Fertility, IVF & Conception: What Couples Need to Know — With Dr Nandita Palshetkar

Trying to conceive isn’t always straightforward, and the confusion around fertility and IVF can add to the emotional strain. The real challenge is understanding when to seek help, what tests matter, and how to make informed choices.

In this episode of The Wellness Algorithm, I’m joined by Dr Nandita Palshetkar, one of India’s leading fertility and IVF specialists, to bring clarity to fertility, conception, and IVF through a practical, science-backed conversation.

To help you understand the tools mentioned in this episode, here are some of the key tests and assessments discussed:

• Serum AMH (ovarian reserve test)
• Pelvic ultrasound and antral follicle count
• Semen analysis
• Hormonal tests such as thyroid and prolactin

This episode is not about quick fixes or guarantees. It’s about understanding the entire conception process so you can make informed decisions at the right time.

For a transcript of this show, go to https://wellnesscurated.life/fertility-ivf-conception-what-couples-need-to-know-with-dr-nandita-palshetkar-2/

📌 Follow us  for more expert-led conversations where science meets self-care.

Transcript

Copy Transcript Copied

Anshu Bahanda: Imagine wanting to start a family and you realise it isn’t happening as you wanted. So every month the excitement builds up and then it turns into anxiety. I have had so many friends go through this and everyone around will say, “oh relax”, and they look at Google and then they get mixed messages, and it just becomes a minefield. It is so, so stressful. Now, here’s something many couples don’t want to hear, that 1 in 6 couples face fertility challenges, according to the World Health Organisation. Not because they waited too long or did something wrong, but because modern life places new pressures on our bodies that past generations never faced. One simple thing, take microplastics for example, they are everywhere. 

Stress, poor sleep, hormonal imbalances, all these toxins we talked about, long work hours, processed food, all of these quietly influence fertility long before we are thinking about becoming parents. And in the middle of this, couples are left wondering: Why is this happening to us? Should we seek help? Is IVF our only option? What do we need to do? Who should we talk to? There are so many questions. Today, we’re bringing clear, compassionate, and science-backed answers to a topic that’s filled with emotion and confusion. This is Anshu Bahanda, and today on Wellness Curated, we’re talking about Fertility, IVF & Conception: What Couples Need to Know – With Dr Nandita Palshetkar. This is a practical, evidence-based look at how fertility really works, what IVF can and can’t do, and how to make informed decisions on this journey.

Welcome to The Wellness Algorithm, where we break down health topics in a way that’s easy to understand and relevant to those navigating their reproductive wellness journey. In today’s episode, we’re focusing on Fertility, IVF, and Conception. It is an area filled with options, but also there’s a lot of confusion and a lot of emotions here. Fertility isn’t straightforward, conception doesn’t always follow the predictable path, and IVF, while an incredible tool, is widely misunderstood and overwhelming. So the need for clarity has grown over the decades, and there's so many tools available. However, it is important to understand what makes sense to your individual journey. To help us explore this, I’m joined today by Dr Nandita Palshetkar. She’s one of India’s leading IVF and fertility specialists with over 30 years of experience. Beyond her clinical work, Dr Palshetkar is also committed to education and research and is known for introducing innovative technologies in and around the field of reproductive health. Before we begin, a small request, please subscribe to the podcast. It’s free, and it supports our mission to bring you meaningful, well-researched and science-backed conversations. And if today’s episode resonates, share it with someone who might need it, they will bless you for a long time for this.

So Dr Nandita, I am going to jump right in and ask you, what is IVF actually? So many of us are totally clueless about this. 

Dr. Nandita Palshetkar: I think this is a really good question, because, you know, there are a lot of couples who come in and they don't know the process. When I tell them you require IVF, they're looking blank at me. In fact, let me tell you one thing. One patient actually asked me, that's a test tube baby, right? So I said, yeah. They said, but how will you put us into the test tube? So it begins with all kinds of, you know, answers. But let me explain to you. IVF is nothing but the creation of the baby outside your body. You know, normally in a, in the body, the egg is released by the ovary. It finds its way into the fallopian tube. And then when you have, intercourse, the sperms are deposited in the vagina and this will swim up through the mouth of the uterus into the uterine cavity and into the tubes. And this is the egg and the sperm, actually meet and fertilise and their babies actually formed in the fallopian tube. And then from the tube it comes to the uterus where it grows for nine months. So this is a natural process. So in an IVF process, what we do is we take the eggs out of the body, the sperms from the husband, and fertilise them in a dish, you know, which actually mimics the fallopian tube. The fluid, the PH, the temperature is all like that maintained, and then three days later, we actually see this baby which is formed and gently pick it up and transfer it into the uterus where it normally grows for nine months. So the creation of that baby outside in the laboratory in a dish is actually IVF.

