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Harvard Data Science Review Podcast
Data Are Born to Reveal: So What Can They Tell Us About Pregnancy?
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- [00:01]
Liberty Vittert
Hello and welcome to the Harvard Data Science Review Podcast. I'm Liberty Vittert, feature editor of the Harvard Data Science Review, and in place of my co host and editor in chief, Xiao Y. Meng, we have our guest host, Arianwin Frank. In an era where information is more easily accessible than ever through online platforms, a majority of people just Google their medical questions and concerns. According to the national center for Health Statistics, more than half of all adults in the United States used the Internet to look for health or medical information. With a rapidly changing landscape revolving around women's health, impacted by technological developments in medicine and artificial intelligence, and political changes such as the overturning of Roe v. Wade, there is a lot of misinformation, disinformation, and just plain old confusing advice available to women through websites and certainly social media platforms. To learn what data science really can tell us about fertility, pregnancy, and modern problems women face regarding their sexual health, we are joined by Dr. Laura Shaheen, a reproductive health specialist, host of the Baby or Bust podcast, author of Fertility 101, and social media influencer. As we dive in, we want to remind our listeners that this content is for educational purposes only, and you should always consult your doctor on decisions that impact your medical treatment. Well, Laura, we really can't thank you enough for joining us. I'm so excited about this episode and I have a thousand questions. So it was hard to bring it down to just these couple. But, you know, pregnancy comes with this sort of flood of advice, or dictates, as it sometimes feels like, about what to eat, what medications to take, even how, you know, sleeping positions, whether to eat fish or not eat fish and cheese. I mean, God, like, it's like, so overwhelming. So, you know, as a physician, how do you determine what guidance to give your patients?
- [02:04]
Dr. Laura Shaheen
Yeah, well, I just completely empathize with what you're saying. I mean, I've cared for women for over 20 years in pregnancy, early pregnancy, fertility. And then I also was pregnant myself, and I remember reading this Dates me a little bit. My kids are teenagers now, but I read what to expect when you're expecting. And I had to close that book because it terrified me. Here I was in obgyn, and you would look in and it would say, like, oh, you know, you have abdominal pain. Okay, well, all these horrible things could happen. And I was like, okay, this is too much. So when I am guiding people or talking about things, I try to teach and kind of explain with physiology or thinking about rationalizations for these kind of myths or strict guidelines that are out there, there's so many extremes. There's so much judgment about what women are doing with their body. And then when they're carrying another human, everybody seems to have pretty strong advice and guidelines for that person along those.
- [03:15]
Liberty Vittert
Lines then I guess, do we have any research on what people should be doing while they're pregnant?
- [03:20]
Dr. Laura Shaheen
Oh yes, but we could certainly do a lot more. It is not perfect. And I mean, my goodness, pregnant women are excluded from research routinely because it's so worrisome. You know, what if you're doing something wrong to harm the fetus, how can you learn about that? And because women could potentially get pregnant, they were excluded from almost all experimental data and research, not even if they weren't pregnant, but because it was a potential or their hormones are just a little bit weird. So it's going to mess up the data. So let's just not test women and just assume that women are smaller men. So I'm trying to warn against having such extreme and really having women live in fear as they're pregnant about all the things that they can do wrong when really they're most of the time they're going to make great choices and everything's going to be just fine.
- [04:17]
Liberty Vittert
So how is the data really collected for pregnancy related recommendations? For example, I get migraines and so I'm taking migraine medicine. And they said, well, you can't take that migraine medicine if you're pregnant. I said, well, what happens? They said we don't know because pregnant women have never been in the study before. So it may be bad, it may not be bad, but it's just better not to take it. So how do you collect data to make these decisions?
- [04:42]
Dr. Laura Shaheen
Sure, lots of different ways. Very often things are studied in animal models like especially medication or pharmaceuticals. And if they see that you give a certain amount of medication to a pregnant mouse or a pregnant animal and then there is an increased risk of miscarriage or birth defects. They'll often say this is pregnancy category. See, like we don't have the data in humans, but in animal models we saw something. So you really don't think that you should take it. And then there are some things where people have accidentally taken medications while they're pregnant and then seen poor outcomes. A great example of that is something called Accutane. Really high levels of vitamin A to treat acne. It does an amazing job. But when people had taken super high levels of vitamin A in pregnancy, there were absolutely birth defects. And so that is devastating. Category X, like you cannot take while you are pregnant because we know that this harms humans. So it's not that in general. We're doing a great job of really making sure the safety is okay in pregnancy. The sort of general line is if you really aren't sure that you absolutely have to take it, maybe don't take it because we just don't know. Or in animal models where they're studying other things, they've seen this. So we have to sort of assume that it might be harmful for humans. So it's kind of piecemeal. And a lot of it is just doing the best that we can with the data that we know.
