Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. In today’s episodes the docs talk about a subject many infertility patients ask about. We talk about the financial aspect of infertility in this episode entitled Things You Should Know About Your Fertility Coverage. The doctors explain the complexities of fertility insurance and what patients should know before starting treatment. They cover the differences between plans that offer no infertility coverage, those that cover only diagnostic testing, and those that cover certain treatments like IUI but not IVF. The discussion includes how many IUI cycles may be required before IVF is covered, the limits on coverage for IVF or third-party payers like Progyny, Maven, and Carrot, and restrictions on egg freezing or embryo creation. The doctors also highlight how high deductibles can affect out-of-pocket costs and point out that some small grants are available, usually based on need or a patient’s fertility journey. They emphasize the importance of understanding your coverage and using your fertility clinic as a resource to navigate insurance options. This podcast was sponsored by The Fertility Centers of Illinois at Milwaukee.
Episode Transcript:
Susan Hudson (00:01)
You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.
Susan Hudson MD (00:22)
Hello everyone, this is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored. I am here with my beautiful, boisterous, and brave co-host, Dr. Carrie Bedient from Fertility Center of Las Vegas.
Carrie Bedient MD (00:37)
Hello? Good. How are you guys? What’s new in your lives?
Susan Hudson MD (00:39)
and Dr. Abby Eblen from Nashville Fertility Center.
Abby Eblen MD (00:42)
Hey everybody.
Susan Hudson MD (00:43)
Hey, how’s it going?
Abby Eblen MD (00:46)
Doing pretty good.
Susan Hudson MD (00:48)
Not much, probably watching too much Netflix.
Carrie Bedient MD (00:52)
So what’s, what are your go-to shows on Netflix? Now I am a Netflix, not even novice, I’m Netflix naive because we don’t have Netflix. So tell me, tell me what I’m missing.
Abby Eblen MD (01:01)
Really?
Susan Hudson MD (01:05)
I go in spurts because I definitely binge when there’s new seasons out. I’m hyper focused on any series at any one time. And sometimes I’ll rewatch a last season when a new season comes, like when a new season’s about to come out. I love Bridgerton. I like Heartland.
Carrie Bedient MD (01:24)
Is Landman on Netflix?
Abby Eblen MD (01:27)
I love, I love, love Landman. It’s Paramount, but I love it. That’s, get so. I didn’t think I really liked Billy Bob Thornton, but he is hilarious. I love that show. I think it is so funny. He has the best one-liners.
Susan Hudson MD (01:31)
It’s amazing.
My husband said that he saw an interview with him one time that when he was in acting school, because he has a certain, I guess, je ne sais quoi about him, they said that if you do not write your own scripts, you’re not going to find a job. That’s how he actually kind of, I think the first one he wrote was Sling Blade or something along that.
Most of his big productions have been things that he’s had a big hand in in forming his character. And I just found that really interesting. But I think honestly, I think there’s a lot of, especially male actors, that they fit a persona and they tend to go towards that. And I imagine if I met them in real life that they would have a flair of whatever that character is because it’s part of who they are. I don’t know.
Abby Eblen MD (02:37)
Yeah, yeah, it’s a great show. It’s really funny. My other go-to show, and I just finished watching the last season because the new season’s coming out soon, is Outlander. So I really like that one. I couldn’t remember if I’d actually seen the last season. As it turned out, I’d only watched part of the last season. So was kind of cool because there were new episodes that I hadn’t seen. So looking forward to that coming out. But this is going to be the very last season of Outlander, unfortunately. It’s a great season.
Susan Hudson MD (02:48)
That’s a great one. I like the Empress. Night Agent. Virgin River. Call of the Midwife. The Crown.
Abby Eblen MD (03:08)
Yeah, that’s a good one. Yeah, that’s good.
Carrie Bedient MD (03:11)
Sounds like there’s a lot.
If I were to ever take the dive, maybe I’ll just never take it because that sounds like a lot to do.
Abby Eblen MD (03:18)
So what do you guys watch at night then, Carrie? Do you watch TV at night?
Carrie Bedient MD (03:23)
Some hockey.
Abby Eblen MD (03:25)
Really? Wow! Yeah, there’s a whole world out there that you haven’t seen.
Carrie Bedient MD (03:27)
Yeah. Yeah.
