Oversharing - Baby Steps: Why You Shouldn’t Think Of Egg Freezing As Insurance || Season 3 Ep. 4

Episode Date: August 28, 2025

Jordana welcomes back her own reproductive endocrinologist and author of The Lucky Egg, Dr. Lucky Sekhon. In this episode, Dr. Sekhon reveals the #1 comment-section myth she hates seeing, debunks misconceptions about fertility as a meritocracy, and explains why placenta health isn’t just the woman’s responsibility. From fertility basics to important facts about ovulation and how age factors into it all, Dr. Sekhon shares insight into the often mystified process of pregnancy. https://theluckyegg.com/ Pre-order The Lucky Egg Here 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 professionals. Hello and welcome back to baby steps. I'm Trigana Abraham and today we have a very special guest. My reproductive endocrinologist, my fertility doctor, is in studio with us today and she's going to answer a ton of your questions and my questions and we're going to get into it. please welcome Dr. Lucky S-Conn. Thank you for having me. Of course. I know you, my second time. Yes.

Thank you for coming back. You were on season one. So it's so great to have you back to get into more things. But since that time, you've actually written a book. Yes. Yes. It's called the Lucky Egg, understanding your fertility and how to get pregnant now. I love that title. Great. And I love the, you can see it here. It's displayed. Comes out when? Comes out January 13th next year. So. Okay. Yeah. You can pre-order. right now. It's available. But it's the book that everyone needs. I like to refer to it as the fertility Bible because I think everyone should know how their body works. So even if you're not actively trying, but you're not sure even where to begin, how to track your cycle, it walks you

through it in a very easy to understand simple way. But it's all backed by data and science. And it's all up-to-date information. So you don't have to wade through Google searches late night, you know, all the confusion that you might encounter on Reddit forums. you're getting it straight from the source. And I felt like this actually wasn't something I wanted to do. I wrestled with this because I knew the commitment and undertaking it would be on top of having a full-time clinical job treating patients. But I was consistently frustrated with the lack of good information out there. And all my patients were asking me about certain books. And I would say, no, I don't really recommend that book because it's not really written by a doctor. And it's really

biased. It's really heavy on the supplements or things that aren't necessarily the things you should be focusing all your attention and efforts on. And it just had to happen. And I felt like if I wasn't going to do it, who was? Totally. And I mean, I've been going through this for a while when even when I, I do think you occupy like a really, such really great space in like fertility information where you're, you know, and you've come up in like my Google searches of like, what does this embryo grading mean or like anything like that, but you, you in particular, I mean, you can find that information in a lot of different websites, but I feel like you have a way of explaining it and it without like kind of feeling like you're going crazy or like, well, it's like learning a new language.

Yeah. This is essentially like a dictionary that decodes everything for you. It even has a glossary at the end because I even felt as a doctor when I started seeing what people were talking about online, I was like, what is D6.PT? Like I didn't even know what the acronyms meant because I feel like this community has been built online and people are sharing information now anonymously or, you know, maybe they're sharing their story openly, but there's like a whole culture surrounding fertility and understanding what's going on and treatment and how to navigate it. And I think it's wonderful to see, but it can be a place where misinformation breeds. And I just feel it's important for doctors and experts to have a voice and have a presence online, even if it's

uncomfortable and it is totally antithetical to what you're taught in medical school about professionalism and having a certain veneer. But I think this is 2025 and we have to meet patients where they're at. And if they're on Google looking for answers, then our names and our articles and the content we create should be alongside everything else that's on there. Right. No, totally. I mean, do you recommend that to your patients? Like, are you like, don't Google anything or are you like? No, because I actually think one of the key ways that you can navigate the journey is to keep yourself educated, right? And so you just have to point people to the right sources. Right. Because there's so much wrong information. And so I will give people websites not just my own,

but like up to date, you know, like these are vetted sources that are, you know, written, authored, or edited by the experts. And so you know you can trust it. But it's important to do your research with guidance. Like you don't want to just be left to your own devices. Okay. So is that sort of, I mean, like we, funny we talk about this on you up about like being a better consumer of like men or like people that you're trying to date like kind of just like knowing how to like weed through the signs or what's right or what's kind of BS. And I think that's sort of what you're saying about like information that you're finding online like how to can you can consume it but just be a better like be more aware

of what's legitimate. I have like a whole playbook that I help people when they send me things online that they see, especially like an Instagram account for example. I'm always like look at the bio, what are their credentials? If they had them, they paid for those degrees and did the work, they would be displaying them proudly. And you can also Google people, but find out what their credentials are. Do they have any? That's the first step. And then their messaging, if there's anything that's really extreme, anyone that is speaking in absolutes, that's a major red flag, because anyone who understands science knows that it's nuanced and there is no black and white answer. And it really just depends. And I think when people are selling something, that's

also a huge red flag. It's a big reason I have really never monetized my account. I've never put things behind a paywall or sold supplements or backed things like that because I don't want it to invalidate my message because immediately when someone is selling you something, you question, can you fully trust them or are they biased? So those are some key obvious things. And I think when you see a lot of like doctor bashing, that's also a key red flag because I find that one of the biggest grifter playbook strategies is to make people feel like they can't trust their doctor. They can't trust conventional medicine. And they're offering some alternate solution.

And that's just kind of a way to get you to buy into what they're selling and to trust them. Right. And I think that can be like really enticing for someone who's maybe like having more trouble with like established, you know, medical protocols to be like sort of lured into. Yeah. It's our fault. something that feels maybe a little bit more like woo-woo or a little bit more like holistic, which again, I think, do you feel like there's like, because I'm kind of like, it's not like

one or the other, like there's a spectrum. I feel like acupuncture can kind of like lie in the middle of those two things where it's like. I've done acupuncture. Right. So I think it's hard to know. I'm a conventional Western medicine doctor. Just thinking it through, I know it's not harmful. Right. And if it could be helpful, whether it's placebo or not, I'm okay with that. And I'm, so I'm very aligned with, you know, what you're saying. I don't think it has. I don't think it has to be one or the other. But I think a lot of times people hear the words like natural and then they automatically assume like a supplement or taking herbs is not going to interact with their medications. It's not going to cause side effects. It can't build up to a level that causes toxicity and

problems like liver failure. All of those things can actually happen. So you really have to be careful. You know, there are a lot of people that are very weary about taking certain medications. Like my parents, for example, like my mom won't take her cholesterol medication because she's like there's side effects. And people are so afraid of conventional medicine and the medications that are prescribed by their doctors, but they're much more apt to take a supplement because it feels like it's natural, but they don't realize that those are not FDA regulated like the medications you're prescribed are. Right. So they're not even studied like in any way close to the way the medications that we prescribe are. And there could be interactions. It could make your treatment

regimen less effective. It could cause side effects. Like, there's all sorts of things that can happen. So it's just important to be honest with your doctor. And I'm not saying don't take supplements. There can be a role for certain supplements, but you just want to be really careful about everything you're doing and know that everything that you do can have a potential consequence. Right. But I was saying earlier it's our fault. Well, I was going to ask you about that. Like, what do you mean by that? The way medicine has been set up, it doesn't allow for enough time. a lot of the time for patients to feel like they're getting the proper counseling, the proper support education. We don't take a 360 approach in this country in terms of supporting people's mental

health. We're kind of just, you know, meeting them for a very short period of time and then they're left to their devices, you know, and an area like fertility, you're in a very vulnerable state. It's time sensitive. And if you don't fully understand what's happening to, you're going to go looking for answers. And so it really is on us as doctors and experts to say, okay, we're going to step in and fill that gap. And that's something that we haven't spent enough time on. And I think part of it is that, you know, the number of people that need fertility treatment outnumber is the number of clinics and doctors. The demand is very high. And the demand keeps getting higher and higher because a lot of us are waiting longer to have kids, right? That's a huge factor in all of this.

