LadyGang - LG QUICKIE: Baby Gang

Episode Date: June 15, 2023

With the help of Dr. Pasternak from Spring Fertility, the ladies are doing a deep dive into all things fertility. From the time you should start focusing on your egg count, to the process of IVF and the financial aspect, you’ll be able to start planning your own baby gang.  LadyGang is brought to you by Spring Fertility! Get $150 off a full consult in any location (CA or NYC) by visiting springfertility.com *Cannot be combined with any commercial insurance. *This discount runs through December 31, 2023. Spring Fertility GIVEAWAY: Spring Fertility and LadyGang are teaming up to empower you with the information you need to know your fertility options and plan for the future of your dreams! 5 lucky winners will win an initial fertility consultation with a Spring provider (in NYC, San Francisco, or virtually). Join the LadyGang secret Facebook group to enter. **Must be 21+ and based in the United States to enter.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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Because we have your number. This podcast was made possible in partnership with Spring Fertility. With full-service IVF clinics, whether you're actively trying to start your family and things are taking a little longer than expected, or you're not ready to have a baby now, but you want to learn more about your fertility and keep your options open for the future, Spring Fertility is here for you. Spring was founded on the belief that exceptional clinical results do not have to come at the cost of compassionate, comprehensive care. Learn more and schedule a consult with a Spring physician by visiting springfertility.com. It's time for a quickie. Podcast one presents

the Lady Gang, the Hollywood girl posse with Lady Gang Quickie. Here's Kelty Knight, Becca Tobin, and Jack Vanek. Let's make this quick. Hello, hello, hello. Welcome to Lady Gang Quickie. I am Becca here with Jack and Kelty. We are beyond excited about this episode because this is a topic we never tire of discussing and you guys apparently never tire of hearing about. So Kelty, who do we have with us today? Ladies, we're so excited to have teamed up with Spring Fertility. And through Spring Fertility, we were introduced to the incredible doctor, Dr. Monika Pasternak. She grew up in Connecticut and has studied literally everywhere, Columbia, University of Miami, Yale, Cornell. She's an

insane doctor. And I think ever since Becca really opened up about her fertility struggles, we've started to become this place in, in our Facebook group and on the podcast where women are like, wait a second, you guys are going to explain how our bodies work. And we are just at that age. And so this is a perfect opportunity for us to talk about that. We have a really, really exciting giveaway for you, for all of our Facebook members, which we're going to talk about in a bit. But first of all, we want to welcome Dr. P and just, first of all, I think it's really interesting just to say to our girls before we get into it is, you know, we've been doing this podcast for eight years and we have been screaming this from the rooftop for eight years. Hey,

do not wait until you're ready to have this baby because it's too late. And I have, we have women working for us. We have women we know, and they're like, no, no, I'm like only 29. I was like too late. Like, you know, and so I just want to like know from you, what's your advice on, you know, we know we are supposed to be 40 when we get a colonoscopy and you know, 40 when we get our first mammogram or whatever. Like what is your take on these ages and what's the real conversation around when we need to start focusing? So I'm going to start off with the fact that we have to break down our eggs. Those are our sex cells, right? So the cells with which we get, which we use to get pregnant, you need right now a sperm and an egg in order to create an embryo. I say

right now, cause I'm very much hoping that down the line we can make a baby from two eggs and to sperm, but right now that's not the case, right? So sperm and an egg. The sperm is coming from people who are born with testicles, people with what's called a male reproductive tract. Eggs are coming from people assigned female at birth who are born with ovaries. So the difference is, and this is the fundamental difference, because I know you've all seen like women walking around, not pregnant much past their early, maybe mid forties, but seeing these ding dongs out there in their eighties, these guys having kids. Right. And I, you know, I say that a bit facetiously and jokingly, but it's, it's true. And the reason for that is that there's a difference in our

reproductive longevity due to the fact that we are born with all of our eggs, whereas men are able to make sperm their entire lives. So you're constantly creating sperm, most men, not all men, but when men ejaculate, that sperm is only two and a half months old. When we release an egg in the middle of our menstrual cycle, for those of us who are ovulating and having regular menstrual cycles, that egg is older than we are. We have had that egg since before we were born. The most eggs you were ever going to have is halfway through your mother's pregnancy with you. Does this mean that we should be doing like egg freezing, like straight out of the womb, like fresh top to the egg freeze? No, absolutely not. I'll get into it. I've considered it.

