WEBVTT - Dr. Lucky Sekhon on What Every Woman Should Know About Fertility in Her 20s and 30s 0:00:00.080 --> 0:00:02.560 I feel so privileged to be a fertility expert in 0:00:02.600 --> 0:00:05.960 a time where success rates are at an all time high. 0:00:05.680 --> 0:00:08.320 Speaking as someone who is yet to go on this journey, 0:00:08.400 --> 0:00:11.640 when do you feel like is the right time for 0:00:12.280 --> 0:00:14.320 women to really start thinking about fatility? 0:00:14.440 --> 0:00:15.640 I think it's never too early. 0:00:15.880 --> 0:00:19.120 Doctor Lucky Second is a reproductive androcrinologist who's helping women 0:00:19.200 --> 0:00:23.479 understand their fertility clearly, calmly, and proactively. She cuts through myths, pressure, 0:00:23.520 --> 0:00:26.520 and online noise and focuses on what really matters. Do 0:00:26.560 --> 0:00:28.840 you have any advice for women who are trying to 0:00:29.520 --> 0:00:31.560 you know, we build trust with their own body after 0:00:31.600 --> 0:00:33.040 they feel like their bodies failed them. 0:00:33.040 --> 0:00:35.280 It's not because of something you did or didn't do, 0:00:35.400 --> 0:00:38.479 and you're definitely not alone. One in six couples have infertility. 0:00:38.560 --> 0:00:40.280 What if this time will be the time. 0:00:40.440 --> 0:00:43.640 There is some serendipity, there is some luck, and you 0:00:43.760 --> 0:00:46.320 just need one egg to make it past all those hurdles. 0:00:46.440 --> 0:00:49.240 Welcome to a Really Good Cry podcast. A Really Good 0:00:49.240 --> 0:00:51.800 Cry is here to help you understand your body, feel 0:00:51.840 --> 0:00:54.720 confident in your skin, manage your emotions, and take back 0:00:54.760 --> 0:00:58.320 control of your health. Because growth doesn't always start with answers, 0:00:58.560 --> 0:01:01.920 Sometimes it starts with a really good cry Lucky thank 0:01:01.960 --> 0:01:04.120 you so much for being here. I really really appreciate it. 0:01:04.160 --> 0:01:06.759 I know you've flown in from New York and I'm 0:01:06.800 --> 0:01:08.280 so grateful to have you on the podcast. 0:01:08.319 --> 0:01:09.200 Thank you for having me. 0:01:09.560 --> 0:01:12.560 We're gonna dive into your book, The Lucky Egg, Understanding 0:01:12.600 --> 0:01:14.520 your Fertility and how to get Pregnant. Now, let me 0:01:14.560 --> 0:01:17.760 tell you, this is one juicy book. There's so much 0:01:17.800 --> 0:01:21.280 information in here. And what I loved about it was 0:01:21.319 --> 0:01:22.840 you don't make it feel too scary. 0:01:23.080 --> 0:01:24.360 Yeah, that's really the goal. 0:01:24.640 --> 0:01:27.120 Yes, and I think that, you know, speaking as someone 0:01:27.160 --> 0:01:31.080 who is yet to go on this journey, I definitely 0:01:31.440 --> 0:01:35.000 feel overwhelmed by this whole space and it's a little 0:01:35.000 --> 0:01:36.640 bit scary. Me and my friends talk about it and 0:01:36.680 --> 0:01:39.800 we're like, I don't know, I'm avoiding it. I'm avoiding 0:01:39.840 --> 0:01:41.760 thinking about it until I'm really ready to think about it. 0:01:41.800 --> 0:01:45.000 And when we are, it feels really intense, especially when 0:01:45.040 --> 0:01:46.040 you're over the age of thirty. 0:01:46.160 --> 0:01:49.160 Yes, it feels overwhelming. There's so much noise and advice 0:01:49.240 --> 0:01:49.800 coming out you. 0:01:49.800 --> 0:01:51.720 A mile a minute, there is, And so I know 0:01:51.760 --> 0:01:53.480 you've been doing this for nearly a decade. I would 0:01:53.520 --> 0:01:56.800 have to start off with some beautiful success stories that 0:01:56.840 --> 0:01:57.800 you've experienced. 