Speaker 2 00:00:00

For me, my perspective is getting a fertility evaluation does not commit you to any form of treatment.

Speaker 2 00:00:05

Yeah, you should just go and get the information and a lot of people are sometimes scared of the information, but being scared of it is not empowering.

Speaker 2 00:00:13

Being scared of it causes you to possibly miss a window of opportunity you could have captured.

Welcome to the Birth Experience with Labor Nurse Mama.

I'm Trish Ware, and today's guest is Dr. Sasha Hockman, a double board certified OB GYN and reproductive endocrinologist.

That's a lot with HRC, fertility in Beverly Hills and Ensino.

Dr. Hopman is a nationally recognized fertility expert, known for blending evidence-based medicine with deeply patient centered.

She's also the host of the Trying to Conceive podcast, where she educates and empowers women with clear, honest conversations about reproductive health.

Between her clinical work, research background, and leadership and reproductive medicine, she brings an incredible depth of expertise and clarity, and I'm so excited to welcome her to the birth experience today.

Good morning and welcome to the birth experience.

I am really.

Excited to hear from you and chat with you.

So first, I would love for you to tell everyone who you are, what you do, where you're at, all the fun things.

Yes, of course.

My name is Dr. Sasha Hackman.

I'm a double board certified O-B-G-Y-N and reproductive endocrinology and infertility specialist.

KA, a fertility doctor I practice in Beverly Hills, California.

And we were just talking about how I live in Calabasas, so it's quite the distance, but, my patients sort of come from everywhere, primarily LA area, but I do see patients from all over the world.

Am I allowed to ask if you've had any, like, I know you can't say who, but have you had any like, pretty famous clients?

I've had like some D-list.

Okay.

I guess you would say.

Not nothing crazy.

We've had some, like pretty big celebrities come through the office, but yeah, not anyone that I've really had to take care of yet.

Yeah, because here's the thing, Dr. Sasha, when you visit.

Like that area, like I visit from Nashville, you're like, okay, am I gonna see anyone famous?

Like, can I, yeah.

But you actually work there.

Yes.

I, I mean, I definitely bump into famous people all the time.

And initially when I first moved here, I was sort of like starstruck.

Yeah.

And the first time I had a patient who I have.

Followed for a long time and yeah, you know, it was pretty famous.

I, I was just like, my God, how am I supposed to be objective?

But you actually really quickly get very desensitized.

And as you get to know these people, you realize,

yeah,

they're no different.

It's just their career.

Yeah, so they're more in the, in the limelight, but that's about it.

It's so funny that you said that because I am having lunch with someone here in Nashville that's from California and has been on TV and is relatively famous.

I don't even honestly know how we connected, but I think I just sent, she had commented on something.

I sent her dm, found out she's here.

We're having lunch tomorrow.

And yesterday I told Steve, I'm like, I'm really trying to come up with every which way to cancel this lunch.

'cause I feel so nervous.

Like, and he goes, babe.

She just did a different pathway.

She's still just a person.

Yeah.

Yeah.

And I'm like, but it's still like a weird, like you forget that these people are just real people or real women who are struggling to get pregnant.

Totally.

I mean, infertility doesn't discriminate.

No.

It

doesn't

matter who you are.

You know what your income is.

Yeah.

What your life looks like.

Yeah, it

does not discriminate.

So that is just a really good segue into what I wanted to talk today, because I would love to talk about unexplained infertility.

And a lot of the reason why, like I was thinking about this ahead of time is that I hear from women all the time, not just with infertility, I also coach women that are in like healthcare or market to moms and a lot of them.

Are helping women through other experiences, but I feel like there's so many different areas where we're just told we don't know.

Like it's, it's vague.

Yeah.

And so I would really love to talk about like what can, like we tell these people that are listening?

'cause I know I have a lot of listeners that want to be pregnant And by the way, if you're listening and you wanna be pregnant, go you, I'm so proud of you.

I wish more people would educate ahead of time, but they get told that they have unexplained infertility.

So I'd just love for you to break that down.

Like what does that actually mean?

Yeah.

I mean, I, I love discussing this because there is a lot of misunderstanding about unexplained infertility.

So let's just start by some basic definitions.

First of all, infertility is the inability to conceive.

After 12 months of unprotected sex, if you're under 35, 6 months, if you're 35 and up, and we even push and say once you've reached the age of 40, then after maybe two to three months of trying, you should really get in to see a fertility specialist.

And, so that's just the basic definition of infertility.

Now, this is not including those who already have a known diagnosis.

