Oversharing - Baby Steps: What The Data Says About Infertility with Emily Oster || Season 3 Ep. 3

Episode Date: August 21, 2025

Jordana is back with economist and data queen Emily Oster for a brand new episode of Baby Steps—and this week, they’re diving into the world of infertility. They’re breaking down what the numbers actually say about getting pregnant at different ages, the latest trends in conception, and answering the questions everyone’s too awkward to ask out loud. Not sure if you should be worried? Totally overwhelmed by fertility TikTok? Tune in for some much-needed clarity, solid advice, and a few laughs along the way.And for more information on how to start your conception journey, go to https://parentdata.org/ Learn more about your ad choices. Visit megaphone.fm/adchoices

A quick note before we get into the episode, Oversharing is a podcast for entertainment purposes only. It is not a medical podcast and does not constitute medical or psychological advice. Always seek the advice of your physician or mental health professional. Welcome back to Baby Steps. And I am so excited to have Professor Emily Oster back on for another episode. Welcome back. Thank you. So in our first episode of the season, we talked about everything to know if you're just starting to try to conceive.

We dispelled a lot of TikTok myths. We went through all the lifestyle stuff. And I think we did a pretty comprehensive job of breaking down what we need to focus on. No one is watching TikTok anymore. So I think we did our job. Exactly. Everyone is the lead to TikTok. We've saved the world.

I think there's conventional advice for like trying to get pregnant. And then sometimes things get more complicated. And if you're someone like me, you can be like, okay, like I did all those things and like things aren't working. And like now where do I go? because there's so much out there that's just about like people who have seemingly normal, straightforward cycles, and I don't seem to be one of them. Yeah.

And that's why I loved, you know, you were on last year when your book The Unexpected came out, which is out now in paperback. Yeah. If you haven't read it yet and you're listening to this episode and you were one of the people like me, it's definitely a great place to start in terms of pregnancy complications. Yes. Yeah. So in that book, we really talk through pregnancy complications, what to understand about them,

and then how to approach those conversations with your doctor, which I think is such an important part of what happens when things don't go like you expect. And then you're like faced with, okay, well, now my experience is not the like middle of the road typical thing. How do I have the best experience that I can, given the medical issues I'm facing? And I think a big question, I think for those of us with more complicated experiences, is like, how do I use the data to help me when I seem to be like in the statistical minority of a lot of the data?

Yeah, and I think that's really tough. And some of it is sort of taking, you know, what are the pieces of the data that might be relevant? But then also more than that saying, like, what are the questions I want to ask my doctor? Like, what are the things I need to understand to move forward? You know, I feel like so many of those conversations and we try to work through this in the unexpected are about, like, why did this happen to me? Right. As opposed to you, what can I do to make it happen differently next time. Exactly.

And I think that's where, like, the data comes in because you can't, the data can't really change the past. but like it can probably give you more knowledge to work with going forward to try to figure out the best route for you personally. Exactly. I also want to talk about the fertility trying to conceive it vertical that you have, which goes into pet pregnancy complications. You can ask PD, the AI chat bot questions about maybe less common, straightforward fertility questions. So I think that's such a great resource for someone who's, again, looking on TikTok for their answers or in a Reddit thread with well meaning. but maybe sometimes unhelpful opinions. Yeah.

Yeah. So in the parent data vertical about trying to conceive, we have a lot of stuff on infertility. And I think one piece that I want for people there is to be able to go and find someplace where you can just, like, first get the basics of like, okay, I want to make sure I understand, like, what happens in IVF? Like, you know, we hear about this all the time. But like, what, like, let me make sure I have exactly the context for like, what are the options,

what is a set of things that's going to happen when I show up for a fertility appointment. and then a place to ask the questions like, what's evidence really say on, you know, the impacts of stress or the impacts of supplements or the impacts of all the other things I'm seeing and, you know, a place to get something other than TikTok or Reddit, something with facts. Right.

Yes, facts, exactly. And I think a lot of the times some of the fertility treatments that you see are sort of, they're presented as like guarantees or they're presented as, you know, cure-alls when I think when you look closer into the data that's not necessary. the case. And I think it's helpful to go into these things with good expectations, which is, I think, where the data comes in handy. Yeah. I mean, I think, you know, unfortunately, I wish that we could say, like, when you really look at the data, like, here's the way you get to 100%. Because that is what people are looking for, right? That is why this is so appealing on TikTok. It's why it's so clickable.

But I think the reality is sometimes more discouraging than that. But it also helps us make the right decisions, which is the thing that is going to maximize your probability of success, even if you can't get it to 100%. Yeah, I think the ideal scenario would be go to a website and find out, like, is there 100% probably that if I do this long enough, is it going to happen for me? And that doesn't really exist. It doesn't really exist. But it can help you, you know, have as much control and statistics as you can get to. Give yourself the best chance. Right. To make it work. And I also want to, I mean, we're going to have on in a later episode, someone else who's on your team.

And can you tell us about the LGBTQ Plus vertical that you have? Because I know you were saying this is one of the most comprehensive places for that kind of information on the internet. So Mariah Goodman has written really a large corpus of information of pieces about family formation sort of in non-traditional ways. And so a lot of this is relevant for the LGBTQ Plus community, but also for people who are building families, you know, with just one person. or, you know, anything outside of the, you know, there is a partner with a vagina and a partner

with a penis and they're planning to come together using those two things to produce a baby, anything else. You know, there are a lot of other decisions that you want to make there, you know, thinking about, you know, donor sperm, donor eggs, you know, different kinds of surrogate, reciprocal IVF. There's tons of option space here. And almost sometimes in those situations, Mariah writes about this really well, there can be almost an embarrassment of options. You know, we have like two uteruses. Like anyway, we have two uteruses and two sets of eggs. Like what, you know, that's great. That's so many options. But also, you know, requires choices. And so I'm, I'm really excited that we have that to help people kind of start in those,

in those journeys with a little bit more control. For sure. And we are going to have them on at, in a few weeks. So you can hear all in our episode. And they're amazing. They are totally. I'm really excited. Yeah. And we are going to love. We're going to dig really into the data as it pertains to sort of like alternative methods of fertility in that space. Okay. So, I mean, we already talked about kind of like how long you should wait before getting an intervention in like the fertility space. And we were talking about how a lot of it depends on your age.

