen after treatment ends. Highlights: Free Masterclass on Handling the Holidays    Join Lana's free MasterClass on November 20 at 6 p.m. CST to learn how to manage holiday gatherings and traditions when childless after infertility. In this live class, you'll gain strategies for building new traditions, handling family dynamics, and creating a plan for holiday celebrations. Register here to reserve your spot!   When Treatment Ends: What Childless Women Really Want    Lana addresses the gap in support often felt after IVF and fertility treatments conclude. Without a plan or follow-up, patients are left to navigate grief, mental health challenges, and marital and social dynamics alone. Lana shares her recent discussions at the American Society for Reproductive Medicine's Congress, where she raised awareness about the importance of continued support for patients who leave treatment without a child.   Real Voices from Infertiole, Childless, Women Who Needed More    Lana shares direct feedback from her community of listeners and followers. Hear heartfelt perspectives from women who longed for acknowledgment and empathy post-treatment, as well as a structured care plan including mental health resources, peer support networks, and follow-up care. These women are calling for a roadmap to help navigate the grief and redefine purpose after infertility.   Advocating for Better Resources when IVF Fails    Lana encourages women to advocate for their needs by requesting additional resources and post-treatment support from clinics and mental health professionals. To the fertility community, Lana calls for a more holistic approach, recognizing that when treatments end, the journey is far from over for many women. Support beyond the treatment room can bridge a painful void.   Why It Matters: This episode sheds light on the immense need for a compassionate continuum of care when ferrility treatment ends without children. From practical resources to sensitive emotional support, The "So Now What?" Podcast aims to uplift women who feel left behind and encourages providers to extend the care they give their patients. Links Mentioned: -Register for the Free Holiday MasterClass here - Free Resource: “The Top 27 Things People Say When You're Childless (…and how to respond)    Download this helpful guide to handle common questions and comments that can feel intrusive or hurtful: https://lanamanikowski.com/thingspeoplesay   For fertility doctors, fertility clinics, and anyone involved in patient care, this episode is a heartfelt reminder that the impact of fertility treatments extends far beyond conception. Understanding and addressing these needs can help more women feel seen and supported through their childless journeys.  

*Hi guys! Liesel here. I wanted to let you know that the Mommy Labor Nurse podcast as you know it is currently getting a HUGE facelift! In the meantime, please enjoy this re-air of a fan favorite episode!! And stay tuned to my instagram for updates on when the new and improved Mommy Labor Nurse podcast will be back with all new episodes!* ****** This week on The Mommy Labor Nurse Podcast, I had the opportunity to chat with the lovely Dr. Natalie Crawford all about infertility and more specifically secondary infertility. Dr. Crawford's Bio: Dr. Natalie Crawford is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and is Director of Patient Experience and Education and co-founder of Fora Fertility, a boutique fertility practice in Austin, Texas. Dr. Crawford values developing close connections with her patients throughout their fertility journeys. She is passionate about education and promotes fertility awareness through social media and community outreach.  Connect with Dr. Crawford: Website: https://www.nataliecrawfordmd.com/ Instagram: @nataliecrawfordmd YouTube: Natalie Crawford, MD TikTok: @nataliecrawfordmd Twitter: @ncrawfordmd Podcast: As a Woman ******  

Hello, beautiful! I'm so glad you're here for this week's episode of The "So Now What?" Podcast.  If you're watching on YouTube, you'll notice I'm in a different setting than usual. I'm currently in Denver, attending the American Society of Reproductive Medicine  (ASRM) Annual Congress. This episode might sound a bit different, but it's coming straight from the heart, and I think it's one you'll connect with if you've been searching for recognition after leaving IVF or fertility treatments without the child you dreamed of. In this episode, I share a deeply personal story about reuniting with my reproductive endocrinologist after six years of wondering what I'd say if we ever crossed paths again. This was the doctor who, back in 2018, told me my only frozen embryo wasn't viable for implantation. It was a moment that shifted everything for me and my journey to motherhood. If you've ever felt like you were left to figure out life on your own after fertility treatments, this episode is for you. I talk about what it was like to finally speak with him face-to-face and express gratitude for his efforts, even though the outcome wasn't what I'd hoped for. It was also an opportunity to tell him how I've moved forward—leaving my corporate career, becoming a life coach, and now dedicating myself to helping women like you who are navigating life after IVF. As you listen, I want you to think about what you would say if you ever had the chance to speak to your own Reproductive Endocrinologist (RE) or fertility team again. What would you want them to know about where you are today? Whether or not you ever get that chance, it's important to acknowledge yourself for how far you've come and the life you're creating, even though it looks different than what you envisioned. After the episode, I encourage you to take a few minutes to write down what your conversation would look like. It's a powerful exercise in recognizing your strength, resilience, and everything you've achieved since your fertility journey ended. And if you're still feeling unsure about what's next, I'm here to help. Book a free Thrive Call with me, and together, we'll create a plan for how you can move forward feeling fulfilled, even without the children you hoped for. It's time to thrive again, and I'm here to walk that path with you. Key Takeaways: You're not alone in feeling left behind after fertility treatments. It's a common experience to feel lost without the support and guidance you once had. Think about what closure looks like for you. Even if you never speak to your RE again, you can still acknowledge what you've accomplished since that part of your life ended. Your story is yours to create. The narrative around living without children doesn't have to be one of loss or sadness. You have the power to rewrite your story into something beautiful and fulfilling. Resources: YouTube:  Watch this week's podcast on Youtube.  Find my YouTube channel here. Free Download: The Top 27 Things People Say When You're Childless and How to Respond. Grab your free copy at https://LanaManikowski.com/thingspeoplesay Thrive Call: Ready to create a plan for thriving without the children you dreamed of? Schedule a free Thrive Call with me at https://LanaManikowski.com/thrivecall Thank you for tuning in this week. Remember, it's never too late to discover your meaning and create a life that feels whole, even if motherhood wasn't part of your story. I'm so proud of you for showing up and doing the work to live life on your terms. Until next week, take care, and know that I see you, I celebrate you, and I love you.  

In episode #336 of The Hormone Puzzle Podcast, our guest Dr. Jaime Knopman, talks about IVF and Egg Freezing- What You Need to Know. More about Dr. Jaime: She is a board-certified reproductive endocrinologist and serves as the Director of Oocyte Cryopreservation at CCRM NY. After graduating Summa Cum Laude and Phi Beta Kappa from the University of Pennsylvania, she earned her medical degree from Mount Sinai School of Medicine and completed residency and subspecialty training at NYU Medical Center. She holds double board certifications in OB/GYN and Reproductive Endocrinology and Infertility and is a fellow of the American College of Obstetrics and Gynecology. As a breast cancer survivor, she is dedicated to fertility preservation for cancer patients. She is also the Medical Director of Chick Mission and advisor to The Breasties, Conceive, and Veracity, and consults for Maven Clinic. She specializes in fertility preservation and infertility treatment, and is a mom of two and a marathon enthusiast. Thank you for listening! This episode is made possible by Puzzle Brew's Fertility Tea: https://hormonepuzzlesociety.com/fertility-tea Follow Dr. Jaime on Instagram: @‌afertilefuture Follow Dr. Kela on Instagram: @‌kela_healthcoach Get your FREE Fertility Meal Plan: https://hormonepuzzlesociety.com/ FTC Affiliate Disclaimer: The disclosure that follows is intended to fully comply with the Federal Trade Commission's policy of the United States that requires to be transparent about any and all affiliate relations the Company may have on this show. You should assume that some of the product mentions and discount codes given are "affiliate links", a link with a special tracking code This means that if you use one of these codes and purchase the item, the Company may receive an affiliate commission. This is a legitimate way to monetize and pay for the operation of the Website, podcast, and operations and the Company gladly reveals its affiliate relationships to you. The price of the item is the same whether it is an affiliate link or not. Regardless, the Company only recommends products or services the Company believes will add value to its users. The Hormone Puzzle Society and Dr. Kela will receive up to 30% affiliate commission depending on the product that is sponsored on the show. For sponsorship opportunities, email HPS Media at media@hormonepuzzlesociety.com

Send us a textIn this week's Taco Bout Fertility Tuesday, Dr. Mark Amols kicks off the "When to Hit the Panic Button" series with a focus on ectopic pregnancies. He explores the risks associated with these high-stakes pregnancies, explains when they occur, and outlines the warning signs that suggest it's time to move on to treatments like IVF. With each ectopic pregnancy, the chance of recurrence rises—so when should you consider more advanced interventions? This episode offers essential guidance for anyone facing repeated ectopics, helping you understand when it's time to take action to protect your health and fertility.Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform. Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com. Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com. Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Did you know that approximately 20% of women suffer with PCOS, or polycystic ovarian syndrome? It affects women of all sizes and shapes and races. For those who also suffer from obesity, having PCOS makes it very difficult to lose weight without intervention. Fertility can also be affected by PCOS and obesity. In this episode, Kate Fuss, an extraordinarily talented PA in the field of bariatrics, interview a renowned Reproductive Endocrinology and Infertility physician, Dr. Carter Owen, about the complex and interrelated issues of PCOS, fertility, insulin resistance and  myriad of issues associated with these struggles. Listen in and learn about how these medical complications are related to obesity, weight loss and fertility. Resources:BariAfterare: www.bariaftercare.comConnie Stapleton PhD website: www.conniestapletonphd.comBariAftercare website: https://www.conniestapletonphd.com/bariaftercareBariAftercare Facebook page (for members only): https://www.facebook.com/groups/BariAftercareKevin Stephens: Your Bariatric Buddy   https://www.facebook.com/groups/yourbariatricbuddy/peopleInstagram: @cale101 (Caleshia Haynes)Instagram: @therealbariboss (Tabitha Johnson)Instagram @drsusanmitchell (Dr. Susan Mitchell)Instagram: @lauraleepreston (Laura Preston)ProCare Vitamins (10% off with code ConnieStapleton)Dr. Carter Owen (TikTok): https://www.tiktok.com/@drcarterowen?_t=8qHKZ6mUftb&_r=1Dr. Carter Owen (website): https://www.ccrmivf.com/northernvirginia/carter-owen-md/Kate Fuss: Banana Bariatrics (online bariatric support community):  https://bananabariatrics.com/Instagram: @banana.bariatricsFacebook: Bariatric Weight Loss Support Group: https://www.facebook.com/groups/bariatricweightlosssurgerySchedule an appointment at Beltline Health: https://beltlinehealth.com/Phone: (470) 419-4380Please subscribe to the show and rate it on Apple Podcasts, download free information at www.conniestapletonphd.com, and follow me on Twitter (@cstapletonphd), Instagram (@cstapletonphd), YouTube, LinkedIn, and on Facebook.

Lauren Rubal, MD, is a USC-trained Reproductive Endocrinology & Infertility physician with a boutique practice in Orange County, CA. Her unique approach focuses on fertility, recurrent miscarriage, painful, irregular, or heavy cycles, and menopause using an integrative lens. Dr. Rubal is double board certified in Integrative Medicine and  Ob/Gyn. She is a FEMM Fellow at the Reproductive Health Research Institute and has completed a Fellowship with the Leonine Forum. Dr. Rubal's greatest career achievement is one defined by its end: leaving a traditional REI partnership to pursue a radically reimagined vision for reproductive care. Her mission is to identify the root cause and heal reproductive issues holistically. She is a Board Member of the Couple to Couple League and serves on the Advisory Board for the non-profit Pre-Health Shadowing. When not at work, she's wrangling her 3 boys with her amazing husband, trying to homestead, or spending time in nature (though, as a native Floridian, usually not in the water). Resources: Fertility Science Institute International Institute for Restorative Reproductive Medicine FACTS About Fertility Natural Womanhood You can connect with Dr. Rubal via Instagram @laurenrubalmd and her website laurenrubalmd.com Related Episodes: Ep 155 - Dr. Marguerite Duane on FACTS About Fertiilty Ep 293 - Dr. Erin Faules on Support for Infertility and Autoimmune Disease If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating or share your feedback on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health. Disclaimer: This podcast is for general information only, and does not provide medical advice.  I recommend that you seek assistance from your personal physician for any health conditions or concerns.

Rachel Weinerman, MD is an Associate Professor at Case Western Reserve University and a Reproductive Endocrinology and Infertility specialist at University Hospitals in Cleveland, OH, where she is the Program Director for the REI Fellowship. She attended Harvard Medical School and completed OB/GYN training at NYU followed by REI fellowship at the University of Pennsylvania. Dr. Weinerman specializes in complex fertility and recurrent pregnancy loss care and is also the Director of Third-Party Reproduction at University Hospitals.  She is an active member of ASRM, SREI, and SART. Her research interests include the impact of ART procedures on implantation environment and neonatal outcomes, and she investigates these areas through clinical and translational methods. She has published numerous research publications, book chapters, and editorials.  Dr. Weinerman is a passionate teacher and educator of medical students, residents, and fellows.   CONNECT DVORA ENTIN: Website: https://www.dvoraentin.com/ Instagram: https://www.instagram.com/dvoraentin YouTube: https://www.youtube.com/@misconceptionspodcast

Obviously, the best way to deal with a concussion is to not get a concussion. But that's not always possible, and nearly 30% of adults report having a concussion in their lifetime. In this episode we cover the basics on how to prevent concussion and what to do if you do hit your head based on what we've learned during this series. We also take a deeper dive into who might be more susceptible to concussion, including if females have special risk factors with special guest Dr. Julie Rios, who is leading a groundbreaking Women's Health Concussion Study that aims to understand the broader effects of concussion on women's health.Julie Rios, MD, specializes in reproductive endocrinology and infertility. She practices at UPMC Center for Fertility & Reproductive Endocrinology and is affiliated with UPMC Altoona, UPMC East, and UPMC Magee-Womens Hospital. You can learn more about her and her work at Julie Rios, MD.Rebecca Rusch is an adventure athlete, 7x World Champion, and 2x Hall of Fame inductee for mountain biking and gravel cycling. She is also a keynote speaker, the bestselling author of Rusch to Glory, and an Emmy Award winner for the documentary Blood Road about her journey to find the spot where her father, a US Air Force pilot, was shot down during the Vietnam War. She is also the founder of the Be Good™ Foundation, which is dedicated to transforming individuals and communities by using the bicycle as a catalyst for healing, empowerment, and evolution. You can learn more about her and her work at rebeccarusch.com.Get Our Active Women's Guide to Concussion: https://www.womensperformance.com/brain-storm-resourcesEpisode 4 Show Notes and Resources: https://www.womensperformance.com/blog/brain-storm-episode-4-podcast-resources Episode 3 Show Notes and Resources: https://www.womensperformance.com/blog/brain-storm-episode-3-podcast-resourcesEpisode 2 Show Notes and Resources: https://www.womensperformance.com/blog/brain-storm-episode-2-podcast-resourcesEpisode 1 Show Notes and Resources: https://www.womensperformance.com/blog/brain-storm-episode-1-the-crash-podcast-resourcesMomentous: Use code BRAINSTORM to get 20% off your first order at https://www.livemomentous.com/

Welcome to another episode of The "So Now What?" Podcast! This week, we're diving into the important topic of body image after infertility—a struggle many women face when their journey to motherhood didn't go as planned. If you've been feeling disconnected or resentful toward your body after years of fertility treatments, this episode is for you. In this episode, you'll learn: Why body image struggles are common for women who are childless after infertility. How to begin the process of healing your relationship with your body by focusing on what your body does for you every day. The benefits of gentle movement and why it's important to move your body with kindness. How to embrace body neutrality as a step toward self-acceptance, even if body positivity feels out of reach right now. Practical self-care tips to help you reconnect with your body, including writing down three things you're grateful for each day. This episode also touches on self-compassion and how small shifts in how you think about your body can lead to big changes in how you feel about it. Whether it's appreciating that your body allows you to take a walk, or simply that it keeps you alive each day, reconnecting with your body is possible—one step at a time. Lana also introduces her Fall Thrive After Infertility Mastermind, a 12-week coaching program designed to support you through challenging holidays like Halloween, Thanksgiving, and Christmas. You'll get the tools and community to help you thrive, even when it feels like life didn't go according to plan. Key Takeaways from This Episode: Body Image After Infertility: Understanding why infertility can make you feel disconnected from your body and how to start healing. Gentle Movement and Self-Care: How small acts of kindness, like yoga or a walk, can help you feel more connected to yourself. Body Neutrality: Why you don't have to love your body right away, but you can learn to accept and care for it. Want More Support? Get the replay of Lana's free class on handling awkward questions about not having kids. Just email her at hi@lanamanikowski.com or DM her on Instagram. Join the Fall Thrive After Infertility Mastermind: Learn more about this supportive, transformative program here. Download Lana's free guide: The Top 27 Things People Say When You're Childless and How to Respond at LanaManikowski.com/thingspeoplesay.  

