Oversharing - Baby Steps: How Do I Know When It’s Time To Seek Fertility Help? Ft. Dr. Bana Kashani

Episode Date: April 19, 2024

Welcome back to Baby Steps! In this first episode of Baby Steps Season 2, presented by First Response, Jordana is joined by fertility and IVF Specialist Dr. Bana Kashani to talk about all the different forms fertility journeys can take. They start things off with what people can expect when they seek the type of professional fertility care that Dr. Kashani offers and the various steps of testing and resources available. They also discuss how to even go about finding the right fertility doctor, and how to avoid some pitfalls along the way. Then they get into how social media can often wrap people’s perceptions of what the ‘right’ things to do can be during your journey, and some pointers to help find the balance between living a bubble and healthy in your life. After that, they address various forms of fertility treatments and some resources for financial assistance to offset the high costs these are associated with. To round us out, Dr. Kashani offers some positive reinforcement to anyone struggling with fertility and gives some encouragement to help you on your way. Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode is brought to you by First Response. First Response recognizes that not all pregnancies are the same, and neither is the road to get there. The First Response brand is fervently committed to supporting, sharing, and empowering all pregnancy journeys and providing accurate information, especially to those struggling with infertility, loss of a baby, and maternal health inequities. With a variety of tests that detect pregnancy hormones early and often, first response is there for you every step of the way. All First Response pregnancy test products are available for purchase at all major retailers in store and online. Be sure to pick one up today.

Information provided herein is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition or the use of medical devices. Hello and welcome back to season two of baby steps. I'm Jordana Abraham and I have a very special guest on today's first episode. But first, I'm going to chat through the episode with my sister, Dr. Naomi Bernstein. Hello, I am so excited for season two. Yes. This was amazing.

I got so much positive feedback. Everyone loves it. As I've told you before, you're so brave for kind of putting it all out there and it's helping so many people. So I cannot wait. Back by popular demand, Baby Step Season 2. I'm very excited about this one. Our first guest is Dr. Kashani, who's a fertility doctor.

and we talk about, you know, it's kind of similar some stuff that we talked about on oversharing about the sort of information your phone gives you about like fertility stuff, what's real, what's not real, what you should try to do, what you shouldn't try to do. And she had a great perspective about, you know, just kind of like trying to do the healthier thing when you can, especially when you're trying to get pregnant, but not letting it take over your life and like, you know, you can try an alternative method. It doesn't mean, like, I think there's, there's this feeling. a lot in medicine of like, don't try that. That's unproven like it's wrong versus dive deep

into like buying the snake oil. So it's kind of nice to have an in-between perspective of like, if this makes you feel good, you could try it. It probably won't hurt you. And there's so much, you know, there's so much out there on fertility. So it was nice to get someone to sort of weed through what's what's been studied and what hasn't. Totally. Because again, every person, product, anything that you're trying to do, somebody's probably making some money on, whether it's like a program or a supplement or a, you know, whatever it is. So it is nice to kind of get a perspective that's not, has no financial incentive. There's no money to be made from this doctor coming in and saying, okay, try it if you want to, but you don't need to

dig deep in here and buy every single thing there is to buy around this or, you know, make yourself crazy with, you know, being obsessed with this lifestyle change, whatever that might be. So I love that. And I love that it's a doctor that's giving you permission to try moderation is what it sounds like. Yes. To try moderation. If something, you know, if something catches your eye and you want to try it, you can explore that with your doctor. Even if again, It's not like fully clinically proven, but it's something you want to try. I think that she just had an open mind to giving different methods a try and also just starting with the things that are a little least invasive.

So if someone says, you know, have a surgery to undo this, but you want to try something that's less invasive soon, even if it's less proven. It's sort of like saying it's okay to explore other options. Right. And I do wonder if there's like we talk about on oversharing a lot, if just kind of feeling a little bit more in control because you're trying something that can't hurt can just calm you a little bit. Right. Like I'm just, I'm trying this thing.

I feel like this could help. It makes me feel like there's something that I can do here versus just sitting back and doing nothing and waiting. And if that calms your nervous system a little bit or makes you feel like you're affecting the change in some way. And I'm glad that, you know, she's giving permission to. go for it if it's something that's not harmful. Right.

Yeah, because a lot of the stuff is like unknown. You know, a lot of fertility is unknown. And there's really no sure thing in any mechanism, but there are a million ways to do something. So I thought that was great. We also talked about male factor in fertility, which I don't think is discussed quite as much. And, you know, what the issues are there.

And, you know, like testing the sperm and what comes out of that. And just, you know, different things. aimed towards male factor, which isn't really discussed as much. And I think that there's not then as much information about. So it was nice to hear from a licensed fertility doctor about this topic, which again, I don't think is talked about as much and can affect up to, I think, 40% she said of infertility cases. Wow. Speaking of like the mental health on the male standpoint, like if they're kind of getting, if they do a test and it doesn't come out great and then they're getting in their head and they're starting to become anxious of like, oh my gosh,

like there's nothing I can do about this or, you know, I'm sure that that's a big factor too and just knowing like, okay, why don't we just try to clean it up for a little bit and retest instead of being like, okay, here are the results of the lifetime. Like here's your fertility results in one piece of paper from a sperm sample that was taken on one day. So that probably gives the men a little bit of like that kind of calm, the nervous system. Exactly. And it was good for destigmatizing something that I'm sure a lot of men don't really want to talk about. Totally. So it was a really informative episode. I got a lot of facts out of there. Dr. Koshani's so knowledgeable. And she just has a very nice, calm demeanor, which makes you feel like all this information is more accessible. So I'm excited for you guys to hear this one. It's going to kick off our new season. And we've got some great guests lined up. So I hope you guys enjoy the season. You can DM me. You can post about it.

let me know and let's get right into it. I'm so excited to be back with our guest, Dr. Bana Kishani. Dr. Koshani is double board certified in obstetrics and gynaecology and reproductive endocrinology and infertility. She's been treating infertility patients since 2014 and has been practicing in Orange County where she grew up since 2017. Welcome to the show. We're so excited to have you on today.

