The Liz Moody Podcast - All The Fertility Qs You’re Too Nervous To Ask: Answered

Episode Date: April 24, 2024

Leading fertility expert Dr. Aimee Eyvazzadeh, also known as The Egg Whisperer, discusses common fertility myths, challenges, and how to best care for your reproductive health. The REAL reason why infertility is increasing Busting the biggest myths around fertility Who SHOULDN’T freeze their eggs The specific at home male and female fertility tests Dr. Aimee recommends The fertility testing protocol everybody should be asking their doctor for The pros and cons of having kids at different ages  How conditions like PCOS and endometriosis can impact fertility and exactly what you can do about it The impact of hormonal birth control on fertility The most common reason for infertility in men The potential risks to conceiving through IVF What you can do if you’re in a location where access to IVF is being threatened by local laws How you can best support a friend or family member who is dealing with infertility How things like breast implants, hair dye, non-organic food, vegan diets, chemicals in beauty products and cleaners, cell phones in pockets, antidepressants, Advil, antihistamines, hot tubs, period underwear, and retinol impact fertility  And so much more At-home fertility tests Dr. Aimee recommends: Prove, Fellow, Path Fertility, Legacy, Evvy, Juno.Bio, and Novel Infertility  For more from Dr. Aimee, you can follow her on Instagram @eggwhisperer or her website, www.eggwhisperer.com. You can listen to The Egg Whisperer Show on your podcast platform of choice or on YouTube. To join The Liz Moody Podcast Club Facebook group, go to https://www.facebook.com/groups/thelizmoodypodcast. Ready to uplevel every part of your life? Order my new book 100 Ways to Change Your Life: The Science of Leveling Up Health, Happiness, Relationships & Success now!  This episode is sponsored by: AG1: visit drinkag1.com/lizmoody and get your FREE year supply of Vitamin D and 5 free travel packs today. Shopify: sign up for a one-dollar-per-month trial period at shopify.com/lizm. Puori: go to puori.com/LIZMOODY and use promo code LIZMOODY for 20% sitewide. Previous episodes referred to in this episode: Why We Have No Work/Life Balance + How To Fix It Tools For Tackling Money Fears & Building Your Best Financial Future With Farnoosh Torabi The Health Effects of Alcohol: Hormones & Brain Health with Dr. Aviva Romm & Louisa Nicola  The Liz Moody Podcast cover art by Zack. The Liz Moody Podcast music by Alex Ruimy. Formerly the Healthier Together Podcast.  This podcast and website represents the opinions of Liz Moody and her guests to the show. The content here should not be taken as medical advice. The content here is for information purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, friends, and welcome back to the Liz Moody podcast. I'm your host, Liz Moody, and I'm a best-selling author and long-time journalist. This podcast is all about helping you live your healthiest, happiest life, whether we're learning why we have no work-life balance and how to fix it, getting concrete tools for tackling money anxiety, or uncovering the effects of alcohol on our guts and our hormones. And yes, those are all real episodes and they are linked in the show notes if you would like to listen. I am so excited that we finally found the perfect guest for an episode that you have been requesting for a very long time. A deep dive into all things fertility.

Whether you're thinking about getting pregnant now, you're struggling with getting pregnant, you're thinking about freezing your eggs, or you just want to know what age you need to be thinking about any of these things. This episode has you covered. My guest today is Dr. Amy Avazade, one of the world's leading fertility. specialist. Actually, a quick fun story. I was already eyeing Dr. Amy for the pod because so many of you had requested her when I was randomly at a party in L.A. And someone came up to me and we were chatting about fertility because I don't do shallow conversations. And she said to me, I have been working with this incredible doctor, Dr. Amy. She's the absolute best in the world. She was traveling from L.A. to Dr. Amy's practice, which is in the Bay Area. So that,

Sinched it for me. Dr. Amy is a graduate of Harvard Medical School, and then she did a fellowship in reproductive endocrinology and infertility and a master's in public health and health management and policy at the University of Michigan. She has been featured by PBS, CNN, the New York Times, Good Morning America, and many, many other outlets, and she's published numerous papers of her own in top peer-reviewed journals. She is known as the Egg Whisper on her wildly popular Instagram, her YouTube and her podcast. And in general, she's just one of the most mission-driven people that I have ever had the honor of meeting. She is deeply, deeply passionate about helping people create the family of their dreams. On this episode, we get into the real reasons why

infertility is increasing. We bust the biggest myths around fertility. We talk about who shouldn't freeze their eggs and who's a really good candidate for it. We get into the specific at-home male and female fertility test, Dr. Amy recommends. The fertility testing protocol that everybody should be asking their doctor for. The pros and cons of having kids at different ages. How conditions like PCOS and endometriosis can impact fertility and exactly what you can do about it today. The impact of hormonal birth control on fertility. The most common reason for infertility in men. The potential risks to conceiving through IVF. What you can do if you are in a location where access to IVF is being threatened by local laws, how you can best support a friend or family member who

is dealing with infertility, how things like breast implants, hair dye, non-organic food, vegan diets, chemicals and beauty products and cleaners, cell phones and pockets, antidepressants, Advil, antihistamines, hot tubs, period underwear, retinal, all of these things, how much do they impact fertility, do they impact fertility at all, Dr. Amy gives us all of the answers to all of that and so much more. We will list all of the tests that Dr. Amy shares in the show note so you can just listen and enjoy and not worry about writing things down. This episode was incredibly clarifying for me, and it was also just a ton of fun. It's an important topic and Dr. Amy gives it the weight that it deserves while making it not scary and really

even enjoyable to discuss. Dr. Amy is a whole vibe. You will hear when you listen. I hope you love this. I hope you share it with anyone in your life who needs to hear these things, especially the part at the end, which definitely made me cry and is so, so, so important. And I would love to hear your thought, so please tag us on Instagram. I am at Liz Moody and Dr. Amy is at Egg Whisperer. Dr. Amy, thank you so much for joining me today. I have been so looking forward to this, Liz. thank you for having me on. Oh, I have been too, and my audience is so excited. I have been barraged with questions. We're going to get to absolutely as many as we possibly can. But let's start off with some myths. Can you highlight some common myths about fertility that we

could just bust right out the gate? I think right now with so many fertility stories that you're hearing that you're going to have a problem, that you are infertile. And I think that's really scary for a lot of women to hear and see. And so that's a myth, that you are going to to have a problem that your pregnancy is going to miscarry or it's going to be an ectopic pregnancy and you're going to have some horrible outcome. Most people do not have infertility, but we're seeing more people coming out about it. And so that causes a lot of fear in women, fear about getting checked. They're scared about getting their levels checked. So that's a myth. Another myth is that it is easy and that it should happen really fast, right? And so we don't really think a woman has

a fertility issue until, you know, it's been maybe six months that she's been trying. But I'm all about checking, planning, that saying, the more you know, the better, well, it's my saying. Not my saying, but it's what I say. The more you know, the better things will go. And then there's a saying that everyone knows that knowledge is power. And the pregnancy journey, you should treat it like a travel journey, right? So when you're traveling, what do you do? You get checked. You go to the immunization clinic. You get all the vaccines for whatever country you're going to. And pregnancy is a nine-month big trip, and you should prepare for it just like a travel journey. Another myth is that sperm doesn't matter. It does. Every embryo is half egg, half sperm. So guys should

be just as mindful about their health, about the medications they're taking, about, you know, the amount of alcohol they're drinking, nicotine they're smoking, whatever else they're doing. It's not just about us. Pregnancy health also has to do with sperm. health going in. Oh, God, there's so many myths. Another myth is that you should wait before you see a doctor. If you have a gut feeling that something's wrong, go in. You don't need permission to do that. You really don't. You don't need to ask your OBGYN's permission to get checked. You can go right to a fertility doctor to do that. In fact, I just got an email from a patient who said, well, my OBGN won't check my levels until I have my annual exam. Oh my gosh, that's so mean. For some reason, a pap smear is like the gateway for you to get your fertility levels checked and to get a fertility consult,

that takes me to another myth. That a pap smear is somehow a fertility check. Like I'll ask a patient, you know, what do you think is wrong? Well, nothing's wrong because I had my pap smear and she didn't see anything. And I'm like, no, that's not a fertility check. A pap smear is just a screening test for cervical cancer and that is it. Your cervix is not a window into your fertility. It cannot tell us if you have any.

endometriosis, PCOS, pulse, fibroids, adenomyosis, a sperm issue, none of those things can be seen on a pap smear. Okay, I have so many questions from there. Let's start with, are infertility rates going up, or is that just a perception that we have because people are talking about it more? The reason why they're going up is because we're waiting longer to have babies. So when I started my practice, the average age of first birth in the Bay Area was 32. And most of my patients were, you know, in their mid-30s. Do you know how old my average patient is right now? How old?

42. Yeah. And I have more patients than ever starting their families over 45. I have patients in their 50s now seeking services. I always have. I'm always like, you're 50, you want a baby? Like my 50-year-old friends call me. They're like, Amy, I have a question.

I'm like, I cannot wait to get you pregnant. They're like, no, no, stop doing that to me. But I predict that in about 20 years, it will be very common for women in their 50s to be starting their families. What is changing? Why do you say in 20 years this will be more common than it is now? Because people are waiting longer because they want to have these experiences. And that's the word that the younger generation is using with me. They're like, I want to have the experience of having the wedding. I want the experience of really enjoying my husband. But is technology changing in a way where it was? will be more possible for people in their 50s to become pregnant? And that takes me to the next myth is that technology has not changed.

