WEBVTT - Ep 143 IVF, Part 1: Infertility 0:00:00.400 --> 0:00:03.160 On my thirty fifth birthday. After talks with my husband 0:00:03.200 --> 0:00:05.480 and deciding we were ready to start a family, I 0:00:05.480 --> 0:00:08.520 stopped taking my birth control pills. After a year, I 0:00:08.560 --> 0:00:10.680 had not gotten pregnant, so we met with a fertility 0:00:10.680 --> 0:00:13.080 specialist who had me undergo a lot of different kinds 0:00:13.119 --> 0:00:16.040 of tests, some that were really painful and evasive, and 0:00:16.120 --> 0:00:19.000 he determined that I have polycystic ovary syndrome but found 0:00:19.000 --> 0:00:22.720 no other underlying issues. Pcos can make it difficult to 0:00:22.720 --> 0:00:25.600 get pregnant naturally, so my doctor recommended I try entry 0:00:25.680 --> 0:00:29.600 uterine insemination. I ended up doing four iuis with him, 0:00:29.680 --> 0:00:32.240 none of which resulted in a pregnancy. Before I started 0:00:32.280 --> 0:00:35.040 seeing a new doctor who recommended I move on to IVF. 0:00:35.760 --> 0:00:38.640 My egg retrieval resulted in five healthy embryos that we 0:00:38.680 --> 0:00:42.360 had frozen, and since then I have undergone three embryo transfers, 0:00:42.360 --> 0:00:45.200 but none of them resulted in a pregnancy either. I've 0:00:45.200 --> 0:00:48.240 done genetic testing, countless rounds of blood work and ultrasounds, 0:00:48.280 --> 0:00:51.920 a mock transfer cycle, a hissteroscopy, an HSG scan. I 0:00:51.960 --> 0:00:55.840 stopped eating gluten, dairy, and sugar. I do monthly ovulation tracking, 0:00:56.000 --> 0:00:59.720 have regular acupuncture and meditation. Sessions made my fertility a 0:00:59.720 --> 0:01:03.800 full time job, and still I have no answers. I 0:01:03.880 --> 0:01:06.440 just turned thirty nine, and I'm always wondering why not me. 0:01:07.400 --> 0:01:09.400 My friends are all having kids and growing their families 0:01:09.440 --> 0:01:11.920 exactly as they had planned. Well, I'm just spinning my wheels. 0:01:12.440 --> 0:01:14.520 There's so much I wish i'd known about fertility when 0:01:14.520 --> 0:01:17.640 I was younger. None of my female relatives had fertility issues, 0:01:17.680 --> 0:01:20.360 and I always had totally normal results at my annual 0:01:20.360 --> 0:01:24.039 exams with my gynecologist. Plus my PCOS symptoms were masked 0:01:24.040 --> 0:01:26.200 by the pill, so I just had no idea that 0:01:26.240 --> 0:01:29.240 I would ever end up with unexplained infertility. I always 0:01:29.240 --> 0:01:31.479 assumed that if I had trouble getting pregnant, especially since 0:01:31.520 --> 0:01:33.640 I didn't start trying until I was thirty five, which 0:01:33.680 --> 0:01:37.319 is considered geriatric in the medical world, that IVP would 0:01:37.319 --> 0:01:40.160 be a safety net that it would definitely work. My 0:01:40.240 --> 0:01:42.959 last embryo transfer was over a year ago, and while 0:01:43.000 --> 0:01:46.720 I have two perfect embryos still sitting frozen and ready beus, 0:01:47.160 --> 0:01:50.640 I've been too scared to try again, going through the appointments, 0:01:50.680 --> 0:01:53.800 the injections, dealing with the effects of the hormones, holding 0:01:53.840 --> 0:01:57.080 onto hope, and telling myself this time will work. I'm 0:01:57.120 --> 0:01:59.120 just not sure I'm strong enough to go through it all. 0:01:59.160 --> 0:02:48.959 Again, thank you so much for sharing your story with us, 0:02:49.240 --> 0:02:54.000 and a huge thank you to everyone who reached out 0:02:54.040 --> 0:02:57.320 and shared their stories with us. You'll hear more first 0:02:57.360 --> 0:03:00.000 hand accounts later in this episode and in the next 0:03:00.160 --> 0:03:03.320 couple of episodes that we'll be doing on this topic. 0:03:03.919 --> 0:03:07.000 And there were so like we were truly overwhelmed in 0:03:07.080 --> 0:03:11.160 the best possible way by the sheer volume of responses 0:03:11.160 --> 0:03:15.279 that we got. Like I never expected it. It was incredible. 0:03:15.360 --> 0:03:17.000 So thank you to each and every one of you 0:03:17.080 --> 0:03:21.440 who sent in your stories. We appreciate you so so, 0:03:21.440 --> 0:03:22.960 so so much. 0:03:23.200 --> 0:03:24.440 We really do. 0:03:24.560 --> 0:03:27.200 It was incredible. It was a privilege to get to 0:03:27.240 --> 0:03:29.080 read through all of your stories, and thank you so 0:03:29.240 --> 0:03:32.000 much to everyone who wrote in, and we tried to 0:03:32.040 --> 0:03:34.600 include as many people as we possibly could, so you're 0:03:34.600 --> 0:03:37.160 going to hear a lot more first hand accounts throughout 0:03:37.200 --> 0:03:39.520 this episode in our next couple episodes. So thank you 0:03:39.720 --> 0:03:41.040 all so much. 0:03:41.560 --> 0:03:45.440 Yes, Hi, I'm erin Welsh. 0:03:44.760 --> 0:03:46.720 And I'm Erin Ollman Updyke. 0:03:46.560 --> 0:03:48.720 And this is this podcast will kill you. 0:03:49.720 --> 0:03:56.080 Welcome to the first of three Yeah. 0:03:55.960 --> 0:03:59.800 Episodes we said in our social media posts that were 0:03:59.840 --> 0:04:01.840 going to do a two parter, and then as we 0:04:01.880 --> 0:04:05.200 started to like plan what that two parter would look like, 0:04:05.280 --> 0:04:08.000 we realized very quickly that this could not only be 0:04:08.160 --> 0:04:10.800 just two parts, that it needed to be at least three, 0:04:11.800 --> 0:04:14.880 if not many, many many more. We're stopping at three. 0:04:15.240 --> 0:04:20.200 So yeah, it's it's going to be a lot, but 0:04:20.600 --> 0:04:23.240 we are really really excited about it. 0:04:23.360 --> 0:04:26.680 So buckle up. Three weeks up. 0:04:27.839 --> 0:04:31.040 You know, this is do I even need to say 0:04:31.040 --> 0:04:33.760 that this is such a huge topic. It just is 0:04:33.880 --> 0:04:36.720 such a huge topic. We always say this, but this 0:04:36.839 --> 0:04:39.680 time we're really showing you that we mean it by 0:04:39.839 --> 0:04:42.880 dividing it into three episodes. And so just to give 0:04:42.880 --> 0:04:46.040 you an overview of what each of these episodes is 0:04:46.080 --> 0:04:50.839 going to include. The first episode, this one today, is 0:04:50.880 --> 0:04:54.839 going to focus primarily on infertility. So I'll be talking 0:04:54.880 --> 0:04:58.839 about the concept of infertility as it has changed over time, 0:04:59.400 --> 0:05:03.200 leading up to the development of assisted reproductive technologies in 0:05:03.240 --> 0:05:06.640 the twentieth century. And Aaron will go into what to 0:05:06.760 --> 0:05:09.640 expect if you go in for a fertility exam and 0:05:09.760 --> 0:05:11.560 how fertility is assessed. 0:05:12.240 --> 0:05:17.320 Yeah, and then our second episode will be mostly IVF focused, 0:05:17.400 --> 0:05:21.640 So what is IVF, how was it developed, what steps 0:05:21.720 --> 0:05:24.640 had to happen for it to be developed, how does 0:05:24.640 --> 0:05:27.719 this technology actually work, and what does a typical cycle, 0:05:27.880 --> 0:05:30.919 if there is such a thing of IVF, actually look like. 0:05:31.600 --> 0:05:32.760 And then our final. 0:05:32.440 --> 0:05:35.840 Episode will explore IVF as it has grown in terms 0:05:35.880 --> 0:05:40.360 of both industry and innovation, from some ethically murky areas 0:05:40.440 --> 0:05:43.280 to some pretty incredible new technologies. 0:05:44.320 --> 0:05:48.440 Even with three whole episodes, there are things that we're 0:05:48.480 --> 0:05:51.400 not going to be able to cover in depth or 0:05:51.440 --> 0:05:54.839 that will miss entirely, and frankly, that would probably happen 0:05:54.920 --> 0:05:58.479 even if we did an entire series on IVF, And 0:05:58.680 --> 0:06:01.680 as always we will put links to sources where you 0:06:01.760 --> 0:06:05.839 can find more info should you want it. But overall, 0:06:06.080 --> 0:06:09.960 our goals for these episodes are number one, to explain 0:06:10.360 --> 0:06:14.640 what IVF is and how it works. Number two, talk 0:06:14.680 --> 0:06:20.440 about other forms of art assisted reproductive technologies. Number three 0:06:20.720 --> 0:06:25.240 present an overview of how IVF technology was developed, and 0:06:25.480 --> 0:06:28.520 for briefly discuss some of the ethical issues that have 0:06:28.680 --> 0:06:33.600 arisen with art in terms of access regulation and as 0:06:33.640 --> 0:06:34.360 an industry. 0:06:35.440 --> 0:06:39.560 And this is suffice to say a very complex and 0:06:40.160 --> 0:06:43.640 very multi dimensional topic, and there are a lot of 0:06:43.640 --> 0:06:47.760 people out there with really strong feelings about it. Our 0:06:47.839 --> 0:06:51.320 intent is not to add to that noise by sharing 0:06:51.360 --> 0:06:55.719 whatever our individual thoughts that we might have about infertility 0:06:55.839 --> 0:06:59.479 and IVF, but simply to just share all of the 0:06:59.520 --> 0:07:01.800 incredible information that we have learned in the. 0:07:01.760 --> 0:07:02.719 Course of this research. 0:07:03.240 --> 0:07:06.680 So hopefully we do an okay job. But of course, 0:07:07.000 --> 0:07:10.720 before we get into that, it is quarantiny time. 0:07:11.160 --> 0:07:14.600 It is Aaron. What are we drinking this week? 0:07:15.080 --> 0:07:22.120 We're drinking a work of art. Good one. It's a 0:07:22.120 --> 0:07:24.360 good one. It's a little inside joke there. 0:07:24.720 --> 0:07:25.080 Yeah. 0:07:25.160 --> 0:07:25.480 Yeah. 0:07:25.480 --> 0:07:27.160 Oh, and by the way, this is what we'll be 0:07:27.240 --> 0:07:30.720 drinking for this week and the next two episodes on 0:07:30.760 --> 0:07:36.760 this yeah. Classic, yeah, and in a work of art, 0:07:37.520 --> 0:07:40.320 tell me what's in it? What are the delicious ingredients? 0:07:40.520 --> 0:07:43.760 It's kind of essentially like a cucumber gimlet. So we've 0:07:43.800 --> 0:07:48.480 got gin, we've got lime juice, we've got cucumber, We've 0:07:48.480 --> 0:07:51.640 got some simple syrup. You can throw some sparkling water 0:07:51.680 --> 0:07:54.680 in there if you like. It's really refreshing, really tasty. 0:07:55.280 --> 0:07:57.880 And we'll post the full recipe for that quarantini as 0:07:57.960 --> 0:08:02.120 well as the non alcoholic clas Ceba rita on our website. 0:08:02.200 --> 0:08:04.000 This podcast will kill You dot com and all of 0:08:04.040 --> 0:08:05.760 our social media channels. 0:08:05.480 --> 0:08:09.440 We will On our website this podcast will kill You 0:08:09.480 --> 0:08:12.760 dot com, you can find all sorts of cool things, 0:08:12.880 --> 0:08:17.520 including but not limited to, transcripts, links to bookshop dot 0:08:17.640 --> 0:08:21.000 org and goodreads lists, links to music by Bloodmobile, links 0:08:21.040 --> 0:08:26.760 to merch links to our Patreon, links to other things. 0:08:26.960 --> 0:08:31.360 I think all the sources, just all the things. You know, 0:08:31.600 --> 0:08:34.080 take a peek, see what you can find. Tell me 0:08:34.120 --> 0:08:34.840 what I'm forgetting. 0:08:38.960 --> 0:08:41.240 You didn't forget anything. I actually that I noticed. I 0:08:41.280 --> 0:08:43.079 thought that it was great, wonderful. 0:08:43.559 --> 0:08:48.559 Then check done done. Should we get started? 0:08:49.320 --> 0:08:51.240 I think that we should. I really think that we should. 0:08:51.559 --> 0:08:54.560 Let's just take a quick break and then I'll get 0:08:54.559 --> 0:08:57.720 started because we're doing all of these episodes a little 0:08:57.720 --> 0:09:00.600 bit out of order where I go first and then. 0:09:00.600 --> 0:09:01.240 I can't wait. 0:09:17.920 --> 0:09:20.560 So my husband and I we started trying to get 0:09:20.600 --> 0:09:24.559 pregnant as soon as we got married. I already had 0:09:24.600 --> 0:09:27.600 my eldest son from a previous relationship, but we were 0:09:27.600 --> 0:09:34.240 desperate to carry on and grow our family. We tried, 0:09:34.800 --> 0:09:37.760 and after trying for a year, we decided to have 0:09:37.800 --> 0:09:41.680 some investigations. We went to the doctor and it turned 0:09:41.679 --> 0:09:46.240 out that my husband had low sperm counts and low 0:09:46.280 --> 0:09:50.720 sperm motility, and so we were told that the only 0:09:50.760 --> 0:09:56.720 real option was to have IVF. We found a clinic 0:09:57.640 --> 0:10:03.800 that we liked, and we also decided to do egg 0:10:03.880 --> 0:10:10.160 donation alongside our IVF treatment. So what that meant is 0:10:10.200 --> 0:10:16.120 that I donated half of the eggs that were harvested 0:10:16.200 --> 0:10:22.559 during the treatment to another couple, So we got nine 0:10:22.600 --> 0:10:28.080 eggs when they went in to collect them, so we 0:10:28.120 --> 0:10:32.400 gave five to the other couple and we had four ourselves. 0:10:33.200 --> 0:10:37.920 The procedure needed ixy as well, which is where this 0:10:38.040 --> 0:10:42.360 sperm is actually injected directly into the egg, so all 0:10:42.400 --> 0:10:46.720 four eggs were fertilized and then it was a very 0:10:46.840 --> 0:10:50.720 anxious weight call in the lab every day to see 0:10:50.800 --> 0:10:55.560 if our embryos had been dividing and developing. And then 0:10:55.880 --> 0:10:59.920 three days later, we chose while the doctors chose the 0:11:00.280 --> 0:11:06.760 two embryos to transfer back into my uterus. It was 0:11:06.920 --> 0:11:11.440 a very nerve wracking day, but we did it. We 0:11:11.480 --> 0:11:14.439 went home and then it was a two week wait 0:11:14.559 --> 0:11:16.960 to find out if it had worked and if I 0:11:17.040 --> 0:11:21.000 was pregnant. We happened to go away for the weekend. 