Thank you so much, Jordana. I'm so excited to be on Betches. I obviously always listen and I'm so. so happy to be here to talk all things related to fertility. Thank you. It's always great when we can have an expert on to talk about, you know, things that women are going through with infertility. And that's basically like all you do. Right. Pretty much. That's the focus of my practice. Here and there, I'll get a mix of more reproductive endocrinology. But the focus is infertility and all fertility related things. And, you know, it's overwhelming for people and patients. And you find a

whole source of things online. But I think that I just love to be. be able to talk to people and educate them. So I'm happy to be able to provide some interesting information here today. For sure. So most people who come to you, are they looking to do IVF or they've been trying and they just kind of haven't had success? And we're starting at square one. Yeah, it's a mix. It's definitely a mix. There's definitely people who walk in the door. They've had no testing at all. They're like, we don't know what's going on. It's been six months a year or more. And then some people come where I have, you know, records from two different IVF clinics where they've unfortunately already, already undergoing cycles, haven't had success.

They're looking for like that third opinion or change a course. Some people are just coming in for fertility education awareness because they want to do something like egg freezing. So it's a whole variety of different types of patients. But most people are coming in with the understanding that they've had difficulty having success and maybe are leaning towards some sort of fertility treatment. So often it's IVF, but we still do a lot of different things as well. Okay.

So walk me through, like, let's say someone's been trying. for a while, it's not really working out, they come in for a consult, like what can they expect? Sure. So first off, I like to open a conversation with my patients, get to know a little bit about them. And most importantly, you know, I'll have people fill out some questionnaires about their medical history as well as their partner's history, but we get down to the nitty-gritty. There's a lot that can be gleamed of understanding about a woman's menstrual cycles. How have those cycles been? You know, are they regular? What someone might consider regular when we pull up their, app on their phone where they track their cycles, we see actually there's a range, right? So

getting down to like the details about their menstrual cycles is important. Prior infections, pelvic surgeries, lots of history questions I think are important. And then also finding out about their partner as well. Family history is important. What's your mother's age of menopause, right? Like if your mom went through menopause early, that can have an impact on your fertility. So the first and foremost thing is I honestly will spend sometimes 30 minutes, just like 20 minutes delving into a lot of these history questions because little, little tidbits of information could be a clue for one additional test that we may consider. Then we'll talk about oftentimes the testing and what can be done to figure out why someone isn't getting pregnant. My practice, I tend to kind of try to make it simplistic and break it down into four different factors. kind of if you break it down into that fashion, it's easy to understand causes for infertility.

So one could, of course, be male factor. So about one-third of couples, there is something going on with the sperm. And so we never want to skip doing a sperm test or what's called a semen analysis. So that's one-third. Yeah. Male factor. So then the other factors are related to the female, and it could be a uterine factor, something related to the uterus or womb where the pregnancy would implant.

It could also be related to the fallopian tubes, which we call tubal-fut. factor. And then lastly, ovarian factor or your eggs. And that could be related to are you ovulating or not? Or is it something with egg quality maybe related to age? And what is your egg quantity? Are you average for, for example, someone who's 35? We test some numbers. See where are you? Are you above average in your egg quantity, below average? And kind of breaking it down into, again, those four factors, then I can describe each test we do for those workups and then kind of decide when to do them and, you know, follow, proceed with the consult at that point and plan when to do those tests. And then based on those results is when we can discuss treatment options.

Got it. So I wanted to go back to one thing you were just talking about when you were talking about menstrual cycles and like people thinking that they're normal when they're not. Like what would you consider a normal cycle? Sure. So by definition, if a female gets their cycles every 21 to 35 days, that's a range. That's normal. Right. So that means that more than likely you are ovulating, okay?

And if for some reason you're falling out of the range and you're getting your cycles every 40 or 50 days, then that is prolonged time between your cycle. So ovulation is a little bit later. And so you have to investigate as to maybe why, which could be various reasons. It could be PCOS or polycystic ovary syndrome. It could be related to other pituitary conditions, something from the brain where the hormones aren't sufficient. It could be related to early menopause. So those are the kinds of things we want to look at. But also, I'll pay attention to one thing that's really interesting is that some people

will tell me, I get my periods every 30 days my whole life. It's been on track, everything. But for some reason, the last five, six months, I'm noticing that there is shortening of the days between my cycles. Now there are every 25 days for the last year. That is actually a sign that could be related to what we called diminished ovarian reserve or reduced egg quantity. Really? And often if people report that kind of like history, when we're talking, when we do the follow-up tests, we find out they have a lower egg reserve or quantity. So it's just a matter of like fine-tuning and getting into some of these details that

would clue us into what's going on with their ovaries and their body. That's so interesting in my mind, you know, obviously not knowing anything medically about this. I would imagine, like, you were like shorter cycle, more periods, more X. But I guess that's not the case. Or is it just the fact that like it's different than it was before? It's different than it was before. And what happens as women get a little bit older is they ovulate earlier in their cycle

instead of the typical day 14. They start ovulating day 10. And it's because of a rise in this hormone from the brain called FSH, which stands for follicle stimulating hormone. It's rising because the brain is sensing the ovary is not. functioning as well. The eggs aren't responding as well. So it's starting to increase its production, which is never like a good sign. We typically want your FSAH to be low or less than 10. So when we start noticing those trends, it's sometimes an early indicator like maybe there is a decline in egg quality or ovarian reserve. Maybe we should act on something sooner than later in terms of treatment options.