If you have irregular periods, if you know you have blocked fallopian tubes, if you know that there is no sperm, you do not need to wait to keep dying because you should actually be getting in right from the get go.

Now when we do a basic fertility evaluation, we are evaluating all the things that are needed to make a baby.

So if you think of it in the most simple form, you need eggs.

You need those eggs to ovulate.

You need a normal female reproductive tract where the fallopian tube is able to pick up the egg.

And then you need a normal uterine cavity, which is where a pregnancy takes place.

And of course, finally, 50% of the equation you need sperm.

So when we evaluate fertility, we start by looking at menstrual cycle patterns to see if ovulation is occurring or not.

We're looking at hormone labs to ensure that there is no hormonal abnormality that could interfere with proper ovulation.

We then also look at imaging of the reproductive tract.

Since we know that fallopian tubes need to be open, we do an imaging study typically called an HSG or hysterosalpingogram.

This is like, the way I describe it to make it easier to understand is the x-ray tube test.

So this is where we place contrast dye in the uterus.

We hope that it fills in the tube and spills out.

And you can see that under fluoroscopy imaging, which is a fancy term for a live x-ray, where you're watching the, the dye fill and spill.

Once we know that the reproductive tract is intact, we also simultaneously will check, semen analysis to make sure that there's.

How to quit sperm and the quality of the sperm is good.

Now unexplained infertility occurs in 15 to 20% of infertility cases.

So that's quite a bit.

Almost one in five couples experiencing infertility.

They're gonna do this full evaluation and everything is gonna come back normal.

And so then patients get really frustrated 'cause they're like, what do you mean everything is normal and I can't get pregnant?

And so this is where I always like to clarify and say.

Having normal preliminary testing does not mean there is an absence of pathology.

It means that the available testing we have cannot pinpoint or diagnose the issue.

Now, we now know with emerging studies that in about 30 to 40% of unexplained infertility, there may be some underlying endometriosis in the female partner.

And endometriosis is really, really complicated.

And that could be a whole episode in and of itself.

Yeah,

probably even multiple episodes, frankly.

But endometriosis is the presence of.

Endometrial glands and stroma, basically the lining of the uterus or cells that are similar to it present outside of the uterus.

And so if you have.

Cells similar to the lining of the uterus on your bowels or on your ovary, on your fallopian tubes, and they respond to hormonal stimulation.

Like a normal lining would thickens in response to estrogen before you ovulate, and then progesterone.

Makes it undergo some cellular changes.

And then when you have a period, imagine shedding inside your abdominal cavity where it's not meant to.

It creates a lot of scar tissue.

It can create a lot of inflammation, and the presentation is extremely variable, where you have some women who have extreme pelvic pain every month during their period.

You have some women who have.

Absolutely no pain, and their only symptom is infertility.

Mm-hmm.

So the range is so dramatic that it can be very difficult to diagnose sometimes, especially since the only way to truly diagnose endometriosis is through surgical staging.

You have to undergo.

At the very least, laparoscopy surgery with tissue biopsy to diagnose it.

And so in many cases, this is gonna go amidst for sometimes up to a decade.

But now in our field with all these emerging studies where we're finding out that maybe in 30% of cases some of these women have zero symptoms and the only symptoms, infertility, it's always at the back of my mind like, Hey, maybe.

There's endometriosis here, but then you still have at least more than half the cases where endometriosis doesn't explain this unexplained infertility.

So it, it can create a lot of sort of frustration and confusion for patients.

And I, I've also sometimes seen things like, well, my, husband's sperm morphology is low and it's male factor.

It's not unexplained.

And while you're not wrong in the sense that morphology, which is the quality, you know, the best sort of test mm-hmm.

In terms of quality of sperm, that still technically would go under unexplained because technically speaking, unexplained infertility is if you have.

Ovulation, at least one open fallopian tube and adequate sperm.

So if there's a good enough concentration and enough of the sperm is modal, meaning they're swimmers, then you still fall under this category because even if not everything is perfect, most of those couples will still go on to conceive.

And in fact, 80% of couples will conceive by six months of trying.

It's, it's just there's so much,

there's so much,

like there's so many different paths.

Yeah.

Even as you were talking, I was thinking, I'm assuming you have some ways that you spread them on, like figure out which path you need to take them on to go deeper.

I, because I'm imagining, well, you said some of the women with endometriosis don't have any other symptoms, like they haven't had rough periods, they don't have any other signs.

Correct.

