LadyGang - Lady Lessons: Fertility

Episode Date: July 15, 2020

To kick off our Lady Lessons summer series, brought to you by Vince Camuto, we are discussing all things fertility related with Dr. Daneshmand. Is one of us trying? When should we all start thinking about freezing our eggs? How do you find the best fertility doctor? Dr. D answers all of our egg-cessive questions. Special thanks to Vince Camuto for sponsoring this series. Use offer code LADY to receive 20% off your next purchase of $75 or more at vincecamuto.com .See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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figs.com and use code figs ca for 15 off your first order that's where figs.com code figs ca hey ladies you know we love having all of our experts on the lady gang and while all of them are geniuses in our book, we want to remind you that sometimes advice is subjective. So take what you want, do your research on your own, but also enjoy the episode. Well, what is this? Welcome to the Lady Gang. That's amazing. Say that again. The Lady Gang. Things are about to change around here. Each week we catch up with Hollywood's hottest girl posse, Kelty Knight, Becca Tobin, and Jack Vanek. hello hello hello everyone whoa so weird it's usually becca doing that welcome to the lady

gang and welcome to a very special episode of the show this summer we've teamed up with vince camuto to present lady lessons a five-part series here on lady gang so after we wrote our book we realized there were other topics in our lady life that we wanted to do a deeper dive into the upcoming curriculum includes conversations about fertility finances race career and mental health. The topics and questions you hear in this series will be community sourced and we can't wait to hear what you think. Without further ado, on behalf of Vince Camuto, we present this week's Lady Lesson. The Lady Gang. Our guest today is the fertility specialist we've all been waiting for and although we've been labeled as unrelatable by TV viewers for not being moms, it may be today

that you find out some of us are actually trying. What if my eggs aren't really cooked as I mentioned in the book, Act Like a Lady. Well, this doctor is here to tell us and answer all of our egg-cessive questions. The board-certified OBG, a reproductive endocrinologist, I'm saying that wrong. Endocrinologist. Whatever. He's been published internationally, not to mention he has a whole lot of awards, honors, and recognition while being fluent in French, ça va bien, Spanish, comment ça, and Farsi. I don't know that one. And two more, right? Yes. Okay. Whoa. So much better than us. But it's technology and technique with IVF, egg donation, and surrogacy that have patients traveling from around the world to see them at the San Diego Fertility Center. Please

welcome to the Lady Gang, Dr. Donna Schmidt. Thank you so much, Gail T. Thank you for inviting me on your show. And it's a pleasure to connect with all of your listeners. So before we kind of get into it, I know that what you do is something that you probably get a lot of people are ages, 30s, you know, 30-ish. I mean, 26, 27. Yes. Yes, exactly. Right. And they come to you because, you know, they've spent their entire lives trying not to get pregnant and being so scared every time their period was late. And then you wake up in your 30s and especially in our generation, we're career women, we have things going on and we wait until later in our 30s to even think about a family, and then it's almost too late, and then it's hard.

And so what is the time that you wish all women and men went and got tested, their fertility tested, if they want to have kids? The issue is that men continuously produce sperm into their 40s and 50s and 60s. Does the quality of sperm decrease over time? Yes. Is it affected by smoking and other potential habits, excessive drinking? Yes. But they still continuously produce sperm.

that sperm production doesn't end. Women have a finite period of time when the eggs are healthy and good quality and viable. So we want women to start testing their fertility at 27 years of age. Now, why is that? All women are born with all the eggs they're going to have throughout their lifetime. It's a million at birth. By the time they reach puberty with their first period, it's down to about 400,000. The first significant decline in the quality of the eggs occurs at 27 years of age. Now, most women have good quality eggs, 28, 29, 30, but that's when sort of the curve starts making a dip. The dip becomes more significant after 32 and even more significant after 35. So if I think women are empowered to tell their OBGYNs, after 27, why don't you just

do one blood test on me, which is all it takes, one blood test a day or two after my period so that I am assured that I still have good quality viable eggs in my ovaries. Just like a pap smear that patients do once every couple of years, why not just learn about your egg reserve? Because in 21 years of my practice, I have seen 28-year-olds struggle with fertility because of egg quality, 30-year-olds, 35-year-olds, 40-year-olds. It happens. It's just the percentage of 28-year-olds are going to struggle is much smaller than the percentage of 38-year-olds. So why not sort of take your reproductive health into your own hands and empower yourselves and just get a blood test. And if at least, you know, your options, even if you're thinking, well, you know, I don't want to

