Saturn Returns with Caggie - *Bonus: Community Q&A* Understanding Fertility & Hormone Health with Dr. Helen O’Neill from Hertility

Episode Date: January 15, 2025

Trigger warning: this episode discusses sensitive topics around fertility. If this is difficult for you, please keep this in mind before you listen. In this special Q&A episode, Caggie is joined by returning Saturn Returns guest, Dr. Helen O'Neill, to answer your questions about fertility, hormones, egg freezing, balancing motherhood and career, and much more. If you’ve been feeling overwhelmed or unsure where to start with your fertility journey, this episode is for you. Dr. Helen O'Neill is a lecturer in reproductive and molecular genetics with an MSc in prenatal genetics and fetal medicine. She’s also the CEO and founder of Hertility, the go-to brand for women’s health, offering hormone and fertility testing, online consultations, and in-person treatments with the UK’s top experts.  Hertility offers comprehensive at-home testing and supports women at every stage of life, from menstruation to menopause. Through groundbreaking clinical trials, Hertility is raising the standard of scientific rigor and education in female health, significantly reducing the time to diagnosis and helping women access specialist care sooner. Whether you’re navigating fertility questions, exploring motherhood, or seeking knowledge to feel more informed, Hertility is here to support you. For £10 off your first order, use the code Caggie10 here and get started on your journey to peace of mind. Learn More: Educational Resources from Hertility ✨ The Proactive Guide to Getting Pregnant ✨ 5 Personal Accounts of Egg Freezing ✨ The Egg Freezing Guide for the need-to-know info ✨ 5 things AMH can tell you about your fertility ✨ How to naturally boost your fertility in your 30s ✨ Pregnancy and nutrition ✨ You can also follow Hertility on Instagram here — If you enjoyed this conversation, don’t forget to follow Saturn Returns for more episodes exploring wellness, spirituality, and personal development. Share this episode with someone who could use a little extra joy in their life, or take a moment to comment and share your thoughts. Your feedback means so much and helps us reach more listeners! Keep up with Caggie: 🪐 Follow Caggie on Instagram: @caggiesworld 🪐 Subscribe to Caggie’s Substack: You Are Not Alone for insights into her personal journey. Discover more from Saturn Returns: 🪐 Instagram, YouTube and TikTok 🪐 Order the Saturn Returns book: Click here 🪐 Join our community newsletter: Sign up here 🪐 Explore all things Saturn Returns: Visit our website

Hello everyone and welcome to Saturn Returns with me, Kagi Dunlop. This is a podcast that aims to bring clarity during transitional times where there can be confusion and doubt. Today we have a special episode as I am joined once again by the fabulous Dr Helen O'Neill, who is the founder of Hertility. Now we put out a little Q&A to our audience to see if you guys had any questions about your fertility, hormones, when is the right time to have kids. It's just such a complex area

that I feel like we're very under-educated in. And this was such an amazing conversation that I got to have with Helen that we thought we'd put it all together and put it into a podcast in case you guys missed it when we put it out on social media. And for those that do not know, Dr. Helen came on the show previously. She is a lecturer in prenatal genetics and fetal medicine. I mean, she is a genius superwoman. I am in awe of her. And she's the CEO and founder of Hattility Health,

the world's first diagnostic and virtual clinic for reproductive health with comprehensive at-home testing. Hattility supports women all the way from menstruation through menopause and their clinical trials aimed to raise the standard of scientific rigor and education in female health, to radically reduce time to diagnostics and fast-track women to specialist care sooner. It's a women and healthcare provider developing next-generation technology to empower people to understand and care for their bodies better, smarter and faster than ever before. It was launched

in 2021. Powered by leading doctors, the AI enhanced at home test provides advanced insights into reproductive health, fertility decline, and the onset of menopause, as well as screening for up to 18 conditions that affect reproductive health. So if this is something that has been on your mind and like me, you're sort of someone that might put things off because it feels a bit overwhelming where do you begin? This episode is for you. I hope it clarifies some things.

And if you guys wanna check out a fertility, I highly suggest doing so. I hope you enjoy this conversation. Dr. Helen, for those that might not be familiar, would you be able to share a little bit about the work that you do? Sure. As mentioned, I am founder and CEO of Fertility and associate professor in reproductive and molecular genetics at University College London. And we essentially have put years and years of research and work into creating a diagnostic test for fertility, infertility, but also all of the different reproductive conditions that affect women. And we had so many questions.

I was actually quite shocked. Our audience is 95% female, so that was kind of helped. But I think also the kind of demographic of our audience being largely 25 to 35-year-old women who are all thinking about these themes that we're going to cover. So if you're happy to, I think we should just dive into some of the questions. Let's do it.

The first one was around age and egg freezing. So we had quite a few in this category, but the question that I picked was, what's the best age to freeze your eggs and when is it too late? Okay. So one of the biggest questions people always ask is when. And I think that was the biggest question I asked myself. It's honestly the reason I started Hurtility was this burning question to know, should I freeze my eggs? Do I have time? Am I okay? Do I have time to wait? Am I going to be the one in six that suffers from infertility? All of those questions lead to a different outcome, right?

All of the different questions that we answer in regards to our lifestyle, our health, our medical history, any conditions we might have, all will lend to an answer for that question. And actually, my biggest aim is that more and more women would track their ovaries, track their rate of ovarian reserve decline and potentially avoid egg freezing at all. Now there are some circumstances where obviously given your age and given your personal circumstances,

it is good to freeze or consider it. But the main thing to consider isn't your age necessarily, it's actually your lifestyle and your health and therefore your ovarian reserve. We see plenty of women who have very low ovarian reserve in their twenties. Equally, we see women who are in their late thirties with a high ovarian reserve. But the thing that we need to determine is quality. As a 35-year-old woman, the narrative that gets pushed around is your fertility dives off a cliff at 35. Is that true?