We play games. We’re nerds. Yeah. All right. What question do we have Susan?
Abby Eblen MD (03:31)
It’s good for you.
Susan Hudson MD (03:37)
So our question for today is, Please help me understand SART data. I have four options in my area and my OBGYN recommended two out of four, basically saying they have different flavors. One is a smaller clinic with one doc while the other is larger with three REIs. I tried reading reviews, parentheses always with a grain of salt and looking at SART data.
On the larger lab is amazing, but how do they know? The smaller one has a note that they do a high amount of diagnostic cycles pre-PGT-A testing cycles, which may impact their numbers. Great to have options, but I’m confused. Also to note that I am egg freezing, age 36, AMH 0.33 taken while on OCPs for 15 years. AFCs range between four to nine. That’s a great question.
Abby Eblen MD (04:32)
That is a great question.
Susan Hudson MD (04:34)
If there’s anybody out there who can truly interpret SART data, I would love to have you as a guest on the show.
Abby Eblen MD (04:41)
So SART stands for the Society for Assisted Reproductive Technologies, and you can actually access that online. And it really is true data because fertility centers have to enter that data before a patient starts into cycle, and then they have to enter that data after the patient finishes. So there’s really no way that somebody can cook the data and change the numbers. So it’s really good information, but it’s harder and harder to interpret. I gave a talk recently, was trying to look at that, and I was having a hard time interpreting it too.
But certainly the things that you want to look at are pregnancy success rates, although in your case you’re freezing eggs. That’s really hard data because that’s actually what I was looking for when I looked at the SART data. All you can really say is how many cycles that they do, or that’s pretty much what I gleaned from it. So I think from that perspective, and I just think a bigger clinic generally does more cycles. They have more experience, more experience with everything, not only creating embryos, also freezing eggs. All things being equal with egg freezing, I would probably go for the bigger clinic. But there’s more nuances that you can look at if you were trying to create embryos or try and get pregnant.
Carrie Bedient MD (05:45)
I would say that you actually can cook the books on SART. It’s not that it’s an intentional deception. It’s that the way that the data is collected, actually tends more, at least for a long time. I think they’ve just started to switch it, but I don’t think the switch has actually become apparent in what the people who look at it see, but it used to be for a long time that they favored fresh cycle transfer clinics as opposed to freeze all cycle transfer clinics because of the way that they requested the data. You could actually have really amazing rates and it wouldn’t show up in that because of how they request the data. There’s also the possibility of someone just not being careful as they’re putting the data in and not matching every single cycle, not reporting every single cycle. There’s definitely an honor system that’s involved there because there’s no checking that happens. SART will occasionally do an audit if there’s something really way out of line in either direction, but that doesn’t account for 95 % of the clinics that are out there. There’s several factors you need to consider. SART data is one, but recommendation of your OB-GYN, people who’ve gone through it, there’s a lot more to it because honestly, you’re not gonna know.
At least not to the level that you’re going to want to know. Let me put it that way.
Susan Hudson MD (07:04)
I also want to say as a former fertility patient, when I was seeking fertility care, I had diminished ovarian reserve, my FSH was elevated, it was between 11 and 12. I reached out to this one clinic that at the time and I think still has a really famous reputation for dealing with patients with diminished ovarian reserve. And at this point, so I had had two children, I wanted to have a third and donor was not really what I wanted at that point. And they told me flat out before I made my appointment that I was going to be recommended to use donor egg because quite frankly, I just didn’t fit into their program. And so their are places that cherry pick and if there’s somewhere that you see that their numbers are way too good to seem true, there’s probably a methodological way that that’s happening and that may not actually represent what is being done. At our clinic, we don’t have any absolutes. If you have an FSH that’s crazy high, I may tell you it’s crazy high and I don’t think it may be successful, but if you really, really wanna go through with understanding that and you truly do understand that, we’ll still do a cycle. Could it happen? Yes. Is it likely to happen? Maybe not, but there are clinics out there who say, you have an FSH of 15, we’re not doing IVF with your own eggs.
There’s so many things that go into success rates. People have different BMI limits. Our BMI limit being in Texas is actually a pretty high BMI limit. Our BMI limit is higher than Abby’s or Carrie’s. And does that play into success rates? We all know that obesity does significantly decrease success rates.