So what do you feel like the solution could be or would be there? That's a great question. I mean, I'm trying to work on the solution in the only way that I can control and that I know how. But I, I, the book is like, yeah, the book is is one way. Instagram has been a way. But I've been frustrated by the fact that it's not easy for people to just find the information they need in that way. It's just like confined to a 2,000 character count caption. It's just not, you can't give the deepest dive.

So that's why I did this book. But I still won't feel like the book is enough. Like I feel like we need to overhaul the Department of Education and start earlier in the way we educate people about their bodies. We need to have some sort of mechanism where there's like a health screening or conversation between a doctor and a patient in their 20s or early 30s in ways that aren't happening right now. Is there any way, and we'll get more into this, but is there any way to know if you're going to have problems with fertility like before you start? Because I think that's sort of the most frustrating part for so many people. It's like, you're told, this is how you don't

get pregnant, like, don't get pregnant, don't get pregnant. And then when you're starting, you're like, assume it's going to be so easy because you've been told forever that it's been, that it's, well, the easy answer. That you've got to watch yourself because you're going to get pregnant. No, I know. It's, it's such a 180 degree turn. And if you think about it, it's so unique to women because we go our whole lives fearing being pregnant. And then like all of a sudden one day you wake up and you're like, okay, now I have to turn the switch on and start caring about it. And it's a very hard thing to mentally adjust to. And to learn all the things that you need to learn, to understand how to track your ovulation, the fact that you're only fertile for,

like three to five days out of the entire cycle, right? And being able to pinpoint what's happening. And it's a lot of information overload because you haven't been thinking about it your whole life. And now all of a sudden it's the only thing that matters to you. I think, you know, it's important for everyone to get that basic education. But I also think that our screening tools need to be better. This is controversial because it's against the guidelines. But I think it's shocking that a lot of people go their whole adult life without getting a pelvic ultrasound. It's kind of on a need to know basis, but there's a lot of things that might be totally asymptomatic, and especially if you're on the pill, which I'm not saying is a bad thing. I think

the pill can be a great thing. It can help people regulate their cycles. It can prevent an unplanned pregnancy. But it's unknowingly sometimes treating things like endometriosis or PCOS, where you have really painful cycles or really irregular cycles. And by correcting some of those imbalances, you're able to get on with your life, but then when you go off of the pill, it can feel very disorienting to be like, wait, I have endometriosis or I have PCOS. These are really common things that affect, at a bare minimum, 10% of the population. Yeah, I mean, that was definitely my experience. I think I was on birth control from when I was 18 until right after my wedding in 2021. And then that's when I went to to see you. And I'm just like, because I just assumed, it's funny, like, they don't even tell you that a

birth control period is not like a real period. Basic fact. I was like, oh, I have extremely regular periods. Right. Right. Right. I have that conversation every day with at least one or two patients. They're like, my period is clockworked every 20 days. I'm like, what about before you start the pill? And they're like, oh, then it was super irregular. You know, and then I'm like, okay, let's talk about that. Right. Because that was the only thing I had heard about like fertility was like, if you have a normal regular cycle, that's like a really good sign. I was like, oh, I've got that. So it's a tricky question. And I kind of went all over the place. But the short answer is you're not going to

know if you're going to have a fertility issue until you try. But the nuanced answer is there can be some things where you know ahead of time someone will, right? Like if someone has, you know, inflamed fallopian tubes and they look like that on an ultrasound or maybe they have chronic pelvic pain and then they get imaging, I can say, okay, now I'm going to do a test and confirm your tubes are blocked. Like you're going to need IVF to overcome this, right? But usually it's not that clear cut. It's like you can't directly test problems with egg quality. And it's also, don't forget, it takes two. It's not just us, right? It's also our partner. So you might have a regular clockwork like cycle outside of being on birth control. You didn't have pain. You have no red flags.

Your family history is great. And we have no reason to think there's anything wrong, but you could meet someone that, you know, has a low sperm count. So there's multiple components that come together to make someone able to get pregnant, to make them fertile. And it's not always going to be constant either. So like just because something is one way at one point in your life doesn't mean it's going to be that way 10 years later when you're actually ready to try. Right. Totally. I mean, you've said this to me, which I've heard in multiple places, that there's like a 15% chance on any given month that you can get pregnant. I feel like anecdotally, it feels like there's a certain percent of the population that just gets pregnant immediately, like on their first time trying. And then for everyone

else to take, it's like it feels like the average is 15%. But that, and you tell me, is completely in my head or like an anecdotal bias. But it does be like for some people, it's like always the first try. And then for other people, it takes like at least five or six months. I think it's hard to judge and it totally is anecdotes. But there tends to be a very strong correlation speaking scientifically between the people that get pregnant on the first try and those that shout it from the rooftops. That's true.

Right. Yeah. So I feel like. Because there is like pride that goes there. It's like an ego. There is like a weirdly there is like a little bit of ego in that. And it's very triggering. I wish people wouldn't say things like that because there's a smugness to it almost.

But they're not, I think they're just celebrating because maybe they were really anxious. I think it's also like you've been lucky in one aspect of your life. And sometimes it can feel like maybe the people who were most scared. Yeah. And maybe the people who are most scared of getting pregnant. Maybe they're the most vigilant about their reproductive health and that goes into it too. Like there's other correlating factors. Maybe. And then you also have the people that, you know, the first time or second time they tried, they got pregnant.

and now they're coming to me struggling for baby number two. Right. And that boggles their mind because they're like, I just assumed, like, I have no problems. And I always have to explain, like, that was then, this is now. A lot of things could change. Men make new sperm every 74 days. Like his quality could have changed. You're older.

That could have affected your egg quality. We know it does, right? And also people over time grow problems like fibroids or endometriosis gets worse. The longer you're off of the birth control pill where it would normally be suppressed. So there's so many things that are changing. There's no constant situation, if that makes sense. That makes a lot of sense. I think there's just, like, feels like, especially with something like fertility.