0:01:58.000 --> 0:02:00.800 I mean so many, you know, I feel so privileged 0:02:00.840 --> 0:02:04.120 to be a fertility expert in a time where success 0:02:04.200 --> 0:02:07.520 rates are at an all time highly Yes. Yeah, if 0:02:07.560 --> 0:02:09.919 you think about when IVF was first invented, and I'm 0:02:09.960 --> 0:02:11.959 talking about IVF, but there are so many different ways 0:02:12.000 --> 0:02:14.120 to help people get pregnant, but that's the one that 0:02:14.160 --> 0:02:17.440 everyone associates with my job, right, But it is the 0:02:17.480 --> 0:02:20.400 most striking change that in the nineteen seventies, when it 0:02:20.440 --> 0:02:22.840 first came about and this technology became a thing, it 0:02:22.840 --> 0:02:26.040 was like single digit success rates. And now every week, 0:02:26.440 --> 0:02:28.520 you know, at least two thirds of my patients who 0:02:28.520 --> 0:02:31.359 had an embryo transfer the week before, I'm calling them 0:02:31.400 --> 0:02:33.520 to say, hey, you're pregnant. Oh my god. No. So 0:02:33.560 --> 0:02:36.320 it's really something that I never take for granted because 0:02:36.360 --> 0:02:40.640 I have predecessors, you know, mentors of mine that always 0:02:40.720 --> 0:02:43.520 remind me of how lucky I am. When they were 0:02:43.560 --> 0:02:46.959 coming up in their careers, They're like, it was really hard, 0:02:47.280 --> 0:02:49.760 you know, to tell patients let's keep going in the 0:02:49.800 --> 0:02:52.200 face of really low success rates compared to what we 0:02:52.240 --> 0:02:53.040 can offer now. 0:02:53.520 --> 0:02:56.880 Yeah, when do you feel like is the right time 0:02:57.480 --> 0:03:00.520 for women to really still think about the to like 0:03:00.800 --> 0:03:03.720 your ideal puss. And if you're talking to them from 0:03:04.080 --> 0:03:05.520 a young age, when would you say this is the 0:03:05.520 --> 0:03:07.760 time we need to stop thinking about it. So. 0:03:07.840 --> 0:03:09.960 I know it might sound crazi or extreme, but I 0:03:09.960 --> 0:03:11.760 think it's never too early. I mean, I have a 0:03:11.800 --> 0:03:14.280 five year old and an eight year old daughter. Both 0:03:14.320 --> 0:03:17.800 of them know how to correctly identify their body parts. 0:03:17.880 --> 0:03:21.240 They know about the menstrual cycle. I think we need 0:03:21.280 --> 0:03:23.880 to normalize this and make it so that people aren't 0:03:23.880 --> 0:03:26.000 growing up afraid of their bodies or feeling that their 0:03:26.040 --> 0:03:28.400 bodies are a mystery. I think it should be a 0:03:28.400 --> 0:03:31.280 topic of conversation, maybe not with the lens of trying 0:03:31.280 --> 0:03:34.359 to get pregnant necessarily, but just understanding your menstrual cycle, 0:03:34.480 --> 0:03:39.240 understanding red flags and identifying things early instead of saying, Okay, 0:03:39.280 --> 0:03:41.680 I'm only going to react after the fact once I'm 0:03:41.720 --> 0:03:44.200 in a moment of crisis when it comes to my fertility. 0:03:44.680 --> 0:03:47.320 I would love for everyone in their twenties to have 0:03:47.400 --> 0:03:50.840 like a secondary formalized education, because high school health class 0:03:50.920 --> 0:03:53.360 or junior high health class isn't enough. The goals are 0:03:53.480 --> 0:03:57.400 very different, and then that's the last of our formative education, 0:03:57.520 --> 0:03:59.520 and we go off into our twenties and our thirties 0:04:00.040 --> 0:04:03.440 and we're expected to, you know, kind of strive towards 0:04:03.440 --> 0:04:06.960 having it all and achieving our professional goals while navigating 0:04:06.960 --> 0:04:09.040 our personal goals, and then magically trying to figure out 0:04:09.040 --> 0:04:12.840 our biological clock, hoping to stumble upon the right obgyn 0:04:12.880 --> 0:04:15.040 and the right Google search or the right group of 0:04:15.040 --> 0:04:18.000 friends that are happening to share the good information. And 0:04:18.080 --> 0:04:20.719 it seems a little bit too left up to chance. 0:04:21.000 --> 0:04:23.080 And so that's really why I wrote this book. This 0:04:23.200 --> 0:04:25.880 isn't for people who are only struggling in the trenches 0:04:25.880 --> 0:04:28.280 of infertility, but it's really for people as they enter 0:04:28.279 --> 0:04:30.680 their twenties and thirties to say, Hey, what should I 0:04:30.720 --> 0:04:33.720 be thinking about? How should I be viewing, you know, 0:04:33.800 --> 0:04:37.800 wellness and my overall habits day to day, and what 0:04:37.800 --> 0:04:39.800 should I be thinking about as I embark on this 0:04:39.880 --> 0:04:41.760 journey of trying to get pregnant so that I can 0:04:41.760 --> 0:04:44.280 be as efficient and as effective as possible. 