So look at 10 35 year olds. Some of them look like they're 45. Some of them look like they're 25. Some of them look like they're 20. Some of them look like they're 50. And it's quite true we often compare ourselves to people the same age as us and say, I don't look that old, do I? It is so dependent on your lifestyle and your overall health that actually the idea of this cliff, for some people it's a gentle curve. It definitely is going down. There is no denying the fact that our fertility is in constant decline. But whether it's in free fall or whether it's in a gradual slope, it really depends on the person.

In terms of lifestyle versus genetics. We'd love to separate out genetics and lifestyle, but the reality is they are so intertwined and we can't separate them. Yes, your genetics plays a huge part. That's why we ask women, what age did your mom go into menopause? Did she struggle to conceive when she had you? Did she need fertility treatment? Because if your mom had a lower ovarian reserve, struggled with infertility and went into menopause earlier,

the likelihood is that you will too. So we can't escape our genetics. But what we can do is help our genetics by increasing our chances of having a healthier body and therefore that our body is hosting those eggs and therefore a better reproductive success as a result. And there's also one thing that you said that I didn't hear you said one in six. Are infertile. Are infertile.

Yeah, we are in staggering. We are in a global fertility crisis. And has that gone up? Yes, it used to be one in seven. And it used to be, I mean, we used to have far higher fertility rates. And when we talk about fertility rates, it means essentially the number of children that a woman will have in her life. And the important considerations are a fertility rate is number one,

but a replacement rate is number one, but a replacement rate is number two. So a replacement rate is the number of people being born to the number of people dying. And we are nearly not at replacement rates. So more people are dying than are being born, which means you get this inversion of population where you have far older people and not enough younger people to actually build an economy, to grow and support an older generation. It's actually a disaster. Is that down to infertility or choice? Both. So a lot of people decide that they don't want to have children full stop. But

more people actually, when we look at the statistics, are childless without choice. So they have tried or waited too long or gone through many different reproductive journeys in order to have a child but have not been successful. So this is compounded by falling fertility rates from a health perspective. So we know that male fertility rates are falling, sperm counts are 50% less than they were 50 years ago. And look at our environments, look at our lifestyles. We are exposed to so much more harmful chemicals and toxins on a day to day basis that that is what is contributing to this falling fertility rate. I'm going to ask another audience question in a second,

but I also wanted to add one more thing on that or ask you one more thing on that, because I think women shoulder the responsibility around fertility, but it might not be. No. So that is also something that's become an increasing problem. We love the narrative that women are fully responsible for a pregnancy, fully responsible for fertility. Even the language that we use around that, she couldn't get pregnant. She failed to get pregnant.

She lost the baby, rather than they could not conceive. And actually 50% of the equation is male factor. So if 50% of what is contributing to forming an embryo, a healthy embryo, is the sperm, then it stands to reason that the health of that sperm is very important in a conception journey. Next question. Success rates. How successful is egg freezing and does the age at which eggs are frozen matter? Success is a story that is on everyone's minds and it's a very difficult one to answer because when somebody says to me, what's the success rate of egg freezing? That's a little bit like somebody saying, what are my chances of getting better if I'm

sick? What are your chances of getting better if you're sick? Depends on what you're sick with, depends on your underlying health, your immunity, your ability to heal. All of those factors are really important in somebody being healthy. And it's no different to a success story when it's egg freezing, IVF or fertility. It really depends on you, your underlying health, any previous medical diagnoses, your hormone levels, your ovarian reserve. The success that you will encounter is so individual and unique, which is why we built

a test that would test everybody from such a personalized angle to look at their lifestyle factors, their menstrual factors, their symptoms, their hormones, any previous infections, any previous diagnoses, family history. That was the most important thing for me when building an assessment of somebody's fertility, wasn't to say, here's your ovarian reserve. It was to say, actually, what are all your menstrual cycle hormones doing? What's your thyroid doing? Do we test your androgens? Do you have symptoms of PCOS?

Do you have symptoms of any other reproductive pathology? Can we look at your lifestyle factors? And what we've seen from our data is all of these play a huge role in the individual success rate. So having that journey to say, fine, we can look at individual success rates or we can look at generalized success rate. So having that journey to say, fine, we can look at individual success rates or we can look at generalized success rates. Success rates are always generalized.

So in women aged between 30 and 35, we see this. In women aged between 20 and 30, we see this. But actually you, as I mentioned, as an individual are very different to all the other 35 year olds out there. So it's not actually that helpful. It's so unhelpful to look at generalized statistics and success rates. It's a good benchmark to look at overall age categories because there are stronger correlations per age,

but nonetheless on an individual basis, you and a hundred other women your age are very different. So how do, because I feel like the underlying motive behind that question might be it's problematic because egg freezing is expensive. And so people want to know if I'm going to invest in this, am I going to get the outcome that I desire? So I guess that's where something like Hurtility can come in to really help people make an informed decision about that. Exactly. It's such a big investment to put thousands into a process that you're not guaranteed. Even the first part of that journey, which is testing your hormones,

testing your ovarian reserve and looking at an ultrasound scan, is far more expensive in a clinic. And for me, my ultimate goal was to democratize it. I was an academic in my 30s, had become single and wondered, do I have time to wait? Do I, as an individual, have time to play the wait game? Or should I rush to do this, knowing I actually couldn't afford to do it? And actually what was shocking to me was realizing how lost I felt at that time, thinking, how is it that I work in the Department of Maternal and Vetal Medicine,

in reproductive medicine? All of my colleagues are world experts in every aspect of women's health. I am lecturing in embryology in women's health. And yet at that moment, I felt lost. Yeah. Because you were the most educated someone could be on the subject. Exactly. And yet you felt lost. And that's what was such a driving force to start Artility, was to say, if I feel lost and don't know where to go, how does anybody else even begin to navigate this journey?

And then to put myself and my, I guess, vulnerability first in creating it was really important to say, OK, how can I arm somebody with all of the information that I spent years learning, all of the information that everybody I know has put together and put it into something that's so easy, that slots into your life, because we're busy people. And I feel like that is from all the messages that I've received. And I'm sure you get all

the time, that most people feel that sense of lostness or confusion. And it's a very personal journey, but also the lack of information or education or awareness around it makes it even more isolating. Yeah. Yeah. I think that's why we wanted to create it like it was your best friend. And we launched an app, we call it the Clinic in Your Pocket, so that we could just say, right, what's the information that I need to know about me, my hormones, my ovarian

reserve? Can I directly book in to speak with somebody? Yep. Can I book another test? Yep. And just to remove the, everything that's negotiable, everything that's confusing, but that confusion should be negotiable. We'll remove that and just make it a little bit easier.