have children now. There are other options available to patients, you know, egg freezing is an option, or at least you just know you're empowered by the knowledge that, okay, I don't have to worry about that aspect. And I can tell you that most doctors will not tell you that. I mean, I was telling Becca the other day, I had a patient right now who's struggling with IVF because she's run out of good quality eggs. And two and a half years ago, she went to her OBGYN and she was 37 years of age. And she already was showing signs of decreased ovarian reserve, meaning that she was having trouble conceiving and one of her hormone levels were out of range.

And her OBGYN said to her, you know, why don't you try another year, year and a half? And if it doesn't work, then go see a fertility doctor. Well, by the time she came to see a fertility doctor, she no longer has any viable eggs in her ovaries. And so the only avenue that's open to her is using donor eggs. Wow. I have a lot of girlfriends who have asked their doctors since my journey started with IVF, I've told them what you've told me.

And a lot of them have gone to the OBGYN and have received the exact same feedback where they're kind of brushed aside and told not to worry. So I guess it's, can you demand that? I mean, obviously it's our body. Okay. Absolutely. You can demand that. It's, it's like saying, you know, I was, you know, I had a fall and could you, can you get me a tetanus vaccine or, you know, absolutely. It's, it's, it's, it's not a particularly expensive hormone test. It's, it's a very easy test to get and you can even don't have to rely on the interpretation of of your ob gyn to potentially you know take action don't take no for an answer don't say don't take the sort of the classic answer which i've heard now for over 20 years is oh you're

young why do you have to worry about it now don't worry about you don't worry about that until you're like 38 and 40 years of age well by the way by 40 years of age 50 of women have run out good quality eggs. Wow. And is this a different thing than, so I was at my, obviously this is a different thing, but I was at my gynecologist recently to get a pap smear. And during when she's doing it, she's like, Oh, it looks like you have so many eggs. And so for me, that like, gave me a peace of mind. I'm going to freeze my eggs this year, but that gave me a peace of mind where I'm like, Oh, I'll probably be fine. So am I not fine? And why, what's the benefit for gynecologists to say that or to do that when if it's not so it could be that they looked at the

ultrasound and they found you know lots of these immature cysts which are essentially each egg develops an assist every month so imagine your ovaries have all these little cysts and every month if you're not on a birth control pill and what happens is one of those cysts grows and becomes a larger cyst and then ovulates basically the cyst first and releases the egg so it could be that during the ultrasound, they looked at your ovaries and they found these multiple small cysts and said, it looks like you have lots of eggs in the ovaries. But that's just one aspect of the egg reserve. One aspect is the number of eggs that you have, but the other aspect is the quality of the eggs. Because we have a whole different group of patients who have an adequate

supply of eggs, but the percentage of good quality eggs has decreased significantly. I had a similar situation when I went to go, I got the blood test. This was years ago, but I was like, I'm so young. I'm so fresh. I get Botox. I feel 25. And she was like, well, let me just test it. Are you thinking about trying? And then she was like, you're, I can't remember exactly what the mechanism of, you know, whatever it was, but she was like, you're at like a 1% or something like you're bad. You're like, if she basically was like, if you want to have a baby, you got to have baby now. Like we're not good. It was so emotional because you're like, it's your womanhood it's your you've spent your whole life trying not to get pregnant and then

you know in addition to a few gray hairs you're all of a sudden like your body is like you're old it's just so emotional um it really is it really is and and i think that the the issue is and that's why the importance of sort of empowering yourself and saying well you know what i'm gonna i'm gonna start this testing early on but frankly um i think that one percent you can't really you know delineate exactly the percentage yeah but but if somebody also tells you well you know you got to have a baby now no you can freeze your eggs if you have a partner you can freeze embryos or if you are ready to have children you can have children but it's not like you know you there the technology is advanced enough now that you know women have many options if they want to

preserve their fertility and say that we're uh like seven years older than 27 and we haven't done the blood test, are we screwed or is there hope? There is definitely hope. In other words, the overwhelming majority of 34 year olds or 27 plus seven will still have a good number of eggs in their ovaries. But it's just, you know, it's a comfort to know that, yes, I have eggs, but it's important to at least speak to someone after you have that test done so they can interpret it correctly because one thing is getting that test the other thing is interpreting it so our darling Becca has been going through it with you um and I mean it wildly Becca do you want to kind of talk about that or yeah so um you know Zach and I have been trying for about two years

