[00:00:00] Dr Renee White: Knowledge is power, and we are all about empowering the mamas of the world. In each episode, we will unravel and interpret the latest research and evidence based practices for pregnancy, postpartum, and motherhood. As mums and researchers ourselves, we have experienced firsthand the overwhelming complexity of information, myths, and those classic old wives tales.

[00:00:27] I'm Dr. Renee White, and this is The Science of Motherhood. Hello and welcome to episode 160 of The Science of Motherhood. I am your host, Dr. Renee white. Thank you so much for joining us today. We have got a regular back on the podcast, Dr. Cheryl Phua, but before we dive into that episode, I just wanted to remind everyone, if you've been following us on socials, very exciting.

[00:00:53] We announced late last year, we now have doulas in Brisbane, which is very exciting. So if you're new to the podcast, you're thinking, what the heck? Hello and welcome. And thank you for joining us first and foremost, when I am not sitting in front of this microphone, having good old chin wag to our wonderful guests here on the Science of Motherhood, I am leading the pack in Australia's first doula village.

[00:01:22] Now, what does that mean? That means I am helping support overwhelmed sleep deprived families when they've got newborns or they're preparing to become parents. And we have got an amazing team. We've got 20 doulas now across Australia, pretty much all along that kind of Eastern seaboard now, except for ACT, but you know, let's see.

[00:01:51] So we've got doulas in Brisbane. Sydney, Melbourne, Geelong, Newcastle, Hobart, and I'm pretty sure that's it. Yeah. So that's all very, very exciting. So if you are someone who is a first time mama and you're thinking, Oh man, I just really want to be confident with this. Maybe you've never held a baby before.

[00:02:15] Maybe you've never changed a nappy. Maybe you're really concerned about, you know, oh my goodness, how do we do this? And I just need someone to come and help support us in those first, you know, four to six weeks of having a new bubby and I've got lots of questions to ask and I kind of want someone on standby.

[00:02:35] And you might think to yourself, I've got friends and family and they're amazing and all the rest of it, but you know, I don't really want to be leaning on them. And maybe they might not be consistent with coming over, or maybe you just want someone with a bit of nonjudgmental advice to kind of be your, be your Mary Poppins for mothers, which we have been called before previously.

[00:02:58] If you're a little bit, you know, lacking confidence, but you want to be empowered and have someone on tap for resources and to hold space for you and give you an opportunity to recover properly after pregnancy and birth, then you might want to have a look at having a postpartum doula. Equally, if you're feeling concerned about birth and you want a cheerleader for that birth process, we have birth doulas as well.

[00:03:29] So if you're, if that kind of, you know, is up your alley, then head over to our website, IfIfillyourcup.com and you can check out all of our offerings there, which is very exciting. Brisbane. Woohoo. All right. In today's episode, as I said, we have got one of our regular guests back. It is none other than Dr. Cheryl Phua. She is an IVF Australia fertility specialist. I love having Cheryl on the podcast. She's got such beautiful energy. And. I always learn so much. I was quite fortunate, I didn't have any fertility challenges. And so this is all new kind of territory for me. So in today's episode, we were looking at, the different types of fertility treatments. We spoke about, you know, what to look at as a couple in preparation for having a baby, you know, preconception health, ovulation tracking, all of those things, those kind of really important questions that couples ask, you know, how long do you try naturally before you kind of start looking at fertility treatments, what the options are.

[00:04:44] And there's lots of acronyms. So there's like IUI, IVF, ICSI, she explains it all, which is great. And then we also talk about, you know, the preconception screening, having a look at genetics and things like that. So it's actually a really informative episode. If this is something that you feel like you are maybe having to start this journey or you're thinking about it.

[00:05:11] Get your pen and paper. Dr. Cheryl is on hand. So here we go. Here is Dr. Cheryl Phua Hello and welcome to the podcast. Well, should I say welcome back to the podcast? Dr. Cheryl, how are you?

[00:05:28] Dr Cheryl Phua: Hi Renee. Thanks so much for having me again. How are you?

[00:05:31] Dr Renee White: My pleasure. Yeah, I'm great. I'm great. It's a bit cold here in Tassie today, but you know, we're making do.

[00:05:38] Dr Cheryl Phua: Yeah, you've got the bright sweater on, so I think that's always important to try and make it a little bit better.

[00:05:43] Dr Renee White: Yes, and for all those playing at home who can't see us, uh, Cheryl and I are twinning today. We've got our beautiful like magenta jumpers, and you've got like, I think it's like a nice like blouse or something going on.

[00:05:57] Dr Cheryl Phua: Oh yeah, exactly, like

[00:05:59] Dr Renee White: Oh yeah, cool. I love that. I love it when I went twin with guests. It feels like I'm like, okay, this is going to be a good one everyone.

[00:06:06] Dr Cheryl Phua: I need something to pep me up for like, so that the weekend is almost here.

[00:06:12] Dr Renee White: So everyone would have heard from our introduction that we had Dr. Cheryl, um, on episode 146 about freezing your eggs.

[00:06:21] So if that is an interest to you, then jump back into that episode. But in today's episode, we are going to be talking about fertility treatments. And I guess, you know, the, the variety that we have on offer, like, thank goodness for technology, everyone. Um, you know, it has, it has come a long, long way over the years.

[00:06:45] Um, but before we dive into that, Cheryl, for those who haven't listened to episode 146, did you just want to give us a quick snapshot of who you are, what your background is, what your passions are?

[00:06:58] Dr Cheryl Phua: Thanks, Renee. Sure. As a quick recap, I'm Dr. Cheryl Phua, one of the fertility specialists at IBF Australia. I work primarily in the CBD in Sydney, but also out in the northern beaches in Dee Why and St. Leonard's. My passion is just empowering women and couples who are thinking of embarking on their fertility journey with information, and just to make sure that they're asking questions, having a chat about things, so that they're actually aware of their bodies and their reproductive potential.

[00:07:26] Also, it's really important for fertility preservation because like you mentioned, technology's expanded far and wide now and it's really, really, science has finally caught up with our aging bodies and we're able to preserve fertility to some extent for women and men for their future use if now is not the right time to start your family, for example.

[00:07:45] Dr Renee White: Oh, absolutely. Um, I'm trying to recall his name, but we had him on the podcast and he was talking about, you know. The, I guess the infancies of IVF and how far it's come.

[00:08:00] Dr Cheryl Phua: Oh, yeah.

[00:08:00] Dr Renee White: And it, it is, it is crazy. It is so, so crazy. You know, like even to the extent they're like, you know, you are using AI and stuff like that to help the lab. Like that is just. So cool. 'cause I think everyone thinks AI is like some like thing that kind of

[00:08:16] Dr Cheryl Phua: To help you write you are like research papers. , reassignment, .