0:11:21.120 --> 0:11:25.520 It was our wedding anniversary, and just by some coincidence, 0:11:26.559 --> 0:11:29.760 we were staying at our same hotel we spent our 0:11:29.760 --> 0:11:31.320 wedding night, and we ended up in the same room 0:11:31.360 --> 0:11:34.800 we spent our wedding night, and that's where I did 0:11:35.080 --> 0:11:39.000 a pregnancy test and we got a positive result. Then 0:11:39.520 --> 0:11:43.280 six weeks later we saw their little heartbeats and we 0:11:43.320 --> 0:11:47.240 found out it was twins. And then those twins are 0:11:47.280 --> 0:11:52.200 now twelve. I also found out that the couple that 0:11:52.360 --> 0:11:55.720 I donated my eggs too, they had a little girl 0:11:55.760 --> 0:11:59.440 as well, so their pregnancy was also successful. So really 0:12:00.160 --> 0:12:01.480 case scenario everyhoe. 0:12:06.000 --> 0:12:07.280 Hi, my name's Maddie. 0:12:07.320 --> 0:12:09.959 I'm twenty eight and my husband and I are currently 0:12:10.040 --> 0:12:12.920 undergoing IVF in the hopes of having our first baby. 0:12:13.640 --> 0:12:15.839 We got married young seven years ago and we weren't 0:12:15.880 --> 0:12:18.240 really in a rush to start a family, but we 0:12:18.360 --> 0:12:20.600 did decide to start trying about two and a half 0:12:20.679 --> 0:12:23.640 years ago. We're trying for about a year, and during 0:12:23.640 --> 0:12:26.319 that time I noticed that my already painful periods were 0:12:26.360 --> 0:12:29.400 now becoming even more difficult to manage, and I also 0:12:29.480 --> 0:12:30.480 noticed some urinary and. 0:12:30.520 --> 0:12:32.320 Bout problems that were quite concerning. 0:12:33.080 --> 0:12:35.120 It took that year of trying to finally get a 0:12:35.160 --> 0:12:38.040 referral to a gynecologist, and within the first ten minutes 0:12:38.080 --> 0:12:40.560 of meeting her, she was pretty convinced that I had 0:12:40.640 --> 0:12:45.000 endometriosis and wanted me in surgery in two weeks. Two 0:12:45.080 --> 0:12:48.400 weeks later, I had a laproscopy and a histroscopy, and 0:12:48.480 --> 0:12:53.040 my surgeon had found stage four endometriosis affecting my uterus, ovaries, 0:12:53.160 --> 0:12:57.079 fallopian tubes, about and bladder, but thankfully she managed to 0:12:57.080 --> 0:12:59.280 remove majority of it and kind of said that for 0:12:59.280 --> 0:13:01.600 the next six month I'd probably be my most fertile, 0:13:01.840 --> 0:13:04.240 and that she'd be quite surprised if I hadn't naturally 0:13:04.280 --> 0:13:07.719 fallen pregnant. And in that six months those boo and 0:13:07.840 --> 0:13:11.240 urinary problems had subsided, and so too did the period pain, 0:13:11.400 --> 0:13:15.480 so we were quite hopeful. Fast forward six months and 0:13:15.640 --> 0:13:18.360 still nothing was happening, so we requested a referral to 0:13:18.520 --> 0:13:21.760 a fertility specialist and she informed us that my husband 0:13:21.760 --> 0:13:24.640 had a low sperm count. His count was roughly one 0:13:24.640 --> 0:13:27.080 and a half million sperm per meal and the normal 0:13:27.160 --> 0:13:30.800 reference point is fifteen million per meal, so she actually 0:13:30.840 --> 0:13:34.640 recommended IXY over IVF to ensure a good fertilization rate. 0:13:35.679 --> 0:13:39.120 October last year, I had my first egg retrieval and 0:13:39.160 --> 0:13:41.680 I was really lucky and had a really positive experience. 0:13:41.880 --> 0:13:44.480 I wasn't shy of the needles, being a healthcare worker, 0:13:44.920 --> 0:13:48.040 and I had a really good result. We retrieved twenty 0:13:48.040 --> 0:13:51.800 eggs and ten were actually mature enough to fertilize. Nine 0:13:51.880 --> 0:13:55.800 did fertilize overnight, and by day five I had six 0:13:56.040 --> 0:14:00.400 really high quality blastocites. We ended up doing a fresh 0:14:00.440 --> 0:14:03.200 transfer with one of them and froze the rest, and 0:14:03.440 --> 0:14:07.400 unfortunately that transfer failed, and since then we've done a 0:14:07.440 --> 0:14:11.680 further too frozen embryo transfers that have unfortunately also failed. 0:14:12.280 --> 0:14:15.240 I've actually just done my second historiscopy in just over 0:14:15.280 --> 0:14:17.560 twelve months to see if there's some kind of issue 0:14:17.760 --> 0:14:20.960 local to my uterus that might be preventing implantation, and 0:14:21.000 --> 0:14:23.480 I've also done multiple blood tests to rule out other 0:14:23.560 --> 0:14:24.520 issues such. 0:14:24.320 --> 0:14:25.920 As immune or clotting disorders. 0:14:27.000 --> 0:14:29.560 We are actually hoping to do another transfer within the 0:14:29.600 --> 0:14:32.240 next month or two, and we remain really hopeful. We 0:14:32.360 --> 0:14:34.880 both say this is one of the hardest journeys we've 0:14:34.880 --> 0:14:36.880 ever been through, and we're very aware that there are 0:14:36.880 --> 0:14:39.920 people who have been on even longer, more painful journeys 0:14:39.960 --> 0:14:43.200 than us. Every day is a battle, and every failed 0:14:43.200 --> 0:14:46.080 cycle is a full cycle of grief. But we're so 0:14:46.200 --> 0:14:48.440 grateful we have the means to do this, and at 0:14:48.480 --> 0:14:51.240 a time where science is learning more and more every 0:14:51.320 --> 0:14:55.400 day about infertility and how to overcome it, and hopefully 0:14:55.400 --> 0:15:23.960 one day we'll get our little baby. 0:15:24.000 --> 0:15:27.560 It seems to me like every few months there's a 0:15:27.600 --> 0:15:33.120 headline that declares, in somewhat alarmist tones, infertility is on 0:15:33.280 --> 0:15:33.800 the rise? 0:15:35.200 --> 0:15:38.160 Is it? 0:15:38.200 --> 0:15:42.400 Is it? The short answer is no, and I know 0:15:42.560 --> 0:15:46.200 that you'll give the longer answer later in the episode Erin, 0:15:46.320 --> 0:15:51.120 but most research shows that actually global infertility has changed 0:15:51.280 --> 0:15:53.880 very little over the past few decades, if at all. 0:15:55.400 --> 0:15:59.360 I think the more accurate headline would be headlines about 0:15:59.400 --> 0:16:02.640 infertility being on the rise. Are on the rise, And 0:16:03.440 --> 0:16:06.200 I'll get into more of the possible reasons for that 0:16:06.280 --> 0:16:08.920 a little later on, But I wanted to start with 0:16:08.960 --> 0:16:12.880 these headlines because I think they provide an opportunity for 0:16:13.000 --> 0:16:17.320 us to think about what infertility can mean for us today, 0:16:17.760 --> 0:16:21.960 and how those definitions are fluid across space, across time, 0:16:22.360 --> 0:16:27.000 and across intent. There's the medical definition of infertility, which 0:16:27.040 --> 0:16:31.040 the WHO says is twelve months of regular unprotected sex 0:16:31.080 --> 0:16:34.560 without pregnancy, and that definition actually has been like the 0:16:34.600 --> 0:16:39.760 medical definition has been revised over the years. There's primary 0:16:39.840 --> 0:16:44.840 infertility it's like no pregnancy ever, and secondary infertility at 0:16:44.920 --> 0:16:49.840 least one pregnancy previously. And then there's what insurance companies 0:16:49.880 --> 0:16:53.400 will consider to be infertility, which changes what they're willing 0:16:53.480 --> 0:16:58.200 to cover for fertility treatment. There's how infertility is used 0:16:58.240 --> 0:17:02.600 politically as a scare tactic to reinforce gender roles. There's 0:17:02.680 --> 0:17:07.399 fertility rate, which some headlines conflate with infertility rate, so 0:17:07.760 --> 0:17:10.280 you know, like the average woman in twenty twenty four 0:17:10.359 --> 0:17:13.360 is giving birth to fewer kids than in the nineteen fifties, 0:17:13.400 --> 0:17:17.640 so infertility must be on the rise, that's not, yeah, 0:17:18.200 --> 0:17:19.840 something having like two. 0:17:19.680 --> 0:17:23.639 Whole pages that I had to cut down just about that. 0:17:24.119 --> 0:17:29.000 It's very very very different. Yes, yes, infertility. The concept 0:17:29.000 --> 0:17:33.040 of infertility varies also across cultures. So for instance, there 0:17:33.080 --> 0:17:36.040 are some cultures that consider someone to be infertile if 0:17:36.080 --> 0:17:39.439 they haven't given birth to a boy yet. Is it 0:17:40.040 --> 0:17:44.480 a snapshot measure or a lifetime measure? If you become 0:17:44.520 --> 0:17:48.359 pregnant after two years, three years, five years, seven years 0:17:48.359 --> 0:17:53.520 of trying does that still count? Like does infertility apply 0:17:53.600 --> 0:17:57.919 to couples or to individuals? Does intent matter? If someone 0:17:58.000 --> 0:18:01.040 cannot become pregnant due to a medical issue, but they 0:18:01.040 --> 0:18:06.240 have never intended to become pregnant, does that count as infertility? 0:18:06.280 --> 0:18:09.639 Along those same lines, if someone never seeks treatment for 0:18:09.720 --> 0:18:14.119 infertility because of lack of access, personal beliefs, other reasons, 0:18:14.720 --> 0:18:18.800 are they counted in these measures of infertility? Will their 0:18:18.920 --> 0:18:23.159 voice be heard? The bottom line is that infertility can 0:18:23.240 --> 0:18:26.679 mean many different things to many different people, and it 0:18:26.720 --> 0:18:29.240 can be difficult to get a handle on where these 0:18:29.359 --> 0:18:33.600 modern measures of infertility are coming from, who they are capturing, 0:18:33.920 --> 0:18:38.520 and who they are failing to capture. This is one 0:18:38.600 --> 0:18:43.040 reason why we should scrutinize headlines claiming a rise in 0:18:43.040 --> 0:18:48.080 infertility rates, first of all, compared to when the data 0:18:48.119 --> 0:18:52.520 that go into modern measures of infertility are incredibly messy, 0:18:53.119 --> 0:18:57.200 let alone estimates from the early twentieth century or before, 0:18:57.760 --> 0:19:00.720 when infertility was even more shrouded in silence than it 0:19:00.800 --> 0:19:05.280 is today. Secondly, these headlines tend to ramp up during 0:19:05.320 --> 0:19:09.840 periods of backlash against progressive movements like women's liberation in 0:19:09.880 --> 0:19:13.359 the nineteen seventies, which was followed by claims that the 0:19:13.440 --> 0:19:18.160 traditional nuclear family was at risk because career hungry women 0:19:18.320 --> 0:19:21.520 were waiting too long to have kids. And then this 0:19:21.680 --> 0:19:24.800 called for a return to a traditional working husband's stay 0:19:24.800 --> 0:19:28.320 at home mom arrangement. And it's you know, we're seeing 0:19:28.320 --> 0:19:32.520 echoes of that today with this tradwife trend and all 0:19:32.600 --> 0:19:37.800 of the birth controlled disinformation that's circulating around social media lately. Yeah, 0:19:38.240 --> 0:19:41.040 And the last thing I'll say about these headlines is 0:19:41.080 --> 0:19:45.080 that right alongside them are reports of out of control 0:19:45.160 --> 0:19:50.480 global population growth, which shows that it's not about infertility overall, 0:19:50.720 --> 0:19:55.520 but it's rather concern over who is having babies and 0:19:55.600 --> 0:20:01.480 who isn't. If infertility in its bio medical definition is 0:20:01.680 --> 0:20:06.400 truly on the rise globally or regionally or within populations, 0:20:06.920 --> 0:20:10.480 we should investigate why that is. Just because infertility is 0:20:10.520 --> 0:20:12.520 hard to measure, it doesn't mean that we shouldn't try. 0:20:13.200 --> 0:20:15.119 And if we want to do that, we have to 0:20:15.200 --> 0:20:19.040 take in all of the various meanings of infertility, what 0:20:19.080 --> 0:20:21.520 it means to people measuring it, what it means to 0:20:21.600 --> 0:20:24.959 people experiencing it, what it means to people treating it, 0:20:25.359 --> 0:20:29.560 and how those meanings change over space and time. For 0:20:29.640 --> 0:20:33.879 a truly amazing overview of this subject. I highly recommend 0:20:34.080 --> 0:20:37.760 that Paul Grave Handbook of Infertility in History, edited by 0:20:37.920 --> 0:20:42.080 Gail Davis and Tracy Lofgren, which was my main resource 0:20:42.160 --> 0:20:47.120 for this first episode. It's a wonderful collection of essays 0:20:47.119 --> 0:20:52.160 and chapters and works that I really just all across 0:20:52.200 --> 0:20:54.359 the board. I mean, I was like completely overwhelmed, but 0:20:54.440 --> 0:20:59.679 I loved it. So I want to first take a 0:20:59.680 --> 0:21:02.480 step back and consider what it means to look for 0:21:02.600 --> 0:21:08.480 traces of infertility throughout history. Humans have experienced infertility forever, 0:21:09.000 --> 0:21:11.760 but infertility doesn't leave marks on the bone, and it 0:21:11.800 --> 0:21:15.600 doesn't get logged in yearly mortality rates or disease tallies. 0:21:16.280 --> 0:21:19.080 With the exception of the last century or so, it 0:21:19.160 --> 0:21:23.000 is rarely openly discussed by those who are experiencing it, 0:21:23.840 --> 0:21:27.119 maybe because they didn't know how to read or write, 0:21:27.480 --> 0:21:31.119 maybe because their writings were not seen as important for preservation, 0:21:31.600 --> 0:21:35.080 or maybe because shame or pain kept them from including 0:21:35.119 --> 0:21:38.679 it in their writings. There do exist some examples of 0:21:38.800 --> 0:21:42.320 letters or diaries where women have described their feelings about 0:21:42.359 --> 0:21:45.000 not being able to have children or not being able 0:21:45.040 --> 0:21:49.760 to have additional children. Secondary infertility is even more difficult 0:21:49.840 --> 0:21:53.960 to spot in history, but these writings are fairly rare. 0:21:54.520 --> 0:21:56.879 So I'm going to read you a quote from Henriette 0:21:56.880 --> 0:22:02.080 Obermuller Vena Dat, writing in her autobiography in eighteen seventy quote. 