Oversharing - Baby Steps: Unpacking The Biggest Fertility Myths Ft. Dr. Lucky Sekhon

Episode Date: November 17, 2023

On this week’s Baby Steps, presented by BetterHelp, Jordana is joined by her own fertility doctor, reproductive endocrinologist and infertility specialist Dr. Lucky Sekhon. They talk about the value of sharing your own experience, and why it’s so powerful for celebrities like Jennifer Aniston to discuss their infertility treatments. Dr. Lucky tells us why and how the egg freezing process has changed over time, where the technology has improved, and why it’s important to look into your healthcare options. They also share the biggest scams and myths to avoid when you’re doing research about your own fertility. Do you really need to avoid scented laundry detergent when you’re trying to get pregnant, or is that simply a misconception? Plus, they tell us what you should be asking on your first consultation with a fertility specialist, how to find the right doctor for you, and the secret to avoiding emotional burnout. 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, your Donna 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 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 Dr. Lucky Sikon. She's a reproductive endocrinologist and infertility specialist.

She also happens to be my fertility doctor. She's here to talk about exploring your options when it comes to fertility treatments, and she's also going to help us unpack some of the biggest fertility myths. But before we get to Dr. Lucky, as always, here's my sister, Dr. Naomi Bernstein. Welcome, Naomi. Thank you. So excited to be here.

I'm excited to hear what, that this is your actual doctor and you having a conversation. That's awesome. I know. It's funny. I mean, like, it's cool because, like, I've been on such a journey with her where we've been through, you know, so many, like, amazing times with amazing results. and then like, you know, there's like the times when it's not working when it's really frustrating. And it's, I think to me, one of the things that I love about her is that she always has,

you know, a plan. It's never like, I don't know. She always like makes me feel like it's going to happen. We're just going to keep going. It's all very like, we're going to try this next time. We're going to tweak it. We're going to do it again. We're going to do it this way.

And it feels like I have someone who's like on my team. And you know, I've talked about this before, how infertility can feel really. isolating and lonely. And it is really helpful to have someone who's so informed, who knows what they're doing, who's like, we are in this together, like, we are going to get pregnant. You know what I mean? Yes. And I even do that with my patients, and I think it means a lot. Like if somebody's going through a hard time and I'm kind of like, we are going to get you feeling better. Like, we are going to do this together. And I can imagine just the little, the bedside manner in the little nuance communications between you and your doctor where, you know, just the positive energy, like you said,

of having someone that's kind of like, okay, what's next? Here's our next option and we're just going to keep going. Probably means a ton versus if they're like, oh, gosh, all right. I don't know. I don't know. Right. You know, so I think that that sounds really great because I think that's just as important probably as having someone who, you know, is a great doctor, but maybe doesn't have that psychological, empathic, positive, you know, I'm the leader of the ship. Totally. And I got you. And we're going to keep moving. Yeah. And I think that's so important when choosing a fertility doctor. So I feel really lucky to have Dr. Lucky, and a pun intended. I think that's especially true just because like you get so many results and

you can sort of work yourself into a tailspin of like online Google searching and and, you know, forum searching. And it's weird because it feels like in this day and age that you can find anything on the internet. And while you can find anything, a lot of the stuff like doesn't really tell, it's never going to be the same as hearing it from someone who does these procedures every day, who's seeing, you know, actual real physical patients all the time, who knows what these results actually mean in the grand scheme of things. And to me, there's nothing really more like soothing than hearing from someone who's seen it all, who's been through it all, who can tell you like the truth about even like the tiny,

everything from the tiny little results to, you know, a miscarriage. And so I think it really sort of highlights the importance of finding the right doctor for you and finding the correct information. We go through a lot of things that you could see online that are kind of really not true or people take, you know, there's a lot of misconceptions about birth control out there, especially like when you're going through like an infertility rabbit hole where you can get scared that the fact that you were on birth control, you know, has caught, there's a lot of stuff that just kind of like conspiracy theories.

And there's so much content out there that I think it's really helpful to like get to the source with real scientific data. Totally. In those moments when it's like five in the morning and you just peed on a stick and it was negative and you can't call your doctor and you feel out of control. and you just want to feel some sense of control, the only thing you have is your phone in your hand and you just start digging and stirring up a bunch of crap. You know, even if it's just people's opinions about, you know, this or that or, you know,

how a celebrity wants to phrase their struggle or what they did or, you know, it's just, these are all so subjective versus what you're going to get when you're sitting in a room with a doctor that you trust. So I really, I hope I can encourage people to do anything but that, to feel more in control in that moment. Go make yourself a smoothie. I don't know. Anything but digging down a rabbit hole on your phone when you're feeling.

Totally. Especially because it's not like your friend necessarily, like you can't get immediate access to your doctor. Yes. When you see, you know, you see the result in the portal or you freak out and you haven't like spoken to anyone yet. It can be easy to do that. So I think what you're saying is also really good advice.

Like it can be tempting to want an answer immediately and to want to figure it out like right away. I can't focus on anything else. But if you can manage to like breathe through that and come at it in a calm way and like wait to speak to an expert where the doctor is, I think your mental health will be a lot better for. Totally. Because there's so much junk out there that's just going to scare you because people are posting whatever they feel like, feel like it whenever they're in the mood. So if someone's in a really negative headspace about something,

they're going to throw it out there and that's maybe not the headspace that you want to be joined up in in that moment. Totally agree. So I think you guys are going to love this episode and you just get a lot of actual facts from Dr. Lucky. Again, she's seen it all, the things that, you know,

you might want to do to help improve your fertility and the stuff that doesn't really matter. So let's bring her on. Let's start this interview. I'm very excited to introduce Dr. Lucky Sigon, a double board certified OBGYN and reproductive endocrinologist, an infertility specialist practicing at RMA of New York, and my personal fertility doctor. I'm so excited to have you on. Welcome.

Thank you so much for having me. I'm obviously a huge Betches fan, and I'm an avid listener of all of your podcasts. Yes, I think, like, it's been so cool to work with you in this way and also, like, all of my friends see you. And I mean, I think I can say this because Sammy's already talked about it. But Sammy also saw you when she was freezing embryos. Yes. And I feel like you are the Betches' fertility doctor, unofficially. Honestly, like I have three dream jobs.

One of them is being a fertility doctor, so I can check that off my list. I would love to be your resident fertility meme expert because I do that anyways. And then the third one is obviously being on the Real Housewives of New York, either as a fertility specialist or just like a character, you know. I could see that for you. Definitely. it'd be funny to like film that in your office. Yeah, that probably would violate HIPAA. I don't know how well that would go over.