[00:08:21] Dr Renee White: Exactly. It's like, uh, we can use it for more than just like writing essays.

[00:08:26] Dr Cheryl Phua: Yes.

[00:08:26] Dr Renee White: And um, content for social media, you know, um, like it, you using it in the lab to like workout prime time for like embryos and just, oh my God, it's so, so cool.

[00:08:39] Dr Cheryl Phua: It's really good. I think it's really interesting because we're at the forefront of that kind of research and we've used it to select which embryo is the best, um, embryo to implant back into a patient to give them the best outcome and the highest chance of pregnancy.

[00:08:50] And in the future, we're hoping to also explore that into say, sperm selection and other selection techniques that might also come in useful.

[00:08:59] Dr Renee White: Man. Okay. So it does have good uses. I love it, not that I'm saying like, it's bad, but like, you know, it gets a bad rap.

[00:09:07] Dr Cheryl Phua: It does. And I think so. Where was it when we had to do our assignments? I think.

[00:09:10] Dr Renee White: I know right, Iwas like, Oh my God, we had to start from scratch.

[00:09:16] Dr Cheryl Phua: All these synonyms combined for like a word.

[00:09:20] Dr Renee White: Yes. But for all those people in their like twenties, we used to use these giant big books called thesauruses. Uh, we didn't have Google and, well, yeah, we did have Google in the 80s, but like, you know, back in high school, everything was from scratch. Yeah. Oh my God. How did we survive, Cheryl? I don't even know.

[00:09:40] Dr Cheryl Phua: I have no idea. They were so worried about plagiarism back then, I'm like, how did you even

[00:09:44] Dr Renee White: I know. Yeah. Why? Yeah. Oh God. I don't even know. I, I would, I used to be, I used to mark exams for uni and I also used to teach classes in uni as well. I, I don't, I don't even know how you would do that these days.

[00:10:03] Dr Cheryl Phua: I know, I think they must also run it through some sort of AI, because it's just, but if you've got so many people writing about the same topic, then surely there'll be some similarity.

[00:10:14] Dr Renee White: Yeah, there's got to be some overlap. But anyways, we've gone Welcome to the Science of Motherhood. We actually here to talk about fertility.

[00:10:23] Um, now we took the, obviously the premise behind this whole topic is fertility treatments, but I think it would be remiss of us to not talk about before we even enter into that realm. What are some of the things that couples can be thinking about to prepare themselves for conception? Because I would imagine that, you know, majority of people are having that conversation with their partner, you know, maybe with their GP.

[00:10:52] What are some of the kind of preconception health checklists that they could be, you know, marking off before we even start about fertility treatment?

[00:11:00] Dr Cheryl Phua: So it's really important, much like general health and well being, lifestyle, diet, exercise, and supplements are really, really important to explore prior to starting on their fertility journeys, either as a single woman exploring egg freezing, for example, same sex couples wanting to share eggs and sperm, um, or even a couple trying to embark on having a first or second child.

[00:11:22] Lifestyle, diet and exercise really, really important. Regular exercise, half an hour walks three or four times a day, whatever suits you from a lifestyle perspective in order to try and fit that into your busy schedule. Ex um, diet is important and studies have demonstrated that the Mediterranean diet in my head, it's pasta and cheese, but it is not.

[00:11:43] So I encourage your listeners to go and research that. There's lots of good websites to tell you what proportion and things to have. It's lots of fresh fruit, veggies, fish, a little bit of red meat and a little bit of carbs, unfortunately, guys. But the Mediterranean diet has been shown to be really high in antioxidants.

[00:12:00] So both for male and female fertility and general health, it seems to be really helpful. In terms of supplements for couples wanting to conceive the female needs to remember to be on a pre pregnancy supplement most importantly folic acid and iodine in most women vitamin D has also been shown to be really really important so you have to be replete in vitamin D and iron stores in order to make sure you can have a healthy pregnancy. In Australia I think that sip slop and slap you Slogan has been so well, so that we are very good at using sunblock, not going into the sun at these horrible hours of the day, but, and keeping skin great and things, but that in itself, if we've got an office job, we're bound indoors, not really going out except for the weekends.

[00:12:45] You'll be amazed to see how many of my patients actually have a low vitamin D level. And they never knew because we don't normally check for it.

[00:12:51] Dr Renee White: Yeah.

[00:12:52] Dr Cheryl Phua: In healthy young women and so that's really important to make sure you can't really overdose on it. So check it with your GP and if it's so you can easily have a vitamin D supplement.

[00:13:01] I just leave a bottle of them in my office. Most of them I remember. And it's simple pill to swallow because it's one of those capsules and not actually one of those dry tablets.

[00:13:10] Dr Renee White: Yeah and so is your recommendation to like almost go get like a blood panel done and just check off those things. As you say, you know, lots of us are living with like vitamin D deficiencies are quite low in it. And so you wouldn't even know, right?

[00:13:27] Dr Cheryl Phua: No, you wouldn't even know. And it's what you don't know, right? It's a bit like not knowing about age, female age and its impact on quality. It's about the same thing because people know, you know, yeah, we shouldn't drink or smoke when we're pregnant, but in the lead up to the excessive amounts of caffeine, for example, too much alcohol, obviously smoking and vaping has been shown to reduce fertility in couples. So those are the other aspects of lifestyle that we also need to be cognizant of to reduce in the lead up to falling pregnant. Some of these things can take three to six months to impact sperm and egg health.

[00:14:00] Dr Renee White: Yeah, I'm so glad that you said sperm and egg health because I was having a conversation with someone the other day and we were talking about, you know, her preconception journey and things like that and there was so much focus on the woman.

[00:14:15] And then like it transpired that like, you know, 12 months later, they did a check for her partner and his sperm was not in tip top shape. Right. And she's like, I feel like we've wasted 12 months when we could have been making other lifestyle changes. It's not just about egg wellness. It's about sperm wellness as well people.

[00:14:38] Dr Cheryl Phua: I would say it takes two to clap whether or not using, you know, whether or not you have a partner, a donor, et cetera. And so we want to remember that there are two components to forming babies, which is the male component, sperm and the female component, the egg. And so it's important that both aspects are optimised from a health and lifestyle perspective.

[00:14:57] Dr Renee White: I do want to ask also, because I feel like I've kind of seen some contradictory kind of statements out there. Some people I've, I've seen are in the school of thought of like, you know, whatever your current state of like, let's say the healthiness of your eggs are, that's what you're stuck with and there's nothing else you can do to change that. Is that true or false? I would love to know that.

[00:15:21] Dr Cheryl Phua: Definitely not true. One of the sort of various complete obsess and you've heard me bang on about it on your previous episode about egg quality.