So historically, part of the evaluation for unexplained infertility, all of these women would undergo diagnostic laparoscopy.

So this is sort of back in the day long before I was a reproductive endocrinologist.

Yeah.

It was the standard evaluation.

Everyone got scoped and then more research found that the number needed to treat for one extra pregnancy was 40.

So you had to operate on 40 women for one of them to get pregnant after this surgery.

And so the guidelines.

Quickly changed.

Yeah,

it's pretty invasive.

It's a lot to go through.

Mm-hmm.

And we definitely, I think that the pendulum has swung the other extreme where we probably under.

Scope patients at this point because we're always hesitant to take someone to surgery because it's, it, it is a lot to go through, right?

I mean, you're gonna have to recover and, it does delay time to pregnancy sometimes without any significant improvement in pregnancy rates.

So, that's no longer part of the evaluation unless a patient really wants to go down that route.

So what do we do for unexplained infertility?

Treatment is actually empiric, meaning we start off with what's called superovulation with intrauterine insemination.

That's considered first line therapy.

Okay?

And the reason is because if you do nothing, you just keep having sex timed intercourse at home.

Your chance of conception at that point is only 2% per month, which is much lower than the baseline of.

About 20% from per month if you're under the age of 35.

So it, it is really, really important to consider the couple's age because as you get older, there is a decline in fertility and once you reach a certain age, it's not really unexplained anymore.

It's because of advanced.

Yeah, there's no more unexplained part of that part,

correct.

Yeah, because we know egg quantity and quality has significantly been compromised as we get older.

I mean, for some, I'm almost 39 and I'm watching this in real time with myself as I'm currently going through fertility treatments for baby number three.

So we're really hoping to continue to grow our family, and I was lucky enough to be able to preserve my fertility a long time ago, but even that has posed some challenges.

And as I am looking at my ovarian reserve and my ovulation patterns.

Everything looks really, really different from when I went through fertility treatments at the age of 32, for instance, before we even started trying.

And so it definitely becomes a lot more difficult.

So I, I would say if you're in your late thirties, early forties, you're sort of out of this unexplained infertility bucket.

This is more so for the younger patient population.

Yeah.

So, to go back to the treatment, if we do nothing, it's a 2% chance per month.

If you do ovulation medications like Letrozole or Clomid are the primary medications we give.

These are oral meds that will help boost the amount of FSH that your brain releases.

FSH stands for follicle stimulating hormone, which is a hormone that will help recruit a follicle to release an egg.

And these mints can sometimes help recruit more than one egg.

And that's what we consider.

Super ovulation or controlled ovarian stimulation, however you wanna call it.

Mm-hmm.

If you do the meds alone.

You're really not changing your chance at conception, it's equivalent to doing nothing because you're really only increasing it to maybe 3% per month.

Now, if you do intrauterine insemination alone and you have the argument, well, motility was a little bit low, morphology was a little bit low, wasn't a perfect semen analysis.

Well, this, the IUI alone only confers about a 4% chance of pregnancy as well, and so you're spending a lot of money.

These are really

depressing numbers.

These are depressing numbers.

Yeah.

But now if you combine superovulation with IUI, you've increased your chance at pregnancy to 9 to 10% based on clo.

That's pretty

amazing.

So it is a big difference.

It's still low.

Like, let's just be honest.

It is not high percentages.

However, I have gotten many couples pregnant with ovulation induction plus IUI in the unexplained infertility category.

In fact.

I would say the majority of my patients who have decided to pursue that route, most of them have actually gotten pregnant using ovulation induction.

IUI.

And I like to stress that because I think that in our field we tend to focus a lot more on I UI is a waste of time.

Don't waste your time.

Like just move on to IVF, but IVF isn't for everybody.

It's also not accessible to everybody.

And also it really depends on patient age.

If you're coming to me with unexplained infertility at age 25, we should absolutely start with more conservative treatment because when you're ready for baby number two, you're still very young.

Versus if you're coming to me at age 35 with unexplained infertility and you're telling me you want three kids.

Now it's a different conversation.

I'm not going to tell you.

You really should start with ovulation induction.

IUI, I'm gonna tell you.

After, normally after three failed, IUI cycles, you move on to IVF.

And the reason that it's three is the magic number is because large clinical trials have compared cost-effectiveness and chance of conception.

And the magic number for being cost-effective and successful is three IUI cycles.

And if after that it doesn't work, you're just increasing cost of treatment without increasing,

instead of putting towards where it would really help.

It should go towards IU.

Yeah.

Yeah.