0:04:44.800 --> 0:04:47.359 I know you said that IVF. Obviously you're seeing so 0:04:47.360 --> 0:04:50.440 many great success stories yeah happen and IVF, which is 0:04:50.480 --> 0:04:53.479 so beautiful. What about when it comes to natural pregnancies. 0:04:53.520 --> 0:04:56.440 Have you seen a trend in what's happening there? Is 0:04:56.480 --> 0:04:59.040 it still the same? Well? Does it feel like it's 0:04:59.160 --> 0:04:59.719 getting hot? 0:05:00.160 --> 0:05:02.280 I think that it's largely the same. I don't think 0:05:02.279 --> 0:05:05.040 there's anything about our biology that has really changed, Right. 0:05:05.080 --> 0:05:07.520 It takes a long time for evolution to actually take place, 0:05:08.080 --> 0:05:12.080 but our behaviors are changing, and we're waiting longer to 0:05:12.120 --> 0:05:14.240 have children, you know, And I shouldn't say it like 0:05:14.279 --> 0:05:16.520 that because it makes it sound like it's an active choice. 0:05:16.520 --> 0:05:18.800 I think it's a confluence of factors of how we're 0:05:18.839 --> 0:05:23.080 living differently. It's taking longer to become financially independent and 0:05:23.440 --> 0:05:26.200 feeling like you're in the right place in your life, 0:05:26.320 --> 0:05:28.599 feeling like you have the right partner. I mean, there's 0:05:28.640 --> 0:05:30.919 good things about that. Right. We now live in a 0:05:30.960 --> 0:05:34.359 society where we're saying, let's not settle and let's not 0:05:34.400 --> 0:05:37.040 stay in toxic relationships just for the sake of Hey, 0:05:37.120 --> 0:05:39.840 I want to have children. And there's technologies to try 0:05:39.880 --> 0:05:41.720 to work around that as well. Right, Like women can 0:05:41.760 --> 0:05:44.279 freeze their eggs and say, I feel less pressured to 0:05:44.800 --> 0:05:46.840 stick with something that's not right for me. I'm going 0:05:46.880 --> 0:05:48.880 to listen to that voice inside my head and say 0:05:49.400 --> 0:05:52.040 let me start fresh, and that would have been really 0:05:52.080 --> 0:05:55.120 hard to do as someone in their mid thirties or 0:05:55.160 --> 0:05:59.120 early forties, maybe twenty years ago, where certain things weren't options, right, 0:05:59.200 --> 0:06:02.679 like egg freezing. But I think you know, the average 0:06:02.720 --> 0:06:04.880 age of when we're starting to build our families has 0:06:04.920 --> 0:06:09.120 definitely increased. Just think about our mother's generation, our grandmother's generation, 0:06:09.560 --> 0:06:12.640 and there's good things about that, right, But our biology 0:06:12.680 --> 0:06:16.640 hasn't kept pace, and we're not really giving women the tools, 0:06:16.680 --> 0:06:20.080 the support, and the education or even the access to 0:06:20.560 --> 0:06:24.040 certain techniques or strategies to try to work around that, 0:06:24.440 --> 0:06:27.599 or even just policies that help us to create space 0:06:27.600 --> 0:06:30.239 in our life so that we can achieve our dreams 0:06:30.279 --> 0:06:32.640 professionally and personally alongside each other. 0:06:33.000 --> 0:06:35.039 You mentioned lifestyle quite a bit throughout this and the 0:06:35.040 --> 0:06:37.200 things that we should be doing in our twenties and thirties. 0:06:37.839 --> 0:06:41.719 Would you say that fertility from your experience is many genetics? 0:06:41.760 --> 0:06:43.760 Is it mainly lifestyle? Is it? You know, what are 0:06:43.800 --> 0:06:48.320 the main factors that are influencing fertility along our journey? 0:06:48.560 --> 0:06:52.440 So timing is really important on two different levels. One 0:06:52.520 --> 0:06:53.760 is the effective age. 0:06:53.839 --> 0:06:54.039 Right. 