[00:15:28] Dr Renee White: Yes.

[00:15:29] Dr Cheryl Phua: The two components at a minimum, really, to look at egg quality. One of them, you're correct, we can't really change that and that's the genetic quality in the eggs.

[00:15:37] That's what leads to higher risk of miscarriages in older women and Down Syndrome because the eggs genetics just aren't right as we age because our eggs have been with us since we were born. The second component that may be able to be improved is egg energy. So the mitochondrial are the powerhouses of energy in all of our cells, especially the eggs.

[00:15:58] And it's this energy that we think as reproductive physicians and biologists have proven this, that it might be helpful in the development of embryos because it gives lens embryos energy to keep dividing and growing inside your body or in our lab.

[00:16:13] So that's what we think supplements, for example, antioxidant supplements like coenzyme Q10, SNAC, NAC, nicotinamide, these things have been shown to improve energies in primate or animal studies.

[00:16:26] And now we're sort of seeing it filtered out into embryos as well. So while we can't change the genetic quality of eggs, cause that's tied very closely with female age, all of these things that are prone to oxidative stress or damage, for example, high BMI, um, diabetes, other health problems, and poor dietary intake and lack of exercise.

[00:16:47] All of these things may be ameliorated if you're doing lifestyle changes to help that portion.

[00:16:52] Dr Renee White: Oh my god, that makes so much sense. I'm so glad because people just make statements and it's never actually logically you know, being sounded out like that for me, but that totally makes sense. You've got the genetics and then you've got the energy from the body.

[00:17:06] Dr Cheryl Phua: But in my setup, like, look, I'm seeing a couple in front of me, which is someone last week. I'm like, look, we're seeing it, but we've got, we've got to do what we've got now. We've got to optimise our chances right now because you weren't ready at five years ago to have a baby and don't beat yourself up over it.

[00:17:18] Now's the time to go for it. So we have to try and optimise other things that we can and what we can't change. It's just a matter of trying to optimise the other aspects that we can try and improve on.

[00:17:28] Dr Renee White: Amazing. Thank you for clarifying that. So let's say we, you know, as a couple you start trying, um, how long do you think a couple should try to conceive a child before they should start looking at fertility treatments?

[00:17:44] And I guess We're probably talking about, you know, a hetero couple, you know, I imagine that's going to be quite different to like a same sex couple or a, you know, single mum by choice, whatever that looks like. How long is like, you know, is there, is there a number or it's just kind of like, whenever?

[00:18:04] Dr Cheryl Phua: Really, really good question, Renee, because there used to be a number. Okay. And then August this year, we sort of endorsed the new definition of infertility, which takes away the stress of a couple saying, Oh my God, I can only see Cheryl after I've been trying for six or 12 months.

[00:18:19] Dr Renee White: Okay.

[00:18:19] Dr Cheryl Phua: That we thought was a little bit unfair because there might be other factors in a couple's history that might mean that they might need to seek help a bit earlier or sooner rather than later.

[00:18:28] And we didn't want that to be a barrier to couples or single women or anything accessing treatment. or a fertility specialist appointment, or even to see your GP.

[00:18:37] Dr Renee White: Yeah.

[00:18:38] Dr Cheryl Phua: Traditionally speaking, and in a lot of international guidelines, prior to this year, the standard definition of infertility or the inability to conceive was in young women less than 35, the absence of falling pregnant, so unable to fall pregnant after 12 months of actively trying to conceive.

[00:18:56] If you are older than 35, these guidelines try to take into account female age and sort of the necessity to be a bit more proactive. So with six months of actively trying regular, unprotected sex, and if you're not pregnant, that's your definition of infertility. Okay. Our new guideline, and I'm just going to bring it up so I don't stuff up the

[00:19:16] Dr Renee White: Yeah, go for it.

[00:19:18] Dr Cheryl Phua: Yeah. Says that, look, the revised definition says that infertility is a disease. So we have to remember that it's, it's a condition, it's a medical diagnosis, is inability to achieve a successful pregnancy based on a parent's medical, sexual, and reproductive history, age, physical findings, testing, or any combination of these.

[00:19:40] In patients having regular unprotected sex without any known cause to suggest impaired reproductive ability, evaluation should start at 12 months if a female is younger than 35 or at six months if someone's older than that, but nothing should deny or delay treatment or investigations of an individual regardless of sexual orientation or relationship status.

[00:20:02] So this is trying to encompass patients who are a little bit more anxious. You've had a family history of troubles with falling pregnant, for example, same sex women wanting to access donor sperm because in the eyes of the law, there was no infertility because they haven't been trying. But they got no sperm.

[00:20:18] So, so we're trying to get around with the new definition, which is broader and hopefully will allow in future more people to access Medicare benefits for fertility treatment.

[00:20:28] Dr Renee White: Right? Yes. Yes. Okay. That is, that's great to hear because yeah, there's, I can imagine there's.

[00:20:36] Dr Cheryl Phua: I know back in the day it was really tricky because Medicare has a very specific definition for accessing Medicare benefits for IVF, for example. But that was quite antiquated, as you can imagine, because nobody looks at it to revise the definitions with all of these new relationships and models that are available now. And so that's part of our sort of initial push to get them to revisit and look at their current Medicare coverage.

[00:21:00] Dr Renee White: Okay. That totally makes sense. All right. So we don't have a definitive number, but, you know, you can kind of proceed as as you feel, I guess.

[00:21:08] Dr Cheryl Phua: And also I think that that guideline of 6 to 12 months is a good time to segue into treatment because prior to that, and hopefully this segues into the next bit about what we're going to talk about for treatment is that it doesn't mean that if you see your GP, or if you see a fertility specialist like myself, that will be forcing you to have IVF straight away.

[00:21:27] It doesn't quite work. Like that's a worry. Oh my God. I stepped through the doors of her office and like, she's going to just push me down IVF.

[00:21:34] Dr Renee White: Yeah.

[00:21:35] Dr Cheryl Phua: It doesn't quite work that way. And it sort of usually works in, involves sort of assessing the female and male or the couple in front of me, seeing what their concerns are, doing some further tests if we need to, and then assessing what the best way forward is in terms of, you know, is there things that we can do? For example, we can track ovulation cycles here at IBF Australia with blood tests and ultrasounds.

[00:21:57] And we are pushing so that it's three months of this will be covered by Medicare. So there's literally no out of pocket costs.

[00:22:04] Dr Renee White: Oh, wow. Okay.

[00:22:05] Dr Cheryl Phua: So this way we know, and we can pinpoint exactly when the egg is being released. So that couples don't miss that fertile window.

[00:22:12] Dr Renee White: Yeah.

