EP216: Breaking the Silence: Navigating Fertility with Dr. Moragianni

Reproductive Empowerment and Fertility Clarity with Dr. Vasiliki Moragianni

Christine interviews Dr. Vasiliki Moragianni, a double Board-certified fertility physician and Johns Hopkins Medical Director of the Fertility Center, about fertility, infertility, and reproductive empowerment for high-performing women. Moragianni shares her personal experience of secondary infertility, miscarriage, diminished ovarian reserve, and unsuccessful IVF after having her first child, emphasizing that “control” looks different for everyone and requires information and options. She explains infertility definitions and earlier evaluation after age 35, highlights that age is the most important predictor of fertility decline, and urges patients to seek care sooner. The conversation addresses stigma and professional silence around infertility and pregnancy loss, especially in demanding careers and medicine, citing higher infertility and complication rates among female physicians. Moragianni recommends optimizing overall health, stress management, and sustainable habits while giving oneself grace. Find Dr. Moragianni on Instagram, Facebook, and LinkedIn.

00:00 Meet Dr Moragianni

01:37 Her Fertility Story

04:22 What Infertility Means

06:19 Age Options And Stigma

10:44 Workplace Silence And Shame

14:14 Physician Fertility Data

15:55 Optimizing Health For Pregnancy

18:04 Stress Self Blame And Grace

19:30 Final Takeaways And Hope

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today I am pleased to be with Dr. Vasiliki Moragianni. Dr. Vasiliki Moragianni is a double Board-certified fertility physician, academic leader, and national speaker on reproductive empowerment for professional women. Originally from Greece, she trained at Cornell, Drexel, Georgetown, and Harvard Medical School before joining Johns Hopkins where she serves as Medical Director of the Fertility Center and Founder and Director of the Recurrent Pregnancy Loss Center. She has built her career at the intersection of clinical excellence and physician leadership with experience across academic medicine, private practice, and health system leadership. Through her keynotes and her LEAD frameworkTM, she helps high performing women transform fertility uncertainty into strategic clarity and helps organizations build cultures where that conversation no longer has to happen in silence. I will put [00:01:00] links to her social media on Instagram, Facebook and LinkedIn in the show notes so that you can find her.

I'm really happy to be talking to Vasiliki today. 

Vasiliki Moragianni: It's wonderful to be here. Thank you for having me. Hopefully it will be a fun conversation. 

Christine Ko: Yeah. I am excited to talk to you about fertility and reproductive matters because I don't think that I really had many conversations with other physicians, even, about it. But before we get into things, can you first share a personal anecdote, just a little bit about yourself, so we can get to know you? 

Vasiliki Moragianni: Sure. I thought it would be pertinent for our discussion here today. I spent my fertile years in training, and I assumed I had time that I ultimately realized I didn't have. So I was in medical school, residency, and fellowship during my peak fertile years. And then I had our first child easily and assumed that I definitely had more time. And again, this is [00:02:00] coming from someone who is specifically focusing their training and job on fertility. When we tried for a second baby, I was faced with secondary infertility and miscarriage, and ultimately the diagnosis of diminished ovarian reserve. So I underwent two IVF cycles which were not successful, and my husband and I made the deliberate decision to stop there. So I guess what I gained out of this experience was our daughter, whom we adore, and she is amazing, as well as reproductive clarity and being honest about what control really means in this situation. To recognize and discuss reproductive empowerment or control doesn't look the same for everyone. It could be that I never want to have children, or I want to keep trying no matter what the modality is. Or I make whatever choices myself or my partner, if I have one, think are most appropriate. Having the information and the options available to [00:03:00] make these choices is what I think is very important. 

Christine Ko: That makes sense. How old is your daughter now? 

Vasiliki Moragianni: She just turned 10. 

Christine Ko: Oh, okay. Your story's interesting to me on many levels, but part of it was true for me as well. I assumed that I would have trouble getting pregnant for the first time. And actually I didn't, but I had secondary infertility for the second one. I have to say though, I was completely overwhelmed. And I think actually looking back that I had secondary infertility 'cause my body was like, There's no way you can handle having another child. I was exhausted and stressed and in no physical state, looking back, to have another child. 