I'll get into this more, but the point being just as a background, let's understand our biology. When you think about quality control, what do you think is going to have more issues with quality control, a cell that is 20, 30, 40 years old or one that's two and a half months old, right? There's going to be a quality control issue with our eggs compared to sperm, generally speaking, even though half of couples who come to see me for a fertility-related issue have a male component, have a sperm component. It's just much easier a lot of the time for us to troubleshoot because that sperm in terms

of quality for the most part that it's significantly improved compared to eggs, even the women who are starting in their twenties. Right. So that, that's, I think a very important thing to solidify in our brain. Like that, that, that is a real difference. Now, as far as what is happening to our eggs as we get older and what do they need to do? Well, eggs and sperm each have to give half of a baby's DNA. Why is this important? Because you cannot, we cannot give our full DNA from our eggs and sperm to a baby, you'd be cloning yourself, right? You've got to have eggs and sperm that have all our DNA divided in half, right? They got to divide in half before they can combine and mix. That division in half for men occurs prior to ejaculation.

So the sperm is less than 72 days old when that is occurring, all right? So our eggs, when that is occurring, it happens when we're going through ovulation. So every month for women who are ovulating, that machinery is a month older, right? So that machinery is constantly aging. And that is what is starting to go. It's one of the most difficult parts of our egg growing to the point where it's able to be fertilized. And so that's the point that becomes the most fragile. And we see that going wrong more and more frequently as we get older, right? So the egg from that standpoint is much more compromised than the sperm. So I like to, you know, if you don't laugh, you cry, right? So I like to call our eggs the original like

cougars of the animal kingdom, straight up 30 plus year old eggs going for like two and a half month old sperm, but it takes several million sperm to find one egg. So like, you know, speaking of dummies, but, but so the point being now, okay, so that's the background. Now let's go back to your question about age, right? By the time we are in our twenties already, one out of four eggs is not doing that division normally. One out of four, 25%. Okay. By the time we're in our early to mid 30s, one out of three is not doing that division normally. By 38, it's one out of two. And here's the big drop off, right? By 43, it's one out of 20 is doing it right. Wow. Okay. So from between 38 and 43, it's a five year, five years, you're going from 50 to 5% of eggs that can lead to a

healthy baby. Now, if you, if you think about it though, it's not like I can look at a pool of eggs and pick out the one. It's just that each egg has that percentage chance of doing this correctly. Right. And what happens if it doesn't do it correctly? Well, most of the time you just won't get pregnant. However, if you do get pregnant, that's, what's causing like 80 to 90% of miscarriages is getting pregnant with an egg that did not divide normally. I, I hate the term miscarriage, even though it's, you know, the technical term is abortion, by the way, let's, let's, let's popularize that as, as a term that we get to use, right. Is, but I call it a pregnancy loss because you didn't miscarry it. You didn't do something wrong, right? We like to blame women.

But so point being here that you're either going to not get pregnant, most likely, second most likely pregnancy loss, then possibly have a baby with chromosomal abnormality with something like Down syndrome, Turner syndrome. There are a few chromosomal disorders that can lead to a live birth. So when we talk about the age at which we need to do this, does this mean that everybody at 22 needs to freeze their eggs. No, no, it doesn't because your egg quality is still pretty good until you are in your mid thirties. And then it's not like, you know, on the eve of your 36th birthday, everything goes to hell in a handbasket. But for people who are trying to plan a family, it is when you want to be more cognizant because the dip in quality is

happening a lot faster at that point. So that's why we say, Hey, if you're under 35, try for 12 months. If you're over 35, try for six months to get pregnant. This is again, for people who are ovulating, because if you're not releasing an egg or ovulating, you're not going to get pregnant, right? So, and it's not that there's actually, technically the definition of infertility or subfertility is trying for 12 cycles and not getting pregnant. But we know that after most people are going to conceive in the first six, but enough conceive in the second six months that it makes sense to keep trying. But we know that a lot of people, in fact, maybe most people these days, especially in certainly different parts of the country, obviously different parts

the world, this is different. The average age of first, second, third baby is different. But a lot of people are trying to have more than one child after the age of 35, 36. So it's more so that we want you to start planning for that. And if we need to pursue some sort of treatment, better to do that at 36 than 42. Not that you can't do it at 42. Of course you can, but in order, in terms of maximizing your potential, because quality is going to go downhill and quantity of eggs is going to go downhill too. Quantity doesn't mean jack in terms of fertility. All right. I'm here to say that. And it's important because we hear that all the time. It's like, Oh, this girl got, we just had a guest on that was like, I got two eggs

