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[00:00:00] Natalie: Starting a family, one of the most rewarding and beautiful times in life. But you know that dream, it's not easy for everyone. And today we're talking about modern fertility, the ups, the downs, and the leaps in science, making it possible for so many. Hi, everyone. This topic is very personal and it can be very emotional. So let me first say, if you have struggled with fertility issues, I know that pain and I'm here for you. I'm here with you. I want to talk about this on a few different fronts today. First of all. I was a health reporter for more than 20 years.

[00:00:33] I have talked to some of the brightest minds in the world on this topic. And in a moment you're going to hear from one of the top doctors who is a fertility specialist. But before we do that, I want to tell you something that I have never publicly spoken about. And it is very personal and emotional for me.

[00:00:49] My husband. I always wanted a big family, but we struggled. And although we now have three beautiful children, we've also lost three babies to miscarriage. I know this [00:01:00] pain. And I know for those of you, who've gone through this. It's hard to describe. In some cases you find out that you're pregnant and maybe you tell people right away.

[00:01:08] But for many people you wait until that 12 week mark, but by then, You've known and you've kept the secret for two months. And if you haven't told anyone and then you go through a miscarriage emotionally and physically, you're doing that without your support network around you, because you haven't told anyone not to mention your hormones are all over the place.

[00:01:28] Being someone who loves to research. And look for answers. This was one of the hardest times of my life because I couldn't fix or figure out what was going on. We wanted so badly to know why I couldn't stay pregnant. And in my case, after hearing, it just happens. I made the decision to switch doctors with the new doctor discovered.

[00:01:50] It's actually pretty common. I had low progesterone. And if you don't know, progesterone is essential in maintaining early stages of pregnancy. One thing that [00:02:00] I've learned as a health reporter and certainly as a mom is to trust your instinct. Don't settle when something doesn't seem right. Do your research, listen to podcasts like this one, find out for yourself what's going on.

[00:02:14] After those miscarriages for us, we had our third child and people often ask us why is there so much space between your kids? We have five years between number two and number three. And that's why we didn't want it to be that way. That's what happened. We realize now that we are incredibly blessed and I'm grateful for a doctor who listened, answered my questions, did the blood work and the research.

[00:02:36] And I'm grateful that I listened to my instinct. Let's talk about this from a medical and science perspective now because it's incredible. Dr. Lax beat Conda poly is with one of the most well-known fertility clinics in the world. She's an award-winning board certified reproductive endocrinologist at CCRM fertility in Colorado. In addition. All aspects of infertility doctor kind of poly specializes in fertility [00:03:00] preservation, particularly for patients with complex medical conditions.

[00:03:03] In addition to her many accolades in medicine, she's just a nice person and she breaks down complex issues in a very understandable way. So let's get started.

[00:03:14]

[00:03:16] Natalie:

[00:03:16] Dr of poly is joining me now. And this topic is near and dear to me in helping a lot of people. And also, as I had mentioned before in the introduction, having personal struggle with fertility and Dr. Kaanapali, I am amazed by what your clinic does and how many people you're able to help, but let's just talk about some basics to begin with how many families struggle with.

[00:03:40] Dr. Laxmi: Thank you, Natalie. First of all, for inviting me to participate today I think that a lot of times people don't realize that infertility is much more common than you realize, and maybe people are not talking about it, but infertility affects one in seven couples. So if you think about your group of friends, You may have some peer members that are actually [00:04:00] struggling with infertility and maybe seeking out some fertility help from infertility specialists, such as myself.

[00:04:05] So it's a lot more common than people actually realize.

[00:04:09] Natalie: Yeah. I think a lot of families think we're just going to get married or whenever we want to have babies, we'll just start having babies. But it is a struggle for a lot of families. How many families do you all see men and women? Because I know you're able to help.

[00:04:23] Dr. Laxmi: We do. So we have a pretty large practice. That's easier on Colorados and we can help a lot of families and achieving their goal of having children in the future. We see both men and women. And one thing that people don't realize is that male infertility is actually a lot more common as well. A lot of times I think that women take on the burden of infertility and maybe the struggle to get pregnant or stay pregnant.

[00:04:46] But in fact, one third of infertility. These is actually known the men's side. So we actually see couples where the male has an infertility issue and they're coming in to seek fertility treatment.

[00:04:57] Natalie: Is there something that we're doing [00:05:00] wrong? I always felt that way with my fertility issues. Like I must not be eating right or not exercising and we blame ourselves, but are there things in our society that you all have been able to identify as.

