Episode Description:

Join host Georgie Kovacs in this poignant episode of Fempower Health, as she shares her personal infertility journey during National Infertility Awareness Week. Georgie recounts her four-year quest to conceive, which involved navigating numerous healthcare systems, enduring misdiagnoses, and undergoing various fertility treatments until she finally became a mother. Alongside her compelling narrative, she answers frequently asked questions about infertility, and explores cutting-edge advancements in women's health and fertility. This episode offers a unique blend of personal experiences and professional insights, aimed at empowering listeners to advocate for effective fertility care.

Key Takeaways:

1. Early and Accurate Diagnosis in Infertility: Georgie's story emphasizes the necessity of receiving a timely and correct diagnosis when dealing with infertility issues. Her experiences highlight the significant impact of medical diligence and proactive healthcare.
2. Self-Advocacy and Education in Fertility: Throughout her fertility journey, Georgie exemplified the need for patients to advocate for themselves and seek comprehensive information. Her proactive approach in demanding further testing and second opinions illustrates the importance of self-advocacy in fertility treatments.
3. Diverse Fertility Treatment Options: Georgie explored an array of fertility solutions, from IVF and IUI to embryo banking and surgeries. Her journey underscores the need for personalized fertility treatment plans and the availability of multiple options to suit individual circumstances.
4. Innovations in Fertility and Women's Health: The episode discusses technological advancements in fertility treatments, such as at-home IUI kits and fertility tracking applications. These innovations have revolutionized fertility management, offering new possibilities and greater control to individuals facing fertility challenges.
5. Emotional Aspects of Infertility: The psychological impact of infertility is a central theme in Georgie’s discussion. She talks about the emotional challenges, societal pressures, and the importance of finding support through resources like Resolve: The National Infertility Association. This takeaway stresses the need for emotional support and community in navigating infertility.

This episode not only sheds light on the complex and often heartbreaking journey towards parenthood but also offers valuable insights and resources for those navigating similar paths.

Mentioned in this episode: / Resources:

• Fempower Health’s resources on infertility and trying to conceive
• Organizations providing trusted resources and support: American Society for Reproductive Medicine (ASRM) and Resolve: The National Infertility Association
• Examples of fertility tracking tools/devices: PROOV, OOVA and Mira Fertility 
• At-home kit for IUI - Mosie Baby
• Recent podcast episodes: Listen here
• Book recommendations: Browse the Book Shop
• Sign up for the Fempower Health Newsletter

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Welcome to Fempower Health. This is Georgie. April 21st to 27th is National Infertility Awareness Week. And with everything going on in the world, especially in the United States, I thought this would be an important topic to cover. And I love that this year's theme is leave your mark. And it's really important that we advocate year round for a patient's right to infertility care and a provider's to practice. What I thought would be helpful in this episode is to, 1, share my story and then to answer some questions that I've seen that many of you have, and also share some interesting tips based on innovations that are happening in the women's health and fertility space. Not planning to cover too many foundations.

You can find that through the American Society for Reproductive Medicine website or on Fempower Health. I have a whole section on fertility and trying to conceive. I've interviewed a ton of experts on various topics. I've written a lot of blogs, especially because of my personal experience with this journey. So you can check all those out. So let's dive in. So first, I thought it would be helpful to share my story. So I'm very happy to report that I have an 8 year old son, but it was a 4 year journey to be able to have him.

So in 2010, I had just gotten married, and I was starting to try to have a child. And I didn't really think much of it, even though I was about 35 years old. My maternal or my paternal grandmother had 14 kids, and everyone in my family had lots of children. It was never an issue. And so it was quite a shock to me when I went to my OBGYN. It was just for a routine exam, and she was just asking me a lot of questions and happened to be a very proactive OB GYN because, typically, the definition of infertility is if you've been trying for 12 months or more and you're under the age of 35, that's infertility. And if you've been trying for 6 months or more and you're over the age of 35, that is also defined as infertility. And in this case, I got very lucky because I hadn't even started trying really, and she did a lot of tests and drew blood for various hormone levels.

And she called me the next day and said, you need to go to a fertility doctor. I was in shock. I was blown away. And long story short, it took 4 years and the 10th doctor to be diagnosed with endometriosis. And that's kind of the end of the story, but I thought it would be important to share the nuances because I think we sometimes forget that we have the right to advocate for ourselves, and sometimes we don't know how to do that. Sometimes we may be missing the signs of when we should be advocating. So now I'll share with you the in between. So the first doctor that I went to, it was a great first appointment.

