Curious about how your reproductive health and fertility options work?

On today's episode, we dive into these important issues with the amazing Dr. Roohi Jeelani, a double-board-certified obstetrician-gynecologist who specializes in reproductive endocrinology and infertility.

Dr. Jeelani is passionate about starting more open conversations about fertility and reproductive health, especially in the South Asian community. She not only shares medical advice but also talks about the social, cultural, and political factors that affect reproductive rights. Together, we explore the complexities of fertility care, the impact of legislation on treatments, and the importance of supporting policies and candidates that protect reproductive rights.

Highlights:

1. Navigating Legal Challenges: Dr. Jeelani explains how laws impact fertility treatments and abortion rights and why it's crucial to support policies that protect these healthcare services.
2. The Journey of Fertility: Learn about the transition from general gynecology to specializing in fertility, and when you should consider seeking fertility treatment based on age and fertility status.
3. Fertility Myths Debunked: Find out why home fertility tests might not be as reliable as they seem, and the importance of clinical tests for effective treatment plans.
4. Managing PCOS: Dr. Jeelani shares tips on lifestyle changes, diet, and supplements to boost fertility in PCOS patients. She also discusses medication options like Metformin and GLP-1 agonists.
5. The Real Deal on Egg Freezing: Understand the egg freezing process, what to expect, and why it's like an insurance plan for future fertility. Dr. Jeelani provides statistics on success rates based on age and the number of eggs retrieved.
6. Personal Advocacy in Healthcare: Dr. Jeelani emphasizes the importance of knowing your body, asking the right questions, and seeking second opinions. She highlights the need for a supportive and comfortable healthcare setting for effective treatment.

Remember, you don't have to walk this journey alone. Being informed, asking questions, and standing up for your reproductive health are key steps.

Who do you want to hear from next? Our podcast is here to educate so you can and advocate for yourself. If you enjoyed this episode, please give us a 5-star review on Apple Podcasts, subscribe, and share with your friends!

Guest Bio:

Roohi Jeelani, MD, FACOG, is a double board certified Reproductive Endocrinologist and Infertility Specialist (REI). A graduate of Ross University School of Medicine, she completed both her residency in Obstetrics and Gynecology and her fellowship in Reproductive Endocrinology and Infertility at Wayne State University – Detroit Medical Center. During her medical training, Dr. Jeelani received numerous awards in the areas of fetal medicine and reproductive medicine. In addition, she has authored a variety of publications and book chapters in well known journals highlighting cutting-edge REI advancement and has presented at national/international conferences and symposiums focused on advancements in women’s health. Dr. Jeelani is an active member of many medical associations. A highly-skilled reproductive endocrinologist and infertility specialist focusing on all areas of reproductive health, Dr. Jeelani has a special interest in oncofertility, toxins’ impact on reproductive function, chemotherapy, and oocyte cryopreservation.

Dr. Jeelani serves patients from our Chicago, IL and our Detroit, MI clinics

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Hey, y'all, it's doctor Samina Rahman, Gyno girl. I'm a board certified gynecologist, a clinical assistant professor of Ob GYN at Northwestern Feinberg School of Medicine, and owner of a private practice for almost a decade that specializes in menopause and sexual medicine. I'm a south asian american muslim woman who is here to empower, educate and help you advocate for health issues that have been stigmatized, shamed, and perhaps even prevented you from living your best life. I'm better than your best girlfriend and more open than most of your doctors. I'm here to educate so you can advocate. Welcome to Gyno girl presents sex, drugs and hormones.

Let's go. Hey, guys, it's me, doctor Saminurman. Gynel girl for Gynel girl presents sex, drugs and hormones. Today you are going to get all the information and info that you want to know about when it comes to fertility. We talked to the amazing doctor Ruhi Jelani with kind body fertility. She is a double board certified ob GYN in REI reproductive endocrinology and infertility, as well as obstetrics and gynecology. She speaks around the world on this topic and she has amazing social media platforms where she is very candid about her own journey as well as issues around fertility and management. We had a great discussion.