Presented in partnership with Fertility and Sterility onsite at the 2024 ANZSREI meeting in Sydney, Australia.  The ANZSREI 2024 debate discussed whether patients with unexplained infertility should go straight to IVF. Experts on both sides weighed the effectiveness, cost, and psychological impact of IVF versus alternatives like IUI. The pro side emphasized IVF's high success rates and diagnostic value, while the con side argued for less invasive, cost-effective options. The debate highlighted the need for individualized care, with no clear consensus reached among the audience. View Fertility and Sterility at https://www.fertstert.org/ TRANSCRIPT: Welcome to Fertility and Sterility On Air, the podcast where you can stay current on the latest global research in the field of reproductive medicine. This podcast brings you an overview of this month's journal, in-depth discussion with authors, and other special features. F&S On Air is brought to you by Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine, and is hosted by Dr. Kurt Barnhart, Editor-in-Chief, Dr. Eve Feinberg, Editorial Editor, Dr. Micah Hill, Media Editor, and Dr. Pietro Bordoletto, Interactive Associate-in-Chief. I'd just like to say welcome to our third and final day of the ANZSREI conference. We've got our now traditional F&S podcast where we've got an expert panel, we've got our international speaker, Pietro, and we've got a wonderful debate ahead of us. This is all being recorded. You're welcome, and please think of questions to ask the panel at the end, because it's quite an interactive session, and we're going to get some of the best advice on some of the really controversial areas, like unexplained infertility. Hi, everyone. Welcome to the second annual Fertility and Sterility Journal Club Global, coming to you live from the Australia and New Zealand Society for Reproductive Endocrinology and Infertility meeting. I think I speak on behalf of everyone at F&S that we are so delighted to be here. Over the last two years, we've really made a concerted effort to take the podcast on the road, and this, I think, is a nice continuation of that. For the folks who are tuning in from home and listening to this podcast after the fact, the Australia and New Zealand Society for Reproductive Endocrinology is a group of over 100 certified reproductive endocrinologists across Australia and New Zealand, and this is their annual meeting live in Sydney, Australia. Today's debate is a topic that I think has vexed a lot of individuals, a lot of patients, a lot of professional groups. There's a fair amount of disagreement, and today we're going to try to unpack a little bit of unexplained infertility, and the question really is, should we be going straight to IVF? As always, we try to anchor to literature, and there are two wonderful documents in fertility and sterility that we'll be using as our guide for discussion today. The first one is a wonderful series that was published just a few months ago in the May issue, 2024, that is a views and reviews section, which means there's a series of three to five articles that kind of dig into this topic in depth. And the second article is our professional society guideline, the ASRM Committee Opinion, entitled Evidence-Based Treatments for Couples with Unexplained Infertility, a guideline. The format for today's discussion is debate style. We have a group of six experts, and I've asked them to randomly assign themselves to a pro and a con side. So I'll make the caveat here that the things that they may be saying, positions they may be trying to influence us on, are not necessarily things that they believe in their academic or clinical life, but for the purposes of a rich debate, they're going to have to be pretty deliberate in convincing us otherwise. I want to introduce my panel for today. We have on my immediate right, Dr. Raewyn Tierney. She's my co-moderator for tonight, and she's a practicing board-certified fertility specialist at IVF Australia. And on my immediate left, we have the con side. Going from left to right, Dr. Michelle Quick, practicing board-certified fertility specialist at IVF Australia. Dr. Robert LaHood, board-certified reproductive endocrinologist and clinical director of IVF Australia here in Sydney. And Dr. Clara Bothroyd, medical director at Care Fertility and the current president of the Asia Pacific Initiative in Reproduction. Welcome. On the pro side, going from right to left, I have Dr. Aurelia Liu. She is a practicing board-certified fertility specialist, medical director of Women's Health Melbourne, and clinical director at Life Fertility in Melbourne. Dr. Marcin Stankiewicz, a practicing board-certified fertility specialist and medical director at Family Fertility Centre in Adelaide. And finally, but certainly not least, the one who came with a tie this morning, Dr. Roger Hart, who is a professor of reproductive medicine at the University of Western Australia and the national medical director of City Fertility. Welcome, pro side. Thank you.  I feel naked without it. APPLAUSE I've asked both sides to prepare opening arguments. Think of this like a legal case. We want to hear from the defence, we want to hear from the plaintiffs, and I'm going to start with our pro side. I'd like to give them a few minutes to each kind of introduce their salient points for why we should be starting with IVF for patients with unexplained infertility. Thanks, Pietro. To provide a diagnosis of unexplained infertility, it's really a reflection of the degree investigation we've undertaken. I believe we all understand that unexplained infertility is diagnosed in the presence of adequate intercourse, normal semen parameters, an absence ovulatory disorder, patent fallopian tubes, and a normal detailed pelvic ultrasound examination. Now, the opposing team will try to convince you that I have not investigated the couple adequately. Personally, I'm affronted by that suggestion. But what possible causes of infertility have I not investigated? We cannot assess easily sperm fertilising capability, we cannot assess oocyte quality, oocyte fertilisation potential, embryonic development, euploidy rate, and implantation potential. Surely these causes of unexplained fertility will only become evident during an IVF cycle. As IVF is often diagnostic, it's also a therapeutic intervention. Now, I hear you cry, what about endometriosis? And I agree, what about endometriosis? Remember, we're discussing unexplained infertility here. Yes, there is very good evidence that laparoscopic treatment for symptomatic patients with endometriosis improves pelvic pain, but there is scant evidence that a diagnostic laparoscopy and treating any minor disease in the absence of pain symptoms will improve the chance of natural conception, or to that matter, improve the ultimate success of IVF. Indeed, in the absence of endometriomas, there is no negative impact on the serum AMH level in women with endometriosis who have not undergone surgery. Furthermore, there is no influence on the number of oocytes collected in an IVF cycle, the rate of embryonic aneuploidy, and the live birth rate after embryo transfer. So why put the woman through a painful, possibly expensive operation with its attendant risks as you're actually delaying her going straight to IVF? What do esteemed societies say about a diagnostic laparoscopy in the setting of unexplained infertility? The ESHRE guidelines state routine diagnostic laparoscopy is not recommended for the diagnosis of unexplained infertility. Indeed, our own ANZSREI consensus statement says that for a woman with a minimal and mild endometriosis, that the number of women needed to treat for one additional ongoing pregnancy is between 3 and 100 women with endometriosis. Is that reasonable to put an asymptomatic woman through a laparoscopy for that limited potential benefit? Now, regarding the guidelines for unexplained infertility, I agree the ASRM guidelines do not support IVF as a first-line therapy for unexplained infertility for women under 37 years of age. What they should say, and they don't, is that it is assumed that she is trying for her last child. There's no doubt if this is her last child, if it isn't her last child, sorry, she will be returning, seeking treatment, now over 37 years of age, where the guidelines do state there is good evidence that going straight to IVF may be associated with higher pregnancy rates, a shorter time to pregnancy, as opposed to other strategies. They then state it's important to note that many of these included studies were conducted in an area of low IVF success rates than those currently observed, which may alter this approach, suggesting they do not even endorse their own recommendations. The UK NICE guidelines, what do they say for unexplained infertility? Go straight to IVF. So while you're listening to my esteemed colleagues on my left speaking against the motion, I'd like to be thinking about other important factors that my colleagues on my right will discuss in more detail. Consider the superior efficacy of IVF versus IUI, the excellent safety profile of IVF and its cost-effectiveness. Further, other factors favouring a direct approach to IVF in the setting of unexplained infertility are what is the woman's desired family? We should not be focusing on her first child, we should be focusing on giving her the family that she desires and how we can minimise her inconvenience during treatment, as this has social, career and financial consequences for those impediments for her while we attempt to help her achieve her desired family. Thank you. APPLAUSE I think the young crowd would say that that was shots fired. LAUGHTER Con side? We're going to save the rebuttal for the time you've allocated to that, but first I want to put the case about unexplained infertility. Unexplained infertility in 2024 is very different to what it was 10 and 20 years ago when many of the randomised controlled trials that investigated unexplained infertility were performed. The armamentarium of investigative procedures and options that we have has changed, as indeed has our understanding of the mechanisms of infertility. So much so that that old definition of normal semen analysis, normal pelvis and ovulatory, which I think was in Roy Homburg's day, is now no longer fit for purpose as a definition of unexplained infertility. And I commend to you ICMART's very long definition of unexplained infertility, which really relies on a whole lot of things, which I'm going to now take you through what we need to do. It is said, or was said, that 30% of infertility was unexplained. I think it's way, way less than that if we actually look at our patients, both of them, carefully with history and examination and directed tests, and you will probably reduce that to about 3%. Let me take you through female age first. Now, in the old trials, some of the women recruited were as old as 42. That is not unexplained infertility. We know about oocyte aneuploidy and female ageing. 41, it's not unexplained. 40, it's not unexplained. 39, it's not unexplained. And I would put it to you that the cut-off where you start to see oocyte aneuploidy significantly constraining fertility is probably 35. So unexplained infertility has to, by definition, be a woman who is less than 35. I put that to you. Now, let's look at the male. Now, what do we know about the male, the effect of male age on fertility? We know that if the woman is over 35, and this is beautiful work that's really done many years ago in Europe, that if the woman is over 35 and the male is five years older than her, her chance of natural conception is reduced by a further 30%. So I put it to you that, therefore, the male age is relevant. And if she's 35 and has a partner who's 35 years older than her or more, it's not unexplained infertility. It's related to couple age. Now, we're going to... So that's age. Now, my colleagues are going to take you through a number of treatment interventions other than IVF, which we can do with good effect if we actually make the diagnosis and don't put them into the category of unexplained infertility. You will remember from the old trials that mild or moderate or mild or minimal endometriosis was often included, as was mild male factor or seminal fluid abnormalities. These were really multifactorial infertility, and I think that's the take-home message, that much of what we call unexplained is multifactorial. You have two minor components that act to reduce natural fecundability. So I now just want to take you through some of the diagnoses that contribute to infertility that we may not, in our routine laparoscopy and workup, we may not pick up and have previously been called unexplained infertility. For instance, we know that adenomyosis is probably one of the mechanisms by which endometriosis contributes to infertility. Chronic endometritis is now emerging as an operative factor in infertility, and that will not be diagnosed easily. Mild or minimal endometriosis, my colleagues will cover. The mid-cycle scan will lead you to the thin endometrium, which may be due to unexpected adhesive disease, but also a thin endometrium, which we know has a very adverse prognostic factor, may be due to long-term progestin contraception. We are starting to see this emerge. Secondary infertility after a caesarean section may be due to an isthma seal, and we won't recognise that unless we do mid-cycle scans. That's the female. Let's look at the male. We know now that seminal fluid analysis is not a good predictor of male fertility, and there is now evidence from Ranjith Ramasamy's work that we are missing clinical varicoceles because we failed to examine the male partner. My colleagues will talk more about that. We may miss DNA fragmentation, which again may contribute via the basic seminal fluid analysis. Now, most of these diagnoses can be made or sorted out or excluded within one or two months of your detailed assessment of both partners by history and examination. So it's not straight to IVF, ladies and gentlemen. It's just a little digression, a little lay-by, where you actually assess the patient thoroughly. She did not need a tie for that rebuttal. LAUGHTER Prasad. Thank you. Well, following from what Professor Hart has said, I'm going to show that IVF should be a go-to option because of its effectiveness, cost-effectiveness and safety. Now, let me first talk about the effectiveness, and as this is an interaction session, I would like to ask the audience, please, by show of hands, to show me how many of you would accept a medical treatment or buy a new incubator if it had a 94% chance of failure? Well, let the moderator please note that no hands have been raised. Thank you very much. Yet, the chance of live birth in Australian population following IUI is 6%, where, after IVF, the live birth is 40%. Almost seven times more. Now, why would we subject our patients to something we ourselves would not choose? Similarly, findings were reported from international studies that the hazard ratio of 1.25 favouring immediate IVF, and I will talk later about why it is important from a safety perspective. Cost-effectiveness. And I quote ESHRE guidelines. The costs, treatment options have not been subject to robust evaluations. Now, again, I would like to ask the audience, this time it's an easy question, how many of you would accept as standard an ongoing pregnancy rate of at least 38% for an average IVF cycle? Yeah, hands up. All right, I've got three-quarters of the room. OK. Well, I could really rest my case now, as we have good evidence that if a clinic has got an ongoing pregnancy rate of 38% or higher with IVF with single embryo transfer, then it is more effective, more cost-effective, and should be a treatment of choice. And that evidence comes from the authors that are sitting in this room. Again, what would the patients do? If the patients are paying for the treatment, would they do IUI? Most of them would actually go straight to IVF. And we also have very nice guidelines which advise against IUI based on cost-effectiveness. Another factor to mention briefly is the multiple births, which cost five to 20 times more than singleton. The neonatal cost of a twin birth costs about five times more than singletons, and pregnancy with delivery of triplets or more costs nearly 20 times. Now, the costs that I'm going to quote are in American dollars and from some time ago, from Fertility and Sterility. However, the total adjusted all healthcare costs for a single-dom delivery is about US$21,000, US$105,000 for twins, and US$400,000 for triplets and more. Then the very, very important is the psychological cost of the high risk of failure with IUI. Now, it is well established that infertility has a psychological impact on our patients. Studies have shown that prolonged time to conception extends stress, anxiety, and depression, and sexual functioning is significantly negatively impacted. Literature shows that 56% of women and 32% of men undergoing fertility treatment report significant symptoms of depression, and 76% of women and 61% of men report significant symptoms of anxiety. Shockingly, it is reported that 9.4% of women reported having suicidal thoughts or attempts. The longer the treatment takes, the more our patients display symptoms of distress, depression, and anxiety. Safety. Again, ESHRE guideline says the safety of treatment options have not been subjected to robust evaluation. But let me talk you through it. In our Australian expert hands, IVF is safe, with the risk of complications of ectopic being about 1 in 1,500 and other risks 1 in 3,000. However, let's think for a moment on impact of multiple births. A multiple pregnancy has significant psychological, physical, social, and financial consequences, which I can go further into details if required. I just want to mention that the stillbirth rate increases from under 1% for singleton pregnancies to 4.5% for twins and 8.3% for higher-order multiples, and that multiple pregnancies have potential long-term adverse health outcomes for the offspring, such as the increased risk of health issues through their life, increased learning difficulties, language delay, and attention and behavior problems. The lifelong disability is over 25% for babies weighing less than 1 kilogram at delivery. And please note that the quoted multiple pregnancy rates with IUI can reach up to 33%, although in expert hands it's usually around 15%, which is significantly higher than single embryo transfer. In conclusion, from the mother and child safety perspective, for the reason of medical efficacy and cost effectiveness, we have reasons to believe you should go straight to IVF. We're going to be doing these debates more often from Australia. This is a great panel. One side, please. Unexplained infertility. My colleagues were comparing IUI ovulation induction with IVF, but there are other ways of achieving pregnancies with unexplained fertility. I'm going to take the patient's perspective a little bit here. It's all about shared decision-making, so the patient needs to be involved in the decision-making. And it's quite clear from all the data that many patients with unexplained infertility will fall pregnant naturally by themselves even if you do nothing. So sometimes there's definitely a place in doing nothing, and the patient needs to be aware of that. So it's all about informed consent. How do we inform the patient? So we've got to make a proper diagnosis, as my colleague Dr. Boothright has already mentioned, and just to jump into IVF because it's cost-effective is not doing our patients a justice. The prognosis is really, really important, and even after 20 years of doing this, it's all about the duration of infertility, the age of the patient, and discussing that prognosis with the patient. We all know that patients who have been trying for longer and who are older do have a worse prognosis, and maybe they do need to look at treatment quicker, but there are many patients that we see that have a good prognosis, and just explaining that to them is all they need to achieve a pregnancy naturally. And then we're going to talk about other options. It's wrong not to offer those to patients, and my colleague Dr. Quick will talk about that in a moment. Look, we've all had patients that have been scarred by IVF who've spent a lot of money on IVF, did not fall pregnant, and I think the fact that they weren't informed properly, that the diagnosis wasn't made properly, is very frustrating to them. So to just jump into IVF again is not doing the patients a justice. And look, there are negatives to IVF. There's not just the cost to the patient, the cost to society. As taxpayers, we all pay for IVF. It's funded here, or sponsored to some degree, and it's also the family and everyone else that's involved in paying for this. So this is not a treatment that is without cost. There are some harms. We know that ovarian hyperstimulation syndrome still exists, even though it's much less than it used to be. There's a risk of infection and bleeding from the procedures. And we can look at the baby. The data still suggests that babies born from IVF are smaller and they're born earlier, and monozygotic twinning is more common with IVF, so these are high-risk pregnancies, and all this may have an impact on the long-term health of the babies somewhere down the track at the moment. That is important to still look out for. But I come back to the emotional toll. Our colleagues were saying that finishing infertility quicker helps to kind of reduce the emotional toll, but the procedure itself does have its own toll if it doesn't work, and so we've got to prepare patients, have them informed. But at the end of the day, it's all about patient choice. How can a patient make a choice if we don't make a proper diagnosis, give them a prognosis and offer them some other choices that exist? And running the anchor leg of the race for the pro side. IVF in couples with unexplained infertility is the best tool we have in our reproductive medicine toolkit for multiple reasons. Professor Hart has clarified the definition of unexplained infertility. As a reflection of the degree of investigation we've undertaken. He's explained that IVF is often importantly diagnostic as well as therapeutic, both demonstrating and overcoming barriers to natural conception. Dr Stankiewicz has convinced us that IVF is efficient, safe and cost-effective. My goal is to show you that IVF is the correct therapy to meet the immediate and big picture family planning goals for our patients with unexplained infertility. More than 80% of couples with defined unexplained infertility who attempt IVF treatment will have a baby. In Australia, ANZSREI data shows us that the average age of the female patients who present with primary unexplained infertility is over 35 years. And in fact the average is 38 years. We're all aware that the average age of first maternity in Australia has progressively become later over the past two decades. Currently it stands in the mothers and babies report at 32 years. If the average age of first maternity is 32 years, this means that at least 50% of women attempting their first pregnancy are over 32 years. Research I conducted in Melbourne University with my student Eugenie Pryor asking university students of their family planning intentions and aspirations demonstrated that most people, male and female, want to be parents and most want to have more than one child. However, in Australia, our most recent survey shows that births are at an all-time low, below replacement rate and falling, with an ever greater proportion of our population being unable to have the number of children they aspire to and an ever growing proportion seeking assisted reproductive care. Fertility declines with age. Factors include egg quality concerns, sperm quality concerns and the accumulation of pathologies over time. Adenomyosis, fibroids, endometriosis are concerns that no person is born with. They exist on a spectrum and progress over time and may be contributing factors for unexplained infertility. Our patients, when we meet them, are the best IVF candidates that they will ever be. They are the youngest they will ever be and they have the best ovarian reserve they will ever have. They will generate more euploid embryos now than they will in years to come. The sooner we get our patients pregnant, the sooner they will give birth. It takes nine months to have a baby, 12 months potentially to breastfeed and wean and of course most patients will need time to care for a young infant and recover prior to attempting another pregnancy. IVF and embryo banking may represent not only their best chance of conception with reduced time to pregnancy but also an opportunity for embryo banking to improve their cumulative live birth rate potential over time. By the time our 38-year-old patient returns to try to conceive for a second child, she will undoubtedly be aged over 40. Her chance of live birth per cycle initiated at IVF at this stage has reduced phenomenally. The ANZSREI dataset from our most recent report quotes that statistic to be 5%. Her chance of conception with an embryo frozen at 38 years, conversely, is one in three to one in four. There is no room for doubt that IVF gives couples with unexplained infertility not only the most effective treatment we have to help them have a baby, but their best opportunity to have a family. Last but certainly not least, Dr. Quick, to round out the con sides arguments before we open up for rebuttal. And I'll make a small plea that if you have questions that you'd like to pose directly to the panel, prepare them and we'll make sure we get to them from the audience shortly. Thank you. So, whilst we have heard that we may be bad doctors because we're delaying our patients' time to pregnancy, I would perhaps put it to you that unexplained infertility is a diagnosis which is made based on exclusion. So perhaps you are the bad doctors because you haven't looked hard enough for the cause of the unexplained infertility. So, in terms of the tests that we all would do, I think, we would all ensure that the woman has an ovarian reserve. We would all ensure that she has no structural anomaly inside the uterus. We would all ensure that her tubes are patent. We would all ensure that she has regular cycles. We would ensure that he has a normal semen analysis. I think these are tests that we would all do when trying to evaluate a couple for fertility who are struggling to conceive. And therefore, the chance of them getting pregnant naturally, it's never going to be zero. And one option therefore, instead of running straight to IVF, would be to say, OK, continue timed intercourse because the chance of you conceiving naturally is not actually zero and this would be the most natural way to conceive, the cheapest way to conceive, the least interventional way to conceive. And whether that be with cycle tracking to ensure appropriate timed intercourse, whether that be with cycle tracking to ensure adequate luteal phase support. When you clear the fallopian tubes, we know that there are studies showing an improvement in natural conception. Lipidol or oil-based tubal flushing techniques may also help couples to conceive naturally. And then you don't have this multiple pregnancy rate that IVF has. You don't have the cost that you incur with IVF, not just for the couple but to Australian society because IVF is subsidised in this country. You don't have the risks that the woman goes through to undergo IVF treatment. You don't have the risks that the baby takes on being conceived via IVF. And so conceiving naturally, because it's not going to be zero, is definitely an option for these couples. In terms of further tests or further investigations that you could do, some people would argue, yes, we haven't looked hard enough for the reason for infertility, therefore we know that ultrasound is notoriously bad at picking up superficial endometriosis. We know that ultrasound cannot pick up subtle changes in the endometrium, as Dr Boothroyd referred to chronic endometritis, for example. So these patients perhaps should undergo a hysteroscopy to see if there is an endometrial issue. Perhaps these patients should undergo a laparoscopy to see if there is superficial endometriosis. And there are meta-analyses showing that resecting or treating superficial endometriosis may actually help these couples conceive naturally down the track and then therefore they avoid having more interventional treatment in order to conceive. There is also intrauterine insemination with or without ovarian stimulation, which may improve their chances of conceiving naturally. And that again would be less invasive, less intervention and cheaper for the patient. And we know that therefore there are a lot of other treatment options available to help these couples to conceive. And if it's less invasive, it's more natural, it's cheaper, that ends up being better for the patient. Psychologically as well, which the other side have brought up, even with Dr Stankiewicz's 38% ongoing pregnancy rate, that also means that 62% of his patients are not going to be pregnant. The psychological impact of that cannot be underestimated because for a lot of patients, IVF is your last resort. And when you don't get pregnant with IVF, that creates an issue too for them. Embryo banking, which was also brought up, what happens when you create surplus embryos and what's the psychological impact of having to deal with embryos that you are then not going to use in the future? So therefore for those reasons we feel that IVF is not your first line treatment for couples who are diagnosed with unexplained infertility. There are many other ways to help these couples to conceive. We just have a multitude of things to unpack. And I want to start off by opening up an opportunity for rebuttal. I saw both sides of the panel here taking diligent notes. I think all of us have a full page worth of things that kind of stood out to us. Since the pro side had an opportunity to begin, I'm actually going to start with the con side and allow the con side to answer specific points made by the pro side and provide just a little bit more detail and clarity for why they think IVF is not the way forward. My learned first speaker, wearing his tie of course, indicated that it was all about laparoscopy and IUI, and it's way more than that. I just want to highlight to you the paper by Dressler in 2017 in the New England Journal of Medicine, a randomised controlled trial of what would be unexplained infertility according to the definition I put out, the less than 35 ovulatory normal semen analysis. And the intervention was an HSG with either oil-based contrast or water-based contrast. And over the six months, there was clear separation, and this is an effective treatment for unexplained infertility or mild or minimal endometriosis, however it might work. And there's probably separation out to three years. So as a single intervention, as an alternative to IVF, the use of oil-based contrast is an option. So it's not just about laparoscopy and IUI. I guess the other thing the second speaker did allude to, fairly abysmal success rates with IUI being 6%. That is a problem, and I would like to allude to a very good pragmatic trial conducted by Cindy Farquhar and Emily Lu and their co-workers in New Zealand that really swung the meta-analysis for the use of clomiphene and IUI to clinical efficacy. And they reported a 33% chance of live birth in their IUI and clomiphene arm. I'm going across to Auckland to see what the magic is in that city. What are they doing? The third speaker did allude to the problem of declining fertility, a global problem, and Australia is not alone. We have solved the problem to date, which we've had for 40 years, with immigration. But Georgina Chambers' work shows beautifully that IVF is not the answer to the falling fertility rates. It is a way more complex social problem and is probably outside the scope of today's discussion. So those are my three rebuttals to our wonderful team. Thank you very much. So... You can't bury them. We'll give them an opportunity. Thank you for the opportunity. So I'd like to address some of the points that my learned debaters on the opposition raised. The first speaker really suggested quite a few things that we probably omitted, like endometritis, failing to examine the male. I think things like that... I think, at a good history, that is essential what we do as part of our investigation. We're looking for a history of cesarean section, complications subsequent to that. We're doing a detailed scan, and that will exclude the fact that she's got a poor endometrium development, she's got a cesarean scar niche. A good history of a male will allude to the fact that he has some metabolic disorder, degree of hypogonadism. So we're not delaying anything by these appropriate investigations. Adenomyosis will be raised. I talked about a detailed gynaecological examination. So I honestly think that a very... As my opening line was, a detailed gynaecological scan, obviously with a very good history taken, is essential. We're not delaying her opportunity to go straight to IVF if we've addressed all these factors. The second speaker talked about shared decision-making, and we'd all completely agree with that. But we have to be honest and open about the success, which my second speaker talked about, the success of the treatment we're offering. And one thing we should sort of dwell on is it's all... It's a fundamental description of the success of treatment is probably all about prognostic models, and that who not model, that's the original model about the success of conception, is really... Everything flows on from that, which basically talks about a good prognosis patient. 30% chance of live birth after a year. That's what they talk about, a good prognosis patient. Perhaps the rest of the world is different to your average Australian patient, but if we talked about that being a good prognosis, you've got a one in three chance of being pregnant by a year. I think most of our patients would throttle us. So that is what all the models are sort of based on, that being a good prognosis patient. So I completely agree with the second speaker that we do have a shared decision. We have to be honest with our patients about the success. We have to be honest about giving them the prognosis of any treatment that we offer. But really, as my third speaker was talking about, it's about giving the patient the opportunity to have a family, minimal career disruption, minimal life disruption. We have to be honest and talk about the whole picture. They're focused on the first child because really they can't think beyond that. We're talking about giving them the family that they need. The third speaker spoke very eloquently about the risks associated with the treatment we offer. I believe we offer a very safe service with our IVF, particularly in Australia, with our 2% twin pregnancy rate. We talk about the higher risk of these pregnancies, but they perhaps don't relate to the treatment we're offering. Perhaps, unfortunately, is the patient, if she's got polycystic ovary syndrome, if she's more likely to have diabetes, premature delivery, preeclampsia. So I think often the risks associated with IVF and potentially the risks associated to the child born from IVF perhaps don't relate to the treatment of IVF per se. It may well be the woman and perhaps her partner, their underlying medical condition, which lead those risks. So I strongly would encourage you to believe that you take a very good history from your patient, you do a thorough investigation, as I've alluded to, looking for any signs of ovulatory disorder, any gynaecological disorder by a detailed scan, checking tubal patency and a detailed history and the similarities from the man, and then you'll find you're probably going straight to IVF. APPLAUSE I'd like to talk a bit about the embryo banking and having been in this field for a long time, as a word of caution, we're setting a lot of expectations. I remember going to an ASRM meeting probably 10 years ago where they had this headline, all your embryos in the freezer, your whole family in the freezer, basically expecting that if you get four or five embryos frozen that you'll end up with a family at the end. We all know that for the patient, they're not a percentage, it's either zero or 100%. And if all the embryos don't work, they don't have a family at the end, you know, it didn't work for them and their expectations haven't been met. And the way we talk about the percentages and that we can solve the patient's problems, that we can make families, it doesn't always happen. So the expectations our position is setting here, we're not always able to meet and so we're going to end up with very unhappy patients. So this is just a warning to everyone that we need to tell people that this doesn't always work and sometimes they'll end up with no success at all. And from that point of view, I think the way it's presented is way too simplistic and we've got to go back to looking at the other options and not promising things we can't always deliver. So just taking into account all our esteemed interlocutors have said, we don't necessarily disagree with the amount of investigations that they described because nowhere in our argument we said that as soon as the patient registers with the receptionist, they will direct it to an IVF lab. I think to imply so, we'd be very rich indeed. Maybe there are some clinics that are so efficient. I don't know how it works overseas, but certainly not in Australia. The other point that was made about the cost of IVF and our, again, esteemed interlocutors are very well aware from the studies done here in Australia that actually every baby that we have to conceive through IVF and create and lives is actually more than 10 to 100 times return on investment because we are creating future taxpayers. We are creating people that will repay the IVF treatment costs over and over and over again. So I'll put to you, Rob, that if you are saying that we can't do IVF because it costs money, you are robbing future treasurers of a huge amount of dollars. I hope the American audience is listening. In America, we call embryos unborn children in freezers in certain parts and here they're unborn taxpayers. Con side, final opportunity for rebuttal before some audience questions and one more word from the pro side. Well, actually, Dr Stankiewicz was very happy to hear that you're not going to send your patients straight to the IVF lab because we've managed to convince you that that's not the right thing to do. I clearly have forgotten how to debate because I did all my rebuttals at the end of my presentation but essentially I'll recap because when we're talking about IVF, as we're saying, the chance of pregnancy is not going to be 100% and so there is a psychological impact to IVF not working. There is a psychological impact to banking embryos and creating surplus embryos that eventually may not be used and they were my main rebuttal points in terms of why IVF was not the first-line treatment. Thank you. So we've heard from the opposition some very valid points of how our patients can be psychologically impacted when fertility treatment is unsuccessful. I will again remind you that IVF is the most successful fertility treatment we have in our treatment armoury. We are most likely to help our patients have a baby with IVF. The cumulative pregnancy rates for IVF have started back in the late 70s and early 80s in single-digit percentages. We now, with a best prognosis candidate, have at least a one-in-two chance of that patient having a baby per embryo transfer and in our patients with unexplained infertility, the vast majority of our patients will have success. We also heard from the negative team about the significant chance of pregnancy in patients with expectant management. You're right, there's not a 0% chance of natural conception in patients who have unexplained infertility, but there is a not very good chance. We know from data that we've had for a really long time, going back as far as the Hutterite data, to today's non-contradictory models, which tell us that a couple's chance of conception per month in best prognosis candidates is one in five. If they've been trying for six months, it's one in ten. If they've been trying for 12 months, it's only 5%, and if they've been trying for 24 months, it's less than 1%. So it may not be zero, but it isn't very good. In terms of our team reminding us of the extended ICMART definition of unexplained infertility, we don't argue. When we say someone has unexplained infertility, we make the assumption that they have been comprehensively diagnosed by a robust reproductive endocrinologist, as everyone in this room is. And I would say one closing rebuttal. IUI success rates have been the same for the last 50 years, whereas IVF success rates continue to improve. Why would you offer your patient a treatment from 50 years ago when you can offer them one from today? Thank you. APPLAUSE I'm going to take a personal privilege and ask the first question, in hoping that the microphone makes its way to the second question in the audience. My colleagues on the pro side have said IVF, IVF, IVF. Can you be a little bit more specific about what kind of IVF? Do you mean IVF with ICSI? Do you mean IVF, ICSI, and PGT? Be a little bit more deliberate for us and tell us exactly how the patient with unexplained infertility should receive IVF. As I said in my statement, I think it's a diagnostic evaluation. I think there is an argument to consider ICSI, but I think ICSI does have some negative consequences for children born. I think perhaps going straight to ICSI is too much. I think going straight to PGTA perhaps is too much, unless there is something in their history which should indicate that. But we're talking about unexplained infertility. So I believe a standard IVF cycle, looking at the opportunity to assess embryonic development, is the way to go. I do not think you should be going straight to ICSI. I think the principle of first do no harm is probably a safe approach. I don't know whether my colleagues have some other comments, but I think that would be the first approach rather than going all guns blazing. I can understand, though, in different settings in the world, there may have... We're very fortunate in Australia, we're very well supported from the government support for IVF, but I think the imperatives in different countries may be different. But I think that approach would be the right one first. We'll start with a question from the audience. And if you could introduce yourself and have the question allowed for our members in the audience who are not here. It's Louise Hull here from Adelaide. The question I would like to put to both the pro and con team is that Geeta Mishra from the University of Queensland showed that if you had diagnosed endometriosis before IVF, you were more likely to have a pregnancy and much less likely to have high-order IVF cycles. Given that we now have really good non-invasive diagnostics, we're actually... A lot of the time we can pick up superficial or stage 2 endometriosis if you get the right scan. We're going to do IVF better if we know about it. Can you comment on that impacting even the diagnosis of unexplained infertility? Thanks. I'd love to take that. Can I go first, Roger? LAUGHTER Please do. Look, I'd love to take that question. It's a really good question. And, of course, this is not unexplained infertility, so this is outside the scope here. And I think, really, what we're seeing now, in contrast to where we were at the time of the Markku study, which was all... And the Tulandy study on endometrioma excision, we now see that that is actually damaging to fertility, particularly where there is ovarian endometriosis, and that we compromise their ovarian reserve by doing this surgery before we preserve their fertility, be it oocyte cryopreservation or embryo cryopreservation. So I think it's a bit outside the scope of this talk, but I think the swing of the data now is that we should be doing fertility preservation before we do surgery for deeply infiltrated ovarian endometriosis. And that would fit with Gita's findings. A brief response. Thanks very much, Louise. Yeah, we're talking about unexplained infertility here, and my opening line was we need a history, but a detailed gynaecological ultrasound. I think it's important it's a really good ultrasound to exclude that, because the evidence around very minor endometriosis is not there. I agree with significant endometriosis, but that's not the subject of this discussion. But I do believe with very minimal endometriosis there is really no evidence for that. Janelle MacDonald from Sydney. I'm going to play devil's advocate here. So everyone is probably aware of the recent government inquiry about obstetric violence. I'm a little concerned that if we are perceived to be encouraging women to IVF first, are we guilty as a profession of performing fertility violence? That's just digressing a little bit, just thinking about how the consumers may perceive this. I think our patients want to have a baby, and that's why they come to see us, and that's what we help them to do through IVF. I'm not sure the microphone's working. And just introduce yourself. I'm from Sydney, Australia. Can I disagree with you, Roger, about that question about minimal and mild endometriosis? I'm 68, so I'm old enough to have read a whole lot of papers in the past that are probably seen as relics. But Mark Khoo published an unusual study, because it was actually an RCT. Well, sorry, not an RCT. It was a study whereby... Well, it was an RCT, and it was randomised really well. It was done in Canada, and there were about 350 subjects, and they were identified to have stage 1 or stage 2 endometriosis at laparoscopy. And the interesting thing is it was seen as an intervention which didn't greatly increase the chance of conception, but it doubled the monthly chance of conception. So there was clearly a difference between those patients who didn't have endometriosis and those that had stage 1 and stage 2 endometriosis. So the intervention did actually result in an improvement. One of the quotes was, well, I heard since then, well, it didn't make much difference. But when you realise that infertility is multifactorial, there were probably other factors involved as well. So any increase like that in stage 1 and stage 2 endometriosis sufferers was clearly beneficial for them. So I wouldn't disagree with you completely, but I do think you've got to take it on board that there is some evidence that surgical intervention can help. And certainly in those patients whereby the financial costs of IVF are still quite, even in Australia, astronomical. Many patients can get this through the public sector or the private sector treatment of their endometriosis laparoscopically very cheaply or at no cost. Thanks, Dr Persson. So you're right that there was also a counter-randomised controlled trial by the Grupo Italiano which was a counter to that. And actually did not show any benefit. But I believe the Marcu study demonstrated an excess of conception and with treatment of minima and endometriosis of about 4% per month for a few months. So absolutely, that shared decision-making. Personally, I wouldn't like a laparoscopy to give me an extra 4% chance of a natural conception for four months, which I think the data was. So basically, the basis to my statement that I said without going into great detail was a review article published by Samy Glarner recently in Reproductive Biology and Endocrinology. And their conclusions were what I basically said, that from looking at all the data, there is no real evidence of intervention for minor endometriosis. We're not talking about pain or significant diagnosed endometriosis on the outcomes of IVF, ovarian reserve, egg quality, embryo development, and euploidy rate. So that was the basis of my... I hate to disagree... I hate to agree with my opponents in a debate, but I'm going to... But there is actually a new network analysis by Rui Wang and some serious heavyweights in evidence-based medicine that pulls together the surgical studies. And the thing that made the most difference to this of mild and minimal endometriosis from a fertility point of view, not pain, is the use of oil-based uterine contrast. And I commend that paper to you, which fits with exactly what Roger is saying. Hi, my name's Lucy Prentice.  I work in Auckland. And I just wanted to point out the New Zealand perspective a little bit. Where we come from a country with very limited public funding for IVF. I'm currently running an RCT with Cindy Farquad directly looking at IVF versus IUI for unexplained infertility. And I'd just like to point out that both the ASRM and ESHRE guidelines, which are the most recent ones, both suggest that IUI should be a first-line treatment with oral ovarian stimulation. We have no evidence that IVF is superior based on an IPD meta-analysis published very recently and also a Cochrane review. And although we would love to be able to complete the family that our patients want from IVF and embryo banking, that option is really not available to a lot of people in New Zealand because of prohibitive costs. We know that IUI with ovarian stimulation is a very effective treatment for people with poor prognosis and unexplained infertility. And I also would just like to add that there's not a cost-effectiveness analysis that shows an improvement in cost-effectiveness for IVF. There's also never been a study looking at treatment tolerability between the two, so I don't think that you can say that IVF is a treatment that people prefer over IUI. So I may turn around and shoot myself in the foot based on our results that will be coming out next year, but I think at the moment I don't think you can say that IVF is better than IUI with ovarian stimulation for unexplained. We have time for two more questions from the audience, and we have two hands in the back. Now we can. It's the light green. OK. Hossam Zini from Melbourne. Thank you very much for the debate. It's very interesting. The problem is that all of the studies that have been done about comparing IUI to IVF, they are not head-to-head studies. The designs are different. They are having, like, algorithmic approach. For example, they compare three or four or five cycles of IUI to one cycle of IVF. But about 10 years ago, our group at the Royal Women's Hospital, we have done a study, a randomized control study, to compare IUI to IVF head-to-head, and we randomized the patients at the time of the trigger who only developed, so we did a low stimulation to get two to three follicles only, and that's why it was so hard to recruit lots of patients. So the criticism that was given to the study that it's a small sample size, but we end up with having IVF as a cost-effective treatment. Our IVF group had a live birth rate about 38%, and on the IUI, 12%. And with our cost calculations, we find out that the IVF is much more cost-effective than the IUI. But I believe that we all now believe in individualized kind of treatment, so patients probably who are younger than 34 years old probably wouldn't go straight to IVF. Maybe I'll do a laparoscopy and a histroscopy first, okay, and we may give them a chance to achieve a natural conception in the next three months or so. Patients who are older than 35, 37 years old probably will benefit straight from IVF. But again, in day-to-day life cases, we will not force the patient to go straight to IVF. I will talk to her and I'll tell her, these are your options, expectant treatment. This is the percentage that you would expect. IUI, this is what you expect. IUI with ovulation induction, this is what you expect. IVF, this is what you expect. And then she will discuss that with her partner and come back to me and tell me what she wants to do. Thanks. I saw a hand show up right next to you, so I'll add one more question given our time limitation. Thanks so much, Kate Stone-Mellon. I'd like to ask our panel to take themselves out of their role playing and put themselves in another role where they were the head of a very, very well-funded public service, and I'd like to ask the two sides what they really think about what they would do with a patient at the age of 35 with 12 months of unexplained infertility. Well, can I say that? Because that's my role in a different hat. LAUGHTER So, yeah, I run the state facility service in Western Australia. We looked at the data, because obviously that's what we're doing, IUI, IVF, and unfortunately we stopped doing IUI treatment. The success rate was so low. So we do go straight to IVF with unexplained infertility. Disappointing, as I'm sure you hear that, Kate, that we do. We looked at the data. Yeah, I think that I would still offer the patients the options, because some people don't want to do IVF. Even though it's completely free, they may not still want to do the injections and the procedure and take on the risks of the actual egg collection procedure. I don't know, religious issues with creating embryos. Yeah, I would still give patients the option. We have time for one more question in the back. We'll take the other ones offline afterwards. We'll get you a microphone just to make sure our listeners afterwards can listen. Following on from the New Zealand experience, which I've experienced... Hello? Yeah. From the New Zealand experience, and having worked here extensively and in New Zealand, you're not comparing apples with apples, Claire. That unexplained couple in New Zealand will wait five years to get funding and currently perhaps another two years to get any treatment. That's then an apples group compared to the pilot group who may, in fact, walk past the hospital and get treatment. The other thing about this, I think, that we need to forget, or don't forget, is the ethics of things here, two of which is that the whole understanding of unexplained infertility needs research and thinking. And if it wasn't for that understanding of what is the natural history of normal and then the understanding of pathology, we wouldn't do a lot of things in medicine. So if we have got a subgroup here that's unexplained, it's not just to the patient, we have a responsibility to future patients and ourselves to be honest and do research and learn about these factors. Now, it doesn't answer the debate, but it is something that's what drives the investigation and management of unexplained delay. And, for example, at the moment, there's quite a discussion about two issues of ethics, one about the involuntary childlessness of people that don't get to see us but don't have those children that they wanted to have because they didn't want to undergo treatment, or it was the involuntary childlessness of a second or subsequent child. And that's quite a big research issue in Europe, I realise, at the moment. And the final thing is about the information giving. The British case Montgomery 2015 has changed consent substantially, for those of you from England, that all information given to patients must include and document the discussion about expectant management versus all the different types of treatment, for and against and risks. And we're not currently doing that in IVF in this area, but if you read about what's happened in England, it's transformed consent in surgery. And I think a lot of our decision-making isn't in that way. So there are a couple of ethical principles to think about. Wonderful questions from the audience. Since we're coming up at the end of our time, we typically end the debate with closing remarks, but we'll forego that for this debate. And I'd actually like to just poll the audience. After hearing both the pro and the con side's arguments, by a show of hands, who in the audience believes that for the patient with unexplained infertility, as defined and detailed here broadly, should we be beginning with IVF? Should we be going straight to IVF? So by a show of hands. And I would say probably 50% of the room raised their hand. And those who think we should not be going straight to IVF? It feels like a little bit more. 40-60, now that I saw the other hands. Well, I'm going to call this a hung jury. I don't know that we have a definitive answer. Please join me in a round of applause for our panelists. In America, we would call that election interference. I wanted to thank our panelists, our live audience, and the listeners of the podcast. On behalf of Fertility and Sterility, thank you for the invitation to be here at your meeting and hosting this debate live from the Australian New Zealand Society for Reproductive Endocrinology meeting in Sydney, Australia. Thank you. This concludes our episode of Fertility and Sterility On Air, brought to you by the Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine. This podcast was developed by Fertility and Sterility and the American Society for Reproductive Medicine as an educational resource and service to its members and other practicing clinicians. While the podcast reflects the views of the authors and the hosts, it is not intended to be the only approved standard of living or to direct an exclusive course of treatment. The opinions expressed are those of the discussants and do not reflect Fertility and Sterility or the American Society for Reproductive Medicine.    