[00:05:12] That are effecting pregnancies.

[00:05:14] Dr. Laxmi: I think that that's one of the struggles that, you know, I see when couples come in to see me or, or even individuals that come in to see me, there's so much blame that's placed on things that we're doing are not doing, but keep in mind that infertility is a medical condition.

[00:05:29] It is a medical diagnosis that is evaluated. We have diagnostics to. identify an issue. And then we have treatment options. It's very similar to diabetes or asthma or other medical conditions that aren't written with responsibility or are written with blame. Um, What we know is one of the biggest factors that's associated with infertility and fertility in general is age.

[00:05:52] And so a lot of people are postponing, starting a family until they're a little bit later. And unfortunately, So crucial [00:06:00] to our ability to get pregnant and particularly for women, because for women are the aging process actually starts when we're in our early twenties or, or so. And that aging increases or accelerates for women in their thirties and early.

[00:06:13] So it's not so much that people are doing something or not doing something, but it is that a lot of people are postponing, starting a family. It is just a matter of age. And that impact on fertility.

[00:06:24] Natalie: Yeah. I know in my twenties with my first baby we didn't have any problems. And then with my last one, I was almost 40.

[00:06:30] What is the average age of people who are seeking help? Like from you? Are you getting people in their forties who are just starting their family, eating their fifties?

[00:06:38] Dr. Laxmi: Yeah. So we are seeing couples and patients that are across the spectrum of ages. I would say that average age of a patient who is doing assisted reproductive technology, something like in vitro fertilization in our practice, we see the average age at age 37.

[00:06:55] However, we're seeing a lot of patients that are even a little bit older, early forties or [00:07:00] mid forties. They're actually starting their fertility. So

[00:07:03] Natalie: I know you do so many things to help people. And I've been in to the clinic, done stories over decades now with you all. tell me about the range of that, because one of the things that I found most fascinating, I think that people listening to this who are thinking I'm having problems.

[00:07:17] I don't know if I need help. Is that the one day workup that you do so that you can. Identify where the problem is. So it's not just, I have to jump into in vitro or something like that, but to know where your problems might.

[00:07:29] Dr. Laxmi: Right. I think that's such an important question and anally. What I would do is take a step back to kind of answer.

[00:07:34] When should you seek in some of these patients don't know, am I having an issue? Is this normal? And what we usually tell patients is. If a woman is under the age of 35, having unprotected intercourse for 12 months is the normal interval of time to achieve a pregnancy. Now, if a woman is 35, then it's really six months and that again goes hand in hand.

[00:07:58] Each component with [00:08:00] infertility because we know that our ability to get pregnant naturally and our ability to have successful fertility treatments, declines over 35. So that's the time when I would tell couples or a patient, this is the time to seek a fertility evaluation. Now, sometimes I have patients who, you know, are 34 years old.

[00:08:17] They've been trying for six months or eight months, and they want to have an evaluation early. There's no harm in getting the information so that, you know Uh, in our practice, we've developed something known as a one day workup. It's a very efficient use of time in that visit. We can do most of the basic fertility testing, which would include blood work ultrasound.

[00:08:38] An x-ray and male fertility testing. So during that one visit, most of the testing can be accomplished. And so patients are able to start gathering the information to help them, you know, one come up with a diagnosis and then kind of figure out where to go for. That's

[00:08:55] Natalie: wonderful. I know for my family, I'm just using myself as an example.

[00:08:59] I know there's so many [00:09:00] great examples out there the emotional roller coaster of I lost a pregnancy and I have to kind of get my body back and wait months. I mean, the waiting process. Is really hard for, for families

[00:09:14] Dr. Laxmi: as, and I think that that's true, especially after a pregnancy loss. And I think that's also true for couples who are struggling to get pregnant in the first pregnancy.

[00:09:23] So you know, we see a lot of patients that are in very vulnerable situations and we understand, you know, their desire to start their family and have a successful outcome. And so kind of having. This gentlemen, streamlined evaluation process, I think can be very, very helpful for patients as they go through this journey.

[00:09:41] One of the nice things that about our practice and one of the reasons I love working at CCRM is that we have so many different support services. So it's not just a relationship between a patient and a physician. We have an amazing team of nurses. We have an amazing team of genetic counselors. If we need to involve them in a, in a patient's care, [00:10:00] we also have licensed.

[00:10:01] Counselors that specialize in fertility, pregnancy loss, sort of all aspects of reproductive medicine. And so when patients come to see us, it's not just getting medical treatment, but you are getting some of the other support services that are so critical to going through this.