We talked about the current climate of fertility in the United States. We spoke about the politics and how it's impacting fertility. We talked about pcos and you're going to learn about management techniques and what it is and why it's important to understand your health. And then we just also just talked a little bit about egg freezing and all that stuff. So I can't wait for you guys to listen to this. Please stay tuned for Gynel girl presents sex, drugs and hormones with doctor Ruhi Jelani. I'm super excited today to have you guys with me on another podcast of Gyneau Girl presents sex, drugs and hormones. Today I have a good friend and colleague that's joining us and we're going to talk about fertility and pcos and all your questions that you may have around that.

It's doctor Ruhi Jalani. She is an amazing, amazing, amazing reproductive endocrinologist and infertility specialist, double board certified and Ob GYN and that ReI as well. She practices in Chicago currently and works under kind Body, which is a nationally run organization. So she works and hones her skills in fertility, but she also is a huge, huge patient advocate. I'm sure many of you know her from her Instagram and her social media platforms, which are probably, I don't know, upwards of like, probably close to a million people following her at any given time on any platform. And, you know, she speaks openly about, you know, her own journeys and is really, I find, you know, we collaborate a lot. We send each other patients in Chicago a lot. And I always tell my patients, like, if anyone will give you hope, it's doctor Jelani.

So I want to send you to her. Thank you, a lot of people. So thank you, doctor Jelani. Oh, and your full bio will be in the show notes, so how to get in touch with her. Thank you so much.

Thank you. Thank you for that very kind introduction. And thank you so much for having me. And I'm honored to be on here. And I think it's so important what you do. I know I personally just being, having, being impacted by fertility and having gone through all these treatments and also just culturally not openly talking about sex, intercourse, vaginismus, pelvic pain and anything related to sex and periods, I'm a huge advocate for you. I send you truly all my patients because I think you do such an important job and a service that we're really missing.

Oh, thank you so much. I appreciate you as well. Well, let's get into it. Let's talk about the fertility world and what's happening. First of all, I mean, I want to really get into pcos a little bit, too. But obviously what's pressing most people right now is all the legislation around, you know, controlling women's bodies, you know, abortion, all that stuff. And, and it's actually rolled over into your realm, the fertility and what it means and what, what's going on? Like, how do you guys, how are you guys handling this? I mean, I know we're in Chicago, so we're kind of like in a bubble.

Yeah.

But there's so many states in this country that have really restricted, you know, health care for women. Abortion is health care. Fertility is healthcare, and, you know, what can be done with, you know, these embryos that are frozen and all of that. So let's talk about how you've dealt with it. I know you've been advocating for it.

A lot, for sure. I'm a part of doctors for fertility, which initially was formed when they reversed Roe v. Wade and that reproductive rights can now then be determined by state by state. When we first started saying, well, this will impact fertility, no one understood how and why. And to be very candid, I didn't either. I was like, well, I get it, but I don't get it. Like, it's super upsetting that happened. But slowly, as you start learning, because they started trying to control, well, when can you get an abortion? What is an abortion? What's termination? Slowly they started saying, well, life begins at fertilization and fertilization, if, you know, IVF happens at the ag retrieval.

What you truly don't know is not all eggs that fertilize actually become an embryo. Not all embryos are normal, and not all embryos implant. And not to get too personal, but with me, it was a really good example of how many perfect embryos it took to help me build my family. It's insanity. So when you hear these laws or when you hear this type of legislation being put into place by people who don't quite understand the science behind it, it's frustrating. But it also then starts to limit what you can do and where you can receive care and what type of care. And there's actually clinics that have shut down because of legislation like those due to fear of not wanting to get prosecuted.

Right. And I think that's a big concern for clinicians not being able to provide the care that we want to, but also being prosecuted for providing the care, like being put into jail for doing a life saving ectopic pregnant surgery or all the things around IVF that you guys do, which is very frustrating. And, you know, other than understanding who we elect and just advocating for yourself, I mean, what other advice would you give the listeners about that?

Support pacs and support candidates. Your voice matters, truly. I'm coming from a place of, like, I don't mix politics with medicine, with my career, with my this, but now if you don't do it, someone's speaking on your behalf. So this is your chance. Like you said, vote for the right candidate, really understand what they stand for. Like, this can make it break the future of reproductive rights and healthcare and other people meddling who don't quite understand what you're going through.

