← The Tamsen Show
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- [00:00]
A
Foreign. Welcome back to the Tamsen Show. So if you are in your late 30s or early 40s and you feel like your body doesn't quite respond the way it used to, you are not imagining it, especially if you've had a baby in the last few years or more than one. A lot of women move from pregnancy to postpartum, straight into perimenopause without anyone saying that out loud. So when your sleep is off, your mood feels unpredictable, cycle changes, anxiety spikes or energy drops. You're left trying to figure out what box you're in. Most doctors don't walk you through that overlap, but today we're gonna change that. Joining me in our Soho studio is Dr. Jamie Griffo. He is a director of reproductive endocrinology and infertility at NYU Langone. Dr. Griffo has helped modernize IVF as we know it today, and his work has shaped how doctors understand fertility and hormones and reproductive aging. And he's here to give us language for what's happening in your body and the confidence to act on it as well. This show is sponsored by MIDI Health. Menopause doesn't happen overnight. It happens over years of nights. Hormones start shifting long before your period ends, and most doctors aren't trained to spot it. That's why MIDI Health exists, and it's why I tell every woman I know about them. MIDI is the only virtual care clinic built specifically for women navigating midlife hormonal changes from perimenopause through menopause. And yes, visits are covered by insurance. Book your first virtual Visit today@joinmitty.com Tamsin that's joinmidi.com Tamsen you know, I talk about sleep constantly on this show. I talk about what it does to your hormones, your mood, your brain, your weight. I'm obsessed with it. And I have to tell you, I was sleeping on a mattress that was genuinely not helping me at all. Waking up, not fully rested, and I'd gotten so used to it, I stopped noticing how bad it was. I switched to a Leesa mattress. And I have to be honest, the difference from one night was real. I fall asleep faster. I'm staying asleep longer these days and waking up without that achiness that I had just accepted as part of what was normal. My bed finally feels like the sleep sanctuary I've been telling all of you to create. LEESA has a whole lineup of mattresses depending on how you sleep. You just take their sleep quiz. It takes less than two minutes, by the way, and they match you to the right one. They're assembled in the USA. They have a 120 night sleep trial, free shipping and easy returns. They've also donated over 43,000 mattresses to families in need across the country, which I love. Go to leesa.com for 30% off select mattresses plus get an extra $50 off with promo code Tamsen exclusive for my listeners. That's L E-E-S a.com promo code TAMSEN for 30% off select mattresses plus an extra $50 off. Support our show and let them know we sent you after checkout, Lisa.com, promo code Tamsen. Welcome to the Tamsen Show. Good to see you.
- [02:58]
B
Good to see you. Thank you.
- [02:59]
A
Yes, of course.
- [03:00]
B
It's great to be able to help educate women to understand their bodies and their systems and what goes on.
- [03:05]
A
I feel like there have been so many questions that we have not had answered for decades now.
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B
Well, unfortunately, we suffer from lack of good science, good studies, and that needs to change because this generation of women has really been left out in the cold with the way we handle perimenopause, menopause and beyond.
- [03:25]
A
Well, there's so many questions I want to ask you. I want to start by clearing things up. Just because you bridge the gap in these areas of perimenopause, postpartum pregnancy, you're talking about a little bit of all of it every day. So for people who are listening and might not understand all these different areas, can you still get pregnant in perimenopause?
- [03:45]
B
Yes, you can. It's less likely. And you really have to start from the beginning and think about where we started as a species about 300,000 years ago. We didn't live very long. Menopause wasn't a thing. We were dead before menopause happened. And the whole female reproductive system was designed by mother Nature. And it had one thing in mind. We had to survive. And life was harsh. And the way we survived was had the right number of babies, not too many, not too few. So the system was designed that you as a fetus in your mother's womb, had 7 million eggs for no good reason, because by the time you were born, a million were left. And by the time you hit puberty, 300,000 were there. And every month, your body, through the hormones in your pituitary, tell your ovary to make you an egg. And in that process, that's where the hormonal shifts occur. Eggs, a bunch of eggs, 500 start growing. One gets selected, estrogen levels go up, that signals the surge to make you ovulate, ovulation happens. Now progesterone comes up with the estrogen and you get the cyclic nature of estrogen. Estrogen, progesterone, the lining of the uterus is receptive for that embryo to implant. If there's no embryo, you bleed. If there is an embryo, it implants. If it's a healthy embryo, you get a baby. If it's an unhealthy embryo, you can just have a positive test, or you can have a miscarriage, or you can have an unfortunate event where you get to 16 weeks pregnant, your baby has a genetic abnormality like Turner syndrome, Edwards syndrome, down syndrome, Klinefelter syndrome, and younger eggs do better. And the system was designed for 14 year olds who were dead by 25 to have only three babies from those 80 eggs that they ovulated in their whole lifetime, from the 7 million they had in their ovary as a fetus.
- [05:28]
A
So that's where we started.
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B
That's where we started.
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A
And what was the average age a woman would have her first back then?
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B
In the beginning it was like 14. And by the time you were 25, you had to have three living children. So the system was never the efficiency we were taught in that third grade sex ed class where it made it sound like every time you had sex, you get pregnant. It's nothing like that.
- [05:48]
A
So fast forward to today. What is the average age of a woman having her first child?
