Her Discussions by Dr Faye - Fertility Expert: Every Girl Should Know Before 25

Episode Date: October 1, 2025

If you’ve ever wondered whether the pill is compromising your fertility, worried you left egg freezing too late, or Googled “am I infertile?” because you’ve PCOS, you are not broken; you need answers.So many of us only start asking questions about fertility as we approach 30, and the panic sets in. By then, we’re drowning in half-truths and shame that makes us feel like we should have known better.Dr Nagla is a fertility expert who will help you understand what really determines your fertility, how PCOS or endometriosis play a role, when to think about freezing your eggs, and the simple habits that protect your reproductive health long-term.The egg freezing calculator: https://springfertility.com/eggcalc/HFEA find a clinic: https://www.hfea.gov.uk/choose-a-clinic/clinic-search/

Is there a position that is more likely to get you pregnant? I'll say, that's a lot that I have just learned. What are the most surprising misconceptions that you've seen when it comes to fertility? So many. People will often ask about if certain positions or will increase your chance of having a boy or a girl,

not going to the toilet because they're worried that the sperm's all going to fall out. Also, a lot of the time not having an understanding around when you're actually fertile. That's really the biggest one. There's a little bit of evidence that having daily sex can slightly lower sperm quality. Really? Yeah. Potentially.

If you're trying to get pregnant, quit smoking, it increases the risk of miscarriage, binge drinking, and especially for men, excessive heat exposure to the testicles, like sitting with a laptop, daily hot baths or jacuzis, can completely switch off your sperm production. If you've ever wondered whether the pill was compromising your fertility, or if you've left egg freezing too late, or Googled, am I infertile? You are not broken, you just need answers. And today we are going to do our best to get through all of them with Dr. Nagler, a fertility expert. But before we get into the conversation that is much needed, I just want to say a huge massive thank you for all the love that we've got on the

first few episodes of Her Discussions podcast. I am so, so excited for the future conversations that we're going to have, bringing you much needed answers about women's health. And the most important thing that you could do to support us on that mission is by leaving a five-star review, please, or a comment or subscribing to the channel if you are not already. With all that being said, let us get into the conversation. Thank you. Dr. Nagler, first of all, I just want to say I'm so ridiculously excited for this episode. I don't think we've had as many questions sent in for anyone before and I think it's such an important topic to break down. But before we get into all of that, I would love to learn a little bit more about you. So before your working facility,

what first of all made you want to be a doctor? I think it's one of those things like from when I was a kid, people would ask you what do you want to do and I would just say, I want to be a doctor. But actually as I went on, I realized I really liked the kind of science side of things. But more than anything, it was like talking to people on that human aspect. Yeah, my parents didn't really push me that hard to do medicine, but they were, was he happy when I did? And then I went to medical school down in Devon, Peninsula, which is now split into Extra in Plymouth. And that was completely different just from growing up in like East London. I went through all of my placements just feeling like, yeah, this is, this is okay. But it was like when I did my Obs and Guine and my Labor

ward placement. I was like, oh yeah, okay, this is what I'm going to do. And for the listeners who don't know what obs and guine is, do you mind explaining it and how actually it touches every woman, not just those who are trying to conceive? Yeah, absolutely. So it's such a huge specialty. So you have the obstetric side, which is the kind of childbirth and delivery and the care of pregnant women. And then the gynecology, which is everything from, you know, gyneecan, to fertility, to scanning, to surgery. And fertility is like one sub-specialty of it. And the way I got into that actually was, I think I was in my third year and I had a little

attachment in an IVF clinic in Plymouth. And I saw this woman who was 28 and had a three-year-old son and she had been diagnosed with breast cancer. and she was freezing her eggs before her chemotherapy and radiotherapy. And my consultant was explaining to me that actually this treatment can massively affect your egg reserve and her chances of being able to have another child in the future. And she didn't know if her family was complete. And I was thinking, okay, well, me as a medical student, I didn't know about this.

So what are the chances that the average person who is experiencing or has been diagnosed with cancer going through cancer treatment? knows that their fertility could be impacted. So that was my kind of gateway, like that was what sparked my interest in infidelity. And actually we looked at numbers in Plymouth and we saw that of the women who were under 40 who had been diagnosed with breast cancer in the single digits, they'd had discussion about freezing their eggs before their treatment. Yeah. I should have said at the beginning of the episode pointed out like this is just such a

sensitive and emotionally charged conversation that we're having. But I think it's a conversation that it really needs to happen. And I think part of that comes from fertility. You don't need to have babies to live, which is so different from other areas of healthcare where you're treating diseases. But I think that that sometimes means people underestimate the importance it plays in people's lives. And maybe rightly or wrongly, the impact it has on people's self-worth. and the meaning it gives their life

and the fact that the majority of these women had not been cancelled about their facility before starting their cancer treatment. That is absolutely wild. Yeah. And the issue is that when we looked at the reasons why, a lot of the time it was because maybe we thought it was somebody else's job to,

or the surgeon should have spoken about it, or the oncologist should have spoken about it, or the nurse should have spoken about it, or we didn't want to talk about it because actually, you know, we're just thinking about, treatment and or you know saving her life you know it feels inappropriate almost to talk about well do you know if you're going to have kids after this but actually what we know and like with most things

if somebody tells you that you can't have something retrospectively that's a lot worse for you mentally than having that conversation beforehand yeah so if i say to you you know and you might say look i've i've got two children or i don't want to have children and that's absolutely fine but as long as that conversation is being had because finding out a few years down the line. And when people go through cancer treatment, when they come out the other side, actually that's when they start to evaluate what's really important to them. And if having a family is something that's really important to you, being told at that point, oh, actually, this treatment has really badly affected your chances. That can be really devastating. Yeah. I'm sure there's a lot of women out there who have known for

maybe their whole lives that they don't want kids. And that's always been something that they have been quite sure of. I hear a lot that those women sometimes feel offended or feel like all they are a baby making machines when they're frequently asked, are they having kids? Are they sure they don't want having kids? But I think it is always important to ask those questions. And it's not just labeling someone as a baby making machine or minimizing them to their ability to reproduce. It's making sure you're having these honest open conversations before, you know, irreversible changes that you can't go back on. Yeah, exactly. And we shouldn't be asking people, you know, do you want to have children just out of our own curiosity? Because it's just a little bit rude. But, you know, if you're in a situation where you've always felt like having a family is part of your future, then it is worth having those conversations. And that doesn't mean that, you know, you're just at a party or your aunt's house and somebody is asking you, but just having real conversations about what's important to you and how you're going to make those. investments for your future.

Yeah. Later, we're going to dive into egg freezing, hormone testing and how modern life actually impacts off facility. But first, I really want to talk about why fertility is such a taboo topic. Yeah. So I recently got my fertility bloodstone. And really interestingly, the clinic that we went to, one of the women who runs the social media for the clinic,

she's worked for lots of businesses on their social media and she said that fertility is like, no, she has never seen anything like fertility on social media because she says their likes are rock bottom because likes are public. Yeah. But their saves are through the roof. Yeah. Why do you think fertility is so taboo? And what are the impacts that you see from that?