Today's summer rewind is a re-release of one of our favourites that we keep coming back to. We'll be back in September with brand new interviews! If you're nearing (or in) your 30s, you might've noticed a new phenomenon taking over your girls' night convos, your office, and your Instagram feeds. It seems like everyone is suddenly getting pregnant, trying to get pregnant, or worried about whether they'll be able to get pregnant when they're ready. The stress of fertility is real, and in today's highly-requested episode, we debunk common fertility myths and get valuable medical advice from Reproductive Endocrinologist Dr. Marjorie Dixon on how to prepare for and take control of your fertility journey, whether you're just starting to learn about natural fertility or dealing with IVF or egg-freezing. If you're stressed about your fertility, or you feel like you don't really understand how your body works, this episode is a must-listen. Dr. Dixon is the Founder, CEO and Medical Director of Anova Fertility & Reproductive Health, a full-service fertility and IVF centre. She has an Accredited Fellowship in Reproductive Endocrinology and Infertility, she's a member of the Department of Obstetrics and Gynecology at Sunnybrook Health Sciences Center, and she's an Assistant Professor at the University of Toronto. She has won the RBC Canadian Women of Influence Momentum Award, and the Canadian Fertility and Andrology Society's Mathias Gysler Award for her leadership in improving reproductive care in underserved communities. She's also a regular expert on Cityline championing women's health and reproductive wellness.Tune in as we chat about:Fertility 101: Understanding ovulation and how to track itWhen are you considered infertile? How long should it take to get pregnant?Exercise and nutrition tips to improve natural fertility and boost egg qualitySupplements and vitamins to help fertilityThe truth about age-related fertility declineProactive fertility assessments and the labs/tests to getFamily planning options for same-sex couples and people who are singleHow IVF actually works, and why some clinics do it betterDealing with PCOS and endometriosisWhen to consider egg freezing and what to expect PS: If you've been dreaming of pivoting into podcasting but aren't sure where to start or how to grow, check our consulting services at teachmehowtoadult.ca/howtopodcast. Sign up for our monthly adulting newsletter:teachmehowtoadult.ca/newsletter Follow us on the ‘gram:@teachmehowtoadultmedia@yunggillianaireFollow us on TikTok: @teachmehowtoadultFollow Dr. Dixon and Anova Fertility: https://anovafertility.com/@anovafertility Sign up for our monthly adulting newsletter:teachmehowtoadult.ca/newsletter Follow us on the ‘gram:@teachmehowtoadultmedia@gillian.bernerFollow on TikTok: @teachmehowtoadult