[00:22:13] Dr Cheryl Phua: And this just supplements couples using the app, using ovulation pee sticks. And some people even use the Mira app, which is something that's available for you to purchase online to try and see if we can help assist couples in timing of intercourse. Because you'd be surprised at how many people get it wrong.

[00:22:31] Dr Renee White: Oh, yeah, I mean, I remember having this conversation with girlfriends, you know, we all were kind of like, yeah we're ready to have kids. And, you know, our friend was like, I'm using the app. You know, we're doing what we're told to do. And she was like,

[00:22:49] Dr Cheryl Phua: Oh, the app says this, you know, I was like, yeah, but the app is an average of all the data you've put in.

[00:22:53] Dr Renee White: Exactly.

[00:22:53] Dr Cheryl Phua: And that's why people are like, Oh, well, yes, it doesn't actually predict anything. It gives you a range because it's taking into account what you put in. So the more you put in, the better it will be. But if you put a month in, it's not really going to know, it's just going to take an average.

[00:23:06] Dr Renee White: Exactly. I think she, like they had been trying for like three months. And I, I said to her, I said, I said, yeah, I hear what you're saying. I said, I said from my past, cause I think we were. We had had our baby probably like 12 months before and I said, if it was up to me, I would, I would say three days before it tells you that you're ovulating because that's what happened to me, um, because it was quite unexpected for us and I was like, just go for it and then

[00:23:38] Dr Cheryl Phua: Yeah every second or third day, go for gold. You just don't know when the egg is going to come away. Precisely. That's exactly right.

[00:23:43] Dr Renee White: Absolutely. Okay. So let's talk about the options of treatment because I'm so glad you've cleared the air because there are people who think as soon as they walk into a fertility specialist consult, they're going to be like, yep, bang straight into IVF, but that's not the case. It's actually quite a few options.

[00:23:58] Dr Cheryl Phua: No lots of women fall pregnant without IVF. So lots of women fall pregnant, for example, after checking the tubes are clear with a tubal flush ultrasound. And then we just combined that with tracking to pinpoint when. The best time for intercourse is, and you'll be surprised that some people are like, Oh, this is exactly not what my app said, or this is not when I thought I would be ovulating.

[00:24:17] And then that actually gives couples that monthly chance, maximising the monthly chance of falling pregnant naturally.

[00:24:26] Dr Renee White: Okay. So let's work through them. So there's IUI, IVF and then ICSI. I want to call it ICSI. Is that right?

[00:24:33] Dr Cheryl Phua: That's very good. That's correct. So IUI, as my patients will know what I say, I call it turkey basting.

[00:24:39] Dr Renee White: Yes, I was, that is the picture in my head as well.

[00:24:43] Dr Cheryl Phua: I'm like, but that's in, in people, I think in most couples and most sort of people who don't really know. the science and technology behind it that sort of at least gives you a rough idea of what we're talking about. So IUI or in other words, Intrauterine Insemination is when we place a cleaned up specimen of a sperm sample, either freshly collected from the partner or from the freezer.

[00:25:08] For example, if you're using a donor or if your partner is literally not here because it's in the army, then you might need that fertile time because he's always a way protecting us.

[00:25:17] Dr Renee White: Yeah,

[00:25:17] Dr Cheryl Phua: So we've got to freeze the sperm so that we can use it at the right time that a lady, a female is ovulating and so we can place it a bit like a pap smear.

[00:25:28] We put up an aliquot of cleaned up, washed sperm into the womb to try and allow as many of the sperm to get to the ends of the fallopian tube as possible so that we can then optimise eggs and sperm meeting and chances of falling pregnant.

[00:25:44] Dr Renee White: Is that something that's done? You know, are you awake? Like have, yeah.

[00:25:49] Dr Cheryl Phua: So it's about, takes only about five minutes or so. It's a bit like a prolonged pap smear is what I explained to my patients. Usually it involves tracking a woman's cycle to see when she's about to release the egg. Some women may need medications either in the form of tablets or injections to produce that egg.

[00:26:08] And then just before we know the egg is about to pop or release, we bring them into the clinic sperm comes in as well. So either a partner comes in on that day or we thaw it out from the freezer. And then in a little plastic catheter, the sperm is inseminated or placed into the womb. And I'm just showing guys, I'm showing Renee a picture, placed into the womb like so, so that it's got the right timing and is slightly closer to get to the end of the fallopian tube than just with intercourse.

[00:26:39] So this works really well for couples who have finding it difficult for timing because of donor, for example, like I said, or if the male partner is just not around physically. Some of my male patients might have troubles with erection or ejaculation and find it a bit easier and less stressful to know that if I can freeze the sample now, I've got some in the freezer, so I don't have to worry that when I'm called upon.

[00:27:03] Dr Renee White: Yes.

[00:27:03] Dr Cheryl Phua: To produce a sample I've got a distress out in this weird room where I don't know, and it's like foreign environment is not pleasant to produce a sample at the best of times.

[00:27:12] Dr Renee White: Yeah.

[00:27:12] Dr Cheryl Phua: There's also been a recent release to suggest that in countries, um, internationally, because not everyone has good access to IVF technology, that this might be helpful in the 30 percent of couples with unexplained infertility. And so all of these. aspects can be used to try and optimise natural fertility.

[00:27:35] Dr Renee White: Okay, that's interesting. I haven't even thought about the like military kind of

[00:27:40] Dr Cheryl Phua: I know, like it's like, you know, like FIFO, um, people that fly in fly out for work, it's quite hard to actually time it.

[00:27:47] Dr Renee White: Yeah. Absolutely. Yeah. Gosh, I hadn't even thought about that. Okay. All right. So that, so that, I feel like that's kind of like base level. Is that like the base level?

[00:27:56] Dr Cheryl Phua: Correct, It's like just optimising and it still gets you back to say your natural chances of pregnancy because usually it's just one egg that we're trying to get to release from your body. It's barely just optimising your monthly natural chance based on your age of falling pregnant.

[00:28:10] Dr Renee White: Okay. All right. And so what's the next level that we would normally?

[00:28:14] Dr Cheryl Phua: The next level, you would looking at IVF, and that's termed In Vitro Fertilization, where we basically take eggs from a lady, female partner, put them with sperm outside of the body. So in the laboratory, under strict environment, and then grow the embryos in the lab before implanting the embryo back into my patient five days later, usually.

[00:28:41] Dr Renee White: Okay.

[00:28:41] Dr Cheryl Phua: That's IVF and the question that you had about ICSI or I C S I, that term is called Intracytoplasmic Sperm Injection, where we sort of get the lab to select the best looking sperm based on microscopic evaluation and inject or force feed one sperm into each egg.

[00:29:01] Dr Renee White: Okay.