0:06:54.120 --> 0:06:57.720 Age impacts our ability to ovulate a healthy egg and 0:06:57.760 --> 0:06:59.600 it's not all doom and gloom. It's not like, oh, 0:06:59.640 --> 0:07:01.840 over thirty five, all of your eggs go bad. That's 0:07:01.880 --> 0:07:05.279 what society likes to tell people. But in fact, even 0:07:05.320 --> 0:07:07.279 in our late thirties and early forties, you still have 0:07:07.360 --> 0:07:10.440 normal eggs that you can ovulate, but the ability to 0:07:10.520 --> 0:07:13.560 do that starts to shift where it takes many more 0:07:13.600 --> 0:07:16.600 cycles for that egg that you need to ovulate to 0:07:16.640 --> 0:07:19.520 be the one that's selected randomly, because it's a random 0:07:19.520 --> 0:07:22.720 selection process that you cannot control, and it can take 0:07:23.000 --> 0:07:24.720 longer to get pregnant, and there can be a higher 0:07:24.800 --> 0:07:27.200 risks of things like miscarriage. So age is definitely a 0:07:27.200 --> 0:07:31.920 big factor, but also timing with regards to knowing when 0:07:31.960 --> 0:07:35.239 you're ovulating right, and so for people who aren't getting 0:07:35.280 --> 0:07:37.960 regular periods and they never know when their next ovulation 0:07:38.080 --> 0:07:40.320 is happening, or they don't ovulate regularly, that can make 0:07:40.360 --> 0:07:44.960 it more challenging. And there are shifts in health in society. 0:07:45.440 --> 0:07:47.960 The rise in obesity has led to more and more 0:07:47.960 --> 0:07:51.280 people having a harder time ovulating regularly, so that indirectly 0:07:51.360 --> 0:07:54.960 impacts fertility as well. Genetics is huge. A lot of 0:07:55.000 --> 0:07:57.119 people aren't aware that if they have a first degree 0:07:57.160 --> 0:08:03.000 relative with premature MENOPAUSEIDS, polycystic ovary syndrome which can lead 0:08:03.000 --> 0:08:07.040 to regular cycles, problems like endometriosis. These are all major 0:08:07.080 --> 0:08:11.320 gynecologic disorders that can relate to fertility issues, and there 0:08:11.360 --> 0:08:14.080 can be a several fold increased risk of you yourself 0:08:14.120 --> 0:08:17.240 having those issues if your mom or your sister first 0:08:17.280 --> 0:08:19.720 degree relative also did so. Genetics can play a huge 0:08:19.800 --> 0:08:21.200 role in fertility. 0:08:20.880 --> 0:08:23.040 And not the specific tests that you recommend women do 0:08:23.280 --> 0:08:26.880 to you know, let's say find out from a younger 0:08:26.920 --> 0:08:29.240 age if these things are an issue for them, like 0:08:29.240 --> 0:08:31.640 what would you recommend some of the symptoms out that 0:08:31.680 --> 0:08:34.079 they should look out for, all tests that they should 0:08:34.080 --> 0:08:34.400 be doing. 0:08:34.679 --> 0:08:37.640 So, starting with your period, if your periods are regular, 0:08:37.920 --> 0:08:40.320 that's the first red flag that tells you that you're 0:08:40.320 --> 0:08:43.680 not ovulating regularly. And if you're not ovulating, you're not 0:08:43.679 --> 0:08:46.040 in the game, right. That means releasing an egg, so 0:08:46.040 --> 0:08:48.280 there's a chance for that egg to get fertilized. And 0:08:48.360 --> 0:08:50.559 so I've had women sometimes come to me and say, 0:08:50.600 --> 0:08:53.000 I've been trying for a year, but I've only gotten 0:08:53.000 --> 0:08:55.640 two periods in the last year, And I tell them, well, 0:08:55.640 --> 0:08:57.679 then you really haven't been trying for the full year, right, 0:08:57.720 --> 0:09:00.880 You've only had two attempts that entire time, and so 0:09:01.000 --> 0:09:03.319 we need to do something to give you that opportunity. 0:09:03.679 --> 0:09:06.120 I think the other major thing is it's never normal 0:09:06.200 --> 0:09:09.200 to have debilitating periods, periods that are so painful that 0:09:09.240 --> 0:09:11.959 you miss school or work. And it takes an average 0:09:11.960 --> 0:09:14.520 of eight to ten years for someone to be diagnosed 0:09:14.520 --> 0:09:18.560 with endometriosis because a lot of times women's pain has 0:09:18.600 --> 0:09:22.520 been dismissed, overlooked, or normalized. It's just kind of told 0:09:22.520 --> 0:09:24.800 to them, maybe by well meaning family members, that this 0:09:24.920 --> 0:09:26.840 is just a burden that women have to bear, and 0:09:26.840 --> 0:09:29.960 it's kind of a normal thing in our family. Heavy 0:09:30.000 --> 0:09:32.480 periods that can be a sign that you have problems 0:09:32.520 --> 0:09:35.160 like fibroids. So I think really tracking your cycle and 0:09:35.200 --> 0:09:38.040 being intentional is important. You want to be in tune 0:09:38.040 --> 0:09:41.240 with your body, right. And then besides that, I would 0:09:41.240 --> 0:09:44.559 say other things to look out for. We know maintaining 0:09:44.559 --> 0:09:47.480 a healthy body weight is really important for metabolic balance. 