Two Peaks in a Pod

Rebel Wilson & Mastering the Art of Flawless Egg Quality

• Beverly Reed • Season 3 • Episode 4

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Dr. Amber Klimczak and Dr. Beverly Reed discuss everything you want to know about the factors that affect egg quality, how you can assess your egg quality, and how you can optimize your egg quality.

https://www.youtube.com/@peakfertility

https://podcasts.apple.com/us/podcast/two-peaks-in-a-pod/id1694248202

Links are in @drhappyeggs IG bio.

Hi, I am Dr. Beverly Reed. And I'm Dr. Amber k Clack. And we are two peaks in a pod. Well, hi everybody. Welcome back. Today we are gonna be talking about a celebrity Dr. Kay's gonna tell us about. Yeah. Okay. Tell me Dr. Kay. Okay, so first of all, I have to preface, preface this by saying. One of my husband's favorite movies. Mm-hmm. Is Pitch Perfect. Really? Is that, isn't that a romantic comedy or something? Well, like, yes. Which if anyone out there knows my husband's listening, like my husband is a giant six three, like manly man and he loves this. Like, is he though, now that we know this? No, I'm just kidding. You know, he likes boy things. Yes, yes, yes. But he loves. Pitch perfect. I swear. Oh my gosh. Okay. I'll walk anytime. It's on tv. He is watching this video week. He's watching it. Great. So I've seen Pitch Perfect probably a thousand times in our In Our Lives. It's a great movie. Okay. I need to watch it. I haven't seen it. It's great. Good music, highly entertaining. But Rebel Wilson mm-hmm. Is one of the actresses in it. She's hilarious. Okay. Um, her character's really funny in it, but Rebel Wilson has, you know, opened up about her fertility journey. Yeah. And she really talks about how it, you know, she was trying to decide should I freeze my eggs or not. Mm-hmm. And when she really started to investigate this process, she figured out wow. Egg quality mm-hmm. Has so much to do with this. And so she was like, I wanna do this while I'm young. Mm-hmm. And I can get some good quality eggs in the bank. Right? Yeah. Yeah. Um, so it's a really good, which is smart. Yeah. Which is a really good point. Yeah. But I will say probably one of the most common questions I get from my patients is. How can I improve my egg quality? Mm. Right? Yes. What can I do about my egg quality? Yeah. Because for some people, maybe they didn't, they missed that chance mm-hmm. To get to, to get them while they were younger, and so maybe they suspect or know they have an egg quality issue and so Yeah. Yeah. Well, I think it's a smart thing for her to do, but I, I agree. There's many women who, who didn't get the chance. For example, I always bring up, because I'm. Elderly at this point in the fertility world that, because sometimes people ask me, did you freeze your eggs? That surely a fertility doctor would've known to freeze your eggs. Right? And they didn't have that when I was younger. Can you imagine that's, that's how much the technology has improved is that when I was in college and medical school, egg freezing was considered. Experimental. Right. I know. It's crazy. Yeah. So I am so glad that so many more people these days are aware of it and that it's no longer experimental. Um, so that's great. That's great. Yeah. Yeah. So I think the topic of egg quality though is really relevant for our patients and yeah. Maybe some of our listeners out there who are not on a fertility journey and just trying to learn more about fertility. Yeah. Um, I will say it's. Complex, right? Yeah. Egg quality, and so a lot of times it just comes up in my consults. Patients throw the word egg quality around, you know? Yeah. It's kind of like just this term that we've attached. Yeah. But sometimes I pause and explain to my patients and say, what do we really think egg quality is? Yeah. What is it, Dr. K? Yeah. Yeah. Do you have a good definition for it? Well, this is the way that I try and approach it is. Mm-hmm. Okay. Well, here's what it's Right. Okay. It's actually just. The ability of the egg that you ovulate, right? Mm-hmm. To be fully mature. Mm-hmm. Be able to be fertilized by sperm. Mm-hmm. Grow to an early embryo, have a normal set of genetics mm-hmm. And implant and make a baby. Mm-hmm. Right. That's egg quality, right? Yeah. It's that it should be doing what it should be doing. Mm-hmm. I think people have. Some idea that their eggs might look like little scrambled pieces of, you know, fragments when they come out. And this thing that you can look at'em and tell, or you know, no, it's actually assessing the reproductive potential of your egg. Yeah. And so this answers the question all that I get all the time. Well, how can you test my egg quality, right? Mm-hmm. Me, because there, if any doctor is telling you, oh, we're doing this test for your egg quality. There is no test for your egg quality. Mm-hmm. We don't have any ability to test your egg quality mm-hmm. With a blood test or even an ultrasound mm-hmm. Or anything like that. Right. Yeah. So it's very, very difficult for someone to understand what their egg quality is. Yeah, absolutely. And you know, as you were kind of de describing that too, another thought came to mind, which is sometimes it's like people think it's all or none. That all the eggs are bad, or all the eggs are good, but realistically it's probably that a proportion of the eggs may have lower quality and maybe some are high quality. So for example, let's say somebody has 10 eggs. There's a big difference between somebody who has nine out of the 10 eggs that are very high quality, versus somebody who only has one out of the 10. And so sometimes it becomes a matter of efficiency. Maybe some of somebody who has low quality eggs will ultimately get pregnant too, but they've gotta get to that one out of the 10 eggs that is gonna be