Right. And then what if for the, for your cycle, let's say some months are 26 days and some months or 32 days. Does that matter? That's typically okay. But again, I think that it depends on that range, right? So if some months it's every 24 days, then it's 34 days. That's a pretty big range. But I think for everyone, you can expect some variation between like a few days here or there, like 26 to 29 days. That's fine. But sometimes if it's always all over the place, it could be a hormonal thing, something related to your thyroid hormone or another hormone from the brain called prolactin. So those are some reasons to do some hormone testing. That makes a lot of sense. It's interesting, I feel like how little we're taught about what to look for in your ideal period. It's funny. I consider myself pretty educated. But I, you know, I was on birth control for like 15 years. And, you know, I would get my withdrawal bleed period. But I always thought that that was like a period. So I was like, oh, yeah. I have a period every like I know to the second that I'm getting my period. I must be like super fertile. And then you go off and you're like, oh, that.

And then you learn, like, those aren't a real period. So it's interesting, like, how little we're taught about. Yeah, it's actually sad. And it's like we learn all these things in high school, right? But there's very little focus on sexual health or just reproductive health. And that's the time where you're going through all these things. And so hopefully now that there's a lot more tools online and education and, you know, even TikTok and everything, we're all learning a little bit more about our cycles and can finally figure out a little bit more.

and then bring those questions to a provider sooner than later. Right. And I feel like you always hear like those stories about the person who, you hear way more stories growing up about the person who got pregnant on their birth control than the person who couldn't figure it out after they went off. So there's definitely a misalignment, I think, with the ease that it is to get pregnant. Or not even knowing that you could only get pregnant like a few days of the month, of the month, which is, again, also kind of crazy that no one tells us this.

Do people ever come into you to your office and you're like, you should keep trying on your own? Or like it's a little too early? Yeah, absolutely. I always tell people, I'm like, we can do all the tests because, you know, everyone's different. Some people want to be able to have control over the situation. And so they don't want to spend six to nine months trying, finding out their husband doesn't have sperm, right? So it's very reasonable to do the testing. If everything comes back okay and they're young and they've only tried for a few months,

I'm absolutely going to say, like, why don't you try for a few more months? There's no need to go on to more, you know, treatments such as IUI or IVF. But I don't think there's any harm in usually doing most of the workup and tests if people understand the pros and cons to them. So usually that's kind of what I'll offer. And then people will pick and choose what to do. Okay. So you're just giving them all the options and they can choose based on how type A they are. Yeah, exactly. Basically. I mean, everyone's different. Like me personally, I was in fellowship. And I was like, okay, I'm going to, I was in my training. I'm like, we're going to start trying. I'm like, I'm going to get my blood test done. I'm going to do my HSG. I'm going to check my tubes.

I'm going to have my husband check his sperm. I'm like, I don't want to find out nine. I've seen so many stories. I'm like, I don't want to find out nine months in that, you know, I have a tubal issue or he has no sperm. So it's just, again, the type A personality. Yeah, no, I was like that as well. Kind of just feeling like, all right, we're going to be like efficient going into this thing.

Do you ever feel like on the other flip side, are you ever. you ever like, I almost like, you come in too late, I can't help you anymore. Yeah. Unfortunately, I think that it's hard because a lot of, most people are getting pregnant, I mean, getting married later in life, right? We're, or even if you don't, you're obviously, everyone's focused on their professional careers, which is great. And we have so many women doing amazing, amazing things out there.

But they're kind of putting their fertility on the back burner, right? Or they're, they're hearing reassuring stories of other people. getting pregnant in their 40s, but most often those people are going through lots of treatments. So I think the hardest thing is when people come in and they're like 42, they're like, sure, we're just started trying, but we don't want to do anything. I'm only 42, but with that age category, IVF is incredibly difficult. In fact, the national success rate with IVF at age 42 is about 5 to 10 percent. And I don't think that people really understand that statistic. They're under the assumption that

they'll be able to do IVF and it'll work, but it is really hard at that point. So those are the people where I'm trying, without being aggressive or being pushy in any way, but just trying to let them know that time is of the essence. And we want to not only preserve their fertility or give them the opportunity to get pregnant now, but if they wanted a second child, this would be the time to bank embryos for another pregnancy, which would be later, like in 43, 44, and that might not be able to happen if they don't freeze embryos at that point. Yeah, I mean, you see all this stuff in the news. I think that when you see the celebrities, like I think Cameron, Cameron Diaz just had a baby at 50, 52, something like that. And you see

that. And I think it's like a double-edged sword because on the one hand, when you're growing up, I remember growing up and seeing like celebrities do this. And I'm like, great, like, I don't have to be worried about not being able to find a boyfriend. Like, sure, like whoever. Like Hillary Swink just had twins at 48. But then you don't really get, I think, like, these things are true, but then you don't really see, like, how they went through to get them or how hard it is or how much probably, how much money they probably spent. Sure. Yeah. And I get it because it's like so personal too. So I understand why it's not like out there and their, you know, their whole personal life isn't, you know, advertised for everyone. But I think that it's also so detrimental because it's really

giving some people false reassurances that it should be fine. Whereas most people are doing some assistance with getting pregnant at, you know, that time frame, whether they're even, you know, using eggs or embryos they froze before or using third-party sources of reproduction such as donor eggs, we don't know. And they're all great options and available, thankfully, but it would be nice if more people came out and kind of were more transparent about it so that, you know, people understood that it's not as easy as just trying at 48 and getting. hunting twins. Yeah. I mean, like it's tough because those are the most visible cases. You're not like

really, you know, those are the celebrities. So that's getting all the attention and you're kind of, it makes it seem easier than it is. But the Jennifer Aniston thing. I was literally just going to say Jennifer Aniston. She's the only one that came out and said, you know, it didn't work for me. I know. And that was so powerful. I felt like, especially as someone who like has all the resources of someone, you know, a celebrity in Hollywood to just say like I feel like I should have done this all earlier. I wish someone said come to me earlier. Yeah. No, absolutely. And I bet you there are a lot of other people out there who, even celebrities, who've gone through that and haven't been able to come out and say it and understandably. But I wish more people to it because it happens to a lot of people.