and this person got 30 eggs. Like, yeah. So let's talk quantity for a second. And by the way, this is a lot of the stuff that I say in my consults to patients. Like I do a full hour with patients. So this is like a lot of the things that I would be talking about. And I wish that all, all people knew about this, but it's something that we don't get educated in. We don't, we don't learn about women's health, like much past, you know, don't get sex. Don't have sex. You'll get pregnant. You'll get an STD. And then all of a sudden it's wait, why didn't you already have sex and have a baby? Right? Like that transition happens seemingly overnight. But so basically remember how I said, you're born with all your eggs. You actually had the most number of eggs

you were ever going to have about halfway through your mother's pregnancy with you. Okay. So that number drops rapidly from halfway through pregnancy to birth. So you lose like 70, 80% of your eggs by the time you're born. So we need to kind of like adjust the narrative on you've lost 90% of your eggs by the time you're 30. Okay. Let's not terrify everybody, right? Yeah. You're losing them, but you've been losing them your whole life. So then what happens once you're born? Most of us born with most of us born with about one to 3 million eggs. That sounds like a lot, right? And I think a lot of us assume initially before you know about this that you're only losing one a month, right? You release one, that's the one that's gone. But in reality,

this comparison I came up with, so I apologize if it sounds like, I don't know, either too elementary or too crazy, but the way that I like to explain the ovaries numerically in terms of number of eggs to my patients is kind of like you're born with this ocean full of eggs, okay? you got this ocean, but the ocean is a finite number of eggs. But I think we all understand the concept of like waves in an ocean, right? You can't stop waves from coming much. Like you can't stop eggs from coming and losing eggs. So every, you constantly have these new waves of eggs coming towards the shore. The difference here is that when a wave in your ovary ocean crashes, all those eggs die off. You don't save them for later. You don't refill the ocean. So the ocean's going to

get smaller every year. The waves are going to get smaller every year until eventually we have, you know, less than a thousand eggs left. And that's when we start the process of menopause. Most of us, that age can vary, but the point being, okay, so you got this wave then, you know, how do you get the one that you can get pregnant with? Well, once we start going through, you know, through puberty, start getting periods, that's when we have the ability to release out of that wave. One little surfer egg pops up, gets selected, and that's the one you release that you can get pregnant with. Some women for various reasons will select two. That's how you get naturally occurring fraternal twins. Right. Um, but the point being that the rest of that wave

is still crashing. Okay. So in reality, it doesn't matter how big that wave was in terms of natural fertility, right? Right. Cause you just need to release one. So that's why when we focus on, I get really, I understand the concept of fertility testing and we are, we can offer people tests that can assess if it's going to be harder or easier for them to get pregnant, but labeling egg tests that assess egg number, like an ultrasound or this blood test called anti-malarian hormone made by eggs, AMH, you might've, if you've heard of it, calling those fertility testing is a bit misleading from that standpoint, because fertility, I know this sounds obvious, so I apologize, but it's not. Fertility is proven by getting pregnant. Yeah. So if you

come in, I've had patients with a very low number of eggs who get pregnant like this. I got the women who come in and they either just had a pregnancy loss and realize they're not ready to be pregnant yet and want to freeze eggs or embryos, or maybe they've had a therapeutic abortion, right? And they just want to freeze eggs or embryos afterwards. And they will come in and have a really low egg count. And I'll be like, look, but you just got pregnant without my help. It doesn't mean anything about your fertility. And I'll have the women who come with tons of eggs who have been trying and haven't gotten pregnant. So egg number, you do need to be able to release eggs in order to get pregnant, right? I can help you with that if you're not

doing it. I can't help somebody who doesn't have eggs remaining, right? Unless we're going to the topic of donor egg, that's a whole other conversation. So let me ask you this. This is a question. Thank you for that. Like now I feel like we got like our... You just answered like 20 questions. I also think it's important to like emphasize what you've just said because we've been told for the last couple of years that like AMH test has been very buzzy with women and, um, and people trying or thinking about fertility. But I have friends in their twenties who did the AMH test who were told you have tons of eggs, you have tons of eggs. And it's definitely was not an indicator. So it was like, they almost had a false sense of, um, security if you will.