Potentially, potentially. Okay, so I always wondered this. What does it mean to be a reproductive endocrinologist? Like the infertility part makes sense to me, but what does that even mean? Yeah, so I usually shorten it to fertility specialists because I feel like it's a mouthful, but really what reproductive endocrinology is is really understanding how the reproductive hormones work. So, you know, you can go to a regular OBGYN and they have a lot of expertise, but people that

are REIs have special training. We spent at least a minimum of three extra years just focusing on problems that surround fertility, even fertility preservation, or helping people deal with gynecologic issues that could one day impact their fertility like PCOS and ametriosis and fibroids. And the vast majority of what you do, is it usually IVF or is it, really just kind of everything. I mean, we definitely do a lot of IVF, but IVF is just one treatment approach, right? There's a lot of other things we do. People will talk about IUI, which is basically inseminations where you're putting the sperm close to the eggs. We help people with irregular cycles, because if you're not ovulating regularly, if you don't get a regular period, it means your ovulation

is irregular and that means you're not really in the game. You don't know when to try. So we do a lot of those types of treatments as well. But I feel like IVF is the most quote unquote sexy thing that everyone always talks about and focuses on. But there's a lot of other things like egg freezing, fertility preservation for the future, helping same-sex couples build their families, helping individual parents by choice. People often say like single moms by choice, but I like saying individual parents by choice because I've seen men and women who aren't partnered, but they still want to have a family and we can help them. Right. And I think you see that more and more. I see at least maybe more publicly about a lot of single women who, you know, they don't want to,

they don't want to be like rushing dating. So they're freezing their eggs as a backup plan or even, you know, as a first plan if they want to have a baby on their own. I'm sure you, and I feel like I've seen so much more of that on Instagram. It's so much less stigmatized than it used to be. Yes. And I love when people share. I don't think everyone has to share, but if you're comfortable sharing, you never know how many people you're helping. And I also think seeing celebrities do it on their own. We don't always have all the details, but I think people are feeling more empowered now than ever to make the decision that's right for them, whether or not they found, quote, unquote, Mr. Wright. Right. And I think the celebrity thing, which you've talked about on your Instagram,

we'll tell everyone where to find you. The celebrity thing, I think is so interesting, because I remember growing up and seeing, you know, various celebrities and they're having babies at like 40, 42, 45. And I do remember feeling like, okay, like, I, you know, especially when, you know, dating, I was like, I can have a baby, you know, at any age. It's not, you know, because that would be the thing that would give me the most anxiety. I think when dating is like this biological clock. For sure. Thing. But I also think, you know, now that I'm like in the thick of, of fertility treatments and that kind of thing, there is a sense of like, most people are not really telling you the whole story. So you're really just seeing that someone had a baby at 42, but you're not seeing

how long it took them to get there. Yeah. I think it's a double edge sword. On one hand, I love to see it. Because if you talk to your mom and especially your grandma, like they will tell you this was not something people shared. It was something that was shrouded in stigma, shame, and people were so afraid to talk about it. And they, you know, were being judged. So rightly so. Now people are shouting it from the rooftops, you know. And when we see celebrities coming out and talking about it or there are headlines that highlight their stories, it makes people feel less alone, right? Infertility affects a lot of people, one in six.

couples or individuals will have some form of fertility issues. That's a lot. So a lot of people are feeling seen and heard and represented. I think it normalizes it and that's really important. But the flip side is, like you said, it can give you a false sense of reassurance about what science can overcome and the things we can accomplish. And while I think IVF has come a long way and the technology is so great, we see that it's not perfect. And, you know, there are certain things that are really hard to overcome, like Naomi Campbell and Janet Jackson getting pregnant in their early 50s. It is pretty miraculous, but we don't know, was that with a donor egg or was it with eggs they previously froze or embryos they previously froze? That's in reality the most likely

thing, but all we can do is speculate. Right. Yeah. And it just, it does, I guess, again, it kind of like hazes, because you're seeing the success. Yes. But you don't see all the people. And I mean, I saw the Jennifer Aniston thing where she, you know, talked about. That was so powerful. That was really. powerful because it's kind of like you're seeing something where it didn't work, which it's not, again, it's not, I don't think it's so helpful to, like, scare people. But I do think that there's something in that of like, okay, here's a situation where it didn't work. And this person had all the money, all the resources kind of in the world. And it just gives you, I think, a more balanced perspective of, oh yeah, of course you should be hopeful, but also maybe like you should be very proactive

also. Yeah. I always joke, like I'll make these memes about celebrity stories and say, like celebrities, they're just like us. And it's a play on that like Star Magazine, you know, those headlines and the tabloids. But it's true. Infertility doesn't discriminate. What is the differential is that sometimes treatments, a lot of times treatments can be very expensive. And they have all the resources, but even stories like Courtney Kardashian. They're like the richest people in the universe.

And, you know, she struggled. But then at the end of it, she had a happy ending, but we don't know how and why and all the details. So I hope that's revealed because I feel like that's like a very important part of the story. I don't know if it will be. I feel like they pick and choose. Right, which to me is sort of like almost worse than saying nothing. Yeah. I gained a lot of respect for Jennifer Aniston because I think that she delivered a message that isn't popular. People don't want to hear what she has to say. I mean, it's obviously sad and disheartening, but I think she probably helped a lot of people and we'll never know how many. But by saying, you know what, I wish I knew about egg freezing. Even with all of my privilege and all the money in the world, no one really sat down and talked to me about this. Maybe she had such a busy career that time just slipped by. And I'm not saying everyone has to have kids or that everyone who doesn't have kids is going to have regrets. But I think everyone should at least carve out the time. And I'm a huge proponent of saying make a thoughtful decision.

Really focus on what you want out of life because trust me, as a busy career-oriented professional woman myself, time flies when you're busy and you're trying to kill it at work and you really need to take the time to think about your personal and professional goals. Totally. And I think that maybe like in the stigmatizing way, it can feel like if you're deciding to freeze your eggs, then you are, you know, taking yourself out of the game or you are, you know, admitting to maybe not meeting someone or, you know, and I, I understand, that's like an ego thing. I think that stops people from doing that sort of thing. But I had this, who was I taught, I was talking to someone about this the other day where I feel like in the future, it's going to be so normalized and the technology is going to be so good that like it will be as normal as going on birth

control. Yeah, for sure. So I've already seen the change. We've looked at our data. I work at RMA of New York. We do thousands of cycles a year and we have so many doctors. So we have probably the largest experience in the country and we've been around for 20 years. So I will tell you that even during my training, roughly a decade ago, I don't want to date myself, I saw that exact sentiment where it's like the person sitting in the chair who's there to talk about egg freezing, shoulders slumped, feeling down on themselves, feeling like they thought they should be in a different place in life at this point. It is very different. Obviously, I still see some of that. But now the narrative has flipped. I see a lot of women that are partnered. They do have a boyfriend. But they're like,

this is for me to take care of myself for the future because I'm not relying on this guy. Like, I don't know where this is going to go. But I think people are coming in feeling empowered. They don't feel that sense of defeat. A lot is changing when you look at the the trends 10 years ago, the average age of the person freezing their eggs was like 37, 38. Now it's closer to 34. I'm seeing a lot of women in their late 20s, early 30s that are not coming in feeling as fearful. They're like, this is normalized. All my friends are doing it.