capable of producing a baby. So I think that's what could make any kind of blood test to check the eggs challenging. What kind of blood test would be able to tell you on an individual level for each egg, whether it's good or bad. Right. Right. Mm-hmm. Absolutely. Yeah. And so then, you know, when we think about egg quality, the way I really approach it with my patients is we have markers. Mm-hmm. Right? We have some data that will suggest some factors that will affect your egg quality. Right? Sure. And we can really counsel our patients on Yeah. On these. So, you know, one of the biggest things to consider is age. Yeah. Age is the biggest driver of egg quality. Yes, absolutely. So by far age will affect your, you know, and this is really frustrating, I think, uh, for us women Yes. Especially if we've decided, you know, we wanna go to college Yeah. And have higher careers. Right. We delay childbearing for a long time. Mm-hmm. And so unfortunately as we get older, almost certainly your egg quality is gonna go down. Yes. Yes. Just a fact. Absolutely. Okay. I did wanna go back to one other thing'cause you did mention looking at the eggs'cause you kind of gave that example. Mm-hmm. Patients think you'll be able to look and see. I would say rarely. Sometimes the embryologist can just look at an egg alone and say, gosh, that looks like a pretty bad egg. Right. Um, now, um, how can she tell It's really about the kind of shape, the morphology, the composition of, of the egg. Um, that can look abnormal. And so usually our embryologists will let us know, Hey, these eggs look to be poor quality. However, even with that, we've seen poor quality eggs actually turn into beautiful embryos. So we would never totally discount an egg based on the appearance alone. But it can be a good hint for us overall if a cycle didn't work to know that the eggs came out looking like that. Um, but if an egg looks good. To the embryologist. That also cannot be reassuring. You don't know what's gonna happen with the egg until you see does it fertilize? Does it grow into an embryo? Is it a normal embryo? Um, and so I think that's important to know.'cause sometimes patients will ask the day of the retrieval, how do they look? Mm-hmm. We can say they look good. And then that can feel very confusing. If a week later we say, well, now you have egg quality problems. And they say, but it looked good. Right? Only so much you can tell by looking at a person alone. It's kind of similar. If you were to look at me right now, you could look at my outward appearance. Can you tell what my inner health is? You really can't. Right. Um, and it's very similar, um, with an egg as well. So although we do look for those clues, you, you may not necessarily, um, get an answer, uh, from that as well, so yeah. Mm-hmm. Absolutely. I've definitely been in that boat before too. Yeah. I shared with patients. Our embryologist is worried about the way the eggs look. Yeah. And then we end up having a great cycle. One getting pregnant on the first embryo transfer. That's right. Yeah. So remember that part of the treatment that we're gonna talk about Yeah. Is IVF So something probably that we're doing is helping things along. Exactly. Because I'm sure she saw the eggs looked fragile. Mm-hmm. She, you know, took very special care of them, right? Mm-hmm. Mm-hmm. To, to help nurture them. And maybe that was difficult for the eggs in the body to do on its own too. But I think that's what I'll go back to say too. There's no test for egg quality, although to me, IVF is in itself a test for egg quality. So if somebody, for example, got 10 eggs and ended up with, let's say six beautiful normal embryos, I would say, you know what? I think you've got pretty good egg quality.'cause you wouldn't have been able to achieve that if your egg quality were poor. Whereas if somebody has 10 eggs and ended up with zero embryos, I would say, look, I am concerned that egg quality could be an issue. Now there are other things we would evaluate and factor in at that point too, and we'll kind of talk about that later. Um, but I really think that's where IVF is so helpful. Yes, it helps you get pregnant, but yes, it also gives you a lot more information that we just cannot find out any other way. Very true. Okay, now back to the age thing. I wanted to bring this up because, do you remember we had a medical assistant who said before. Oh my gosh, Dr. Reed, why are your patients so beautiful? They look so young and all, and I'm like, it's so true. I think,'cause we have a lot of patients from social media, we've got Instagram influencers and everything. And my patients come in, they may be 43 and they look like they're 20 or something. And I'm like, oh my gosh. Their skin is perfect. You know? And I think these days it's nice'cause we have a lot, you know, they've got Botox and fillers and I'm telling you, today's women are looking. So good. But I find it that these patients are the ones who are the most frustrated, right? Because if you're looking and feeling like you're 20, but your ovaries are not agreeing, that's frustrating. Right? Yeah. I know we don't have Botox for the ovaries, right? Maybe you might, we'll talk about our PP later, right? Um, but, but I think that feels frustrating because as a woman, it does take a lot of effort to take care of yourself to maybe exercise. Look nice and look young and everything. So when you are doing all of those things to find out that it doesn't really seem to help the ovaries, it can feel really frustrating. Extremely. Mm-hmm. Yeah. Mm-hmm. Yeah, I get that a lot where my patients say, I live a very healthy lifestyle. Yeah. I'm doing all of these things right. Why is my egg quality poor? Yeah. And I think honestly, for most patients in that category, maybe patients that are 40 and above. It's