So yeah, so the next step is usually IVF, but if you are slightly older and you wanna have a large family, then you should really consider doing IVF right off the bat.

Why?

So you could bank embryos for future siblings because by the time you come back for baby number two at H 37.

It's not gonna look the same as when you were 35.

And that's assuming you're trying to fast track everything.

Yeah,

because everyone's different.

Sometimes you're like, well, I wanna breastfeed for two years and I don't wanna stop that early for the sake of having another child.

I, I don't wanna have any regrets.

If you wanna take your time, then you just have to plan for what your future family looks like.

Which, you know, for me was a big thing.

I really wanted to enjoy the postpartum experience.

I wanted to enjoy breastfeeding.

I didn't wanna feel rushed.

So before ever having my first child, we created embryos so that.

You know, now that we're in this position of, it's, it's hard for baby number three.

I'm so grateful I have these embryos as backup.

You know, and even already, our first embryo transfer was not successful.

So

I was gonna ask you, so you were already doing what you're doing now when all this went down?

Yeah.

'cause I was wondering if infertility doctors behave a little bit different than the average population because you know what, you know.

That's a great question.

I would say not really.

A lot of my colleagues are super fertile and they've never done any fertility treatments.

I would say most, almost all fertility doctors have at least frozen their eggs.

Okay.

Just as backup.

So that behavior is probably different from the rest of the population where, because we know what we know.

Yeah, most of us have preserved our fertility.

Also female physicians have the highest, like one of the highest rates of infertility where 25% of female physicians are infertile.

And so

which do you think is related to stress?

Absolutely, I think it's stress, but I think more so it's sleep patterns.

Oh, okay.

I think, I think the really disrupted sleep also contributes because what, I have a lot of patients who are female physicians.

Mm-hmm.

And, the ones who are in a surgical specialty where, or emergency medicine where they tend to be up a lot in the middle of the night.

They are usually my worst prognosis patient.

Wow, that's pretty interesting.

Yeah.

Yeah,

because I'm, I'm, even, as you were talking, I was thinking, gosh, I feel like everyone, you know, 'cause you go through, I, I started young, so not me.

So when I'm saying you, I mean everyone else in the world, but most people spend a lot of years, mostly their twenties, try not to get pregnant.

Correct.

Maybe they are going to have a hard time getting pregnant and they just don't know it.

So like, I feel like it should just be a rite of passage, like 18.

You get a fertility workup.

I, I really think that, our biggest problem right now that we're dealing with is everyone wants to be reactive, not proactive.

For me, like, you know, you wanna have kids, why are you going to wait until you've not gotten pregnant for a year to then find out that there was something you could have fixed?

You know what if there's mild male factor infertility because his testosterone is low?

And you could have fixed that with a medication, which takes about sometimes three to six months to see improvements.

Yeah.

But you miss this whole window of opportunity for a year.

Yeah.

Because you're just crying.

So, you know, for me, my perspective is.

Getting a fertility evaluation does not commit you to any form of treatment.

Yeah, you should just go in, get the information, and a lot of people are sometimes scared of the information, but being scared of it is not empowering.

Being scared of it causes you to possibly miss a window of opportunity you could have captured.

Yeah,

get the evaluation

information is power.

Information is power.

Yeah.

Get the information and then it's up to you as the patient to decide what you're gonna do with it.

Nobody can tell you what to do.

You know, you, you have all the choices and yeah, I always tell people like, if you saw a fertility doctor who's pushing you in a direction that doesn't feel right to you, get, go get a second opinion.

In fact, sometimes I, if my patients are like, well, I like, you know, I like the plan, but I'm kind of skeptical.

I'm, and I always tell them, go get a second opinion.

I want you to be short about the treatment plan.

You should never feel pressured to do something.

This is my recommendation, and if you want to hear a different perspective from a different physician, please go get a second opinion.

You should.

It's nothing

to be, there's so much integrity and trust building in that, just in that,

yeah,

I feel

it's.

You know, a patient's journey isn't about me, it's the doctor.

It's about them.

Mm-hmm.

What is your goal?

How are you trying to get there?

You should feel comfortable with the plan, and sometimes just hearing another perspective from another physician, or even just hearing the exact same recommendation from another physician can make someone feel really at ease about what they wanna do next.

Yeah.

I love that.

Okay, so we got a little bit off track.

Yes.

Back on track.

So let's go back to where we were.

You said you have a nine to 10 or the percentage goes up to nine to 10%, but you correct.

See even better than that with your own clients, depending on their age.