Yeah. So I think there's this idea and I think there's almost like two schools of thought on the 40 plus like conception story. And I think some of them is like you see like, oh, there's tons of, you. when you hear a lot of this data of like, I don't know about data, but you hear a lot of these stories, but, oh, more women are having kids over 40 than ever before. I think they said like 10% of, right? Was it 10% in New York or 10%?

I think it's in New York. I think that's not overall. But yeah, it's gone up so much over time. Right. Teenagers stopped having babies and women in their 40s are having more. Yeah, basically. The teenagers' moms are now having more people in their 40s. And I think you hear data like that.

And for someone who's maybe. in their late 30s or early 40s, you're like, okay, like, I'm going to be fine. Mm-hmm. But then you also, I mean, we've talked about this on the last episode that it is also statistically true that the older you are when you're trying to have kids, the more difficult it is. And, I mean, you see the success stories. You see the, um, Hillary Swang says, has twins at 48 story, um, more like often in the

news, but you don't really see, um, like all the behind the scenes together. Yeah. I mean, the, the chance for someone who is sort of in their early 40s, from 40s, 40, the chance of conceiving naturally in a given cycle is about 5%. Oh, wow. And so it's low. And that number would be more like 30% in your kind of late 20s. So when you say conceiving naturally, does that mean like with a live birth or just

like any kind of pregnancy? A pregnancy that can take like, yeah, conceiving a pregnancy. So just like. So just having like a clinical pregnancy. Exactly. So that's not even, I mean, I assume then the number of like live births would be lower than over 40 naturally is even lower than that. Yeah.

So those numbers, you know, it's not. I think there's a both and to this, which is like that number is not zero, whereas, you know, that number if you're 55 is zero. Like people are not conceiving. What age is the number zero? So at some point you hit menopause. It's sort of like defined as like a year after your last period. So it's a sort of retrospective look.

But for most people, that's 50 or 51. And so, you know, after that point, the chance is zero. for about 25% of women, their last cycle is an ovulatory cycle. So like a principle you could get pregnant, the chance of a chromosomal abnormality at that age would be very, very high. So there isn't, so, you know, it's only at menopause when it's really zero. It goes down a lot over your 40s. So it's not zero at 40, but it's low. And that number is the reason that people are often advised if you are going to start trying to conceive after 40.

see your doctor immediately. And not because that necessarily means we're immediately going to do IVF, but you want to have some testing done to see, you know, what, like, how are things looking? The chance that, like, you're going to have trouble is higher. And so acknowledging that, figuring out, okay, you know, does it seem like I have eggs? Does it seem like everything is, you know, operating? Is my partner sperm working in the way it should? at Lisa will give you the best chance of sort of starting out and trying and getting to that 5%.

And then you're also in a better position if you do want to pivot to another kind of assisted reproductive technology. Okay. So most, you're saying most of these, the 10% of women that are getting pregnant in their 40s are, we would assume using like probably a reasonable share. I think we don't have, I'm not sure that we have, too interesting question. I don't think that we have in the data information that would tell you what share of births to people over 40 are assisted reproductive technology. But we might have that. Not at all. But we may have like some information about what share of births are our IVF in that age group.

Okay. And does it matter if you're like a healthy 40 or if you're like a less so? Like does that really affect your chance? Like if you feel like you're 40 but you feel like you're as healthy as a 28 year old, does that actually matter? I don't believe we have data about whether that matters. There are certainly, you know, physical, there certainly is going to be variation across people, but whether it's associated with like, you know, your 5K time or something,

I don't think there's good evidence on that. Okay. And then can I ask why is that, like, like, okay, we were born with the amount of eggs. Do the eggs just, like, go bad? Do they, like, rot? Yeah. Or like they do? Yeah.

Yeah. Yeah. I mean, rot is a little strong. But, yeah, they, they over time, they pick up, they sort of pick up mutations, basically. And so they. Just due to time. Yeah. And so then they're more likely.

So this sort of difference in fertility is basically all about these sort of differences in chromosomal abnormalities in the egg. And so some of those, you know, sometimes we will see that. So it's like an increased risk of Down syndrome or one of the more common trisemies. But there are many other chromosomal abnormalities where you simply would never get a fertilization or you would never get to the point of, you know, the egg dividing. And that is also going up as you get older because the eggs have just been around longer and they've had more time to pick up errors.

Got it. Okay. And then what about, I've heard a lot about, like, autism and age. Is there a correlation between their father's age or something like that? There's a relationship between both maternal and paternal age and autism diagnoses. It's very difficult to figure out how much of that is a result of, is actually a result of sort of a causal impact of parental age as opposed to a difference in diagnosis. So this sort of gets much deeper into the question of like, why has off, why have autism rates gone up over time?

In general, a lot of that, very large share. Is it all, hard to say, but a very large share of that is about changes in diagnosis. People who are having kids older tend to be people with more access to resources, more access to doctors, a higher chance of a kid being diagnosed conditional on a set of symptoms. And so separating out, you know, does age actually impact these symptoms as opposed to just impacting diagnosis? That's a tricky. that's a tricky question. That's very interesting and not something I've like really heard before in terms of people unpacking that data because if I mean people want like a it feels like people

want a rule right or like a straight like non-newon statistical fact of like older more chance like older bad younger good like or like older you know issues younger no issues and I yeah and they want to cut off like people want to want to make deal they want to cut off and like all many of these things it's like there's no cut off. And it's really complicated, in part because there's kind of a reason many people wait, which is because of resources and because of other things. And so actually conditional on, it may be hard to get pregnant, but you may be better equipped to have a kid and those things fight against each other.

But it is, I mean, someone we had, I asked people to submit their questions and someone said, is pregnancy possible after 40 40? Absolutely. It's absolutely possible. Without frozen X. Yeah. Absolutely possible to get pregnant at 40 without Frozen X. Is it like 5%?