And our issue was never actually the ability to conceive. It was the quality of my eggs. And so I thankfully have a really great OBGYN where after the second miscarriage, she said to me, you know, a lot of the time your body knows when something is abnormal or it's not a viable embryo and it will get rid of it on its own, which is what happened. And so she suggested talking to a fertility specialist, but in my mind, I also had the experience that Jack did where in my early thirties, I was having an ultrasound and the doctor was like, oh my gosh, look at all those eggs. And so I had a false sense of confidence in my ability to make a baby and conceive. Well, not to conceive, but to actually get to the finish line. so she said to me if you want more than one child I would definitely suggest freezing some embryos because that is you know peace of mind you don't have to rush because I also wasn't necessarily

ready to do one kid after the other but we want more than one so that was when I was led to Dr. Donishman because he's he's very humble but he's the best he's the greatest and I drive to San Diego for him because that's what I do. I used to do it for my highlights and now I do it for my IVF. Times have changed. Times have changed. But I will say I had a really false sense of confidence and I started my, I got pregnant for the first time, I believe I was, I think I was 33. I'm now about to be 35. And even going through IVF, I mean, he's incredible and he was able to get us viable embryos, but you know, he said it himself that I actually got more than what he had anticipated. And when he told me the number of what he had anticipated, I panicked because I

just didn't think I was that person. And I don't think anybody ever does. So it was an incredible experience. And now we have some frozen embryos that are healthy and like ready to go. So there's no better feeling. I didn't realize the weight that would be lifted just the moment that I found out that I didn't have to hurry up and keep trying and hopefully get something healthy. And I think Becca's story is really important because when there's a decrease in the quality of the eggs in the ovaries, that could present itself different ways. In some patients, it presents itself as a lack of ability to conceive. But in other patients, it could be miscarriages, even one miscarriage, for example. Why? Because 75% to 80% of miscarriages are secondary

to chromosomal abnormalities with the embryo, which is secondary to a declining egg quality. And for some patients, it's just a subtle sign. Sometimes their menstrual cycles are about 28 days apart, and over time it becomes 25 days, 26 days. And that subtle sign tells us that the number and the quality of the eggs is starting to decline. So I think that story is really important. And can you tell us, I have a lot of girlfriends who aren't quite, they're not married yet, but they're wanting to get ahead of it and freeze eggs. But what's the difference between freezing eggs and embryos? The difference is that eggs are more fragile than embryos. So when you freeze eggs, you subsequently thaw them, the survival rate on eggs is lower than embryos. So

we expect, for example, when we freeze embryos, the survival rate typically should be especially good quality embryos over 96, 97% survival rate. Oh, wow. On eggs, it could be about 60% to 70%. And then can you get more, if you're freezing eggs versus embryos, do you usually get more eggs in an embryo or is it? Absolutely. So it's kind of an attrition process. If you think about it, we retrieve the eggs.

Out of those eggs, only a small percentage of them are going to be good quality. There's an attrition after retrieving the eggs. Only a small percentage of eggs actually make it to viable embryos. And depending on the age of the patient, their egg reserve, that could be as low as 10%. or it could be 30%. And in egg donors who are in their 20s, very young, or in patients who are in their 20s, we expect about 40% of those eggs to be healthy. But even in a 24, 25-year-old, when you retrieve 10 eggs, it's not like all 10 are good quality eggs. Only maybe 40% to 50% are going to be good quality. And then that percentage decreases as time progresses.

I have a question, Becca. Would you share a little bit about the process and how you felt? because I think the reason that so many people, so many women get turned off by this process is that we hear from our friends, Oh my God, I'm doing these injections and I'm feeling awful and I'm on these hormones and then I get in this way. Yeah. So, so maybe I I'm happy to hear that it was not so difficult for you. Um, would you share a little bit of that? Yeah. So, um, I had my initial appointment and we did, I believe we counted my resting follicles, um, which I think was like 23 or something. And then, you know, he gives everybody a very specific protocol for injections and, and, and how, and how many days it depends too on the person. Right. So throughout