And I know we touched on this on the podcast, but also I've heard some stories from people that have come on my retreat or messages about how the medical industry talk about fertility and especially, I'm not trying to bash men, but when men are communicating to women about such a vulnerable subject and they're using this terminology that is like crushing. Yeah, I think that's, that was a lot of our thinking when it came to the health assessment. So creating a health assessment that made, that wasn't just a barrage of questions, albeit that every one of them is so important, but that it was an educational storyline that for every question we ask you, we

justify why we're asking it, you know, whether it's an STI, which is deeply personal, that somebody could say, you know, one in four will suffer. So there's no shame there. But it's better to let us know because some can impact your fertility and to use the health assessment as a tool to educate while also being supportive, to say nobody's judging you here and everybody knows when you sit in front of a complete stranger and they're asking you about your sex life, how you bleed, when you bleed, any pain.

When you're having intercourse, that's a deeply disturbing concept, is to sit in front of somebody. And what's more is it strips you of your pride and it makes you even more vulnerable. So to remove that as well and to be able to say, right, well, we're going to create a calculator that can do all that for you and never judge you and have all the results and information and calculation

go to just you, I think is a hugely liberating thing to give somebody. Yeah. Also on that, there's something that I wanted to ask, but I think when people are afraid to ask the questions, then they end up going to Google or, and then that just creates its own issues. But you mentioned about STIs in terms of affecting fertility. Yeah. Could you debunk STIs in terms of affecting fertility. Yeah. Could you debunk some of the stories around that?

So both chlamydia and gonorrhea can block your fallopian tubes so they can cause scarring. And the problem is you can be infected and not know. And so if you go untreated, you risk having scarring on your fallopian tube and your fallopian tube connects your ovaries to the uterus. And that's when the ovaries release an egg. You're hoping that egg is going to make it in order to be fertilized. And if you have a blockage along your fallopian tube, then you really reduce your chances of falling pregnant naturally. And that's why those questions are important to us, because if we're going to look at your ovarian reserve and your hormones, they could are important to us, because if we're going to look at your ovarian

reserve and your hormones, they could be perfectly within range. But if you're not conceiving what you need is help. And if that unlocks an additional examination for you that we at least know, OK, you're at higher risk. So let's let's look at your fallopian tube. Let's look at the health of your uterus. Then it means you're getting help much sooner rather than just being told to keep trying. Okay. Next question. What are the first steps in the egg freezing process? Okay. I think the biggest, I guess, hesitation that people have when it comes to egg freezing

is the timing, right? When should I do this? When is a good time to do this? And I think the easiest way to break it down is to say from first appointment to it being all done, eggs in the freezer, it can be as short as two weeks. Okay. Really? Yeah. Can be as short as two weeks. All in all, three weeks. And if you think that we can give up a month, that's fine. I think most people really hesitate because they're afraid of how long it's and what the process is going to entail. So it's easy to break it down like a regular menstrual cycle, right?

If you think in a regular menstrual cycle, your ovaries contain all of these follicles that contain immature eggs, and you typically produce enough hormone to mature one of those eggs. And then midway through your menstrual cycle, which is ovulation, that egg is released and it waits to be fertilized. The lining of your womb has built up in anticipation of a pregnancy. Our bodies love to think we're going to get pregnant every single month. And then when that pregnancy doesn't occur, the lining of your womb will break down and you'll have your period.

Now, if you think about egg freezing, you have all of these immature follicles. In an egg freezing cycle, you want to mature as many of those as possible. So what you're doing is you're giving yourself exogenous hormones through an injection for those first 10 to 14 days. So you're really trying to say instead of maturing one egg, let's mature as many of these eggs as possible. And then when you have enough eggs and they're of a certain size, so you'll check on a scan to check that they've matured and developed, then you'll give a trigger shot, which is going to mature and release those eggs. So essentially what you're doing is you're mimicking your menstrual cycle, but you're

multiplying it by giving yourself additional hormones and then releasing. So then around the 14th day, you will go in and you'll have an ultrasound scan. It's transvaginal. So inside and a needle will be passed through. We'll go through the vaginal wall and it will aspirate some of those eggs. So you're just going to basically and that's under mild sedation. You're kind of probably out in 20 minutes, maybe 30 minutes. And still an invasive.

Oh, listen, I am not trying to diminish anything about it. I think I once you are a little bit clear about the timelines and the physical procedure itself, you can start to come to terms with it when there are so many unknowns, including timing, money, success rates, how long it's going to take, what it's going to do to your body. Then it's actually a bigger hurdle. And I think once you can break down the steps in a tangible means, no, no disrespect to the physical impact it's going to have on your body.

And I always say this anytime I lecture, I first talk through how easy it is. Then I show a picture of a very bruised belly and I say, well, this is the physical impact and it can be, it can be quite a lot. Because also the amount of hormones that are going through your body make you feel a little bit. A little bit, a lot. And I think that is the missing piece of the communication on the clinical journey that so often is not communicated. We're told to just keep going, go through it, try and juggle work.

I would give up work for that time. Remove all stresses and give yourself and your body the respect that it deserves on such an important journey, even if it is two weeks. What about the contraceptive pill or the injection or coil? Does that affect? Yeah. Because I don't think they talk about that either. No, they don't. So as with anything, I would prepare your body. Number one, come off your form of contraception.

How long? Three months. Three months. Minimum. But in that three months and then for our following three months, you're going to be getting your body ready for this journey. The life cycle of an egg is around 90 days. So it stands to reason that within those 90 days, you would eat the best you can, keep your body moving. Well, we want as much blood flow as possible, not a sedentary lifestyle, reduce or remove rather

alcohol and smoking. An interesting thing that we looked at our data, there was a small group of people, actually a small group of people, actually a big group of people, but not many, that had tested twice with us. And they were the only ones whose egg reserve, whose AMH result had actually gone up, not down. As you can imagine, the textbooks all say AMH goes down over time. But these were the only people who saw a significant increase in theirs. And we went back to the data to see what was the contributing factor of that. Did these people have anything else in common?