0:22:02.800 --> 0:22:06.040 I bought books, I talked to women's doctors. I decided 0:22:06.040 --> 0:22:09.040 to do everything they told me to. I saw the midwife, 0:22:09.119 --> 0:22:11.360 I was told this and that. I heard that there 0:22:11.400 --> 0:22:13.800 was a recipe, but that it might kill me. I 0:22:13.800 --> 0:22:16.600 wouldn't have minded. If only I could have become a mother, 0:22:17.000 --> 0:22:19.800 if only I could have born Gustave a child. I 0:22:19.960 --> 0:22:22.080 was so certain it was my fault. 0:22:22.800 --> 0:22:23.359 End quote. 0:22:25.280 --> 0:22:29.919 Infertility or difficulty conceiving shows up in pagan mythologies with 0:22:30.040 --> 0:22:34.880 goddesses of fertility, and plays in religious texts like the Bible, 0:22:35.520 --> 0:22:38.879 in epic poems. In works of art. We see traces 0:22:38.920 --> 0:22:43.000 of infertility in instances of royal succession, like where a 0:22:43.040 --> 0:22:46.359 male heir is not produced, but for the most part 0:22:46.840 --> 0:22:50.879 in those stories it stays more of an historical plot 0:22:50.920 --> 0:22:55.440 point rather than the lived experience being important on its own, 0:22:56.280 --> 0:23:00.919 probably keeping infertility partially shrouded in silence. Theat history is 0:23:00.960 --> 0:23:04.920 its affiliation with sex, which has always been pretty taboo 0:23:05.000 --> 0:23:10.159 in Western culture. Especially sex without procreation, as well as 0:23:10.200 --> 0:23:14.760 the fact that bearing children has been the expectation, the 0:23:14.960 --> 0:23:18.840 norm throughout all of history, and when that didn't happen, 0:23:19.080 --> 0:23:23.719 it was a noticed and be tinged with shame, indicative 0:23:23.800 --> 0:23:28.679 of a problem. Finally, infertility has mostly been seen as 0:23:28.720 --> 0:23:33.639 a woman's issue, thus not as important for documenting. Who 0:23:33.720 --> 0:23:37.800 is doing the writing after all, who is actually deciding 0:23:37.920 --> 0:23:41.200 what is important in history, you know, and what should 0:23:41.240 --> 0:23:44.800 be preserved or not? Would they have viewed a woman's 0:23:44.840 --> 0:23:48.480 infertility as relevant to the historical record or just to 0:23:48.800 --> 0:23:54.440 whatever story they're telling. As Davis and Lochrin, the editors 0:23:54.480 --> 0:23:57.919 of this book put it, quote, these problems are magnified 0:23:58.040 --> 0:24:02.720 when tackling infertility experiential state that exists as an absence, 0:24:02.920 --> 0:24:06.359 the failure to engender pregnancy that plays out on the 0:24:06.400 --> 0:24:11.400 bodies of women, a historically marginalized group, and that, it seems, 0:24:11.520 --> 0:24:16.520 often further stigmatizes its subjects, thus rendering them inarticulate or 0:24:16.560 --> 0:24:22.640 silent end quote. Where we see the most references to infertility, 0:24:23.000 --> 0:24:27.879 or maybe more precisely, involuntary childlessness is in medical writings 0:24:28.480 --> 0:24:31.520 with hypotheses as to why someone is not able to 0:24:31.560 --> 0:24:35.760 become pregnant or treatment handbooks to target different perceived causes 0:24:35.800 --> 0:24:41.000 of involuntary childlessness, ranging from the biological, to the psychological 0:24:41.119 --> 0:24:45.520 to the spiritual. Today, if someone goes in for fertility testing, 0:24:45.760 --> 0:24:48.600 doctors will try to pinpoint the precise issue and come 0:24:48.680 --> 0:24:51.280 up with treatment based on that. But we know a 0:24:51.280 --> 0:24:54.800 whole lot more now about reproductive science than, for instance, 0:24:54.880 --> 0:24:59.119 ancient Greek physicians, who largely viewed reproduction in like plant 0:24:59.240 --> 0:25:04.840 soil terms. The man provides the seed semen the active 0:25:04.960 --> 0:25:09.320 dynamic material, and the woman provides the substrate, the soil 0:25:09.520 --> 0:25:12.960 the menstrual blood in which the seed is planted. And 0:25:13.040 --> 0:25:17.120 this agricultural metaphor reinforced the role of the man as 0:25:17.119 --> 0:25:20.560 the active partner and the woman as passive, which still 0:25:20.600 --> 0:25:24.080 finds its way into the way we talk about some 0:25:24.160 --> 0:25:29.640 of these aspects of fertility or reproduction. The sperm invading 0:25:29.720 --> 0:25:33.840 the egg, you know, like this very much active role 0:25:33.920 --> 0:25:38.040 and then passive role. And it also explains why the 0:25:38.160 --> 0:25:43.359 terms fertile, barren, and seed are associated with producing offspring. 0:25:43.840 --> 0:25:46.679 I never in a million years would have thought about that. 0:25:47.800 --> 0:25:52.159 There is like so much about agriculture and reproduction in 0:25:52.280 --> 0:25:56.480 ancient Greece and it makes sense, I mean, it's yeah. 0:25:56.600 --> 0:25:59.520 And also what kind of makes sense along these same 0:25:59.560 --> 0:26:02.960 lines is treatment. So in ancient Greece, a lot of 0:26:02.960 --> 0:26:07.159 the treatments for improving conception, and this extended all the 0:26:07.200 --> 0:26:10.600 way to medieval times. They tend to center around either 0:26:10.640 --> 0:26:14.840 balancing out the humors, of course, or prescribing recipes that 0:26:14.920 --> 0:26:21.200 included ingredients associated with fertility, like the sexual organs of animals, 0:26:21.240 --> 0:26:25.400 of certain animals in particular, plants that produce a whole 0:26:25.440 --> 0:26:28.159 lot of seeds, or animal dung which was used to 0:26:28.200 --> 0:26:30.400 fertilized fields for planting crops. 0:26:31.000 --> 0:26:31.240 Oh. 0:26:31.800 --> 0:26:33.480 Gross, but logical in a way. 0:26:33.800 --> 0:26:39.080 Yes. And while many of these treatments were geared just 0:26:39.119 --> 0:26:43.000 towards women, some involved both a husband and a wife, 0:26:43.240 --> 0:26:46.719 and a small handful were just for men. Recipe books 0:26:46.760 --> 0:26:50.320 from medieval England sometimes included tests meant to show the 0:26:50.400 --> 0:26:53.199 source of the infertility. Is it from the husband? Is 0:26:53.200 --> 0:26:56.560 it from the wife? For example, quote the man and 0:26:56.640 --> 0:26:59.560 woman should each urinate into a pot of brand and 0:26:59.600 --> 0:27:01.920 the pot were then left to stand for a period 0:27:01.960 --> 0:27:04.960 of seven, ten or fourteen nights. At the end of 0:27:05.000 --> 0:27:08.240 this time, if the fault lay in one partner, then 0:27:08.240 --> 0:27:11.720 the pot containing his or her urine would stink or 0:27:11.760 --> 0:27:17.320 contain worms. But if neither pot contained worms, then may 0:27:17.440 --> 0:27:20.280 men help them to have a child through medicines. 0:27:20.880 --> 0:27:23.760 End quote yea yeaiyii wow. 0:27:24.720 --> 0:27:28.359 I mean is there something to that? I don't think so, 0:27:28.560 --> 0:27:31.840 but it is very interesting. What worms? 0:27:33.400 --> 0:27:34.120 What worm? 0:27:34.520 --> 0:27:36.760 What worms? I'm so curious a. 0:27:36.760 --> 0:27:37.960 Cup of brand and urine. 0:27:38.040 --> 0:27:39.000 I mean, I. 0:27:40.480 --> 0:27:41.680 Don't even know what to say. 0:27:42.080 --> 0:27:46.000 Yeah, you don't have to say. I don't know, speechless. 0:27:48.000 --> 0:27:49.920 And of course these books would not have been the 0:27:49.920 --> 0:27:54.040 only sources of information about pregnancy and conceiving. We have 0:27:54.200 --> 0:27:57.159 no way of knowing how much knowledge was exchanged between 0:27:57.200 --> 0:28:01.840 women or between men, and never written down. These treatments 0:28:01.920 --> 0:28:04.720 and tests followed the logic of what was then thought 0:28:04.720 --> 0:28:08.320 to lead to pregnancy, which, by the way, just as 0:28:08.359 --> 0:28:11.159 a reminder, not like you need the reminding, but I 0:28:11.160 --> 0:28:14.960 mean we all need the reminder. You couldn't go out 0:28:15.000 --> 0:28:17.880 and get a test to tell you within a matter 0:28:17.920 --> 0:28:20.840 of weeks that you were pregnant. You had to wait 0:28:21.280 --> 0:28:22.560 like a long time. 0:28:22.600 --> 0:28:23.240 Very long time. 0:28:23.680 --> 0:28:24.040 Yeah. 0:28:24.119 --> 0:28:26.600 And I think it also forces us to consider how 0:28:26.760 --> 0:28:31.360 much our current definition of infertility depends on our biomedical 0:28:31.480 --> 0:28:35.359 understanding of reproduction. Which we really only gained in the 0:28:35.359 --> 0:28:39.440 twentieth century. I feel like historically infertility was an absence 0:28:40.320 --> 0:28:44.520 of something, and then it grew into more refined definitions 0:28:44.560 --> 0:28:46.760 of Oh, it is a presence of this issue, It 0:28:46.800 --> 0:28:49.760 is a presence of this issue, all of these different things. 0:28:49.840 --> 0:28:53.040 And also, I mean, of course, I want to acknowledge 0:28:53.040 --> 0:28:57.640 that unexplained infertility makes up a huge proportion of infertility cases, 0:28:57.720 --> 0:28:59.840 or people who seek infertility. 0:29:00.160 --> 0:29:02.160 Will get there, We will get there. 0:29:03.560 --> 0:29:07.640 The word infertility came to prominence in the late nineteen seventies, 0:29:08.000 --> 0:29:11.760 replacing the terms barren and sterile. People knew you. 0:29:11.800 --> 0:29:15.160 Say sorry, sorry sorry sor yeah you're saying nineteen seventies. 0:29:14.920 --> 0:29:16.800 Okay, that's what I read that. It was like, I 0:29:16.880 --> 0:29:20.600 think that infertility had been used, it had been a term, 0:29:20.760 --> 0:29:24.520 but it really I think replaced the other two around 0:29:24.560 --> 0:29:24.960 that time. 0:29:25.280 --> 0:29:26.360 That makes sense, That makes sense. 0:29:26.640 --> 0:29:30.320 Yeah, people knew what sperm and eggs were since the 0:29:30.360 --> 0:29:33.960 seventeenth century, but it wasn't until the late eighteen hundreds 0:29:34.000 --> 0:29:36.960 that scientists figured out how they work together. 0:29:37.640 --> 0:29:37.960 Cool. 0:29:38.560 --> 0:29:40.320 Yeah, that's an entire story. 0:29:40.680 --> 0:29:46.800 It's also so so that's so much earlier than I expected. Somehow, 0:29:46.840 --> 0:29:49.960 like it's it isn't that it is the eighteen eighties. 0:29:50.480 --> 0:29:53.760 Wow, Yeah, like the late eighteen hundreds. I don't know 0:29:53.800 --> 0:29:56.320 why it struck me as late, because I feel like 0:29:56.360 --> 0:29:59.240 if they had known what they both were, But I 0:29:59.240 --> 0:30:01.520 think it was more to like the role that each 0:30:01.560 --> 0:30:06.160 of them played. But even still, sperm and eggs are 0:30:06.200 --> 0:30:10.200 just one piece of the puzzle. For much of human history, 0:30:10.240 --> 0:30:13.880 the nitty gritty of human reproduction remained more or less 0:30:13.880 --> 0:30:17.960 a mystery, and where there's room for doubt or uncertainty, 0:30:18.400 --> 0:30:23.160 there's often room for blame. Women historically and even today, 0:30:23.360 --> 0:30:25.760 tend to shoulder more of the blame when it comes 0:30:25.760 --> 0:30:29.840 to difficulty conceiving, and it's not uncommon to hear modern 0:30:29.880 --> 0:30:33.640 stories where a straight couple goes through fertility testing. The 0:30:33.680 --> 0:30:36.800 doctors find a potential contributing factor in the woman, they 0:30:36.800 --> 0:30:40.400 take steps to treat that, and then months or years 0:30:40.440 --> 0:30:43.960 down the line, finally like still nothing's happening, and they 0:30:44.040 --> 0:30:49.720 finally test the man and find additional issues. In this 0:30:50.000 --> 0:30:54.200 Palgrave Handbook of infertility book, I came across the story 0:30:54.280 --> 0:30:56.800 of a woman who, quote, over a two year period 0:30:56.800 --> 0:31:01.040 in the late nineteen forties, underwent two dilation and curati operations, 0:31:01.160 --> 0:31:06.320 a tubal insulflation, a selpindrogram, an endometrial biopsy, and a 0:31:06.360 --> 0:31:10.920 host of injections, courses of tablets and douches before her husband, 0:31:11.000 --> 0:31:16.200 Seamen was tested and found to contain no spermatozoa end 0:31:16.280 --> 0:31:22.000 quote wow wow, So yeah. We can see this blame 0:31:22.040 --> 0:31:25.400 with many royal families, where women were seen as responsible 0:31:25.440 --> 0:31:28.240 for producing an air and a spare, as well as 0:31:28.240 --> 0:31:32.520 other children for forming political alliances. If a woman failed 0:31:32.520 --> 0:31:35.360 to fulfill her royal and marital duties in that way, 0:31:35.760 --> 0:31:38.320 at the least, she was frowned upon. At the most 0:31:38.720 --> 0:31:42.240 she was disposed of, as Henry the Eighth famously did 0:31:42.280 --> 0:31:45.720 to several wives, even though scholars think that he was 0:31:46.040 --> 0:31:48.880 probably the common denominator and that it was actually quite 0:31:48.920 --> 0:31:52.160 common because at the time forty percent of Tudor marriages 0:31:52.200 --> 0:31:57.080 had no children. Really really, that's what at least historical 0:31:57.080 --> 0:32:02.440 calculations estimate. A marriage without children could be seen as 0:32:02.440 --> 0:32:07.080 a sign of God's disapproval or later on unpatriotic, because 0:32:07.120 --> 0:32:11.280 a thriving population was important for military and economic strength. 