Two Peaks in a Pod

Tay Lautner: Why She Tested Her Fertility and How You Can Too

• Beverly Reed • Season 3 • Episode 6

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Dr. Amber Klimczak and Dr. Beverly Reed discuss how Tay Lautner opened up about why she did fertility testing. They discuss types of fertility tests available as well as what they can and can't tell you.

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. Hi everybody. Welcome back. Today I have a new celebrity to run by you, Dr. K, and I feel like this might be in your age range. So I, I wanna see if you know who the celebrity is. Have you heard of a guy named Taylor Latner? Yes. Okay, good. Okay. Because I'll say he's a little young for me, he's like out of my age range. Like I, I don't, I haven't really seen much of what he's in, but I know all the girls are always talking about him. Do you think he's handsome? He's, I was like, I think he is like really known for his body, right? The werewolf on on Twilight. Twilight, yeah. Have you seen Twilight? Uh, yes. Okay. Maybe the first one, is it good or, I think so. I read it. I mean, I guess if you only saw the first one, maybe you weren't that into it. Right. I'm definitely not into fantasy. Okay. But I mean, yeah, I think I saw like the very first movie, but yeah, he's, he's very good looking. Okay. I feel like maybe I'm too old for twilight and stuff, so I don't know. But um, but anyways, earlier this year, his wife was in the news in People Magazine and what I thought was really cute is his wife's name is Taylor. Okay. And his name is Taylor, but he also dated Taylor Swift. Okay. I think he's really, they only date Taylors. Is that some kind of like egotistic trait or something if you like, repeatedly wanna, um, date people with their same name? Actually, it does remind me, I've had patients like this before who not only had the fir, the same first name, but they had the same last name as each other. Oh, wow. Yes. Wow. That is so interesting. Um, because of course they got married and then, yeah. Mm-hmm. But, um, so that's, it's. It's really cute, I think, but, but probably a little confusing when they're calling to schedule appointments and they're like, wait, is this the male? You know, Taylor for example, or female Taylor. Um, but anyways, they were sharing, and I always love it when celebrities share about fertility and. His wife was saying that she had been on birth control pills for many years, and that her OB, GYN, suggested getting some fertility testing done because she had been on birth control pills for so many years. And really, it sounds like her concern was maybe she didn't have any eggs left, and so I thought this is such a good thing for us to talk about. Number one is, is that even a, a reasonable concern? Um, and, but beyond that, I think really what she was trying to get down to is, am I fertile? Am I losing my fertility? How can we know if we're fertile, if we're not ready to have a baby yet? And so I'd say, let's dig in. What do you think? Yeah, I mean, I definitely think it's a very fine line mm-hmm. For, you know, physicians to help. Their patients advocate. Right. And wanna investigate things, but also not scare them. Yeah. You know, more information. So it is, I mean, women I think are really at risk of being scared by some of these things. So I think this is a really important conversation so that you can kind of know, should you be worried if like just taking birth control pills for 10 years, does that. Make you run out of eggs. Well, I think it's so important to talk about too, because you know, I, I am on social media, Instagram, TikTok, and I will say this is a really common type of account that one might have, which is you'll have some sort of hormone coach. Mm-hmm. I'm, I for YouTubers, can see me. But for those who are listening, I'm kind of maybe mocking that term a little bit. Right. Because. There are people who claim to be experts in hormones. Although if you go to look at their credentials, they don't usually have any training in hormones. Um, but oftentimes they will try to scare you and say, oh my gosh, did your evil doctor give you birth control? Well. It's causing all these problems and you need to do a birth control cleanse and, and all these things. And I thought, what in the world? So I think maybe in the beginning, maybe we should even say that as fertility doctors. I actually think birth control pills can be really favorable for fertility. Absolutely. Yeah. And I mean, they decrease your risk of ovarian cancer by 50%. Mm-hmm. If you've been on them for several years. Mm-hmm. So, I mean, I think. That's pretty good for your fertility to not have ovarian cancer. Absolutely, and I will say one of the most common conditions that we both see is women who have endometriosis. And when you're on birth control pills, that is very suppressive to endometriosis. And in fact, there are studies showing if you're on birth control pills, you will have a lower rate of forming what's called endometriomas or pockets of endometriosis on your ovaries. I think it makes a lot of sense too, because one of the leading theories about how endometriosis occurs is that it's because whenever you have your periods, some of it can backflow through your tubes and implant in places it's not supposed to be, but when you're on birth control pills, your periods tend to be a lot lighter and everything too. And birth control pills are very high in progesterone levels, and that's what's so great about it is the progesterone really kind of keeps as much endometriosis from forming. So in those women, I think it's actually beneficial for their fertility. Yeah, absolutely. Mm-hmm. PCOS women also use birth