Oversharing - Baby Steps: Am I Making The Right Fertility Decisions? Ft. Emily Oster

Episode Date: November 3, 2023

On this episode of Baby Steps, presented by BetterHelp, Jordana is joined by one of her favorite authors, economist Emily Oster. They talk about how Jordana’s friends ended up giving her several copies of Emily’s books the moment she started trying to have a baby, and why Emily’s data-driven approach is so helpful to hopeful moms. Emily shares some of the best lessons she’s learned, both from her own experience conceiving, as well as in the years researching the effectiveness of different strategies and decision-making processes. She also shares some fascinating info on how the uncertainty of pregnancy often leads to suboptimal decision making, and why you may want to take bold steps sooner than you’d expect. This is a conversation you’re going to want to hear. Thanks again to our presenting sponsor, BetterHelp! Visit BetterHelp.com/BABYSTEPS today to get 10% off your first month. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello and welcome to Baby Steps, presented by BetterHelp. I'm your host, Jordana Abraham, and on Baby Steps, we're exploring the various paths to parenthood that lay ahead when starting a family doesn't come easy. With the help of weekly guests, I'm taking you on my own fertility journey and asking the questions that need to be asked. Trying to have a baby, especially when you experience obstacles, can be a huge emotional and mental challenge. And that's why I invited BetterHelp to join us as the presenting sponsor of Baby Steps.

If you're thinking of starting therapy, I recommend giving BetterHelp a try. It's entirely online, convenient, and suited to your schedule. Just go to betterhelp.com slash baby steps today to get 10% off your first month. That's BetterHelp, help.com slash baby steps. Therapy can give you the tools to navigate the difficult transitions in life, and the path to parenthood is definitely one of them. My guest today is Emily Oster, author of Expecting Better, and some of my favorite books and articles about parenthood and all the things surrounding it.

But before we get to Emily, as always, here's my sister, Dr. Naomi Burns. I'm so excited for this guest. I can't wait to hear your conversation. I love her. So Emily Oster is like, she's an economist. What she wouldn't think of as someone you would go to necessarily for parenting advice. But what I love about her and I follow her on Instagram and I was the first time I was pregnant, someone gave me her book. And it was just like a really relaxing way I thought to go into pregnancy. Because basically what she does is like she's not really telling you what to do. She's not like giving you advice on what you should or shouldn't do. She's saying like here is the actual data. Here are the studies. And like you can make that

choice for yourself, but you should have the full information. And basically what she was saying also on this episode is like doctors don't really like tell you this is how much coffee you can have and the studies show like all this stuff or you can have a glass of wine every now and that. Like they don't really tell you that. And part of. the reason is because like it takes too long. I think in medicine things seem very black and white. So it's much easier to say just like don't drink, don't have any coffee, don't eat sushi. And it takes a lot longer if you're a doctor in a room with a patient going through the entire thing and you know, what the studies say. So I think her book is really, really helpful and really just takes a lot of the, because I'm sure you know from being pregnant three times that there's this feeling of like every single thing I do feel so dire for this.

child inside me and it's all because it's growing inside you it's not even like when the kid is out and like you know the kid at school could make them feel bad or mess them up here it's kind of like all you a hundred percent control or so it feels like right totally and I love what she's doing with this too because it really suits kind of the advice that I give a lot of people which is sort of figure out what you can control even writing a list of kind of like here the here's the research, here's the information that I have. And once I realize, like, this is the only parts of this that I can, this is the only information that I have, these are the only things that I can control. You can look at that and say, okay, now what? Can I do some of this? Do I want to do some of this?

Or do I want to just like let this feeling pass through and move forward, just not doing anything? So I, I'm curious to hear, you know, the conversation that you have because I think a big part of getting unstuck or making a decision or making a move is like gathering all the data and then calmly kind of looking at it and saying what can I actually where can I effectuate change within this or not versus when it's all in your head and swirling around when the doctor's like kind of like like well you could have a glass of wine but I don't know if it's the best idea it's kind of like well I don't know what am I supposed to do with that well what am I supposed to do with that right Exactly. What am I supposed to do with that? Should be like the title of this episode.