At some point we do have to make limits because of safety, but we tend to be more generous because, I mean, quite frankly, we have a larger population.
Abby Eblen MD (09:21)
The one thing I’ll say about cherry picking for this patient, good news, bad news, is I think you said that your AMH was 0.3, is that right? So you’ll know pretty quickly if they cherry pick and they, like Susan said, if it was like the clinic she talked to, you’ll know pretty fast when you talk to them because they’re going to say you don’t fit the profile because your AMH is abnormal. And so if they pick patients based on AMHs, you’ll know fast if that’s going to work or not for you.
Carrie Bedient MD (09:47)
I would suggest interviewing or talking to both of them because with an AMH that is that low, there’s a pretty high chance you’re probably going to have to do this more than once. And there’s a pretty high chance that they’re going to be giving you information that you are not going to be excited about hearing. And that means that you need to trust what they are telling you and also what they are doing for you because there’s a pretty good chance that at some point they’re going to tell you something that is not pleasant to hear, and you need to really trust that they’re doing their best by you, which I’m sure both will, but you may feel that more in one place versus the other. And if you like being in one place more than the other, that’s something to think about, particularly if you’re gonna have to do this a couple of times to get a decent number of eggs to freeze.
Susan Hudson (10:29)
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Susan Hudson MD (10:58)
All right, well today we are going to talk about age and lifestyle and how do age and lifestyle play with each other because we know they’re both important, but where do we draw the lines? What do we think is a line if any? Our first question for today is, does age matter more than lifestyle when it comes to getting pregnant?
Abby Eblen MD (11:21)
Mostly yes. Age is the biggest predictor for fertility success. If somebody’s on the underside of things, so under 35, they can have a lot of kind of strikes against them. And still, even if they don’t have that many eggs or they have other factors going on, still the quality of their eggs, even though they have a lower number, works better than if we had a large quantity of eggs in an older woman particularly people that were doing IVF. Now if you’re doing IUI, I would still say that that’s the case, but the egg number wouldn’t matter as much if you were just doing IUI. But for the most part, age is the best predictor of how much success they’re going to have with IVF.
Carrie Bedient MD (12:03)
A lot of this is going to depend on what is the lifestyle factor itself. And so if you’re talking about a lifelong cocaine and injectable drug habit, I mean, I take the healthy 42-year-old compared to the 28-year-old drug user, things like that. But that’s a pretty extreme example.
Fortunately doesn’t fit most of the people who are walking into our clinics but lifestyle encompasses an awful lot of things because it’s sleep, it’s nutrition, it’s weight, it’s exercise, it’s stress level, it’s just this long laundry list, exposures, so it’s gonna be a nuanced answer for every single person who’s asking that question.
Susan Hudson MD (12:44)
Also think that lifestyle factors, although they do affect fertility rates, I think they almost have a bigger impact on pregnancy success. And are we looking at mom being healthy? Are we looking at baby being healthy and reducing the risks of the pregnancy itself? Realize that being pregnant is one of the most dangerous things that most women will ever do in their life. And when you have lifestyle factors, like all those things Carrie just talked about, we know that we tend to see increased risk of blood pressure issues in pregnancy, things like preeclampsia, increased risk of gestational diabetes, increased risk of c-section, increased risk of prematurity, all those things play a part. And so when we’re counseling patients, of course, our primary role is to help them get pregnant, but we also want to be responsible in making sure that they have the things set up to make the actual pregnancy be as successful as possible.
Carrie Bedient MD (13:48)
Absolutely.
Susan Hudson MD (13:50)
Alright, so our next question is can a healthy lifestyle offset being in your late 30s or 40s?
Abby Eblen MD (14:00)
Yeah, I think it can. I think that age is important, but as Carrie mentioned before, if you’re a smoker and you’re in your early 30s, that’s a big deal because your egg count’s gonna be lower. I think if you’re heavier, that can be more challenging sometimes, particularly with pregnancy issues that Susan talked about. So I think if you have a healthy lifestyle, if you exercise, if you eat well, Mediterranean diets are the things that we recommend, I do think that that definitely has a positive impact on your eggs and potentially your success.
Carrie Bedient MD (14:32)
I would agree with all of that. One of the big challenges when people come to us and they say, I’m super healthy, I do XYZ, all these really healthy habits that the three of us don’t do on a regular basis ourselves, there’s the impact that it has on the egg and there’s the impact that it has on the pregnancy.
