Should I Delete That? - Ozempic, egg freezing and the fertility timeline: your questions answered

Episode Date: August 10, 2025

JOIN US LIVE IN EDINBURGH ON 3RD SEPTEMBER - Head to SIDTLive.com for more information and to purchase tickets.Today - we’re discussing a topic that’s deeply personal, sometimes overwhelming and often very difficult to talk about: fertility. We are joined by an incredible guest - Mr Ali Al Chami - a leading fertility doctor and the medical director of the Avenues fertility clinic in London. We asked you on Instagram for your questions for Ali - when is the right time to freeze your eggs? Could taking Ozempic or a GLP-1 help you to get pregnant? How can our lifestyles affect our fertility? We asked Ali all of those questions - and many more - to attempt to demystify fertility. Whether you're actively going through treatment, thinking about your future, or just want to better understand the emotional and medical realities of fertility... we hope this episode is a useful tool. You can find out more about Ali's work at Avenues here: https://avenues.life/ Follow @avenues.life on Instagram Follow us on Instagram:@shouldideletethat@em_clarkson@alexlight_ldnShould I Delete That is produced by Faye LawrenceStudio Manager: Dex RoyVideo Editor: Celia GomezSocial Media Manager: Sarah EnglishMusic: Alex Andrew Hosted on Acast. See acast.com/privacy for more information.

There is one child in every class that is as a result of fertility treatment or IVF. And I think if it wasn't to the restrictions and to the limitations and eligibility, maybe you'd have seen more. Hello and welcome back to Should I Delete That? Today we're talking about a topic that's deeply personal, that can be very overwhelming and often very difficult to talk about, which is fertility. We are joined by an incredible guest today, Mr. Ali Al-Chamey, who is a leading for, fertility doctor and the medical director of the Avenues Fertility Clinic in London, which is actually one of the first clinics in the UK to integrate AI technology to improve fertility outcomes. And I've seen some of it in action.

It is very cool. But Ali is actually my fertility doctor too. I actually met him through work, but I instantly knew that I wanted him to look after me going forward with all things fertility because he was warmer and kinder than any other doctor I've ever come across in this space and also explained everything to me. so much detail and I felt more informed than I ever had been about what was going on with me reproductively and the clinic avenues has been incredible as well and I feel very lucky to have found them because I speak to so many of you online about fertility and we all have a million questions

about it I asked them if we could get Ali on to answer as many as possible I asked you for the questions on Instagram and there were literally thousands and I feel really bad that we can't answer them all but I try to group and pick out the most frequently asked questions to hopefully help as many of you as possible. Some of the most common were, when is the right time to freeze your eggs? Could taking a Zempic or a GLP1 help you to get pregnant? How can our lifestyles affect our fertility?

So whether you're actively going through treatment, thinking about your future, or you just want to better understand the emotional and medical realities of fertility, we hope this episode is really useful for you. Let's jump into the chat. Here's Ali. Hi, Ali.

Hello. How are you? I'm very good, very good. It's strange to see you in this context because we've met a few times in the fertility context because we've worked together. But thank you so much for agreeing to come on the podcast and answer all of our fertility questions

of which we have a lot. As expected, I put a question box out and there are thousands of questions. And I actually feel bad withilling them down because there's questions I can hear from people as well. They're a bit desperate for answers because, and I think that's kind of representative of, like, reproductive health, isn't it? A lot of us, a lot of women are looking for answers for stuff that we find it quite difficult to get.

But I think a good place to start would be talking about fertility issues in general and whether it's on, whether they're on the rise. Someone actually asked, are fertility issues increasing? Why is everyone I know having IVF, including me? Is there something to that? I mean, thank you for having me today and I'll do my best to answer all your. questions and this is our daily daily basis we get asked and I'm glad that there will be more awareness from such podcasts and meetings so first of all yes it is on the rise so you see the recent statistics you might have seen this on the

news at least there is one child in every class that is as a result of 30 treatment or IVF and I think if it wasn't to the restrictions and to the limitations and eligibility maybe you'd have seen more and and if you you look at the other day I was doing looking at the office of national statistics when you look at the age of starting our families for women and men it's actually increasing compared to our parents our grandparents so this by itself is is one of the main causes and there is a reason behind this because of the life and the requirements economic conditions and also because I

think there was the 70s and the culture was like how to delay your family, how you can focus on your profession more, when actually you can work on both together if the law was more flexible, if there was good maternity, then people would have had the courage to start their families early without thinking too much about the other factors. So all this has caused us to start late having our families and this is one of the main causes because even the the older generation when they started early if they have left it longer it's not that they were more fertile no actually they they would have experienced more

infertility besides the what we are seeing now when you see it some reports of the impact of in uterus the exposure to all the pollution this by itself is also having its impact and it's cumulative so it's getting worse and worse and when you see the number of the sperm, some reports suggesting that it's getting less, when there is no more diversity. Now it's actually more open about starting our families. If those who are single or in same-sex relationship, now it has become a little bit more feasible compared to before. So this all resulted in delaying starting our families. And as a result, more infertility. Now IVF is not anymore considered as a taboo, although some people don't speak about it openly.

