Speaker 1: On my thirty fifth birthday. After talks with my husband
Speaker 1: and deciding we were ready to start a family, I
Speaker 1: stopped taking my birth control pills. After a year, I
Speaker 1: had not gotten pregnant, so we met with a fertility
Speaker 1: specialist who had me undergo a lot of different kinds
Speaker 1: of tests, some that were really painful and evasive, and
Speaker 1: he determined that I have polycystic ovary syndrome but found
Speaker 1: no other underlying issues. Pcos can make it difficult to
Speaker 1: get pregnant naturally, so my doctor recommended I try entry
Speaker 1: uterine insemination. I ended up doing four iuis with him,
Speaker 1: none of which resulted in a pregnancy. Before I started
Speaker 1: seeing a new doctor who recommended I move on to IVF.
Speaker 1: My egg retrieval resulted in five healthy embryos that we
Speaker 1: had frozen, and since then I have undergone three embryo transfers,
Speaker 1: but none of them resulted in a pregnancy either. I've
Speaker 1: done genetic testing, countless rounds of blood work and ultrasounds,
Speaker 1: a mock transfer cycle, a hissteroscopy, an HSG scan. I
Speaker 1: stopped eating gluten, dairy, and sugar. I do monthly ovulation tracking,
Speaker 1: have regular acupuncture and meditation. Sessions made my fertility a
Speaker 1: full time job, and still I have no answers. I
Speaker 1: just turned thirty nine, and I'm always wondering why not me.
Speaker 1: My friends are all having kids and growing their families
Speaker 1: exactly as they had planned. Well, I'm just spinning my wheels.
Speaker 1: There's so much I wish i'd known about fertility when
Speaker 1: I was younger. None of my female relatives had fertility issues,
Speaker 1: and I always had totally normal results at my annual
Speaker 1: exams with my gynecologist. Plus my PCOS symptoms were masked
Speaker 1: by the pill, so I just had no idea that
Speaker 1: I would ever end up with unexplained infertility. I always
Speaker 1: assumed that if I had trouble getting pregnant, especially since
Speaker 1: I didn't start trying until I was thirty five, which
Speaker 1: is considered geriatric in the medical world, that IVP would
Speaker 1: be a safety net that it would definitely work. My
Speaker 1: last embryo transfer was over a year ago, and while
Speaker 1: I have two perfect embryos still sitting frozen and ready beus,
Speaker 1: I've been too scared to try again, going through the appointments,
Speaker 1: the injections, dealing with the effects of the hormones, holding
Speaker 1: onto hope, and telling myself this time will work. I'm
Speaker 1: just not sure I'm strong enough to go through it all.
Speaker 2: Again, thank you so much for sharing your story with us,
Speaker 2: and a huge thank you to everyone who reached out
Speaker 2: and shared their stories with us. You'll hear more first
Speaker 2: hand accounts later in this episode and in the next
Speaker 2: couple of episodes that we'll be doing on this topic.
Speaker 2: And there were so like we were truly overwhelmed in
Speaker 2: the best possible way by the sheer volume of responses
Speaker 2: that we got. Like I never expected it. It was incredible.
Speaker 2: So thank you to each and every one of you
Speaker 2: who sent in your stories. We appreciate you so so,
Speaker 2: so so much.
Speaker 3: We really do.
Speaker 4: It was incredible. It was a privilege to get to
Speaker 4: read through all of your stories, and thank you so
Speaker 4: much to everyone who wrote in, and we tried to
Speaker 4: include as many people as we possibly could, so you're
Speaker 4: going to hear a lot more first hand accounts throughout
Speaker 4: this episode in our next couple episodes. So thank you
Speaker 4: all so much.
Speaker 2: Yes, Hi, I'm erin Welsh.
Speaker 3: And I'm Erin Ollman Updyke.
Speaker 2: And this is this podcast will kill you.
Speaker 3: Welcome to the first of three Yeah.
Speaker 2: Episodes we said in our social media posts that were
Speaker 2: going to do a two parter, and then as we
Speaker 2: started to like plan what that two parter would look like,
Speaker 2: we realized very quickly that this could not only be
Speaker 2: just two parts, that it needed to be at least three,
Speaker 2: if not many, many many more. We're stopping at three.
Speaker 4: So yeah, it's it's going to be a lot, but
Speaker 4: we are really really excited about it.
Speaker 3: So buckle up. Three weeks up.
Speaker 2: You know, this is do I even need to say
Speaker 2: that this is such a huge topic. It just is
Speaker 2: such a huge topic. We always say this, but this
Speaker 2: time we're really showing you that we mean it by
Speaker 2: dividing it into three episodes. And so just to give
Speaker 2: you an overview of what each of these episodes is
Speaker 2: going to include. The first episode, this one today, is
Speaker 2: going to focus primarily on infertility. So I'll be talking
Speaker 2: about the concept of infertility as it has changed over time,
Speaker 2: leading up to the development of assisted reproductive technologies in
Speaker 2: the twentieth century. And Aaron will go into what to
Speaker 2: expect if you go in for a fertility exam and
Speaker 2: how fertility is assessed.
Speaker 4: Yeah, and then our second episode will be mostly IVF focused,
Speaker 4: So what is IVF, how was it developed, what steps
Speaker 4: had to happen for it to be developed, how does
Speaker 4: this technology actually work, and what does a typical cycle,
Speaker 4: if there is such a thing of IVF, actually look like.
Speaker 3: And then our final.
Speaker 4: Episode will explore IVF as it has grown in terms
Speaker 4: of both industry and innovation, from some ethically murky areas
Speaker 4: to some pretty incredible new technologies.
Speaker 2: Even with three whole episodes, there are things that we're
Speaker 2: not going to be able to cover in depth or
Speaker 2: that will miss entirely, and frankly, that would probably happen
Speaker 2: even if we did an entire series on IVF, And
Speaker 2: as always we will put links to sources where you
Speaker 2: can find more info should you want it. But overall,
Speaker 2: our goals for these episodes are number one, to explain
Speaker 2: what IVF is and how it works. Number two, talk
Speaker 2: about other forms of art assisted reproductive technologies. Number three
Speaker 2: present an overview of how IVF technology was developed, and
Speaker 2: for briefly discuss some of the ethical issues that have
Speaker 2: arisen with art in terms of access regulation and as
Speaker 2: an industry.
Speaker 4: And this is suffice to say a very complex and
Speaker 4: very multi dimensional topic, and there are a lot of
Speaker 4: people out there with really strong feelings about it. Our
Speaker 4: intent is not to add to that noise by sharing
Speaker 4: whatever our individual thoughts that we might have about infertility
Speaker 4: and IVF, but simply to just share all of the
Speaker 4: incredible information that we have learned in the.
Speaker 3: Course of this research.
Speaker 4: So hopefully we do an okay job. But of course,
Speaker 4: before we get into that, it is quarantiny time.
Speaker 2: It is Aaron. What are we drinking this week?
Speaker 3: We're drinking a work of art. Good one. It's a
Speaker 3: good one. It's a little inside joke there.
Speaker 5: Yeah.
Speaker 6: Yeah.
Speaker 2: Oh, and by the way, this is what we'll be
Speaker 2: drinking for this week and the next two episodes on
Speaker 2: this yeah. Classic, yeah, and in a work of art,
Speaker 2: tell me what's in it? What are the delicious ingredients?
Speaker 4: It's kind of essentially like a cucumber gimlet. So we've
Speaker 4: got gin, we've got lime juice, we've got cucumber, We've
Speaker 4: got some simple syrup. You can throw some sparkling water
Speaker 4: in there if you like. It's really refreshing, really tasty.
Speaker 4: And we'll post the full recipe for that quarantini as
Speaker 4: well as the non alcoholic clas Ceba rita on our website.
Speaker 4: This podcast will kill You dot com and all of
Speaker 4: our social media channels.
Speaker 2: We will On our website this podcast will kill You
Speaker 2: dot com, you can find all sorts of cool things,
Speaker 2: including but not limited to, transcripts, links to bookshop dot
Speaker 2: org and goodreads lists, links to music by Bloodmobile, links
Speaker 2: to merch links to our Patreon, links to other things.
Speaker 2: I think all the sources, just all the things. You know,
Speaker 2: take a peek, see what you can find. Tell me
Speaker 2: what I'm forgetting.
Speaker 3: You didn't forget anything. I actually that I noticed. I
Speaker 3: thought that it was great, wonderful.
Speaker 2: Then check done done. Should we get started?
Speaker 3: I think that we should. I really think that we should.
Speaker 2: Let's just take a quick break and then I'll get
Speaker 2: started because we're doing all of these episodes a little
Speaker 2: bit out of order where I go first and then.
Speaker 3: I can't wait.
Speaker 6: So my husband and I we started trying to get
Speaker 6: pregnant as soon as we got married. I already had
Speaker 6: my eldest son from a previous relationship, but we were
Speaker 6: desperate to carry on and grow our family. We tried,
Speaker 6: and after trying for a year, we decided to have
Speaker 6: some investigations. We went to the doctor and it turned
Speaker 6: out that my husband had low sperm counts and low
Speaker 6: sperm motility, and so we were told that the only
Speaker 6: real option was to have IVF. We found a clinic
Speaker 6: that we liked, and we also decided to do egg
Speaker 6: donation alongside our IVF treatment. So what that meant is
Speaker 6: that I donated half of the eggs that were harvested
Speaker 6: during the treatment to another couple, So we got nine
Speaker 6: eggs when they went in to collect them, so we
Speaker 6: gave five to the other couple and we had four ourselves.
Speaker 6: The procedure needed ixy as well, which is where this
Speaker 6: sperm is actually injected directly into the egg, so all
Speaker 6: four eggs were fertilized and then it was a very
Speaker 6: anxious weight call in the lab every day to see
Speaker 6: if our embryos had been dividing and developing. And then
Speaker 6: three days later, we chose while the doctors chose the
Speaker 6: two embryos to transfer back into my uterus. It was
Speaker 6: a very nerve wracking day, but we did it. We
Speaker 6: went home and then it was a two week wait
Speaker 6: to find out if it had worked and if I
Speaker 6: was pregnant. We happened to go away for the weekend.
