Ep 47: Everything You Want to Know About Fertility and Pregnancy with Fertility Specialist Dr. Cindy Duke

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I'm so excited to have today's guest on the show to talk about a topic I know many of my listeners are really interested in: fertility. Whether you're actively trying for a baby or are only just starting to consider getting pregnant, it's good to know what to expect with your fertility and when to seek help.

To talk all about fertility today we're joined by the amazing Dr. Cindy Duke. Cindy M.P. Duke is a M.D. Ph.D trained Physician Scientist who is Board Certified in Obstetrics and Gynecology and Fellowship trained in Reproductive Endocrinology and Infertility (REI). Dr. Duke is also an active member of her community and is also the host of the ‘Girl Powered Success & Survival International’ (aka GriPSSI) Podcast, which is aimed at highlighting the work and dynamic career paths of women and girls around the globe! 

Dr. Duke and I talk about what you should expect from your fertility appointments, when you should seek to meet with a fertility specialist, and some of the common obstacles she sees couples facing when they are trying to get pregnant. 

We also discuss the importance of male partners taking part in the fertility process, too, because often times there are fertility issues on their end as well. You'll leave this episode with a much better understanding of fertility treatment and all the questions you should be prepared to ask a fertility specialist!

In this Episode, You’ll Learn About:

  • Why and how Dr. Duke got into the field of fertility 
  • When people see fertility specialists in their pregnancy journeys
  • How to prepare for your first visit to the fertility specialist and what they'll ask
  • Three questions to ask your fertility specialist
  • The top three things Dr. Duke sees people dealing with in terms of infertility
  • Why a male partner should partake in fertility appointments and treatments
  • Why you don't need to break the bank for ovulation test, pregnancy tests, and vitamins/supplements
  • Dr. Duke's thoughts on complementary or alternative fertility treatments, like teas, supplements, and acupuncture
  • Common misconceptions about fertility appointments and treatments

Links Mentioned in the Episode

Keywords

fertility, in vitro fertilization, infertility, IVF, male fertility, pregnancy, supplements

Categories

General Pregnancy, Health & Wellness, Podcast

Keywords

fertility, in vitro fertilization, infertility, IVF, male fertility, pregnancy, supplements

Categories

General Pregnancy, Health & Wellness, Podcast

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Speaker 1: I'm so excited for today's episode! We have the fabulous fertility specialist, Dr. Cindy Duke, and warning, there is a bit of discussion surrounding more adult topics.

Speaker 2: Welcome to the All About & Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

Speaker 1: Nicole: Well hello there. Welcome to another episode of the podcast. This is episode number 47 and I'm so glad you are here today. I hope you are having a wonderful day. I'm having a great day because I am super excited about today's episode. It is with fertility specialist, Dr. Cindy Duke. Dr. Duke has her own practice in that sunny Las Vegas, Nevada where she treats patients from all backgrounds on issues related to fertility preservation and infertility. Outside of her clinical work, Dr. Duke is a speaker, she's a philanthropist and she focuses on global girl empowerment, including empowering single mothers. She is the CEO of the recently formed Girl Powered Success and Survival International Academy. Dr. Duke has over 36,000 followers on Instagram where she provides great information related to fertility, and fun fact, her brother is actor Winston Duke. He played Baku in black Panther, but guys, please do not contact her trying to get in contact with her brother.

Speaker 1: Nicole: All right, so this episode is packed full of information. We talk about the top reasons or causes for infertility. She shares with us mistakes that women and men make in regards to fertility. We talk about what to expect when you see a fertility specialist as well as how complimentary or what are sometimes termed alternative therapies like acupuncture and herbs, how those fit into fertility. And then finally things you can do right now to improve your fertility. This is great information, whether you've never had a baby before or whether you've had a baby and you want to have another one. One of my favorite interviews for sure and I know that you will enjoy it.

: Nicole: All right now before we get into the episode, a quick listener shout out. This is to Eveabbate, and the title of the review is thankful and it says, "so thankful to have come across this podcast. I wanted straightforward episodes and answers and that's exactly what I got even though I'm not pregnant, but we're trying to conceive, I feel more informed and more confident for when I do get pregnant. I'm recommending this podcast to all of my friends and family." Thank you. Thank you. Thank you so much for that kind of review. I really appreciate those lovely words and I had listeners just like you in mind when I asked Dr. Duke to come onto the podcast and I'm certain you'll find this episode as helpful as the rest and I also wish you and all of the folks listening who are trying to get pregnant an easy time conceiving.

: Nicole: All right, and one quick announcement before we get into the episode. If you don't know, I have a Facebook group called All About Pregnancy & Birth and beginning this month we will start giving away one spot every month in my signature online childbirth education class, The Birth Preparation Course. The Birth Preparation Course ensures you are knowledgeable, prepared, confident, and empowered going into your birth. We're giving away one spot in the All Access level every month. That is a $297 value, so to find out how you could win that spot, you've got to join the group. You can search for it on Facebook, All About Pregnancy & Birth or we will of course link to it in the show notes. And if you're curious about The Birth Preparation Course, then definitely check out my free online class on how to make a birth plan that works. There's tons of useful information in there on how to make a birth plan, what to include, how to approach it. Some really important things you need to know before you write a single word of it, how to get your doctors and nurses to pay attention. Women love this free class and it's a great way to get a feel for the chorus. You can sign up for the free class at www.ncrcoaching.com/register.

: Nicole: All right. Without further ado, let's get into today's episode with Dr. Cindy Duke. Hey Cindy, thank you so much for agreeing to be on the podcast. I am super excited to have you here today. We have, or I should say, I have lots of women who listen who actually aren't pregnant yet and are thinking about getting pregnant or want to get pregnant soon. So it was really important for me to bring a top notch fertility specialist on to help them as they're thinking about getting pregnant. So thank you.

Speaker 3: Cindy: Thank you. Hello to everyone listening. Thank you for having me on. I'm really excited to be here.