but it's becoming more and more you know we see this every day and because there's more sperm factor problems and more ovulation problems access to the to the health care when someone is waiting for a few years to reach a certain limit to be eligible then suddenly she faces the very difficult truth that my ovarian reserve is very low I'm not now not eligible because of my low ovarian reserve so we face another problem so it's it is a very difficult truth fact that and the you know the the it is estimated that we'll have more and more if now one and seven babies is as a result of fertility treatment some sort of it's going to be more frequent one and seven yes yeah that's extraordinary so either needing like some sort of ophilation induction

or IVF or insemination so it is on the it's definitely increasing wow do you feel just anecdotally like or research based obviously we know age is a factor and I'm aware that people will be listening to this and I think we need to be very heavy on the fact that we recognize the economic effect and the reason as to why that is and like those women are under so much pressure in a million ways to have careers to earn enough money. We know cost of living. Like there's so many factors. We definitely don't want this to be like a judgment by any stretch. But you mentioned about like pollution and stuff like that. Do you feel, because I feel like every now and then you see these crazy

like headlines or things being like or having your laptop on your lap. can affect your sperm or having, like, I don't know, drinking will affect your, is, do you see big links with like lifestyle and the change in our lifestyles and our fertility? Certainly. This is a fact. So when you see someone who has some problem in the sperm, like the way they swim or they count, and you ask them to do some lifestyle changes or something that it is that you do called sperm DNA fragmentation, it tells us how much damage there's in the genetic material

of the sperm. And you see improvement when they stop. smoking or when they start having better try to focus more on their diet. But my concern is that even when you do this effort, we still have some concerns what is considered organic and not organic, what is good, what's bad. And it's as if you are doing a battle to when you go to the shop, you ask someone who's young now exposed when they see a bottle of sugary fluid, full of sugar, is cheaper than water. I mean, how we present things. This is all impacting us and the future generation. And there's no doubt that it has an impact. What is the

safe drinking? We used to think, is it 20 units? Is it 15 for the female? Is it really the case? Or actually, you know, it can be better? So we are having more and more information now. And certainly the lifestyle is important, but it takes lots of effort to have this lifestyle. That's why people are seeking more advice from nutritionists, from fertility coaching, because they need more guidance and it's not widely available. What it means to have oxidants in our diet and exercise is very important. Again, how we look at our body image, you might see someone who's very fit and might be classified as their high BMI versus someone who looks actually normal BMI, but they might not be fit or their diet is or they have some family predisposition

of high cholesterol or high blood pressure. So yes, pollutants are extremely important and we should be more, we are living in a big city, how, you know, I used to have once the app that you see that amount of pollution, if you just walk in the street parallel on the other side, so then you find less pollution just because there are less scars.

How much this has an impact? Definitely there is something how it affects our lungs, everything. Going back to the horizon, fertility and you touched on, well, you cited one of the reasons being is that we're waiting later in life. And I think this sort of brings us to the issue of preserving fertility or think, you know, it's really hard, isn't it? Because, you know, we hear that 35 your fertility goes off a cliff. And that can be really scary to women who maybe aren't in relationships and want to be in a

relationship before they have children. They're not in a place financially to have children, whatever the reason might be. Firstly, does fertility drop off a cliff at 35? Is that true? It starts dropping from even earlier and younger. But at 35, it starts dropping more dramatically in count and in quality. And because the problem is that you don't know how long it will take someone to get pregnant. So they might turn 36 and a half by the time they have their first child.

So suddenly they feel they are 3940 for a second child. And we used to say, for example, for food preservation, to freeze their eggs by the age of 35 or so, but now advise even earlier. Do you know why the low three years ago that you can freeze the eggs up to 10 years if it's social egg freezing? So if someone used to do the freezing at the age of 30, by the age of 40, 41, they couldn't use their eggs, yeah. So but now it has changed. You can freeze up to longer time. So even early 30s is better. And I encourage also couples to consider embery freezing,

not along with egg freezing. Now here, the legalities can be different because embryo freezing needs consents from both. Those who see themselves starting their family as single mom also to consider using donor spam as well. Because there's no guarantee, but certainly it's give some reassurance. And I also encourage, as if it is special, I can only say one. thing. For a couple who feel ready, don't delay, just start. You know how difficult it is, but if you can start early, that's the best thing. And I suppose that's looking at it purely from a fertility point of view, right? There are lots of social and economic. I know. I guess