really a sense of shock that they experience. Mm-hmm. When they're being told, Hey, essentially you're aging and there may not be that much you can do about it. Mm-hmm. That's, it can feel like such a shock because you say, but I feel young. I feel fine. I feel healthy. Like, what are you talking about? You crazy doctor. Right. Funny.'cause I feel like 10 years older than my age. You're an old soul. I wouldn't be surprised. You're an old soul. For sure. My doctor told me I was aging. I'd be, yeah. Well you're paranoid as a IL doctor. I know. You're always worried. Oh my gosh, I'm running outta eggs. I'm like, you're, um, okay. So, so I think really, but the whole point of that is the mo, the best surrogate marker for egg quality, without a doubt is age. I would rather have one egg from a 25-year-old than 10 eggs from a 45-year-old. That is what a big difference, age can make on quality. Um, but here's why you won't hear about it too much from us. I certainly have the new patient appointment. We will bring it up because we need to be realistic and review the statistics with you, okay? But the reason after that appointment you probably won't hear too much about it is'cause we know there's nothing you can do about it. You can't age backwards. Right. If you can tell me how I want you too. Mm-hmm. Right? There's nothing you can do about it. It's, it's, it's hard. But, but you've just gotta acknowledge that. And so, although we're gonna be doing, talking about a lot of things to optimize your egg quality today, you've really gotta take that pressure off of yourself, of thinking that somehow we can biologically change the way our bodies are made as well. Right? Mm-hmm. And I think the other thing to just understand in, in terms of interpreting the data and what we have available mm-hmm. Is everything is on a spectrum, right? Mm-hmm. So yes, for some women, you might have friends that are able to get pregnant maybe in they're late thirties. And for you, you've really been struggling to get pregnant in your late, late thirties. Could it be an egg quality? Issue for you still at that point in your life, even though other people have not had problems. Mm-hmm. Yes. Yeah. Remember it? These are averages, right? Yeah. So we all kind of age on our own timelines. Mm-hmm. So you might have friends or family members who maintain maybe quantity, but quality too, up until a longer point in, in their lives, right? Yeah. They don't have control over that. Yeah. And what do you think, you know,'cause you mentioned the spectrum, I think it's so true. Don't you think there are some lifestyle factors, for example, that may push somebody, um, maybe higher or lower on that spec spectrum of egg quality, right? Yeah. Do you? Absolutely. Yeah. And the number one, um, item that has been heavily researched as smoking. So we know that smoking. Accelerates the rate at which we go through our eggs and absolutely is gonna accelerate the rate at which your quality decreases. Yeah. Um, in, in your eggs and something that is modifiable, right. Everyone can potentially quit smoking. So that is a huge recommendation. And then I think we've extrapolated a lot, but there's still, you know, there are studies coming out about vaping, et cetera. Mm-hmm. So any type of. Exposures like that, we really encourage our patients to stop.'cause there are so few things that you have control over. Mm-hmm. Right, right. Yeah. So I mean, sounds like a lifestyle overall. I do think we talk a lot about diet and nutrition or sometimes you could just have an underlying fertility issue or genetic problem or something that can be affecting. Your egg quality. I know two of the fertility conditions that I think can really affect egg quality are PCOS and endometriosis. These are, um, different conditions that really, through different mechanisms of action, can really lower egg quality. And sometimes you, um, maybe have not been correctly diagnosed in the past. Sometimes we will get patients that, um, it got missed or. Misdiagnosed even. Right, right. For either of those conditions. Yeah. Mm-hmm. Yeah. So for our listeners out there that might know, oh, I have PCOS. Mm-hmm. Or I have endometriosis. The way you can kind of think about this is that women with PCOS and endometriosis often need a lot more quantity of eggs in order to make an embryo successfully. Or make a baby successfully, because like we're seeing maybe. A larger percentage of your eggs are not good quality or not capable of making it. So we see a bigger attrition or a bigger drop. Mm-hmm. When those patients go through treatment like IVF where we might start with a good number of eggs, right. But end up with a smaller number of embryos available or ultimately and births. Right. And so you can think about that in terms of, well, how do they know that Mike? Quality is affected. Same thing. We see women with endometriosis and PCOS go through that decline much more sharply. Yeah. You know, I think with PCOS, what's so nice is we have very specific criteria on how to diagnose somebody, um, with PCOS based on their history, their blood work, and their ultrasound. So as a fertility doctor, we are very familiar with that, and that is pretty easy for us to be able to assess even within the first. You know, couple of visits with us, we can tell you about that. But I think what is more challenging about endometriosis is there's no blood test that can tell you if you have endometriosis or not. There's no really ultrasound test, um, that can totally rule it out. Now, I will say sometimes we can see things on ultrasound where we can rule endometriosis in. So if we see a cyst filled with endometriosis on your ovary. You can say, okay, you have endometriosis, but if you don't see that, I would never tell somebody, oh, you don't have it. Because those