And this is something I want to explore. And not everyone who comes to talk to me actually does it. But they're at least having the conversation, which I think is so important. Yeah. I think that, I mean, that must be a huge difference. And also the technology, I'm sure, makes it so that it's slightly more successful, I would imagine, than it was years ago. It's way more successful because we used to do something called slow freezing, which is exactly what it sounds like, just slow programmed cooling. And now we do rapid cooling called vitrification.

Everyone's doing that now. That's like standard of care. So really much better thought survival rates, better outcomes. But the biggest game changers, people are doing this younger when they have more eggs to freeze. and they're better quality. And I think part of it is improved awareness and a lot of it is more insurance companies are covering this. Right.

That was another thing I was going to ask about. I feel like there's a lot more benefits than there were before or companies that, some companies that totally cover it or that just offer a lot more than they used to, especially in cities like New York, I'm sure, or companies like that who want women to remain in the workforce that want them to be being able to focus on that without having to worry.

I would say 10 years ago looking at it, our data again, zero percent of cycles were covered. Now it's about 50 percent and it's growing. So that's really encouraging. PSA that I always like to share with people is, you know, most of your listeners are probably like young people in the professional workforce that, you know, when they're going on interviews, don't be afraid to ask, do you have fertility benefits or do you have benefits for egg freezing? Because HR will start to notice that that's something that's a driver. and, you know, people talk about how post-pandemic, the workforce is more focused on perks and, you know, what comes along with your salary. And I think that we all need to kind of drive this change and really advocate.

And if you're already working at a company and they don't benefits, go talk to your HR. And I've always said my DMs are open. I've had so many opportunities to talk to HR people and companies and go give talks. And sometimes it works. It's worth the effort. Right. Yeah. I think, I mean, to me, it's like something that.

could save you if you're interested in it, thousands, tens of thousands of dollars. Yes. I guess let's backtrack and talk about, because obviously, like you said, like IVF is the is the splashy thing that probably most people want to talk about. Yeah. But just like from the get go, how like I know there's, there's a lot of traditional advice about when to see a doctor if you, you know, are having trouble conceiving. And it kind of feels like to me, it's almost, it's funny. I feel like my friends are either in the, we got pregnant immediately, like the first time we tried, or it's taking like a year or more. Yeah. So it's interesting because it almost feels like, but you still like the average, I think the average is like three months or something to get pregnant. Yeah. It really depends on the person,

right? I think what people find shocking, because health class doesn't teach you this and maybe it's good. They don't tell a room full of teenagers. It's actually kind of difficult to get pregnant or challenging. But even in your 20s, when you're considered in your most fertile phase of life, and we think you have great ed quality, right? Even then it's like 20% chance each month that you're going to get pregnant. So we normally say the majority of couples, like 85 to 90% will be pregnant after one year of trying. So that's why, and I think it's, you know, a good thing to tell people, but I also think sometimes it's used to dismiss people, too, that have concerns because it's like, oh, you're so young. Like, you've only been trying for four to five months, like, keep going.

the reason you're given that advice is that it might be completely pointless to do testing or, you know, it might be premature to do treatment at a certain point because it just takes time and persistence to get there for, and the reason it's so inefficient is, A, there's like two to three days where it actually makes sense to try because when you ovulate or release an egg, it doesn't wait around, you know, it's like 12 to 24 hours. So you need to really concentrate your efforts like out of every calendar month for like two days. And even if you tell you, it perfectly, there isn't a guarantee that the sperm and the egg are going to like each other and get together and actually turn into an embryo a week later and actually be a normal embryo that

implant. So you're expecting a lot of things to line it perfectly. And obviously it's going to take multiple tries, usually for the average person to get there. And the reason why you might hear, okay, you're under 35, you have time, like you can go up to a year. But if it's been a year, it's time to get testing and treatment is because of that statistic, which I just shared. Right. but it's not wrong to be seen earlier. And in a city like New York, where everyone most of the time is like type A and wanting to be proactive, I often see people earlier than that. So I think, you know, you got to talk to your OBGYN or your primary care doctor.

And if you have concerns, I think it's fine to seek that evaluation out sooner, especially if you have certain features. Like waiting a whole year and being under 35 is not appropriate if you don't get regular periods because then you don't even know when you're ovulating. Right. If you have really painful periods or, or heavy periods or you have a family history of early menopause or anything that's like a red flag to you where you're like, this might be a problem. It's always better to just be proactive and go in

earlier. Right. And I feel like it's so hard to tell like if you're on birth control. If like, because to me, it's funny. I like, I didn't realize that like a period on a birth control pill was not a real period. Right. So I just assumed I got regular periods because it would be like the withdrawal week and that would be like me getting periods. Yeah. But then when I went off birth control, I mean, that's why I had originally come to you is that I didn't get a period. But it's funny, just like even, you know, being at the time 32 years old, not knowing that that wasn't what I should have been looking for. It's just interesting how little information we're really taught about our own reproductive systems until we're really trying. Right.

And it's the pill is a tricky thing, right? Because it's something that is basically you're building up your lining and you're stopping it for a week if you take the placebo pill, the sugar. pill. And then you're shedding like a fake period, basically. It's not because you ovulated. And so that's something I see a lot. And people villainize the pill because they're like, well, you know, it masked that I had PCOS or I all of a sudden went off of it and then started having painful periods. It masked that I had endometriosis. I do think it's important to know what's going on with your body. But the pill is actually a really efficient way to treat or effective way to treat things like PCOS and endometriosis in different ways.

And so it's like you were unknowingly treating the problem. But people, I think, feel a lot of a sense of betrayal. They're like, oh, my God, I went like, I don't know when this problem occurred. And now it's uncovered because I went off the pill. But I want to make it clear the pill definitely doesn't cause those problems. Oftentimes we're going to recommend the pill as a great option to treat those problems. And I'm on TikTok and Instagram and I see like it gets villainized all the time. people are like, doctors are just throwing the pill at everyone. I obviously don't think that's

the right approach. But yeah, you're right. Like if you are on the pill, you're creating this fake period so you don't really know your pattern. So one of the things I always say is once you do go off the pill because you're ready to start trying or for whatever reason, obviously be prepared that you could get pregnant. So anytime someone's like, should I go off for like a year and just let my body get back to its normal? I'm like, only if you're okay with getting pregnant, right? and that's especially important in these trying political times. But I think monitoring your cycle is the first step. Like track it.

And don't just track when you get your period. That's obviously the most important thing. But any symptoms, even if you're getting migraines, like track that because that might have a pattern where you're like, oh, that's a menstrual migraine. There's a whole host of symptoms that might revolve around your cycle and understanding your body, I think is really important in general. So just tracking is the first step. Right.