[00:29:02] Dr Cheryl Phua: The first half, and it still works the same, pretty much the same as an egg freezing patient, because we still need to give hormone injections in order to grow as many eggs as possible in a cycle upon retrieval of the eggs instead of freezing the eggs like we mentioned in the last episode, we're basically combining eggs and sperm together in a dish, if the sperm count is normal, and if there's no other indication for injecting one sperm per egg, we would normally just put eggs and sperm together in a dish and incubate them for five days, which is a normal course of what happens in women's fallopian tubes.

[00:29:42] Dr Renee White: Yeah.

[00:29:43] Dr Cheryl Phua: The best looking embryo usually gets implanted on a fifth day, and if there are any surplus embryos, they can be frozen. usually in men with very low sperm counts, or if we're having to retrieve sperm from the testicle itself, this happens if someone's had an injury or a blockage from where the sperm is produced in the testicle, the outside world, then that means that there is insufficient sperm.

[00:30:10] You just chill out with the eggs and dish overnight. And that's when we've got to force feed one sperm per egg. And then the next step happens the same way. We just grow them for five days, implant the best looking one. And if there's extra ones, we would aim to freeze residual any extra surplus embryos.

[00:30:26] Dr Renee White: Okay. All right. That makes sense. Okay. So IUI, then we've got IVF, which is like them just chilling out in the dish and then ICSI is like, no, hold on a minute, we're going to hand select these.

[00:30:36] Dr Cheryl Phua: You have to like force feed the sperm to egg.

[00:30:38] Dr Renee White: Yeah okay.

[00:30:39] Dr Cheryl Phua: And the whole premise of IVF when it was first, like sort of started all those years ago in the late seventies, early eighties, was because there were a lot of women back then, clearly gynecologists were quite gung ho in the day, you If someone was having a problem, they just removed women's fallopian tubes just to fix a problem.

[00:30:58] And so because of that, some women ended up having no children and no fallopian tubes on either side and these women would be labeled back in the day as barren because there was no way that the egg and sperm could meet without. the tunnel which connects where the egg is released to the womb where the embryo or the baby grows.

[00:31:17] Because of these women IVF was sort of looked upon and that's when we sort of bypassed the tubes.

[00:31:23] Dr Renee White: Yeah, right.

[00:31:24] Dr Cheryl Phua: And so we did the growing in the lab and then we implanted things back into the womb itself.

[00:31:30] Dr Renee White: Wow. Okay. I did not know that. That's very interesting. I have a question around after each one of these treatments, is there like an optimal, I want to think of like nutrition and lifestyle, like, is it go home and rest for like two days? Like what's the optimal thing look like? And does it look different for everyone?

[00:31:57] Dr Cheryl Phua: It does look slightly different for everyone, and I, we normally say sort of lifestyle and exercise, diet and supplements we continue on. No heavy sort of exercise or high intensity stuff, because some people might start to feel quite uncomfortable.

[00:32:11] And usually after egg retrieval, we would also recommend just gentle exercise just to prevent exacerbation of their pain or anything after the surgery. But with implantation or when we implant or transfer the embryo. Following growth in the lab, then from that perspective, there's no need to lie in bed or anything because we want blood flow to the womb.

[00:32:33] So we should do the normal activities as you normally would, because most people would not even know when an embryo is implanting in their womb.

[00:32:42] Dr Renee White: Yeah, that makes sense. Yeah, just continue on. Just don't go and run around.

[00:32:45] Dr Cheryl Phua: Exactly. Try not to stress about it. It's easier said than done. But it's one of those frustrating things that people feel like they shouldn't move because things might fall out. And I say, no, it's not going to be, it's sandwiched there safely in the womb. It's not going to fall out if they do a wee or if they sort of walk around or anything like that.

[00:33:01] Dr Renee White: I know I, I have to admit, like, we were very fortunate and we were able to conceive naturally. But it is that thing when you're a first time kind of pregnant, we lived in this, you know, giant building with, it had like eight floors of parking and I would have to go almost to the eighth floor to park.

[00:33:20] So I was going round and round in circles and I'd have to go over like like I think it was like three or four speed bumps each level. And I remember doing this and I'm thinking, Oh God, is this affecting my pregnancy? Like I was just like, buh bum buh bum buh bum like this the whole time. And I was like, don't be ridiculous Renee.

[00:33:41] Dr Cheryl Phua: Because everything is there, right? You know, your bladder, bowel, everything is around the same pelvic area. And so people get worried because they're not sure, which is completely understandable. And that's why it's sort of really good because we sort of tend to do everything with an ultrasound so people can see what we're doing.

[00:33:55] And then it senses them. Oh yeah, it's a different organ. And so that's why it's sort of going to be safe to continue.

[00:34:01] Dr Renee White: Yeah,

[00:34:01] Dr Cheryl Phua: And I also think I don't know about you, but a lot of my patients and friends and colleagues have been like, Oh yeah, my friend, so and so my friend Jane, she's tried once and she fell pregnant.

[00:34:12] I highly recommend your listeners look online and just go Google say monthly chance of falling pregnant against age and they'll be able to see that even in the 20s it's only 25 percent monthly chance of falling pregnant.

[00:34:26] Dr Renee White: Yeah.

[00:34:27] Dr Cheryl Phua: So it's, it's really frustrating when people just, you know, get stressed out because peer pressure is there.

[00:34:32] You know, you get pressure from your friends, colleagues, people that you would pass on the street, your family, all of these people always have, it's a bit like once you have children, everybody has a thing about how to raise them.

[00:34:43] Dr Renee White: Oh yeah.

[00:34:44] Dr Cheryl Phua: It's exactly the same thing. I think so everybody feels the need to chime in and give you that two cents worth, but it doesn't, it's not always that quick and it's not always that simple. For the vast majority of couples.

[00:34:54] Dr Renee White: Oh gosh, absolutely. Absolutely. I think it's the, we were actually talking about this on the weekend with a group of women that I was kind of working with. Yeah. And I think there's just, In high school, you know, in health education classes, they put the fear of God into you.

[00:35:12] And the only thing they teach you is like body parts and how to put a condom over a banana or a cucumber. And you think as like a 16 year old, you're like, Oh my God, if I have sex, I'm going to get pregnant.

[00:35:24] Dr Cheryl Phua: Yes. And I will be like the end of life.

[00:35:28] Dr Renee White: Exactly. And then like you get to your twenties and thirties and you're like, okay, I'm ready to have a baby.

[00:35:33] And you just think, Oh, all of a sudden, as soon as I have unprotected sex, it's going to happen.

[00:35:37] Dr Cheryl Phua: It's going to happen.