it's a sad truth, isn't it, that we do have to take our age into account. Can I ask on that before? Because I think we do level so much of this. And obviously both Alex and I are women. So we do talk about it in the context of women. We know women's fertility. falls off a cliff and we know ultimately our fertility end because we have the men of and we do see famous men or any men but typically famous men having babies well into their 70s and 80s because they can but what happens to a man's fertility throughout his life maybe this question 15 20 years ago used to be as long as there's sperm no problem in age but now there is enough evidence and to suggest that the men fertility also declines with

age. And specifically after the age of 45, particularly after the age of 50, higher risk of autism, less chance of natural conception with the partner and less success and higher risk of abnormal embryos after the age of 50. But it starts earlier. So this concept that the male fertility doesn't, it does decline, but it's a little bit at a little bit, you know, older age, not as early as the female and you know the egg and the sperm they compensate for each other so if the sperm is so good if someone is healthier definitely the decline will be less and less dramatic for the for the men and the women so that's why it's from both to they help to assess but the egg is much more powerful so the egg can correct the sperm much more than what the sperm can do for there so men think they

are strong but actually even if you see the size of the sperm versus the egg so the egg can is so strong that it can, even with a very poor quality sperm, it can correct. But the sperm cannot do this to the egg. That feels quite representative. It doesn't it? It feels powerful. Yeah. A strong woman can make any sperm work.

Although saying that, whenever we do fertility stuff, my husband Dave, they're always like, you've got super sperm. It's great sperm, and then my eggs are just very near and far between. But you've got Tommy. So you're stepped up. And I think I had good quality, just not many. They work together, yes. Talking about egg freezing, because a lot of people wanted to know about that,

I think there are a lot of people considering it. They don't know if they're ego candidate, whether they should take the leap or whether a lot of what is being, all this information that's coming out of them about egg freezing is just companies sort of preying on women's insecurities. What would you say to that? What would you advise? I would suggest for anyone to consider this as an option and not to leave it long,

because unfortunately what I see in clinic sometimes people regretting not doing it or regretting not doing it more than once. It depends on their reserve. And if someone is being told you have low reserve, it's not worth doing it. This is not true because at the end of the day, the embryo comes from one egg and one sperm. But of course, an egg at the age of 30 can have better chance compared to five eggs at the age of 40. Egg freezing at older age has much less chance, but it doesn't mean that we don't do it. So, yes, I encourage them for at least to do their MOT and not only to rely on a blood test,

which is the AMH, anti-malarian hormone, which is the hormone that comes from around the follicles, but to have the proper assessment, including looking at the ovaries, looking at the follicle number. And many times people, because here the system is in a way, they don't get, get checked unless there is something wrong. But sometimes we see an ovarian cyst, we see a big fibroid. So it's good to have this assessment from the gynecology point of view, to see the follicle count, see the AMH, and then I know where I stand, what are the options, when to consider doing it. So at least to do this assessment, and yes, I encourage to do it, but not to consider it as a guarantee. It's never a guarantee. So not to assume I have 15 eggs. I can now go for five

years, no, because you don't know how they will behave in the future. For example, in our clinic at Avenues, we have AI integrate in a way that we give scoring for each egg and tell us, what's the percentage of this egg converting into an embryo? So it's more information, not only relying on number of eggs and age, but also per egg, what I expect to have. So that all helps them to have more insight, more to make the decision for the future. So someone can freeze, well, someone can have their eggs harvested and then the AI, the technology can decide which of the, does it, is it sort of taking into account how mature the egg is and things like that, how likely it is to fertilize.

Yes, what's the possibility of this egg converting into an embryo? Because usually you do this calculation based on age and it's an estimate, but here with AI, of course, it has been trained based on thousands of eggs and patients to anticipate, Okay, my time you might see someone from 10 eggs, but this could result in 15% chance of converting into an embryo and someone else, 70% converting for a specific egg to convert into an embryo. So then I would know how many cycles to do, what's my target? And I never, I personally never like, say to someone, you have to target this number of eggs. You know, it's in the context of the discussion we mentioned, the importance of age, but also not to put too much pressure. because if someone has relatively low reserve,

they're not going to reach 20 eggs from two sides. It's too much to put them under this pressure. So you have to put a realistic target and to have some reassurance. And, you know, if we're seeing this more and more, I think when it comes to starting a family due to all the economics, I'm seeing more and more people ready to start their family on their own as well. And then this is why I say, okay, you know what? I'm not ready now to get pregnant,

