← This Is Woman's Work with Nicole Kalil
This Is Woman's Work with Nicole Kalil
Fertility Myths, IVF & the Pressure Women Carry with Dr. Lucky Sekhon | 415
00:34:33
Dr. Lucky Sekhon joins Nicole Kalil for a no-BS conversation about fertility, IVF, egg freezing, infertility, and the myths women have been sold about their biological clocks. This episode breaks down the science behind reproductive health, fertility treatments, lifestyle factors, and social media misinformation — while reminding women that fertility is not a measure of worth.
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If you love the show, the best way to keep it going is simple.
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Share it, rate it, and support the
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sponsors who support us. I am Nicole Kahlil and you're listening to the this is Woman's Work podcast. We're together. We're redefining what it means, what it looks and feels like to be doing woman's work in the world today. And part of that redefinition is finally getting honest about our fertility Specifically the noise that tells us that there is an ideal sequence, you know, education, career, partnership, skin care, success, babies, and then bliss. Or that we're running out of time. As if fertility is a predictable performance metric instead of a complex human experience. We've been flooded with messaging about having it all. And when it comes to procreating, a
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lot of how to, when to, if
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to, while also being given wildly incomplete, often misleading information about how our bodies actually work. We're either told you have plenty of time or you waited too long, sometimes in the same breath. Which is, and I'm being kind here, not helpful. The story we've been fed and sold is that fertility is straightforward, predictable and obviously a woman's responsibility to manage, or worse, a reflection of her worth, her discipline or her life choices. That if it doesn't happen easily, you must have done something wrong, you didn't do enough, or you did too much. Regardless, clearly there's something wrong with you, which is absolute bullshit. Let's be clear that framing is not just outdated, it's damaging. Our bodies are not machines with guaranteed outputs and fertility is not a personal failure. It's biology, it's probability, it's science. And yes, sometimes it's incredibly frustrating, confusing and unfair. Because of all of that mixed and false messaging. Today we're going to get informed so you can understand your body, your options and what's actually backed by science, not TikTok trends or wellness marketing. When it comes to your fertility, ultimately this is about agency, which is absolutely woman's work. Whether you want to get pregnant right now, someday or never, you deserve clarity without judgment and support without nonsense. Which is exactly why we're having this conversation. Dr. Lucky Cecan is a double board certified reproductive endocrinologist who has helped thousands of individuals and couples navigate fertility with medical expertise, cutting edge science and a healthy dose of compassion. She's the author of the instant national bestseller the Lucky Egg where she breaks down everything from egg freezing to IVF with clarity and honesty. So lucky, thank you for being our guest and I feel like the best place for us to start is to ask you to share some of the biggest myths that the outdated information that women are still being told about our fertility, how to procreate.
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C
Yeah, I think that's a perfect place to start because I think myths and misconceptions are so damaging in so many different ways and they have led to a lot of the needless self blame and shame around this subject when in reality one in six couples or individuals are going to face infertility and this is more common than we are acknowledging as a society. I think the biggest myth is this idea that there's a fertility cliff, and it leads to much anxiety about turning 35. People think, oh my gosh, all my eggs are going to turn bad. Or, you know, I can see my opportunity to become a mom slipping away because I just haven't found the right partner. And I'm here to tell you that the reality is more people than ever are building their families at later ages than their mom's generation and their grandmother's generation. This is a very real shift that has happened, and science, thankfully, has helped us to fill in the gaps. But evolution takes a ton of time, and we as a society have evolved socially, but biologically, our biological clock is what it is. And there's been a lot of really interesting data showing that the average age of having your first child has markedly increased. The live birth rate has dropped in our teens, which is a good thing, right? Means it speaks to the power of contraception and education. But in our 20s and 30s, there's been a drop in birth rate, but a market uptick in late 30s, and even particularly our 40s. And a lot of this is because it's taking longer for us to feel financially stable and ready. Some of it's the societal expectations shifting more openness to this idea that not everyone has to have a family by a certain age or get married and settle down by a certain age. I think these are all positive things. But the problem is, is that the last time a lot of people talked or thought about their fertility was health class in grade school. And then you're kind of let out into the world in your 20s and 30s, and there's no formalized education or training to really be able to make informed decisions and be strategic. And so you're kind of counting on the randomness of your friend group or your OB GYN or someone informing you appropriately so that you can make decisions and not feel blindsided later down the line. But, um, but fertility is not a cliff. It's a continuum. You know, and. And you can still ovulate healthy eggs even when you're 38, even when you're in your 40s, even when you're in your mid-40s. But is it something that we want to count on? Do we want to just say, like, let's just hope we get lucky and ovulate the right egg? No, we want to be proactive. And so that's why we say it's important to understand human reproduction. Is inefficient. I think that's another big myth is like, well, my friend said she got pregnant on the first try. It feels like everyone around me is getting pregnant easily because no one, I mean, usually has that experience. I think the people that are getting pregnant easily and having, you know, a really smooth path are usually the ones shouting it from the rooftop. But in reality, Even in our 20s, it could be a 20% chance with each ovulation that you might get pregnant. And so it's very normal. And we do need to normalize this idea of trying over and over and hopefully persistence paying off. But you have to know when to call it and when to seek out expert help for testing and potentially treatment. And. And under 35, that means don't wait longer than a year. And if you're 35 and older, don't wait longer than six months. And if you're in your 40s, this might sound really alarmist, but I don't think it is. I think it's appropriate and proactive. Don't wait longer than three months.