Yeah. Where, and I think that's why you see a lot of misinformation online because it's like something that worked for one person can feel like, well, this worked for me. And then you're like, okay, well, then I should try this. Right. Everyone's body and everyone's circumstances are so different. Can I tell you the number one thing that I hate in the comment section of anything I posts online is I'll talk about some like add on thing that you know maybe it's not harmful but

I'm telling you that the data has not shown there's a randomized control trial finally came out and it showed that this is probably not effective right I'm not saying no one should ever try it but there's always some of the comments that will be like well I had this happened to me and then I did this and then I got pregnant and it's this like fallacy right and I'm sure you talk about it with emily like regression to the mean like you could have kept maybe trying whether or not you added that extra thing in. Right. You were going to be successful eventually, right?

We don't know. But I think it's a fallacy in the way a lot of people think and it's human nature to attribute whatever thing that you did differently, you're going to attribute your success to that. Right. And that's how a lot of myths and misconceptions start. What do you think is the biggest misconception? Like when you see when people...

How much time do we have? Like when people come into you, like what is the most common thing that people are saying that's just completely wrong? In no particular order, I would say people feeling like they, you know, drink their smoothie every day. They do yoga. They maintain a normal weight. They take care of themselves.

They're the picture of health. They're doing all this stuff for longevity. Like they feel like they would never have a fertility problem. Right. And that's how I felt for sure. People assume that everything is in their control. And I always explain that it's like kind of like dating, right? Right.

Any life thing like education, whatnot. Like people put in a certain amount of effort and then they expect a certain amount of results, right? But I find dating and trying to get pregnant are two areas in your life where it's like, yes, your efforts matter. You know, being the healthiest version of yourself, it does matter. I'm not going to say it doesn't matter. But it also, you need all these other things that you have no control over to line up, right? And same with dating.

It's like, you know, you can make yourself available. You can work on yourself. But if you don't come across the right person, that's for you, like it's just not going to work out. You need all the external factors. Totally, which can be especially infuriating in like a city, like New York where like everyone, you know, you're taught as a woman like you take your life into your own hands. You can control your outcome. You can get like get the better job, get whatever. And like, that's all in your power. And then this just feels like, oh, like I can do all this planning or I can do I'm super healthy or I work out or I eat healthy. And like there's no. Yeah. It's very hard to uncouple this idea

of merit. Like everything's a meritocracy. And, and, and, and, that's not the case for fertility. Fertility is unfair. A lot of things in life are unfair, and fertility issues are one of them. Right. Right. It's not like something you did. It's not your fault. That's always the biggest message. I think another big myth is that it's usually a female problem, right? And that's a big, big issue because 50% of the infertility that I treat is a male factor. 50%. Wow. Yeah. And sometimes there's a combination of fact. But it's more common than you know. And I think a huge misconception when it comes to male health is, okay, the woman has to watch what she eats. She has to not smoke, like keep drinking to a

minimum. It's really about their body because they're the ones that will try to carry the pregnancy in most cases, right? And their contribution from the male side is just make sure you have good swimmers. And once that part is done, like you're done. And there's a lot of interesting data that's come out that shows that there are a lot of paternal genes in the placenta. And so chronic medical conditions, things that are not well-controlled, obesity, for example. In men. In men can actually influence the health of the placenta and therefore chronic things that can come up during obstetrical care in their partners. So like preeclampsia, even morning sickness, some of it has been linked to the male partner. Really? Yes. Because they affect the placenta. They affect the

placenta. There's a lot of paternal genes in the placenta. And the placenta is very important because it's what, it's the conduit for nutrients and oxygen to get to the baby, right? So if you don't have good blood flow through the placenta, your blood pressure goes up in the third trimester and, you know, you get things like preeclampsia, which can be very dangerous. Also, it can affect the health of future children. Like men with uncontrolled diabetes, their children are more likely to be diabetic and have metabolic issues. So this is newer information that's coming to light, but people haven't gotten the message out there yet. Would that be through the mechanism like of the embryo? Like because the embryo?

The embryo actually breaks up into two pieces. It differentiates into cells that become the baby and cells that become the placenta are the ones that the cells that line the outer part of the embryo. And when you talk about embryo grading and there's like a three-digit score, that last letter is corresponding to the quality of the cells of the placenta, the one-day placenta. Interesting. Okay. I didn't realize. I thought the placenta was like something a woman's body just like grows or has to almost like the uterus. I'm so glad we talked about this. I'm just spelling already. No, a lot of it comes from the male side. So now that makes a lot more sense why like the male DNA or the male genes would. And that's why I talk to both partners about their lifestyle. And, you know, sometimes I'll note this pattern where like the male partner will glaze over their vaping habits or whatever. Like my sperm's fine and I have to explain all of this to them. that there is a real reason and there should be a motivation to be the healthiest version of themselves. And this is like new research that's sort of coming out.

Yeah. I mean, it's kind of been something that we've known over the past like five to 10 years, like people have been researching it. But there's been some bigger studies that have come out with really compelling data. Is there anything else that you feel like has been really like advancing in recent years around? I keep seeing this stuff about them growing like a, about them having like using three people to get rid of the genetic disorders.

Three parent. Yes. Yeah. Yeah. It's not really three parents. but it is interesting. It's like you're using basically the reason why this is a technology that's been developed and it was a huge breakthrough that came out of England recently where they reported, I think, I think it was eight live births. Don't hold me to that. But like a case series of

seemingly healthy, live born children that seem to not have these mitochondrial disorders. So mitochondrial disorders are genetic diseases that you can inherit from your mom. And we always get our mitochondria from our moms. I don't know if you remember from high school biology, or maybe it was elementary school, like the mitochondria is the powerhouse of the cell. That's the only thing I remember. It's so important for everything. So like energy, like any organs in our body that require lots of energy, like our heart, our brain, like that's all mitochondria. And so there are certain genetic disorders that affect the functioning of mitochondria. And if a woman carries that disorder and maybe it's late in onset, so she didn't even know she had it by the time she was pregnant, she will give it to 100% of

children. So it's like there's no option other than do you want to use donor egg if you don't want to pass this disease. Because sometimes depending on the type of disorder can be really, really terrible. And so this is a really cool novel approach to try to overcome this without saying to the female partner, the only option you have to have a child is to use donor egg, right? They basically take an egg from a donor and they take the woman's eggs. They fertilize both with that partner sperm. Right. And then they scoop out the nucleus that has all the DNA that's joined together from one

of the eggs, from the donor egg. And then they put in the nucleus from the woman's egg, the patient's egg, the patient that doesn't want to pass on the disorder. And they put it in. It's called mitochondrial replacement therapy. So they have like three parents sort of. But they don't because all you're getting from the donor is the mitochondrial DNA, which makes up like less than 1% of the total DNA.

It doesn't determine traits or anything like that. Okay. So it doesn't mean like that. So it's actually really cool. It wouldn't look like the donor. No, exactly. You're just getting the mitochondria, and that's the healthy version that you want. That's crazy.