Speaker 1: Nicole: Yeah. Well why don't you tell us a little bit about yourself and your work?

Speaker 3: Cindy: Well, I think you've mentioned I'm a fertility specialist, so that means I'm an obstetrician gynecologist by training who then went on to do sub specialty training in reproductive endocrinology and infertility. That's a three year training program. And so I treat women or thinking about getting pregnant, those who are actively trying but not successful yet, those who have had a history of multiple miscarriages, what we call recurrent pregnancy loss, as well as those who are looking to preserve their options for future fertility. And so that would be women who maybe would like to have children in the future but aren't ready yet or don't have a partner or God forbid, those who have a diagnosis, like a cancer diagnosis and require some treatment like chemotherapy or radiation that could potentially damage their eggs. And so we freeze eggs beforehand.

Speaker 1: Nicole: Okay. Awesome. I think people don't realize how much that fertility doctors do. So, very involved in your work and you're in Las Vegas, is that right? So what led you to become a fertility specialist?

Speaker 3: Cindy: Oh my goodness. You know, it's funny about that question because when I applied to medical school and started medical school, I intended to become a pathologist.

: Nicole: Interesting.

: Cindy: And then I started medical school, loved the anatomy lab, but realized that I loved talking to patients.

Speaker 1: Nicole: And for the listeners, pathologists like look at slides all day, they don't, they don't talk to anybody.

Speaker 3: Cindy: I quickly realized, oh my goodness, that may not work. And then I became interested in infertility by happenstance. So as a second year medical student where you were supposed to do an OB GYN rotation, but the rotation that I was supposed to do, the resident had actually gone on maternity leave very early. So in a quick about term, they had to find a new clinic for me. And the clinic that had an opening was the fertility clinic. And so I didn't even know the field of fertility medicine existed until I went into that rotation and I was just fascinated. I mean it had a little of everything they were doing, you know, see patients in their early pregnancy. But there were also helping patients to get pregnant, treating men as part of the treatment for fertility. And then they did research and I actually was an MD PhD student, meaning I was working on both my medical degree and my PhD in what ultimately was a PhD in microbiology and immunology. So it just seemed to tie everything in and they did surgery. I like using my hands, so it seemed like the perfect fit for me.

Speaker 1: Nicole: Right, right. That's awesome. So tell us a little bit, just a little tiny bit more. I know you said it's a three year training beyond OB GYN, but just so folks can get a spectrum of like what you went through for medical school, your PhD, your residency, the training afterwards, how that worked and where'd you go?

Speaker 3: Cindy: Yeah, it was a long time. So you know, I grew up in the Caribbean, I grew up in the Southern Caribbean, Trinidad and Tobago. So I did all of my pre college education in the Caribbean and then we moved to the United States. I went to college in New York city city college, in New York, and I got my bachelor's degree in biochemistry. So that was a four year degree. Then I applied to medical school. And was accepted into the MD-PhD, or what we call the physician scientist training program. And so ultimately that was an eight year program. So in those eight years I earned my medical degree, a master's degree and my PhD. So after those eight years I went on to do residency, which is a four year program. I completed my residency at Johns Hopkins hospital in Baltimore, Maryland. And from there I went to Yale New Haven hospital at Yale University School of Medicine. And I did a three year program sub specializing in reproductive endocrinology and infertility. So altogether after college, it took me, let's see, eight plus four plus three, so 15 years of training to become the REI specialist that I am today. And of course once I finished fellowship, I was looking at all my options and I decided, you know what, I'm going to open my own practice. And that's how I ended up in Las Vegas. Opened my own clinic called Nevada Fertility Institute.

Speaker 1: Nicole: Awesome, awesome, awesome. So guys, you can hear that she's obviously very well educated and qualified to give you information today. That's why I was so super excited to have Dr. Duke on today. And also I will link to her, she has a podcast that she just released and I'll link to her website and she has a great Instagram feed. So I will link to all that so you guys can get more from her afterwards. So let's get into when should a woman see a fertility specialist?

Speaker 3: Cindy: Well, the number of reasons for seeing a fertility specialist, I'll start by categorizing them. So women, they come to see a fertility specialist because they've been actively trying to get pregnant and haven't been successful or they get pregnant but do not stay pregnant, meaning they miscarry. A woman may choose to come see a fertility specialist simply because she wants a check up. So she may not be actively trying to get pregnant right now, but perhaps she's looking into freezing her eggs or she simply wants to know what her status is. So if you're someone who's tried to get pregnant or what we call trying to conceive, the way we categorize coming to see the doctor depends on your age as a woman and how long you've been trying for. So if you're a woman under age 35 and you've been having regular unprotected sex, if you're in a heterosexual relationship, if you've been having regular unprotected intercourse for a year and haven't gotten pregnant, you should go see a fertility specialist.

Speaker 3: Cindy: So if you're under 35, 12 months of unprotected, regular intercourse, and by regular we mean having intercourse every other day around the time of ovulation, then you should go see a fertility specialist. If you do not ovulate at all, you should go see them right away. If you're a woman 35 and older, we say six months of unprotected intercourse. So if you're 35, 38, 40, 41 we say have regular unprotected intercourse for six months, and if after six months you're not pregnant, you should be seeing a fertility specialist. So that's how we classify infertility. It's based on the woman's age, not the age of the guy in the relationship, but the woman and whether you're 35 and older or under 35. We now have a slight modification to the over 35 group, it's not a rule of thumb. But we encourage women over 40 if you are trying unprotected intercourse for three months and not pregnant, we encourage you to come see us.

Speaker 3: Cindy: And that's just because we know over 40 the window that a woman has available for getting pregnant is a lot shorter. And so we say don't wait six months but at least three months instead. So that's the person coming in who's been trying to get pregnant. If you're someone who's been getting pregnant but not staying pregnant, then we recommend as fertility specialists considering seeing someone like us, if you've had at least two pregnancy losses. And so pregnancy loss can either be recurrent positive pregnancy tests that then stopped being positive. We call those, you know, like biochemical pregnancies or if you're someone who gets pregnant but doesn't stay pregnant, meaning you miscarry at any course or you have recurrent still birth, et cetera, you should come see a fertility specialist as well. And then of course, like I said, anyone who's considering pregnancy or just wants to know their general fertility status, it doesn't hurt to see someone like myself.