Yeah, no, I think that, I mean, that's helpful information. And I think that, again, even if it's not a year, to me, like, if I do look back, I'm kind of like wishing that I went off a little sooner just to like, because if I went off right when I wanted to start trying, I feel like you don't get that. It feels a lot more dire. Yeah, but you were like observing. Yeah, but you were like, observing. Yeah, I mean, it wasn't my ideal situation, but it would have been fine. And one thing I want to say is if you're over 35, we say don't wait longer than six months. And that's great advice, you know. even if you go in at the four to five month mark just to start getting some preliminary tests done. And if I waste my breath talking to you for an hour and you end up getting pregnant on your own the month after, like, that's great. I love when that happens, right? It makes my job easier. If you're 40, don't wait longer than three months. I know that sounds like a really short amount of time. But it's important to understand that obviously not a popular message and it's going to make you feel nervous. but we have to confront the fact that we don't make new eggs and we don't fix our eggs over time. So egg quantity and your quality of your eggs changes.

And it does change at a faster rate as you get into your late 30s and 40s and beyond. But I also want to balance that by saying people get pregnant on their own without my help all the time in their late 30s and 40s. Right. And so it's just that it takes longer to ovulate that healthy egg and there are higher rates of things like miscarriage. So you just don't want to wait a long time because time equals eggs, right? Right. And it's also just kind of feels like, like you said, like there are these statistics, but everyone is so different. So it's so hard to like know, especially if you've been on the pill for a while just like what your body is like off of it, what, you know, what issues you might come across. Totally. So I think that's an important message. But I mean, speaking of the birth control issues and stuff on on the internet with a lot of people saying it's bad or don't take it or it's the reason that you're, you know, having trouble with. infertility. What else have you seen out there? Because I've seen it all, I feel like, and especially in the Reddit threads or everything. I feel like there's so much out there. And it reminds me almost of

like the advice you see about dieting where one person's like, you know, don't eat any fat. And the other person's like only eat fat. And you're kind of, and I think when you're trying, you're kind of like, I don't know. Right. And I don't. And the stakes again feel so high. Yeah. That I think it would be great for you to like, you know, what is the most popular thing you see that's just a complete scam? Oh, well, how much time do you have? So I want to say anytime I post about birth control pills, that's like a morning I wake up and choose violence because I know there's going to be violence in the comments. It's so polarizing. I think people mistake me saying that the pill shouldn't be villainized. It's not a cause of all the problems, like you said, with saying like it doesn't have side effects and

it's for everyone. No, that's not true. I mean, there's so. many different formulations, and maybe it's not for you. But I think a lot of people just shut it down when I'm talking to them about it, if I think it's the right thing to recommend because they're like so afraid of all the stuff that they've read online, right? But another area of misinformation is, you know, all of the ways that you can fix your egg quality. I mean, people are making a killing off of that fear that women have, right? They're selling super expensive of supplements. Like, I'm talking, I've seen supplements that cost $1,000. What are even in those supplements?

God only knows. I mean, that's a good point to bring up, too, because people automatically assume the word supplement means all natural, better than the evil pharma companies, right? Better than a medication that could be prescribed. But it's actually very unregulated. And it's scary. They've done studies where they've looked at certain supplements and found all sorts of compounds and things in it that aren't good for you. And I've talked to cardiologists who are like, yeah, I'm seeing tons of patients with like arrhythmias. I've talked to liver specialists at see patients and liver failure because I think we've like gone in this direction where people just are in overdrive with the supplements because it feels

good to feel like you are taking control of your health. And, you know, everyone's doing their research, but it's really hard to vet who's actually giving you good scientific information and who's just trying to make a quick buck. So I think it's hard. I think, you know, when it comes to supplements for fertility, my advice, this is what everyone will probably want to know from this, is if you're not trying to get pregnant, I think it's fine to just be on a multivitamin. If you're trying to get pregnant, a prenatal has a very specific formulation, and you want

to be specifically on folic acid, ideally a few months before trying to get pregnant three months. Right. And it's to prevent certain types of birth defects. And so you don't need, like, the fancy form of folic acid and really just go to the the ACOG website, ACOG. It will break down all of the things that are ideal to have for pre-pregnancy and in-pregnancy and look at the label on what you're using and see if it compares. That's the simplest thing. But honestly, like a lot of the cheaper ones that are just like at CVS or Dwayne Reed are actually more closely adhering to the recommendations than the fancy, nicely packaged ones

that are expensive. What about COQ10? I love CO-Q-10. Yeah, because it's not going to have any harms. I mean, it could have some GI side effects, but honestly, I have yet to meet a patient that's had any side effects from it. I take it. It's good for so much more than fertility. It's a really potent antioxidant. It's been used in other fields of medicine for a variety of indications. So I don't have a problem with people doing things like that, even if we don't have the greatest

data, because it might be helping their overall health, and it's certainly not going to be harmful. But there are other things like DHA, which is like giving yourself a form of testosterone, essentially, Lots of side effects, and there isn't a lot of good data to justify taking on those risks. That might not be popular because a lot of people are recommended to take that. I think everyone can benefit from vitamin D. There's some data that shows better or higher pregnancy rates in the summer months, and we think it might be related to exposure to the sun and more vitamin D. So most of us are deficient living here.

And it's like a hormone, right? It's actually, yes, it's a complicated thing that can affect more than reproduction. so I feel like it's a good thing to be on. But it's going to be in your prenatal as well. But taking a little extra can't hurt. Got it. Okay. And then what about,

I mean, I've heard, like you hear a lot in the supplement sort of world around avoiding these, you know, products, maybe mainstream. I've heard, you know,

you can't use any, anything scented on your, no, no scented detergent, nothing, you know, something about the parabins. Yeah.

Like a lot of like, you have to be super clean in all of your products and or, I mean, And to me, obviously, like, you see tons of people who get pregnant who are living very, like, toxic lives. Right. Toxic lives. You know, you always see, like, just people who are, you're like very, are, you're sure are not buying the unscented deodorant or like the aluminum free deodorant.

Yeah. Yeah. So it's tough because you're kind of like, well, maybe that's it and it can't hurt. Yeah. But also, like, then you're living your life in this, like, ultra-controlled way. and does it actually do anything? No, again, I think it comes back to, for some people, it's really helpful to say, I'm going to control whatever I can control

because you can feel really out of control when you're not sure what's happening with your body and why you're not getting pregnant, right? You can't control what's happening inside your reproductive tract and force things to happen. You can try, but it's not going to work. So there's so much left up to chance and the unknown and you just have no way of controlling.

So, of course, controlling your diet, your supplements, your environment is maybe going to make you feel better, but it might make a lot of people feel anxious and, you know, drive them nuts as well. So I don't think that there's nothing to it. Obviously, our environment can impact our health. And, you know, there are so many different types of compounds that are used, chemicals that are used as preservatives.

I think you have to take a very measured balanced approach, right? If you think about all the different variables that could impact your health and your fertility, you have to think of them as being weighted differently. Unfortunately, age takes the most weight. Like, that's what I care about the most. And that's something that we need to keep in mind in terms of how aggressive we need to be or, you know, whether it makes sense to be proactive in certain ways.

