← The Neuro Experience
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- [00:00]
A
Doctor Ghadir, welcome to the neuro experience.
- [00:03]
B
Thank you so much for having me.
- [00:04]
A
I think it'd be really great if you could give us a quick rundown on a bit of your background, where you studied. I know that you've got great experience, including research under your belt, too, that I personally would love to know about also.
- [00:21]
B
Okay, wonderful. So thank you so much for having me. I'm Shaheen Ghadir. I am one of the physicians at the Hunt Youth and Reproductive center in Los Angeles, California. And I'm a local Angelina know, born and raised. And I went to UCLA undergrad. I went to medical school at the Central University School of Medical School in San Juan, Puerto Rico. And then I did my residency training at Kaiser Permanente here in Los Angeles, California, and then did my fellowship training again at UCLA and Cedars Sinai Medical Centers when I covered both of those hospitals and was fortunate enough to join a local group where I worked for the last 18 years and this year decided I needed a change in my career and joined a new group that's building right now the most innovative and most advanced fertility center on the west coast in the heart of Beverly Hills, where I'm going to be working.
- [01:11]
A
What is the most advanced center? What does that entail, as opposed to just being an intermediary? Intermediary average center.
- [01:20]
B
I was waiting for someone to ask you that, so thanks for asking me that question. We are going to have the most advanced equipment in the world of fertility. We're going to have incubators that take videos as embryos grow and watch them, but with the newest technology that makes it into like a humid environment, very similar, like the inside of the fallopian tube. We're going to have some of the most advanced materials, technologies. Everything that's available at the highest and newest level in the world of fertility is going to be in our lab there. And I'm really excited to see that.
- [01:55]
A
Have you. So is that in terms of IVF treatment? Yeah, everything.
- [02:00]
B
Well, IVF treatment, egg freezing treatment. So anything that has to do with egg, sperm and embryo happens in our IVF laboratory and it's going to be happening in this advanced location.
- [02:12]
A
Oh, wow. Well, this is great. We have. I'm really excited to talk to you for several reasons. We've had so many questions that have been sent through mainly on reproduction from both a female and male perspective. I'd love to separate the two and understand a bit more about that. And I'll get into the first part of it, which is I notice you speak a lot about biomarkers of fertility, one being amh. And I want to understand that because even for me, for example, I've got a close, you know, a close circle of girlfriends who, you know, we all talk. When you're in your 30s, you're, you know, fertility is definitely up for discussion no matter where we are, whether it's Saturday, we're out, or whether it's a weeknight. So fertility is always up for discussion. I've heard AMH is maybe one of 10 or 12 biomarkers when you're assessing fertility. But the thing that I always, often, always confuse is the fact that I have a friend who has an extremely low AMH, 36, was told she was, she's 36 now, and she found this out maybe around 33, 34, tried to conceive, was told that it's, you know, she's got next to nothing. Chances complete, you know, gave up. And then she, she has a little. She has a son now and she conceived naturally. So my guess, my question is, can you help me understand what AMH is?
- [03:41]
B
So anti mullerian hormone or. AMH is the hormone that's released from all of the eggs that a woman has in her body. So when we do the simple blood test, the higher the AMH level, that means the more eggs you have, the lower means, the less eggs. It does not mean you will get pregnant or you will not get pregnant at all. So it's a predictor of the quantity of eggs that you may have there. But we know that people sometimes have very low egg reserves and actually still can be pregnant and do really well. I've had patients, I have actually a friend that used to work in our clinic, and she had the lowest AMH level. She had three beautiful kids. But if she was going to do fertility treatments where we take the eggs out, she may not have been one of those people that makes 20 or 30 eggs. She may have been someone that made much smaller numbers. I had a patient a year ago and she was turned away from clinics because her AMH was so low. She actually did fertility treatments in other places and it didn't go successful. But. But she came. I said, I'm happy to help you as long as you understand the implications that this may be difficult and it may take a while. We did a few cycles and eventually she made a beautiful, genetically healthy, normal embryo. And one of the best phone calls I ever got when she called me and said, my baby is in my arms, thank you so much and thank you for giving me the faith to do this. So it's a good screening test because there's nothing better than that to tell us how, how fertile you are. But it's not an all encompassing blood test that tells you everything about your fertility that you would know. There's nothing that can do that for us. And there are other markers. There is fsh, there's your estradiol levels, there is lh, there's all these other markers that also give us information and Hib and B, but none of them are perfect. So sometimes we look at multiple different markers to give a better understanding overall and then it's still up for interpretation by your physician and how we explain to people what this means and what is it going to do to your overall fertility.