Yeah. I think that and I mean, especially with infertility stuff, there's so many decisions that you need to make. So many times you're at a certain point and you're like, well, should I keep trying naturally or should I try IVF? Should I, you know, should I do IUI before I do IUF? Should I just try naturally and, you know, do the thing that all the annoying people say. Relax. Relax. Right. Right. It's like, yeah. Right. You know, and like, like, yeah. Right. You know, and like, like, yeah. Right. Right. And, like, like maybe I could get pregnant without any of this assisted stuff or maybe I am overthinking it. And I think there's so many decisions that it feels like a lot of pressure to make the right decision because the consequence feels like so high stakes. And Emily, you'll hear us talk about this thing where she talks about how there's no secret option C, which is basically saying like people delay making these decisions because they think like something's going to happen where they're not going to have to make the decision.

Like something really positive is going to happen where they're going to not or even negative. I guess. Something's going to come in so that they don't make decisions. And like, once you accept that there's no secret option C, it kind of forces you into a decision, which is good. Yes. And getting to the point where you're like, there's no right or wrong move here. There's just going to be a move and it's going to play out, however, it's going to play out. And it's not like if I pick A or I pick B that I'm going to turn around and be like, oh, I really regret picking A or picking B. You're going to pick it. You're going to move on. You're probably going to end up feeling better just having made a choice. So yeah, it's hard. And that could go for anything in life where you're sort of like waiting for the perfect until you feel 100% about something. It's like,

you might have to make the choice while you feel 73%. You might not feel 100%. Yeah. And I think what you just said is so important, like the psychology around it. Because like whatever you do do, like even if it's not, it doesn't lead you to immediate success, you're going to learn something from it. And, you know, that'll inform your next decision. So I feel like there's this pressure of like the right, the wrong decision. It's really just like the decision. Because you're you're trusting your own, like again, with her, with Emily, all the data. It's not like you're just picking one out of a hat.

You're gathering all the information. You're making an informed decision with lots and lots and lots, probably a forethought. So then you just have to let it ride and relax into it and realize I put enough positive, hopeful energy and data into this decision that I did the best I could. And now I just have to wait and see. Agreed. So this was a really helpful episode. I think for anyone who's kind of like faced with these decisions feels a little like paralyzed by them. Have a listen. Let's get into the interview. I'm so excited to bring on economist and author Emily Oster. Welcome. Thank you for having me. I have to say, I feel like you are sort of like among my friends who are pregnant or trying to get

pregnant, you know, like the way that people pass on maternity pants or something when they're done having kids. Like, I got expecting better from a friend who was like, I'm done, please take this. And like, it will contain all the information that you need to know to not drive yourself crazy. So I feel like I'm sitting in front of like a hero, not just for me, but among my whole friendship circle of people in their mid and early 30s. I felt like I thought you were going to say, I feel like I'm sitting in front of the maternity

pants of authors. It's like, yes. That is a treat. Well, thank you. That makes me very happy. Well, I'm glad. For anyone unfamiliar with you, you are an economist, which I think at first glance doesn't seem like someone who would be talking about medical stuff or motherhood or anything like that. But can you just kind of explain like what you do and how you got into this and all that? Yeah. So I'm trained as an economist and my sort of specific area of expertise is data and statistical methods. And I was working as an economist, as a professor, and then I got pregnant. And I found myself using the tools

from my job, the data part in particular, in the service of my pregnancy and using statistics to try to think about the right choices about the kinds of questions I think almost everybody has when they're pregnant. Like, can I have sushi? Can I have a cup of coffee? And should I have an epidural? And I was doing all this work. And then as I will sometimes say, like, I took it a little far. and I wrote a book with all of the work in it. So expecting better is really a book that came out of my own pregnancy, some combination of my desire to know these things and the training that I had that hopefully will help people know them better.

Yeah. And I mean, to me, it's sort of just like an anxiety-reducing thing because you're not really even really giving advice about what to do or not to do in these books that you're writing. You're really just telling people the facts and then the statistics and the studies, not even necessarily the facts because what is a fact, right? It's a fact. But you're kind of empowering them to make their own decisions.