But then, yes, like lifestyle does play a role. It would be foolish for me to say it doesn't. You know, anything that's good for your heart health is going to be good for fertility. So if you think about it like that in a more holistic way, it's less overwhelming and you're like, okay, I'm just going to try to be healthier, right? I'm going to adhere to like a Mediterranean-style diet because everyone knows that is healthier. It's chock full of antioxidants, low in processed carbs. You're eating lean protein, seafood. I mean, it's all good. Keeping alcohol intake to a minimum doesn't mean you have to cut it out of your life

completely. You know, some say it could be helpful to have a glass of red wine here and there because it does have antioxidants in it. But I would say less than four drinks in a given week, which is actually kind of strict, I think. You know, when I tell people that, their eyes pop out of their head, They're like, uh, okay. Do that in a night. Exactly. Yeah. But that's, you know, a hard thing to study.

But if you look at the body of literature, it's kind of the trend is towards better pregnancy rates, whether you're talking in patients trying on their own or with treatment, if they are at that level or below. Okay. Not smoking is always going to help you. I mean, smoking is one of those definitive things where like this definitely can impact your fertility. And for sure, it's going to impact your general health. So not to be preachy, but if you're smoking, you should stop because it can put you into

menopause earlier. A lot of people don't know that. But yeah, I think, you know, when it comes to all the things you were talking about, like endocrine disruptors, that's what they're called. It's a real thing. It is a real thing. My whole take on it when I was trying to get pregnant and when I've been pregnant is I'm just going to minimize my exposures as much as I can. Like, it is kind of silly to be using plastic for our foods and warming up plastic because microplastics do get into your food. And, you know, do I know it has a direct effect? on your case and your case of infertility? No, I don't, but whatever we can do to reduce those types of exposures make sense. So, like, switching to glass bottles, you know, I think fragrance is an easy

one to cut out. I feel like fragrance is kind of offensive to the other people in the room a lot of the time. And we don't really know what's in it. It's just on the label, fragrance. So there's a lot of chemicals that we know can go into fragrance that have been shown to be associated. See, we can't really prove causation. But there's studies where they've looked at these compounds in the urine of women and men and compared it to sperm quality, compared it to their pregnancy outcomes. And especially if you're pregnant, those exposures might have some sort of indirect effect. So I'm not promoting trying to live in a bubble and being really paranoid about your environment. But I do think it makes sense to at least try to pare it down a little bit.

Like try to simplify your life. And if you know that there are easy ways to cut certain things out certain exposures, I'd say do it. Okay. I mean, that's helpful. And what about dairy? Because I've, you know, when I was, when I first went to the gynecologist and I was saying, I was, I was, you know, thinking about it, she was like, eat lots of dairy. And then I, you know, saw something online that was like, you need to cut out all of your dairy. Yeah. So what is the dairy verdict? Yeah. So dairy and gluten. Those are like the two that is really popular for like just restricting yourself and kind of torturing yourself, I think. Obviously, obviously, if people have gluten intolerance or are they lactose intolerant? Yeah, like having an inflammatory reaction

to these foods, like it's not great. It's going to make you feel sick and it's just like not good for your general health. But if you don't have an intolerance, there's no reason for you to cut those things out. Enjoy your life. Eat the bread, drink the milk. Okay. Good to know. I feel like milk is illegal now. Like people look at me crazy because I live in Williamsburg. If it's not oat milk or like cashew milk, I'm a weirdo. Right. They don't even carry like whole or skin milk. It's like toxic. It's so weird. I don't know.

It's crazy. But yeah, you see so much, I think about, and what about working out? I've also seen that. Or it's like work out, but not too much. I know. But like, but more than you are, but less than like you used to when you were. Especially, I'm sure you see so many women who probably just got married and were like, and that was me.

Totally. Where I was like really working out. And then again, like the messaging is all like a little, feels a little confusing. You don't want to be extreme. That's like the theme of today's conversation, right? So extreme on the side of working out too much is like, yeah, if you're a professional athlete or you're training for the marathon, plus also caloric restriction. So basically your brain, right, that's supposed to send signals to the ovary to tell it

to ovulate an egg can get stressed out and say, oh my gosh, there's not enough energy for us to even just maintain normal day-to-day function. Like, let's shut this down. We're not going to ovulate because we can't support a baby right now. That actually does happen. but it's not because you went to Pilates five times in one week. It's like, you know, people who have disordered eating, you know, or if they're exercising a lot and restricting calories, if you're stressing your body out, like you know, you know when you're being extreme, right?

But really it is recommended for fertility and just for your general health, again, going back to heart health, you should do cardio like three times a week. If you can, at least like 30 to 40 minutes, it's better for you, right? Right. And so a lot of times I hear people saying, I'm not exercising. And I'm like, well, that's not good either, right? You're like deconditioning yourself. And it gets a lot harder once you're pregnant than to get back into it. And it's been shown time and time again that pregnancy outcomes are better if you're someone who can exercise throughout your pregnancy, obviously with modifications. So I think this whole thing about like you shouldn't exercise at all is complete BS. And I think you just don't want to be extreme. This episode of Baby Steps is sponsored by BetterHelp. 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 spell 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 BetterHelp. Visit BetterHelp.com slash baby steps today to get 10% off your first month. That's BetterHelp, HELP.com slash baby steps. And let's talk about PCOS because, you know, I have lean PCOS. I know like a ton of people who have been diagnosed with that. Is that like a new thing that people are getting diagnosed with more or am I just seeing it everywhere because I have it? I think you're seeing it everywhere because it basically tends to emerge in your 20s and 30s. And,

And maybe because our generation, a lot of us have been on the pill. And then we're only noticing it when we go off. I don't think it's more prevalent, but I do think it's really common in general. And maybe people are just talking about it and sharing more and actually getting it diagnosed because that often happens where people are like, oh, I've just had these really irregular periods for years and I never really, no one ever looked into it or told me anything about it. And then I'm the one diagnosing it.

So what it is is important to understand in a nutshell. it's basically that signal that your brain is sending to the ovary to ovulate. It's almost like your ovaries are resistant or stubborn. Right. And why that is, we're still trying to figure out, but it's a combination of your genetics. It's a combination of potential environmental factors. It's linked to your metabolism, oddly enough. So it's like the ovaries are resistant to the signal, but also a lot of times the cells

of your body might tend to be resistant to another hormone called insulin, which controls your blood sugar. So a lot of women with PCOS will have like a common family history where they're like lots of diabetes, lots of high blood pressure in my family. It doesn't have to be the case. But you have this metabolic component, which brings me to my next point, which is a lot of women with PCOS might have trouble with weight gain. But that's not one of the diagnostic criteria. And there is this subsect of women with PCOS that have lean PCOS. And, you know, I like made a joke once that like people feel complimented because they're like, I guess you're calling me skinny.

But it's important to recognize because a lot of women with lean PCOS might get dismissed because their OBGYN or their doctor might just say, you know, well, no, you don't look like someone who has PCOS. But what we've learned is these signaling problems can happen regardless of that metabolic component. And it doesn't take very much to rule in for the diagnosis. If you have irregular cycles, if your ovaries look a certain way, you tend to have a lot of eggs and they're kind of crowded. There's an appearance.