So it, it's not really a better percent, it's usually like, you know, the cumulative pregnancy rate is gonna be higher because if you do multiple cycles, then your chances of getting there are usually high.

Yeah.

But for those who end up.

And sometimes when we do these ovulation induction and IUI treatment cycles, that's when I'll actually discover, oh, it turns out there's actually a really bad male factor in fertility.

It's not really unexplained anymore.

The first semen analysis was perfect, and so we were duped into thinking that

yeah,

everything is great.

Yeah, trickster,

right?

But really semen analysis show that.

We have very few total modal sperm to place in the uterus at the time of insemination, or IUI.

And so now I can actually sit down and say, Hey, this is a really bad sperm sample.

I'm repeatedly seeing this for I UIs.

I think it's time to move on to IVF now.

Yeah,

we're at least get in with a male reproductive urologist to get that sorted out.

Now if after three failed, I UIs, this is when I. Usually most doctors will sit, sit back down with a couple and say, Hey, your option is to continue doing these IUI cycles, which is not usually recommended, but is still a viable option.

Or you move on to IVF and I. VF is the treatment for unexplained infertility that is often both diagnostic and therapeutic.

This is where we now get to see.

What is the egg doing with the sperm in a laboratory setting?

Mm-hmm.

Do we have poor fertilization?

Is the issue really with the sperm here, or are we having poor embryo development?

Are the embryos.

Degenerating and breaking down what's happening here.

Or sometimes we get great embryo development.

And I actually, I've, I've seen this a few times recently with some of my patients with unexplained infertility where they make beautiful embryos and then we go to biopsy, to embryos to do chromosomal testing, and the majority of them are chromosomally abnormal.

And so then that begs the question like, what is happening here?

Mm-hmm.

Is this an egg quality issue?

Is it a sperm quality issue?

And this is where you can do some further investigation because some genetic labs are actually able to tell you if the chromosomal abnormality is coming from the egg or the sperm.

And now that's

so interesting.

Yeah.

Wow.

And is that more of a later development?

Like is that just we're getting better and better with these things?

Yes, we're getting better and better because the genetic testing platforms are certainly improving.

There was a lot of controversy in the past about how reliable, genetic testing of the embryos is, which is called pre-implantation genetic testing.

Mm-hmm.

There's different types of PGT.

The most commonly used one is for ploidy, so it's called PGTA pre-implantation genetic testing for ploidy.

We also can test for monogenic diseases, so diseases that are inherited.

We can also test for, structural rearrangements in the chromosomes.

You can test for a lot of things, and now more recently we can do what's called whole genome sequencing, where we are sequencing the entire DNA.

Classically, when you're doing PGTA, we're looking at just whole chromosome numbers.

Mm-hmm.

Do you have the right number of chromosomes or not?

Yeah.

However, if there are small, deletions or small duplications in the DNA that are not compatible with life or even just a single gene mutation that's not compatible with life, we are not seeing that.

And this is why in general, when you do IVF with.

Genetic testing of the embryos.

We usually recommend having two to three chromo only normal embryos per desired child, especially if you're trying to preserve your fertility for the future for future siblings.

Okay?

You're wanting at least two normal embryos per desired child, which confers an 80% chance at one pregnancy if you have two 95%, if you have three.

And the main reason for that is because there is limitation for PGT where we're not seeing.

Everything in the DNA and understanding whether it's gonna work or not, but withhold genome sequencing that is now available.

Mind you, the biggest downside is it's a lot more costly, however.

Mm-hmm.

There is the, you know, you can counter argue and say, well, the upfront cost is more costly, but then you're possibly saving money in repeat embryo transfer cycles.

Mm-hmm.

And then you're also saving time to baby.

And so, with whole genome sequencing, we're able to see if there are.

Reduced viability variance.

And there's a specific company that does this called Juniper.

And so they will tell you which embryos are most likely to actually result in a pregnancy.

They'll also be able to tell you which embryos are affected with diseases and what kind of disease this possible child.

We'll have in the future.

So they provide a lot of information and we definitely, that's

incredible.

Yeah.

Yeah.

So, we're

like so futuristic, aren't we?

So futuristic.

I mean, it's,

I know

it's really cool because I mean, for example, I have a patient who is young, they have unexplained infertility.

We did their first IVF cycle a couple years ago.

Got them baby number one pretty easily.

It was after the second embryo transfer, which always proves the point that you need more than one embryo per child.

But then with the remaining embryos that we transferred, none of them worked.