A lot of people, unfortunately, even my patients, I've had them have to end their journey because it didn't work out. And it's really sad and disappointing. So it's good for people to understand that because I think that then they don't feel so alone or and know that it's not just, you know, everyone who has a IVF cycle and embryo transfer works the first go around, right? Yeah, no, I think it's a, it's, and it's tough because it's like the one hand, you get like the celebrity stuff. And then on the other hand, you get like the Reddit Facebook groups, which are like a black hole of despair.

Yes. So it's kind of like, where's the middle balance between like hopeful optimism and like doing, you know, understanding the world. but also not like scaring the shit out of yourself. Sure. You can those, you know, but then there's little things that can be teased out from those. And everyone's experience is valid. But yeah, yeah, definitely you can go down that black hole.

And it could be a little bit negative and make you lose hope. But I think that's where you go back to your doctor or your provider and try to bring up options and find the hope again and find a solution and find a plan and a track for yourself. So if someone's looking for. a fertility doctor, like what do you suggest they are the steps they take to find the right one for them? Sure. So there's a lot of like different ways and avenues. A lot of people have a close relationship with their OBGYNs, their own private gynecologists. And so they may have referrals for fertility doctors they've worked with and may provide some referrals. So that's one source. Obviously,

online is a good source because there's a lot of good ways to look at reviews for your doctor and see what matches your personality style. So there's even a website out there called Fertility IQ. And basically it is like a Yelp for fertility doctors. But it's really good because first of all, anyone who's writing a review has to be show proof that they were a patient at that clinic. And it's very specific questions. It's not, it's like very specific questions. I think that that would be one of the best resources in trying to find a doctor because you can find out like how they do their cycles and how their office staff is. I mean, there's one thing about your physician. There's something about the office staff about the lab that they use. And so doing your research is really important and finding

out what's the right fit for you because some people really want somebody who's just straight to the point and, you know, just provides them with facts and answers and evidence-based medicine. And some people are really looking for something different. They want someone who's going to, they need that little bit more TLC. They need some more handholding. They need somebody who is sensitive. to this very sensitive situation. And so you can kind of tease those things out by like finding reviews or just word of mouth. And I think that what's important is, you know, try someone out. And if you feel like something's not right or it's not the right fit, you're not forced to stay with that provider.

And always consider a second opinion because you never know. You might find someone else that matches your personality style or your goals a little bit differently. Right. I think what you also said before, which I wanted to highlight, That's what you said about the whole staff. Oh, yeah. Because people, I think, don't realize that they're not really speaking to the doctor that often, usually in these scenarios. They're usually mostly talking to, like the nurses and, you know, the way that the, like you said, the way the office is run.

I think there's a question on fertility IQ that was like, are you treated like a number? Do you feel like you're treated like a person? So so much more than I think you would immediately think. And these journeys are like oftentimes, like on the longer side. I mean, hopefully they're not. But even like if you do IV. or if you do anything. It's a kind of an extensive process.

You're coming in regularly, frequently. You're seeing those nurses, the staff. So you want to feel comfortable in that environment for sure. You want to make sure they're returning your emails, your phone calls. You want to feel like you're welcomed when you come in. And those things, I think, make a difference. If you're going in and you're stressed already and you don't like that staff member, they haven't responded to you or they were rude, that stress can, you know, carry a weight

on you during your STEM or your cycle. So I think you really have to feel comfortable where you are. And if something doesn't feel right, then it's completely reasonable to consider another option. Totally. And I think that like one of the benefits of the destigmatization of fertility treatments in recent years is that I know so many friends who have, you know, you know, you know, you're not to feel like people. Yes. For sure.

Yes. Huge. And then what would you say, like, do you give advice for patients? Do you ever find that it's lifestyle choices that are affecting fertility? Or if someone changes those, does that really move the needle? Because I feel like there's a lot on Instagram or TikTok or all those things that sort of imply that it could be the chemicals in your cleaning products or not eating non-organic berries or whatever it is. I think that you have to find a balancers. Obviously, so many benefits of living a healthy lifestyle.

not just for fertility, right, for every reason, right? We know that we shouldn't have processed foods or fast foods. Like we should have more whole fruits and vegetables and try to cook at home and easier said than done for a lot of busy people. But I think that it's about finding a balance. And so I do think there is like a little bit of a cumulative effect where if you do minimize some exposures, overall, that's going to be better for your equality, your own health. So what I tell people is if you can cut out plastics, then do it.

because we know that in general it's just not even for egg quality purposes or sperm. It's good for our health to not have microplastics right around. So don't cook your food. Don't heat up your food in plastic temperware. Try to avoid plastic water bottles. There's BPA in receipts. When you go to the store, if you don't need a receipt, don't grab it and hold it, right? You can actually get.

I don't even know that. Yeah. So thermal receipts, you touch them. There's BPA. It can get absorbed by the skin. They've actually found higher levels of BPA in people's blood who are people who are. cashiers. Yeah, cashiers. Yeah. Wow. So that's why sometimes they'll wear gloves, you know. But anyhow, so just like I'm not someone who's like, we can't, we cannot live in a bubble, right? We just can't.

Don't be an extremist. But every thoughtful choice you make that you minimize one thing that's easy to do in your life, it's going to have a benefit. And so, again, having more antioxidants in your diet, organic blueberries, pomegranates, assay, all these things are probably good for fertility and our own health. So I think that it's a matter of just finding that balance. Of course, we know smoking is not good for everything related to health, especially for fertility, both for men and women. So cutting that out. Alcohol use is obviously controversial, but definitely binge drinking is not good for fertility. And when you're pregnant, you're not supposed to drink.

So trying to reduce that exposure prior to while you're conceiving is probably a good idea. But that doesn't mean you have to refuse that glass of wine when you're at a social event just because, right? You have to find a balance. And that's kind of what I tell people about lifestyle. I think that's a good way to look at it as, you know, it's good for you in general. And so because I think when you're trying and failing to have a baby, it can feel like I'm just changing my life and I'm doing all these things and it's not even working. Right.