You know, it's that very long consultation where they explain to you all about infertility, what happens with the procedures, their recommendations about your medication protocol and whether or not you need an IVF and all of that wonderful stuff. It was like an hour-long appointment. And then I was told, okay, come in for your testing. So I went into the appointment and they put in the vaginal ultrasound, and they also drew blood. And I will never forget the doctor who came in, and this is, by the way, a top fertility clinic. It was a different doctor than the one who had a very long appointment with me. I don't think he even said hello. He sat down in his chair, stuck the vaginal ultrasound into my vagina, and then said, okay.

Looks like you're good to go. Let's do IVF. And I'm like, what? What? What? I didn't even know that IVF was the next step. I thought there was gonna be this whole process. We're gonna have all these conversations. And, I hate to say it. You know? Then I started the IVF factory, and I was so stunned that I actually left that clinic. I called my OB GYN, and I was like, this was a robotic experience.

Like, I can't do this. Can you please recommend someone else? So she referred me to my next doctor who I was with for quite an extensive period of time. And I hate to say it, but I feel like he took advantage of my health insurance. And I was getting a lot of IUIs and nothing was happening. I wasn't getting pregnant at all. There were no miscarriages or anything like that. Nothing was happening. It was just IUI after IUI after IUI.

And I even went to his nurse team, and I said, I I just don't know what to do here. And they even said it's probably time to move on. Now quick backtrack here. I have a background in health care. I've been in the biopharmaceutical industry my entire career. I'm very comfortable speaking with clinicians and being in the health space, but fertility was like a whole new beast. So I did wanna at least overlay that as you continue to hear my story. The rest of this, I don't remember all the timelines and doctors and things like that, but I'll just tell you generally some important things that I I had experienced.

So one, I went through this journey of trying to find cost effective ways to do fertility treatments. And because I wasn't getting pregnant, the decision I made was, look. I'm getting older, and I know I'm on a biological clock. So why don't I bank my embryos? And so I decided to bank them until I could figure out what was going on. And so I kept begging these doctors to do tests because all they kept telling me was that I had unexplained infertility. And my thinking was either they weren't trying hard enough or the science hadn't quite caught up yet. And so I advocated for myself to do more and more testing, and none of the tests were coming back. And clearly endometriosis was not coming up as a conversation.

And I'll explain to you in a minute why. And so, I left clinic after clinic. I'd gone because I was trying to find a clinic that would give me an answer. Like, unexplained infertility wasn't enough, and it's really expensive to do IVFs. And so, I kept shopping. Like, another interesting experience I had was at an academic medical center where I was tracking my basal body temperature. And this is before all these wonderful apps that exist now, just to show you how much things have changed because now there's probably, like, a 100 plus apps like that. But it was a paper chart, and I was so excited.

I brought in my paper chart, and I was like, let's talk. I'm excited to share what's going on with my body. And the doctor looked at me. He goes, I don't need to see those. I already know what we need to do. And so I immediately left that doctor and did not go back. And I found other doctors, you know, that were absolutely wonderful. We just could not figure out how to get me pregnant.

So then I went to the 10th doctor, and he said, look. Let's do some more blood work, and he did this autoimmune protocol with me as well. So it was basically blood work to better understand the autoimmune profile, so to speak. And he called me up and he said, look, I think you have endometriosis. And I was a bit surprised because I don't have symptoms. I mean, now that I've been in the indoor community, I have symptoms, but they're so slight. And I only know them because I know the condition much more in-depth than I did back then. But, I did not have the severe pelvic pain that so many women have.

And so I was excited. It was actually one of the best days of my journey outside of having my son and finding out that I was pregnant because I finally had a diagnosis. Like, I can't. It sounds so weird to say this even now, but I was so excited when I was told that I had endo because it was finally not unexplained infertility. So I had a couple of options. He said, look. You can get the surgery, and then we can confirm it. And then they'll actually remove the endo while they're doing this. It's so if they find it, they'll remove the endo, or you can just continue doing IVFs.