AB: So tell me, Dr Nandita, from all the couples you've seen, from all the experiences you've had, when would you advise a couple to see a fertility specialist? When would you say, don't wait anymore? Now you go. 

NP: I think indications are changing. But as we say in our science world, if you've had unprotected sex for one year and you haven't conceived, you definitely should see the doctor. Secondly, if you're more than 35 years old, don't wait for one year, wait for six months. Otherwise, go see the doctor. If you're older than 40 years, I would say, don't wait. You should go immediately so that you get the basic test done. You know, it's important because it can be treated right away and you don't waste time. But there is also another indication which is there, which is, you know, like, preventive health. Preventive health is such a big thing now. We need to, you know, look at preventive health and incorporate it in our lifestyle. So I tell girls that suppose you're unmarried or you've not found a partner, or you're busy with your career, you don't want to have a baby yet, I think it's important to test your fertility in your late 20s. And you know, in the morning I had a patient who was 28-year-old with an ovary of 45-year-old.

AB: Wow. 

NP: This kind of accelerated ageing is being seen in nearly one third of my patients in my OPD. And that's why I feel that, you know, you can do preventive care, you can do the test, which is known as Serum AMH, it's an Anti-Mullerian Hormone, it's a blood test, along with a sonography. And that will really give you an idea. So you can also use the newer technologies like egg freezing, embryo freezing to preserve your fertility. So even if there is ageing, you can actually, you know, have a baby when you're 40 with the eggs that you've frozen when you were in your early late 20s or early 30s. So it is something that one should be aware of. And I'm so glad you asked this question 

AB: And I'm so glad you mentioned egg freezing because I can't tell you how many young people today are confused about what it involves. So if you can quickly talk to us about egg freezing Just give us a brief idea of what, what does it involve? 

NP: You know, it involves eight to 10 days of medications where we, instead of making one egg, the body usually makes only one egg. So we try to make 10 to 15 eggs, both of these eggs, during your menstrual cycle with the help of ultrasound or USG. And then once the eggs are say about 2 centimeters or 18 millimeters, we give a kind of a trigger. Trigger is another injection which actually matures the eggs. And then we go in with a needle and just remove the eggs out of the body. You know how we remove blood tests? Similarly, the needle just reaches from your vagina to your, it's a 15, 20 minutes procedure. You're not awake, you do not feel any pain. And, in three to four hours, you can go home. And that's it. That's the process of egg freezing. Because once the eggs are in the IVF lab, we do a process and we freeze these eggs. And do you know something? What is the shelf life? As long as I maintain the temperature of -196 degrees, I can keep it long enough.

AB: Wow. Okay. And tell me, a lot of girls are worried that egg freezing will involve a lot of hormones and hormone injections. Is that right? 

NP: See, hormone injections are involved because you need hormones to prepare the, you know, your ovary to produce more eggs. So, yes. But remember that this hormone injection actually is out of your body within 24 hours. And IVF has been there for decades, I think more than five decades, and these injections have been used. And there is enough studies being done to see that they don't have, they've not had any effect on the women who have been subjected to it. So it's a very, very safe treatment. 

AB: Okay. And now I want to talk to you about age. As we know, you know, scientifically as well as experientially, as you grow older, fertility goes down. So can we talk a little bit about age impacting fertility for both men as well as for women? 

NP: Yeah, I think, a very important question. Age is very, very important. And in fact there is a lot of research now going on anti ageing, how to halt your biological clock, etc. But if you look at the Indian ethnicity, we age seven years earlier than the Caucasians. I mean, it's really sad, but true. And it could be any cause. It could be because of pollution, etc, because the study actually studied Indians in India to foreigners abroad. So we don't know whether the AQI is affecting us or whatever it is. But yes, age, you know, I always, I'm a little worried about announcing this, but have your first baby by the time you're 27, 28, that, yes, that would be the ideal age. But of course, anything under 35 is good enough. And if you can't have the baby, at least freeze your eggs, freeze your embryos as early as possible. Also, you know, as you age, the chance of having a mentally retarded child also increases.