little endometriosis implants, these are like little bits of tissue similar to the lining of your uterus that end up implanted throughout the pelvis. Um, and everything. You just can't see those a lot of times on ultrasound. And so I've had cases where sometimes I do IVF. And let's say it's a young person and I saw her egg quality wasn't great, who I said, you know what, I think you probably have endometriosis based on what I'm seeing because a young person should have good egg quality. You're doing all the right things and, and so maybe this could be a hint as as to possible endometriosis. Now, ultimately the treatment for severe endometriosis IVF anyways, but that's kind of where it starts to help the patient understand what could be going on rather than this umbrella term that they sometimes are given as. Unexplained infertility. Oh, you're having trouble getting pregnant. Nobody knows why. And it's like, no. Now we're starting to get answers for you. Definitely. Mm-hmm. Yeah. Um, okay, so if all these factors affect egg quality and we can't change age, what are the things you think we can change and what do you think are the most important? You mentioned smoking and vaping. I'll say these days I don't really see a lot of smokers. I would say smoking is kind of out of fashion at this point, but I do agree vaping. Mm-hmm. Um, that maybe a lot of former smokers now vape, so. You should wean down or cut that out. Um, but what are some of the other lifestyle factors do you think could be reversible maybe for patients? Yeah. I mean, I like to um, chat with my patients about doing everything in moderation. Mm-hmm. You know, I think that's a pretty good rule.'cause it's hard sometimes, even in the initial patient, um, consult to go through everything they could possibly be doing. Mm-hmm. I actually have had. Discoveries later with my patients after I even seeing them for mm-hmm. Several weeks or even a month, and, and I find out, oh, they've been doing something that Yes. Is so unusual Yes. That I did it, you know, that I didn't pick up on it. Right. That's right. And so I always, you know, try and mention, remember if you're mm-hmm. If you're doing anything to access, yeah. It's probably not great for high quality, really anything. Right. Yeah. So for example, if you are exercising mm-hmm. To excess mm-hmm. If you are dieting to excess, right? Mm-hmm. You're really limiting your fuel, right? Yeah. For, for your egg production. Mm-hmm. Right. Your hormone production, it's gonna affect your egg quality, right? Yeah. You're drinking to excess. Mm-hmm. It's probably affecting your egg. Quality. Absolutely. Um, you know, if you're eating certain foods that are unhealthy to excess, right? Mm-hmm. You don't have to completely limit yourself. Right. But if you're overdoing with the sugar, and most of the time people know when they're doing these things. Yes. Right. Well, I would say probably, I hear you mentioned diet and exercise, and I do think that there's a lot of patients. That don't realize that that is affecting their fertility. Okay.'cause back to my patients that are Instagram influencers. Mm-hmm. Right? They've gotta wear their bikini on Instagram. Right. So they've gotta be looking good and skinny and everything. And of course we are inundated with information telling us that eating healthy and being thin and exercising, these are all things that are really good for us. Right. So this may be the first time anybody in their whole life has been told, maybe this isn't the best plan for you right now. Mm-hmm. And what is so interesting is this is probably a really important part of how our bodies were designed in general, right? The concept is that if you don't have enough calories for yourself, you may not have enough calories to carry a baby. And so the brain works. The way the brain works is if you are in a negative calorie deficit. It oftentimes will turn off your reproduction. Some women will stop ovulating, or for women who are still ovulating, their egg quality can decline. Some of their hormones can be lower. Um, and I think it's really an under-recognized cause of, um, fertility issues and. I'll say, when I talk to these patients about it, they really don't wanna hear it, right? Because nobody wants to be told you need to gain weight, you need to be eating more calories, and maybe you need to stop doing as much cardio. Um, a lot of these patients are very resistant to that. Um, overall. Mm-hmm. I agree. It is a tough conversation. Yeah. Especially if that's what, maybe they're building a lot of their livelihood, et cetera, off of. Yeah. Yeah. Um, but then what's hard is then the opposite group of patients. Maybe patients that have a higher, um, weight or body mass index. Um, I will say a lot of them have already been told and by friends, family, okay. You, you do need to lose weight to, to help your body. Doesn't that feel so conflicting is, but Dr. H, you told my friend she needed gain weight and now you're telling me I need to lose weight. Why the difference? But the hard part is having a really high amount of body fat causes so much inflammation in your body and in those patients, any level of exercise is beneficial, whether it's a little, whether it's a lot good for you. Um, and really diet is so important in that case, um, as well. More so focusing on really bringing in those. N uh, nutrient dense foods, um, and, and avoiding all the simple carbohydrates, the sugars, and all of that too. Yeah, I really would like to do maybe a study on those continuous glucose monitors, so you know how I wear those from time to time. Mm-hmm. Um, and I think it's so helpful in really just trying to understand how your body responds to certain meals. I know when I wore mine, I was. So surprised.'cause sometimes I could be eating something that