You can Google image it if you don't believe me. and then often there might be this, you know, high testosterone levels. Your ovaries make testosterone. A lot of people don't know that. And it all seems not related, but it is related. And there are ways with lifestyle approaches, diet, exercise, but not always can be controlled with your lifestyle, so don't beat yourself up. But also even medications to, you know, bring down that insulin resistance and lower the

amount of testosterone being produced by your ovary. Those interventions alone could make your cycle a bit more regularly. right? Even without any like other medical intervention. Yeah. So I think getting a thorough workup and making sure not missing anything because one of the major things that we do when we're diagnosing PCOS is look for thyroid issues, look for other hormonal imbalances that are completely unrelated that can mimic PCOS. I think going to a specialist makes a lot of sense in that case. Yeah, that makes sense to me. And I think, you know, like there seems to be like a pretty straightforward plan of action. Yeah. If you're not trying to get pregnant,

understand what's going on with your hormones because no two patients with PCOS are the same. You guys are like snowflakes. Okay. So you have to be treated like an individual. There isn't like a cookie cutter approach. Some people have acne. Some people have quality of life issues like that where you're like, okay, well, I can put you on a medication called spronolactone that will, you know, lower your testosterone levels

in your skin and it works really well. If you're trying to get pregnant, then we need to get you to ovulate regularly and at least help you to understand when to time your attempt. and if that proves frustrating or it gets annoying after a while because it's like unfair that you have to do a little bit of work to just do what everyone does on their own every month. And, you know, I think that that can wear on a person. So sometimes people will move on and be like, you know what, let's just bypass this whole ovulation thing and do IVF, which is stimulating your ovaries, taking eggs out, making embryos, and then just putting the embryo into the uterus and not really

fuzzing around or worrying about when the egg is being released. Right. Which is what, you know, what I wound up doing as well. And then also just kind of like, I remember when considering IVF, there was like that factor of like, you know, feeling like because I had BZOS, it would take me a little longer. Yeah. And then also feeling like, you know, I didn't, let's say I do want three kids or something like that. And I am, you know, in my mid 30s.

So I think there's this, this sense of if you, you know, if you're lucky enough to be able to afford it or you have insurance that covers it or if it's accessible to you, this idea of like, even if it's not, even if I, you know, it could be fine right now, I want to know that in the future that I have, you know, I'm not being held back by the biological clock. Because something I always see that you say on social media is that your uterus itself doesn't actually age. Yeah. I feel like nobody knows that. And so I'm going to keep shouting it from the rooftop. I need to get merch and put that on a T-shirt. Forever young. No, but it's so important to know that because the one thing that affects, you know,

when it comes to timing and age, the one thing that is affecting your fertility are the ovaries and the eggs they contain. If you take the eggs out of that environment and you freeze them, they're not aging over time. That's another misconception that, oh my gosh, they're going to get freezer burn, but that doesn't actually happen, right? Are they cold in there? I don't know.

Yes. They stay stable. They're in liquid nitrogen and they're not going anywhere. They're not aging and there's no metabolism. So you can effectively, I've had patients who have frozen their eggs or they made embryos, which we'll talk about. and they've come back in their 40s and gotten pregnant very easily because we've kind of canceled out the thing that would have originally made it very difficult at that age to get pregnant.

Your uterus will always be able to respond to hormones even if we removed your ovaries, which hopefully you don't have to go through that, but we can give you the hormones to support that early pregnancy and then your placenta starts churning out those hormones at around seven weeks. So you could be in menopause and I could get you pregnant if you had frozen your eggs, which is amazing. Yeah, that's kind of incredible. I mean, and I guess one of the few benefits of PCOS is that a lot of the times you do get a lot of eggs. Yes.

Right. Yeah, we still haven't really figured out the link. It's not as simple as, oh, you weren't ovulating. So you're like stockpiling them because if that was the case, no one would freeze their eggs and we would just put everyone on birth control. Right. But we know that there's an association. A lot of women with PCOS tend to have a lot of eggs. It's not a necessity.

It's not like you have to have that to be ruled in. But yeah, it's an advantage. I think there's also like a lot of people that have been told, I have PCOS so like I'm never going to have kids. And I think that's so sad because that's so incorrect. And imagine having that weighing on you since you were a teenager. I've heard that multiple times. The main way it affects your fertility is that it makes it hard to know when you're ovulating or you're not ovulating so you're not in the game. But that's kind of one of the easiest problems that we correct. Right. It's just annoying to have to do the work to correct it. Right. Yeah. I think a big thing when

doing IVF or any really fertility treatments is like there is there does tend to be this sort of false sense of control yes to an extent I mean obviously you're you're doing more controlling than you are just if you're just trying naturally yes but I do think there is this this sense of like okay and especially I think for me where it's like you know you you get a lot of eggs you're lucky enough to make a lot of embryos and then you're like okay well like that's it I'm now controlled the situation and now it's like done, which is like not always the case. Correct. I think that's so important and people are talking about that more.

Like IVF doesn't mean, you know, that's the ultimate step that's going to get you there. Right. Not a guarantee. Yeah, it's not a guarantee. That's the saying. IVF is not a guarantee. And that is true. And that goes back to what I was saying when we're talking about celebrities, right?

Right. I think people overestimate. Like they think we're in the sci-fi world now where we can just overcome everything. And I think, yes, IVF has been around for 40 years, and we've gone from single digit percent live birth rates, which I don't know how anyone practiced in this field. I would be so depressed. But my mentors will tell me about that. They're like, oh, like people, we used to be like surprised, like 5% success rate. Right.

Now what we actually see is like, okay, each embryo that is, if we know it's genetically tested, which is something we can do now, which has been a game changer. each embryo has about a 60 to 70% chance, best case scenario, that it could implant and result in a live birth. So, yeah, like a large majority of the patients going through an embryo transfer, which is part of IVF, where we drop the embryo off the top of the uterus, they're getting pregnant. But sometimes it takes a second try, and sometimes it takes a third try statistically because two thirds will work. So, I mean, that is much better than that 20%, you know, of trying each month on your own, which is more like 15% in your 30s. So it is considered much more efficient. And even I have that fallacy in my mind. Like I'm kind of really pissed off if someone doesn't get pregnant from the embryo transfer

because we do have high success rates. But I also know that you can't control everything. Right. And even though we can test the embryos, the testing isn't perfect. It's not telling you everything that's important. You know, you and I have 46 chromosomes, but that doesn't mean that we never get sick and our bodies don't break down in other ways. So there's just a lot.

I think it's like oversold almost and people will assume like, my embryo was genetically normal and tested. So like, why isn't it 100%? I'm like, because that's not how biology works. Right. Yeah. I mean, I saw, it's crazy though, the technology. Like, I can imagine that number will only get higher. I saw something online. I'm sure you've seen this where they made an embryo to 14 days or something. Was that it? They like from nothing, from no one. Yeah. Yeah, you can like activate eggs and you can get them to turn into embryos. That's a lot of stem cell research is being done. Right. So, like, you can actually direct the development of those embryonic cells, those stem cells, into

becoming cardiac tissue. It's like a very active area of research. And it's part of regenerative medicine and it may change the world. But it's not an embryo that could actually turn into a baby. Okay. That's important to realize. That's probably good. You can't grow up.