Speaker 1: Nicole: That was outstanding and very clear and I really appreciate you adding the, the piece about age. I think in our society and we see sometimes celebrities getting pregnant at later ages, women don't realize the impact that age has on fertility and we're not trying to be like discouraging, but we just want you to have a realistic picture of what it's like.

Speaker 3: Cindy: Yeah, and it's really important to emphasize that because as women we're born with all of our eggs. We do not make eggs as we age. And so when a little baby girl is born, she's born with all the actual she will have for the rest of her life and as she grows up or egg numbers decrease such that by the time you're age 30, three zero guys, 70% of the eggs you are born with are gone. And by the time you're 40 only about 3% of the eggs that you are born with are remaining.

: Nicole: Oh I did. I know it was that low.

: Cindy: Yeah, no, it's a dramatic drop off. And so that's part of why at 40 we say, you know what, don't waste time because you're really only left with about 3% of your eggs. And if becoming a parent is a priority for you at that point then you're working with a really small window of time. The other kicker with all that is not only are we born with all of our eggs, but obviously our eggs are then aging with us. And so for example, if you're 35 years old, your eggs are actually 35 years old too. So they don't perform the same way and the same energetic way that they would have at say 20 or 25 likewise, 40 year old eggs behave differently. And of course with that comes the increased risk of things like down syndrome and other chromosomal differences that can impact your chance of pregnancy and your child's quality of life. And so we really encourage women to at least come in and talk about maybe freezing your eggs so you can stop the aging of the eggs if you're not ready to get pregnant.

Speaker 1: Nicole: Awesome. Excellent, excellent information. And again, ladies, not to scare you, but we want you to be informed. Like that's the whole purpose of why we're having this discussion today. So what can women expect when they come see you?

Speaker 3: Cindy: I like to tell women that the visit to the fertility specialist should not be anxiety provoking, but it is. So what I encourage is to have a few things ready for that first visit so that it can be as informative and as productive as you want it to be. So a couple things that you can expect is your fertility specialist is going to ask you questions about your family and your family history. So before coming to see the fertility doctor, it's actually a very good idea to maybe have a quick chat with your family, ask your parents whether or not there are any members of the family on either side of the family who had children who died young, not from an accident. Any kids with diseases such as sickle or sickle cell trait, family members who have severe learning problems or mental disability. You want to know that kind of history because you will be asked for it and it's actually because it has a true important bearing on your own fertility status.

Speaker 3: Cindy: We ask that you, if possible, have your records sent to us from your OB GYN or family practice doctor. So, you know, pap smear records, if you're someone 40 and older, your mammogram records, things like that should be sent to your OB doctor. If you're someone who's had children before but are now struggling to get pregnant, you should also have your pregnancy records sent beforehand because we'll ask you for those and we'll ask you very detailed questions about your prior pregnancies. How far along in the pregnancy did you get, how far along did you deliver? Was it a full term delivery of preterm delivery? If you had a C-section, why did you have a C-section? Those are questions that doctors will ask at your fertility appointment, not because we're being intrusive, but because it's really important that we know those things. If you're someone with chronic diseases like high blood pressure, diabetes, rheumatoid arthritis or lupus, we should get those records too. If you're not able to get them, at least be familiar with your own medical history cause we'll ask you questions cause those things can all impact fertility in that it can impact your chance of getting pregnant, but it also impacts your chance of staying pregnant. And so we want to know about that. We want to make sure you're being well cared for, that they're being well managed before you get pregnant.

Speaker 1: Nicole: That is awesome information. So a lot of it at that first visit is really information gathering. So the better prepared you are with that information, the more you'll get out of the visit?

Speaker 3: Cindy: Absolutely. Because certainly at my clinic, for example, I actually ask these questions of the patient before they arrive, so we have them fill out a questionnaire online. My staff are also very good about calling patients that say, we don't have any records for you yet. Do you have records that we can maybe help you obtain by contacting the various doctors on your behalf? Because it makes it a more productive appointment. If I spend the bulk of the appointment finding that information, I can quickly assess your story if I have the information already and give you more details, but that's something that I like to tell patients that they can expect. The other thing is the big fear that people have when they're coming to see the fertility specialist is they think we're going to automatically push in vitro fertilization.

: Cindy: That first visit is not an IVF sell, it shouldn't be. It should not be an IVF sell. It's an appointment to really get to know you, understand your goals. You know, some people come to see a fertility specialist, like I say, because they're trying to get pregnant. But the things we want to know is what's your timeline? How quickly do you want to get pregnant? Maybe how many children you're looking to have or how many more you want to have. And in some cases some family members are coming in because they want to get pregnant, but they're looking to do what we call family balancing. Maybe they have, you know, for boys or for girls and they're looking to now have a child of the opposite sex. And so that's something that we like to find out. Those are the questions we ask you.

Speaker 1: Nicole: So you're really trying to, which I love, you're trying to get people ready, get women ready ahead of time so that when they come to this visit you can really focus on what they want and come up with a plan as quickly as possible to help them get there.

Speaker 3: Cindy: Exactly. That's really the goal. The goal is to get to know you, understand your priorities as it relates to the pregnancy and then come up with a plan. So during that first visit you may also get some blood work because we're testing things like your ovarian reserve, meaning how many eggs do you have remaining, how is your thyroid gland working because it plays such an important role in fertility. We check your vitamin D levels so you'd get some blood drawn as well. And at some clinics they even do an ultrasound on that first visit, an internal ultrasound.

Speaker 1: Nicole: Okay. And if you find, you know, I hate, I don't want to throw any of my REI colleagues or infertility colleagues under the bus, but should women have a little bit of pause if at that first visit there's a big push and sell for IVF. Is that something that they should be cautious about?