so it's like important to to emphasize that those blood tests don't actually have as much meaning as we've been told to place on them i do think that it is a good test it's a test i order for a lot if not all of my patients but it's not something that is the end-all be-all break-all like i'm not what's more important to me is age but you're not you're going to find the the women in their 20s who would benefit from starting early as well. Yeah. So a question we got from our audience was said as someone going IVF or going through IVF right now, I'd love for people to be more upfront about cost and affordability. Um, and so I want to get into this cause I think it's really important because we, everyone knows everyone's known someone that has done IVF and it does seem to be

like a little bit hidden behind a curtain, which is why we wanted to partner with spring fertility on this. So, you know, tell I I'm Kelty. I come into you for a consult and like, what are you telling your clients about, Hey, this is how we're going to do this. This is how we're going to pay for. I know you're not like the pay person, but like what, what does it take financially and time wise to make hopefully a baby? Yeah. What's the average price of like a one cycle. And, and the time period is a really good question. Cause a lot of people think that you have to invest like six months of your life and stop everything to do this. Okay. Yeah. So let's talk about time, time first. How long does the cycle take? So you've got the people who want a baby who come in

and they want to get going as fast as possible here. I'm going to be talking about probably as like a cishet couple, just because that's going to be the fastest route. Cause you don't have to get donor tissue or third party tissue. Okay. So that changes things depending on what else we need. Something else we're adding on some months. Okay. You're adding on some time because you need to select the donor tissue. If it's an identified donor, not an unidentified donor, they need to be screened, legal contracts. That gets a little bit more, I don't want to say complicated because we help simplify it for patients, but it's longer. So let's say this is just a couple who comes in. One of them's got eggs. One of them got sperm. One of them's got,

like the one with eggs has a uterus, right? So if you come in, you're going to do a consult. And if it's virtual, then you come in later for ultrasound and blood work. If you're there that day, you're going to probably do it all at once. The blood work, for example, I'll give you, I'll talk about what would happen at spring. You'll do your ultrasound. I'll assess, you know, I take a full medical history on all patients. Yes, I focus gynecologically speaking, but I do a full medical family history because I, you know, I, you want to know the age that someone's mom went through menopause. These things are important because they can be correlated from one generation to another, right? So consults like a, can take quite some time. They can take the full amount of a lot

of time that you're given. Sometimes if you've already had a consult or you're really familiar with the topic, they don't take the full time, but so you're going to get, um, ultrasound consult and blood work done blood work, usually for both partners. Why? Because if you, one of the things that often has not been done by the time someone comes to see me is screening for genetic conditions that you might be a carrier for that you would never know you're a carrier for, because you're not going to have symptoms. But if two carriers have a baby together, they have a 25% chance of having an affected or sick child. So common, probably the one that most people have heard about is cystic fibrosis. That's the most common way that it's inherited. It can be inherited in

other patterns, but that's the most common way. So that test is, that's the rate limiting step in terms of moving forward. That test is going to take anywhere from two to four weeks to come back. So let's say if you're coming in and haven't had that test done yet, that's going to be the longest block towards getting started. Why do I need to wait for that? Because if you and your partner are both carriers for a disease, I'm going to want to build these things, not to get too complicated into this, because I would go over that with a couple individually, but DNA probes to identify where specifically on your chromosome this

mutation for this disease is located so that we can actually map it out in embryos and tell you which embryos would be affected by that disease and not put those embryos. That happened to a friend of mine, both her and her husband were sister fibrosis and they had IVF and they had to do IVF because they wanted to try to make sure that they had a healthy baby. And is it, do you have to do IVF in order to do that? No. But the other way to do that is to get pregnant, test a pregnancy with something, one of the invasive forms of prenatal testing, specifically like an amniocentesis in the second trimester. And if you determine the baby is affected, have like a late second trimester termination. Which is illegal in a bunch of

places. So cool. Yeah. Cool, cool, cool. So I have to say that because it's technically not the only way to determine pre-birth, but this sounds, I mean, for people who have the opportunity to do IVF and have the ability, it's usually a more preferable option, right? So that test takes three weeks to come back. So let's say that you've had that done already and you've come to my office and I'm just doing a hormone panel on you. I'm just looking at your thyroid, making sure that looks good. Your blood counts, making sure that looks good. I'm going to need an infectious disease panel on both you and the male partner because everywhere that's making embryos is technically a tissue bank, right? So I need to know that somebody is not carrying a communicable