Speaker 6: It was our wedding anniversary, and just by some coincidence,
Speaker 6: we were staying at our same hotel we spent our
Speaker 6: wedding night, and we ended up in the same room
Speaker 6: we spent our wedding night, and that's where I did
Speaker 6: a pregnancy test and we got a positive result. Then
Speaker 6: six weeks later we saw their little heartbeats and we
Speaker 6: found out it was twins. And then those twins are
Speaker 6: now twelve. I also found out that the couple that
Speaker 6: I donated my eggs too, they had a little girl
Speaker 6: as well, so their pregnancy was also successful. So really
Speaker 6: case scenario everyhoe.
Speaker 5: Hi, my name's Maddie.
Speaker 7: I'm twenty eight and my husband and I are currently
Speaker 7: undergoing IVF in the hopes of having our first baby.
Speaker 7: We got married young seven years ago and we weren't
Speaker 7: really in a rush to start a family, but we
Speaker 7: did decide to start trying about two and a half
Speaker 7: years ago. We're trying for about a year, and during
Speaker 7: that time I noticed that my already painful periods were
Speaker 7: now becoming even more difficult to manage, and I also
Speaker 7: noticed some urinary and.
Speaker 5: Bout problems that were quite concerning.
Speaker 7: It took that year of trying to finally get a
Speaker 7: referral to a gynecologist, and within the first ten minutes
Speaker 7: of meeting her, she was pretty convinced that I had
Speaker 7: endometriosis and wanted me in surgery in two weeks. Two
Speaker 7: weeks later, I had a laproscopy and a histroscopy, and
Speaker 7: my surgeon had found stage four endometriosis affecting my uterus, ovaries,
Speaker 7: fallopian tubes, about and bladder, but thankfully she managed to
Speaker 7: remove majority of it and kind of said that for
Speaker 7: the next six month I'd probably be my most fertile,
Speaker 7: and that she'd be quite surprised if I hadn't naturally
Speaker 7: fallen pregnant. And in that six months those boo and
Speaker 7: urinary problems had subsided, and so too did the period pain,
Speaker 7: so we were quite hopeful. Fast forward six months and
Speaker 7: still nothing was happening, so we requested a referral to
Speaker 7: a fertility specialist and she informed us that my husband
Speaker 7: had a low sperm count. His count was roughly one
Speaker 7: and a half million sperm per meal and the normal
Speaker 7: reference point is fifteen million per meal, so she actually
Speaker 7: recommended IXY over IVF to ensure a good fertilization rate.
Speaker 7: October last year, I had my first egg retrieval and
Speaker 7: I was really lucky and had a really positive experience.
Speaker 7: I wasn't shy of the needles, being a healthcare worker,
Speaker 7: and I had a really good result. We retrieved twenty
Speaker 7: eggs and ten were actually mature enough to fertilize. Nine
Speaker 7: did fertilize overnight, and by day five I had six
Speaker 7: really high quality blastocites. We ended up doing a fresh
Speaker 7: transfer with one of them and froze the rest, and
Speaker 7: unfortunately that transfer failed, and since then we've done a
Speaker 7: further too frozen embryo transfers that have unfortunately also failed.
Speaker 7: I've actually just done my second historiscopy in just over
Speaker 7: twelve months to see if there's some kind of issue
Speaker 7: local to my uterus that might be preventing implantation, and
Speaker 7: I've also done multiple blood tests to rule out other
Speaker 7: issues such.
Speaker 5: As immune or clotting disorders.
Speaker 7: We are actually hoping to do another transfer within the
Speaker 7: next month or two, and we remain really hopeful. We
Speaker 7: both say this is one of the hardest journeys we've
Speaker 7: ever been through, and we're very aware that there are
Speaker 7: people who have been on even longer, more painful journeys
Speaker 7: than us. Every day is a battle, and every failed
Speaker 7: cycle is a full cycle of grief. But we're so
Speaker 7: grateful we have the means to do this, and at
Speaker 7: a time where science is learning more and more every
Speaker 7: day about infertility and how to overcome it, and hopefully
Speaker 7: one day we'll get our little baby.
Speaker 2: It seems to me like every few months there's a
Speaker 2: headline that declares, in somewhat alarmist tones, infertility is on
Speaker 2: the rise?
Speaker 3: Is it?
Speaker 2: Is it? The short answer is no, and I know
Speaker 2: that you'll give the longer answer later in the episode Erin,
Speaker 2: but most research shows that actually global infertility has changed
Speaker 2: very little over the past few decades, if at all.
Speaker 2: I think the more accurate headline would be headlines about
Speaker 2: infertility being on the rise. Are on the rise, And
Speaker 2: I'll get into more of the possible reasons for that
Speaker 2: a little later on, But I wanted to start with
Speaker 2: these headlines because I think they provide an opportunity for
Speaker 2: us to think about what infertility can mean for us today,
Speaker 2: and how those definitions are fluid across space, across time,
Speaker 2: and across intent. There's the medical definition of infertility, which
Speaker 2: the WHO says is twelve months of regular unprotected sex
Speaker 2: without pregnancy, and that definition actually has been like the
Speaker 2: medical definition has been revised over the years. There's primary
Speaker 2: infertility it's like no pregnancy ever, and secondary infertility at
Speaker 2: least one pregnancy previously. And then there's what insurance companies
Speaker 2: will consider to be infertility, which changes what they're willing
Speaker 2: to cover for fertility treatment. There's how infertility is used
Speaker 2: politically as a scare tactic to reinforce gender roles. There's
Speaker 2: fertility rate, which some headlines conflate with infertility rate, so
Speaker 2: you know, like the average woman in twenty twenty four
Speaker 2: is giving birth to fewer kids than in the nineteen fifties,
Speaker 2: so infertility must be on the rise, that's not, yeah,
Speaker 2: something having like two.
Speaker 4: Whole pages that I had to cut down just about that.
Speaker 2: It's very very very different. Yes, yes, infertility. The concept
Speaker 2: of infertility varies also across cultures. So for instance, there
Speaker 2: are some cultures that consider someone to be infertile if
Speaker 2: they haven't given birth to a boy yet. Is it
Speaker 2: a snapshot measure or a lifetime measure? If you become
Speaker 2: pregnant after two years, three years, five years, seven years
Speaker 2: of trying does that still count? Like does infertility apply
Speaker 2: to couples or to individuals? Does intent matter? If someone
Speaker 2: cannot become pregnant due to a medical issue, but they
Speaker 2: have never intended to become pregnant, does that count as infertility?
Speaker 2: Along those same lines, if someone never seeks treatment for
Speaker 2: infertility because of lack of access, personal beliefs, other reasons,
Speaker 2: are they counted in these measures of infertility? Will their
Speaker 2: voice be heard? The bottom line is that infertility can
Speaker 2: mean many different things to many different people, and it
Speaker 2: can be difficult to get a handle on where these
Speaker 2: modern measures of infertility are coming from, who they are capturing,
Speaker 2: and who they are failing to capture. This is one
Speaker 2: reason why we should scrutinize headlines claiming a rise in
Speaker 2: infertility rates, first of all, compared to when the data
Speaker 2: that go into modern measures of infertility are incredibly messy,
Speaker 2: let alone estimates from the early twentieth century or before,
Speaker 2: when infertility was even more shrouded in silence than it
Speaker 2: is today. Secondly, these headlines tend to ramp up during
Speaker 2: periods of backlash against progressive movements like women's liberation in
Speaker 2: the nineteen seventies, which was followed by claims that the
Speaker 2: traditional nuclear family was at risk because career hungry women
Speaker 2: were waiting too long to have kids. And then this
Speaker 2: called for a return to a traditional working husband's stay
Speaker 2: at home mom arrangement. And it's you know, we're seeing
Speaker 2: echoes of that today with this tradwife trend and all
Speaker 2: of the birth controlled disinformation that's circulating around social media lately. Yeah,
Speaker 2: And the last thing I'll say about these headlines is
Speaker 2: that right alongside them are reports of out of control
Speaker 2: global population growth, which shows that it's not about infertility overall,
Speaker 2: but it's rather concern over who is having babies and
Speaker 2: who isn't. If infertility in its bio medical definition is
Speaker 2: truly on the rise globally or regionally or within populations,
Speaker 2: we should investigate why that is. Just because infertility is
Speaker 2: hard to measure, it doesn't mean that we shouldn't try.
Speaker 2: And if we want to do that, we have to
Speaker 2: take in all of the various meanings of infertility, what
Speaker 2: it means to people measuring it, what it means to
Speaker 2: people experiencing it, what it means to people treating it,
Speaker 2: and how those meanings change over space and time. For
Speaker 2: a truly amazing overview of this subject. I highly recommend
Speaker 2: that Paul Grave Handbook of Infertility in History, edited by
Speaker 2: Gail Davis and Tracy Lofgren, which was my main resource
Speaker 2: for this first episode. It's a wonderful collection of essays
Speaker 2: and chapters and works that I really just all across
Speaker 2: the board. I mean, I was like completely overwhelmed, but
Speaker 2: I loved it. So I want to first take a
Speaker 2: step back and consider what it means to look for
Speaker 2: traces of infertility throughout history. Humans have experienced infertility forever,
Speaker 2: but infertility doesn't leave marks on the bone, and it
Speaker 2: doesn't get logged in yearly mortality rates or disease tallies.
Speaker 2: With the exception of the last century or so, it
Speaker 2: is rarely openly discussed by those who are experiencing it,
Speaker 2: maybe because they didn't know how to read or write,
Speaker 2: maybe because their writings were not seen as important for preservation,
Speaker 2: or maybe because shame or pain kept them from including
Speaker 2: it in their writings. There do exist some examples of
Speaker 2: letters or diaries where women have described their feelings about
Speaker 2: not being able to have children or not being able
Speaker 2: to have additional children. Secondary infertility is even more difficult
Speaker 2: to spot in history, but these writings are fairly rare.