the process of the injections every couple of days, I was going down to do ultrasounds where he's checking the growth of the follicles. And so the injections for me really weren't, weren't that bad. And I'm terrified of needles. I, you know, like a tiny little ice cube to numb the spot a little, it's like an insulin needle. So it's really, it's a wimpy needle. Um, and Zach did it for me every night. And I think I did 12 days. I think I did 12 nights of, of the injections and halfway through we incorporated an afternoon, but I have to say it was really, um, it wasn't until the very, very end of that 12 days where you actually feel your ovaries are like, you know, they're, they're bigger. So you kind of have like a heavy feeling there. Um, the retrieval was so

easy. I like, you know, you're it's what, 15 minutes, right? Do you go under, do you go under for it? You do. Um, but it's the shot, like, what are you putting in you? So essentially there are two main hormones that we, um, give patients. And those two hormones are the same two hormones that are released from the brain to the ovaries every month as an egg matures and develops up until the time of ovulation. So one is called follicle-stimulating hormone, which is FSH, and the other one is called luteinizing hormone, which is LH. So we're giving these medications in roughly the same percentages as the brain does every month, but we increase the dosage of those because if we give a low dose, which is what the brain does, the brain gives a very low dose of

these hormones. And the reason is because humans are mono ovulators. Most of the time, they ovulate one egg at a time. Um, but we're not interested in, in let's say Becca making one egg because then you dare mono ovulate girl. So we giving it in a higher dosages. So Becca can make 10 eggs, 15 eggs, 20 eggs so that we have a higher chance because we know out of those 10 or 20, only a small percentage are going to be good quality. So then, um, the, we have the retrieval. Um, it was really easy and a lot of women, you know, we're doing this during COVID where everyone's working from home, which I honestly, I was so grateful cause I didn't know how I would feel. I didn't know if I would want to be around people, but to be honest, I definitely could have

done that as busy as, as we've ever been, you know, the final day, you don't want to be physical or like the last couple of days. And I completely stopped working out because you have to. Um, but emotionally I'm so sensitive to hormone changes and I really didn't experience much at all. And I'm curious as to, is it just because of the way that I'm taking the hormones or is it just a fluke? And I got lucky. I think most patients will say that the side effects or, you know, the symptoms are, are not you know terrible from the medications um the most common side effect from these medications is feeling tired on them the second most common is feeling a little bit bloated because the ovaries

enlarge because you suddenly have instead of one egg you have 10 eggs or 15 eggs um and then you can have you know breast tenderness or some occasional headaches and um but i do think the experience of each patient is is different it's much much like if you were to take a birth control pill, particular birth control pill, and one patient could cause nausea and some symptoms, another patient, they're like, it has no effect on me. But I think the majority of patients do well. Becca's experience in terms of side effects is more the overwhelming majority. And how long is the entire process from start to finish? Because I've heard different things like for egg freezing, for example, it's like two weeks to six weeks or four weeks. So

is it different for every person? Typically, in most cycles, the whole process is two weeks. In other words, from the time you start the medications to the time we retrieve the eggs, it's completed within two weeks. Now, there are some clinics that use older types of medication regimens, and those are longer, sometimes three weeks, sometimes four weeks, sometimes five weeks. We don't use those older type of medication regimens. Why? Because there have been published studies, including ours, to show that the shorter cycles, the shorter medication treatments are more effective and give us better quality eggs. For girls that are not in Southern California who can't go to you, what would you find, like, what would you tell them as far as finding the best

fertility specialist for them? One of the most important things is word of mouth, you know, the experience of others, you know, forums such as this in terms of how other patients have experienced. Because, you know, if you, obviously every fertility center markets itself as a great center with great pregnancy rates and great doctors. And I think there are two things that are important. I think the experience of others in terms of they felt that they really were cared for and that the doctor spent a good amount of time explaining everything in detail. Because anytime a patient has a question, you have to make sure you address the question so that they're well-informed. Because if they're well-informed, then they're empowered. That's the first thing.