0:32:12.160 --> 0:32:13.920 But of course there's the caveat that I had. 0:32:13.840 --> 0:32:17.400 To be the right people reproducing right I mean, honestly, 0:32:17.440 --> 0:32:20.320 that's still the vibe from all of the articles today 0:32:20.440 --> 0:32:23.880 about fertility rates or infertility rates, like, that's the vibe. 0:32:24.080 --> 0:32:28.960 It is the yep, it is yep, it is eugenic, 0:32:29.000 --> 0:32:37.360 y eugenic adjacent. For centuries, women have been scrutinized for everything, 0:32:37.520 --> 0:32:42.120 their behavior, their bearing, their morality, their personality, their indulgences, 0:32:42.200 --> 0:32:47.120 their activity, their education, and especially their bodies to fat, 0:32:47.320 --> 0:32:51.400 too thin, too tall, to short, whatever it is, it 0:32:51.440 --> 0:32:54.520 was their fault. In the nineteenth century, it was thought 0:32:54.560 --> 0:32:57.520 that the more passionate the woman, the more likely she 0:32:57.560 --> 0:33:02.120 would be infertile, ending in an orgasm for a woman 0:33:02.360 --> 0:33:05.600 was thought to be less conducive to child bearing. Ah, 0:33:06.840 --> 0:33:09.600 one of the more depressing things I've I've read. 0:33:09.800 --> 0:33:13.240 It's also not accurate scientifically, let me tell you. 0:33:13.560 --> 0:33:20.000 Oh fascinating, Okay, The moral and medical explanations of infertility 0:33:20.240 --> 0:33:24.480 blended together. By the late eighteen hundreds. The causative agents 0:33:24.520 --> 0:33:28.840 of gonorrhea and syphilis and their effects on fertility were recognized, 0:33:29.360 --> 0:33:33.840 but in general, physicians believed that women's reproductive biology was 0:33:33.920 --> 0:33:37.680 more complex, and so women were more likely to experience 0:33:37.760 --> 0:33:43.520 complications from these infections compared to men. One physician R. A. 0:33:43.680 --> 0:33:47.400 Gibbons said in a nineteen ten address to the Medical 0:33:47.440 --> 0:33:51.600 Graduates College that quote, in many cases of sterility about 0:33:51.600 --> 0:33:55.600 which you will be consulted, it is undoubtedly the fault 0:33:55.720 --> 0:33:56.320 of the woman. 0:33:57.000 --> 0:34:00.120 End quote. 0:34:00.240 --> 0:34:04.720 Ninety six book titled Sterility by Robert Bell begins with quote, 0:34:04.960 --> 0:34:08.480 in considering the important subject of sterility in the female, 0:34:08.840 --> 0:34:12.879 we must not forget the fact that occasionally impotency may 0:34:13.000 --> 0:34:17.360 exist in the male. This is of such rare occurrence, however, 0:34:17.440 --> 0:34:21.600 that it may be looked upon almost as phenomenal. Moreover, 0:34:21.680 --> 0:34:24.160 when it does occur, it can generally be traced to 0:34:24.200 --> 0:34:27.520 the effects of some previous gone a real or syphilitic attack. 0:34:28.040 --> 0:34:28.640 End quote. 0:34:29.560 --> 0:34:33.560 Wow, yeah, it's just so blatant. 0:34:34.200 --> 0:34:38.080 It's also so interesting the use of different words, right, 0:34:38.320 --> 0:34:42.200 like sterility versus impotence. Like, it's very interesting. 0:34:43.440 --> 0:34:46.680 It is. It is. And I don't know, like if 0:34:46.680 --> 0:34:49.840 the definitions have I mean, I'm assuming that they have changed, 0:34:50.080 --> 0:34:53.200 or like the umbrella has changed. Yeah, I don't know. 0:34:53.600 --> 0:34:56.839 It's interesting. They all just have such like weight to them, 0:34:56.920 --> 0:34:58.640 no matter what, like on both sides. 0:34:58.920 --> 0:35:06.040 Yes, Yeah, this attitude, this belief that women were more 0:35:06.120 --> 0:35:09.840 to blame for any sort of issues of infertility in 0:35:09.960 --> 0:35:14.239 a couple. This became a self fulfilling prophecy because if 0:35:14.239 --> 0:35:17.880 physicians were taught that male infertility was rare, then they 0:35:17.880 --> 0:35:21.200 were less likely to examine the husband of a couple 0:35:21.320 --> 0:35:26.319 having difficulty conceiving because also, I say husband, because for 0:35:26.400 --> 0:35:28.520 the most part in this period of time, the only 0:35:28.560 --> 0:35:31.080 people who were seeking, or the vast majority of people 0:35:31.080 --> 0:35:34.520 who were seeking and would be seen by physicians, had 0:35:34.560 --> 0:35:37.040 to be a married couple. There was that sort of 0:35:37.120 --> 0:35:43.279 morality component to it. Some physicians did recognize that it 0:35:43.400 --> 0:35:47.080 wasn't necessarily the wife's fault, the woman's fault with eugenic 0:35:47.160 --> 0:35:50.919 y undertones. So quote A great many women are, through 0:35:50.960 --> 0:35:54.640 no fault of their own, incapable of becoming mothers. The 0:35:54.719 --> 0:35:57.319 reason for this is that they have been infected by 0:35:57.400 --> 0:36:00.640 venereal disease, which is the great foe to the reproduction 0:36:00.760 --> 0:36:04.120 of the race. The husband has infected his wife and 0:36:04.160 --> 0:36:06.799 thus robbed her of the power of maternity. 0:36:07.200 --> 0:36:07.760 End quote. 0:36:08.360 --> 0:36:12.440 It's so interesting erin Yeah, there's Oh, there's just so 0:36:12.560 --> 0:36:16.560 many layers of like connotations and assumptions that go into 0:36:16.880 --> 0:36:18.239 like a sentence like that. 0:36:18.680 --> 0:36:22.239 I know, I know there are directions like where is 0:36:22.239 --> 0:36:25.919 the blame going? Who was the active? Who was who 0:36:26.000 --> 0:36:29.040 was the Yeah? The subjectives yeah. 0:36:29.000 --> 0:36:30.799 Robbed her like everything about. 0:36:30.520 --> 0:36:36.520 It, the word choices yeah, yeah yeah. And we've got 0:36:36.560 --> 0:36:40.239 more because just for ice, we do just wait for it. 0:36:40.960 --> 0:36:44.200 The development of testing and treatment for STIs in the 0:36:44.239 --> 0:36:48.879 early twentieth century helped to reduce infertility associated with those infections, 0:36:49.360 --> 0:36:53.959 but it didn't remove the language of blame. The psychogenic 0:36:54.080 --> 0:36:57.800 model of infertility rose to prominence in the nineteen thirties, 0:36:58.760 --> 0:37:03.680 basically this idea that certain women brought on their infertility 0:37:03.800 --> 0:37:06.920 by not adapting to established gender roles. 0:37:07.280 --> 0:37:09.360 Can I just guess that Freud had something to do 0:37:09.400 --> 0:37:09.600 with this? 0:37:09.840 --> 0:37:17.879 Yes on the Dot? Got it of Yes, Yeah. It's 0:37:17.920 --> 0:37:22.400 been called a quote psychic conflict flying under a gynecologic 0:37:22.520 --> 0:37:29.760 flag end quote. Go Ross, it's awful Ross. Yeah. Okay, 0:37:29.800 --> 0:37:32.360 So I'm going to read you a quote from Freud's 0:37:33.000 --> 0:37:40.360 colleague Helene Deutsch. I also quoted her in our menopause episode. Quote, 0:37:41.440 --> 0:37:45.480 has her fear of the reproduction function proved stronger than 0:37:45.520 --> 0:37:48.160 her wish to be a mother? Is she still so 0:37:48.280 --> 0:37:52.280 much a child that she cannot emotionally and consciously decide 0:37:52.320 --> 0:37:55.840 to assume the responsible role of mother. Is she so 0:37:56.000 --> 0:38:00.800 much absorbed emotionally in other life tasks that she fears motherhood? 0:38:01.440 --> 0:38:06.000 And above all, has the sterile woman overcome the narcissistic 0:38:06.320 --> 0:38:11.560 mortification of her inferiority as a woman to such an 0:38:11.600 --> 0:38:14.799 extent that she is willing to give the child as 0:38:14.880 --> 0:38:17.319 object full maternal love? 0:38:18.200 --> 0:38:24.000 End quote? Oh, the rage of coursing through me. 0:38:26.600 --> 0:38:33.040 I'm sorry, I know, I know, yep, yep, yeah, Like. 0:38:35.239 --> 0:38:42.080 I don't even have like, I. 0:38:39.239 --> 0:38:43.880 It's amazing that that was not very long ago. 0:38:44.760 --> 0:38:48.080 Yes, that was less than one hundred years ago. 0:38:49.200 --> 0:38:51.279 I mean less than a hundred years ago. And then 0:38:51.440 --> 0:38:55.640 sort of like we've talked about the time that it 0:38:55.719 --> 0:39:00.960 takes for something to leave this tradition. I mean, Freud 0:39:00.960 --> 0:39:03.000 had was so influential. 0:39:02.680 --> 0:39:08.239 So influential, like still to this day influential. Yeah, and 0:39:08.280 --> 0:39:11.520 you can't like separate that kind of thing out from 0:39:11.560 --> 0:39:14.160 all of the other ideas, Like, sorry, okay, this is 0:39:14.200 --> 0:39:15.400 not an episode about Freud. 0:39:15.800 --> 0:39:19.640 I know, maybe someday now, I don't know if I'm 0:39:19.800 --> 0:39:23.239 I don't know if I'm prepared to do that. But 0:39:24.920 --> 0:39:29.759 also people sometimes blamed infertility in men on their quote 0:39:29.840 --> 0:39:33.680 unquote domineering and controlling mothers. So it was just like 0:39:33.800 --> 0:39:38.759 always you know, just you know, we're not surprised, just disappointed. 0:39:39.239 --> 0:39:42.319 You can blame a mother for infertility. That's just like 0:39:42.840 --> 0:39:44.239 that's taken a cake, right. 0:39:44.320 --> 0:39:49.160 I mean, yep, yep across the board. Though, you know, 0:39:49.200 --> 0:39:52.640 I do think it's important to note that infertility for 0:39:52.680 --> 0:39:56.600 both men and women was and continued to be highly 0:39:56.640 --> 0:40:01.000 stigmatized and full of blame language. And there's no doubt 0:40:01.040 --> 0:40:05.520 that shame also silenced men writing about their fertility issues. 0:40:05.640 --> 0:40:08.960 A history of male infertility seems even more difficult to 0:40:09.000 --> 0:40:12.200 get a handle on in some degree. And although the 0:40:12.200 --> 0:40:15.880 psychogenic model of infertility fell out of favor in subsequent 0:40:15.920 --> 0:40:19.880 decades as we learned more about how human reproduction works, 0:40:20.320 --> 0:40:24.520 it still lingers in some ways, like the advice that 0:40:24.880 --> 0:40:29.319 you will come across, Oh you're just too stressed, try 0:40:29.320 --> 0:40:32.719 to relax and then you'll get pregnant, or you just 0:40:32.760 --> 0:40:35.880 don't want it enough. Maybe it's your body's way of 0:40:35.920 --> 0:40:39.480 saying this wasn't meant to be. All of these types 0:40:39.520 --> 0:40:43.920 of things have echoes of the psychogenic model, but the 0:40:43.920 --> 0:40:49.520 more positive legacy is that the recognition that Experiencing infertility 0:40:49.560 --> 0:40:53.680 and going through fertility treatments can have profound impacts on 0:40:53.760 --> 0:40:58.160 mental health, revealing a need for mental health professionals infertility 0:40:58.160 --> 0:41:03.040 clinics not as gatekeepers for who is deserving of fertility treatment, 0:41:03.040 --> 0:41:05.600 which is kind of what they started out as in 0:41:05.640 --> 0:41:10.239 some degree, but as support. The twentieth century, which i'll 0:41:10.280 --> 0:41:14.239 talk much more about next episode, dramatically changed not only 0:41:14.239 --> 0:41:17.319 the way that infertility was studied or treated, but also 0:41:17.360 --> 0:41:20.680 the way it was experienced, which I haven't really talked about, 0:41:21.000 --> 0:41:24.239 in part because it's so big, it's so personal, it's 0:41:24.280 --> 0:41:29.719 not at all universal or generalizable. As our understanding of 0:41:29.800 --> 0:41:34.360 human reproduction grew, and as technologies like IVF developed in 0:41:34.360 --> 0:41:37.520 the late nineteen seventies, as these opened the door to 0:41:37.600 --> 0:41:44.839 new possibilities, infertility became something to overcome through science, but 0:41:44.960 --> 0:41:49.520 not for everyone. Stigma, silence, or a lack of access 0:41:49.600 --> 0:41:53.000 prevent people from seeking treatments in the first place, and 0:41:53.040 --> 0:41:57.000 the treatments aren't always successful or the cause of the 0:41:57.000 --> 0:42:02.839 infertility remains unexplained. In some ways. The improvements in reproductive 0:42:02.840 --> 0:42:07.640 technology have given us this illusion of complete control over 0:42:07.760 --> 0:42:12.319 our fertility, and many modern narratives of infertility tend to 0:42:12.440 --> 0:42:16.440 reinforce that control by highlighting stories where there's a beginning, 0:42:16.840 --> 0:42:20.560 a middle, and a happy ending, either through pregnancy and 0:42:20.680 --> 0:42:25.040 birth of an IVF baby, or adoption or surrogacy or 0:42:25.040 --> 0:42:28.719 something similar, something that's like and then here is the 0:42:28.800 --> 0:42:32.799 happy ending that everyone expects. The stories of people in 0:42:32.840 --> 0:42:36.080 the middle of IVF or who have tried IVF but 0:42:36.160 --> 0:42:39.239 have not gotten pregnant or delivered a baby. These are 0:42:39.320 --> 0:42:44.400 less common stories, which can add to the silence surrounding infertility, 0:42:44.520 --> 0:42:49.120 perpetuating the myth that fertility is a universal or universally 0:42:49.160 --> 0:42:55.399 desired experience. The idea of having it all plays into this, 0:42:55.719 --> 0:42:59.680 suggesting that if you don't have kids, whether that's voluntary 0:42:59.800 --> 0:43:04.040 or involuntary, you're missing something. You can't have it all. 0:43:05.120 --> 0:43:07.160 We could do a whole episode on the problem with 0:43:07.200 --> 0:43:10.280 the phrase having it all it's one of my least 0:43:11.120 --> 0:43:15.919 liked phrases, or doing it all. But silence can also 0:43:16.040 --> 0:43:21.360 be protective, preventing intrusive questions or platitudes like maybe this 0:43:21.520 --> 0:43:24.160 is the way it's meant to be for you. And 0:43:24.320 --> 0:43:27.560 these days, with the advent of contraceptives that in general 0:43:27.600 --> 0:43:30.919 allow us to have more control over reproduction. We can 0:43:30.960 --> 0:43:34.279 better control our own narrative, whether we want to tell 0:43:34.320 --> 0:43:37.560 anyone or whether we want to keep it private. Sharing 0:43:37.600 --> 0:43:42.360 stories of infertility or hearing those stories can reawaken painful feelings, 0:43:42.880 --> 0:43:45.960 or it can create a sense of community, or both, 0:43:46.280 --> 0:43:49.960 or neither, or something else. There's no simple answer or 0:43:50.040 --> 0:43:54.879 universal experience. And the same applies to the concept of infertility. 