[00:00:00] Corinne Foxx: Welcome back to another episode of Am I Doing This Right? I'm Corinne Foxx.

[00:00:05] Natalie McMillan: And I'm Natalie McMillan.

[00:00:07] Corinne Foxx: And we are best friends, confidants, millennials, and the hosts of Am I doing This Right? A life how-to podcast from the perspective of non-experts.

[00:00:17] Natalie McMillan: And each week we cover a new topic and we drink a new bottle of wine.

[00:00:23] Corinne Foxx: Yes we do. And this week we are talking fertility 1 0 1 egg freezing IVF and more with Dr. Serena H. Chen who I am so excited to have on. So excited. I feel like we've been talking about this episode for so long and we've been

[00:00:42] Natalie McMillan: waiting for the expert. Like, yes,

[00:00:45] Corinne Foxx: we, we wanted the right expert.

[00:00:46] Natalie McMillan: Cause we can't talk about, oh, I have no idea what's going on.

We have a lot of questions, too many questions for her, but we found her and I think she's perfect.

[00:00:53] Corinne Foxx: She is definitely perfect. So we're gonna be talking to Dr. Chen about when we should consider. Egg freezing the IVF process and how reproductive conditions affect fertility. Yeah, we're really at the age where we have to start

[00:01:08] Natalie McMillan: thinking about these things.

I know it's scary, but it's like, And so many listeners have P C O S and like there's so many factors that go into fertility that it's like, yeah, we don't even really know. We really don't. You know, nobody told us these things. Oh, definitely. Hence the entire podcast. Right,

[00:01:25] Corinne Foxx: exactly. Hence hence the ethos of the podcast.

Right. And at the end of the episode, we're gonna be playing.

[00:01:33] Natalie McMillan: recent obsessions, recent obsessions. I did not know what we were yeah, we're doing recent obsessions today. Okay.

[00:01:41] Corinne Foxx: But not, but what are we drinking on the bloody? All right. We

[00:01:46] Dr. Serena Chen: have,

[00:01:47] Corinne Foxx: I have a good feeling about this, right? It's a pretty bottle. I don't even see the bottle.

I just, I just got a

[00:01:53] Natalie McMillan: ping. It's called Colme. It is. Oh, from it's from Argentina. Now what type of wine this is? I don't know. It just says white wine product of Argentina. I'm excited about

[00:02:04] Corinne Foxx: it. I have a, a feeling for it and it's a twist top.

[00:02:08] Natalie McMillan: Oh, see, we're starting, we're starting off on the right foot. Here. We start off on the right foot with the twist

[00:02:12] Corinne Foxx: tops.

Thank you. You guys, I can actually drink the wine. The last few episodes one. I have not actually been able to drink it that much because I was on antibiotics. Yeah. But I'm

[00:02:23] Natalie McMillan: bet you took, but you took one for the, you took a little sips for the team so you could

[00:02:26] Corinne Foxx: reach. I did, but also. I I, part of it is that I forgot I was on

[00:02:30] Natalie McMillan: antibiotics and I started drinking, but Hey, you're here.

You're here to tell the tale. Cheers. Cheers,

[00:02:42] Corinne Foxx: Natalie. I'm really excited because we have a date night

[00:02:45] Natalie McMillan: tonight. We do have a date night tonight. I'm so excited. You guys,

[00:02:49] Corinne Foxx: we like, I feel like we have things like we have our, have we ever talked about Lidy committee trips? You're explaining that to our, I don't know, to the listeners.

[00:02:59] Natalie McMillan: If we have, we've never explained it.

We may have mentioned it without explaining it. So

[00:03:04] Corinne Foxx: not only, and I have like little things we do, and I just love that we have a date night. Tonight's literally in the

[00:03:09] Natalie McMillan: calendar.

[00:03:09] Corinne Foxx: It's date night, the calendar also, I had to invite Joe because we do that like, so he knows like, oh, tonight is where I'm. Yeah, he CC'd just so he knew where I was.

Yeah. We're going to dinner in a movie. Mm-hmm um, but we're going to like a fancy dinner. I

[00:03:24] Natalie McMillan: know I'm like really excited for absolutely no reason for no reason other than it. Thursday. And we're both trying to like live life a little bit more. Yes. You know, so we're like, oh my God, it's a school night. And we're going out on the town though.

I will say at 5:30 PM. see.

[00:03:39] Corinne Foxx: Okay. That's what that is. Because last night we went to a friend's birthday dinner and it went until 10 and I'm not kidding. I was basically had my head on the table. I was so tired. I was like, how is this possible?

[00:03:52] Natalie McMillan: I think we have talked on the podcast maybe about how I cannot.

I can't wind down when I go home. Oh, really? yeah, I think so. So if I'm like at a social event and I come home, no matter what time I have to wind down for like three solid hours. And Karen's always been like, what are you talking about? But then you experienced

[00:04:09] Corinne Foxx: it. I did, I had went out a few times in the last like month or so, and I would come back like at 10 or 11 and I could, I was exhausted, but my brain was still going.

I know, and I could not wind down. And finally I was like, oh my God, Natalie. I understand what you're talking about. It's torture because I've never had that. But last. I was so tired at that birthday dinner. I was like, I got home and I was like, bam, I know

[00:04:34] Natalie McMillan: I can't, it was three hours for me cuz it ended at 10.

I went to bed at one.

[00:04:37] Corinne Foxx: Yeah. You texted me at like 1250. Like I think I'm going to bed now. I was like, why I woke up this morning? Like, oh man, I'm glad that didn't happen to me. I know anyways, Natalie's one. I have a date night tonight and then sometimes we like to go on little trips together. Mm-hmm called the Lidy committee trips.

Yep. And they're coming up. Oh yeah, we do have one.

[00:04:55] Natalie McMillan: September, we're going to Austin, Boston, Austin, which we need to plan yeah, we do need to, we do need to get tickets. We'll be fine. We'll

[00:05:02] Corinne Foxx: be fine. Good. We'll figure it out. Okay. Let's get into this week's episode. Let's do it. And I'm really excited for Dr.

