Should I Delete That? - Demystifying Fertility with Emma the Embryologist

Episode Date: October 30, 2023

This week on the podcast, Em and Al are joined by embryologist and lab technician at the Evewell Clinic, Emma The Embryologist! Emma's mission is to reduce fertility journey anxiety. Alex met Emma during her own fertility journey, and wanted to get her on the pod to demystify common misunderstandings around fertility. She discusses eggs, sperm, discharge, and stresses that there is no such thing as a fertility cliff.Follow Emma on Instagram @emmatheembryologistFollow us on Instagram @shouldideletethatEmail us at [e-mail] by Daisy GrantMusic by Alex Andrew Hosted on Acast. See acast.com/privacy for more information.

I've got a 10-year-old daughter. I do not want her to grow up in that world. I want her to grow up in a world where it's okay to talk about pregnancy. It's okay to talk about your period. It's okay to talk about the gunk that comes out of your cervix and it's not an egg. It's okay to talk about all these things because you've got every right to understand your bodies. Hello and welcome back to should I delete that. I'm M Clarkson and Alex has a mouthful of tea.

I'm so sorry. thought I had more time than I did. I'm Alex Light. As you went for that, I was like, you're a fool. I did not time that very well. Hello, I'm Alex Light. How are you doing? Good. I just washed my hair for the first time in a week, how gross, but it feels incredible. Welcome to my team. It feels so good. It's just one of those, I just, I don't, I actually don't know why I haven't washed it, but I've just kept pushing it and pushing it. And then this morning, I was like, oh my God, I'm going to wash my hair. and it just feels, I feel like a Disney princess or something. I just feel amazing.

Yeah, you do look beautiful. Look at it, all washed and clean, stunning. There's something to be said for looking like an absolute trash bag, six days out of seven, because then when you do pull it out, you have to do the bare minimum. I'm just going to wash my hair, and everyone's going to go, oh my God, you look amazing, what's different? But every day when I wash my hair, I get so many compliments,

and I'm like, I could have these every day, but that would earn it. it would desensitise you. Agree. I don't want the bar that high way in life. I'm setting myself up to fail. Yeah, absolutely. That's kind of like how I like to live my life. No, my good, my good.

My good is that we can't really give any specifics because we don't have them. But we are talking progressively seriously about going on tour. We've been talking to promoters. I mean, I don't know. I didn't ask your permission before I said that. might have wanted to do like a huge reveal. But I feel like it's, no, I just feel like it's, it's very exciting.

And we're just... Isn't it scary, though? It's scary, it's regional. We had such a big meeting yesterday. It's regional. Yeah, we had such a scary meeting yesterday. It was a roller coaster because you're, because it's a cruel world, this touring business. I can see why rock stars do drugs.

Oh my God, are we going to end of this? Drug addicts after this. On drugs. It's the only way to get through. Probably. Probably. Yeah, it's a bit brutal, but we think we're getting there. Yeah, that'll be my good too. Okay, anything bad? Well, my awkward leads very nicely onto my bad. Um, so I'll just do both if that's all right. Um, my awkward is that Betty sneezed into my mouth. It was a horrifying moment for both of us, way too intimate. She hasn't really looked at me since. I can't really look at her. Licky Linda. She's stepping it up a notch. Sneedy Susan. right in my mouth like hit the back of my throat and everything your reflex is to swallow

isn't it anyway that shouldn't be it shouldn't be it shouldn't be I did and I was like Dave I just swallowed her sneeze that's my awkward and then I put it on Instagram and I was like

ha ha she just sneezed into my mouth and she just sneezed into my mouth like loll do I need to go to A&E right I mean this story was up for like 15 minutes and in the space of these 15 minutes. I had about, I think I had six DMs saying something, saying all along the lines of your waste, this is such a waste of the NHS's time. Like this is, this is like precious,

valuable time that you're wasting? And I'm like, guys, do you honestly think? I'm going to put myself in the car, trundle myself off to A&E, get there, get asked, what's your accident or emergency and go, my dog sneezed in my mouth? It was obviously a joke. And my reflex was to follow it. Your respect for the NHS is on the floor. Clearly. What's what. So, so, yeah. So I had to clarify that it was indeed a joke.

Anyway. My bad actually is not too dissimilar, given, it's a segue from A&E. I wasn't going to go to A&E because I do care about the NHS and their precious resources. But I did, unlike you, you selfish bitch. But I did consider going to a walk-in centre, which is an I considering my ailment. My toenail, I did not want to talk about it. I wanted to let it go. I never wanted to bring it up again. I hate myself. Okay. I'm sorry, guys. I hate myself that I'm

telling you. It's gone from bad to very, very, very bad. It's so painful. Last night, because I don't sleep. Well, I do. I would like to, but I'm not at the moment. It's just not in that era. I was up with Arlo at like 3.30. She finally went about to sleep and I was lying there for over an hour I couldn't sleep because my toe was throbbing so much so what did I do

for the first time since I got an infected toe now I googled it which I hadn't done yet well when I tell you I was on the mum's net forums for hours

and general consensus is that I have to go to a walking centre sharpish because otherwise my toe might fall off it was very scary or you might get a sepsis don't say that Alex

I've just taught myself round to not go into the walking centre. I don't... No, I'm not going because I don't want to waste NHS resources but I have booked to go. I had to Google it and I hate myself

for having to Google it for infected toenail specialist near me and I have found a podiatrist around the corner and I have an appointment tomorrow afternoon for them to deal with it. So I'm doing something about it.

You say, every single week you say, I don't want to talk about this I don't want this to be my thing I don't want to bring it up and every single week it without fail you bring this up I feel like

you want to talk about this so let's talk about it so I think you yeah you definitely have to see someone because it could get infected into your bloodstream I know but you are seeing someone

and actually it looks fine like my toes still look I've got stunning feet I've always said this about myself and they still look great like it doesn't look like there's anything wrong with it that's what's really weird

Like, it looks absolutely fine. Apart from occasion, it gets big red. And I've been doing everything right out. I do hot soaps every night with Epson salts, and then I put my mesium sulphate on it, and I wear the plasters, and I change the dressing twice a day. I'm being so good, but it's not working. And, you know, one of my feet grew when I was pregnant.

One of my feet is still a six, and now one of them's a seven, and I've been crashing my little feet, and this is on the big foot. It's on the big foot. So I think I've just been, like, Cinderella's ugly step-sisters. cramming my massive trotter into my old little shoes. You might have to go up to a seven. And I've hurt myself. Well, I know, but Al, the other one is still very much a six.

So the other day I had to wear odd shoes. On to that track day to do the driving, and I had to get one size six plinthole and one size seven because they're very adamant that the shoes have to fit properly because you're using better. That is so weird. So I had to have old shoes. It's so annoying.