0:43:55.000 --> 0:43:58.880 On the one hand, thinking about infertility in purely biomedical terms, 0:43:58.920 --> 0:44:03.120 as we often do these days, reduces this multi dimensional 0:44:03.160 --> 0:44:07.560 experience to one aspect. But on the other the understanding 0:44:07.600 --> 0:44:10.920 that we gained throughout the twentieth century about the biological 0:44:10.960 --> 0:44:14.440 causes of infertility has helped to reduce the stigma and 0:44:14.560 --> 0:44:18.400 blame surrounding it, not globally but in many parts of 0:44:18.440 --> 0:44:22.360 the world, and it has allowed so many people to 0:44:22.480 --> 0:44:26.879 fulfill their dreams of having children. And so Aarin, I'll 0:44:26.920 --> 0:44:29.479 now turn it over to you to tell us all 0:44:29.560 --> 0:44:32.800 what to expect if we go in for fertility testing. 0:44:33.480 --> 0:44:37.359 Ooh, I cannot wait to We'll take a quick break 0:44:37.400 --> 0:44:38.359 and then I'll get into it. 0:44:52.480 --> 0:44:55.160 Hi were the yet man's I'm Brooke and I'm Rachel, 0:44:55.239 --> 0:44:57.520 and we wanted to share parts of our IVF journey, 0:44:57.680 --> 0:44:59.400 the good, the bad, the ugly with all of you. 0:45:00.040 --> 0:45:02.680 We started our journey in twenty twenty one. We decided 0:45:02.680 --> 0:45:04.640 that each of us would like to carry a biological 0:45:04.719 --> 0:45:07.760 child using the same donor sperm. I started the process 0:45:07.800 --> 0:45:11.400 first with IUI, and after several attempts, was unsuccessful. I 0:45:11.440 --> 0:45:14.799 then started the IVF process with follicle stimulation followed by 0:45:14.840 --> 0:45:17.759 the egg retriple. In February of twenty twenty two, I 0:45:17.800 --> 0:45:20.680 did a frozen instead of frush transfer because of overstimulation 0:45:20.760 --> 0:45:24.279 during the retrieval process. In April of twenty twenty two, 0:45:24.320 --> 0:45:27.239 I had a successful embryo transfer and implantation, followed by 0:45:27.239 --> 0:45:30.200 a healthy baby boy born in December of twenty twenty two. 0:45:31.560 --> 0:45:33.799 And now for the ugly part of the journey. I 0:45:33.880 --> 0:45:36.879 started my journey shortly after Rachel did. I had two 0:45:36.920 --> 0:45:41.879 egg retrievals because the first one only three embryos survived fertilization. 0:45:42.480 --> 0:45:45.360 After my first two embryos failed, I had an endometrio 0:45:45.400 --> 0:45:49.719 biopsy to test my progresstern window and test for endometrioses. 0:45:50.320 --> 0:45:52.759 For those of you that have never had when done, 0:45:52.800 --> 0:45:56.680 it's very painful, not a great experience at all. During 0:45:56.680 --> 0:45:59.200 this time, Rachel became pregnant, and it was very difficult 0:45:59.200 --> 0:46:01.560 for me because she was able to become pregnant with 0:46:01.640 --> 0:46:05.480 the first transfer and I was continuing to have unsuccessful transfers. 0:46:06.120 --> 0:46:09.160 It was very taxing on a relationship and my mental health, 0:46:09.400 --> 0:46:12.000 but we kept pushing on. By this time, our son 0:46:12.160 --> 0:46:14.600 was born and it made all the insecurities I had 0:46:14.640 --> 0:46:18.760 about not being his birth parent disappear. On my fourth 0:46:18.800 --> 0:46:21.719 transfer attempt, I did become pregnant. However, I started a 0:46:21.760 --> 0:46:25.120 bleed about two weeks after. I went in for an 0:46:25.200 --> 0:46:27.520 ultrasound and I found out I had a sub qoreanic 0:46:27.640 --> 0:46:31.960 chematoma that was bigger than the fetus itself. But there 0:46:32.000 --> 0:46:34.080 was still some hope because the fetus was still there 0:46:34.360 --> 0:46:37.960 and the bleeding had stepped. However, when we went in 0:46:38.040 --> 0:46:42.600 for the heartbeat check, it wasn't there. It was literally heartbreaking. 0:46:43.520 --> 0:46:45.359 At that point, I was abating on whether or not 0:46:45.400 --> 0:46:48.320 I wanted to keep trying, but we made it further 0:46:48.400 --> 0:46:50.920 than we had previously, so there was no indication that 0:46:51.000 --> 0:46:55.080 the next transfer wouldn't be successful. I tried one more time. 0:46:55.760 --> 0:46:58.759 It was my fifth and final transfer, but that was 0:46:58.760 --> 0:47:02.759 also unsuccessful. My next step would be shut to shed 0:47:02.800 --> 0:47:05.000 down my entire immune system to see if that would help. 0:47:05.400 --> 0:47:07.279 So I had two choices, give up on having a 0:47:07.280 --> 0:47:10.640 biological child or see if my wife, Rachel could get 0:47:10.680 --> 0:47:14.680 pregnant with my embryo, and after much discussion, we did 0:47:14.800 --> 0:47:17.960 a reciprocal IVF Rachel would attempt to carry one of 0:47:17.960 --> 0:47:22.320 my embryos. The first attempt has resulted in a chemical pregnancy. 0:47:22.840 --> 0:47:25.520 The embryo started doing plant and then detatched for an 0:47:25.600 --> 0:47:28.719 unknown reason. It could have been a genetic issue with 0:47:28.760 --> 0:47:32.600 the embryo or the embryo quality itself, but they weren't sure, 0:47:33.760 --> 0:47:36.040 so we did the same protocol and tried it again, 0:47:36.360 --> 0:47:38.080 which was successful. 0:47:38.840 --> 0:47:41.600 And I am now currently twenty five weeks pregnant and 0:47:41.680 --> 0:47:44.880 do in August with our second son as biologically brooks child. 0:47:45.480 --> 0:47:47.640 And I still struggle sometimes wishing that I could have 0:47:47.680 --> 0:47:50.000 been the one who carried her second son, but for 0:47:50.040 --> 0:47:52.400 some reason, it wasn't meant to be, and the journey 0:47:52.440 --> 0:47:54.120 to our family wasn't an easy one, but we can 0:47:54.160 --> 0:47:55.880 finally see the light at the end of the tunnel. 0:48:00.080 --> 0:48:04.160 Journey to IVF was one that we never expected. Having 0:48:04.200 --> 0:48:09.160 our first son unassisted and then being diagnosed with secondary infertility, 0:48:09.719 --> 0:48:14.560 five long years of trying and five missed miscarriages. We 0:48:14.560 --> 0:48:18.200 were always told it's just bad luck or it happens 0:48:18.200 --> 0:48:22.279 to everybody, but eventually you start looking for answers, and 0:48:22.440 --> 0:48:25.759 science really was the only way that we could bring 0:48:25.880 --> 0:48:30.239 our miracle baby home. Through one and a half egg 0:48:30.320 --> 0:48:35.600 retrievals due to one canceled because of poor outcomes, COVID 0:48:36.239 --> 0:48:40.960 closed clinics, moving our two precious tested embryos to a 0:48:41.160 --> 0:48:45.640 clinic five hours away, we finally reached a time where 0:48:45.680 --> 0:48:48.960 we were able to transfer our embryo and have our 0:48:49.000 --> 0:48:53.480 miracle baby. Without the science of IVF, my family would 0:48:53.560 --> 0:48:54.320 not be what. 0:48:54.160 --> 0:48:54.960 It is today. 0:48:55.360 --> 0:49:03.279 But it's not without shots, tears, blood, ultrasounds, financial, emotional 0:49:03.440 --> 0:49:07.600 and physical stress. And for anyone in the trenches, I'm 0:49:07.640 --> 0:49:11.160 forever grateful to have you by my side and I 0:49:11.200 --> 0:49:14.759 will always be there no matter what. To root everybody on. 0:49:15.600 --> 0:49:19.640 IVF is not something that is easy or taken lightly, 0:49:20.120 --> 0:49:23.480 but it is a chance to give us the dream 0:49:23.640 --> 0:49:25.000 of expanding our family. 0:49:53.280 --> 0:49:55.839 So Aarin, you started off your section, and I love 0:49:55.960 --> 0:49:59.680 that we sometimes we just work together so well, don't we? 0:50:00.239 --> 0:50:01.239 All the time you. 0:50:01.160 --> 0:50:04.280 Started off your section talking about this idea of whether 0:50:04.440 --> 0:50:09.239 or not infertility is actually on the rise, and that's 0:50:09.280 --> 0:50:13.040 where I wanted to start too, And where I wanted 0:50:13.080 --> 0:50:18.359 to start was really looking into what you started with, 0:50:18.400 --> 0:50:22.680 which is what is really the difference between fertility and 0:50:22.800 --> 0:50:27.759 infertility and how do we use that those definitions when 0:50:27.800 --> 0:50:32.360 we're talking about how to treat infertility as a medical disease, 0:50:32.440 --> 0:50:37.480 if that's what we're calling it. So governments, all governments 0:50:37.840 --> 0:50:40.839 cite fertility rates like that's the data that we have. 0:50:40.920 --> 0:50:44.920 We have data on birth rates, and yes, birth rates 0:50:45.360 --> 0:50:50.520 have declined substantially in the US, for example, in like 0:50:50.560 --> 0:50:55.040 thee in nineteen fifty women had close to five children 0:50:55.160 --> 0:51:00.000 on average. And as a disclaimer, all of the language 0:51:00.200 --> 0:51:04.759 around fertility and infertility is so incredibly heteronormative, and so 0:51:04.960 --> 0:51:07.319 I use the term women here because that is what 0:51:07.360 --> 0:51:10.879 all of the data sites, and we do not have 0:51:10.960 --> 0:51:14.439 good data on the experience or the lived experience in 0:51:14.719 --> 0:51:17.799 transgender and gender diverse individuals, not to mention the fact 0:51:17.800 --> 0:51:21.560 that definitions of infertility don't even take into account people 0:51:21.640 --> 0:51:26.960 who are gay or anything like that. So I apologize 0:51:27.000 --> 0:51:29.400 in advance that that is the reality of the situation. 0:51:29.520 --> 0:51:31.520 But when I say women talking about people with the 0:51:31.600 --> 0:51:36.520 uterus here. So on average women had five children in 0:51:36.719 --> 0:51:37.560 nineteen fifty. 0:51:37.960 --> 0:51:39.399 By twenty twenty two, the. 0:51:39.320 --> 0:51:41.760 Birth rate in the US is about one point six 0:51:42.120 --> 0:51:47.839 births per woman, So obviously that's a statistic. So that's 0:51:47.880 --> 0:51:50.520 a huge decline in the total fertility rate. And it's 0:51:50.520 --> 0:51:53.560 not just the US. The global fertility rate has more 0:51:53.560 --> 0:51:57.000 than had from again close to five four point eight 0:51:57.120 --> 0:52:00.000 in nineteen fifty to two point two three in twenty 0:52:01.760 --> 0:52:08.120 But much of this decline is quite intentional, and some 0:52:08.280 --> 0:52:12.759 of it is a very good thing, because some of 0:52:13.120 --> 0:52:15.880 the statistics when you look at what has been on 0:52:15.920 --> 0:52:20.000 the decline year over year, is things like birth among 0:52:20.080 --> 0:52:25.560 those age fifteen to nineteen children, babies, having babies has 0:52:25.600 --> 0:52:26.480 been on the decline. 0:52:27.040 --> 0:52:27.760 That's good. 0:52:28.719 --> 0:52:32.279 It's also the increase in the availability of contraception and 0:52:32.320 --> 0:52:35.920 the ability for people to decide to either delay or 0:52:36.120 --> 0:52:39.839 forego altogether childbearing if that's what they decide, and that 0:52:40.000 --> 0:52:44.880 wasn't always possible. So has this also led to an 0:52:44.960 --> 0:52:50.239 increase in infertility? In everything that I was reading, I 0:52:50.239 --> 0:52:53.080 didn't find any data to show that the things that 0:52:53.120 --> 0:52:57.239 we're going to talk about that cause infertility, the underlying 0:52:57.400 --> 0:53:00.319 things that can cause it to be difficult or close 0:53:00.320 --> 0:53:04.799 to impossible to conceive without medical intervention don't seem to 0:53:04.840 --> 0:53:09.040 be on the rise. And what's interesting is that nowhere 0:53:09.080 --> 0:53:12.680 in the reports that I read about fertility statistics do 0:53:12.719 --> 0:53:15.920 they say that the infertility rate has increased. But that 0:53:16.080 --> 0:53:19.920 is absolutely the takeaway of a ton of websites and 0:53:20.000 --> 0:53:25.959 news articles that take data from these fertility statistics. Now, 0:53:26.000 --> 0:53:30.200 what is true is that the demands for assisted reproductive technologies, 0:53:30.239 --> 0:53:35.400 including IVF, have increased, though in some cases they've started 0:53:35.440 --> 0:53:37.960 to level off and in some countries they're still continuing 0:53:38.000 --> 0:53:41.600 to rise. But that still doesn't mean that we can 0:53:41.640 --> 0:53:47.879 conflate those two things, fertility and infertility. And I think 0:53:47.920 --> 0:53:51.520 that's one of the things that's really tricky when we 0:53:52.080 --> 0:53:56.680 in medicine, as we do in medicine, define and view 0:53:56.880 --> 0:54:02.799 infertility as a disease, as this medical phenomenon, because some 0:54:02.880 --> 0:54:07.600 of this decline infertility rates might be due to things 0:54:07.760 --> 0:54:10.920 like an overall increase in the age at first birth, 0:54:11.440 --> 0:54:15.120 which has been increasing, and we know that and I'll 0:54:15.120 --> 0:54:18.720 talk more about this. The age of your eggs. 0:54:18.400 --> 0:54:22.280 Specifically, and also the age of the sperm. 