0:09:47.800 --> 0:09:50.320 There is this concept of insulin resistance, which you may 0:09:50.360 --> 0:09:53.120 have heard of. This is a major buzzword in the 0:09:53.160 --> 0:09:55.880 wellness world, but it's actually a real issue that I 0:09:56.000 --> 0:09:58.760 see play a role in many cases of infertility and 0:09:58.880 --> 0:10:03.520 pregnancy loss. Insulin is basically a hormone that your body produces. 0:10:03.600 --> 0:10:06.160 It's like a key that unlocks cells, that helps the 0:10:06.160 --> 0:10:09.360 blood sugar get stored effectively in your cells. And a 0:10:09.400 --> 0:10:12.200 lot of people's cells might not be listening to the 0:10:12.240 --> 0:10:16.559 signal of insulin. There's like resistance to it and sometimes 0:10:16.640 --> 0:10:19.400 weight gain, especially around the mid section, or having a 0:10:19.440 --> 0:10:22.480 strong family history of type two diabetes. These are dead 0:10:22.559 --> 0:10:26.800 ringers where you're like, okay, pcos someone having polycystic ovary syndrome. 0:10:26.800 --> 0:10:29.800 There's a strong relationship. The reason why it matters is 0:10:29.840 --> 0:10:33.160 that insulin gets produced at a higher level if your 0:10:33.200 --> 0:10:36.240 cells aren't listening to that signal, and that can actually 0:10:36.360 --> 0:10:39.800 cause your ovaries to overproduce testosterone and it can lead 0:10:39.840 --> 0:10:43.520 to unhealthy balance imbalances where the eggs are being matured, 0:10:43.559 --> 0:10:45.920 so it can affect our egg quality, the ability to 0:10:45.960 --> 0:10:49.240 ovulate a healthy egg. It can also make it easier 0:10:49.240 --> 0:10:53.280 to have problems like miscarriage. Most miscarriages are not within 0:10:53.320 --> 0:10:56.400 our control. I want to make that clear. Most of 0:10:56.400 --> 0:10:59.440 the time, this is just you ovulated an egg that 0:10:59.480 --> 0:11:02.520 had a type BO or error. But those typos or 0:11:02.640 --> 0:11:04.760 errors in the genetic code of those eggs are more 0:11:04.920 --> 0:11:08.079 likely to happen if the environment around the egg when 0:11:08.120 --> 0:11:12.800 it's maturing is affected by things like insulin resistance or imbalances. 0:11:13.040 --> 0:11:16.120 So it's really important to think intentionally about how do 0:11:16.160 --> 0:11:19.160 we make someone more responsive to the effects of insulin. Right, 0:11:19.200 --> 0:11:22.920 if someone is overweight and they lose weight, that alone 0:11:23.000 --> 0:11:26.160 can help, But building muscle can make you more sensitive 0:11:26.160 --> 0:11:29.600 to insulin. The way we eat, the pattern that we 0:11:29.720 --> 0:11:32.559 have in our diet in terms of fiber and protein, 0:11:32.640 --> 0:11:36.200 and trying to avoid glucose spikes and really stabilizing your 0:11:36.200 --> 0:11:38.520 blood sugar. All of this matters. And this is not 0:11:38.600 --> 0:11:41.040 a moral feeling. There are a lot of people who 0:11:41.040 --> 0:11:43.600 this is just genetically how they're wired, and it's not 0:11:43.600 --> 0:11:45.840 always going to be possible to fix it with diet 0:11:45.840 --> 0:11:48.880 and exercise. Sometimes you do need the help of certain medications, 0:11:48.880 --> 0:11:51.839 whether that be metformin or GLP one agonists. 0:11:52.040 --> 0:11:54.400 Yeah, I was going to ask about GLP one's day 0:11:54.440 --> 0:11:58.600 TIPA you mentioned them now, So why is that helping? 