Speaker 3: Cindy: I think you should have some, you know, second thoughts on it. Yes. Now I would say the caveat is some women show up and it's very clear they need IVF on that first visit. That's on who they were seeing before they start interacting with the fertility specialist. So, for example, some of my OB GYN colleagues out there, by the time their patient is getting to me, they've already done some of that initial infertility workup, some of the general OB guides. And so in that case, the patient may already have had some of her basic infertility bloodwork done. Maybe we already know that her fallopian tubes aren't working.

: Nicole: Got it.

: Cindy: Fallopian tubes, that's the place where the sperm and egg usually meets in a woman's body to start a pregnancy. So if it's happened that she's had them removed, then we know already that the only way she's going to achieve pregnancy is with in vitro. So in that context, that may be the reason why she's hearing about IVF at that first visit. But yes, if it's a first time seeing someone ever talking about your fertility issues, then it shouldn't be IVF focused. It should be your health. Figuring out what's going on with you, figuring out your goals and doing initial assessments to determine what your fertility concerns are and the causes.

: Nicole: Got it. Perfect. Perfect. So what are three questions that women should ask a fertility specialist when they visit?

: Cindy: I think it's really important to find out from your doctor what are your chances for a pregnancy based on your current situation. You know, it's honest to say that as fertility specialists we are hope specialists. We are people who believe that there are chances and ways to get pregnant. But we also, I know for myself in particular, I like to be realistic with my patients and so it's really important to tell them the honest numbers. So for example, someone's showing up at 25 who hasn't had any periods. Usually the cause for her not having periods and therefore not ovulating is very different from say someone who's 45, 46 47 showing up, wanting to get pregnant, but not having periods anymore. And so it's important to find out what are your chances because those two patients will have very different chances of success. And as a result, that conversation will actually be guided in a different direction for both. So you want to know you, what are your chances? That's number one. And what's a realistic timeframe to pregnancy. So, some patients, you know, it may only take six to eight weeks in terms of treatment to achieve pregnancy, but the average time frame, meaning from the day you arrived at your clinic to the first pregnancy tests, it's really somewhere between 12 weeks to six months, meaning three to six months.

Speaker 3: Nicole: Oh wow.

: Cindy: I think it's important for patients to hear that because when they show up for fertility appointment, a lot of patients, particularly the ones who are eager to get pregnant now, they've been trying for so long, oftentimes they just want it done. It's a stressful process. They want to have that baby. Usually when you're trying to get pregnant, suddenly everybody's pregnant around you. So of course it's writing, but asking about that realistic timeline. If you are at a clinic and they're telling you things like you could be pregnant in a month, you know, it's not very realistic and it actually sets you up for expectations that would only really not pan out. And it's not because your doctor is incompetent, it's just that the timeline was so short in terms of the expectations that were laid out for you. And then number three would be, you know, if you're talking about getting fertility treatments, finding out what your coverage is, like if you have health insurance, what does your insurance cover, what is not covered? What might be your copay or deductible? What can you expect in terms of costs?

Speaker 1: Nicole: Got it. All excellent questions. Excellent. Excellent questions. So if you could generalize, when you see women, what are the top three reasons that women have trouble getting pregnant?

Speaker 3: Cindy: The top three reasons coming through our door are the ones who don't have regular periods. So that's called an ovulation. And it tends to be women who have something called polycystic ovarian syndrome, EOS. And so those are usually the women where their menstrual cycles aren't regular per se. Meaning they get periods, many of them, but they don't come at a regular predictable time every month. Or they only get very few, like three to four periods a year. And then the very extreme of it is they get no periods at all unless a doctor gives them a medication, like something called Provera. So that's probably one of the top reasons. The next big reason actually involves women who have what we call tubal factor. So these women who have tubal scarring either scarring because of something called endometriosis or history of pelvic inflammatory disease or infection with things like chlamydia that led to scarring of the fallopian tubes or God forbid they've actually had the tubes removed or tied.

Speaker 3: Cindy: So we do have women who had tubal ligation because they thought at one time they were done and they either have met a new partner or they're on a different stage in their lives and now they'd like to continue building their family. So that's tubal factor. So the first thing I said is those who aren't ovulating regularly, those with tubal factor. And then the next big group of women who come in would be those who have what we call diminished ovarian reserve. So those who their egg numbers are on the lower side. That could be from natural processes like aging. So many women at age 38 and older have diminished ovarian reserve, less eggs compared to their peers of the same age group or someone who's had maybe repeated surgeries on her ovary for like ovarian cysts, et cetera, and now the ovaries have less eggs or she's had chemotherapy or radiation for history of cancer.

Speaker 1: Nicole: Okay. All right, and then what about the male factor? How much of fertility is related to men?

Speaker 3: Cindy: Now this, this is actually gonna blow most people's minds, the chances of infertility 50% of the time, half of the time it involves something that includes the male partner.

Speaker 1: Nicole: Wait, I'm sorry, did you just say 50%?

Speaker 3: Cindy: I did. I did. And I like to emphasize this because it is not uncommon that the only person coming in to see us at the infertility appointment is the woman, right?

Speaker 1: Nicole: Wow. I knew it was high, but I don't stay as up on fertility stuff just because it's not what I do so much anymore, but 50% okay, ladies, that means you need to bring your male partner in if you have one. If it's related to fertility.

Speaker 3: Cindy: It's really important because you know, we have patients come in and I'd say, Oh, was your partner today? And she'd say, Oh, you know, I came in, I just want to get checked out first. You know, we think it's me and it's near impossible to get the guys in many times at the beginning you have to like we spend months working her up doing her testing and then it comes back and she has nothing obviously going on or she does have something going on. But guess who also has something going on?

Speaker 1: Nicole: Mmm, right, right. So is it important to evaluate both people?