I thought was pretty healthy overall. So for example, for a snack, I'd say, well, I'm just gonna eat popcorn. That's better than eating chips. For example, popcorn made my blood sugar go way up. And so I, how much popcorn were you having? I know, I didn't feel like it was that bad and I said, oh my gosh, like. If this was really helpful for me to identify what foods really make my blood sugar high, and so I think that could potentially be helpful for people trying to get their blood sugar under control because I have found uncontrolled blood sugar to impact egg quality as well as sperm quality too, right? Mm-hmm. Yeah. Yeah. And I guess since I bring up sperm, most of the things we're talking about today are good for eggs and sperm. Right? Very true. Yeah. Yeah, very true. Yeah. Um, okay. You touched on alcohol. This is, this is another thing that you can really get me worked up on, um, which is that, um, this is a common question that we both get and we have different answers for. Um, but I will say this is something that my view really changed on over time, and it changed on based on the personal experiences of me watching my patients, who did IVF, and then seeing what happened when they stopped drinking alcohol and did IVF again? And I have seen some drastic differences when somebody may not have even been a heavy drinker to start with. So let's say somebody has a glass or two of wine every night. I mean, I don't think most people would consider that heavy drinking. Um, but I have seen such different outcomes and when I saw that, I really started digging into the research on it and. Sure enough, studies clearly show the more you drink, the lower the outcomes are for both, um, the guy and the girl for both parties involved. Um, but what was interesting is I feel like when you're looking at egging and sperm quality, you are getting a glimpse into your health overall. Okay. And that is such a gift to us, really, right? Because a lot of times you don't really know these things are gonna cause a problem for your future self, but how often do you get the opportunity to essentially have your cells and get to see what they're exposed to and then have the chance to improve it. Um, and so when I look to see, okay, if alcohol is affecting eggs and sperm like this, what else is alcohol? Affecting, and really it affects all parts of our body and it makes sense, right? When you're gonna disinfect something, what do you use? Sometimes alcohol, right? Because alcohol kills everything that you put on it, right? So then if you drink what you literally use to kill everything, what's gonna happen to your body? Right? So alcohol is associated with a higher risk of dementia later in life. It is, um, associated with at least seven different types of breast cancer. I mean, sorry, cancer. It's. Seven different types of cancer overall, but for breast cancer, which is one of the most common cancers that we as women get, it is one of the biggest modifiable risk factors. And I don't feel like there's been enough information that has been given to us as doctors, even all as a whole, to really be able to express this as a patient. And so when, when I saw what a big effect it was. I actually stopped drinking. I used to love a margarita or a glass of wine, and I said, you know what? Why would I drink poison? That's what it's, and so, um, that's why you might see different effects or different answers from different doctors and everything, but, but I'm very anti-alcohol at this point. I, I take more of a moderate approach, but here's what I explain to my patients is that Americans are just not moderate with alcohol. The problem. Mm-hmm. Um, really we're not great at moderation in anything, I think. Yeah. But especially not alcohol. And what we think is socially acceptable is actually heavy alcohol use. Right? Mm-hmm. So even though you might say, well, I don't think a glass or two of wine is heavy alcohol use, it is based off of the studies. So what I explained to my patients is moderate alcohol intake is one drink. Every other day for women, one drink a day for men and one drink a lot of times is less than they think, right? Mm-hmm. Our glasses of wine are huge. Mm-hmm. Right? So it's truly, you have to look up, you know, for whatever your beverage of choice is, um, you know, and. People figure out they're drinking a lot more than they're, you know, maybe admitting to themselves. Yeah. You know? Yeah. That's the difference. Yeah. Yeah. Absolutely. Um, okay, so what about diet, you know, and when I say diet, I don't mean restricting calories or anything like that. What is the diet that you like to recommend for your patients who are asking about the best ways to improve egg quality? Um, so I mean, you and I have talked about this a lot. Mm-hmm. We do. I think the Mediterranean, Mediterranean diet is easy for patients to understand, but a lot of times what I'll do with my patients when I've been doing more recently mm-hmm. Is I ask them, tell me about your diet. Mm. Right? Mm-hmm. And I really listen to what they're saying'cause I have some patient. For example, who, um, are vegetarian. Mm-hmm. Or a lot of patients nowadays have more restrictive. Mm-hmm. You know, they're gluten intolerant, et cetera. So I listen to them and I do feel like that sometimes gives me a little bit more insight on how I can help them Yes. To, to fix their diet. I mean, we're not dieticians, we're not nutritionists. Right. But a lot of times when I listen, I can understand kind of where. For example. Yeah. A lot of my patients from certain backgrounds, my Indian patients mm-hmm. Um, my Asian patients, they, you know, are dealing with high hemoglobin A1C levels. Mm-hmm. High insulin levels, high blood sugar levels. And when I talk to'em, they're eating white rice. Mm-hmm. Every single day of