but I can use donor spam to fertilize these eggs. So yes, I encourage everyone to do their testing, to see where they are and then think about it, of course, to get more information sooner rather than later. You would recommend someone rather than just do like the blood test that you can do at home, you'd rather look at just on a practical level. If someone's listening and maybe they're, I don't know,

it's 32 and they want to have a child, but they don't know if they're ready right now. you would say the best thing for them to do would be co-and-see you go and see a gynecologist have their internal everything looked at and their bloods and then they can make a more informed decision from there because AMH is a number and it's a blood test

but two people of the same age same blood test AMH but one might have 20 follicles the other one might follicle is the looks like a black hole by ultrasound on the ovary it's actually the nest where the exits yeah so someone might have better follicle count this means better chance of conceiving naturally or if or if they need to freeze their eggs where someone who has lower follicle count I might find a cyst sitting there that needs to be

looked at in few months so so it's always good to do proper assessment full assessment and then you know have more information because it's I see lots of and when I hear from my patients my AMH is low panicking okay it's important to do something but so let's do the whole assessment Many people get pregnant without even knowing that they have low reserve. They might struggle with a second child if they started early because the equity is still good. And if someone is having regular cycles, it means they are ovulating regularly in the vast majority of their cycles. Otherwise, they wouldn't have regular cycles. But if someone has their cycles spaced out, and this is mainly for polycystic ovaries, it means they are not ovulating.

But they might have plenty of follicles because of polystic ovaries. And the reason why I say to get checked, every now and then I see someone who has been told you have polycytic ovaries, that's why your cycle is irregular. And I expect to see very high follicle count, very high image. We do an internal ultrasound, you see actually very low number. So it's actually completely the opposite. But their diagnosis was given based on just the history and assuming she's young, she has polystic ovaries, irregular cycle. That's a shame there's misdiagnosis, but not really surprising. okay so that's when that's when to sort of go for so yeah for fertility preservation to sort of get an idea

a full picture of fertility what about people who are trying and have been trying for a while this this girl says i'm almost 36 i've been trying to conceive for eight months how long do i wait before seeking help yeah it depends how you look at it i i would do the basic tests to to see if we identify echoes. For example, if someone tells me I have very long cycles once every two, three months, if they try for a year, it means as if they have tried only for three cycles, because they are not ovulating. So this is something that we need to look at properly. If there is a significant sperm factor, it doesn't mean that there's no way of getting pregnant naturally, but it means that we should interfere sooner rather than later. If the ovener

reserve is on the lower side, the egg count, also to do something about. it and not to wait until two years of trying to do something maybe I can consider some embryo freezing and then I continue trying naturally to give some reassurance in case I'm not able to to achieve a natural pregnancy as a couple the what if one of the tubes is blocked if I just by simple history if someone has a previous chlamydia infection or previous ovarian cyst or a complicated appendix surgery so if the one or both of the tubes are blocked so if the sperm is not able to reach the egg just wasting time indirectly. So that's why doing the test and the way I

advise someone who's now 38, 39 versus someone who's 36 versus someone who's 30, the duration of trying whenever I assess any couple is as important as their age. Because statistically speaking, if someone has been trying for two years, their chance every time they have intercourse has dropped dramatically because it would have worked. It doesn't mean it's impossible to work later, but then they should do something about it. So for this specific question, I would advise to do the basic tests, to know where we stand,

and one might have reassurance, okay, now I have the confidence to try for another four or five months. By the end of one year, I can do something about it, yeah? But if there are any abnormal tests, what's the point of losing more time? And if someone is raising this question,

it means they are concerned. So the basic thing is to do these tests. We check simple things also, like not only the ovaries I've checked their thyroid, yeah? So these are important and hopefully everything is good. Then, okay, I try for another five, six cycles by the end of one year. Because, you know, in her age group, by the end of one year, probably 70% would have achieved a pregnancy. Some people would have got pregnant the first six months.

Yeah. And if everything is good, okay, I can't try more. Yeah. But if I identify a factor, I deal with it earlier. That's what a lot of people are asking as well about unexplained fertility. Yeah. Because I think if you reach a year of trying, without a pregnancy, that the diagnosis then is for infertility, is that right?

Yeah, unexplained. I think we fail as doctors to find a reason. So we say it's unexplained. But actually now with all the, like, when I see someone who is at a certain age group where, you know, the main cause why fertility doesn't work naturally or even by IVF, why when we transfer a very good-looking embryo, it still doesn't implant? And the main cause is the quality, and what we mean by this, the genetic material. When it's abnormal, it will either not implant or end up in miscarriage.