Right. Well, I just wanted to touch base on that because you're my first fertility specialist I've had on. So I wanted to get your opinion. I really want to do a deeper dive into something that we all know. I mean, I think that you and I treat in our offices a lot, and we both have, you know, a good number of south asian followers, and we know it impacts south Asians more as well. And so I wanted just to elucidate some issues around fertility and what is polycystic ovarian syndrome treatments around it all the things that you always talk about in terms of supplements that might help and all of these things. So I guess we should start. Like, you can describe how you talk to your patients about PCOS and what is it, and how do you talk to them about it?

Yeah. So PCOS is polycystic ovarian syndrome. It's actually a misnomer because every time I say that, the first thing I get is, well, I don't have cysts. So it's actually not cysts, but it's a lot of follicles or eggs on your ultrasound, so it actually comes across as a high ovarian reserve. So when you get scanned or when you do blood work, everything looks perfect and your egg count looks very high. We're going to talk about a little bit of the differential diagnosis, but most people also don't find out they have pcos until they're actually trying to conceive. So, believe it or not, even if you didn't know in the past and you find out when you're actually trying to get pregnant, that is typically when most people find out. In order to be diagnosed with PCOS, you need two out of the three.

And they're really vague diagnoses, but you need to have multifollicular ovaries, meaning greater than twelve eggs on one or both ovary. Biochemical or clinical signs of hyper androgynism, meaning acne and male pattern hair growth. Right. I'm south asian, so whenever I go around and be like, oh, I'm hairy. And they'd like, of course you're hairy, you're brown. Yeah.

Right.

So it's male pattern or something. So you want to make sure you're looking at male pattern hair growth right here on your knuckles, here on your toes, hair on your chin and around the nipple. But it's more of a male pattern hair growth that's important to differentiate. And then the third one is irregular cycles or periods greater than 35 days apart. This I learned as a doctor to ask, because I remember, I asked, are your periods regular? And they're like, yeah. So I was like, okay, well, have you come in with your next bleed? Well, it's like, in two months. And I'm like, wait, that's not regular, but that's regular for them. So it's important to ask, like, greater than 35 days apart is another science.

If you have two out of the three, and you may not. Right. There's a PCOS syndrome. That's the whole syndrome. And then there's a PCO phenotype where you have the ovarian appearance of PCOS, but maybe not necessarily the rest of it, and you still, when it comes to fertility, I treat these patients like a PCOS variant.

Yeah. And I think it's important to understand. People always ask, oh, can I get rid of it? It is what we consider, like a genetic predisposition. Right. I think that that is something, you know, in a perfect storm of environmental factors, you might manifest some of those, but. And you're right, that's to your point, that some people don't find out till they have fertility problems because they don't realize that this little, you know, hair here and there that they've developed or their cycles have always been 35 to 40 days. So it doesn't seem like a big deal, and they don't find out until they're not able to get pregnant or having challenges around it. But I think that's something I always emphasize with patients that it's not something that you'll necessarily get rid of, but you can control with different techniques, whether it's diet, exercise, modification, medications and all that.

Yeah, for sure. I was misdiagnosed, and I was diagnosed correctly when I was younger, but then when I was trying to conceive after I kept failing letrozole and clomid, the res were like, well, you were misdiagnosed. You're actually not pcos because you don't look like a pcos. And then I get so frustrated because my whole life here, I thought I was pcos, and I am, but it's just not all pcos look the same. They don't present the same way. But it's definitely something important to know that, especially south asian pcos, I'm very lean. I don't look like a typical pcos. I don't have that cystic acne.

So, so easy. Especially being treated in Detroit, where majority African Americans and their pcos present so differently. So it's constantly like, well, you don't look like this PCos patient, so you must not have it.

Yeah. And I think, you know, to the point of South Asians, you know, I think the statistic is we're like a quarter of the world population, but like 67% of the world. Diabetes, heart disease, all of that stuff. So we carry a heavy burden of metabolic dysfunction, and most of us know somebody that had a heart attack and died before the age of 50. So I think we carry such a load of metabolic dysfunction that I think that's why I think it's like one in four. I think south asian PCOS. And to your point, it doesn't always mean that the classic stereotype that we probably learned way back in the day when PCOS was really initially talked about as sort of someone that suffers from obesity and they have, you know, facial hair, they might have, you know, this acanthosis in the back of their neck. They might have, you know, facial hair, hair loss, maybe male pattern balding.