- [05:33]
A
So yeah, that's really interesting because when you really think about it, it is about one egg being fertilized. So if it is a low amh, it doesn't mean that you're, you know, definitely not going to get pregnant. It's more so got to do with the quality of your eggs, not the quantity.
- [05:49]
B
Well, a lot of times the AMH level has to do with the quantity. I have learned over time that sometimes quantity and quality go hand in hand. So not always, but sometimes they go a little bit hand in hand. I will tell people that are younger and have a low AMH that you're probably going to have better quality than the same woman 10 years older than you with that same AMH number. So be optimistic.
- [06:13]
A
Yeah. Okay, so then what are some of the things that we can be. We can't change amh. Correct. It's never going to change.
- [06:22]
B
You know, I was just watching my own post that went up the other day about that question. In a couple situations, for example, women that have been on birth control pills for really long periods of time, like 10, 15 years continuously, sometimes that AMH number goes down and gets very suppressed because the ovary is put to rest and not really functioning at its maximum potential. And going off can for some people, not all people, allow that AMH level to come back up a little bit. But there are people that say, oh my AMH was this and now it's higher. It's usually a difference from a lab to a different lab. If you did The AMH test 30 days in a row, I guarantee you you're not going to have 30 of the same exact number. It's just like any other thing in the blood. It kind of goes up and down from lab to lab. It's a little different. But when you're looking at it As a marker for eggs in your body. We know that women cannot create new eggs, so it doesn't really go up. It may wake some of the eggs up, but in general it's very rare for that number to go up.
- [07:24]
A
So what's the standard protocol if a woman does have a low amh, but she wants to conceive naturally? Maybe that'll just take a bit of time. Correct.
- [07:32]
B
I'd say be very careful. So it can take time. But I think if someone has a low AMH and you're getting a big hint that your fertility has declined, why not be more proactive and try to collect as many eggs as you can, Try to allow the laboratory environment to increase your chances. In my opinion, I think it's better to be proactive when your AMH is low and rather than just leaving it to luck on your own and see what happens.
- [07:56]
A
I think a lot of women are scared of doing egg freezing.
- [08:01]
B
I think you're right. I think you're 100% right. People are scared because they don't know much about it. I just had a patient, literally the hour before you called that she came in and when I told her it's about a two week process, she looked at me and said, are you sure? I thought this is like a long process that's going to take months and this is going to. I said, no. From the beginning to the end of the process of the injections, it's about 10 to 12 days. And usually two days after your last injection, your eggs come out with what's called an egg retrieval. And that's basically how it works. Women are scared because it is an aspect in an area of a female's life that maybe didn't go exactly as planned. Maybe someone was hoping to have kids and meet Mr. Right and do all of this earlier and maybe it didn't go exactly. And now someone may be a little older and having to discuss that in their head. What do I do? So I think the unknown is always scary for many people. I know it can be for me, when it comes to certain things. I think knowledge is power and I think learning and talking to the right person that you click with and you mesh with and can understand and can explain to you in a way that teaches you about your fertility will take away a lot of those myths and fear. Because I hear from many people after they did the procedure that it was much easier than they had anticipated. And that's always a very reassuring thing for me, that we're making it as easy as possible. I have to tell you, I said that comment somewhere and someone sent me a message and said, that's very insensitive of you to say that. It's so much easier and it shouldn't be so scary. But what I'm trying to say is that. It's not that I'm trying to be insensitive. What I'm trying to say is that the realistic fact of giving yourself those couple injections every day, doing a couple blood tests and ultrasounds for about a two week period is usually much easier than the entire process that someone who doesn't have the details has imagined in their head.
- [09:58]
A
Yeah, absolutely. And look, it goes hand in hand with even male fertility as well. I know that we're seeing a rapid decline in infertility in the United States, and forgive me if I'm wrong, but does this have to do with the testosterone deficiency that we're currently facing?
- [10:18]
B
No, I think you're absolutely right. I think that our environmental pollutants and things that are out there in the world that we are just not clear on, anything from our deodorant to our fragrances to the. I mean, I'm terrified to eat out of a plastic Tupperware anymore. I mean, the things that I hear about, every single thing that is affecting our life and we just don't know can be complicated. But we have seen in this last decade that sperm quality has gone down in the world and it could continue to progress and we're not exactly sure why. So we do believe that it has aspects of environment that are affecting us that is then affecting the natural testosterone that's built in our body and then affecting sperm quality.
- [11:03]
A
Correct. And I think it's. I don't know, is it 50, 50 for male and female? If you're trying to conceive, it's 50% egg quality quantity and 50% semen quality.