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Okay, so those are some good guidelines. And I want to get into the. Assuming we want to get pregnant, what do we do? Because you made an interesting point there. We are often most educated about our fertility when we have no interest in getting pregnant.
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C
Exactly.
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Like in our teens. And then when it comes time where we do want to, we're not exposed to a lot of great information. And I. I mean, I got pregnant at 36, and I remember being referred to as a geriatric pregnancy. And I looked at my doctor, and I'm like, do not ever use that term with me again. Put it in your notes.
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C
Yeah. I trained in New York, where it's. I think regionally there's differences in, like, what the norms are. But I never used that term when I was delivering babies on the labor floor. I would say we would say advanced maternal age, which also isn't great. But there's, you know, a different way of saying it than geriatric. I've just never heard that anywhere other than the movies. But I'm hearing it from people like you that say that they experience that term.
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B
Assuming we are looking for education and information when we're trying to get pregnant, I think there is a lot of advice online and on social media, and like you said, we talk to a friend or the people around us. What's dangerous about that and what are they getting wrong?
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C
Yeah, I mean, the danger is, is a lot of time people opining on women's health are not experts. They're far from it. I always say, like, I think the world would be a safer place if less people had podcast microphones. And that's not a dig at you?
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No, I, that's why I bring on the experts.
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I almost never do solo episodes because it's like I have a very narrow expertise. I've already covered that. Like, we're going to bring in the people who know what they're talking about,
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but it's like there' a responsibility for anyone that has a platform to make sure they're vetting who they're bringing on and lending their platform to. And I think a lot of people without credentials who've never sat across from another person or treated them for their infertility are out there giving advice freely and speaking with confidence in a way that's very dangerous. And you know, most of the people that are misinforming on social media are trying to sell you something. There's always a link in bio, you know, as a follow up. I think supplements are peddled to so many and it's really preying on their desperation and their fear and making them feel like, hey, there is something that you could be doing and if you're not doing it, you're not going to pony up the money for these expensive supplements. Well, then it's on you if this doesn't work out. Right. And so there's this very toxic mentality in the world of fertility medicine. And you see it in all of the self help books. You see it in a lot of the things that the wellness gurus are spouting online where they, I think initially the person who's consuming this information thinks they're getting what they want, which is it is easier mentally to feel like you're being handed a checklist. And if you do all these things right, then your journey will like be more likely to succeed. But I think when we lean into that magical thinking of, well, take these, you know, 20 supplements and this cleanse and detox and all these teas and tinctures and everything will be fine, you'll reverse your biological clock. And it's also sending this very negative message, which is not true, that the reason you're in this predicament in the first place, the reason you're experiencing infertility or you've had losses, is because you didn't have this information and you didn't do the right thing. So shame on you. And I think that's where a lot of the shame and blame comes from. And it makes people Feel really anxious. It robs them of their joy. They feel like they have to live in a bubble. They have to be afraid of everything that they touch. I mean, there's one fertility book that's been around now for decades and it's probably been the number one resource that my patients have come in and said, oh, I'm reading this, what do you think of it? And I've read it cover to cover many times. I've done like book reports on my blog. So if you want to check it out, you can on my website. But the truth of the matter is it's written by a non expert who happened to do like two to three rounds of ivf. And it has crazy advice. Like, it's like don't touch receipts because they're coated in plastics or toxic chemicals. And it's like you can't live in a bubble, you know, and like, it's just, um. There's a never ending list of examples that I could give you. But I think the biggest danger, even talking to non expert friends who are well meaning is there's a lot of anecdotes and that's not science. Right. And, and a lot of times if someone's going through a difficult journey of one cycle after the next and they haven't gotten there and every time they're adding in a supplement or trying a different program and now all of a sudden it worked, they attribute that better outcome to that one intervention and I don't think that that's accurate. And it leads to a lot of magical thinking and people buying things that they don't need.