That's the most common cause of pregnancy loss as well. So it's until a month where there is the good sperm and good egg. There are other factors related to the receptivity of the lining, of the uterus, of the womb, immunological factors. We have lots of factors that are responsible. The problem is that we don't have, you know, lots of certified tests to say that's why the HFA, for example, classify them as add-on treatments or lack of evidence. So unexplained infertility, when we see very good sperm count, swimming well, normal morphology,

they look right. Does it mean there's no sperm factor? No, because we can do this test, I mentioned, DNA fragmentation. It might be high, and this could be the cause. And that's why even when you do IVF sometimes, even in the lab, we see low fertilization related to poor sperm. Is it related to some immunological factor? problem. So that's when we have to look at this in details. And most of the times you find

a factor. Or if we do the genetic testing on the embryos, if they end up to you see a low percentage of normal embryos. So there is a reason that you are failing to find it with the basic tests. So we say that's why now the unexplained fertility percentage is less because we are identifying more factors. When we use more, better technology, taking the history in details, trying to understand more about the journey. This all helps us. Can I ask about stress? I feel like this comes up a lot with infertility.

People just say, well, just relax, it will happen. How big a factor is stress on both the woman and the man? So it has an impact directly and indirectly. Indirectly, when we say too much stress, so people try to time intercourse at a certain time of the month or not able to have intercourse because of the, the amount of stress and commitments. So it makes it even worse. And directly now, there is also more evidence that stress has an impact.

It's clearly on the sperm factor and on the X. So when the level of stress is high, it certainly has an impact on the outcomes. And it becomes like a vicious cycle even more and more difficult. And that's why people sometimes go for other treatments such as acupuncture or or some sort of, you know, any approach. I advise some people they feel better with exercise. They work more just to be able to cope with this. And it takes lots of courage for people to go and speak to a fertility specialist,

just to make this step because they feel that they failed. And I failed to why I might have done something wrong. Maybe I had too much alcohol at some point. Maybe I didn't do the right. They start blaming themselves and this makes it more difficult. So I try to tell them it's, we have to admit that this is something, it's not related to you as a person. You're not responsible for this. It's everything.

As we said, how we were raised and spoken about all these factors. And then we have to find a way. I think about it as if I have a blood pressure problem, I take a tablet. So I have to deal with fertility in a way. Many times, interestingly, when you try to reassure the couple and when they know, okay, you know what, I'm doing IVF next cycle. I see this every year, five, six times. Long history of unexplained infertility. They go on a holiday, come pregnant naturally.

Just because you know what, I'm having it. So they forget about all the stress. I'm leaving this for later because they are less anxious about it, go on holiday, and then it can still work. So stress is important, and that's why try to have your test, try to understand more, do it in the right place to have better understanding and it needs to build up this relationship with your doctor, with the, you know, with the whole team, and to make sure you are in the right place, in terms of technology, in terms of the communication is extremely important, not to feel as a number in a certain place.

Because, I mean, the whole thing is stressful, isn't it? I mean, whether you're just trying naturally, whether you're doing IVF or IUI, whatever, like you still have to have it still has to be timed perfectly doesn't it which is very confusing it's very hard to get your head around and then once you have hopefully timed it perfectly you still have everyone has that two week wait you just have to wait and see and that's really it's really stressful and you can't think like oh is it's something that I did because I remember when I first came to see you and I just presume that my low AMH and my lack of periods or my strange periods was all as a result of my eating disorder, you know, I thought I've really, I've punished my body

and this is its response. And you were like, no, not necessarily. You know, that might not be the case. And that was such a relief. I was like, oh, God. You know, I've carried that thinking, like, I've really, I've, like, messed up my body somehow. And nature is, is surprising in a way because suddenly you see some activity somewhere. I mean, you wouldn't be expecting and then see ovaries, even those who are diagnosed with what we call POI, premature ovarian insufficiency, 5% get pregnant. I'm speaking about the relatively younger age.

There is every now because sometimes the immunological factor, that's why when we do the workup for them, we check if they have antibodies for the thyroid, for the ovary, for the adrenals, and then you see some activity. They come back,

even they are on HRT, but there is abnormal bleed or I'm not having a period. We realize they are pregnant, even when everyone told them, it's impossible to get pregnant. This is nature. Yeah.

It can still happen. So I learned after not to say it's impossible. There's nothing impossible, but also we have realistic hope as well. Yeah, of course, okay. Can we talk about weight? Yeah. And fertility.

Obviously, many people have come up against this. If they want to have IVF and the NHS, they have to be below a certain threshold of BMI. I think it's 30. It is 30, yeah. It's 30, which for some people is very difficult because of their body composition. They're just the way their genetic makeup.