Now, if you’re talking about straight pregnancy outcomes, absolutely lifestyle, mostly is going to trump the impact of age because if you’ve got a really healthy 45 year old, yes, she’s going to have slightly higher risk of all the things that Susan mentioned earlier, the diabetes, the preeclampsia, the preterm delivery and so on. But it’s a tiny increment higher as opposed to if you have the eggs of a 45 year old woman, it doesn’t matter how healthy she is or isn’t, there’s going to be a huge difference between those eggs versus those of a younger woman. Some of this depends on the nuance. When you’re talking about eggs, there’s more of an impact of age than if you’re just talking about the pregnancy outcome itself.
Susan Hudson MD (15:34)
Yeah, I mean, if you’re sitting there and you walk in and you’re 42 plus and you’re planning on using your own eggs, we’re all gonna be nervous. It doesn’t matter how much you exercise, how healthy you eat, but if you’re looking at just carrying a pregnancy and perhaps considering things like donor eggs or donor embryos and you have all those healthy things going for you, then we’re going to be like, great, 42, yes, you’re increased risk, but you have all these other things going for you. I think it does make a difference when you’re talking about eggs versus actually pregnancy.
Carrie Bedient MD (16:14)
Absolutely.
Susan Hudson MD (16:16)
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Susan Hudson MD (17:34)
Okay, if I’m younger, can poor lifestyle habits still significantly hurt fertility?
Carrie Bedient MD (17:42)
Yes, absolutely. Smoking is the big culprit here, far and away. That’s the one that I would guess all three of our minds zeroed in on immediately with this question. Smokers tend to have earlier age of menopause, they’ve got decreased egg quality, and they’ve got decreased egg number. Yes, you can absolutely do damage there. There are many fertility clinics where they will not treat you, period, end of story, until you stop smoking because it has such a negative impact on success rates. I would say that is one of the biggest lifestyle factors that doesn’t matter how young you are, can still have a negative, outsized negative impact.
Susan Hudson MD (18:21)
On that note, I was recently talking to a friend of mine who’s an orthopedic surgeon and apparently when people are going in for knee replacements, they are having them do the urine nicotine tests and if your urine nicotine test turns out positive, insurance is refusing to pay for knee replacements.
Abby Eblen MD (18:37)
Really? Wow. No kidding.
Carrie Bedient MD (18:43)
Wow.
Susan Hudson MD (18:45)
I’m curious if that might, as we get more and more payers, like insurances paying for fertility treatments, if that might come to pass. I mean, if they’re starting to do that for knee replacements, I can certainly see how they might do that for things like IVF. Talking about kind of picking on the guys a little bit when it comes to lifestyle factors, the two things that I think of in addition to taking testosterone. Do not take testosterone if you are thinking about having children ever in the future. But those guys who come in who are morbidly obese and the ones who are drinking way too much, you guys who are drinking a six pack a day, y’all are the ones that are going to walk in and we’re going to do the semen analysis and those swimmers are not going to be good. Whether it’s quantity or quality wise, it takes a big hit.
And so when we’re talking about these things, I know we’ve been talking about eggs a lot, but sperm matter, it’s half of the equation.
Abby Eblen MD (19:48)
Well, and with men too, when you talk about weight, the heavier a guy is, the more estrogen a guy makes, and that truly affects the sperm count. In fact, a lot of the men who do urology and see our male patients ultimately will put men not only on a supplement to increase the hormones that would increase sperm production, but they also put them on an estrogen blocker because that also can have a negative impact on the amount of sperm that they have and the quality of the sperm.
That makes a huge difference as well.
Susan Hudson MD (20:15)
We hit this a little bit earlier, but at what age does fertility decline outweigh lifestyle factors entirely?
Carrie Bedient MD (20:22)
I would say for sure 44 or 45. Now there’s the very, very, very rare case where you’ll have the 44, 45, 46 year old get pregnant. Usually it’s after multiple, multiple cycles. And typically the people that we are doing those multiple, multiple cycles on are the ones that are the healthiest because they can tolerate those multiple cycles. And one of the problems with age is that you just have had more time to accumulate insults to the body, whether that’s high blood pressure, high cholesterol, diabetes, whatever it may be. And in a lot of the times doing those repeated cycles is not something that anybody is real excited about in the setting of those medical conditions. But if you’ve got someone who’s otherwise totally healthy and is going for that challenge and they’re a reasonable candidate, based on their discussions with their doc and everybody collaborating together, those are the ones where we’ll try. But like we said, we typically caution three different ways very explicitly. This is highly unlikely to work, and you need to know that going in, because it’s one thing if you’re disappointed at a sad outcome, but it is something completely different if you are surprised. And we don’t want surprised in a setting like that.