Yeah. I think one of the reasons is that we don't think of fertility or infatility. as a medical condition. That's the first thing. So people take it very, very personally in a way that you may not with other diseases. You know, it's so often linked to your identity as a person. Especially as a woman.

Yeah, exactly. It's something that a lot of us take for granted. Like we have this image. Some people, and I'm not saying this is for everyone, but from a child, you might be thinking of yourself as like a mother. And it becomes so ingrained. into your idea of your personhood and what you expect from your future. And then when you couple that with the fact that all we're ever taught is how to not get pregnant, then when you

take away contraception, then the logical thought is that, okay, well, I'm not using any contraception, I'm going to get pregnant. But then when you realize that, you know, one in six couples is affected by infatility, the expectation and the reality are so far apart. And that is the source of, I think, so much disappointment and disillusionment and people take infidelity as, you know, they feel guilt and shame and that there's something wrong with them, that they're not a woman. And I'm talking about this from a female perspective, and we're going to talk about male fertility as well. Yeah. But yeah, it hits people really hard and especially if they're in a time in their life when lots of their friends are having children, you know, they talk about feeling really left behind

or really stuck or really lonely. So, I think a lot of it is because fertility is treated like this kind of personal virtue and infidelity is not seen as the medical condition that it is. Yeah. There's so much I have to unpack on that. I did not realise that one in six couples were affected by fertility. That's actually, you know, I think about my home group of girls, those six of us. And to think that one of, you know, that's a lot. It's a lot. Yeah. And you spoke about birth control as well. which a huge number of the questions that we got were about birth control and the impacts on fertility. But first, what I want to do is hammer down the basics.

Can you explain the basics of what happens to a woman's body in terms of her fertility over the course of her lifetime? Yeah. So the first thing to say is that as women, we are born with all of the eggs that we're ever going to make. So by the time you're about four, five months, a fetus in your mother's uterus, that is the most eggs that you will ever have. And that drops down when you're born. And then when you go through puberty or adolescence, you maybe have around 400,000 eggs. And it just decreases basically over the course of our lifetime. Each month, when you have your period, you are releasing one egg.

And by the time that you go through the menopause, it's not like you've got actually the, zero, you probably have a few thousand kind of immature eggs. But each month you can only release one egg anyway. And I've spoken about this analogy before of describing your ovaries like a bank account where all of your eggs are stored. And each month you'll bring some follicles or egg sacks to the surface of your ovary. Your brain will send a signal to your ovary to allow one of those follicles to become the bigger one and when it gets to a certain size around the middle of your cycle, that will basically rupture and release an egg. If you are trying to get pregnant and you've had unprotected sex around the time, then hopefully, you know, a sperm is

going to be there waiting to fertilise that egg and if that implants into the lining of your womb, you get pregnant. And if you don't get pregnant, then all of those follicles will kind of just die off and you'll get a period and that process will start again the next month. The important thing to say is because, you know, lots of people are doing more testing, which is great. I'm very much an advocate for having more data around your personal health. But I think a lot of people are panicking about their egg reserve or finding out that their AMH is low. Month on month, whether you have a thousand pounds or a million pounds in your bank account, If you're only withdrawing one pound or releasing one egg, your chances of pregnancy in that month are the same.

So it's one of the things I say several times a week, if not every day, that your AMH or your egg reserve does not impact your chances of natural conception. It only tells us about your egg quantity. It doesn't tell us about the quality of your eggs. And that's something that we know we don't have a test for like AMH, but we do know that your egg quality goes. down with age. The other side of that is that I see a lot of women coming, you know, in the late 30s or early 40s who have a really good lifestyle, look after themselves, you know, exercise regularly, eat well. And then you explain this thing about egg quality and they say, but I've got a really good lifestyle. But we can't, we can't counteract that age-related decline in our air quality. I'm so glad that you spoke about tests because, my perspective on fertility has completely changed over the last two years. I think Faye two years ago really felt almost, felt extremely angry about the rising fertility marketing because I felt as

though they were almost like a false sense of security in some ways because actually you can do all the tests that you want. They might all come back normal but you still might struggle to conceive if there is a physical abnormality that you you actually don't know that you are infertile until you try to conceive. Would you agree with that? Yeah. Yeah, absolutely. So I felt that they were maybe luring women into a false sense of security, capitalising off women's fear. Then I had one of my consultants on a rotation who she spoke to me a lot about her struggles with facility and she had gone through several rounds of IVF. I saw like firsthand the emotional toll that it had on her.

I fell into the trap of thinking that this is not something you have to worry about until you're past 30. You know, the clock strikes midnight on your 30th birthday and suddenly fertility is on your mind. She completely opened my eyes to that not being the case, which meant that I wanted to make a video about this further and unpack, I think, a lot of the issues with fertility marking and the rise in testing. Yeah. But also highlight some of the really important parts, which I think AMH is, you know, is an

important part. And for anyone who's not medical who's listening, AMH is like, sometimes known as the egg timer. Do you want to explain in a little bit more detail what AMH is and why it can be an important markers to test for? Yeah, absolutely. AMH is a hormone, which is basically released by the, not by the, not by the but the kind of immature follicles.

And it's a pretty reliable reflection of your egg reserve. The issue that I have with it, and I think, or you're saying it in terms of the marketing, first of all, I mean, you can imagine that when there's something that is that people want so desperately, there is a huge market for people to capitalize on that, which is unfortunate. But that doesn't mean that we shouldn't test IAMH,

but we just need to do it in the right context. right context. I mean, you all know, like, we're always told right from the beginning, like, you never do a test if you don't know what you're going to do with it. So my slight issue is that people do this blood test and they don't know how to interpret it. They don't know what it's useful for. And I think it's only half the picture. I really think people also need to be having a scan alongside of it. And I'm going to say something which I feel like is maybe a little bit controversial because it's not strictly speaking in the guidelines, but I do feel like all women, and this is my opinion,

should, you know, ideally in their 20s or their 30s, have a pelvic ultrasound scan. So a scan, ideally if it's feasible, where the probe goes inside the vagina, so you can have a good look at all of your anatomy, you know, your ovaries, your fallopian tubes, you may not see them on the scan, your womb or uterus, etc.