The only thing that's changed is egg freezing. So more and more women are freezing their eggs, and luckily, they're freezing at an earlier age. So when egg freezing started, what I found in my practice is that it was women between 37 and 40 that were freezing their eggs. And they have been so vocal about what happened to them doing that. they've scared the heck out of the 25-year-olds. So now the age has shifted. Now younger women are doing it at an age where they're freezing good eggs. So the 50-year-olds who are waiting until they're 50 to start their family, they're going to be using

their frozen eggs. So I predict, and I think I'll be right, is that the 50-year-olds who are doing it are going to be doing it with their frozen eggs. So they're going to be their own egg donors. In the future, I hope that there is going to be. a way to reverse menopause, slow menopause, turn a skin cell into an egg. But until then, the best technology we have is egg freezing for these women in their 50s if they want a baby with their own DNA. I'm 37 years old. Are my eggs too old to be frozen? No. Egg freezing is for women

in their 30s and their 40s. It's just that when you're 37, the egg viability is not the same is when you were 27. If you look at what happens to a woman's eggs between 37 and 39, it's dramatic. If you look at what happens to a woman's eggs between 27 and 29, it is not much changes. So that's the thing. So if you're someone who's, let's say, 37 and you want to freeze your eggs, I would actually ask you, how many kids do you want? And then I'll give you an assessment as to how many eggs I think you should freeze to give

yourself the best chance of having the family size that you want with your frozen eggs. And it could be 20, right? And it's also about the whole picture. Like, what does your uterus look like? Do you have fibroids endometriosis? There's some sort of implantation issue that we might be dealing with. And you might be someone who actually needs, let's say, three or four embryos to have one live birth. So that's all about, you know, seeing a fertility doctor and talking to them about your whole story. I mean, I've frozen five eggs from a 37-year-old and she gets two or three healthy embryos, but I've also frozen 14 and have only gotten one healthy embryo. Is there an age where you would say it's probably not a good idea or worth it for you to

freeze your eggs? I would never say that. And I'll tell you why. Because it can be part of someone's journey. Having the experience of seeing what happens when you go through treatment, retrieving an egg, and then seeing for yourself that it doesn't work is important for some women. the oldest egg, are you ready for this? Are you ready?

That I've ever frozen, 51. She came from another state because I have this reputation of believing in everybody. And that's true. I believe in everyone. I want them to reach their goals. And let me tell you, if that 51-year-old egg turned into healthy embryo, I told her I might jump off the building and be dead because I'll be so excited. But unfortunately, it did not work.

So we froze it. We tried again. We tried to turn into an embryo. and it did not work, but she was thankful. She said, I just needed to see it for myself. Some people just need that. It's one thing for a doctor to say, your eggs will suck, it won't work. What I say is the reality is that this won't work,

but we would never tell a man who has one sperm at 51 that he can't try. So, yeah. At what age would you say, though, that the reality is this won't work? Because I wish everybody could just go freeze their eggs, but it is very expensive and it's not accessible to as many people as I would like it to be. So at what age would you say if you're being cost conscious, if you're being conscious of other factors, the likelihood is that it is not worth what you might put into it. Yeah. I mean, if you're 45, 1 to 2%, 46, 0.01%, 44, 4%, 43, maybe about 11%, 42, maybe 15%, so you can see that, you know, if you keep going down between 40 and 41, maybe 25%,

39, probably about 35%. So the likelihood goes down. And then if you compare that to, let's say, a 29-year-old, you're talking about 85% at 29. So it's dramatic and it's so unfair. And when you say 29%, what do you mean by that? So that your efforts will turn into a healthy pregnancy. Okay. Interesting. So as a 37-year-old, what am I looking at? I think it's a really good statistic for a 37-year-old, you're probably looking at least 55% depending on how many eggs you freeze. If it's a high number, then you might give yourself an 85% chance, depending on how many eggs. I make plans with patients. I estimate, based on your numbers, that I'll get five eggs per cycle. So we should do five cycles. And if you can freeze embryos, if you're with a partner that you're

likely to want to have a child with, is that always the preferable option? Always, because then you know that your eggs will turn into an embryo and then that embryo then has a chance for pregnancy. So what I say is eggs are a chance for an embryo, not a baby. It's an embryo that's a chance for a baby. An egg just can give you false hope that you're going to have a baby and that's just not fair for women to have this false hope. So I try and encourage women if you're at an age where, let's say, your eggs will have probably run out very soon, try and make embryos with your frozen an egg sooner than later so that if they don't work, you have an opportunity to still try with the eggs that you have.

I have patients who, let's say, froze eggs, not with me, of course. Let's say you're 46, you froze eggs at 37, you just did it once, and then you thaw them and none of them survived. Like, that's heartbreaking. But if they had known, let's say at 39 or 40 that none of them would have survived, then they could have frozen more. So there's this thought that people will just freeze and forget. and my thought is freeze and don't forget, keep thinking about your fertility and think about

where am I at right now? Does it make sense to make embryos or not? And then at least know what your options are so that if something happens to you, like one of these worst case scenarios, at least you say, well, I was given the option, I was given the choice, and I said no. And so now I can accept where I'm at right now. And then I always talk to my patients about what else would you do? What other options are you open to when it comes to growing your family?

Are you open to egg donation, embryo donation, adoption? Because those are wonderful ways of being a parent. Is there anybody that you would say shouldn't freeze their eggs? If somebody's listening and they're like, I'm 18 and I can do this, my company is offering it and I'm 22. Like, is there anybody who shouldn't do it? Yes. I mean, I think if you're dealing with a lot of stress in life, if you're having some psychiatric issues that are unresolved, egg freezing isn't for you right now.

It's a very emotional process. I tell people that my egg freezers cry more than any other patient. And a lot of it is because they're just not used to feeling hormonal. They're doing this for the future. And they're also thinking about being a mom. It's a very emotional thing. And so if you are already dealing, let's say, with untreated depression or anxiety or there's just a lot going on in your life, it's not a good time to freeze your eggs.

Find space for it. And the space is probably about one to two months of time. where you can really just focus on yourself and not have to worry about other people, you know, deadlines, big bachelor parties or events that you're flying to just because of the recovery that's needed. Let's talk about the hormones for a second. I have a girlfriend who froze her eggs and she feels that it impacted her hormones in a negative way for about two years afterward.

Have you seen that in your practice? Luckily, I have not seen that. Is there anything that we could do if that's the nervousness around free? freezing our eggs if injecting ourselves with hormones is the reason we're not wanting to do it. Yeah. It depends what hormone. I mean, it could be a thyroid disorder. You know, maybe the hormones caused her thyroid to go out of whack, so to speak, and that could be affecting her. So someone's afraid of those kinds of changes. You can always do baseline hormone levels and see where you're at, so you can understand how can this process potentially impact those hormones. But luckily,

they come out of your system when your period starts. And I tell people, the snarkiness, the it should end when your period is over and they're out of your system. 100% they're out of your system. You're dosing yourself once a day. Some doctors choose twice a day, but there's a reason why it's just once a day and it's because it only lasts in your system a day. Oh, that's interesting. That's actually really comforting. Okay, let's roll back to something you said earlier, which is let's prep for this vacation that we're taking. And I imagine one of the elements of prep is to figure out where your fertility is at this moment. But I went into a doctor, and they were like, we don't like to test for any sort of fertility

things until you've tried to get pregnant for at least six months because then it gets up in your head, whether it's positive or it's negative, and we just find that that doesn't bear as good of results. But I was like, I don't want to get pregnant right now. I want to know how good my fertility is so I can put it off as long as possible. So where do you stand on testing fertility, especially for people who are not immediately trying to get pregnant, but maybe looking for a little bit more permission to hold off. Right, because you might learn something that tells you you shouldn't hold off. So I think people

should be tested right away. I wish there could be just some general fertility checkup that's done by the time a woman's 25. Because fertility actually declines around 25. I mean, not quite, but this is the reason why when we choose an egg donor, for example, we want egg donors that are under the age of 30. So there is a percentage of women who are already going through changes that they may not notice because they're, let's say, on birth control pills. There's a famous story, well, I think it's famous, but it's Caroline Lundy story. I don't know if you know her. She's from The Bachelor.

So she was on birth control pills, stopped the pill, and found out that she's basically in perimenopause. And had someone checked her levels while she was on birth control pills, she would have known. So we went through nine egg retrieval cycles for her and froze 11 eggs, right? Yeah. Before she was even 30. had she not taken it upon herself to check her levels, she would have never known. And she tried to advocate for herself and ask a doctor to check, but they said the same thing to her.

It's going to go into your head, you're going to worry, but they're just basically patronizing us and saying we can't handle the results, which is ridiculous. Of course we can. That is fascinating and powerful. Okay, so then what are we asking for? And how good of a sense can we get of what our fertility is with the test that exists right now? Yeah, so I would say if your OBJJUyan is basically gaslighting you and saying you don't need to know, they're not fertility-minded. That's not the right practice to be asking.

A lot of fertility clinics, well, most of us, all of us, will do fertility checks for any woman who's fertility curious. So there are actually very easy ways that you can check from home. So you can do an AMH test, for example. There are companies that sell that. You can do urine FSA, so that's an ovarian reserve test. You need a pelvic ultrasound, though, to look at your uterus and your ovaries. an easy sperm test. So if you're partnered, every female fertility doctor, I can guarantee you,

it's probably checked if they're in a heterosexual relationship. They're male partner's sperm even before they got engaged. But that's another thing that you can do from home. Where is the sperm test? Where do we get those? So there's one. It's really cool. It's the prove male fertility test. So it's a little chip you attach to your phone and then you put your sperm in it. And then your phone basically acts like a microscope. It's pretty awesome. Oh, that's super cool. And then there's one that you can do it at home and ship from home. It's called the fellow test. So that's a little. another one that you can do. So I have patients order that one. And are there brands on the women's side? Totally. So Novalin fertility. They have a great at home. FSA, comprehensive fertility hormones,

just as one drop of blood. And then the prove complete test. So you can track your hormones during a cycle and get a really good sense as to what's going on. But to get a fertility assessment, I don't know if you've heard of my Tushy method. Tell us about it. Yeah. So there's the five tests that you can ask for from your doctor. So it's basically. Basically, you go in and your period starts. Okay. On cycle day three, they can check your FSA, esterdial, and AMH, and run your genetic test. So that's a chromosome analysis and a carrier screen to see what genes you carry.