Speaker 2: So I'm going to read you a quote from Henriette
Speaker 2: Obermuller Vena Dat, writing in her autobiography in eighteen seventy quote.
Speaker 2: I bought books, I talked to women's doctors. I decided
Speaker 2: to do everything they told me to. I saw the midwife,
Speaker 2: I was told this and that. I heard that there
Speaker 2: was a recipe, but that it might kill me. I
Speaker 2: wouldn't have minded. If only I could have become a mother,
Speaker 2: if only I could have born Gustave a child. I
Speaker 2: was so certain it was my fault.
Speaker 6: End quote.
Speaker 2: Infertility or difficulty conceiving shows up in pagan mythologies with
Speaker 2: goddesses of fertility, and plays in religious texts like the Bible,
Speaker 2: in epic poems. In works of art. We see traces
Speaker 2: of infertility in instances of royal succession, like where a
Speaker 2: male heir is not produced, but for the most part
Speaker 2: in those stories it stays more of an historical plot
Speaker 2: point rather than the lived experience being important on its own,
Speaker 2: probably keeping infertility partially shrouded in silence. Theat history is
Speaker 2: its affiliation with sex, which has always been pretty taboo
Speaker 2: in Western culture. Especially sex without procreation, as well as
Speaker 2: the fact that bearing children has been the expectation, the
Speaker 2: norm throughout all of history, and when that didn't happen,
Speaker 2: it was a noticed and be tinged with shame, indicative
Speaker 2: of a problem. Finally, infertility has mostly been seen as
Speaker 2: a woman's issue, thus not as important for documenting. Who
Speaker 2: is doing the writing after all, who is actually deciding
Speaker 2: what is important in history, you know, and what should
Speaker 2: be preserved or not? Would they have viewed a woman's
Speaker 2: infertility as relevant to the historical record or just to
Speaker 2: whatever story they're telling. As Davis and Lochrin, the editors
Speaker 2: of this book put it, quote, these problems are magnified
Speaker 2: when tackling infertility experiential state that exists as an absence,
Speaker 2: the failure to engender pregnancy that plays out on the
Speaker 2: bodies of women, a historically marginalized group, and that, it seems,
Speaker 2: often further stigmatizes its subjects, thus rendering them inarticulate or
Speaker 2: silent end quote. Where we see the most references to infertility,
Speaker 2: or maybe more precisely, involuntary childlessness is in medical writings
Speaker 2: with hypotheses as to why someone is not able to
Speaker 2: become pregnant or treatment handbooks to target different perceived causes
Speaker 2: of involuntary childlessness, ranging from the biological, to the psychological
Speaker 2: to the spiritual. Today, if someone goes in for fertility testing,
Speaker 2: doctors will try to pinpoint the precise issue and come
Speaker 2: up with treatment based on that. But we know a
Speaker 2: whole lot more now about reproductive science than, for instance,
Speaker 2: ancient Greek physicians, who largely viewed reproduction in like plant
Speaker 2: soil terms. The man provides the seed semen the active
Speaker 2: dynamic material, and the woman provides the substrate, the soil
Speaker 2: the menstrual blood in which the seed is planted. And
Speaker 2: this agricultural metaphor reinforced the role of the man as
Speaker 2: the active partner and the woman as passive, which still
Speaker 2: finds its way into the way we talk about some
Speaker 2: of these aspects of fertility or reproduction. The sperm invading
Speaker 2: the egg, you know, like this very much active role
Speaker 2: and then passive role. And it also explains why the
Speaker 2: terms fertile, barren, and seed are associated with producing offspring.
Speaker 3: I never in a million years would have thought about that.
Speaker 2: There is like so much about agriculture and reproduction in
Speaker 2: ancient Greece and it makes sense, I mean, it's yeah.
Speaker 2: And also what kind of makes sense along these same
Speaker 2: lines is treatment. So in ancient Greece, a lot of
Speaker 2: the treatments for improving conception, and this extended all the
Speaker 2: way to medieval times. They tend to center around either
Speaker 2: balancing out the humors, of course, or prescribing recipes that
Speaker 2: included ingredients associated with fertility, like the sexual organs of animals,
Speaker 2: of certain animals in particular, plants that produce a whole
Speaker 2: lot of seeds, or animal dung which was used to
Speaker 2: fertilized fields for planting crops.
Speaker 7: Oh.
Speaker 3: Gross, but logical in a way.
Speaker 2: Yes. And while many of these treatments were geared just
Speaker 2: towards women, some involved both a husband and a wife,
Speaker 2: and a small handful were just for men. Recipe books
Speaker 2: from medieval England sometimes included tests meant to show the
Speaker 2: source of the infertility. Is it from the husband? Is
Speaker 2: it from the wife? For example, quote the man and
Speaker 2: woman should each urinate into a pot of brand and
Speaker 2: the pot were then left to stand for a period
Speaker 2: of seven, ten or fourteen nights. At the end of
Speaker 2: this time, if the fault lay in one partner, then
Speaker 2: the pot containing his or her urine would stink or
Speaker 2: contain worms. But if neither pot contained worms, then may
Speaker 2: men help them to have a child through medicines.
Speaker 3: End quote yea yeaiyii wow.
Speaker 2: I mean is there something to that? I don't think so,
Speaker 2: but it is very interesting. What worms?
Speaker 3: What worm?
Speaker 2: What worms? I'm so curious a.
Speaker 3: Cup of brand and urine.
Speaker 5: I mean, I.
Speaker 3: Don't even know what to say.
Speaker 2: Yeah, you don't have to say. I don't know, speechless.
Speaker 2: And of course these books would not have been the
Speaker 2: only sources of information about pregnancy and conceiving. We have
Speaker 2: no way of knowing how much knowledge was exchanged between
Speaker 2: women or between men, and never written down. These treatments
Speaker 2: and tests followed the logic of what was then thought
Speaker 2: to lead to pregnancy, which, by the way, just as
Speaker 2: a reminder, not like you need the reminding, but I
Speaker 2: mean we all need the reminder. You couldn't go out
Speaker 2: and get a test to tell you within a matter
Speaker 2: of weeks that you were pregnant. You had to wait
Speaker 2: like a long time.
Speaker 3: Very long time.
Speaker 5: Yeah.
Speaker 2: And I think it also forces us to consider how
Speaker 2: much our current definition of infertility depends on our biomedical
Speaker 2: understanding of reproduction. Which we really only gained in the
Speaker 2: twentieth century. I feel like historically infertility was an absence
Speaker 2: of something, and then it grew into more refined definitions
Speaker 2: of Oh, it is a presence of this issue, It
Speaker 2: is a presence of this issue, all of these different things.
Speaker 2: And also, I mean, of course, I want to acknowledge
Speaker 2: that unexplained infertility makes up a huge proportion of infertility cases,
Speaker 2: or people who seek infertility.
Speaker 3: Will get there, We will get there.
Speaker 2: The word infertility came to prominence in the late nineteen seventies,
Speaker 2: replacing the terms barren and sterile. People knew you.
Speaker 3: Say sorry, sorry sorry sor yeah you're saying nineteen seventies.
Speaker 2: Okay, that's what I read that. It was like, I
Speaker 2: think that infertility had been used, it had been a term,
Speaker 2: but it really I think replaced the other two around
Speaker 2: that time.
Speaker 3: That makes sense, That makes sense.
Speaker 2: Yeah, people knew what sperm and eggs were since the
Speaker 2: seventeenth century, but it wasn't until the late eighteen hundreds
Speaker 2: that scientists figured out how they work together.
Speaker 3: Cool.
Speaker 2: Yeah, that's an entire story.
Speaker 4: It's also so so that's so much earlier than I expected. Somehow,
Speaker 4: like it's it isn't that it is the eighteen eighties.
Speaker 2: Wow, Yeah, like the late eighteen hundreds. I don't know
Speaker 2: why it struck me as late, because I feel like
Speaker 2: if they had known what they both were, But I
Speaker 2: think it was more to like the role that each
Speaker 2: of them played. But even still, sperm and eggs are
Speaker 2: just one piece of the puzzle. For much of human history,
Speaker 2: the nitty gritty of human reproduction remained more or less
Speaker 2: a mystery, and where there's room for doubt or uncertainty,
Speaker 2: there's often room for blame. Women historically and even today,
Speaker 2: tend to shoulder more of the blame when it comes
Speaker 2: to difficulty conceiving, and it's not uncommon to hear modern
Speaker 2: stories where a straight couple goes through fertility testing. The
Speaker 2: doctors find a potential contributing factor in the woman, they
Speaker 2: take steps to treat that, and then months or years
Speaker 2: down the line, finally like still nothing's happening, and they
Speaker 2: finally test the man and find additional issues. In this
Speaker 2: Palgrave Handbook of infertility book, I came across the story
Speaker 2: of a woman who, quote, over a two year period
Speaker 2: in the late nineteen forties, underwent two dilation and curati operations,
Speaker 2: a tubal insulflation, a selpindrogram, an endometrial biopsy, and a
Speaker 2: host of injections, courses of tablets and douches before her husband,
Speaker 2: Seamen was tested and found to contain no spermatozoa end
Speaker 2: quote wow wow, So yeah. We can see this blame
Speaker 2: with many royal families, where women were seen as responsible
Speaker 2: for producing an air and a spare, as well as
Speaker 2: other children for forming political alliances. If a woman failed
Speaker 2: to fulfill her royal and marital duties in that way,
Speaker 2: at the least, she was frowned upon. At the most
Speaker 2: she was disposed of, as Henry the Eighth famously did
Speaker 2: to several wives, even though scholars think that he was
Speaker 2: probably the common denominator and that it was actually quite
Speaker 2: common because at the time forty percent of Tudor marriages
Speaker 2: had no children. Really really, that's what at least historical
Speaker 2: calculations estimate. A marriage without children could be seen as
Speaker 2: a sign of God's disapproval or later on unpatriotic, because
Speaker 2: a thriving population was important for military and economic strength.