The reason being is that when we do the scan, we also look at the number of follicles on your ovary. So if I go back to the bank account analogy, so as I was saying, you would generally release one egg, right? But the difference is if somebody has a very low reserve versus a high reserve, each month the person with £1,000 of the bank account

could bring like five follicles to the surface of their ovary. They'll still only ovulate from one and the other four will just be discarded. If you have somebody who has a million pounds of the bank account, they might bring 20 follicles to the surface of the ovary. They'll still release one egg from one follicle and the other 19 will be discarded. Why that's important or what AMH is actually really important for

is when you're thinking about fertility treatment, like egg freezing or IVF. When we do, for example, egg freezing, we give you medication. It's the same thing, that hormone that tells your ovary to let that follicle grow to release an egg. But we give you higher doses because obviously we don't want to get one egg. We want to get, you know, as many as we can. But we can only work with what your ovary is giving us, right? So we'll give you enough medication.

In a perfect world, the person with five follicles will get five eggs. And in a perfect world, the person with 20 follicles will get 20 eggs. So you can see that that's a very different outcome, right? And that doesn't mean that the person who has five eggs has done badly or, you know, they've gone to the wrong clinic or something like that. That's the best that we could have hoped for. Yeah. So that's why it's relevant. It's not relevant for your chances of getting pregnant each month.

It's relevant for us in fertility treatment to know what we can reasonably expect in a cycle and also to guide us on how much medication we need to give you. I want to go back to the pelvic ultrasound. So what are you looking for when you're, so you're looking for the follicles? Yeah. Is that anything else that you can see on the pelvic ultrasound that you think is important for women to know in their 20s and their focese? Yeah, for sure. We look at all of the anatomy, right?

So we're going to look at your uterus or your womb, the shape of it, the size of it. Now, do you have any fibroids? Are there signs of endometriosis that we can see? Are there signs of adenomyosis? Are there things like polyps or little growth in the lining of the womb, could actually be, you know, competing with where an embryo or a future baby would want to implant. We're looking at your ovaries. We're looking at that also is giving us a reflection of your egg reserve.

So we're looking at loads of things. And I find it quite difficult. You know, sometimes I see women coming to the clinic, having tried for a period of time. It's the first time that they're having a pelvic ultrasound scan. And at the same time where I'm having this discussion about fertility, I'm now telling them, for the first time that they have endometriosis or that they have PCOS. And I feel like that's difficult, you know.

It's a lot of information to be taking in anyway this discussion about your fertility. Yeah. But it would feel a lot better if that was known information, you know? What a sorry state of affairs it is that that is the first time that these women are getting such a big diagnosis

that probably actually may explain a lot of things that a lot of unanswered questions they might have had as well for the last. And I'm so glad that you spoke about at-home testing because with half a million women on the gynaecology waiting lists on the NHS, I don't want to talk badly about any services that offers to give those people answers. But as part of the video that I did about facility, I did an at-home test. And I also went to a clinic. Yeah. So the clinic offered a service that was £500, £500, included 24 blood results that came back 24 hours later.

pelvic ultrasound and then a consultation, and in the consultation, my results were explained with a consultant who was a registrar on the first IVF case, like an extremely accomplished fertility consulting. And a nurse was also there to support emotionally. And that was £500 all in all. That is a lot of money for a lot of people. The at-home test, I got my results back. And I already knew that my AMH was low because I had it explained by this consultant with the nurse there and they were unbelievably supportive and explained to me, you know, it doesn't mean that you're infertile. It just means that sand is tipping down the egg timer and it's probably something you should be thinking about if you don't see yourself having kids in your next five years,

it would be a good idea if you to consider freezing your eggs. And if you do want to consider freezing your eggs, now would be a better time than waiting later because you're better to freeze your eggs when your egg count is, your AMH is higher. Yeah. And you're younger so that your egg quality is better. Yeah. And that was all explained to me. It wasn't, you're in first, it wasn't, I didn't have room to misinterpret it. Yeah. And the emotional support was absolutely unmatched. A couple weeks later, I get a notification through on my phone and I'm sent a PDF with the results on. And they told me the same thing. You know, my AMH is low. And I worry that if I'd got the results my phone first, what the emotional consequences would have been. Not having, and that's

with a medical background. And I worry about people who don't have a medical background. Yeah. Interpreting those results. I would say that the results are beautifully laid out, beautifully explained, but there's something about that human to human contact that, you know, makes you feel safe. And this is an incredibly emotive conversation. On the other hand, I do recognize it's a shame-filled topic for some women. It is so much easier for them to do a test in the comfort of their own home and actually receive the results in the comfort of their own home. And they might not want that human contact. Yeah. But then I get my results and then they recommend the next steps. And to get a scan was 250 quid. So book in a private consultation with a

gynecologist, another couple hundred pounds. Yeah. And actually it ends up being more expensive. Yeah. Something, look, we're talking about expensive stuff anyway. And in this economic climate, it feels extremely difficult to have these conversations about private options. Yeah. But I think the one thing that we have to be is up front.

Yeah. And I think if you go into these at home tests, you have to know that you will likely have to spend a couple hundred. pounds more to then get further, further answers. Absolutely. Yeah. So with half a million women on the gynaecology waiting list on the NHS, we also have a perfect breeding ground for misinformation on social media. And this is why I think it's incredibly important that, you know, women like yourself, doctors like yourself, put themselves out on social media like you have been doing. I cannot emphasise that enough because I think as, doctors, we are losing the war against misinformation. And, you know, I've seen that in

practice and I'm sure you've seen it in practice as well. Yeah. For listeners who are looking for answers about their body, do you have any advice on where they can find reliable information when they might be waiting for these appointments? So I think if you think about your future, and what I would really urge people to first of all do is to sit down, either with themselves or with a partner and ask yourself what you really want from your life. And if having a family is an important part of your future, if you're not sure about it,

but you want to do something to protect it, then I do feel like it is important to invest in it because there's not many other things like that we want to achieve, you know, whether it be a career or something material where we're not doing the research or we're not finding ways to invest in the future. I would probably find a clinic where you could have some investigations and have a consultation either as a single woman or as a couple because like we were saying earlier, you know,

doing a at-home blood test is fine, but you probably will need to have a scan and to have a consultation with someone who can help you put that information together. And that doesn't mean that you need to freeze your eggs or you need to freeze embryos. that's not always a feasible option financially for everybody. But for example, if you knew that, you know, things like quitting smoking or reducing alcohol intake or making certain lifestyle changes could improve your chances of intensity, then you would probably do those things. And I think it would be better to have those conversations now looking to the future than it

would be to, in a way, bury your head in the sand. And like we were saying earlier with those women who are being told, you know, after their cancer treatment, actually your chance have significantly gone down to then live with the regret of not having had that conversation or made those decisions yourself proactively. Knowledge is power. Yeah. I will always, always say that. And I think that when when I got the results back, the consultant was brilliant. And she was saying, are you sure you're okay? You sure you're okay?

And I said, yeah, because now I know, like now I have. the options laid out in front of me. Yeah, it's probably like a lot to take in. And especially when in your 20s, you probably think you're, you take it for granted. It's actually quite an empowering thing. It's, I find it was one step backwards for two steps forward. Yeah. You take the emotional hit, but then you move forward with just all your options and the, that empowerment. Yeah. I went to a quite high end Harley Street clinic and it was 500 pounds all in, which, I had a conversation with my friends afterwards where I said, look, I actually think you should all get your AMH checked. You're all in stable relationships.