So what's the point? And then it's so frustrating. And you've like restricted yourself so much and missed out on things. And then you're just like, why did I do that? Was that worth it? So finding the balance where it's not super. hard to, you know, cut those exposures out, but, you know, enough that you know it's going to be good for you.

Right. So, like, if you're at the store, like, I'll tell people, I'm like, you have a choice of picking a cleaner cleaning product. Like, try to pick that one if you can when you're changing it up. But it doesn't mean you have to go get rid of every single household product in your house just to get all clean products. So it's, again, it's about a balance. Right.

What about supplements? Yeah. Supplements. Supplements are tricky because, as most people know, but a lot of people don't, they're not regulated by the FDA or the Food and Drug Administration. So you can have, there are some companies that are really good and their products are very clean. There are some that, honestly, they could make their supplements in their garage and we don't know what else is in there, right? That could be detrimental. So I don't love people to load themselves up on like 20 different supplements because

who knows if there's an accumulation of something within all those supplements that's actually not good for fertility. But I tend to tell people definitely prenatal vitamin that all should have folic acid. It doesn't have to be anything super fancy, but definitely a prenatal. I like most people to be on vitamin D. We're all low. We're all not in the sun as much or outside. A lot of people are working from home nowadays as well. So we're mostly deficient in vitamin D. And then I do tend to recommend co-enzyme Q10 or co-Q10. It's an antioxidant. Doesn't really have a lot of side effects. And so I'll usually recommend that, especially women over 35. And then here and there, there's like some other supplements, like for male fertility that will suggest.

and consider if the sperm counts are low. And so those are the things that I typically will start with. Some people will go see acupuncturists and they'll come to me with like a different list and we'll kind of look through it and sift through it and I'll be like, okay, this one's fine, this one's fine. Please don't do this one. It's just not useful. So that's kind of the way I approach it.

Should men take KU10? Yeah, men can take KU10. Usually the dosing is different. Like I'll tell men 200 milligrams is appropriate or sufficient for sperm health and then for women between 400 to 600 milligrams. Got it. I've heard a lot of different things about an astride. For anyone listening who doesn't know what that is, that's basically the pill that men take to sort of like retain not lose their hair, which I think a lot of men in their 30s are on. That seems to be a big fear. But I've heard, I've heard like very varying things about whether you should stop that or not.

What's your take on that? Topically, where people just apply it to their, you know, hair, it's probably not bad, but I do think that in certain circumstances it can affect sperm health. And it's on like a case-by-case basis. So it's just the way that, you know, some people smoke and they get, for example, lung cancer and some people are non-smokers. And unfortunately, they get lung cancer from secondhand smoke. It's just a different exposure thing. Right. But what I was going to say was basically, in some people, we've done sperm tests and we see that their samples are fine. And so maybe they can stay on it, but we don't know down to the level of DNA still if it's having an effect on sperm health. So if it's possible, I like to have people come off of it for a couple of months during

like that prep for IVF, for example. Got it. So when there is a problem with the sperm, when you're saying there's a third is male factor, like what are usually the issues that you find when it's a male issue? Yeah. So oftentimes it depends. If it's just like a mild motility issue where the sperm aren't swimming well or the numbers are like borderline low, then I think that changing some lifestyle factors like reducing heat exposures, cutting out this hot tub, steamroom, jacuzzi, that could help, maybe implementing a supplement, like a male fertility supplement, cutting out smoking, reducing caffeine and reducing alcohol use. Those things can help, and men are lucky.

They make new sperm about every 72 days. So there's definitely improvements that can be seen within a three-month type. frame for those borderline cases. And sometimes that will help them be able to move from doing, not having to do IVF and being able to do something like IUI treatments. But in more severe cases of male factor where there's significantly low numbers of sperm or there is a significant issue with the morphology, that's when IVF should be done. And oftentimes at that point, I will also work with a male fertility urologist. We'll refer out for, you know, an examination and maybe some hormone testing for the male. So a physical exam should be done. It's very, very rare, but in severe

cases of male factor, I mean, there could be testicular cancer that could be identified. We wouldn't want to miss that. In cases where there is no sperm seen on a sample, there could be a blockage of what's called the Vaz deference, which is the tubes that connect the testicles to the urethro to be able to ejaculate and have sperm come out. So these are the times where we work hand in hand with other specialists to do that workup. And then some men have, actually a hormonal issue from the level of their brain. They're not making enough testosterone or another hormone called larynizing hormone LH, and it's affecting their sperm production. Sometimes people have to start pills like Clomid, which is given to women and men can take it to help

improve their sperm. So this is where we can all work together as a team and kind of formulate a plan to also help the males. Well, I didn't know that about like the infertility urologist and how that can help a situation that makes a lot of sense. At what point would you use like a male sperm donor. Yeah. So in circumstances where there's absolutely no sperm found within the sample, the ejaculate, or even when male fertility urologists, they can go do a microscopic procedure where they actually go into the tubules and the testicle and look for single sperm. If they've attempted that and it has not been sufficient, then oftentimes then you can go on to sperm donor. And some men will say I'm not, some partners will be like, I don't want to do that.

big surgery. It's a huge surgery. I just don't want to do it. We typically recommend speaking to, like, a therapist who focuses on understanding third-party reproduction, which is the use of, you know, donor sperm. And if they're okay with that, then they can move on to that option as well. Right. And so if someone needs donor sperm or donor eggs, is that something that you guys facilitate? Yeah, absolutely. So I like to tell people, first of all, about the process and what it looks like and how they can get these things and how there's various different companies out there that provide donor eggs or sperm. There's an extensive screening that is done for anybody who's donating what's called gametes, eggs or sperm, and that involves a medical history, genetic testing oftentimes,

blood work, checking for infectious diseases. So we kind of lay out what the process involves. And I will usually have patients talk to, like I said, a therapist who specializes in explaining all the considerations in using donor eggs or sperm. And that's things like, okay, well, what are you going to tell your future child that, you know, they were conceived with donor eggs? And that's a personal decision between couples. Some people feel very open about it. Some people would like to, you know, probably keep that a personal thing for themselves and maybe tell their children at age 18. So those are the things they want to think about before making that decision. And then in terms of facilitating the process, I usually have people start exploring. For example, okay, look at these donor egg

profiles, find two or three that you like, send them to me. Let me look at them too and give you my input. And then we always have to verify that it would be a match or not before proceeding. So those are the things that we do to help. Right. And the match, I assume in part, is like, do you carry any of the same traits? Or they have any disorders that you also have? Yes, for sure. We want to make sure that if somebody is a carrier for a severe condition like cystic fibrosis, that your partner, you know, has been tested and is not a carrier. We wouldn't want to risk having, you know, a child be affected with something severe like that. Right.