Speaker 2: But of course there's the caveat that I had.
Speaker 4: To be the right people reproducing right I mean, honestly,
Speaker 4: that's still the vibe from all of the articles today
Speaker 4: about fertility rates or infertility rates, like, that's the vibe.
Speaker 2: It is the yep, it is yep, it is eugenic,
Speaker 2: y eugenic adjacent. For centuries, women have been scrutinized for everything,
Speaker 2: their behavior, their bearing, their morality, their personality, their indulgences,
Speaker 2: their activity, their education, and especially their bodies to fat,
Speaker 2: too thin, too tall, to short, whatever it is, it
Speaker 2: was their fault. In the nineteenth century, it was thought
Speaker 2: that the more passionate the woman, the more likely she
Speaker 2: would be infertile, ending in an orgasm for a woman
Speaker 2: was thought to be less conducive to child bearing. Ah,
Speaker 2: one of the more depressing things I've I've read.
Speaker 3: It's also not accurate scientifically, let me tell you.
Speaker 2: Oh fascinating, Okay, The moral and medical explanations of infertility
Speaker 2: blended together. By the late eighteen hundreds. The causative agents
Speaker 2: of gonorrhea and syphilis and their effects on fertility were recognized,
Speaker 2: but in general, physicians believed that women's reproductive biology was
Speaker 2: more complex, and so women were more likely to experience
Speaker 2: complications from these infections compared to men. One physician R. A.
Speaker 2: Gibbons said in a nineteen ten address to the Medical
Speaker 2: Graduates College that quote, in many cases of sterility about
Speaker 2: which you will be consulted, it is undoubtedly the fault
Speaker 2: of the woman.
Speaker 3: End quote.
Speaker 2: Ninety six book titled Sterility by Robert Bell begins with quote,
Speaker 2: in considering the important subject of sterility in the female,
Speaker 2: we must not forget the fact that occasionally impotency may
Speaker 2: exist in the male. This is of such rare occurrence, however,
Speaker 2: that it may be looked upon almost as phenomenal. Moreover,
Speaker 2: when it does occur, it can generally be traced to
Speaker 2: the effects of some previous gone a real or syphilitic attack.
Speaker 6: End quote.
Speaker 3: Wow, yeah, it's just so blatant.
Speaker 4: It's also so interesting the use of different words, right,
Speaker 4: like sterility versus impotence. Like, it's very interesting.
Speaker 2: It is. It is. And I don't know, like if
Speaker 2: the definitions have I mean, I'm assuming that they have changed,
Speaker 2: or like the umbrella has changed. Yeah, I don't know.
Speaker 3: It's interesting. They all just have such like weight to them,
Speaker 3: no matter what, like on both sides.
Speaker 2: Yes, Yeah, this attitude, this belief that women were more
Speaker 2: to blame for any sort of issues of infertility in
Speaker 2: a couple. This became a self fulfilling prophecy because if
Speaker 2: physicians were taught that male infertility was rare, then they
Speaker 2: were less likely to examine the husband of a couple
Speaker 2: having difficulty conceiving because also, I say husband, because for
Speaker 2: the most part in this period of time, the only
Speaker 2: people who were seeking, or the vast majority of people
Speaker 2: who were seeking and would be seen by physicians, had
Speaker 2: to be a married couple. There was that sort of
Speaker 2: morality component to it. Some physicians did recognize that it
Speaker 2: wasn't necessarily the wife's fault, the woman's fault with eugenic
Speaker 2: y undertones. So quote A great many women are, through
Speaker 2: no fault of their own, incapable of becoming mothers. The
Speaker 2: reason for this is that they have been infected by
Speaker 2: venereal disease, which is the great foe to the reproduction
Speaker 2: of the race. The husband has infected his wife and
Speaker 2: thus robbed her of the power of maternity.
Speaker 6: End quote.
Speaker 3: It's so interesting erin Yeah, there's Oh, there's just so
Speaker 3: many layers of like connotations and assumptions that go into
Speaker 3: like a sentence like that.
Speaker 2: I know, I know there are directions like where is
Speaker 2: the blame going? Who was the active? Who was who
Speaker 2: was the Yeah? The subjectives yeah.
Speaker 3: Robbed her like everything about.
Speaker 2: It, the word choices yeah, yeah yeah. And we've got
Speaker 2: more because just for ice, we do just wait for it.
Speaker 2: The development of testing and treatment for STIs in the
Speaker 2: early twentieth century helped to reduce infertility associated with those infections,
Speaker 2: but it didn't remove the language of blame. The psychogenic
Speaker 2: model of infertility rose to prominence in the nineteen thirties,
Speaker 2: basically this idea that certain women brought on their infertility
Speaker 2: by not adapting to established gender roles.
Speaker 3: Can I just guess that Freud had something to do
Speaker 3: with this?
Speaker 2: Yes on the Dot? Got it of Yes, Yeah. It's
Speaker 2: been called a quote psychic conflict flying under a gynecologic
Speaker 2: flag end quote. Go Ross, it's awful Ross. Yeah. Okay,
Speaker 2: So I'm going to read you a quote from Freud's
Speaker 2: colleague Helene Deutsch. I also quoted her in our menopause episode. Quote,
Speaker 2: has her fear of the reproduction function proved stronger than
Speaker 2: her wish to be a mother? Is she still so
Speaker 2: much a child that she cannot emotionally and consciously decide
Speaker 2: to assume the responsible role of mother. Is she so
Speaker 2: much absorbed emotionally in other life tasks that she fears motherhood?
Speaker 2: And above all, has the sterile woman overcome the narcissistic
Speaker 2: mortification of her inferiority as a woman to such an
Speaker 2: extent that she is willing to give the child as
Speaker 2: object full maternal love?
Speaker 3: End quote? Oh, the rage of coursing through me.
Speaker 2: I'm sorry, I know, I know, yep, yep, yeah, Like.
Speaker 3: I don't even have like, I.
Speaker 4: It's amazing that that was not very long ago.
Speaker 3: Yes, that was less than one hundred years ago.
Speaker 2: I mean less than a hundred years ago. And then
Speaker 2: sort of like we've talked about the time that it
Speaker 2: takes for something to leave this tradition. I mean, Freud
Speaker 2: had was so influential.
Speaker 4: So influential, like still to this day influential. Yeah, and
Speaker 4: you can't like separate that kind of thing out from
Speaker 4: all of the other ideas, Like, sorry, okay, this is
Speaker 4: not an episode about Freud.
Speaker 2: I know, maybe someday now, I don't know if I'm
Speaker 2: I don't know if I'm prepared to do that. But
Speaker 2: also people sometimes blamed infertility in men on their quote
Speaker 2: unquote domineering and controlling mothers. So it was just like
Speaker 2: always you know, just you know, we're not surprised, just disappointed.
Speaker 4: You can blame a mother for infertility. That's just like
Speaker 4: that's taken a cake, right.
Speaker 2: I mean, yep, yep across the board. Though, you know,
Speaker 2: I do think it's important to note that infertility for
Speaker 2: both men and women was and continued to be highly
Speaker 2: stigmatized and full of blame language. And there's no doubt
Speaker 2: that shame also silenced men writing about their fertility issues.
Speaker 2: A history of male infertility seems even more difficult to
Speaker 2: get a handle on in some degree. And although the
Speaker 2: psychogenic model of infertility fell out of favor in subsequent
Speaker 2: decades as we learned more about how human reproduction works,
Speaker 2: it still lingers in some ways, like the advice that
Speaker 2: you will come across, Oh you're just too stressed, try
Speaker 2: to relax and then you'll get pregnant, or you just
Speaker 2: don't want it enough. Maybe it's your body's way of
Speaker 2: saying this wasn't meant to be. All of these types
Speaker 2: of things have echoes of the psychogenic model, but the
Speaker 2: more positive legacy is that the recognition that Experiencing infertility
Speaker 2: and going through fertility treatments can have profound impacts on
Speaker 2: mental health, revealing a need for mental health professionals infertility
Speaker 2: clinics not as gatekeepers for who is deserving of fertility treatment,
Speaker 2: which is kind of what they started out as in
Speaker 2: some degree, but as support. The twentieth century, which i'll
Speaker 2: talk much more about next episode, dramatically changed not only
Speaker 2: the way that infertility was studied or treated, but also
Speaker 2: the way it was experienced, which I haven't really talked about,
Speaker 2: in part because it's so big, it's so personal, it's
Speaker 2: not at all universal or generalizable. As our understanding of
Speaker 2: human reproduction grew, and as technologies like IVF developed in
Speaker 2: the late nineteen seventies, as these opened the door to
Speaker 2: new possibilities, infertility became something to overcome through science, but
Speaker 2: not for everyone. Stigma, silence, or a lack of access
Speaker 2: prevent people from seeking treatments in the first place, and
Speaker 2: the treatments aren't always successful or the cause of the
Speaker 2: infertility remains unexplained. In some ways. The improvements in reproductive
Speaker 2: technology have given us this illusion of complete control over
Speaker 2: our fertility, and many modern narratives of infertility tend to
Speaker 2: reinforce that control by highlighting stories where there's a beginning,
Speaker 2: a middle, and a happy ending, either through pregnancy and
Speaker 2: birth of an IVF baby, or adoption or surrogacy or
Speaker 2: something similar, something that's like and then here is the
Speaker 2: happy ending that everyone expects. The stories of people in
Speaker 2: the middle of IVF or who have tried IVF but
Speaker 2: have not gotten pregnant or delivered a baby. These are
Speaker 2: less common stories, which can add to the silence surrounding infertility,
Speaker 2: perpetuating the myth that fertility is a universal or universally
Speaker 2: desired experience. The idea of having it all plays into this,
Speaker 2: suggesting that if you don't have kids, whether that's voluntary
Speaker 2: or involuntary, you're missing something. You can't have it all.