0:54:22.320 --> 0:54:28.000 Our major driving forces behind what we conceptualize as infertility, 0:54:29.080 --> 0:54:34.520 but it still all depends on what somebody's experience is 0:54:34.800 --> 0:54:38.319 of it. So anyways, let's get a little bit more 0:54:38.400 --> 0:54:42.520 into the details of how medicine defines infertility and what 0:54:42.760 --> 0:54:47.680 happens if somebody wants to become pregnant and hasn't. So 0:54:47.760 --> 0:54:50.440 you mentioned it at the top erin the medical definition 0:54:50.520 --> 0:54:53.920 of infertility today, though it still depends a little bit 0:54:54.000 --> 0:54:57.680 on what society is writing it. Per the who is 0:54:57.760 --> 0:55:00.920 the inability to achieve a pregnant and if that is 0:55:01.000 --> 0:55:06.400 desired after twelve months of regular unprotected sexual intercourse, again 0:55:06.760 --> 0:55:10.080 heteronormative as heck, but that's where we are. This is 0:55:10.120 --> 0:55:13.920 a medical definition, and per the World Health Organization and 0:55:14.080 --> 0:55:18.520 so many societies, it is seen as a disease of 0:55:18.600 --> 0:55:22.720 either the female or the male reproductive tract or both. 0:55:23.920 --> 0:55:28.960 And so that is the point, twelve months of unprotected 0:55:29.000 --> 0:55:32.919 sex without a pregnancy. That's usually the point at which 0:55:32.960 --> 0:55:37.279 an investigation into what the cause of infertility is would begin. 0:55:38.719 --> 0:55:41.680 So a question that people often have, because it's a 0:55:41.719 --> 0:55:46.359 logical question, is like why twelve months? And in part 0:55:46.440 --> 0:55:49.800 it's because of just the odds. So if you look 0:55:50.160 --> 0:55:56.920 on large population scales. Most sources estimate that conception rates 0:55:57.000 --> 0:56:00.960 in the first month of attempting to get pregnant are 0:56:01.040 --> 0:56:05.000 about thirty percent. So the first month thirty percent. Then 0:56:05.080 --> 0:56:08.000 if we look out at six months, the cumulative conception 0:56:08.080 --> 0:56:11.440 rate at six months is about seventy five percent. And 0:56:11.480 --> 0:56:13.640 then if you go to twelve months, it's about ninety 0:56:13.640 --> 0:56:16.880 percent of couples that are trying to conceive will have 0:56:17.000 --> 0:56:20.000 conceived in twelve months. So that's the main way that 0:56:20.040 --> 0:56:20.560 we get there. 0:56:21.320 --> 0:56:23.840 I have what's interesting? Do you have a question? 0:56:24.000 --> 0:56:26.200 I do because I feel like it plays into this too. 0:56:26.560 --> 0:56:30.840 What is regular sex? Is there a definition by the who? Yeah, 0:56:30.920 --> 0:56:34.920 I hope that you are going to ask such a 0:56:34.920 --> 0:56:35.480 good question. 0:56:36.560 --> 0:56:38.080 Let me scroll down to the bottom where I have 0:56:38.120 --> 0:56:39.120 my fun facts section. 0:56:39.480 --> 0:56:40.160 Oh nice? 0:56:40.880 --> 0:56:45.080 How often do you have to have sex penis and 0:56:45.080 --> 0:56:45.560 a vagina? 0:56:45.640 --> 0:56:48.239 Sex has to happen ideally one to two times a 0:56:48.280 --> 0:56:53.399 week at a minimum to be considered regular. And what's 0:56:53.440 --> 0:56:57.360 also important is that the timing is actually really important 0:56:57.440 --> 0:57:01.399 because the egg only lives in the female reproductive tract 0:57:01.400 --> 0:57:04.239 for about twenty four hours, but the sperm lives for 0:57:04.320 --> 0:57:08.240 up to five days. So the fertile window really starts 0:57:08.280 --> 0:57:13.680 about six days before ovulation, peaks about two days before ovulation, 0:57:14.080 --> 0:57:17.640 and then is done essentially by the time that ovulation happens, 0:57:18.000 --> 0:57:20.120 because the sperm also need time to swim all the. 0:57:20.080 --> 0:57:21.560 Way up to the Philippian team. 0:57:21.880 --> 0:57:26.200 Okay, God, so that's also a lot if you are 0:57:26.560 --> 0:57:29.760 busy and trying to do this for a very long time, 0:57:30.000 --> 0:57:36.640 just just saying okay, so yes, that is that's what 0:57:36.880 --> 0:57:42.040 is considered regular enough sex. What's interesting about this timing 0:57:42.160 --> 0:57:45.160 of twelve months is that if you were to follow 0:57:45.200 --> 0:57:48.960 again on a population level, couples who haven't conceived at 0:57:49.000 --> 0:57:53.440 that twelve months for another twelve months, fifty percent of 0:57:53.480 --> 0:57:57.560 those couples would conceive in that next twelve months within 0:57:57.600 --> 0:58:01.200 two years, so the cumulative can option rate increases to 0:58:01.240 --> 0:58:04.320 about ninety five percent at two years. 0:58:04.600 --> 0:58:04.960 Okay. 0:58:06.000 --> 0:58:11.480 Now this changes significantly with age, especially with the age 0:58:11.560 --> 0:58:14.400 of the person with the uterus or the woman, and 0:58:14.480 --> 0:58:17.120 we talked about this a little bit in our menopause episode. 0:58:17.280 --> 0:58:19.360 Those of us who ovulate are born with only a 0:58:19.400 --> 0:58:21.680 certain number of eggs, and at some point in our 0:58:21.680 --> 0:58:26.240 reproductive lives, those eggs either are fewer and farther between, 0:58:26.760 --> 0:58:29.600 or are of lower quality in a way that impacts 0:58:29.640 --> 0:58:33.480 the chances of pregnancy. In most of the medical community, 0:58:34.040 --> 0:58:38.200 this starts at around age thirty five. Realistically it starts 0:58:38.200 --> 0:58:42.360 to decline a little bit before that, but between ages 0:58:42.440 --> 0:58:46.960 thirty five and thirty nine, the spontaneous conception rate at 0:58:46.960 --> 0:58:50.800 that one year mark is actually only sixty percent compared 0:58:50.840 --> 0:58:53.920 to ninety percent if you're younger than thirty five, and 0:58:54.040 --> 0:58:56.080 at two years it's eighty five percent. 0:58:56.960 --> 0:58:57.200 Okay. 0:58:57.320 --> 0:59:00.400 Now, male fertility also declines with age, but it gets 0:59:00.600 --> 0:59:03.680 far less attention because we don't understand it as well 0:59:03.720 --> 0:59:08.000 and nobody talks about it. But for that reason, somebody 0:59:08.000 --> 0:59:11.120 who is thirty five or older would often start, or 0:59:11.160 --> 0:59:15.240 it's recommended that they start this infertility evaluation at six 0:59:15.280 --> 0:59:18.520 months of trying to conceive and not conceiving, rather than 0:59:18.560 --> 0:59:19.480 waiting the whole year. 0:59:19.920 --> 0:59:22.960 Okay, So what does that actually look like? 0:59:23.280 --> 0:59:26.800 What can one expect if you are trying to get pregnant, 0:59:26.880 --> 0:59:29.200 you haven't gotten pregnant, and you go to your doctor's 0:59:29.240 --> 0:59:34.320 office for an infertility evaluation. Obviously this is going to 0:59:34.320 --> 0:59:38.600 look different at every single healthcare facility in every single country. 0:59:39.440 --> 0:59:41.240 But what I'm going to kind. 0:59:41.040 --> 0:59:45.520 Of focus on is what the very general evaluations are 0:59:45.560 --> 0:59:49.200 going to be focusing on how we're going to try 0:59:49.240 --> 0:59:52.800 and pinpoint what a cause of this inability to conceive 0:59:53.240 --> 0:59:56.400 is and then get into what those causes are and 0:59:56.440 --> 0:59:58.520 then what the options are for how we treat it, 0:59:58.640 --> 1:00:02.200 because while we intended this as a study of just 1:00:02.320 --> 1:00:06.680 like IVF, IVF is not often the first step depending 1:00:06.720 --> 1:00:09.720 on what the underlying cause of that infertility is. 1:00:10.240 --> 1:00:14.600 Yeah, I'm really curious about this decision tree process. 1:00:14.920 --> 1:00:19.680 Yeah, it's it's really complicated, but it's really interesting. So 1:00:20.080 --> 1:00:23.800 at that twelvemonth or six month mark, depending on your age, 1:00:24.280 --> 1:00:27.600 the initial doctor's office visits, this is probably gonna be 1:00:27.600 --> 1:00:29.919 pretty boring. You're gonna be answering a million questions about 1:00:29.920 --> 1:00:34.840 your personal life, about your medical history, etc. Most often, 1:00:35.760 --> 1:00:37.959 probably because of all the things you talked about, Aaron, 1:00:38.000 --> 1:00:40.200 about the history of how we view infertility as a 1:00:40.200 --> 1:00:43.720 female problem. It's usually the female partner who shows up 1:00:43.800 --> 1:00:48.600 first to the doctor. But all of the literature says 1:00:48.840 --> 1:00:51.400 this should be an evaluation of the couple. It should 1:00:51.400 --> 1:00:53.880 never just be an evaluation of one partner. If there's 1:00:53.880 --> 1:00:56.760 a two partner scenario, which in all of the texts 1:00:56.760 --> 1:01:01.120 that's the assumption, and then the next step that's going 1:01:01.160 --> 1:01:03.720 to happen after this kind of history gathering to see 1:01:03.720 --> 1:01:06.880 if there's any clues as to what the problem could be. 1:01:07.800 --> 1:01:10.840 There'll be a bunch of blood tests and probably some 1:01:10.960 --> 1:01:15.440 imaging studies for the female and a semen analysis and 1:01:15.600 --> 1:01:19.680 maybe some blood work, but honestly often not even blood 1:01:19.680 --> 1:01:20.760 work for the male. 1:01:22.000 --> 1:01:25.200 What would the blood work show, great question. 1:01:25.720 --> 1:01:28.200 So for women, the blood work is going to assess 1:01:28.240 --> 1:01:32.160 a few different things, probably some measure of ovarian reserve, 1:01:32.320 --> 1:01:34.680 so you're going to be checking some hormone and there's 1:01:34.680 --> 1:01:37.120 a few different that people might check to assess your 1:01:37.120 --> 1:01:39.800 ovarian reserve, how many eggs. 1:01:39.400 --> 1:01:40.680 Do you have left. 1:01:41.120 --> 1:01:44.560 They'll also check other hormones to see if there's a 1:01:44.640 --> 1:01:47.920 reason that you might not be ovulating as much as 1:01:47.920 --> 1:01:50.640 we might expect or on a regular a basis. That 1:01:50.800 --> 1:01:53.320 goes along with some of the menstrual history that you're 1:01:53.360 --> 1:01:57.680 going to ask about what someone's cycles are like, and 1:01:57.800 --> 1:02:01.600 checking on things like thyroid hormone, prolactin hormone, these other 1:02:01.680 --> 1:02:04.160 things that if they're out of whack, can contribute to 1:02:04.280 --> 1:02:05.760 ovulation issues. 1:02:06.720 --> 1:02:07.560 In the men. 1:02:08.360 --> 1:02:12.080 You could have similar things be checked, but it's really 1:02:12.080 --> 1:02:14.880 going to depend on like how far down the rabbit 1:02:14.880 --> 1:02:17.320 hole you end up going, or if a cause is 1:02:17.400 --> 1:02:21.480 identified prior to that. The blood work for men is 1:02:21.600 --> 1:02:28.760 not as straightforward or as algorithmized, I guess, okay, as 1:02:28.800 --> 1:02:31.600 it is unless you find something and then you might 1:02:31.640 --> 1:02:32.880 chase it down, if that makes sense. 1:02:33.320 --> 1:02:36.560 Yes, I had no idea that you could get a 1:02:36.960 --> 1:02:40.760 feel for ovarian reserve with a blood test. Yeah. 1:02:40.840 --> 1:02:42.560 Yeah, there's a few different things you can check. 1:02:43.240 --> 1:02:45.960 Wow, okay, cool. 1:02:45.680 --> 1:02:48.640 It's really important too. But anyways, I could go on, 1:02:49.360 --> 1:02:53.120 I won't. So then the imaging studies that you're going 1:02:53.160 --> 1:02:55.760 to get might be things like ultrasounds, just to assess 1:02:55.840 --> 1:02:58.400 the structure of the uterus see if there's things like 1:02:58.560 --> 1:03:03.120 fibroids or or something that could be contributing. They might 1:03:03.160 --> 1:03:06.920 also do what's called a histroosyl pingagram, which you mentioned 1:03:06.920 --> 1:03:10.160 a little bit Aaron as well in one of your quotes, 1:03:10.920 --> 1:03:14.920 And this is quite a painful procedure from my understanding, 1:03:15.040 --> 1:03:18.560 but it's very good for looking at the entire shape 1:03:18.640 --> 1:03:21.600 of the uterus itself and to see if there's any 1:03:21.640 --> 1:03:26.280 blockage of tubes or other abnormalities of the uterine cavity 1:03:26.680 --> 1:03:30.280 that could be contributing, and in some cases people might 1:03:30.400 --> 1:03:35.000 end up even undergoing exploratory surgeries depending on again what 1:03:35.120 --> 1:03:39.800 they find on all of these initial evaluations. Interesting again, 1:03:40.480 --> 1:03:43.840 for the men, you look at the sperm and you 1:03:43.880 --> 1:03:46.280 see how many there are, you see what the shape 1:03:46.280 --> 1:03:49.080 of them are, and you see how well they move. 1:03:49.240 --> 1:03:53.920 So you're also looking at things like motility. Now there 1:03:54.000 --> 1:03:56.120 might be more depending on what you find, but that's 1:03:56.200 --> 1:03:59.000 kind of the first start, and it gets you to 1:03:59.320 --> 1:04:03.560 a lot of these different causes of infertility. So let's 1:04:03.560 --> 1:04:07.120 get into what these are. If we look super broadly, 1:04:07.280 --> 1:04:12.080 like really really broad, there's kind of three huge categories. 1:04:12.440 --> 1:04:16.320 It could be male factor infertility, it could be female 1:04:16.400 --> 1:04:20.760 factor infertility, could be both and that happens, or it 1:04:20.800 --> 1:04:26.280 could be unexplained infertility, and we'll get there. So at 1:04:26.280 --> 1:04:30.040 its core, if we're looking at male factor infertility first, 1:04:30.960 --> 1:04:33.000 at its core, this is going to be an issue 1:04:33.000 --> 1:04:37.960 with sperm, either amount of sperm or the effectiveness of 1:04:38.000 --> 1:04:42.560 those sperm. So this could be an issue with spermatogenesis. 1:04:42.600 --> 1:04:45.400 So either you're not making enough sperm, or you're making 1:04:45.440 --> 1:04:48.320 sperm that are morphologically abnormal. 