And I think the offer again, don't quote me on this, but I think it was something effective. You can do this autoimmune protocol with the IVF, or you can just get the surgery, and then we can take it from there. So I did the numbers, and I was like, well, if I do an IVF, which I've done a couple of by now, I'm gonna pay all this money for the medication and the treatment, and I'm gonna be using embryos, and I'm getting older. So this is a little bit crazy because the surgery for endometriosis was way less expensive. So I thought, okay. Well, we need a diagnosis, an official confirmed diagnosis. So I had the laparoscopic surgery, and it was confirmed that I had endometriosis. Now a lot of people will say once you have the surgery within 6 months, you could just get pregnant on your own.

I did not. So then I decided it was time for my last IVF and I was very certain this was it. I was doing one more and then I am done because just nothing was making sense. I tried acupuncture. I tried taking a break from fertility medications. I banked my embryos. I felt like I was standing on my head trying to get pregnant. It was ridiculous.

New York so that New York could say what medications I needed to get quickly shipped to New York so that New York could say what medications I needed to get quickly shipped to my hotel so that I could dose myself up before my client meetings. I mean, it was nuts. I wasn't sure what to do with this IVF because now I had 3 doctors that I trusted through this journey. And I called all 3 of them for one last consult, and I asked a very difficult question, which is after everything that I've done for these past 4 years, why is it that you think that I'm gonna be able to get pregnant? And I left those three consults and looked at my now ex husband, and I was like, I still don't know. I feel like we're taking a ball, throwing it in the roulette wheel, and hoping it lands on. Yes. You're pregnant. So, this sounds so strange, but I was like, you know what? We're gonna do the thing that no one else has done, which is an autoimmune protocol with an IVF treatment.

So that's what we did. And, I couldn't believe getting the call that I was pregnant. It was quite unbelievable. And for me, I actually think the autoimmune protocol was it because I did have embryos from very early on in my fertility journey, and I ended up using those. And I had a chemical pregnancy, and I was going through quite a bit of intense stress at the time. And so sometimes I wonder if I wasn't going through all that stress, would I have been able to have more children? But now I am almost 2 years postmenopause. So the ability for me to have children is now over, but that is okay. My son is 8.

He is healthy and thriving and all of that. So that's my story. And I wanted to share all of that because you hear how I had to advocate. I was learning about my body. I really had to do a lot of deep searching around what I wanted to do and what I could handle, going through these fertility treatments and figuring out what was it going to take for me to say this is now complete and all that good stuff. And, yes, we thought about adoption and, you know, being a foster parent and all of those things. So all of those were under discussion, and it just so happened again that I got pregnant. So now as far as some key questions and other thoughts around what's happening in this space since my journey began.

So one is, I know there's a common question out there around IUI versus IVF. In an IVF, they're having to retrieve your egg and they take your partner's sperm. And then for lack of scientific terminology here, they put them together in a petri dish and they grow, and then the embryo gets put back into the woman's body. And with an IUI, there is no egg retrieved. They essentially take the sperm and use a device to insert the sperm through the woman's vagina and the cervix. And the intent is that it's going to get a lot closer to where the woman is going to be ovulating. So what's interesting here is a couple of things. 1, I know now there's a lot more discussion around men's sperm.

It was really concerning because back in the day, it was really thought infertility was a woman's problem. But just in case the message isn't fully out there, it's really important for the male sperm to also get tested. I didn't ever run into that issue because I was working with reproductive endocrinologists and their specialists that you can work with for infertility. Your OB GYN is much more of a generalist. They can do IUIs and things like that. But once you need deeper workups and specialists, you should be going to a reproductive endocrinologist. But I'm not sure if you're outside of working with reproductive endocrinologists, ologists, if it's common practice for the men's sperm to be tested. So I just wanna make sure that if you are one of these people who is struggling to conceive that, and if you're a person with a uterus that you're not thinking it's just you, both people have to be tested because at least a third of infertility cases is male factor infertility.

If you do need to do an IUI, what's really cool is there is a company out there called Mosie Baby, and they're really allowing for access to IUI. And you can now do the IUI at home. And so that's something that you can certainly consider, a couple of other things. So one is if you are struggling to conceive, I think it's really important to understand why you aren't getting pregnant. And I think it's really important for you to advocate to understand the why. So it shouldn't be a path of “I can't get pregnant.” Now let me go do an IUI or IVF. It's “I can't get pregnant.”