And she was going crazy, being like, well, we got there so easily the first time, what's happening this time?

So I said, okay, we're, we're gonna have to make new embryos at this point, and then maybe we try doing whole genome sequencing this time to see if we find anything out.

And what we've discovered is that, you know, all the embryos are a affected by a disease that was not even known to the parents.

Both parents are carriers for really severe diseases, and the maternal disease is highly associated with implantation failure.

So now I'm checking all of her, her labs, including her cholesterol, which is through the roof.

By the way, I would never even think to just routinely check lipids on a 25-year-old.

Yeah.

You know, a thin, healthy 25-year-old, it wouldn't even cross my mind.

I check it.

LDL is so high.

I mean, it's, it's.

Through.

It's really truly through the roof.

So I'm like, okay, now we have to work with cardiology.

We need to get this sorted out in hopes of making this work in the future.

So this

is, I so scary for this mom.

It's so scary.

But you know, it's crazy.

Like without doing IVF with whole genome sequencing,

she would've

never known, gone on mist for forever.

So now,

yeah,

we have an explanation for their unexplained infertility.

Yeah.

Interesting.

Yeah,

it's so interesting.

So you said before, you said, I don't remember the term you used, but from this to baby, what is the norm?

Yeah.

The time to baby.

What is the norm?

Like?

Is there a normal, is that just literally, there's so many different variants?

It depends on.

A lot of things.

So that's what I thought.

How aggressive are you gonna be with treatment?

Are you gonna be successful the first time or not?

Are there gonna be hiccups along the way of treatment?

Sometimes we have a timeline in our mind, like, I'm gonna do IVF this month.

Next month we're doing an embryo transfer.

But then after doing an egg retrieval, we find that there's very poor embryo development and we have nothing to transfer.

Right.

So now we have to go back to the drawing board and realize that this is gonna take a lot longer than anticipated.

This isn't going to be a straightforward, unexplained infertility, just do IVF and get pregnant.

Right.

'Cause there's a lot of misunderstanding there too.

Well, okay, just do IVF, but that doesn't guarantee anything.

Once again, it's both diagnostic and therapeutic, but really IVF is an opportunity and a very unfortunately expensive way to diagnose a problem.

Yeah,

not necessarily.

And you're talking lots of cycles, right?

If you're saying this many embryos

sometimes,

and that's a lot of time.

It is a lot of time.

Most will actually do if you're, if you're 35 and under, I would even argue if you're 37 and under and you have relatively okay.

Reserve.

So the amount of eggs that are available at a time to recruit and retrieve them, then your chances are pretty high that the first cycle's gonna work.

In fact, you have about a 65 to 70% chance that your first IVF cycle's going to be successful.

And those are really, really high odds.

Wow.

Especially from the last odds we talked about.

Exactly.

So IVF is definitely way higher chance of conception in a given cycle compared to IUI.

I mean, it's a massive difference.

Mm-hmm.

However, there's gonna be a small percentage of patients who are not gonna be successful.

The first IVF cycle.

And may need a second, may even need a third, and extremely rare cases may need more than that.

Now, as you increase maternal age, the chances of needing multiple IVF cycles definitely goes up.

So in a 40-year-old, for instance, I usually quote that it, like three IVF cycles will confer about a 40% chance of live.

So if you're 40, it's not the same thing as, for instance, when you're 32, most 32 year olds will do one cycle.

They're done sometimes two, if they're trying to really bank a lot of embryos for the future, versus a 40-year-old is usually going through multiple cycles just to get to baby number one.

But it is really variable.

I've had 40 year olds where we're successful the very first IVF cycle, and I've also had 40 year olds where after five IVF cycles, I tell them, this isn't normal.

We should have already gotten there.

Now it's time to discuss other options.

It, it's so much, I'm just, as you're talking, just the process of getting pregnant, going through pregnancy.

And postpartum is so hard anyway.

But then when you're talking about what they've been through now, just like you were saying before, they get into postpartum and they're having to think, do I need to start doing it again because my age, I'm running outta time.

And what are the chances on top of dealing with postpartum?

Yes.

That's a lot.

That is

the hardest thing for me to explain to patients who have never had a child.

Yeah.

Even I have changed so much as an ob, GYN ever since having a baby.

It's one thing to know, like I, I always knew, I've always wanted to be a mom.

When I'm gonna have my child, I'm going to be obsessed and love.

Et cetera, et cetera.

But no amount of words can prepare you for the chemical changes that happens in your brain, no in your body.