Speaker 3: Cindy: Yes. And so it goes without saying that the male partner in a couple, if it's a heterosexual couple, should be evaluated very early in the process. And here's the other reason why a lot of the things going on with guys are reversible if we can identify them. And so, you know, like I just said earlier, for women, we're born with all of our eggs. We don't make new ones. It's very different for guys. Guys keep making sperm their entire lives, but as they age, their sperm numbers decline, they drop. So it's really important to check because sometimes there are medications we can put them on to help boost his sperm. That way you can start making more. The other reason is because nowadays, especially in the Western world, including the United States, many guys are taking supplements and different things to boost their performance, how they look, how they feel and workout at the gym. But those things almost always involve something that causes the testicles to go to sleep, meaning they sperm or they decrease how much sperm they're making. And so it's really important to evaluate him early, figure out what he's taking, figure on his medications, his supplements and vitamins. I'm using air quotes when I say vitamins because there are a lot of things that guys take that actually negatively impact their sperm counts and fertility that we can correct if we know about it.

Speaker 1: Nicole: Right, right. That's awesome. Great information. So what are three mistakes then that you see women or even men making before or couples making before they come in to see you? What are three mistakes you see?

Speaker 3: Cindy: I think one is taking a very long time before coming in. So it's common to see people and it always blows my mind who they've been trying to get pregnant for well over a year, two years, three years, nine years, and never got an evaluation related to that. They haven't actually counted it as trying. So what I say to couples and to anyone listening, if you've been having regular unprotected intercourse, even though you weren't actively trying to get pregnant, if you guys aren't using any form of birth control, you're not using condoms, anything at all. And you had even a pregnancy scare and all that time that still counts as having tried, even though you weren't thinking you were trying. You were trying. And so if you haven't gotten pregnant despite all these years of unprotected intercourse, that's something, there's something going on there either with both partners or at least one of them that's preventing pregnancy.

Speaker 3: Cindy: So that's the, one of the big things is people take very long time before they come in to get evaluated longer than most of them realize. The second reason, the common mistake I see is in terms of just figuring out when in your cycle you're ovulating. So I prompt a big one. I go on and a lot of people don't either remember what the menstrual cycle looks like or when they're ovulating. So it's not uncommon for me to meet women who think they're actually releasing an egg when they're bleeding, when they're having their period, which is the exact opposite. And it leads to them having, they're trying meaning they're having intercourse at the wrong time of their cycle. And so I encourage people to, if you're thinking about trying to figure out, first of all, are your cycles regular? Maybe download one of the many apps out there that help you track your period. If the period tracker just isn't working out very well, that may be a sign that you're not having regular periods or doing ovulation predictor kits, which is testing your urine in the morning time to know when it's your peak fertility window, so to speak. But again, you need to understand when that might be.

Speaker 1: Nicole: Perfect. Excellent information. Anything else that is a mistake, and I should say guys, those ovulation kits aren't terribly expensive anyway. I think they keep coming down in price and you can get less expensive ones. So they're not like you're going to be spending hundreds and hundreds of dollars every month trying to figure this out.

Speaker 3: Cindy: Absolutely. And to add to that you actually, you don't need the expensive ones. So I know some of them, you know, they can cost 40 something to 70 something dollars. And so if you're buying multiple kids over a number of months, it adds up very quickly. But the truth is the ovulation kits that they sell at the dollar store, which is just a special stick you dip in your urine and you look for a color change. It works just as well.

Speaker 1: Nicole: I love that. Yes. Same thing about pregnancy tests. I personally used dollar store pregnancy tests. They work just as well.

Speaker 3: Cindy: It works just as well and so you don't need to break the bag to figure out if you're ovulating. Same thing goes for vitamins, all those things you do not need to break the bank. They all have the same basic function and basic ingredients and so except for all the gimmickry and the extra bells and whistles, you're getting the same information.

Speaker 1: Nicole: Exactly. Love that. Love that. And then is there anything else? Did we cover...

Speaker 3: Cindy: Well for guys? Right. I would say a few things that you can do beforehand that I see people not taking into consideration would be against supplements. A lot of guys are taking workout supplements, muscle building supplements that have testosterone like gradients. And so the other thing is for a lot of guys they've been told if you take testosterone, you have more vigor, more libido, more desire, but almost all of those things, while it gives you more performance, decreases your sperm counts. And so you really, really, really want to avoid those things. If you're a guy who's not feeling energetic, you don't feel like you are able to maybe maintain an erection or you have problems with ejaculations come see the doctor before you start taking supplements that your friends have recommended or before you start taking testosterone. Testosterone is essentially male birth control. Don't take it if you want to have children.

Speaker 1: Nicole: Okay. All righty. Love this. This is so much great information. I'm so glad you're here. So what are three misconceptions about fertility treatment? I know one you talked about already is the length of time that it takes. Is there anything else that people have misconceptions about?

Speaker 3: Cindy: The big thing that people have misconception about is that when they do fertility treatments, particularly in vitro fertilization, and in vitro fertilization or IVF is the process where we take eggs from a woman's ovaries and create embryos, meaning we fertilize them with sperm in the laboratory. Many people believe when we go in to take out eggs, we're taking out all of their eggs. And so they're very worried that coming to the fertility doctor means we're gonna take all of their eggs. And then even if they wanted to try in the future and now they're gone, that's not true at all. And so when you see us and we treat you, if we're doing in vitro fertilization, the eggs we're taking from you in any given month are all the eggs that your ovaries would have used up anyway in that month, that's it. We're not taking any of your other eggs to come in the following months.

Speaker 3: Cindy: We're only getting the eggs that your ovary would have used that month anyway. So IVF is really an egg rescue mission and rescuing the eggs for that month. But no, we're not using up your eggs. We're not taking eggs that you otherwise would have held onto for a while. That is not how it works. So I think that's one of the common misconceptions, as it relates to fertility treatment. The other is a lot of people think that if they come in for fertility treatment, we can select eye color, hair. color, all sorts of things about their baby. We don't have that technology yet.