So I think your big classic example is coffee and pregnancy and, you know, what the doctors say versus what you say. Yeah, I mean, I think coffee is a great example because you will get a tremendously wide variety of advice. So people will tell you we can't have any coffee. People will say, well, you can have two cups of coffee. Well, you should ask your barista, like how much caffeine is in. the coffee. And part of what's so frustrating about that is like, I don't, like, why? You know,

people, and this is what I wanted to know is like, why not? How can I make this choice if I don't understand what I'm trying to avoid and what would be the reason to avoid it? And so much of the book is really like, okay, here's why they tell you to avoid coffee. Here's actually the quality of the evidence to suggest what the actual data says about the possible risks of that and what you should be worried about. And then, you know, you have that now you can make whatever choice works for you about coffee or any of these other topics. Right, because it seems like most medical advice is sort of meant to minimize the chances of the doctor being sued in a lot of ways. I mean, I don't think I would say it. I wouldn't say that. I mean, I think there's a,

yeah, there's a piece of that, something called like defensive medicine. But I think there's also a piece of kind of wanting to give people rules that are easy. So if you sort of thought, like, what's an easy thing to tell people? It's like, well, an easy thing to tell people is don't have any caffeine. And then it's like, well, because you don't really need caffeine. And I think where a lot of us, this falls down, it's like, well, actually, I do kind of need caffeine. Or at a minimum, I would really enjoy it.

It's something that I have, that I value and like. And so I want to understand, is it actually dangerous or are you just telling me this because that is sort of the safest way or because you know that that that. that would be safe as opposed to actually thinking about the risks and benefits. Exactly. Because when you're at the doctor, the doctor doesn't have like an hour and a half to sort of break down the studies on caffeine and how some say that you could have four cups and some.

Like you said, it seems like it's probably a lot easier just to give a blanket response. And then like the worst thing that could happen is you don't have coffee when you could have had coffee. Right. They probably don't see that as big deal. Yeah. And I think in some ways it's not a big deal. And it was part of what's interesting about this.

You say, like, well, what's the big deal? Like, why is it so hard to, like, avoid coffee and avoid all the stuff for nine months? And on the one hand, like, yeah, that's not a big deal. On the other hand, I'm not doing that on my normal life. And so, like, I could ask the same thing, why are you still drinking coffee? You know, as a not pregnant. I say, well, it's like, I like it.

Okay, well, that's also true for me. And so I think we're, you know, we're like, we want to think, we just want to think rationally about these choices. and I think the book helped people do that. And that's ultimately, it's ultimately why people like it. Yeah. And I think it just gives people like the power to make their own decisions, which is awesome. And I mean, it brings me, today we're here to talk about trying to get pregnant.

But I do find it interesting. As someone who's been trying to get pregnant for like a year and a half, it can kind of feel like you kind of have to follow all these rules of like almost acting as if you're pregnant. But the really sucky part of it is that you don't even get. like the upside. You're just kind of getting like the promise that like maybe if you do these things for long enough where you cut out gluten or I mean there's just if there's so much on the internet and like there's so many people who have you know the thing that worked for them, the fertility acupuncturists that work for them, the food, the diet that worked for them or so they think.

So there can be so much out there. And to me like the idea of following all of these rules and driving yourself nuts when there's, you know, you're not really sure what the day. is actually saying or what's important or what's helping you can lead to feeling like I'm doing all this stuff and I'm not even like in service of a greater good. Yeah. I mean, I'd sort of separate two things out there. So one is, you know, when you are trying to get pregnant, there's this period where like you could be pregnant.

And this you call like the two week wait when, you know, after ovulation before pregnancy, when like you could be pregnant. And then people often feel like, well, I have to in that period adhere to all of these complicated pregnancy rules. And, you know, if that's two months of that, maybe it's not such a big deal. If it's two years of that, well, that's actually a lot of time. And since many of those rules aren't really things you need to be adhering to, even during pregnancy, it is, I think, valuable to be like, hey, what would be the reason I would

eventually want to adhere to this rule or not so I can decide whether I want to be doing it for all of this other extra time? The second piece is that in the space of infertility, there is so much magical thinking out there around other restrictions and things like gluten-free or take this set of supplements or, you know, stand in this way or whatever it is, like the thing that worked for people. Most of those things don't have a lot of data behind them. But for at least some people, I think it is helpful to feel like you're doing something. And so there's a complicated sort of psychology there around kind of do you want to do something

because it helps you feel more in control of the process, even if it probably isn't having any actual impact. Right. If it's soothing to you in some way, shape, or form, again, it's probably not hurting to be cutting out dairy or something. On the other hand, like, you know, it could be. And so some of those things are more complicated than others. And so, you know, thinking about, thinking about whether things sort of serve you and serve your mental health, is it an important part of this?