There are fewer babies born in the United States these days than in years past. But is it all about choice, or could there be medical reasons, too? We're talking about falling fertility rates, as well as the rise of IVF – including what it involves and why it's sometimes put in the same conversation as abortion. Our guest today is fertility specialist Natalie Crawford, MD. Dr. Crawford is board-certified in Obstetrics and Gynecology, and in Reproductive Endocrinology and Infertility, and she hosts the podcast “As a Woman: Fertility, Hormones and Beyond.”  Learn more about our guests: https://www.theNewsWorthy.com/shownotes Sign-up for our bonus weekly email: https://www.theNewsWorthy.com/email Become an INSIDER for ad-free episodes: https://www.theNewsWorthy.com/insider This episode was sponsored by: Sign up for a $1 per month trial period at shopify.com/newsworthy Go to Zocdoc.com/newsworthy and download the Zocdoc app for FREE. Then find and book a top-rated doctor today. To advertise on our podcast, please reach out to sales@advertisecast.com #fertility #IVF #babies    

Join HeHe as she sits down with Dr. Jessica Ryniec from CCRM Fertility of Boston to delve into the crucial topic of sperm quality and male fertility. In this episode, they discuss what sperm quality means, how sperm analysis is conducted, and the impact of lifestyle, supplements, and medications on sperm health. Dr. Ryniec also provides insights into the factors affecting sperm morphology, the importance of a healthy lifestyle, and the potential effects of lifestyle choices like bicycling and using hot tubs. Learn about the role of antioxidants in sperm health, the importance of using fertility-friendly lubricants, and the process and benefits of freezing sperm for future fertility planning. Whether you're trying to conceive or just curious about reproductive health, this episode offers invaluable information and expert advice.   Understanding Sperm Quality Sperm Morphology and Variations Key Terms in Semen Analysis Who Should Get a Semen Analysis? Impact of Lifestyle on Sperm Quality Supplements and Medications for Sperm Quality Lubricants and Sperm Health Steps for Getting a Semen Analysis Freezing Sperm: When and Why     Guest Bio: Dr. Jessica Ryniec is double board certified in Obstetrics and Gynecology, as well as Reproductive Endocrinology and Infertility. She joined CCRM Boston in 2020 after completing her fellowship at the University of Vermont Medical Center in Burlington, VT.   She received her undergraduate degree from Wake Forest University and her MD from Georgetown University School of Medicine in Washington, D.C. During her residency for obstetrics and gynecology at Rutgers Robert Wood Johnson Medical School, Dr. Ryniec received the Excellence in Female Pelvic Medicine Award and recognition for Outstanding Accomplishment in Women's Health.   In addition to presenting her research at prestigious medical conferences, such as the American Society for Reproductive Medicine and the Society for Reproductive Investigation Annual Meeting, Dr. Ryniec has authored several publications for notable peer-reviewed journals, including the American Journey of Obstetrics and Gynecology.   Dr. Ryniec practices medicine embracing the motto of Cura Personalis, or care of the entire person. She believes in education and in the value of shared decision making and patient empowerment, and spends time on social media educating, empowering, and supporting people while trying to conceive, going through fertility treatments or fertility preservation. She believes in family, and understands that family comes in many forms, and is committed to helping her patients achieve the family they desire. Social Media: Connect with HeHe on IG  Connect with Dr. Ryniec on IG  Connect with HeHe on YouTube   BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!

Rachel Fine, Registered Dietitian Nutritionist, Certified Eating Disorder Specialist, and Certified Counselor of Intuitive Eating works with dancers worldwide to help them build supportive relationships with both food and body. Dr. Randi Goldman, MD is a New York-based Northwell Health physician specializing in Reproductive Endocrinology and Infertility, Obstetrics, and Gynecology. FREE 7-DAY TRIAL to become The Healthy Dancer®: https://dancenutrition.com/membership/ Nutrition is essential for elite dance performance. Rachel Fine is a board-certified dietitian with advanced certifications in Eating Disorders, Sports Nutrition, and Intuitive Eating. A note from Rachel: The importance of dance nutrition goes beyond our plate. This is why I created www.DanceNutrition.com and The Healthy Dancer®. Dancers, dance educators, and dance parents can utilize these resources to access information and guidance about fueling for performance! Disclaimer: This is produced for informational purposes only. This information is general, not specific to you. The information in this podcast does not substitute for medical advice. The viewer or listener assumes full responsibility for consulting a qualified health professional regarding health conditions or concerns, and before starting a new diet or health program. --- Support this podcast: https://podcasters.spotify.com/pod/show/dancernutrition/support

It's been two years since Roe v. Wade was overturned by the Supreme Court. As the power to rule over women's reproductive rights reverts to the states, we are seeing many move toward vast limitations of reproductive choices, including bans on terminating pregnancies, but also devastating impediments toward the processes that have helped those who are struggling with infertility have a chance to conceive. To open up this conversation and really delve into what this decision means, we have Jen's longtime friend Amy Hardin joining the pod. As women who lived their childbearing years under the protections of Roe v. Wade, Jen and Amy discuss what the aftermath will look for the next generation of women.  Later on the show, we'll feature an interview with Dr. Natalie Crawford, a Reproductive Endocrinology & Infertility Specialist in Austin, TX who really helps us break down all the salient issues. Dr. Crawford sensitively approaches all the repercussions of not having a safe way for a woman to terminate a pregnancy that many of us may not have even considered. Wherever you stand on the issue of abortion, these conversations show the ripple effect this decision has had on women's ability to make health choices for themselves and how it affects women who do wish to conceive and the hurdles they will now face. * * * Thought-Provoking Quotes: “Reproductive care doesn't exist in silos. Abortion access is just one part of the triangle of reproductive care. And fertility care is on one end and gynecological care and OB/GYN care is on the other, but they all exist together, for a variety of reasons.” – Dr. Natalie Crawford  “You could die in pregnancy even though you have zero risk factors. We know that this happens. And so when we start assigning the idea that reproductive choice or ending a pregnancy is morally bad because you're killing a baby or a fetus, what we're really doing is devaluing the life of that mother who's carrying the baby because at any moment it could go a way that could turn lethal.” – Dr. Natalie Crawford  “We have allowed politics to infiltrate medicine and people are getting cared for differently because of the current political world. That should terrify anybody who knows somebody in their life with a uterus, that really should terrify you.” – Dr. Natalie Crawford  “Black women have three to four times the chance of dying in childbirth, even when controlled for proper prenatal care or socioeconomic class, meaning even if you are educated and you have access to care, the color of your skin is a contributing factor to you walking out of childbirth alive. That is devastating.” – Dr. Natalie Crawford  “You're either a fan of reproductive care and you respect the fact that people deserve the integrity to make their choices with their medical professionals and their loved ones, or you don't.” – Dr. Natalie Crawford Guest's Links: Website - https://www.nataliecrawfordmd.com  Fora Fertility - https://www.forafertilityaustin.com  Instagram - https://www.instagram.com/nataliecrawfordmd/  Twitter - https://twitter.com/ncrawfordmd  Connect with Jen! Jen's website - https://Jenhatmaker.com/ Jen's Instagram - https://instagram.com/Jenhatmaker Jen's Twitter - https://twitter.com/JenHatmaker/ Jen's Facebook - https://facebook.com/Jenhatmaker Jen's YouTube - https://www.youtube.com/user/JenHatmaker?sub_confirmation=1 The For the Love Podcast is a production of Four Eyes Media, presented by Audacy.  Four Eyes Media: https://www.iiiimedia.com/ To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Today, we're discussing a subject that plays a crucial role in many people's lives: birth control. I had the pleasure of chatting with our guest, Dr. Bana Kashani, about this topic in great detail. Dr. Kashani provided tremendous medical insights and discussed the various forms of contraception, what to expect with each, and debunked some common myths. Birth control isn't just about preventing pregnancy—it's about empowerment, choice, and taking control of your health. Whether you're thinking about changing the current birth control you're on, needing to consider your options after you have baby (if you're pregnant), curious about how different methods work, or just looking to understand more about this important aspect of reproductive health, this episode is for you. We navigated through the maze of pills, patches, IUDs, and more so that you can make an informed decision that best suits your lifestyle and needs. Now, let's meet our guest! Who is Dr. Bana Kashani? Dr. Bana Kashani is double board-certified in Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. She has been treating infertility patients since 2014 and has been practicing in Orange County, where she grew up, since 2017. Dr. Kashani received her medical degree from the University of South Alabama, College of Medicine, where she graduated at the top of her class, and she completed her residency at the University of Southern California. There, she received tremendous experience in all facets of Obstetrics and Gynecology but specifically had an interest in Reproductive Endocrinology and Infertility. She continued her medical training and pursued a subspecialty in Reproductive Endocrinology and Infertility at Rutgers, New Jersey Medical School. Since Dr. Kashani is focused on providing her patients with the most personalized approach to fertility services and treatments, she opened up her own practice in 2020. Her practice's mission is to ensure patients feel comfortable and cared for since infertility treatments can be overwhelming. What Did We Discuss? In this episode, we chat with Dr. Bana Kashani about navigating birth control. In a rapidly evolving landscape of reproductive health, navigating the variety of birth control options can be overwhelming. Here are several of the questions that we covered in our conversation: How do you help patients determine which birth control method is best suited for them? What factors should individuals take into consideration when selecting birth control to meet their needs? What are the most common forms of birth control available? Can you talk about the efficacy of these methods?  What are the main differences between barrier methods and hormonal methods? When talking specifically about hormonal birth control, how effective is it in preventing pregnancy, and is there any negative impact on fertility when used for an extended period of time?  Can you explain what Long-Acting Reversible Contraceptives (LARCs) are and how they differ from other forms of birth control? What are the benefits and drawbacks of LARCs compared to other methods? What are some common side effects associated with different types of birth control? We know that it can be overwhelming when navigating the world of birth control, but we hope this episode leaves you feeling more knowledgeable about the different forms of contraception as well as empowered to choose the right form for you. Dr. Kashani's Resources Website: www.banakashanimd.com Instagram: @dr.banakashani Thank you for listening to this episode! Be sure to follow us on our podcast Instagram page @thebabychickchat. Let us know what you think and if there are any other topics you'd like us to cover. Cheers to being empowered to make your own choices! Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to the next episode of Evie Unbounded

Send us a Text Message.On this episode of 'Taco Bout Fertility Tuesday,' Dr. Mark Amols delves into the often misunderstood relationship between menstruation and ovulation. Just like we assume thunder follows lightning, it's a common belief that a menstrual period always means ovulation has occurred. However, this isn't always the case.Dr. Amols begins by breaking down the menstrual cycle into its two main phases: the follicular and luteal phases. He explains the roles of hormones such as FSH, estrogen, and progesterone in regulating these phases and preparing the body for a potential pregnancy.Listeners will learn how and why anovulatory cycles happen—situations where the ovaries do not release an egg, yet menstrual-like bleeding still occurs. Dr. Amols discusses various factors leading to anovulation, including stress, hormonal imbalances, PCOS, and significant weight changes. He highlights the signs to watch for and explains how bleeding without ovulation can still happen.The episode also covers methods to diagnose anovulation, such as ovulation predictor kits, progesterone level tests, and modern fertility apps. Dr. Amols offers practical advice on managing and treating anovulatory cycles to help those trying to conceive or seeking to understand their menstrual health better.Tune in to uncover the truth about your menstrual cycle, and learn why having a period doesn't always mean you're ovulating. Don't miss this informative and eye-opening episode of 'Taco Bout Fertility Tuesday.'Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform. Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com. Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com. Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

In this insightful episode of Redefining Family, Jonathan is joined by Dr. Mark Leondires.  He is the founder, Medical Director and Partner in reproductive endocrinology at Illume Fertility and Gay Parents To Be. He is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility as well as being a  passionate advocate for LGBTQ+ family building. Dr. Leondires reflects on his upbringing in a Greek Orthodox household where he was unaware of the concept of being gay until college. Despite a strong desire to be a dad, it wasn't until his mid-thirties that he realized his relationships with women weren't fulfilling his dream of fatherhood. Currently, 70-80% of Dr. Leondris's patients are LGBTQ+. He shares his family story, being married to a man and having two kids through egg donation and surrogacy.Before meeting his husband, Dr. Leondires was prepared to become a single dad. In 2010, Dr. Leondris and his husband achieved a pregnancy through egg donation and surrogacy, prompting him to recognize the challenges LGBTQ+ families face and inspiring him to help others. His caregiving nature led to the creation of Gay Parents to Be, an organization that supports LGBTQ+ family planning.Dr. Leondires and Jonathan share their experiences of choosing egg donors, emphasizing the importance of examining the donor's family tree. They also discuss the rigorous selection process for surrogates and egg donors, with only a small percentage making it through. The importance of being truthful with children about their origins is highlighted, with a suggestion to practice the story while holding the child. Jonathan shares his journey of informing his mother about his surrogacy plans, highlighting her ongoing struggle to fully accept it.The discussion touches on the legality of gay surrogacy, noting that the US and Canada are the only countries where it is fully legal. They also talk about handling societal norms, like celebrating Mother's Day in LGBTQ+ families.