Chen. So

[00:05:11] Natalie McMillan: let's discuss why we chose this

[00:05:13] Corinne Foxx: topic. Yeah, well, I mean, we have to be honest here. Sex ed in the us basically taught us. Absolutely not, not one single thing. Absolutely not one single thing. So in our adult age, I feel like we both still have questions about our reproductive health and beyond that, as we get closer to the age where we might even consider having kids, fertility really becomes top of mind.

And we really don't any don't really know anything about our own fertility. I don't,

[00:05:38] Natalie McMillan: I don't at my Colt school, we learned about fertility via they put a pair on top of a toilet paper.

[00:05:45] Corinne Foxx: What

[00:05:45] Natalie McMillan: does that have to do with anything that was your uterus and your vagina? Like your canal? That's that's what they

[00:05:51] Corinne Foxx: did.

Yes. I thought that was like stuck. I

[00:05:54] Natalie McMillan: didn't know what you're talking about. They stuck straws with's on the top. This was my diagram for, this is what your reproductive health looks like. that is

[00:06:03] Corinne Foxx: more confusing than it

[00:06:04] Natalie McMillan: is helpful. Yeah. Yeah. Yeah. I mean, try going to a cold school.

[00:06:09] Corinne Foxx: all right. Well, we have a lot of questions for Dr.

Chen, and I'm sure you guys have a lot

[00:06:14] Natalie McMillan: of questions as well. Yeah. And I think they'll get answered. Oh, for sure. Yeah.

[00:06:17] Corinne Foxx: But let's introduce Dr. Chen before we bring her on.

[00:06:20] Natalie McMillan: Yes, our expert. So Serena H Chen, she serves as director of reproductive medicine at I R M S, which is the Institute for reproductive medicine and science in New Jersey and at the Copperman Barnabus medical center.

Wow. I know, I'm sorry. Cooperman, Cooperman, Cooperman, Barnabus, Cooperman. She's also an associate clinical professor at Rutgers New Jersey and Rutgers R WJ medical schools. She feels privileged to be trusted with the reproductive health of people in so many different situations and is dedicated to improving access to reproductive technology by breaking down barriers to care and.

Raising public awareness. We love technology, love technology. You know, we love technology. , she's amazed and grateful every day at the explosion in reproductive science that is happening today, but feels that physicians and scientists must advocate for better support for providers. And patience mm-hmm patient and physician stress and burnout continue to be the biggest barrier between the promise of these new technologies and their actual delivery.

Wow. I know. And, uh, we'll plug her at the end, all of her social things so that you can join her in advocating for better reproductive health for everyone.

[00:07:41] Corinne Foxx: Wow. Well, let's bring Dr. Chen on the party.

[00:07:52] Dr. Serena Chen: Hello, Dr. Chen. Hi Chen. Hi guys. It's so nice to see both of you. I'm really excited to be here. We're

[00:07:59] Natalie McMillan: so excited to have you.

[00:08:00] Corinne Foxx: We are so excited to have you. We were talking before we hopped on with you that there's so much about fertility and like our own female health that we just like don't know, and we're not taught.

And now we're both 28 and we're, you know, thinking about our future and if we wanna have kids, and this is something that's on our minds that we just don't feel well educated in.

[00:08:24] Dr. Serena Chen: I can't believe all the great content that you guys put out there. I've seen the reviews. It, you know, it's just, it's really exciting.

And reproductive help is a big one. And the hard part is people don't feel comfortable asking about it. So I'm so glad you guys feel comfortable talking about it. Yeah.

[00:08:42] Corinne Foxx: Oh yeah, no, we have a lot of question

[00:08:44] Natalie McMillan: partially it's for us.

[00:08:47] Corinne Foxx: you know, so you've been working in fertility for a long time now, and I was really curious how you've seen reproductive medicine change over the course of just your own career.

[00:08:59] Dr. Serena Chen: Oh my gosh. It's changed so much. We used to do a lot of testing, but no treatment because we really didn't have a lot of treatment. And now. We don't do that much testing and we, or I guess we do, we, we don't do that much more testing than we used to do. And we have really great treatment that works really, really well.

And actually one of the reasons I got into this field is because when I started IVF was super new and interesting, and there really were not a lot of pregnancies at all, but it just seemed like. You know, crazy science. And I was like, wow, you know, help me get people, get pregnant by growing, making a little embryo on a test tube.

That's incredible. I wanna be part of that. And now today it's so effective and it's so safe and it is more widely accepted, which is really, really wonderful. We still have to work on getting better. Coverage for it. But if somebody has access to IVF and they have infertility, if you can persist with it and not to get discouraged or run out of insurance, then you know, everybody can get a baby.

So we still have some challenges, but the technology itself is amazing. What is

[00:10:14] Corinne Foxx: the success rate that you guys are seeing? I don't know. Is there like a success rate that you're seeing now?

[00:10:20] Dr. Serena Chen: There's a lot of different answers to that question. So, as I said, if you are accepting of the full range of treatments and you have full excess, and you can keep going, ultimately we think it's a hundred percent, but some of those people might need IVF.

Some of those people might need donor X. Some people might need donor sperm or a gestational carrier. And that third party reproduction where you're involving another person and making the baby. You know, a lot of people don't feel comfortable with like, some people will be like, you know, I I'm done. I tried really hard with my own eggs and my own sperm, and now I'm gonna adopt, or I'm gonna live a wonderful and rich life with, you know, without children, which, you know, I have all kinds of other things in my life.

So ultimately that's a very personal choice, but on a technical level, theoretically, if you remove all those barriers, we can make a baby for everybody now. The per cycle pregnancy rate is a little bit different because the average number of IVF cycles to a baby in this country is supposedly like two and a half or three.

So. It is a little bit of an inefficient process, which is not surprising because humans make a lot of eggs and sperm and embryos that just are not capable of making a pregnancy. And you know, a lot of pregnancies are not capable of making a healthy baby. So you do a lot of times have to be like, okay, I'm doing IVF.

That didn't work. I'm doing it again. That didn't work. Okay. Let me try it again. And you know, and then I'm successful. So that is a fairly typical scenario for people going through fertility treatment. I hope did that answer your question?