- [11:14]
B
It's about 40, 40, because sadly we have this bucket called unknown or unexplained infertility. That's about 20% of people. Like, we just, like, you're young and healthy and your sperm looks good. You're young and healthy and your eggs look great. We just don't know why the two of you are not getting pregnant. So it's about 40% known male, about 40% known female, and about 20%. We're just not exactly sure what's going on and why you're not getting pregnant.
- [11:41]
A
Correct. And that was actually going to be my next question. So I didn't know that there was this bucket and I Asked a, we had a family medicine practitioner on here not long ago and it was Dr. Kyle Gillette. And I actually asked him, I said, is there such a thing as unexplained infertility? And he said, you know, it just comes down to the physician and how well they're being monitored and everything that they're going through. And it got me thinking about one of my good friends back home in Australia. She's now got a six month old, but she was trying for a very good year. And I kept asking her, I'm like, is there anything wrong? She's like, no, we've had a semen check. My eggs are checked. Everything like they, everything was perfect. It was just. She even did this, she even did this opening of the fallopian tubes where she put oil through her. I'm not sure what that is. We can go into it like everything was clear and she still wasn't falling pregnant. So she went down the IVF route and on her second try she fell pregnant. And that was, you know, that's really interesting to know that if you've got, you know, if you're getting regular periods, you're getting your, you've got your AMH like down, everything's there and you're still not falling pregnant.
- [12:45]
B
I think there's a lot of truth to what the other physicians said. I think if there are physicians that are not getting good diagnosis, I see patients all the time that come in and say, my doctor said there's no reason and then I pinpoint the reason and we do it. But even at the level of a reproductive fertility specialist like myself, with the best technologies available, there are sometimes occasions where we just do not know why. So we are getting better and better in diagnosing lye, but there are still situations that are just humanly impossible for us where we are with science to be able to do something like that. Your friend had a hysterosalpingogram. It's a test where we put a dye in to the uterus and then it comes out the fallopian tubes and it flushes. If it's oil based, the media, it actually has been shown to increase fertility because it flushes your fallopian tubes. And for the next three to four weeks the highway for the sperm and egg to meet each other are really clean. So it's easy for them to say hello and say, let's fertilize each other.
- [13:44]
A
Oh, do you suggest that?
- [13:45]
B
I think it's a great idea. The research has shown that it used to be the research did was oil based. I think the hysterosalpingogram that does the fallopian tube test in general, and I don't necessarily use the oil based one. There are some people that after flushing their fallopian tubes, a percentage, not a huge one, that get pregnant like within a month or two afterwards all the time. I think it's a good starting point. If you're trying naturally and you're not going to ivf, I think it's an excellent starting point to make sure that your fallopian tubes are normal.
- [14:15]
A
Wow. Okay, wait, let's go to the start and let's talk about a menstruating woman who is getting her period very regularly, same day every single month. That's a very. Right. Now we've got a strong prediction. A predictor of, I guess, ovulation. Would you.
- [14:33]
B
Is that not 96% of women that have regular menstrual cycles, which is generally by textbook every 28 days, are ovulating.
- [14:42]
A
Okay, and can you get a period without ovulating?
- [14:44]
B
You can. So what is your period and ovular. The period is just the shedding of the lining of your uterus. So if you are an obese patient with polycystic ovarian syndrome and the lining of a uterus just gets thicker and thicker and thicker and thicker for six months without a period and eventually a few of those capillaries and some of the lining of the uterus is going to just shed a little bit and you're going to have some bleeding. What is that bleeding? It's part of the lining coming out. Is that a real period because you ovulated? No, but it's equivalent to a period. You're bleeding because the lining, it just can't support itself any longer. And you had what's called breakthrough bleeding without really ovulating. So yes, you can have a period and not be ovulating regularly.
- [15:25]
A
Yeah. Okay, so let's just say a woman wants to conceive naturally. She is in her 30s. This is generally the age bracket of a lot of the women who have written in between. Like I mentioned earlier, between 35 and 42, she's getting her period regularly and she wants to start conceiving naturally. What are some of the things that she should be doing to look out for? I'm talking blood tests, supplementation, environmental factors, sleep, exercise. Let's go through everything.