infectious disease. Otherwise they have to have their tissue quarantined, right? Those tests take three to five days to come back. So let's say that now we have all our stuff. Okay. So let's pretend you didn't have like the testing before we're three weeks in, we've got all your stuff. Now we're ready to go. Let's say you're not carriers for any of the same conditions. Okay. So then you're going to do an IVF cycle. If I, there's multiple ways to get started with an IVF cycle. the traditional way that we all learned how to do IVF or what's called controlled ovarian hyperstimulation, because I'm growing more than one egg, that's going to start, oftentimes starts with your period. We can actually start at multiple times during the menstrual cycle,

but I can either start you off with some form of pills or hormone patches to get you ready. I can just start you at specific times in your menstrual cycle. But let's say whatever we did, I got you ready while we were waiting for those results of genetic testing. So now three weeks and we're ready to go. In the meantime, you've gotten your medications. You've learned how to give yourself the shots. Like we had, we have video tutorials at spring that we made on exactly how to do it. So the, from most women now clinics differ on the duration of, of these IVF cycles. It depends on several factors, but most people would tell you it's going to be between generally eight to 14 days of medication. Most of my patients are taking probably 10 to 15 days of

medication. Some clinics, it ends up being shorter depending on how they start patients and the dose of medications they give. So the active form of it, when you're not coming in every day, you're coming in four to six times probably, maybe less, maybe more depending on who you are and what your cycle looks like. We are doing ultrasounds to monitor how your follicles, if you remember that term, how those are growing. We're often doing blood tests to determine the hormone levels that are being made by your growing eggs. So just to go back for a second, people assume that I'm giving them estrogen and these ovarian hormones when they're going through IVF. That's not the case. We are giving you what are called, generally speaking, there

can be some variations, what are called follicle-stimulating hormone and luteinizing hormone, FSH and LH. These are the same hormones your brain makes every single month in order to grow one egg. I am giving you hormones your body sees every single month, just in higher doses. Why? Because normally your body is giving you enough, like think of it like one flower versus a garden. Your body's giving you enough to grow one flower. I'm going to give you more. So I give you enough to grow the whole garden, that whole wave of eggs that you had. That's my goal is to get them all to grow. Right? So from, take me back from you, you did the consult. Now you're doing these weeks? Let's say that three weeks, let's say that three weeks and we're ready to

get started. We've gotten you started. So then that's going to be about, let's say two weeks. Cause I'm going to go, I'm going to hedge on the longer side now. Right. Okay. Let's say two weeks of shots followed by an egg retrieval, egg extraction, whatever you want to call it. That's done under anesthesia. It's done vaginally for like 99% of patients. So that no scars, no, no, nothing. You would never know physically you would have it done, but it's not, you know, it's, you're going to be crampy. You essentially ovulated that whole wave of eggs, right? So you're going to feel crampy, bloated, uncomfortable for several days after most people feel much better four to five days out, full recovery can take 10 to 14 days for a lot of people.

But in the meantime, you're not, once I've taken those eggs out, you're not coming into the clinic anymore. That's when we are doing the work in our lab, your partner or whatever, or whatever sperm source you're using. We got the day of the retrieval of the egg retrieval, either fresh, if it's from a partner, frozen if it's from donor sperm, or sometimes from a partner as well if they can't be present. And we are fertilizing those eggs that we got out the same day we take them out. And we are growing them to various stages of embryo development depending on the individual. Most people are trying to get to this stage called blastocyst. And those are five to seven days after the egg retrieval is when those develop. Everybody is different. Some people

I transfer embryos earlier, but if you want to be able to do that genetic testing, like we were talking about for a specific mutation, like cystic fibrosis, or if you even want to test for chromosomal normality of the embryo, is it 46XX or XY, that's done at the blastocyst stage. So we are then getting a small biopsy for a lot of people of a couple of cells from that embryo, amplifying that DNA and telling you if the embryo looks healthy or not. But that last five to seven days to make the embryo biopsy gets sent out can take five days to two weeks to come back with the results so let's say like in terms of time frame we're now what after their egg retrieval we're what five weeks from the time of consult if we've gone you know back to back then it's another week

six weeks of embryo from embryo development and then we can start getting you ready for an embryo transfer if we want if you want to put that embryo right back in your uterus i will often start getting women ready for that transfer while we're still waiting on the genetic testing because you can do those two things at once. Got it. Sometimes that's not the case if we're planning for multiple children. I know we're going to need to do multiple IVF cycles depending on the person. I might go right into another cycle, right? But then the embryo transfer cycle, we can get started as soon as we have those results. And so from the time of the first medication for embryo transfer or your first visit to come in to see me to embryo in the uterus is about three weeks later. So all in all,