Then cycle days 8 through 10, you can do a fallopian tube test. And there are different ways of doing that. I do a gentle tube test in my office using something called XM foam. A lot of doctors order something called the HSG or histrocell pingogram. By the time everything comes back, it's your next period. you have a full assessment. And of course, along the way in that cycle, you can also get a pelvic ultrasound. So that's what the tushy method is. Tubes, uterus, sperm, hormones, and your genetics all can be done in one cycle. You can get it ordered by your OBGYN, and then take that information

to a fertility doctor to get a fertility assessment, or the fertility doctor can order these tests for you. And how good of a sense are all of those things going to be able to give us of our fertility at the moment? They can't tell us that you have good eggs. That they can't tell. But for the most part, if a young woman has a good egg count, she probably has good eggs. But they can give you a really good window into what's going on. And if there are any issues that you should be aware of, if there are fibroids, if there is endometriosis, if there is a fallopian tube that's blocked, those are important things to know before you start trying. If I came to you and I was like, I'm 37, I want to wait as long as possibly possible. But I'm interested in having one child, what would you say to me?

I'd say, let's freeze eggs. and if your current partner is the intended father, and that's not going to change. So I have this like, what is the potential that you guys are going to be together in five years from now? If the answer is over 90%, then I would say let's make embryos with his sperm. And then when would you say I would need to use that embryo by? As long as you're healthy and you don't have fibroids growing, you know, over time fibroids can develop, endometriosis can develop. But for the most part, you know, I say you can carry even up until you're about 51. Obviously, there are health risks associated with older age and pregnancy, but I would encourage

you to do it sooner than later. I don't want to do it sooner. Could you share some benefits and drawbacks of getting pregnant in your 20s versus your 30s versus your 40s? And you can even do 50s if you want. I wasn't going to include 50s, but you seem like we could. Yeah. I mean, the benefits of getting pregnant younger is there's less pregnancy complications

associated with that, like less risk of preeclampsia, diabetes, preterm labor, the list goes on and on. Your body recovers a lot faster. And then as you get older, you're at higher risk of having genetic abnormalities in your pregnancies, for example. So the age of the egg has a lot to do with that. Your risk of having a chromosomal abnormality or a miscarriage. So you might have to deal with a couple of miscarriages, for example, if you're 40. The benefits, though, there are so many benefits of being an older mom, right?

So you're more financially secure. You know yourself. your relationships are more stable, your job's more stable. So a lot of women say, I could have never had a baby at 25, you know. So I can totally relate to that. But there are some 25-year-olds that are perfectly ready to have a baby at 25. But most women in the Bay Area are not like that. Most women, if I were to say to you, you're 25, you have a great job, get pregnant right now.

And they're like, have you lost your mind? Like, no. Yeah, it's so interesting. But if I'm doing the embryo testing, is it not going to have a genetic abnormality because you would be testing the embryo for that? Right. So embryo testing looks at the chromosomes of the embryos only. I hope things will change and it will get better and we'll be able to see way more than just chromosomes. So I'm always careful when I talk about embryo testing. A lot of people use the term genetically normal, but it's not. It's chromosomally normal, not genetically normal. So you can still have a baby that has a genetic disorder. But it's the best thing we have to screen embryos. And it's the only thing we have. And that's one of the most common causes of miscarriage would be an embryo that's chromosomally. abnormal. So if you're an older parent and you're doing it with an embryo that's been screened and it's frozen and all those things versus if you just conceived via sex at an older age, would you

be less likely to have a miscarriage with a screened embryo? Absolutely. Yeah. So I have patients that think it's too dangerous to get pregnant at home, right? Because they're so scared that they might have to deal with the worst case scenarios, like having to interrupt a pregnancy for a chromosomal abnormality or a miscarriage. And I get that. But I take that. But I take. tell people you never know when you're going to ovulate that golden egg, you never know. And anytime a person says, I want to have a pregnancy, you also have to say, and I accept all the things that could possibly go with that. But some people have those conversations and they know themselves really well and they know that they will spiral if they have a miscarriage. They're going to suffer

greatly. And they would rather not try at home and choose IVF to genetically test embryos so that they give themselves a higher chance of having a chromosomally normal pregnancy. So if you have fear around that, that can be a really helpful option. Absolutely. Are there signs that we should look for to have a guess that our fertility might be a problem down the road? Yeah. So it's that cycle irregularity that can happen. Some women have irregular cycles because of a really common condition called PCOS polycystic ovary syndrome. It's not about cysts, about having these little tiny cysts on your ovaries, causing a hormonal imbalance that can make your cycles irregular. There are patients, and these are sad stories where they've gone to their OBGYN, and the OBGYN

just says you have PCOS, doesn't do any tests, and it turns out that they were going through early menopause. So I call PCOS, please confirm this ovarian syndrome. People should confirm it, not just assume that they have it. How do they confirm it? The hormone tests. Okay, but it is definitely confirmable. If you ask your doctor, I would like it confirmed that.

I have PCOS. I don't want you to diagnose me based on symptoms. I want to know via test. Exactly. Because then you are going under this assumption that this young woman's irregular periods are due to this condition. And she might completely miss out on her chance of freezing eggs. So irregular periods is definitely one of them.

Having heavy periods, having pain with sex, painful periods. A lot of people think that that is normal. It is not normal. What do you mean by painful? Like some cramps or like, like, I can't get out of bed. I can't go to work today. Can't get a bed. I force myself to go to work. It's so much pain that I'm throwing up. There are people that have that and just thought that that was normal, but that is a fertility-threatening condition. So any woman who has endometriosis, I encourage them

to freeze their eggs as soon as they know that they have that. Why does endometriosis threaten fertility? So endometriosis can rob a young woman of healthy eggs because of what it does to them. It causes them to act much older. It causes the eggs to be less mature. and less genetically normal. And also, it can lead to implantation issues and cause miscarriage. It is also associated with a condition called adenomyosis. Adonomyosis is inflammation in the walls of the uterus and they commonly go together. I very rarely get genuinely excited about skin care, but this is one of the most innovative products that I have come across in years, and I am so obsessed with it. I've been telling all of my friends to get it, so now I need to tell you guys.

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It just depends on the whole picture. How many kids they want? How old they are? How old they're going to be when they have their next baby? How much they've gone through? How long they've tried. So if someone, let's say, is 36 PCOS, they've been trying for five years and I know they want two or three kids, I'll encourage them to preserve their fertility and make them.

make embryos. And if they just want to get pregnant right now and have a child, is it just a matter of getting that condition under control to the best of their ability? Absolutely. My process is diagnosis, prognosis, and treatment. And that's the approach I take. And then it's all about making sure that I'm giving everyone the tools to give themselves the best chance of pregnancy at home first. Because if I can do that, guess what, sometimes I don't have to do the work because they get pregnant without my help. But then when we're prepared for treatment, they're in the best shape possible. Their hormones are balanced. The sperm's as healthy as it could be so that the treatment is as successful as can be. They're tricky conditions to treat though, and there's a lot of

confusion and disagreement about the best way to treat them. How do you treat PCOS or endo in your practice? So for PCOS, it's just looking at all the hormone levels and seeing what is needed to be done. it's from head to toe, head therapy, right? So a lot of PCOS patients have depression, have anxiety. I mean, these women have been told sometimes at a young age that they'll never be able to have kids, and they come to me so scared out of their mind that I'm going to tell them the same thing, and I just turn it around for them. And I say, no, you're actually dangerously fertile because you have so many eggs,

and this is a gift. Because so many people are always having negative thoughts. I call them the ants, and I try and teach them to brush them off their shoulders, and always think about what the best case scenario is with this condition. So the best case scenario is that your menopause will be later and that you have a lot of eggs. So that's actually a good thing. And there are cases of patients with PCOS who are, they're a little bit more difficult than others. But for the most part, PCOS does not mean infertility.

So that's what I teach my patients from the very beginning. And then it's all about figuring out the right medications to help her and everyone's different. For some people, they want to be more natural. So there are vitamins and supplements that I recommend. For some people, they want as much help as possible with prescription medications. So sometimes I use things like metformin, semi-glutides. That family medication works really well, like Ozympic or Manjaro can really help PCOS patients, especially if they're struggling with their weight.

Is it a side effect of weight loss that your PCOS would go more into remission or is there some other mechanism of action? Yes. So women who are curvier, what that does is it can raise your testosterone, cause insulin resistance. And these women, they're working their butts off. They literally say to me, Amy, I've changed nothing about how I eat. I eat so healthy. I work out, and I'm still gaining weight. I know that to be true. And with a medication like this, it can decrease whole body inflammation, and it can help them lose weight. They'll see the results in the gym. Their testosterone levels will go down, and they can ovulate, maybe even without my help. And you've seen that in your practice, that just that change actually helps bring that ovulation on. That's interesting. Yes. That's really interesting. And then you said that there were vitamins and supplements you recommend. Can you share some of those?

Absolutely. So, Kokutin, ovacetal. Those are the two main supplements that I recommend to my PCOS patients. And somebody with endometriosis. What do you do for them? So when it comes to endometriosis and how I treat patients, if they're coming to me for pregnancy help, I explain to them what endometriosis is, what it can do to their fertility. and talk them about fertility preservation.

And there are some patients who are not open to doing IVF fertility preservation for themselves, and that's okay too. You don't need to do fertility treatment if you have endometriosis. There are things that you can do that could help, like an excision surgery. So for patients who are not ready or willing or they just don't want to for their own reasons to do IVF or do egg freezing, We have great excision surgeons in the Bay Area that I refer them to. And then they'll do surgery first. And then I've had plenty of patients get pregnant after excision surgery, after all that inflammation is removed.

Are there lifestyle interventions that help with endo? Yeah. So healthy eating is definitely one of them. And building muscle mass. So I tell my endo patients, it's not about losing weight. It's about decreasing the overall estrogen that your body is exposed to. Fat cells get converted to estrogen. Estrogen feeds endometriosis.