- [15:56]
B
Okay, so which one of those aspects do you want to touch base first? All of them. Okay, so one, I think that if a. I think before you actually make that decision to start trying on a regular basis, maybe once a year. And this is my opinion only. There's no board of medicine that really agrees with this right now. But I can tell you, from what I see, I think that Sometime in your 20s, you should become proactive. And once a year, when you go to your gynecologist for your annual checkup to get that AMH test, I think it's nice to compare what it is this year and the year before to see if it's dropping rapidly or if it's pretty stable. So I think that's a really good thing. So let's say it's stable. Let's say you are ready to start your family, you found your partner, and you are ready to go. You know that your egg reserve is decent, and there's no reason to be concerned about a diminished ovarian reserve and jumping to fertility treatments. So some preconceptional things that need to be good. I think getting an annual physical not only with your gynecologist, but with your regular doctor to make sure that your thyroid is good, they're not missing any issues or anything else that could be affecting your fertility is huge. And I gotta tell you, I asked this question of many of my patients. When was your last general checkup with your general doctor? And the answer, the majority of the time was, oh, I haven't gone in years, or I've never gone. So I think that's a really, really important tool and nothing to forget. Then there's some basics of how proactive you want to be. So I'd say, because I see this all the time, try for a few months, and if it's not happening, then you gotta get a little proactive. So checking of the fallopian tubes with that test called an HSG or a hysterosalpingogram is really easy. And you get a lot of information. It sometimes helps things open up and get pregnant quickly. Your partner doing a sperm analysis, I mean, that's an easy test to do, and I think it gives a lot of information. Why be trying and trying if there's a major sperm issue? So making sure the fallopian tubes are good, making sure your egg reserve with that AMH level is good, and also the sperm analysis is great. I'm going to back up a little bit. So before all of this, I think it's really important also to start taking your prenatal vitamins, your omega 3 DHA. I love this supplement called CoQ10. It's CoQ10. Coenzyme Q10. It's a strong antioxidant that slows down the aging of a female's eggs. It also reduces the oxidative damage. For sperm. Women are recommended to take 600 milligrams a day. Men are recommended to take 200 milligrams a day. I think it should be part of everyone's supplementation in your reproductive years.
- [18:29]
A
That's a lot because I was actually looking at my. I've got the Thorn Coq 10 and it's 100 milligrams. And when I did hear you say 600 milligrams per day, that's six of those on top of absolutely everything else. Is there any, is there any like the one. Can you be taking 400 milligrams?
- [18:47]
B
The ones that I prescribe come in 200. But a patient the other day told me that she found the 600 milligram tablet. I think people are getting better at making them. The hundreds are just miserable to have to take six of them. So I think you should try to find the 200 milligrams or the 300 or even the 600. So you could just take one or two or three a day versus six. But the research has shown that women need 600 milligrams and the men need 200 for good sperm optimization.
- [19:15]
A
I've also heard that taking three and a half to four grams per day of L carnitine can really help with egg quality as well.
- [19:25]
B
Well, I think the data for amino acids is there more for men. And L carnitine data is there about sperm quality more than egg quality. I'm not so aware of the fact that that's really true for egg quality.
- [19:38]
A
Wow, really?
- [19:39]
B
Yes.
- [19:39]
A
Oh, okay. That's, that's something that I was really like banking on because it's something that I, I saw. I forget who the, the. She was an MD who, who spoke about this. Okay, I want to go back to you mentioned thyroid. I want to understand how thyroid plays as a biomarker.
- [19:56]
B
Absolutely sure. Thyroid well being and the checking of the tsh, the thyroid stimulating hormone, is a good place to start when it comes to doing any kind of evaluation of the thyroid. The reason is that you must have a competent functioning thyroid to be able to carry a pregnancy and have a successful pregnancy. It is very easily correctable if your thyroid is slow. An ideal TSH level is around 2. So normal, just a normal person, it's usually between 0.5 and 4.5. But if we have a thyroid of about 4.4.2, maybe if you're not trying to get pregnant, it's great. For pregnancy reasons, though, the American Society of Reproductive Medicine has recommended to get the TSH level closer to a 2.0. So as long as you get it sometime between a 2 and a 3, I'm really happy with that and it's easily correctable. And the thyroid overlaps a lot with the menstrual cycle, with ovulation, and with the maintenance of pregnancy with the IQ of your child. And so all of these things. In my opinion, the thyroid needs to be optimized before trying to get pregnant.
- [21:00]
A
That's interesting. I was reading actually about ferritin and iron studies. I had bloods taken and I had some taken in September last year and I was actually going over them and I realized that I have low ferritin and iron studies. And once I was doing some of the research, I noticed that there is a. I guess it's a precursor to thyroid stimulating hormone or it plays a role in thyroid health. And I thought that was pretty interesting.
- [21:27]
B
Many of these hormones and all of these blood tests that we do are intertwined with each other and we are not exactly sure how they are intertwined, but I think over time they're kind of popping up and we're understanding the background about how these are related to each other. So I think it's really interesting that this is all unfolding the way it is and we're learning more and more every day.
- [21:46]
A
Yeah. And you mentioned, you know, when you talk about the aging egg and oxidative stress, you could probably put that on par with general lifestyle habits. Because if you want to lower oxidative stress, then you want to be sleeping well and maintaining a well balanced diet and maybe doing things such as, I don't know if sauna use or cold water immersion, if that's implicated in fertility.