I didn't want this to be my thing. It is. It is. It's not your thing. That is so weird. Are you going to have to like, oh my god you're going to have to dest in yourself to like a lifetime of buying two pairs of shoes just so that one fits because i don't think retailers offer right now no i know and there's a gap in the market pick a mix no i don't think you can pick a mix it's so because my left one that's roomy as hell i'm like

wiggling my toes around it's true because these shoes i'm wearing because of my running train is there are seven and a half so my left foot is swimming in there my right foot fits well it's so How annoying? Did it grow during pregnancy or after pregnancy? I just want to know what I've got to look out for. I actually think it might have been after. It's so weird. It's so weird.

Just one foot. And that's not even my awkward. Whilst we're chatting, awkwardly. Okay. Go on. I've stolen this awkward. Okay, love it. One of my goods, apart from the tour, is that Georgie's back.

Georgie's been gone for ages. I didn't see her before because everyone had COVID. Arlo had COVID and Alex had COVID. And Georgie's vulnerable. So we didn't see Georgie when we all had COVID. Then she went on the cruise. So we haven't seen it for like three weeks, which was like the longest since Arlo's been born.

So she came over last night. Minza so much, so great. Had a lovely time. ate pizza. Lovely, lovely, lovely. She did a bath time, bedtime with Arlo. We ate pizza. Stunning.

Bye. Bye, Georgie. Georgie says, bye. Always crying. I've got to go. I closed the door. And then I got a voice note from Georgie. There is a man on the other side of our street.

Yeah. With his arm up in the air. And she looks at him and says, thinks to herself, well, it must be one of their neighbours. Obviously me and Em look quite similar. It's dark. Yeah. He probably thinks I'm M.

So she waves back. This man was not waving. He was holding his key in the air to lock his car at the other end of the street. But she gave him arm up wave, which it's not my awkward, but he lives on the street, and he definitely thought that was me. Like he'll be like, God, there was a weird one when coming out of that house. and now when he sees me coming out of this house, he'll just know forever that in this house

there's a weird woman that waved at him. He won't know that that weird woman lives four miles north. He'll just think it was me. So thanks, Georgie. How embarrassing. Further ruining my reputation on this street. Oh my God, her awkward really is your awkward. Love this.

This week's guest, really special one for me. We'll explain why in the episode. but this is also such an informative one about all about fertility, demystifying fertility, discharge, which I have a bone to pick with them, you'll see it comes up. But we have the brilliant Emma, the embryologist, on today and hope you enjoy. Hi Emma. Hello. Thank you. Just as if we haven't been chatting for an hour, but hi. Thank you so much for coming in to join us today. Thank you for having me. You are an embryologist, which is.

very fucking cool and a lab manager at the Evewell which is the clinic that I went to to have all my treatment all my fertility treatment yes which is how we came to know each other I was kind of thinking the way here like how do I explain our relationship but I think you have honestly is the best one I think you've seen my embryos up close and personal what does an egg look like when it's just naked oh well they don't oh we're starting there. Okay, they don't come out naked. They come out. Yeah, so they come out the ovaries surrounded by a ball of cells and then we have to do some fancy stuff to them to get all that off and then we see them making. They have got a shell on them. No way. Yeah, a bit like

chicken eggs. They have to have a shell on them otherwise they wouldn't stay together. So they're individually, or they're individually wrapped. No, they are actually, they are individually wrapped inside like a ball of cells. So when they come out, they are, if you're imagining you're ovulating naturally, they would come out in a ball of cells, float down your fallopian tube, hopefully meet a sperm. Bob your uncle. Just the one egg. One egg a month, if normally.

Obviously what we're doing with IVF then means that we try and get more of them to try and get a bunch of them to try and make lots of them. Cool. So you don't break the shell? No, you don't break the shell. You do go through it, to put the sperm in, but you don't break it.

We leave it intact. I have so many questions. I didn't realize I had so many questions. Can I keep going with this? Look, can we come back to this? You can keep going for a small amount of time because I do need to ask you something. If someone's naturally ovulating

And the, like, it's a gooey discharge, right? It's the egg coming down. No, the gooey discharge comes from your cervix. It's got nothing to do with your ovaries or your fallopian tubes. Oh, wow. Okay, what's the egg that comes out? It doesn't come out. It stays in your body.

It comes out of your ovary. Uh-huh. You have sex. If this, if we're talking about normal. No, no, we're talking about like the months where you don't have a baby. Nothing. No, you don't, you don't ever see your egg. It's, so put it in context, an egg.

Okay, let's go. Let's make this really easy. An egg. in its most basic shell form is about one tenth of a millimeter in size. So if you can imagine a ruler. It's actually bigger than I thought. It's a hundred micro.

A tenth of a millimeter. Wait, so that must be visible to the naked eye. If you know what you're looking at, I know, I can see them just about. A tenth of a millimeter. There are 100 microns across. That's the tiniest little thing in the world. It's the biggest cell in the human body.

Sorry, a tenth of a millimeter. Oh, I'm going to love this. I'm going to blow your mind. A tip of a millimetre? Am I getting that right? Is it a millimetres or a tenth of a centimetre? So we call them micrometers. So it's a hundredth of a centimetre? Yes. Oh, I don't think you could see that with your naked eye. You can if you know what you're looking for. Just about, you can see the dots in the dishes. But I don't ever just, I don't move them around like that. I have microscopes. That help me.

Trying to cut the sperm. I'm like, I'm not about to announce I'm some sort of superhero. Actually, guys, I've got x-ray vision. But that's just amazing. And that's the biggest cell. Biggest cell in the human body. Wow. Okay. Now, if I tell you, the sperm is the smaller cell in the human body, and I'm going to blow your mind.

And then you put them together and humans get made. That kind of figures. So that discharge. That's a tiny little sperm. The discharge is to do with your estrogen levels at the time of ovulation. They go up to a point that forces your body to ovulate. And the discharge that you see at the time of ovulation is because you are estrogenized. That is a word.

And that's what you see. It's got nothing to the body. The eggs in your, the egg's in a different part of your body. You told me that the discharge was the egg. Was the egg? Was to bring the egg down? Okay, so what I thought, what I thought was like fully true was that it was like the white of the egg, you know, when you're like, a egg.

And it's just a good one. I was like, oh, my egg. Emma, we don't deserve you on this podcast. You know, these questions, I'm one bit worried. But yeah, let's go. This is someone who's just had a year of a little treat. as well. I'm like, oh. I've just had a kid.

Yeah. But you know, managed it, so it's fine. Why do you need to know all this shit? It's fine. That's mad. That is mad. Sorry, you said when I got here that you were going to blame my mind. I am going to blow your mind. I've already, I've already had it blame.