I'm talking about 11, about, yeah, about 11 weeks from first consult to embryo in your uterus. If you are going straight through and have had no testing done beforehand. So I thought it was like a year. So that's, but I'm giving you the best case scenario, right? Of course. Of course. You know, the most women, especially if you're planning for more than one child, most women are going to need more than one IVF cycle, unless you're extremely lucky from that respect. Here's where quantity matters, right? If you had a high egg quantity. I froze embryos a couple of years ago, but it was very surprising with the shots from the first shot to actually retrieving the egg is like two weeks. And that was shocking to me because I think we all like women think it's

going to take months and months and months of taking medication and doing all that. So best case scenario, it only being two weeks was. Yeah. Best case scenario. And there are women, believe me, I have some sweet, wonderful women who it takes a lot longer for like they, my coworkers eight cycles. Yeah. For one reason or another, or sometimes even within one cycle, for some reason, things will not grow. We need to try something else. Like there are, we always have the outliers who is going to take a much longer period of time for Dr. P give me like a roundabout of like, if you want to, if you're thinking about your fertility and you want to come for a consult and you're not using our lady gang special thing and,

and you want to do a round of egg freezing and freeze some eggs, like, can you give me a very baseline of like, this is the money you should have. And like, we can also, can you finance it? Can you put on a credit card? Yeah, sure. So when we are, I will say that the average cost, and this includes medications, I think that's important. I'll get into that. The average cost for egg freezing cycle from first consult to actually eggs out and frozen for most people, about 12 to $13,000. Now remember that about a third of that cost is medications. I'm not, I don't manufacture the medications, right? That's, you know, a fertility pharmacies and, you know, pharmaceutical companies make the medications. We have orchestrated something

through spring where we have gotten this package deal for people, you know, through certain pharmacies. So we can mitigate the cost of that and get you that for the lowest cost possible. But I think this is important because you'll see practices putting online egg freezing $7,000, and that's not including the cost of medications for the most part. So just be cognizant of that, that you're still paying for that. And that's for somebody who has zero insurance, right? A lot of companies have especially – I'm in the Bay, so a lot of fintech and tech companies are starting to cover this for people. quite frankly even though age is not in and of itself an infertility category i already explained it we're all heading for that same cliff so this should be covered for everybody the fact that it's

not is bonkers to me we do have at spring a payment plan option for people for one egg freezing cycle because we don't want people to not be able to do it where we charge that where they get charged uh 244 dollars every month over three years no interest we don't want people like we don't want to take advantage of this. That's amazing. That's incredible. And therefore we're hoping that more people will be able to do it that way. Okay. When we come back, we have a few quick questions from our Lady Gang community. When it comes to getting pregnant or freezing your eggs, finding the right fertility clinic can make all the difference. Let me tell you, I've been there. I've done this. Big fertility clinics often have long wait times, appointments that start late, doctors that treat

you like a number and protocols based on doctor schedules, not your own body. I get a lot of from women all over the country who are going through IVF and they're dealing with kind of nightmare clinics. Spring Fertility believes you deserve peace of mind that comes with having the best of both worlds, the best results and compassionate care. Spring Fertility dreams big with you and supports your goals no matter what. With personalized treatment plans, a team that really gets to know you and easy to schedule appointments that start on time, Spring is here for you. They have locations in the Bay Area and New York. Spring Fertility offers the most advanced fertility treatments in a warm, approachable setting. IVF, egg freezing,

egg donation, surrogacy, and more. Book a consultation at springfertility.com to learn more. Big giveaway alert. Don't you sleep on this because Lady Gang has teamed up with Spring Fertility to empower you with the information you need to know your fertility options and plan for your future of your dreams. Five lucky winners will win an initial fertility consultation with a spring provider in New York City, San Francisco, or virtually, all you have to do is go to the Facebook group. If you're not in it, you better get in there and you're going to see it. You're going to see the post about the spring fertility giveaway. All you have to do is enter your name and your email to qualify. Must be 21 years and based in the United States to enter. Good luck.