[00:12:07] Corinne Foxx: Yeah, no, totally. It's crazy that there is, if, you know, obviously there's so many barriers to being able to, to do all of the different treatments, but that there is, you said we can make a baby for everyone, depending on your circumstances, of course, and you know, your access to care, but that's fascinating.

And it speaks

[00:12:26] Natalie McMillan: to the science too, because it's like, even. Straight up getting pregnant is kind of a miracle.

[00:12:32] Dr. Serena Chen: Like

[00:12:34] Natalie McMillan: it's a big deal, you know, so yeah, it really speaks to the science there, but I'm curious in what setting would somebody first come see a fertility specialist or do you think it's something we should all do?

What's your stance on that?

[00:12:47] Dr. Serena Chen: I love that question. That's a great question. So I would say in the old kind of reactive, maybe a little bit patriarchal system. Of healthcare, we would be like, oh wait until you're sick. And then we'll take care of you. And I think people nowadays really like you two, obviously this is the reason you have me here is you wanna be proactive.

About your health. So why are we waiting for a problem? Why don't we see what is going on? See what our risk factors are and address those ahead of time before we even wanna concede them. That's actually ideal. Like if you look at the old studies on smoking, a lot of people are like, well, if you ask a pregnant woman against quit smoking, the outcomes are not that different.

That's because, you know, we don't see a pregnant poison until she's like 12 weeks pregnant. And then we're like, Hey, why don't you stop drinking whiskey and quit smoking then, you know, it's a little bit late then mm-hmm so you really, you know, at 28 when you're like, oh, I'm still a few years away from having a baby.

Now is the time to be like, well, let me eat more vegetables. Let me get better sleep. Let me exercise a little bit. Let me quit smoking. Now, if I'm smoking, let me. Optimize my health. Now let me see the doctor and see, do I have risk factors? Do I have like ovarian cyst? Do I have a strong family history of premature menopause or endometriosis things that I, that we know in the medical field could impact your ability to conceive?

You know, like do, do I have a family history of. Early cancer. Like, is that something I should I get genetic testing for something like that? Are there genetic diseases in my family? You know? So there's all kinds of things that you can do right now years before you're ready to conceive to set yourself up for a healthier family.

Yeah. Yeah. I didn't

[00:14:42] Corinne Foxx: even, I didn't consider that, you know? Yeah. It is. We are, we are taught that once you have a problem, then you go to the doctor, right. And you don't really think, well, you know, I can get ahead of this. There's a lot I, we can do right now. That impacts like I have endometriosis. So it is on my mind.

And I am, you know, more aware of my fertility because of that. But even if you don't have endometriosis or you don't have some kind of reproductive Condit, It is good to start thinking about it, you know, as young as, I mean, guys, we're not that young anymore, but you know,

[00:15:12] Dr. Serena Chen: you're young. I think like the common, like

[00:15:15] Natalie McMillan: thing that you just always assume, I guess is like, you think you're pregnant, you take a pregnancy test.

Yeah. Then you go, yeah. You know, and really that is kind of

[00:15:23] Dr. Serena Chen: wards. And, but our system sets it up that way because a lot of. You know, if you look at the billing codes, a lot of this proactive, preventative health stuff is not, there's not as many codes. It's not as well covered. And the doctors that are seeing all the sick patients are like, well, I'm too busy to see you.

You look fine. So it's not really part of a system. So that's why, you know, something like your podcast is really important where people learn for themselves. And then. You know, once you're knowledgeable and you know what to look for and know what to do for yourself, you can advocate for yourself because it definitely requires self-advocacy.

[00:16:06] Natalie McMillan: And for other people too. Yeah. Just like getting the word out that this is something to be advocated

[00:16:10] Dr. Serena Chen: for. Yeah. One

[00:16:11] Corinne Foxx: thing that I think specifically like our age, um, and like our circumstances, our friends have been considering a lot is egg freezing. Yeah. and I'm curious on, like, when you think someone should consider egg freezing, like, is there an age, uh, like having a certain condition, like a circumstance that you would say makes someone a good candidate for that.

And also maybe someone listening, what is egg freezing

[00:16:37] Dr. Serena Chen: yeah. If they don't know. Yeah. So egg freezing is this concept that is really grown in popularity in recent years because our technology got really, really good. 10 15, 20 years ago where we went from something called slow, freezing to something called rapid vitrification.

And it completely changed the game because we went from a really low pregnancy rate to the same pregnancy rate as. Fresh eggs. It's like, literally, like you're pressing the pause button and then you press plague. It's it's incredible. And so with vitrification and really good pregnancy rates, egg freezing makes sense for more people because to freeze your eggs, you do have to take some medication and for like a week to 10 days, and then you do have to get an egg retrieval.

Usually it's done. Anesthesia. So you go to sleep for like 10 minutes and we put a small needle into the vagina while you're asleep and we pull out the eggs. It takes about 10 minutes. So not a surgery, but it's an ultrasound guided needle procedure. The needle's about the same size as a blood dry needle.

So you have to go through a procedure and a process to freeze your eggs. And so, you know, if it doesn't work so well, why are you putting yourself through that? But now it totally makes sense because that process. So much less risky than having a baby or getting pregnant. And if the success rates are really high and it can really change the gain for your fertility prognosis for a lot of people, it makes a lot of sense.

So egg freezing. The first thing happened in 2005 or 2012, 2013, where ass RM and the American society for clinical oncology said, listen, most people have cancer. They're definitely gonna have worse fertility. Once we finish treating their cancer, their fertility's gonna plummet. So. Those people definitely should have egg freezing and egg freezing was still a little bit new then.

And people were like, even if it doesn't work so well, even if it works a little bit, your eggs are gonna be crap after this cancer. So all those people should freeze their eggs. So that's been standard of care for a while. We still don't have good access for all the cancer patients in the United States, but theoretically, every young woman with cancer should be told, you know, let's see if we can freeze your eggs.

If we can do it safely. You know, it depends on the circumstances, but a lot of people can do it nowadays because. We know how good egg freezing is. We've been expanding the indications. And personally, I feel like every young woman should have access to egg freezing if they want it. I feel like everybody should understand it, get all the information and be able to say yes or no.