- [05:55]
B
So in 1984, it was 19. A woman had her first baby, an average age of 19 in the whole United States.
- [06:02]
A
Wow.
- [06:03]
B
Last year in the whole United States, that number was 30. And I'm not in the United States, I'm in New York City. It's a different beast. Our patients are in their late 30s, and we weren't designed for that. Because you have limited eggs, you're losing them. You have quality of eggs changing as you get older. You have hormones changing because of that. So your body is going through lots of changes. It's very difficult to get pregnant. It's very difficult to stay pregnant. For instance, a 40 year old woman has about a natural pregnancy rate of 2 to 3% per month of getting a baby.
- [06:35]
A
So how do we get optimism in here? Because for the woman that's listening right now that says, listen, I think I still want to have A Baby, I'm 37, 38 years old. What are my options?
- [06:47]
B
So this is where this generation's been left out in the dark. It's the reason we started freezing eggs in 1999. Because we were watching our patients get older and older knowing that they were going to have a harder time getting pregnant. If you're trying to do IVF with eggs that are 40 year old and over, we do very poorly. We do pretty well up to about 41 and then the bottom falls out. So 42 is not the age to be start. Women need to know that. And women need to understand the science. Because if you fail to plan, you plan to fail. Now don't tease me on that. That's a Taylor Swift song. But not about fertility. But it should be about fertility.
- [07:26]
A
I think you deal with women all day long, so it's okay.
- [07:28]
B
Well, my daughter's 18 and 16, so I know all the words. But the thing is, I heard that song. I was like, she's talking about fertility. No, but she is. She's talking about fertility because we're waiting longer. And for women, it's a thing for men, ask al Pacino. He's 82 years old. How's that? Well, men have germ cells. We're making fresh sperm every day for
- [07:47]
A
the rest of their lives, for the
- [07:48]
B
rest of our lives. And women, you start with 7 million eggs. You got a million in your ovary when you're born. You got 300,000 at puberty. Every month, your body selects 500 at random. One gets chosen to be ovulated. You waste 499. So you burn through thousands and thousands of eggs every year. And by the time you're 42, you're pretty much down on eggs and ones that are there are less likely to get you pregnant. So one of the strategies we took was let's get those younger eggs in the freezer. You start your family when you're 30 and have your babies later when you're older. Because that's what's happening when you say
- [08:19]
A
start your families, you're saying freeze your eggs.
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B
Freeze your eggs. Yeah, but you're starting your family because you're taking your 30 year old eggs and you can be like, my 54 year old patient who froze her eggs in 2010, has a 15 month old baby because she did that. She wouldn't have that baby. I have a 51 year old who's, she's 24 weeks pregnant. She froze her eggs in 2012, she had a 15 month old baby and she's now pregnant again because that's how long it took her to finally get around to having her baby. Now, those are outliers, but a lot of my patients are in the 40s having babies. And the reason they're successful is because they froze their eggs when they were younger or they froze embryos because some of these young career women at 30 are saying, Look, I'm on career path, I'm not having a baby anytime soon. Let me put my embryos in the freezer.
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A
So when should you difference between eggs and embryos?
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B
Yes.
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A
Can you explain the difference?
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B
So an egg has mom's DNA. An egg after it's ovulated has only 23 pairs of chromosomes. We all have 46. How is that? Well, you get half from the sperm, 23, half from the egg, 23. And when an egg fertilizes, is fertilized by a sperm, now you have an embryo and then that embryo grows and develops. Most embryos are not healthy and won't make a baby. That's what most people don't understand. And the younger you are, the more likely that embryo is to be healthy. But even young, healthy women, more than half of the embryos they make are chromosomally abnormal, won't make a baby.
- [09:43]
A
So you prefer somebody to freeze their
- [09:45]
B
eggs younger if, if they're gonna, if they're planning to have their babies older? Yes. A young single woman frees, frees her eggs because, you know, she doesn't know what sperm she's going to use.
- [09:56]
A
What, what age should a woman ideally freeze her eggs?
- [09:59]
B
So I'm in a field where I talk to lots and lots of patients. There's words I don't use. Should is a relative term. What really needs to happen is women need to understand the science. Women need to be taught this at a very young age. Women need to have the ability to make decisions about when they're going to have their families and understand the biology and understand what it means to have a clock and wait. And if they don't, then they don't plan and they just expect life to happen. Like Instagram, Everything's perfect. Perfect. It's not.
- [10:32]
A
No, I get it, I get it.
- [10:33]
B
One in six women experience infertility. Now, some of it's male factor related, but all women experience age related decline in fertility. And it starts much sooner than you think. You start to see a change in fertility at 25, because the quality of your eggs and the number of your eggs starts to fall in a measurable way. Now, you don't notice it as a woman. You may not have symptoms, but perimenopause starts around that time. You don't really feel it, you can't measure it. But then as you get into your 30s and into your 40s, you start to notice changes. And it's a long time from going from optimal fertility to menopause. You know, it's like 52 is average age of menopause. So it's like 27 years where you're in a state where your body's changing, your ovaries are changing, your hormones are changing. And some people are very sensitive and feel it. Some people doesn't bother them.
- [11:24]
A
Well, so I don't want to scare people, but you're saying that in your late 20s, you're starting to see a change. Correct. In your hormones.
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B
And it's a normal, healthy change.