Well, let's talk statistics, I guess, as it pertains to trying to get pregnant. Because I've seen about 10 different statistics on how many months it takes the average couple to get pregnant, about the miscarriage rate, about, you know, the miscarriage rate after one miscarriage. What is the, what does the data say about all of this? So really the most important sort of organizing principle for all of this. And in a lot of my work, I try to start in this very broad way so people can kind of understand where any answer comes from. So the most important organizing principle is that on average, as you age, it gets more difficult to get pregnant and more difficult to sustain a pregnancy.

And the reason for that is that your eggs basically age over time and the chance of a chromosomal abnormality as a result of a mutation in the egg goes up. And what that means is that as people age, miscarriage becomes more likely, difficulty getting pregnant becomes more likely. And that influences how long it takes to get pregnant and influences when, you know, when people are told that they should pursue sort of possible alternative avenues like infertility treatment. So generally, sort of on average, takes couples about three months to get pregnant. That's not a super helpful number because, like, what do you mean? Do you mean like 16-year-olds who are like not trying to get pregnant? Because that seems to happen in like a week.

You know, it's sort of like, but that's an average number. Generally, if you're sort of under 35, they would say, you know, you want to wait like six months of trying before you go pursue infertility treatment. Yeah. As you get older, it's actually less time. And some infertility doctors will tell you basically if you're trying to get pregnant after 40, just talk to a reproductive endocrinologist immediately. Right.

not necessarily because you're going to want to do something, but because like the chances of needing to have some kind of intervention are much, are much higher. Right. And you would need to do those interventions sooner. Yeah, exactly. And you're like you're losing time. I mean, this is the other sort of as you age, you're losing time.

And so there's such a fine line here because on the one hand, some of this is so panic-inducing. Like every day you're losing time and your eggs are aging, you know. And it's actually, the reality is, that's the voice in the back of my head. That's the voice in your head. But, you know, the reality is that the, you know, decay in your fertility over time, it's there. It starts, you know, more or less as soon as you, you know, get your period, kind of your best time to get pregnant was when you were 16. But there's no cliff, right?

Sometimes people will tell you what. At 35, like your eggs are, that's it. You're basically done. You know, you're dried up old hag. Geriatric pregnancy. Geriatric, elderly premed gravid. That's the best one. But actually, that's not true. This is the decline. is, you know, reasonably, reasonably smooth, more or less through your entire, you know, reproductive, reproductive years. So there's no kind of discrete change in the chance of getting pregnant between 34 and 35. And I imagine, I mean, it's, I imagine the data doesn't sound that great about how long it should take to try to get pregnant because you would imagine, I know so many people who get pregnant on the first try and then so many other people who it takes

a much, much longer time for. So the average, it almost kind of feels like it's either right away or like, hang in there? Yeah, I mean, it's like an interesting statistical question is, you know, usually we think of numbers as being sort of what we call normally distributed. So like sort of distributed like a bill curve. And if that's true, like the average is really informative. But actually in this case, it's probably not the way the distribution looks. It's probably more like a large share of people get pregnant sort of right away within the

first month or two. and then there's a very long tail. So there's people who it takes a very long time. So the average there is like, it's actually not a super helpful number. I mean, the average could be really high. It could be 10 months, but actually most people are getting pregnant in one or two months, but a few people are taking an extremely long time. So I'm just not sure this is a place where the average is a helpful, is a very helpful number.

Right. Yeah, that seems to be the case, at least, you know, anecdotally, that just kind of feels like how it is. I feel like most people are not in that three to six month range. It's like right away or a year and a half. Yeah. Yeah. One way to say that is like is with, you know, you might expect if you say the average is three,

that would be the most common. But I don't think that's right. Like I think the most common is almost certainly, you know, in the kind of one or two. And then there's this like large number of people who take a longer time. And then do you know the statistic for like what percent of women who are trying to have kids? And again, I feel like this is that if you talk about trying to. trying to isolate results. This is probably tougher because I say, what percent of women, you know, have infertility

problems? But then, you know, you take into account people who maybe like should have, should biologically have less fertility problems, people in their 20s or earlier 30s, and then people in their 40s, it's like, how do you can, I feel like the data feels like a little confusing in that way because it would be skewed, right? Yeah. I mean, it's a very hard question to answer. So there are things you can do, like look at historical.

data from like the 1800s and ask you know for people who got married for the first time at different ages like what is the chance that they got pregnant and like that they ever had any children which is a sort of very historical metric of like what was the chance of of infertility by age and and that's where we see you know some of this kind of as you as you age it it declines and you know people who get married after 45 like generally the the chance of having children after that is fairly is fairly low at least in those kind of historical samples. But answering the question you want kind of now is very hard because of the selection of who's in what group and because our data isn't very good.