But it's low. It's low. I mean, it's not, it's not as easy as it was before. Okay. As it was when you were younger. Yeah. Right. Okay. And that there's, and let's talk about that like 35 year old cliff. There's no 35 year old cliff.

I mean, on the sort of glass at full glass at empty here is like, you know, your fertility is kind of highest in like your early 20s, late teens. And then it's on a sort of slow rocket down. Right. To menopause. And so it was easier to get pregnant at 27 than at 30, then at 32, then at 35. But there isn't some cliff. at 35.

Okay. It just keeps declining from from there. So if you're 34, you don't have to look at 35 with some like, do you stay for a crazy. Like we've sort of given people this impression, like somehow like, yeah, the day you turn 35, your eggs are just like, well, that's enough. Thanks very much for playing. It's just like absolutely not the way.

Not the way. And let's talk about like, you know, early stage kind of like thoughts or feelings like there might be an issue. Like so someone writes, does having. a short luteal phase impact your chances of conception. So the luteal phase is second phase of the menstrual cycle and, you know, it would typically be sort of 14-ish days. And sometimes people talk about if that phase is, you know, shorter than 10 days, that that might not be enough time to support the like implantation of a pregnancy. And that I think there is some evidence in that direction.

And so if your lodeal phase is very short, is an example of something where you're, you're you probably want to go talk to your doctor before you try to conceive, just to see if there is something going on. And there are various, like, tests they can do at different times in the cycle to sort of see how things are going. Some people think they have a short ludial phase, but actually what's short is the beginning phase, right? So some people's cycles are 21 days, and they ovulate on D7. Is that better? That's fine. That's like, there's no, yeah, there's no, like, sort of how long it takes you to ovulate does not seem to relate. It's more, so it's more The question is the second part.

The length of the radial phase than the follicular phase. Yes. Okay. And what about super long? Is that also? Again, probably like that doesn't come up as, that doesn't come up as much. If you have a very long cycle, it is probably because you have a very long follicular phase. Okay.

Like if you have a 35 day cycle, you're probably ovulating. Right. And I would imagine the major issue with that would just be like less chances. You just don't have as much time. Exactly. If you have a cycle every 21 days, you have a lot of shots in a given year. a cycle 35 days, you don't have as many, as many shots in a given year. Got it. But the cycle length in itself is not an issue. Normal cycles vary between 21

and 35 days. The short ludial phase might be something to look into. I think this is like a general sort of coming in. I know we talked more about this in the last episode of this, but a sort of general thing about sort of coming into the attempt to conceive in the first place is it is a good opportunity to like take stock of where your cycle is. Does it seem like you are having a standard ovulatory, follicular phase, luteal phase cycle that is consistent, and you see signs of ovulation, however you're looking for them. Like, if you have that coming into your pregnancy, into your attempt to get pregnant, you were going to have a better shot than if you don't have that. And so when you are in the process of evaluating that, if you come and you're like, okay, look,

you know, I've been looking for ovulation, but I haven't seen any signs of ovulation for several months. Or I've been, you know, doing this and I realize my luteal phase is, you know, seven days. that is an opportunity to talk to your doctor before you start trying and say, hey, I'm concerned about this. Can we like give me the best chance possible? Can we like evaluate what's going on? Is there anything you can do to prevent a chromosomal abnormality miscarriage besides not being over a certain age? No. And I think it's really, really important to tell people, you know, about 90% of miscarriages in the first trimester are a result of a chromosomal abnormality. And other than your age, there is no way to control those things. So there's nothing you can do besides.

doing. Besides trying earlier. Right. Yeah. That's it. Which again, you can't really. Which you can't really do control in the moment. And so I think it's both important to say that, you know, because just that's true, but also because this is a stage at which people blame themselves so much for, you know, I did this.

I had this, you know, this, I had an airhead. I had, you know, a second glass of champagne, whatever it is. And so much of this is just out of your control. I mean, I guess the tough thing is it's hard to know if it's a, you're saying most cases of a miscarriage, are a chromosomal abnormality. Yes. But they don't really test. They don't test.

I think if you have had in the place where, you know, people would do some testing is if you have had two or three miscarriages, even in the first trimester. Again, it's very likely that is just, you know, multiple-ish, random issues of chromosomal abnormalities. There are a small number of other things, and we talk more about this in the unexpected, a small number of other things which could cause an increased risk of miscarriage, which are worth evaluating if you have had two or three early miscarriages. There are some testing that you can do to see, you know, is there something else going on? Right. That potentially be treatable.

Is there any merit to advising, like a testing, a first miscarriage? Or do you think that that's unnecessary? Generally, people would not test a first miscarriage because it's just so common. You know, like at least 25%, possibly, you know, as high as 50%, depending on when you count conception from, of pregnancies and in miscarriage. Right. And that just means like if, you know, a lot of people are going to have a miscarriage. And is that number like increasing or is that number pretty standard? That number is dependent on age.

So as people are... Can you control for age in that? Yeah, you can control for age. And so the question of like, is it increasing over time? You know, I... Well, I think there's part of it that's like, okay, you can, now you can test much earlier than you used to. Right.

Exactly. So I think that the two things that mean we see way more miscarriage. are that people are getting pregnant older and then we can test immediately. Right. So in a sort of like, you know, a historical time period in which you like didn't know you were pregnant

until you like missed several periods. And in fact, we didn't even like consider people pregnant until the baby started to move. Well, there's a lot fewer miscarriages after 20 weeks than before. You know, now that you can test, you know,

six days before your missed period, that's, we're going to detect a lot more miscarriages. And that's like, but I don't think we have much evidence that the actual rate of loss has gone up. Okay. Other than the age and the...