Dr. Armando Hernandez-Rey is Conceptions Florida's medical director and triple-board certified in Reproductive Endocrinology and Infertility; Obstetrics and Gynecology; and Surgery. Dr. Armando Hernandez-Rey has over 24 years of experience in the medical field. He graduated from Universidad Autonoma de Ciencias Médicas de Centro America in 1998. He attended medical school at the University of Miami Miller School of Medicine for his specialization in Obstetrics and Gynecology. He specializes in treating patients with polycystic ovary syndrome (PCOS), recurrent pregnancy loss (miscarriage), and severe endometriosis. He is especially interested in fertility preservation (eggfreezing) for patients who must delay childbearing for personal or medical reasons, including cancer and systemic lupus erythematosus. Dr. Hernandez-Rey is an assistant clinical professor at the Herbert Wertheim College of Medicine at Florida International University and serves as an ad-hoc reviewer for the prestigious peer-reviewed journal, Fertility and Sterility. He has also published several articles and chapters in medical literature.   Website https://www.conceptionsflorida.com Instagram https://www.instagram.com/conceptionsflorida/ Facebook https://www.facebook.com/conceptionsfl Tiktok https://www.tiktok.com/@conceptionsflorida     For more information about Michelle, visit: www.michelleoravitz.com   The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/   Instagram: @thewholesomelotusfertility   Facebook:https://www.facebook.com/thewholesomelotus/     Transcript:   Michelle (00:00) Welcome to the podcast, Dr. Hernandez -Ray.   Armando Hernandez-Rey MD (00:04) Thank you, Michelle. Thanks for the invitation. It's really an honor and a privilege to be on your show, on your podcast.   Michelle (00:09) Yes, well, I've heard a lot about you over the years because I've had a lot of patients go to you. And one of the things that I've heard is that you do really well with surgeries and fibroids and you're able to in and   but in a way that still preserves fertility. So that was one of the things that I've learned.   Armando Hernandez-Rey MD (00:32) Well, reproductive endocrinology and infertility as a subspecialty is a surgical subspecialty as is OB -GYN, which is a mandatory path to get to the infertility route. Unfortunately, a lot of the newer generation is not operating because they're not taught, not through no fault of their own, they're not taught. The reality is that it is...   Michelle (00:47) Mm -hmm.   Armando Hernandez-Rey MD (00:55) for a myriad of reasons this phenomenon has happened. Number one, the minimally invasive surgery tract has been developed where you have the person who's really just really perfected their obstetrical skills. And then you have the gynecologic oncology route and the pelvic urogynecology or pelvic reconstruction route and the minimally invasive surgical route. And a lot of the reproductive endocrinologists,   have said, you know what, I'm going to forego surgery and I'm going to refer it out. My personal philosophy, and this is in no way critical to absolutely anybody, it's just my own, is that I went into medicine to be a surgeon, I actually wanted to be an orthopedic surgeon. I ended up not liking it, I had a very bad fracture when I was in my teens playing competitive soccer, and I really had some PTSD from that fracture, so I just couldn't see myself doing   orthopedic surgery, but I somehow found my way towards OBGYN, absolutely loved it. And eventually towards the reproductive endocrinology route, which encompasses a lot of surgery, should you allow it. And so yes, like you said, fibroids are an important part of fertility. you, tubal reconstruction used to be much more important than it is now. People are more, are bypassing that route and going directly to in vitro fertilization.   Endometriosis, as I said, I was running a little bit late today. I was in a very, very complex endometriosis case with a patient with bilateral endometriomas and complete frozen pelvis and scar tissue. And, you know, just a little bit longer, I had to work with the colorectal surgeons to do some resection of the colon because it was, you know, endometriosis is such an awful, awful disease. So yes, to answer your question, I...   Michelle (02:41) Yeah.   Armando Hernandez-Rey MD (02:44) Absolutely love surgery. I think it's an integral part of the infertility journey to get a patient from being infertile to getting them to a high level of success with any sort of treatment. And hopefully it's more conservative than having to resort to artificial insemination or in vitro and with just surgery and corrective surgery, we can help the couple achieve a pregnancy.   Michelle (03:07) Yeah, and I think it's important because I think that a lot of people might not realize that there are certain people that specialize in this or have experience doing that, doing surgery and really getting in there because it is important to find somebody who's specialized if you have a complicated case.   Armando Hernandez-Rey MD (03:23) I think it's important. I think people feel well taken care of. Again, my perception, people feel well taken care of when everything is done in house. Meaning, you know, there's no messages that get lost as you refer a patient out who may have the minimally invasive surgery knowledge, but not necessarily the focus on infertility, reproductive endocrinology.   Michelle (03:33) Mm -hmm.   Armando Hernandez-Rey MD (03:50) specialist has and I think people feel comfortable with that.   Michelle (03:52) Yeah, absolutely. Because there's some people that will take out fibroids, but they're not doing it with fertility in mind. You know, for many women, it could just be just taking out fibroids, but you're doing these things with fertility in mind.   Armando Hernandez-Rey MD (04:07) There are many great surgeons out there that are not infertility specialists. You know, I want to make sure that I'm clear. I just think that I was, I always love surgery. I happen to do surgery and I feel my patients feel very comfortable with me doing the surgery and not being referred out. It's what I think. You know, the journey, the infertility journey is very complex. It requires a lot of a woman in particular more than the male and to be   Michelle (04:25) Yeah.   Armando Hernandez-Rey MD (04:36) you know, passed around, it gets complicated. And I think it's nice to be able to offer that service to patients.   Michelle (04:44) Yeah, for sure. And then you do specialize in miscarriages.   Armando Hernandez-Rey MD (04:49) Sure, I mean, I think we all really have a focus on on as you know, we're all specialized in miscarriages and and PCOS and all that there's some people that tend to see More miscarriage patients or they people will refer miscarriage patients to us We have a particular kind of focus on that, you know, I think a lot of it is   genetic, a lot of it is immunologic, a lot of it is just taking a holistic approach to things and not just focusing on one or the more common causes of infertility. And even now, I think that, you know, the use of supplements, which maybe 15 years ago was maybe considered some snake oil. Now, I think there's a lot of provocative data that has shown that supplements do work, in particular in   Michelle (05:18) Mm -hmm.   Armando Hernandez-Rey MD (05:44) cases with recurrent miscarriage. And now we have the ability to measure those levels and we are now ability to supplement those levels and they have tremendous impact positively on these patients.   Michelle (05:57) And what supplements have you seen help with miscarriages?   Armando Hernandez-Rey MD (06:02) Well, I think a lot of it has to do with what the cause of the miscarriages is. Oftentimes, believe it or not, miscarriages can alluded to fibroids, it could be anatomical, sub -mucosal myoma. Well, there's not gonna be any supplement that's gonna help with that. It's just purely the surgical route or the diminished ovarian reserve,   Michelle (06:07) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (06:29) cause for recurrent miscarriages, which is older women or ovaries that are behaving or eggs that are behaving older than what their chronological age would dictate, you have a higher chance for aneuploidy. And in those cases, there's a variable cocktail of supplements that we use, including ubiquinol, including N -acetylcysteine, including vitamin E, even melatonin has been shown to be very, very effective. And I can go on and on, even alpha lipoic acid.   Michelle (06:50) Mm -hmm.   Armando Hernandez-Rey MD (06:57) as well. There's some very nice studies coming out of Mayo Clinic that have shown that aflalipoic acid is very, very good for recurrent miscarriages. So again, things that we thought were, well, they can't hurt, now we know that they absolutely help.   Michelle (06:57) Yeah.   Right. Yeah. I mean, that's great because it just helps to know that there's something that people can do that really does make a difference. And it's not just like in theory with miscarriages when it comes to immunology. I'd love to talk about that because I know that that's a big one. Actually, I did see a study that showed that women who have are more sexually active, that their immune system calms down. It behaves differently in the luteal phase.   Armando Hernandez-Rey MD (07:31) Mm -hmm.   Michelle (07:44) so that it's able to receive life so that it's not seeing like the sperm as an invader the, yeah.   Armando Hernandez-Rey MD (07:50) So women that are more sexually active than others, it's probably a function of repeated antigen exposure, which is the more the woman is exposed to the antigens of the sperm, more there becomes an acquiescence by the immune system to be more receptive of that embryo. Because remember, the embryo is   Michelle (08:06) Mm -hmm.   Armando Hernandez-Rey MD (08:19) a haplotype, meaning it's half female, half the woman, half the mother, and half the male. And the only genes that the immune system of the mother has got to harbor the pregnancy are her own. And so oftentimes the immunologic processes are heightened because it does not recognize the male antigens that are formed part of the embryo in general. But as a whole, I mean, recurrent pregnancy loss,   Michelle (08:33) Mm -hmm. Right.   Armando Hernandez-Rey MD (08:47) is, is a small portion of the general population and, it's skewed towards advanced maternal age and advanced paternal age. so the immunologic component, while absolutely important, I think it's the one where we're still not a hundred percent sure how to absolutely treat it. Although supplementation and.   immune suppression definitely are known to work. It's the testing that I think we still need a lot more work in doing because you know people talk about NK cells and you know that was part of my thesis when I was a fellow. So we talk about NK cells and ANA and antiphospholipids and all of that and the reality is that these tests have very very   poor sensitivity in the realm of immunologic infertility or reproductive immunology. And so you may have COVID and then you can test positive or lightly positive for NK cells. And so I think that the overwhelming response by the treating physician is, well, they're positive, they must be immunologically incapable of handling a pregnancy. So therefore we should treat.   Michelle (09:40) Mm -hmm.   Armando Hernandez-Rey MD (10:04) with nowadays what we use as intralipids. Back in the day, we used to use IVIG that has kind of fallen by the wayside a little bit. I think it's better to treat empirically than to have someone treat or test for all of these different immune markers that really, really in the presence of immunology and reproductive immunology,   They have very low sensitivity. Now if you're treating or you're looking for lupus or rheumatoid arthritis or mixed collagen disorder or Sjogren's for sure, they are your go -tos every single time.   Michelle (10:44) And what about a PRP for ovaries? What has do you do offer that?   Armando Hernandez-Rey MD (10:50) ovaries. American study of reproductive medicine came out with a black box warning that they do not recommend PRP for ovaries. Now, PRP for recurrent implantation failure, poor lining development, there is some very robust data that there may be some room or benefit for this.   Michelle (10:57) okay.   Mm -hmm.   Armando Hernandez-Rey MD (11:14) And we do do offer that. We do not offer intra ovarian PRP because ASRM has a huge black box warning on this. It's a liability. The potential for infection is there. Tubo ovarian abscess have been reported, adhesions, periovarian adhesions, and with very little to no benefit whatsoever. I mean, the whole premise for it is that we are...   Michelle (11:16) Okay.   wow, okay, I didn't know that.   Mm -hmm.   Okay, got it.   Armando Hernandez-Rey MD (11:42) regenerating the follicle complex and therefore improving egg quality and that definitively has not been shown to be the case. Although anybody who suffers from that as I would be would be like, slide me up. But unfortunately, you know, it's very easy for us to fall prey to things that we desperately want without having the medical literature to corroborate it or back it up.   Michelle (11:49) Got it.   Right.   Got it. So that's actually showing to not necessarily be what a lot of people originally thought, but for the uterus, it has been shown to help.   Armando Hernandez-Rey MD (12:15) Yes, we are doing PRP installations and very select group of women with those diagnoses in particular. And.   Michelle (12:25) So who would be a good candidate? Somebody who's had failed transfers, inflammation.   Armando Hernandez-Rey MD (12:30) Yes, someone with very high quality embryos, high quality embryos that are not getting pregnant. Also patients, for example, patients who have adenomyosis that do not develop a nice lining, a thickened lining. Those have been shown. Our numbers are very small, you know, by no means.   Michelle (12:42) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (12:53) they are in the realm of what a randomized controlled trial should be. We're following the data from the randomized controlled trials and from the literature that's out there. So patients with adenomyosis who have poor lining development, recurrent implantation failure, so patients with euploid embryos, that means a normal embryo that's tested that looks to be high quality. Also, after a second implantation failure, we'll...   offer that to the patient as a possibility.   Michelle (13:19) Mm hmm. Got it. Awesome. And then also we were talking about Ozempic pre -talk. So I'd love to get your... Yes. Yeah. Ozempic babies.   Armando Hernandez-Rey MD (13:24) the topic du jour these days, right?   It's right. So as we were discussing, I mean, this, this phenomena is not really a phenomenon that's surprising at all. It is just a, a byproduct, a side effect of, of how the medication works and the effects that positive effects that I have on women with in particular, and ambulatory disorders, specifically polycystic ovarian syndrome, which is often tied to or associated with insulin resistance, obesity, sometimes even overt.   type 2 diabetes and the elevated levels of insulin, the elevated testosterone levels, they all work together to create this sort of environment within the ovary and the system of the female which creates an ovulatory disorder or dysfunction. And as a woman loses weight by virtue of the way that these GLP1s or glucocortes   Michelle (13:58) Mm -hmm.   Armando Hernandez-Rey MD (14:22) Glucagon like peptides work They're very successful. They're very good at number one slowing gastric emptying which in turn slows down the release of sugar into the blood system to the Number one number two it stops the the release of glucose produced by the liver and Number three increases insulin levels so increase insulin levels helps get the the   the sugar into the muscles out of the circulation and out of stimulating the ovaries and the theca cells to produce more androgens which then get produced produce more estrogen which then stops the hypothalamic pituitary ovarian axis from functioning correctly and as these levels drop patients automatically begin to have spontaneous ovulation if the system is working and the male has normal sperm and they're sexually active.   this is how the ozempic baby phenomena occurs. And what we discussed also is that the concern is of the downstream consequences of ozempic babies given that the current recommendations are to have at least a two month washout period before anybody starts to try to conceive.   Michelle (15:32) So two month washout means like really not trying anything. Yeah. And then also, I know like naturally, myonocytol is really helpful as well for insulin resistance. It might take a little longer. And then also metformin has been used as well.   Armando Hernandez-Rey MD (15:37) No exposure, right? No exposure.   Yeah. Yes. So, my own hospital is, is a, is a great product. my own hospital alone, although you will find oftentimes my, my own hospital with a D chimeric, hospital and really the literature shows that my own hospital by itself is the one that truly has the most benefit might be hard to find.   Michelle (16:06) Right, yeah.   Right because for a little while they said my own hospital and dechiro, but now they're going back to saying just my own ocital, correct?   Armando Hernandez-Rey MD (16:23) Yeah, well the way that it's normally found in the body is at a ratio of 20 to 1. And that's what those supplements show, 20 to 1. Although we know now that in the ovary it's almost 40 to 1 ratio of myoinocytol to D -chimeric, inocytol.   Michelle (16:30) Mm -hmm.   Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (16:49) Myo Inositol is actually not an essential vitamin, but it's considered like a vitamin, but it's in the category of B8 It's a glucose like peptide that basically helps to Help the system function by processing the circulating blood sugar in a way that's more physiologic and there by lowering insulin levels and thereby also helping tremendously with   Michelle (16:56) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (17:16) regularity of cycles and even spontaneous ovulation as well. And metformin obviously is medication that's been around for many, many years. It is somewhat of a controversial drug. It is an anti -aging drug even these days because we know that insulin levels are so profoundly toxic for aging for the muscle and for the system in general.   Michelle (17:29) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (17:45) And so we know it works, we know that it helps with the efficiency of insulin. And so it's certainly been used for many, many, many years in the presence of patients with polycystic ovarian syndrome. I would challenge people to be a little bit more meticulous about using it in patients who are the lean PCOS.   Michelle (18:11) Right.   Armando Hernandez-Rey MD (18:11) or the skinny PCOS or the ovulatory PCOS even though insulin levels have been shown to be higher, slightly higher in...   Michelle (18:19) So you're talking about being cautious with metformin, not necessarily myonositol. Yeah, yeah.   Armando Hernandez-Rey MD (18:22) Metformin, you also don't want very high levels of myelonostetal because they can be, you know, there is some quote unquote toxicity. I think the recommendations are up to four grams per day. I think all the recommendations are four grams per day in two divided doses, two grams in the morning and two grams at night. I've seen patients be on eight grams and 10 grams and toxicity really starts happening around the greater than 10 gram dose.   Michelle (18:29) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (18:52) I in our office we only use it, you know, what's recommended which is the four gram total per day two grams in the morning two grams at night and I don't think it's the end -all be -all I don't think it's you know treating anything in life is multi -pronged. It's not just one single thing perhaps but I definitely believe very wholeheartedly that it does assist in in adjunct treatment, although we certainly have patients put patients on on myocytil and combined with   Michelle (19:06) Yeah. Right.   Armando Hernandez-Rey MD (19:20) diet and exercise and have been able to achieve pregnancies on their own, which is obviously what we want instead of having to go through treatments.   Michelle (19:27) That's great. I mean, I will say that I was very surprised this past year. two different patients came from different, different places, not yours, it was other doctors, but I think the nutritionist there suggested metformin when they did not have insulin resistance or PCOS for egg quality.   Armando Hernandez-Rey MD (19:47) Yeah, I'm not familiar with any studies that have shown that have improved that. In fact, when I was a fellow, we were, just as I was coming into fellowship, where I trained, Rutgers was involved with a very well known and publicized study, it's called the PP COAS study, which looked at patients on placebo versus metformin alone versus metformin with Clomid, sorry.   placebo versus clomid versus clomid with metformin and there was no difference in pregnancy rates or anything else. I'll go one step further with them going back to the myonocytol. It has even been shown to decrease the rates of gestational diabetes and so in our patients with PCOS with who are you know   Michelle (20:18) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (20:39) Stage one, type one obesity, type two, we'll continue them on the myonostetal throughout the pregnancy and when they leave us and go to their OB -GYN, in our referral letter back, we'll say that we're recommending for her to continue on myonostetal because there have been improvements in sugar levels and glycemic control and reduction in gestational diabetes overall.   Michelle (20:54) Yeah, that's good to know.   another big one is vitamin D. A lot of people, even though we're in Florida here, we have a lot of sun. A lot of people are very deficient in vitamin D.   Armando Hernandez-Rey MD (21:11) Yeah, What it is is a combination of things. Number one, we're not as sun exposed as you think we are. You know, we're always in a car, we're always indoors, it's very hot. And yes, we go out to the beach and there is a lot of sun, but we become very, very sensitive to the sun and to the untoward effects of the sun.   Michelle (21:17) Mm -hmm.   Armando Hernandez-Rey MD (21:35) So we protect ourselves tremendously. That's number one. Number two is that I think the levels are set higher than what the average person can sustain with just diet and sun exposure. And actually the recommendations now in the infertility world that when you order a vitamin D from Quest, they'll tell you that the levels are, you want them at   Michelle (21:38) Mm -hmm.   Armando Hernandez-Rey MD (22:04) definitively above 20 Certainly above 30 and now recently now the recommendations are that for them to go above 40 and and and Yeah, I'm not yeah, so I heard I've read 40 I it was a Paper that came out of Either the Lancet or   Michelle (22:11) Yes, yep, I've been hearing that or even 50. Yeah.   Armando Hernandez-Rey MD (22:27) or fertility necessarily, anyone, one of, that they recommend now for vitamin D levels to be above 40. So that's really hard. I mean, I work really hard. I take a lot of vitamin D and I'm just barely scraping like 50. You know, I take about 5 ,000 units a day, which is what we're recommending nowadays, 5 ,000 units of vitamin D. And I take that every single day and I barely scratch,   Michelle (22:38) Mm -hmm.   Yeah.   Armando Hernandez-Rey MD (22:56) you know, 45, 50 every time I get an average check. So I'm not getting as much sun as I think I am, number one. I am out fairly often. I do play some golf, not enough. And yet it's not enough. So definitely supplementation's important.   Michelle (23:03) Mm -hmm.   Yeah, magnesium is also important. That's another thing. It's to not be deficient in magnesium because magnesium plays an important role of our absorption of D, which, you know, obviously doing this, I learned, I was like, that's might be deficient magnesium and be taking a lot of D and then their body's not processing, which is why it's important sometimes even in foods, foods have everything. So like,   even beef liver, you know, from Chinese medicine perspective is so beneficial because it has iron, but it has it in a combination of nutrients that helps the body absorb it.   Armando Hernandez-Rey MD (23:46) Yeah, B6, B12 are incredibly important for iron absorption as well. So all of these things are extremely important. Everything is all intertwined and we're just learning about this. And for us, I've really gotten grabbed hold of this whole longevity thing, hence my aura ring and all of this. And...   Michelle (23:57) It is.   Yeah.   Armando Hernandez-Rey MD (24:09) I'm just trying to apply a lot of the things that we know today work for longevity medicine and anti -aging principles to the infertility world because it's all intertwined. It's all intertwined.   Michelle (24:16) Yeah.   without a doubt. It's funny because that you say that because I always say it's pretty much anti aging. Yeah.   Armando Hernandez-Rey MD (24:26) Yeah, totally, totally. They're even coming up with a way to stop menopause.   Michelle (24:36) wow. How?   Armando Hernandez-Rey MD (24:37) which is extremely interesting. Believe it or not, recombinant antimullerian hormones.   Michelle (24:42) How is that? Explain that.   Armando Hernandez-Rey MD (24:46) So the way that antimullerine, the function of antimullerine hormone at the level of the ovary is that it stops follicular recruitment. That's why women with PCOS have higher AMHs and therefore they have higher egg counts and higher, they tend to go into menopause later on, et cetera. That's because they have high levels of antimullerine hormone. So by reproducing or creating it in the laboratory and then from an early stage,   This is in its infancy, by the way, okay? So this is, yeah, this company, I believe she's a Harvard scientist, biochemist or something, who's coming up. My point is that, listen, that it's all intertwined, aging and even in menopause, for God sakes. Now I've been doing this for so long that I now,   Michelle (25:18) It's new.   Mm -hmm.   Armando Hernandez-Rey MD (25:39) seeing menopausal patients who were like, you know, listen, you took care of my baby, you're a reproductive metachronologist, you understand the science, will you treat me? And, you know, like, and I realized, like, somewhere, some women got like, they got a some bad luck thrown their way because, you know, with the WHI results and the way they were interpreted, they made hormones bad. And somewhere along the way, someone said,   It's okay for women to suffer from menopause, just suck it up. Like it's not okay. That's not okay. That's not okay. And so if you start from very early on and, you know, and, and really practice what you preach, which is healthcare and not sick care, which is what we practice in the United States, you know, we're just very, we, we're not proactive. We're reactive to when a patient is sick instead of early intervention, early screening and all of that.   Michelle (26:25) Yeah, absolutely.   Armando Hernandez-Rey MD (26:30) And that goes for the infertility world and that goes for a woman's long reproductive life extending past menopause. I think we still have a lot of challenges to overcome, but I think that we're heading in the right direction. Sorry to digress a little bit. I went off on a tangent there for a second.   Michelle (26:43) Yeah, for sure. no, it's okay. But you know what? I love the passion and I love that, that, you know, ultimately is great. It's important, very important, because it's true. And I agree a lot with what you just said, that we should be proactive when it comes to healthcare. I mean, really when it comes to so many things and something else that I...   that I read, it was an animal study. It was a study on, I believe it was like, I don't remember which kind of animal it was. I think it was like either sheep or cows or some form of those where they actually gave them oxytocin right before IUI. And that improved the chances of the conception rates, which I thought was very interesting because I think that that's one of the things with IUI that's missing because obviously you're taking away the connection.   that is usually there when you're just under natural circumstance. And I thought it was interesting because I was looking into it for something else to understand from a Chinese medicine perspective, because they have this heart -uterusconnection, that connection, the bonding. And so what I found was interesting too is that oxytocin increases around ovulation and after intercourse. And usually what they look at it as its role is usually for labor.   not so much conception. So I was just going to kind of like pick your brain on that. Any thoughts on that?   Armando Hernandez-Rey MD (28:13) Well, I mean, oxytocin is secreted at the time of... I'm not sure of ovulation, I didn't know that. But definitely at the time of...   Michelle (28:21) or it increases around that time, like right before ovulation in the cycle, a woman cycle.   Armando Hernandez-Rey MD (28:27) What we know that it's involved is at the time of orgasm. And so this may promote uterine contractility, which is what is used for intrapartum, to promote contractility of the uterus, to promote descent and eventual delivery. And we know that it's intimately involved in orgasm, we're seeing.   Michelle (28:33) Mm -hmm.   Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (28:55) during intercourse and orgasm and so with you know the projection of with the secretion of oxytocin and it causing uterine contractility obviously not at the same level that it does during labor but at smaller amounts then I can see how there could be a role for oxytocin in artificial insemination.   Michelle (29:18) even in fertility in general and because it's got to be there for a reason why would the body produce it around that time?   Armando Hernandez-Rey MD (29:25) Well, yeah, I guess, but it's either IUI or IVF and we definitely don't want oxytocin during the IVF cycle.   Michelle (29:33) Right, because you don't want to contract, right?   Armando Hernandez-Rey MD (29:35) Right, because we're transferring an embryo where there should not be any oxytocin. And you can have the most beautiful embryo, but if you screw up the embryo transfer, through no fault, just because it's a difficult transfer for a myriad of reasons, and you cause uterine contractility, then there's a high likelihood of pregnancy not occurring during that time.   Michelle (29:57) Right. I think it would be an interesting thing to look into for IUI. There might be something to it, because if it works with animals, and the animals obviously have similar certain functions that we do, mammals, that seems like an interesting thing.   Armando Hernandez-Rey MD (30:10) Yeah.   I think there's not going to be a lot of resources put into improving IUI, to be honest with you. IUI, I think it is what it is. And I mean, I think the majority of research is going to go to improving even more IVF rates, because I think ultimately patients are going to want to go more.   Michelle (30:22) Mm -hmm. Yeah.   Armando Hernandez-Rey MD (30:40) towards IBF, no matter how hard we try to say, hey, listen, there's this option or this option or this option. It's more become a more of an instant gratification society. Number one, number two, people are waiting longer. So therefore they're more pressed for time, if you will. And I think there will be less of a motivation to go down a treatment option that frankly,   Michelle (30:48) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (31:07) You know, has a low pregnancy rate.   Michelle (31:09) Right. And then my other question is, what are your, thoughts about a lower intensity cycle?   like lower amounts of hormones for older women. In some cases I've heard it might be a little better. you do? Yeah, yeah.   Armando Hernandez-Rey MD (31:24) We use it all the time. Yeah, we use it all the time. I think it's...   a very successful option in cases with severely diminished ovarian reserve. I think that the senescent ovary does not do well with high impact medication or high doses of medication separately, but you know, jointly the medication costs are exorbitant and you end up having the same number of eggs that are mature, that get fertilized with a mini stent protocol as you do with   Michelle (31:38) Okay.   Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (31:59) a high dose regimen.   Michelle (32:02) Okay, so you've seen good success with that.   Armando Hernandez-Rey MD (32:06) Well, I mean, not good success because generally these cases are, we've seen success. Let's call it that. Because the patients that you're treating with these medics, with this protocol are patients who are POI, you know, premature ovarian insufficiency, diminished ovarian reserve, poor egg quality, high rate maniploidy. So these are your poor responders essentially. And they're very...   Michelle (32:12) Yeah, okay.   Mm -hmm. Mm -hmm.   Armando Hernandez-Rey MD (32:34) specific factors that propel a woman to have success with this protocol compared to her twin sister with almost the same testing who doesn't do as well.   Michelle (32:47) Got it. And then lastly, we talked about this in the pre -talk, let's talk about marijuana and sperm, data is showing. Yeah.   Armando Hernandez-Rey MD (32:55) I don't do it myself, but I have no problem with people that do. What the data has shown that we're just becoming more and more familiar because the overwhelming number of people who are using cannabis and open about it, which is the second part, which was very difficult to conduct studies because it was so people were ostracized. They were looked at.   not the wrong way and seen as in the fringe. And now it's, you know, it's so mainstream. but so now we're, we're keenly aware, of patients were able to analyze them and what we know without a shadow of a doubt that the potency of the cannabis that's being produced these days is anywhere between eight to 12 times more potent than I think I use the joke of the guys at Woodstock back in the sixties, right?   Michelle (33:21) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (33:46) where everybody was getting pregnant and everybody was high on life, all of those things. And then what we've also known, which I did mention, is that using the vape pens, whatever types of inhalers as opposed to the traditional joint, if you will, increase the potency of that by a factor of two to three. The cannabis that was already potent to begin with.   Michelle (34:08) Yeah.   Right.   Armando Hernandez-Rey MD (34:14) So what you're seeing in males in particular, and I'm not sure that the literature is so complete on the female aspects, are that we're seeing a high levels of fragmentation. And what fragmentation is, is imagine that sperm is like an Amazon box. And inside that box, there's a porcelain doll that's wrapped in these packing cubes. They're held very, very tight. And under...   Michelle (34:26) Mm -hmm.   Armando Hernandez-Rey MD (34:40) The best of circumstances, those packing cubes are wound so tight, packed so tight that nothing, if I kick the box off the Amazon truck, nothing is gonna happen to the porcelain doll. Well, as fragmentation occurs and it happens under natural conditions and old guys like me, you know, patients who, occupational hazards, firefighters, exposed to toxins, a lot of people who use fertilizers, et cetera, et cetera.   you see high levels of fragmentation. I'm talking about DNA fragmentation. And so what we're seeing is high levels of fragmentation at the level of the DNA of the sperm, which has significant effects on embryo quality, embryo development, and pregnancy rates, and high levels of aneuploidy, which is abnormal embryos. So,   Michelle (35:10) So you're talking about DNA fragmentation. Yeah. Yeah.   Mm -hmm.   Armando Hernandez-Rey MD (35:33) You know, I'm not here to like, you know, slap you on the wrist and say don't smoke weed, but really that's what you're facing. And we know that this happens in women with cigarette smoking. Like this is a well -known cause of an accelerated transition to perimenopause. You know, 65 % of women who smoked a pack a day for greater than 15 years will go into menopause before the age of 40, assuming they started before their 20s. That's a pretty...   Michelle (35:40) Bye.   Mm -hmm.   Armando Hernandez-Rey MD (36:03) ominous number, actually. Thankfully, not many women smoke these days, cigarettes anyway. So I guess the results of cannabis on females is yet to be elucidated, but we definitely have some pretty compelling evidence in terms of the male data that show that it can have detrimental or deleterious effects on sperm quality and not necessarily on numbers.   Michelle (36:04) Yeah.   Mm -hmm.   right, which is what people look at usually when I mean, that's like the, the analysis is always on numbers shape and, numbers shape it. Yeah. And morphology and they won't necessarily look at the DNA fragmentation. That's actually not something that REIs usually initially look at.   Armando Hernandez-Rey MD (36:33) Exactly.   the thesis in morphology.   is done in a well not initially unless there's comorbid situations or things that raise your red flags. For example, advanced paternal age, we always do it. Particularly in egg donor cycles, right? Because patients will be like, well, I'm using an egg donor and why don't I have bad energy? Well, because your husband could be 70 or 60 and   Michelle (37:11) Yeah.   Armando Hernandez-Rey MD (37:14) And then their fragmentation is completely elevated and through the roof. So yeah. So, you know, firefighters, occupational hazards.   Michelle (37:18) Right. So, yeah, it's important. It's important for people to hear this because they can go in and say, the semen analysis was perfect. But that, like what you just said, is not really checked. So they may not, in a healthy, like, younger guy.   Armando Hernandez-Rey MD (37:35) It's not as nuanced as we once thought it was.   Michelle (37:38) Yeah. Yeah. Interesting. It's, it's fun. It's always fun for me to talk to our, our ease, you know, just to get, to pick your brain and get your thoughts. and you're my neighbors. So it's pretty cool.   Armando Hernandez-Rey MD (37:50) That's right. Thank you very much for the invitation. This was really fun. We spoke about a wide array of different topics here. So this was really nice to connect this way.   Michelle (37:53) Yeah.   Yeah.   Yeah, for sure. And I know that a lot of people are going to be like, this is interesting information. Cause I know that what you just mentioned, a lot of it is not common knowledge. people don't know automatically hear about this or really know to think about asking about it. So, so I appreciate all your information, all your good, good data. And, for people who would like to work with you or in town, how can they find more about you?   Armando Hernandez-Rey MD (38:27) Well, we are at Conceptions Florida. We have two offices in Merritt Park, Coral Gables and one in Miramar and hopefully soon also in Boca. And I'm there Armando Hernandez -Ray, MD I'm sure. Easy to find these days on Google, but I'm happy to help in any way that we can. We've been doing this for a long time, quite successfully, thankfully. And we take a lot of pride, humbly speaking, but probably also.   in having a good footprint in South Florida and the infertility world and trying to offer the best care possible.   Michelle (39:01) Awesome. Well, this was such a pleasure and thank you so much for coming on today.   Armando Hernandez-Rey MD (39:05) Thank you, Michelle.    