So that's one thing I tell them to do lift weights. You don't have to get a six-pack or you don't have to look like a gym rat, but really get as toned as you possibly can. That can really help. Will that help even outside of getting pregnant? Would that help with somebody who's experiencing endometriosis symptoms? It absolutely can. So there are plenty of studies to show that.

And there's also red light therapy. So I have my patients buy a red light and they say that their pain is much better. They sleep better. their overall quality life is better. And then the other drug, a lot of people don't know about, is naltrexone. Naltrexone is an opioid antagonist, and it's a great medication that can help with chronic pelvic pain. It's not a drug like codeine or anything like that. It doesn't make you sleepy, but it's definitely something that can help with endometriosis pain. If we have been on hormonal birth control, and we are no longer on hormonal birth control, will that have a negative

impact on fertility? Yeah, so when it comes to endometriosis or just in general? Just in general. Oh, in general? So being on birth control, no, I mean, birth control pill is great. It has some side effects. Some women can't tolerate it because of some of the side effects they get. But overall, it doesn't hurt your fertility at all going on and off of it. The only thing about the birth control that annoys me is it tricks women. It masks infertility because they think that these regular periods that they're having are because their cycle is normal. But in fact, it's just the birth control pill making your cycle normal. So that's interesting.

So they could be having this underlying condition, but they wouldn't know because they're having this 28-day kind of fake cycle via the hormonal birth control. Exactly. If we have gone off hormonal birth control and we haven't gotten our period back, is that going to be a problem for fertility? Yeah. It just means that you're not ovulating. And it's not because of the birth control.

Why is it then? It's because of another ovulatory disorder. It could be due to a thyroid issue, a prolactin issue. It could be because of PCOS. It could be because of decreased ovarian reserve, meaning that your egg count is really low. So again, it's something that was probably there already, but the birth control was just masking it. Exactly. How long after going off birth control have you had people get pregnant or do you say people can get pregnant?

Immediately. So there's this post-pill effect where actually you're more fertile right after you stop. the birth control pill. So your pregnancy rate after you stop the pill is actually quite high. So you don't need this washout and there are people online. God bless them. Who sell these like birth control pill washout regimens or these birth control pill recovery regimens. And I'm like, that's not a thing, right? You just stop the pill. It's out of your system. Well, I think one of the reasons that is a thing or a thing that people are able to sell is because so many people experience these symptoms, experience a lack of a period post-birth control pill, and they feel like

they need to remedy that somehow. And I don't think they're making the connection like, oh, this is something that was existing underneath that the birth control pill was letting me not see for some reason. A hundred percent. And then they go to their OB and they're told things like, you should wait a year. But the person who's selling that recovery kid is going to listen to them and make them feel heard, right? Yeah. So if you are listening and you are having a any sort of symptom post-birth control, it's actually probably taking you away from getting diagnosed to be attributing it to the birth control pill. And instead you should say, this is something I need to get figured out. Exactly. Get checked. Do the tushy? Yeah, do the tushy or the

huh, the h part. Do the age. Do the age. So PCOS, endo, things like that, can impact the female partner's fertility. Are there any conditions on the male side that you've seen impact male fertility? Oh, yeah. Testosterone. Guys are taking it. Too much? Too little. Yeah. I mean, it's not having endogenous testosterone too much. It's taking it. These guys are like, I just wasn't feeling myself. So I just went and got some testosterone. And I'm like, get out of my office. Seriously? Like, you're on testosterone? You know, and they're like, oh, we've been trying for two years. And I'm like, well, let's do a semen analysis. There's no sperm. And then he's been on testosterone. And the clinic who prescribed the testosterone, I feel like I should be out there with signs saying like if you are trying to get pregnant, do not. enter. There should actually be warning signs at these clinics, and it still happens. So no, don't take supplementary testosterone. There's no amount of testosterone that you can take that would be safe if you're trying to conceive. Testosterone's a birth control pill. It's a great birth control because it tells your balls to go on vacation. Literally, when you take testosterone,

it tells the brain to stop sending signals to your testicles to make sperm. So basically, the balls say, okay, it's already being made, so I'm not going to do it anymore. Wait, why don't we use this as male birth control. I feel like we've been looking for male birth control for like years. But then you're going to have all these guys with road rage. Yeah, okay. This is a strong point. Do I want the trade off? I don't think so. Okay, are there any other things that if we're looking at our male partner and we're trying to make sure that they don't have an underlying condition that might be impacting the fertility conversation? Is there anything else? Yeah. So if they're having groin pain that should be looked at, so there's a diagnosis called varicoseal. It's a dilated vein that

sits on the testicle that transmits heat and it can affect the sperm quality and count, and it can drive the sperm count down. If you have a guy that's like, I don't know, my balls hurt, you know, one side maybe more than another, he should get checked out for something called a vericoseal. So that's another thing that can affect the sperm count. Is there any sign if you are male or female that like you're probably pretty fertile? I'm thinking about all the men who are like, yeah, I know I've got good swimmers. I get hard all the time. I mean, that goes to a myth that my favorite is like I knock someone up at 18 so it's not me. Previous paternity is not a sign of current fertility. So there really isn't. That's the thing. Like I can't just look at someone on a Zoom call and be like,

you know, your sperm count's amazing. And regularly being able to get an erection or ejaculate is not a sign that you're very fertile. I just feel like there's a lot of men who are like, I'm virile. Like, I got this. Right. Right. The amount of your load is not consistent with your sperm count at all. Sorry, guys. Okay, if somebody's listening and they want to add in a few lifestyle things just to help buoy their general sense of fertility, they're not struggling in any way. They don't feel like they need to go down a diagnostic route, but they just want to add in a few lifestyle things, things to eat, supplements to take. What are maybe three you would recommend on the male side and three you would recommend on the female side? Exercise, eat healthy, and get good sleep.

Okay. I mean, for both. because the thing is if you're getting good sleep, your stress is low. Right? So in order to get good sleep, you have to reduce stress because if you're stressed out, you're not going to get good sleep. Eating healthy is important for everybody. Ultra-process foods are very bad for your fertility.

And then exercise is great. When you say ultra-process foods are bad for your fertility, what's the mechanism of action there? It's just all preservatives and crap in your body that can raise your cholesterol, raise your glucose, affect your hormones. Is there anything that you would stop doing if you're? if you were trying to think about your fertility or just beginning that conversation? Smoking.

Smoking is the worst thing you can do. It kills eggs. Women who smoke excessively go into menopause earlier, and you can't get the eggs back. Once they're gone, they're gone. Unfortunately, with sperm, it's a little bit easier. So with sperm, the sperm life cycles 90 days. So if you have a guy who's smoking,

he should stop, and stopping will help his fertility in three months, basically. So his sperm will get better, but not for eggs. Okay. Interesting. And does that include marijuana? Is it a tobacco thing?

Nicotine. Nicotine exposure is terrible. I tell my patients who are smoking cigarettes, whatever way, vaping, hook up, whatever it is. Yeah, I was going to say if it's the nicotine itself, that would be vaping is also bad. Chewing tobacco. I tell them, look, your pregnancy rate is going to be 50% lower than what I'm quoting you. Are you okay with that? And it causes a lot of marriage issues or relationship issues because the guy's like, it's not me.

I'm like, dude, she's going through surgery. I mean, it's a procedure. You know, egg retrieval is not a surgery. But like you're cutting her chances in half by still smoking. I have that really honest talk with the female patient. I say, it's like, is this okay with you? That you're with this partner and he's going to be the future father to your baby and he's being a dick. It gets my goat so much, how much of the onus of all of this.

is still put on the female partner that even the infertility so often blamed on the female partner, you have to find the doctors, make the appointments. It's like it is a two-to-tango situation. It makes me so angry. It does. And I try and encourage the male partners to be as involved. They come to the office. I don't get them to do the embryo transfers, but when there's an insemination, I have them push the syringe so they feel like they're a part of it.

And I joke and I say she shouldn't be lifting a finger. And so when it's time to eat, she's just going to open her mouth. for you to feed her, and I'm serious. I love that. If we're thinking about our fertility, we're thinking about starting that part of our life, how early would you say we should be starting thinking about preconception prep? As far as preconception prep, probably three months before you're trying to conceive, you know, start your prenatal vitamin, you know, start looking for an OBGYN.

I think I should make the tushy method, patushy, because pregnancy providers the pee, but that didn't make sense. You know that movie knocked up? Mm-hmm. What does she do? She went and interviewed all these OBGYNs before she got pregnant, and that was just so hilarious. You can't do that anymore. OBs aren't going to make meet and greet appointments with you anymore. That's the thing of the past. Now you're lucky if you get an appointment by the time you're four months pregnant. Remember, the annual exam is not an annual exam anymore. It's a pap smear every three years. So young women are not seeing their OBGYNs as regularly as they were before, and a lot of these exams are being done by health care extenders, nurse practitioners,

family practice doctors. So a lot of times when a woman gets pregnant, she doesn't have an OBGYN. So part of that three months is find an OBGYN. Do the research, make an appointment, so that once you're pregnant, you're already VIP. So as soon as you get pregnant, now you're a very important pregnancy to them, and they're not going to say things like, we've never seen you in our practice. you're new to us. We don't have any openings. You can come in when you're like 13, 14 weeks pregnant. Oh my God.

That would stress me out so much to have a baby growing in my body. And I would want somebody to check on it immediately. You know what I mean? To not be able to go in for months would stress me out so much. And that's the common experience. That is a common experience now. And depending on what state you live in, it's really bad. Oh, that's awful.

What are some less common things that we should test for if we are struggling with conception and all the common tests come back normal. Like our tubes are normal. We've passed the tushy with flying colors. Yeah. So sperm DNA fragmentation. So you've heard that saying you can't judge a book by its cover. Same with sperm.