- [11:33]
A
Is that perimenopause?
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B
Well, it depends on how you define it. Things are changing because eggs are changing. You're having fewer good quality eggs. So your body will change eventually. We'll call it menopause when you've not had a period for a year. It's a pretty arbitrary definition, but we have to have some way to think about it.
- [11:49]
A
But we usually say 10 years back is when perimenopause starts to have signs. Right?
- [11:55]
B
Approximately in most patients. But it probably happens earlier than that. You just don't feel it. And it's manifest by a changing fertility, a changing chance of getting a good embryo. And that starts in the late 20s, early 30s. Early 30s. It's very modest, very minimal. But around 37, you start to see a real blip at 40, another blip at 42. If your plan is to have a baby at 42 naturally or even with IVF, you're going to fail. It doesn't work very well unless you make plans, unless you take an action.
- [12:29]
A
But I think as I was coming up into, you know, I was on my career path, I wasn't necessarily thinking about it. I went to. I got a divorce at 40 years old. I did go to see a fertility specialist, but now I'm 40 years old and didn't even. I didn't even understand what I was doing. I was like, what are my options? I didn't even know. And this is now 15 years ago. So that was not a conversation I was having with my gynecologist. It wasn't a conversation. I. I didn't even know what I was asking when I went in there. If you were my doctor and I was 30 years old and came into you, would you say you don't use the word should would be a good idea. Tamsyn, freeze your eggs now?
- [13:09]
B
Well, I would say let's do a workup. Let's do Some blood work on you and see if we get a sense of where you are on the curve of your ovaries changing. And then let's have a discussion. Let's talk about what happens. Let's see what happens at this age, this age, this age. And what is your career plan? What is your life plan? And when do you want to have those babies? And if you're going to have them here, you need. You need to think about possible options. You know, in its worst form, what we do for someone who's in their 40s and we can't get them pregnant, we do egg donor. We take a young, healthy egg of somebody else, which is a wonderful option. Those babies are loved. They do great. And for some women who would never have a baby had they not done it, it's. It's incredible. But most people want their own eggs. So that's why we started freezing eggs in 1999. And we did it in. We got really good at it to the point where we're like, okay, this should work, but how do we prove it? Now, I'm a doctor, I have daughters, I've gone through fertility treatment as a doctor, not just as a patient, not just as a doctor. And you think about it, well, how do I do this? Well, scientifically, because we have responsibilities as physicians to be doing things right, proper, optimal. And so we had spent four years and got really good at it. So then we said to a group of women who needed IVF in 2002, where nobody had insurance and a lot of people couldn't do it, and they needed ivf, nothing was. Was working. We said to them, how about this? We're going to pay for your cycle. We'll pay for everything. Drug, anesthesia, whole deal, retrieval, make freezing those eggs, and then three months, four months later, thawing all those eggs to see how good we are. Because we need to know this, because we need to see if this is a viable option, because our patients are getting older and this is going to be the solution. And it was an easy recruit. Most clinical trials, they describe something that patient. Patient looks at. He says, that's fascinating, doctor. Ask her, not me. This one was like, sign me up yesterday. And our oldest baby from that study is in her third year of college, turned 20 in July.
- [15:02]
A
And you follow?
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B
Yeah, she's incredible. She's amazing. And her parents are amazing because this was their only hope. And this was our only baby because they were part of the study. And, you know, she wasn't the optimal age to freeze. The patients in the study were 27 to 37 mean age 34. And what we said to these patients, look, if you did IVF cycle at that age, 50% of you would get a baby from one cycle. We want to figure out how good egg freezing is. So we did it on those patients and 57% of them got a baby. And it was not statistically better, but it was better. And so we realized this could fly, this could be a good thing for a lot of reasons, not just for infertile patients. But what about the woman who gets breast cancer is going to get chemo's or her eggs are going to be ruined by chemo. We could freeze our eggs and do fertility preservation. So that started around 2005. Since then we've been freezing eggs at NYU and we've done it longer and more volume because we're in New York and a lot of people have insurance coverage now, which has dramatically improved it.
- [16:04]
A
Something I talk about constantly on this show is advocating for yourself at the doctor, going in prepared, asking the right questions, finding somebody who actually listens to you. But here's a part I never address enough, which is a step before all of that actually booking the appointment. I changed doctors five times before I found the right ones. And every single time it was the same experience. Call the office, get put on hold, call back, find out they're closed already, find out they don't take your insurance, start over again. I spent more time trying to book appointments than I did actually at appointments. And I'm someone who genuinely prioritizes this stuff. Zocdoc fixes a part that was always broken. This episode is sponsored by zocdoc. Zocdoc lets you search and compare local in network doctors see actual availability and book instantly. They have more than 150,000 providers across 200 specialties in all 50 states. Real reviews from real patients and appointments usually happen within 24 to 72 hours sometimes same day. I chose my doctor based on the profile and reviews and actually showed up feeling like I already knew what I was walking into. And it is completely free to use, which still gets me every time. Your health matters. And taking care of yourself shouldn't be complicated. Find and book the right doctor with Zocdoc. Head to Zocdoc.com Tamsen to get started and check that appointment off your to do list. That's Zocdoc.com Tamsen Can I tell you something embarrassing? I put off eye exams for years. Not because I didn't know I needed one, because the whole process felt like a whole thing. Find a doctor, figure out if they take your insurance, go to the appointment, then go somewhere completely different to get the glasses. I'm a person who talks about taking care of yourself for a living and I was still avoiding this. Warby Parker fixed every single part of what was annoying about it. Eye exam glasses, contacts, sunglasses all in one place. Their stores are clean and modern and feel nothing like the fluorescent light optometrist situation I grew up with. Prescription glasses start at 95 and that already includes anti reflective scratch resistance and UV protective coatings. And they're covered by many major insurance plans and will handle the paperwork for you. Which honestly is the thing that gets me most I picked up a pair recently and I will tell you the quality for the price is genuinely not close. I wear them constantly over 300 stores across the US so there is likely one near you and over 20 million pairs donated to people in need through their Buy a pair give a pair program right now buy one pair of glasses and get 20% off any additional pairs at warbyparker.com Tamson that's 20% off any additional pairs when you purchase one pair at w a r-byparker.com Tamsen if there's a woman listening right now that did not freeze her eggs, what are her options?