It's hard to explain that in a really concise way. No, I mean, that's pretty incredible. Yeah. Yeah. And people are excited about it because, you know, there is this idea of, well, you know, we are born with all the eggs that we're ever going to have. And egg quality is a huge barrier to success for a lot of my older patients. Like, as you get into your 40s, it just becomes harder to ovulate a healthy egg.

And so this idea is really exciting to some people because they're like, well, maybe there's a way to kind of fix our eggs while still retaining our genetic material. Yeah. And I mean, eight people seems like a lot to start anyway. So it's a really exciting area of research, but it's actually banned here. Really? So it's only been something that they've been able to study overseas in Europe. Yeah, I guess we'll see how that progresses. Yeah. Hopefully. If you go back to like to IVF, I think in general.

Yes. And like the, I mean, how old is the oldest IVF baby is what? Born in 1978. Don't make me do the math. So like, close to 50. Right. Right. Yeah.

So it's crazy. I mean, the science has really not been around that long, but it seems to be like improving. Has it been improving like progressively or just like much better than it was 20 years ago? Oh my God. Every year it gets better. Every year it gets better. But there are certain like acceleration events. If you think about the timeline.

And, you know, I talk to my mentors who talk. who taught me from the very early stages of my career. And I remember them saying things like, oh, you're going to be so lucky. You get to call so many patients and tell them they're pregnant. Like, we had a 5% pregnancy rate. It was like a miracle if anyone got pregnant. And imagine, like, back then no insurance was covering IVF. And people were really putting it all in the line and trying to do something for this like 5% chance.

Now, if you have a really nice, well-graded embryo and it's genetically tested, we didn't know how to do that back then. Now you can grow embryos out much further and you can assess them and weed out the ones that aren't ever going to lead to a pregnancy. And you can test them and you can say there's like a 60 to 70% chance of live birth. Now, I know that that doesn't happen for everyone and sometimes it can be really difficult, but more than 90% of patients will have a live birth after three consecutive embryo transfers with the right conditions. If they have no uterine issues and if, you know, you have a well-graded embryo that's genetically

tested, that's pretty miraculous if you think about the short amount of time that IVF has been a thing, right? Right. Well, when I mean, you talk about this in your book that like IVF, I think is seen as like this guarantee or this like cure-all. Or this thing that's sort of like looming in the back of like, if all else fails, I'll just do IVF and work. So can you talk about like what the misconceptions are around IVF?

Yeah. So IVF is trying to get around one major problem. it's the inefficiency of human reproduction, right? We talked about this like throwaway stat of like 15% chance of pregnancy each month. That's if you're like in your mid-30s, right? If you're in your early 40s, it's more like 5% chance per month or maybe even less. And your 20s, at best, it's like 20 to 25%. And why is it so low?

Because every month you're only working with one egg. It doesn't matter if you have a really high egg count or not. There's like a lottery. It's almost like a slot machine. We're at random. You ovulate one egg. It's not based on merit, whether it's a healthy egg or not. And that egg may or may not fertilize, may or may not turn into an embryo.

And that embryo, a lot of the times, could be abnormal, especially as we get older. Right. And so what we're doing with IVF is we're hijacking this system. We know there's a ton more eggs that we could get to. And there's this weird thing happening in the background where it's like you have a bunch of eggs that come to the surface. They're available. I know how to get to them.

Those are the shots that you're taking during the eight to 10 days leading up to an egg retrieval. We can reach those eggs by ripening and maturing them and then extract. them. So instead of working with one long shot, you can work with 15 long shots or 20 long shots, but there's still long shots, right? It's still inefficient. That inefficiency doesn't magically get rectified just because you did IVF. You're working within the confines of that. So you start off instead of one egg with 15 or 20 eggs, hopefully that would be a great number, right? And not every egg will fertilize, not all of those eggs. It's like survival of the fittest. And I always use my hands and

show patients. I'm like, you start with this many and the numbers will whittle down. But hopefully if we start with enough, we'll still have multiple embryos, right? And then we can test them, we can freeze them, get those results back, and then use one at a time. But sometimes people have a very small number to start with. And so with that whittling down of numbers, they don't get an embryo at the end of it. Or maybe they have a lot of eggs or they don't have a lot of eggs, but there's a much sharper attrition because of quality issues. Right. So you don't always get an embryo. And I usually say to patients in every patient's situation is different, right? But in the large majority of cases, I'll say if we can get normal embryos, that's usually like the hump we need to

get over. Okay. Now, the hardest part is there are a lot of patients that will have implantation issues, but I will say that those are few and far between versus the first problem that I stated, which is making the embryos. Is the problem that much more people are saying. Egg quantity and quality is the hardest problem that we deal with. And that's hard to rectify.

There isn't really a treatment to make you generate more eggs, right? We're working with what we've got. And the only way to counteract, if there's a low number to start with, or there's really sharp attrition because of quality being a problem, is to do more than one round. And that isn't always feasible for people. Right. Mentally, physically, emotionally and financially. Right.

And I think a lot of people have this in mind. I know a lot of women who are single and have frozen their eggs or just as this like sort of insurance policy. But even with that, I think it's hard to know. You can't test the quality, right? I never say insurance policy, and this might be like a little semantic, but I think it's not an insurance policy, because an insurance policy implies, like your house burns down, you're going to get the insurance for it, right?

Like a guarantee to an extent. Correct. Correct. Whereas this is more like a head start because you have a larger pool theoretically, because you could get to more. When you're younger, you tend to bring more to the surface because it's a reflection of how many you have in the resting pool. You're born with a certain pool of eggs, one to two million, and that's all you get, right? And depending on how much you have in your stockpile. I like to call it a pantry, right? And imagine every month the pantry unlocks. I don't know how to unlock it, neither do you, but a certain number, get out of the pantry and go into the kitchen cabinet. There's see-through. That's what I can see when I scan you in your ovaries.

And it's like rationing, right? It's like any supplies. You ration them. So if you have a lot, you bring a lot to the surface. I know how to open the kitchen cabinets and take the eggs out and I can freeze them. I can turn them into embryos and freeze them before they go to the wayside because they're perishable. They're constantly just kind of getting wasted. And so... You mean like in every month that you're not having a baby? Right, exactly.

Well, even the months that you are having a baby because only one egg got ovulated, the rest of them go away, right? And even when you're pregnant, that's not protective. You're not stockpiling your eggs. They're still coming to the surface in waves. They are?

Yes. So when you're pregnant, you still have... You're losing eggs. You lose eggs starting when you're a 20-week fetus. Actually, you start with like 6 to 7 million. And by the time you're born, you only have one to two million left. Which seems like a lot.

Yeah. But it's crazy to me that that's like your starting point, right? So like before you can even start ovulating and releasing eggs, you're losing them before you can use them. So why do men's sperm get worse over time? So it's different. For us, when we think about egg quality, what's happening, it comes down, without boring you with all the scientific details, it comes down to the number of packages of DNA in each egg chromosomes, right? That's how our DNA's package. And imagine there's like this filing cab.