So sperm DNA fragmentation is one way to know if there's something else wrong with the sperm that's affecting its ability to fertilize your eggs. There's also a test called a sperm methylation test. That's another way of looking at sperm. And that will tell you if you should forego trying at home because there is a sperm DNA issues. So these are both advanced sperm DNA tests. And those are from a doctor? No, they're consumer direct. So pathfertility.com does the DNA methylation test and the legacy.com test is also an at-home test. You collect a sample, ship it out and you can do those tests.

The other thing is, you know, part of my why of the tushy is chromosome analysis. So a lot of people think, oh, I've had my tushy checked. I did my carrier screen. I'm like, no, you didn't do all the genetic testing that you could possibly do. So a chromosome analysis can sometimes. be a reason why someone has all the other things that are normal, but this is one thing that they can do. The other test is something called the receptiva DX test. It's a test for silent endometriosis. And I also do other testing, like looking at the microbiome of the uterus and looking for

bacterial pathogens. So that involves an endometrial biopsy. So for my patients that just like, Amy, I just want you to do all the tests, like these are some of the tests that I do. Sometimes it doesn't make sense to do them because if we're doing it. IVF, for example, we're going to basically solve the issue if there is an issue with a sperm DNA fragmentation test by taking a single sperm and injecting it into the egg. But some people want to know more before they start their journey, and these are some of the tests that we can do.

Wait, I feel like we talk so much about all of the different microbiomes of the body, and I've never in my life heard anybody talk about the microbiome of the uterus. Oh, yeah. Oh, yeah. No, definitely. A healthy uterine environment also includes a healthy microbiome. So we do test for it. prescribe probiotics, both vaginal and oral, and depending on what we learn, sometimes we retest. And there are actually at-home tests. There's the Evie test and the Juno.combiot tests. These are at-home vaginal microbiome tests. And for women who, let's say, aren't seeing someone like me who are going to do these tests

on the uterus, this is another way of getting those things tested. Oh, that's so cool. I have a few friends where they have done basically every test that they can get their hands on, that they feel like exists and they've tried to get pregnant for well over a year and it's just not happening for them. But there's no reason that anybody can discern. In your opinion, is there always a reason for infertility and we just maybe haven't identified what it is or what's going on there? Yeah. So can I ask how old they are? Can you tell me? I'm thinking of a few, but in their early 30s, not that old. Yeah. So when you're young and things just haven't worked out, there's always a

reason. And if you've done all the tests that I've mentioned, the first thing that I'm thinking of is an egg quality issue. So while you're young and you have good hormone levels, you might not have as healthy eggs as you would assume given your age. There could also be a fertilization issue. So sometimes people sugarcoat the semen analysis and they say, oh, the sperm looks great, but the motility is a little bit low and the morphology is a little bit low. So they're just not getting the right answers about what's going on with sperm. So the sperm might be good, but they're just not strong enough to fertilize at home. So those are the two big things that I see happen. In both of those cases, would the solution be IVF? Not necessarily. If there is an egg quality

issue, what you can do is something I call it ovulation augmentation, because you're already ovulating, but the medical terminology is ovulation induction therapy. So that's where you're helping a woman grow more than one egg. So if you think about it, there's an egg quality issue and you're only ovulating one egg a month. It's only one chance. A lot of people assume that the one egg that your body picks to ovulate is a good egg, wouldn't you assume? I would hope. You would. So if you have 10 eggs and, you know, your body picks one out of the 10 to ovulate that month, that should be the good egg, but that's not how it works. So if I can somehow get that patient to ovulate two, and depending on her age, sometimes it's five. So if I have

a woman who's over 38, I'm like, let's ovulate three or four eggs and give you the best chance because of the numbers, right? So if you're in your early 30s, this can be one way of improving your chances. And then you can also add IUI as well. the intra-eatern insemination, just depending on what the sperm side of things look like, and that could potentially help as well. So the IUI is if the sperm motility is being massaged a little bit, perhaps? Perhaps. And yeah, I wash sperm.

I have this really cool sperm sorting chip that I use on all my IUI's. It's called Zymot, Zymot, you can go to zymotfertility.com. I should be a brand ambassador for all these people. But, yeah, I think the pregnancy rates are higher if you use that in couples who are like the friends that you've described. But in your mind, is there always some reason and you just need to figure out the reason? When you have a patient come in and they haven't been able to get pregnant, are you always like, there is some reason? I just need to figure out what it is.

Always. Always. There's always an explanation. Okay. That's interesting. I feel like people make it sound so mysterious. You know what I mean? You know how you described to me when you went to your OBJN and they said to you, you can't handle it?

Yeah. It's the same thing. So when people go to the fertility clinic and let's say you're 42 years old and your doctor says it's unexplained to you, well, that's not. You're 42. That's the explanation. But they didn't want to sit down and talk to you about it. It's much easier for them to say, I don't know. Everything looks great.

See you later. At what age do you start thinking of the age as the explanation? As far as the age that I think it could be the explanation, it's over 35. So for me, if I couldn't get pregnant, you would consider my age the explanation. explanation. Yeah. So if you came to me, I've been trying for a year, I would say, you're healthy, you're young. Don't get me wrong. You're not old. Please don't take this the wrong way. I would say it's just because your eggs are not going to be as viable at 37. And we just haven't found the golden egg. And there are things that we can do. And then the protocol would be to freeze an embryo and do an IVF type transfer. Yeah. Or you can also consider ovulation augmentation. You can also take the fertility pills and ovulate two eggs, just as long as you won't. get mad at me if you get pregnant with twins. I would definitely get mad. Okay, I'm sorry. We won't do that. Yeah, and that's the thing. It's like, I talked to patients about that. So when you're doing ovulation augmentation, there is a higher likelihood that all the eggs get fertilized and then you have

multiples. Yes. I mean, we're talking about an 8 to 10% chance of twins. That's a lot. For other people, it's like, okay, so 92% of the time I'm going to get pregnant with one. I can take that. But for some people, they can't tolerate even like a 2% chance of twins. They want it to be zero. And for them, then doing IVF and transferring one embryo is the best option. And then you have a natural modified protocol for IVF. Is that right? For IVF, I have as natural protocol as possible. I mean, I want to put people through what I would want to go through myself.

And that's the least amount of shots, the least amount of hormones. When it comes to transferring an embryo, you've probably heard of people that talk about those atrocious shots. Oh, yeah. Yeah. And I've seen people on the Internet do them. I have friends who have done them. seems awful, but you do much less, right? Exactly. I try for most patients. It's not for everyone, a modified natural cycle transfer approach, just going off your own hormones and using them

and transferring a week after ovulation. And why wouldn't other doctors be doing that? Because they're not as crazy as I am working seven days a week. That's the thing, because you just never know when a woman's going to ovulate and when her transfer is going to land. So the lab I work with is open. That's just how I have always worked. So other doctors, they have to have to have. a fixed date, you know, it has to be on a Friday. They can't move it to another day. It's just kind of how the schedule works. Clinics more and more are learning that the modified natural cycle can be better for patients. And so it's fun to see that. And I'm really happy for all the patients out there, but there's still a lot of clinics that are just stuck in their ways.

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There's menopause classes with leading doctors. There's script writing with Mindy Kaly. Literally, you name it, they're on masterclass and it is such a good way to get off your phone, but have something that's like not quite as long or hard to get into as a TV show or a movie and that it just keeps you entertained and interested. And you are learning. There are over 200 classes from the world's best all for just $10 a month when billed annually. And you get unlimited access to every class on the platform so you can learn at your own pace

whenever you want on your phone, your computer, or even in audio mode like a podcast. If you're looking to stop scrolling and start consuming entertaining content that makes you feel excited and helps you learn, Masterclass is it. And the best part, every membership comes with a 30-day money-back guarantee so you can start learning risk-free. Right now, our listeners get an additional 15% off any annual membership at Masterclass.com slash Liz Moody. That's 15% off at masterclass.com slash Liz Moody. Is there anything else you'd want people to know about IVF that maybe isn't common knowledge right now? Absolutely. The one thing is about genetic testing of your embryos. Never sign discard paperwork before your IVF cycle

because your embryos that are called abnormal can actually be perfectly normal. And when I say abnormal, this is what happens when a patient gets her genetic report. Hi, you have three abnormal embryos. We're going to discard them. Click or you'll just get an email. You'll never see a report. And then when a patient comes sees me and then I ask for their report and I'll say, oh, this embryo was a low mosaic, this embryo was a segmental, this embryo is a chaotic, they can all be prioritized for a transfer and actually have a really good chance of working. So the one thing every IVF patient out there should know who's doing genetic testing of their embryos is that genetic testing of embryos is not a yes or a no thing. It should be used as a way to prioritize

your embryos, not to discard them up front. So I don't think patients are getting enough counseling about their reports, there's no informed consent going on because they're signing discard paperwork before they even know what they have. It just breaks my heart because I've had patients who've called after I've done the consult and they find out that, yeah, indeed, that abnormal was really a low mosaic and these embryos are considered just as good as normal embryos. What's a low mosaic mean? It's an embryo that has a small percentage of cells that are abnormal in the placenta. But what we've learned with many years of research is that the pregnancy rate of a low mosaic is just as good as a uploid miscarriage rate, the live birth rate equivalent. So a lot of clinics now actually label low mosaics

as normal so that they don't have to even explain that to patients. But unfortunately, a lot more clinics label them as abnormal, and that causes patients to discard perfectly healthy embryos. And then if you discard them, you have to go through the shots and the retrieval and all of that again. Or even use an egg donor because you were lied to and now you're at an age where you can't do more cycles. Are there risks of IVF pregnancies that we should be talking about? Absolutely. So that's why the modified natural can sometimes be better. So one of the risks of an IVF pregnancy is something called IUGR. So having a smaller baby. The other risk is of placenta previa. So that's where the placenta sits over the cervix. I'm making IVF sound terrible, aren't I? Right? It's a good. I mean,

But it's important to know. It's so important to know. Let me just think. What are the other risks? I mean, I would say the risk that people think are associated with IVF are increases of breast cancer, higher risk of having a baby with autism, developmental issues. That's not true. None of those.