0:11:58.760 --> 0:12:01.000 I've had a sage like people get being able to 0:12:01.000 --> 0:12:03.120 get pregnant after they've been on GLP. Is that to 0:12:03.160 --> 0:12:05.560 do with the weight loss or is there something else 0:12:05.600 --> 0:12:07.479 that happens when people are on these peptides. 0:12:07.600 --> 0:12:11.960 It's both weight loss because weight is basically like that 0:12:12.040 --> 0:12:15.480 fat can be like another organ that actually helps you 0:12:15.600 --> 0:12:20.160 overproduce too much estrogen. So in our fat cells we 0:12:20.280 --> 0:12:24.959 convert excess testosterone to estrogen, and so it's all related. Right, 0:12:25.040 --> 0:12:28.559 Your ovaries will overproduce or have a tendency to overproduce testosterone, 0:12:28.600 --> 0:12:31.600 maybe because insulin is causing that to happen, and then 0:12:31.640 --> 0:12:34.360 that extra testosterone is getting converted in your fat cells 0:12:34.400 --> 0:12:38.520 to estrogen. Estrogen is confusing your brain, which is listening 0:12:38.520 --> 0:12:40.959 for the estrogen signal to see what your ovary is doing, 0:12:41.320 --> 0:12:43.360 and then it's not sending the signals to the ovary 0:12:43.360 --> 0:12:46.240 to tell it to ovulate effectively. And it's this vicious cycle. 0:12:46.840 --> 0:12:49.800 And so a lot of people are having what they're 0:12:49.800 --> 0:12:53.920 calling ozembic babies because yes, they've had this lifelong history 0:12:53.960 --> 0:12:57.160 of irregularity in their ovulation. It's linked to insulin resistance. 0:12:57.200 --> 0:12:59.880 Maybe they've struggled with their weight. Now they're correcting that 0:13:00.040 --> 0:13:02.800 underlying disturbance, and all of a sudden, the signals from 0:13:02.840 --> 0:13:04.800 their brain are getting through to the over and low 0:13:04.840 --> 0:13:07.840 and behold, they're ovulating and that was the thing that 0:13:07.920 --> 0:13:09.800 was making it harder for them to get pregnant. So 0:13:10.360 --> 0:13:12.560 it's helping a lot of people because it's a very 0:13:12.640 --> 0:13:15.439 potent way to help with weight loss and to make 0:13:15.440 --> 0:13:18.920 someone more sensitive to insulin, especially certain formulations of GLP 0:13:19.000 --> 0:13:19.760 one agonists. 0:13:19.880 --> 0:13:23.240 Does that have any benefit for people have endometriosis or 0:13:23.280 --> 0:13:25.680 is that issue completely separate to this. 0:13:26.120 --> 0:13:28.959 I think we're still in the research phases of this. 0:13:29.160 --> 0:13:32.800 You know, endometriosis is a different entity, but it is 0:13:32.880 --> 0:13:37.360 related to inflammation and having too much insulin, and that 0:13:37.400 --> 0:13:40.880 insulin resistance I'm talking about is also a pro inflammatory effect. 0:13:41.640 --> 0:13:44.240 Enomeytriosis is a really important one because it's such a 0:13:44.280 --> 0:13:46.560 quality of life issue and there's so many different ways 0:13:46.559 --> 0:13:50.280 it can impact fertility, and no two cases of endometriosis 0:13:50.360 --> 0:13:54.120 are going to be exactly alike. It's very unique per individual. 0:13:54.520 --> 0:13:57.400 But it's basically a condition where the cells that act 0:13:57.520 --> 0:13:59.480 like the innerlining of the uterus that are supposed to 0:13:59.480 --> 0:14:02.280 build up and be hormonally responsive and then shed every 0:14:02.280 --> 0:14:05.120 month when you get your period, are found in other 0:14:05.160 --> 0:14:07.920 parts of the body that they shouldn't be, most often 0:14:08.000 --> 0:14:10.640 the pelvic cavity, and we still don't really truly understand 0:14:10.679 --> 0:14:12.800 the mechanism of why this happens to some people and 0:14:12.840 --> 0:14:16.080 not to others. We know that we all sometimes menstrate 0:14:16.080 --> 0:14:18.960 a little bit backwards. It's called retrograde menstruation through the 0:14:18.960 --> 0:14:22.640 fallopian tubes. And our immune system is like a janitor 0:14:22.720 --> 0:14:25.680 that goes around and kind of recognizes, oh, these cells 0:14:25.680 --> 0:14:29.200 are foreign, let's clean them up. But some people's cells 0:14:29.280 --> 0:14:32.520 may evade detection by their immune system, and it can 0:14:32.560 --> 0:14:34.920 