- [18:50]
B
So get a consult. Don't start. Don't say I'm going to try for a year and see what happens. Get a consult for several reasons. 1. If you want to have a baby, you want to have a healthy baby. We now have tests. We'll take some blood from you and your partner and see if you have risk of having a baby with a genetic disease. No baby needs to be born today with a genetic illness. We can screen you both, tell you if you have risk. Most people don't, but let's say you both carry cystic fibrosis gene. 25% of your babies are born with a lifelong illness. We can Prevent that with IVF, Tay, Sachs, Canavans, Gaucher's disease. There's 558 genes. Some of them I don't even know the diseases. That's how. But no woman has to. So before you even start trying, women need to be educated about this and know that you can reduce your risk and have a safer pregnancy by doing this test before you start. So get in and talk to your doctor and get the test. It's a blood test. It's simple.
- [19:41]
A
How difficult is it when you said there's changes that start much earlier than we realize how difficult is it when a woman is really maybe in the later part of perimenopause, but still interested in having a baby? Does that make it remarkably difficult?
- [19:56]
B
Yes, because the chance of getting a good egg changes. So here's how I can describe it. A 25 year old woman, that's peak fertility. And that's when you start to see a measurable decline. You will read in the lay press that her chance of a baby each month is 20%. And that's nonsense. It's not.
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A
What is it?
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B
That's the chance of getting a pregnancy, not a baby. It's probably less than that. It's probably 10 to 15 at best. And you can go six months and not be pregnant. You think there's something wrong with you and you're normal. You just didn't get a good egg yet. Because it takes a lot of eggs to find the one that's going to make the baby. And even the ones that are chromosomally normal, only a fraction of those make a baby. And if you think about the way this system was designed, you went through 80 eggs to get your three babies from the time you were 14 to 25. And in the 80s when you were 19, by the time you were 30, you went through 120 eggs. You had your two or three kids. Not that you were trying every month, but that worked out okay. But now you're starting at 37. You have to go through a lot more eggs to find the one good one. You can spend month after month after month going one egg at a time. It doesn't work very well. That's the patient. We get in and say, look, you want a family? Let's talk about how many good embryos you need to do that. You need for every baby. One chromosomally normal, healthy embryo gets you 63% chance. You need three to get 96% chance. So you gotta do IVF and get enough embryos in the freezer that you can build your family. Because you're gonna be older after you have a baby and it's gonna be harder.
- [21:18]
A
So a lot of the people that listen to our show are, you know, in their 30s, 40s, and then others are the parents of, you know, these young people. So what do you want all of them to know right now whether their daughter's 20 years old or 30 years old, so that they're aware when it comes time to have this discussion.
- [21:36]
B
So if you're a single woman and you're in your 30s, go get an evaluation and learn. Learn the science, learn the information that's here, that you can start planning your family even before you know you're ready to have a baby. Because if you don't, you lose opportunity. And, you know, a lot of women show up to me, they're 40 years old, they've never tried, and they're like, I want a family. And I look at them and I say, well, your chance of pregnancy naturally is about 2%, so you're going to try.
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A
It has to be difficult for you
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B
to say, yeah, it's terrible. It's like. And no one told you this, so don't take it personally and don't feel embarrassed like this is a problem. We have not got this message out. Women have to have their families when it, when it works for them, when they can have a success, when they can have the best environment for that child. Because wanted children who are planned for. And we need to make it easy for women because naturally we're all older, our lives have expanded, we're doing things later. And for men, we get away with it. We have germ cells. We don't even understand what the clock is. Women know what it is, but they don't know how to address it because no one teaches them the science. So learn the science.
- [22:41]
A
So you go in there, you ask for labs. Are there certain labs you need to ask for?
- [22:44]
B
We're going to check. Day two of your cycle. There's a marker that tells me your eggs are good and it's FSH and estradiol on day two. If the FSH is under 14, under 10 is better. And if the estrogen is under 100, that says your ovary is functioning well and you have good quality eggs in there. And you can get one to make a baby, that's one thing. But what about the number? There's a test called AMH or anti mullerian hormone, which drops with age. And when it's really low, you have fewer eggs. That means you have fewer opportunities. And those women will have a harder time as they get older, faster than younger women. If you're young and have a low amh, you know you still have a good chance of getting pregnant naturally.