That's very difficult. Is there a real reason why women above a certain BMI shouldn't be offered IVF? Is there a reason? Why do the NHS do this? So you know, whenever they decided for that number, 30, why not 31? Why not 29, yeah? So they needed to use a cutoff. And because studies historically were using this cutoff to see, based on this BMI,

what's the chance of having good quality eggs or low quality eggs or the outcome. how much dose is needed. And because it's eligibility and there's the taxpayers, so they're starting, you know, as if someone is accusing another, like the patient, not doing enough to lose weight. And so basically when someone is doing their best and they drop the BMA, it doesn't need to reach 30 because we have lots of evidence as well,

where in countries there's no such a restriction that they still do well. Those who have holistic ovaries, it's very difficult for them to lose weight. They have insulin resistance. And I remember when one of the studies, they look at the distribution of the body fat. You see some people who might have high BMI, and it's the feminine distribution of fat, they are much more fertile compared to someone who has almost normal BMI, but who could have different.

So this should be taken. You have to look at each patient a little bit differently, take the history into consideration, and certainly BMI is not a limit. It's not fair to use it as a cutoff point. But yes, if someone has very high BMI, also we have to think about the risks in obstetrics. We have to think how we prepare. For example, our anesthetic team, the anesthetist,

they do some measures. I use different. I give them some blood thinners as well to protect them against any clots. So I have to do it more personalized way. But I don't use it as a factor that say, no, you are not. It just, they will put on more weight. They will get more frustrated. It's so difficult. That's really nice to hear it again, like without the judgment. And I think because obviously, like, it's such a frustrating thing. We've interviewed people on this podcast. We had

lovely Laura Adlington came on and she said this. She, she was just, no one even did any testing for her. They just turned her away sort of on site. And I imagine that's very demoralizing. And I think that's something that we hear from quite a lot from people, that it's just like, well, they don't want to pursue it because I don't feel like they're going to have anyone in their corner. And I think what you were saying before about, like, lifestyle components in general, like if people feel like it's their fault, and I think women do shoulder a lot of this responsibility, as you said,

then they fear, and it's kind of like, I think it's easier for some, it's easier sometimes to not get the answers if you're scared that the answer is not what you want. But it's really encouraging to hear a doctor speak so practical. rather than judgmentally. I remember during my training, there was a patient who actually brought her mom. She told me, I would just want to show you,

we are in the family. This is our body habitus. This is how we are. And I go to the gym. I do some running. But just as I'm very fit, you know, I can go up the stairs, you know, ask me, she wanted to prove to me.

And I'm like, I felt so bad because I couldn't because there's like on the file and the eligibility. Another thing that's also frustrating when you say, you know, the number of cycles, you know, All this needs to be looked at because it's not fair. Or if someone, you're not eligible to have more than one cycle, or because of your BMI, or because of your age. And by the time they, like, for example, I have no waiting time to start someone.

But I agree with them. Can we do anything to improve regardless of the BMI? Can I do something on my lifestyle, on my diet, to be more prepared? Then I'm not losing time. I'm actually working to improve outcomes. That's how we should think about it. rather than using a certain number because it's we are human beings so we have to accept this that we can do you know the percentage of 40% are classified as obese in the UK in the reproductive age

so this is a major problem for those who put these numbers who use this classification they created this problem and then we can work on it it's not something that is just more awareness in the school, when they send the report to the children, to their parents, your child is overweight. You have to. But it's like a report as if, again, now you're stressing out the parents instead of saying, okay, what can we do about it? How can we improve this? How can we support this to improve the changes? Can I just talk quickly about weight loss injections? Because I do think we'd be remiss not to talk about them. I mean, must have had at least like 300 questions about them. Because I think that, you know, given the demographic of women who follow us, it's around

this age that they're starting to think about, you know, they are thinking about fertility and OZNPIC is intersecting with that because so many people are taking OZNPIC or Wagovi or or Monjaro or any GLP one drug. Are you seeing a lot of patients who are taking it? I see a lot who are taking it and I see a lot who didn't know that they can take it and that it can make a difference for them. You can take it for short period of time. Of course, avoid, you know, actively trying for pregnancy. that time but actually because this will improve your chances later if you manage as I said do not let's put realistic targets each one you know who's taking this

medication not to target something that to make you feel frustrated if you don't reach that weight target but any change that you do could make your journey a little bit easier and then hopefully to enjoy your pregnancy and to reduce the risk of diabetes in pregnancy high blood pressure so yes these medications are helpful for some. Some people, they might feel the side effects or so. But it's worth giving it a try under the direct supervision of the health professional. And, you know, you can say I will take it over the next three months, do more exercise, and then I start my treatment.