So I think you need to take these things into account. And after the age of 44, it's one in a hundred babies which are mentally retarded. With men, fortunately or unfortunately, ageing doesn't affect them till they turn 50. After 50, there is a slight increase in autism in some other problems, but it's very, very low. The chance of having it is very, very. So I think, men also, the earlier they have a child, it's always better.

AB: Okay. And you talked about a fertility test for girls called serum AMH and a sonography. What would you recommend? Any other tests that you would recommend that people do beforehand, men or women? 

NP: I think men’s Semen Analysis, a simple test of the semen with semen which is probably two to three days old, not 15 days. You have not masturbated or you're not had sex and you give you a test. No, you have to masturbate and throw the sample off and then two days later give the sample for testing. Because sperm deteriorates when it's in your body for a long time. So to actually know what it is. So when we tell people who are having, wanting, a baby that they should have sex, alternate day, because then the sperm is also refreshed, rejuvenated, and it's much better. It's stronger, the mobility is good. 

AB: Okay, and then tell me about lifestyle issues, things like sleep, smoking, stress. You talked about microplastics, alcohol. How do these affect fertility? 

NP: You know, fertility is not only science, you know, like medicine. I think there's a lot of science, which involves holistically, if you look at it, I think, the environment today, the environment is playing a big, big part, okay? The environment, pollutants, you know?  We have pesticides in our food. I mean, however much you wash them, sometimes you cannot get rid of them, those pesticides, microplastics. So I think these changes need to be done. Then the lifestyle also, you know, sleep early, exercise, we become couch potatoes. So exercise, sleep early, and eat good, healthy food, you know? I believe supplements should be taken because sometimes the food doesn't give enough of the body's requirements. And one thing that is really, really important is also mental health. You know, stress of any kind or anything actually disturbs your whole hormonal access. You know, the brain controls the ovary. So this axis, known as the HPA axis, gets altered because of stress. I think it does affect subtly, does not cause infertility. But I believe that if you are in your best frame of mind, mentally happy in a good, you know, positive environment, the success rates are also better.

So I think, you know, I always say there are four pillars to our medicine in IVF. One is nutrition, one is sleep, one is exercise, and one is mental health. I think these are very important. You know, the ovarian reserve testing for a girl is very, very important. So it's a simple blood test called Serum AMH, which can be done any time of the cycle. You don't have to be on the second day of the period or third day of the period. And, ultrasound. Ultrasound looks at the ovary and does an antral follicle count. So they actually count the small number of eggs there in the ovary. And that gives us an idea how good or how bad the girl's reserve is. So I think this is a test. And of course, other hormones like thyroid, prolactin are important. And I feel anaemia is very prevalent in women.

Nowadays, I'm seeing a lot of, you know, fatty liver because of obesity. The girls have a fatty liver. People don't, you know, in the reported fatty liver, people just ignore it. But I think that so contributes. And it's important to check your liver enzymes to see if they're elevated so that you take steps to treat it. And obesity is a big problem, which is a hurdle also. 

AB: So tell me now, can you explain the process of going through IVF in simple, everyday terms so that someone who's intimidated by it relaxes a little bit?

NP: Thank you. I think that is very important because today IVF has become patient-friendly. So what happens if a girl walks in, into my clinic, I explain to her the process, and let me take you through the steps that she goes through. So first, a blood test and a sonography is done to assess her. Once we have a look at the reports and decide that she's going five years, we stabilize her thyroid, we stabilize a vitamin D, B12. And, if there is any anaemia, we correct it. I think all these things are taken care of. And then she enters the process of IVF. So the process of IVF usually starts on the second day of a period. So from the second day to the tenth day of a period. The first day is the day you start bleeding. That is day one to day ten. Usually she takes hormonal injections, and they're taken every day. Now, how do we know that the eggs are growing? Because sometimes we need to titrate the doses. You know, give a higher dose, give a lower. So we do sonography on day two, then day six, day eight, and usually day ten is the final day. And that day we, you know, we do sonographies every, every maybe four sonographies in a cycle. And then we give an injection, a trigger to rupture the egg or to mature the egg. Then before the egg matures. So once I give a trigger between 34 to 36 hours after the trigger, I go in and retrieve all these eggs. Once I have retrieved all these eggs, these eggs are then taken into the laboratory. And as I said before, the girl then wakes up on the table. Usually my patient asks, how many eggs did I get?