- [22:12]
B
So I'm gonna. I think that you're absolutely 100. Right. I'm so glad that the emphasis on sleep has popped up in our culture now. I think it's so incredibly important to understand that your body's well being depends so much on a well rested, healthy body. So whether it has to do with the appropriate amount of sleep or a diet that's healthy. It is shocking to me after doing this for almost 20 years, the lack of knowledge that people have on what's considered healthy and what is not for their diet. Yeah, anything. I've kind of come to this place, like the majority of things that have an expiration date on it or in a box are probably not good for you. So that Mediterranean diet, which I just believe is the absolute best diet out there that I'm aware of, that fits into my lifestyle, I think is one that's extremely important and excellent for future fertility and overall well being. And it's high in antioxidants which keep you from aging. And we know that it's good for fertility. So the sleep, also the aspect of the mental, which is the mind and meditation and everything that comes with positivity and being grounded. I think those things have a lot to do with fertility and have been ignored for years and years and years. So I think stress and sleep, diet, emotional and mental aspects of it, have a lot to do with it. And I think these are really important things have control over before trying to conceive.
- [23:41]
A
Why do you think we're seeing a culture, especially here? You know, I don't see this in Australia, but I see it here, especially in New York, where I live. Why do we, why do you think we're seeing a culture of women now wanting to push back and have kids later on in life? 39. I'm seeing a lot of women at age 40. I actually have a, a couple who is a, who have been my clients for the past, I would say year. And she accidentally fell pregnant. She's 43 and her husband is 48. Why do you think that there is this culture of waiting?
- [24:13]
B
I mean, I think just the social aspects of career oriented people in our country here in the US has pushed fertility to just the side and in the back of the mind and not to the front. You know, if we look back, many of our generation's parents were having us in their early 20s and it was a lot, lot easier to conceive. And to this day, I think it's a lot easier to conceive when you're in your early 20s, when the female body is actually in its prime to conceive and carry. I think the social aspects of making career number one and family building number two, which has happened in this country has really caused a major influx, an increase in the level of infertility. And it's the. When people ask me what is the number one reason and cause of fertility in this country? I know hands down because the average age of a woman that comes into My clinic is 39 and a half years old. Is age related. And at the age of 39 and a half, when people are about to turn 40 and they're thinking about their fertility and what's going to happen is not the right time to be thinking about your overall global fertility and family planning, it's just not the right time at all.
- [25:25]
A
So freezing your eggs, then. So you're saying that no matter what age a woman is, if she has young and healthy eggs, then that is fine for implantation.
- [25:34]
B
Well, listen, we all know that it's. You have to look at everything. You have to look at where are you on your life. You have to look about where you are in your career. But that's why thinking ahead, whether you're ready to carry a pregnancy and have the child, and freezing your eggs when you're young and you're healthy is so much smarter than just waiting and not really addressing this big, big area of your life.
- [25:55]
A
Yeah, it's. I'm seeing. It's interesting. Do you. Obvious. I don't know if you follow. You're in, you know, you're in Beverly Hills. Do you follow the Kardashians? Because one of them just went through some extreme fertility treatment. And I think she's. Courtney, I think, did she give birth or. She's pregnant right now.
- [26:12]
B
So I actually was at an event where I ran into their mom and I said to her, okay, I want you to thank your daughters, because being open about every aspect of your life, maybe in my eyes, is not the appropriate thing, but the fact that they have been incredibly open about their fertility, I think has been huge for the American culture. They have opened people's eyes that it happens to everyone. You have to be proactive, you have to be smart. And it's not really a taboo anymore. Because about 10, 15 years ago, when I was doing this, I had people that were just silent, just radio silent about everything that had to do with their fertility and never wanted to bring it up, but now it's not. People are. It's actually considered to be smart and proactive to freeze your eggs, to talk about it, to let people know that you've done the right thing in this world. And I'm so proud that they have done that. And I let their mom know to please tell them that I believe that they have really changed the culture in this country about being so open about their fertility.
- [27:12]
A
But I don't think she froze her eggs. Was. Were her eggs frozen?
- [27:16]
B
Well, we just don't know. So this is a very big topic. I have had many a famous patient that has come into my office that really doesn't want to go public about it. And I think it's a personal thing. I think it's very personal. I don't think anyone has to I don't think anyone needs to go and tell the world what they've done for their fertility. But we know that there are certain limitations on older women who are over the age of like, 44, 45 getting pregnant with their own eggs. And when we see people over the age of 45 getting pregnant with their own eggs, you know, we have to start thinking either they were proactive and froze their eggs, or it's the egg of an egg donor. And I'm absolutely fine with both of them. As long as my patient is okay with both of them, I'm okay with it. If you're not okay with using an egg donor in the future, then you need to be proactive for yourself and freeze your eggs at a young age so you never have to be in that situation at an older age.