But it's really that phenotype that people still assume is. And so I oftentimes will have doctors dispute me on a patient that I'm pretty sure that I think has PCOS because they meet the criteria, but they're super thin like you. No, no, that can't be the case.

No, 100% like PCOS presents really differently, especially in South Asians. And it's super important to actually understand the diagnostic criteria, to know when to advocate for yourself, because I had to do that. And it was sad because I was a patient and doctor, and then I already had the diagnosis, but then was constantly being told I didn't fit that because I kept failing what worked. Not all PCOS present the same, and not all of them will respond the same, and not all of them will get pregnant the same. So just because you have PCOS doesn't mean you may not need fertility treatment. And then I, in my head also, this kind of really messed with my head because I was like, oh, yeah, I'm going to take lectrozone. It'll work because that's the only problem that I need to restore ovulation. But you're right, like, exactly what you said.

There's a whole syndrome associated where there's a metabolic component, there's a health, there's a lifestyle, there's so many factors that go into it.

Right, exactly. And I think that's where some patients get this delayed diagnosis, or they may not even be told about it for the longest time. And there's a higher. It's mental health awareness month right now in May. I don't know when this is going to air, but there's a huge burden of depression and anxiety among PCOS patients as well, because of, I think, all the factors associated with it. And so I think it's important to really look at each individual as a whole. Right. And what they're experiencing with their cornea.

Do you ever see, like, the blood level that you're talking about that's elevated a lot of times at PCOS is the anti malarian hormone. Do you ever see patients have that really low amh and then they have.

There is, interestingly, there was a paper that showed accelerated ovarian aging in PCOS patients. PCOS is really hard to diagnose as we get older. Typically, they present with a high amh because their egg count is so high, and that's one of the diagnostic criteria. But if you're older and then you present to a fertility doctor, sometimes it can be harder to diagnose PCOS because your account may not necessarily be as high and it's not necessarily diminished reserve unless they've had intervention. And in Europe and in India and South Asia, they actually still do ovarian drilling where they try to get rid of a lot of the eggs on the surface to restore ovulation. So in those patients, sometimes you do see a lower reserve, but not naturally. You shouldn't see the natural decline.

Right. Okay, let's talk about how you go about counseling these patients about their fertility and know sort of, well, let's talk about fertility testing for a second, because, you know, I often get patients come in like they're 28, 30, or maybe 33 years old, and I just want to get my fertility checked because I need to know if I should get going right away or if I should. Like, I'm okay to wait a while. Like what? I mean, I can tell you my spiel, but I want to hear what your spiel is when you have patients. I mean, obviously, I do fertility treatments in my office, but I get a lot of patients that ask me about fertility treatment and evaluation.

I really do appreciate what you do. I think you tee them up perfectly for me, and I think that's important also how they segue from their gynecologist to a fertility doctor, because fertility is scary, and I think you do such a good job of preparing them and transitioning them. To me, that's one of the things in my journey. It was, you fail now you have to go to the doctor without really understanding, like, what's my workup? What's different? What can they do? What can you do? And I think as a provider at the gynecologist, like, you are my go to, right? Like, as patient, like, I trust you. I go to you. I don't want to leave you. So I think that was important, and I think it's superim, super grateful that you do that because your patients are mentally prepared, because it is mentally and emotionally tolling. My spiel is if you had unprotected intercourse under 35 for a year and you're not pregnant, that means you fall in that subfertility category.

And it's important to differentiate because a lot of my patients always start with, well, we weren't really trying. Right. And I always say, well, what does that mean to you? Like, oh, well, we didn't really use tests, and I didn't use ovulation predictor kits and blah, blah, blah. Have to undo that and say, well, that's actually trying. And even though you're not trying, because without trying, if you're not using any barrier withdrawal or anything, 80% of couples after one year of unprotected intercourse should be pregnant. So that's one. If you're over 35, it's six months, not because your fertility drops, but because your quality drops. So your take home baby rate after 35 drops.