Making Sense of the Carnivore Diet? Is the carnivore and animal based diet all sizzle and no steak? Join me as i interview Dr. Robert Kiltz to make sense of the carnivore diet. This episode is available on the Apple and Spotify Platforms Dr. Kiltz is a Diplomat of the American Board of Obstetrics and Gynecology and Fellowship trained and Board Certified in Reproductive Endocrinology and Infertility. A Graduate of the University of Southern California, he completed medical school at the University of California, Davis.  A thought leader in the keto carnivore movement, Dr. Kiltz believes that an animal-based diet dramatically improves mental clarity, fertility, and health, empowering people to live their best lives. In addition to his own media channels, Dr. Kiltz appears regularly on numerous popular blogs and social media outlets, and has shared his views as a speaker at TEDx. Listen to this episode on both Apple and Spotify Platforms. SUBSCRIBE / RATE / FOLLOW The Makes Sense with Dr. JC Doornick Podcast https://podcasts.apple.com/us/podcast/makes-sense-with-dr-jc-doornick/id1730954168 Follow/Connect with Dr. Robert KiltzWebsite: www.doctorkiltz.com IG: @drkiltz  Follow/ Connect with Dr. JC "The Dragon" Website: www.makessensepodcast.com IG: @drjcdoornick The Makes Sense Podcast available on Spotify and Apple - You will find a "Follow" button top right. This will enable the podcast software to alert you when a new episode launches each https://podcasts.apple.com/us/podcast/makes-sense-with-dr-jc-doornick/id1730954168 Click this link to SUBSCRIBE/RATE/REVIEW - https://ratethispodcast.com/makessensepodcast Thank you for your support with our podcast on apple and spotify. Our mission is to remove the blindfolds from the sleepwalking masses and begin the uprising of the sleepwalking masses. OUR SPONSOR: MAKES SENSE ACADEMY Enjoy the show and consider joining our psychological safe haven and environment where you can begin to thrive. The Makes Sense Academy. https://www.riseupwithdragon.com/makes-sense-academy   Highlights: 0:00 - Intro 4:37 - Reproductive Endocrinology? 7:03 - Why are we all sick? 10:14 - A unique approach to fertility 14:30 - What's the difference between Keto and Carnivore? 15:52 - What is Ketosis 17:30 - Plants are not required in our diet? 19:01 - Are humans depleting the meat resources? 23:19 - Is science just a belief system? 25:04 - Who is the carnivore diet right for? 26:53 - What is the Carnivore Diet? 30:13 - Who should not do the carnivore diet? What about high cholesterol? 34:16 - Do people with high markers (Cholesterol, HDL, LDL) need medication? 37:46 - If you are struggling with your health? 41:32 - Are Vegetables and Carbs necessary at all? 46:06 - The Choice is yours 50:47 - Where should I get my meat?  