Let's figure out why and then make a decision for the pathway forward because there are some foundational tests that you can get done to better understand the challenges with your infertility. Obviously, endometriosis can be a factor, your thyroid health, polycystic ovarian syndrome, whether or not you're drinking a lot, whether or not you have insulin resistance, your weight. There's so many different factors, and it's really important to do that assessment. And I'm a huge, huge advocate for it. And fun fact, I actually started a company called fertility for me, and it was born out of my journey because I felt like I wasted so much time trying to conceive and going through that infertility process. And then I was, you know, 41 when I delivered my son, And so I thought, wow, that time could have been shrunk if I already just knew what I needed to know. And I felt like I was figuring it out along the way. So the whole idea was to optimize your journey so you're not wasting that time with the biological clock, etcetera.

So when I was looking at that, I will never forget. I was reading a Reddit post, and a woman had posted saying, look, I'm 40. I have 2 embryos that are frozen, and I wanna do an IVF. I'm constantly miscarrying. Should I use 1 or 2 embryos? And I wrote back to her and I said, I don't think you're asking the right question. The question you should be asking is why are you not getting or why are you not staying pregnant? Because there is testing that you can do if you're having miscarriages. And by the way, data shows that at least 10 to 20% of pregnancies end in miscarriage. People do think that number is actually higher, maybe 40% or higher.

So if you are having a miscarriage, please do not feel shame or that something is wrong or broken with you. A lot of it is due to chromosomal abnormalities. You can get, you know, all sorts of testing done. They actually recommend if you do have a miscarriage to save the tissue, which I know is an overly medicalized term for the tissue that you have miscarried, but that's what they call it. But you can actually get that tested to see if it was chromosomal abnormality or you can get further workup that I'm sure a reproductive endocrinologist can do for you. I I said to her, like, she's gotta figure this out first because this is not about the number of embryos. It's the root cause. And, therefore, once she figured that out, then she could make decisions because especially if she's 40, she's never going to have embryos that are any younger than what she was at the time.

Now I do not wanna get into this whole discussion around testing the quality of your embryos. Yes. You can freeze your eggs, but even when you freeze your eggs, it doesn't mean that you're going to get pregnant down the road. So there's a million nuances here around fertility, and I can't cover all of that in an episode. So you can follow a lot of the experts live interviewed a lot of them on femme power health and you can research all the nuances around fertility I more just wanna get around this theme of innovations, things you should advocate for to just hopefully help you get a jump start, and then you can look for these various experts to answer any of your other questions. So, again, please understand why you can't get pregnant. I know that another couple of factors. So, one, thinking about clinic shortages and doctor shortages.

So a lot of the fertility doctors are older and going to be retiring. And, you know, given that there's expected to be a shortage of OB GYNs and reproductive endocrinologists are a subspecialty under that. You know, we could expect longer wait times in fertility clinics. And I know there's wonderful organizations like mate fertility. They're really working on providing access to all for infertility, but that's gonna take time for them to continue to build and expand. But people are working on this, but this just goes to show why it's even more important to monitor your “trying to conceive” timeline. So, again, infertility is defined as 12 months of trying to conceive or more under the age of 35 and 6 months or more over 35. So if you fall into this bucket, don't wait because you may be running into a situation where, you know, you're getting older, you wanna have your child, and, oh, by the way, now there's a wait list.

Please do not put yourself into that situation. Couple more things that I wanted to bring up. Progesterone. So I interviewed doctor Amy Beckley, back when she was first starting out, and she has a company called PROOV. And I was so excited to get to know her, and it's so fabulous to see what she's been doing with her company. And she's been an advocate for progesterone. When you get pregnant and after ovulation, your progesterone should be rising. And I think it's 21 days into your cycle.

It could have changed a little bit, so don't quote me on that exact number. But generally, there's a time after you ovulate where there's blood work that can be taken where they test your progesterone level. However, that is one point in time. And what Amy has been advocating for is you need those progesterone levels to stay high if you do end up getting pregnant to keep that pregnancy. And, she's been a huge advocate for it. Progesterone is such an important hormone, and year after year, it's getting more and more positive attention. I know up until now, it's always been about estrogen, but we cannot forget the importance of progesterone. Nonetheless, what's been interesting too is even with the data that she was gathering, and I know a lot of other startups like Oova and Mira fertility, they have also been adding progesterone as a test to their fertility testing protocol.