Sometimes for another group, it really depends. I don't tend to say like a blanket, say, you know, one versus the other. You might say, let's do embryo freezing, give more hope. work more on my lifestyle and then do the implantation, delay it a little bit less. So it depends where they are and depends on the age, the results. And then I'm ready for the implantation with better BMI. And here we are speaking, there is a very big group who have BMI between 30 to 35.

And these, they still perform very well, yeah, in terms of outcomes. And there's no, it's just you need to use the right protocol. You need to, you know, keep going. But if some, you know, I really don't like to use number because when I see the patient, I look at everything, you know, it's not only this number, BMI, yeah. The countries that don't have BMI restriction, there are lots of promising studies in terms, yes, in terms of numbers, it might be a little bit less, but actually still there is good percentage of good quality eggs and good number of embryos, as long as you do it in a safe way

any more personalized approach. Can we talk about OZempic babies? Yeah. Because this is a trend, but I've seen it a lot on TikTok. People claim that OZMPIC is making them more fertile and that they are taking OZMPIC and it's kind of bypassing their contraception and they are becoming pregnant. Is there any way scientifically that OZMPIC would make you more fertile?

If anyone is having some weight loss, regardless of how they had the weight loss, and they started with a relatively, you know, higher weight, they will automatically become more fertile. So some people, they actually get pregnant because they start, and they've never had cycles, because they have managed to lose weight, whether it was empty or by exercise, they start having cycles. they start ovulating and they can get pregnant. So it's not only this specific medication, it's if they are losing weight, it means they will be more fertile because the balance of the hormones improves as well. Why does being overweight affect your fertility? Because you know the hormone balance in the body and the levels of estrogen. So by the way, fat is a very important compartment in the body to have healthy, you know,

and implantation but when it is very high it affects the percentage of how the hormones convert within the body and this could have an impact on the receptivity on the ovulation it kind of stops this what we call the cascade of events that will yield in ovulation or the quality of the egg and the implantation as well so at different levels and it has an impact also on the outcome of pregnancy that's something that's separate as well so and that's why we go to the distribution of the of the fat tissue that it can can have a major difference that's why we say historically if you see even in the Greek goddess of the you see that the way they are

it's like you don't see someone who's very slim and and that's the fertile way you think that someone is classified as very high BMI but actually they could be very fertile it's just the way their bodies are to be like this yeah so it's not it isn't a blanket which I guess is to your point earlier about the BMI, like it's not a unanimous, like it's not one size fits all, it's not binary. That's super duper interesting because I, yeah, I didn't know why weight was such a barrier and why weight was such an important like marker for certifying.

So the estrogen levels could be higher than usual and doing the suppression and all the hormone cycle gets affected because, you know, the physiology of how it works, So the brain would send signals, which is the FSA, you'll hear about this, that goes to the ovary and send signals, okay, grow a follicle, an egg, and that follicle would produce estrogen. So all this will be impacted. All this, you know, system will be affected because of the high BMI or high weight.

It's really interesting. And I don't think it's something that we should, like, shy away from. I think it's important to know why it affects. flexibility, doing my research for this, for you coming in today and the Ozmpic baby thing, their theory, this theory is that, I don't know if this is true, I wonder, I want you to tell us if this is true or not, but their theory is that fat cells store estrogen, so that when you lose the fat cells, it opens up and releases estrogen into the body. Is that, is that true? No, not really. It's actually there's less, um, so in that like when we lose more fat tissue, yeah.

Because with a high percentage of fat, there will be high levels of estrogen. And this is not something that's very good, yeah, when it is too high compared to. So they should be in balance. So it's not that it's released actually more controlled, more physiological, more normal, rather than having this big compartment that can be releasing the estrogen and the conversion to other hormones. Don't believe everything you see on TikTok. So the conclusion in a way was right that it could improve, yes, because they are losing weight. If someone does exercise or use any other medication, they are going to lose weight.

It will make them more fertile and better chance. But, sorry, just on the ozempic thing, just while we're here, you can't take it while you're pregnant. No. I suspect you won't have seen cases of this yet because it's still really new. my worry with the fertility in an ozempic conversation is that for a lot of people who've lost a lot of weight they quite like losing weight, they quite like being smaller. You'd presumably just put on all the weight while you were pregnant

and then some and then I don't know what would happen after you had the bed. I mean this isn't really a question. This is just, I guess. I think you mean like those who are pregnant and still take it or? No, I mean, if you got pregnant, you'd have to come off it. Yes. Because it's a lifetime job, but you'd have to come off it whilst pregnant and presumably whilst breastfeeding.