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B
Yeah. And recency bias and all that. And I think we can understand the inclination when we're afraid or when something isn't going the way we want it to, we sort of seek out getting some sort of semblance of control back.
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C
Right.
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And I think that's the feeling that you get when you follow the step by steps and you buy all the supplements. You know, whether it works or not, it feels like we have something to do. And you pointed out that these people have no training. I would also reinforce they also have no liability, which makes it a lot easier for them to say whatever the hell they want to say.
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C
Exactly.
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When you're a medical expert, you have frameworks and rules and things that you need to follow, which I think is important when it comes to something as important as our health.
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Yeah, absolutely. I mean, I'm putting my medical license on the line. Anytime I'm giving advice or, you know, I'm treating A patient. And that's the infuriating thing about a lot of these people that are spreading misinformation is that good luck finding them and, and having them explain to you why you had an adverse outcome. You know, you're not going to be able to track them down and they're gone with your money. And I know that sounds really cynical, but it's really sad. Some of the things I see another huge red flag. I see a lot of like fertility coaches online and it's like, you know, I'm going to charge you thousands of dollars to have a conversation with me, a non expert. And it's really just a big scam. And there's a lot of people preying on the desperation and the, you know, devastation of women who are going through this really lonely, isolating experience. And they're looking for answers. And I think the onus is also on the doctors too. Right. We have to ask ourselves, and I'm continually asking myself this, how can we as physicians, how can we as clinics better support our patients so that they're not, you know, kind of running into the arms of other people that can't be trusted and who aren't actually equipped to help them? There's a lot we could be doing better,
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yeah, I do think it's almost a sort of perfect storm because it feels a lot as a woman when I go to my doctors or, you know, some being dismissed or feeling like a symptom isn't that
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big of a deal.
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I often talk about my perimenopause journey where like I had to really advocate research. I got a lot of the, oh, that's just part of the deal. It's just part of aging, you know. And so I guess my question is what do we need to know about fertility? What's Most important? Basic 101 education that we need to have so that we can build off of it without getting distracted by all the noise?
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C
Yeah, I think the answer is somewhere in between the two extremes. Right? There's the two extremes of being too complacent and too laid back and saying human reproduction is inefficient. Just keep trying. I see a lot of 20 something year olds who are experiencing infertility feeling dismissed and feeling like they're told, oh, don't worry, you're young because there is this bias towards like it's going to happen for you. But if it hasn't happened in two years, I mean the guidelines say you should be doing something proactive and looking for answers as to why it hasn't happened. So I think there's a lot of kicking the can down the road for some groups and and then there's also over alarmist advice where people will be told, oh, you have a low egg count, you're going to definitely have problems getting pregnant. It's like, well no, because we're all on a level playing field. We're all ovulating only one egg each cycle. So if you have a regular cycle and you're ovulating one egg per cycle, whether you have a lot of eggs stocked up or a lower number isn't really the defining factor that's going to predict whether you run into Trouble or not. And so I've heard crazy things like young patients in their, you know, late 20s, early 30s, who have been told even by some experts, believe it or not, you're going to need donor egg because your AMH level, which is a marker of ovarian reserve or the number of eggs you have, is just so low. And it's like, I don't. I question that person's actual expertise and knowledge because that's just not a known predictor of being able to get