Right, then people conceiving later, which then leads itself into that. All right. Someone asks, how do I track ovulation accurately if I have PCOS or irregular periods? Does having PCOS mean I should automatically see a fertility doctor or can I manage this myself? You should automatically see a fertility doctor or at least talk to your OB because it may well be the case that you can manage it yourself. But if you are actively trying, this is a cause of something.

substantial amount of infertility. And so talking to someone to make sure you give yourself the best chance before you start trying is a good idea. PCOS definitely often leads to unpredictable ovulation. This is where techniques to track your ovulation to make sure you're having sex at the right time can be very helpful. The ring, these different kinds of apps, checking your cervical mucus, peeing on the ovulation sticks. All of these things can be very useful. if especially, they're especially useful if you have such a regular cycles. Right. And to bring it back to our last episode, like, these are the things where like there's, you know, there's more lifestyle or tracking things that are more helpful as it relates

to tracking your ovulation and getting to figure out when you're ovulating. Okay. So you would say, you would suggest if you have PCOS. I would talk to earlier intervention. What are some of the reasons behind secondary infertility? Like, because a lot of people write in and they're like, I, you know, I had a super easy first pregnancy, no issues. It worked on my first time. And now the second one's kind of a nightmare. Why do you think that is? Yeah, there's a few things going on. So one is, you know, people vary in, fertility is kind of a noisy process. And so some of secondary infertility is actually like,

you just, it is not as easy to get pregnant as you thought. You got like a good draw on the first one. And then like, and then, you know, it's harder. It's harder the second. time you don't get as good a draw. Like there's an element of randomness and, you know, among people who are, it sort of goes off. It's a converse of the other thing where somebody goes through a ton of, you know, maybe goes through all the way through IVF for their first pregnancy and then unexpectedly gets pregnant naturally with a second kid. Right. It could be the opposite. It could be the opposite. It could sort of like, it could be the opposite. Second thing is that people are older and age impacts for fertility. I know you're tired of me saying that. And the third thing is I think there's

there's a piece of this which is because you are chasing after a smaller, a small person now, people don't have sex as much. Interesting. And they don't have like, so there's a sort of the secondary infertility, which is like, I really am trying and it's not working. And then there's secondary infertility, which is like, well, we're so fast last time. And it was like, yeah, well, you're having sex every day. Like, you know, like.

And then, and now, like, it's hard to find, it's hard to find the time. And, you know, things are, are. So we're like, we're just not trying as hard. Right. Like, sort of, I'm not trying as hard. So I think all three of those things. And then what about like... If there's like a delivery, you know,

is there anything like that could happen with like a C-section that would prevent you from... There are some... So C-sections can have some impact on fertility, although a single C-section would be sort of unlikely. You know, if people have many, many C-sections, then the sort of scarring aspects can have... Can make it more difficult to implant,

but generally with a single C-section, no, we would not... That would not probably play a role. Got it. And if you've already had a child, are you less likely to have issues having a second? Or is it kind of... Because we've learned, again, sort of think about, like, if we think of people as a

sort of having like a distribution, I'm drawing. Like, that's a normal distribution. Yeah, I'm belfer. Sort of a distribution of how fertile they are. Once we learn that you're able to have one kid, we have learned something about where you likely are in the distribution. Right. Now, we haven't learned everything.

Like, you know, but we've learned something about you. And so the chance that you are in a sort of more fertile part of the distribution has gone up. Okay. If you told me, like, this person, like, got pregnant easily seven times. in a row, I think we could say, okay, that person probably, like, is very fertile. And we would maybe be more surprised if they had trouble on the eighth time, you know, if they weren't. Got it.

Like up to the age issues. If you only have one draw from that, we should update a little bit, but not as much as if we had, you know, seven. Okay. And is there any truth to the idea of, like, okay, if it took you a while to have your first, then by the second one, your body knows what to do. That is not. I've heard that a lot.

I mean, that's, I think that's true for labor. Like after you, like your body does, I think it is labor is easier typically the second time. Like, you know, everything is stretched once before. Okay. It, you know, you know, you know more what you expect. So there's various reasons why the second baby is much, typically much faster to give birth. But that's different from the second pregnancy. That's not true about the second pregnancy.

Okay. So you're not, it's not like, oh, the second will be easier once you figured out the first. Unless you're like, oh, I know what works for me in terms of now tracking. Yeah, totally. Exactly. Like you've learned something about your own thing, but like the body part. It's like your brain that's learned or something. So someone writes in, trying to conceive and terrified after preeclampsia with my first.

Do you have any advice? Preeclampsia comes in a lot of different forms. So it's characterized by high blood pressure, protein in the urine. And it's like a really, I want to acknowledge here, like this is a really scary complication because it really sort of almost pits mom against baby. Interesting. Because the cure for preeclampsia is delivery. And so if you develop preeclampsia,

you know, at term, like at or after 37 weeks, they just deliver the baby right away, and that's, you know, typically totally fine. If you develop preeclampsia at 28 weeks, then it's really a balance of, you know, how long can we sort of keep mom stable while we wait and we may have to deliver very early, too early for the baby, you know, so it's like, I think that, that tension is so emotionally draining for families on top of just all of the sort of physical stuff. So I want to name why this is like, I totally hear this person's concern. The risk of reoccurrence of preeclampsia depends a lot on when it occurred in the first pregnancy. So if you have a sort of very early preeclampsia, the chance of recurrence is very high. If you have preeclampsia much later, the chance of

reoccurrence is lower. One thing that I will say, there's two, I think, reassuring pieces here. So one is we actually do have some treatment for preeclampsia. So this is why a lot of people are prescribed baby aspirin. Okay. There's good evidence that taking baby aspirin starting typically around 12 weeks of pregnancy, lowers the risk of preeclampsia recurrence by about 20%. So, you know, it's not 100% down, but like that's a solid reduction in the risk. So do they have everyone do that or just people who are at risk? At this point, if you have any risk factors for preeclampsia, which is basically almost everybody who is like, you know, if you're over 35, if you're overweight, if you, you know, conceived with, like almost anyone with any sort of. There's really no downsides

to baby aspirin, so pretty much just everybody gets it. Got it. Or like a large share of people. And the other reassuring thing I would say to this person is because you now know what to expect, your doctor is going to be in a much better position to help you monitor this. So some of the sort of scariness of this diagnosis and what happens after will be lowered by at least knowing what to expect. Right.