The way you feel about your newborn, the way you wanna bond with your newborn, like it's.

For, not, obviously not for everyone, but for many women it's like truly the most magical experience ever.

Mm-hmm.

But it's also really hard because you're like navigating all these emotions and

mm-hmm.

You know, just this, the crash from no estrogen or progesterone in your body, postpartum, and now having to even consider.

Going through fertility journey while you're navigating this is extremely challenging

and, and the guilt they must feel pulling away from their time with that baby.

Totally.

I mean, it's a lot to navigate and I try to really kindly.

Bring it to their awareness.

Like, trust me when I say you wanna prepare before having your first child, 'cause you wanna just be in that newborn bli.

Mm-hmm.

And be in your bubble and not think about other things.

Yeah.

Because there is the possibility of having postpartum depression, postpartum anxiety, and you don't want external factors that just amplify that feeling.

Yeah.

Yeah, it's a lot.

I, and you know, I get a lot of students who have gone through IVF and now they're with us, and we are a little bit different than a lot of birth classes or communities because I hang out with them twice a month on Zoom.

We call our pregnancy happy hours.

So I spend a lot of.

Yeah, I spend a lot of time with these moms and it's really, I'm, I'm really so grateful even for our conversation, because I think we know that it's a journey and it's a hard journey, but like that's a lot to navigate.

Yeah.

That is a lot to navigate and this conversation's so interesting.

I feel like we could go on and on, but I guess I'm gonna boil it down to like, what would be your top, like three tips to someone who is experiencing infertility or unexplained infertility?

Is this gonna be hard?

Am I making

this hard?

There's so many tips I would have.

I would say, number one, get the support you need.

This is so underrated.

Mm-hmm.

Everything you're feeling is so.

Valid.

It is so normal.

It's an emotional rollercoaster.

It's hard to navigate.

It is isolating.

Even when you have friends that you have known that you know have gone through it, it doesn't mean that your journeys look the same.

Mm-hmm.

They may have been successful off the first cycle, or they may have had a much harder journey.

You don't know how it's gonna compare.

And so no matter what.

If you're going through infertility, it's always gonna be somewhat isolating because your journey is your own.

So please seek the support that is needed, whether it's through friends, family, or through professional help.

Like there's, mm-hmm.

There should be no stigma attached to that.

No shame surrounding that.

See a therapist if you need to.

Be on meds if you need to.

I'm gonna say see a therapist.

Yeah.

Yeah.

I feel like all of us should be anyway, but yeah.

Brain should be.

Yeah.

And this is really hard to tackle.

So that's tip number one.

Number two, make sure that you are working with a fertility specialist.

A who's board certified, but also B, who speaks sort of the same language as you.

Your Dr. May be amazing, but if you are not really aligned, you're not feeling really comfortable with the.

With the plan, you don't feel like you get to ask your questions or their way of communicating just doesn't work for you.

Go get a second opinion, get a third if you need to.

You should feel comfortable through this process.

And then three, just, really think of what your.

Desired family size looks like, and plan accordingly.

Just plan accordingly.

I know it's so easy to get tunnel vision and think, well, I just want a baby yesterday.

Yeah.

So whatever I need to do to get pregnant tomorrow.

But you don't wanna be on the flip side of that, wishing that you had done things differently.

Mm-hmm.

To be able to grow your family to the desired size that you want.

Yeah, I would imagine that one right there also saves them money in the long run.

It absolutely.

Because like you said, they're gonna get older.

Yeah.

Things are gonna, now they have what they were dealing with plus this.

Yes, yes.

So the older you are when you're navigating this, and this is particularly true once you reach your late thirties, early forties, and especially once you've passed 42.

It is most likely that you will be doing multiple IVF cycles compared to fewer.

The younger you are.

Yeah, the younger you are, the higher the quality of eggs, the larger the quantity of eggs.

As you get older, you need more eggs to make up for diminished quality, but you have fewer available and that really just translates into way more IVF cycles.

Like I've gotten 40, I've gotten 44 year olds pregnant with their own eggs.

However, usually it's taken an average of eight to 12 IVF cycles.

That is,

that's

insane.

Extremely expensive, extremely time consuming, and really, really hard for them to navigate when they have their toddler at home.

Yeah, I, I've just really, I feel like the thing that has landed the hardest for me talking with you today is the emotional toll that they're going through, whether they get pregnant or not.

Yes.

Because it, even if they get pregnant.

Now they have the normal emotional toll that we go through through pregnancy and, and postpartum, including probably a lot of suppressed emotions and like Yes, like you said, tunnel vision on just getting pregnant with the baby.