Based upon her own decision making, she should have access. And, but the truth is very few people have access. So a lot of, a lot of newer companies that really work hard to try to recruit, uh, very talented people like Google, apple, Facebook, you know, places like that. And you know, these competitive financial firms where they're competing for talent, a lot of them do provide egg freezing benefits, which.

Awesome. Because a lot of people are shopping their jobs. By, you know, healthcare benefits and reproductive benefits are something that a lot of people are looking for. So the access is getting better, but it it's still not, it's still not perfect. We've been working really hard. Like there's only like nine states now that have egg freezing mandates.

I'm in New Jersey. That's one of them. And we worked really hard to get that mandate. I wanted this mandate to cover everybody, but. That was a little too much for the legislators to swallow. So we got medical egg freezing passed, which covers cancer, transgender youth, people who are going through surgery.

You know, like, let's say you have to get your ovaries taken out or your uterus. That's gonna, even if you don't take out the ovaries, it's gonna impact how your ovaries work. So you definitely should. Have egg freezing before that, but there are other circumstances under which we really feel like, you know, people just delaying childbearing feeling like, well, I'm not gonna be ready to have a baby until I'm older.

I wanna freeze my eggs. Now, endometriosis, I think is a good reason for people to think about freezing their eggs because endometriosis people definitely have a higher risk for infertility. So I feel like 28. You know, if everything looks great, 28 might be a little bit early to freeze your eggs because you might be like, do I really need to do this right now?

But honestly we don't know the answer. If 28 is too early until, you know, we examine you and you look at your numbers. So if you have a history of endometriosis, I would wanna know what are your ovaries look like? What is your egg number, your AMH or anti Mullar hormone. And then I would want you to like, understand the finances, the pros, the cons, the risks, the benefits, and be able to have you say yes, Dr.

Chen, I wanna do this or no, this is not for me.

[00:22:00] Natalie McMillan: Yeah. Yeah. And that's the importance of that preventative?

[00:22:04] Corinne Foxx: Care. Yeah. Just knowing your body, your circumstances, and like what's available to you. Yeah, I think is so empowering. And I have went to a fertility specialist and here in Los Angeles, just to have that conversation of like, where am I at and how much is this gonna cost?

And I do wanna do it. And, and maybe when I do, I'll share it with everyone on the podcast, how it goes. But one thing I, I wanted to talk about because there's egg freezing, then there's also. I V F mm-hmm . And I know that, you know, a lot of, uh, people who have trouble with conception or single parents or people in the LGBTQ IA plus community, this is a really good option for them.

But what's the difference between. egg freezing and IVF, or where does IVF come into the egg freezing process? yes,

[00:22:53] Dr. Serena Chen: they're very related because egg freezing is kind of like the first half. So you do the stimulation of the ovaries, so you make more than one egg and we need, we like to get a lot of eggs because a lot of eggs are no good.

So we need a lot of eggs to get a good one. So that's the same in IVF and egg freezing that first part stimulate the ovaries. Can I ask you really quick? What is a follicle? So a follicle is just the little circle that surrounds the egg. You can't see the eggs on the ultrasound, but you can see the little S that's filled with fluid around the egg and as the egg mature.

The follicle grows. So that's one of the measurements. One of the things we can measure on ultrasound to see what your progress is like, how close you are to ovulation, or how are you responding to the myth?

[00:23:42] Corinne Foxx: Okay, sorry to cut you off. I just wanted to, I had that question. I .

[00:23:46] Dr. Serena Chen: So you're taking these medicines, you're doing ultrasound and blood work.

We're watching the follicles grow. We're watching your estrogen levels rise. That part is all the same in agri, in, in egg, freezing and IVF. And then we give you a trigger shot and you go to sleep for 10 minutes. We pull the eggs out, all of that's the same for egg freezing. So then we freeze the eggs for egg freezing.

And then for IVF, we do. IVF in vitro fertilization, which just means we're fertilizing outside the body. So, you know, it's usually in like a Petri dish and you put the eggs in, you've washed the sperm and gotten the really good sperm. You take the good eggs and then you put them together. There's a couple different ways to put them together.

One is just to drop the eggs into like a bath of sperm. The other way is to do icky, where we actually inject the sperm into the eggs. And there's a lot of different reasons to do one versus the other. But IIE is usually done for if there's a problem with the sperm. It's not as healthy as it should be.

Or if you are doing you're planning to do genetic testing on your embryo. Doing just one egg into the one sperm into the egg helps keep the genetic testing results more accurate and a little bit more clean. So then once you put the sperm and the egg together, then you wait about 20 hours to see if it fertilizes, not every egg will fertil fertilized, but like, you know, so every step of the way you'll see some drop off.

So. Typical fertilization is around 80% of the mature eggs will fertilize. And then not all the fertilized egg will, will divide and grow and make an embryo. And then not all the nice looking embryos will have normal genetic testing. And not all the genetically normal embryos will actually make a pregnancy and then not every pregnancy will result in a baby.

So there is that natural drop off, and that's not just infertility patients, although they probably have more drop off than fertile patients, but that is just human biology, human reproductive biology.

[00:26:00] Natalie McMillan: Yeah. Yeah. So with the difference between the egg retrieval and then the next step would probably be the IVF and the embryo creation.

How long is it between putting the sperm and the egg together and then implanting?

[00:26:17] Dr. Serena Chen: So it depends. If you're doing, uh, genetic testing, usually make the embryo in one cycle and put the embryos back in another cycle, cuz you the em embryos spend a couple weeks in the freezer waiting for the genetic testing results because the genetic testing results, we, we don't have the ability to get instant results yet.

Maybe someday we will. But right now we don't. Uh, so if you're doing genetic testing, then we do have to wait. So it's usually two completely separate menstrual cycle. So a minimum of probably, you know, five weeks between the retrieval and the transfer for that. Now, if you're not doing genetic testing, you can put the embryo in 1, 2, 3, 4, 5 days.