[00:10:18] Natalie: Yeah. I mean, that's, that's a big part of it because when you lose a pregnancy, your hormones, you go through that postpartum depression that many women do that we have to pay attention to that we have to address it and finding people to help you don't have to do it alone.

[00:10:31] It's really hard for families. Okay. I want to talk about the. Because I am blown away by the science of what you do and how you're able to help people at every stage. We talked about miscarriages and identifying, but tell me a little bit more about the different things that you do and where science is going in in your world.

[00:10:49] Yeah.

[00:10:49] Dr. Laxmi: Well, it's kind of surprising that the world of reproductive medicine is still pretty much in its infancy. If you think about the first successful IVF babies um, [00:11:00] that was in 1978. And so Louise brown is only 43 years old. And over the past four decades, there's been a tremendous amount of scientific knowledge and advancement that we have not just on the fertility treatments, such as IVF, but also our understanding about reproductive medicine.

[00:11:18] You know, how does fertilization occur? What are the. That are important for an embryo and a uterus to communicate and attachment to occur. We're gaining more information about why certain patients have miscarriages. And it's one of the reasons why I selected this field of medicine to specialize in because it's such an exciting field.

[00:11:38] Um, And just thinking of. Everything that we've learned over the past four years, really, over the last 15 years, the major scientific advancement in our field is really on genetic screening of embryos. And so there are times that couples are not necessarily struggling with them for stability, but they may have a genetic Link to a specific disease [00:12:00] and that's something that they don't want to pass on to their children, their grandchildren, or, you know, in their lineage.

[00:12:06] So sometimes we say patients that are interested in being able to screen out certain types of genetic illnesses. From their family. So IVF which is creating embryos outside the body. So IVF just means that we fertilized eggs outside the body is a tool that we can use for genetic testing. Um, So embryos are created.

[00:12:26] We can biopsy or remove a couple of cells from an embryo. And then from those cells, we can extract DNA. Which is just our computer code and the way that we function. And from that computer code, we can gain lots of information. We can do chromosome testing. So as women are getting older, we know that they're more at risk of miscarriage, primarily because the chromosomes in an embryo have not lined up properly.

[00:12:51] You can actually do screening ahead of time so that we can identify the healthiest embryos that will go on and have a successful pregnancy. Well, we can [00:13:00] also do genetic testing for specific diseases. So for example, sometimes I have patients who have a significant history of breast cancer in their family, and they are concerned about maybe passing that onto their children or their grandchildren.

[00:13:13] And so if there's a gene that's associated with that cancer, we can actually create targeted. And identify which embryos there for which children would have. Wow.

[00:13:26] Natalie: That's amazing. All

[00:13:28] Dr. Laxmi: of that technology has really evolved over the last 15 to 20. Yeah.

[00:13:32] Natalie: can you give me a couple of other examples? Like I find this story so fast in some of the, just heartwarming or stories or babies now.

[00:13:40] That you've helped families through like this. Give me

[00:13:42] Dr. Laxmi: some examples. Absolutely. So um, for example, you know, sometimes we see patients who had no fertility struggles, they went on and had a successful pregnancy, but at the delivery, their child may have been diagnosed. With a condition that they didn't know about [00:14:00] that was not picked up during their prenatal course.

[00:14:02] So now they may have a child that's affected with a significant illness, and now they have this information. Both partners may be carriers for that mutation, and they are concerned about having additional children with this lethal mutation. So I've had a number of patients that actually come to see me after they get a diagnosis from a newborn.

[00:14:22] And so then they'll come to see. For IVF and genetic testing specifically for that, disease. The other population of patients that I see is one of my passions is in cancer. So I see a lot of cancer patients at the time of their diagnosis because things like chemotherapy, radiation, or surgery. In fact, both male and female fertility.

[00:14:43] So I specialize in fertility preservation. So I have patients who come to see me before they go through their cancer treatment. Thinking about, can I freeze eggs before they go through treatment and may be experiencing fertility? Can I freeze Emory or freeze eggs so that if they struggle with fertility [00:15:00] issues or multiple miscarriages, after they go through their cancer treatment, we have healthy.

[00:15:06] And Bruce have biological children.

[00:15:10] Natalie: I remember a story this was years ago. I believe it was from your office and you probably have examples of this, of a family that struggled and they gifted the two, I think it was their their. Egg retrieval at the age of 1819, because they never wanted that young girl to have the problems that they had.