- [06:16]
Liberty Vittert
The Accutane example is such an interesting one. You have sort of like an unexpected or unknown. Unknown, unknown. But what about how data's played a role in changing recommendations? Have there been examples of where something was an accepted practice or a recommended practice and then we all of a sudden have all this data and studies to show, oh gosh, this was totally wrong, or vice versa, something you absolutely weren't supposed to do. And actually it's changed now that that's recommended.
- [06:46]
Dr. Laura Shaheen
Sure. I've got two great examples. One is your first question about something that was assumed to be safe and then realized that it absolutely wasn't. And it's DES or diethylstilbestrol. That is a estrogen like chemical that was used as a pharmaceutical in the 1920s through 1970s in pregnancy to prevent miscarriage, to prevent preterm contractions, to help with some menopausal symptoms. Like it was actually actively given to women in pregnancy to help decrease the risk of some pregnancy complications until it was realized that children born after in utero exposure to DES had an increased risk of vaginal clear cell carcinoma and a lot of uterine birth defects that affected their ability to conceive in the future. And so DES was pulled from the market in the United states in the 1970s. You're not able to prescribe it anymore. But that is an amazing example of something that was actively given to women in pregnancy, thought to be safe, thought to treat poor pregnancy outcomes, and found to be absolutely harming. The answer for your second example, I think a really good one is SSRIs in pregnancy. So selective serotonin reuptake inhibitors like Prozac, Zoloft, et cetera, it was assumed in the beginning, like, oh gosh, as soon as you're pregnant you should stop them. But nowadays we have so much information on how maybe the wrong thing to do is automatically get off these medications if someone truly needs them. To help with anxiety, depression, mental health, it's the worst time to just dramatically stop it. And maybe the safest thing to do is to work with your doctor on dose and type that you're taking. But it sometimes can increase anxiety or even be associated with increased miscarriage if you stop it too soon.
- [08:53]
Liberty Vittert
You know, I think since so much of your work focuses heavily on supporting individuals through the fertility process, what do you see as the most significant challenges that people face when they're trying to conceive? And you know, sort of from a statistical standpoint, is getting pregnant becoming more difficult or there improvements in success rates? You get this idea that fertility is decreasing and is it because women are having longer careers and so they're waiting till they're older so they're not having as many kids? Or is fertility itself decreasing? Is the 20 year old having a harder time getting pregnant? And have you seen data to support either side of that?
- [09:36]
Dr. Laura Shaheen
It's hard to say because it's so multifactorial. People are having fewer babies than they were in previous generations. People are waiting longer to start their families, and sperm counts are going down through the decades. So there's many different things to think about. One thing that I'm pretty sensitive about is every time that people talk about waiting to have children, it's always blaming women for focusing on their career and shouldn't they do both at the same time? So I'm very sensitive to that. The average age of the first baby born for women just across the United States has only increased by two years in the last couple decades. It was like 25 a couple decades ago, and now it's 27. I mean, definitely on the coast and in big cities, I think people are starting their family in their 30s. And definitely age and fertility are absolutely related. But I also think our environment is totally different than it was a few decades ago. So there's cultural reasons that people are waiting, there's socioeconomic reasons that people are waiting to have kids. But the environmental factors I think are very interesting. I interviewed Dr. Shana Swan, the author and scientist of the book Countdown on my Baby or Bust fertility podcast. And it's a fascinating story because she actually wanted to prove these theories wrong. People have been saying for decades, like, oh, sperm counts are dropping, sperm counts are dropping. And she said, I really am not sure. I mean, maybe we're measuring sperm differently. Maybe people are collecting it in a different way. And she really, really went through it and she realized, oh my goodness, it's true. Like, sperm counts are actually decreased by 50%.
- [11:21]
Liberty Vittert
50%?
- [11:23]
Dr. Laura Shaheen
Yeah. Wow. And not only did she figure that out, but she went into the lab because she's a scientist and looked at it on a mouse model, sort of showing that increased exposure to endocrine disruptors, specifically phthalates, is associated with lower sperm counts and even changes in genital structure and function for rats. So it is definitely multifactorial. But I think it's very simple to just say, oh, people are waiting longer and it's their fault that we're having less kids. It is all sorts of things. It's all intertwined, you know, as you've.
- [12:00]
Liberty Vittert
Treated so many Women over your 20 year career in this, what has sort of surprised you the most about what you've seen, what people know, what people don't. What's been the most surprising thing you've seen sort of in your practice?