After the egg retrieval, the most common time is to put. The embryo in five days after the egg retrieval. Um, and then, yeah. Wow.

[00:27:12] Corinne Foxx: Is it cuz you're just the most like viable? Yeah. Fresh like,

[00:27:17] Dr. Serena Chen: well, because in that type of cycle where you're not doing freezing. The ovary and the uterus are all synced up. So just when you know, and the embryo has to implant around when it's around six or seven days old.

So you, you have to get it into the uterus in order to implant, you have to do that or you have to freeze it. Otherwise it's not gonna survive. Okay.

[00:27:41] Corinne Foxx: And then about the, the implantation of the embryo, because we've heard that, like you only implant one embryo at a time, and then we've also heard that you implant multiple and that's how like Okta mom hap happened.

so

[00:27:54] Dr. Serena Chen: they all take, yeah. Yeah. You know, the Okta mom thing was, that was kind of a mistake. So that really what really put her at risk. I'm really glad she did well, but that. That was really outside the guidelines. The current guidelines are really single embryo for mostly everybody. Now, women over 40. If they don't do genetic testing, it's reasonable to put in multiple embryos because most when you're over 40, most of your embryos are abnormal.

So basically you're putting a lot of embryos in hoping that one of 'em is gonna be normal. So you can put like two, three or four embryos in, but the likelihood is only zero or one of those embryos will be normal. So you're not really increasing. Somebody's multiple pregnancy risk. Having more, you know, I mean, everybody thinks twins are so cute, but it's super high risk for the baby and the yeah.

For the babies and the mom definitely serious complications can potentially happen. So we like to mostly put in just one embryo at a time, every patient is a little bit different, but in general, those are the modern protocols, but we used to put in a bunch, cuz we used to be really bad, bad at IVF and we didn't make very good embryos and we didn't do a lot of genetic testing.

So. And the pregnancy rates were much lower. So that's kind of how. Tried to get just one pregnancy was throwing a whole bunch of embryos in there, but that is a very outdated approach. Okay. Good to know.

[00:29:21] Natalie McMillan: Very good to know. Yes. Well, I feel like we always talk about women and you know, like over 40 embryos, all this, but what about men?

Do men have a fertility clock? Because I think it's

[00:29:33] Dr. Serena Chen: everybody thinks they don't. They do. They like to pretend they don't, you know, they all. It's like, oh yeah, like I'm gonna reproduce until I'm 90 or I'm almost dead, but, you know, and theoretically they can, but there is definitely a decline in the quality of this firm and an increase in birth defects as you get older.

So, um, men. Have different types of issues, but there definitely is. We do definitely see reproductive aging in men and, and an impact upon the risks to the children as they get older. So their biological clock doesn't quit quite as early or quite as loudly, so they can reproduce for a lot longer than women, but they, there still is a biological clock.

Having said that for both men and women, you can't stop the biological clock, but definitely optimizing your general health can, you know, can make a difference. And then

[00:30:30] Natalie McMillan: should men consider freezing their sperm?

[00:30:34] Dr. Serena Chen: That's not a society. Like it's not like a, an American society for reproductive medicine guideline right now.

But it seems to me that a proactive, like guys who are being proactive should freeze their sperm before they turn 40. Uh, because that's when. Kind of see the, the rigs really go up or maybe, you know, maybe even younger sperm freezing is a lot easier and a lot less expensive and a lot more accessible than, so it seems like a very reasonable idea for somebody who really wants to be proactive.

And we are seeing that a lot of people, men and women really are having kids later and later and later. So it seems like a very reasonable thing to do. And of course, guys that have cancer or have to undergo. Significant medical treatment that might affect their fertility. You know, they definitely should treat there.

Wow.

[00:31:25] Corinne Foxx: Listen, ladies and men out there. Oh, cause I Def I definitely have not heard that. You always think that men can like. Have kids, no one ever, but it makes sense that their quality goes down as well. I know we're talking a lot about like IVF and like, you know, working with a fertility specialist, but there's a lot of listeners listening right now that are trying to conceive naturally and are curious, like how often should they be having sex and when should they be doing that?

And there's all these like, weird tips on, like, you should lay a certain, put your legs up the wall. Yeah, exactly. Are there any of those tips that are actually true and helpful?

[00:32:02] Dr. Serena Chen: So I think you guys have just stated the most common questions people have about conception and also the most common misconceptions about conception.

Cause this having a certain position and having sex constantly are both docs of Google myths. And Dr. Google did not go to medical school, you know, so you really only have to like, if the sperm is good and, and you're healthy, then you really only have to have sex a couple times a week to like, make sure that there's always sperm around in the Philippian tubes.

That's how our system is designed. It's designed. So the sperm can hang out and be happy in the fallopian tubes. And. For the egg, the, the egg has very precise timing. Yeah. That is crazy. Yeah. So sperm can live for days and days and days in the fallopian tubes. Whereas the egg really, once it ovulates only has like 24 hours to be fertilized.

So cuz the egg is like the largest cell in the body. It's super complicated because it, it is responsible for providing all the biologic material for three days of the embryo. Life. So it has to do everything. It has to bring all the proteins, the DNA, the RNA, all the mitochondria, and you know, also like maybe a snack and a change of clothing in case you get wet, freezes everything.

And meanwhile, the sperm, the is essentially a DNA missile. Okay. Just like this little clump of DNA attached to a tail with like some mitochondria around the neck to provide some fuel. And you know, this sperm is just like, has to run around and stay active until it finds the egg. And then they all try to race to the egg and the winter only one gets in and the egg shuts down everybody else.

And all the other little sperm are like, didn't make it, they're stuck on the outside. And the sperm that makes it shows up and says, Hey. I brought my DNA. Are you ready to replicate? Right. And, but they don't do the sperm. Doesn't do anything for three days. Okay. That DNA doesn't do anything. It takes three days for the sperm to actually gear up and start making proteins and things like that.

So that, that. The egg has to provide everything in the first three days. So it's really only available for fertilization for 24 hours. The sperms job is to stick around. So sex twice a week means that you always, if you're a normal fertile couple, the sperms around you don't have to have sex all the time.

