Episode 31: Our Top Questions from our Patients

Dr. Amber Klimczak and Dr. Beverly Reed discuss the most common questions they get from their patients.

Transcript

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Hi, I am Dr. Beverly Reed. And I'm Dr. Amber Klimczak. And we are Two Peaks in a Pod. Hi, welcome back everybody. Dr. Kate, how's your week been going for you? It's been busy. Busy but good. Back into it. I have a few days off, so I'm kind of getting back into the swing of things. Yes, amazing. Okay, good. Well. I thought today would be fun because I wanted to kind of ask you about what are some of the common questions you get, because at this point we've been doing this for years now. It's not uncommon that we will hear some of the same questions over and over. And of course we never mind repeatedly answering them. That's our jobs. Um, but I thought it'd be interesting to see if we see the. same questions amongst each other too. Yeah. And, um, so let's just kind of go every other one. I did kind of jot down some of my top questions and I'm going off the cuff here. So and so I'll start off with this one and I'm curious to see if you hear it too. One of the top questions is, Can I have twins? Will you, can you help me have twins? Yes. Do you hear it? Yes. I think this is really common for our patients because they've been trying such a long time and their dream is that they can just knock out two babies at once. I think they really like the idea of having twins and just one and done. I get asked this question a lot. Yes. And my answer is, I hope not. Yes, yes, yes. Well, and I, surprisingly too, we even, and we tried to actually train the front desk on, um, you know, how to appropriately handle the phone calls too, because we even get people who don't have fertility problems or any issues at all who want to call just to have twins, and we definitely don't do that. We don't offer that as a service or anything like that. Right. Certainly not. Yes. And then when it comes to treatment, certainly there is nothing that we would do to try to purposely give somebody twins. But admittedly, sometimes it can be a side effect of treatment. I think one of the biggest misconceptions out there is that people often assume, when they see somebody with twins, that they did IVF. And maybe that was the case about, you know, 10 15 years ago, but no longer the case anymore. Do you want to explain why? Yeah, I talk to my patients a lot about this. Um, I think some people are even maybe scared of IVF for this reason because they think it means that they're going to get twins, but nowadays with modern fertility treatments, the most likely way that you're actually going to get twins is not from IVF, it's from other treatments, like treatments that use injections and then inseminations where we're basically getting you to ovulate more than one egg, but we don't have as much control over how many are fertilized and then become a baby. And so those are by far and wide Much more common cycles to have multiples from as opposed to IVF, because now with IVF, we really just try and put one embryo into the uterus at a time to decrease the chances of twins and higher order pregnancies. Right. And in fact, because people do try to, you know, pressure us sometimes, can you put two in, can you put two in, but here's the thing. We have, um, guidelines from our national fertility organization called ASRM. And these guidelines are. very particular in telling us how many we're allowed to put in. And it is dependent on certain things like age and whether you did genetic testing of the embryos and quality of the embryos and maybe fertility history overall. Um, but still Dr. K and I, we want to be good doctors. We want to follow the rules. Um, and every now and then we may make an exception for Certain circumstances, but, but overall we are little followers. yes, definitely. And then I would say the vast majority of, um, multiples that I have are non I vfs. So these are on patients that I gave maybe Clomid or Letrozole medication to, and maybe we did an insemination or maybe they did timed intercourse with that. We really don't have much control either way. So if somebody wants twins, it's not like I can purposely give it to them. Um, if they don't want twins, it's not like I can avoid it in these types of treatments. So I do always counsel about their risks. The thing is that twins are higher risk for the mom. It's higher risk for the baby. So we wouldn't do that on purpose, but certainly it does happen from time to time. And when it does happen, we're so grateful for high risk OB doctors and medical advancements that the vast majority, um, do well. But, but again, we're aiming for what's going to be healthiest for mom and healthiest for baby too. Absolutely. Okay. Okay. So I would say this is probably the top question I get from my female patients and that is what can I do to improve my fertility? Yes. Yes. Well, I have to say I definitely hear this, but also sometimes my patients are teaching me. They have sometimes done all of this research before they've even come for their first appointment. I'm always so impressed. Don't you? Yes. I mean, I think the internet has been great because patients are so much more educated and successful. these things. And so often to me on vitamins and supp know, they've already done changes. But I know that a good period of the new over all the things they fertility. And I know you Certainly there's lifestyle adjustments that we can do