- [12:14]
Dr. Laura Shaheen
Lack of education on reproductive health. And I only see it getting worse. I remember my health class in middle school and high school where it was just taught how easy it is to get pregnant when you're not ready. And you've got to be so good at contracepting. And that's it. It's like. And nothing else. Nothing about how the menstrual cycle works or how when you do actually want to get pregnant, it's easy for some people, but not everyone. So we learned that when we're first learning about health and then in the movies and in social media, it sort of feels like, you know, it's the storyline of I want to get pregnant, I stop my birth control and then I get a positive pregnancy test and then next scene in the movie is a beautiful baby. And so our expectations are really not reality. Depending on lots of different factors and how, how old people are when they're starting their family, you know, their medical history, all that. I mean, even when we're our most fertile, the first month that you try, it's a less than 20% chance that you actually get pregnant. But in our mind, it's 100%.
- [13:25]
Liberty Vittert
It's 100% it's gonna happen.
- [13:27]
Dr. Laura Shaheen
Exactly. And I think that we live in a little bit of a immediate gratification sort of feeling. It's like we're in our Amazon prime society right now. Like, I want to get pregnant. I stopped my birth control, I want it yesterday. So I see people coming to me pretty quickly, which I'm glad that they're coming and asking questions so I can make sure everything is okay, because I don't want people out there trying for years and then finding out that there's a low sperm count. So that's great. But just this real lack of understanding and truly thinking that there's something horribly wrong with them because they've been trying for three months. And that same thing goes for miscarriage. I mean, miscarriage is so common. You hear this one in four number everywhere, and people think it means one in four women have had a miscarriage. Miscarriage? No, it's one in four clinically recognized pregnancies. So think about how many pregnancies somebody might have in their life. More than one in four women have had miscarriages. And we just absolutely think it's our fault we've done something wrong. In the movies, people don't talk about miscarriage. Your friends don't talk about it, your parents don't talk about it. And it's so common, yet when it happens to you, if you don't share, you don't really get vulnerable. You don't ask questions, you assume it's you. So a lot of my interactions with patients truly is educating just on how their body works. You know, what a menstrual cycle is like, you know, how common miscarriage is and how it really does usually take more than one try to have a baby. So I love that part of my job. But I'm just really shocked, like in this day and age, how little education and understanding of just how our bodies work. It leads to such stress, worry, and, you know, just a lot of heartache, honestly.
- [15:15]
Liberty Vittert
Well, according to Forbes health, up to 13% of women in the US experience depression after childbirth, with as many as 43% also experiencing anxiety. How does your field address the mental health challenges associated with emotionally sensitive situations like postpartum depression or like pregnancy loss or fertility concerns?
- [15:39]
Dr. Laura Shaheen
Yeah, so I am a reproductive endocrinologist or fertility doctor. So I'm usually seeing people who are trying to get pregnant and they might be struggling or having multiple miscarriages. And I am addressing the medical piece and doing testing, but I think a big part of my job that I was not taught how to do in medical school, but is really addressing the mental health piece and the emotional piece because that is just as important. There's so much self blame, there's so much fear and anxiety that goes into trying to get pregnant again after a miscarriage. And I try to really help people find resources to cope with the grieving. Even if it takes a year or more to get pregnant, they're still grieving that year that they didn't have a baby and they Were expecting to have a baby. And so trying to teach people, give resources, say, hey, let's address this now, because it doesn't magically go away. And I do feel that that's a very important thing to help prevent or at least help people get help sooner if they do have postpartum depression because parenthood is hard, if they've learned how to ask for help, how to cope, how to manage stress, I'm hopeful that in the postpartum period we could help them in that really vulnerable and delicate time.
- [17:06]
Liberty Vittert
That's such a good point. And you know, coming back to this mental health aspect, is there evidence? You always hear these stories of women who haven't been able to get pregnant, have tried everything, and then all of a sudden, as soon as either they stop trying or they get a surrogate or whatever, they magically get pregnant. As soon as all the stress is gone and all the, you know, all this, they get pregnant. Is it that, I don't know, 5% or whatever of those women that would just happen anyway, or is there any evidence to back this idea that as soon as the stress goes away, you do get pregnant? Or that stress contributes so much to the inability to get pregnant? Is there evidence to show that? Or are these just the random stories we'd hear?