The Lady Gang. I want to say to everyone listening, these are the kinds of things that they can get more into when you go and do this consult? Because at like the hardest thing about your job is that you're like, everyone's different. And then there's this whole thing can happen. And there's a role over here that you can roll down this hill. So just very top level thoughts on this. Um, what are the chances of genetic testing coming back positive in any form? Do you know, like how often you see that? Is that something people really need to be really worried about? So the chance of an embryo coming back normal depends on age. Remember how we, I talked about like that division of the egg and the chance of it doing that normally, that's correlated to what

the chance of having a normal, what's called a euploid or chromosomally normal embryo is. So each person in their twenties, and this is, again, I'm referring to the female partner. Again, biology is unfair, right? But female partner in their twenties, for the most part, you should assume that each embryo has about a three out of four chance of coming back normal. Okay. Right. And then as you get older. Right. For somebody who's in their early to mid thirties, it's about two, each embryo is a two out of three chance of being normal by 38. It's 50% by 40. It's one out of three by 41, 42. It's about one to one out of four to one out of five chance. But this is, remember, this is a lot of

this. I hate to say this cause I hate saying luck, but it does come down to that because it's not like you're going to have four embryos and one's going to be normal at 42. Each one has that percentage chance. Someone said, I have no idea what this is. So I'm just going to read it as it the best way to prepare for a FET FET? I have several embryos on ice and we'll be preparing for baby number two. So an FET is a frozen embryo transfer. And when we are free in order to do genetic testing, most of the time you are freezing embryos and waiting for the results. And once you freeze, first of all, 98 to 99% of embryos are going to survive the freeze thaw process. So you can leave them frozen for two days or 10 years. It really doesn't matter. But when we saw them

to get ready for a transfer, there's multiple ways that we can prepare a woman's body or the uterus specifically to put an embryo back in there. And this, unfortunately, I hate giving this answer to people when I do either podcasts or bigger talks, because it sounds like, oh, well, what's my specific situation? But it really does depend on who you are, your body, age, do you ovulate, et cetera, et cetera, et cetera. But there are basically three general types of ways to put an embryo back in someone's uterus. One is just to put it back when an embryo would normally be implanting, which is about a week after you ovulate. So because the embryo has to meet a sperm, if you're talking about in the body, a sperm in the fallopian tube,

fertilize, move down the tube, grow, grow, grow, come into uterus, implant. That takes time. So what you're doing in what's called a purely natural cycle is just putting an embryo back in the uterus normally when it would have arrived there, right? Then there's called a modified natural cycle, which is when we can give some what's called priming, like a birth control or progesterone pill, just to sync up the timing, make sure things don't go too fast or too slow, and then give a pill like this medication called letrozole or Femara that helps assist in the endometrium or uterus being more receptive. but you still, concept is the same. You ovulate or we help you ovulate, put an embryo back there,

you know, six to seven days later, depending on a few different factors. Then the oldest way to do this, which is the, you know, the traditional way of doing an embryo transfer is what's called a medicated or controlled FET cycle. And that's when we are hijacking your body system. I am not allowing you to ovulate. I am giving you estrogen in some form, be it pills or patches to build up the lining of the uterus. That's what normally happens every month when you're growing an egg and that egg is making estrogen, your uterine lining gets thicker. I think you talked about this with your hormone expert previously, right? And then, so we're giving you estrogen patches to make that happen. And then we're giving you

progesterone, usually injections to prepare the actual lining to be receptive to an embryo implanting. Progesterone is called that because it's pro-gestational, it's pro-pregnancy. You need it in order to be able to sustain a pregnancy. And the window of implantation is very, very small. So that's why this timing is so, so specific. So this last one, that medicated cycle is just a much, it's a more aggressive way of doing it. The timing is, you know, we are controlling everything as the person managing the cycle. It it's, you know, on the one hand, people are like, well, why wouldn't everyone go for that? That seems like the most, you know, you're taking the most control over it. I mean, nobody wants to give intramuscular shots in the butt for like

five, six, seven weeks. So I do try to avoid those when possible. This is so wild because that's why I had to stop my mid-transfer. Well, not mid-transfer. I was prepping my body to transfer, doing the progesterone shots, and my body freaked the fuck out, for lack of a better term. Like fevers, couldn't stand up straight. It's the biggest thing I get complications from or hear people with complications or complaints from, for sure.