I was talking to Emma just before we started, right? And I'm going to ask you a question. And I can't wait to hear what you answer. Why do men have nipples? Is it because they start out as... women and everyone starts with a woman. I never thought you would get that. I knew that. Everybody starts with a woman and then they become, because that's what the

cervix is the same anatomy as a penis, right? But then it just becomes an outward one rather than a man. So hold on a minute. You know that, but we're not quite sure about the egg coming. It's amazing. This is amazing. Yes, that's exactly right. My favorite thing about my... My favorite thing about myself is I'm so inconsistent. Sorry, if that's the egg white, what about the yoke? What's the one? What did you have to think happened to the yoke?

Yeah, you're right. No, I don't know. I've always been really confused and I think, okay, truthfully I'm interested because I was always interested in the, I get the biology of human starting, like the nipple thing. But with the eggs, I was always very confused

because I, and I genuinely think it's because I was on birth control since I was 15 to, well, I mean, I shouldn't have been, I don't think. With hindsight, I'm like, oh my God, it's actually wild but I was on hormonal contraception for like 10 years. But I just didn't know my body because I didn't, you didn't make normal discharge. I didn't really have a clue.

And then I had six months off it before I got pregnant. And I was like, oh, Jazzy, discharge. And I just kind of thought of that. I didn't even know that ovulation wasn't a period. I didn't know anything about myself. And that is why we're here because doesn't that scare you? It is. Actually, we're having this conversation and we don't understand our own bodies.

And that, that I think is what makes me do what I do because I'm like, this is not okay. Women need to understand. And I do think, like, we're not taught it. Like, I think I must have been taught obviously. the nipple thing and the cervix thing and whatever about like, you know, the basic biology of making a human, which means if it, if you thought it was going to blow my mind, did it blow your mind? It blew my mind. Actually, Emma, can you explain quickly for any listeners whose minds also might be blown? So when you create an embryo, the embryo, the egg is always

what we call an X chromosome, which is female, because they just are. And it's the sperm that decides, decides the gender of the baby or the embryo. So some sperms will be X, some sperm will be Y and it depends which one gets into the egg that creates the embryo that will from the minute of fertilisation has a pre-designed gender but that gender so the Y chromosome doesn't actually sorry guys actually do much apart from act as a genetic switch to change the embryo from its default which is a female to this male which exactly what you've just described them which is the the anatomy changes so you end up with testicles instead of ovaries you end up with a penis instead of a cervix and it is literally that switch that comes from the Y chromosome but it doesn't

happen until six or seven weeks gestation. So you are sexless. So you are sex, we know you're female. All embryos are developing for the first six weeks in the default. They go through what's the default and that is the female. Wow. We're like bumblebees then. I haven't got clear about bumblebees. I actually know quite a lot about bumblebees. Go for it. Well they determine the gender. They can choose what sex, sorry, not gender. They choose what sex they want their the offspring to be so they'll only make like a tenth or even less

of them to be male because it's the female bees that do all the working got really into bees a couple of years ago because they only need the men to carry on making bees they don't need the men for work

because they're not as good at working as women so they only make a finite amount of men they only make like six or something so they've got the men and then just to keep fertilising. There's a lot of animals that can have gender design like amphibians are really good if you put amphibians in a whole single

single sex environment one of them can change gender really it's Jurassic Park I only learnt that from that nice I always think with like Henry the 8th and stuff and when you see those gender reveals of like men getting really pissed off that they're having a girl and I'm always like you did that like that was on you they didn't know that back then they didn't know that back then so the women got the blame for that as well yeah I still feel like women do it when I see these stupid gender reveals and you can see that men are like pissed off that it's gone all pink your fault I'm like yeah what was your stupid sperm should have sent a man down there Fascinating. God, we've got so many questions. I can tell this is going to be.

And we've got, we've got, listen to questions. Can I ask one for myself? Sorry. Yeah. I'm so excited that you're here. So, okay, so I know someone who swears down that she decided, I bet she determined the sex of their children. Bullshit. Obviously bullshit. She's like, yeah, I had a lot of baths with my son because I really wanted a boy and it made a bar. Anyway, I know that's a load of shit. But is there something to be said? I, I, I, I, read somewhere when I was pregnant that if you have sex at the beginning of your ovulation or at the end that it would determine the sex. No, because the sperm, I mean, there is some, if you, I mean, look, if you look of hard enough anything on Google, you'll find what you want

to find, right? Because don't you stop looking when you found the bit you want to find? That's stumbling. It's so, so true. That's my favorite thing about the internet. It's like pretty much always find what I want. So, yeah, I mean, the idea is that female sperm swim quicker than male sperm and all that. It's all nonsense. It's all absolutely nonsense. Otherwise, I mean, without a technology we've got and what we can do now, you don't think we would have got there and we would have had this amazing outcome

of, you know, have sex on this day and you're going to have a girl and it doesn't work like that. Nutrition, no, you can't change it. At the end of day, it's just which sperm gets up there and which one gets in. And is it true that... And they work as a pack,

so it's not like there's just one sperm that gets into the egg. They have to work together as a pack. It's like a pack of sperm. It's like a pack. Is it true that collectively we're more likely to have boys than girls. So if you look at, yeah, the gender, the gender female divide is, I think, 50.3% are males and

49.7% of females. And we don't know why. Well, I suppose if you look at evolution, it's probably because women will outlive men. It's generally accepted that, and I presume it's just an evolutionary thing, but if you do do a gender count on a man's sperm, it doesn't sit exactly at 50-50. It's about 51.49. Boys to girls. How fascinating is that? They're not feminists at their core. They're trying out. Yeah, exactly.

Where's the equality? We see your little sperm. Try it. Just try it. Fascinating. Fascinating. Okay. So the reason you're here, in your own words,

you are on a mission to reduce fertility, journey, anxiety. Yep. And that's across the board, whether conceiving naturally or IVF. and we asked listeners for questions and as you know because I showed you a lot of them we had a lot so we're just going to dive straight in if that's okay

yeah that's fine and I think we should start at trying to conceive a lot of people asking when to seek help with trying to conceive at what point it's a great question and I'm probably going to say this far too much during this podcast but everything is about context everything we do every discussion we have

has to be context driven there is no right or wrong answer for a person's family journey or when they should do this. I think we talked about this earlier is people need to butt out of everyone's lives and stop telling them what to do. Ultimately, trying to conceive can be an incredibly exciting time. It can also turn into a bit of a fucking nightmare

because if it's not working, it's searching around for that information that's going to help you and support you through just isn't there, hence the reason we're all sat here having this chat. I would say that if you are anywhere, especially early 30s, mid-30s, and it's been six to eight months, get yourself in your GP. There are tests that can be done. They don't need to cost a fortune.

No one's out, you know, no one's going to start pushing you down the fertility clinic route and all of that. But I think what's really important is people, if you are trying to conceive, get the right information about how to conceive. We've just talked about the fact that actually none of us really understand our bodies and what we should be looking for for ovulation. There is so much good education out there on this now. there's a wealth of people doing trying to conceive you know

A to Zs and all of that to help people understand that and to get it right so that it happens quicker and if it's not happening go and get some help yeah because the longer you leave it the older you get the older you get the harder it gets so for me I'd say it's context led is how old are you when you're starting to try to conceive and we'll put it into numbers they say that women under the age are about 40 in the first year 80 to 85% of people will conceive in the first 12 months. They say under 40. Under 40.