control pills. Yeah. It can be really beneficial for your symptoms that you might be experiencing. So there's a lot of positive reasons why you should. Go on birth if someone recommends them to you. Sure. So, um, so for, to hear somebody say it causes infertility, um, you know, really I, I have not seen that. Um, so I would say beneficial for women who have endometriosis, beneficial for women who have PCOS. Now, what if you don't have any of those things? Is it beneficial for you? I mean, maybe you may not have benefit besides the fact that you have, uh, reliable contraception, right? Um, but even in that case, is it causing you to run out of eggs? No, absolutely not. There is no concern or no proof that birth control pills make you run out of eggs sooner. And here's what's really um, interesting is a lot of women say, well, I want my body to be in its natural state. Okay? But you have to ask yourself truly what is the natural state? Okay? So if we were cave women, our natural state would be that we are always pregnant. Or breastfeeding. Right? That's the natural state. Sounds awful. I know. That's the worst, right? And when you're pregnant, your estrogen and progesterone levels are very high. Right. Um, and then when you're breastfeeding, your hormones are very low. But that's the natural state. It is not actually natural for us to ovulate every single month for years and years on end without getting pregnant. That is not the natural state, and I think that doesn't really occur to people very often. Now, am I suggesting that you constantly be pregnant and breastfeeding? Well, no. Culturally that's, we know that's not normal. That's not what I did or anything. But in the meantime. Is it okay to be on birth control pills, which almost in a way can reproduce that pregnant state, or at least your ovaries are gonna think you're pregnant based on the, on the hormones and everything. Um, and so again, I, I don't think being on birth control pills alone would be a reason to stress or worry about whether you're fertile or not. Right? Yes, absolutely. I think there is this big push for people wanting to be natural, you know? Yeah. Most birth control pills are made of your naturally recurring hormones. Right? They're mimicking a normal physiologic environment for you. Mm-hmm. So I don't think you're putting foreign substances into your bodies. Yeah. Yeah. And the other thing I would say too is birth control pills are different than they used to be in the very beginning. Admittedly, they were higher dose birth control. But these days they, um, have both medium and low dose birth control pills too. So if you're worried about dosage things, it's always something you can talk to your doctor about as well to, to look for adjustments on that. Um, but I do think it's important to say that if somebody feels the need to test their fertility, one of the main tests that often gets talked about is testing a blood test called a MH. Anti larian hormone, and this is a substance that is released from the ovary that can give us an indicator of what somebody's ovarian reserve looks like. But I will say when you're on birth control pills, it may not always be accurate. Right, right, right. And maybe this is kind of the concern. Yeah. People have encountered. Mm-hmm. Yes. And so here's what I would tell a patient. If a patient says. I want to check my ovarian reserve and I'm on birth control pills. I would say, sure, we can do that. And if your result comes back as normal or high, great. Okay. But if it comes back as low, I would say don't panic. And maybe just stop your birth control pills for a few months, let it wear off. And we know the ovaries should bounce back after being on birth control pills. And then you can get a true reflection of what your results look like. So I think that's the important part, is if you choose to do this test while you're on pills, just understand there's a fairly high risk of getting a false positive and you just don't wanna get worried for no reason. Um, I do think it's, you know, reasonable to pursue further testing. But you just don't want to get up caught up in a loop where you're stressing your rest yourself out too. Absolutely. Yeah. When you stop your birth control pills within some amount of time, your fertility should return to what it should be at that age and time point. Regardless of whether you've been on birth control pills previously, nothing should be changed. Absolutely. Now, when you're on birth control pills, can you check other hormones? Well, I mean, you can check'em, but they're not gonna be accurate, right? So I've seen sometimes where somebody says, oh my gosh, my doctor checked my estrogen and progesterone level and they were zero, and I was not surprised at all. Of course, there's zero. You're on birth control pills, okay? We know those hormones come from active ovaries. Okay? But they say, well, shouldn't my hormones be high from my birth control pills? Well, birth control pills have usually different forms of estrogen and progesterone that are sometimes not detectable on our routine assays. And so if your results come back as zero, but you're taking birth control pills, I know your hormones are still high, but I would recommend against testing estrogen progesterone, F-S-H-L-H while taking pills. They're just not gonna be accurate. It's not useful at all. Absolutely. Mm-hmm. Yeah, I get that question a lot too. Yeah. Yeah. Um, okay. Going back to checking a MH, which I said you could check that, but Dr. K. Does a MH tell us if we're fertile or infertile? No, exactly. Absolutely not. Yeah. Mm-hmm. Mm-hmm. So, super important, and probably the most important information that we could arm you with if you're