So for a bunch of different reasons. Right. Which makes it tough to feel like soothed by the data in the infertility space because it's all just feels like the only real statistics they give you were like the percent chance that your embryo works when you do IVF. Right. And even that is actually pretty varies a lot across provider and varies a lot of. across time and across people and just, I don't know. Right.

That number, even the average there is probably not that helpful. But I imagine it's bet like the data will only get better with something like IVF that's been around what, like 30 yearsish. Yeah. So I think it will only get better. I think the thing that the IVF data is largely missing is this individual component, right? So the chance of getting pregnant with IVF, and I'm assuming you're going to talk to some infertility doctors, and so they will, they can talk to a little bit more about why this is true.

But the chance of getting pregnant with IVF is going to vary a lot based on the reason that you're pursuing IVF. So if the reason that you're pursuing IVF is that you have like PECOS and you're not ovulating, but you're 25 and you have a set of healthy eggs and you have a partner with no sperm, you know, mobility problems, IVF is very likely to work for you because it's going to definitely fix the problem that you have. And sort of similarly, somebody whose problem is a black fallopian tube. Okay, well, we know what that problem is. Ivf is specifically designed to fix that problem. When the problem is more nebulous, like, you know, you're older and so you have fewer eggs and

or you have fewer eggs and the eggs are less likely to be viable, then IVF may well work. And it works for a lot of people in that situation, but it's less obvious that it's the direct solution. That's a place where I think we could improve the data. So to be able to tell people more directly, like for people who are coming and seeking fertility help with your particular set of considerations, here is the chance that it will work. Right. Is there any data on IVF and the difference between children born from IVF and children born without assisted fertility?

There is a little bit of data on this, and you will sometimes see comparisons of, like, health outcomes for either babies or moms who have kids or IVF or not. So, for example, there was a study the other day that said, like, the risk of stroke, which is extremely uncommon pregnancy complication, but that that is higher if you've had IVF. The problem with both that study and this entire literature is that the characteristics of people who choose to have IVF are quite different than people who don't.

Not so much choose, but the characteristics people who end up having IVF are quite different from those who don't. And that makes it really, really hard to compare outcomes for kids and outcomes for parents. I would say sort of looking at it all together, if there are any effects they are really small far below where we could reasonably expect to detect them well that's definitely encouraging i mean it's funny they when i when you before i did ivf they show you a video and it's like you know basically the again the medical disclaimer video about like you know

that there are increased chances of this you know these pregnancy complications and ibf but they also say the people who are more likely to have done IVF are more likely to have had these other conditions which have caused them to want to do IVF. Yeah. And I mean, this is a place where I think I spend a huge amount of my professional time talking about like how important are those differences in driving differences and outcomes. And I tend to think that data like this, which just compares to groups that made different choices and says, you know, well, the difference between the groups is because of this particular

choice. That kind of data is bad. And most of the time it's sort of so bad that you basically just can't learn anything. from it. And so I usually just am like, yeah, this day is just trash. Yeah, I mean, that's most of what I get from reading your newsletter. Right. Most data is trash. Thanks. That's what my newsletter. It's very constructive. Like here is a new study. It's trash just like last new study. Did you think about calling it that instead of this study is trash instead of parent data. It's good. It's catchy. It's good. It's catchy. This episode of Baby Steps is sponsored by Better Help. It's almost the end of the year.

And this time, while it can be exciting, can also be really stressful. And a lot of people feel a lot of sadness and anxiety about it. And it's not just the stress of finding gifts, but it's also the stress of seeing your family, of it starting to get cold, a little seasonal depression. But adding something new and positive to your life can counteract some of those feelings. And therapy for me is always something I go to when I'm feeling anxiety or stress around anything, whether it's the holidays, winter, or just like things that are going on in my life that are not going as I planned.