And they were the group of people who had given a bell call. Wow. Yeah. So that's massive. Yes. So the lifestyle guidance that you typically get is everything in moderation. But actually, our evidence now shows if you give it up completely, anyone can do three months. Especially if you're investing that much money in an egg

freezing cycle, it will pay you back tenfold. So give yourself the best chance. Yeah. Okay. How important is the number of eggs frozen versus the quality of those eggs? It's the most important contributing factor is egg quality. Quality over quantity. It's the reason I wrote a grant last year to do the first study that looks at

the cloud of cells surrounding an egg. And we wanted to determine quality in the eggs because at present there is no test for egg quality. So it's not actually, if you get loads, it doesn't? No, there's no test for egg quality. So it's not actually if you get loads, it doesn't? No, there's no test for egg quality. That's crazy. We can determine how many eggs you have and your relative fertility because you have so many eggs.

But in reality, all it takes is one good quality egg and you'll get pregnant. Okay. But there is no test for quality. It's something we're working on so that we could give people peace of mind in an egg freezing cycle to say how many good quality eggs you might be freezing. Right, because at the moment it's kind of based on the numbers.

Yeah. So people are told just just go through another cycle. Because I know the narrative is like, oh, I didn't get many. And that's sort of deemed as a failure. Yes. Whereas you're saying that that's not necessarily true at all. Yes. Whereas you're saying that that's not necessarily true at all. Well, unfortunately, when we look at our success rates, they're built off poorer outcome individuals. Think about it.

The people who've waited, the average age for egg freezing tends to be around 39. So when you look at the different age rates, yeah, you're going to see an impact of success as a result of that. But it doesn't mean that somebody is not going to conceive if they've only frozen three. Would a clinic prefer you in this instance to have more eggs that would lead to more embryos being fertilized, that would lead to more transferable embryos? It's a real it's a rate of diminishing return, right? You start with a number of eggs. Let's say you start with 10 eggs. Maybe eight would fertilize. So the sperm actually creates, as I go, maybe six might go on to form a blastocyst, which

is the state of a stage of an embryo that is transferable. You might transfer over time four of them, maybe one might take. That's what we see. We see that our success rate kind of diminishes. So it stands to reason that having more would yield higher success. But if you have more and your lifestyle isn't good, you're of a much older age and you haven't taken into account the things that can lead to higher chances, then your chance may be the same as somebody who has excellent health and won. I feel like I know the answer to this question, but in terms of when is the right age to do this, or is there a right age, when would you recommend people freeze their eggs?

Yeah, people freeze their eggs definitely too late. And I think that's why I guess I wanted to emphasize the point about timing and how long it takes to be like, if this is something you are putting off, but you definitely want to do it, do it sooner rather than later because you're only going to get older unless, first of all, every single day. So that's why I think if it's something that you definitely want to do and you have money to do it, just get on with it. But each person is very different. So that again is why we wanted to assess what an individual's risk was before you they make that step. Before you make that decision, or especially in the case of wanting to decide

whether or not you should do it. There's plenty of people I will say, you know, don't bother, you've got time. Or I'm a big fan of telling people to just get on with it and have a baby. But that's obviously not easy for anyone if they're not in a relationship. I think the part, the one I-

Slight pari-ventry there. Slight pari-ventry, yeah.. I think the one I... Slight parry of entry there. Slight parry to entry. And I do think more people should do it on their own as well. Yeah, for sure. It's not easy, but then nor is regret that you never did it. If it's a case of doing it on your own or never doing it at all, do it on your own. It's the greatest gift you can give yourself. And that's why I think I struggle when it's a case of a relationship and they're

like, oh, we're in a, we're in a long and stable relationship. We're married, but we're going to go through this egg freezing or IVF journey to give ourselves more time. I know like more time for what? More time for what? It's only going to get harder because you're going to get older. Yeah. Do you come across that a lot?

Yeah, quite a bit. Yeah. They're like, well, we want to have one naturally and then we'll do the rest as IVF. But I guess the emotional component there for women that have been brought up with this sort of fantasy that certain things need to happen. You need to meet the right person. You need to spend a certain amount of time together. Yeah.

Then you do the thing, get married, have a baby. You're saying like... I just think that takes a lot of time, right? It does take a lot of time. And I think most people. And then added now, everyone's having their career. Right. Yeah, exactly. So something's got to go for me. The man!

Yeah, there's plenty that we can get rid of. No, I in all seriousness, I think where I struggle is that some people will delay it because they want to spend two years engaged. They want to spend a year planning a wedding. They spend all of their savings on one day only to realize they are now going to be in a very expensive journey of IVF and infertility. And it also puts a huge amount of pressure on that next stage. Mitosis over marriage, I think, which is just procreate deposits over diamonds.

Very pragmatic about these things. Yeah, I just think babies over wedding bells. Let's just just go for it. You will sort yourself out sooner than you know when you have a human to look after. Okay. Aggie? Yes? What are we waiting for?