I know that you all want kids and it's important to you. A lot of them said, I don't think I can afford it. But I know that they get a £400-pound ASOS order every month, you know? It's true. And I think money conversations are always difficult. And I don't want this to be taken the wrong way. But I think we see investing in our health as a bit of a waste of money. because we know that access to doctors is free.

So I think it can make people more reluctant to pay for these things. But you're right. I understand that. But I think that the issue is that when you're at the point of seeing a doctor in the NHS, it's a much more reactive approach. You know, you've gotten to that point maybe now trying and things haven't gone to plan. It would be far better to have, you know, made that investment earlier on to understand more about your own personal health

to understand your future goals and made those just kind of decisions proactively. The NHS has not designed it that way for that kind of preventative care. One thing I want to say about egg freezing is I see a lot of narratives online about egg freezing and it ranges from people talking about it as insurance. Yeah.

And I don't agree with that term, to be honest, all the way up to being a scam. Yeah. And I think it's neither of those things really intrudy. I mean, number one, it's not, egg freezing is not insurance because if you're paying for insurance, that means that if something bad happens, your insurance is going to pay out. Yeah. Egg freezing is not a guarantee in that way. In the same way that it's not a scam, I think I would prefer people thought of it maybe as an investment.

Yeah. You know, you've decided that this is something that you want in your life and you're making proactive decisions to do it. But it's, but you have to appreciate that when you freeze you. your eggs, you're freezing a single cell. Now, not every egg that you thaw or defrost is actually going to survive that process, about 85 to 90% of them will survive. There's drop-offs at each point, so not every egg will fertilise, and then not every fertilised egg is going to make a good quality embryo that will give you a baby. So the higher numbers that you start with, the better your chance are at the end. But this, you have to remember what I was saying, you know, if you're

somebody with a low reserve who gets five eggs from one cycle of egg freezing, that doesn't give you actually a very high chance of one baby. I can link some resources, but there's a really good, which I use in clinic, it's an egg freezing calculator, which gives you, you put in your details like your age and how many eggs that you freeze, but we know that if you, say, for example, freeze 20 eggs, you have an extremely high chance of having one child and a very good chance of having two children. But if you have five eggs, it's not giving you the same level of assurance. And again, what I was saying about the AMH is that it guides us, right? So we know that somebody who has a potential to maybe get four or five eggs in a cycle probably need more cycles to have that

same effect. I'm starting the process for egg freezing next month. And I have to say I'm feeling a little bit anxious because I've heard a lot of fun stories about the, the hormone side, could you talk me through the, for my personal benefit as well as the viewers, could you please talk me through the process of egg freezing and what I may expect next month? Yeah, yeah, absolutely. So the process of egg freezing or the stimulating of the ovaries is basically like the first part of IVF as well. You normally, and this is in a kind of standard protocol, you start your medication and it's called, FSA, which is the same hormone, that signal that your brain is sending to your ovaries, but we give

it to you in the form of an injection. So you have that every day. On average, people have a couple of weeks of injections. Now, some people feel absolutely fine. Some people feel good. Some people feel really up and down emotionally. We don't really have a way of knowing who it's going to be, but it's finite because it's, as I say, a couple of weeks of injections. And in that time, you'll be coming in for quite regular scans and blood tests. And the scans are internal scans. So the probe goes inside the vagina. We look at the ovaries and we measure each of these follicles or these little egg sacks.

And then when they get to a good size, again, after about a couple of weeks of injections, you have a trigger injection. And that trigger injection basically sets off a process where the eggs kind of mature. Then you have an egg collection. and it's a procedure which is done it can be done different ways so some people will have it under local anaesthetic most places will do it under deep sedation

essentially you're asleep but you're breathing for yourself but you're not feeling any pain and it's exactly the same way there's a probe that goes inside the vagina and a little needle attached to the probe goes into the ovary and sucks the fluid out of each one of those eggs the fluid goes straight into the lab The embryologist is waiting to check the fluid under a microscope to see if it contains an egg. And one follicle can give you one egg.

So at the end of the procedure, by the time you've woken up, you'll know how many eggs have been retrieved. But you don't know anything about, you know, the quality or the maturity, for example. That's the process of egg freezing. They'll be frozen and then, you know, they can be frozen for up to 55 years. And then you come back and decide however it is you want to use them. if you're going through the process of IVF, it's essentially the same thing, but the egg is left in a dish with the sperm to see if it fertilises, and then over the course of the next five days,

you see if it gives you an embryo, or we call it a blastocyst, it's just basically a five-day-old embryo. And at that point, you can either transfer it or you can freeze them and then come back and transfer them at a later date. That has made me feel a little bit anxious, thinking about waking up, and being told how many eggs have been retrieved and then likely, you know, the recommendation of, right, we need to probably do another cycle or we've got enough.

Yeah. Is that generally what happens? Yeah, so, I mean, you would see how many you get. And again, it also depends on your future family planning goals. So, yes, if you, you know, retrieved, say, five eggs, the recommendation is probably going to be that you have a further cycle. But it depends. And also the really important thing, and all of these things that we've been talking about

have been about quantity, not quality. Yeah. And the younger you are, the better quality of the eggs are. And we know that because when we look at women who are under 30 who get pregnant, one in 10 of them will have a miscarriage. And then when you look at women who are, you know, over 40, 45, over half of them will miscarry. And that's more so because of egg quality

and the genetic makeup of that embryo. So in preparation for my egg freezing, I really wanted to do a bit of a health kick and cut alcohol, make sure that I'm eating better, make sure that I'm exercising better. Have I left that a little bit too late if I'm going to start the process next month or is that still important for me to be doing?

Yeah, I really like this question because I had somebody very close to me going through IVF who had spoken to a friend or seen something online. And they had quite a low egg reserve actually. And they called me up and they said, you know, I haven't been on this specific diet. Like should I cancel my treatment and start again in six months? And I was like, absolutely not. You know? So in terms of, you know, lifestyle, there are a few things that you can do. and most of those things are not going to dramatically change your outcome.

And I say that because, you know, again, it comes back to what we're saying about women feeling a lot of personal guilt and shame. You know, that one glass of wine you had or that odd cigarette you had or that McDonald's you had is not the reason why you're not getting pregnant. Okay, so let's just, in terms of evidence, things that you can do to improve your chances. quitting smoking, that's probably the biggest one. Reducing alcohol, having a healthy BMI. In terms of diet, the only diet that has some evidence around it is having a Mediterranean-type diet. You don't need to cut out entire food groups. And I know there's a lot of things about ultra-processed food.