I've been to therapy for over eight years now, and nothing has helped me quite as much as therapy has overcome whatever obstacles come my way. If you're thinking of starting therapy, give better help a try. It's entirely online designed to be convenient, flexible, and suited to your schedule. Just fill out a brief questionnaire

to get matched with a licensed therapist and switch therapists anytime for no additional charge. Find your bright spot this season with better help. Visit betterhelp.com slash baby steps today to get 10% off your first month. That's BetterHelp, H-E-L-P.com slash baby steps. Speaking of which, I recently read just, I think, yesterday morning about, in your newsletter, about studies on stress and pregnancy.

And I think for people who have gone through multiple miscarriages or who have spent a lot of time trying to get pregnant, battled in fertility, the stress kind of feels like it's like, there's no way it's going to be totally gone. Yeah. Right. So I really like that. Because it was basically kind of like part of this, the way I was thinking about it, is like, can your thoughts impact your future?

Can your thoughts impact your success with this? And people do say positivity is also, like, helpful for anything, whether you're dealing with cancer or any sort of medical ailment. They say that there's truth in that. Is there truth in that? I'm sure that there's some interesting literature on positive thinking. In the space of pregnancy, you know, I think people worry a lot about the kinds of stress you're thinking about, like, I'm worried about this.

I'm worried something will happen to the baby. I'm worried about my job. like the sort of standard everyday anxiety stress errors that we are having. And there is I don't think there's much evidence that those affect pregnancy. When we look at studies with really extreme kinds of stress, like the death of a spouse, the death of a parent while you're pregnant, it does seem like there are some measurable, but really quite small impacts on birth weight. And so this is something it's like good to know because if you have one of these very

stressful events during pregnancy, it's good to be aware of that risk. But the ways that people worry about this, they're worrying too much for the most part about stress. And then, of course, that makes people more stress. It's like, I'm worried. But now I'm stressed out about being worried, like I'm stressed. I'm not meditating enough. I should meditate more. It's like, it's just like another thing to add to your anxiety bucket is your lack of meditation. Right. Or your guilt over feeling guilt is a It's another good one. That's another good one. So, I mean, I think this data is so up on.

Another thing, I think, as someone going through, like, fertility treatments, there's so many options, right? Or it feels like there's so many options. And you have this thing in your newsletter about no secret option C. Can you explain sort of like what that concept is? Because I think about that a lot as it pertains to decisions in this process. Do I want to go through IVF? Is it going to help?

Do I want to, you know, should I just keep trying? naturally, all these kind of questions that you ask of yourself. Yeah. So this idea is really intended to help people kind of work through situations in which you have a choice and both choices are kind of not the, like whether they're bad or they're just not the thing you wish was happening. Right. So infertility is a good example. You say like I have to choose between like doing IVF or like just continuing to try to get pregnant. And like, neither of those are necessarily appealing options, right? Because IVF is physically draining and expensive and has, you know, other, like it may be emotionally hard to start doing that, but continuing to try,

especially if you don't think it's going to work. It's also emotionally draining and, you know, takes time and maybe affects your relationship. Like, both of these things are not where you want to be. I think sometimes people will just avoid making the choice because they're waiting for secret option. Like they're waiting for just like magically getting pregnant like with no work. You know, it's like, well, unfortunately, there is no secret option C. Like these are the only two options you have. And sometimes that kind of mantra just being like, hey, I actually have to choose one of these. And I get it.

Like neither of them are good. But there's no secret option C. I have to make these options as good as I can and then pick one of them. And for some reason for me, and I I think I'm glad to hear this has helped you too. Like that mantra is really helpful in recognizing the need to move forward. I use it with my kids too. To, in order to like help them just actually make decisions.

Just recognize like you're waiting for something that's not happening. So we need to move. You need to choose now. You need to choose one of these two things because you're not magically going to be able to watch television for six hours and also do your homework. That's right. The day is not going to acquire additional hours so you can. secretly do all of these things. Right. Okay. Yeah. So I think, I mean, I guess that forces one to make a

decision. And then what about dealing with results that you're getting that are sort of like ambiguous? Do you ever, as an economist or someone who's, you know, always looking at data, if you get data, that's like the data says we don't know. So let's say there's a skincare ingredient. It's like the data, no one's really tested it. How do you deal with things like that? It's hard to get comfortable with decision-making with uncertainty. And it was something that came up a lot during COVID, actually, was people saying, basically,

I have to move forward on some choice without having all the information I would like to have. But I think that comes up a surprising amount in our lives to say, like, well, in order to take this next step, I have to do something. I have to either use the skincare ingredient or not.