Vasiliki Moragianni: Yeah. Which is an excellent point because I'm not sure where you were in your career, but I'm sure it was already demanding when you were trying for your first baby, but add a newborn or a young infant to that crazy schedule and then trying to conceive, time intercourse, and figure out your cycle [00:04:00] regularity. None of this is easy and it only gets harder, and all of that as age increases, fertility declines so that it keeps compounding.

Christine Ko: Yeah. I was done with training. You referred to reproductive control. I wanted to try once I was done with training, knowing that I assumed it would be harder for me. But like I said, just you never know until you start trying.

Vasiliki Moragianni: Yes. And we talk about it with patients all the time. There's no screening test for infertility. It's not that I can check your whatever hormone and say, Oh, you're infertile. Come see me. It's more of a, you come to me with your diagnosis of infertility. You tell me, I've been trying, if you're with an opposite sex partner, then we try to figure out possible reasons why. So it is again, even more burden on the patient. It's not that you can do a test that rules in or out infertility. 

Christine Ko: Yeah. It's hard. Is the definition of infertility still a year of trying to get pregnant and not being able to?

Vasiliki Moragianni: [00:05:00] It is a year of timed, unprotected intercourse for somebody with regular cycles, and this is the definition, regardless of the age of the egg source. However, we oftentimes hear about one year versus six months. This comes as the caveat in terms of when to start testing. So an evaluation is more appropriate after age 35 after six months of trying, versus before age 35 a year is okay. It's all based on chances of conceiving at each part of a reproductive life. Obviously when somebody is 40 years of age, you don't wanna wait for them to be evaluated, and then you identify something that has worsened with time in the interim. 

Christine Ko: Yeah. I appreciate you saying that because as someone who did go through secondary infertility, a year is a long time.

Vasiliki Moragianni: Absolutely, yes, of course. These are the strict definitions that we use, but at the same time, I always tell my patients, If it's on your mind, if it's worrying you, if it's worrying your [00:06:00] partner, if it's increasing your stress around this process, then see someone sooner. Asking some questions can only be useful and enlightening. 

Christine Ko: Yeah. What do you wish everyone knew? Or something you wish you had known earlier, in either your personal, or just the fertility journey that you see people go through?

Vasiliki Moragianni: I always view this as a patient issue and an institution or systems issue. So in terms of the patients themselves, I want them to take home: number one, age is important. It's the most important predictive factor. Unfortunately women, we are born with all the eggs we will ever have. So by the time we even hit puberty, we are behind many hundreds of thousands of eggs. So we're already starting at a disadvantage. Do not panic. There's always hope, but it's important to understand that fertility declines with time and it's continuous and irreversible and you can't feel it or see it in any way [00:07:00] or measure it truly, objectively.

That's number one. Number two is understanding your options. There are different options at any level in the reproductive journey. So if you understand where you are and what options are available to you, then you can figure out what makes most sense to you. In terms of the system, the changes that need to happen surrounding exactly what you were talking about: the stigma, the taboo, this loss of control and non-accommodation of anything, needing to suffer all of this in silence. Because you're gonna be viewed as more professionally risky if you're going through fertility treatment or you're trying to get pregnant. These are not okay things in our professional development, and this applies to any high demand career: an attorney, somebody in business, somebody owning their own business.

So it's important that institutions and leaders normalize all of this. We all normalize it. We talk about it. We raise awareness. When somebody has [00:08:00] diabetes, they're not ashamed to say, I need to take my insulin or go to my medical endocrinologist. Of course, as they should not be. But why are we afraid to say, or ashamed to say, I have infertility, I'm having a miscarriage. I'm going through IVF treatment. My partner has no sperm. Whatever the case may be. These are not things that you chose or caused. These are medical conditions that warrant medical evaluation and treatment in a safe space for that to take place.

If I need to lie to my employer about my appointments during an IVF cycle every other day, it's gonna add so much unnecessary stress that will not help anyone. Normalizing and supporting people through a very normal human process is very important and changing the culture. So we talk about it, we embrace it. We don't do anything special with it. We just deal with it as any other medical condition because it is one, and it's related to [00:09:00] biology, and biology does not wait for our career and our call schedules and all of that. 