Abby Eblen MD (21:36)
Side note when you were talking here a minute ago about things that even a young person could do that would damage eggs. This really is a niche. This really isn’t truly a lifestyle thing. If you’re the person who has the misfortune of having cancer at an early age and you’re exposed to chemotherapy, people are always confused about what that really means. A lot of it largely depends on the type of chemotherapy agent that you use. Some of them permanently damage your egg pool and make it really small or or basically just kill all your eggs and you don’t have any eggs left that are useful. But even if it’s a chemotherapeutic agent that decreases your pool of eggs, you at 33, 34 are really more like somebody in their late 30s in terms of the numbers of eggs that you have and really your reproductive lifespan. Just something to think about if you’ve been exposed to chemotherapy, even if you’re having regular cycles, even if your doctor says, I think you’re fertile, you may very well be, but you have a shortened lifespan there in terms of when you can conceive.
Carrie Bedient MD (22:32)
Just having a period doesn’t mean that you are fertile. And that’s particularly true for the folks who’ve gotten chemo where they didn’t have a period for a while and then it came back. The automatic assumption is, yeah, I’m getting a cycle, therefore I’m fertile. That’s not always the case. All of this applies to men too. And it also applies to chemotherapy given for other reasons than cancer. So lupus is a big one here, renal disease, kidney disease, and lupus patients.
Oftentimes requires chemo agents that are pretty strong and they work, they do their job, but they’ll damage the egg supply. And I would like to make a note that the methotrexate that we give for ectopic pregnancies is not in this category. It’s not gonna have the same kind of effect that you see with the chemotherapy that’s given over long-term high doses, multiple cycles, the one-off shot of methotrexate at really the very low doses that we give for an ectopic. That’s not the type of chemo we’re talking about here.
Susan Hudson MD (23:30)
All right. Do lifestyle changes improve egg quality at any age or only when you’re younger?
Abby Eblen MD (23:36)
I wouldn’t say they really improve, well, I guess if you.
Susan Hudson MD (23:39)
It maximizes your egg quality, whatever your egg quality may or could be. So if you’re 35 and you have X egg quality, you’re not going to necessarily improve it, but it’s not going to make it worse. And so we want to have everything going towards great egg quality that we possibly can.
Abby Eblen MD (23:43)
Right, yes.
Carrie Bedient MD (24:01)
Agreed.
Susan Hudson MD (24:03)
Okay, does male age matter as much as female age or does lifestyle play a bigger role for men?
Carrie Bedient MD (24:10)
I don’t know that it necessarily plays, drink for drink, pound for pound, a bigger role. I think that there are certain behaviors that are much more tolerated in men than in women. Alcohol, for example, we were talking about this one a little earlier, where we’ve got a lot of guys who come in and say, yeah, I have three beers a night, four beers a night. I have a 24 pack over the course of a weekend and…When you compare that to the women for the most part by the time they get to us the women have really really cut back. So they still may be drinking the occasional glass of wine beer, whatever but it’s not to the same degree. When we see the guys stop what they’re doing because they are doing so much more relative to what the women are doing There’s a bigger impact to be made.
If both of you were jumping, one jumping off a table and the other jumping off a roof, there’s a lot bigger difference of what will happen at the end of that. If you’re drinking a lot or smoking a lot or have considerably higher BMI, when you make the change, there is more room for improvement.
Abby Eblen MD (25:20)
Well, and one of the big factors too, which I think all of our listeners probably know this, is women are born with one set of eggs. And like Carrie said, over time, your eggs can have repeated insults and you’ve got that same group coming along. Men make sperm every 72 days. Even if they have an insult, give them three months and sort of the slate is wiped clean because they have new sperm. And so I think that makes a big impact as well.
Susan Hudson MD (25:43)
What are some lifestyle changes that really can make a meaningful impact in IVF success?