And like, that's it. I'm going to, and I can't, I have acquired all the information I can, which is that we have no idea. or we know very little or we know a little bit, you know, something, but not everything. And getting comfortable with that idea of just having to make a choice and recognizing that you could make the best choice ex ante and it could be wrong exposed. It could have been the wrong choice.

That's really hard. Unfortunately, most things like skincare ingredients, like you're not going to be too wrong. You know, it's like either you're, I'm sure your skin looks lovely with or without the ingredient. And most of these things are not an especially big deal. But I think it is a skill to learn to move forward when you don't know, when you don't know everything. Right. And I think people see that all the time because there's so many people, I think, who get infertility diagnoses and, like, they try to find out what is wrong.

And they're kind of like, well, we just really don't know. No, no. So it's sort of like, what are you supposed to do with that as a person? I guess you just keep trying. Seems to be like the answer. Yeah, or, you know, or ask the question, like, you know, what would be different if I knew the answer to this? I mean, as people, I think we're always kind of drawn, like, we want to have an answer. But sometimes, like, that's not decision relevant.

Sometimes it's like, no matter what would be the answer to this, the thing you would do is the same, right? There's a, there's like a very famous example of the ways in which people are not good at decision making in which the sort of frame of the question is you're taking a test. And the question is, do you want to go on vacation? do you want to take a vacation after this big exam? And it turns out, like, people, if you say, like, you failed the exam, they choose that they want to take the vacation. If they say, okay, if you pass the exam, do you want to take the vacation? Yes, they want to take the vacation if they fail.

They want to take the vacation if they pass. But they don't want to take the vacation if they don't know whether they failed or passed, even though no matter what the outcome was, you would want to take the vacation. And I think there's a piece here around how hard it is for us to move forward when there's uncertainty, even if the uncertainty is completely irrelevant for what we would do next. So I want to know why I'm experiencing infertility, even though no matter what the answer is, IVF would be the next step. And sometimes just saying it actually, I wish I knew, but it doesn't matter for the decision.

And we just need to do the decision and not think about this. I think that's great advice, especially because the world that we live in, I think now is one where you as a patient can get. much information where it almost feels like too much information and then you're like, then you become hyper fixated and hyper anxious about every moving part of it when really I think if you if you think about the decision in a meta way of like, I'm going to do the thing anyway, no matter what this little like, you know, thyroid function test says or I think it's very easy to get caught up and really hyper-focused.

And I say that not just for myself, but for all the Reddit threads online. BF and infertility. And it's kind of like if anyone else were to read them, they would be like, first of all, this is like people speaking a totally different language. Right. Yeah. I don't know what any of these words are. Right.

Is this actually helping to be like so intensely deep diving into every little thing that could go wrong or your doctor prescribes you this dosage and someone else online's dark doctor prescribed them that slightly higher or lower dosage? I mean, I think there's a question of separating sort of worry from action. and that worry isn't usually serving us if there is not a choice to be made. If we're just worrying, that's not moving us forward.

That's what I told myself right before I deleted Reddit thread. Yes. Yeah. Which I think was a good move. That was a good choice. Yeah. I think that, you know, it's kind of like, there is a certain element, I think, of like trusting in the system,

which as you said, like, if you look at the data on a meta level, which is what you do every day, like generally seems to work for most people, not that it works for everyone, which leads me to like really my last question for myself and for the listeners of like, is there data on if you are trying to have a baby, the general statistic for which that will eventually happen? I don't think that there's data that will answer that question in the way that you want is maybe what I would say. So there are statistics we could say, like among people who get you know, married and start trying to have a family at 25, how many of them get

pregnant, you know, it's a very large number. It's the, it's the vast majority. But I don't think that number is helpful for some of the same sort of average time to pregnancy reasons we talked about before, because once you are in a space where it's hard and you haven't immediately gotten pregnant, then there's way more heterogeneity. There's way more variation across people. And I also am not sure it's always helpful for people to have a number here. The number's not going to be 100%. It's not going to be 0%. And so thinking about how to move forward in a place where you can't be guaranteed that this will work, but also it might. That's kind of the challenge. Yeah, that's, I guess, the ultimate mind game of all of this kind of stuff, right? Although also knowing

that there are alternatives to, you know, having a family. I mean, I think, so for me, that piece of kind of thinking about either by yourself or if you have a partner, you know, with your partner kind of before you embark on some, either an initial fertility journey or particularly if you're, if you're pursuing infertility treatment, it's actually worthwhile having a conversation about how far down this road are we going to go. And what are the other alternatives we would consider to grow our family? And for some people, there are a lot of things that would be on that table.