the week. Yeah. Very high glycemic index food, right? Yeah. There are a lot of us, including myself, who the only time my blood sugar spikes is when I eat. Right? White rice. Really? Yeah. Is that what, okay. It's notorious ing, absolutely notorious for spiking your blood sugar. Ah. Um, and so like I really listen to that and you know, when I tell people I want you to meran diet, I want you to eat fish three, four times a week. I hate fish. I eat fish. You know, so like I, I'm trying to now kind of expose myself to, okay, what can we work with? Yeah. Because sometimes I realize, I dunno if they're gonna listen to me. You know, if I just say, okay, go fish. Well, I know and I will say some, I, it's interesting there are a lot of people with this. Seafood, a version really. Um, and so I, I have some people who just say, Nope, I refuse. Not worth it. Yeah. Um, but yeah, I mean, I think, look, there are some other ways to get your lean protein in besides seafood. We think seafood is great for you, but if you can't eat seafood, then lean protein like chicken or Turkey or things like that can be really helpful. You wanna avoid high fat meats, you wanna avoid processed meats, and then you really wanna be working in a lot of vegetables. If you do carbohydrates, you really want to do whole grains. Really kind of think about something that's gonna be hard for your body to process or break down. Those are gonna be better foods for you. And some fruit is okay, but even fruit can really spike your blood sugar. So you want to limit your fruit overall. But I do really like your point of really trying to understand what they eat. And in fact, sometimes you could just start a food journal for yourself for a week. You could probably have your fertility doctor take a look at it for you. Um, I know for me personally. That's even been helpful.'cause sometimes I'll get frustrated. I try to follow a healthy diet and then if I'm not losing weight, I think, gosh, I've been eating so great. And then when I write it down, I'm like, oh, well I did forget about that cookie I got from Panera Bread the other day. Right. I mean, sometimes it's easy to forget all the times that we, um, we're not eating what we were, um, had initially aimed to as well. So, yeah. Um, okay, so we talked about diet and smoking and alcohol and weight and exercise. What about all of the hidden factors in our environment? Right. I mean, I feel like these days it seems like we are surrounded by toxins everywhere. Mm-hmm. Don't you think it's hard to. Be able to control that in some way. Right. Yeah. And I mean, there's certain toxins that it's, it's unavoidable. Yeah. Right. It is really hard. Mm-hmm. I know we've talked a lot about plastics here, um, on this podcast. Yeah. I know everyone's obsessed with avoiding plastics out there. Me? Yeah. It's hard. It's really hard. But one thing that I do, um, cover with my patients, which, if you're one of my patients listening, you probably remember this, but I always wanna know what my patients do for work. Yes. Yeah. Mm-hmm. Um, because there are some things that you don't realize that you're exposing yourselves to. I have a, and this goes for sperm too. Mm-hmm. Um, and so I always just wanna listen like. Are you just, you know, working a desk job or are you kind of working with chemicals, exposures, things like that. So there can be sometimes more avoidable things. Are you using proper protection when you're doing that? Yeah, especially some of my men, I have had men that work outside in the heat. Mm-hmm. I've had women that work with pesticides. Mm-hmm. Like all sorts of things, you know? Yeah. You're like, I never really thought about that. Yeah. Yeah, yeah, yeah. Um, well, whenever I was doing my training to be a fertility doctor, my thesis that I did was on how BPA, which is oftentimes found in plastics, can affect your fertility. And when I first started the research, I actually didn't think there was much to it. I said, surely. This was harmful to us. The government would protect us from this, right? This would be regulated in some way. And so when I started to do the experiments and I saw how BPA was affecting things on this microscopic and molecular and genetic level, I was actually really horrified. And then I went a little crazy and I tried to get rid of. All the plastic and really anything else too. So I totally changed my lifestyle for myself and my family. And they know at home, I mean, if they get like a free plastic cup at at school or something, it's getting chunked in the trash. Like they know my rules. But admittedly, as somebody who's gone crazy and tried to get rid of all plastic, it is impossible. So hard. There are some things that just come in plastic as we're even filming this. You can see my plastic cup with my iced tea in it from lunch. I mean, what are you gonna do when you're at a to go place? And all they have is a plastic cup, you know? And so really what I've had to. Learn myself, um, is really, you can't eliminate. So just try to minimize your exposure mm-hmm. To plastics as much as you can. If you have the option, use stainless steel or glass to drink out of Dr. K's famous for her granny glass. I think it's the younger people these days use Stanley cups. She use a gran, she uses a granny glass to drink out. Um, look, even at this. Draw. If you have the option for a glass or metal straw, I think that's probably healthier for you when you're going to a business and they wanna give you a receipt, politely decline it. Receipts, have BPA, um, in it as well. And so just try to make these part parts of your just daily habits. Also think about. Fragrances and, and these things too. Um, really try to get, and I know it's not any fun, you won't smell as nice, but try to get things that have no, or low fragrance in them so that