depending on kind of what your already baseline is but I also talked to them a lot just about timing of intercourse and how long to wait and when does ovulation actually happen and what markers are they using at home to track because I think a lot of those things are really confusing and we've had Prior podcasts where we sort of talk about what you can launch on your own and how you should time it. And so I think that's a really big topic for my patients. And often, Dr. Reed knows this, my patients get pregnant as soon as they come to see me. So sometimes it's just a timing thing. I'll do an ultrasound. I'm like, all right, have intercourse tomorrow. I'll see you. with a positive pregnancy test. That's right. That good luck rubs right off. And I always think that's so fun because they're always so surprised and I'm like, yep, we'll still take the credit for that. Um, okay. So another question I hear a lot is that, well, first, I guess we'll say one of the more common treatments that I would typically recommend for somebody is to take Clomid and do an insemination or sometimes Letrozole and insemination. But oftentimes they will say to me, well, the sperm is normal. On a normal semen analysis, do I have to do an IUI? Do you get this one a lot? Yes, all the time. Um, and it really depends on the population of patient, what their diagnosis is, as to whether I recommend an insemination or not. But a lot of times what we might be doing this for is for that unexpected, Explained infertility couple, we've done a lot of the testing, can't really seem to find a direct reason why they're having trouble conceiving. And what I explained to them is that when we use something like Clomid and Inseminations together synergistically, the studies really do show that the pregnancy rates are higher. And the reason why is you may not have anything wrong with. sperm, but when you have timed intercourse at home, most of that sperm is actually lost in the vagina and trying to make its way up through the cervix and into the uterus such that even if you're ejaculating millions of sperm, probably only a few handful of sperm are making it all the way to the egg, which is waiting in the fallopian tube. It's quite the journey. And so when we do an insemination, we wash the sperm, we concentrate it, we bypass the cervix, vagina, we place it right at the top of the uterus and make it. easy for the sperm and egg to get together. Um, so substantially increasing the chances of those two coming together and fertilization happening. Absolutely. Okay, good. Do you have another question you get a lot? Well, it's sort of similar to twins, but I get asked a lot. Can you help me have a boy or a girl? Oh yes, yes, yes, yes. O this one a lot too. Um, a is kind of mixed, right? kind of treatment we're d the hard answer to that i but it does involve some IVF treatment. I think most patients when they come in for a consult just for this reason are really hoping we're going to have an easy answer like, Oh, if you just have intercourse on certain days, or if you have intercourse using a certain position, or if we spend this sperm in a certain way, this is going to just magically give you a boy or girl. And although we would love for that to be true. And we do understand that that is on the internet saying that those things may help. Ultimately, we know, especially in our experience, that the only way to know for sure is with IVF. With IVF, you can do testing on the embryos to know which one are boys versus girls, but here's the difficult part of that. It's still not a guarantee. because you can only choose if you have both available. Sometimes somebody will make all male embryos. Sometimes somebody will make all female embryos. So you have to have, of course, the adoption of whatever desired gender you're looking for. And then the other thing is that even when you try to implant an embryo, it doesn't always stick, right? And so, for patients that may be choosing this type of treatment, We're letting them know that definitely we can try to help you as best as we can, but it's never. Yeah, and it, I have, I have a couple patients right now that I'm doing IVF with and we had unexpected gender results and it can be really disappointing when you have your mind kind of wrapped around a certain gender. Um, or maybe you want a certain gender first. Yeah. And you wanna transfer that embryo first. It, it's definitely a challenging situation. Yeah. Yeah, absolutely. And I mean, I think it's so nice sometimes to be able to know what you have embryo wise, but sometimes too it may be almost dream crushing. So an example would be. Maybe a 40 year old patient. She did IVF. Let's say she had two normal embryos and she's so excited, but they're both boys. And she said, well, I want to have a daughter at some point. And she knows that if she doesn't go to bank more embryos, she may lose that chance because by the time she will have had babies, she would be older and may not be able to respond, um, anymore to an IVF cycle. So I, I do think it can be hard feelings to grapple with, but at least having that information also gives you the power to decide without change kind of her next step. Okay, so another common one that I get, it's really kind of maybe two questions. So one is how often should we have intercourse and two is like, when can we have intercourse? When can we not have intercourse? So I would first say, what are you trying to do? How often, how often can you have intercourse? Whenever you want. But