You don't have to have sex at the time. You're ovulating all this idea of, I need to know exactly when I'm ovulating in order to concede. Is a myth that kind of stresses people out. I think, I don't think it's a good idea.

[00:34:55] Corinne Foxx: That's so interesting to see how we've heard of like ovation tests and people peeing on sticks and like having to know when the egg is gonna be, you know, I didn't know that the sperm is just hanging out in there waiting for it to show up.

[00:35:08] Dr. Serena Chen: Yeah. Yeah. So people who have irregular periods, that's what I tell 'em. I'm like have sex twice a week then, you know, there's always a sperm there whenever the, the egg comes out, but it, you know, if you have a regular period, you really should see the gynecologist and get checked out. Cuz there could be some risk factors associated with that.

But, but we don't really want people to stress about when to have sex because we know that if you can not stress and relax, you actually will have sex during your fertile time. If you're healthy, you know, and you're not using contraception. Couples tend to have sex at the right time. Wow. Yeah. You follow your natural

[00:35:46] Corinne Foxx: biology.

[00:35:46] Natalie McMillan: Yeah. What would you say to somebody who's been actively trying for a while and it hasn't happened yet?

[00:35:53] Dr. Serena Chen: So that is a very stressful situation. And I think a lot of people really are afraid to go to the doctor because they're afraid something might be wrong, but. That, you know, if you're, if you're stopped contraception for six months, if you're over 35, 12 months, if you're under 35 then, and nothing's happened, then you really need to see the doctor and just make sure everything's okay.

And most of the time there's nothing serious going on. And even if there's something serious going on, usually we can address it and help you get. But you shouldn't let it go on and on and on. Cuz not only are you like not getting help, but you're also really raising your risk for like depression, anxiety, things like that.

Cuz. Incredibly stressful to, you know, be trying to conceive and not to conceive. Yeah. Yeah. I,

[00:36:47] Corinne Foxx: I could imagine. I mean, I know people who have struggled and, you know, they've confided in me in like the mental health aspects of, of, you know, not it not coming as easily to them as either siblings or, you know yes.

Um, and just feeling. Courage, but it's good to know. Like if you're struggling, don't wait too long and see someone like you and there are options. Yeah.

[00:37:11] Dr. Serena Chen: Yeah, absolutely. Absolutely. There are.

[00:37:14] Natalie McMillan: Speaking of mental health, you know, recently we had Roe V. Wade overturned, which has been ver I think we're all a little hard on all of us.

[00:37:25] Dr. Serena Chen: Yeah. Yes, really? Yeah.

[00:37:28] Natalie McMillan: So, you know, I think it's quick to just think that it only affects abortion, but. Can you speak on if it has larger implications and then even with IVF, cuz I know there's things being said about IVF being affected by this. What's your take on that? So

[00:37:45] Dr. Serena Chen: the issue is that this legislation, I guess, is designed to shut out.

A certain type of abortion, uh, termination elective, termination of viable pregnancies or theoretically that's what a lot of the people who are in support of this legislation want to do, and they do that by defining, uh, pregnancies. As a person, like they give a pregnancy, the legal status of a person before they're a person.

And that's general concept is called personhood and personhood bills. If you define, like, let's say an embryo as a person, it could affect what we do in IVF. Cuz we make embryos all the time. And we freeze embryos and we select embryos and we biopsy embryos and we test embryos and we will often discard embryos if they're genetically abnormal, cuz we know they can't make a, a healthy person.

Right. Right. So, and all of those things that we do, depending upon how the bill is written could be considered illegal. And now like in Missouri, for example, Illegal means you're be charged with a felony and thrown in jail. So there's all different kinds of punishments for these illegal actions. So here we are trying to build families, preserve fertility, help people have babies, and yet we could be prosecuted by the law.

That is something that IVF doctors across the country are really, really concerned about. And in every state, the concerns are a little bit different. So we're, we're really, really concerned. And the other issue is that these laws impact not just what they're meant to impact. Elective pregnancy termination of a viable pregnancy, but they also impact just routine medical care for women of reproductive age, who may have all kinds of medical problems because of various things that happen in pregnancy, whether the pregnancy is normal or abnormal and this idea of abortion.

You know, encompasses routine medical procedures of let's say, removing pregnancy tissue from a uterus that's causing somebody to, you know, be at risk for death because it's infected or because it's causing a lot of bleeding or things like that. Those can all, I think, mistakenly fall under the category of abortion because legislators are not doctors and they wrote these laws.

Without really understanding biology or medical care. And, you know, I heard a story just today about Missouri. Where a lot of doctors at a medical center were told, well, with this new log and the felony and charges and possible jail time, you should make sure that before you take the person to the, or to take care of them, that you see that it's documented that their life is really at risk, which means that we're waiting till they have enough blood loss that they're showing signs that they might.

Be close to death, which is extremely, extremely dangerous and exactly the opposite of what we were told to do when we were train. To take care of patients. You guys are really young. Like if this happened to you, let's say you ha you got a pregnancy and it was stuck in the tube and that's a pregnancy that cannot survive.

It can't be transplanted to the years. It's never gonna make a baby, but it, your tube is very small and delicate. And as the pregnancy expands and grows, it's gonna cause the tube to burst. You're gonna have internal bleeding as a young person, you'll probably have some pain and discomfort, irregular bleeding, you go see the doctor.

You are gonna look fine for a while, even with internal bleeding, because you're young and healthy. What happens in young and healthy people is they compensate for it. They have strong hearts and lungs and good blood and they can look okay for a while and then suddenly, boom. And then they're like, basically, like they could die super quickly.

So the standard of care. Is to address this before you ever get to that point. And just, you know, we, we don't wanna play brinkmanship with some, with a human life, but that is essentially this medical center is worried about their doctors, worried about people going to jail, trying to find a balance. It's not really possible to find a good balance when you have a law that does not take into account human biology or good medical care and is only trying to reach some other.

Agenda some political agenda. So it is really, really concerning. So we, I am not talking about, oh, somebody's gonna give themselves an abortion with a coat hanger. I'm just talking about normal women's healthcare. It is being compromised right now. And, and doctors really need to be able to take care of their patients, keep them healthy, keep them safe.