None of those are true. You'll also read research that there might be a higher risk of something called an imprinting disorder. So these are very, very, very rare diseases. Luckily, I've never seen in my practice in the last almost 20 years. conditions like Beckwith-Weedman syndrome, for example. There is a potential link to an increased risk of congenital anomalies. So we're talking about maybe a 1 to 2% increased risk. But I think that has a lot to do with the genetics of the people that are doing the IVF.

Like they need to do IVF. There's something genetic about why they have to do it. And that might be what's increasing that risk. It's not necessarily IVF itself that's causing it. And also IVF babies are more often induced, aren't they? Yes, I recommend to my patients not to go past their 39th week. With IVF specifically? With IVF specifically.

How come? Because the placentas might not be as healthy as non-IVF pregnancies. And why is that? A lot of it might have to be with just the nature of the process. I don't think we really actually know. And once you have your baby, if it's an IVF baby, is there any concerns post facto? No. I don't think you need to worry about watching your baby for any conditions.

that they might develop because you went through IVF. And are there any risks with just having frozen eggs or frozen embryos in the first place? No. When it comes to having frozen eggs, one of the things people worry about is like, I'm going to put it through so much. It's going to get frozen and it's going to get frozen and it's going to get frozen again and it's going to get tested and then it's going to get thought again. And the thing is, the technology is really good.

Your eggs can totally get through that if they're strong eggs. It is wild to think about though, you know? Like I put bolognais in my freezer and it got free. freezer burn and it wasn't as tasty later. And I, you know, happy to have it there. But it's crazy that I can take an egg, I can fertilize it or not, and then revisit it in 20 years. It doesn't feel comprehensible. Totally. 15 years ago, we were saying, fresh is better than frozen. Okay? Because of that freezer burn thought. And now we say frozen is just as good as fresh. And you really feel that way. Yeah, absolutely. Depending on your age, of course. But if you have someone who's, let's say, 25 freezing their eggs, I would say, these frozen eggs are just as good. Thawing and injecting the eggs versus collecting them fresh, your outcomes will be similar. Of course, every lab is different. Every lab has their strengths. So a really good lab, that is the case. I know that we're in California, but in your community, are there conversations happening about the way that laws are changing around frozen embryos and

the way that we're treating those politically at this point? Absolutely. It's freaking bonkers, right? We have conversations about that all the time, even though we feel like, we can't be touched here in the Bay Area, but we're deeply affected by it. I mean, I'm affected by it because I have patients that come to me from all over the country, and people from Alabama were reaching out to me saying, like, can you take my embryos? What am I going to do? And of course, my doors are open for anyone, anywhere. But I think this is driving a lot of patients in other states, like Texas, for example, to move embryos and to even start treatment in California. If somebody was listening and they were at a state where they felt like there was potentially a risk of that, would you encourage

them at this point to get treatment in a state like California where it's less of a risk? Absolutely. I would encourage someone who lives in one of those states where your reproductive rights are being robbed even more than they have already been for us here in California because certainly we're affected, but not when it comes to IVF. They knew two years ago that this might be coming in Alabama because the Supreme Court, those cases, they don't hear them in a week later they settle, right? So this was going through over a long period of time. And so, people who are in a state where something like this might be happening, you're going to see clues ahead of time. So if you see that there's a bill that's being put through, those personhood laws,

you might start seeking help elsewhere. Can you move frozen embryos? Absolutely. You can move frozen embryos. So if you've done it already in a state like Alabama, could you call your clinic and move your embryos? You can move them right now. You can move them to California. Okay. All right. Anything else that somebody should know if they're considering IVF. When it comes time to considering IVF, you really should do your homework at front. Become knowledgeable. Take an IVF class like mine. I have IVF classes for people all over. People from all over the world take them just to become knowledgeable. Empowering yourself with this knowledge can make your cycle go smoother so that you know what questions to ask during your cycle. So you don't feel like something is happening to you. You feel

like you're part of the process. And the other thing that I want IVF patients to know is that taking care of your mental health from the very beginning is really important. So many of my patients have suffered from trauma, depression, and I ask them to please start seeing a psychologist, a psychiatrist from the start, not after your IVF cycle doesn't work. It's important to have that support, build your fertility team with therapy, build an exercise routine in, talk to an acupuncture. If you like acupuncture, find a mindfulness routine, pick your mantra. You said acupuncture. Is there legitimacy to the idea that acupuncture helps with fertility? If doing acupuncture decreases your stress, improves your sleep, improves your mood, I don't see how it cannot help with your fertility,

right? But if it's something that you dread, if you wake up in the morning saying, I have acupuncture today, I don't know how I'm going to fit that in. It's not for you. But if you wake up and you're like, I love my acupuncture as I feel so heard. They're almost like part of your like therapy team. You know, I encourage people to do it. But I never fertility acupuncture shame anybody. So I say if you hate it, don't do it. And then we've mentioned mental health a number of times.

A lot of people will say to my friends who are struggling with infertility, just don't stress out. As soon as you're not stress out about it, it'll happen for you. It's a really annoying thing to hear when you're going through infertility. How big of a role is stress playing in our fertility conversation? It's the stress that I tell patients is what gets you to pick up the phone, make this appointments, get out of the car. It's a healthy amount of stress. But I don't think stress causes infertility, but it can really hinder the joy that you experience every day. So I want patients to find joy.

Do something every day that's going to make you vibrate. I want you to feel that joy. Listen to that song. Drink the cocktail. I did just say that. It's okay. Drink the coffee. You know, eat the bread.

If you're a fertility patient, you know what I'm talking about because I don't want this experience to rob you of your joy. My patients are just so near and dear to me and it just kills me how much they suffer each and every day. I want them to live their lives and have fertility just be a part of it, but not be everything. I love that you say that because I do think it can feel so all-encompassing. It can take the joy out of sex. It can take the joy out of your monthly cycle, not that that's a super joyful time for many of us, but you live in dread of like, am I going to get my period this month or not? It can take the joy out of most moments of life and you almost forget that this is still your life,

even while you're waiting and planning and hoping for this other life. Right. It causes you to isolate yourself from loved ones, from friends. Do you have any other tips that have helped your patients or that we might find in that course if we were your patient? for bringing that joy back in? Yeah, just plan dates, like plan fun things. And know what your limitations are. So you can go to the friend's house but have a signal with your partner so that if it's

time to tap out, you can tap out, but you can still enjoy your friends, you know. And there are apps that I share with my patients that they have really funny tips. If someone asks you a really personal question, like how to get out of it, and I have to tell you my favorite, are you ready for this? This is really good. Okay. So if your mother-in-law ever ask you about when you're going to start having a baby, all you have to say to get her never to ask you again is you just say, you know your son's penis is so big, it just does not fit into my vagina. We're working on it.

She'll never ask you again. Or you say this, you say, we're just enjoying anales so much. So amazing. once we stop enjoying it, then maybe we'll have a baby, and maybe it's none of your business. I mean, you can just make it funny, but that's kind of my style. I think it is crazy that it is a normal question to ask because essentially what it means are like, are you raw dogging your partner right now? You know what I mean?

I think it is wild that we live in a world where your mother-in-law can basically say, are you raw-dogging your partner right now, you know? Right. And that's how you just get her to never. ask that question again. Okay, so this is related. If we're talking about this stuff, I got a listener question that I've been trying to get pregnant for a really long time and every time people ask me about it, it makes me want to die. What do you tell people to do, maybe not when it's their mother and law are invasive like that, but like just well-wishers, friends, people who are rooting for you.

He just changed the subject. Just be like, you know, I just had another thought. Have you seen this movie? You just say, like, did you watch the Academy Awards? You know, what did you think about that? Just change the subject. Or you say, you know what? When I have something to share about this, I will let you know. I love you. I know that you're thinking of me.

But this is just too personal for me to share. Is there anything on the flip side that you would say somebody who wanted to support somebody who's going through a fertility journey could do or could say that would be really helpful? Absolutely. So if you have someone that's opened up that they're on a fertility journey, you say, what can I do for you. How can I help? What do you need for me? I want to be here for you as much as you need me. Just know that I will always be here for you to talk to. I will not give you stupid advice that I know you don't need. I know how smart you are and you don't need me to do any research for you, but I'm just going to be a sounding board. So anytime you have an

appointment, you call and you just bitch to me and I will be here for you. I will be that person that you talk to in the car on the way home from that appointment. I will be that person that you call when you get that bad news. And I will be that shoulder for you to cry on. If you need some fuzzy socks, if you need some lavender candles, I will run to the store and get them for you. Okay, two questions on that. One, is it ever helpful to make suggestions? I just want you to be abundantly clear. If we're the supportive person, is it ever helpful?

Because people mean well, but they will tell you like, oh, have you tried this? Have you tried this? Have you tried this? Would you say universally, don't do that? Don't do that. Don't do that. You can say, do you need me to help you go to your doctor's visits with you and help you write notes and help you figure out what questions to ask if they share things like they're feeling frustrated that they're not being heard? But I can guarantee you that your friend has done their research.

I mean, could you ask, like, do you need any help with anything? That should be their way of saying, yes, can you help me do some research and see what other doctors I should see? But don't just start saying like, well, are you drinking this? Have you tried this? You tried this supplement. Yeah. And don't share friend stories. Like, did you know so-and-so did this and this and she got pregnant? Don't do that either. Okay. And then my second question is, and this is maybe a little nuance, but how much is too much to ask to support where you're rubbing their face in it or you're being annoying versus being like a good, helpful friend? Yeah. I mean, if you send them a text and you say thinking of you and they just send you the middle finger emotion. then you know it's time to back off. Yeah, back off.