if you're trying to get pregnant, we can certainly be strategic. Okay, um, and so, basically, any time other than ovulation, that's just for funsies, you guys can do whatever you want. But, ovulation, we really try and say, every other day around the expected ovulation. That's what I tell my patients. Um, if we know with more certainty time of ovulation, if I'm monitoring to monitoring them with ultrasound and blood work, then I'll have it then have intercourse a couple of days in a row because I'm more certain about it. But when you guys are at home trying on your own, I usually say every other day, don't overdo it. I have some patients that do it for six months. Seven days in a row, every single day, and I think that that can be pretty exhausting. But some people may be up for it. I will say, I had a consult the other day, and I mean, I just said that, I said that could be exhausting. And they're like, we've done it every day for two months. And I'm like, wow. Every day for two months? I'm like, oh my gosh. We need some ibuprofen. So I, you know, I think it's patient dependent, but I agree probably for most people that would be quite a bit. Yeah, okay, so you said two part question. One is how often and then what was the other question? Well, they always are asking that, you know, when can I have intercourse, when am I not, meaning like around certain treatment times. And I think it totally varies. So different things that can come up with like, what about if I'm at, Taking injection medications to do IVF. What if I'm about to do a frozen embryo transfer? What if I'm pregnant? Is it okay to have intercourse? You know, these, I'm hearing about intercourse a lot. Yes. Yeah. One of my husband's quotes when we were going through fertility treatment is that he never expected it to have such little sex. He's like, I don't understand. We're trying to get pregnant. You keep telling us not to have sex. It's because we don't really need him. Once we have his sperm on ice, no, not part of the experiment. It's like no fun for the male partner. But, yeah, I mean, when I tell my patients that once they start taking injections for IVF, there really is a risk of having intercourse during that stimulation. There's a few different things that can happen. One is that after we do your retrieval, there's the chance that some of those eggs drop down into the pelvis. And then if you have multiple eggs that are in the pelvis waiting to be fertilized and you have intercourse, you can conceive multiple babies. Um, really not the situation that we want to be in. Also, depending on what kind of intercourse you're having, it puts yourself at risk of something called ovarian torsion. Um, so if you're really, you know, active during intercourse, we worry that that ovary can kind of turn on itself because it's been Big has lots of follicles on it. Um, and that's a surgical emergency and something that we really don't wanna be dealing with in the middle of IVF'cause we're, we wanna have as many eggs as possible and you're ovary available for the future. So I usually say during my IVF stimulations, once you really start taking those injections follicles stop, start growing, no intercourse. Yeah, absolutely. And then what do you do for frozen embryo transfers? I feel like there's been conflicting things. Even I know more recent I've seen. Some studies showing maybe you should have intercourse before a transfer, but then other people say, no, you shouldn't. It might cause cramping. I've seen both ways. Do you have a preference? What do you think? So I'm okay with it leading up to the transfer for the most part. You know, it just kind of depends on the patient's situation. Um, but then after the transfer, I really don't like them having intercourse while I'm waiting for that embryo to implant. In my mind, I'm just like, let it just stay. sit there, don't touch her, just, you know, like let her implant. And then once we have a pregnancy, I'm like, do whatever you want. Yeah. Okay. But then if we have a patient listening who just had intercourse and she just had her transfer and now she's panicking, you would tell her it's probably fine. Yeah. We like, listen, this is like us hedging. Yeah. Um, Dr. Reed always says she wishes she could wrap her patients in bubble wrap after the, after the transfer. Yeah. Yeah. So we, um, do a little bit of voodoo in fertility, right? We always try and just do everything we possibly can to have a success. It does not mean that it makes a big difference, especially at that time. And what about when they're pregnant? Do you give them the go now? Yes. I let, I let patients have intercourse during pregnancy unless they're having bleeding and the reason why I say not with bleeding is not because you're really going to harm the pregnancy, it's because it's going to make you crazy. When you're having bleeding during that first trimester, a lot of times it can be from the cervix and when you have intercourse, it can make it worse and then you're going to be convinced something's going on. So as long as everything's going well with your pregnancy, you really can have intercourse. Yeah. And I did want to circle back to that, you know, back when you're trying to get pregnant on your own, the everyday versus. Every other day. I just want to say to either way is fine. You're not wrong. I, sometimes I see people like get into online fights about this and the Facebook groups, they're like, my doctor said every day, my doctor said every other day. I