You know, then they go to their rooms and after a couple of hours, you know, they drink, eat, and then they go home in two to three hours. So it's an OPD process, short general anesthesia. And then the work begins in the laboratory. So that is the process. Now once the babies are ready, we call the patient back after three days and gently, you know, this time there's no anesthesia. The patient is just taken in like that into the IVF laboratory and we load one or two babies on a, you know, thin tubing, which is a catheter. And this tubing is, you know, gently inserted into the uterus, the cavity. Then we just inject those embryos into that cavity. It's a process without anesthesia, very painless. And I, it's very easy. I must have done thousands of embryo transplants. The skill of the doctor. I think that is the most important step. 

AB: What a fantastic job you have. I think I saw this film which was about the first IVF baby.

And that's when you, you know, when you see that, you realize the significance of this. But tell me, what are the chances of success given today's technology?

NP: That's great. You know, when I began 35 years ago, the success rate was 10-15%.

Today, 35 years down the line, the success rate is 50 to 60%. So the younger the girl is the better the success rate. If you're 40 plus, your success rate drops to below 40%. So I think that's what I meant, you know, that assess your fertility earlier, freeze your fertility if you feel you don't want to have a baby so soon. In fact, you won't believe it. The other day I had one of my friend's daughters come to me. She says, Nandita aunty, I don't want to have a child. I said, oh, okay. So she said, but you know what? In case I feel like it when I'm older, I can't do it. So I'm going to freeze my embryos because Nandita aunty is sitting in my backyard and I didn't use them. She froze her embryos. 

AB: Very wise. 

NP: She said I'm keeping my doors open. In case I want to have a child, I will have it later on, if I don't want to, that's fine. So yeah, there are different thought processes with this generation. 

AB: Yeah, no, absolutely. But tell me, in terms of IVF treatment, you know it's, people say it's very emotionally and physically demanding. So what should couples realistically expect during the process? 

NP: You know what the problem is? Infertility is like a social stigma. It's not only a disease, you understand, kind of a social pressure that we put on ourselves. And even if, you know, nowadays I think mother in law's father in laws are pretty liberal. But there is unspoken pressure on the girl. You know, the girl is

AB: Absolutely. I wanted to ask you about that. 

NP: The girl is with her friends, the friends have children and all they're discussing is nannies, timetables, this class, that class, music, sports. And this girl feels left out of it. You understand? Nobody does it on purpose. It just happens. It's a natural thing that really happens. So I think there's a lot of unspoken pressure and of course a lot of families still do have you know, they are pressured that okay, it's high time you have a child, blah, blah. So I think it's a very, very emotional journey and if this girl has support, especially from the husband, you are in it together. The husband comes for everything. He's with it, he's supportive to her. I think it is amazing. And secondly, even the family in India, of course we have, you know, the mother-in-law, the father-in-law, the sister-in-law coming, etc. I think the village which is behind this couple, I think it makes a lot of difference because remember one thing, when you have one child which is, is born, a family is created. Father, mother, but uncle, aunts, grandparents, I don't know. You understand? 

AB: Everyone. Yeah, absolutely, absolutely. But I want to ask you about something slightly sensitive now. You know, you talked about the pressure on the woman. But from what I've seen with friends, I also have seen this in different stratas of society and not just Indians, I've seen this globally. The assumption is there that the issue is with the woman, how common is male infertility?

NP: This is, you know, “dubti rag pe haath rakhna”. But yeah, I think, but things have really changed. Do you know, 30% of infertility is because of the man. Around 30% percent is because of the woman. And 30% have a little bit of a man responsible, a little bit of both the people are responsible. And 10% actually don't find any cause why the couple is infertile. So actually, the severe male infertility is 30% plus I would say another 30% mild infertility, which actually contributes. So 50 -50. In short, the man and the woman are responsible for infertility. You know, initially, when I started practice, the girl would come alone. She would, “oh, my husband doesn't want to do the test, but I want to test” and all. But today is different. The boy comes, he will test his treatment. The girl is working, she's busy in the office. He will bring all the reports and, you know, find out what's wrong. So I think that's a change which I'm seeing in my practice. But yes, probably that is maybe 1/3rd of my patients. 2/3rd , yes. And also, you know, the men feel inadequate. That, yes, there's something inadequate in them. So I think it's a very tricky situation.