Being worried about going to jail?

[00:43:19] Natalie McMillan: Yes. Well, I was gonna say it is a double edged sword because it's like the mother doesn't wanna go to jail and the doctors don't wanna go to jail. So it's like, you know, at what point do the doctors just start saying, okay, well this isn't something I offer or, you know, and then the resources

[00:43:34] Dr. Serena Chen: become more limited.

It's happening. Yeah. It's happening already. A lot of doctors are saying, you know, we already have a shortage of obstetricians in this country because it's, it's a really. You know, it's a really demanding field, a very time consuming. There's a lot of doctor burnout because the healthcare system is broken and then we had COVID.

So we really have a big doctor shortage, especially in the middle of the country. And a lot of doctors that are trained as obstetricians can do just GYN. They can just say, you know, the pregnancy part is really too difficult and too complicated and too hard on my life. And now I could be thrown in jail for it.

Let me just do pap smears in my. You know, and just stay away from this whole area. We, we are already seeing access to care issues because of this, even though nobody's actually, maybe nobody's actually gone to jail yet for this. It's

[00:44:29] Corinne Foxx: terrifying. And I just, I applaud the work that you do. And I applaud you speaking on this from the doctor perspective, because I mean, you's brave, it's brave, but also, I mean, you know, the work, you know, you've trained for this and for laws be made by people who are not doctors as.

Insane to me, um, or women, or right. And, and we could listen to you all day, but luckily you do, um, Instagram live every Tuesday and what I'm sure you're talking about these kinds of things. What other things are you talking about on the IG live? Yeah. And where can our listeners find you?

[00:45:04] Dr. Serena Chen: So we talk about everything like fertility preservation, it's been pride months.

So last month, so we were doing a lot of LGBTQ family building. We are gonna be having like a, a Roe V Wade discussion, probably multiple discussions coming up. You know, we try, we, we talk about sperm. We talk about the embryology. We usually have. Some of our patients on to talk about their stories and their experience.

And that's on my practice side, cause we've got like 11 really wonderful doctors and we kind of all rotate every Tuesday, 4:30 PM Eastern standard time. And the hashtag the handle is IVF underscore I R N S. That stands for Institute for reproductive medicine and science. So, um, so we're in New Jersey and New York, but you know, the Instagram lives of course are for everybody.

And we do get people from kind of all over. Um, I do think people enjoy just, you know, being able to hear. Just talk to doctors directly put in their, you know, comments and their questions. So that, and it's fun for us too. Oh man. Awesome.

[00:46:09] Corinne Foxx: I can't wait to watch. I know me too, cause we have a million questions for you, but we have to let you go, but thank you so much for your time and your wisdom.

This is gonna be so helpful for so many people we know so much more. Oh my God. I know. Um, and I. Motivated to, to probably start the egg freezing process. I'm like, OK, you gotta go home home. Yeah. Yeah. But thank you so much for coming

[00:46:32] Dr. Serena Chen: off. Oh, I'm so, I'm so glad. And, and I also would like people to follow me on Twitter and Instagram, Dr.

Serena H Chan, cuz we are, you know, I'm gonna be talking a lot about the whole Roe V Wade and women's health issues and, and I'm probably gonna be asking people. For help to speak up about this. So I appreciate your voices so much for bringing those issues up because the more people that hear about this, I think, you know, we can get more people to, to vote and say, you know, no, we don't wanna shut down women's health.

You know, we want. We want women to have a choice and, and, and to be, be able to feel comfortable

[00:47:12] Natalie McMillan: with their healthcare. Yeah. And we'll, we'll, um, leave all your information in, in our show notes.

[00:47:16] Corinne Foxx: Yeah. So

[00:47:17] Natalie McMillan: they can easily

[00:47:18] Dr. Serena Chen: click. That would be cool. Thank you so much,

[00:47:20] Corinne Foxx: Dr. Have a great

[00:47:22] Dr. Serena Chen: rest of your day. You guys too.

Thank you so much. Bye. I love her.

[00:47:36] Natalie McMillan: I secretly the whole time was like, do I move to New Jersey so that she, we might have to get

[00:47:41] Corinne Foxx: care honestly, with truly, truly the way things

[00:47:45] Natalie McMillan: are headed, the, the way things are headed. I'm like, well, Dr. Chen, but she is

[00:47:49] Corinne Foxx: so knowledgeable and we will link all of her socials in our show notes. If you guys want to connect with her.

Yes, because she's got a lot of great information, especially right now. Everything that's going on. Yep. And we hope you guys learn more about fertility when to see a fertility specialist, how the IVF process works, which I

[00:48:10] Natalie McMillan: learned a lot about, oh my God. Me too.

[00:48:12] Corinne Foxx: And you have a more empowered stance on your reproductive health, because knowledge is power power, but

[00:48:20] Natalie McMillan: I also do, I really do feel.

I feel, yes. I feel empowered. I feel like, you know, I do have type one. That is a condition. Yeah. I probably should have it. Have it

[00:48:29] Corinne Foxx: checked out it's it's worth a, a check's going on. It's worth a check. Okay. Now, so let's circle back on this wine that we've been drinking and reveal our, what tea of the week?

Our what? Tea.

[00:48:42] Natalie McMillan: Okay. So it is the COE. It's just, uh, it just seems to be a white wine from Argentina. It's it? It's a 2021. Okay.

[00:48:51] Corinne Foxx: So she's fresh. Okay. So one, two are hot. Which would you like to intro the hot? Yes, she's a fellow endo warrior with me, but I feel like she's been really transparent about her fertility journey, her endometriosis, her, she had IVF, she had her IVF process, um, how difficult her pregnancy was.

And she's also just an advocate for women's health. Yep. It's. Amy Schumer, Amy Schumer. So one, two Amy. There is a no, I thought this was a hair in my wine, but it's just bubbles. Ah.

[00:49:27] Natalie McMillan: Yes, it is. It does have some little, you know what, there's a term. There's a term. It's a hair. Oh,

[00:49:34] Dr. Serena Chen: it's a hair in

[00:49:36] Corinne Foxx: your own. It's definitely my own hair.