Yeah. The first 12 months, 80 to 85% of people will conceive. In the following six months, up to 18 months, you should get to about 90. Then if you go to two years, you actually only increase that by 2%. So you're always left with a population of people that won't conceive. And those are the people that end up needing some sort of reproductive support. Right. One in five couples will seek reproductive advice.

Yeah. One in eight couples will need help. Okay. It's massive. That's a lot. It's a lot. And from my experience, a lot of that is driven by the lack of education that we're giving young women to acquire the help they need, the understanding they need, the reproductive advocacy they need. And also, I think what we'll probably talk about a lot today is what we can do.

But what I'd like to go back to is how we make people a bit more aware. So that when this all happens, if it all happens, you are aware of what you're. you need to do to take the right steps because most of the people I see and sit in front of me, most of the one in eight are of advanced, what we call advanced maternal age and because nobody actually bothered to have the conversation. And if I have to sit in front of one more 40-year-old woman that said to me, why did no one tell me this? Yeah. Then it's just something I have to do every day and I want it to stop. I've got a 10-year-old daughter. I do not want her to grow up in that world. I want her to grow up in a world where it's okay to talk about pregnancy. It's okay to

talk about your period. It's okay to talk about the gunk that comes out of your cervix and it's not an egg. It's okay to talk about all these things because you've got every right to understand your bodies. So my advice is don't leave it very long. Your GPs are there to help you and if they don't help you, go and see a different GP. Spirm counts, the first thing you need to do. I was going to say, what are the tests? First thing you need to do is to have a sperm count. It's the easiest thing to look at 40, even potentially 50% of our reproductive failures now are male factor. There are things we can do. But it's important we know.

Because I think, like, I'm vaguely aware of that as a statistic, but also I feel like societally, maybe because it happens to the woman's body, but it does feel like it's fertility is a woman's issue. Yeah. We know that in the last 50 years, male sperm counts have declined by two thirds. So we know, and there's not a lot we can do about that.

Why is that? You know, lifestyle, environmental factors, just where we are. I mean, it is, fertility is on the decline. But the point is it's about knowing what you can. And there are things we can do about it, and we'll probably touch on it later. But go and get sperm count. I mean, it's the easiest thing to do.

Maybe not, they don't think it is, but it absolutely is compared to what the women have to do. They just have to wank in a pot. Hundreds of thousands of stories around that that we might, could do a whole other podcast on. The good, the bad and the ugly. I've got some very funny ones. But women, you need to go and speak to your GP

about making sure are your cycles regular. You know, start tracking things, start looking at things like your menstrual cycles. Your menstrual cycles tell you a huge amount. yourself you should be having periods irregularly do you think with that do you think tracking apps are good yeah i think i think it helps you get some reproductive control and understanding i think as long i think some of the tracking acts can be really good because they tell you what other things to look out for like signs of ovulation and stuff yeah so yeah i think they can be really helpful but you

absolutely need to get like you've got to get your own control over this so yeah first thing to look menstrual cycles like is it normal speech or gp the longer this goes on the more stressed everyone gets the older everyone gets and that's just counterproductive. Yeah. Okay. Do you know, not to throw a massive spanner in the works, but I went to my, for three years, I think, three years now over, I haven't had a period.

And I went to my GP about it last November. And I just got the referral letter yesterday. Horrendous, isn't it? Horrendous, yeah. And I was really confused because I got it and it was a scan. I was like, I've, I've had my scans now. I don't need another scan. I'm confused.

I rang up the hospital and they said, oh, this is for your referral for missing periods. I was like, I'm pregnant. I'm pregnant. Definitely not having them anymore. Yeah. Oh my God. That's so bad. It's really bad.

It's really bad. It's really bad. Okay, so let's, I think one of the questions you have there is about home kits. Right, which I did as well. Yeah. So let's go there. So there are companies now offering home testing reproductive kits. I am a little bit sat on the fence with them about the sperm

I think it's okay in the fact that they can tell you there's sperm there and they can tell you that they're probably moving what they can't tell you about the sperm is a shape and a lot of my diagnosis comes from how the sperm looks which you can't do on a I think like a faux par pregnancy testing thing that you run the semen in one side and if it comes up blue or something it's okay you still need to have a semen analysis done a proper sperm check

but actually there are some really good companies out there now starting to help women I mean, no, it's not so much of a fertility thing, but it's more of a understanding awareness, reproductive awareness. They're not all created equal, some of them are better than others. There is a company called Hurtility at the moment

that I've got a lot of funding and have done really well. The times have put them up as like this big to watch company and they are advocating for women having blood tests done from home and reviewing all the different types of results to talk about your reproductive health. I mean, I can personally vouch for them. That's the one that I used.

Yeah. came back with low AMH and I honestly just thought I've pricked my finger and put a bit of blood, tiny bit of blood in a thing. There's no way they know from that how, what my ovarian reserve is. And then it's when I came to the Eve well. So the woman that set that company up as a molecular geneticist. So she's probably one of the cleverest people I know. And so she is. There's no way she could know. I was like, nah, fuck this. Tiny bit of blood, no way. So when they developed the company, it was from that level of experience of, which is why, like I said, they're not all created equal, but there are definitely better products out there than others. So the GP weight thing

is, that's awful. Yeah. But you shouldn't have to go through what you went through because your situation is a little bit more unusual if not having periods for three years. That does need quite a different level of investigation. And it should have been quicker. So, fertility. Would you recommend everybody get a grasp of their, of their. I think one of the other questions you've got is when now like absolutely now if I get my way and yeah I'm a bit like Marmite you either love me

or you hate me and I'm trying to get into the schools like at senior schools because actually I feel so passionate about this now like learn about yourself now yeah yeah yeah okay so say someone at the age of 25 does the fertility test it comes back with a low

AMH what do you then suggest that she does again it depends It depends on what their future plans are, and it's really difficult when you're that young. I'm not sure they are aimed at women that young, unless you are trying to develop a family. I wouldn't want to, as a non-clinician, I'm not going to go into that area too much. Remember, a low AMH does not determine your ability to get pregnant. Can you tell us what AMH is?

Sorry, it's an anti-malarian hormone, so it talks about your ovarian reserve. So it talks about how many eggs are left in your ovaries, and it's a number that correlates to that. What it doesn't correlate to is your fertility. It doesn't correlate to how fertile you are and if you're going to have sex this month and get pregnant because at the end of the day if you're ovulating and you're of a good age group and all of that then that's what determines that.