Carrie Bedient MD (25:49)
Will I get in trouble if I say smoking again?
Abby Eblen MD (25:51)
No, because that’s a big one. mean, that’s the one we all look at. Yeah.
Susan Hudson MD (25:52)
Nope.
Carrie Bedient MD (25:55)
No.
Susan Hudson MD (25:56)
How much does it affect it?
Abby Eblen MD (25:58)
Pretty dramatically. So we think it’s probably 40 to 50 % reduction in pregnancy rate in women who are smokers. So it makes a huge difference. I would say ideally if you’re a smoker, you really probably want to quit for two to three months before you do IVF if you really want to see the benefit from that impact. Because, it can lurk in your urine and in your body for a while. You really want to get all of that, all those carcinogens out of your body before you do IVF or get pregnant in general.
Susan Hudson MD (26:24)
Lifestyle-wise also obesity. We know that having a BMI greater than 30 is going to significantly decrease your outcomes. And the bigger you are, the more it’s going to have an impact. We all know there are lots of women out there who have larger BMIs who spontaneously conceive. But if you’re already having challenges, it’s something that we really want to have better control over to give you every little statistic point we can.
Carrie Bedient MD (26:54)
That applies to men as well. Sperm like to be in their very closely temperature controlled environment. And when you are carrying extra weight, that extends to the testicles and they can be warmer for longer, which is not good, just because they don’t have the same freedom to regulate their temperature in the same way by moving up or down. That can have a large impact. The other thing that can have an impact is marijuana use. And with respect to both sexes, the marijuana can impact the HPO or HPT access, which is the connection between the brain and the ovaries or the testicles. And it can interfere with that signaling. The other thing that we see in women in particular is that when we put you to sleep for your egg retrieval, if you are a heavy marijuana user, our anesthesiologists will figure that out pretty quickly if you haven’t told them. In part because if you’re smoking it, they can tell with how you’re coughing and how it’s harder to get your airways taken care of well. And you’ll burn through the propofol and the anesthetic agents a lot faster. I’ve seen tiny little women who never disclose that they were marijuana users go through doses that would really stun a much larger human being because because of their metabolism and what the marijuana does to it.
Susan Hudson MD (28:12)
On a related note, when we’re talking about lifestyle changes that can have a meaningful impact, Carrie, we were talking a little bit earlier about shift working. And unfortunately, shift work or nighttime work specifically can have a negative impact on fertility success rates. How do you normally counsel your patients? I think you have more shift workers than the rest of us.
Carrie Bedient MD (28:36)
Yeah, between the casinos and the warehouses, and all the restaurants that are open all the time, what I tell people is do what you can reasonably do, because a lot of the times they’re working that shift for a reason, because that’s what their lifestyle will permit, that’s what their job will permit, and telling them, you need to go to days is not easy. And sometimes it’s not easy because there’s no job that’s available. Sometimes it’s not easy because that means a huge pay cut. Sometimes that’s not easy because the people who work days are a lot crappier than the people who work nights in their particular job. ⁓ That is no slight on anyone who works days, but for those of you who know, you know.
Abby Eblen MD (29:11)
Hahaha
Carrie Bedient MD (29:18)
Looking at those types of things, yeah, if you can shift, fantastic, but also fertility is not your entire life. There is quite a lot of other stuff going on and it needs to be one part of it, not the whole picture for the most part.
Susan Hudson MD (29:33)
Is it better to delay treatment or optimize lifestyle or start sooner because of age?
Abby Eblen MD (29:38)
It’s kind of a balance. If you come to see me at 42, I’m not wild about you waiting six or eight months to lose a bunch of weight. It really depends on your individual situation and how old you are and how much time you have. Overall, if you’re on the younger side of things and you have time to make lifestyle changes, like if you really heavy and you lose weight, that can make a big difference in just your overall health, the health of your pregnancy, in addition to helping you get pregnant. The one side of that too that we haven’t mentioned, and this is not really a lifestyle choice, but the heavier that you are, the more likely you are for your hemoglobin A1C, which is a measurement of your glucose control. It could be out of control and that may limit you from trying to get pregnant because of that. You may end up ultimately being diagnosed with diabetes. So any changes that you can make ahead of time, I think for most people, for most people I would say lifestyle changes trump…I would do that first, that trumps getting pregnant unless you’re in your late 30s, early 40s. Ultimately, that’s a decision that you and your doctor will have to make discussing your own unique situation.