So you want to be quicker to start seeking treatment or intervention. And at 40, you want to seek care even before you start trying because most of your eggs will be abnormal than normal. So if you're 40 and you're thinking about building a family or starting a family, seek out help. You don't have to stop trying to seek out help. You can do both tandemly. And if you're pregnant, wonderful. That's what we want. But if you're not pregnant, at least you're teed up to get going.

And what do you tell them about, you know, the. The blood test that they'll come for? And you're like, oh, I did an at home amh or, you know, at home fsh on day three or whatever. Or my doctor did this and she said it was fine. So I figured, like, my fertility was fine. You know, I always tell patients to snapshot in time, and, you know, it's like. Like, really? I always talk about how you guys use it in fertility land, right? Like, it's used to see how you might respond to these medications. But I'd like to hear what you can tell.

You're 100% right. It is. It's an assessment of the now, your time stamp of the now. It doesn't indicate whether you're fertile or infertile. It helps us gauge your quantity and your quality in that moment. Remember, one third of infertility is unexplained. So you could have perfectly normal egg sperm tubes, and you can still be infertile. Cause there's an underlying physiology or pathology that we don't quite understand.

So just because they're good doesn't mean they're actually good. These are just markers of if we were to do IVF or egg freezing or treatment. What do these numbers help us gauge treatment options?

Well, let's go back to the PCOS question and how, you know, how you guide patients in pcos, do you? You know, there's all the questions about, you know, should I be on metformin? Should I use inositol? Should I, what should I be doing to optimize my fertility? I'm only 25, but I want to get pregnant when I'm 28, that kind of stuff. What do you tell patients how to optimize their fertility when they have pcos? And what may you use when you're actually treating them?

Yeah. So to optimize your fertility, you want to look at your body as a whole. So lifestyle, mediterranean diets, the best for fertility. Pcos, you want to be lower on the glycemic index, not complete keto, but something that's manageable, sustainable, long term, so low processed food, more fruits, more vegetables, more lean meats, adding in omegas, that's the most sustainable. Kind of like a well rounded diet for PCos. I'm a big believer in supplements. I know not everyone is, but I added in something called an acetal. An acetal really helps with egg quality.

It works through an insulin mechanism. So it's an insulin sensitizer. In a lot of pcos, patients tend to have insulin resistance, which the short way to test for it is hemoglobin a one c. So we say, well, if your a one c is fine, you may not have it, but that's actually not true. The true way to check it is to check your response to glucose. So you're supposed to actually do a 75 grams glucose load and check your fasting insulin to post load ratio and then treat with metformin because it takes such a long time to do, and most res, or even endocrinologists don't do it. We use hemoglobin, a one c, as a surrogate marker or your overall health.

And so you tell them and then, so what diet you talked about, maybe, obviously incorporating exercise and that capacity and acetol. Where do you fall on with metformin? You will start it on patients with. Obviously, I started on most of my PCOS patients, if they are struggling with visceral fat or, you know, especially if their hemoglobin a one c is elevated. And is that kind of your way of treating that stuff?

Definitely. I try to do it with, like, PCOS tend to have a central obesity issue. Even me, even though I'm really lean, it takes me so much of my diet, like clean eating and working out to manage my blood sugar levels, to manage my cholesterol levels. So there's this huge metabolic component to it. So I'm a big advocate for metformin.

And, of course, we have to talk a little bit about the GLP one agonist.

Yes.

A few years ago, actually, I started studying these obesity medications, like, before the craze happened, because, you know, I had been reading about them, and so I would have these patients on metformin that were pcos that would fail metformin. They weren't losing weight. And it was interesting because back then that they could get on ozembic, like the patient's covered their ozembic because they had failed metformin. So it's like you had pcos, you failed metformin, you weren't a diabetic. You could get these medications, and they responded so well, like it was amazing. And then, of course, when the stock and supply has been diminished, and everyone's trying to use these medications now because they are great drugs. The PCOS patients, if they're not in the category of obesity, which a lot of my patients weren't anymore because they had been using those epics. So they weren't obese anymore and they didn't have hypercholesterolemia or anything like that, but they still are struggling with this metabolic disorder.

That was the one downer for me was like, now they can't even get it. But how do you feel about those medications when it comes to fertility and pcos? And of course, I talked about Zembic babies was some, I remember there was.