You're not going to be shocked or surprised. You're not going to be shocked. And, you know, there is this baby aspirin stuff which can help. Do you have any statistics on what percent of infertility cases? are unexplained. And, you know, if you were given this diagnosis, what would you do with that information? Yeah. So a large share, you know, probably more than half of fertility is unexplained. If we sort of think about fertility as being, infertility as kind of being like 30 percent issues with mom, 30 percent issues with dad, 30 percent of, you know, that doesn't add to 900,

but, you know, 30 years like, of these sort of some combination. And even within those categories, a lot of, there's a lot of unexplained nature. So we can understand a lot about, sperm, sperm kind of have one job. They need to like have the right shape and swim. So we actually, once, you know, you know, those things are either true or not true. There need to be some sperm. They need to have the right shape. They need to swim. That's basically it. Well, cut and dry. Yeah. Within the sort of infertility associated with, with the woman, we have, you know, some sense of like, you can not have enough eggs. You could have an issue with the uterus, an issue with the fallopian tubes. Those are diagnosable. But there's a pretty large share even there where,

we don't really know and then the sort of combination part we really don't know so it a lot of infertility ends up being just unexplained right yeah and i mean i've had this kind of thing too where it's like with a lot i think for for women in infertility it's like well it could be this thing but there's a lot of people like it could be endometriosis but there's a lot of people who have endometriosis who have kids or it could it could be like a uterine septum but like there's a lot of people who have that so i think it kind of feels like for the women a lot of the time it feels like a little bit of we're sort of guessing. We don't know.

Right. And even, you know, we sort of say, like, you need high quality eggs. We don't have any way to measure that. Right. So we can, we have these tests that measure how many eggs you have. And those can be helpful in telling you how successful IVF will be because it gives you some sense of like, what is the sort of likely yield from an IVF cycle. Right.

But it's those aren't, that's not measure of quality. We don't have any measure of quality. There's no, like, test you can do where you can be like, okay, what share of your eggs are going to be like, top shelf. Right. I guess the only way to do that is to make them into embryos. The only way you guys make them in embryos and test them, exactly. Right.

So there's no, like, ex ante way to say anything about your egg quality. I guess unless you have multiple miscarriages and then you would test those miscarriages, right? And if they were normal, it might tell you the egg quality was probably fine. Yes, exactly. So there are a few things. But, again, like, for, you know, when people are often looking for, like, like, okay, I'm having trouble conceiving, like, up front, I want to know, like, is it because of the quality of my eggs? It's like, no one's able to tell you. Yeah.

So if you were, if one were diagnosed with that. Like, I guess what do you do with that information? I'll explain infertility. Generally, then you just do IVF. So a lot of, you know, and I think this is a little tricky because if there are sort of a set of of kind of diagnoses of infertility for which other interventions are like sort of lower lift interventions might work. So interuterine insemination. Okay. Which is something's called IUI where you take the sperm and then you sort of stick it in and put it right near the cervix or possibly.

you know, stick it all the way in. That can be very helpful if the reason that you are struggling to conceive is, you know, the sperm doesn't swim very well or, you know, mainly that, but a few other, or like there are some issues blockages. And so there's like a few things where that can be a very effective solution. But for most things, or like a large share of unexplained infertility, basically the answer is just IVF is what we've got on the table for that. And speaking of IUI, I've heard from certain doctors that like almost like people just do it for like insurance purposes, but like it doesn't, it's really not very effective and it's almost just a way to get. IUI can be very effective if you have a problem that is fixed by what IUI is doing.

Getting the sperm close to the cervix. If that's the problem, this system will fix it. A large amount of infertility is not about things that are getting the sperm close to the cervix, in which case most of the reason people are doing this is because, because insurance needs you go through some number of cycles of IUI before they give you the IVF clearance. Right. Which is not ideal because, of course, the faster you get to IVF, like in some sense, the better if that's what you're going to need. What are your thoughts on using chat GBT to talk more in depth about test results? Like just to, you know, to use that as a tool to interpret things.

So people are using AI for a lot. Yeah. I think that there's two. And I think it can, I mean, it can be an incredibly useful. tool. I think there's a couple of cautions. So one is that, you know, you're like, you're putting your personal medical information into a database that is used for training data. And so I would be careful about, you know, putting in very detailed things about my personal self into, you know, an AI that's going to be trained. Remembering it? Yeah. Exactly.

And the second piece of it is these models still have, and this is like a whole for other podcasts, But these models still have a lot of problems with hallucinations. And they like want, they make things up. Really? Yeah. And chatGBT wants to make you happy. Like they want to answer your question. That's like it's like they've like programmed in this new personality that like really

wants you to feel good about yourself. They want you to feel like it's answer your question. That's so funny. And so it will make like they will make things up. You think about Siri who will be like, I don't know that one. Right. ChatGBT will not say that. They'll be like and you know, it'll make things up me.

You'll be like, that's not right. And they'll be like, oh yeah, that's not right. It's like my nine-year-old, you know, it's like, yeah. So I think it is, it can be a very helpful way to, like, this is a machine that knows a lot. And sometimes it can pick up. Like, there's interesting uses of AI for, like, picking up details of test results that might, like, link to something and something else that you wouldn't see. Otherwise, it maybe your doctor even wouldn't see. So I don't think it's a crazy thing to do.

I'd be careful about my personal information. And I wouldn't, like, actually make any decisions based on the information I would. was given from chat GPT, it's more of an idea generation process. Okay. So you could take those, bring them to a real doctor who can give you a more nuanced breakdown. Yes. Of that. All right.

Note to self and immediate. Because I feel like people, you know, I think we're in this world that we're in, you could see a test result in a portal before your doctor has seen it. And then immediately like, you know, like doom scroll about your thing or ask chat. I think personally, I think it would be best if the portal results did not show up before your doctor told you them. But I guess that's the system we have arrived at. There's a lot of chatter saying that all pregnancy complications come from the man.

Is this true? This is not true. All pregnancy complications do not come from the man. I'm not, yeah, I mean, it said it's the last time. I just don't even know where this came from. And it is not, it's just not, it's not right. A lot of pregnancy complications, unfortunately, do come from mom. Right.