And don't get to be wrong, you should try to stick with a whole food Mediterranean type of diet. but you also don't need to beat yourself with a stick if you had a chocolate bar, you know. Okay. So those are the main things. There's no miracle kind of supplement or drug or guide that is going to dramatically change your outcome. I'm really happy you touched on the shame thing because I think the first thing that I thought when I got my low AMH back was, God, what, like, what have I done that's caused this? Is this, you know, all the two years in the NHS living off NHS biscuits to get me through the afternoon?

Or was it my stress? And that personal blame really is difficult to navigate. In terms of a low AMH, what sort of things can cause a low AMH? Yeah, this goes back to what I was saying earlier about being born with all of the eggs that you're ever going to make. So I try to drill this in because, you know, it just illustrates the point that it's not something that you have personally done to cause your lower MH. We were born with all of our eggs and they will decline over the course of our lifetime. Okay, yes, we know that if we do things like quit smoking or binge drinking or have a normalish kind of weight, those things will help. But above and beyond that, NHS biscuits or stress, you know, those things are not going to be affecting your egg reserve.

And it's something that people ask all the time as well, you know, whilst they're in treatment, like, oh, this has been a particularly stressful month. Should I delay my treatment until next month? I think it's always a good idea to be in a good frame of mind whenever you're going to go through something that is physically or mentally demanding. But in terms of the actual evidence, there is no evidence that you being stressed will affect the outcome of your IVF or your egg freezing cycle. Interesting. Yeah. Okay. Another question I had about egg reserve and AMH, I'm going completely off tangent now.

But obviously we know that the age that women are starting their periods is getting lower. As a consequence, if they're losing those eggs once a month earlier, are you seeing more women with lower AMHs or does that impact AMH? There's no evidence to support that. And it's the same thing with like if you don't have a period because you have a coil or you're on the pill, for example, you know, you're still each month that process of those follicles, as I said, coming to the surface of the ovary being discarded is still happening, even if you're not ovulating or even if, you know, whatever type of contraception you're on. So there's no evidence that, you know, that will speed up your how quickly you go through the menopause or your egg reserve. And actually that's one thing that people ask me about egg freezing. Well, if I'm freezing my eggs now, does that mean I'm going to have less eggs to use later?

And as I was saying, you know, what we're doing in a cycle of egg freezing is that we're getting all of those follicles to grow and trying to get all of those eggs in that cycle. Those immature eggs would have been discarded anyway. So it's not like you're going to have less eggs to use in the future or you're going to go through menopause sooner. I'm so glad you said that because I had one of my close friends asking. me a question a couple of weeks ago. And I didn't, I don't think I did a very good job of answering it. She asked me what's happening to all the eggs whilst I'm on the pill because she was saying, you know, where are they going? Are they being saved up? Will I, and it's similar, will I have more eggs when I come off the pill? You explained that really wonderfully that those eggs are still being

discarded. It is not affecting. We don't have evidence that it's affecting our timeline. No, we don't. What are the most surprising misconceptions that you've seen when it comes to fertility? So many. Okay, so people will often ask about if certain positions will increase your chance of getting pregnant, or will increase your chance of having a boy or a girl, or, you know, things like people putting in tampons after sex, or not going to the toilet because they're worried that the sperm's all going to fall out.

I think also a lot of the time not having an understanding around when you're actually fertile. That's probably really the biggest one. When you ask people, when I say regular sex, I presume at least that means that it's each month around your fertile window. You've had a partner who works a way it's seen and it's once every three months. Sometimes it's not once. I think this was in medical school. Somebody was having anal sex. See, this is what I mean.

This is what this lecturer was saying. Like, you have to be quite explicit. Yeah. In like that this person understands because you, you can't take for granted people's understanding of these things. You know, a lot of people haven't had these conversations where, you know, their mum and dad is teacher or someone has sat them down and said, this is how someone gets pregnant. You know, these are taboo topics. And as doctors, I think it is our job to not be ashamed to really lay out the facts as clear as day. Yeah.

That's wild. Anal sex. Jesus. I think you've touched on some great points there. I vividly remember an episode of keeping up with the Kardashians where Kim is like lying on the bed, rocking herself backwards to try and tip the spoon further back. So I would like to go back to those misconceptions and just lay out. Like, let's clear it up. So positions.

Is there a position that is more likely to get you pregnant? So any position where you can ejaculate inside the vagina has the same chance of conception. You have millions and millions of sperm in the ejaculate and they are traveling up through the cervix, through the uterus, to the filopine tubes, where hopefully there's an egg there waiting. And that process takes minutes. So less than five minutes. So lying with your legs in the air for 20 minutes or not going to the toilet. Like these things don't make a difference.

Do it however you want to do it, but yeah, there's no specific position that's going to increase your chance of pregnancy. And same thing with the toilet. Go for a wee after your sex because it reduces your chance of urinary tract infection and it makes no difference for your chance of consumption. Perfect. Love that. And the tampon just same again. They're travelling really fast. You don't need to put anything in there. They're getting to their destination without any additional. thing from you, you know what I mean? Perfect.

Yeah. And regular sex. Yes. Regular sex means different things to everyone. Just think about that. So there's a few different ways to track when you're ovulating. Of course you can just have regular sex throughout the month. That's absolutely fine.

You don't need to do it every day. There's a little bit of evidence that having daily sex can slightly lower sperm quality. So every other day is fine. Really? Yeah. So daily sex can reduce potentially. If you want to do it every day, don't let me. stop you. Yeah. But, you know, every other day is plenty. Yeah. But you also just need to

have an understanding when you're ovulating. Lots of people think, well, I'm ovulating on day 14. Well, you're only ovulating on day 14 if you have a 28 day cycle. Yeah. It's that second half of the cycle, which is quite fixed between ovulating and you're getting your period, called the Luteal phase, of around 14 days. So you can see if someone has a 30-day cycle, they could be ovulating around day 16. Yeah. And if somebody has a 24-day cycle, they can be ovulating as early as day 10. So if you are not aware of that, you could just be missing the window completely.