Speaker 2: We could do a whole episode on the problem with
Speaker 2: the phrase having it all it's one of my least
Speaker 2: liked phrases, or doing it all. But silence can also
Speaker 2: be protective, preventing intrusive questions or platitudes like maybe this
Speaker 2: is the way it's meant to be for you. And
Speaker 2: these days, with the advent of contraceptives that in general
Speaker 2: allow us to have more control over reproduction. We can
Speaker 2: better control our own narrative, whether we want to tell
Speaker 2: anyone or whether we want to keep it private. Sharing
Speaker 2: stories of infertility or hearing those stories can reawaken painful feelings,
Speaker 2: or it can create a sense of community, or both,
Speaker 2: or neither, or something else. There's no simple answer or
Speaker 2: universal experience. And the same applies to the concept of infertility.
Speaker 2: On the one hand, thinking about infertility in purely biomedical terms,
Speaker 2: as we often do these days, reduces this multi dimensional
Speaker 2: experience to one aspect. But on the other the understanding
Speaker 2: that we gained throughout the twentieth century about the biological
Speaker 2: causes of infertility has helped to reduce the stigma and
Speaker 2: blame surrounding it, not globally but in many parts of
Speaker 2: the world, and it has allowed so many people to
Speaker 2: fulfill their dreams of having children. And so Aarin, I'll
Speaker 2: now turn it over to you to tell us all
Speaker 2: what to expect if we go in for fertility testing.
Speaker 4: Ooh, I cannot wait to We'll take a quick break
Speaker 4: and then I'll get into it.
Speaker 8: Hi were the yet man's I'm Brooke and I'm Rachel,
Speaker 8: and we wanted to share parts of our IVF journey,
Speaker 8: the good, the bad, the ugly with all of you.
Speaker 8: We started our journey in twenty twenty one. We decided
Speaker 8: that each of us would like to carry a biological
Speaker 8: child using the same donor sperm. I started the process
Speaker 8: first with IUI, and after several attempts, was unsuccessful. I
Speaker 8: then started the IVF process with follicle stimulation followed by
Speaker 8: the egg retriple. In February of twenty twenty two, I
Speaker 8: did a frozen instead of frush transfer because of overstimulation
Speaker 8: during the retrieval process. In April of twenty twenty two,
Speaker 8: I had a successful embryo transfer and implantation, followed by
Speaker 8: a healthy baby boy born in December of twenty twenty two.
Speaker 9: And now for the ugly part of the journey. I
Speaker 9: started my journey shortly after Rachel did. I had two
Speaker 9: egg retrievals because the first one only three embryos survived fertilization.
Speaker 9: After my first two embryos failed, I had an endometrio
Speaker 9: biopsy to test my progresstern window and test for endometrioses.
Speaker 9: For those of you that have never had when done,
Speaker 9: it's very painful, not a great experience at all. During
Speaker 9: this time, Rachel became pregnant, and it was very difficult
Speaker 9: for me because she was able to become pregnant with
Speaker 9: the first transfer and I was continuing to have unsuccessful transfers.
Speaker 9: It was very taxing on a relationship and my mental health,
Speaker 9: but we kept pushing on. By this time, our son
Speaker 9: was born and it made all the insecurities I had
Speaker 9: about not being his birth parent disappear. On my fourth
Speaker 9: transfer attempt, I did become pregnant. However, I started a
Speaker 9: bleed about two weeks after. I went in for an
Speaker 9: ultrasound and I found out I had a sub qoreanic
Speaker 9: chematoma that was bigger than the fetus itself. But there
Speaker 9: was still some hope because the fetus was still there
Speaker 9: and the bleeding had stepped. However, when we went in
Speaker 9: for the heartbeat check, it wasn't there. It was literally heartbreaking.
Speaker 10: At that point, I was abating on whether or not
Speaker 10: I wanted to keep trying, but we made it further
Speaker 10: than we had previously, so there was no indication that
Speaker 10: the next transfer wouldn't be successful. I tried one more time.
Speaker 10: It was my fifth and final transfer, but that was
Speaker 10: also unsuccessful. My next step would be shut to shed
Speaker 10: down my entire immune system to see if that would help.
Speaker 10: So I had two choices, give up on having a
Speaker 10: biological child or see if my wife, Rachel could get
Speaker 10: pregnant with my embryo, and after much discussion, we did
Speaker 10: a reciprocal IVF Rachel would attempt to carry one of
Speaker 10: my embryos. The first attempt has resulted in a chemical pregnancy.
Speaker 10: The embryo started doing plant and then detatched for an
Speaker 10: unknown reason. It could have been a genetic issue with
Speaker 10: the embryo or the embryo quality itself, but they weren't sure,
Speaker 10: so we did the same protocol and tried it again,
Speaker 10: which was successful.
Speaker 8: And I am now currently twenty five weeks pregnant and
Speaker 8: do in August with our second son as biologically brooks child.
Speaker 11: And I still struggle sometimes wishing that I could have
Speaker 11: been the one who carried her second son, but for
Speaker 11: some reason, it wasn't meant to be, and the journey
Speaker 11: to our family wasn't an easy one, but we can
Speaker 11: finally see the light at the end of the tunnel.
Speaker 12: Journey to IVF was one that we never expected. Having
Speaker 12: our first son unassisted and then being diagnosed with secondary infertility,
Speaker 12: five long years of trying and five missed miscarriages. We
Speaker 12: were always told it's just bad luck or it happens
Speaker 12: to everybody, but eventually you start looking for answers, and
Speaker 12: science really was the only way that we could bring
Speaker 12: our miracle baby home. Through one and a half egg
Speaker 12: retrievals due to one canceled because of poor outcomes, COVID
Speaker 12: closed clinics, moving our two precious tested embryos to a
Speaker 12: clinic five hours away, we finally reached a time where
Speaker 12: we were able to transfer our embryo and have our
Speaker 12: miracle baby. Without the science of IVF, my family would
Speaker 12: not be what.
Speaker 5: It is today.
Speaker 12: But it's not without shots, tears, blood, ultrasounds, financial, emotional
Speaker 12: and physical stress. And for anyone in the trenches, I'm
Speaker 12: forever grateful to have you by my side and I
Speaker 12: will always be there no matter what. To root everybody on.
Speaker 12: IVF is not something that is easy or taken lightly,
Speaker 12: but it is a chance to give us the dream
Speaker 12: of expanding our family.
Speaker 4: So Aarin, you started off your section, and I love
Speaker 4: that we sometimes we just work together so well, don't we?
Speaker 2: All the time you.
Speaker 4: Started off your section talking about this idea of whether
Speaker 4: or not infertility is actually on the rise, and that's
Speaker 4: where I wanted to start too, And where I wanted
Speaker 4: to start was really looking into what you started with,
Speaker 4: which is what is really the difference between fertility and
Speaker 4: infertility and how do we use that those definitions when
Speaker 4: we're talking about how to treat infertility as a medical disease,
Speaker 4: if that's what we're calling it. So governments, all governments
Speaker 4: cite fertility rates like that's the data that we have.
Speaker 4: We have data on birth rates, and yes, birth rates
Speaker 4: have declined substantially in the US, for example, in like
Speaker 4: thee in nineteen fifty women had close to five children
Speaker 4: on average. And as a disclaimer, all of the language
Speaker 4: around fertility and infertility is so incredibly heteronormative, and so
Speaker 4: I use the term women here because that is what
Speaker 4: all of the data sites, and we do not have
Speaker 4: good data on the experience or the lived experience in
Speaker 4: transgender and gender diverse individuals, not to mention the fact
Speaker 4: that definitions of infertility don't even take into account people
Speaker 4: who are gay or anything like that. So I apologize
Speaker 4: in advance that that is the reality of the situation.
Speaker 4: But when I say women talking about people with the
Speaker 4: uterus here. So on average women had five children in
Speaker 4: nineteen fifty.
Speaker 3: By twenty twenty two, the.
Speaker 4: Birth rate in the US is about one point six
Speaker 4: births per woman, So obviously that's a statistic. So that's
Speaker 4: a huge decline in the total fertility rate. And it's
Speaker 4: not just the US. The global fertility rate has more
Speaker 4: than had from again close to five four point eight
Speaker 4: in nineteen fifty to two point two three in twenty
Speaker 4: But much of this decline is quite intentional, and some
Speaker 4: of it is a very good thing, because some of
Speaker 4: the statistics when you look at what has been on
Speaker 4: the decline year over year, is things like birth among
Speaker 4: those age fifteen to nineteen children, babies, having babies has
Speaker 4: been on the decline.
Speaker 3: That's good.
Speaker 4: It's also the increase in the availability of contraception and
Speaker 4: the ability for people to decide to either delay or
Speaker 4: forego altogether childbearing if that's what they decide, and that
Speaker 4: wasn't always possible. So has this also led to an
Speaker 4: increase in infertility? In everything that I was reading, I
Speaker 4: didn't find any data to show that the things that
Speaker 4: we're going to talk about that cause infertility, the underlying
Speaker 4: things that can cause it to be difficult or close
Speaker 4: to impossible to conceive without medical intervention don't seem to
Speaker 4: be on the rise. And what's interesting is that nowhere
Speaker 4: in the reports that I read about fertility statistics do
Speaker 4: they say that the infertility rate has increased. But that
Speaker 4: is absolutely the takeaway of a ton of websites and
Speaker 4: news articles that take data from these fertility statistics. Now,
Speaker 4: what is true is that the demands for assisted reproductive technologies,
Speaker 4: including IVF, have increased, though in some cases they've started
Speaker 4: to level off and in some countries they're still continuing
Speaker 4: to rise. But that still doesn't mean that we can
Speaker 4: conflate those two things, fertility and infertility. And I think
Speaker 4: that's one of the things that's really tricky when we
Speaker 4: in medicine, as we do in medicine, define and view
Speaker 4: infertility as a disease, as this medical phenomenon, because some
Speaker 4: of this decline infertility rates might be due to things
Speaker 4: like an overall increase in the age at first birth,
Speaker 4: which has been increasing, and we know that and I'll
Speaker 4: talk more about this. The age of your eggs.