1:04:47.800 --> 1:04:48.439 In some way. 1:04:48.560 --> 1:04:51.120 Either they can't move as well, they have some kind 1:04:51.160 --> 1:04:55.320 of DNA issue. There's a lot of possibilities. Issues with 1:04:55.360 --> 1:04:59.439 spermatogenesis are the most common, but there's tons of other 1:04:59.440 --> 1:05:01.400 things that could be going on as well. You can 1:05:01.440 --> 1:05:05.720 have issues with sperm transport, either because of blockage of 1:05:05.800 --> 1:05:08.040 not being able to make it down the vast deference 1:05:08.080 --> 1:05:11.960 to be ejaculated, or because like in our cystic fibrosis 1:05:12.000 --> 1:05:14.800 episode we talked about just like the absence of ccilia 1:05:15.000 --> 1:05:18.560 being able to help the sperm be transported. And you 1:05:18.600 --> 1:05:22.480 can also have hormonal or endocrine disorders that affect sperm production. 1:05:22.920 --> 1:05:25.960 Those are kind of the three biggest categories that contribute 1:05:25.960 --> 1:05:30.960 to male factor infertility. When we look at female factor infertility, 1:05:31.440 --> 1:05:33.040 the way that I think of it is it's most 1:05:33.080 --> 1:05:37.240 easy to split it up by like organ or area 1:05:37.440 --> 1:05:40.920 of the body. So you can have issues with your ovaries, 1:05:41.480 --> 1:05:45.760 either you have irregular or non ovulatory cycles. We see 1:05:45.760 --> 1:05:49.600 this in things like PCOS or other hormonal disruptions, maybe 1:05:49.640 --> 1:05:54.640 thyroid disorder or prolactin, or issues with the ovaries from 1:05:54.760 --> 1:05:59.640 ocite aging or depletion, either because the eggs themselves are 1:05:59.680 --> 1:06:02.840 of life or quality because of age, or there's just 1:06:02.920 --> 1:06:06.840 not as many eggs to be ovulated. But you can 1:06:06.880 --> 1:06:10.840 also have blockage of the floapian tubes, and this is 1:06:10.960 --> 1:06:14.360 most commonly caused by things like pelvic inflammatory disease or 1:06:14.400 --> 1:06:18.600 severe endometriosis. You can then have problems with the uterus 1:06:18.640 --> 1:06:23.320 itself that might impair implantation. This could be structural things 1:06:23.360 --> 1:06:29.920 like fibroids or acceptate uterus like me or or an 1:06:30.000 --> 1:06:35.440 insufficient lining of the uterus. You can also have cervical factors, 1:06:35.800 --> 1:06:39.120 either from previous trauma to the cervix or a reduced 1:06:39.120 --> 1:06:43.400 cervical mucus that impairs sperm transport. Then there's even more 1:06:43.560 --> 1:06:47.439 rare causes like autoimmune diseases. There is a very very 1:06:47.520 --> 1:06:52.800 long list of possible causes. Then, for both men and women, 1:06:53.160 --> 1:06:56.960 you could have karyotype abnormalities. Right, you might have certain 1:06:57.000 --> 1:07:00.320 genetic disorders that just make it really difficult to either 1:07:00.600 --> 1:07:03.440 get pregnant in the first place, or a cause of 1:07:03.480 --> 1:07:07.440 recurrent miscarriage could be a karyotype abnormalities. That means abnormalities 1:07:07.440 --> 1:07:10.240 in your chromosome that are small enough that they usually 1:07:10.240 --> 1:07:13.720 don't affect you, but it does affect the egg or 1:07:13.720 --> 1:07:18.760 the sperm that you're trying to produce. And then there's 1:07:18.880 --> 1:07:25.400 unexplained infertility, which is exactly as dissatisfying as it sounds, 1:07:25.480 --> 1:07:29.640 because what it means is that you have done all 1:07:29.680 --> 1:07:32.080 of this work up, you have gone through all of 1:07:32.120 --> 1:07:36.960 these tests, all of this blood work, and we didn't 1:07:37.000 --> 1:07:39.840 find anything, and you're still not pregnant and you want 1:07:39.880 --> 1:07:40.040 to be. 1:07:40.720 --> 1:07:46.919 I have a question about unexplained infertility. How has that 1:07:47.160 --> 1:07:52.200 term shrunk over time? Like how has it you know, 1:07:52.680 --> 1:07:56.360 are there still things that were exploring that, like, oh, 1:07:56.400 --> 1:07:58.360 it could be this, and it's just like finding the 1:07:58.440 --> 1:08:01.200 right tests or develop in the right tests or you 1:08:01.280 --> 1:08:01.600 know what. 1:08:01.520 --> 1:08:03.680 I mean, Yeah, I do, I do. It's a really 1:08:03.720 --> 1:08:08.720 good question. I don't know is the short answer classic. 1:08:10.200 --> 1:08:13.280 But it's such an interesting question because from what I read, 1:08:14.440 --> 1:08:20.479 the thought behind unexplained infertility is that it isn't one thing. 1:08:21.960 --> 1:08:25.439 It's a bunch of little things that might contribute to 1:08:25.800 --> 1:08:31.200 relatively like a relative subfertility. And the idea of subfertility 1:08:31.280 --> 1:08:33.000 is something that like I thought about writing a lot 1:08:33.000 --> 1:08:37.840 about and then I didn't because who boy. But anyways, 1:08:37.840 --> 1:08:40.639 it's like it's a bunch of different things that might 1:08:41.360 --> 1:08:44.400 cause it to be a little bit harder or take 1:08:44.439 --> 1:08:47.360 a little bit longer to achieve a pregnancy, but all 1:08:47.400 --> 1:08:52.640 combined together, right, So like maybe you have slightly on 1:08:52.720 --> 1:08:55.559 the low side of a sperm count, and maybe you 1:08:55.680 --> 1:09:00.639 have a slightly less receptive endometrium, and maybe you have 1:09:01.080 --> 1:09:06.760 slightly hostile cervical mucus something that is that the term 1:09:07.240 --> 1:09:11.000 it's a term. I don't know that it's a good one, 1:09:11.360 --> 1:09:14.920 but right, like, maybe you have a little bit of 1:09:15.000 --> 1:09:18.240 a lot of things, right, or maybe you have pcos 1:09:18.920 --> 1:09:23.040 so you're ovulating but not on a very regular cycle, 1:09:23.400 --> 1:09:26.720 and then your partner also has like a little bit 1:09:26.800 --> 1:09:30.360 of a low sperm count or something. But again those 1:09:30.520 --> 1:09:34.240 you would think that, Okay, well we've identified some causes. 1:09:34.479 --> 1:09:34.719 Right. 1:09:35.880 --> 1:09:38.519 So that's why it's really I think frustrating, is that 1:09:39.040 --> 1:09:44.439 there still is this unexplained infertility that in most estimates 1:09:44.479 --> 1:09:47.679 that I read, accounts for anywhere from ten to twenty 1:09:47.800 --> 1:09:54.519 percent of cases of infertility, which is huge, right, And 1:09:54.680 --> 1:09:58.480 so like, ah, I just can imagine it's so painful, 1:09:58.680 --> 1:10:01.720 right to not have any answer. 1:10:01.760 --> 1:10:06.280 Deeply frustrating and unsatisfying. And so is this is that 1:10:06.400 --> 1:10:08.840 like a formal is there a point at which there's 1:10:08.960 --> 1:10:13.000 just like, well, we've done everything, so it's unexplained infertility 1:10:13.160 --> 1:10:16.240 and then that's like the diagnosis on the chart whatever. 1:10:17.000 --> 1:10:19.760 So it is definitely a diagnosis that gets put on 1:10:19.800 --> 1:10:23.719 a chart. The question of how much of a workup 1:10:23.760 --> 1:10:27.160 has been done before that is the label that gets 1:10:27.160 --> 1:10:29.679 put on is probably going to vary depending on where 1:10:29.720 --> 1:10:32.080 you are. So I can't answer the like, what is 1:10:32.160 --> 1:10:35.760 that point, okay, because it's going to depend on where 1:10:35.760 --> 1:10:38.360 you are and what resources you have too, right, because 1:10:38.360 --> 1:10:40.720 some of these tests are not exactly easy and you 1:10:40.800 --> 1:10:42.960 have to have access to a specialist to be able 1:10:42.960 --> 1:10:45.000 to do it. And so maybe there is for some 1:10:45.080 --> 1:10:47.200 people an answer, but they just can't get it because 1:10:47.200 --> 1:10:49.080 they don't have access to what they need to get 1:10:49.080 --> 1:10:49.599 that answer. 1:10:50.080 --> 1:10:52.679 Okay, Yeah, it's a good question. 1:10:54.240 --> 1:10:56.720 But so once you've gone through all of this work 1:10:56.800 --> 1:11:00.479 up and maybe you have found a cause or maybe 1:11:00.520 --> 1:11:04.240 you haven't, the options for treatment that are available to 1:11:04.320 --> 1:11:06.840 you are going to depend on a lot of different things. 1:11:07.200 --> 1:11:07.720 They're going to. 1:11:07.680 --> 1:11:11.600 Depend in part on what if any identified cause of 1:11:11.640 --> 1:11:16.559 infertility there is, and hopefully anything that was found that's 1:11:16.680 --> 1:11:20.720 correctable is corrected, and in some cases that might be 1:11:20.840 --> 1:11:23.880 all that you need. Right if there's a thyroid condition, 1:11:24.400 --> 1:11:27.240 then if you can correct that, perhaps that's the only 1:11:27.439 --> 1:11:31.799 kind of thing that you would need and that wouldn't 1:11:31.880 --> 1:11:38.640 necessarily fall into medically assisted reproduction MAR or ART. And 1:11:38.680 --> 1:11:42.519 we'll get into that specific definition in a minute, but 1:11:43.000 --> 1:11:47.600 that couple would still meet the criteria for diagnosis of infertility, 1:11:48.040 --> 1:11:52.840 which I think is important. Okay, yes, But the other thing, 1:11:52.880 --> 1:11:56.160 in addition to what the cause of infertility is in 1:11:56.240 --> 1:11:58.040 terms of what the next steps are going to be 1:11:58.479 --> 1:12:01.439 will very much depend on what your access is like 1:12:01.479 --> 1:12:04.639 and what your finances are like. And that's true here 1:12:04.680 --> 1:12:09.080 in the US, but also everywhere. Access to all forms 1:12:09.120 --> 1:12:14.960 of assisted reproductive technologies is absolutely incredibly unequal because it's 1:12:15.080 --> 1:12:20.760 incredibly expensive everywhere, not just in the US. So what 1:12:21.160 --> 1:12:25.679 are some of these different options. One of the first 1:12:26.040 --> 1:12:29.720 is ovulation induction, and this is something that can be 1:12:29.760 --> 1:12:34.080 done with either oral medicines or sometimes injectable medications. And 1:12:34.120 --> 1:12:37.920 it's what it sounds like. It's inducing ovulation in someone 1:12:38.040 --> 1:12:41.879 who isn't ovulating or who's not ovulating on a regular schedule. 1:12:42.840 --> 1:12:46.240 And so this can be done with timed intercourse, so 1:12:46.280 --> 1:12:50.040 like using a medicine and then just having sex when 1:12:50.120 --> 1:12:53.479 you're like on the right schedule with this medicine, or 1:12:53.800 --> 1:12:56.680 depending on the cause, it can also be done in 1:12:56.720 --> 1:13:04.000 combination with IUI or intrauterine insemini. Intriuterine insemination involves taking 1:13:04.040 --> 1:13:07.960 the sperm, washing it because did you know that if 1:13:08.000 --> 1:13:09.960 you don't wash the sperm, you're going to have a 1:13:10.040 --> 1:13:14.719 massive like reaction to that unwashed sperm if you inject 1:13:14.760 --> 1:13:15.920 it straight into the uterus. 1:13:16.320 --> 1:13:19.200 I did indeed, because it plays a role in next 1:13:19.280 --> 1:13:21.799 episode and the history of development of ibs. 1:13:22.080 --> 1:13:23.599 Oh my gosh, I can't wait. 1:13:23.680 --> 1:13:26.120 And it give me such an appreciation for my cervical 1:13:26.200 --> 1:13:29.720 mucus I had to say. I was like, Wow, you're 1:13:29.760 --> 1:13:34.960 protecting me so well. Anyways, so intuterine insemination is usually 1:13:35.680 --> 1:13:40.439 in combination with ovulation induction, and that can use either 1:13:40.479 --> 1:13:43.880 a partner sperm or it can use donor sperm. And 1:13:43.960 --> 1:13:46.679 so that is one of kind of often the first 1:13:46.880 --> 1:13:49.879 areas that you see this being able to be applied 1:13:49.960 --> 1:13:55.280 to more than just heterosexual couples is ovulation induction with IUI, 1:13:57.520 --> 1:14:01.679 and those are kind of the main options that we have, 1:14:02.320 --> 1:14:07.320 and then we get into ART or assisted reproductive technology. 1:14:08.520 --> 1:14:11.120 ART is the broader term and I don't know if 1:14:11.120 --> 1:14:14.040 people say art or art, but I'm gonna say art. 1:14:14.439 --> 1:14:14.879 Okay. 1:14:16.600 --> 1:14:20.200 So this is a broad term that includes conventional IVF 1:14:20.840 --> 1:14:24.439 or in vitro fertilization, which we'll talk a lot about 1:14:24.479 --> 1:14:30.320 next episode. It also includes IVF with ICSI, which is 1:14:30.560 --> 1:14:36.160 intra cytoplasmic sperm injection. And it also includes some other 1:14:36.280 --> 1:14:40.040 acronyms like gift and jift I think, and some other 1:14:40.120 --> 1:14:44.320 things that most places don't do anymore, but we're kind 1:14:44.360 --> 1:14:46.840 of earlier versions of IVF. 1:14:47.439 --> 1:14:47.839 Okay. 1:14:49.120 --> 1:14:53.960 But in short, art means any process where we're taking 1:14:54.080 --> 1:14:57.479 eggs out of the body, we're taking sperm out of 1:14:57.520 --> 1:15:00.960 the body, and we're joining these up and growing an 1:15:00.960 --> 1:15:04.960 embryo outside of the body and then re implanting it. 1:15:05.760 --> 1:15:09.240 And that, dear listeners, is going to be the subject 1:15:09.320 --> 1:15:11.280 of next week's episode. 1:15:12.439 --> 1:15:19.759 Bear Okay, So someone goes in. Let's say a couple 1:15:19.960 --> 1:15:24.680 goes in for fertility testing, go through all of these 1:15:24.680 --> 1:15:27.000 different processes. Let's say that they do this and that. 1:15:27.920 --> 1:15:31.320 What are the different characteristics of the couple, like age 1:15:31.680 --> 1:15:36.640 or whatever? When when go I UI, when go IVF? 1:15:36.720 --> 1:15:40.000 When do you do all these different ICSI? Like what when? 1:15:40.720 --> 1:15:44.519 What why, Yeah, decisions when, why? What? How? 1:15:44.880 --> 1:15:45.800 Yes? All of this? 1:15:47.040 --> 1:15:48.080 Yeah, it's a good question. 