So yeah, so know roughly when you're ovulating, you can use like apps to track it. You can do ovulation predictor kits. I know some people find doing more tests, especially when they're trying to get pregnant, quite anxiety-inducing. So you don't necessarily need to do that,

but you can. And you can do things like checking your basal body temperature. So there's different ways, monitoring your cervical mucus around the time that you ovulate, it becomes very thick and stretchy, a bit like egg white. So there's different ways to do it. You find the way that works for you, but the important thing is you need to start having sex before you ovulate, because if you wait to the day of ovulation, your chances of getting pregnant actually going down. And the reason is because once the egg is released, it's only there for about 12 to 24 hours. But sperm can survive

for up to five days. So what you really want to do, and your highest chance of conception actually, are timing intercourse so that you're doing it around two days before you ovulate because you want that sperm to be there waiting to meet the egg. And you also don't need to save up sperm. That's the other thing I hear. You know, people waiting like a week and then saving it for like the day of ovulation. Actually, you're increasing the number of dead sperm in the in the ejaculate. So you want to be ejaculating regularly in order to increase a chance of conception. I didn't know that. So that's a lot that I have just learned. So ejaculating too much may lower the quality of the sperm. Potentially. Yeah. But saving up your sperm may increase the number of dead sperm. Yeah. So actually, you know, so much of the onus on facility is put some women. Yes. But there's a sweet spot for the amount of ejaculations. And that actually kind of maybe brings me nicely onto the fact that it's very different for men because men produce sperm every single day. But it takes about three months to

reach the ejaculate. So whilst women, we're born with all of our eggs and they're going down as, you know, time goes on, for men, you can actually make major lifestyle changes today. And in three months' time, dramatically improve your sperm quality. So the big things I would say is if you're trying to get pregnant, quit smoking. Smoking is bad for both egg and sperm quality. And especially for men, cannabis as well. Yeah. Really bad. for sperm. We even see that it increases the risk of miscarriage for the female partner because it affects the DNA in the sperm. So quit smoking, binge drinking as well. I mean, generally trying to cut down or cut out alcohol whilst you're trying to get pregnant is a good idea. If you have excessive

heat exposure to the testicles, like sitting with a laptop on your lap all day or daily hot baths or jacuzis, because the testicles are outside the body for a reason, right? So it's to be kept cool. So if So constant heat exposure can also affect your sperm quality. For men who go to the gym, things like steroids, anabolic steroids, can completely switch off your sperm production. You know, taking supplements, things like testosterone as well. That tells your brain that there's enough testosterone, so we don't need to produce more. So, yeah, those are big things, big fertility red flags for men that you can change and actually

expect to see a big change in about three months time. I did not think about sitting with a laptop on your lap for all day. Yeah. And lots of people work from home now, right? So, yeah, they don't think about that. But that can have an impact. And to think about all the stress that people might go through with struggling to conceive and just these small tweaks actually that they might not even have ever thought could be doing harm.

Yeah. So we've got a community question. We've got a huge, there was a huge number of community questions. all about birth control and the impact on long-term facility. Can you talk a little bit about that? Yeah. So I think birth control, the pill, especially gets really bad reputation online. And I'm not saying it's perfect, but I think it gets really unfair press. The main reason for that is because, you know, people will often go to their GP, perhaps when they're younger, with painful periods.

or irregular periods and it's not at all unreasonable to be on the pill for that but the problem is that if you're then on it for 10 or 15 years and you come off it thinking right I'm ready to get pregnant now the reasons why your periods were painful

or irregular haven't gone away so you know you get this kind of slightly incorrect cause and effect where people think well I bid on the pill my periods are painful or irregular you know it's the reality is that probably those problems were there

and the pill was masking those issues. So for example, people with PCOS the pill is very good because you have regular withdrawal leads. We know that if you have PCOS and you don't ovulate at all, you ovulate very infrequently, that's

really not very good for the health of your uterus, your womb. And the pill actually protects against cancers of the lining of the womb. That's a good thing. Yeah. For people who have very painful periods, like, for example, with endometriosis, being on the pill can actually slow down the progression of endometriosis. If your periods are really heavy, you know, for fibroids, again,

like being able to omit some of your periods or have significantly lighter periods, those are all positive things. The issue comes from not investigating the underlying cause of these problems, and then coming off the pill when you're ready to get pregnant, and then, you know, the expectation that we should just get pregnant, but those reasons are still there. I'm so glad you spoke about that with endometriosis and PCOS because a narrative I see online that I find quite frustrating is the pill is just a plaster over endometriosis and PCOS

when actually there are benefits to taking the pill. I can understand in a world where women's health is just consistently ignored and puts to the bottom of the pile, it can feel like not addressing the central issue, which it doesn't. It doesn't treat the central issue, but there are benefits associated to it. It's not like the doctor is putting you on the pill

and just to shut you up. Yeah. So I think if you are going to see your doctor because your periods are painful, they're heavy or they're irregular, it's worthwhile having investigations. Being on the pill or having a coil is a very, you know,

can be for certain people be a very good treatment option. But you need to have a, awareness that, you know, those problems that you had before are not disappearing. And when you come off that contraception, they're still likely to be there. And if you're coming off the contraception because you want to get pregnant, it's probably a good idea to come off before, you know, the day that you are like, right, I want to have a baby tomorrow. Because you need to, you need a bit of time and a bit of time for your periods to return. You know, you might need more investigations or treatment. So it's just about having an understanding of what is the underlying cause.

Next, I want to talk about timelines. Do you think that too many women are leaving thinking about their fertility until it's too late? Yeah, that's a tricky one. I mean, I'll say yes in terms of thinking about their fertility. It's such a personal choice about when to start a family. And generally people are starting families later. And it's not even always a personal choice. Sometimes it's just, you know, outside circumstances.

A lot of people don't feel financially that they're not. they're in a position to have children. So there's a lot of like societal reasons why people are also delaying. But yes, I do think we need to be thinking about it earlier. If it's something that you seriously consider to be, you know, a very important part of your future, I don't think that there is a point that it's too early to think about it or to make proactive decisions. When me and my boyfriend had this conversation, I said it's such a sorry state of affairs that you either have to have money to raise a child or money to freeze your eggs.

Like, it's a really difficult economic climate. It's getting harder and harder to afford to be able to have children. And I saw a really interesting social media post that it said the next indicator of wealth is going to be how many kids you have. For sure. Next, I want to come on to endometriosis and PCOS. So we've got a community question. How does endometriosis?

and PCOS impact your facility. Okay. I'll talk about them separately because they're very different disease processes. And the first thing to say is actually for both is that it may not necessarily affect your fertility. One thing I hear people saying is, well, I've got endometriosis so I won't be able to get pregnant. I've got PCS, so I won't be able to get pregnant. That's not categorically speaking true. Because, okay, coming first to PCOS, one of the hallmarks of PCOS is that you either have very irregular periods or,

no periods and that means that you're either ovulating really infrequently or not at all but you can have PCOS and have regular periods so if you're ovulating you can get pregnant

but the issue is if you're not ovulating at all or if you're ovulating very infrequently it's really hard to know when that's going to happen and how to time intercourse around that that's one of the biggest issues with PCOS is the timing of things

but there are treatments for that. So there are medications, we call ovulation induction, that can help you to ovulate. For some people, you know, even things just like lifestyle changes or weight loss will mean that their cycles return to normal. But I'm quite conscious of talking about weight loss, specifically in the context of PCOS, because we know that PCOS have, people with PCOS have higher insulin resistance. So one of the things that's really frustrating is when somebody comes with PCOS, and they're just told just go and lose weight. Well, it's by definition more difficult to lose weight. And also then, you know, that might have impacts for things like funding for, you know,