These are the proteins that keep the packages of DNA, the chromosomes organized. That's what breaks down as we age. They're called cohesions. And so over time when like, you know, all the things are supposed to be happening when like the chromosomes from the male side and the female side come together, they can become much more haphazard and you lose some and you gain some. And that's how you end up with an embryo that has missing or extra DNA. That is coming from mostly the female side.

Some sperm will have typos, but because men are always regenerating sperm cells, their proteins are fresh and new and the filing cabinet is organized and that doesn't happen as much. As men get older, they do start to accumulate mutations in the DNA in their sperm that can be passed on. But it's not about can you get someone pregnant or can they stay pregnant. Yes, there's some diminishing fertility and higher risk of miscarriage in a subtle way. But there are associations between advanced paternal age like over 45, definitely over 50, 60, and things like autism, like neurodeveloping. developmental problems, certain developmental disorders, even like childhood cancers have been linked to having a much older father. And are those things that can be detected in like DNA? Not really.

They're like point mutations. Like there are subtle things. You don't, you need to know what to look for. Whereas when you're testing embryos, it's much easier because you're like, it's kind of like black and white. I'm counting the number of chromosomes. Right. Because we know that that's kind of the end product of female aging when it comes to how it relates to egg quality. But IVF won't guarantee you anything against like autism or anything. No, I get asked that all day, every day because people are traumatized by, you know, they have a family member, they have something that's happened in their lives, and they are so worried about it being hereditary, like, what can I prevent? And there are things that you can test in the embryo beyond the number of chromosomes. And it's important. This is a great

PSA, actually. Like sometimes people will have a really strong cancer history in their family. Like they're like, my mom, my maternal aunts, all of them had breast cancer. And they may not have ever talked to anyone about it. And I'll say, maybe you want to get tested. I mean, it's a really emotionally charged topic. But if you want to know this information, it could change how you get screened and what insurance would cover for screening for your own health. But also from a fertility standpoint, this is something that you could pass to 50% of your children if you carry a mutation that could predispose you. It doesn't mean you are going to have cancer, right? Right. So there's certain genetic mutations that we can get passed down, you know, throughout our family. And if we are a

carrier and maybe we don't know if it's going to affect our life or not, but it's something that's kind of weighing on you and you don't want this to weigh on your future child, you could say, hey, I want to create embryos and I want to test them for this mutation because we know what we're looking for. With autism, we don't know what we're looking for. We don't even know if it's genetic. I mean, some cases might be genetic. Some cases might be multifactorial. Some of it's environmental. Who knows? So you don't know what to look for. If you know what you're looking for, then you can test. So when people are like, I have a strong family history of schizophrenia or, you know, whatever it is, if it's not associated with a known gene mutation, I can't test for it in the embryos. It will decrease the likelihood of like a miscarriage based on a, because most miscarriages are from chromosomal errors.

But not necessarily like other. It's not going to reduce your risk of birth defects, right? Like birth defects occur in 2 to 3% of the general population. And it doesn't have to do with chromosomes. I mean, sometimes it can be. but there can be things that arise just during normal development. And these are things you'd identify on like an anatomy scan, you know, sometime during the second trimester.

So there's a lot of misconceptions going back to your original question, you know, about what science can achieve in terms of success, what it can overcome. Even when I was a medical student and I was single, I remember saying, oh my gosh, like I will wait until I'm in my 40s to have children and it's fine. I'll just do IVF. I said that. Yeah. Can you believe that?

I mean, I totally can believe it because I feel like you see that a lot and it feels like it's, again, it's, you don't hear about or you hear about the people who had success with it and you don't hear how hard it was. Totally. When I met my husband, I was 28, I think, 27, 28. And I told him, like, during the early part of our relationship, I have a career, like, I'm not going to want to have children until I'm in my 40s. Like, this is just a thing. And then we got married in our early 30s and I was training in this area. and seeing all this stuff, seeing all these stories play out of people that thought they could control every aspect of everything and seeing how unpredictable some of it can be.

And it scared me. And I went off my birth control. Like literally like a few months into training, I was like, I know that the timing's not perfect. And he was like, what the hell happened? Right. I said, you know, I've seen that science can only go so far. And I don't, I feel like, you know, we know we want to have kids together and we just bought a one bedroom apartment.

And this is really stupid. But I think we should try because I'm. convinced I might have a problem, you know, because I see it all. So you had your first, first daughter, um, without treatment. Right. Yeah. Yeah. And like earlier than I had initially wanted to because I got scared straight, so to speak.

Um, and then I didn't actually expect for it to happen like within the first six months, but then it did. So I'm, but I'm not one of those annoying people that shut it from the rooftops. Don't worry. Well, I have a question, I guess, about that because I know, um, I think you talked about this on your Instagram. where you said for your for when you did an egg group you'd end up doing an egg retrieval right and you you didn't have great results right correct yeah so I ended up getting pregnant and and then I freaked out

a little bit because my grand plan was I know I'm in my mid 30s I know I might want to have two to three kids and just with my career and stuff it's not going to be back to back and I felt very overwhelmed and so I said okay we're going to try for a few months and then maybe we'll freeze some embryos just so that I can kind of have the big picture in mind and and feel a little bit more secure Right. In the background, like another thing that scared me. Exactly, a head start. What scared me was that my AMH level had dropped. And even though I know that that doesn't tell you whether you're going to be fertile or not because you only ovulate one egg per month, knowing that a marker was showing me in real time, like, this is what's happening to my biology. I'm losing my eggs. And I know it's like there's the intellectual side of my brain and then there's me as a woman facing the same emotions that anyone faces when I tell them their AMH has changed, right? in a negative direction. And so automatically it kind of just was like a reality check for me. So I wanted to freeze embryos. But then I was pregnant and then I was breastfeeding and couldn't do anything. And then very quickly I said, you know, I actually went to Dr. Flister, who's one of my colleagues at RMA of New York,

and I was like, I want to freeze some embryos. And it wasn't straightforward because my numbers were lower. And so I had one cycle where I got something, but it wasn't enough for my goals. Like I wanted to have, I always tell patients, try to have two high quality tested embryos per child. Because if it's a 60 to 70% chance for most people, then having at least two, three, if you're really conservative, is going to kind of cover your bases as much as you can. And so then I set out to do more. But I went to like Mexico during Zika. And so then they were like, you should wait six months. And in that time, things really changed.

And so I had a canceled cycle. Then I had another cycle where I only got two eggs and nothing turned into embryos because when you start it with a number like two, even if you have decent. egg quality, like you might not end up with anything, right? Well, why do you, why would one get like two eggs on one cycle and a lot more in another? It's just totally random. Well, I didn't get a lot more in another. I think most people won't have like such disparate, yeah, results. But sometimes you can have some months that are better than others. And I think it comes down to like the number of the eggs that you recruited in that cycle. They're in this bubble of fluid called a follicle and how many receptors were on the follicle, like how responsive were they? What's going on with your general

health. There's so many external factors. Right. But eventually, like, I did multiple retrievals and then got to the number of embryos that I wanted. And then I was like, okay, great. And then I didn't do anything for a long time. And then when I was trying at 37, 38 for baby number two, it was a lot harder to get pregnant. And then I was like, I'm going to use an embryo. And that's what happened. So I've experienced the patient side of the journey. And I've also experienced that crazy 180 degree shift in thinking, like quite drastically actually. Right. Like everyone around me had it in their head of like, oh, this is her plan.