really in your day-to-day life, your, your toxin level, um, can be a lot lower. Um, okay. What are your thoughts about caffeine? Do you think caffeine affects egg quality? Um, I mean, I don't think it's probably as extreme as some of these other mm-hmm. Factors. Mm-hmm. But again, and I do talk about this, um, with my patients. Yeah. I think to excess, we know for sperm that, you know, men who consume excessive amounts of caffeine, we have really nice studies to show it can affect your sperm quality. Mm-hmm. Um, egg quality, again, it's harder to study. Mm-hmm. Right? Mm-hmm. It's just, there's no, there's no, um, way to do that test, right? Mm-hmm. Semen analysis is such a good marker. Parameters for sperm. Mm-hmm. Um, so probably, right. Mm-hmm. If you're drinking excessive caffeine, you're probably affecting your egg quality. Mm-hmm. Um, most of my patients actually don't drink excessive caffeine. Yeah. Right. And I'll say for some reason it's the men that I find it more. So. Is that the case with you? Um, I think so, but I will say I don't really, I'm not as restrictive with caffeine on the men because as you said, it has to be really high amount. So I do feel like in women, I tell them to keep it less than 200 milligrams per day, but that's more so because I know it may increase risk for miscarriage in pregnancy. Mm-hmm. So I just am kind of like get in the habit of those lower amounts now, but they kind of sometimes feel jealous if they're like, okay, but what about him? Does he have to stay less than 200 milligrams? Today and I'm like, not really. Yeah. You know, not we, I don't have great data to show that, so. Yeah. So they can get a little annoyed because of that. Very true. Um, okay, so what about fertility supplements? I don't think we're gonna talk about all the individual supplements. But overall, if a patient comes to you at her new patient appointment and, and you don't know about egg quality even, and she says, should I take this huge list of supplements? What do you think? Yeah, I'm not a huge supplement doctor. My patients know this about me. You know, I really like to stick to evidence. Based things. No supplement is gonna have that highest level of evidence, randomized control trial showing that it makes a significant difference in your fertility journey. Um, however, most of the time they're not harmful. Right? Um, and so they might add a moderate increase, um, in some of these markers. So I tell them, if you wanna take them right, you can don't. Spend a lot of money on them. That's one way it can be harmful. Do not spend excessive amounts of money on fertility supplements. Um, and make sure you're reading the ingredients. Have your fertility doctor read the ingredients.'cause some of these things can mm-hmm. Have disruptors in it. So we have to make sure that you're not doing anything harmful to your fertility. Um, so a lot of times my patients will send me all their ingredients of the things that they're taking. Yeah. Um, and you know, I would say most of'em are fine and I, you know, allow them to stay on'em, but I don't usually. Promote, um, many of the supplements. Yeah. Yeah. Um, and I would say, I mean, maybe we should mention prenatal vitamin and vitamin D. Of course we recommend for everybody. Um, but we're talking about other supplements beyond that, and what I usually tell people is I'm not typically recommending supplements right off the bat if they've never mm-hmm. Tried any testing or treatment because at that point I'd say, well, fertility supplements may be helpful for egg quality. But we don't know your egg quality, right? Mm-hmm. And so I don't want you to have to be putting anything into your body that you don't necessarily need. However, if I have a circumstance where, because of their prior treatment history or something like that, I highly suspect they have an egg quality issue, I do send them a safe list of, Hey, these are the supplements that may be helpful. These are the ones that I know won't cause any harm. There are some that I do believe, um, can cause issues or problems and so I usually give them my list of ones that please don't take these, these are okay if you want to, but to be honest, we have to know there's no magic supplement that can all of a sudden just make you go from having like, in my case, 46-year-old eggs to 25-year-old eggs. It's just not, not gonna happen. It's not realistic. Actually, I think this is one place that chat, GPT is really helpful. Okay. Yeah. So you know these patients that they take a ton of supplements. Mm-hmm. If they have like their ingredient list online. Yeah. I think you could copy and paste your ingredient list. Sure. To chat GPT and ask if any of these are harmful for fertility. I think that's really helpful. Yes, yes. Because they put some weird stuff in there. You might not know what you're taking. Yes, definitely. Definitely. Um, okay. And then what, what do you think about, um, are there certain protocols, certain, for example, IVF protocols that you think might be better for certain types of egg quality? Tell me what your thoughts are on that. Yeah, I mean, I think this is tricky with the data, right? Mm-hmm. Because unfortunately when people are switching around the protocol on you on, for IVF cycles, it probably means something hasn't gone. Mm-hmm. Well, for you, yeah. Um, so that's a little, little bit of the limitation mm-hmm. For us, when we interpret this data. If you're, um, trying to figure out, okay, would a, would a better IVF protocol, uh, work for someone with low egg quality mm-hmm. Um, you have to kind of take that into account. Mm-hmm. But I do tend to change things if we have had a poor cycle where we s. Mm-hmm. That there could be an egg quality issue. Mm-hmm. Um, a lot of times we can change the, the type of way we do the