Speaker 3: Specifically, and also the age of the sperm.
Speaker 4: Our major driving forces behind what we conceptualize as infertility,
Speaker 4: but it still all depends on what somebody's experience is
Speaker 4: of it. So anyways, let's get a little bit more
Speaker 4: into the details of how medicine defines infertility and what
Speaker 4: happens if somebody wants to become pregnant and hasn't. So
Speaker 4: you mentioned it at the top erin the medical definition
Speaker 4: of infertility today, though it still depends a little bit
Speaker 4: on what society is writing it. Per the who is
Speaker 4: the inability to achieve a pregnant and if that is
Speaker 4: desired after twelve months of regular unprotected sexual intercourse, again
Speaker 4: heteronormative as heck, but that's where we are. This is
Speaker 4: a medical definition, and per the World Health Organization and
Speaker 4: so many societies, it is seen as a disease of
Speaker 4: either the female or the male reproductive tract or both.
Speaker 4: And so that is the point, twelve months of unprotected
Speaker 4: sex without a pregnancy. That's usually the point at which
Speaker 4: an investigation into what the cause of infertility is would begin.
Speaker 4: So a question that people often have, because it's a
Speaker 4: logical question, is like why twelve months? And in part
Speaker 4: it's because of just the odds. So if you look
Speaker 4: on large population scales. Most sources estimate that conception rates
Speaker 4: in the first month of attempting to get pregnant are
Speaker 4: about thirty percent. So the first month thirty percent. Then
Speaker 4: if we look out at six months, the cumulative conception
Speaker 4: rate at six months is about seventy five percent. And
Speaker 4: then if you go to twelve months, it's about ninety
Speaker 4: percent of couples that are trying to conceive will have
Speaker 4: conceived in twelve months. So that's the main way that
Speaker 4: we get there.
Speaker 3: I have what's interesting? Do you have a question?
Speaker 2: I do because I feel like it plays into this too.
Speaker 2: What is regular sex? Is there a definition by the who? Yeah,
Speaker 2: I hope that you are going to ask such a
Speaker 2: good question.
Speaker 4: Let me scroll down to the bottom where I have
Speaker 4: my fun facts section.
Speaker 2: Oh nice?
Speaker 3: How often do you have to have sex penis and
Speaker 3: a vagina?
Speaker 4: Sex has to happen ideally one to two times a
Speaker 4: week at a minimum to be considered regular. And what's
Speaker 4: also important is that the timing is actually really important
Speaker 4: because the egg only lives in the female reproductive tract
Speaker 4: for about twenty four hours, but the sperm lives for
Speaker 4: up to five days. So the fertile window really starts
Speaker 4: about six days before ovulation, peaks about two days before ovulation,
Speaker 4: and then is done essentially by the time that ovulation happens,
Speaker 4: because the sperm also need time to swim all the.
Speaker 3: Way up to the Philippian team.
Speaker 4: Okay, God, so that's also a lot if you are
Speaker 4: busy and trying to do this for a very long time,
Speaker 4: just just saying okay, so yes, that is that's what
Speaker 4: is considered regular enough sex. What's interesting about this timing
Speaker 4: of twelve months is that if you were to follow
Speaker 4: again on a population level, couples who haven't conceived at
Speaker 4: that twelve months for another twelve months, fifty percent of
Speaker 4: those couples would conceive in that next twelve months within
Speaker 4: two years, so the cumulative can option rate increases to
Speaker 4: about ninety five percent at two years.
Speaker 5: Okay.
Speaker 4: Now this changes significantly with age, especially with the age
Speaker 4: of the person with the uterus or the woman, and
Speaker 4: we talked about this a little bit in our menopause episode.
Speaker 4: Those of us who ovulate are born with only a
Speaker 4: certain number of eggs, and at some point in our
Speaker 4: reproductive lives, those eggs either are fewer and farther between,
Speaker 4: or are of lower quality in a way that impacts
Speaker 4: the chances of pregnancy. In most of the medical community,
Speaker 4: this starts at around age thirty five. Realistically it starts
Speaker 4: to decline a little bit before that, but between ages
Speaker 4: thirty five and thirty nine, the spontaneous conception rate at
Speaker 4: that one year mark is actually only sixty percent compared
Speaker 4: to ninety percent if you're younger than thirty five, and
Speaker 4: at two years it's eighty five percent.
Speaker 3: Okay.
Speaker 4: Now, male fertility also declines with age, but it gets
Speaker 4: far less attention because we don't understand it as well
Speaker 4: and nobody talks about it. But for that reason, somebody
Speaker 4: who is thirty five or older would often start, or
Speaker 4: it's recommended that they start this infertility evaluation at six
Speaker 4: months of trying to conceive and not conceiving, rather than
Speaker 4: waiting the whole year.
Speaker 3: Okay, So what does that actually look like?
Speaker 4: What can one expect if you are trying to get pregnant,
Speaker 4: you haven't gotten pregnant, and you go to your doctor's
Speaker 4: office for an infertility evaluation. Obviously this is going to
Speaker 4: look different at every single healthcare facility in every single country.
Speaker 3: But what I'm going to kind.
Speaker 4: Of focus on is what the very general evaluations are
Speaker 4: going to be focusing on how we're going to try
Speaker 4: and pinpoint what a cause of this inability to conceive
Speaker 4: is and then get into what those causes are and
Speaker 4: then what the options are for how we treat it,
Speaker 4: because while we intended this as a study of just
Speaker 4: like IVF, IVF is not often the first step depending
Speaker 4: on what the underlying cause of that infertility is.
Speaker 2: Yeah, I'm really curious about this decision tree process.
Speaker 4: Yeah, it's it's really complicated, but it's really interesting. So
Speaker 4: at that twelvemonth or six month mark, depending on your age,
Speaker 4: the initial doctor's office visits, this is probably gonna be
Speaker 4: pretty boring. You're gonna be answering a million questions about
Speaker 4: your personal life, about your medical history, etc. Most often,
Speaker 4: probably because of all the things you talked about, Aaron,
Speaker 4: about the history of how we view infertility as a
Speaker 4: female problem. It's usually the female partner who shows up
Speaker 4: first to the doctor. But all of the literature says
Speaker 4: this should be an evaluation of the couple. It should
Speaker 4: never just be an evaluation of one partner. If there's
Speaker 4: a two partner scenario, which in all of the texts
Speaker 4: that's the assumption, and then the next step that's going
Speaker 4: to happen after this kind of history gathering to see
Speaker 4: if there's any clues as to what the problem could be.
Speaker 4: There'll be a bunch of blood tests and probably some
Speaker 4: imaging studies for the female and a semen analysis and
Speaker 4: maybe some blood work, but honestly often not even blood
Speaker 4: work for the male.
Speaker 2: What would the blood work show, great question.
Speaker 4: So for women, the blood work is going to assess
Speaker 4: a few different things, probably some measure of ovarian reserve,
Speaker 4: so you're going to be checking some hormone and there's
Speaker 4: a few different that people might check to assess your
Speaker 4: ovarian reserve, how many eggs.
Speaker 3: Do you have left.
Speaker 4: They'll also check other hormones to see if there's a
Speaker 4: reason that you might not be ovulating as much as
Speaker 4: we might expect or on a regular a basis. That
Speaker 4: goes along with some of the menstrual history that you're
Speaker 4: going to ask about what someone's cycles are like, and
Speaker 4: checking on things like thyroid hormone, prolactin hormone, these other
Speaker 4: things that if they're out of whack, can contribute to
Speaker 4: ovulation issues.
Speaker 2: In the men.
Speaker 4: You could have similar things be checked, but it's really
Speaker 4: going to depend on like how far down the rabbit
Speaker 4: hole you end up going, or if a cause is
Speaker 4: identified prior to that. The blood work for men is
Speaker 4: not as straightforward or as algorithmized, I guess, okay, as
Speaker 4: it is unless you find something and then you might
Speaker 4: chase it down, if that makes sense.
Speaker 2: Yes, I had no idea that you could get a
Speaker 2: feel for ovarian reserve with a blood test. Yeah.
Speaker 3: Yeah, there's a few different things you can check.
Speaker 2: Wow, okay, cool.
Speaker 4: It's really important too. But anyways, I could go on,
Speaker 4: I won't. So then the imaging studies that you're going
Speaker 4: to get might be things like ultrasounds, just to assess
Speaker 4: the structure of the uterus see if there's things like
Speaker 4: fibroids or or something that could be contributing. They might
Speaker 4: also do what's called a histroosyl pingagram, which you mentioned
Speaker 4: a little bit Aaron as well in one of your quotes,
Speaker 4: And this is quite a painful procedure from my understanding,
Speaker 4: but it's very good for looking at the entire shape
Speaker 4: of the uterus itself and to see if there's any
Speaker 4: blockage of tubes or other abnormalities of the uterine cavity
Speaker 4: that could be contributing, and in some cases people might
Speaker 4: end up even undergoing exploratory surgeries depending on again what
Speaker 4: they find on all of these initial evaluations. Interesting again,
Speaker 4: for the men, you look at the sperm and you
Speaker 4: see how many there are, you see what the shape
Speaker 4: of them are, and you see how well they move.
Speaker 4: So you're also looking at things like motility. Now there
Speaker 4: might be more depending on what you find, but that's
Speaker 4: kind of the first start, and it gets you to
Speaker 4: a lot of these different causes of infertility. So let's
Speaker 4: get into what these are. If we look super broadly,
Speaker 4: like really really broad, there's kind of three huge categories.
Speaker 4: It could be male factor infertility, it could be female
Speaker 4: factor infertility, could be both and that happens, or it
Speaker 4: could be unexplained infertility, and we'll get there. So at
Speaker 4: its core, if we're looking at male factor infertility first,
Speaker 4: at its core, this is going to be an issue
Speaker 4: with sperm, either amount of sperm or the effectiveness of
Speaker 4: those sperm. So this could be an issue with spermatogenesis.