Okay, next question. Periods. What to do with irregular periods? So irregular cycles are due to a number of different things that contribute. So lifestyle is one of them. So often we see people who are over exercising under nourishing and the first thing that your body will do in response to any kind of stress, whether it's a lack of nutrients, whether it's physical stress and raised cortisol, lack of sleep, over exercise, is it will say,

this is not a safe environment to host a pregnancy. Wow. I need to reserve all energy to keep you going. And so the first thing that will go in those circumstances is your period. Your menstrual cycle is a really, in fact, it's the sixth vital sign. It, you know, along with your temperature, your pulse, your pallor, your heart rate. Your period is a very important marker of your overall health. And so understanding when it's irregular, when it's too, when you bleed for too long, when you don't bleed

for long enough, when your cycles are too far apart or when you're getting them every two to three weeks. But let's go into specifics because what is too long, what is too short? So your regular menstrual cycles should be 28 to 35 days. So day one of your menstrual cycle is when you bleed. And the last day is essentially the day before you bleed again. And when you think about this beautiful orchestra of hormones that is playing in this monthly cycle, if you are not producing enough or producing too much of any one of those,

what you'll see is a dysfunction within that menstrual cycle, whether it's how much you bleed, how little you bleed, the pain you're experiencing, how long it is until your next cycle. If you think about it like from a mechanical perspective, if you need a certain amount of hormone to get you to ovulation, you need a certain amount of hormone to be triggered for a proper, you know, for the lining of your uterus to shed, you need, it needs to be in kind of like clockwork. And when that starts to fall off, like if your watch was slow, you'd get it serviced because you would say the components aren't working properly. And yet we don't think the same with ourselves. And so often there's simple contributing factors that are difficult to remove,

but are actually removable, like stress, where possible. Try and remove stress. And with the pain parks, obviously people that are on that, like, it can be painful, but what at what point does that sort of indicate that there's underlying issues? When you are struggling to do your day to day tasks, when it is affecting your ability to get out of bed, affecting your ability to work, to concentrate,

you shouldn't have abnormal pain. Like we can anticipate pain. We know that the contractions of our uterus to really, to allow us to menstruate are similar to that of a heart attack. So actually stronger than that of the contraction of your heart when it's having a heart attack. Nobody nobody talks about that.

But we can anticipate that that process is going to cause a little bit of pain, but it shouldn't leave you doubled over. Equally with ovulation, if you, we can anticipate a small bit of pain in the release of an egg every single month and it goes either side. I feel like I can feel that. Yes, you can feel it. It'll pop. Yeah. It's like an egg being cracked. And then you get all the, the egg white to know you're ovulating. Lovely. Yeah. I love to talk about egg white. Once you know, then you know, actually you're like, I have ovulated.

The egg has been released. Yeah, which people need to know. So the pain piece, what could be the underlying cause of, you know, if people literally cannot get out of bed or they're literally like crunched over. So often it's endometriosis. One in ten have endometriosis and yet the average time to diagnosis is now nine years. And what is endometriosis? So endometriosis is when that lining essentially grows elsewhere in your reproductive organs. It can be on your diaphragm. It can be on the actually ovaries itself. And because of the hormonal receptivity of that tissue

that builds up and breaks down, that can really affect you from a cyclical basis. So if that tissue goes elsewhere, then you're going to really struggle when you are going through a monthly cycle because you can have what's called an endoflare up and you get real pain. But what's difficult is that it can form in so many locations in the abdomen and beyond, and it is so misunderstood that people have, when they've finally gotten

a diagnosis, it's been found all over their internal cavity, on their diaphragm, sometimes within the lungs. It's crazy to think how prevalent this condition is and how poorly we understand it. And that's why we are so proud we can predict it with 98 to 99% confidence in eight days. So we're not trying to remove anyone from the occasion. We just want to get somebody to an endospecialist much sooner. Why is it something that's so misunderstood? When you think about pain, amount of bleeding, it's a very subjective, pain is very subjective.

How much I might react to the exact same bang on the leg as you might react could be wildly different. And there's a lack of trust when it comes to believing somebody's pain threshold. Especially women around this stuff. So when women are in pain, especially when it comes to pelvic pain, we just think that they're exaggerating a period. And the reality for so many women is a period, as I mentioned, can be more painful than a heart attack.

We just don't take women seriously. And that is unfortunately what comes hand in hand with getting a diagnosis is a lack of trust, a lack of referral, a lack of education and a lack of action to believe someone enough to say you are describing symptoms that really put your life in a different category to somebody else who's just getting on with it. You need help. But unfortunately, women are told to tolerate pain and to anticipate heavy bleeding, to anticipate all of the parameters that actually, when turned up a little bit more, even a little bit, can mean something quite serious is happening

to you. And how does endometriosis impact your fertility? When it comes to endometriosis and fertility, the important consideration is the grade and severity of endometriosis. So often what we see is a delayed journey to diagnosis and then a delayed fertility journey as well. And unfortunately, that lends to two risk factors. One is that you have fewer eggs of lower quality, and the other is that the lining of your uterus is not as healthy. So to me, I wish everybody understood whether they had it or not much earlier, because it means you can take action.

If you understand whether it's affecting your ovaries, then you will understand whether or not you will need help, particularly to protect and remove those eggs a little bit earlier in your journey. Rather than waiting, you might have endometriomas. It might affect the... What's that? It's when you have this endometrial tissue essentially anywhere, but you might have them on your ovaries as well. And so being able to understand the health of your ovaries, the health of your uterus is such a critical factor in your fertility journey on top of everything else we have to consider.

It's hard. But that's really helpful for people that might be really struggling with their periods to actually do something about it. OK, hormones, AMH, discussion of AMH, i.e. advantages, but also limitations associated with AMH measurement. Yeah. So AMH is a really important marker of ovarian reserve. And what it is, it's anti-malarion hormone. And so when I described our ovaries, I should have brought my little uterus with the ovaries,

our ovaries with all of these immature follicles, a follicle essentially is a poor description for what the egg is inside. So in our ovaries, we have all of the eggs we'll ever have, and each of those produce anti-malarion hormone. So when we measure the amount of AMH in our blood, it's a really good surrogate marker for the amount of eggs that we have. However, we touched on the fact that there is no test for quality. And also another limitation is the fact

that a measurement of AMH does not take into account your thyroid health, your uterine health, your ovarian health, your menstrual cycle hormones. And that is why we refuse to test AMH on its own. We refuse to test anything in isolation actually, because a marker of ovarian reserve is very limited if you don't take into account somebody's menstrual factors, lifestyle, health, diagnoses, other hormones. And so in the context of everything else, it can be quite powerful. But the limitations again are that you could have lower ovarian reserve, be quite healthy and everything else