What your AMH tells us is is your fertility waning early or if we are going to do IVF how many drugs we need to give you? We use it really, really proactively in IVF day to day because we're trying to work out what drugs to give women to make them have an egg collection. So remember, that's

where that came from. But it's also a really good reproductive marker. But it's It does not determine your ability to get pregnant next month at the age of 25. And that I think needs to be real. And I think what I love about the Hortility test is it comes with a whole heap of information about what this actually means. Because what we don't want to do is then encourage people to go into dangerous life choices or difficult life choices without the right support and advice. So all of these things need to come with the right clinical understanding. The amount of my friends I've had conversations.

with who are like thinking about having babies but then there's so many factors like their careers and like are they married or their house is big enough or can they afford it and like there's all this and then then they're like I know time's passing like we're interrup 30s so shall I go and get it checked but then if I go and get it checked it makes it really real and that's I think like the I think people want to be in the denial but that actually causes quite a lot of anxiety because you think oh I just won't think about it and it'll probably be fine yeah and then because if you go and get the test it's kind of taking a step, isn't it, to be like...

Yeah, absolutely. And when I did it, I wish I hadn't done it. I wished at that time that hadn't done it when it came back low because I was like, that means I have to do something about it now. Like, I have to make a decision. It was nice when like ignorance is bliss, but actually it was so good that I found out.

Like, thank God. Yeah. Yeah, I think, yeah, I think there's two sides to every conversation isn't there. But the one I would like to advocate for is that you get the right advice. Oh, well, 100%. 100%. And also, I know the sad thing is, or the frustrating thing is,

actually, like the one friend I'm thinking of who I've had this conversation with, she wants to go and get it, but she's scared. And I think that's like, and I don't know if it's always been there, but it does feel like there's this background kind of terror in a lot of women that it's not going to be easy for them. Yeah, well, that's, I mean, unfortunately, that's a lot to do with the media and how they've portrayed fertility and fertility treatment in general. It's not ever been positive.

It's not ever had a positive aspect to it. It's always been this real negative money-making industry that isn't there to do anything but do that. Again, we're not all created equal and actually some of us actually do just want to do what's right and help people get the right advice. So I think the media has done us a really, really bad disservice in that. Yeah. What would you like to see the media changing? I'd like them to be a bit more asking the right questions of really good clinicians and asking them what all these tests mean for women and when we're like having this sort of conversation about actually no one's telling you what you need to do. But stop slamming us. Stop slamming us as these

awful entities that are actually trying to make people come through the door and do egg freezing and that. No one's trying to do that. What we're trying to do is give people reproductive control back. Yeah, I keep seeing it's like like op-eds, I guess, but like sort of Instagram infographics being like

is egg freezing just a money-making scale? Like does it really work? Very like stylist and Grazia are doing them. Very like it's a contentious thing and it's like is it? It should be impact. It feels, I don't know, it feels like that it's all up the debate a lot which maybe it has to be you know in order to keep everything transparent but then

I still have from my head this kind of not a shame around IVF in terms of shame of needing it but when we were growing up it always felt like it was talked about as like some sort of rich game that people were playing like but I isn't that awful yeah it's only as I've got older I'm like oh my god like that's horrendous because you must have been everyone I'm watching do IVF now I'm like this is the most traumatising and horrendous thing and yet the way we talk about it is it's like, or talked about it. I don't know what, do you know what I mean? Yeah, no, no, totally.

And I think actually what you just touched on there is it is the most horrendous thing. It shouldn't be. No. Because actually, medically, it's actually quite doable. It's actually very medically doable. I think all we've created is this fear around it. And a lot of this is because we don't understand it. Yeah.

So if we can understand what's going to happen from A to B and we understand the risks involved and why it might not work and how in my age group, why will it work? And all of those questions, I think we can alleviate some of the horrendousness. So that it just becomes this medical process that you completely understand and you go from A to B. Yeah. And that's hopefully where we're trying to get to. Okay.

Yeah. Yeah. I've never really thought about the optic. Yeah, the narrative around it. It's very negative. Yeah. It's very negative narrative around. Yeah, I know someone who had,

but it would be like people who had twins of a certain age and people would be like, oh, that must have been an IV again. And it's like, yeah. Yeah. Like, why did you? Like, it's only literally, literally now it's all clicking in my head. I'm like, oh my God, that's a really fucking weird thing to say. Yeah, I remember someone saying to me.

My friends got twins. and she gets that all the time. Really? They're identical. It was just one of those things. And actually, again, what we talked about is, like, why do people come up to you and think it's okay to say something like that? Yeah.

God, you're really weird. And why do they care? And why do you care? Yeah, why do you care how you made the baby? Yeah, exactly. Really weird. Really weird. Never thought about that.

So, speaking of freezing eggs, a lot of people are asking, because obviously, is there a certain point past, which you shouldn't freeze your eggs because of the quality of the eggs declining due to age. Someone's asking, I'm 34. Is it too late for me to freeze my eggs? Oh, we're going to get sciencey now. Okay, let's go. Let's try and make this a science bubble that I can probably encompass quite a lot of the questions you've got on there.

So, there is no cliff. There is no cliff that we're all, we are not all falling off a cliff at 35. The fertility cliff. There is no cliff that we have our happy birthday to you. Bang, you're on the floor. Is there not? No, it doesn't work like that. But there is a decline.

And the decline has to be noted because it is very real. We are born with all our eggs. As females, we are born with our eggs. And throughout our lifetime, those egg stores will become depleted. They will become depleted throughout, mainly after our puberty years. Well, actually, I'm not going to go into it, but you lose quite a lot even when you're a child. But as you go through puberty, you're releasing one egg a month or one or two eggs a month. you're actually recruiting quite a lot

and then one becomes the chosen one being out it pops and you do that for about 30, 35 years of your life as your egg stocks dwindle you then go into the menopause and that's why you end up being perimenopausal and menopausal and you then stop right because your ovaries are empty

that's what causes menopause what happens is because you're born with all your eggs they're like in a stasis of like a dormant sleep state and that's fine for a while but as we age that dormant sleep state and then they start to be awoken to be recruited for ovulation after your 35, 36, 37 and onwards. They start to make more mistakes because they've been dormant for so long. Well, bless them. So when you're younger and you're ovulating, your eggs are most likely and we

call it genetic competence. So we're talking about the genetics that allows you to be human and the only way I can term it without going into what me and Alex were discussing earlier. If anyone that's a good thing. On my Instagram there is a library analogy where I talk about the difference between chromosomes and genes and why it all matters. But ultimately it's called genetic competence to being a human being. So as we get older, more of our eggs are genetically incompetent because they have been in our bodies for 35, 36, 37, 38 years. And that decline happens quite much more rapidly after we're 37 than it does in our 20s or early 30s. So what we know is that a woman in at 35, of all the eggs she's ovulating, we expect about

60% of them to still be genetically competent. At 35. At 35. By the time you're 37, we think it's about 50%. By the time you are 38, we think it's about 40. By the time you're 39, we think it's 30. 40, it's 25. 41, it's 15.