Speaker 4: So either you're not making enough sperm, or you're making
Speaker 4: sperm that are morphologically abnormal.
Speaker 3: In some way.
Speaker 4: Either they can't move as well, they have some kind
Speaker 4: of DNA issue. There's a lot of possibilities. Issues with
Speaker 4: spermatogenesis are the most common, but there's tons of other
Speaker 4: things that could be going on as well. You can
Speaker 4: have issues with sperm transport, either because of blockage of
Speaker 4: not being able to make it down the vast deference
Speaker 4: to be ejaculated, or because like in our cystic fibrosis
Speaker 4: episode we talked about just like the absence of ccilia
Speaker 4: being able to help the sperm be transported. And you
Speaker 4: can also have hormonal or endocrine disorders that affect sperm production.
Speaker 4: Those are kind of the three biggest categories that contribute
Speaker 4: to male factor infertility. When we look at female factor infertility,
Speaker 4: the way that I think of it is it's most
Speaker 4: easy to split it up by like organ or area
Speaker 4: of the body. So you can have issues with your ovaries,
Speaker 4: either you have irregular or non ovulatory cycles. We see
Speaker 4: this in things like PCOS or other hormonal disruptions, maybe
Speaker 4: thyroid disorder or prolactin, or issues with the ovaries from
Speaker 4: ocite aging or depletion, either because the eggs themselves are
Speaker 4: of life or quality because of age, or there's just
Speaker 4: not as many eggs to be ovulated. But you can
Speaker 4: also have blockage of the floapian tubes, and this is
Speaker 4: most commonly caused by things like pelvic inflammatory disease or
Speaker 4: severe endometriosis. You can then have problems with the uterus
Speaker 4: itself that might impair implantation. This could be structural things
Speaker 4: like fibroids or acceptate uterus like me or or an
Speaker 4: insufficient lining of the uterus. You can also have cervical factors,
Speaker 4: either from previous trauma to the cervix or a reduced
Speaker 4: cervical mucus that impairs sperm transport. Then there's even more
Speaker 4: rare causes like autoimmune diseases. There is a very very
Speaker 4: long list of possible causes. Then, for both men and women,
Speaker 4: you could have karyotype abnormalities. Right, you might have certain
Speaker 4: genetic disorders that just make it really difficult to either
Speaker 4: get pregnant in the first place, or a cause of
Speaker 4: recurrent miscarriage could be a karyotype abnormalities. That means abnormalities
Speaker 4: in your chromosome that are small enough that they usually
Speaker 4: don't affect you, but it does affect the egg or
Speaker 4: the sperm that you're trying to produce. And then there's
Speaker 4: unexplained infertility, which is exactly as dissatisfying as it sounds,
Speaker 4: because what it means is that you have done all
Speaker 4: of this work up, you have gone through all of
Speaker 4: these tests, all of this blood work, and we didn't
Speaker 4: find anything, and you're still not pregnant and you want
Speaker 4: to be.
Speaker 2: I have a question about unexplained infertility. How has that
Speaker 2: term shrunk over time? Like how has it you know,
Speaker 2: are there still things that were exploring that, like, oh,
Speaker 2: it could be this, and it's just like finding the
Speaker 2: right tests or develop in the right tests or you
Speaker 2: know what.
Speaker 4: I mean, Yeah, I do, I do. It's a really
Speaker 4: good question. I don't know is the short answer classic.
Speaker 4: But it's such an interesting question because from what I read,
Speaker 4: the thought behind unexplained infertility is that it isn't one thing.
Speaker 4: It's a bunch of little things that might contribute to
Speaker 4: relatively like a relative subfertility. And the idea of subfertility
Speaker 4: is something that like I thought about writing a lot
Speaker 4: about and then I didn't because who boy. But anyways,
Speaker 4: it's like it's a bunch of different things that might
Speaker 4: cause it to be a little bit harder or take
Speaker 4: a little bit longer to achieve a pregnancy, but all
Speaker 4: combined together, right, So like maybe you have slightly on
Speaker 4: the low side of a sperm count, and maybe you
Speaker 4: have a slightly less receptive endometrium, and maybe you have
Speaker 4: slightly hostile cervical mucus something that is that the term
Speaker 4: it's a term. I don't know that it's a good one,
Speaker 4: but right, like, maybe you have a little bit of
Speaker 4: a lot of things, right, or maybe you have pcos
Speaker 4: so you're ovulating but not on a very regular cycle,
Speaker 4: and then your partner also has like a little bit
Speaker 4: of a low sperm count or something. But again those
Speaker 4: you would think that, Okay, well we've identified some causes.
Speaker 5: Right.
Speaker 4: So that's why it's really I think frustrating, is that
Speaker 4: there still is this unexplained infertility that in most estimates
Speaker 4: that I read, accounts for anywhere from ten to twenty
Speaker 4: percent of cases of infertility, which is huge, right, And
Speaker 4: so like, ah, I just can imagine it's so painful,
Speaker 4: right to not have any answer.
Speaker 2: Deeply frustrating and unsatisfying. And so is this is that
Speaker 2: like a formal is there a point at which there's
Speaker 2: just like, well, we've done everything, so it's unexplained infertility
Speaker 2: and then that's like the diagnosis on the chart whatever.
Speaker 4: So it is definitely a diagnosis that gets put on
Speaker 4: a chart. The question of how much of a workup
Speaker 4: has been done before that is the label that gets
Speaker 4: put on is probably going to vary depending on where
Speaker 4: you are. So I can't answer the like, what is
Speaker 4: that point, okay, because it's going to depend on where
Speaker 4: you are and what resources you have too, right, because
Speaker 4: some of these tests are not exactly easy and you
Speaker 4: have to have access to a specialist to be able
Speaker 4: to do it. And so maybe there is for some
Speaker 4: people an answer, but they just can't get it because
Speaker 4: they don't have access to what they need to get
Speaker 4: that answer.
Speaker 3: Okay, Yeah, it's a good question.
Speaker 4: But so once you've gone through all of this work
Speaker 4: up and maybe you have found a cause or maybe
Speaker 4: you haven't, the options for treatment that are available to
Speaker 4: you are going to depend on a lot of different things.
Speaker 2: They're going to.
Speaker 4: Depend in part on what if any identified cause of
Speaker 4: infertility there is, and hopefully anything that was found that's
Speaker 4: correctable is corrected, and in some cases that might be
Speaker 4: all that you need. Right if there's a thyroid condition,
Speaker 4: then if you can correct that, perhaps that's the only
Speaker 4: kind of thing that you would need and that wouldn't
Speaker 4: necessarily fall into medically assisted reproduction MAR or ART. And
Speaker 4: we'll get into that specific definition in a minute, but
Speaker 4: that couple would still meet the criteria for diagnosis of infertility,
Speaker 4: which I think is important. Okay, yes, But the other thing,
Speaker 4: in addition to what the cause of infertility is in
Speaker 4: terms of what the next steps are going to be
Speaker 4: will very much depend on what your access is like
Speaker 4: and what your finances are like. And that's true here
Speaker 4: in the US, but also everywhere. Access to all forms
Speaker 4: of assisted reproductive technologies is absolutely incredibly unequal because it's
Speaker 4: incredibly expensive everywhere, not just in the US. So what
Speaker 4: are some of these different options. One of the first
Speaker 4: is ovulation induction, and this is something that can be
Speaker 4: done with either oral medicines or sometimes injectable medications. And
Speaker 4: it's what it sounds like. It's inducing ovulation in someone
Speaker 4: who isn't ovulating or who's not ovulating on a regular schedule.
Speaker 4: And so this can be done with timed intercourse, so
Speaker 4: like using a medicine and then just having sex when
Speaker 4: you're like on the right schedule with this medicine, or
Speaker 4: depending on the cause, it can also be done in
Speaker 4: combination with IUI or intrauterine insemini. Intriuterine insemination involves taking
Speaker 4: the sperm, washing it because did you know that if
Speaker 4: you don't wash the sperm, you're going to have a
Speaker 4: massive like reaction to that unwashed sperm if you inject
Speaker 4: it straight into the uterus.
Speaker 2: I did indeed, because it plays a role in next
Speaker 2: episode and the history of development of ibs.
Speaker 3: Oh my gosh, I can't wait.
Speaker 4: And it give me such an appreciation for my cervical
Speaker 4: mucus I had to say. I was like, Wow, you're
Speaker 4: protecting me so well. Anyways, so intuterine insemination is usually
Speaker 4: in combination with ovulation induction, and that can use either
Speaker 4: a partner sperm or it can use donor sperm. And
Speaker 4: so that is one of kind of often the first
Speaker 4: areas that you see this being able to be applied
Speaker 4: to more than just heterosexual couples is ovulation induction with IUI,
Speaker 4: and those are kind of the main options that we have,
Speaker 4: and then we get into ART or assisted reproductive technology.
Speaker 4: ART is the broader term and I don't know if
Speaker 4: people say art or art, but I'm gonna say art.
Speaker 2: Okay.
Speaker 4: So this is a broad term that includes conventional IVF
Speaker 4: or in vitro fertilization, which we'll talk a lot about
Speaker 4: next episode. It also includes IVF with ICSI, which is
Speaker 4: intra cytoplasmic sperm injection. And it also includes some other
Speaker 4: acronyms like gift and jift I think, and some other
Speaker 4: things that most places don't do anymore, but we're kind
Speaker 4: of earlier versions of IVF.
Speaker 2: Okay.
Speaker 4: But in short, art means any process where we're taking
Speaker 4: eggs out of the body, we're taking sperm out of
Speaker 4: the body, and we're joining these up and growing an
Speaker 4: embryo outside of the body and then re implanting it.
Speaker 4: And that, dear listeners, is going to be the subject
Speaker 4: of next week's episode.
Speaker 2: Bear Okay, So someone goes in. Let's say a couple
Speaker 2: goes in for fertility testing, go through all of these
Speaker 2: different processes. Let's say that they do this and that.
Speaker 2: What are the different characteristics of the couple, like age
Speaker 2: or whatever? When when go I UI, when go IVF?