Some article about that being overweight doesn't cause you to be infertile. Most patients with pcos are also obese, and they're infertile because they don't ovulate. One of the pathophysiology behind that is the insulin resistance and high testosterone and estrogen levels. So with ozempic, when you have that weight loss, your insulin spikes decrease, therefore your testosterone decreases, therefore you start ovulating, and hence the ozempic babies. When you look at textbook first line of treatment for PCOS, it's actually diet and weight loss. Does it work in everybody? No. But does it work in a PCOS patient? Yes. And im sure you can tell with your patients, too, that not all of them whove lost weight have restored ovulation in regular cycles because PCOS is multifactorial.

So, like, for me, it wasnt the weight component. It was just my inside metabolic health overall. So even when I was trying to get pregnant and stay pregnant, my doctor would always be like, you dont want to lose weight because youre so lean, but you have this metabolic syndrome that if you actually do control your spikes of your blood sugars, it will prevent you from miscarrying. So it's complicated. Not as easy as lose weight. You'll get pregnant. But, yes, with ozempic, it can happen in some patients. And I personally think it's a great drug.

I also say it's very new, so you don't know long term side effects. This is not something that you want to use without adjusting and modifying your eating and your diet and your lifestyle. So you want to do them randomly. So I think looking at when you intervene with ozempic and how you maintain that it's also not safe in pregnancy and it's not safe in fertility. So when you're taking ozempic and you're trying to pursue fertility treatment, we can't give you anesthesia. So your last injection has to stop two weeks before anesthesia, and then there's a six week washout period before you actually get pregnant. Good.

Okay, so my next questions.

All right, awesome.

Well, I mean, you know, as a patient who's kind of gone through all of this, like, you know, you and I have been patients for different things. And so, you know, we have an idea. We're in the medical system. We know how to navigate the healthcare system, right? So I think, you know, for us, it's, it was hard, but it's like, you know, much harder for someone who has no idea how to navigate the health care system. And we all know the healthcare system's flawed on so many levels. But how do you like, what kind of, what kind of information would you want the listeners to hear about in terms of, you know, the best way to advocate for yourself, the best way to get the help you need, the best way to navigate the system? You know, I hear a lot from, when I have patients that come from other fertility centers, not yours, that they feel like they're just like on a milk, like I'm on a mill, you know, and they just, I'm just a number, number over there. And I think the truth is, you know, some of the big centers do become, you know, sort of like, you know, you're on an algorithm and, you know, it's very algorithmic. And, and so some people feel detached from the people treating them.

So I guess my question is twofold. One is, you know, how did, how do you combat that in your own practice? And number two, like, what advice do you kind of give, you know, the people listening about navigating their own healthcare and. And how to. How to best advocate for yourself.

I always tell my patients that, educate yourself. I know this is really. It's overwhelming, to say the least, but really educate yourself. Like, there's all these channels, social media, there's these amazing podcasts like yours, there's resources. So really find yourself that buddy or that group, or really to learn about your body and learn about the questions to ask. So when you sit in front of that doctor, you know the right things. In a perfect world, you shouldn't have to do that, and you wouldn't have to do that. And you really do want to not say, don't trust your doctor, but really, you know, not have to push.

But there's difficult cases. I was talking to somebody yesterday and saying, 80% of fertility cases fit in this bread and butter. So that cookie cutter approach is fine, you'll get the baby, but 20% of cases are very difficult where they don't fit in that box. And that's when you really have to be like, okay, wait a minute, let's step back. Like, what do I have to learn? What do I have to ask? What should I be doing? They don't fit that standard. And I, unfortunately, was in that 20% where it became really frustrating. I also always say, never be shy to seek a second opinion. Like, we all, as doctors, want what's best for you.

We want you to get pregnant. We want you to build your family. We want you to learn about your bodies. And you do such a great job of educating and knowing that there's other options out there. I. I had to seek lots of second opinions before when I had my son. Just, I wanted to know, am I doing the right thing? Is there anything else I'm missing?

And you're a fertility doctor, and so that's. I mean, so everyone else should be feeling reassured that, like, every one of us, you know, that experience issues within even our own specialty, you know, we've all had to struggle with trying to figure it out. But it's okay to, like, you know, get the help you need to ask the questions and to seek. Seek advocacy through, you know, even other people.