42. It's 10. So there's your decline. It's not a cliff. That's gradual. But it's fairly speed up, right? Because until you're 35, we think everyone sits around. Even in your early 20s, you're going to have abnormal eggs.

Everyone has abnormal eggs. Can I ask about the genetically incompetent eggs? Would they be eggs that would be unable to be fertilised? Or would they be eggs that could be fertilised but not create a viable pregnancy? So that's a really good one because I think the misconception when you're trying to conceive is that you're not getting fertilisation. That's probably not true. Fertilisation is actually the easy bit for eggs and sperm to do

in most scenarios, unless there is a really, really, really low sperm count or a really, really problematic ovulation, like what you were having. Yeah. So if you're ovulating and you've got normal sperm, there is an embryo. Right. Like, if you're trying for 12 months, there's definitely six or seven or eight embryos. Really? The difference is, is that embryo compatible for implanting into the lining of your uterus,

also called a womb, Alex. I just learned that yesterday. today we don't want to talk about. You've learned that yesterday. You've had a year. Yeah, I know. Fertility dream. Sorry, Alex.

That's right. That's my favourite thing I've learned about you today. So the embryo, it's to do with its then compatibility with being able to go on and make a human. I think I'm going to throw it out there and it might not go down very well. But nature has actually got a really good quality control mechanism. And it is actually in a way. the kindest thing. So it will stop embryos growing.

Nature's like, if you imagine an embryo's got a blueprint, right? And if the blueprint's incorrect, the embryo will just, it can't grow, it can't build itself. So it depends on how incorrect that blueprint is to when that stoppage happens. So it either stops before you get pregnant or it causes a miscarriage in most occasions, not in all, but in most occasions.

So as we age, we have more genetically incompetent eggs. You'll find that women, as they get older, struggle to conceive. have more miscarriages, have more affected pregnancies. So all of these things are related to age, but it is not a cliff. So the question about when you freeze your eggs is I think if we can try and put it into a numbers game, if you can imagine that at 34, we expect 60 or 70% of your eggs to be genetically normal, how many eggs do you need to be freezing to be confident that you've got a family in the freezer?

And I hate that term, but it is what it is. So probably at 34, you're looking at needing about 15 or 20 eggs. to be frozen, to know that you've got good eggs of genetic competence to make you pregnant later down the line. The same can't be said when you're 38, you need more. So the question to your 38-year-old woman is... She was 34. No, you're 38-year-old woman on the chat that said, shall I still freeze my eggs at 38?

The question to her would be, get yourself looked at by a good clinician, because actually, is it worth you doing it? Because if you're only going to get six eggs, if that's all we can do, because that's what your AMH tells us, we can do, then I think my answer is no, because you need a huge amount of eggs to protect your reproductive future at the age of 38. You need about 30 or 35 eggs. But if it's... And that's to create one embryo. No, hopefully more. But again, it's the unknown, isn't it? So it's just, it's a statistics game. It's about knowing that of those eggs, say you collected 30, only 15 of them, or maybe let's go 12 would be genetically competent.

Of those 12, only eight of them would fertilise. Of those eggs, only so many of them would grow. Does that make sense? Sorry, no you go ahead. When you, yeah, it does. When you say 30 eggs to have in the freezer, are those 30 eggs or mature eggs? Yes. So yeah, that is a lot.

So then you've got to get more to start with. It would take me years. I don't think I'd ever get there. But that's the point. So for someone like you, if you were 38, I, a responsible clinician would be saying this to you and saying this is not, like this isn't going to be a viable option for you. Please don't spend 40 grand. But what if she just really wanted a kid?

Then maybe if she just really wants a kid, we need to educate on having solo motherhood. Yeah. Starting to talk about dosing a donor sperm and creating embryos. Because that's very different. So, okay, right. So you're not saying you're 38, it's not viable. Not at all.

No children. It's just... I'm talking about egg freezing being a viable option. Egg free. Okay, so in that case, you look at doing embryo freezing. Yeah. So you'd just, you'd need to find some sperm. You would just, yeah. Cool.

just need to find some sperm but yeah yeah i think that sounds very simple but it is actually quite simple but yeah is it so sperm banks yeah there's catalogs and donor banks yeah catalogs there's catalogs like mini oh my god love that photos of the sperm no of the men photos flick through oh nice though i had one mom say to me once she goes i've picked my donor i went have you that's lovely looks just like brad pitt i said okay oh my god you see pictures of them yeah yeah and the american banks yeah not in the uk The UK can't do anything. It's in the UK, you just get blinds there.

You get, they're not blind. The sperm's not blind, but it's like a blind date. A little bit. You get a characteristic profile. Oh, wow. Of the sperm or of the man. Of the man. So, like, he likes his hobbies and stuff.

Yes. Do you think. Six foot two, brown hair, blue eyes. Yep. Well, you're not going to do yourself dirty on that, are you? Like, if you were writing up your own thing and they want, you want people to choose you, you're going to make yourself sound really good. Catalogs.

In America? America do a lot of sperm donation. We also get a lot from Denmark. So the Spirondavian do a lot of donations. Oh, so you can get, so if you go to an, like a sperm back here in the UK, is it all like UK sperm or do you import sperm? It depends whether persons, most of the time they, because you have to commit to donating sperm for months on end.

It's not like you go in and it's one job. They commit to donating for six to 12 months routinely. It's a lovely thing that people do, isn't it? Yeah. And people donating their eggs. In this country, definitely, because it has to be what we call altruistic, which means it's for the greater good, because you can't profit from it. Can you not?

No, not in this country. You're not allowed to profit from any donation. You can't profit from anything here. But in other countries, there is concern about donation around the sort of the renumeration they're getting and if it's a little bit on the bribery edge on the preying on the vulnerable. So I think that is something to keep in mind if you're looking at donation is how you feel about those aspects. Again, no judgment. It's not my business, but it's, there are elements

that need to be considered. But in the UK, you are getting altruistics, but yeah, they don't get anything for it. They literally get their train fare. Wow. That is nice then. That's really nice. And people donating their eggs. I get like, I do a thing on Friday, it's called Feel Good Friday where people send in their good news of the week. And I'm actually getting, uh, increasing, like I'm seeing more and more women who are donating their eggs. Really? Yeah, that is definitely becoming. And I think again this comes from us thankfully sat here doing this and highlighting the awareness that this is a real need this is like really there are women out there that don't have any eggs um multiple reasons can't go into that but this is where we're at yeah can i zoom back to you mentioned the rise

of solo like the how we should be taught by solo motherhood more and like that is an option are you seeing that more uh rise definitely yeah definitely i think that um the stigma attached to being on your own, the need for a man or a partner to be in your life, all of that has shifted somewhat. Women have been now afforded the opportunities that they haven't been before, they have good careers, and ultimately people are starting to not settle for any less than what they want to be as their perfect situation. So I have watched women that have frozen eggs and have actually said to me, this is the reason, I'm so glad I froze my eggs, because now I didn't end up racing into a relationship with someone that I didn't really want to be with because I felt

like I had some reproductive insurance. Yeah. Egg freezing is not a complete insurance policy. We haven't got time to go in it. There's a lot about it. It should always be seen as an option, not an insurance policy. But she made it, she changed my mind on how I viewed it. And she said, I definitely would have just stayed in a relationship because I thought I should and I wanted to have a baby. And actually, she's come out the other side and gone, I don't need to be with anyone to have a baby. So that whole that whole thing has become really, I hate the word popular, but

I think it's more highlighted and in the culture we live in a bit more accepted. Yeah. Women, and it's amazing. In theory, and I might be very wrong here, but in theory, that could be a very affordable way to have a baby because it's just insemination, right? You don't necessarily need any... It really

depends again on the age of the patient coming to sit in front of you. Insemination can work really, really well in the right context. You wouldn't need to go. go, you just put it in. The right time at the right month with a bit of donor sperm, yeah. That's an option.