Do you ever get women who come to you, like single women who are looking, you know, to have kids on their own? I'm sure, like, so the process is similar for that. Sure, yeah. So single moms by choice is a whole new thing. And it's not just moms. It's single, you know, parents. But, yes, we do have, I do have patients who are women and who have decided that

that's the journey that they want to embark. on. And so we go through the same process and considerations in selecting donor sperm. And then depending on their age and their factors, sometimes they don't have to do IVF. They can do things like insemination, which is they haven't really been trying. You know, it's not like they have infertility. Maybe that works for them. Or in women who are older and maybe they want to have the option of having two biological siblings, they rather do IVF so that they can use the same sperm and freeze embryos for not only, you know, their first child, but have them available in right. for their second child.

Right. And is the process similar for a surrogate? Yeah. So the surrogacy process is a little bit different. There's different agencies that focus on helping what we call gestational carriers now. And basically there's like a pool of people that are available and willing and ready to offer this amazing service. And what happens is the agencies will help link intended parents with these gestational carriers. They're first of all going to see their intentions of why they're doing this.

and make sure that that's, first of all, something that would be open to the intended parents. Then as my part is doing an extensive screening on those gestational carriers, looking at every single record from their prior deliveries, seeing if there were any issues that came up during their pregnancy. And not just during delivery. What if they had high blood pressures during pregnancy? Well, that's not necessarily a good thing for somebody who may be carrying a pregnancy. So there's like a medical screening that's involved to be able to even say that.

Yeah, exactly. What about the cost of all these things? I assume, obviously, some people have really good insurance or financially well off. What advice do you give to people who are kind of struggling financially to pay for all these treatments? Yeah. More and more states are thankfully having a little bit more of a mandate and coverage and more employers are providing coverage. But it is hard and it is very expensive. And so there are different resources.

So some clinics provide lending options so that you can get loans specifically targeted to help pay for IVF treatments. Sometimes they're lower interest, and so they are available, and they don't really have as strict of qualifications as some other loans that people may want to get. So that's one option. Another option is that people can start, you know, apply for a low-interest credit card and be able to put it on a low-interest or 0% interest credit card and put the treatment cycles on there so that they can pay for it.

Some people have done GoFundMe's where they are able to get. some family members or friends or people to help contribute. And especially it comes down to when time is of the essence and people feel that pressure that they have to do treatments because they're getting older, but then financially it's just really hard. There are other programs with even medications and injections where you can, if you can't afford those medications, you apply, they look at your tax returns and they can significantly discount some of the medications, like even up to 75% off.

So very important for you or any patient is to ask their clinic. what resources are available for those that may not be able to have the financial means. That's super helpful for anyone thinking about, it seems like many different options that you can have to try to make this work. I also saw something and let me know if you've never heard of this before. Someone actually just wrote it in a review for our last season, is that they're in this program where they're doing an egg retrieval and the program pays for it and they take half the eggs. Yes. You've seen that? Yeah. You have seen that. Okay. I was like, this person making this up? No, it's actually, I think it's a great program because there are a lot of

women out there who have heard experiences of maybe older cousins or friends who've had difficulty conceiving. And they're now in their early 30s or late 20s and they're like, I would love to freeze my eggs. I would love to. But for some reason, you know, either their insurance doesn't cover it or their employers don't. And it's a lot. It could be about, like let's say average about $10,000 for the cost of this. Well, there are service. out there that will allow people to go through the process of donating their eggs. Some people get like 30 eggs a cycle. They don't really need to freeze 30 mature eggs at like late 20s. So they are able to donate 15 of them and keep 15 for themselves, for example. And it provides

them the option to undergo the egg freezing process without a cost to them and also really help another family that would love to use those eggs and be able to start a family with them. That's a very interesting option. I'm surprised that I had never heard of that before. And it does seem like, you know, if you're going through the process yourself, then you might be more likely to like want to be helping someone. I mean, I could understand maybe not wanting to have some, a child that's technically yours out there. But I think if you've seen a lot of people experiencing this, it is such a beautiful thing to be able to donate and help help people. Yeah. It's definitely a personal decision. And everyone who's considering this should still like think about all the considerations,

before they proceed with this, but it's an option. And it's nice to have options, I think so. Right. And for the gestational carriers, I think you see all these. Maybe these are also like amplified by the news or by, you know, things you see on Instagram or social media. Do you get people who use like their family members often for donor eggs or for gestational carriers?

People often bring it up. It's always like the first thought a lot of times in women who, for example, can't get pregnant with their own eggs. are like, let me use my sister. But what happens is, is a lot of times that same fertility issue or egg quality issue is also present in family members. And so they're not always the best candidate. We can screen them and look at things, but oftentimes they're not always the best candidate. So I tend to not use a lot of family members as, you know, donor eggs. But for gestational carriers, it is an option friends or family have offered. And it's an incredible gift because the cost of using a surrogate is,

is really high. It's probably one of the most expensive things in this country because of just so many different factors that are, you know, accounted for from medical bills to legal bills and just like various fees. So being able to cut out some of the compensation fees and costs by having a family member offer to do it is an incredible gift. Yeah, I've heard from Brian Kelly who had his son on his own through a gestational carrier that it was like $250,000 or something like that. I mean, I think the expectation is definitely consider between 150 to 250 for the whole process. It is, yes. I mean, it's crazy, but it also like it is a big ask.