- [23:27]
A
So that would be the first test.
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B
That would be the first test. And then most patients, you give them good news, not all. And the ones you don't, you say, look, what can we do? We can store your eggs now because they're not going to get better as you wait, so at least you can have a chance for later. Or you can use egg donor as a backup. Or if you can't get pregnant when you wait. But let's look at each age. Chances are so just naturally 25 year old fertile women, you know, at the end of a year, they're not all pregnant. Maybe 80% of them are, 20% are not. That's, they're called infertile. It's about one in six women now in the United States are infertile. And like I say, about 40% is male factor. But a lot of times the male factors also have a female factor because of older eggs.
- [24:10]
A
Is there another reason beside age that women are not getting pregnant?
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B
There's endometriosis, there's fibroids, there's ovulation dysfunction. So there's a lot of other things. There's tubal damage from infection. You know, there's a lot of things that can, can contribute. Most people don't have those things.
- [24:27]
A
Yeah. You know, but a lot of women are aware that they have endometriosis now. And that is a big conversation. I feel like it came right before the menopause conversation where women, young women were saying, hey, I do have that. I am aware of that. I.
- [24:40]
B
Well, for years women were ignored. Oh, you have pain. Don't worry, you're fine.
- [24:43]
A
Right? You just have a bad period.
- [24:44]
B
Yeah, yeah. And it's like, no, no, no, something's wrong. If patient's telling you something' patients know. And if you don't listen as a doctor, you're not doing your job and you have to talk to patients. Okay, well, what could this be? What are the possibilities and what are the options that we have? Let's do, let's do an MRI and see if you got something going on in there. Let's, you know, first start with an ultrasound. And then if you're still having pain, then you have to have a surgery to diagnose endometriosis. And people are hesitant to do that now. You have to have surgery. Yeah, the surgery now is so much less invasive. It's a day surgery. It's a laparoscopy. You can find it and then you can treat it. And women should know that if you're struggling with your activities of daily living and you can't get through the few days with your period, you can't even go to work. That's not normal. Then your doctor needs to listen to you and figure it out and help you find a treatment plan for that. And then fertility is part of that discussion. Because endometriosis patients are more likely to be infertile and more likely to need IVF. If you have stage three advanced endometriosis, 75% of those patients will need IVF to get a baby. And if they're older, it's even worse. Wait, so if you have, what, stage four and three or four endometriosis, advanced endometriosis, natural conception, doesn't happen for 75% of patients. 75% will be infertile and need IVF. And IVF works very well for that group of patients, but most don't even know, especially when the eggs are younger. Well, you know, if they get operated on by a reputable surgeon, they're told, the doctors now are really like, people are a lot more on it now than we used to be. Like generalists, surgeons, they know, they say, oh, go talk to a fertility special. You better learn about this. You know, you might have trouble getting pregnant later. I don't want to alarm you, but you shouldn't be planning now.
- [26:23]
A
Pcos. Is that the same situation as endometriosis?
- [26:26]
B
Well, it's different in that those patients have a better prognosis. They just don't ovulate. It's easy to make them ovulate. And if that doesn't work, IVF really works well for that group of patients because they have lots of eggs and you can get lots of eggs. The problem is they don't ovulate an egg most of their cycles, or when they do, it's not an optimal environment for that. That embryo to make a pregnancy. So that's a very treatable thing. And, you know, about 15% of patients will get diagnosed with polycystic ovaries. And I hate that we call it a disease. Disease, Excuse me. It's not really a disease. It's a altered, normal, abnormal way your body approaches hormones, and there are treatments for it. And it's, you know, poor women get this diagnosis, they think there's something wrong with them.
- [27:11]
A
I know.
- [27:12]
B
And there are things that you can do to correct it, you know, pretty easily. If you control diet, you control insulin, you control sugar, and you can do a lot of good things and get them pregnant, you can do that, too. They have a very good fertility rate. It's just some of them need ivf.
- [27:28]
A
Is there anything that a woman can do to have a better chance of conceiving when she's in her 30s or 20s? 30s.
- [27:36]
B
Well, I think nutrition is important. Smoking is the worst thing you can do to your ovaries and eggs. Don't smoke any smoke. You know, alcohol in moderation is probably not a problem. But less is better. And stress is not helpful. Although it's not contraception because if it was, nobody in New York would have a baby.
- [27:57]
A
Yeah, it was stress. Take that off the list.
- [27:59]
B
And you know, alcohol, like instead of pills, we send you to the bar. It's like, no, those things interfere. But you want to be healthy, you want to take good care of yourself, you want to exercise, you want to eat good, nutritious food, you want to get plenty of protein in your diet. And those are the things you can do that help.
- [28:16]
A
I know GLP1s are a whole other conversation that, you know, they just are a whole other conversation. Do they play a part in this in helpful in any way?
- [28:25]
B
Well, for patients with polycystic ovaries, they do, because patients who have PCOS who take GLP1s now they get their hormones in shape and now they start ovulating and they get. That's where this whole thing like, you know, Ozempic babies and, you know, GLP1 babies. It's because now they start ovulating for the anovulators. And a good percentage of those are the patients who have a high BMI or a little bit overweight and who benefit from these drugs. They are miraculous. There's also the anti inflammatory aspect of it, which may have an impact on fertility as well. That's a whole area of research that needs a lot of work and we need a ton of research more in women's health, in women's medicine. In the past, women were ignored. We did everything in men. We had studies that didn't even include women because they had cycles and that would interfere with the studies. It was. We were just behind the eight ball and it needs to all be fixed.