is within range. You have regular menstrual cycles and you get pregnant straight away. You could have lower ovarian reserve and none of the accompanying other health effects or condition and you're not going to get pregnant straight away. So using AMH on its own as a measurement of fertility is limited. What's more important is taking it into account with everything else, which is why we are so obsessed with everything else that comes with the whole picture. Yeah. Next question is around motherhood and pregnancy. What's the best thing we can encourage our

men to do to prepare for babies? I think it's about understanding both the physical burden that your body is going to undertake and the mental burden and the change that you will experience with both of those. So you're going to experience the pressures and the stress of physically feeling different, whether it's nausea, whether it's, you know, pain, discomfort, constipation. But it's also about supporting then the mental health of somebody along that that journey. I always describe pregnancy as a marathon. And it's about getting through that and understanding that it doesn't end with baby,

that you wake up and you realize is the start line, not the finish line. And I wish more people better understood the fourth trimester. And let's talk about that, because I feel like that is a part where there's so much focus around the birth, the pregnancy up until the birth. And then I remember I sat with a woman at a dinner party and she was out for the first time having given birth. And I think she actually worked in the NHS or something. And I was like, what is it like? She said, imagine having a car crash and being handed the most vulnerable thing in the world and being sent home. Yeah. I was like, God, with nothing.

But imagine being in a car crash with no sleep and being handed the most, while your body is undergoing all of these changes. There's two things to think about that. Number one is the strength of our ability to know what we are doing and to block out the noise that you hear about what you should be doing. Because actually-

What do you mean specifically with that? I mean, we have an innate biological knowledge to a certain extent, how to nurture and care for that baby. But we're told so many different things. So much information. And it's hard to block that out, actually. What's difficult is, you know, all of the different things you're told you shouldn't be doing.

And yet, from an evolutionary perspective, we have a very finely tuned sense of what we should do. And that is to protect our young and to do so in the best way. And when you think about going through pregnancy, you don't tell your body how to make a baby. It does it. You don't tell your body, now's the time for the cartilage to form.

Now the bones are forming. It knows to do it. This is an interesting one. Something that I definitely am aware of. Coping with comparison on fertility journey. I think coping with comparison full stop is what we're all struggling with. Coping with comparison on how, I mean everything, look at this, Instagram versus reality. Instagram shows we are sat here polished, having a lovely conversation. Reality is we both have a cold. I fell off my bike this morning.

I was up all night. Like we what we see and what we get and what we experience ourselves are so far from the curated narratives that you see out there. I think a lot of people should just take a step back from social media and not compare fertility journeys, because at the end of the day, yes, somebody might have gone through seven rounds of IVF and it's always worse than what you're going through. But what you're going through in the context of everything else that you're experiencing might be just as bad. So yeah. It does seem to be quite a very triggering subject because if let's say someone is on

their fertility journey, they're trying to get pregnant, it's not happening for whatever reason. And then their friend just gets pregnant like that. And it can feel, it's hard not to compare because it's something that you're focusing so much of your energy and attention on. But I guess that's also a thing that women kind of not put against each other necessarily, but like you say, everyone's experience is different. Yeah. It's the most natural feeling in the world to feel disappointed. Yeah. And yet what you should be feeling is happy for somebody. But it's OK to be happy for somebody else and sad for yourself.

And I think allowing yourself a little bit of space to say, it's OK, I will get there. And if I don't, there's there's other ways. You have to forgive yourself for the guilt of feeling bad that you're not feeling happy that somebody else is celebrating something that you desperately want. Mm hmm. And what about the comparison in parenting? Because I feel like with newborns that that is well, it doesn't actually stop at newborns, but that seems to be sort of perfectionism around parenting. Like everyone's telling you how to do it or judging the way

you're doing it. Where do you think that's come from? And has it got worse? Because I think it's got worse. Definitely, because we see all these perfect portrayals of how things are done. You might say it's gotten worse, but actually I think there's a lot more resources for people now that inherently we can all become better parents as a result of the ready to go advice that is being given to us. I look back on previous generations, they had no internet, no advice, nowhere to turn to to ask is this normal and nowhere to turn for help. So we can be quite negative about the comparisons that are made with parenting types. But actually, at least there's a lot more evidence and help available to people. And how they choose to do it. How they choose to do it, exactly.

Can antidepressants like SSRIs cause infertility and be pregnancy safe? So there's actually very little evidence around antidepressants and SSRIs. And that's what's really difficult is when we don't have enough evidence, it's hard to make a concluding statement about effectiveness or root cause. And actually, one of the hardest things to attribute any root cause with is infertility. How do you blame a certain thing on causing fertility issues in the absence of a huge randomized control trial? And when we couple this with the fact that we're all waiting a lot later to have children, who's to say that the infertility wasn't caused by just waiting later? At present, we don't have

enough evidence to suggest that antidepressants or SSRIs could cause infertility at all. And in fact, it may be that coming off those may have a detrimental effect on somebody's pregnancy journey and they may be more likely to have depression during pregnancy and postpartum. So you have to really consider the individual and what is most safe for them and their mental health. Okay. How can fertility help women understand their hormone health and fertility potential at any stage of life. It's about understanding what the things in your life could be doing to contribute to poor health, poor hormone health and reduced fertility and understanding where you stand.

So we have spent years creating an appropriate health assessment that asks you all of the relevant questions that you need to know and that we need to know to get you to a clinical diagnosis. When we look at all of the contributing factors to our health, menstrual health, hormone health and our fertility, you have to take into account ovarian health, uterine health, hormonal health, thyroid health, all part of this beautiful playbook of our overall health, irrespective of your need to have children or desire to have children, but also your fertility. So we take into account lifestyle factors. We now have enough evidence to suggest that vaping

significantly reduces ovarian reserve. Alcohol can contribute to ovarian reserve. We now know that over exercising, of course, contributes to your fertility. So taking into account all of the possible risk factors, whether it's your menstrual cycles, whether it's your symptoms, whether it is your lifestyle factors, whether it's previous infection or any conditions, those are all important for us to determine. Given the high prevalence of women who have at least one hormone out of range and the high prevalence of reproductive conditions like PCOS, endometriosis, it was really important for us to build in a risk stratification. So today, based on