mean, honestly, either way is fine. Like whatever works best for For y'all is really the answer there. Yes. Okay. So this is one that I get a lot and this is kind of more, we're in the testing, right, and we get blood work back, ultrasound back. And I'm trying to explain to my patient about ovarian reserve, kind of approximately how many eggs do we have to work with? And I always get asked the question. But is that good? Is that good? And it's, it's, um, you know, a modifier, right? Good or bad. And I think that's a really tough question to answer. Um, and so I, I certainly do a lot of counseling around that discussion. So I'm curious if your patients ask you about this. Absolutely. They do. And, but you know, I'm such an optimist. Like I'm always like, yes, because I do feel like there's always, Not always. The vast majority of the time, there's a good way to frame it. Yeah. And, because sometimes people, let's say I have a patient, and I give her maybe multiple diagnoses in the same day. Let's say I say, you have PCOS, and you have polyps, and the sperm's a little low, right? A patient like that is then feeling like it's the end of the world, right? Oh my gosh, I'm so unlucky. Why do I have all these things happening? But they don't realize for us, That's all just easy stuff. That's a dream patient. I just see me. And so really, I'm like, look, sometimes you have to start from the point of, oh my gosh, you have a uterus. Amazing. Oh my gosh, you have ovaries. Amazing. There is some sperm there. Amazing, right? So I think because we see really some poor prognosis patients that when we see a patient like that and they're feeling like it's the end of the world, I just, I do feel so differently about it. And I'm like, look, we're going to get you pregnant. And the biggest thing is, you know, maybe that information may feel bad in that moment. But that information is so important for us to be able to make a plan to help you, you know, So i'm almost always like yes, this is yes And I I know some people they just they are more negative thinkers I think so many of us are I probably am when it comes to myself, too And sometimes it's almost even painful to try to think a positive thought when you've been through a lot of trauma and hurt But i'm like what i've learned is even if you can't think a positive thought You Maybe just a neutral thought. Mm-Hmm. Instead of a negative thought. Mm-Hmm. Instead of thinking My uterus is so bad and you don't wanna think my uterus is good, just say my uterus. Mm-Hmm. That's a good starting point. You know, so, yes. Yeah. Yeah. I, in my reports on people's, um, utero, I often say the word unremarkable. It's unremarkable. That's a good thing. I'd like to have an unremarkable ants. Yes. Yes. Um, okay, so another question I will get commonly is, do I have kids? Do you ever get personal questions? Oh, personal. I was like, wait, what? Yeah. Do people want to know, like? Yes. Because I often do share with my patients that I was also a fertility patient, um, and they're always curious to know, will it work for you? What did you do? You have, you know, have kids. So yes. And I have pictures of my kids. Um, so sometimes they see that too. And yeah, I'm always like, you know, and I'm also a sucker for girls. I'm always trying to convince my patients to transfer girl embryos. Because they don't always go for it. But yes, you know, I think my patients out there know listening that I have two little girls through fertility treatment. Yeah. Yeah Yeah, I do get that question, do you? Yeah, I get it so much, but um, and I am just careful though about sharing So if they ask me I share because they want to know Um, I actually don't have tons of pictures around my office or anything because I know it can be a sensitive subject Mm hmm And sometimes they will ask me, did you go through fertility treatment? I did not. And I don't want that to be triggering for everybody, but I do feel like it's such an important part of who I am. Even though I didn't have trouble getting pregnant, I did have trouble staying pregnant. I know my body always wanted to go into labor early. I had to be on progesterone shots and, and all these things for preterm labor. So I did experience kind of a lot of stress on that side of things. But here's what I. Ultimately realized is the most important thing in my life is my kids. And that is what drives me every single day in what I do. And I just always think when it, cause when I get home and see my kids, I love them so much. And I'm like, I want everybody to have this. And that's what I think. Just, I still remember when we did our groundbreaking for the building and we brought our kids with us and we took that photo. It was just like such a special moment because I know that's what drives you too. We're just two moms wanting to help other people get to be moms. Absolutely, yeah. The amount of joy that our kids bring us, I think, and I have so many patients that Dr. Reed knows that I have grown very attached to, and I just want them to be parents, you know, I'm like, you guys are going to make the best parents, and it's really challenging that there's people out there that probably wouldn't make the best parents that get to have children, you know, and I know that's frustrating for my patients, and so we just work really hard so they can experience that joy and be parents, because they deserve it. Yeah, absolutely. Alright, should we wrap it up for the week? Yeah! Y'all have a good week! Alright, thank you guys! Bye!