pregnant when it comes to ovulating that one egg each month. So, you know, I think that the truth is somewhere in between those types of extreme ways of thinking. And it's all about the balance. Not panicking too soon. Like not panicking at all, I should say, but not freaking out and intervening too soon. Understanding that this takes time and persistence. But following kind of that logic of, okay, the younger you are, maybe the more time you have to play around with a very inefficient process, and the older you are, the less time you have. And so you want to just be really mindful of that. I think it's important to maybe define for listeners what is the biological clock and what are the concerns. It's not as much the number of eggs. The only reason I care about the fact that the number of eggs over time is declining, and it tends to decline very slowly in your 20s and early 30s and then speeds up as you get towards your mid to late 30s and especially in your 40s. That matters because one of the most effective, efficient treatment options, ivf, the first part of it is relying on my ability to get to an adequate number of eggs. The more eggs I have to work with, the more tools in my toolkit, the better the chance treatment. And so as you get older, it can be harder to be successful with IVF because you're limited to fewer eggs. But what really matters for your fertility is the ability to ovulate a healthy egg. And that's your egg quality. And so just understanding when it's time to seek help, I think is the biggest thing. Understanding what day to day behaviors and habits can actually optimize your fertility and not focusing on the really weird, random pieces of advice like avoid receipts and like, don't touch anything, be in a bubble. I think there's so much emphasis on like, microplastics and toxins. And yes, I think it's important that we focus on all of those things. But how about the really obvious things that are in front of us, right? Insulin resistance, obesity, you know, endometriosis, just the very simple bread and butter things that can be picked up on a basic fertility workup. Oftentimes, I think people really zoom in to, like, the sexy topics of, you know, things that we know could have an effect on our health, but very indirectly. And I think people don't focus on the fundamentals or the basics. And so I always get asked this, especially when I'm doing media interviews, why is infertility becoming so much more common? Like, what is it in our diet? What are we doing? And I think, yes, there are things that have shifted in, you know, our environment, but I also think our, it's our way of life. Like, you know, even me as a doctor, like I'm sitting at a desk the majority of the day. I'm so sedentary, unless I make an active effort to be active and go for a walk or go work out. I think we live more sedentary lives than ever. I think we're in this digital age where even when we're at home or we're opening up our laptop or on our emails, we're not exercising enough. In most cases, I think the diet has become ultra high processed foods and that's become more convenient. Right. And I think, you know, drinking, smoking, like it sounds very boring. And it's, it's true. It's like the most valuable health advice when it comes to the behaviors and lifestyle factors that can actually impact our fertility is the non sexy advice. But it's anything that's better for your heart health is better for your fertility. So that's how I recommend, you know, people drown out the noise is focus on the basics. Focus on like the big picture. Um, I think all too often the things that make the, for the salacious sound bite or the clickbait that you see online, it's never going to be, you know, the, the basics that you really need to focus on. It's going to kind of veer you off into a different path and just make you feel more anxious than when you began looking for the information in the first place.
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B
Yeah, I feel like the sexier it is and the more it involves a promo code, the more it's a red flag, Right, Exactly. And you gave us some of these important basics. So this is going to sound maybe like a continuation of that question. But for those people who want to find that appropriate in between, they're not complacent. They're also not putting themselves in a bubble. What are some of the things to focus on? You mentioned movement. You mentioned not being behind a screen all the time. Basic nutrition. Don't eat processed, ultra processed foods. What are your thoughts on things like supplements? Is there any supplement that is helpful? Acupuncture, cycle syncing? These are kind of more common things that I'm hearing about that seem like they could be helpful, but I'm just not sure.