- [29:18]
A
Well, I feel like you're doing a good job of catching us up in a lot of ways.
- [29:21]
B
Well, we are. The fertility field has done a lot, but now what's next? Well, medical centers are starting to realize it. We have a women's center, Mignone women's center, because women realize that you have to dedicate resources to it. So they have. And now there's women focused studies and women focused treatments and we need to do that. It's important.
- [29:45]
A
It's summer now and I don't know about you, but my sleep has already been a whole situation. Long hot nights, lying there wired. All I want to do is drift off. And the thing is, I was doing all the right things. Cool room, no phone. But the thing that's made the biggest difference is what's on my nightstand. Magnesium Summer quietly drains your magnesium every time you sweat. A hot afternoon, a workout, you lose it. And magnesium is exactly what your body needs to recover and relax and get a restful night's sleep. I keep Magnesium Breakthrough by Bioptimizers on my nightstand and it is one of the things I would not go without. What makes it different from the magnesium most people are taking is that it combines multiple bioavailable forms of magnesium in one capsule instead of just the one or two you find in most supplements. So your body actually absorbs and uses it the way it's supposed to. Here's what you get when you go to bioptimizers.com tamsen and use code TAMSEN15% off your entire order. A free travel sized bottle of Masimes Bioptimizer's best selling digestive enzyme added to your automatically when you use our exclusive code. That's a $20 product free on top of your discount. This is a limited time offer and while supplies last, you cannot get this on Amazon. You can't get it in stores. The offer exists in one place. My link, my code. That's it. Buy Optimizers Breakthrough Science results. You can feel my morning walks are one of the things I protect most of my life right now. The problem is summer throws everything off. I'm traveling out of my routine, doing different things, and all the habits I've worked so hard to build start slipping. That's exactly why I love Cachava now has travel packs because the one thing I'm not willing to let slip when I travel is my nutrition. One packet has everything. Protein, fiber, greens, probiotics, electrolytes, vitamins and minerals omegas. All of it in one shake. I can just throw it in my bag and head out the door. No artificial flavors, no colors, no sweeteners, non gmo, no soy, no gluten, no animal products, no preservatives. Just clean nutrition that actually tastes good. My favorite is chocolate mint, which is backed by popular demand. And honestly, I understand why there are eight flavors in all, so there's something for everyone. Summer is a season where routines fall apart. Cachava travel packs are how you make sure yours does not take your daily ritual with you. Go to kachava.com and use code TAMSIN for 15% off your first order. That's Kachava K-A C-H-A-V-A.com, code TAMSIN. Well, let me ask you this question. A woman hearing this? I think a lot of women blame themselves. I think maybe they're not hearing that statistic of, you know, is it one in six times? It's the man's, it's an issue with the men.
- [32:12]
B
One in six infertility is what you see in couples. Okay, 40% is male factor related.
- [32:18]
A
40% is male factor related.
- [32:20]
B
Forty percent male factors also have a female factor too.
- [32:24]
A
What do you want, women?
- [32:25]
B
Fault isn't the right word to use. We gotta change the whole dialogue. Women, it's not your fault. You don't get pregnant. It's nothing you're doing. You were never in control of it in the first place. The problem is, we've told women forever, you've been in control of your life. You will have your baby when you're ready, go out and do all the things you want to do and then just have your family and everything will be perfect. Nonsense. You are never in control of your fertility in the first place. The only thing you're in control of is when you try, if you try with who you try and when you try. And that's it, you're not in control of the outcome. And so women need to lose that right off the bat. Because the biggest question I get asked by my infertile patients is they say, what did I do wrong, doctor? Why is this me? You know, And I'm like, awful. Why do you think it's your fault? Well, I must be doing something. Must be my stress. I should quit my job. It must have been what I did when I was in high school that weekend or that one in college, or, you know, I did this, I did that. They invent ways to blame themselves because you're programmed to think like that loses it. It's wrong. It's biology. It's a biologic system designed 300,000 years ago. And unlike your iPhone, which has had 17 versions in 20 years, women are using a 300,000 year old technology. It hasn't changed. Because evolution, when something works, it's fixed. We're not that different than plants, you know, Sex ed shouldn't be, oh, have sex one time, you'll be pregnant. You ever see a farmer put one seed in the ground, you know, and say, crops come in, I'm good. No, they throw 100 seeds on the ground. And so one learn that because that will take the temperature way down. Because if on top of the disappointment of not being pregnant, you're blaming yourself for something that's not your fault, that's a recipe for disaster. Plus your hormones are going up and down like a yo yo, you're not going to have an easy time with it.
- [34:09]
A
Well, I hope every woman hears that, because I hear so many blame themselves. And that is, you know, that is. That is not helpful. Not okay. And we do have to change that language. There's no question about it at all.
- [34:19]
B
And you need to get educated. You need to learn the science, you need to learn the biology. And if you actually do, you'll feel more optimistic as a woman because you'll see it's just a numbers game. And then how do I play this numbers game to win? And what can I do? I'm 30. Okay, I can just try. But let me go see a doctor and make sure I'm doing everything safe and right.