You can't just buy your own. I'm sorry, ladies. You still have not figured out a way to cut the men out, okay? Of the equation. We're getting there. We're getting there. Dr. Lucky is on the case. So choosing a clinic, and I know like if you're lucky enough to live in New York City,

I feel like there's a lot of options there. I'm sure a lot of places do not have to. I'm sure people who are flying in or coming into, especially with the laws regarding in different places. I mean, definitely from out of state I see more patients because they're like, I'm more comfortable freezing my embryos in a state that I feel confident will stay blue and not be an issue. Do I think that's necessary?

I don't know. I feel like you have to do what's comfortable for you. But like right now, people are able to do IVF everywhere in the country. It's just, it makes me nervous that people have challenged it and been like, an embryo is a person. And, you know, they want to put restrictions on how we practice. So I can see why people feel more comfortable. But I don't necessarily think that anyone in a red state has to do IVF out of state. I feel like that just adds a whole layer of complexity. And right now, there isn't anything in place where like I really think that there is a reason to do that. So just to put that out there. What do you think you should look for in a fertility clinic?

Like is there published information about success rates? Oh, yeah. Yeah. I just went off on a tangent. Sorry about that. But basically, you know, you, I think, need to feel comfortable. So first step is finding a place and that could happen a variety of ways. Your OBGYN will probably have colleagues that they know and trust.

So I think getting a referral from your doctor, if you like your doctor and trust them, then that's like a good starting point. I think even word of mouth, like a friend saying, like, I had a good experience with this person at this clinic. That is going to give you probably a very accurate assessment, right? That was their experience. I think you can look online too at reviews, but you have to be careful because, like, people are biased. But if the large majority of the reviews are kind of pointing in the same direction about a certain doctor in a certain clinic, then that can give you a sense of comfort as well. In terms of like the things to look for from a strategic standpoint, there's so many different types.

of clinics. And I will say they're not all created equal. And not everyone is practicing in a uniform way. And that's okay. Like variety is the spice of life. But I do think that there are things that, you know, if I was talking to a friend or a family member out of state and I'm helping them navigate where to go, what I will tell them, and this is my personal opinion as a professional in the field, is I think it's great to go to a large center that's been around for a long time. Okay. And, you know, that's because you know it's established. It's not going anywhere. So if you're freezing eggs or embryos there, you feel confident they're going to be there. Not going to go out of business. Yeah. And then have to like transfer them somewhere else. Like it's just, you know, that longevity

and also safety track record, right? Like if they've been around for 20 years, they know what they're doing in terms of storing your eggs and embryos and keeping them safe, whether it's like Hurricane Sandy or a blackout. Like there's contingency plans in place, right? Right. Those are things people don't think about. High success rates. And I think even if you're freezing eggs, you should care about their IVF success rates because it's a way to kind of detect, you know, which labs are cutting edge and have good quality control. And that might not be easy to come by data. And this isn't the greatest way to go about it, but there is an actual regulatory body called the Society for Assisted Reproductive Technology or SART, S-A-R-T-R-T-org. It's objective at least, right? It's a third party that we all

have to report to. Some clinics don't report to them. And I personally as a patient probably wouldn't love that. Like, I want to go to a place that's vetted and reports their data. because they get audited. And you can actually, it's not easy to navigate, but if you look up certain clinics, you can look them up by name, and you can look at the live birth rate per patient. And I'd say anyone that in the under 35-year-old age group, because when you start introducing age as a factor, it's variable, but if your success rates are like 60 to 70 percent, like that's actually pretty good, right?

Because that tells you not only that their lab is probably decent, but also they're able to support their patients and keep them in treatment where the majority. of patients are getting pregnant before they are discharged from the clinic. Oh, okay. It's kind of like an indirect hack. It's not the perfect system, but I think that that's helpful. But I think also questions to ask if you go for your first consult because, you know, I'm Canadian and where I'm from, like, you can't just doctor shop.

And I'm not advocating doctor shopping, but you can't just, like, switch doctors easily. It's very hard because everything's paid for by the government. Oh, I didn't know that. I always say that one of the benefits of living in this capital. capitalist hellscape that we call America is that you can take your business elsewhere, right? So like go for a consult and know that you're not like locked in. Speak to a couple people. Yeah.

You don't have to do that if that's overwhelming to you. If you like the first person you speak to, then great. But things to ask are like what are their policies surrounding certain things? Like do they grow their embryos to day five? Because that's like a more modern approach. Or like something like I know you guys don't transfer more than one embryo. But you know, to people give you like pushback about that. or some people want that?

Yeah, it's not like, I wouldn't say it's a rule. Every patient's treat it as an individual. But in the large majority of cases at our clinic, we're doing a lot of genetic testing embryos. So if you have a genetically tested embryo with that high success rate, it's actually against recommended guidelines. It's not the right thing to do to put more than one back because there's such a high chance of success.

And there's a really high risk of twins, which are more high risk pregnancies. Same if you're using donor eggs to make embryos. those are usually from donors in their 20s and they're going to have a really high rate of being healthy and have a chance of working. So the standard of care, right thing to do is to put back one at a time. But if a patient has a really hard case or they didn't test their embryos for whatever reason and they're older and it makes sense, it's justifiable to put back more than one, I will. I will definitely. But ask them if they have a policy on that because a place that's kind of like willy-nilly, like, we don't care. You're like, okay, well, do they care about anything? You know? Right. Or like

I can imagine, like, if you transfer more than one, it's more like it seemed like it would be, for them, they would get a higher success rate from doing that. Yeah. And also like, is that because their success rates are lower? So they need to do that. You know what I mean? Ask about if you're doing genetic testing of embryos, what will they report to you? Because it's not just normal versus abnormal missing or having extra DNA. It's like there's some in between results where it's like there's a mixture. And, you know, we will transfer a mosaic embryo. So it's like so granular. But like, Like that is a really good tip because people won't know to ask about that because you don't want to go into a cycle and then be like, oh, I didn't know that that wasn't even an option or that, you know, every clinic does things a little bit differently. So I think going to a large reputable place and being able to ask these questions. A huge question though, and the biggest source of stress for a lot of patients is lack of communication. So always ask your doctor, like, what is the best way for me to communicate with you? Do you provide your email? How do I reach out to you if I've questions because you will have questions. Yes. A ton of questions. And so I think being able to have

that open line of communication and asking about it in advance so that you're not blindsided. Yeah. That makes a lot of sense. And I'm sure like, I'm sure you see this with patients where if it's going well, you're the best friend. And if it's not, you know, there's like, there's still their best friend. You're still their best friend. But there's like, you know, there's probably like a frustration. Oh yeah. Even though those things are like beyond your control. It's the hardest part of my job. I think there is a huge emotional component to my job. And it's probably why I feel like I got hit by a truck every Friday evening. It's like, you know, there's a lot of emotional ups and downs.