: Nicole: Okay. All right. I didn't know that people come in and ask for those types of things.

: Cindy: There are things we can select for and help with. So we have technology now where we can find out if the embryo is male or female before we put it until the mom for IVF. So you can certainly select, so we call that family balancing. So for example, if, let's say you've got three daughters but you want a son, we can help you figure that out before you're pregnant. We have technology like that. We have technology where we could identify diseases before pregnancy. So for example, if both parents carried genes for sickle cell disease and they're interested in finding out which of their future embryos, babies may have sickle cell, we can screen for that, we can test them and let you know beforehand which ones have the disease. We have technology to do things like that. But no, we don't have a technology for eye color, which is a very common reason people ask.

Speaker 3: Cindy: We don't have anything that can guarantee hair color, hair, texture, skin tone. We don't have things like that. And we certainly don't have anything at the moment that can help us determine IQ intelligence.

: Nicole: I am sure people ask about that too. So what are your thoughts on complimentary or what may be considered alternative therapies for fertility such as acupuncture or anything like that?

: Cindy: I'm a fan. I'm a proponent. I encourage patients to consider those things. They have a role now? Do I think it's the efficient for someone who truly has infertility to overcome it? No, but like you said, it's complimentary. So it does complete therapy paradigm. So I certainly encourage my patients to get acupuncture. I encourage them to, if they're interested and they want to see an herbalist or fertility specialist, it's okay to consider it. But I give you some caveats here and some words of caution. So in terms of acupuncture, if you're going to consider it, it's recommended that you probably start it about six weeks to two months before you initiate your fertility treatments. So we encourage patients, if you're going to consider it, that's what you should do. If you're someone who was seeing an herbalist, etc, this is really important for me to clarify. So there are some promises that herbalists make but aren't really realistic. I just have to be honest here. There are certain things that they're being promised. They're being told a certain herbal remedies can maybe shrink a fibroid or make their fibroids go away. I know for a fact that's not true. I believe in drinking teas. I believe in a lot of herbal supplementation, but there's no current herbal that can do that.

: Cindy: The other thing is if you're on supplements, you really need to understand how they work. Because many supplements may have a function that actually goes against your fertility goal. So some of them actually work as well as a birth control does. Yeah, you need to know what you're taking and don't just jump online and read something or read someone's testimonial and they said, Oh, this worked for me. You know, you know what we say in science and have one, one person, yes, one person's testimonial does not equal evidence. It's not research, it's not science, it's one person's experience. And so it's very important to keep that in mind. The other is if you are finding that you're spending a lot of money on these therapies, you're probably spending too much.

Speaker 1: Nicole: Okay. Okay. Got it, got it. So you're definitely open and willing to work with some of those things. And the other thing is that you need women to be honest about what they're taking and just put it all out there. There's no like judgment or anything. You got to know everything so you can come up with a good plan.

Speaker 3: Cindy: Yeah, because like I said, some of those supplements actually work against your fertility goals. And so if you don't tell me, then we're actually not working together. So if you're on medication, for example, there's one out there, it's called chaste tree extract. And a lot of people are taking Bitex because they've heard that it's an ancient Mayan remedy. It's an ancient this that, and Bitex does have some hormonal activity in your body. The issue is by text works as progesterone. So if you take it the whole month, you're actually not going to achieve pregnancy. There's a very special time where that may work, but only that time. And so it's important that you let me know. Cause if you're on Bitex and I'm treating you for fertility but you haven't told me, then your uterus isn't really willing to receive that baby.

Speaker 3: Cindy: It's not going to let that baby implant. And so we're working against each other at that point. And so it's very important that you tell, I actually say to patients, if you're getting fertility treatments, you should not be on any herbs or supplements that your doctor didn't recommend. And if you speak to a trained herbalist, they will tell you the same thing. Usually they say let's do your medications and your herbs and your supplements two months before hand, not while you're getting treatment. Acupuncture is different. You can continue and should continue your acupuncture during treatment and even during early pregnancy because it helps to decrease stress levels, stressful hormone levels. It helps to relax patients. It can help with blood flow in the uterine lining. And so yes, acupuncture, we encourage and we say continue, but supplements and herbals and teas really, really, really tell us and ideally stop them until you've been told otherwise.

Speaker 3: Nicole: Got it. Perfect. Perfect. So what are three things that you recommend women can do right now to help improve their fertility?

: Cindy: Let's see. I would break it down by age. So, okay, let's say, Oh, another misconception as I lead into this, some believe that birth control causes your fertility to go away. So it's not uncommon that women would come in and they say, oh, I stopped my birth control cause I felt like it was killing my eggs. That's not true. Eggs just naturally decline, whether you're on birth control or not. As a woman ages her egg number will decrease. But things that you can do to help would be looking at your body weights and your body fat. And so what we talk about with women is the two extremes actually work against you. So if you're really, really, really slim and don't have a lot of body fat, you will not ovulate.

Speaker 3: Cindy: So if you're someone who is an intense athlete, someone who maybe you're a gymnast or a marathoner, you're a professional athlete. If you have very low body fat, ideally if you have body fat less than 12% that actually leads your brain to say, you know what, we're not healthy enough to have a baby. And so it won't ovulate. And so if you're someone who's got a body mass index and definitely a body fat percentage under 12% you might want to gain a little bit of weight and a little bit of body fat to help your chances of fertility. Likewise, if there's someone who is what we call overweight, so if you are over the, what we call weight thresholds for your height, then we might recommend trying to lose about 10% of your weight because we know that up to between 20 to 30% of women who lose about 10% of their body weight, if they're on the overweight side, they will actually start ovulating spontaneously.

Speaker 3: Cindy: And so if you're trying to get pregnant, some weight loss may help you get pregnant without the aid of fertility treatments.

: Nicole: Gotcha.