[00:15:29] And as you just spoke about a moment ago that the eggs are so healthy at that young age, that then it allows it allowed that young woman to wait. To start a family without the fear of not being able to get pregnant later in life.

[00:15:45] Dr. Laxmi: That's right. And I think, you know, a lot of young women who want to come in to just do fertility preservation, maybe when they're in their twenties or early thirties, they want to freeze eggs because they are focused on other things in their life.

[00:15:56] Maybe they are very clear, you're driven. Maybe they're in a field [00:16:00] where, you know, most of their career advancement is unfortunately happening during their reproductive years. And so they want to be X one there, you know, it's 30 years old so that if they postpone a pregnancy until they're 40 or 42, they still have, you know, healthy eggs that are,

[00:16:15] Natalie: that's amazing.

[00:16:16] Okay. Sensitive topic. But I think it's one that people listening are thinking about, and that is the cost. Does insurance cover fertility issues? Are you giving me just kind of a, an idea of how. General families deal with this because they want so badly to have this family, but maybe they're thinking I could never have.

[00:16:36] Dr. Laxmi: Yeah. And I think that that's one of the barriers for, for patients. And what we're finding is that actually more and more insurance companies are covering the cost of fertility, diagnostics and treatment. So I think that for a patient who is uncertain, if the cost is going to be prohibitive, it would be worthwhile talking to your HR department and finding.

[00:16:59] [00:17:00] Specifically, you know, do you have any fertility coverage? Cause a lot of times the diagnostic testing will be covered because again, keep in mind, this is a medical diagnosis. So if I had someone with heart disease and chest pain, an EKG would be covered by insurance. And so, infertility should be treated in a very similar manner.

[00:17:18] I think where it becomes a little bit more variable is on the treatment and that's really going to depend on the insurance coverage and also. Employer, you know, electing fertility benefits as part of the compensation package, but we're finding that more and more insurance companies are actually covering the cost of.

[00:17:36] Testing and treatment. That's good to hear

[00:17:38] Natalie: everyone should have the opportunity to grow a family. Absolutely.

[00:17:42] Dr. Laxmi: There's also a national move to have infertility coverage for patients in different states. So although there's no national law for this or federal law, certain states do have mandates for insurance coverage.

[00:17:55] So for example, Colorado is the eight. The state that has some [00:18:00] fertility benefits um, that law was supposed to be in active January 1st, 2022 that has had a little bit of a delay. So governor Polis, who's the, governor of Colorado. Postpone that decision until July. So stay tuned for that information, but you may also want to check to see if you're in a state that has a mandate for,

[00:18:21] Natalie: and when I want to talk about two other things before we wrap up one is that I know you treat people.

[00:18:27] In other states you don't have to live here in the state of Colorado. What should people look for when they're thinking that they need help? What should they look for online? Who should they look? Is there a difference in a fertility, doctors and clinics and what they're doing? Yes.

[00:18:43] Dr. Laxmi: Now

[00:18:44] that's such an important question.

[00:18:45] Thank you for asking that. Um, No two fertility clinics are the same. There's actually a lot of variability from clinic to clinic, even in the same city or in the same state. There's a great resource that I usually recommend patients look into. So it's [00:19:00] called the society for assisted reproductive technology.

[00:19:02] So you can go online and just put that into your search engine. It is a program that is under the. CDC and start is a national organization is a governing body. 95% of fertility clinics across the country are participants of start and sees young. Colorado is a participant. When you are a member of SART, you allow.

[00:19:26] An outside governing body to come into your clinic and look at your statistics. Because a lot of times a fertility doctor can say, I have X percentage pregnancy rave, and maybe even be inflating their success rates. But if a consumer or a patient doesn't have a reliable source to really verify that information, it can be very difficult to make these decisions.

[00:19:48] So going to the start date, There's a map on starch. You can go to a specific state, you can click on the map and identify a particular grade. You can look at pregnancy rates. So that is a [00:20:00] great option to evaluate clinic, to clinic, right at Cesar in Colorado, we do see a lot of patients that come from out of state or even internationally.

[00:20:09] So I would say about half of my patients are traveling to Denver to seek treatment with. And a large part of that is that our, our pregnancy rates are far superior than a lot of other places. So I think this is particular to if a couple of requires assisted reproductive technology like IVF then doing your homework can be very, very helpful in shortening the time.