Christine Ko: Yeah, a couple things. I was doing this meditation practice. I've stopped doing it 'cause I got too busy, which is bad, but it was this app by Sadguru, S-A-D-H-G-U-R-U. He was talking about women's bodies and how the hormonal changes that we have from puberty onward through menopause are just so different than a man. And one of the things he said, you reminded me of it, 'cause he was saying, really once you start having periods, you know, puberty for most girls, women, that's when you know you can have a baby. And he made this offhand comment that if a woman doesn't have a baby by the time she's 19 or 20, that already then her body is out of balance. He wasn't saying that so you have to then have a baby that early. He was saying that's why meditation and some of the things he recommends are very important for [00:10:00] women. What do you think of that? I thought it was so interesting when he said that 'cause I thought, If evolutionary, biologically, we are designed to be able to be fertile that early, maybe it is a stressor on our body when we delay it. 

Vasiliki Moragianni: My training is in Western medicine. There definitely can be value in many other modalities, and I support all of them for my patients and myself personally. But Western medicine data shows higher risk of complications in your very young reproductive years and again your more mature reproductive years and optimal timing somewhere in between. So a 12-year-old getting pregnant, body-wise, is not ideal because the risk of complications is higher as it also is in a 45-year-old woman. 

Christine Ko: Oh, that makes sense. Okay. And you were saying that there's this silence around reproduction. Part of it I think is because of job security. 

Vasiliki Moragianni: Sure. 

Christine Ko: Especially when you're applying for a job and say you're already pregnant, you don't wanna say, Oh I'm gonna need maternity leave. I've talked to people who they feel [00:11:00] awkward about it, as if you're lying, but it really seems like you can't necessarily say that. It's difficult.

And then the other thing I was thinking when you mentioned diabetes, and oh, if you have to take your insulin shot, you'll just say, Oh, I need to go get my shot now. But I actually think that we don't talk about even medical problems.

Vasiliki Moragianni: Absolutely. 

Christine Ko: Like I had breast cancer, people seem surprised that I openly say that I did. And I've talked to other physicians who have had cancer, and some of them, not all of them, some of them actually don't wanna say that they had cancer. One person told me because they feel ashamed, Why did my body get sick? As if it's a failure. So even medical conditions, to some people, there is still some kind of stigma. Like, My body's not the optimal healthy.

Vasiliki Moragianni: Yeah, that's an excellent point. In medicine, we are almost trained, or the mindset [00:12:00] is, Oh, I am so tough, I can survive anything. Bring it on. It's okay. I got it. It's a combination of, If I have anything wrong with me health wise, then I'm not gonna be as sought after as a workforce member in this very demanding career, and also, all of us personally have done so many things. I've taken my MCATs, my step 1, 2, 3; gone through residency, call nights, crazy things. And now the one thing I cannot control. I cannot make my eggs young again, or my sperm function in the way that I want it, or my uterus will not hold onto a baby long enough. So this loss of control of, Ugh, why did I fail? And because, I think, still pregnancy and fertility is a little bit more romanticized. Oh, two people fall in love and then there's roses and rainbows and a baby. Because of that, we also don't equate fertility with a medical condition. As long as you want it, it should happen. So I think a combination of factors there of how we are [00:13:00] predisposed to not thinking the right way. And that's why we need to change this culture, talk about this openly, make it a part of normal conversations so that there is a safe space for all of us because it is absolutely necessary.

Christine Ko: Yes. I also think there's been a cultural shift where now, it's 2026: it's not so much expected that a girl will become a woman and have a child or more than one child. But I think even 10 years ago, it was looked upon as a little bit more odd if you're a woman past reproductive age and you have not had a child as if kind of your only 

Vasiliki Moragianni: Purpose.

Christine Ko: Purpose. 

Vasiliki Moragianni: Yeah. Yeah. Your only mission in life is to procreate. A hundred percent. And again, this is all about understanding what this means to you, and if understanding more about pregnancy and risks or going through fertility preservation, and you say, Whoa, this is not [00:14:00] for me. This is control. You take back control, and you understand, and you say yes and no to the things that make sense for you and your body. It's not about, let's all have millions of babies because that is not the path for everyone. 

Christine Ko: Yeah. I love your attitude towards this, that really we should think and be aware of what each of us wants. We're each unique individuals. Also I really appreciate your putting forth the idea that we should break the silence about this as much as we can because a lot of physician women definitely do encounter this because, as you said, a lot of our reproductive years are during our training. 