- [28:09]
A
Yeah, no, I completely agree. I think it's a very individual choice. I don't think, you know, there are some women who don't want to do it there mentioned that they think that it's a. It's a harsh undertaking for your body and maybe they don't want to fill themselves up with the hormones that are, you know, injected for the two weeks that you mentioned.
- [28:25]
B
Thank you for saying that sentence and I'm going to address it right now. You are not, I want to repeat, you are not injecting yourself with hormones for two weeks. You are injecting yourself with a pituitary gland stimulant, which is the LH and FSH hormone stimulants that they give a signal to your pituitary, which then gives a signal to your ovary, when your ovary then produces its own hormones, such as estrogen and progesterone. So you are absolutely not injecting yourself with estrogen or progesterone hormones. And that is one of the biggest myths in this entire process.
- [29:00]
A
And what does that do? Injecting yourself with this pituitary stimulant.
- [29:04]
B
So when every single month there is a cycle, during the 28 days of your cycle. So it kind of starts with these hormones, these FSH and LH going up. Then your body starts to produce estrogen, then you release that one egg that starts to grow because of that rise in estrogen, and then you ovulate, and then the hormones, if you're not pregnant, drop, and then it does not maintain the lining of your uterus and you get your period, that is your menstrual cycle, the four weeks. In a nutshell, we are giving you higher doses of the FSH and the LH that triggers the pituitary. And instead of releasing that one egg naturally for your ovulation, this time you're going to hopefully maybe grow 10, 15, 20, 25 eggs that are going to be retrieved during a quick little procedure that's about 10 to 15 minutes under a light sedation in our surgery centers that are specialized in collecting eggs and then those eggs come out. So it is a different version of trying to get more eggs efficiency than the one egg that your body is making that way.
- [30:05]
A
And then once those eggs are retrieved, what's to say that they're all going to survive? Is there a survival rate if you get, let's just say 15, are they all going to survive?
- [30:16]
B
It depends. If you are 23 years old, there's a majority of them are going to be excellent quality and survive. And if you are 43 years old and you make that many eggs, the majority of them are probably going to be, will survive. But survival is not what we are looking for, will not be genetically healthy is what we are worried about. So survival of an egg in the laboratory environment due to technologies and techniques that have improved have increased tremendously. Most eggs will survive, but their well being has to do with the well being of the DNA and the chromosomes that are inside of them. And that has to do with the female age.
- [30:54]
A
So then you would say that maybe if you are planning on doing egg freezing for the three months prior to that, or maybe even the six months prior to that, you really want to maybe eliminate alcohol, get into good sleep habits, get your CoQ10, do your prenatals, do your blood work.
- [31:12]
B
So yes and no. I think it's important to have a healthy lifestyle. But you taking six months off at the age of 43 to take vitamins and sleep well are not going to improve your eggs in six months. You actually harmed yourself. So when I give people supplements, I tell them you're taking these supplements because you're a female in your reproductive years. And I believe that these help maintain your body in a way that is ready for pregnancy when it happens. So if you're going to take time off to do this, be careful because there's no, your eggs are not going to suddenly become younger. You're not going to grow eggs because when I give the supplement prescription to patients, some of them are like okay, perfect. So how long do I have to be on this before doing this? And I never, I always say I am not postponing any cycle for a supplement. Those are given to you from now to prepare your body for Being prepared for a pregnancy and just as a good support for a reproductive age woman, even if you're not trying to be pregnant. Because I even give my patients that are 31 who are not trying to be pregnant right now. I think a prenatal vitamin is a wonderful supplement to act as your multivitamin for reproductive age women. So to answer that question, I don't think it really improves things. I don't think you're preparing things. I think it's just getting your body in the place where it needs to be with the supplements that it may lack to carry a healthy pregnancy, but it is not improving your egg quality. And people, please be careful. There's many people that think I need to be on these for three months before doing this. There's no data that says you being on a prenatal vitamin or an antioxidant for three months made better eggs or changed your eggs or gave you more eggs.
- [32:53]
A
Is there any success stories that you can share with us where you've had? Maybe a patient who came in and with a. I don't know, I don't know what type of case it would be, but it was great success and egg retrieval went great. Maybe she had a low AMH, maybe she was 39 and everything went great after that.