We have to handle it very carefully. We have to be very empathetic. But I think it's the, you know, I think it's the same, Anshu, for man and woman. You have to be empathetic to the girl as well as the man. I think both of them need their tender loving care, you know, and today children are, I would say, mollycoddled, but my parents would say that about me and I say that about the next generation. But yeah, we do try and protect them against the world. And so they're not ready. They want, you know, they get everything very quickly. They want results quickly. So the pain level is much, much lower. 

AB: Yeah, it's the instant gratification generation as we call them. 

NP: That's the one. 

AB: Everything on tap. There's Uber's on tap and everything's on tap, and everything’s on tap, right?

NP: So is what they think of delivery, I think. That's crazy. 

AB: But I want to ask you, while we're on the topic of male fertility, I want to ask you, how important are sperm quality and testing, and what do you think men should do to understand or improve their fertility at an early stage?

NP: I think what is important is first to diagnose the problem. So do the test. If the quality is poor, then you have to look internally. 

AB: And what are the tests? 

NP: Yeah, Semen Analysis. Simple, straightforward analysis. There are not many tests that we do. Okay. The simple thing is to look at yourself. Do you smoke, do you drink alcohol? Do you take drugs? Do you do a lot of steam and saunas? Because that is also not very good for testes. And do you keep laptops on your lap near your testicles? And it creates heat, so that's not good. You know, even wearing underwear, working near furnaces. I, some feel even riding the motorcycle for very long can probably affect it because that gets heated, you know? Though the latest motorcycles are much better and they have the technology. But all these things do matter where a male is concerned. And I think these are things one should look at. And of course, you know, pollution is a big contributor also these days. So we have to keep these things in mind. You know, eating anti-inflammatory foods. I think it's really, really important. 

AB: So tell me, Dr Nandita, there's so much that's happening in the world of science, right?

Are there any scientific breakthroughs for fertility? How do you see this shaping up? How do you see fertility treatments shaping up with the new technologies coming in? 

NP: Oh God, we have opened Pandora's box. You're not going to believe this, just last two weeks ago, I read that now we can manufacture eggs and sperms in the lab. You don't need the woman, you don't need the man. You take a skin cell. You know, the skin, it has a DNA. And that skin cell is converted into an egg. And, you probably, you know, now this problem, which I'm saying the eggs are less, this, that will not arise because you just take the skin, produce 20 eggs for a child. But, yeah, a litter of mice has been born. 

AB: My goodness. 

NP: Of course, this technology has to be confirmed safe. See, you may very well create the egg, but what is the longevity of the egg? What are the after effects? Will this child have cancer? Will this child have other problems? Will the DNA. So all those things definitely need to be studied. And so far we don't have answers. But yes, the technology is here. Then there's another technology called CRISPR. And there are these two ladies, Emmanuel and Jennifer Doudna, who actually won the Nobel Prize for it. And I think 2021 or 2022, just post Covid. And you know what the technology is, it's gene editing. So suppose I have a family, I belong to a family where Thalassemia is a trait. Now if I marry somebody who also has a Thalassemia trait, the child can suffer from Thalassemia. And Thalassemia is bad because they need blood transfusions and usually life is hardly, you know, 20, 25, 30. We have a pre implantation diagnosis by which we can identify. Okay, this embryo has got only a trait. This embryo is free of any trait or any disease. Got a disease. Now this is a new technology called CRISPR. And yeah, two women have won the Nobel Prize for this technology. CRISPR, Emmanuel and Jennifer Doudna. But this is actually gene editing. You know when you're doing your time lapse photography, when you're combining videos, you splice it. Okay, I want this and then you join it. So actually you can edit a baby.

The baby has a gene which is not good, which is a disease giving gene like Thalassemia. This virus is loaded with the DNA. Scissors it's called and it's infected. It goes and cuts that DNA, that faulty DNA and inserts the normal DNA and this baby becomes disease free. The embryo becomes disease free. So I think with this gene editing, right now we just throw away these embryos which are diseased, but 10 years down the line we will be cleaning up this baby and the baby will be fine. And they're used for a lot of cancers and different kinds of things where they can be eliminated. In fact let me tell you one thing. You know in China, 1 set of twins was born where Dr He tried this CRISPR in a, you know, in humans. And he, these babies were born, they would not ever get HIV or I think it was cholera. 