Well, I mean, I think there's more factors with the mom, right? Yeah, you're the one who's having, you know, they're like, this is very physically draining on your body. like making another person. You know, you make a whole organ, right? Like the placenta is the only example where like it's the only example of like an organ shared between two people. Like a share like you and the baby each make half of it. Wow. And it's like a whole organ that like controls all of your hormones and all of the aspects of your body and you like make it all yourself. And then it's discarded at the end. That's the placenta. Yeah. Wow. The placenta is really cool. I've seen some stuff about them, about like scientists creating an embryo and then like sort of harvesting it

to a certain phase in a pod. Right. Like to the idea that maybe in the future we could grow people in pods. Yeah. I don't know how far we've gotten on that. Yeah. I don't know if it's like something that's going to happen tomorrow, but it wasn't very interesting. Yes.

There's like a lot of ethical questions about how far you want to push the embryonic development before. Anyway. It's for a different day. Yeah, a little matrix. Yeah. Exactly. A little matrix-like.

Is there a correlation between miscarriage and endometriosis? Yes. Okay. Yes. Do you know, like, what the, like, is there a, is it a high statistic? Because, again, that's one of those things you hear. Oh, there's plenty of women who. There are plenty of women.

I don't know how high this correlation is. Like with many, you know, issues, sort of uterine-related issues, there are going to be an increased risk. But it is also true that a lot of people with endometiosis get pregnant. Right. So it's one of those things where it's like, could be that, could be something else. Exactly. I've also seen a lot of this stuff on TikTok about ureaplasma.

Have you heard about this? I haven't even heard of that. It's like a bacterial infection that like they don't test people for that you have like other some people on Instagram being like, I struggled with infertility for years. And then like finally I asked my doctor to test for urea plasma. And like they cured it and that was my issue. I've never even heard of this. Really?

Yeah. Okay. Yeah. Well, I guess TikTok's a lot. Maybe not. I need to look into it. Okay. It's on my list.

How would you use the data? hypothetically you, use the data to decide if something is just bad luck versus an issue worth finding, you know, interventions. I think the general way you want to approach the data is to ask a question, like, how much have I learned about what's true of me and about sort of what's going to happen in the future based on this event? Okay. And so to take like miscarriage as an example, which is probably a sort of salient example

in this, if I have one miscarriage and you think about how much have I learned from that, the answer is a little bit, but not very much. So given how common miscarriage is, like the increase. risk of having another miscarriage. There's a little bit of an increase after one, but it's not very big. And I think from that I would say, look, this is very, very likely, just bad luck. I haven't learned very much from it. And so it isn't something that should spur me to do something.

The second miscarriage, then, you know, after having two losses in the first trimester, the risk of another one does go up, you know, somewhat substantially. Again, not to 100%. I'm not saying, like, but it is higher than it was otherwise. And that's the point in which I think you want to say, okay, like, what have I learned? You know, let me pursue a little bit. Is there something else I should do? Something I should change having learned, you know, with this additional information.

I think a similar point could be made about, say, IVF cycles. I think a lot of people, you know, you have one and it doesn't work. The question of like, what should I learn from that? There, I think it is probably the case that you want to try to learn from every single one. because of course some of it is that, you know, sometimes it's luck. But you don't get an infinite number, you know, you don't get a million IVF cycles. And so even though I think it is very hard and for many people, you know, talk to people struggle with this, there's this feeling of like it didn't work.

Let's get, let's get back on the train. Like let me just do another, let me do another cycle right away. I don't want to take the time to sort of step back and reflect on this because I'm very, because it's very hard to do that. But there is real value there. in stepping back and saying, have I learned anything from this? And maybe the answer will be no. Maybe like actually we sort of did everything.

It all looked great. You know, just it didn't work. Yeah. But maybe you have learned something. And opening up yourself to even the hard conversation about like, what have I learned from this? That's quite important for making good decisions. Yeah. Almost like approaching it like a scientist would.

Yeah. Right. What is the new information I got from this cycle? Exactly. What are the variables I changed? What can we do going forward? knowing that. Yeah. And I think that's, the way you put that is, is like almost exactly how I might put it to a doctor, right? Rather than, you know, what did I do? What do we do wrong? Or, you know, why did this happen? Which is like not a very precise way to put it to sort of say, you know, what do we learn from this? And is that something that we should take to change something next time. Right. And I think that attitude, although it feels like a little cold or a little like removed from it, I actually think that that, you know, if you can take that out of it, it does make it feel like, okay, like it doesn't feel like every cycles like a waste or every, you know, failed attempt is a waste. You can look at it as almost

like every cycle is something where I learned a little, I learned new information about the way that I'm doing this. Exactly. Yeah. That's very hard though. Let's get into the IVF questions. Let's get into IVF. Yeah. We touched on this a little bit as it pertained to regular, um, conception. But in terms of IVF, are supplements all the waste? And is there anything that I can do to improve the person rights to improve fertility outcomes? Right. So I should, say on parent data we have i'm going to be aping here a lot of uh dr brenna slocum who wrote some amazing stuff for us um so uh supplements there's really no good evidence for the supplements that people are told to take during this period pretty much yeah i mean the you know you should take some folic

this is always true you're trying to conceive people should be taking folic acid a lot of women are anemic and should have some iron need some vitamin c to absorb the iron these are none of these things have to do with IVF. These are just like things that, you know, women who are trying to conceive may consider to be a nice thing to take. And those are basically, that's basically kind of it. Okay. And all of these other supplements, you know, to increase your egg quality, you know, like, even, even that, you know, so much of this is framed as, like, increase your egg quality. We don't have any way to measure egg quality. Like, we don't, like, that isn't something that you can get as an outcome. So anybody who told you, like, people took this supplement and we

measured their egg quality, it was better. is lying because we don't know how to measure egg quality. Right. So speaking specifically, just like it starts with the egg. You're saying a lot of that is not, it's sort of anecdotal. It's sort of anecdotal, yes. And so, you know, will it, like, are these supplements going to hurt people? I'm not going to hurt you except that they're often very expensive.