interested in quote, getting your fertility tested, is that there's really not any good test for us to be able to tell you. Yes, you're for sure gonna be able to have a baby. Mm-hmm. You know, there's no blood test that you can go into someone's office and get drawn and really assess your fertility in that way. A MH is really a marker that we fertility doctors use a lot, and you've probably heard us say this before, but it really helps us to understand more so about your treatment, how we might dose you, how you'll respond. Of course, we use it as a surrogate marker maybe for egg supply, but remember, your egg supply also doesn't determine whether or not you're gonna be able to get pregnant. Absolutely. And I think when somebody's checking their ovarian reserve, oftentimes it's because they're looking for some sort of reassurance. But even if you have a normal or a high level, it doesn't tell us what your egg supply is gonna be a year from now or two years from now, and all those things. So an important thing we always try to bring up is if you know that you're not ready to get pregnant now, and you're gonna be delaying fertility and you're worried about your fertility. Really, you should consider freezing your eggs or freezing embryos if you already have a partner. Um, because regardless of what your results are, it's the best way to help your future self as well. Yeah, absolutely. Because I get questions all the time. Mm-hmm. How do I know if I'm fertile? Yeah. Right. And the answer is you have to try. Yeah. Right. And for some women, that's not feasible. Right. Right. It's not the right time in your life. Mm-hmm. You're not ready, you're not there. And so we don't have a good way to assess that for sure with certainty. Yes. Now, a lot of times when patients are doing blood work, they're kind of more doing this on their own or with their OB GYN, but let's kind of talk about some additional fertility testing they could consider. And so I think the main thing to think about, which Dr. K was already alluding to is when we say fertility testing, okay, we can do tests to rule out common causes of infertility, but even if all that testing is negative, we still can't say for sure that you'll be able to have a baby and until you're ready to actually try. Okay. Um. But in terms of additional fertility testing, I will say the, the number one thing that's the easiest thing to do is actually just look at your history. Okay? Now, admittedly, taking a menstrual history is gonna be, um, more difficult if you're taking birth control pills because when you're on birth control pills, I would almost kind of consider your periods to be fake periods. They're not real periods. But if you're not on birth control pills, the pattern of your periods is so helpful for us to determine if we think you are releasing an egg every month to see if you're ovulating every month. We know. If you have regular periods and you get fertile discharge and breast tenderness, um, a couple weeks before your period, 95% of those patients are ovulatory, they're releasing an egg, whereas can you describe a pattern for us where we would suspect that they're not ovulating? Yeah, so I mean, women who have extremely. Spaced out periods. Maybe you go 40 days without getting a cycle, or you skip cycles completely. You have irregular bleeding patterns. We're more suspicious that you're not releasing or ovulating an egg each month. Yeah. Actually, you know what? See my new ring? I have, I was just noticing that. Okay. Yeah. This. Well, so these are one of these rings mm-hmm. That kind of is supposed to check your health in general. Right? Okay. Mm-hmm. And so I did actually just get an alert. Oh, your temperature's gone up. We think you ovulated and everything today. So today, yeah. Well a couple days ago. Yeah. Okay. Um, and, um, and so it's able to kind of predict ovulation and, um, when your period will come mm-hmm. And all of that. So it's kind of cool to have all these different trackers. Day. So yeah, I'll keep you updated, see if it's right. I love that. Um, but, but anyways, I think that's really helpful because, so if you're having regular periods, then I would say you are most likely ovulatory. If your periods are irregular or spaced out, then we would say, look, you probably are going to experience some fertility problems, but. As fertility doctors, this is one of the things that we are so good at fixing ovulation. It's a really easy issue for us to, to help you with. And so you can come in, get your hormones checked, get an ultrasound done, take fertility pills, and, and usually we can get that straightened out pretty easily for you. Yeah. If you're listening and you think this is your problem, come see us at peak fertility.'cause we love, we love those patients. These are our easy patients, the easy ones. Um, okay. So that's the easiest test'cause you get to do that test, um, on yourself at home. Um, but okay, let's talk about the test for fallopian tube. So, okay. I actually grabbed our little model here, honey reach mm-hmm. For our YouTubers here. Okay. So we've got our uterus, the home for the baby. Here's our fallopian tubes here, right? And so when we do just a regular sonogram, which is an important test as well, we're able to see the uterus, we're able to see the ovaries, but we usually can't see the fallopian tubes. In the rare case that I can see the fallopian tubes, it's usually a bad thing because if a fallopian tube is so swollen, I can see it on the ultrasound, it might be damaged. Okay? Um, and so the way to assess your fallopian tubes is to have a special test called HSG. Dr. K, do you wanna tell us about our hsg that we do here? Yeah. Yeah. So the, the way we describe