You should feel very comfortable of saying like, I don't want to be in your face. Just know I'm here for you and just let me know when you need me. Okay. Okay, a few more listener questions. How can I not get miserable and lose hope when others can get pregnant and I can't? That's a really tough one. And I think that there's something about just knowing that there's always a way for you to be a parent. And that's what I tell my patience.

So losing hope is natural and normal, but I think of hope as also being practical. I use hope as having only practical emotions. So it's not about being positive. It's about being practical and saying, where am I at right now? And what are my options for being a parent? So while you feel like there's no hope for you, it might be time for you to think about what's more important for you? Is it more important for you to pass on your DNA?

Or is it more important for you to be a mother? Because not everyone was born with a uterus that can carry your pregnancy. Not everyone was born with healthy eggs. There are so many amazing ways of being a parent. So if you're in a situation where you've tried it all and you're like, I have no hope, it might be a good time to meet with a fertility therapist if you haven't already to start thinking about creative family building. Another listener question, is there truly nothing that you can do to prevent early miscarriages?

So angel method. Angel Method.com. So I came up with this because I got so sick of people being told that there's nothing you can do to prevent early miscarriages. So it's basically a mnemonic for all the things that you can do. So you can check the list, check all the boxes and say there's nothing I can do, right? Because it could be a progesterone issue. there could be a chromosome issue, there could be a fibroid issue, an anatomic issue. So there are absolutely things that can be done if you have one of those things to prevent another loss.

But if you don't have any of those things like a uterine septum or a fibroid sitting in the middle of your uterus, then you know that it's most likely an abnormal embryo, and that's why the miscarriage happened. It's protecting against something. Yeah, it's not protecting. It's just science, you know. It's just biology. When an egg and sperm come together, sometimes the cell divisions are abnormal, and the pregnancy is not normal. It's not because of anything that you could have done to prevent it. But sometimes there are things, and that's why I want people to get checked if you've had a miscarriage,

even one. And that's another peep of mine when patients are told you have to have three until I'll test you. And I'm like, well, that's not fair. We would never tell a man that he would have to bleed out three times and suffer terribly before we would do a single test on them. But for some reason, we think it's okay to do that to women. So if you have had one miscarriage, go to this angel method.com and test for all these different things. I call it the prevent miscarriage workup. It's not the recurrent pregnancy loss workup. It's the prevent miscarriage workup. We should be talking to women about this even after one miscarriage. Should we be talking to women about it before one miscarriage? Yeah, so I talked to women about it before if, let's say, their mom had several miscarriages or their sister or there's some sort of family history, then yes.

Okay. And I just want to be abundantly clear about this. If you don't have. have something on that list. So many people blame themselves for miscarriages. Can you speak to them really quick? A hundred percent. It doesn't matter how intelligent you are. How many degrees you have you have. You're still going to blame yourself. And then I always have to say, okay, this mantra is, it's not my fault. Repeat after me. And I'll sit with them in my office and I'll say, I want to hear you say it out loud. It was not my fault. Because we'll blame the fact that we bent over and picked up our laundry bin. Oh my God, this is the worst. We'll blame ourselves because we got an argument with our husband, you know, over something that was silly and we'll think

that it's because we raised our voice. And that's why, you know, the miscarriage happened or blame ourselves because we went up the stairs, you know, and it's like heartbreaking because that pregnancy was everything. It was our future. It was our hopes. It was our dreams. It was our baby. It was everything that we had imagined our life could be and just completely taken away from us. And I just want you to say really clearly, like Dr. Amy says it wasn't any of those things. None of those things. It is not the argument you had that caused it. It is not walking up the stairs that caused it. It is not lifting up something that was more than five pounds that caused it. It was biology. Human biology caused it. Nothing that was in your control caused it.

How can people find a good fertility doctor? Interviewing. I mean, unlike what we talked about and knocked up where, you know, interviewing OBJuans for meet and greets was a thing and now it's not a thing. It's absolutely a thing when it comes to a fertility doctor and talk to your friends. Go on Reddit. Go on Facebook. Look at the reviews and see who you think you might have a good connection with. Are there screener questions that are helpful, you think?

I think you just go in and say, what do you think my diagnosis is? And listen, what do you think my chances are? These are my family size goals. What do you think the best treatments are for me and see what they have to say and see how that feels? Okay. I'm going to do a little speed round. Okay. I'm going to give you a bunch of things.

and I want to know what is the impact of that thing on fertility if there is any. Okay. Breast implants. Breast implants. Unclear. It is unclear. However, I've had patients that said removing them made them feel better. They felt like they were dealing with some autoimmune issues and removing them helped.

So maybe. Hair die. No. Does not affect your fertility. I mean, if you're using really toxic hair dye every three months forever, then maybe. If you get pregnant that you're not supposed to dye your hair, anymore? Is that not true anymore? I mean, I tell patients wait until after the first trimester. Non-organic food. Fertility-friendly. Organic food's very expensive to buy and to maintain that and to have this

expectation that if you don't, it's going to hurt your fertility. That's just unfair. I mean, there's certain foods that people say you should get organic more than others, but I think for the most part, if you are eating non-organic, you're going to be okay. And you've said healthy diet a few times. What does a fertility-friendly diet look like to you? Green leafy vegetables, bright, colorful, foods like fruits and as far as meat, lean meats if you're a meat eater, avoiding very sugary foods, sodas, for example, fast foods. I had a registered dietitian on the podcast and she has friends who are fertility registered dietitians and they say apparently that they won't work with vegans because they find

it so hard to have vegans get pregnant. Do you experience that in your practice? Well, I live in the Bay Area. A significant percentage of my patients are vegan. And I have a fabulous fertility nutritionist I send my patients to. She just published a book called Getting Ready for Baby. And she's out of Seattle, Washington. And her website is mind, body, nutrition.

And she's awesome. So that would not be a challenge for her, someone who's vegan. Does being vegan, in your opinion, impact fertility in any way? If someone is mindful of the amount of protein that they're getting, the iron they're getting, it will not affect your fertility. What about overall toxic load? like the chemicals and cleaners, plus the nail polish plus air fresheners, should we be thinking about our overall toxic load when we're trying to get pregnant? Yes, I do have my patients go to this website's Million Marker,

and they have a list of products that are vetted and considered safe. And I say, like, overall, like, look at your deodorant, look at your lotions, look at the fragrances. But the thing is that we're being exposed everywhere. I mean, it's impossible to be toxin-free, but there are certain simple changes that you can make. What are a few things you recommend to your patients? One is deodorant, switching your deodorant. Another one is looking at things that you're always using like your toothpaste, your toothbrush, lotion.

What about cell phones and pockets or laptops on laps? I mean, it can cook your balls. I mean, those things get hot for guys, especially. So it's a heat issue? For men, yeah. I know there are people that are adamant that the Wi-Fi signal is like affecting our eggs and affecting our sperm. I'm not so sure about that. Okay.

If you were trying to get pregnant or you were worried about that, would you have? have your partner not carry his cell phone in his front pocket? I would. I would probably move it to the back or on the counter. Okay. Antidepressants. Safe. Are there any prescription medications you would have somebody reconsider if they're trying to get pregnant? There are some chronic medical problems that there are medications that are fertility unfriendly, but those patients, they'll need specialists to help them. But for the most part, in terms of like psychiatric medications, I mean, pain medications, for example. So if you're a chronic pain patient, let's say you're taking Vicodin and Tileloid and things like that, those are things that we would need to adjust.

But you will have patients get pregnant. Will you have them stay on antidepressants for their pregnancy? Yeah, absolutely. I mean, pregnancy, you're very vulnerable during that time. And a mom being depressed is not going to be good for fetal health. Yeah, I think it's the part of the conversation we often miss is we're like, oh, this is dangerous. And it's like, well, we need to weigh it against the dangers of the thing in its absence. Exactly.

Yeah. Hot yoga or hot tubs or saunas or getting hot generally. Getting hot generally. I mean, our bodies are hot. As far as hot yoga, I don't think anything in extreme is good in pregnancy. Just for fertility. Oh, for fertility. Oh, I don't see any problem with hot yoga.

I have friends who have their partners avoid any heat during the time when they're trying to do fertility stuff. Is that true? For men, yes. Don't cook your balls. I have t-shirts. I can give you one. But yeah, for guys, for sure, they shouldn't cook their balls. No hot yoga, no hot tub, no steam rooms, nothing like that because it literally will harm your sperm.

So if I was going to do a frozen embryo, my partner could not go in the hot tub for like three months before or how long? If you're doing IVF to create frozen embryos three months before he should stay out of the hot tub. And then this is the reason why guys love me so much. I tell them to ejaculate every other day for 30 days leading up to the egg retrieval. Why? So 15 times in 30 days, but not in two days, please. So the why is that the more frequent the ejaculation, the lower the secret. sperm DNA fragmentation. We know that. And that improves embryo quality. So a lot of people think

they should save up for that big day, right? Like they look at that cup and they want to fill it up. They're like, I'm going to save up. I'm not going to ejaculate for two months and the cup's going to be full. I'm like, that's gross. That's totally disgusting. Like, that's not what we want. Ew. We actually don't need a large volume of sperm. I mean, we just need like however number of sperm cells are as egg cells, plus more, obviously. But that's what I recommend. Wait, so I've heard a version of that with just having sex to have a baby as well, which is like you should only do it at that time so that it's kind of saved up. You shouldn't have sex too regularly if you're trying to get pregnant. Is that not true? Whoever said that hates men. I'm just kidding. That goes along with your wife doesn't need an orgasm. Those people are mean too or your partner.

So as far as sex, I say have sex every other day starting about three days before you anticipate ovulation up until two days later. So that's a good window of time to be having sex. Can you have too much sex and negatively impact your results? No. But if I told people to have sex daily, that's really hard for people to achieve. And I don't think you need daily sex. You just need to make sure that your timing is that sperm is there when an egg drops. Once an egg drops, it's only in the fallopian tube for max 24 hours. If you have headaches, allergies, brain fog, skin irritation, or you've been dealing with hormone issues,

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A hundred percent. I'm like, you got that from Facebook, didn't you? And it's 100% not true. 100%. All of the anecdotes are just anecdotes. Just anecdotes. That's so sad. I want a girl so bad.