set up shop. And the lining of your uterus is 0:14:34.960 --> 0:14:37.520 meant to be a little bit sticky and invasive. It's 0:14:37.560 --> 0:14:40.120 meant to receive an embryo and allow it to kind 0:14:40.120 --> 0:14:43.440 of burrow its way in, and it can really be 0:14:43.480 --> 0:14:46.120 effective at creating new blood vessels. And so what can 0:14:46.200 --> 0:14:49.040 happen is is if it's in the pelvic cavity, it 0:14:49.080 --> 0:14:53.200 can start setting up shop and becoming hormonally responsive, and 0:14:53.240 --> 0:14:56.680 every time you're getting a period, it's stimulating those implants. 0:14:57.080 --> 0:14:59.480 And what's really mysterious is that it can be found 0:14:59.520 --> 0:15:02.360 in remote locations, like it's been documented in the brain, 0:15:02.640 --> 0:15:06.000 in the lung cavity, but most often it's like location, 0:15:06.120 --> 0:15:10.160 location location, it's in the pelvic cavity causes really painful periods. 0:15:10.200 --> 0:15:12.680 It can cause blockages in the fallopian tubes. It can 0:15:12.680 --> 0:15:14.560 make it harder for an embryo to implant, It can 0:15:14.600 --> 0:15:17.080 affect egg quality, it can cause your eggs to get 0:15:17.080 --> 0:15:20.600 depleted faster. But there are many women that have endometriosis 0:15:20.720 --> 0:15:23.880 that go on to have healthy pregnancies without any issue. 0:15:24.200 --> 0:15:26.440 But there are some women with mouth cases that end 0:15:26.560 --> 0:15:29.920 up having major problems with fertility. So there's a lot 0:15:29.960 --> 0:15:31.960 we still don't understand about it. But we know that 0:15:32.040 --> 0:15:35.120 a huge mechanism of how it affects fertility is through 0:15:35.480 --> 0:15:39.040 inflammatory pathways, and we know there's a lot of information 0:15:39.080 --> 0:15:41.760 now coming out about how GLP ones may help with 0:15:41.840 --> 0:15:45.360 inflammatory issues in our body in general. So you may 0:15:45.400 --> 0:15:48.000 have heard of people saying, you know, my eximo got 0:15:48.040 --> 0:15:51.240 better while I was on a GLP one pagonist. They're talking, 0:15:51.440 --> 0:15:55.120 you know, about so many different potential off target health effects, 0:15:55.120 --> 0:15:57.000 and I wouldn't be surprised if we find out that 0:15:57.040 --> 0:15:59.400 there could be a benefit for women with enomytriosis. 0:16:00.000 --> 0:16:02.400 Hearing people or friends coming out with telling me that 0:16:02.440 --> 0:16:05.480 they've got endometriosis more than I've heard, you know, in 0:16:05.520 --> 0:16:07.520 the past. Maybe just because they're more open about talking 0:16:07.600 --> 0:16:10.880 about it. But what are some of the tools, techniques, 0:16:10.960 --> 0:16:14.680 the medications, or the holistic treatments that people can do 0:16:14.720 --> 0:16:16.720 that you've seen have really helped them. 0:16:17.000 --> 0:16:20.280 Yeah, I think you know, the key is really trying 0:16:20.320 --> 0:16:24.560 to lead an anti inflammatory lifestyle. And I know that 0:16:24.640 --> 0:16:26.960 sounds kind of woo woo, but it is a real thing. 0:16:27.080 --> 0:16:29.720 I've had many patients with endometriosis, and I do think 0:16:29.760 --> 0:16:32.400 it's amazing that we're having this conversation. And that's why 0:16:32.480 --> 0:16:34.440 you're hearing about it more because more and where women 0:16:34.480 --> 0:16:36.920 are going to their doctors and saying, you know what, 0:16:37.240 --> 0:16:40.120 I am going to keep probing and asking questions because 0:16:40.160 --> 0:16:43.040 it just doesn't feel right that it's so painful. And 0:16:43.120 --> 0:16:46.120 I think a huge red flag or hallmark sign that 0:16:46.160 --> 0:16:48.600 you could have endometriosis is a history of really painful 0:16:48.600 --> 0:16:50.960 periods and then you went on the birth control pill, 0:16:51.120 --> 0:16:54.720 you shut down ovulation, you shut down that stimulation, and 0:16:54.800 --> 0:16:57.720 all of a sudden that pain went away. That is 0:16:57.800 --> 0:17:02.720 really endometriosis until proven other wise. So I have