So I can see both sides of the coin there. It's very interesting. So I wanted to talk about some stuff that I've seen, you know, obviously like your phone hears you speaking and I get fed a lot of fertility stuff on TikTok on Instagram. And it's hard to like sift through what's legitimate. what's not. A couple things that I've seen a lot lately, which I wanted to get your take on, was this idea of mucinex for aiding people to get pregnant. Yeah. So let's talk about it. I've actually recommended it for people before. The science, there's like old studies that were back from like

starting, I think in the late 80s or 90s that looked at this. But basically, mucinex is something that thins out mucus in the body, right? So most of the time you take it because you're congested and you need to get out that mucous. But there is something important called surgery. cervical mucus, right? And cervical mucus is the mucus that sits in the cervix, and it's a very supportive environment for sperm when you're trying to conceive naturally. That's where the sperm sit and wait, and then they make their way through to the uterus and then the tubes. Some women have really good cervical mucus, and it usually presents itself during ovulation. And some women, it's a little bit thicker. And so the concept behind eucinics is that maybe it thins out the

cervical mucous a little bit and might help with the sperm being able to make their way through the cervix and into the uterus. So I have suggested it for people sometimes if they wanted to, if they've told me, I don't really see cervical mucous, even though I know I'm ovulating, right? So it's something that's not really harmful that we know of. So I don't think it's a bad idea to consider. Is that going to be the answer to help you get pregnant when you've been struggling with infertility for two years? Probably not. But nevertheless, is it something that hurts. Yeah.

Yeah. Got it. And then the other thing I've been seeing is OZempic. Right. As obviously like the OZempic craze has kind of taken off in the past couple of years. I'd always thought that like that was something that people had to go off of to get pregnant. But then what I've been seeing on TikTok is that people go on OZempeg and then they get pregnant. It's so confusing, right?

So the reason for the recommendations for all these injectable weight loss medications and coming off of them before getting pregnant is that we just don't know the effects on egg quality or the baby, right? So we don't know if some of these, their GLP1 antagonists, if they're going to have an effect on development, birth defects, things like that. So we usually recommend people coming off of it about two months prior. Not a lot of data as to why we suggested arbitrary two months, but it seems safe enough for equality. So that's where it came from initially. But what's going on is that a lot of people, PCOS is a very common condition. Most people have a type of PCOS where it's related to having an issue with ovulation and it's very weight related. So one of the first things that we recommend in most patients with PCOS is lose 5 to 10% of your

body weight and you might start ovulating again and having periods again. Well, Ozambic obviously helps you lose 5 to 10% of your body weight. All of a sudden you're ovulating when you weren't and you didn't know, right? And then you got pregnant. And so that's what's going on is it basically is helping people get their ovulatory cycles back. Got it, but you probably don't recommend it. No, yeah. I mean, I do think it's a really good idea for women to consider weight loss before pregnancy

if you're overweight or obese because those pregnancies are higher risk. They're the risk of diabetes, high blood pressure during pregnancy, early deliveries. You want to be at a healthy body weight before getting pregnant. So if that's a matter of doing six months of some of these weight loss injections before conceiving, that's a great idea. But you should be using some form of contraception. whether that be condoms or birth control during that time frame so you don't get pregnant, I think it's the safest approach.

Right. But then once you go off, wouldn't you gain back the weight as you were getting – I guess you're going to be gaining weight anyway if you're pregnant. Right, right. That's the concern, obviously. But I think then that that takes the self-control of like, okay, I am coming off, but I'm going to still try to maintain a good diet and exercise to maintain this weight loss. But that's something to be determined because it's really easier said than done.

Right. That's very interesting. I wanted to ask about this other thing, speaking of things that I see online that give me anxiety. What are your thoughts on reproductive immunology? Because I've seen that a lot for people who've had failed transfers. There's like groups and Reddit threads and all that. It seems what I've seen is that it's not really proven. And a lot of doctors have kind of mixed feelings about it. So what's your take on that? Sure. So first off, reproductive immunology is like the study of the immune system and how it can affect your chances of getting pregnant. And the reason this emerged is at the level of the uterine lining, which we call the endometrium, there are immune cells that sit there and allow and support implantation of a pregnancy. There's a balance of these cells called T-helper cells, for example, or natural killer cells. So there's all these immune cells that typically help us fight off infections that are also in our uterus. And so there's a whole. theory that maybe there's an imbalance in these cells, right? And that's why once an embryo is placed in the uterus and with IVF, for example, through a transfer, maybe it's being rejected. Maybe the immune cells are attacking the embryo. Maybe something's off that's not allowing that embryo to implant. Or furthermore, maybe it's something that you get pregnant, but that baby isn't able to grow past a six-week range, seven-week, eight-week, and all of a sudden you have a miscarriage, something's going on where there's some sort of antibody, some sort of something

that's gone wrong with the immune system that's kind of stopping the pregnancy from continuing. And I think there is probably some validity to it, and it's just still under investigation. But I think it only applies to a very small subset of patients. So the majority of patients really don't need a reproductive immunologist, and I would say even I would probably say less than 5 percent do, but that's still not. 0%. And so it's it's something that, like I said, I can't say that it's all validated studies. I can't say that every single treatment option is worthwhile doing. But when you're in a circumstance where you're trying to choose between, you know, I haven't had success after

three or four attempts at pregnancy, whether they be miscarriages or failed implantations, and I'm trying to decide on having a gestational carrier or going to a reproductive immunologist, then, I mean, oftentimes you should go seek every option you can and see if there is something that can be identified and give it a try. Because my biggest thing is you never want to look back in life and also say, like, I have a regret. Like, I wish I just looked into that, right? But it's, again, personal situation.