AB: Wow. Okay 

NP: So but of course he was jailed because we don't know the effect of this on humans yet.

We don't know what would be the subsequent, you know, maybe 10 years down the line cancer or they develop something else or they die early. Like you know, Dolly, right, was cloned. She was born a sheep. 

AB: Dolly the sheep. 

NP: Dolly the sheep. Yeah. She was born at her mother's age. Her cells were not of a newborn, they were of old age. So that is a new thing. The Yamanaka factor which thou has shown but how you can bring the cells back to the you know, state zero. 

AB: Dr Nandita, quickly tell us about Dolly before I go on to the last question. 

NP: Dolly was the sheep which was cloned. So normally when you want a baby you have the egg and the sperm, right? So the DNA comes mixed from you and your husband. But Dolly DNA came only from a mother because her skin cell was taken and that was converted into an embryo. So the DNA is the same now. The DNA is taken from a 40-year-old. In the womb, what happens is there's resetting of the clock and the DNA actually goes to zero. And then. Do you know when ageing starts? Can you tell me? Come on, tell me.

AB: As soon as you're born, ageing starts from conception. 

 NP: Yes, but in the womb. It starts in the womb. Depends on all the epigenetics, the external factors, everything. So I think that is important and that is something you need to remember. So Dolly was conceived from her mother's DNA.

AB: Okay, Dr Nandita, my last question to you before we go on to the rapid fire round, is for anyone planning to conceive, what are the key things that they should keep in mind, you know, stuff that you would advise them as a doctor to bear in mind. And what are the things that can help them as well? 

NP: I think coming early is very, very important. The age of the woman is really important. Second is, lifestyle. I think smoking, alcohol, drugs is a no, no. Exercise is very, very important. Nutrition. There is a fertility diet, which is a high-protein diet, a Mediterranean diet which really helps. And today, I mean if people don't have it, we use a lot of supplements to help patients and of course mental health. Mental health is very important. And today we have technology that is my fifth pillar. And this is the technology which is there in the lab. We have Artificial Intelligence, we have time lapse photography. So it all helps me. For men we have so many different techniques of choosing sperm. You know, microfluidics, magnetic, activated, sperms. I know it all sounds very fantastic to you, but these are all the technologies that we use in the lab to give a child. So I think going to a high end laboratory also matters and all the other four pillars which I mentioned definitely will help. Obesity is also very important from a fertility point of view. And it contributes to bad quality eggs to the end, bad endometrium, to the hormonal disruption.

AB: I want to quickly go on to a rapid fire round. I'm going to ask you the most googled questions about fertility, IVF and conception and you can clear it up for us. So the first one. Does stress really reduce fertility? 

NP: Not really, but no.

AB: Now this is something you touched on. Does tight clothing affect sperm? 

NP: Yes. So tight underwear is a no no.  

AB: Okay. Is day 14 ovulation true for everyone? 

NP: No. If a girl has a 28 day cycle, she can ovulate between 12 to 14 today. 

AB: And are period tracking apps reliable? 

NP: Pretty much. They are good. So there's no harm in using them. 

AB: Does traveling during IVF harm the cycle?

NP: Not at all. Not at all. I tell my girls, don't sleep in bed for two days and then they go back to work. 

AB: Okay, lovely. Thank you so much. Thank you, Dr Nandita. We've had such an informative and groundbreaking conversation today to remind us that fertility isn't just a medical journey, it's a personal one. And thank you for helping us understand how conception works. Knowing where to seek help and learning what IVF can and cannot do. Giving people clarity on this particular topic, which, you know, people are hesitant about. But it's such an important topic in their lives and the right guidance can really, really help people. But it can also be overwhelming if you don't have the right answers. So if someone in this episode helped you understand your own fertility journey a little better or offered clarity on IVF and conception, please share it with people who might need this information. And don't forget to subscribe. It's free and it helps us continue creating a community that learns, supports and grows together. I am Anshu Bahanda. Take care of yourself. Be patient with your process and trust that informed choices can make a real difference in your well being. Thank you.