[00:20:30] To a

[00:20:30] Natalie: successful outcome. Yeah. I'm going to link start to the show notes for anybody who wants to click on that and we'll link your website as well. And then I want to talk about, I don't think we did this a moment ago and I think it's really important for someone who's just starting to think. I want to start a family.

[00:20:45] What can I do? Or maybe they've already had some issues. What are some things people can do at home now without having to go to that next level?

[00:20:53] Dr. Laxmi: Absolutely. So there's some lifestyle modifications or lifestyle things that I usually tell patients to kind of think [00:21:00] about because some of the patients that I see are not struggling quite yet, but they just want to have a consultation or a conversation to talk about, Hey, we're ready to start a family.

[00:21:08] And. How can I optimize that opportunity for natural pregnancy? So a couple of things we know one is weight is a big factor on having a successful pregnancy and fertility. So what I I usually tell patients is avoid the extremes in weight. So too high of a BMI or too low, that would be my can actually impact a woman's menstrual cycles for ambulation and not only in getting pregnant, but it can impart.

[00:21:35] In pregnancy. So having a healthy weight, appropriate diet, I wish there were some sort of magical diet that was the fertility diet, but there have been studies that have looked at different types of diets. Very few of them actually have an impact on fertility. The only one where we have clinical data about improving egg and sperm quality is Mediterranean.

[00:21:55] So lots of vegetables, omega-3 rich [00:22:00] fish, whole grains, and really eliminating red meat. And you can think that people who have a Mediterranean diet are probably a little bit more healthier. They're exercising, regular they're you know, sleeping well in terms of vitamin supplements, women who are planning a pregnancy should be on a prenatal vitamin that has at least 400 micrograms of folic acid.

[00:22:17] That's important for the neural tube in the B. More properly. The other supplement is D H a so 200 milligrams of DHA, which is fissural is really important for fetal brain development. The other things that I tell patients are the things that you might be entering into our bodies. So cutting out tobacco, cutting uh, drug use, some of those environmental factors can also have an impact on.

[00:22:41] Natalie: I know you're doing a study there at CCRM. Tell me about that. It's the SIU study.

[00:22:46] Dr. Laxmi: That's right. So, you know, there's been a lot of research looking at different types of antioxidants or supplements. And do they have an impact on fertility? The data's pretty conflicting about. These different types of supplements, [00:23:00] but a couple of things that we know cook, you tend to be helpful.

[00:23:02] High dose fish oil on the men's side sink and vitamin E has had some improvements on sperm parameters at CCRM. We did a clinical trial evaluating a new supplement, and it's called SAE. You probably have seen it in your grocery store. They look like. Yeah, exactly. Sometimes they're covered in dark chocolate

[00:23:24] or fruit. That's grown in Brazil. So we wanted to do a trial to see, is there a benefit of us? I need as a new supplement for infertility patients. So we did a trial in couples that had. Try to IVF, but we're not successful. We put women on us ag supplements. It is a supplement that is created versus Durham patients.

[00:23:42] We get it directly from the fruit in Brazil. It has the highest antioxidant concentration. So it's not available over the counter. We put. On SAE for eight to 12 weeks. And what we found is that we were making more embryos and more chromosomally, normal embryos. And so we really are [00:24:00] finding that SAE could be a new supplement.

[00:24:02] That's really beneficial to our patients. And in fact, because the initial studies were so promising, we've now offered it to patients who are doing IVF for their first time.

[00:24:12] Natalie: That's great. And we're just learning so much. And I know the research that you all are doing and the people that you have day in and day out is helping the advancement of couples trying to get pregnant and your science.

[00:24:24] I'm amazed by it. Thank you so much for your time today. I always learn when I talk to you all and where should people go? I'll put it in the show notes, but where do you advise people to go to get more information on your clinic? Our website.

[00:24:38] Dr. Laxmi: A great resource for information. So it does have information about the different CCRM sites.

[00:24:44] So there are a number of CCRM clinics across the country, so you don't always have to come to Colorado. Um, So you may have a CCE from a site that's in your backyard. On that website, it also has information about the clinical trials that we have going on. It does give you an overview of [00:25:00] the one day workup, different types of fertility conditions and fertility.

[00:25:04] Natalie: Terrific. Dr. Kaanapali. Thank you so nice to talk to you today. So

[00:25:08] Dr. Laxmi: lovely to talk to you. Thank you for

[00:25:09] Natalie: the invitation you bet, and all the best to those out there that are trying to get pregnant or are, are struggling. We feel your pain and there is help. And it's good. It's good to hear it today. Thank you.