100%.

Oh, one other question I was going to ask you, because people ask me this all the time when they're choosing a center to go to. Like, are there statistically things they can look, you know, oh, this center has a higher rate of, you know, ivf success or, you know, that kind of thing. Like, is that something that when someone's trying to choose a center and they're, they're like, obviously I refer to you guys, but like there might be some other patients listening who's primary gynecologist or primary care providers, you know, don't, you know, give them, don't have a connected with. So how would they look?

Yeah, there's a SArt database that's manned by the CDC that reports center outcomes. Most centers are very comparable outcomes because we have access to the same technology. So for me the biggest thing is success set aside because most centers have to follow these guidelines. And most centers, we standardize care so much that most are anywhere from 50% to 70% success based off of euplate embryos. Your age and your health really look for such an intimate process. Doctors that you're comfortable with, clinic that you feel comfortable with, that you're not stressed, that moves at your pace, that's answering your questions. Because I think that's the toughest part, not being able to really understand everything that you're going through and kind of blindly following through and success. Yes, it's important, but know that most centers have very comparable success.

And then one last thing is, you know, the other thing I get asked about a lot is around egg freezing and do I recommend it? And I, you know, I have my spiel where I talk about, you know, like, your 24 year old eggs are going to be better than your 39 year old egg. So, you know, to have it as an insurance policy is what, you know, you should look at it as. But is that kind of how you view it as well or when your.

Yeah, and my, it's not my pet peeve, but it bothers me when patients are like, oh, I did my at home testing and everything's fine. So I didn't freeze my eggs and now I'm here at 40 and I want to say like, nothing trumps fertility. Like age. Age dictates fertility and younger eggs are always better eggs. So if you're even thinking or asking me should I freeze my eggs, my answer is yes.

Right. And there's so many organizations now that actually like, will cover some of those fertility costs for freezing because they don't want their, you know, high functioning women to get pregnant.

Yeah.

So whatever it is, but at least they're offering it, you know, as you're climbing the ladder of success in the corporate world or. Yeah, field you're in. But yeah, I always advocate for it too. I mean, but I also, you know, you also have to remind people that, you know, egg freezing is an insurance plan. You still want to try it. But you know, live birth rates are variable, right? Yeah. And if you could freeze an embryo.

It'S better than okay, you should just do this.

Okay. Awesome. Okay. Do you, do you actually have like rates that you can quote for like for egg freezing or is it so variable?

Most of the data for egg freezing is for women in their thirties. You need 15 to 20 eggs in your early thirties for an 80% chance of one live birthday. When you hit your forties, you need 40 frozen eggs for one baby. So if you look at most centers, they don't do egg freezing for women over 40 because that means a lot of cycles. And not to say women are committed to do that, but it's hard to swallow, right, to say, hey, you need to do this x number of times.

Do you want to just quickly walk someone through what it looks like to get egg freezing? Yeah.

Egg freezing is not a bad process. It actually doesn't take months. That's the first question I get, like, I don't have months to give to this. It's a ten to twelve day process. So because you're not implanting, it's cycle independent. You can travel short trips throughout it and just have to take your meds with you, but you cannot go out of country or be gone. So you start your injections, for example, today you come in for monitoring, which is blood work and ultrasound every third or fourth day. So it's about five appointments and then after two weeks you're done.

Your retrieval happens under iv sedation, so you go to sleep with anesthesia, we do an ultrasound at the tip of the ultrasounds and needle and then we suck the eggs out and then we pass it to the lab the next day. They'll call you and let you know how many were mature. And we expect about a 70% to 80% maturity. So if we have ten eggs retrieved, we should expect eight frozen.

Oh, wonderful. Okay, awesome. Well, that's very helpful actually. I think those are some of the big questions I always get asked. I'm always like, let me just have you see Doctor Jelena.

Thank you. I really appreciate it.

So. Yeah, but you do amazing work and I love all the advocacy and education you do on your form. Please follow her on with Doctor Rukhi Jelani's. I think that's what your instagram. Yeah, but you know, she's always talking all over the world and speaking and researching and she's doing all the stuff because this is a true passion of hers, I could tell.

Thank you. Thank you for having me. And I love working with you.

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