And like we're riding that roller coaster with you. But I think you have to establish that good relationship. And it can't just be in good times only. You have to be like trusting the process. Yeah. And I think as a doctor, something that I really strive to do is like it's human nature to not want to have the hard conversations, right? But like you can't avoid them.

You have to confront the hard stuff straight on. And, you know, patients will stick with you. Patient dropout is the number one cause of people leaving and not leaving with a baby, right? Right. Is that they got burnt out. And maybe some of it is like financially related for sure if like you have to do multiple cycles and it's a hard case. But a lot of times it's like the emotional burnout.

Yeah, it's definitely an emotional roller coaster. It's an emotional roller coaster and you kind of have to be there and as present as you are during the good times and the bad times because there's nothing more gratifying. Like right before I got here today, I discharged a bunch of patients to their OB or, you know, and it just felt so good because a lot of those were tough cases where it's like that wasn't like a straightforward path, but we finally got there and that's really gratifying. Right. And I mean, something I think to wrap up, but I think that like is probably helpful for people to hear is

if you see people with enough persistence and who are probably open to, you know, trying multiple different things or going multiple different ways or different options to get. get there, do you see with the vast majority of people that eventually with persistence, it gets there? I do. And I don't mean that to sound like toxic positivity because I'm not about that. I just think that that should give people hope. But I also want to counter it by saying, it is okay to say like, you're done, you know? And that is a very personal decision. And again, I think we just have to support people regardless of what they decide. But don't let them be done

prematurely because I didn't communicate effectively as a doctor or because we as a clinic didn't support them or, you know, it's hard enough as it is. So any of those variables we can control and try to make easier is what we should be doing because it's a journey. And we want to get you to the end of it. We want to get you to the finish line. Right. And I think you see that most places, like, I mean, just in our culture or just anecdotally from people you see like most people with the resources who, you know, who hang in there and persevere long enough, you kind of see that in this day and age, they can, I definitely do. I also think, you know, sometimes people take a break. Sometimes people decide they're done and then they come back and they're like, you know what,

I've thought about it and I've kind of taken some time to heal. And I think that's important too. Like you need to put yourself first. It's not like do this at all costs at the cost of my relationship or my personal mental health. You got to take breaks and you have to really think, I think the best advice that I've ever given to my patients is that your life is still happening and you still need to live it. Right. And so all the things we talked about, the restrictions, all of that, like take a step back and realize that your life is still happening even though you're in this journey.

And like you have to learn to reconcile those two things and you can't stop living. You can't stop going on vacations. Right. And you just need to make sure that you're treating your whole self and you're not just kind of focusing on this one area because it takes. time. Yeah. And it's very stressful. And I would have met, I mean, the most annoying the thing, I think unsolicited advice or things that you get is like when you stop stressing. Oh yeah. It'll just happen. You know, like you hear like the, you know, the urban legend of the person

who decided they would like to take a break and then they just relaxed and everything was fine and it happened immediately. Yeah. Everyone hates that girl. Right. I'm sure stress does take a, take a toll on your body. But I mean, like, what is your, like, is that a reason to take a break if you're feeling overwhelmed? Or is that something where you're kind of like, it's not going to really make a difference? No, 100%. I think, you know, everyone can feel really anxious at times. You're never going to feel the exact same way throughout the whole thing, right? So no feeling is permanent. But if you're feeling like you're spending more time feeling overwhelmed and anxious and depressed, then not feeling those things, then that might be a sign that it's time to take a break. Also, I have a lot of patients that come to

me and they've never needed a therapist. But now going through all of this, it's like, it's so anxiety provoking. And there is almost like an element of PTSD for patients who've had recurrent miscarriages and things like that. I often will say, and it's like hard to say it without a patient maybe taking it the wrong way, but you know when someone could use the extra help. And a lot of clinics, like we have a mental health team. We have someone that like actually provides that support, but sometimes people need more than that. So I think it's important for, us to not just focus on the physical like diagnosis, treatment. It's like you have to also think about the mental health aspect for sure. Totally. And we'll have a therapist on this show, someone that you know

too in the future episode to talk about that kind of stuff. But I think it is really helpful, especially with this stuff. And I've found because I have a, you know, I have a male therapist who's like, you know, very in tune with this stuff and everything. But there is a sense, and I saw someone for a while, like a perinatal therapist who knows really about like all these results and what they mean, because it can feel like you're speaking a totally different language. Totally. All the acronyms. Yeah. Right. Or like the, you know, you know, if you're talking about like your levels being a certain way or this. And like it's like it's like it's hard for, I think for someone to talk through it who's not specialized in that. I mean, obviously, a stress is stress. Yeah. But I think it can be

really helpful to have someone who understands that world as well. Yeah. And I think people overestimate how much they can handle. So I think have a low. thresholds to lean on people and people aren't always going to want to lean on their family and friends because they're like, I don't want to now feel pressure to give constant updates on my status. Right. So just kind of really thinking through that thoughtfully and carefully and giving yourself more support than you think you might need. I think that's great advice. And I mean, honestly, I've learned so much, obviously just from you being my doctor, but also from watching your social media because I feel like every day there's just like, I feel like I'm an expert. I'm obviously

not an expert, but I feel like I'm an expert because I watch so many of your videos and I just feel like they're so informational and really important stuff for people to know. And you've answered pretty much, if you look at Dr. Lucky's Instagram, you will see literally the answer probably to any fertility related question that you have if you keep going deep enough. So where can they find you? So I'm at RMA of New York, which is a large New York City-based practice. but we also have labs and clinics and doctors even in Westchester, Brooklyn, Long Island, but we have a bunch of offices in Manhattan. I'm specifically in Soho and Midtown East, and I am taking new patients.

So if you want to come see me, come on down. You can also go to my website. I have a personal blog where I try to answer these questions, but in more than just like a 90-second reel on Instagram. It's more in-depth. It's called the lucky egg.com. I know the name is cheesy, but it works. I love it.

And then my Instagram is just my first name. name. Last name. So L-U-C-K-Y dot S-E-K-H-O-N. And I'm on TikTok too, but I'm still dabbling. I'm still learning how to use TikTok for the next generation. Yeah, I actually love the lucky ag.com. I wanted to call this podcast, the bad egg, but the office thought it would be too negative. Yeah, I agree. I just thought it would be like a, you know, punny. Anyway, thank you so much for coming on. We have to have you back. I feel like we've just barely scratched the surface of all the fertility questions. Maybe next time we'll take questions from the audience. I mean, I believe in the secret. I put it out in the universe. I want to be the resident expert here at Betches. And like, I make a mean meme. So put me in coach.

I think you are. You've earned it. And we'll be back next time on baby steps. 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 BetterHelp. Just fill out a brief questionnaire to get matched with the licensed therapist and switch therapists anytime for no additional charge. 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. Betches.