So what Amy has done is she's partnered with doctor Amy, who's a reproductive endocrinologist out of California who can do, for lack of a better word, like a telehealth visit progesterone prescription, and they can work with you on that. So if you are a woman who is having these miscarriages, who knows, maybe progesterone is an issue. And that one time blood test may not be as effective at giving the whole picture of what's happening to your body as a progesterone test like PROOV and what OOVA is doing and others that show changes over time so that you can better understand what's happening. But just know if your doctor isn't going to prescribe you progesterone, if you're doing this at home and it is something that's needed. Apparently, doctor Amy has partnered with PROOV, and that's a way to be able to get that. The other thing I wanted to address, which I believe is the last thing, is Ozempic. So Ozempic, we go via and all of these other, GLP1 drugs. They were really designed for insulin resistance, and weight loss happened to be what many would call a positive side effect.

And so, obviously, many people are taking it. I was doing some research to find out what the American Society For Reproductive Medicine has officially stated about the use of Ozempic and Wegovy and and drugs like that for trying to get pregnant because, again, you don't wanna have you don't wanna be overweight. You don't wanna have insulin resistance. And so, theoretically, it would be like, well, why don't you take this? So the statement is that the latest that I've seen was actually with Dr. Lora Shahine, who was also a previous guest, and she talks a lot about miscarriages. What she was saying is that the recommendation is actually and, again, this is not scientifically based, but more of just based, but more of just colleagues talking about the best that they can do with the little information we have is to actually stop taking medications like this 2 to 3 months before you are trying to conceive. I heard that in male models, she was stating that there are deformations. Is that the right word? There's malformations, I think, is the word I'm trying to say, with the fetuses in animal models when it comes to these products. And so it's still a drug.

And so there is concern about trying to take these medications while you're trying to conceive. And so, obviously, talk to your doctor about what you need to do, but the experts in this space, aren't too keen on it yet, and they're actually requesting that more trials be done to have much more certainty about a scientifically based recommendation, but that's kind of what they think at this point. So I believe that covers everything. Again, just advocate for yourself. This is a hard journey, and, you know, I remember those days. You're like, you know, pregnancy test after pregnancy test, negative, negative, negative. I mean, I remember the tears where, you know, I would see people constantly, you know, getting pregnant and just the silly things people would say to me that they didn't realize were so silly and hurtful and having difficulty going to baby showers. And, of course, you're happy for your friend, but you feel like crap.

Then, you know, what's the exact second I'm gonna ovulate so I can time intercourse at the exact right time, like, all of those things. It was crazy making, and so I empathize with you and your loved ones who are going through this journey. It is really hard. I think we would all love to wave a magic wand. One of the things I have found in life is it's so much easier when someone can say the pain is gonna end in exactly 3 weeks. And then, you know, to brace yourself for 3 weeks, and then the thing will be over. But with infertility, you know, I hate to say it. Some of us get lucky.

We get easily diagnosed with the root cause. We can have whatever treatment or just try naturally once the root cause is fixed, and then you're pregnant. And that is fabulous, and I truly, truly hope that happens for you. And in some cases, you know, it's someone like me and many of the others out there where it's, like, month after month, try, try, try, and you just never know when it's gonna end, and it can really grate on you. So I would also recommend talking to people. I know not everyone is comfortable being open. I personally found Resolve: The National Infertility Association. Their support group was incredible.

It opened my eyes to the sheer number of people that were struggling. Now we have social media where people talk about their stories there. So maybe if you're not comfortable talking, maybe you can follow some of these people through their fertility journey. And maybe at some point you guys would feel comfortable with each other to DM, whatever it is that you need to do, but just know you're not alone. Acknowledge how you feel, and, and I wish you the best. I truly hope that this episode was helpful. I know hearing people's stories can sometimes help you not feel alone. And it's been a while since I spoke so much about mine, so it was kinda nice to get it off my chest.

And, thank you again so much for your support of Fempower Health. If you have any questions on this topic, please let me know. And if there's other topics you would like me to cover where it's just me talking about my thoughts, feel free to send me a note at georgie@fempower-health.com. Wishing you the best.