- [17:51]
Dr. Laura Shaheen
Anyway, great question. First of all, one in five couples that do conceive with IVF will go on to add to their family without any intervention. Stress and fertility have got to be related. Is it that struggling to have your family is stressful, or is it you were stressed out and that's why you have infertility? It's hard to piece apart this absolutely interconnected role of the mind body. If someone is in a very high stress, fight or flight cortisol pumping state, their reproductive system is going to shift away from reproduction. You know, it's going to be like, all right, we need to focus on running away from that bear. But there are people who get pregnant and have babies in the middle of war and famine and very stressful events. So it's just not black and white. I think that those stories of someone who struggled for years to conceive, they finally have a baby in whatever ways. But a typical story that's shared at gatherings is while they adopted and then all of a sudden they got pregnant again. You know, we pass on those stories because they are amazing and wonderful. And then it also plays into this, oh, well, finally you found a reason you were stressed out. And this happens in many different pain points in society. Like, oh, they had Cancer. Oh, well, they smoked. Okay, now we figured that out. So that's not going to happen to me because I don't smoke. You know, so it rolls into a little bit of self soothing and a little bit of comfort and you're sharing these like miracle stories. And I love the stories and I think it's great. But also, yes, stress and fertility are absolutely related. And so I tell people, listen, I think it is important and you cannot eliminate stress, but we can all work on stress management. So it goes into that same mental health and emotional wellness piece of caring for my patients. I sort of say, listen, if you are standing next to somebody at a bus stop and you both step into the lane when the bus is coming and you step back out, the person who has been working on breathing techniques and you know, getting vulnerable mindfulness, whatever it is, yoga, I don't care what it is, that person is going to recover from that huge cortisol spike faster than the other person that was standing right next to them has never worked on finding what works for them as far as to manage stress. So I know I'm not answering your question with black and white and it's because there is evidence that shows stress is immediately absolutely involved in fertility and IVF outcomes. And there are studies that show that it's absolutely not. And there are people that love to argue both. And I just don't think anything, especially in reproduction, is black and white.
- [20:59]
Liberty Vittert
If you could think of the top five things that really have sort of data, evidence based that will give you the best chance of having a healthy pregnancy in the average individual, what would that be?
- [21:15]
Dr. Laura Shaheen
That's a fun question. Let me think about it on a lot of different levels. So number one, if someone has a chronic illness, something like high blood pressure, diabetes, hypothyroidism, if they've got a chronic illness, one of the best things that they can do is manage that chronic illness very well before they even get pregnant. So working with your primary care doctor or your obstetrician to sort of say, hey, I am planning on getting pregnant, I am taking this medication for my high blood pressure. Is this safe in pregnancy or should we switch? So being prepared and planning to get pregnant if you are able too, and managing chronic illnesses if you have them, will absolutely help with improved pregnancy outcomes. On that same line, if someone's planning to get pregnant, taking a prenatal vitamin is a wonderful way to decrease poor pregnancy outcomes. If you take a prenatal vitamin for three months before you get pregnant, you have a lower chance of so many things. High blood pressure in pregnancy, preterm delivery. If you take it for a month before you get pregnant, you have a lower chance of hyperemesis or nausea in pregnancy. We think it's the B6 level that helps decrease that nausea. If you are taking a prenatal vitamin that has folic acid in it before you get pregnant or in early pregnancy, it decreases the risk of neural tube defects and spina bifida and things that are associated with other types of birth defects with the baby. And then in pregnancy, things that can improve health. Is getting prenatal care, just going to see the doctor, get your checkups, or the midwife, you know, catching things like preeclampsia early or high blood pressure in pregnancy, later in the pregnancy, getting ultrasounds to look for any sort of issues with the baby kind of earlier in pregnancy so you can plan ahead. Or like I just mentioned, spina bifida if you figure that the baby has that in pregnancy. In my training at UCSF in San Francisco, they were doing fetal surgery, so they were actually fixing the little defect in the spinal cord in utero. And then by the time the baby was born, it was fixed. I mean, that type of thing is absolutely amazing. So planning ahead, taking a prenatal vitamin, getting good prenatal care, Those are my top three.
- [23:50]
Liberty Vittert
You know, with so much advancement in technology and in artificial intelligence, where do you see the future of reproductive health? Are there any sort of particular innovations that you're excited about, or are there serious concerns that you have that you think need more attention?