And then I just got really freaked out. And I think that all of us to some degree freak out a little bit when we have to all of a sudden confront these issues and start thinking about our fertility and our future. Well, when you said your AMH dropped, does that fluctuate a lot? It's not that it fluctuates, but it's a normal thing to happen in our 30s, right? Yeah, we start to lose eggs at a faster rate. And it can be different for different people. If you have certain conditions like endometriosis, you are at a higher risk of losing eggs faster if your mom went into menopause earlier.

But it's not necessarily a problem. There's a lot of people walking around outside on the sidewalk with very low AMHs and maybe they've had no issues with their fertility, but they've never gotten it checked. They have no idea. Right. Well, that was my other question. So we had someone on, Maria was on a different episode. She was telling us about that she was diagnosed with primary ovarian. sufficiency, POI. My question about that was like, so let's say she was, like, she also said she was

only ovulating like two follicles. She said she was only ovulating two follicles from like one side. The other side wasn't producing any for a while. But for something like that, if they're only dropping one, one egg every month, why does it matter if there's two or if there's 30? Yeah, so I could see how that would be confusing. P.O.I is actually a condition. It's different than diminished ovarian reserve. Diminishing of Reeserve and Reserve is like the overall stockpile, the number in the pantry is low, but you're still able to take them over to the kitchen cabinet, open one cabinet each month, whether it's one side or the other, and take out an egg, right? What happens with POI is that you run so low that your brain, which is sending signals to the ovary

to tell it to release an egg, to mature and release an egg, it starts falling on deaf ears. Because there aren't enough. It's almost like if you have a jar of marbles and you run so low, so when you swill it around nothing escapes because it's so low. Okay. So it wouldn't matter if there were a bunch there. Yes. And that is a problem for fertility. So as much as I shout from the rooftops, you know, your AMH doesn't define your fertility to a point. If it gets so low, and it's not about the number, it's more about like the functioning of your ovaries, if your numbers drop below a certain critical threshold where your ovaries stop listening to signals and it's just so low it can't

release eggs reliably, that can affect your fertility because if you're not ovulating or you don't know when you're going to ovulate next. You ovulate so infrequently, then you're not really in the game. Right. So that's the issue. And with POI, you can sometimes squeak out an egg here or there. And I've had patients where it's like, you know, we'll randomly kind of bring them in for ultrasounds and I'll try to help them time things because ovulation predictor kits, all of that stuff is not going to work well for them because it's picking up the really strong signal from the brain. And they're going to think, hey, I'm ovulating all the time. But really it's them detecting their physiology, which is your brain's trying to whip your ovary to work.

Right. Right. And so it can be really confusing to people because they're like, well, I'm testing at home and I'm getting the signals and then I'm not getting my period. And it's because they're not actually ovulating. I hear a lot of stories on this show. Is there anyone whoever comes to you and you're like, there's nothing I can do? Or is there kind of always something if you're open enough to different options?

I think there's usually something as long as you're open to different options. I think the issue is not everyone's open to different options and not everyone can afford different options. And that's the hard part about my job, right? Because we're seeing a lot of improvements in coverage for fertility treatment, but it's far from universal. And I always say if there's a will and you're open, then there's a way. But not everyone's going to feel comfortable going the route of using donor egg or using a gestational carrier if it's difficult trying to do it with their own eggs or having them carry. And what do you tell people who come to you and they have, you've run all the tests and

you've done everything and you can't. And that's like, I think that's, what is that, 50% of issue, you said? It's usually like we say 15% or unexplained. Oh, 15% percent. Yeah. Why do I think it was 50? No, no, no. Okay.

So 15% is of infertility cases. Like, there's nothing you can point to. So what do you, in that scenario, like, what do you usually? Oh, and that's a huge tagline, like for the grifters online. They're always like, here's what doctors don't want you to know. There is actually an explanation and I have all the answers. I mean, I think it's easy to explain when I say there is no direct way for me to test your egg quality. And that's such a huge important factor in all of this.

You know, usually there is a clue of something going on. Like if someone comes to me at 28 and all of the tests are normal, but they're like, I have really painful periods. I'm like, oh, okay, maybe you think everything's normal, but maybe you just haven't been diet. diagnosed with endometriosis yet, right? And that is something that can affect your fertility in so many different ways and no two patients with endometriosis are exactly alike, because for some people, it causes blocked tubes and scarring. For other people, it causes mainly egg quality issues. For some people, it's problems with implantation if it affects the muscle of the uterus. So it depends where it is, it depends how severe it is. That is probably the underlying cause in a lot

of cases of unexplained infertility. And if you look hard enough, you may, see clues of that, whether it's on imaging or just listening to the patient talk about their history and how painful their periods were. The pain went away when they went on the pill. And sometimes it makes sense to send them for surgery, to do an exploration and to really get a diagnosis. And the nice thing about that can be that sometimes you can actually treat it then at the same time, right? And that might improve the overall environment and make things a little bit less inefficient. But there's not always going to be an explanation. And sometimes when things really don't make sense, doing other tests that aren't part of the routine work up.

Like someone who's really young and the sperm looks great, everything looks good on imaging, they've never had a painful period in their life. And you just really don't know what's going on. Like I will do specific specialized genetic tests like a karyotype to say, like do you have a translocation, like a rearrangement in your DNA that is silent and goes undetected. But when your DNA tries to join with your partners, it leads to a lot of abnormal embryos. things like that go into the bucket of, you know, thinking outside the box and just trying to understand everything that you can. But there won't always be an explanation, but I always say

that doesn't mean that there isn't a solution. Right. So in unexplained infertility, if you do something like IVF, does that still usually work? It works a lot. And it's hard to explain to patients because they're like, what do you mean? We don't know why, right? And I explain to them, it may be something beyond what we have tests for. Like it could be a sperm egg interaction issue. And just by virtue of injecting the sperm directly into the egg outside of the body and cultivating it into embryos outside of the body, if there's endometriosis or something affecting that process normally,

that may be the solve for it. Or maybe your egg quality isn't what we think of for the typical 28-year-olds, right? That's also a possibility. We have a major blind spot that we don't have a test for that. And so you get a lot of information. I always say if someone's going through IV for the first time, it's not just therapeutic. It's also diagnostic because sometimes you're going to see, oh, why is there such a low fertilization rate? There's something going on with the sperm that we didn't think about.

And sometimes that can also indicate egg quality issues. Sometimes it's everything got to day three, but then they all drop off after that. And that can sometimes actually be a sperm issue as well as an egg issue. So you can kind of get clues because you're looking at biology happen in real time. There's always some sort of thing if you keep searching. Exactly. And you can now test embryos, and so that can also help you identify the ones that have better reproductive potential.