Some people are like, I can't go through that again. And there's this great service out there called surrogacy. And I rather just do that. I don't want to, you know, continue to explore. for myself. Everyone's different though. Right. I think that's a good take on it. It seems like the idea of, again, like, and correct me if I'm wrong, what I'm hearing is, is like your approach is kind of going from the least invasive to the most invasive, if you can. I mean, instead of skipping to the

most invasive. Or most extreme. Exactly. Yeah, yeah. It's just so different than what we typically expect when we're trying to start a family. So if that means going to reproductive immunology before that next step, then I think that's really what's appropriate. Awesome. What would you say, I mean, you've been doing this over 10 years. What would you say is like the thing that you wish that more people knew before they came into your office? Anyone who's listening to this show who's maybe just starting to try or just starting to

think they might have, might be having some trouble conceiving. Like what would you say you wish more people knew? Yeah. I mean, honestly, I wish more people knew how much age impacts our fertility. And it should be almost like a PSA because we have all these things out there such as like treatments like IVF and then even egg freezing's out there. But really the test of it is trying to get pregnant at a younger age. Our bodies were meant to have children in our 20s.

That's the reality. And yes, most people are not having children in their 20s. They're waiting until they're in their 30s. But I wish people just knew more that no matter all the technology that we have, age can sometimes not be overcome. And that's not just related to egg issues. Sometimes the uterus is affected as well. So if it's really important for you to have the option of having a child or a family,

I think that you should definitely consider your fertility and at a younger age and just explore different options than you're typically considering because sometimes it isn't an easy, like straight shot path to pregnancy. You don't try the first or second month and get pregnant. So keeping that in mind is really important. Right. And is there any specific, I mean, I know. that 35 is a geriatric pregnancy, but is it just kind of like the younger, the better?

Honestly, the younger, the better. I mean, even me, like, I focused, I don't know how many 15 years after high school to do all of my training. And I ended up having my daughter, I'm actually here in New York, right, when I was 33 at the end of my fellowship, I postponed, right? And it didn't happen right away for me. And I had been married since 25. And I sometimes look back and I'm like, maybe if I actually had started earlier, I might have even had like a third child or like I just you go through these motions and thoughts all the time and you see people in your like in my office who are later on in life and they're like I wish I just did this sooner I did wish I considered it I didn't know how important the age factor was so I think that that's my biggest thing is

if that's something really important to your like life goal we get really caught up in like you know our careers and everything and so sometimes we push things back for our specific timeline but sometimes, you know, just reevaluating and seeing if you should do it sooner might be the better option. I think that's great advice. It's funny. I feel like that's why family planning is so hard because it's always the people who were like, we saw everyone else struggling.

So we started early and then like annoyingly what happened on the first try. It's always like the opposite of what you're looking for. And the people who think they have all the time in the world wind up, you know, struggling more. So before we end the episode, this episode is brought to you by first response. Providing support to women struggling to conceive is so important. and something that personally hits home for me, which is why for the next few weeks and during National Infertility Awareness Week, we're partnering with First Response to bring you valuable

information and tips that can be useful no matter where you are in your pregnancy journey. I'm personally a huge fan of First Response. As you guys know, I've had a lot of struggles with infertility. And anytime I need to take a pregnancy test, first response is my go-to test. I literally will not take any other test. And in these kinds of situations, days can feel like months or years. So that's why I love First Response. I really just trust them. to be accurate, to be sensitive, and to be early. The information provided herein is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition or the use of medical devices. For the next few weeks, we'll be bringing you a segment called positive reinforcement presented by first response. We know that waiting for the positive test is exciting, but also stressful. No matter what you're struggling with on your journey to conceive, we're here with a little positive reinforcement. Can you give some positive reinforcement to any of the listeners struggling today? Yeah. So obviously everyone's journey is a little bit different. And I just want everyone to

keep some glimmer of hope, right? It's not always this straight track from point A to point B. Sometimes there are roadblocks, things that come up. But in the end, have that glimmer of hope and have something to hold on to. There's always going to be another test or another option or another solution. You can always get a second opinion, think out of the box, do something different. Do not give up hope because oftentimes one of the hardest things that happen to people is they can't do it anymore and it's understandable. But kind of regrouping, reframing and finding support groups out there, I think that that's the most important thing is to look for that, look for that hope and hold on to it and find somebody who can support you. I love that. And I think one of the things that

this show really tries to show is that there are a million ways to start a family. Yes. And one way or another, if you really want it, you know, it can happen for you. Absolutely. And it's okay that it didn't happen the traditional way because in the end, once hopefully you are able to start your family, thankfully all those difficult struggles, they fade away. You don't focus on that.

You focus on your family, which is nice. Totally. I feel like anyone who, anyone in my parents' generation who like you ask about this who did go through it, like kind of almost forgot. Yeah. Like you said, like it was tough and then they got through it and now they're fine. Right. Exactly. Thank you to our sponsor First Response. For nearly 20 years, First Response has supported Resolve's mission to empower the infertility community through providing resources and support for individuals and couples on their path to parenthood. Resolve.org is home to many resources for the infertility community, including free support groups, books,

and more. Resolve is dedicated to ensuring that all people in their family building journey are empowered by knowledge, supported by community, united by advocacy, and inspired to act. All first response pregnancy test products are available for purchase at all major retailers in store and online. Be sure to pick one up today. Thank you so much. I learned so much today. I'm sure our listeners did as well.

Are you accepting new patients? Yes, of course. Where can they find you? Yeah. So you can, my practice is in Orange County, California, and you can go to my website, banachashawnee MD.com, and I'm happy to see you. I take a very different personalized approach to fertility care. It's kind of like a small concierge type of practice.

So I'm always looking for finding a good new solution for you. And Jordana, this was awesome. I love talking to you. I loved being here. So thank you so much for having me. Same here. Thank you for all the info. Thank you to our sponsor First Response.

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