Today, we sit down with Dr. Lauren Rubal, a Reproductive Endocrinology & Infertility physician who focuses on fertility, recurrent miscarriage, painful, irregular, or heavy cycles, and menopause through an integrative lens. Instead of taking a bandaid, one-size-fits-all approach, Dr. Rubal views each patient as an entire person - body, mind, and soul - and works to address the root cause of reproductive disorders. But she wasn't always in this field. Dr. Rubal started her career in conventional medicine, and even practiced IVF. What prompted her to leave and start her own practice? How does Integrative Medicine differ from a more typical medical approach? What's so bad about IVF? Is there any such thing as "ethical" IVF? And why is hormonal birth control an ineffective treatment? We address all that and more. Find Dr. Rubal at: https://www.laurenrubalmd.com/ Get your tickets for Share the Arrows: https://www.sharethearrows.com/ --- Timecodes: (01:22) About Dr. Rubal & her practice (05:20) The process of IVF (13:11) Ethics of “donating” sperm (15:15) Egg fertilization & the fate of embryos (20:17) Egg grading & testing (34:55) Embryo transfer process (43:55) Risk of miscarriage (45:10) More ethical IVF? (46:15) Selective reductions (51:11) Why Dr. Rubal left the IVF practice (58:47) Why we need education about fertility (01:04:57) Her integrative approach to health (01:07:25) Where to find Dr. Rubal --- Today's Sponsors: Covenant Eyes — protect you and your family from the things you shouldn't be looking at online. Go to coveyes.com/ALLIE to try it FREE for 30 days! Birch Gold — protect your future with gold. Text 'ALLIE' to 989898 for a free, zero obligation info kit on diversifying and protecting your savings with gold. Patriot Mobile — go to PatriotMobile.com/ALLIE or call 972-PATRIOT and use promo code 'ALLIE' for free activation! Balance of Nature — Balance of Nature's proprietary blend of 31 fruits and vegetables come in easy to swallow capsules to give your body the nourishment it needs. Go to BalanceofNature.com and use code ALLIE for 35% off. --- Relevant Episodes: Ep 976 | Birth Control: What the Media Won't Tell You https://podcasts.apple.com/us/podcast/ep-976-birth-control-what-the-media-wont-tell-you/id1359249098?i=1000650764644 Ep 959 | Birth Control Is Making Women Bisexual | Guest: Emily Detrick https://podcasts.apple.com/us/podcast/ep-959-birth-control-is-making-women-bisexual-guest/id1359249098?i=1000647441400 Ep 254 | Birth Control, IVF & Surrogacy https://podcasts.apple.com/us/podcast/ep-254-birth-control-ivf-surrogacy/id1359249098?i=1000475691301 Ep 695 | Why Children's Rights Trump Adults' Feelings | Guest: Katy Faust https://podcasts.apple.com/us/podcast/ep-695-why-childrens-rights-trump-adults-feelings-guest/id1359249098?i=1000583336623 Ep 554 | IVF, Embryo Adoption, & Surrogacy: Answering the Hard Questions | Guest: Jennifer Lahl https://podcasts.apple.com/us/podcast/ep-554-ivf-embryo-adoption-surrogacy-answering-the/id1359249098?i=1000549207733 --- Buy Allie's book, You're Not Enough (& That's Okay): Escaping the Toxic Culture of Self-Love: https://alliebethstuckey.com/book Relatable merchandise – use promo code 'ALLIE10' for a discount: https://shop.blazemedia.com/collections/allie-stuckey Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Angela Thyer and Judy Simon discuss their book 'Getting to Baby' and the importance of nutrition and lifestyle in fertility. They share their backgrounds and how they came together to help women improve their nutrition and health for better fertility outcomes. The book covers the connection between food and fertility, the importance of whole foods, debunking misconceptions about diet and fertility, and the benefits of intuitive eating and cooking. They emphasize the need for diversity in food choices and the impact of processed foods on fertility. The book also includes practical tips and recipes to support a healthy pregnancy journey. The conversation covers topics such as the importance of breakfast and meal timing, the impact of nutrition on fertility, the role of integrative medicine in fertility treatment, and the power of lifestyle choices in influencing fertility outcomes. The guests emphasize the importance of combining foods and the role of vegetables in supporting digestion and overall health. They also discuss the impact of stress, sleep, and epigenetics on fertility. The conversation highlights the need for a multidisciplinary approach to fertility treatment and the importance of finding a supportive healthcare team.   Takeaways Nutrition and lifestyle play a crucial role in fertility and improving fertility outcomes. Eating whole foods, including a variety of fruits, vegetables, plant-based proteins, and whole grains, is important for fertility. There are many misconceptions about diet and fertility, such as the need to cut out carbs or follow specific diets. It's important to focus on nourishing the body with whole foods. Intuitive eating and cooking skills are valuable in creating a healthy and sustainable approach to nutrition. Diversity in food choices is essential for optimal fertility and overall health. Processed foods can negatively impact fertility, and it's important to prioritize whole foods. The book provides practical tips, recipes, and a six-week blueprint to support a healthy pregnancy journey. Breakfast is an important meal for fertility and overall health. It is best to have a substantial breakfast with protein, fiber, and vegetables. Meal timing is crucial, and it is recommended to have more calories earlier in the day and fewer at night. Combining foods, especially vegetables, can support digestion and nutrient absorption. Stress, sleep, and lifestyle choices have a significant impact on fertility outcomes. Epigenetics plays a role in fertility, and lifestyle choices can influence gene expression. A multidisciplinary approach to fertility treatment, including integrative medicine, can provide comprehensive support. Finding a supportive healthcare team is essential for navigating the fertility journey.   Guest Bio: Judy Simon Judy Simon, MS, RDN, CD, CHES is an award winning registered dietitian nutritionist who specializes in reproductive health. She is the founder of Mind Body Nutrition, PLLC and a clinical instructor at the University of Washington. Judy's expertise includes fertility, PCOS, eating disorders, weight inclusive medicine and reproductive health.  Judy has held leadership roles in the American Society of Reproductive Medicine Nutrition Special Interest Group and is a Fellow of the Academy of Nutrition and Dietetics.  Judy integrates mindfulness, intuitive eating, eating competence, while taking a non-judgmental, inclusive down approach to help people have healthier, more fertile lives.  Judy is the co-founder of Food For Fertility program and co-author of the upcoming (April, 2024) book Getting to Baby A Food-first Fertility Plan to Improve Your Odds and Shorten Your Time to Pregnancy, Ben Bella Publisher   Guest Bio: Angela Thyer Angela Thyer, MD is board certified in Reproductive Endocrinology and Infertility, Ob/Gyn and Lifestyle Medicine. She is a founding partner of Seattle Reproductive Medicine. Dr. Thyer completed her undergraduate education at Duke University, medical school at the University of Cincinnati College of Medicine, residency at Oregon Health and Science University, and fellowship at the University of Texas Health Science Center at San Antonio. She completed The Culinary Coaching program through the Institute of Lifestyle Medicine in 2020 and became a certified plant-based chef through Rouxbe in 2022. She and Judy Simon, MS, RDN created the Food for Fertility program and have co-authored a book coming out in 2024, Getting to Baby: A Food-First Fertility Plan to Improve Your Odds and Shorten Your Time to Pregnancy which highlights the best foods to optimize fertility.   Website & Social media links (Facebook, instagram, twitter)   Instagram: @angelathyermd Website: angelathyermd.com     For more information about Michelle, visit www.michelleoravitz.com   Click here to find out how to get the first chapter of "The Way of Fertility" for free.   The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/   Instagram: @thewholesomelotusfertility   Facebook:https://www.facebook.com/thewholesomelotus/         Transcript:   Michelle: So Angela and Judy, welcome. Angela: Thank you so much. We're excited to be here, Michelle. Michelle: So I'd love for you guys to give a background first. , I'm very excited to be talking about your new book, Getting to Baby. I would love for you first to share your background so people can know more about you and what got you to doing this type of work. Angela: Okay. Sure. I'm a reproductive endocrinologist and infertility specialist. So first I trained in OBGYN and then specialized in reproductive endocrine and infertility. And then I got board certified in lifestyle medicine. So, which is a more holistic kind of way to look at all healthcare, more of a preventive lens of like, how can we look at lifestyle measures to, you know, really help people in all phases of their life. Angela: And I've always been interested in food, nutrition, exercise. And so over the years, it just became a bigger and[00:01:00] bigger part of my practice. And I've always been interested in obviously hormones, but metabolism and Judy and I started working together at the university of Washington. And we found we had this common interest in really helping women, you know, work together to improve their nutrition and health, which subsequently leads to improvement in their fertility. Michelle: Oh, totally. Judy: And I'm a registered dietitian, as Angela mentioned, and my master's is in community health education. And I sort of went through traditional training, and when I came back and re entered, you know, medicine, gosh, about 20 ish years ago, all of a sudden, PCOS and all these things that I had never really learned about just came front and forward. Judy: And so I was fortunate to connect up with Angela and really do the deep dive into, Hey, what do we know about insulin resistance? How is this affecting fertility? And these were things that traditionally I hadn't been taught. [00:02:00]So really, I think we kind of joined each other's worlds. You know, I joined American Society of Reproductive Medicine and, you know, joined all the fertility docs. Judy: And You know, Angela would come to the nutrition conferences. So we did a lot of cross pollination and from that we went off and both started into private practices and she'd refer these amazing patients and we decided, wow, we're seeing them one at a time. Wouldn't it just be the coolest thing if we could start classes? Judy: So about 12 ish years ago, we started the food for fertility classes where we brought women in who were trying to conceive. Many of them had PCOS, endometriosis. unexplained, lots of different diagnosis. And that's who we brought the food and the people and the lifestyle into the classroom, which is really why we wrote the book. Judy: It's kind of, we took all our years of experience, science and knowledge and said, let's make it accessible to more people. Michelle: That's awesome. And so [00:03:00] talk about the book. What's in the book? And obviously it's for people trying to conceive, getting to baby. What were the top things?  Angela: Yeah. Well, we, we started off by, you know, kind of, we always want people to understand the whys, you know, why this, why that what's the connection, what's the underlying biology and physiology? And then what evidence do we know? A lot of nutritional studies about fertility or observational studies, like they'll a population will be observed and they'll say, okay, people who ate these kinds of diets or these kinds of foods had higher fertility and more successful outcomes than people who ate this kind of diet. Angela: So, you know, we, we want to, wanted to present all that information. So people kind of have background and good knowledge and can kind of say, oh, okay, well. Maybe that would be a good idea for me. You know, it's not, it's, it's a broad spectrum of what, you know, a good diet could look like. It's not just one thing. Angela: Obviously [00:04:00] mainly plant forward. Cause I think we all need to eat more fruits and vegetables and plant based foods. But there is room, you know, for some animal foods too, especially things like fish and whole fat dairy, which have shown to increase some fertility benefits. So, you know, we kind of go through all the food groups and talk about what's, what we, where we have evidence, what's good, what's not so good and what vitamins and minerals and nutrients they're adding. Angela: And then, you know, some of the biggest things that we're like, if you want to incorporate this, it's a really, it's a how to. Right. So we wanted to make it like accessible in this sense that anybody at home could be like, Oh, okay. I, gosh, I just want to add one little thing this week. What would I add? What can, what's my takeaway? Angela: What's my smart goal? So people can kind of set their own goals and try to move forward with that, making a little progress at a time. And then the greatest thing I think is sharing stories from our patients who are just fabulous[00:05:00] women who've been on their own journey. And we had so many stories, we couldn't even share them all in the book. Angela: But kind of telling these journeys that sometimes took months, sometimes took years and how they were able to incorporate changes and see changes in themselves. and feel increased energy and then kind of have improved fertility. Maybe if they had a partner, you know, their partner's health was also improving at the same time. Angela: And so many of them were successful either With natural conception, or if they were infertility treatments, having better success in those treatments and making better quality embryos that we were like, wow, you know, that's really what's in the book. So as much as we could share and keep it accessible and reasonable in length. Angela: That's, that's what the book's about. Michelle: I found it very user friendly and I really enjoyed the image of the plate and how half of it was greens, which is great because I do believe that it's so important to get the greens. And there's so many nutrients that you can get[00:06:00] from that. And you talked about some misconceptions too, like on treating PCOS and like common misconceptions on what to eat for fertility. Michelle: So I'd love to touch upon that. Judy: Yeah, well, one of the things that we tried to bring out in the book is when we first started doing our classes, a lot of the reasons women would be referred to us as we'll just go lose weight. So nothing, you know, focusing on their health and we're like, Oh no, no, no, this is not a weight loss class. Judy: This is totally about how to nourish yourself. And actually. Take away the shame and guilt in, you know, whatever size body you have being able to get the benefits of the nutrition and the lifestyle. Right? So, for example there's a lot of people that would come in with a whole list of foods that they thought they shouldn't eat because somebody told them that. Judy: And we're like, well, are you allergic to them? No. Well, okay, you know, here's a safe And that's what we tried to do in the [00:07:00] book. Like showing in all these different, you know, sure, maybe you can't tolerate dairy. Here's a sub, here's something else you can, you can place out so that everybody would feel included, that anybody could be in the classes, read the book and really get the benefit out of it. Judy: So when, when you talk about myths, probably the biggest one is, you know so many women are told cut out carbs. Cut out carbs and we're like, Oh no. Well, what's in whole grains and ancient grains. We know those inositols we hear about in PCOS. Guess where they come from? White beans, buckwheat. So we're saying where can you get these ancient grains are just so filled with minerals and also really showing that looking at the quality of carbs that you're choosing most of the time is actually going to be beneficial. Judy: And this is kind of relief for women to hear like, I don't have to starve myself. I get to eat and try new things. Michelle: Yeah. That's such a good point. And also, cause a [00:08:00] lot of times when people have carbs, it's simple carbs or juices where you're taking basically, even if it's fresh juices, like we're really meant to have the whole fruit, right? The fiber like, and digest it slowly so that it's not a sugar spike. I'd love for you to talk about that too, the importance of, of actually having the whole food. Angela: Yeah, we definitely talk about kind of it being a whole food diet because that is so important and The issue with I mean, yes, you can get some of the nutrients if you juice But you're also gonna get mainly sugar without the fiber if you've removed the fiber. So the fiber is so important both to slow down your digestion and really pay attention to gut health. Angela: And I know you focus a lot on gut health. You know, that's where so much of our health overall starts. And there's so many connections between the gut and the mind and the body and the hormones and everything else, every, every system. And so, having that [00:09:00] fiber in your diet, really from whole foods. I mean, especially plant based foods, right? Angela: Because animal foods don't have fiber, but the plant based foods really then is is great food for the microbiomes, the microbiome, our microbiome and the bacteria, the 3 trillion bacteria that live in our gut. And it helps create, you know, it's more anti inflammatory because so many people kind of can get. Angela: almost a chronic inflammation from not eating enough fiber, not feeding their microbiome. And then that can lead to more issues in more body systems that they may not even be aware of. But nobody is, you know, advertising whole foods, like whole foods. So much of what people see and kind of the noise that feeds in is just, you know, everything else that's marketed in a box or a bag or somebody. Angela: And so that's what, and so sometimes those help people put health claims on other products that [00:10:00] aren't whole foods and then whole foods kind of get neglected. And so, yeah, we definitely want to say, you know, it's important. And we talk about eating the rainbow and the colors because each colors, providing different phytonutrients. Angela: And so, you know, you want that broad range because the more diversity you have in your fruits and vegetables, the more diverse a microbiome you're going to develop, the better protection for your immune system and just make everything else work better in your whole body. Michelle: I love that you talk about diversity because actually a lot of people end up developing sensitivities even if it's healthy food that they eat all the time and it's important to have diversity because it really allows the body to get so many different benefits and also not get too intolerant of one specific thing. Michelle: The body likes diversity. Judy: Absolutely. And we really wanted people to feel inclusive with the book. So that's why there's so much [00:11:00]culinary medicine, like just basic skills. Here's how you can throw something together without even a recipe, you know, just really, you know, five steps to a great salad. What should it have, you know, different things like that. Judy: And we also wanted it to really highlight the, All the global cuisines. And so for example I see a large population of South Asian women, right? And so there's, there, there always were like their diets too high in carbs. And we talked about what are all the wonderful things that herbs that you're using, the dolls, you know, the pulses, but we tried to make sure we had things from all regions because unfortunately a lot of people here in the medical world, like, Oh, just eat the Mediterranean diet. Judy: We're like, Oh no, no, no way. That that's so exclusive. It's not inclusive. We want to talk about, you know, foods from, you know, West Africa or Central America, a lot of the indigenous healthy foods, and then also what's seasonally available. And so one of the things that we really tried to [00:12:00]share is a lot of different types of foods. Judy: Simple preparation, but let people start where they're comfortable. So if you're a chef that only has three or four recipes and you're still sort of using some are processed foods, maybe they'll start with adding a soup or adding some vegetable dishes or adding a salad and letting them know you're going to get benefits from those first steps. Judy: Because some people feel like, like I just talked to someone, she goes, I'm trying to be all in, you know, trying to be perfect. Do you know what I mean? Michelle: Yeah, Judy: And that's stressful. It's stressful to feel like you're getting a grade on your diet. And we want people to feel like it's fun. They're having a date night with their partner and maybe they're trying a new recipe in the book. Judy: Or they got inspired because there is a lot of pressure when people are trying to conceive. And the book is also for those people who are like, Hey, we want to get pregnant in the next year. What's the path to a healthy pregnancy? We have no idea how long it's going to take, but [00:13:00] what's going to prepare us? Judy: And you know, Michelle, that like 50 percent of pregnancies are unplanned. So a lot of people, you know, maybe they're exposed to a lot of those fertility disruptors, and if they would have known even a few months in advance, they could have decreased some of the risks, you know that could impact their fertility and pregnancy. Michelle: definitely. I remember seeing something, it was about a burger or like a chicken sandwich or something. It was a sandwich with a bun that the woman just kept in her closet and just saw what happened and it was not, it was not good. Breaking down and I'm like, whoa That is crazy. Like things are supposed to break down if they don't break down and they don't yeah Just break down like what happens in your body So talk about the importance of eating whole foods. Michelle: Listen, we're going to have processed food once in a while. It's not like, you know, end all be all like, it's not one thing or another, obviously, [00:14:00] but talk about the importance of really being intentional about choosing more whole foods in your diet.  Angela: Well, you know, I do think, I think that everybody's so different in what they eat, but I think that, yeah, the ultra processed foods and processed grains, so like breads, cereals, pastas, Anything it's just so it it's everywhere, right? It's it's you can't get away from it and it's become normalized And it and so it has become acceptable and ordinary And the problem with those foods is yeah, you don't need to say i'm not never going to eat that again But it replaces it, you know, it takes the place of whole foods. Angela: And so I think you know Where do you get whole foods? Well, it's hard to get whole foods You You know if you're eating If you're buying foods at convenience stores or fast food restaurants or even regular restaurants Sometimes i'm surprised that menus don't have Kind of like more vegetables available when we talk about the fertility plate[00:15:00] and the whole plate being half Vegetables, right? Angela: You're not going to get that in a restaurant, like the restaurant usually. So, you know, we, we have talked to women, we didn't really talk about this that much in the book, but like, I think some of the women gave us examples of, you know, planning when you go to a restaurant, gosh, what can I eat from this menu that would be more of a whole food, what are the, sometimes the side vegetables are something they'll order from some of those things to say like, yeah, I don't need to necessarily go for the most. Indulgent luxurious meal. I want to go for the whole foods cause I know that's what my body needs. So we talk about being intuitive eater or competent eater. It, you know, I don't think this is taught well in schools. So, you know, to, to be honest, nobody, it's nobody's fault. Like where you are, it's a growth opportunity for everybody to be like, Hey, I didn't really get this education growing up. Angela: My parents worked. I didn't, you know, I didn't cook that much growing up, but now I'm an adult. And I need to really learn about [00:16:00] nutrition and what my body needs and how to heal myself through food. And what that might mean is I need to cook more. And if I don't know how to cook more with whole foods, You know, there's opportunities to learn. Angela: There's so much now available on YouTube, or that's both good and not so good, but you know, you can find the good, the good things and learn to cook with whole foods and buy things like our book, which are trying to teach people almost some intuitive cooking skills. Cause you don't always want to be cooking from a recipe. Angela: You want to get some basic staples and some comfort in the kitchen and some things you really are good at, and then always build new and add new. Okay. But yeah, so that was like one of the tenants of our philosophy of how we taught was, let's talk about, you know, building a meal. Let's talk about what vegetables are going to be in the meal, what protein is going to be in the meal. Angela: And for us, that was mainly going to be a [00:17:00] plant based protein. So either beans, lentils. tofu or tempeh or edamame, so a soy based protein, or fish, since all of those have been shown to increase fertility. And then whole grains, those ancient grains, so not processed and kind of putting that all together and nuts and seeds and other things that provide those denser nutrients. Angela: And really starting with like cutting things up, like, okay, let's prep everything. Let's do the mise en place. Let's get everything ready. Let's plan meals. So you're going to have leftovers. because it takes work and effort. You don't want to put all that effort in and then only eat once. So you want to have some leftover meals that you can repurpose throughout the week or free some of these meals that you're going to be able to then thaw out next week or next month when you're more time pressed, and you know, you've got your own freezer meal that you've prepared that you're going to be able to thaw out and cook and have a nutritious, delicious, quick meal, right? Angela: So it's just a, I think it's a mindset, right? [00:18:00] It's a different way to think. And, and everybody can get there and just build that knowledge and build those skills. And that's exciting. Michelle: It is exciting. I find that whenever you're learning something new, like you, you make it more complicated in your mind. You're like, oh, I have to do this whole thing. But you don't realize, like as you learn it, you could really strategize and make it so much easier and cheaper. You could save money that way. Judy: Absolutely. Michelle, you bring up a really good point. And what's really fun is a lot of the women who've taken classes or patients of ours, like even after like two years after they have their baby, I'll get an email. You know, I saved all those recipes from class and I still love the, you know, the quinoa mango black bean salad. Judy: It's so delicious in the summer. I take it to parties or one patient just wrote me about the soca bread made out of chickpeas that they start to add them to their repertoire or you want to increase their self efficacy, their confidence and their competency. And then when they do eat out, you know, maybe [00:19:00] they do broaden and they, you know, they go for an Indian meal or an Asian meal and they know like, Hey, I'm going to order one whole vegetarian. Judy: So I get more broccoli and veggies like they know how to order and feel good. When they go out or they travel, you know, how can I take that and keep it better? And, you know, just really, you know, giving them that support. And so in the book, for some people, this is really new. We kind of do like a six week blueprint, but we also say like, If you feel pretty good on some of the skills and you've checked the box, awesome. Judy: Work on some of those things that you, you want to build up stronger in your repertoire. And if you feel like you need more time, I remember when our class switched to virtual and we started to go to every other week, the women were like, this is kind of good because I have more time to work on my goals. Judy: I kind of like that other, remember the every other week model? You could do that with a six week plan. Maybe I'm going to try to do this over twelve weeks, you know, three months, give myself some time to To try new things.[00:20:00] And the thing is you're getting the benefit with every step you take. There's a benefit, you know? Judy: And so the cool thing for us is sometimes at the end of the class, women who didn't eat in the morning, they like. You know, we started eating in the morning because of class and the food was really good. They started regulating their cycles, Michelle. It was amazing. And one of our last live classes before COVID, I remember one table of four, they were all kind of waiting to get their cycles and things and getting ready for IVF. Judy: And they all went on to conceive. They all got their cycles and went on to conceive. And that was just, the cost of food and, you know, putting a little bit of time in so that lifestyle does make a difference whether someone's going for art treatment or they're, you know, they're, you know, they're just maximizing their fertility options. Michelle: Yeah, there was actually a study on girls in college that skipped breakfast and how it impacted their cycles I thought that was interesting[00:21:00] Judy: I would guess negatively. I'm thinking if Michelle: Negatively, yes negatively. Yeah. Yeah, Judy: You know, I just want to check. Michelle: They most of them started regular and it they became irregular. Judy: You know, and people are getting into a lot of fads where they're really time boxing their food. I just talked to someone in a smaller body and she says, I'm trying to eat clean. So I only eat between this time and this time. I go, Michelle: Mm hmm Judy: you should eat when you're hungry. Your body needs nourishment all day, not just eight hours. Judy: So sometimes we see people that are going to overboard. And they're restricting, and then their reproductive axis is not getting the nutrients it needs. And I'm like, that's not what you want to do for ag health. That's not what you want to do for reproductive health. If you feel cold at night and you're, and, and you know, and as we know with, you know, acupuncture and Chinese medicine, energy is such an important concept. Judy: So if you're freezing all of a sudden, and you're starving [00:22:00] yourself, you're not nourishing your body. Michelle: Absolutely. And actually in Ayurvedic medicine, they say that when the sun is out, that is when, because we, you know, we, we respond to the elements. And when the sun is out, especially like around 12 PM, you should have your largest meal because it increases your own digestive fire because we get influenced by nature. Michelle: And actually the morning you should have breakfast, you should have food during the day when the digestive fire is. Increase the most and when you shouldn't is as it gets darker like a couple hours before you go to sleep That's when you can give your body a break. So it kind of According to Ayurveda, it's a little bit more flipped than what's typically done where people skip breakfast. Angela: Right. And, and, you know, that, that exactly parallels some of the metabolic studies, right? So what Ayurvedic medicine is known for so long, right? And then Western medicine has to come and prove it that like our digestion is[00:23:00] better in the morning and the way glucose and, and. nutrients are processed in the morning is better when we have more energy and we're more active throughout the day. Angela: And then at night, things are winding down and slowing down and you want your body to relax for sleep and not be digesting a big meal. And, and we do talk about that, but it is really hard for people to flip to try and get more calories and earlier in the day when fewer at night when the typical pattern is, is the opposite. Michelle: and it's going to give them a lot more productivity and energy to have a good breakfast because you know, protein, you got those good fiber and vegetables and berries and, really start your day right. Judy: We encourage people if they're really set in a way, we're like, we'll do it as an experiment. Be curious. Try it on the weekend. Maybe try it on the weekend because you don't want to change your flow. See how your energy feels, especially when people are telling us they're fatigued. Judy: They're like, I'm so tired. And it's [00:24:00] like, and most of their energy intake is at night. They wake up not hungry. You know, we do try, you know, try to flip that around and that's part of that intuitive eating and eating competence and see where your body, because really people know a lot about their body and so we want them to be in tune to that too and trust that. Angela: And I was just going to add that, you know, sometimes people have these ideas of what a typical breakfast, lunch, and dinner is and what food should be part of those meals. And we say, Hey, that does not have to be the case either. I love a breakfast salad. I love eating my leftover dinner from the night before for breakfast. Angela: If I've made something delicious, I made this great stir fry and I've had a little bit because it's late, but I'm like, I want to have that for breakfast. I'm going to have a big bowl, you know, so I love having those other things early in the day because I do feel like it gives me great energy. And then the other thing that we talk about is, you know, the[00:25:00] walking after meals and especially getting outside early in the morning and getting that sunlight to really Start your day and, and get your clock going and how important those rhythms can be to recognize that you have, your body has a rhythm, sleep consistency is important, exercise and movement throughout the day is important, all these other things that we want to build in, you know, to our base for overall wellness to support fertility. Michelle: Yeah. I love it. I love it that you're a doctor and you're interested in this because unfortunately it's not as common. Like people don't know about all of these things about really connecting with nature and the nutrition aspect of it. So it's amazing. It's so well rounded because you have like so many different backgrounds and perspectives on Judy: We, we, we, yeah, we try to bring it all together and that's why this book would have been much longer if our publisher didn't say stop, you know, it was like twice as long. You'll see when you're writing your book, you want to share everything. And so we did include [00:26:00] two chapters on like boosters and disruptors, you know, talking about stress and sleep. Judy: And then also some of the disruptors like, you know, alcohol, cannabis, endocrine disruptors, because we didn't want to scare people, but we felt they needed to know. And you know, science based, evidence based, but we did put it at the end. You know, we really focus on the food and feeding yourself because really that's what our program is all about. Judy: But we find that when they put it all together and they get to those boosters and they add the movement and the stress and so many of our patients, patients who do acupuncture will say, well, that's one of the ways I always say, what do you get out of it? Cause I always want to know. And they go, Oh man, I'm such a good place to do. Judy: I leave in my stress level is so much better. I go, then that's something you want to include in, in, in what you're doing for your health. If you have the privilege and you have the accessibility to it. So we, we try to make everything accessible. Because there's so [00:27:00] many women and men who don't have access to medical care when it comes to fertility. Judy: It's really the underprivileged do not have access or such limited access that we thought if we could at least cover the main things and it could be, you know, available in libraries or, you know, things like that and audio books that that would be a way that more people could really have that information. Michelle: Well, it's great information. And also, I love that it talks about. combining foods, in Chinese medicine, we have a lot of formulas of herbs. So each herbal formula has different herbs and they work together as a symphony. And a lot of times they'll include ginger or digestive herbs to help assimilate. Michelle: So working together, And a certain symphony is what makes it that much more beneficial for the body. And I like how you talk about the importance of combining foods. You were talking about putting [00:28:00] vegetables because if you just eat meat without vegetables, it's not going to be able to simulate as well and digest as well without those vegetables helping in that fiber. Angela: Right. The vegetables are actually pretty protective, right? So I mean, there, you know, there have been studies that look at people who eat just more of an all meat diet and then people who eat more of a vegetable based diet, but with meat and the gut is healthier, right? If you incorporate those vegetables the, the, because the fiber from the vegetables is so protective. Angela: That then you are able to digest the, the meat and make use of the nutrients in the meat as well. So I think that's, that's great advice. And I think that, you know, out here we're in Seattle. And so we have a lot of, you know, we have a number of people who are trained in acupuncture. They are, you know, trained in traditional Chinese medicine. Angela: And we have always basically said, you know, gosh, I don't know that area, [00:29:00] but I trust. The practitioners in my area who knows so much this has been around for so long that let's, you know, combine and talk about the best of all worlds and support everybody's health. And then the same with fertility clinics, like some people really are going to need that extra step of a traditional IVF clinic. Angela: They might need insemination. They might need IVF. And then all these other things are going to be supportive and enhance their success because it's so expensive. And the last thing you want to have to do is multiple cycles. And so the more efficient you can make each cycle by bringing your best self forward into the process and taking the time, like a lot of people, you know, want to kind of take a lot of time to get to a fertility clinic. Angela: And then once they get there, they want IVF yesterday. Like they want to be pregnant yesterday. So And it's still really about the time and the investment in, [00:30:00] you know, producing optimum health for you and your partner. And so that, you know, it might take a good three months, right? Of preparation to say, let's make sure when you do IVF, if you need IVF and you're going to do it, that everything's perfect. Angela: As great as you can make it going into the cycle instead of just like, Oh, there's an opening next week. Let's get started. You know Michelle: I wish all reproductive endocrinologists spoke like you Angela: Oh, yeah. Thank Judy: she, and she, and she walks the walk, you know, for all the patients we've had together. A lot of times after that initial consult, she'd be like, okay, I want you to do, you know, food for fertility and work on nutrition and lifestyle for three months. You know, let's see, you know, what we can do with some of these biomarkers that are, that are elevated in a very positive way. Judy: And then quite often during that three months, a woman starts cycling. I always, I remember saying to Angela once years ago, I go, What if you put the [00:31:00] fertility clinics out of business? I mean, we were kidding, you know, when I said that they have the role. So please don't think I'm saying that, but you know, we did. Judy: And she's like, great. She was like, wonderful. Let's help people on the easiest journey. Let's not, you know, when someone gets sent to me and they've already had three failed IVFs. for whatever reason. And they're like, okay, I want to work on my nutrition. I'm so happy to work with them, but I feel really bad because they're pretty wounded because they've been pretty disappointed and let down. Judy: And sometimes it was something obvious that nobody ever brought up, you know, their eating disorder, their PCOS, that things could have been optimized first. So I think that's where we all work together. So I feel like that's why when you work in integrative planning, You know, practices. We, we work with, you know, fertility yoga instructors that we really trust and, and, and, and D's and dietitians and, and, you know, we know which clinics are going to be weight shaming, you know, we want to know [00:32:00] where can our patients put the best team together, where can they get support groups from resolve or other organizations so that they feel as fully supported as they go on this journey, because a lot of people, Never expected this. Judy: They just, I went through unexplained infertility for years. Never thought that was in the bags for me, but it was like. You know, you feel helpless. So having a community, and I think when we all work together interdisciplinary, you know, and we know the best people to send our patients to, or best organizations, or how to check, we really help them. Judy: We really, we really can help. So we're excited about you, you know, your future book. Yes. I mean, you know, I was just coming first, but yeah, looking for resources is so important, Michelle. Angela: And I, right. And I think, you know, those resources are great. And then also if somebody is seeing somebody and it's not clicking. You know, it could be it could be their doctor. It could be their [00:33:00] dietitian. It could be whatever They you don't have to stay with the same person. You can actually go get another opinion you might You know, click better and work better with someone else who Has different information even it's not all the same. Angela: So each of us don't necessarily provide the same information or You know, it's an art and a science and I think we all feel that that we connect with people It's so important, but we all connect differently And and as an individual each person should really You Make the most of that and, and really make that work for them. Angela: They're the ones they're invested in it. Michelle: That is so true. Absolutely true. I've seen people who have been going for years to one reproductive endocrinologist and then when they changed different approach, different energy, just like, and it was a different outcome, Angela: Yep. Michelle: you know, it happens.  Judy: And if you make a change, [00:34:00] no one's mad at you. We all want the same end result. I always tell them all the clinics in this town, they're all friends. They all know each other, you know, professionally, they all know each other. They're going to send your charts. Judy: They're not going to hold them back. You know, everybody does want a positive outcome, you know, to take place. Michelle: Yeah. Yeah. That's great. I mean you know, not always the case, , but when it is, it's amazing, and it's true you really do have to find that alignment and I always say, you know, it takes a village and creating a team of different people that can support you in different ways. Michelle: When going through this, but of course nutrition is so important in Chinese Judy: We all eat. Michelle: Yeah, we all eat and we eat for a reason a good reason, right? Angela: Mm hmm. Michelle: And the spleen and stomach are actually the center and they're like the mother in a sense, you know the nurturer Aspect of our bodies and that is really where everything else gets built they [00:35:00] talk about pre heaven chi pre heaven energy in the kidneys And of course the kidneys are really important But sustenance, the energy with which we can sustain and increase after our genetics is food, Angela: Right. And I think, you know, that's just kind of being understood. I mean, I think in science, Yeah. We now are recognizing, you know, there's genetics, and then there's epigenetics, which is how the genes are expressed and the epigenetics is how we influence which genes are expressed. And that has to do with our nutrition, our stress. Angela: Our sleep, our movement, our community, our mental disposition, our mental health, our optimism. All these things have a huge impact in our health by the epigenetics. And I think people sometimes think it's just genetics and things are. A predetermined and it's going to be one way and it's totally [00:36:00] not. You have so much influence as a, as an individual about what path your life can take and how your health is affected by these decisions you make every day. Michelle: which is so empowering, I think, to know that you actually can have a hand in your Angela: Mm hmm.  Judy: , I was just thinking we almost wanted to add a whole another chapter on epigenetics, but we had to pull it back. So we just kind of sprinkled it in, you know, the lifestyle things. But even when we work with people who are using donor eggs, their health will have an impact on these epigenetics. So that really empowering that mom, you are the full mom, you know, even with a donor egg, what you eat, your life, your health. Judy: Is going to have an impact on your baby. And I think that really helps people to know that Michelle: That is such a good point. It's really true because it's, it's all important. It's all parts of the [00:37:00] whole.  That's where you do have control right over your lifestyle. And these some of these decisions because you don't always have control over your fertility. I mean, certain aspects are just out of your control, and you do feel that helplessness. Angela: And so I think where you can feel good and feel empowered is, you know, these are the actions I can take. These are the steps I can take. I am making progress. I am growing as a person. I'm helping myself. I'm helping my community. Whatever the case may be, I try to recommend not kind of losing yourself in just trying to get pregnant. Angela: Really recognize your, yourself as a whole person and all the things you are providing to, to your community through purpose and service and love and, and everything you're doing is just, it's key to who you are and it brings you strength and peace. And that's just really [00:38:00] Great to know and you, those are decisions you can make. Angela: That's not something out of your control. Michelle: That's so important. And thank you for bringing that up and you guys, I could talk to you guys for hours cause you know what, you know what I love? Well, first of all, your knowledge, you guys are very knowledgeable about what you're talking about, but the passion , and the compassion. With which you are operating  Michelle: I think we both have one major thing in common is that we love this community and it's a beautiful community to serve. And so for people who want to find you or read your book, how can they find you? Judy: Well, the book is available at all major books, booksellers and many of the independent ones request it getting to baby book.com. It will be released April 9th. So I'm not sure when this is released, but April 9th will be released. It can be pre-ordered. You can follow me at Fertile Nutrition or on my website, mindbody nutrition.com [00:39:00] and Angela. Angela: And you can also request the book from your library. So libraries don't automatically stock books, but if individuals make a request to a library, the library can order the book. So that's something to know as well. And then I'm at AngelaThiremd. com or at AngelaThiremd on Instagram. Michelle: Awesome. It was such a pleasure meeting the two of you. You guys are so nice and so knowledgeable and just really lovely to talk to. So thank you so much for coming on the podcast today. Angela: Thank you, Michelle. Judy: Michelle. Thanks, Michelle. Angela: to you as well. 