suppression of the LH surge, right? Mm-hmm. A lot of times we're doing an, uh, antagonist protocol. You might try, try something like a flare protocol. Mm-hmm. Or micro flare. We use Lupron, so I will try and switch it. I know a lot of people, um, do mini stimulation cycles. Sometimes there might be. Uh, thought that the higher doses of IVF medications could be doing something to the egg quality. I will say it's, you know, it's hard. Mm-hmm. Again, it's gray. We go back and forth on this. Yeah. Um, you know, we at our practice really don't use high, high, high doses of IVF medications that might be out there other places. Mm-hmm. So that's probably fairly limited here. Yeah. But yeah, I do switch around the protocol. Yeah. I think really with us and this, what I found is it's hard because with those big studies, it's. You're trying to get all people that are exactly the same in this study. Mm-hmm. And what we know at this point is our bodies are all just a little bit different. Mm-hmm. So sometimes you really have to watch and see what they did and then make some little tweaks. I say it's like if you made a lasagna and it didn't turn out how you wanted to, you kind of make little tweaks to say, okay, how do I make it better? And it depends on what you found was wrong with the lasagna. Right. Yeah. Um, and so that's kind of how coming up with an IVF protocol, um, can be, um, okay. Dr. K, so I know you do something called PRP where. We can draw blood from the patient and we concentrate down the platelets because platelets are full of growth factors and growth factors can be rejuvenating. And it's kind of interesting'cause these days they're just injecting this PRP everywhere. I see. They inject it into this. Gout for hair loss into the face for wrinkles. I want it in my jaw. I know I was gonna tell you. I, we'll, we'll talk about that later. Maybe I can help you out with that. But, um, they're injecting it everywhere. And so the thought is if you inject PRP into the ovaries, can you see, um, a difference? And most of the patients who are getting this are patients who have really low accounts or are perimenopausal or, um, just kind of really this is their last resort. Um, but I wanted to get your opinion,'cause I know you do a lot of PRP, do you think injecting PRP could help egg quality? Yeah. Well this is anecdotal data, right? Okay.'cause we have small numbers of patients that are doing this. Yeah. Um, you know, I can share the data about the meta-analysis that are out there, right? Mm-hmm. There's, there's a pretty big meta-analysis about ovarian PRP mm-hmm. Um, that does say some of these things that you might say mm-hmm. Are quality related mm-hmm. Will improve after PRP. Right. Um, so number of mature eggs, um, potentially can improve decreases in FSH levels. Mm-hmm. So can improve, um, and then ultimately clinical pregnancy rates, but not live birth rates. In my own experience in this practice, um, with my patients, I have seen what I would say is an improvement in high quality, for example. Mm-hmm. I had a patient that I had cycled through IVF many times. Mm-hmm. Who I did PRP for and then we did P and then we did IVF again and we made embryos for the first time. Wow. Now I'll say the embryos were not great quality. Yeah. And this patient did not get pregnant, right? Mm-hmm. So when I counsel my patients about mm-hmm. PRP, it's really challenging'cause it's moving something. Mm-hmm. Moving the dial in the right direction with PRP. Mm-hmm. Um, I'm seeing increases in a MH. Mm-hmm. I'm seeing increases in natural follicle counts. Yeah. I'm seeing D decreases in FSH for sure. Yeah. But ultimately. I'm not seeing those results with IVF outcomes afterwards. Yeah. I do see patients get pregnant on their own. Yeah, absolutely. Yeah. Absolutely. And the data is out there to show that mm-hmm. In some of the follow up studies. Yeah. Um, but I. Why talk about what is your goal for PRP? Mm-hmm. Is it to do better at IVF? Mm-hmm. Because we're probably not gonna do better at I vf. Yeah, yeah. Absolutely. Okay. Gotcha. Um, okay. Well probably the last thing I did wanna just mention, um, because they're on another social media account that I saw, they really highlighted this study that I think was helpful. And the whole point of this study was to point out that oftentimes if an IVF SI cycle doesn't work. It is kind of blamed on egg quality and it's blamed on the woman, which it is hard, like why are we always blaming women? Right? And what the study found, and they found this out by using donor eggs, um, is that a lot of times the sperm can have a really big impact on the result as well, but maybe it's an under-recognized factor. And beyond that, we know very well. Lab quality is important. That's why we are so obsessive about our embryology lab, making sure that the conditions are always perfect. And so if you're in a situation where you tried IVF treatment and it hasn't worked and you were told it was because of egg quality, yes, optimize all those things. But maybe some other questions to ask is, Hey, is there any additional testing? My partner, um. Could consider maybe doing like DNA fragmentation testing on the sperm, just to see if there's any other factors that weren't, weren't recognized at the time. Um, and then also just making sure that you feel comfortable with the lab that you're at too, asking your doctor, Hey, what are your pregnancy rates? You know, what are your outcome rates? Just making sure that you feel really comfortable with where you are as well, so. Okay, good. Well, we're gonna wrap it up for the week. We would so appreciate it. If you guys found this podcast helpful, if you could leave us a positive review. Um, if you're on YouTube, make sure you subscribe for more and we will see you guys next time. Have a good one. Bye.