: Cindy: So be aware of your weights. Be aware, especially that if you're someone who is underweight or overweight, it can directly impact your fertility. The other thing is not taking active steps to determine if you're ovulating. So like we talked about earlier, figuring out whether you're ovulating, figuring out if your periods are regular is a key early step that can really help you determine if you need to see your doctor sooner than later. And then what's the third common mistake that women make or men, will this include men?

: Nicole: Yeah, sure.

: Cindy: The common mistake that I would say is the assumption that I've had a child before so I can't possibly have infertility and that is not true. There's actually something called secondary infertility, meaning in people who have had one or more children before, they can still go on to struggle. And so it's really, really important that as someone who had children before, you still follow those rules that we talked about. So notice I said, if you're under 35 having unprotected intercourse for a year but didn't get pregnant, you should go ahead and seek help. In no way did it include someone who had a child before or not. And that's because it doesn't matter infertility affects everyone. And actually 16% of couples who have had a child before go on to have infertility.

Speaker 1: Nicole: Huh. Interesting. I did not know that. I did not know that. And then I'll just add also like in terms of improving your fertility, I know you just talked about weight, just try to be in the healthiest, getting a state of as healthy as you can period. So really nourishing and thinking about what you put into your body and taking the best care of yourself that you can. I'm sure that helps a lot. Not just your physical body but also your like a mental and emotional health as well.

Speaker 3: Cindy: Oh absolutely. So diet is huge. Quality of diet is huge. We actually emphasize if people can, we try to encourage that they avoid red meats. So if you eat red meat, not as often, you know, watch your dairy intake. Certainly if you're someone with PCOS you want to eat a healthy diet, a low carb diet, not a no-carb but a low carb diet and eat regularly. So we don't emphasize a starvation type diet when you're trying to conceive.

Speaker 1: Nicole: Got it. Perfect. Perfect. Well awesome. Well just wrap up just a couple of quick questions about how you feel about your work. What's the most rewarding part of what you do?

Speaker 3: Cindy: I think it has to be the babies.

Speaker 1: Nicole: That's what I was going to say. I didn't want to answer the question for you, but I can imagine it must be incredibly rewarding when people come back and bring their babies.

Speaker 3: Cindy: Oh my gosh, yes. So yesterday we actually had three babies come in all unexpectedly. They came in to visit, moms and dads brought them in and uh, it just lights up the world. It gives you so much energy and just seeing a new human being, just to think a whole person is packaged in that little person.

Speaker 1: Nicole: Yeah, I know. And like, I'm sure some of them have long journeys and that just must be incredibly rewarding.

Speaker 3: Cindy: You know, it's like you're visiting with miracles, you know, and that's something just, it lights up my whole soul to be able to see a miracle embodied before us because yeah, the stories are, oh, you know, one of the babies that came in yesterday, mom and dad had been trying for eight years, then they'd had a few miscarriages. So this baby was what we call a rainbow baby. And that just meeting her was like just looking at her and she seemed like an old soul, you know? Like she, she knew that she had come to heal.

Speaker 1: Nicole: Oh, I love that. I love that. Love that. So on the flip side, what can be frustrating about your work?

Speaker 3: Cindy: Well, it's because it's not an exact science, right? And so it's not guaranteed and it hurts me and I'm sure it hurts all of us in the field that, you know, when a patient comes in, we know that they're coming in with extreme emotion and they really want to hear us say, I guarantee you that you'll take home a baby. Yet we're not able to guarantee a take home a baby. We can truly, truly improve chances for pregnancy and chances for taking home a baby, but it's not 100%. And so that can be really painful just explaining that or watching someone work their way through that. And for me personally, my big frustration is that I know it's still a costly process. I know. And so like many others in my field, I'm actively involved and advocating for making our care and our services more affordable, more accessible, so that more and more people can get in to afford treatments. So that, that is a frustration. I know it, I know patients get frustrated. I'm not sure that they know that we understand their frustration and agree with them because I know there are a lot of misconceptions out there that, you know, fertility doctors are just in it for the money. But that's not true. That's not true.

Speaker 1: Nicole: Yeah. Yeah. So what would you say you're especially passionate about in caring for women? It's probably hard to narrow down one thing. You just seem so committed to really helping women achieve their, their dreams.

Speaker 3: Cindy: It is, for me, it's a passion. It's a life passion. And for me it's a holistic approach. So you know, much like we alluded to here today, it's not just about helping someone achieve pregnancy or preserve their fertility, but I want to make sure they're in a good emotional state. I want to make sure that they feel empowered and emboldened. But what do I enjoy? Well, if you ask me what's my research in the field of fertility and the world of fertility, it involves working with women, particularly those with a cancer diagnosis. It's called oncol fertility. So really, you know, I partner with a charity. So we offer services to help women freeze their eggs or create embryos, if they've been diagnosed with cancer so that they can afford a chance of having a biological child in the future. So for example, with that charity we're able to get them their medications at no cost for fertility treatments.

Speaker 3: Nicole: Oh nice.

: Cindy: Oh yeah, we can save them up to $6,000 that way I also waive my own professional fees. So the only fees they pay for if they have to pay for anything would include just the laboratory services. So that's one of the things that I'm passionate about and making it affordable and accessible to patients. And those include patients who are as young as 14 or 15 years old, helping them freeze eggs before their treatments or having their ovaries taken out, et cetera. That's one of my big passions. The other passion of mine is working with women who have what we call diminished ovarian reserve or those who are older. And so you know, one of the things I'm, the one misconception out there is that if you've had menopause, meaning if your eggs are gone, you could never carry a baby. That's not true. And so we do have women who have delayed fertility maybe for career reasons or they did meet the right partner in some cases who are now in their mid forties maybe early fifties still interested in having a baby, but not sure it's possible.

Speaker 3: Cindy: While it is possible, it's possible with the use of donated eggs, but it's possible. And so I work on just educating women about that and helping to debunk some of the myths around fertility and pregnancy over 40.

: Nicole: Love it, love it, love it. So let's just end with what's your favorite piece of advice to give to women who were thinking about getting pregnant?