[00:35:38] Dr Renee White: Yeah. And it's just, I feel like we really need to change the conversation on that because it's not true at all. So,

[00:35:45] Dr Cheryl Phua: And the number of women and young girls being put on the pill, which is great because it helps their menstrual management, it helps acne, helps period pains, but also the impact of stopping it.

[00:35:55] Some people are just i'll stop and i'll fall pregnant the next month. Some patients need some time to recover their hormones and everything to work again. And people think that being on the pill and like having great periods means that. whatever problem it was fixing for you while being on the pill, then might present itself once it's off the pill and when you're actually trying to fall pregnant.

[00:36:14] Dr Renee White: Yes. Yes. It's also a very good point. I want to talk about, I guess, the people who, you know, we've, we've spoken on this podcast previously, you know, experts with PCOS and, um, endo and things like that. Um, And I know, like, as someone who has a family history of it, what are some of the things that, I guess, are options for them? Because, you know, I work with people who, like, I'm currently working with someone through their fertility journey and supporting them as a doula through that.

[00:36:47] And, you know, things like, as I said, PCOS and Endo crop up. What are their options? I guess because we've spoken about, you know, tracking ovulation and, and things like that. How do you work through that with them?

[00:37:01] Dr Cheryl Phua: So in terms of PCOS or for example, endometriosis, it sort of depends on the underlying reason why a couple is taking a bit longer than average to fall pregnant.

[00:37:10] And so there are different treatment options for, um, the various presentations that people see me with. Moving on, first of all, I guess endometriosis because it's such a poorly diagnosed condition because most teenagers with painful periods or even young adults,

[00:37:25] Dr Renee White: yeah,

[00:37:26] Dr Cheryl Phua: Will very rightly put them on something like the pill to manage their symptoms because at that time they're probably not looking to start a family.

[00:37:32] Yep. painful periods and stuff. We know the pill works really well for vast majority of women and so that's just in a holding pattern. But then we need to dive deeper and to actually figure out why is it that they've got painful periods? Is it just something that they're going to grow out of? Is it something deeper that might affect their future fertility chances?

[00:37:50] For example, endometriosis. Yeah, it's such a big. Topic that the federal government is actually given more funding to patients so that from next year, if you're seeing a gynecologist for review with suspected endometriosis, you get a longer consult and if you get more money back from your initial consult fee because it's such a big undiagnosed area.

[00:38:14] If someone's having really painful periods and it's affecting their sex life and they can't have intercourse because of pain with intercourse, then that's definitely something to explore the pros and cons of that stage about sending them to a surgeon to do keyhole surgery to look for and clean up endometriosis if it's there.

[00:38:31] At the same time, sometimes we can also check if the tubes are functional or has scarring from endometriosis affected the functionality of their tubes and that could improve their symptoms and optimise natural fertility. Someone with no symptoms, Renee, then that comes to have be, that's the trickier sort of subset or group of patients in which, in which, It could be silent endometriosis causing fertility troubles, but at what point do we bite the bullet to say the risks of surgery are now outweighed by the potential benefits for your future fertility journey?

[00:39:06] That's a conversation to be had with your fertility specialist.

[00:39:10] Dr Renee White: Okay. I just have another question around the actual term escapes me, but it's almost like, is it like secondary It's almost like you fell pregnant the first time really easily and the second time.

[00:39:24] Dr Cheryl Phua: Secondary infertility, yeah.

[00:39:27] Dr Renee White: Secondary infertility, yeah. Okay, so I was on the right track there. Like is there, is there any more like, you know, uh, I guess, light that we can shed on that? Like what's going on there?

[00:39:39] Dr Cheryl Phua: So back in the day, it wasn't that common because people were having their first child earlier.

[00:39:44] Dr Renee White: Right.

[00:39:45] Dr Cheryl Phua: Now that people are delaying childbearing, so if the age of mothers having their first child is older, that would just mean logically that your second child will be even older and therefore that comes into like there's a lot more couples seeing me who have no issues falling pregnant five years ago with little Johnny but now being a bit older having taken a bit of time between babies it's finding it difficult to fall pregnant.

[00:40:10] And at that stage, a lot of things we need to explore so we know how was the pregnancy, were there any complications that might have led to issues with the womb or the carrying capacity, for example, have there been lifestyle changes that might have affected sperm health? All of these things need to be readdressed because it's a bit like trying to find out again why

[00:40:30] Dr Renee White: Yeah,

[00:40:30] Dr Cheryl Phua: A female age is taken longer now when there was no issues before.

[00:40:35] Dr Renee White: Yeah, okay. Yeah, because I've, I've just seen that like prop up a bit more in conversations and stuff like that, but that does make sense, I guess.

[00:40:44] Dr Cheryl Phua: And also, and people sort of tend to be like, oh, it happened once before, it's going to happen again. And then when it.

[00:40:49] Dr Renee White: Yeah, my body knows what it's doing.

[00:40:50] Dr Cheryl Phua: Yeah. And before you know, it's been 18 months, you're like, oh crap, you know, I'm now 42. That, that, that's kind of the, um, situation that a lot of couples find themselves in.

[00:41:00] Dr Renee White: Yeah. Okay. That's interesting to know. Um, I guess before we wrap up, I wanted to also talk about, and this is like, obviously, this is a very cool science-y kind of thing that I love because I'm, I thought I was going to become a geneticist.

[00:41:15] Dr Cheryl Phua: Oh wow, it's a big, big thing.

[00:41:17] Dr Renee White: It turns out that I, it just didn't vibe with me at uni. So I was like, yeah, I don't want to do this anymore. Evidently biochemistry was my thing. So I've moved towards that instead, but I think it would be remiss of us to not talk about, you know, the genetic side of this. Um, and there was some additional funding towards preconception, genetic testing.

[00:41:41] So can you just walk us through what that looks like, um, both from, uh, pre conception and then also like pre implantation as well.

[00:41:52] Dr Cheryl Phua: So importantly, this all stemmed because of this couple, which was really, really good at lobbying, Greg Hunt at the time, way back and the health minister when he was a health minister in order to get coverage for couples intending to conceive or who are pregnant to explore genetic testing of themselves to make sure that there wasn't any hidden genetic or gene changes that could be passed on to their children.

[00:42:19] So for the people that are saying not very good at biology, when eggs and sperm meet, we're sharing genetic information so that there's a copy of genes from mum or egg donor, a copy of genes from the sperm or dad. And so when it combines together, the embryo or the baby is a combination of the male and female genetics.

[00:42:39] Now we all carry hidden genes, but unless we've got bad copies that are present, will we only know or have that condition? Mackenzie's mission was what started this all off. So this couple had a baby called Mackenzie. Unfortunately, she had inherited, unbeknownst to them, Mackenzie had inherited a spinal muscular atrophy gene, one from each parent.