And the other thing is make sure that the lines of communication are always open. So if a patient needs you, they have to be able to reach you. The other factor I do think is that if you then look at fertility centers, now not just fertility doctors, but also in any profession, then you get into the sort of the upper echelon of those who do research and who publish. Then you're in the sort of the upper echelon of a minority of fertility doctors that are on the cutting edge of research. Because if you do research, you're constantly around people who are doing research, you're constantly around people who are innovating, who are creating creative protocols to improve the quality of the eggs. And so with this research, we gain more information on how to better treat

patients and how to make IVF, for example, safer and how to make it more effective. That actually brings me to a question. I got an email from the clinic and it actually was very comforting about pregnancy during COVID. And I think that that was really insightful. We have so many women who listen who are thinking about conceiving or are already pregnant, really close to their due dates and very scared. So can you tell us a little bit about what you guys have found out? Absolutely. So we've been sort of following the latest research and publications on COVID-19 as it relates to fertility and pregnancy. So the studies and publications on pregnancy have been very reassuring and on two fronts. Number one,

there was actually several papers published in the New England Journal of Medicine and one in Lancet, which is the major British medical journal that showed that there was no evidence of vertical transmission of the virus, meaning that the virus being transmitted through the placenta to the fetus causing malformations or other effects. So that's one piece of good news that we have thus far on the virus. The second piece of news came out from Columbia University, which now is doing universal screening on all pregnant patients. And what they did was they tested all pregnant patients. And those that tested positive, 87% of those patients who tested positive for COVID-19 either had no symptoms or had mild symptoms. And the percentage of patients that went on to having

more severe symptoms was no different than the general population. Because one of the initial worries about the virus was, oh my goodness, immunity is altered. It's not weakened. Most people think, oh, pregnant patients have weaker immunity. It's not weaker immunity. It has to do with T helper cells and the percentage of T helper cells versus the other T cells, immune cells. it's altered. So our concern was, are pregnant patients more prone to this virus? And if they get it, are they more prone to having severe symptoms? And the Columbia University study showed that no, that wasn't the case. It was the same as the general population. So, so far, the data has been reassuring. Of course, we tell patients to take all the precautions

and make sure you protect yourself. So now that the potential babies, no, the embryos are done and they're frozen and they're on ice, they're waiting. Is there a time when your uterus has a past due date or is it just the eggs? Interestingly enough, the uterus doesn't age the same way as the ovaries do. And how do we know this? Because patients who've run out of good quality eggs, patients in their 40s, when you use an egg donor for someone, for a donor who's in her 20s and you create embryos and you transfer them into a patient who's 45, they have the same rate of pregnancy as somebody who's 35. But that doesn't last the whole way through. Typically, we don't recommend for patients to get pregnant beyond 49 years of age. There's a couple reasons

for that. Number one, the uterus does start to show some level of aging, especially if menopause occurs because now you have, you know, estrogen levels drop. And so blood supply, the uterus changes, but also above, above the age of 49, the risks and complications during pregnancy are much, much higher. And these risks could be as, as, as grave as a stroke, high blood pressure, diabetes, premature birth, placental abnormalities, those start to increase significantly after 49 years age. Becca, do you feel so good? Like you have 15 years. I know it actually, I never knew that it would feel this good. I think that first of all, I should say after the retrieval, it is a stressful time because every couple of days you're getting updates and you're finding

out the attrition rate, as he said, you're losing eggs and you're losing embryos and they're testing them and some of them are not actually healthy. So those two weeks, because I would say, isn't it about two weeks if you do the PGT testing? Exactly right. Exactly right. Yeah. It's not six, seven days for the embryos to kind of develop to that mature stage of blastocysts. And then we typically wait another five to seven days for the genetic test results. Right. So that period of time was a little scary just because you know that there's a chance that you could end up with none. And I had a point in my, in my, um, I think I was on day five and only one fertilized egg embryo. I don't know. Is that the right? Only one, only one, one,

one embryo was showing that it was going to be a viable, I guess. So I was really nervous about that because, you know, but then the others caught up, I had some late bloomers, but it is stressful. But then as soon as we found out our results and now that they're just on ice waiting for whenever we're ready to implant, it's like, it's a really crazy liberating feeling. And, um, I mostly just want every woman, I just feel like I want to shout it from the rooftops because we aren't given all the information for some reason. And, um, you think that your OBGYN, even especially a female OBGYN, you would think that they would be really well versed in this.

but I'm finding that that's not the case and a lot of the time. And so that's why we want to talk about it here because it's like, you know, it's the, it's really one of the most important things I think once you're at this point in your life to be empowered by the information and know that you have options. And then I have another question. If, if you go to implant the embryo, if, if someone has had an abortion before, if someone has had a miscarriage before, if someone, And, you know, does that affect how well the embryo will take or is every kind of new implantation like a new period cycle? It's actually every new implantation is like a new period cycle.