had 0:17:02.760 --> 0:17:06.959 many patients who've tried different ways of eating, trying to 0:17:07.240 --> 0:17:12.080 adopt a more pro antioxidant type diet like a Mediterranean 0:17:12.119 --> 0:17:16.000 style diet. There are some supplements that have been touted 0:17:16.040 --> 0:17:19.480 as having anti inflammatory effects and maybe being helpful, and 0:17:19.560 --> 0:17:22.560 a lot of this has been studied, but the reality 0:17:22.720 --> 0:17:24.760 is is that a lot of the data on supplements 0:17:24.880 --> 0:17:28.120 is not from well designed studies, and you're looking at 0:17:28.160 --> 0:17:31.119 different types of patient populations, and you don't always know 0:17:31.160 --> 0:17:34.119 what you're getting in each bottle of supplements. So I 0:17:34.119 --> 0:17:36.560 think it's harder to really put a finger on exactly 0:17:36.600 --> 0:17:39.760 what supplements are better for endometriosis. I think when it 0:17:39.800 --> 0:17:43.480 comes to medical management, that's usually the mainstay is, well, 0:17:43.600 --> 0:17:46.439 let's stop what's driving this, right, And so if someone 0:17:46.480 --> 0:17:50.600 says I have debilitating cramps, I've been diagnosed with endometriosis. 0:17:50.600 --> 0:17:53.040 And by the way, the diagnosis, the gold standard way 0:17:53.119 --> 0:17:55.400 is kind of invasive. You have to have a surgery 0:17:56.080 --> 0:17:58.199 where they go through the belly button with a camera 0:17:58.240 --> 0:18:01.400 and actually visualize and take a sample of the tissue 0:18:01.400 --> 0:18:03.560 that they think looks like endometriosis and send it off 0:18:03.560 --> 0:18:07.320 for analysis. That's not very practical to send everyone to 0:18:07.359 --> 0:18:10.239 the operating room just to get a diagnosis. And I 0:18:10.280 --> 0:18:13.280 think that you can make the diagnosis clinically and say, listen, 0:18:13.560 --> 0:18:17.879 it's probably endometriosis. Sometimes you can see it on ultrasound, 0:18:17.920 --> 0:18:20.199 But even if you have a clean looking ultrasound with 0:18:20.280 --> 0:18:21.920 no signs of it, it doesn't mean it's not there. 0:18:21.960 --> 0:18:25.119 It can be insidious in the pelvic side wall. But 0:18:25.280 --> 0:18:27.520 a lot of times if someone's not trying to get pregnant, 0:18:27.840 --> 0:18:31.159 stopping their ovulation. And I know that's not a popular answer, 0:18:31.200 --> 0:18:33.480 and I think a lot of women are very angry 0:18:34.160 --> 0:18:37.520 and bitter, and rightly so about maybe ten years prior 0:18:37.960 --> 0:18:40.399 twenty years prior, being in their teens and it not 0:18:40.480 --> 0:18:43.720 being explained to them clearly. You know, we think you 0:18:43.760 --> 0:18:46.480 of endometriosis. This is why we're advising going on the pill. 0:18:46.560 --> 0:18:48.119 So I've had a lot of patients who are like, 0:18:48.680 --> 0:18:50.440 I went on the pill in my teens. I don't 0:18:50.480 --> 0:18:53.440 know why. I've never explained, and now I'm coming off 0:18:53.480 --> 0:18:56.480 of it and I'm having trouble with my ability to 0:18:56.520 --> 0:19:00.000 get pregnant, and I'm the one diagnosing them with endometriosis, 0:19:00.359 --> 0:19:03.480 when in reality, whoever put them on the pill likely 0:19:03.800 --> 0:19:06.240 suspected that that was what was going on. So I 0:19:06.240 --> 0:19:10.480 think it's about education and trusting women, even at a 0:19:10.520 --> 0:19:13.639 young age. To understand complicated things about their body and 0:19:13.680 --> 0:19:16.199 making sure people are as informed as they possibly can be. 0:19:17.200 --> 0:19:20.840 Sometimes medications isn't going to cut it, and that's where 0:19:20.880 --> 0:19:23.280 surgery could have a role to say, Okay, let's have 0:19:23.359 --> 0:19:26.080 you go see an endometriosis expert. This is what they 0:19:26.119 --> 0:19:28.320 do all day, every day, and they can do it 0:19:28.440 --> 0:19:32.280 via a minimally invasive approach and remove those metriosis lesions 0:19:32.720 --> 0:19:34.680 and it may help to improve your pain and even 0:19:34.760 --> 0:19:36.080