IVF is an option. I suppose to put it into my love, my phrase of the day context is a lot of the women that come to do solo motherhood are a bit older, so in advanced paternal age. So it is a little bit more challenging. So we do do a lot of IVF and creation of embryos in that cohort of people.

God, that isn't so empowering. It is, isn't it? Yeah, I love that. That's so cool. really cool um to wrap up i'm sorry to like press on this but to wrap up the conversation because i think a lot of people are asking about egg freezing to wrap up that conversation and to kind of debunk the idea that egg freezing doesn't work it does work it does work and have you seen it happen i do it i mean i do it a huge amount now more than i used to so i give you some numbers so when the eve well

opened in 2018 eight percent six percent of our cases were for egg freezing to by two thousand 2020, it was 12%. By 2021, it was 15. 2022 was 20%. And this year already, we are at 29% of our cases at egg freezing. Wow. I think the thing to be aware of with egg freezing is we are a real technologically brilliance now. We've got it right. But the results you're seeing are from five, six years ago.

Right. Because the average time it takes a woman to come back and use her frozen eggs is about five or six years. So the results you're getting from, you can't determine whether an eggs tolerated it all until you thaw them out. Got it. So you can put them in the freezer and it can all go really well. But actually the flip side of that is they have to survive and they have to fertilise and they have to do all the bits they need to do to make a human. So the stats we're on now is sort of six year delayed from where I think we are.

I think we're in a really, really good place now. If a woman was 30 years old and she was single and she knew she wanted children, at what point, and she did her fertility test and everything looked normal, at what point would you say to her and assuming she remains single at what point would you say egg freezing might be something to look into I think if she's still on her own

and is still in a position where she wants to have children and she's not sure actually or even if she's not in a position where she quite knows if she wants to have children because I think that's a real conversation at the moment is I actually don't know what I want to do but I don't want the option to be taken away from me

and that's okay you've got to put the financial element in this egg freezing is expensive I would say before you're 33-34. Really? Yeah, get them in the freezer. Okay. Because they're just more likely to work. Yeah.

And the longer we leave it, the more we need, the more rounds we need, the more expensive it is. It is more expensive, yeah. So basically as soon as possible. Yeah, I don't, I mean, I'm certainly not advocating for 21-year-olds walking into the clinic the minute we're illegally allowed to do it. Because I don't, I think the statistics show that actually the decline between fertility between 21 and 34 is actually not great. It's negligible. it's as we get into that advanced maternal age.

So yeah, I would say that's what we normally say to patients. Can I ask a selfish question then? On that, so if from 21 to 34, fertility doesn't decline that much, would that mean that then, I mean, I was tested for AMH when I was 33, would that mean that I've always had a very low AMH? Potentially.

I just presumed it was because of my age. No, I mean, again, I don't know, because we never tested you, but no, potentially. Potentially, that just was your makeup. Does lifestyle affect you, a woman as much as it affects, if sperm counts being reduced due to a lifestyle? It's the same thing. Yeah, lifestyle is a massive, a massive problem in fertility.

Our, like, humankind's lifestyle. A bit of both. But I will say that, like, I have seen men turn their sperm counts around from ditching the crap, the vaping, the recreational drugs. All of those can really hit your sperm count and really, really hard. And you can turn it around? You can. If you're giving them, again, when people are looking to do IVF, I always say, and I think we'll probably come on to this. Because I think one of the questions is maybe we'll go there at the end, but I always say, get yourself in a really good nutritional place.

There's very little you can control about IVF, very little. A lot of it's out of even my control. But the bits you can control is how you look after yourself in the run-up to anything. Yeah. So sperm takes 120 days to be made in the testicles, 90 to 120. that they're remaking it. Women's eggs, although they are already in your body, they're being recruited,

and that recruitment process takes between 90 and 120 days as well. So you can get yourself in a really good nutritional space and get rid of all the crap and all the vaping. Like I said, that we know that vaping's really bad for sperm. Is it? Cocaine's really bad for sperm. Is it? Yeah.

They should put that on the fucking billboards, the anti-baping ones. I thought you were going to say we should put that on the cocaine package. I'm not sure anyone was regulating that. Yeah, what are the little baggies. Who could we talk to about that? Can put a big stamp on the packets of cocaine. I'm not sure we're going to win that one. So interesting.

So there is things you can do to make sure that you've got some control over what you put in your body, right? Yeah, no, that's really good to hear. So people, people recreationally. Do you know, though, I found that I had to take that nutritional advice with a pinch of salt a little bit. Stop taking cocaine. Yeah, I had to stop taking care. It was really hard. bum bum but I'm back doing it against it's fine

the baby is thriving a lot of movement lot of movement yeah that I found that I had to find the balance with that because that freaked me out a bit at first because I remember the first round that I did I was like I can't eat any crap and I'm scared and I've got to eat like loads of mushrooms

and pomegranates and all that and I feel like that took its toll on me a bit and kind of made me freak out about food. I think when we say nutritional space, I suppose it's about good living, isn't it? It's not about drinking a bottle of vodka on a Friday night. It's not about, I think you have to, it has to work with your life. It has to work within your framework. Yeah. But there are certainly things that need to piss off if you're going to start doing, like really committing to conceiving and stuff like that. If it's not working without getting it to piss off if that makes sense. Yeah, yeah, totally. Cool. So

sperm can be affected by nutrition, by what the man is consuming and questions, sorry if you sit with a laptop on you willie does it affect your sperm? It's about heat so lots of things that hot balls, hotballs, they hang outside your body for a reason

they don't want to be hot really so that's why they don't dangle down just for like entertainment value so it's just dangled no balls that dangle Do you know what my favourite word is? This will help with this conversation. My favourite word, no, no, it's not dangle.