Really? So then the solution is a different type of like what you were saying before without these totally assisted medically? Yes, but not everybody is a candidate for that. and that gets a little bit more complicated, like past a certain age. And it's not, I hate saying I don't trust a woman's body, but it's true at a certain point, I'm not going to trust an egg that she's ovulating in a follicle to make the kind of progesterone and estrogen I need to sustain a pregnancy. There can be, maybe you've had more than one unsuccessful transfer in the modified

natural way. So there are patients who I go right to controlled cycles with, but for the most part, I at least try one or two on less medicated ones, but yeah, it's, it's not, it's not fun. We did have a question here that was like, what vitamins are represented aside from a prenatal? What are your thoughts on that? So I think that a prenatal, first of all, is just a great multivitamin with extra folic acid, folic acid, which is very important for the development of baby's neural tube, which leads to basically spine, skull, et cetera. So folic acid is that, so I have a lot of friends who just take prenatals instead of multivitamins and they aren't actually trying to get pregnant. Right. So, I mean, I do that and I am not actively trying

to get pregnant. My babies are in liquid nitrogen, frozen, waiting for the right time. Hey, hey, hey. But the, as far as other things that I think are generally good for fertility, now, mind you, There are, there has been no one large randomized control trial that has shown that one supplement other than folic acid, that supplements that any specific supplement is absolutely necessary. And you can go, the supplement industry is like the cosmetic industry, right? You can go broke on supplements. So I do caution people to be careful with that. And also things that are not FDA approved because they just aren't as well studied. But what I will say is other things that I think I focus with, with supplementation on not just what's good for fertility, but what

do we generally need? We are all, we are all, unless you live traipsing around a Caribbean Island, we are all low in vitamin D all of us. All right. You only absorb 10% of vitamin D orally. So in order, and I, you know, I live in California now I live in the Bay. I'm, I'm an East coaster, but like I live in the Bay and my vitamin D is still low, even though I don't have four seasons. Right. So I tell almost everyone to be taking a 2000, a vitamin D supplementation in addition to prenatals of at least 2,000 international units daily. And I also recommend to most people omega-3s. So again, this is different. If you want to ask just for the be-all, end-all, like what I'm generally saying, most of my female patients are on a prenatal, vitamin D, omega-3.

We have found, especially like omega-3, in smaller studies, they may improve egg and embryo quality, and they may be important for the neurodevelopment of a pregnancy. Vitamin D is necessary for so many things in our body that we do not even take into account, not just bone health. And there are studies looking into, does this cause low vitamin D fibroids? How much does it impact fertility? Those are the three things I tell everybody to be on. The other one that you'll hear a lot is coenzyme Q10. So CoQ10, it's a really nice antioxidant for our cells. I personally take CoQ10 and I think most people who are pursuing fertility are taking CoQ10. But when you look at the head-to-head studies of were embryos in people

who took CoQ10 better quality and higher success rate in terms of live birth than people who didn't take CoQ10, and they're not. But everything else then is very specific for do you have an underlying condition? Do you have something called diminished ovarian reserve or low egg count? Do you have polycystic ovarian syndrome or PCOS? There are certain supplements that are more beneficial to people who are specifically in those categories, but you can also get sold on things that are absolutely not beneficial. I know a lot of my patients with PCOS come to me being like, don't worry, I'm taking DHEA, I'm taking like testosterone, et cetera. I'm like, you don't need that with PCOS because at baseline you have a more what's called androgen or testosterone

dominant reproductive milieu than people who don't. So I wouldn't just say other than the ones I listed, it is not a one size fits all for just take a supplement. That's helpful. Cause I know a lot of women are going breaking the bank, breaking the bank. Yeah. Uh, Dr. Pasternak, we're so excited to have you. You must come back. Your brain is insane. Like the things that came out of your brain in such a short amount of time is just, you're so smart and we are so excited everyone because we have a very special code for you. Um, use our code lady gang, and you're going to get $150 off a full consult in any of the spring fertility clinic locations in California or New York. And the discount runs all the way through the end of this year. So it's going to

make it super affordable for you to go in and have your consult with Dr. P or any of the other amazing doctors at spring fertility and, um, really get in control of this. And we hope that We answered some of your questions and we obviously we'd love to have you back on to answer more. And thank you for being here. And we weren't here for a long time, but we were here for a really educational time. Oh, yeah. Thanks for listening. The Lady Gang is produced by Alex Ingber, Steve Delameter and Jared Monaco.

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and join our secret Facebook group. It's super fun. See you next Tuesday. Thank you to our partner, Spring Fertility, for this episode on fertility and women's health. If you're interested in learning more about IVF, egg freezing, surrogacy, and more, head to springfertility.com.

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