Previous history of abortions or miscarriages should not have any impact on the ability of the uterus to allow implantation in a healthy pregnancy. And are you able to expand on, you had asked me at one of my ultrasounds, my lining was a little bit thinner than normal. And you asked if I had had an IUD and I did. So can you tell me a little bit about that? That's a great question. Wow. You got, you got, you have a good memory. So what we hear everything, we never forget. It's interesting that one of the things that we actually, this is one of our abstracts that we just sent research abstracts to the American Society of Reproductive Medicine is one of the things that we realized is that some

patients who've had a history of an IUD, it has a lasting impact on their uterus, a lasting negative impact on the uterus. And how do we know? Because when we start to prepare the uterus to allow implantation to occur, the uterus is supposed to get thick with estrogen administration. And that lining of the uterus, if it doesn't get thick, then one of the things that we think about is, okay, well, did you have an IUD in place at some point? So that is unfortunately what we're discovering is it could be a long lasting effect of the IUD. And that's something that has not been talked about. If you go on the website, if you look at studies on IUDs, it's safe. There's no issues. Yes, it's very safe. However, there should be a little bit of a caveat, a little bit of sort

of a disclaimer that this could have an effect on your fertility. We even see this in gestational surrogates who are very fertile, who are, for example, they're gestational surrogates who carry a pregnancy for someone who can't. And if they've had a history of an IUD, they struggle with being able to have a uterus that's receptive to implantation. And is that all IUDs? Because there's the copper and then, so you think, so it's been all. Well, it hasn't actually, the Mirena IUD, which has progesterone, tends to be the biggest culprit. We think that perhaps the reason is because with the Mirena IUD, with IUDs, the way they work is it's sort of a mechanical structure that prevents implantation. But, and in copper IUD, for example, copper is

also toxic to the sperm as well. So it's not just an implantation issue. It makes the lining of uterus less receptive for the embryo to implant, but also has a toxic effect on the sperm as well. And we think that progesterone may be lingering in the uterus and in the cells on a microscopic level for a long time after the IUD is removed. Now girls who are trying to get pregnant right now and having trouble, who have had an IUD, there is a solution, right? Yes, absolutely. There is a solution. Sometimes we have to wait. Sometimes the solution is you got to wait, but most of the time we can counteract that with different types of estrogen. So estrogen can be given, for example, vaginally, it can be given through a patch, orally by injection,

So we can most of the time overcome it. In a small percentage of patients, what has to happen is we have to wait. We have to wait until the effects of the progesterone are gone and the Mirena IUD gone. Sometimes for some patients, I've seen that even take up to two years. Oh, wow. We have to take a break. And when we come back, we have fan questions for the doctor. Sounds great.

You're listening to The Lady Gang. Okay, and we're back. So we had our lady gangers send in some questions that only you can answer because usually we do this with the three of us. And if we try to answer any of these questions, it would be an actual disaster. Okay. So first question comes from Tal and she says, I've been on birth control since I was 14 years old. Does that affect my fertility later in life? I've heard so many different things. So on a birth control pill should not have any impact on your fertility. However, what it does do sometimes is it can hide signs of decreased egg reserve.

So it may be a good idea sometimes to take a month or two break, sort of assess your fertility if you're concerned about it, or if you're at that age where you should test it, and then get back on the birth control pill. That was actually what a friend of mine went to her doctor asking for the FSH hormone test. And the doctor flippantly just told her, oh, it's not worth it because you're on the pill. so it wouldn't be accurate anyway, as opposed to telling her, come off the pill for a month or two and let's do the test. Exactly right. And there are some hormones that the birth control pill doesn't affect. The anti-malarian hormone that gives us an idea about a count is not as affected

by the birth control pill. Plus you can always do an ultrasound on the ovaries and that shouldn't have an impact. But again, the best thing is if you truly want to have an information on your fertility, stop the birth control pill for two months, use a different type of contraception for that, those couple of months and get your hormones tested, get your ultrasounds done in terms of your ovaries. Good to know. Okay. So second question comes from Corinne. She says, I'm trying to get pregnant and I have three different periods slash ovulation tracking apps and they all predict different times for my ovulation during my cycle. And I don't know what to trust? How do I know when I'm truly ovulating? I got a simple method for you. So