Speaker 2: When do you do all these different ICSI? Like what when?
Speaker 3: What why, Yeah, decisions when, why? What? How?
Speaker 2: Yes? All of this?
Speaker 3: Yeah, it's a good question.
Speaker 4: So sometimes IVF might be the first thing that you
Speaker 4: go to. Okay, IVF might be first line therapy in
Speaker 4: cases like, for example, if there's bilateral tubal occlusion. Right,
Speaker 4: So if you're both Philippian tubes, you go through this
Speaker 4: workup and you find out that both of your Philippian
Speaker 4: tubes are completely blocked, then it's either IVF or a
Speaker 4: surgery to try and reconstruct those tubes. Right, So IVF
Speaker 4: might be the first line in that case. A time
Speaker 4: when IVF might not be the first line would be
Speaker 4: if somebody has something like PCOS, for example, then you
Speaker 4: might reasonably try ovulation induction either alone or with IUI,
Speaker 4: And the decision there really just depends on the couple.
Speaker 4: It depends on the situation. So it's not like a
Speaker 4: black and white there. It's very much a gray area,
Speaker 4: and there are kind of a lot of other cases
Speaker 4: where you might try other things unexplained infertility. Generally, the
Speaker 4: recommendation is to start with ovulation induction and IUI combined.
Speaker 4: The thought again being that if there's multiple things that
Speaker 4: are all contributing to cause this relative subfertility. Then if
Speaker 4: we can induce ovulation and put the sperm right at
Speaker 4: the top of the uterus at the right time, then
Speaker 4: we have maybe the highest chance of success before we
Speaker 4: jump to something as expensive and time consuming as IVF,
Speaker 4: IVF with ICSI. With that, intra cytoplasmic sperm injection is
Speaker 4: first line for severe male factor infertility because in many
Speaker 4: cases with severe male factor that's the only way that
Speaker 4: you're going to have a successful pregnancy. And depending on
Speaker 4: the age of the couple, especially the age of the woman,
Speaker 4: it may be that the recommendation is to go straight
Speaker 4: to IVF. Also depending on how long they've been trying for,
Speaker 4: So it's also the case that if a couple has
Speaker 4: been trying for greater than two years or greater than
Speaker 4: three years, regardless of what you find as the cause,
Speaker 4: it's possible that someone would recommend IVF as the first
Speaker 4: just because statistically there's such a small chance of the
Speaker 4: other options being as effective, like per cycle. And similarly,
Speaker 4: if the age of the female is greater than thirty
Speaker 4: five or definitely greater than thirty nine. But it all
Speaker 4: is just kind of depend a little bit on each
Speaker 4: individual circumstance.
Speaker 2: Right, Okay, okay, And.
Speaker 4: Finally, of course IVF would also be a first line
Speaker 4: if the underlying issue isn't this medical definition of infertility
Speaker 4: that we have defined, but what is called social infertility.
Speaker 7: Right.
Speaker 4: If you are a lesbian couple trying to get pregnant,
Speaker 4: IVF is often though not always, because ovulation induction plus
Speaker 4: IUI could also be an option, but often IVF is
Speaker 4: one of the first steps for things like that, or
Speaker 4: for a single mom who wants to get pregnant, also
Speaker 4: for somebody who has a genetic condition that they want
Speaker 4: to ensure doesn't get passed down to their children, and
Speaker 4: we mentioned this briefly in our Huntington's episode, but this
Speaker 4: is also relevant for people or couples who are carriers
Speaker 4: of things like sickle cell or cystic fibrosis. IVF can
Speaker 4: often be first line for that, and it is used
Speaker 4: in combination with things that we'll talk about later, and
Speaker 4: that is pre implantation genetic testing for these specific disorders.
Speaker 4: So there's a very wide range.
Speaker 2: Yeah, I think it's it's interesting how like what IVF
Speaker 2: started out in terms of like, okay, who is going
Speaker 2: to be using IVF, and then how that evolved over
Speaker 2: the decades afterwards, which is it's kind of as the
Speaker 2: technology changed, as regulations changed and so on, which we'll
Speaker 2: get into more of that, but I do have more questions.
Speaker 2: So one of the questions is, so we you have
Speaker 2: mentioned fertility rates globally and in the what are infertility
Speaker 2: rates and like, how are those measured on a global scale?
Speaker 2: What numbers go into that? Great question.
Speaker 4: I'll talk about this a lot more in our last
Speaker 4: episode of this series, but let's.
Speaker 3: At least mention it. Globally.
Speaker 4: It's estimated that one in six couples worldwide experience infertility
Speaker 4: at some point in their reproductive lives. Of course, this
Speaker 4: only includes this medical definition of infertility, right, Okay, so
Speaker 4: globally that's looking at like fifty million or more couples.
Speaker 3: It's a huge number.
Speaker 2: Yeah, it's huge.
Speaker 3: Okay.
Speaker 2: Interesting. I have a question that's, like you talked about
Speaker 2: how this is what to expect if you go in
Speaker 2: for fertility testing, what is like even before that, you know,
Speaker 2: let's say that you're trying for a year to become pregnant,
Speaker 2: not getting pregnant, who do you do? You go to
Speaker 2: your primary care and then you get a referral to
Speaker 2: a like who is the person you ultimately see?
Speaker 4: That is such a good question because I have a
Speaker 4: lot of personal feelings about it that aren't that relevant.
Speaker 4: But it is going to depend so much on where
Speaker 4: you live and who you have access to and who
Speaker 4: your doctor is, because the first steps of this infertility workup,
Speaker 4: and even like what I would also say is so
Speaker 4: important that gets overlooked is like preconception counseling if people
Speaker 4: want to get pregnant, like understanding that you are most
Speaker 4: fertile in those six days prior to ovulation, and like
Speaker 4: the timing of intercourse. We don't get taught that in
Speaker 4: high school biology class, right, We're so focused for so
Speaker 4: much time on like not getting pregnant, often not always,
Speaker 4: but so even that most of this initial workup is
Speaker 4: very reasonable to be done by most like general practiceers
Speaker 4: what they're called in most places. That being said, not
Speaker 4: all physicians are trained in women's health equally and so
Speaker 4: or in like reproductive health in general, because again we
Speaker 4: have to look at both women's and men's health, and
Speaker 4: so it's very possible that some like GP type physicians
Speaker 4: wouldn't feel comfortable initiating that depending on where you are
Speaker 4: depending on what you have access to, So then you
Speaker 4: might be referred to an obgian who might focus just
Speaker 4: on again, the female reproductive tract.
Speaker 2: So it is.
Speaker 4: It's part of the kind of issue with people getting
Speaker 4: access to the right kinds of care is that, yes,
Speaker 4: most of this evaluation can reasonably be started at least
Speaker 4: in like a general practitioner's office if they feel comfortable
Speaker 4: with it.
Speaker 2: Interesting, Okay, I feel like Aaron. I feel like there's
Speaker 2: like a thousand more questions that I like have that
Speaker 2: are just kind of like lingering in my head, just
Speaker 2: dancing around, but I don't know what they are. But
Speaker 2: I guess this is why we're doing multiple episodes, so
Speaker 2: that I can think back and then ask these again. Exactly.
Speaker 3: But we're just going to keep talking.
Speaker 2: I'm just going to keep talking forever. But we should
Speaker 2: probably wrap up this episode now, Okay, I think so.
Speaker 4: I am really excited for next week to get into
Speaker 4: what the heck is IVF and how did we come
Speaker 4: up with it and how does it exist today?
Speaker 2: Yes, I am excited for that, but we should do
Speaker 2: the sources for this episode first. Absolutely, I have a few,
Speaker 2: but I want to give a second shout out to
Speaker 2: that incredible book that I've mentioned a few times now. Second, third,
Speaker 2: fourth shout out the Paul Grave Handbook of Infertility and History,
Speaker 2: edited by Gail Davis and Tracy Loughgrin, which that was
Speaker 2: just a great It was a really interesting resource and
Speaker 2: had so much like very commentary and like scholarly research
Speaker 2: on the subject that was sort of all over the
Speaker 2: place and but also really comprehensive.
Speaker 4: I have to admit that my sources for these three
Speaker 4: episodes are a mess, being very mixed up, fair warning.
Speaker 4: But for this episode a few papers that I would
Speaker 4: like to especially shout out that I found really interesting.
Speaker 4: One was kind of an old paper now called the
Speaker 4: ABC's of Subfertility, so interesting extent of the problem. It
Speaker 4: had a lot of detail in there about infertility as
Speaker 4: well the World Health Organization fact sheet on infertility, as
Speaker 4: well as a textbook on reproductive medicine. And we will
Speaker 4: post all of the sources from this episode and all
Speaker 4: of our episodes and the next episodes on our website,
Speaker 4: this podcast would Kill You dot Com under the episodes tab.
Speaker 2: A huge thank you again to everyone who has shared
Speaker 2: their first hand accounts with us and who have just
Speaker 2: like really, it's it's been incredible and incredible privilege, like
Speaker 2: you said, Aaron, to be able to you know, read
Speaker 2: these hear these stories. Thank you, thank you.
Speaker 3: Yeah, we really really appreciate it. It's so meaningful. Thank
Speaker 3: you it is.
Speaker 2: Thank you also to Bloodmobile for providing the music for
Speaker 2: this episode and all of our episodes.
Speaker 3: Thank you to Tom Bryfogel and Leanna Scolachi for the
Speaker 3: incredible audio mixing.
Speaker 2: Thank you too, exactly right, and thank.
Speaker 4: You to you listeners the first of three episodes. There's
Speaker 4: so much more to come, but thank you for sticking
Speaker 4: this one out.
Speaker 2: Yeah, let us know what you think. And a special
Speaker 2: thank you of course to our amazing generous patrons. We
Speaker 2: I mean, we really we can't say it enough. Thank you.
Speaker 2: It really your support means the world. Until next time,
Speaker 2: wash your hands you feel the animals.
Speaker 13: Oh bub bub bub
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