- [33:10]
B
A story that I love because it's public and because it is a person that I knew through my high school years. Mercedes Javit, MJ on the. It was the TV show on Bravo called Shaws of Sunset. I gotta tell you, mj, really, I would see her, I would tell her, you need to freeze your eggs. She was my friend in high school. She came and froze her eggs at the age of 44. She didn't have a ton of eggs and I was very concerned. And she calls me at the age of 46 and said, I met Mr. Wright, I want to use the eggs. So he came in, they fertilized, and guess what? She made a beautiful, healthy embryo that we then transferred into her uterus. And she delivered at the age of 47 and has been incredibly open and such a support to women everywhere about this idea of what she did. Now, do I tell people to come in at the age of 44 and do this for the first time? And that's what I'm encouraging. Not at all. But she's a story that if you're 44 years old, you should not give up and say, it's just too late and I'm not doing it. It can still happen. The ideal, perfect goal is to do this earlier and healthier and have more eggs and not put yourself in that situation. But she's a perfect example of someone that still did not give up and still did it and did amazing.
- [34:30]
A
Wow.
- [34:30]
B
But we have a lot.
- [34:31]
A
I love that I'm gonna look that story.
- [34:32]
B
A lot of stories like that.
- [34:34]
A
Well, I want to switch gears and talk to you about miscarriages. And is it true if I say that miscarriages are due to something happening with the sperm? Like something wrong in. In the sperm DNA?
- [34:50]
B
No. I mean, that could be one of the hundreds of reasons of why. One of the spirit. But when you make an embryo, you take an egg and a sperm together, the embryo can be normal or it could be abnormal. It could be from the egg, it could be from the sperm. It could be from the egg and the sperm. It could be absolutely normal. And you put it into a person who has underlying medical issues like blood clotting disorders, autoimmune disorders, very inactive thyroid, or a lot of other things, including issues in the uterus that can cause a miscarriage. So the whole. The. The bucket of miscarriage is huge. And what you said is just one small drop in that bucket.
- [35:33]
A
Yeah, I heard that actually, as well. Which has gone rampant. It's gone. It's had millions of views. I'm going to send it to you on Instagram. I'm like, that can't be right. That's just like blaming. It could be one reasonable for a miscarriage.
- [35:44]
B
It could be one reason that's very valid, but definitely not the reason. There is no.
- [35:50]
A
Actually, yeah, Yeah. I actually wanted to touch on PCOS as well, because we didn't get there. And how polycystic ovarian syndrome is affecting fertility as well.
- [36:02]
B
So I did my thesis in the area of pcos, and in the US we don't really call it pcos. So I just. For those of you who are listening. Oh, no, it's okay. So PCOS are based basically, so everyone understands polycystic ovarian syndrome is an area that really.
- [36:18]
A
That must be an Australian term.
- [36:20]
B
It is, it is. And I learned that from my Australian patients because I have a lot of patients that come from Australia to see me. But pcos, pcos, Polycystic ovary syndrome, whatever you'd like to call it, affects in our country about 8% of women. And unfortunately for those of you who don't know what it is, these women are affected with anovulation, which means they don't ovulate well, they don't have regular menstrual Cycles, they have their insulin receptors in their body, which is the root of the problem, don't work really well. And since insulin receptors and testosterone receptors are similar, there's an overlap. So they have a lot of testosterone binding to their body. So these women also get abnormal growth of hair on their chins and on their body. They also get sometimes male pattern baldness. Many of them are also overweight. So all of these. And also when you look at their ovaries, many of these women, but not all, also have a polycystic appearing ovary, which means lots of little cysts on their ovaries, which can give it a particular look. Some textbooks call it a ring of pearls, where around the ovary there's like a whole row of these follicles. But you don't have to have every single aspect that I've talked about right now. You can have some of them and you still get diagnosed with it. But. But it does, in many people, affect your egg quality and make you have poorer egg quality, which makes it harder to get pregnant. And since there's a lack of ovulation for many of these patients, also makes it even harder.
- [37:50]
A
So how can a woman know if she is ovulating? And when I've seen these ovulation strips that are connected to an app on your phone that are now available for people, and it's so funny, I think back to my grandmother who had 10 kids, I'm like, wow, she just freeballed all 10 of them.
- [38:07]
B
And I guarantee you she did not have an automated home ovulation.
- [38:12]
A
No, no, she. I don't even. I don't even know what happened there.