It's scrotum. Oh, that's such a bad word. Scrotum is my favourite word because it's... It sounds ditchy. So they sit outside your body because your body temperature is 37 and testicular function is optimal at 35. So your testicles sit outside your body. So if there is any reason that your testicles are too close to your body,

if you are... And this will come up in our BMI conversation. So if you, as a man, are very overweight, your testicles are closer to your body, so they get hot. Oh, no, that's interesting. So you get lower sperm counts. You get lower sperm counts from men who spend multiple hours on their bikes. Again, not because of the actual cycling,

it's because your testicles are close to your body. And so your testicles are sitting at 37 more often than they're sitting at 35, so it can't take over. So they're sweating. Chefs have a really, really low sperm count, naturally because their testicles are all by ovens. Really? Gordon Ramsey's a massive talker about this.

He talks about this quite a lot. Yeah, he talks about him needing XE to have his children, some of his children. Really? Because they have, they get hot. You get hot by the ovens. Laptops are the same. Did not know this. So it's not about the laptop, it's about heat.

You lost. Oh my God. It's not. I want to convey about. Next to an oven. It's just a lot. So it's about heat. So anything that keeps your testicles hot for a large portion of the day.

I love that. She's got her giggle Testicle How old are you? I just think it's funny that they hang I'm really sorry I'm really sorry On their own without a willie

testicles are just funny Oh I don't know I think they're funny Even with the Willie They're quite funny But yeah But yeah so it's all to do with heat Sorry sorry sorry

And it's all to do with function So they can't function at that temperature And that's why men shouldn't have hot baths either Again that's actually a bit of a myth Because it's only for 20 minutes So not Dave's not like no He goes for four hours. God, I know.

Get wrinkly. It's making little dumplings. But I think it's, again, my lovely word, context. It's about how long you spend at that temperature, right? Like, short exposures aren't going to do it. It's broken. You've broken. I love it that testicles break people.

Sometimes you're thinking about Dave's dumplings. Should we call this episode of Dave's dumplings? I'm sorry, I'm all right. Okay, one last question about sperm really quickly because actually a lot of people ask this, does age affect male fertility sperm? Yeah. And why don't we talk about that?

Because Mick Jagger has all done us all that. A conversation that needs to be had. Yeah. Who's the other guy? Robert De Niro's just heard of kids. They were all having kids in their 70s and 80s. Of course it's possible, but it is a complete, misconception that men do not have a decline in fertility. They absolutely do. It is not as dramatic

as females and ultimately given the world we live in most of the time you are with someone close to your age group. So a man in his 50s is with a woman in her 50s. So you ain't going to notice if he's got no sperm left because they're not trying to conceive anymore because she can't conceive anymore. So it's always on the woman. It's when we start to, so go back to what we're talking about earlier about donor sperm, there is a cutoff for donor sperm of 45. The reason is because there is a fertility decline and a quality thing as men age. So they do have a menopause. It's just not as dramatic.

It doesn't involve hot flashes as much as women. It doesn't make you quite as bonkers. But it exists. And it's, you know, it's like we've got all these celebrities that maybe, but they're going out with 20 year olds. And instead of needing a whole heap of sperm, you just need a couple because Because the eggs are so young. Yeah. So it's completely misconstrued.

So does it become, like, you just end up with empty semen? No, no, I mean, it's very unusual that you'd end up with no sperm in a man. Like even a man that's in his 70s or 80s, you probably will see something. Would they have genetically incompetent? No, it doesn't work like that. Okay. Because it's because they're not born with all their sperm. But what they will end up is lower counts, lower motility.

It won't move as well. Probably go to sleep a little bit. Just like the men themselves. Exactly. Yeah. Sperman and men. Hand in hand. So yes.

It absolutely does decline. Yeah. Okay. It does. BMI and fertility. I know you were a bit nervous about answering this question. Because this is, and this is a very emotive thing because obviously BMI is a barrier for a lot of people when it comes to accessing fertility, like especially on the NHS. A lot of people are asking how, you know, they're struggling to conceive, but when they go to the doctor, the only thing that's brought up is their weight. Yeah, their weight.

And this is, this is a. big question but like how how can they navigate that so it and it is about navigating it and it's about making sure that you get the right advice to what you should be doing so there's a really good fertility coach on instagram called fat positive fertility who i would recommend that anyone who is struggling to access fertility care because of their bMI has a look at her page and a chat with her because she does quite a lot on how you advocate for yourself and how you make you make make sure that you are given the right tests for when you're trying to conceive. There are a lot of facts around fertility treatment and high BMIs in the fact that, and I think

this is a really important one to note, the drugs don't work in the same way and we have to mimic, like there's a lot of, I think a lot of doctors go away from treating women of high BMI is because it's challenging. And I think if you are picking a clinic to have fertility treatment in there are two things I'd say, make sure the doctor knows exactly what they're doing. They shouldn't be guessing this. There is a protocol. I'm not going to pretend to know it because I'm not clinical enough.

But what I will say is that there are a lot of clinics that do not have the facilities to sedate women with high BMIs. And that is to do with the regulations around medical treatment in this country. And it's all to do with the anesthetist regulations. So you need to pick a clinic that can support you being sedated. So I suppose those are my medical facts. But I would say anyone who is struggling to access basic. fertility investigations should probably look at someone like fat positive fertility and how they have can advocate with you um because i i just don't know enough about the roots in um and i do

really think it's it's it's badly done it's very and i feel i feel awful for these people going in and just being told this is all it's about it's not all about that no but there are challenges that should be discussed and i think that's important to discuss them and find out what they actually are rather than people saying you can't have IVF because you're this BMI. And it's like, well, what? Tell me why. I think that's really interesting because of that. Yeah. And stimulation medication is that right?

Yeah. So it doesn't take as well in high BMI because you do need more of it. And it doesn't respond as well. Because as we get a higher BMI, we have more, normally more fat cells that produce estrogen. So it's to do with the hormonal conflict. Again, I'm not a clinician. I'm not going to go into it. But I think it's really important that you find a doctor that understands what your needs are

and they can treat you appropriately. But it has to be in a clinical setting where you can actually go through any treatment that you need to have. What I hate seeing is people come in for investigations and then get told, well, we can't treat you here because we don't have the facilities. Yeah. So there are, like go, fat positive fertility has probably got a lot of information that can help women navigate their way through what is an incredibly difficult situation. to be in. But fertility, bottom line, fertility treatment is possible when you're in a larger

body. Absolutely. It's just finding the right people who are going to be able to help you. And it's actually finding someone that is going to do it with you and not work against you. Absolutely. Yeah. Amazing. Thank you so much. Oh my God. This is amazing. I had literally had about a thousand more questions to ask you, but we've got to wrap up. Thank you so much. Thank you so much for coming in. Thank you so much for the most fun podcast I can pretend. Yes. That is a feedback that we live for. Thank you so much. This was absolutely fascinating. I learned so much in this hour. Like, yeah, a lot. Thank you so much. Thank you very welcome. Thank you. Should I delete that is part of the ACAS creator network.