NHS funding for fertility treatment. So weight loss and lifestyle can be a management option, but it needs to actually come with support, not just being told to go and lose weight. So that's one thing. But those things you can treat, like, you know, helping people to ovulate with certain medications. There's some evidence that, you know, the insulin resistance that people with PCOS experience can also affect things like the egg quality. So that, yeah, those are the main ones for PCOS. It's around ovulation. But as I say, it's something that's relatively easily

treated. I'm really glad that you said the important things point out is that just because you have those conditions, it doesn't mean you can't get pregnant. Because also you see women with those conditions who were lured into this false sense of security and then they don't go on contraception and then get pregnant when they don't want to be getting pregnant. What about endometriosis? Yeah, so endometriosis is a bit different. So endometriosis basically is, so the endometrium is the lining of the womb and there's part of that which you shed each month when you get your period. So endometriosis is when you have cells that are similar to that lining, they grow outside of where they should be. And the most commonplaces are.

are in the ovaries, in the fallopian tubes, but it can go far beyond the pelvis as well, even in the lungs. And yeah, the hallmarks of it is that people usually have very painful periods. You know, it's a spectrum. So some people have quite mild disease, and it doesn't affect their fertility and they get pregnant without any help. And then you have more severe cases. So endometriosis can cause scar tissue inside your pelvis. That can affect your philopies. tubes. As we were saying earlier, the fallopian tubes is where the egg and the sperm meet to fertilize. So if you have scar tissue that affects your tubes, that can that can affect that process. It can make it harder for the ovaries to release an egg. If you have endometriosis

in your ovaries, you might hear people talking about these chocolate cysts in the ovaries. That can impact the egg reserve and the air quality. And it's also just a general condition where things are quite inflamed and angry in your pelvis, and that can be a little bit of an inhospitable environment for pregnancy. But again, so it depends on what your goals are. Some people will get pregnant without help. Some people will need IVF. Some people will need surgery before IVF. It's also possible to have your eggs frozen before going through a major operation for endometriosis, especially if you're going to have big cysts removed from your ovaries, because, you know, it's not through the fault of your surgeon, it's just invariably when you take away the cyst,

you take away some healthy tissue as well. And that can cause your egg reserve to drop. So it's possible to stimulate the ovaries, extract those eggs and freeze them before you go through a big endometriosis surgery. And I think we spoke about the women with cancer who weren't spoke about these options. It's also, it's really important for women with, yeah, endometriosis to also know that they can, yeah, freeze their eggs before. these surgeries. I think my experience is a bit skewed because I work in a very busy centre in London. So these conversations we have fairly routinely.

But we also work as a satellite clinic for clinics further afield. And we just did an egg collection for a woman recently who kept on having her endometriosis surgery cancelled. And just last minute somebody said, what are you going to do about your fertility? And she was like, what do you mean? you know, they were like, well, you're going to have this operation, if you thought about freezing your eggs. Like this lady was coming up to her surgery. It was cancelled on the day.

And she opportunistically managed to freeze her eggs. But that could have just as easily not happened. They're bringing up the facility on the day of a, or just before an operation, she's probably waited in pain for months. Years. Yeah, years. And it's because the surgery was. cancelled that she had the chance to do that.

God, and it's just, because you just can put yourself in that woman's shoes of being so, so, so, so desperate for this, for this operation. Yeah. But then having to weigh that up with her, like, her concerns about her fertility. That's why are we putting women in that position. And she wasn't thinking about her fertility because she was living every day in so much pain. Yeah.

And that's why it's our responsibility as doctors, as healthcare professionals who are looking after these women to try to protect their future interests. Because the goal is that after this operation, she's hopefully not going to be in this level of debilitating pain. And maybe when that happens, she might think, what else do I want for my life? Do I maybe want to start a family? It's not the case for everyone.

But if it is, you know, it's our responsibility to have had that conversation before. Yeah, yeah. I'm so glad you spoke about that. Another group of conditions that affect facility that I do not think is spoken about enough. is SCIs. Would you mind explaining how STIs can impact your facility? Yeah, absolutely. Well, we know that most people who will have an STI, specifically chlamydia, will not have any symptoms at all. But we know that even just one case of chlamydia can badly affect your fallopian tubes. So again, this is what we're going to, going back to saying

about, you know, treatment being quite reactive. So if we try to think a bit more about preventative approach, you know, like quitting smoking or whatever, but actually having regular STI screens or using barrier methods of contraceptions, that's really important for your future fertility. And we have these conversations with women from, you know, in secondary schools when they're teenagers about not getting pregnant. I think there's something to be said about having the conversations about protecting your fertility from the point that you become sexually active. So having these conversations in schools about not just protecting yourself from pregnancy, but protecting your future desire for pregnancy as well.

Exactly. Another community question that we had is how do you know something is wrong with your facility? What signs should women look out for? So some of the warning signs that you can look out for in terms of, let's talk first about your periods. Is your period regular? Can you look at a calendar and know within the space of around few days when to expect your period? If the answer to that is no or you're not having a period each month, then that deserves investigation, right? Do you have PCOS? Are there other hormonal issues? Are there thyroid problems? So you need to have some investigations.

Are your periods really painful? And this isn't the issue because we've told for so long that these are women's troubles or, you know, know, you just put up with the pain or some people have higher pain thresholds. If your period is so painful that you are can't canceling social plans, you can't go to work, that's not normal and that needs investigation. And if your periods are so heavy that you are flooding through pads or you're having to use pads and tampons, or you're actively avoiding leaving the house on, you know, on certain days of the month, again, that's probably too heavy. And that should be ringing alarm bells for things like fibroids,

endometriosis, PCOS, other hormonal imbalances that you need to take a look at. Another community question we had was how many years before trying for a baby should you start thinking about your fertility? You could argue that there's not like a limit on that in terms of just your lifestyle, right? Like in terms of having a fertility friendly lifestyle, should we say, like smoking or binge drinking or just having a generally healthy lifestyle. I don't think it's too early to have those conversations really at any stage. And those things are going to help you in all your areas of life. You know, if you live in a healthier lifestyle is just better for you in general.

It's not an either-all thing. And it's so personal as well if you know that that is something that is important to your future, the earlier, the better. And if you thought about infidelity as a medical condition, in the same way that you thought about other, like, say like a heart condition, for example, well, probably you would try to have a good diet and a good normal weight and all those sorts of things. You wouldn't say like, okay, well, by the time I'm 35, I'm going to start thinking about that. You would just probably try to make those choices earlier on.

You've co-authored a lot of research into fertility. Is that any area of fertility you think there isn't enough research on that you'd like to see more of? Well, I think women's health as a whole is woefully underfunded. I mean, that's a really hard one. All of it. Yeah, I think conditions like probably like endometriosis because the thing is like endometriosis affects like one in 10 women. 10% of the population.