this is that you we're actually gonna do an x-ray. HSG is a really long word for an x x-ray called hysterosalpingogram. And so the idea is it kind of feels like getting your pap smear done at the beginning. We put a speculum in, we put a small little catheter up into the cervix. And then we push some dye through that we can see on the x-ray and the dye will flow out through your fallopian tubes if they're open. If your tube is blocked, we'll actually see it go in. This is a blocked fallopian tube over here. It looks kind of scary. Um, the dye will go in and it will stop, and we won't see any flow coming out. We can see that on x-ray very clearly. So we know right then and there are your Philippian tubes open or closed. The other thing that we're looking for is, you know, are your Philippian tubes kind of located in unusual places? Does it look like the dies? Free, you know, freely spilling out, or maybe your tubes are scarred in place. Um, the dye doesn't really move around once it comes out. So that could be evidence that maybe your tubes aren't gonna be able to function and do what they're supposed to do. Yeah, and I will say that one third. Of infertility cases are caused by tubal blockage. And so I do think this is a nice test if you feel worried about your fertility, to just rule that one out. Um, admittedly, if you read elsewhere about the test, um, you may s. See that some women have had a bad experience having this test, and it always breaks my heart. Um, and it's important to believe their stories because it really is true, um, that this test can be very painful or uncomfortable for some women. And this is where I love to brag about ourselves here at Peak Fertility because we have really designed such a gentle approach to doing HSGs. So I would say the very first thing is we're just very gentle overall when we're placing the speculum, everything is just nice and smooth, and we're taking our time. We're not in a rush. We're just really trying to make our patient feel, you know, safe and cared for. Um, but the second thing is there are some places that use a clamp on the cervix, and we have actually found you don't actually need the clamp. And so that right there tends to reduce a lot of the pain discomfort. The next thing is we offer nitrous laughing gas to just help you sort of just relax your body through the procedure. Take the edge off for you. We use numbing spray on the cervix. And then we also use a really gentle device that doesn't even have to go all the way inside the uterus. It just goes into the cervix. And so when we do this test almost every time after the test, the patient says. Oh my gosh, that was so much better than what I read online. And so I've tried to tell people, maybe stop reading online if you're gonna have it with us, because it's gonna be a really good experience overall. Um, but I do think it's challenging if you are somewhere else, maybe those are some of the questions you can ask your clinic is, Hey, do you guys have any special techniques to really help me with comfort, um, throughout the procedure? Um, and it's something we're trying to help clinics just everywhere, just be able to incorporate this technique because we really want it to be easy on, on women everywhere. Okay. Now if we as women have to go through that, we've gotta ask the guy to do something, right? Yeah. So in our patients who are partnered, um, to a male, then should we ask them to get their sperm checked? What do you think? Yeah, I think it's fair. Absolutely. I mean, I think if you have a partner, but y'all are considering maybe delaying getting pregnant, it's reasonable. Yeah. If you want him to really assess his fertility. To know, you know, you can get a semen analysis. That's the test that we recommend for all men who were interested in learning more about their fertility. I always tell the guys it's not gonna hurt you or harm you in any way, although most men don't love to do it. Okay. Um, but we also have answers right then and there, and it's such a good marker of their overall health. And a lot of times I find that my guys are really interested in, you know, cleaning up their lifestyle after they see some of these results. Mm-hmm. So many men nowadays are also on testosterone, and you can tell men that testosterone will stop your sperm production, but sometimes they don't believe it. Mm-hmm. Until they see the semen analysis report. Yes. Um, and that can be, you know, pretty shocking. Mm-hmm. But again, then they have time to stop their testosterone before you guys are ready to really get pregnant. So I think these are all really important reasons to consider a semen analysis sooner rather than later. Absolutely. We know once a man. Stops taking testosterone. It can take anywhere from three to six months for the sperm to fully recover. And imagine you had no idea there was an issue, you were ready to start getting pregnant and then you have to wait six months. Like, we're impatient. We like to get to it, right? Um, so I think it's such a great, easy test to be able to do. There are different types of semen analysis. In most cases, it's just a basic semen analysis where they're able to check the volume of the semen, how the concentration of the sperm, how many sperm are there, and whether they're swimming, if they have enough of them that are swimming and if they're swimming forward like they should be. Um, for some men, they like to even go beyond that and do some. Sperm testing where we can look to see if there's any DNA damage in the sperm at all. Um, but at a minimum, a basic semen analysis I think is very reasonable. And again, just like tubal problems explains one third of infertility issues, sperm problems explains