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C
Yeah, just to clarify, because I can give you more granular detail, right. I don't want to give people just really general advice and kind of hand wave. The best diet for fertility that has been studied, and this is a really hard thing to study in isolation, right, because the people eating the salads and the whole foods are probably the people that also aren't smoking. So it's hard to isolate out one behavior when you're looking at biostatistics. But in general, the best diet for heart health is also considered the best diet for fertility. And it's, it's, it's delicious. It's eating the rainbow, right? It's like having healthy sources of lean protein, healthy sources of fat. So you're thinking, you know, avocado, nuts, seeds, a variety. You want variety in vegetables and fruits. And you want to really try to get most of your nutrition from whole foods rather than processed foods. When it comes to exercise. 150 minutes Ideal of cardio per week. So breaking that up, that could be like a brisk walk that you take for 30 minutes. You know, Monday to Friday doesn't have to be anything so intense, but just really moving your body and getting a cardiovascular workout. But also resistance training, adding some sessions of resistance training throughout the week. And again, make it practical. Like sometimes I'm doing squats in my office between calls. You know, you got to do what you can when you can. Resistance training is important because it builds muscle, and muscle can actually help your body respond to insulin more effectively. Insulin is a hormone that helps you store blood sugars effectively. And a lot of us have a little bit of trouble getting ourselves to listen to that insulin. And so we end up having a system where your body overproduces insulin. And a lot of people don't understand the link between that and fertility. But there's actually two major links. One is insulin actually acts like a growth factor on your ovaries and can make your ovaries overproduce in an unhealthy way. Testosterone. And that creates an environment around the maturing eggs. When your brain is sending signals to your ovary to get you to mature and ovulate an egg, it makes that egg more prone to Errors. So it can lead to, you know, worse egg quality than what we would have assumed or expected for your age. There can be a link to things like miscarriage. And this is not something that's a moral failing. It's not like, oh, you had too many candy bars, so you have insulin resistance.
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B
No.
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C
There are people that are doing everything right, but it's just genetically and metabolically how their body is wired. There are certain ethnicities, like, I'm South Asian, I'm Indian, My whole family history is like type 2 diabetes, hypertension. It's like, there's a metabolic syndrome there. And so I work extra hard. You know, I'm someone that takes metformin. That's a medication. On top of trying to lead a healthy lifestyle, sometimes you need the help of medications. And so there's ways to test for this in blood work. There's also clinical clues that I'm always listening for when I'm talking to my patients. But insulin resistance is a bigger problem than most people realize, and it's massively underdiagnosed. And I do think it's important for people to understand how diet and exercise can help with it, but it may not be the only fix. And sometimes you do need medications. I'm seeing a lot of patients who are benefiting from GLP1 agonists because it's just a way to kind of rewire their brain and their body, and it can help them to become more sensitive to insulin. Insulin resistance can also create an overall environment that's more inflammatory, and so it can lead to a lower probability of an embryo implanting successfully as well. So really something to focus on through diet, exercise, sleep. We don't talk about sleep, but that's something that falls to the bottom of our priority list all too often in a world where you're trying to just, you know, achieve all the time. And there can be irregular ovulation issues. Overall, it can affect your general health in a way that's not great for your fertility indirectly. Really trying to aim for at least seven hours a night, never smoking is just never going to be good for your fertility or general health. And alcohol intake should really be minimized. Less than four drinks in a given week, those are like, the big things to focus on. Supplements. Supplements. There's very poor data, I always say, like the chapter that I wrote on supplements in my book, and I created a whole table because I was like, how do you even approach the massive amounts of information and poorly designed studies? So I created a table where I basically listed out and Brainstormed here are all the supplements that are touted to have benefits for male and female fertility. Let me state what the supplement is. What is the typical dosage that's been studied and that is often recommended to take? What are the side effects? What are the adverse outcomes that we know about from the studies and what do the studies actually show and what's the quality of the data? And I kind of served it up on a platter so that the reader can then make an informed decision and maybe walk away from reading that very simplified table and say, you know what? Seems like I probably don't need all 20 of these, but maybe because of my PCOS, like, maybe I'll try the Inositol because there's some fair evidence that it can weakly in a, in a weak way, help you be more sensitive to insulin. And it's not really associated with that many adverse or major side effects. Right. So you can kind of weigh, I would say the best supplement that's been studied for fertility that I usually do recommend my patients take, because I think it can potentially help and it's unlikely to be harmful, is Coenzyme Q10. CoQ10 is a potent antioxidant. It also is thought to better support mitochondrial health and mitochondria, the powerhouse of the cell, remember from high school biology, is how our eggs and sperm get energy. You know, 600 milligrams a day is what's been studied. Again, it's not a magic bullet. And I think when, if I had a pie chart that showed the relative contribution that people think supplements have to overall outcomes and what the data actually shows, it would be a stark contrast. Acupuncture, it's not going to be harmful. I've gone to acupuncture as an Eastern medicine doctor. It's very relaxing. Maybe there's a placebo effect. You know, it's been around for a long time. The thought process is that it may help to improve blood flow to our reproductive organs. I've had some patients that anecdotally seem to have done better or had a better response. But I've also had patients where they've done all the things, including the acupuncture, and it didn't make a difference. And studies haven't shown yet that it actually moves the needle when it comes to live birth rates increasing. But I think there's no harm. And if you enjoy it and find it relaxing and it's an excuse to take a nap in a nice, quiet, dark room when no one bothers you for 30 minutes. Go for it.