So sometimes you don't get the answer at the beginning, but just by going through the course of treatment, you can learn a lot. And does it make sense in all cases to do IUI before IVF? It seems like... Not all cases. No. Like when someone comes to me at 38 and they say, I want to have two kids, I talk to them very seriously about the strategy or trying to be more strategic.

and maybe going straight to IVF because you may want to freeze embryos for the future. Because while an IUI could be successful at 38, things start to really accelerate when we think about how our egg quantity and quality changes over the next few years as we get into our 40s. And so you might be better served at that moment to say, let me make a thoughtful decision and have embryos banked for the future because they're not changing once they're frozen. They're not deteriorating over time. And your uterus doesn't really age, you know, in two, three, three years, your chance of that embryo thawing out and implanting successfully is the same

as it would be today. So if you were, to go back to the, to the egg freezing discussion, if you're like a single woman and you're looking to do that, what, what, I mean, obviously, is it always like the younger, the better? Or is it like, what age would you be like, you should, you'll have much better success usually if you try before this age? Yeah. I mean, I think that 28 to your early 30s, leading up to your mid-30s, that's like the sweet spot because it takes a lot, you know, from going through fertility treatment. There's a lot that's asked of you as a patient. So do I think everyone when they graduate high school should just like go to the fertility

clinic in their town and like have a consultation and go through this process, which can feel really invasive and bring up a lot of information and questions you might not be prepared to confront? No, I think that you have to have a certain degree of emotional maturity to handle the process. And not a lot changes with your egg quality in your 20s and early 30s. And most people will tend to have a good count in their 20s and early 30s. So I feel like that tends to be the sweet spot. People usually at that point in their lives may have jobs.

Maybe their jobs have benefits. So it's also on a practical level, you know, maybe easier to do something like that when it's being covered and you don't have to pay for it out of pocket because there's so much technology involved. It's very expensive. So I think, you know, that is really my recommendation is to do it before 35. But that's not to say you can't be successful if you do it after. After 38, the success and the confidence that we have in frozen eggs really starts to drop off.

But I have seen people be successful. But generally speaking, you need a lot more eggs to feel like you're going to have enough to overcome the attrition that we anticipate. So how many eggs would you say would be, would you recommend someone have at 31 if they're if they're freezing eggs to have two kids, let's say. I think that the answer is going to depend on the doctor and the clinic that they work at and their experience. So I'm never cagey about giving these numbers, but it's very hard to find people that will commit to numbers if you look online. But I'll tell you what I tell my patients.

And this is based on real world data. Every week, people come back to thaw out their eggs now. So we're like actually seeing this information. When I was training, I remember the people that trained me were like, it makes me nervous when people come back to thaw out their eggs. because like we just don't know how the stats are going to play out. Now it's like, I don't even think twice. I'm like, let's saw her eggs. Let's saw her eggs.

Like it's not something we feel nervous about because we have 90% thought survival rate. Right. And then from there, it's kind of mirroring the same attrition we see with normal IVF. Like 70 to 80% will fertilize and then maybe like 60% on average will turn into embryos. It really depends on the person. And then what proportion of their embryos are healthy or not depends on their age. So if you're in your mid 30s, a minimum of 15, I would ideally like to be, above 20 because we always think of it as like a 10 to one ratio from eggs to live birth.

Oh, so like divide by 10 to get the number. Okay. And it's not, that's not the case for everyone, but specifically in your mid 30s, right? And so if you want to have enough and you want to have wiggle room so that you might have enough embryos to have up to two children, then 20 would be a good place to start. When you're 38, it's harder to know, but like over 30, you know, 30 is going to make me feel a little bit more confident, but you really don't know because you're on an area of the curve where those errors or typos we talked about in the number of chromosomes start to crop up much more rapidly. And so it's hard to say where someone will actually fall on the data curve, right? And you don't, you can't, it's unlike in a cycle where you're freezing embryos,

if you don't get great results, you do it again the next month. This is like sort of, you're not going to try again until you're a guesstimate. Right. You know, you don't want to be guessing with something so important and time sensitive, but it's all we've got. One pro tip that I talk about with my patients, they'll come back to me sometimes just to check in. They're like, hey, remember me? I froze 25 eggs with you when I was 32 and now engaged. Yeah, they're still there. Now I'm engaged and they'll come with their fiance and they'll say like, how should I

think about these eggs? And I think it's a great conversation to have because I'm like, okay, are you comfortable taking some of them or do you want to take all of them and turn them into embryos now because I understand that you're not ready for another three, four years to start trying? But if we find out something now from that taking that next step, that might give you recourse to do something about it now while you still have the egg quality and the numbers you have now. Important conversations probably early on.

I don't think people realize that you can then freeze them again at the embryo stage. You don't have to use them then. You can test them. No, I think that's really empowering to know. What would you say? I've heard this from a few different people and like talking about how if you go to like Greece or like turkey or somewhere like that, you can get the same. You can get IVF for like a much cheaper rate.

Is that something you would caution against or you think is. spine or like how do you how do you look at those have you heard that yeah no for sure medical tourism that's what we call it right um and there's a lot of like influencers on tic talk about it and they make it look really luxurious because they're like hair plugs and and freezing right exactly exactly they're doing and they're on vacation and they're in an Airbnb and like i think everyone's got to do what's right for them and i do think that the cost is prohibitive for too many people so i understand trying to find other avenues. And I'm actually, you know, very supportive of it. I do think that there's caution to be had and people should be aware. You know, this is not like a process that just happens

like that. This is like a two-week process. It's a medical procedure. Like I do have safety concerns with people going through this in a foreign country, not having the normal support system they would normally have. And then jumping on a plane like the next day after having a procedure and they could have complications. And, you know, so I- - anesthesia, right? Yeah, and I think it's harder

to vet clinics in other countries. I also think we don't really know what the success rates look like. Success rates vary so much from one lab to the next. And I think, you know, there are certain standards here and there's like, you know, a regulatory body that vets certain

clinics. There's something called SART, the Society of Assisted Reproductive Technology, and you can go online and you can look at success rates from one clinic to the next. And you know that they're following and adhering to certain guidelines and you just don't know that in other places. So I'm not saying it can't be done safely or successfully. Obviously, people are successful with IVF and other countries. I will say

there's a reason I came to practice here as a Canadian who has no family anywhere near here, right? Like I wanted to be in the place where there were a lot of cutting edge advances being made and better success rates because that's why I want to be able to offer my patients. So lab is paramount and that's what people don't focus on. That's what you would suggest, like looking up. For anyone even looking in the United States or by them or interviewing or having consults with clinics by them, like what are the key things to, I think, leave those consultations with, like what knowledge? So this is going to maybe be controversial, but this is just my honest, professional opinion. And it's logical. Volume is really important, right? I know there are

probably some good small clinics. Maybe there are some really large clinics that aren't as great. But in general, when you think about it, if you're going to get a surgery, would you rather go to the surgeon that's done 100,000 cases or the guy that's only done 2,500? Okay. Right. Like a lab that's well honed that does a lot of everything, not just freezing eggs, but they also know how to thaw them and fertilize them. And they're doing like thousands of cycles per year. Okay. In my opinion, like when I'm advising a friend or a family member overseas or anywhere and they're trying to vet different clinics, I'm like, go to the bigger busy.

year one because they do more cases. They also have the infrastructure to do your retrieval seven days a week. It's not like, oh, my embryologist doesn't come in on, you know, this day. They're available. And, you know, patients always ask me, they're like, you guys are so busy. You know, how long will it take for me to get it? And I'm like, we can just start when you get your period. I don't have to put you on birth control. I don't have to line you up and say you're going to come in in three months. This is a time sensitive thing. So I think going to a big clinic that can handle patients coming in when it's right for their cycle to actually get started. Right.