Dr. Shahin Ghadir is a renowned Los Angeles-based fertility specialist and a partner at the Huntington Reproductive Center. With dual board certifications in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, his expertise is widely acknowledged. Dr. Ghadir serves as an assistant clinical professor at UCLA and USC, contributing significantly to medical education. Recognized as a Top Doctor by Los Angeles Magazine and a Super Doctor of Southern California, his reputation is bolstered by excellent patient reviews and a strong presence in the fertility community. Dr. Ghadir is known for his compassionate care and dedication to helping patients achieve their family-building dreams.In this episode, Shahin and I discuss:Anti-Müllerian hormoneInfertility in men and womenUnexplained infertilityEgg freezingMiscarriages0:00 Introduction3:03 What is the most advanced center?4:10 What is Anti-Müllerian hormone?11:50 Infertility in Men13:34 What is unexplained infertility?17:19 How to conceive naturally at the age of 35-42 years27:47 What is Egg freezing?36:26 Why do miscarriages happen?45:13 EndShahin's Links and Resources:Website - https://drghadir.com/Instagram- https://www.instagram.com/drshahinghadir/?hl=enLinkedin - https://www.linkedin.com/in/shahin-ghadir-776ba77a/Facebook - https://www.facebook.com/DrShahinGhadir/--Unlock the knowledge of trusted creators at: https://dexa.ai/Research report - Dehydroepiandrosterone (DHEA) protects hippocampal cells from oxidative stress-induced damageThe Neuro Athletics Newsletter: https://bit.ly/3ewI5P0 Instagram: https://www.instagram.com/louisanicola_/ Twitter : https://twitter.com/louisanicola_The Neuro Athletics Newsletter Instagram: @louisanicola_Twitter : @louisanicola_YouTube: @Louisa NicolaThe Neuro Experience Podcast is proud to have hosted: Dr Andrew Huberman, Dr Gabrielle Lyon, Dr Layne Norton, Thomas DeLauer, Shawn Stevenson, Dr. Rocio Salas-Whalen, Saad Alam, Uma Naidoo, Dr. Lanna Cheuck, Angela Lee Pucci, Jillian Turecki, Dr. Jordan Feigenbaum, Dr. Darren Candow, Dr. Sue Varma, Evy Poumpouras, Dr Casey Means, Renee Deehan, Dr Chris Palmer, Dr Charles Brenner.

Check out Eu Natural's Conception For Her, Conception For Him and the His & Hers Conception Bundle and find out why these fertility aid multivitamins have over 23,000 five-star reviews. Disclaimer: Today's guest, Dr Kim Garbedian, does not endorse or financially benefit from our partnership with Eu [“YOU”] Natural. Eu Natural did not commission or approve this episode. Please talk to your doctor or a trusted medical professional to figure out which supplement options are best for you. On today's episode of Girlboss Radio, we're opening the door to the fertility clinic and asking *all* the questions you might be having about fertility, egg freezing, IVF, the impact of age on your fertility and whether you have to give up alcohol while undergoing fertility treatment. Today's guest, Dr. Kim Garbedian is a Royal College of Physicians and Surgeons certified Gynecologist and Reproductive Endocrinology and Infertility Specialist who leads Pollin Fertlity, a modern and empowering fertility clinic in Toronto, Canada. This episode gets into both the emotional and physical considerations of fertility treatment, and we think it's a worthwhile listen, regardless of what stage of life you might find yourself in—and even if you're undecided on the whole kids thing. New episodes of Girlboss Radio drop every Tuesday. Never miss an episode by subscribing here: girlboss.com/pages/girlboss-radio-subscribe. Girlboss' very first course, Spark Your Career Renaissance, will help you unlock your differentiator to go from stuck to success. Learn more and enroll at course.girlboss.com/courses/spark-your-career-renaissance. Sign up for Girlboss Daily, our must-read morning newsletter, at girlboss.com/newsletter. You'll get A+ career advice, dream job postings, free coffee every Friday and a few emojis (because we're fun like that), delivered right to your inbox. Looking for your next dream employee? Post your open role on our Girlboss Job Board at jobs.girlboss.com.

Today, I am blessed to have Dr Robert Kiltz with me. Dr Kiltz is the Founder and Director of Central New York's first successful IVF center. He is an American Board of Obstetrics and Gynecology Diplomate, as well as Fellowship trained and Board Certified in Reproductive Endocrinology and Infertility.  Dr Kiltz specializes in advanced reproductive technology, laparoscopic and minimally invasive surgery, gynecology, endometriosis, and recurrent pregnancy loss. He advises and consults with clients from all over the world on reproductive health and fertility issues. He is known for accepting the most difficult IVF cases that other doctors/centers turn down. He specializes in Reproductive Immunology in treating recurrent pregnancy loss, unexplained infertility, and failed IVF attempts.  In this episode, Dr Robert Kiltz compares the human body to automobiles and discusses fats. Dr Robert Kiltz discusses sugar studies as well as fertility issues. Tune in as we discuss the best ways to care for your body, diets, glycans and sugars, and fertility. Download your FREE Vegetable Oil Allergy Card here: https://onlineoffer.lpages.co/vegetable-oil-allergy-card-download/

Dr. Ghadir is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. He's one of Hollywood's most in-demand fertility experts, dedicated to helping people overcome reproductive and infertility issues to achieve their goals of having the family of their dreams. 15 Daily Steps to Lose Weight and Prevent Disease PDF: https://bit.ly/46XTn8f - Get my FREE eBook now! Become a Genius Life Premium Member! Learn more: http://thegeniuslife.com This episode is proudly sponsored by: JustThrive makes high quality probiotics with mental health in mind. Get 20% off the Just Calm and Just Thrive Probiotic when you go to JustThriveHealth.com and use code GENIUS at checkout! Bite makes my favorite low toxin toothpaste alternative sent in refillable, compostable pouches! Head to trybite.com/genius or use code GENIUS for 20% off of your first order. LivOn Labs are masters at liposomal encapsulation to maximize absorption of nutrients like vitamin C, magnesium threonate, glutathione and more. Right now get 1 free vitamin C box when you buy one at LivOnLabs.com/genius/.