And, you know, they may get in the way of some of this real learning that people want to do. So it's just not a lot of evidence for supplements. Which is interesting because I feel like a lot of doctors will recommend them or say them and is that you think that's more to like give patients a sense of being able to control something there's a really nice piece um and in by a doctor that i read a few months ago which is about like why why do we give people this advice about supplements you know in the infertility context when it doesn't work and i think it is you mean his view was it's really like you know we want to tell people we want there to be something that people can do you know this isn't hard like this isn't

harmful it's like the placebo effect it's like the it's like the placebo effect that the placebo is like a real thing. This is more just like, it's like a mental health support almost. Like, you know, we want, we want to help people feel better and feel like they're doing something. And this is something we can tell them to do that like definitely feels like you're doing a thing. You know, you're paying a bunch of money for this stuff and you're taking it every day. It's like making your bed. It's like making your bed. And it's not going to hurt. So why not? Why not tell them? And I think, of course, the counter argument there is, well, then are people going to blame themselves when they don't get pregnant or they didn't take it at the right time? You know, you didn't, I skipped it. I missed a day of my, you

know, fancy supplement and like that's why it didn't, that's why the cycle didn't work. Right. So do you think there actually is anything that you can do to improve IVF outcomes or egg retrievals or IVF transfers or anything like that? There are certainly a lot of variation across, say, providers in how successful they are at this. So I definitely believe that there may be, you know, people who are better and worse at doing this. Okay. So like choosing the right doctor, Choosing the right doctor, having the doctor sort of grade the embryos correctly. Like, well, how are they doing? Like, you know, there's a lot of like doing of the IVF, which it seems like there must be

variation in how good people are at doing that. Okay. And there are other things that are going to impact the success of IVF, like the age of your eggs and, you know, how many do you have and all that kind of stuff. But that's... Her under control. Those are not really in your control. So it seems like the best thing you can do is just do your research to find a high-quality

doctor and a high that works with a high quality lab exactly that's something yeah which is definitely something asking them about you know what are their success rate it looks like what are their success rates look like for people like you i think that's like a probably an overlooked issue which of course like if i am you know look if i wanted if i were a like a reproductive endocrinologist and i wanted to have the best IVF success rate possible the thing i would do is have a bunch of patients whose issue is like they have a blocked fallopian tube. Right. And they're 32. That's like a, that person is like a real high chance of success because you know there's no problems with their eggs. There's probably no problems with the sperm. The problem is definitely something that can be fixed by putting the embryo right

in the uterus. I mean, that's a good, that's a good point because I, you know, I've spoken to many fertility clinics and, you know, I have, I have embryos, but some of them will say, well, we'll only take your embryos if they're this great. Exactly. And so like, are, and their rates are, they're rates of success are really good, but are their rates of success really good because they're only taking these embryos? Right. And so if you're, if you know, if you're a person who's 42 and has, you know, some lower grade embryos that you want to implant and the fertility clinic has had a lot of success with 32 year olds with like, you know, grade 8, AA embryo, whatever, like you're, you're not going to learn that much from that. So I think asking the clinic, you know, what,

what does your success look like with someone with my profile? Have you seen this? Have you seen a case like mine before? Yeah. Have you seen a case like mine before? Exactly. Exactly. Overcome that. That's a great, that's a great point. In terms of like embryo transfers and implantation, is there, like what would actually interfere with that? Like, what would cause issues with implantation? If your uterus, I mean, implantation requires, you know, the like embryo to find its way to the right part of the uterus. And so issues with, with the uterus can affect implant and just sometimes it doesn't implant. Right. Well, is that due to genetic, like, you know what I mean, they say, there's just a, there's a number of randomness there that like it just sometimes it doesn't.

It seems, because that's like the kind of thing where it feels like, you know, they have this method. And I think they say like 60 to 70 percent of all the embryos implant. And if they're genetically tested, you're like, well, why isn't it? 100. Yeah. It's because it's just like the, like, you know, the human body is like a like a hot, confusing mess. Right. Right.

You put the thing in there. You're hoping it's going to find the wall to implant, but like, slimes it doesn't. Well, I mean, it's interesting. Someone I had told me that it was like very interesting that like, you know, human reproduction, pretty inefficient. So inefficient. Yeah. When you compare ourselves to like, you know, I just got a puppy from a litter of like seven puppies, right? Like they're, you know, and it just feels like to get one can feel like such a obstacle course.

And someone was saying like, it's almost only due to our brains that we can even like do this that we haven't died out. Because, you know, like something about, and tell me if this is true. Like he said something about how like because we're standing, that's something about like that makes it less efficient because you're you're not on like four legs and you're standing and that makes it harder to carry a child. I think the fact that we are standing up. So my understanding of this is that the standing nature of our need to walk standing like this has necessitated a pelvis of a certain size. Okay. And the sort of evolutionary tension is that like really, ideally, the brain would be bigger when you were born. So then, you know, you would not be such a like a floppy mess for so many years.

But unfortunately, like if the brain were any bigger, it couldn't get out. And so we've like evolved to a place where the brain is almost too big, but most of the time not too big, but sometimes too big. Which is why, of course, like in the past maternal mortality was so high. Right. still is too high, but for different reasons. And so, like, basically where the sort of standing up is the reason birth is so difficult and is partly the reason that, that, like, you know, for more childhood, like, all of the stuff is very complicated.

So it is due to our big brains. It is due to our big brains. But I'm not sure the conception piece of that is, I'm not sure it's the conception piece so much as, like. Well, it sounds like our brains are helping and hurting because they're helping us come up with C-section technology. Right. but also getting in the way of being born.

Right. Yes. Yes. What a time. If we were giraffes, it would just like fall right out, but also no C-sections. But you also think about that,

like a giraffe standing up and walking, like within probably, what, a couple days? Yeah. I think it's almost, no, I think it's almost immediately.

Yeah. I think basically, I think the giraffe baby like drops out. I don't think giraffes lay down to give birth. I think they just drop it. And keep walking. Yeah. And then they just,

the baby kind of catches up. No maternity leave. Don't quote me on this. I'm not a giraffe. I'm not a birth expert. You're not doing statistics there. That seems. One of other question is how effective is IVF?