Vasiliki Moragianni: We know from studies that whereas the general population is affected by infertility at about the rate of 12%, in female physicians, the rate is 24 to 30 plus percent, so double at least. And some specialties, for example, female surgeons, are twice as likely to have [00:15:00] pregnancy complications than the female partners of male surgeons. In general, as you said before, we interestingly understand very little or know little about our own biology, and we delay more than most other professionals. So when physicians are compared to other high achieving professionals, infertility and delayed childbearing is more pronounced in the physician population. It's not just a feeling we have, this is supported by data. It is a thing, and we need to understand it and do something about it.

Christine Ko: Yeah. Okay, so in addition to seeing a trained professional like you when you're thinking about your reproductive journey, are there other things that women should or could be doing when they're thinking about fertility and taking back control of this reproductive journey?

Vasiliki Moragianni: Yeah. So in general, pregnancy, the reproductive system, is not [00:16:00] a top priority for survival, right? If we are chased by lions in the jungle, we're not gonna preserve our uterus. Our brain and our heart are more important. So that means that we need to have the rest of our body working optimally for the reproductive system to become a priority as well. Things like extreme stress.... when I use the term extreme, I don't know what extreme is for everyone. For some people, they get a lot of stress and anxiety and their periods go crazy when they're taking an exam. Other people are going through war and are able to have a baby, right? So it's different for every person. But getting stress control through meditation, through medications, whatever is sustainable long term. Effective for you. Get in the habit of that now. Prepare yourself for that.

Optimize any kind of health conditions that you have. If you have high blood pressure and it's not well controlled, and sometimes you take a medication, and it's a medication that's not safe in pregnancy, that's not a good plan. Let's optimize [00:17:00] that in preparation for pregnancy. Your diet, your exercise regimen, should be something that is healthy, conducive to fertility and pregnancy and also sustainable.

Everything in moderation. Caffeine, alcohol. No smoking, obviously. So optimize your health. The same as if you were going to run a marathon, because fertility and pregnancy are like a marathon. It's not a sprint, it's a marathon. So optimize yourself, mental health and body health wise.

Christine Ko: That's really good advice. It goes along with when I was trying to get pregnant the second time, I was way too stressed. I wasn't sleeping enough 'cause my daughter wasn't a good sleeper until she was over age two. She wasn't sleeping well, so I wasn't sleeping well. And I think it was high stress, but I like your comment about that. Some women are going to war, and they can still get pregnant. So it's different for everyone. And I would say, when I got pregnant with my first, with my daughter, I was still stressed because I was in a new job. It was high volume, [00:18:00] and so I would say, I was still stressed during that time, but I got pregnant. This question of stress, I feel, is always hard because I knew I was stressed when I had secondary infertility. And I guess what I'm saying is, it's hard not to start to blame yourself. Like, why can't I be less stressed! When the fact is, I am stressed.

Vasiliki Moragianni: Yeah. I was thinking as you were talking that clearly these are the ideal things to do, but if achieving those things is adding more stress, it defeats the purpose. Because you are stressed or because you had that extra cup of coffee or because you didn't work out the last three days you're not gonna conceive this cycle. That's examples of how this does not work, right?

Giving yourself a lot of grace through this journey, which is gonna be long and difficult or short and easy, whichever the combination is for you, but just giving yourself a lot of grace and space to understand your body, listen to your body, and make the decisions that make sense to you while of course, using common sense in terms of your [00:19:00] choices.

Christine Ko: I love that. I really do think, looking back, I wish I had been nicer to myself. I think women and women physicians are maybe the worst at being kind to themselves and giving yourself some grace.

Vasiliki Moragianni: We're probably not the best at this because we haven't learned it from our environment. And therefore, creating and cultivating this supportive environment for each other will then help each one of us feel better within ourselves. 

Christine Ko: Yes. Amazing.

Do you have any final thoughts? 

Vasiliki Moragianni: So my advice is keep in mind, age does matter when it comes to fertility. No reason to panic. Just schedule an appointment to talk to someone. Get information. Understand your body. Listen to your body, and just understand your options and fit them into your overall life and career plan. There are always options available, and there is always hope. 

Christine Ko: Thank you. Thank you so much for your time. 

Vasiliki Moragianni: Of course. It was [00:20:00] my pleasure.