- [38:16]
B
Yes, well, she probably started having kids very young and not in her 40s, so I can guarantee you that's one of them. But the Ovulation Predictor Kit, which there are many different versions of them, some people call it the pee on the stick. Now, some of them are automated. Some of them you stick into a machine, it reads it on your phone. There's many different versions of it. I think that's the easiest and best way to check ovulation. So if you're having a regular period that is around 28 days, sometime around day 12, 13, 14 is when ovulation is going to occur. For the average woman, it is important to know, and not just look at an app that says, oh, today I'm ovulating. But it's important to know that if you are actually ovulating yourself, so you should check your urine, it is checking for a hormone called lh LH goes up and down right before ovulation. So the day before ovulation, people get a spike or an LH surge in their LH hormone. And that is what's being checked on that strip to see if it's elevated or goes high and tells you that within the next 12 to 36 hours, you will be ovulated. So I think that's a perfect, easy way. Other things to look for is if you get a little cramping around day 12, 13, 14, and you're noticing a clear vaginal discharge that's similar to egg whites. Many people believe that that's also a signal of ovulation without necessarily, not necessarily having to check the ovulation predictor kit or. But if you're completely confused, if you think you may have ovulated seven days later, if you check a progesterone level in your blood, if the progesterone is over the level of three, you've ovulated. If the progesterone is over a level of 10, you've had a great ovulation.
- [40:01]
A
You know, with all of this information, you know, I. That I retrieve from. From these podcasts that I do, it's actually staggering how many women actually just don't know the science that goes into conception. I was speaking to one of my friends last night who said that she's planning on, you know, in a year that they want to start having conceiving. And I said, great. And then we actually got. I said, you know, this is who I'm interviewing tomorrow. She has no idea about when she's ovulating. You know, she has no idea about anything. And I said, how is that possible? She's like, I don't know. I'm just going to just try and just. Just see how we go.
- [40:42]
B
It is absolutely baffling to me, the lack of knowledge by women about how their body is working and how conception works and the basics that they're missing. So we're obviously doing a horrible, horrible job teaching people about their bodies and how to do this at a younger age.
- [41:04]
A
Yeah. So that's all it is. It's about your 20s, really.
- [41:08]
B
It is. You gotta learn.
- [41:09]
A
20S and 30s, you gotta learn or listen.
- [41:11]
B
You gotta learn or listen.
- [41:12]
A
What else do you have to tell me? Anything else that I have missed?
- [41:17]
B
You know, I think I want to put a little bit of emphasis on the fact that I think that egg freezing is the smartest thing for a single woman, or if you're a couple and you're not a single Woman, it doesn't mean you ignore this. You can either still freeze your eggs or you can have the choice of making an embryo, which is the egg and the sperm together. But be proactive. You've been proactive in every aspect of your life to become successful about your career. We do all of this for what? I mean, in my case, I have four kids. I've worked and worked and worked so I can have a beautiful life with my family. That's for me, what is very, very important. And for that reason, I think of it, if I didn't do all the things I needed to do, and I've had to do IVF with my own wife, and I do have twins from ivf. I have four kids. My middle two are from ivf. I would have been in trouble. And then all of my goals in life that I tried to do would have been nonsense to me if I didn't get to where I wanted to be with my family. So I think being proactive in more than one area of your life is a big goal that I would love to stress to your audience.
- [42:20]
A
How important is it to also educate someone around? Let's just say you've got the embryos, but why is it that if you do the implantation that sometimes it just doesn't work out?
- [42:32]
B
There are many things. I mean, I have patients that come to me and I tell them, like, so when you put the embryo back in the other clinic, did they check your uterus first to make sure it's nice and clean and looking good? Like, no. So there are some amazing fertility doctors around the world, and then there are some that maybe don't do things in a way that would be ideal. I think it's extremely important to make sure that whoever is doing everything for you is really, really good at what they're doing. A sloppy practice of medicine and not doing this ideally can lead to low success rates and loss of beautiful embryos. So I don't know how to urge people. And it's a sad thing, is that some patients have absolutely no clue on how you assess your doctor. But I think in this day and age, doing some good research can help you a lot.
- [43:21]
A
Well, we will link your practice and all of your social handles below. This has been extremely informative for me and I hope for many of the listeners who are going to hear this. And where do you hang out most? I see you now on Instagram a lot.
- [43:37]
B
So we are there. My handle is Dr. Shaheen Ghadir with a Dr. Shaheen Gadir on Instagram, on Facebook, on TikTok. We have revived our YouTube channel to get things out there again. We're trying to do everything to educate people. I have a website called drgadir.com and also our clinic, the Huntington Reproductive center, havingbabies.com there's a lot of places where we go out there to give information. Be proactive. I also have a podcast called the Fertile Life podcast by Dr. Shahid Ghadir that has a lot of good, good people on there that talked about their journeys and we taught. Sometimes I did them alone, just talking about a topic. So take advantage, get educated, and in the worst case scenario, do a consultation and ask a doctor about everything that you're thinking or your questions, just so you're proactive.
- [44:28]
A
Thank you so much, Dr. Gooder, for being part of the youg Experience podcast.
- [44:32]
B
It's a pleasure to be here. Thank you so much for having me.