the largest database of its kind, we have predictive capability for 18 different pathologies and we can do that within eight days with 98 to 99 percent confidence, both precision and recall. And we've tested our clinical diagnosis model against gynecologists and it performs as well. That's not to say we remove the gynecologist at all, in fact the opposite. We want to be able to remove those in-between steps that women seem to have to jump through in order to get in front of a gynecologist. And so being able to remove those in-between steps that women seem to have to jump through in order to get in front of a gynaecologist. And so being able to streamline somebody to care but more so to assess them for any risk factors through a comprehensive health assessment

and blood test is what we wanted to create. Does Hertelity offer tailored recommendations for women considering egg freezing, including timelines and preparation? Yes. So what we do is if you think about two parallel situations, one is that you go to a fertility clinic straight away, the other is that you go with her fertility. If you go to a fertility clinic straight away, they will test your, some of your bloods, not all of the ones that we do, they will do an ultrasound scan, then you have to have another consultation, you'll have to have, do, they will do an ultrasound scan, then you have to have another consultation, you'll have to have, they'll tell you about your protocols and what to expect. So it's up to four appointments, maybe, yeah, anything up to four appointments for that one.

That costs an awful lot. Oh, I know some clinics that will charge £200 just for AMH alone. And when you compare it to Hurtility, you've done a full comprehensive health assessment, which they don't ask you a full medical history, a detailed medical history compared to ours. I'm not bashing on any clinics at the end of the day, we need them, but it's not in a clinic's best interest to say what are the things that you might be able to do so you don't need IVF or here are the things, here's the information that maybe you don't need to freeze your eggs right now. So with Hurtility for £149, we are doing a full health assessment, doing a tailored blood test, a diagnostic blood test.

We can then bring you for, you can have an online consultation with a fertility advisor so that we can work through it, or a gynaecologist to let you know what your protocol would be. And then we're working towards being able to do remote. So obviously we'll send you for an ultrasound scan and have a look at your ovaries and look that everything's OK. But to me, the biggest barrier to entry is the financial cost of those first steps, which isn't necessary and also physically having to go to a clinic, which isn't necessary for the first steps.

And also in terms of the financial cost, another question was how much does egg freezing cost? Yeah, so egg freezing costs on average around £5,000 for a cycle. But what you need to take into account is once your eggs are frozen, you're going to need to go through IVF to use them. So it's great to have them as a backup. Yeah. I didn't even know that. Well, if you think about it, right, you've frozen your eggs, you don't need to do anything next, your partner will, or you have to get donor sperm. Those eggs need to be fertilized. So the rest of that journey needs to be done in the clinic.

So it's all very fine to say, I've spent £5,000 freezing my eggs. But that's just a big one. Should you need them, yeah. Should you need them, you then need to consider either your partner's sperm and sperm preparation or donor sperm, which is going to cost you. Then the fertilization, culturing, potential testing, transfer is going to happen. You're going to have to come back in for procedure to transfer the embryo.

How much does that part cost? So that can be an additional £3,000. Okay. Maybe more. So it's lumpy. It's lumpy. Okay. Maybe more. So it's lumpy. It's lumpy. Yeah. Never used the word lumpy before but in the context of... It's hefty. Egg freezing. It's expensive. Yeah. Yeah. Egg freezing is just one part of the journey. Do you have any thoughts on how companies

or businesses, because obviously a huge factor here is that women have these careers and they don't want to give up. Not that they necessarily are, but that's often a contributing factor to the delay in motherhood. Is there, and then the responsibility falls on the woman usually to bear the financial burden. Of course. Do you have any thoughts on how we can alleviate that? So many thoughts. I do think it's a workplace's responsibility to acknowledge that there is

an imbalance and to provide resources to their employees such as screening. Right now, huge companies, I won't name names, will either freeze their employees' eggs for free or they will pay up to £27,000 per employee for fertility treatment. Now, what message does that give you? Everything's fine, we'll pay for their IVF. Instead of saying from the earliest age, let's assess you whether you're at higher risk for infertility and maybe we can make the steps to address that so that you don't end up needing one, two, three, seven rounds of IVF.

So what was the second part? They're paying up to 27,000. They will pay out 27,000 pounds to the individual worth of fertility treatment. That's a big payout when you could just acknowledge and screen and tailor to the health of your female employees at a much earlier stage and your male employees and their partners. And that kind of brings me to another thing, question around that is, that's obviously a big conversation piece

and potentially problem for a lot of people. But then what about the actual motherhood, managing career, the balance of all of those things, maternity leave, because that seems to be where women feel like they fall behind. Like they may be killing it at work and progressing on the career ladder. And then suddenly they have a kid and they feel like they are not back a few steps. I think it's quite a personal decision.

I look at my own journey and started a company when I was three months pregnant and worked through my maternity and then with baby number two, I took two months off and then worked through. And that's definitely not to be recommended. I didn't tell you I've been up all night. But at the same time, I think it's different for different people. Some people get up in the morning and have it run at six in the morning. Other people get up at midday. For some, different lifestyles suit you differently. We have this perception that having a baby equals dropping

everything else. When in actual fact, when I said mother pregnancy is a marathon, so many women are rushing up to this, they're frantic, get all the pieces in place, and then they leave, they drop everything. If you are running fast enough and you all of a sudden stop, you will trip. It's about gently reducing the workload till you get to that point, or not necessarily letting everything drop. Picking up or keeping going with the bits that you like. It's a hugely personal thing because some people love what they do and other

people can't wait to not do what they do. And I do think that we can do more in the workplace when it comes to the return to work. There is a company called Postpartum Plan and this woman is incredible. She basically builds all of the tools that women need to brace themselves, to prepare themselves, to ready themselves for the return to work. So it's a shout out for them. But when it comes to actually the workplace and their responsibility, that's why we provide workplace benefits to go in and say, we're not just going to tell you that everyone needs

a fertility test and everyone needs a fertility consultation and all of the different services we provide, we're going to go in and we're going to educate your workforce about hormone health, about menstruation, about an IVF journey, about managing menopause, about balancing your hormones, harnessing your hormones to be better in the workplace. Because the return on investment that an organization gets from people being better educated and equipped and getting medical help sooner is far exceeds what they're going to have to put in in order to provide that for their employees. And they just need to switch their mindset around that. Yeah. Yeah, that's really powerful.