And they have embryologists that have done a lot of these procedures because they're technically doing like these microsurgical procedures on your sperm and your partner's eggs, right? Right. And it's quality control too. Like you just want to have the infrastructure. And that's something that I as a clinician don't control. I can navigate helping to stimulate your ovaries and knowing if you're lining is thick enough to schedule the transfer.

And those are all really important parts in what I do. But I rely heavily on a team of 30 to 40 embryos. biologists that are a well-oiled machine and they operate with such efficiency and they are constantly looking at the results, constantly troubleshooting, doing quality control. And that's what happens behind the curtain. And that's what determines ultimately success rates. Yeah. I mean, I haven't heard that before.

That's really good to know. So it's like the quality of the lab and the volume of the lab. Yes. Those two things. Yeah. And I think both of them often go hand in hand. And when you look at success rates, I think people don't look at that when they're thinking about egg freezing because they're like, well, I'm not there yet. But the place that's

best poised to freeze and thaw your eggs well is going to be the place that also does IVF well, right? Like it's all kind of in the same bucket. Right. You keep them together. This has been so helpful. I feel like there's so much more that we could cover, but I'm so glad that your book is coming out because people can like really read through all of it yourself. And they can go to your website with the lucky egg.com. Yes. Which I mean, I've been to even as even with you as my doctor, I've been to. Like, again, just to get, you know, peace of mind. The deep dive. Right. It's so important to have just like really thorough medical, like, advice that's well tested and comes from a reliable source. So I think what you're doing with

the lucky egg is amazing. To close out the episode, let's take a moment to recharge with a segment sponsored by first response. Every moment of the fertility journey is different for everyone. And we all handle waiting for that positive test in our own way. No matter what you're struggling with on your journey to conceive, our friends at first response want to help you find some positive in the negative, whatever that looks like for you. So my last question is for listeners out there and you probably deal with people who go through sort of extensive fertility treatments. A lot of the times it's longer than they anticipated or it's more grueling or they're not getting the success they want. What is some advice you give to patients to kind of keep them hopeful and optimistic and positive

throughout a process that can kind of feel at times probably a little bit hopeless. Well, I think it's important to approach it like a marathon, not a sprint, right? It's all about building up resilience so that you can kind of stay in the game. There's a really good study that came out that suggested that up to 20 to 25 percent of patients drop out of treatment prematurely, and they actually looked at reasons why. And it wasn't what you would normally guess, like it must be financial. It's actually psychological fact. And, you know, this was in patients that lived in mandated states covered by insurance.

So we know that supporting people with their mental health and giving them the tools so that they can be resilient and stick with it until they get to that successful outcome. Because so many people will be successful if they stay in it long enough and they have the right tools. And maybe it involves, you know, pivoting to different options. But you have to be in it to win it. That's what I always tell my patients. And so I think you have to be kind to yourself and give yourself grace. I think people put so much pressure on themselves. I'm not going to be able to take a vacation. I have to cut out gluten and dairy and do all these restrictive things and make my life a living hell because if I put in the effort, I'm going to get the result. And we've already talked

about how that isn't true. It's okay to take breaks. There's studies that have looked at, you know, taking a cycle or two off. Does it have any negative impact? And the answer is no. And so I think this feeling of urgency of like, I just have to make my whole life an identity about this. Otherwise, it's not going to go my way. It's not true. And I think it's actually very damaging to take that approach. It can affect your mental health. It can affect your relationships. It's so important to cultivate your relationships and find ways to have joy in your life outside of fertility treatment, even though it's hard. I know it's easier said than done. But finding a community, even if it's online, if it's anonymous, because you don't feel comfortable sharing this in your

day-to-day life with your friends or your family. But I think if you can talk to your friends and family, even if you trusted people in your life, and give them the tools, right? And that's why I always say this book is not just for people going through a struggle, but it's also for people that want to know how to better support their loved ones that are going through it, because the onus shouldn't be on the person struggling to now educate everyone around them. Right. So I think giving people tools like, hey, maybe read this or if you want to know more about this process. And also setting expectations and boundaries is so important. From the beginning, you take a very thoughtful approach and say, all right, you know, I want to share this much or I will give you updates. Like, please don't

keep asking me. Yeah, like little things like that can go a long way. And it's all about setting yourself up for success. So just be really thoughtful about who you share this with and how you want to share it. And, you know, ask people for what you need. And they'll usually give it to you. But a lot of times they just don't know what the right thing to say is. And I think you just have to protect your mental health. So much of my book, and what I love about this podcast, we were talking about how season two is a little bit different, but how you incorporate your sister in the mental health conversation being a huge focus because so much of this is mental and not physical. And that is probably one of the most under-anticipated aspects of the journey for most of my patients.

100%. Definitely was for me. I think that's really, really good advice. And I know, again, that we've just scratched the surface of everything. So where can people find you to hear more, to see more? I know obviously the lucky egg comes out January 13th, but you can pre-order it now on Amazon or anywhere you get books, I assume. Exactly. Right. But where can they find in the meantime while they're waiting? Where can they find more information and more? Because you're constantly giving out so much like amazing fertility information in like very fun ways that this podcast also kind of does where we like to take the edge off. It doesn't have to be so intense all the time. So where can they find more from you? Well, I practice medicine at RMA of New York. I see patients. I take on new patients

for egg freezing, embryo freezing, IUI, IVF, even just doing a fertility checkup and counseling. I'm online on Instagram at lucky.ccon, sekh-h-h-o-n. My website is thelucky egg.com. And it also has a lot of really cool calculators. So there's an egg freezing calculator. How many eggs does it take to make a genetically tested normal embryo? Right. There's also like a pregnancy milestone calculator if you put your due date in and it'll tell you like when is your anatomy scan when is this when is that and i think that's the key is really just arming yourself with good information because when you know what to expect that's at least one less thing that feels out of control totally that's great advice thank you so much for coming on today thank you for having me this was such a great episode we'll be

back next time bye so thank you again to first response the pregnancy test brand that is there for you no matter where you are on your journey when it comes to pregnancy and planning first supports and empowers women along their journeys because every test is more than just a result.