So I don't know what that would do to just to the mental health of somebody. But at the same time, yeah, I mean, they have, and we know that it's normal to put on weight, but it's in a controlled weight during pregnancy. But because they, also from the mental health point of view, because they managed to get pregnant when they were struggling to get pregnant, they get more motivation. They also do more effort. But it is, as we said, there's some.

sometimes predisposition, someone who has holistic ovaries, suddenly they might feel put on lots of weight during pregnancy. They struggle after pregnancy as well, after giving birth. That's the, hence the support is very important. You know, how many patients have enough time to discuss with their doctor or their midwife proper sit and discuss, you know, how I can approach this, what it means to put on more weight in pregnancy. So our system is made in a way because of the shortage of staffing and so that everything gets delayed, the discussion gets delayed, the tests delayed. Unfortunately, this is a fact, yeah. And am I right in thinking you have to wait for a year before you can get, or is it you have to have been trying for two years or one year

before you can get IVF on the NHS? Yes, it's at least one year. And, but, you know, it depends on the local authority as well. And many patients by the time they are seen, so some local authorities, they use the cutoff of 38 or 40. So she would have been trying from the 38 to 40 and then by 40, oh, you're not eligible anymore. Or by the time she reaches the IVF clinic because she would have been seen by GP, then gynaecologist, then she's not eligible. So this is very precious time, very precious.

After the age of 35, every few months count. Yeah. It's scary, but we have to face it as well. And better that we know it than not. Yeah, yeah, sooner. I mean, because many people they just follow and they do what they are told. But even we can help more if we see them earlier, we can always do our best. But the earlier we see the couples, the better it works.

And secondary infertility, you wouldn't be eligible for any NHS. No, because even when their children are from previous relationship, as I have a child, It's, and this is, you know, if we're speaking about number and population and even like social relationships and the size of the families or like how many people you know have more than two children, you know, maybe you can count them. But you're not eligible and secondary infertility could be extremely frustrating and challenging to parents or to moms and dads because, you know, the second child is more like a sibling for their first child. child. And they might leave it and they think we are satisfied. We have our son or our daughter. And then when they are seven, eight years, everyone has a sibling. They are willing to do anything. And it might be already too late. So my advice also to couples, I know how time flies. We all know this. I have two daughters. Some moms, they enjoy a lot to do the breastfeeding that they don't want to

stop. And sometimes it goes beyond like two years. I'm like, you know, and they are trying. But most of the times they because you know due to the pressure of life and so so try to start your family you know just to try for a second child relatively early of course if someone had cesarean section they have to wait you know a good year before they try again do you because of the scars so for it to heal i did but let me just so i didn't know that exactly and i think it's easy to bury a head in the sand yeah with it which i think yeah that's kind of what i did which is when I did my first AMH test at 33 and I got a shot, I think it was three.

Yeah. And I got a shock because I just kind of presume, I was like, I just don't need to know about that. But then that was great because it led me down the path to like thinking about things and getting things going. And I don't think if I'd have had that test, I think I probably still wouldn't have children now. Do you think?

I just be thinking about it. I was so scared of having children. But that fast-tracked everything. And I'm so glad that it did. I'm so happy that it did. So, yeah, I do think there is definitely power in knowledge and in just knowing what's going on inside you, right? Because you just got no clue.

Get checked, get, you know, sometimes you could detect something not relate to fertility directly. How many women struggle with pain during their period? You know, endometriosis. You spoke a lot about it. One in five women who have subfertility have underlying endometriosis, not always we see it by ultrasound. or the percentage of women who have vaginismus, which is very painful intercourse,

again, it takes them lots of time to speak to effort it, specials to ask for help. And there are ways to help, yeah. So, but this is, there are some subgroups of all this that there are hiding symptoms that you can approach, you can do something about endometriosis. There's something called adenomyosis, which affects the uterus. And it could cause painful periods, heavy periods. and people are told just you have heavy periods. So try to live with it and then start having anemia.

She feels low. She might feel depressed. She doesn't know why. But actually it could be because of some subclinical anemia or because of something that can be sorted or at least to know more about it, to know how to deal with it. So that's why checking, you know, your body, your anatomy, your physiology is important. Under active thyroid, it can be sometimes, even if it's what we call not giving clinical symptoms,

It could be a contributing cause to subfertility. It could be a cause of miscarriage. And that's a simple blood test that we can check as well. Yeah. Okay. So everybody needs to be empowered and get their eggs checked, basically. That's the takeaway, right? Check your eggs, people.

They're ovaries. The eggs, we check them after we collect them. So get the ovaries check. Check your ovaries. Yeah, yeah. I've obviously learned a lot. Well, thank you so much. Thank you so much for having.

answering all these questions. We'll leave a link to Avenues, the clinic. You're the medical director of Avenues, the clinic, which I can vouch for as well. And we will leave the link in the show notes. And thank you so much for doing. Thank you. Thank you. Should I delete that as part of the ACAST creator network?