Egg freezing versus embryo freezing, what are the main differences and is one more successful than the other? Okay, so this one comes up quite a lot. Should I freeze my eggs or should I freeze my embryos? You're going to think I'm repeating myself all the time by saying this is a really personal decision. If you are in a relationship, then you should freeze both eggs and embryos. Why? Why? Because it still gives you reproductive autonomy should your relationship fall apart. Yeah, because that's the tricky one if you freeze an embryo

and then the relationship ends. And there have been really sad cases where women have frozen embryos with their partner, the relationship is broken down, and they are not able to use those embryos legally. They've gone to the Supreme High Court and those embryos have had to be discarded, destroyed because their partner refuses to allow them to use them. Even when they've said, I promise I will not take any financial, you know, any finances from you for this. I will do it completely independently. So that is why you should always have reproductive autonomy. In terms of success, it used to be that considered that freezing embryos was far more successful than eggs. But our technology has moved and we now use

vitrification and so your success rates are actually comparable. So I still think that if you are not in a relationship and want to freeze an embryo and that requires you to get a donor and you're still in your head thinking maybe I might meet somebody along the way, then freeze your eggs, not embryos. Because if you have to pay for donor sperm and fertilization of that and you meet somebody, then they're not usable either. They're redundant. How much does sperm cost? Like donor sperm? Donor sperm costs about £800 per vial, £600 to £800 per vial.

All right. The reason I say per vial is that people will buy multiple vials because they want to know that if they have one baby using that donor and they want a second baby or a third, they want the siblings to have the same donor. Tinnitus. Oh wow. That's fascinating. I think a lot of women are choking in choice. The fact that you are given a choice to wait, to delay, to freeze, to pause, is actually almost one of the hardest things that we have to deal with. I now have to choose this. No time is going to be the right time. But at the same time, we're quite lucky that we have technology that allows us to essentially

put the control back in our own hands, albeit that it's limited control, albeit that the success rates aren't ever going to be amazing. At least we can take some bit of information and control in the absence of just waiting and waiting on someone else. Yeah, that's very true. OK. Would love some information to mentally prepare for pregnancy.

No info out there on this. Pregnancy is going to be one of the hardest things you go through because you are using all of your own resources to feed a baby. because you are using all of your own resources to feed a baby. And when we imagine that something has to come from us, then it means you say, right, I'm going to prepare my body. I'm going to make sure I have all of my, everything in the correct dose. So check your deficiencies.

You are going to make sure that you are eating so healthily. And that sounds so generic and boring. But so often we use early pregnancy or pregnancy as an excuse to just eat more as opposed to eating what is going to contribute to a healthier baby. Take iodine. Studies have shown that mothers who take iodine during pregnancy and breastfeeding, their babies have a significantly higher intelligence score. I know. Really? I know. I take iodine every single day. Because we just don't get enough of it. When we think about the different stages of our pregnancy, you are building and nurturing different parts and components of that fetus and baby.

And it stands to reason that we would supply our body with as much good nutrients as we can in order to feed that baby. And that is particularly true in the last trimester when we are so much more prone to being anemic. And if you have low iron levels, low hemoglobin levels, low ferritin, then it's one thing that it's going to impact your baby. It's going to impact you. But think about your body and your recovery postpartum.

You are going to lose blood no matter what way you deliver. And if you're already iron deficient and have low hemoglobin, low ferritin, then postpartum, you're going to be a lot worse and the recovery, therefore, is going to be a lot worse. I prepared therefore is going to be a lot worse. I prepared as if my blood was the most important thing to me. When they took massive vials of blood, I was like, oh, I did my own in a capillary sample because I said I cannot afford to lose any blood to sending large volumes off, which again, a lot of people, you know, that's just part of the

journey through the hospital. But being mindful of your iron levels is really critical to your recovery, postpartum health, mental health, because your energy levels are going to be so much lower if you do not have enough blood, hemoglobin, ferritin, if you think about it, your body requires iron to transport blood to all of your body. If you don't have enough iron, you're going to struggle to just keep going. And when coupled with that car crash and the sleepless nights, if you have low iron, you're going to struggle a lot more. So that's one of the most important things. Yeah, making sure you're deficient, that you're not deficient. Would that be having extra supplements or just through food?

As much as you can through food, but obviously, take your prenatals. It's better to take methylfolate, L5-methylfolate, than folic acid. It's more easily absorbed. And making sure you have your enough omegas in your diet, but also you can supplement with them. Yeah, your body is going to be used and tested to its to its limits. So making sure that you yourself are healthy is critical to a healthy pregnancy journey. OK, well, thank you so much. You're welcome. health or healthy is critical to a healthy pregnancy journey. Mm hmm. Okay. Well, thank you so much. You're welcome.

As always, it was super informative. And I think that we have so much for our audience to digest and get into, which I think will be immensely helpful. Yeah. Thank you. It's always meant to be supportive and not scary, I think. Can feel scary, I think, but that's largely down to a lack of knowledge on the subject.

And I think that, you know, people love to, they love to say that, you know, if you have information that it's just scary or you won't know what to do next, but it's the opposite, actually. There's nothing more scary than being in the dark without the answers. At least you can do something when you have answers, irrespective of what those answers are. 100%. Thank you for listening to this episode of Saturn Returns. I hope that you found it informative.

I'm also going to put some educational resources that Hattility have on their website at the bottom in the show notes. Some of these include the Proactive Guide to Getting Pregnant, 5 Personal Accounts of Egg Freezing, 5 Things AMH Can Tell You About Your Fertility, and How to Naturally Boost Your Fertility in Your 30s. And if you guys want to get the fertility kit yourself, so you can do that at home testing, you can use the code CAGI10 for 10 pounds off your first order. Thank you so much for listening,

and thank you Dr. Helen for coming on the show again. And as always remember, you are not alone. Goodbye.