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B
Love that. Okay. I cannot let you go without asking this question. Why is infertility still treated like it's a woman's issue and only a woman's issue, when we know that that's not the full picture? It takes two to cradle Django.
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C
Yeah.
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B
So what are your thoughts on that?
- [31:08]
C
Yeah, I mean, so many. You know, I think I see a wide range of attitudes towards this. Let's say I have met many wonderful couples where the partner is just so amazing and it's like, what can I be doing better? And. And then you also have the other end of the extreme where it's like, well, I don't need to get tested because this is likely her problem. Right. I'm seeing less and less of that. I think that we are doing a good job of raising awareness. I did a fertility talk at a big company yesterday and a lot of men came to the talk and I was like, wow. So I think things are changing. But the truth is, it's still shocking to many people that 50% of couples with infertility will have a male factor. I'm not saying it's just the male, but there could be a combination of things on both the male and female side. But people are shocked to hear that. And I'm like, I don't get why that's shocking. Because it really is an egg and a sperm. Right. They should share 50, 50 in the responsibility of creating a healthy pregnancy. But I think there is a bias against women when it comes to assuming the responsibility. The majority of the responsibility, one is we don't make new eggs ever. We're born with all the eggs we're ever going to have. We don't make new eggs or repair our eggs. So automatically there's this assumption that, oh, my gosh, it's age related. It's like the egg problem, the female biological clock. Men are always making new sperm. Every 74 days, new sperm cells regenerate. And so it feels like they're invincible. And we all know the Hugh Hefner types, like people in their 70s and 80s who have fathered children. Right. I don't even know if he had children, but I know that there's this, like, trope of the silver haired fox with a younger woman. And it's like, it can't be a man's problem. Right. Men are invincible when it comes to aging. And that's not true. Men have a biological clock. And there's a lot of things that can go wrong with sperm production. And the thing to know about that is that because there's an opportunity to always make new sperm, they should be super focused on what can I do to be healthier? Because there's an opportunity to make things better. And I think there's on both sides an opportunity to optimize your health and show up and bring your A game. But I, I do think that more couples need to be coming to the table together and I think that we need to be continuing to shout this from the rooftops because it really is not just about having enough sperm, having sperm that can swim in a forward direction. There's also something called DNA fragmentation. And we know that things like smoking, excessive drinking, sedentary lifestyle can play a role in all of that. And the sperm plays a huge role in getting an embryo to grow to the stage that it needs to get to. And we see a lot of improvement when we make certain interventions happen on the male side in overall treatment outcomes. And so that's a really important point. And I'm glad you brought it up.
- [33:51]
B
It felt necessary because again, I think we often take the lion's share of the shame and the blame and the pressure and all of that. So for the listener, if you are looking for a medically science backed, data driven information about fertility, go get your hands on this book. It's called the Lucky Egg. It's available wherever you buy books. But let's keep our local bookstores in business and you can find more about Dr. Lucky on Instagram theluckyegg.com We're gonna put all the ways to find and follow her in show notes. Dr. Lucky, thank you for doing this work, for being here today, and for supporting us in our fertility journeys.
- [34:33]
C
I appreciate this conversation so much. You know, we need to get this information out to more people, so I do hope that they find the book helpful and I hope we can have another conversation soon.
- [34:45]
B
I would love that very much. All right, friend. If this conversation did anything, I hope it replaced some of the fear, pressure, and frankly, the complete crap that's out there. I hope it replaced it with clarity. Because life is never about doing everything right or perfectly timed. It's about understanding what's real, what's possible, and what's actually in your control. Your body is not a problem to solve or a timeline to be, and your fertility, whatever that looks like for you, will never be a measure of your worth. So get informed, ask all of your questions, advocate for yourself, and choose what's true and real and right for you, because that will always be woman's Work.
- [35:33]
D
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E
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C
Some follow the noise. Bloomberg follows the money. Whether it's the funds fueling AI or crypto's trillion dollar swings, there's a money side to every story. Get the money side of the story.
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D
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C
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B
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