It's fine. Do you, do you see it? No, maybe it's bubbles anyways. Okay. One to Amy Shum. ,

[00:49:47] Natalie McMillan: I'm not mad at it.

[00:49:48] Corinne Foxx: Oh. And I'm not, you know, it didn't get better. It didn't open

[00:49:51] Natalie McMillan: up. It didn't. Yeah. Whites, I think tend to not,

[00:49:54] Corinne Foxx: it kind of got worse as it got as it set. I

[00:49:58] Natalie McMillan: wonder if it's because you just ate like zucchini bread.

It could be,

[00:50:02] Corinne Foxx: it could be, it could be okay. Wanda, Amy Schumer, what are you gonna eat it? I'll give

[00:50:06] Natalie McMillan: it a six and a half. Okay. I'll meet you there. Six and a half, six and a half. Like it's, it's fine. It's fine. It's nice. If somebody gave it to me, you know what also, I think if it

[00:50:14] Corinne Foxx: was cold, I'd be like, it has to be, it has to be chill.

It needs to be chill. It would be, it would be there, but it's good. Okay. Six and a half out of Amy Schumer. For this wine.

All right. This is the part of the episode where we play a little wrap up game. And this week it's recent obsession. Recent what we are recently obsessed with.

[00:50:40] Natalie McMillan: Yes. I actually would like you to go first. Okay. Because, so she brought in. You know, these bays bags, B E I S everybody loves them and I've never really seen one everybody.

So I would like to know

[00:50:52] Corinne Foxx: what the hype is. Okay. So I got the work tote. Okay. This is not an ad. It sounds like one, but it's not,

[00:50:59] Natalie McMillan: but Hey, if you wanna sponsor us, let us know. And it's a very

[00:51:02] Corinne Foxx: square, classic looking bag. Yes. Looks very profess. It feels very professional Uhhuh, and this is my recent obsession and inside the bag there.

Okay. Wait, I have to show you. You look, first of all, do you see this? Is that a

[00:51:16] Natalie McMillan: laptop CA like a laptop case?

[00:51:18] Corinne Foxx: No, I don't even, maybe it is. Oh yeah. I just put a bunch of, uh, lip gloss in here. So there's like a little, um, little pouch. It's a removable pouch. Oh, it

[00:51:29] Dr. Serena Chen: wait.

[00:51:30] Corinne Foxx: No, it's not, there is a SEP,

[00:51:32] Dr. Serena Chen: it's like just a

[00:51:33] Natalie McMillan: pouch.

Oh, it's a, it's a laptop pouch. No, this is, oh, it's just like a pouch pouch. No, it's just a pouch. You put an iPad in

[00:51:39] Corinne Foxx: there. You can put all, no, the, I, there is a separate sleeve. There is a computer iPad sleeve. This is just a pouch

[00:51:48] Natalie McMillan: also. It's like a very, it's like a two in one purse, cuz that's like a whole other purse.

Yeah.

[00:51:53] Corinne Foxx: There's also okay. There's the pouch. There's also like little pocket. Oh, so here's the laptop part. You see it. Ah, yes. Stick that in. And then there's stuff for my pens. There's a little place for my pens. A little thing. Oh, there's a zipper here. I don't know what that's for. Why there's zipper on the side and it's very sturdy.

I like that. When I put it up,

[00:52:15] Natalie McMillan: it's like, we're not falling over. No, it has like little. Think again, if you think I'm gonna fall over. No, I'm not. It would never

[00:52:21] Corinne Foxx: fall. No. So I feel very professional and very luxurious. Yes. And very efficient. I

would

[00:52:28] Natalie McMillan: agree with all of those

[00:52:29] Corinne Foxx: three things. I do have to figure out how to put the pouch back in.

Yeah. But this is my recent obsession and we'll link in the show notes. If you guys wanna base back and you wanna feel like a boss, bitch. Yes. I love that, Natalie. What's your recent

[00:52:40] Natalie McMillan: obsession? My recent obsession is not as. It's not as useful at all. And I am late to the party as I am with most things, but the duo lingo TikTok truly.

[00:52:51] Corinne Foxx: Oh, their Twitter. Account's pretty spicy too.

[00:52:54] Natalie McMillan: Oh, I didn't know about the Twitter account. Yeah. Oh, so that's probably gonna become my newest recent obsession because I, so my thing with TikTok is I don't go on my, for you thing. I literally only look at what Karen has sent me and what Connor has sent me.

And like, those are my feeds and that's it. And I don't open it every day, but somebody was like, you have to just like, look up the duo lingo one. So I did. And I'm like, this is so insane. . Like it is beyond, I don't think I've seen their TikTok. I just know from you have

[00:53:26] Corinne Foxx: Twitter TikTok. They're like very passive aggressive

[00:53:28] Natalie McMillan: on, on Twitter.

Oh, oh, well, they're passive aggressive in their comments on TikTok, but their tos are, oh,

[00:53:35] Corinne Foxx: I've seen 'em they have the guy in the thing in

[00:53:37] Natalie McMillan: the, like in the costume, the duo. Yeah, the giant, like. Owl and like he's talking, he's like, it's you just have to see it for yourself. Maybe we'll post what on the story we should.

It is the most, what I love about it is this is a corporate company and it is the most inappropriate really. Oh my God. Yes. They're talking about how he has a dumpy. Like

[00:54:02] Dr. Serena Chen: some shit. What it's insane.

[00:54:06] Natalie McMillan: There's a

[00:54:06] Corinne Foxx: fly in my wine cup. It's really taking turns, giving 6.5 . Um, okay, so we're gonna put that in the stories

[00:54:15] Natalie McMillan: today.

Yes. You've gotta see

[00:54:16] Corinne Foxx: it. I'm very excited to watch it and like always you guys feel free to right. Interview the podcast. If you love it, it helps us grow. This is a great episode to share it with your girlfriend, literally all of your. Spread the word and we will be back next week with another episode.

Love you guys.

[00:54:37] Dr. Serena Chen: Bye.