- [34:39]
A
One final question for you. What do you want? What is next in the fertility space?
- [34:45]
B
Just getting better at what we do, at finding the embryo that's going to make the healthy baby and being more efficient at it. How do we find the egg that makes the baby? And there are less invasive ways that we can do that so that we can assure a good outcome and be able to help women have babies when they're ready, when it works for them, because they're having them older.
- [35:06]
A
Is there anything men should know about
- [35:08]
B
this transition in medical school? Yes, maybe a little, but it's totally underrepresented, not talked about. And let me tell you a story, because this will be interesting and especially in media. So a year 2000, I was part of the Society for Assisted Reproductive Technologists. We were a group of fertility specialists trying to help the narrative. So we're smart. And there were mostly guys at that time. Now my division, there's 11 women and three guys. Women are in this field, and they should be, but back then. So we wanted to get the message out that age matters. And so we, with our own money, put a national campaign on. And we said, look, pay attention. As you get older, your fertility declines. And we did this national campaign. One day into it, we were called out by the National Organization for Women, saying, we're trying to scare women. We're trying to get them to come to see us. And all we were trying to do is educate them about something they didn't know. So we shut that down, really, in a hurry. Facts are facts. Science is science. Learn it, understand it.
- [36:15]
A
Do you think people want to hear it now?
- [36:17]
B
No one wants to hear that, oh, I'm going to have a harder time getting pregnant. But every woman knows that instinctually, they don't understand it. If you understand it, you're going to feel a lot better about it than it's just this black box floating over your head that you worry about left and right and you can do nothing about it. That's one of the things about egg freezing. Women who freeze their eggs, they feel like, okay, I did something and I
- [36:38]
A
have a backup plan.
- [36:40]
B
It's a very positive experience. They're going through egg retrievals like an IVF patient is. Their attitude is so different than an IVF patient who's had a miscarriage, who's failed, and they're on their last legs and they're afraid it's not going to work. The egg freezer is like, wow, I'm starting my family now. This is cool. I'm doing something about that thing I've been worrying about for five years, because they usually worry about it for three years before they come see me and two years before they freeze their eggs.
- [37:01]
A
What's a change of accessibility now to be able to do this? Insurance of companies or one of the
- [37:07]
B
things that's really happened. This is great because women are in the boardroom now, so they're making decisions. And in year 2000, they were the executives and they were the ones at 40 going through five IVF cycles to get a baby, maybe did egg donor. And now they're in the boardroom thinking, I want to attract top talent women. Because women are in the workforce and they should be. And there's a lot of great women doing a lot of great things and they should be in the workforce, but they shouldn't sacrifice their family. Same with our residents. They shouldn't sacrifice their family. So our residents either freeze their eggs or they have their babies. Our fellows, we make it easy for them to have their babies while they're training with us because if that's what they want to do at the time, because that's their optimal time, we have to be more family friendly, we have to be more family centric. We have to be more supportive of
- [37:50]
A
women because, face it, and men need to hear that.
- [37:52]
B
Yeah, men need to hear it. We don't get a vote in this. Women decide when a baby happens, if a baby happens, and with who a baby happens. And so why don't we just say, okay, that's the fact and end of story. And now help be able to have the right environment so they can have the best outcome for their life and their family. Because if they have a good outcome with their life and their family and their babies, then we all benefit. And I agree. It really is the message. Now, having done that, I've been In this field 40 years I've been a patient who's gone through it, so I know what it's like to fail because it failed and eventually succeeded in other ways. But, you know, we need to talk about this. Women need to know about it. It's not to scare you. It's to help you. It's to help you plan. Because if you have a plan, you're going to be better off. If you fail to plan, you're planning to fail. That's not what you want to be doing.
- [38:42]
A
There's no question. Dr. Jamie, thank you so much.
- [38:45]
B
Oh, it's my privilege.
- [38:46]
A
I really appreciate it.
- [38:47]
B
I'm really big advocate for women's health. And we need to figure out this hormone stuff. We need to figure out estrogen replacement for women because estrogen is important and the Women's Health Initiative just didn't get it right. And this generation of women has really suffered for it.
- [39:00]
A
Yeah, we a lot about perimenopause and menopause. I know there's this overlap of women trying to get pregnant during, you know, perimenopause. It's difficult. And yet there's no question we talk a lot about estrogen and estrogen replacement. And hopefully with some of the recent changes we've seen, we're gonna see, you know, see women being aware of it.
- [39:18]
B
We need more research, we need more women. Friendly stuff. And we need to just.
- [39:23]
A
And less noise. I think there's a lot of confusion.
- [39:25]
B
Yeah, we need to start. Start doing it. Our species are our patients, our women, our mothers, our sisters depend on it. We need to get our act together. So let's talk about hormones. As you get older, you don't just stop making estrogen one day. It's a gradual, slow change because your ovaries are changing, because the number of eggs there are changing, and the amount of hormones that the ovaries make because your ovary makes your estrogen progesterone, and probably a zillion other things we haven't even discovered yet. And your wellbeing is attached to your estrogen. There's a reason you feel so bad when you have your period. Your estrogen's low. It's tanked.
- [39:58]
A
Well, that's why. Trust me, I know. I can tell you firsthand. But so what is the overlap of the symptoms between that perimenopause time and postpartum? Because those crossover like this.