And I assume this depends on many other factors. Yes. So I think the simplest number to say is, you know, if you have like a genetically normal, you know, you ployed, like we say the uploid embryo that you're implanting the success rate 60 to 70 percent. Okay. So that's pretty good. And then you're sort of backing out from there, like, what, you know, what is the chance that you get a genetically sort of like a, high grade genetically, sort of typical embryo out of a given IVF cycle. And that is going to

depend on how many eggs you get, how much they're fertilized. And so the sort of success rate varies a lot with what you come into the, like what you come into the cycle. Right. Which makes it so hard to be like Googling IVF success rates when it's all like once you, I think once you get into like a little bit of a more complicated pregnancy, it's so much more important your individual factors. Yeah. And then there are questions. like, you know, like people use donor eggs. And the success rates can be really high with donor eggs because you're getting an egg from someone who is much younger.

Right. And, you know, then you're kind of working with a very different set than your own egg structure. And how many eggs would you say is like a good number? So there's eggs and then there's embryos. And again, you want to like back out. So if you want, you know, three embryos. How many? Embryos is what they say like, well, most likely, I think there's a 90% chance of a live birth.

Right. And that's sort of, because that's like multiplying out this, like, what's the chance of, of conception with each of these, which each of these, these embryos. But how many eggs you need to get to that is going to depend a lot on, like, how many of the eggs are chromosomally normal. And so is this sort of like more is better? More is more. Yeah.

But is there a case like with PCOS where like more is not necessarily more? Like if you have PCOS, you're more likely to have a lot more eggs. But is that, are those eggs, is it matter about egg quality? Does that affect egg quality? Egg quality. But egg quality is a lot. It's just going to be about chromosomes and about your age. Okay.

So there's ways to test for that. Okay. And why don't doctors let you, why do they advise against transferring more than one embryo? Because twin pregnancies are complicated. And so, you know, I think it used to be before we did a lot of embryo testing, like for chromosomal issues, the sort of chance that any given embryo has a chromosomal problem is reasonably high. And so if you sort of said, okay, well, only like chromosomally normal pregnancies are going to implant.

So we're going to put two in because we don't know, like, and maybe half of them are not normal. So we kind of, in expectation, we get one. Now that we're in a position where it's much, much more common to be testing embryos at either day three or day five and sort of having some sense of like we're implanting embryos. We have a much higher confidence are genetically normal. They don't want to implant two because twins are complicated. Like the risk of preterm birth is, I mean, many people carry twins totally fine, but the risk of preterm birth is higher and there's other risks for months.

And I think you've, I've seen this in popular culture, this notion that like, IVF medications are bad for you, like, or lead, you know, imbalance. Lead to cancer or whatever. Yeah. Lead to other issues. Lead to other stuff. Is there any evidence? We really don't have much evidence for that. No.

I mean, we have like, like, all of that would be correlational. And do you have any data about, like, if a person miscarries during more than three transfers or more than three transfers don't work? What is the likelihood of each subsequent transfer not working? We don't have a lot of detailed data about things like sort of that exact. question, back to the sort of question of what do you learn, you have learned something there. You know, maybe it is three times bad luck in a row, but it's also the case that like if you think about, if you said, you know, we have, we've three times we've implanted a genetically normal, you know, embryo and the chance of implantation is, you know, 60 to 70 percent.

You're at about 90 percent chance that one of those things would have worked. Now you know you're in the 10 percent. So you're in the 10 percent. That's still 10 percent. still, you know, some reasonable chance that if you did it again, you would get success, but you have learned something. And so I think that's like an opportunity to talk to the doctor about like, have we learned something? You know, what do we want to do as the next step? If the uterus doesn't age, then what is like, what is the reason to implant? Let's say

you have frozen embryos from a younger age. Is there any sort of like impetus to put the, to use those embryos sooner rather than later? Or could you use them at 48? And it wouldn't matter. You can use them at 48 from the standpoint of the embryos, but as you age, things get more complicated. So some of the pregnant, there are pregnancy risks which go up over time, things like preeclampsia or gestational diabetes. Like there's a bunch of things where the potential complications basically coming from like mom's physiology are increasing over time just because you're older and you're at higher risk for hypertension and the things that come with that. With age, yeah. With age. And so it's sort of, it's like it's not the age of the embryos.

the embryos are just frozen, they're just unaged. But you haven't unaged. And so, so that's, I think that's the reason why, you know, there could be an impetus to sort of move more quickly, even if the embryos are frozen, although certainly less than if you were using the current eggs. I think that's really helpful. Those are all our user submitted questions. I know there's, we didn't cover like half of what, you know, entails IVF. And I know that they can find so much more information on parent data.org. You have a reproductive endrochronologist on there who's also answering these questions probably from a medical standpoint a little more like specifically yeah and we have like a lot of you know like really in the weeds so we have another reproductive and

endocrinologist colby hancock who wrote like what i think was i was just reading it last night in preparation for this like a really detailed thing on embryo grading so if you're like you're gonna like i'm gonna see this embryo grades and you know the numbers like 811 or 8 pf she's got like this incredible detail about what all those things mean really which you know if you're in it this is one of the more confusing aspects. So having like some backgrounds, you understand when they give you some numbers on this, you know, thing that comes up in your portal that no one's told you about, you can actually understand the numbers. You don't even have to ask chat GPT. So that's great. I mean, there's a lot. It's funny. There's so much information on the internet. What I love about what you do

is that you really fully go into the data and you're getting a really high level response to things that, again, there's so many different opinions on. There's so many different options on. So I love what you're doing. I think it's great for the, you know, the community that's trying to get pregnant, the community that's having issues getting pregnant, and all, you know, even all sorts of other people who are trying to conceive in all sorts of different ways that are more niche or not. There's really not that much information for the more niche you get in this space. So I think it's amazing what you're doing. Thank you. Thanks for putting it out there and let me tell people about it. Of course. And we'll be back next time on Baby Steps.