: Cindy: Take control of your fertility. Absolutely. Actually just become your advocate. So you know, be more aware of your period. Know if it's regular, emphasize if you're in a heterosexual relationship that your partner come with you to your appointments, especially the first appointments, those initial evaluations, because he should be evaluated too. That's really important. But it's really taking control. So if you're 30 or older in particular, and maybe you're not planning pregnancy yet or you haven't thought about it, but you're going in to see your OB GYN for your annual examination, you should initiate the conversation if they haven't, you know, say doc, I'd like to talk a little bit about my chances for future pregnancy. Can I have an evaluation and maybe your doctor, if they're comfortable, will do that there. If they're not, they'll refer you to someone like me. And most importantly, if you're approaching 35 and haven't had children yet, or you're thinking you'd like to have more children, you should seriously consider freezing eggs if not making embryos and freezing them.

: Nicole: Got it. So just take control and be empowered to advocate for yourself.

: Cindy: Yes, yes, yes. I think, you know, unfortunately we've done a great job with our advice for women taking control of their lives, taking control of what they do with their future. But we haven't talked about the fact that the eggs do go away.

Speaker 1: Nicole: Yeah, exactly. Exactly. Well, women will certainly be able to take control and better advocate for themselves after all of the great information that you have provided in this episode today. So I am so appreciative of you coming on.

Speaker 3: Cindy: Thank you for having me on. Thank you. Thank you. Thank you.

Speaker 1: Nicole: Yeah. So where can people find you?

Speaker 3: Cindy: Oh my gosh. Where can they not find me? Well, as you know, I'm very active on Instagram. So @DrCindyMDuke on Instagram, that's my handle. And I share information about all things fertility related. I share things about hormones and how the impact of fertility. I just share things about fibroids and how we can treat fibroids while preserving a woman's fertility and keeping her uterus in place. So that's me on Instagram. But I also talk about things like herbs and supplements and how you can use those for your benefit while seeking treatment for fertility. But then of course, I also talk on my podcast and so I have a podcast which was launched a couple of weeks ago and it's Girl Powered Success and Survival International. And so on my podcast you can find that on any of the streaming networks. And I'm interviewing women from around the world just talking about the things they've done to embolden themselves in their lives, their career, their family. And it's really neat, really cool. We also discover some really neat careers that most of us have not heard about before. And so you can find me there. I am on Twitter at the same handle at Dr. Cindy M Duke, on Twitter and Facebook. Same thing. I have a page or you can go to my website, www.drcindyduke.com.

Speaker 1: Nicole: Awesome. Perfect. Perfect. Perfect. Well, thank you so much again for coming on today. Lots and lots of great information. I know the readers, I mean, sorry, not readers. Listeners are going to find it extremely useful. So I appreciate your time.

Speaker 3: Cindy: My pleasure, and thank you so much for having me on.

Speaker 1: Nicole: Okay. Now did you learn a lot from that episode? I told you it was packed full of information. Now you know after every episode when I have a guest on, I do something called Nicole's notes where I just talk about my top three or four takeaways from the discussion. And here are my notes from today's episode.

: All right, number one, please do not wait to see a fertility specialist if it's been awhile and you're trying to get pregnant. If you are under 35 and you've been having unprotected intercourse for at least a year, you've been trying to get pregnant for a year and you're not yet pregnant, you should go see a specialist. If you're between 35 and 40 and it's been six months, you should go. And as Dr. Duke said, newer evidence suggests if you're over 40 and it's been just three months, then you should go. Now going to see a fertility specialist does not mean that you have to do anything, but it will be incredibly helpful to help you know what your options are so you can kind of plan and take control of your fertility. You definitely want to be sure you maximize that visit by doing things like sending your records ahead of time and remember your male partner needs to come to if you have one, because a a good bit of infertility, it's related to the male partner.

: All right, number two, something that Dr. Duke said, and this kind of piggybacks on the last one about taking control. You need to know your body, understand your menstrual cycle and what that means for your fertility. It's the same thing that you need to do during your pregnancy and for your birth. Really know your body and how those processes work. That will help you go a long way towards getting pregnant if you just kind of understand those basic fundamentals of how your body works and your menstrual cycle and how exactly you get pregnant. And then the last thing I want to say is for those of you who know someone who's trying to get pregnant, just a little piece of advice. Don't say things like, just relax or it will happen when it happens and please do not ask couples, when are you going to have a baby? When are you going to have a baby? All of those things can be pretty supremely annoying and to be honest, mostly unhelpful when you really want to be pregnant and it's not happening as soon as you'd like it to. It can be so hard. For our first daughter, it took us six months to get pregnant and in hindsight, obviously that is not a terribly long time.

Speaker 1: However, it felt like an eternity at the time. And I remember when one of my colleagues announced that she was pregnant while we were trying. She's a lovely woman. I like her, respected her and let me tell y'all, I'm going to be honest, I low key, hated her when she said she was pregnant because it was just, you know, the stress. I just really wanted to be pregnant. So it's different. If someone asks you for advice or your opinion, then sure, absolutely give your advice, give your feedback, but unsolicited comments and advice that is generally not a good idea.

: All right, so that is it for this episode of the podcast. Be sure please to subscribe to the podcast in Apple podcast or wherever you listen to podcasts, Spotify, Stitcher, and you know, I would love it if you leave a review in iTunes or it's now Apple podcasts. I love reading those reviews. They really, really warm my heart. I appreciate folks taking the time to do so. It also helps other women find the show and I can give shoutouts on the podcast episodes. Also, I would love to hear your experience with trying to get pregnant. Let us know in the Facebook group, again, it's called All About Pregnancy & Birth. We will link to that in the show notes or you can search for it on Facebook. Now, next week on the podcast, I am talking about sexually transmitted infections and how they impact pregnancy and birth. This was a request from one of my course members actually. So come on back next week. And until then, I wish you a healthy and happy pregnancy and birth.

Speaker 2: Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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