[00:43:04] There was no significant family history on either parent's side, But when McKenzie was delivered and it's important to remember that none of the testing in pregnancy picks this up. This is not like Down Syndrome or other genetic problems where we can easily screen for impregnancy. Mackenzie was born, she wasn't well. She had to go to the baby nursery and then it passed away, I think, when she was about two. And from that, they went to investigate why are her muscles not working outside of her mum's womb. And they realised that she had this spinal muscular atrophy syndrome that basically meant that babies were not usually able to survive past a certain age outside of the womb.

[00:43:42] Dr Renee White: Yeah.

[00:43:42] Dr Cheryl Phua: When they went back to test Mackenzie's mum and dad, they realised that each one of them had a silent dud copy of this gene and Mackenzie was the one in four unfortunate bub that inherited only the bad copy. So even if you and your partner have the same gene change, it's not a hundred percent that the baby will only inherit the bad one.

[00:44:05] It's about one in four or one in two, depending on what kind of change that is. And so through lots of lobbying and through Mackenzie's mission, they then decided and eventually got Medicare to cover three of the most common inherited conditions affecting children. for young adults. The most common one is cystic fibrosis.

[00:44:26] This affects people's lungs, mucus, pancreas. One in 25 people carry it. And it's one in 2, 500 people have lived with the condition and if it's severe, children have to have physio, lung physios, and then eventually have to have a lung transplant because it just fills up with mucus. The second thing is that McKenzie's mission or spinal muscular atrophy carrier rate is one in 40 adults silently without knowing.

[00:44:54] And the last part of the three gene tests that Medicare completely covers, so no cost to females, it's something called fragile X syndrome, which can cause learning difficulties. So these three are what someone in Medicare very cleverly looked through a thousand of genes that were covered in McKenzie's mission and said, these are the most common, most debilitating.

[00:45:15] And so we're covering it that would be picked up in about one in 300 couples. Having that change, if you check for three things, now what's available on the market, because Medicare now covers these three, is that if you want it to pay for more, you can opt to go privately. And there's many, many companies that do it now to 290, 500, 800.

[00:45:40] How long is a piece of string?

[00:45:42] It's like what, how big a panel of genes you want to test. And the more you check, then the more likely it is that you might find a similar one in a couple wanting to conceive. The general recommendation from all of the groups from RANS CoRG to the genetics. Um, group two GPs would be to consider doing this before you fall pregnant or in the first four weeks of pregnancy, because nobody really wants to know when you're 35 weeks pregnant, there may be a chance and the testing around them might involve thinking about stopping a pregnancy.

[00:46:16] So that brings too many stressors with the testing. When it comes, what do we do? I know that my partner and I carry something.

[00:46:25] Um,

[00:46:26] some couples just opt to take the plunge and try to fall pregnant and they can opt to do testing in pregnancy either with an amniocentesis, removing fluid from baby or just see what happens at birth.

[00:46:39] Totally fine. Other couples would usually try and reduce the risk of passing the bad gene down to their children and not have an affected child. And that's when your question came in about genetic testing in the setting of IVF.

[00:46:54] Dr Renee White: Yeah.

[00:46:55] Dr Cheryl Phua: Because we're able to check embryos to only select unaffected embryos.

[00:47:02] Dr Renee White: Okay, so you're checking the embryo, you're not checking the, I'm just thinking you're not checking the egg and sperm.

[00:47:09] Dr Cheryl Phua: No, we're unable to at the moment, but we can check the embryos because by the time the embryo gets day five to six days of age, it's got hundreds of cells. And so we're able to take five or ten of the placenta cells and test for that.

[00:47:24] Dr Renee White: Ah, okay. Okay. That's very clever. And do you, I think the, so the Medicare rebate that came in sometime this year?

[00:47:34] Dr Cheryl Phua: November 2023.

[00:47:35] Dr Renee White: Oh, wow. Okay. Yeah. Yeah. Wow. It's nearly been a year. And have you seen, and I don't know if you've got numbers or anything like that, but have you seen an uptick in people actually utilising this?

[00:47:47] Dr Cheryl Phua: Very much so. So when I first sort of, when it first came out and became a little bit more known, the cost of doing this was $1, 400 a couple.

[00:47:55] Dr Renee White: Wow.

[00:47:56] Dr Cheryl Phua: It was a very small proportion of people did it because they're like, Oh, you know, we've got no family history. This is another additional cost. Now it's covered by Medicare. Quite a lot more women are accessing it for themselves. So they know.

[00:48:06] Dr Renee White: Yeah.

[00:48:07] Dr Cheryl Phua: And so that at least give them a bit of peace of mind to know that the most common bad ones are covered and people can also elect to do more testing if they want to for bigger panels.

[00:48:16] Dr Renee White: Is it just a blood test or is it

[00:48:17] Dr Cheryl Phua: It's a blood or saliva test. Whichever, two options.

[00:48:20] Dr Renee White: Oh, wow. Okay. Oh, so really easy then.

[00:48:23] Dr Cheryl Phua: Yes, correct. And again, Renee, because of this increase in awareness of fertility and genetic problems, lots of patients are also coming now because they themselves have tested for something positive. For example, the Angelina Jolie breast cancer gene.

[00:48:39] Dr Renee White: Yeah, yeah.

[00:48:40] Dr Cheryl Phua: BRCA1 or 2. Yeah. They found out because they've got family members that have had breast cancer early and they're wanting to either do testing to negate that from that so that children don't have to worry about it. All of those things are also increasing. Whereas in back in the day, I used to see couples who had affected children, was the way they found out they carried something, whereas now it's a bit more proactive, a bit like fertility, preserving your fertility with egg freezing. People are more proactive about checking their family history and genetic conditions before coming to see a fertility specialist.

[00:49:16] Dr Renee White: Yeah, that makes sense. Okay. Thanks for clarifying that. And yeah, Yeah, people are,

[00:49:22] Dr Cheryl Phua: I know people need to know more about it, because the poor GPs are bundled with the responsibility of doing all of these checks, all of that, you know, the antenatal screens, all of the infection tests, and then to also talk about genetics. It's very tricky for them in the very short timeframe they've got.

[00:49:38] Dr Renee White: Yeah, yeah, absolutely. Okay, well, thank you for that. We're going to quickly dive into our rapid fire, which I know we did um, In our previous episode, but I reckon if we switch gears and we kind of frame it up with fertility treatments, um, in mind, that would be really, really useful. Are you ready, Cheryl? I tried.

[00:50:01] Okay. What is your top tip? for mums wanting to, who like conceive a child, maybe thinking about they're going to have to go down the fertility treatment route.