- [40:10]
B
I would imagine if you're breastfeeding, your estrogen level is very low. So postpartum depression is a big problem. That's not talked about. Needs to be aggressively dealt with, with. And no one wants to hear from a woman who just had a baby that they're unhappy. And it's not. There's not. They're not unhappy. They're just estrogen deficient. They feel terrible, they need treatment, and someone needs to recognize it and listen to them. And hormones in one way, antidepressants another way, that's a really, really bad thing. But a lot of women are walking around being treated for hormone changes. That's why so many women are on antidepressants. That's why so many women are on stimulants and then need sleep medicine. And you're on all these things that are really bad for you. And it's really that your hormones are not optimized and the symptoms are brain fog. I mean, every woman knows. When you say that every woman knows what that is, guys do, too. We just don't think about it. We're not smart enough. But your vagina gets dry. You have pain with intercourse. You don't feel like having intercourse because your testosterone is low.
- [41:12]
A
And that can be a crossover of both of those things. Is that right?
- [41:14]
B
Well, post delivery, that's kind of protective because you don't want to get pregnant again. You just have a baby, right? So mother nature gives you a natural kind of one. You don't ovulate because you're breastfeeding. Your prolactin levels are high. You don't. You don't ovulate, and you know your estrogen's low. You're not. You're not feeling comfortable having sex, so you don't get pregnant. But, you know, during the 30s to the 40s, these subtle things are happening, and a lot of the symptoms that women have are being ignored. Oh, you're just complaining and like, no, you're not. You're feeling everything you feel. You don't make that up. No one wants to be miserable. It's not like you go, you say, well, I'm going to make this up and get some sympathy. No, you don't want to feel this way. You want to feel great. And so some of that is hormones that can be treated, it can be managed, and it has to be intertwined with your fertility plan. Some women need to be on some forms of estrogen hormone replacement during the time between babies just to feel better if their ovarian reserve has changed so much and they're in the perimenopause and are more symptomatic because perimenopause is not a place place It's a spectrum. You go from optimal to estrogen deficient menopause. And there's this whole spectrum of symptoms that get ignored because no one wants to hear it and no one wants to do anything about it. Well, women need to be heard and need to be treated. And in fact, I think a lot of women's healthcare is they're treating this unbeknownst. I mean, the extreme of that. Phil Sorrell, who, he's a psychiatrist who went into reproductive endocrine as a hormone replacement. He trained me. I was a fellow at Yale. And 1988, he was a psychiatrist who in the wards started giving women who had all these psychiatric diagnosis estrogen replacement, natural estrogen, 17 beta estradiol, natural progesterone. And all of a sudden they were no longer bipolar or schizophrenic or whatever. And their families were like, how did you do this? And he said, you know what? I'm in the wrong field. I need to go over here. And he started training us in hormone replacement. And then the WHI hit and then Estrin got a bad name.
- [43:17]
A
And that is a 2002 study that we talk about a lot.
- [43:19]
B
Yeah, yeah. And it's really put a dent in how we manage women and it's really hurt the field, and we need to fix that.
- [43:28]
A
I hope we're changing it. We're talking about it every day.
- [43:30]
B
Well, what's happening is there's women out there talking about it and they're trained and they've gone through it, they've experienced it personally, but they're physicians. They're in this arena. And it's going to change and it's going to get better. You know, removal of black box warnings was a. Was a good thing because women need estrogen. And you're going to live half your life with no estrogen. You need estrogen. There's a reason a woman breaks her hip and is dead within a year. We can't have that. There's a woman, a reason a woman gets UTIs. And that even happens at perimenopause because you don't have enough estrogen protecting your bladder. So we need to get there. And a lot of science has to be done, a lot of good studies, and it's a really hard thing to do in the United States today with.
- [44:13]
A
That's a finite amount of time.
- [44:14]
B
Yeah, that too.
- [44:15]
A
Thank you.
- [44:16]
B
One other thing I want to say, and it's more about optimism.
- [44:21]
A
Yeah.
- [44:22]
B
Because I think everything's so negative that women react to that. And I think what Women need to understand that if you understand the science behind and the biology of how you get a baby, that if you understand it, you will be more optimistic than you think. Even though you're a little older and even though you know what's happening and you'll see what the path to success is and you can participate in that. And if you can, you'll have a much better fertile journey. You got to be active. No one's going to hand it to you as a woman. You owe it to yourself and your future babies to learn this and use it wisely and make good decisions. Because that's your power.
- [45:02]
A
Thank you, Dr. Grifo. Thank you so much for being here. If you are listening and something in this conversation resonated, I would love to hear about it. If you haven't left a review yet, please take a moment wherever you're listening. It truly helps the podcast grow and I read all your comments. You can find more information about Dr. Griffo and his work at NYU Langone in the show Notes and I will see you in the next episode. Insurance isn't one size fits all. That's why customers have enjoyed Progressive's Name your Price Tool for years now. With the Name youe Price Tool, you tell them what you want to pay and they'll show you options that fit your budget. So whether you're picking out your first policy or just looking for something that works better for you and your family, they make it easy to see your options. Visit progressive.com, find a rate that works for you with a Name youe Price Tool Progressive Casualty Insurance Company and affiliates Price and Coverage Match limited By state
- [45:53]
B
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