I guess if I'm doing the frozen embryos, I get to choose, right? Okay. Retinal. Safe when trying, not in pregnancy. Period underwear or having any sort of PIFs or something like that in that area. Yeah. So, I mean, again, it's just a month of time of exposure, and I don't think it really affects your fertility. Advil or antihistamines?

Safe. Okay. That was my whole list. Is there anything that you feel like should have been on the list, one of those little types of things that you would recommend people avoid, that wasn't on the list? Yes. Lubricants.

So if you're trying to conceive, there are lubricants that basically kill sperm in their tracks. And there are ones out there, I don't want to name names, that are promoted as fertility lubricants, but they actually are not that. So you can literally crack an egg in your house, grab that egg white, and it acts like a great lubricant, open up that olive oil, and have some sex. You'll never. Egg whites? Egg whites.

I love. Oh, the best. Okay. In my brain, I'm thinking salmonella in my vagina. No. Sexy time. I thought this would go viral. It actually did not.

I don't know why. I actually did a live sperm show thinking that people on YouTube with like, what is that? And click on it and watch. But I actually took sperm and I expose it to a whole bunch of lubricants and showed what it looked like under the microscope before and after. It was very fun for me. Poor sperm, though. That feels okay. I can get on board with olive oil.

The idea of putting, like you guarantee I can't through my mucus membrane. No. No. No. Oh my God, that's so weird. And it's just the texture of it is. Yeah, just the viscosity and everything about it. It doesn't hurt sperm at all.

Same with coconut oil. So coconut oil is a good one. Canola oil. Interesting. Yeah. Okay. And the female orgasm, does that help us get pregnant? No.

But it makes your relationship better. And people ask me like, what's the best position to? have sex. And I say it's a position you enjoy the most because if you're enjoying sex, he's going to enjoy sex. Because if you're looking like you're in pain every time you're having sex, then he's not going to have the best orgasm. And his sperm load is not going to be as good. So, you know, when a guy is really enjoying sex, his sperm quality is going to be better. I mean, we know that because when a guy goes into a room to collect a sample and if he's really stressed out, the sperm's going to be really bad. And when a guy comes out and the sperm's really good, I'm like, you must have been watching something

amazing. Yeah, it's actually really interesting. Like the technology. world that you don't have to send them in there with like a gross magazine like in the old movies. It's just a Wi-Fi singing. Yeah. That's so interesting. No truth to any position or like putting your legs up after nothing like that. Okay. Any other myths that you've heard of like this helps you get pregnant that you're like that actually doesn't make a difference?

Waiting to go pee. I mean, I tell people just like wait five minutes, but with gravity that stuff needs to come out because if the semen's not the good stuff, we don't want that bacteria in our vaginas. What else? No, I think that's everything. Okay. Is there anything that I should have asked you if we're speaking to this fertility conversation that I didn't ask you? No, I think you did an amazing job covering everything. I can't think of anything.

Then can you leave us with one homework assignment? Let's say for somebody who is actively trying to get pregnant and somebody who just wants to protect their fertility for the future, something that we can do as soon as we turn off this podcast if we are either of those people. It's the same homework assignment. Ask yourself, what do you want? and what is it going to take to get what you want and are you willing to do it and be very clear. So if you're someone who's considering fertility,

you're saying what I want is I want to delay in my childbearing, be very specific, I want to get pregnant at 37, I want a girl first. And then what is it going to take? Well, it's going to take checking your fertility, doing egg freezing, going through these steps, and then ask yourself, am I willing to do it? And if you're not, then you have to change

so that you're not surprised that you're not going to get what you want. And of course, we can't have it all. And then if you're someone who is actively trying do the same thing. What do I want? Well, I want to get pregnant. Is it as soon as possible? A girl, a boy, it's okay to say those things. You're allowed to put it out there. And then what is it going to take? Well, you need to make sure that you're with a doctor that's going to describe your diagnosis to you and give your options and then really honestly sit down and listen and say, well, I'm willing to do that. And if not, go back to the doctor and say, well, I'm not willing to do that. And I've kind of changed what I want.

This is what I want now. And that's the homework. Those are the three best questions you can ask yourself when it comes to any question in life. Anything that you have in front of you. I love that. Okay. I have a question about that. We haven't talked about the money part of this very much. We've alluded to it.

We've touched on it a little bit. But what if what they want is this and the thing standing in the way is money? Are there scholarships? Are there funds for this stuff at all? Does insurance cover any part of this? Yeah. So if you're with a company that doesn't have coverage, I recommend that you go. go to your human resources and ask them what you can do to get coverage.

It has nothing to do with your insurance plan or the insurance company. It has to do with the plan that your employer offers the employees. And sometimes you can advocate for changes. I've seen patients do that. When it comes to paying for it out of pocket, there are financing companies. So you can finance over a long period of time with great terms. There are now some companies with no interest rate and you don't even have to qualify for the loan. So there's no like credit application that you have to fill out, zero percent interest.

So there are a lot of companies that are doing that now. My prediction is we will be just like other countries, like Japan, parts of China, where they're offering these things for free. The government's paying for it because their live birth rate is going down so much. We're getting there. We are there. We are. And if we don't do something about it, we're going to have huge regrets. We're acting too late.

So if I had my way, you know, if someone said Amy, like, what would you do? I would say, please just let me take care of as many patients as I can while I'm alive with no, like don't even take money out of it. Just say as many patients as you can see, please see them and help them. And we're not going to charge them. It's going to be free. But I think we're going to need to do that at some point. But I feel like we should do it now because people who will put themselves through fertility treatment, they're going to be amazing parents, right? They're going to read to their kids.

They're not going to be like me handing them a kid. You're born. Here's your iPad. True story. No, but they're amazing parents and they just glow and they love their children and they take such great care of them and they just make the world a better place for my family. So that's where my bias is. Anyone who comes to me, I want them to have as many kids as possible because that's what we need

in the world. What I do is just based on love, right? I'm bringing love into this world and there's no better way than doing that by having loving people, have children and have loving people in society, right? And have people who really want children, have children. Right. Yeah. I think that's such a beautiful point. Can you tell us a little bit?

You've mentioned a few offerings. You've mentioned things that people can have access to on your website, on your Instagram. We have a podcast. Talk about all of that stuff. Yeah. I mean, I think the funest thing for me is to do these live classes. So I do about one to two live classes a month teaching people about their fertility through my IVF classes. So you don't have to be my patient.

You can get all my tips through that class. And it's accessible. It's not expensive. and I hope people will take it if you're interested. And it's more like a master class too. So even if you've gone through IVF and you feel like you know it all, trust me, there are things that you're going to learn from that class that you didn't already know. And there's also my podcast.

And I'm basically on all social media platforms, maybe coming soon on OnlyFans. No, I'm seriously. Great, really? No. So this is my new thing. I've been talking about getting your fertility checked. my practice is 16 years old now, but still people aren't listening to me. You know, they aren't getting their fertility checked. And I feel like the only way I can reach people is by going on

Onlyfans. And may I'll be like, I'll shave my legs for you and teach you about AMH and sperm. It's an interesting point, though. What's the barrier? Why do you think that you've been talking about this for so long and people are not doing it? I think that somehow when it comes to like getting your blood sugar checked in diabetes, there's no shame. But there's still shame. It's cultural. It's religious. It has to do with how you were raised. When it comes to fertility, we don't think of it as a medical issue. There's spiritual stuff that goes into it. I'm just thinking egg leaves ovary, matches up with sperm. But there are all sorts of things that people think of when they think of fertility. So getting your fertility check, people think that there's something wrong with them. And that's not true.

So I think that's still the issue that we deal with is there's still the stigma around getting checked. Luckily, the stigma around getting your eggs frozen. It used to be, you know, I froze my sister's eggs, gosh, 15 years ago. And she felt shame. She felt ashamed that she had to do that. I forced her to. She did not want to. It's a good story.

But after she did it, she's like, oh my God, all of a sudden I feel proud. The shame is gone. So I want people to feel proud, feel empowered. get their levels checked and feel like they have knowledge about themselves. It's really that simple. I do think in so many parts of our life, having the knowledge, taking the action is the antidote to shame. And so I think that's a really powerful sentiment. Thank you so much, Dr. Amy. Thank you, Liz. I love this conversation. I think you're helping so many people. And I'm just really in awe of the mission of your work and how mission driven you are.

And I just think you can see how much of yourself you put in this. And I think it's really beautiful. Thank you for saying that. I hope you found this episode clarifying, hopeful, helpful. And I hope you love Dr. Amy and her incredible wisdom as much as I did. I certainly have a lot to think about with my own journey. And in general, I've just been talking about this episode since we recorded it. It is such an under-discuss topic, which is hurting all of us. Please, please, please share this episode far and wide so we can all have the information that we need to make the

decisions that are right for us. And if someone shared a link to the episode with you and you were new to the podcast, welcome. I'm so glad that you're here. If you are not following the podcast, all you have to do is go to the main podcast page on whatever platform you like to listen on. That is the one that lists all of the Liz Moody podcast episodes and you will see the word follow under the logo on Spotify. And then there's a little follow with a plus sign button on the top right of that same page on Apple Podcasts. There was also a recent episode. Apple update that has changed things up a bit. So if you follow the podcast there, even if you've been following it for a really long time, go to that little button in the top right and click

turn on automatic downloads. Otherwise, the podcast might not keep showing up in your feed. And we do not want that because we have so many good episodes coming up. They release every Wednesday and now every other Monday as well. We've got some great ones with celebrities you might know from your favorite teen movies back in the day. We've got one all about cortisol, another one diving into ways to hack your brain to live your best life, just so much good stuff. So make sure that you're following so you do not miss out. Okay, I love you, and I will see you on Wednesday for the next episode of the Liz Moody podcast.