So maybe they've had a lot of hardships with their partner and like all of these other things.

And baby, we all know baby doesn't make everything better.

Yeah,

yeah,

yeah.

I think there's also a lot of trauma associated where like you start to almost.

Not believe that this is gonna happen.

Mm-hmm.

And so what I often see with patients is sometimes just not allowing themselves to be happy about the pregnancy.

Mm-hmm.

Not taking the pictures of their bump, not doing the maternity issue.

Yeah.

Because it's

surreal and they don't wanna lose it.

Yeah.

Like, they almost feel superstitious.

Like, if I celebrate this mm-hmm.

It's gonna go away.

And then finally, when they're on the other side, a lot of times they look back and they're like, man, I, I really wish I enjoyed this.

Yeah.

And

so

yeah,

yeah, I got pregnant with Grayson at 42 after having, so I had all my other kids before I was like pretty young, and then Laney at 32 and Grayson at 42.

But I had three losses before I got pregnant with him.

I'm so sorry.

And it was a totally different journey with me.

For him, and I'm so grateful for him.

But during my pregnancy I had so much fear and I've never been a fearful person.

But I also, I literally still, the night he was born felt like.

It wasn't really happening and he was gonna be taken from me.

Like it was the weirdest experience I've ever gone through.

So, oh God.

For those of you guys listening, I highly recommend therapy.

You know, it's funny, was such a fan.

I worked for infertility with my, for my first, and then he was an IVF baby.

My postpartum, I had terrible anxiety.

Like I felt like someone was gonna take him from me.

That's how

I felt with Grace too.

I feel like I had limited time with him.

So you saying that totally resonated because mm-hmm.

I had the worst postpartum anxiety and I would just hold him and cry and be like, I hope.

No, I hope I never lose him.

Yeah.

It's like you almost cheated the system to get him, so someone's gonna take 'em.

Yeah.

That's how I felt with Grayson.

Yeah.

Like.

I did.

It was, it was really hard and I never, obviously, you know, when I was younger, I, I used to joke that I could, like, someone could sneeze in the room and I would get pregnant.

Like, I was so fertile.

Yeah.

And so then I was dealing with all this anger towards my body, like, what is happening?

And, and then, yeah, the, the hardest thing for me was like.

Really realizing I got to keep him like he is mine.

I get to keep him.

Yeah, so I definitely dealt with that too.

So thank you so much for being here, and I did share in the beginning about your podcast, but I'd love for you to share with everyone where they can find you online.

Yeah, so you can find me on Instagram at Sasha Hackman md. I also have a podcast called Trying to Conceive with Dr. Sasha Hackman.

And the Instagram handle for that is trying to conceive pod so you can find me there as well.

I'm so shocked that that handle wasn't taken.

Me too.

' Trish: cause I

teach

my

clients.

I was trying to be creative because I didn't think it was available.

And then when I just decided to look, I couldn't believe it.

When, when clients first come to me, they have all these usernames and I'm like, what is it you wanna do?

And I'm like.

That's what you should name it.

And trying to conceive is so clear.

Yes.

Yeah,

exactly.

So kudos to you.

It's perfect.

Thank you.

Because when I saw that, I was like, I'm really shocked that this is a newer podcast.

Yeah, it's brand

new.

Why was it not

taken episodes out?

So,

yeah.

Because people should have taken that years and years ago.

Yeah.

Yeah.

I lucky you.

Well, good job you.

I got lucky.

Yeah.

So thank you so much for coming today.

I, I feel like I have so many more questions we may need to have you on again, not that infertility.

I'm obviously at the other end of the infertility spectrum.

They're coming to me when they are pregnant, but I know so many women who just wanna be pregnant so bad are just soaking up all the pregnancy information.

So,

yes.

Thank you so much again.

Thank you for having me.

I wanna say this personally, this conversation really landed on me.

The emotional toll of infertility is real, and whether you would just diagnose, told it's unexplained, have been trying month after month, or have walked through the testing, the treatments, the procedures, just to get to pregnancy, and now you're pregnant.

If that's you, I want you to know.

I see you.

I'm here for you.

And truly, the strength it takes to keep showing up through all of this is extraordinary.

You are a superhero, even on the days you don't feel like one.

I hope this episode with Dr. Sasha Hockman was clear and informative for you today.

As always, make sure you guys hit subscribe, leave us a review, tell us what you wanna hear more of, and I will see you again next Friday.

Bye for now.