That's the same as diabetes. When you look at, you know, how much funding goes into diabetes versus something like endometriosis, it's like a drop in the ocean. I have never thought of it that way that endometriac. affects the same proportion of people as diabetes. And you're completely right. We have entire diabetes consultants in hospitals,

but there's nowhere near the same level of investment in tend metriosis. Yeah. Yeah, women's health on the whole is just, it's, I mean, yeah, the level of funding is really quite appalling. Community question. When should you start thinking about freezing your eggs? And do you have an age that you're, would say is the best. So I would say if you are thinking about freezing your eggs, ideally

you want to do it before 35 if you can. I'm seeing more and more women who are coming to do it in their 20s. Some of them are being paid for by the tech firms that they work out. That's an interesting trend I'm seeing at the moment. The younger, the better because, you know, again, it's not just about quantity. It's also about the quality. So if you are able to do it younger, then that would be good. But, you know, even doing it, say, after 35, it's fine, but we just have to have kind of reasonable expectations about what we can hope to achieve and we might need to get more eggs because we know that, you know,

the quality is not going to be as good as if you came when you were 25. I'd really like to speak about the difference between egg freezing and embryo freezing and how that can impact success rates as well. Yeah, absolutely. So as I was saying earlier, the first part is the same, you know, in terms of stimulating the ovaries and extracting the eggs. For egg freezing, you freeze at that point. Then if you're freezing embryos, you're going to see how many of those eggs fertilize and then how many of those develop over the next, you know, five, six days to give you a good quality embryo. Now, when you freeze an egg, you're freezing a single cell versus an embryo, which is between like three and 500 cells.

So it's a bit more robust and it has a higher chance of surviving the thawing process. So as I was saying, when you defrost or thaw an egg, it's about, let's say, 85, 90%. For embryos, about 95% survival. So you will lose fewer in that de-froasting thawing process. And also you have a lot more information. If you know, for example, you have X amount of good quality embryos, that gives you a bit more assurance about, you know, your chances of a live birth, you don't have as much information when it comes to egg freezing. And would you recommend, I guess it's a case-by-case basis, but what conversations do you have

with your patients when you're helping them decide which is best egg freezing or embryo freezing? So, I mean, first of all, it's personal circumstances, right? If you're coming as a single woman, that conversation isn't there because you're freezing your eggs. If you're thinking about freezing embryos versus eggs, the important thing to remember is, is that eggs belong to you. An embryo belongs to you and your partner. And you're creating human gametes together. So you also have to go through some legal paperwork

to say, well, if something happens to one of you, if you break up, if one of you dies, what's going to happen to those embryos? Do you give permission for the other person to use them? So that depends on, obviously, your personal circumstances. I've seen people do things like extract eggs, freeze half of them as eggs and freeze half as embryos. Interesting. That's something that you can do.

Again, these are quite personal choices. But generally speaking, if you are married or if you, if this is the person that you are wanting to have children within the future, then freezing embryos has certain advantages. but the important thing to remember is that they belong to two people, not just to you. Gosh, that's, as if the conversations weren't heavy enough that you have to have the conversation with your partner, what happens if one of us dies and we just have these embryos lying around. God. Yeah.

Another community question I think is really important to talk about, but a little bit sensitive, is can abortion impact fertility? This is a bit of like a nuanced kind of answer. So it depends, right? Having an abortion or termination in and of itself is not likely to affect your fertility. But, for example, any procedure where you have put something inside the womb, you know, whether that is a surgical management of a miscarriage or a termination, you know, that does have the potential to create scar tissue inside the uterus. I think that's one of the things actually we probably don't talk about quite enough. Okay. Is this condition called Asherman syndrome? You know, essentially, as I say, anything where you're placing an instrument inside the uterus has a potential to create scar tissue. So if somebody comes after a miscarriage or termination where they've had this procedure, for many, many months they're not having a period or their periods are significantly lighter.

That should also just ring some alarm bells for this condition. And you need to think about, is there potentially any scarlet? art tissue inside the womb. But having a termination in and of itself doesn't, you know, increased your chance of infidia. I think what happens sometimes is that people get pregnant quite young. You know, we see people coming in their 30s, for example, and they're like, oh yes, I had a termination when I was 16. And then they think they incorrectly link that to the fact that they're having difficulties getting pregnant now. But that was probably 15 years ago, you know, or more even. So you can't underestimate the time.

time and age from a last pregnancy. Yeah, I mean, the termination on its own is not going to be the reason why you're having difficulty is getting pregnant now. But often we see that it's many, many years ago. Yeah, God. It's just there's a lot of feelings to navigate. Yeah. How do you personally support couples and women going through these conversations and processes?

I think the first thing I would say is if you're going through this as a couple, that, you know, I would hope that people will think about this as a team effort, you know, rather than thinking, well, you're the problem or you're the problem. And oftentimes, look, the onus has been on the woman. So sometimes I think when you realize there's a male factor, it can sometimes feel like it's kind of leveling the playing field a little bit. Yeah. But ideally people are thinking about this as we are trying to get pregnant together. and removing that kind of finger pointing or guilt part of it. And the other thing is just to really think about it as a medical condition rather than, you know, a virtue. And just normalising a lot of the feelings because people feel guilt or shame or stuck or isolated.

And, I mean, most clinics, as we would do where I work, offer some counselling as part of, as part of the. the package of your of your treatment. And so I'd also encourage people to access that where it's available. So Dr. Nagler, we've been asking this question to all of our guests. What do you think every woman should know by the time that she turns 25? I think every woman should have an understanding of, first of your anatomy and correctly naming and understanding your anatomy. and also the understanding of how your menstrual cycle works. Because I think if you're starting out from a place of understanding,

if something is not going to plan or not happening as you would expect, that probably is going to trigger something to say, oh, maybe I should go and have that checked out, you know. Maybe it's not normal for me to not be able to go to work when I get my period. You know, I think if we have a better understanding of our bodies, of our anatomy, of our menstrual cycles, they were much more empowered to know when something is wrong and seek help. I think about all the times in school we got asked to put a condom on a dilder wearing beer goggles

and actually not nearly as much time was spent on understanding the cycle, which, you know, I completely get that sex education is important, but that should also include, I think, the understanding of your reproductive health beyond just do not get pregnant. And we're also in this era now of like, you know, so many supplements and biohacking and longevity and all these things, especially where fertility is concerned.

There is a huge market for people to try to capitalize on your fears and your anxieties. So having an understanding of the basics and also knowing that there is no miracle supplement or no guide that you can buy, that is going to change that is really important because that also kind of protects you from being exploited, essentially. I think that's so important. Thank you so, so, so much for coming on. I think that's potentially one of my favourite episodes that we record.

And I think there's so much value. I hope that everyone can take away. So honestly, thank you from the absolute bottom of my heart for, spending your time just imparting all that knowledge, it was absolutely phenomenal. Thank you. Thank you for having me. I've had fun.