[00:50:12] Dr Cheryl Phua: Optimise lifestyle and diet and start on a prenatal supplement. It's really important. See your GP early just for tests to make sure, for example, that you don't need a booster shot for rubella or German measles. All of that can optimise your, um, fertility journey.

[00:50:27] Dr Renee White: Okay, love that. Um, do you have a go to resource for parents thinking about, you know, conceiving a child or about to dive into any one of those fertility treatments?

[00:50:39] Dr Cheryl Phua: Lots of IVF clinics and IVF Australia have a good resource on our webpage to tell you what it looks like.

[00:50:45] We've got fertility advisors and we'll soon hopefully be having a GP with a fertility interest to try and optimise people's health and general well being before embarking on this journey. College website, so the Ranscog or obstetrician and gynecologist website gives you a detailed information sheet for patients about what to eat, what not to eat, what supplements you should be on and what to reduce when you're trying to fall pregnant.

[00:51:09] And all of these places have really good resources, including lots of people, um, lots of dieticians, naturopaths and general health and lots of um, people who are really keen to explore knowledge and share their knowledge and fertility journey have a lot of good resources on their web pages. So I just sort of go on social media, go on the internet and find these links.

[00:51:31] Dr Renee White: Love that. Thank you.

[00:51:32] Dr Cheryl Phua: And I can send you can link it to your

[00:51:34] Dr Renee White: Yes, that would be amazing. Please do. Uh, final question which we ask everyone, what do you keep on your bedside table?

[00:51:43] Dr Cheryl Phua: I can't say the same thing as last time.

[00:51:44] Dr Renee White: You can say whatever you like. Maybe they haven't listened to Episode 146

[00:51:48] Dr Cheryl Phua: A glass of water. I definitely don't drink enough. And Renee is showing her, like, I've just made a cup of tea. That's my first drink of the day. That's like one.

[00:51:55] Dr Renee White: Oh, Cheryl, that's not good.

[00:51:56] Dr Cheryl Phua: I know, I've had two coffees. It doesn't count. And so I just sort of pause myself. So I make sure there's a bottle or glass of water next to my bedside table because I know that I don't have enough.

[00:52:04] Dr Renee White: Oh my god, yes, and you're in an office, which is probably

[00:52:08] Dr Cheryl Phua: I know, and the tea was not even far, I have no excuse.

[00:52:14] Dr Renee White: I think we need to get you a drink bottle with like those, like, dates.

[00:52:18] Dr Cheryl Phua: I have one, it's just, remembering to take it is the problem.

[00:52:23] Dr Renee White: Okay, yeah, it is, it is. Thank you so much. Where can we find you if someone wants to reach out and have a chat to you about their fertility journey?

[00:52:31] Dr Cheryl Phua: Anytime. I'm on social, so Dr Cheryl Phua, you can link me on insta. I've got a webpage drcherylphua.com and reach out to me either by hotdoc or on my website. Make appointment to see me or just reach out on social medias. And if it's a simple question, I sort of normally reply back, but if it's something medical, something that you shouldn't be sharing with me on social media platforms, because who knows what meta is listening to.

[00:52:58] Dr Renee White: Yes. Speaking of AI and meta things, right? Just like, Oh my goodness. Yes. Yes. Yes. Thank you so much for your time. I appreciate that. I've learned so much.

[00:53:10] Dr Cheryl Phua: So if you've learned something, it makes me feel a bit better because, you know, sometimes it's a bit difficult to know what level to pitch it at. But I think any information is good information, especially for people who feel a bit lost.

[00:53:20] It's still taboo, like, you know, and people don't feel comfortable even talking to their friends or family about this.

[00:53:26] Dr Renee White: Yeah, absolutely. And I love it how you break it down. Like, I just, I love it. I think it's so good. But as Cheryl said, there's going to be heaps of resources that we're going to be able to connect people with.

[00:53:37] But yes, if you have a short question, please DM Cheryl. Otherwise, we're going to

[00:53:42] Dr Cheryl Phua: Slide into my DMs.

[00:53:42] Dr Renee White: Did you do telehealth? If people aren't,

[00:53:46] Dr Cheryl Phua: Yes, if people are not from like, if telehealth is no problem, um, yeah, we do everything.

[00:53:51] Dr Renee White: Amazing. All right. Well, thanks again for your time.

[00:53:55] Dr Cheryl Phua: We're also running more information seminars through IVF Australia in our new clinic here at Bond Street.

[00:54:00] So watch out on the IVF Australia socials or their website. We've just done two egg freezing talks a couple months apart. There'll be one coming up for Rainbow Families or Donor Conception in November. So watch that space, there's drinks, nibbles, come along, have a listen, have a chat and it'll be some of us speaking there.

[00:54:18] Dr Renee White: Oh my goodness, that is amazing. Thank you so much for sharing that.

[00:54:21] Dr Cheryl Phua: And we're hoping, like I'm forcing them, we're hoping that they'll basically expand it to different types. For example, one of them I wanted to explore is different types of fertility treatment and what it looks like for the lay person to try and see it on the screen so that they understand what they go through.

[00:54:35] Dr Renee White: Sometimes people just need like an infographic, you know, like not too many words, just some infographic.

[00:54:42] Dr Cheryl Phua: Yeah. And this is, you know, seeing it in person, seeing videos of what happens in a lab, seeing what the lab looks like, like a cook's tour. I just think that's a lot more interesting and people can understand it a bit better.

[00:54:53] Dr Renee White: I want to see that.

[00:54:54] Dr Cheryl Phua: Come along.

[00:54:55] Dr Renee White: I should, I should come along. I haven't been to Sydney in a while.

[00:54:59] Dr Cheryl Phua: I think they're trying to like also make some of them a webinar so people can access it if they're not in Sydney. So hopefully that will be watch this space.

[00:55:06] Dr Renee White: Yeah, keep us in the loop. That'd be awesome. Thank you so much.

[00:55:09] Dr Cheryl Phua: Yeah.

[00:55:10] Dr Renee White: All right, everyone. Until next week, we will see you.

[00:55:14] Dr Cheryl Phua: Thanks for having me. Lovely as always to chat.

[00:55:16] Dr Renee White: Thank you. If you loved this episode, please hit the subscribe button and leave a review. If you know someone out there who would also love to listen to this episode, please hit the share button so they can benefit from it as well.

[00:55:32] You've just listened to another episode of The Science of Motherhood, proudly presented by Fill Your Cup, Australia's first doula village. Head to our website, ifillyourcup.com to learn more about our birth and postpartum doula offerings, where every mother we pledge to be the steady hand that guides you back to yourself, ensuring you feel nurtured, informed, and empowered so you can fully embrace the joy of motherhood with confidence. Until next time, bye!