you take the total length or the interval between your two periods. And it's a simple formula because a lot of these apps are inaccurate. So what happens is you say, okay, the interval between one period and the next is about 28 days. You subtract 14 days each time. So you're ovulating on day 14. When's the best time to have intercourse? Day 12 and 14. So two days before your ovulation and a day of ovulation. That's going to be your most fertile time. Remember, the sperm is going to be active and it's going to be alive sometimes for days. That's why we say have intercourse before ovulation, just in case you ovulate a little bit early, the sperm is there. Take the total length from one period to the other, subtract 14 days, and that's when you're ovulating, and that's what

you should show. All right. I'm going to go into my BuJo period tracker here. Throw that ovulation in there. But what if you don't have a 28 day cycle? It's just 14 days from the start. If you have a 30 day cycle, you're ovulating on day 16. And if it varies, then kind of make a formula. So if you say, well, I have periods about every 28 to 32 days. Okay. So that means you're ovulating anywhere between day 14 to day 18. So having, of course, starting on day 12, every other day until day 18. Okay. Last question comes from Kristen. She said last year, I found out that I have a uterine cyst and that it could be a sign of endometriosis. I'm in the process of figuring out if I do in fact have this, but what could this mean for fertility? Could this cause issues

later down in the line when we try to have kids? I'm 26. I'm not even close to ready to have kids, so I'm kind of freaking out. Well, endometriosis is one of those few syndromes or few conditions that actually can have a significant impact on fertility. And what is endometriosis? Every time a patient has her menstrual cycle period, what happens is the lining of the uterus sheds with blood and comes outside as a period. But in some patients, in fact, in many, many patients, some of those cells can flow backwards through the fallopian tubes. And then in a small percentage of patients, those little cells can start implanting and attaching to the ovary, to the uterus, to the bladder. Now, for some patients that causes pain for them every month when they

have their periods, sometimes significant pain. For some patients, they're asymptomatic. They don't have any pain at all. The first time they discover it is, oh, we did an ultrasound. We see a cyst that looks like an endometriosis. There are three effects of endometriosis that we have to be very careful of. Number one, endometriosis, because of the inflammation it creates, it can destroy the sperm before the sperm has a chance to fertilize the egg. Number two, when the body sees the endometriosis, the immune cells get activated and the immune cells come in to destroy endometriosis, but just like in rheumatoid arthritis, not only does it destroy the good cells, the bad cells, but also destroys the good cells. So patients with endometriosis can run out

of good quality eggs much faster. The third thing that it can cause is scarring because this constant inflammation and repair, inflammation every month, every month, what happens is creates scarring around the fallopian tubes, around the ovaries. The fallopian tubes have to be free to be able to pick up an egg. So when they're scarring around the fallopian tubes, it impedes the ability of the fallopian tube to pick up an egg. So three effects. And so with patients with endometriosis, we just have to be more vigilant, especially with the egg quality. And so I would recommend to that particular patient is every year, get your egg reserve done to make sure that the endometriosis is not having a significant impact on your egg count and egg quality.

Wow. You have to come back because we have about 15 more questions. I know I need, I need to know. So we need to, yeah. Um, my pleasure. If you want to check out Dr. D you can visit the San Diego fertility center. Um, we're going to post his Instagram as personal Instagram as well. Um, but essentially it's S and then his last name Donishman D A N E S H M A N D. We're going to post it too. So you can swipe up and follow along. Um, and we'll keep you uh you know we'll keep you in the loop when becca decides to implant one of the embryos you know now that it's out there we can exciting i might wait i might wait till 49 we have a lot of work to do for lady gang so that would honestly that works for my timeline okay fine fine um

thanks for coming on yes thank you so much absolutely i mean kelty jack and uh becca i would say this was an absolute pleasure and i think you're doing incredible work and educating women out there so kudos to you and and uh more power to you thank you thanks all right if you're in southern california make the drive it's worth it guys and we will thank you you're coming see you next tuesday see you next tuesday thank you for listening and make sure to rate and review this podcast wherever you get your podcast we have new episodes of lady gang every tuesday and thursday follow us on social media at the lady gang uh follow us personally at kelty most importantly at becca and at jack banik the lady gang network is produced by will sterling steve

delamater kirsten woodward and elizabeth beckwet thanks for rating and reviewing wherever you get your podcasts and tune in for new episodes every single week