1:15:48.160 --> 1:15:52.519 So sometimes IVF might be the first thing that you 1:15:52.600 --> 1:15:57.160 go to. Okay, IVF might be first line therapy in 1:15:57.439 --> 1:16:02.360 cases like, for example, if there's bilateral tubal occlusion. Right, 1:16:02.400 --> 1:16:04.640 So if you're both Philippian tubes, you go through this 1:16:04.680 --> 1:16:06.960 workup and you find out that both of your Philippian 1:16:07.000 --> 1:16:11.559 tubes are completely blocked, then it's either IVF or a 1:16:11.600 --> 1:16:15.960 surgery to try and reconstruct those tubes. Right, So IVF 1:16:16.080 --> 1:16:18.960 might be the first line in that case. A time 1:16:19.000 --> 1:16:21.960 when IVF might not be the first line would be 1:16:22.160 --> 1:16:27.920 if somebody has something like PCOS, for example, then you 1:16:28.040 --> 1:16:34.000 might reasonably try ovulation induction either alone or with IUI, 1:16:34.479 --> 1:16:37.559 And the decision there really just depends on the couple. 1:16:37.760 --> 1:16:40.640 It depends on the situation. So it's not like a 1:16:41.000 --> 1:16:44.800 black and white there. It's very much a gray area, 1:16:45.280 --> 1:16:47.599 and there are kind of a lot of other cases 1:16:47.760 --> 1:16:52.800 where you might try other things unexplained infertility. Generally, the 1:16:52.840 --> 1:16:58.200 recommendation is to start with ovulation induction and IUI combined. 1:16:59.200 --> 1:17:02.880 The thought again being that if there's multiple things that 1:17:02.960 --> 1:17:08.519 are all contributing to cause this relative subfertility. Then if 1:17:08.560 --> 1:17:12.840 we can induce ovulation and put the sperm right at 1:17:12.840 --> 1:17:15.479 the top of the uterus at the right time, then 1:17:15.520 --> 1:17:19.000 we have maybe the highest chance of success before we 1:17:19.120 --> 1:17:23.280 jump to something as expensive and time consuming as IVF, 1:17:24.880 --> 1:17:30.360 IVF with ICSI. With that, intra cytoplasmic sperm injection is 1:17:30.760 --> 1:17:35.320 first line for severe male factor infertility because in many 1:17:35.360 --> 1:17:38.479 cases with severe male factor that's the only way that 1:17:38.520 --> 1:17:44.200 you're going to have a successful pregnancy. And depending on 1:17:44.560 --> 1:17:48.559 the age of the couple, especially the age of the woman, 1:17:49.160 --> 1:17:52.080 it may be that the recommendation is to go straight 1:17:52.120 --> 1:17:56.639 to IVF. Also depending on how long they've been trying for, 1:17:57.200 --> 1:17:59.360 So it's also the case that if a couple has 1:17:59.360 --> 1:18:01.840 been trying for greater than two years or greater than 1:18:01.880 --> 1:18:06.360 three years, regardless of what you find as the cause, 1:18:06.640 --> 1:18:09.920 it's possible that someone would recommend IVF as the first 1:18:09.960 --> 1:18:14.160 just because statistically there's such a small chance of the 1:18:14.280 --> 1:18:19.840 other options being as effective, like per cycle. And similarly, 1:18:20.000 --> 1:18:22.160 if the age of the female is greater than thirty 1:18:22.200 --> 1:18:24.680 five or definitely greater than thirty nine. But it all 1:18:24.760 --> 1:18:27.920 is just kind of depend a little bit on each 1:18:28.000 --> 1:18:30.160 individual circumstance. 1:18:30.240 --> 1:18:32.880 Right, Okay, okay, And. 1:18:32.800 --> 1:18:35.400 Finally, of course IVF would also be a first line 1:18:35.439 --> 1:18:39.920 if the underlying issue isn't this medical definition of infertility 1:18:39.920 --> 1:18:43.680 that we have defined, but what is called social infertility. 1:18:43.800 --> 1:18:44.000 Right. 1:18:44.160 --> 1:18:46.320 If you are a lesbian couple trying to get pregnant, 1:18:46.400 --> 1:18:50.920 IVF is often though not always, because ovulation induction plus 1:18:50.920 --> 1:18:54.720 IUI could also be an option, but often IVF is 1:18:54.880 --> 1:18:57.160 one of the first steps for things like that, or 1:18:57.200 --> 1:19:01.080 for a single mom who wants to get pregnant, also 1:19:01.760 --> 1:19:04.559 for somebody who has a genetic condition that they want 1:19:04.560 --> 1:19:07.200 to ensure doesn't get passed down to their children, and 1:19:07.240 --> 1:19:10.120 we mentioned this briefly in our Huntington's episode, but this 1:19:10.280 --> 1:19:13.120 is also relevant for people or couples who are carriers 1:19:13.120 --> 1:19:16.720 of things like sickle cell or cystic fibrosis. IVF can 1:19:16.800 --> 1:19:19.759 often be first line for that, and it is used 1:19:19.760 --> 1:19:22.280 in combination with things that we'll talk about later, and 1:19:22.320 --> 1:19:26.480 that is pre implantation genetic testing for these specific disorders. 1:19:27.200 --> 1:19:29.360 So there's a very wide range. 1:19:29.920 --> 1:19:33.719 Yeah, I think it's it's interesting how like what IVF 1:19:33.800 --> 1:19:36.760 started out in terms of like, okay, who is going 1:19:36.840 --> 1:19:39.639 to be using IVF, and then how that evolved over 1:19:39.680 --> 1:19:42.920 the decades afterwards, which is it's kind of as the 1:19:43.000 --> 1:19:48.760 technology changed, as regulations changed and so on, which we'll 1:19:48.760 --> 1:19:51.719 get into more of that, but I do have more questions. 1:19:51.760 --> 1:19:55.960 So one of the questions is, so we you have 1:19:56.120 --> 1:20:02.320 mentioned fertility rates globally and in the what are infertility 1:20:02.400 --> 1:20:06.880 rates and like, how are those measured on a global scale? 1:20:06.600 --> 1:20:09.240 What numbers go into that? Great question. 1:20:10.120 --> 1:20:12.920 I'll talk about this a lot more in our last 1:20:12.920 --> 1:20:16.160 episode of this series, but let's. 1:20:16.000 --> 1:20:19.040 At least mention it. Globally. 1:20:19.120 --> 1:20:24.520 It's estimated that one in six couples worldwide experience infertility 1:20:24.680 --> 1:20:28.439 at some point in their reproductive lives. Of course, this 1:20:28.600 --> 1:20:34.400 only includes this medical definition of infertility, right, Okay, so 1:20:34.560 --> 1:20:39.120 globally that's looking at like fifty million or more couples. 1:20:40.320 --> 1:20:41.280 It's a huge number. 1:20:42.200 --> 1:20:42.960 Yeah, it's huge. 1:20:43.160 --> 1:20:43.519 Okay. 1:20:43.760 --> 1:20:48.200 Interesting. I have a question that's, like you talked about 1:20:48.240 --> 1:20:50.800 how this is what to expect if you go in 1:20:50.840 --> 1:20:55.920 for fertility testing, what is like even before that, you know, 1:20:56.000 --> 1:20:59.040 let's say that you're trying for a year to become pregnant, 1:20:59.200 --> 1:21:01.559 not getting pregnant, who do you do? You go to 1:21:01.560 --> 1:21:03.280 your primary care and then you get a referral to 1:21:03.320 --> 1:21:06.160 a like who is the person you ultimately see? 1:21:06.520 --> 1:21:09.559 That is such a good question because I have a 1:21:09.560 --> 1:21:13.120 lot of personal feelings about it that aren't that relevant. 1:21:13.560 --> 1:21:17.799 But it is going to depend so much on where 1:21:17.880 --> 1:21:22.200 you live and who you have access to and who 1:21:22.240 --> 1:21:27.479 your doctor is, because the first steps of this infertility workup, 1:21:27.520 --> 1:21:30.040 and even like what I would also say is so 1:21:30.080 --> 1:21:34.280 important that gets overlooked is like preconception counseling if people 1:21:34.320 --> 1:21:38.040 want to get pregnant, like understanding that you are most 1:21:38.080 --> 1:21:41.400 fertile in those six days prior to ovulation, and like 1:21:41.439 --> 1:21:43.559 the timing of intercourse. We don't get taught that in 1:21:43.600 --> 1:21:46.640 high school biology class, right, We're so focused for so 1:21:46.800 --> 1:21:51.200 much time on like not getting pregnant, often not always, 1:21:51.280 --> 1:21:56.519 but so even that most of this initial workup is 1:21:56.840 --> 1:22:00.640 very reasonable to be done by most like general practiceers 1:22:00.760 --> 1:22:04.920 what they're called in most places. That being said, not 1:22:05.120 --> 1:22:10.840 all physicians are trained in women's health equally and so 1:22:11.760 --> 1:22:15.360 or in like reproductive health in general, because again we 1:22:15.400 --> 1:22:18.080 have to look at both women's and men's health, and 1:22:18.200 --> 1:22:23.040 so it's very possible that some like GP type physicians 1:22:23.120 --> 1:22:26.120 wouldn't feel comfortable initiating that depending on where you are 1:22:26.160 --> 1:22:28.439 depending on what you have access to, So then you 1:22:28.520 --> 1:22:32.800 might be referred to an obgian who might focus just 1:22:33.160 --> 1:22:35.479 on again, the female reproductive tract. 1:22:36.160 --> 1:22:37.160 So it is. 1:22:37.240 --> 1:22:39.840 It's part of the kind of issue with people getting 1:22:39.880 --> 1:22:42.400 access to the right kinds of care is that, yes, 1:22:42.600 --> 1:22:46.000 most of this evaluation can reasonably be started at least 1:22:47.200 --> 1:22:51.639 in like a general practitioner's office if they feel comfortable 1:22:51.680 --> 1:22:51.880 with it. 1:22:52.520 --> 1:22:56.320 Interesting, Okay, I feel like Aaron. I feel like there's 1:22:56.320 --> 1:22:58.800 like a thousand more questions that I like have that 1:22:58.880 --> 1:23:03.479 are just kind of like lingering in my head, just 1:23:04.200 --> 1:23:07.840 dancing around, but I don't know what they are. But 1:23:07.920 --> 1:23:10.280 I guess this is why we're doing multiple episodes, so 1:23:10.320 --> 1:23:13.960 that I can think back and then ask these again. Exactly. 1:23:14.360 --> 1:23:16.120 But we're just going to keep talking. 1:23:16.640 --> 1:23:20.960 I'm just going to keep talking forever. But we should 1:23:21.120 --> 1:23:24.800 probably wrap up this episode now, Okay, I think so. 1:23:24.960 --> 1:23:28.280 I am really excited for next week to get into 1:23:29.160 --> 1:23:31.680 what the heck is IVF and how did we come 1:23:31.760 --> 1:23:34.799 up with it and how does it exist today? 1:23:35.560 --> 1:23:37.920 Yes, I am excited for that, but we should do 1:23:37.960 --> 1:23:41.840 the sources for this episode first. Absolutely, I have a few, 1:23:41.920 --> 1:23:44.240 but I want to give a second shout out to 1:23:44.439 --> 1:23:48.000 that incredible book that I've mentioned a few times now. Second, third, 1:23:48.000 --> 1:23:51.559 fourth shout out the Paul Grave Handbook of Infertility and History, 1:23:51.680 --> 1:23:55.680 edited by Gail Davis and Tracy Loughgrin, which that was 1:23:56.439 --> 1:23:58.800 just a great It was a really interesting resource and 1:23:58.920 --> 1:24:06.200 had so much like very commentary and like scholarly research 1:24:06.400 --> 1:24:08.600 on the subject that was sort of all over the 1:24:08.600 --> 1:24:11.640 place and but also really comprehensive. 1:24:12.280 --> 1:24:14.559 I have to admit that my sources for these three 1:24:14.560 --> 1:24:20.400 episodes are a mess, being very mixed up, fair warning. 1:24:21.120 --> 1:24:23.840 But for this episode a few papers that I would 1:24:23.880 --> 1:24:26.919 like to especially shout out that I found really interesting. 1:24:27.520 --> 1:24:30.960 One was kind of an old paper now called the 1:24:31.000 --> 1:24:35.600 ABC's of Subfertility, so interesting extent of the problem. It 1:24:35.640 --> 1:24:37.920 had a lot of detail in there about infertility as 1:24:37.920 --> 1:24:42.559 well the World Health Organization fact sheet on infertility, as 1:24:42.600 --> 1:24:46.120 well as a textbook on reproductive medicine. And we will 1:24:46.120 --> 1:24:49.160 post all of the sources from this episode and all 1:24:49.200 --> 1:24:52.360 of our episodes and the next episodes on our website, 1:24:52.400 --> 1:24:54.880 this podcast would Kill You dot Com under the episodes tab. 1:24:55.920 --> 1:25:00.360 A huge thank you again to everyone who has shared 1:25:00.479 --> 1:25:03.920 their first hand accounts with us and who have just 1:25:04.040 --> 1:25:07.439 like really, it's it's been incredible and incredible privilege, like 1:25:07.800 --> 1:25:10.719 you said, Aaron, to be able to you know, read 1:25:10.760 --> 1:25:13.559 these hear these stories. Thank you, thank you. 1:25:14.120 --> 1:25:17.679 Yeah, we really really appreciate it. It's so meaningful. Thank 1:25:17.720 --> 1:25:18.040 you it is. 1:25:19.360 --> 1:25:22.360 Thank you also to Bloodmobile for providing the music for 1:25:22.439 --> 1:25:24.480 this episode and all of our episodes. 1:25:25.040 --> 1:25:27.880 Thank you to Tom Bryfogel and Leanna Scolachi for the 1:25:27.880 --> 1:25:29.080 incredible audio mixing. 1:25:29.600 --> 1:25:32.120 Thank you too, exactly right, and thank. 1:25:31.960 --> 1:25:35.599 You to you listeners the first of three episodes. There's 1:25:35.680 --> 1:25:38.719 so much more to come, but thank you for sticking 1:25:38.760 --> 1:25:39.280 this one out. 1:25:39.640 --> 1:25:42.599 Yeah, let us know what you think. And a special 1:25:42.640 --> 1:25:46.360 thank you of course to our amazing generous patrons. We 1:25:46.600 --> 1:25:49.559 I mean, we really we can't say it enough. Thank you. 1:25:49.840 --> 1:25:53.240 It really your support means the world. Until next time, 1:25:53.640 --> 1:25:55.839 wash your hands you feel the animals. 1:26:01.880 --> 1:26:13.520 Oh bub bub bub 1:26:16.680 --> 1:26:16.880 Bu