Susan Hudson MD (30:40)
Here’s a little shout out to our listeners. If we’re talking about these things and these different subjects apply to you, don’t wait until your doctor tells you, hey, you should stop smoking, drinking too much, you should work on losing weight. You know what you need to do. I want you to start working on those things now. Because…What we’re telling you is not unique to our practices. Every reproductive endocrinologist is going to…
It’s not even unique to our area of medicine either, probably. ⁓
Carrie Bedient MD (31:17)
Every primary care physician, every physician across fields is going to push for these things because they improve things most of the time.
Susan Hudson MD (31:24)
You should not be surprised when your doctor tells you you need to work on these things. The best answer that I ever hear is, I am currently working on this. That, honestly, I am almost as happy as if you would have told me you quit, because starting to work on any of these issues is the hardest part of the entire thing.
Abby Eblen MD (31:45)
Just bear in mind if it’s weight loss and you’re going on GLP-1 inhibitors, it’s great because it helps you lose weight, but you have to wait eight weeks before you can get pregnant because there’s data to suggest there could be an issue with fetal development. Make sure you disclose them to your doctor because I think now too that think we go these in pill form, more and more people think less that it’s really any big deal. And just as a side note, they’re like, yeah, I’m on this weight loss drug. And we’re like, why didn’t you lead with that? Why didn’t you tell us about that? Because that’s really important for us to know that.
Susan Hudson MD (32:13)
One more, are miscarriage and chromosomal risk driven more by age or lifestyle? Why are these things important?
Carrie Bedient MD (32:21)
When you are at an older age, all those chromosomal abnormalities, too many or too few, Down syndrome, those types of things, that is driven largely by age. If you’re going one for one, age is going to really very significantly impact those chromosomal abnormalities.
Susan Hudson MD (32:39)
I think that’s the big one for that. I don’t know of any lifestyle factors that specifically increase chromosomal abnormalities. Lifestyle wise.
Carrie Bedient MD (32:42)
Yeah.
Abby Eblen MD (32:42)
Yeah.
No, but miscarriage though, miscarriage would be like if you’re out of, if you have diabetes and it’s not under good control or if you have thyroid condition, it’s not, really a lot of things that are not under good control can increase your risk for miscarriage. It may not be due to a chromosomal issue though.
Carrie Bedient MD (33:04)
Or medication that you are on to keep something under control, but that is not a great idea for pregnancy itself. That can impact miscarriage and pregnancy loss as well. One thing for our listeners to consider as we’re talking about all this lifestyle stuff, and this piggybacks on Susan saying, don’t wait for us to tell you. When we do tell you, it’s coming from a place of love and we wanna help.
And sometimes the kindest thing to do is not necessarily the nicest thing to do because the nice thing to do, at least in my house growing up, was you just, don’t mention somebody’s weight. You don’t mention somebody’s habits. If you, if you don’t have anything nice to say, you don’t say it. But in the setting of medicine, the kindest thing to do to improve your success rates and improve your outcomes is to mention the thing that’s uncomfortable, the weight, the smoking, the drinking, things that people feel very judged for when another comments on it. And there’s not judgment here. It’s a, you’re coming to me for me to help you. And this is me telling you, this is worth your time and your effort. And I can’t tell you the number of patients over the years who have really gotten upset at that. And even despite taking a lot of care and being very gentle, in how we say that. There’s still a lot of very hurt feelings that can come from that. And truly, it’s not personal, it’s not judgmental. You’re about to spend a ton of emotional, physical, financial, and mental energy on this. So let’s help you as best we possibly can.
Susan Hudson MD (34:37)
All right, well to our audience, thank you so much for listening and subscribe to Apple Podcasts to have next Tuesday’s episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us spread reliable information to as many people as possible.
Abby Eblen MD (34:38)
Visit Fertilitydocsuncensored.com to submit specific questions and sign up for our email list. Pick up your copy of the IVF Blueprint today at Amazon, Barnes & Noble, or your favorite bookstore. Check out our Instagram and TikTok for quick hits of Fertility tips between weekly episodes.
Carrie Bedient MD (35:07)
And as always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we will talk to you soon. Bye!
Abby Eblen MD (35:16)
Bye.