- [24:07]
Dr. Laura Shaheen
Oh, my gosh, there's so many things. I mean, there's still so much that we don't know about reproduction. Even just the study of the scientist that was going through IVF in pregnancy, who did 26 MRIs of her brain throughout the pregnancy to see how much it changed in pregnancy. Like, no one's ever done that before. But that's amazing. Thinking about how the estrogen and the progesterone levels are affecting white matter in your brain. And how is that going to help us understand menopause and cognitive function? I think that the more that we study, the more we'll know. But, I mean, there's always little discussions at all the medical conferences like artificial wombs. Is there going to be a point where we don't have to ask for people to be gestational carriers, that we're somehow able to get an embryo to a certain point? Or if there's preterm labor and the baby delivers? This is a way to keep the baby safe in that really vulnerable time before viability. I mean, things like that are amazing on a genetic level. Almost all miscarriages are a genetic issue or a chromosomal issue within the embryo. But it's not everything. My mentors at Stanford have incredible research looking at microarrays and whole genome sequencing and finding very specific mutations that lead to miscarriage. So we'll be able to screen embryos for not just a chromosome issue, but, oh, if there's this mutation and chromosome number six, we know that embryo is not going to get past eight weeks of gestation. So we're just not going to transfer that embryo because we're going to prevent that miscarriage. That's amazing. You can think about if you want to get into genetics, crispr. I mean, that's really genetically, ethically challenging. But right now, I talk to people about how the final frontier in fertility is age or function of the egg. And of course, the sperm is very perfect. There's just so darn many of them. And we can just usually find one to work with. But eggs are so limited in age and fertility. And right now, really all I have to offer someone, which is an absolutely beautiful way to build a family, but is donor egg. If someone really has such poor egg quality or age, or we just can't find any normal embryos, we can create an embryo with an amazing, altruistic, incredible person who gives up their egg at age 25. It works really well. But we've made sperm from skin cells. Are we going to get to the point where we can make eggs from skin cells too? Or could we find the issue that is the age factor of eggs and fix it with CRISPR somehow? I tell my patients, sometimes I can give you an option of egg donation or embryo donation or something like that, but science hasn't caught up with what you need. So maybe someday will be able to help people. I mean, There's. I've seen 16 year olds run out of eggs, premature ovarian failure. This is not someone who waited too long into their 40s to have a baby. You know that that can happen. And so that person, you know, just had a consult with someone who was 25 this week and stopped having periods because they were in menopause. And I was like, I can't fix that, but you can still be a mom. You know, we can still help you have a baby later. It would just be with someone else's egg. And so, I mean, I know I went all over the place, but like, you can see like from the carrying the pregnancy to the egg to, you know, genetics. There's so much on the horizon.
- [27:33]
Liberty Vittert
Yeah. There's so many exciting things. Well, I could ask 8,000 more questions, but Ari is going to come in with our magic wand. We always finish with a if you could wave your magic wand question. So Ari's going to finish up with our magic wand. So if you could wave your magic wand and give any currently existing, like medicine or health practice that you do to help expecting mothers or to help people trying to get pregnant or anything in your practice, really, what would it be and why?
- [28:02]
Dr. Laura Shaheen
Oh, my gosh, the longer I do this, the more humble I get and the more comfortable I get without having 100% success rate. But just on an emotional level, I wish that every embryo transfer that I do would result in a beautiful, healthy baby, because that's what we all want when we are in that room and doing that embryo transfer. And it happens the majority of the time, but when there's a negative pregnancy test or a miscarriage, it's just devastating. And so, although ethically I know we'll never be there, scientifically I know will never be there. I do wish, and if I had a magic wand, I could make every embryo transfer be successful.
- [28:52]
Liberty Vittert
Well, I think that is a beautiful hope to end on. Where can people find more from you and more information on sort of all this work that you've been doing over such a long and really impressive and caring career?
- [29:06]
Dr. Laura Shaheen
So. Oh, my gosh. I love hosting my podcast every week, the Baby youy Best Fertility Podcast anywhere. You listen to podcasts. You can also find me my website, drloreshehan.com Instagram, TikTok, YouTube. I really love educating. I'm trying to get that education that's lacking out into the world, and so if we can help people find that, that would just be really rewarding.
- [29:30]
Liberty Vittert
Laura, I mean, we really can't thank you enough for taking the time to be with us today.
- [29:35]
Dr. Laura Shaheen
Well, I really enjoyed it. It's wonderful to be here and thank you so much for the opportunity.
- [29:44]
Liberty Vittert
Thank you for listening to this week's episode of the Harvard Data Science Review Podcast. This content is not a substitute for medical advice, so you should always consult your doctor on decisions that impact your medical treatment. To stay updated with all things HDSR, you can visit our website at HDSR, MITPress, MIT.edu, or follow us on X and InstagramHDSR. A special thanks to our executive producer, Rebecca McLeod, producers Tina Toby Mack, Arianwen Frank Gavin Yang and Bell Riley. If you liked this episode. Please leave us a review on Spotify, Apple or wherever you get your podcasts. This has been the Harvard Data Science Review. Everything Data Science and Data Science for everyone.