for some people there are fewer, but it feels like a conversation that probably wants to happen earlier rather than later. Right. And it can be so weird, I think, to like, weird is really not the right word. But it can be, it can feel, I think, kind of sad or depressing to even have that conversation because it almost feels like by saying something is an option, then you are saying that the other thing is not going to work. Right.

Yeah. But that's not true. I mean, that's the way that works. The data says that that's not true. That's not true. That's not true. And I think, you know, people's psychologies around this differ, but I think for a lot of people, actually there is a fair amount of value in having thought about that in advance because you may end up, it may be harder to think about it down the road. Right. And for me, at least for every step of what I've been through, I feel like

the idea that I would have done IVF when I started trying to get pregnant was seemed like so crazy and so far off. But then by the time I had decided to do it, it was kind of like it didn't seem like that big of a deal like almost like the more your mind can get used to the the thought of something the less like crazy it seems yeah right absolutely yeah and then like there's a space for following up on all these all these conversations and you know i think when people first start getting start thinking about getting pregnant they rarely have this conversation that's probably fine because for a lot of people it works works right away it's once it doesn't that i think it starts you start wanting to get on the same the same page well this has been so helpful i

I, again, feel like I have been speaking to one of my idols in the space because, like, this is, you know, this becomes like a large part of what I consume. And you know the, the best part about following you on Instagram and you guys should all go follow Emily on Instagram, what's your Instagram handle? It's Prof Emily Oster. Prof. Emily Oster. I watch your Q&A's on Wednesday. And even as someone who doesn't have kids, I actually really enjoy the ones about having kids because it just goes to show me that like the stress doesn't really end, you know, No. Once you get there, you know, it's like not because in your head, I think when you're trying so hard to achieve something, you're like, well, once I have it, then I won't be stressed about anything.

And I see the questions that people ask you. And I'm like, oh, they're probably, they might be even like more stressed than I am. So in some way, that's soothing. I don't know why. No, no. I think it is. It's like sort of, it's always interesting to see like, huh, everyone else is also really anxious. Like, that makes me feel better. Right. Everyone else is overanalyzing, you know. Exactly. I'm not alone. Exactly. But thank you so much for coming on. Where can everyone find you? I know you have so many different things going on.

You have their newsletter, podcast. So the best place is parentdata.org where you can subscribe to the newsletter and you can search all the stuff that I've written about parenting and pregnancy and Instagram, where it's Prof Emily Astor. Great. And the parent data, you now also have like a search engine, right? Yeah. So parent data.org will get you to the website where you can search or you can ask our chatbot,

whose name is Dewey, who will answer questions. amazing I mean like that's kind of like the dream because you know I I I told you in the beginning I'm not sure if I was on air but I DM'd you because I'm like I have these questions I don't know anyone who knows the answer you know the answer but now you've created a system chat bond knows the answer yes it's better so let's see it will be like your answer's not that great but Dewey really knew Dewey was so nice somebody was like Dewey's such a nice so nice so nice I don't I think they meant it in contrast but anyway better bedside manner yeah Dewey has a really nice bedside manner.

It's the sweetest chat butt. Well, it's easy to not get jaded when you're a robot. I totally agree. Thank you so much for coming on. I will be continuing to follow you. And I know the listeners will get so much out of this episode. So thanks so much. Thank you for having me.

Thanks again to Emily. I'm such a huge fan and continue to be. This was super helpful. And thanks again to our presenting sponsor, BetterHelp. We hope this episode has been a help to you on your path to parenthood. If you want to get started with therapy, I highly recommend trying better help. Just fill out a brief questionnaire to get matched with a licensed therapist and switch therapist anytime for no additional charge. Visit betterhelp.com slash baby steps today to get 10% off your first month.

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