one third of fertility issues. So by having just those two tests alone, you have ruled out the vast majority of fertility issues at that point. So I think those can be, um, really helpful. Um, it is kind of funny because now seeing so many men on testosterone, we, this is a very common thing, just when I'm out and about in the wild and I see a guy with like huge muscles, for some reason that's the first place my head goes is his sperms probably terrible. You know? Where I think is that, is that jaded now? I think about it with road rage. Yesterday I was leaving here and this guy got outta his car. Oh. Stopped his car in front of someone and banged on their, on their, and I was like, gosh, that guy's probably on testosterone. Yes. And everybody's on very high levels and there's, I really there's road rage. Yeah. That's what they call it is. I know he had road rage. So, um, so yeah, be, be on the lookout for that. I do think and imagine too. If you're a younger woman these days, you're, you know, maybe dating somebody, you're starting to get serious. It's not like this topic may have come up before, right? Mm-hmm. So I have so many of my female patients that were shocked that their partner was taking testosterone. They didn't know. And the poor guys, they're taking testosterone'cause they wanna get the big muscles to get the pretty girl and all the rest of it, right? But it ends up being an important conversation to have later. And for the guys, I do feel bad for them because I've had. So many of them tell me, nobody told'em that testosterone was bad for the sperm. Mm-hmm. And they can end up really shocked when we tell them, you have zero sperm on your semen analysis. And they're like, what? How can this even be possible? So, yeah. Um, okay. Any other tests you think could be helpful when somebody's trying to, um, have their fertility tested? Yeah, so I think, um, one test that we've talked about on this podcast quite a bit that maybe people have haven't heard about if you're not interested in fertility is the saline infusion sonogram. Um, so sometimes just listening to my patient's bleeding pattern mm-hmm. Et cetera, can make me more suspicious about. Something may be going on on the inside of the uterus. Some patients might have already heard that they might have something going on with their uterus, but they're not really sure how it affects their fertility. So some of the things that you might have growing on your uterus would be like a fibroid fibroids, or benign muscular growth. So you can kind of see them here on our model. Fibroids are kind of tricky because they have a complicated relationship with fertility. They have to be located really, probably more so affecting this inside cavity in order to have repercussions for your fertility. But you might have some hints that you have them if you have heavy bleeding during your periods or maybe. Um, irregular bleeding patterns that can be associated with fibroids. Same thing for polyps. Polyps are just benign cellular growths. Those are little tiny growths on the inside. I'm actually not sure. I think the black things are supposed to be polyps on here. They're too small for you to probably see, but those are little gross on the inside lining of your uterus. These things, anything that might be pushing or affecting that cavity, they can get in the way of a baby growing right, or an embryo implant in that inside lining. Saline infusion sonogram is a really nice way to look at the inside of your uterus really clearly. Similar to the HSG and set four instead of dye, we use water saline just going up through the cervix to kind of open up the uterus, and then we do an ultrasound at the same time to see if anything's hiding there. If we find something, it's actually nice because it's very treatable and it's usually a minimally invasive procedure that we do something called a hysteroscopy, where we put a camera inside. The uterus is typically where we go from there, and we just use a little shaver or device to remove any polyps or fibroids that we might see that we think are affecting the cavity. So. Easy usually to diagnose and to treat, you know, doesn't require doing big time fertility treatment, so Absolutely, yes. Very helpful. Well, um, we talked about a lot of the tests that we can use to find the major causes of fertility issues, but if all of this testing is normal. Then you finally do go to get pregnant and you're not getting pregnant. That was probably the true test. Right. And so in that case, why is it that you're not able to get pregnant? Well, we know on a microscopic level there can be so many other explanations and sometimes it's not until you go through a treatment cycle of some sort that we're able to give you some additional details. So just kind of looking back to. Um, our model here and just, let's say somebody's trying on their own, they're having intercourse. Well, the sperm start off in the vagina here, but we know there can be vaginal pH disruptions. There can be unfavorable vaginal discharge, the opening to the uterus, the cervix could be narrow or king. There's so many other additional things that we may not have an easy test for, but can, um, cause fertility issues, but can also be overcome with fertility treatment. But some patients will even require the most aggressive treatment like IVF. With IVF, we're over able to overcome some issues such as can the egg and the sperm find each other? Can the egg penetrate the shell of the egg to fertilize it? Can they grow into embryos? Are they genetically normal embryos? Do they implant? There's so many other things that can happen that you really just can't pick up with a basic test. And so that's why as we circle back to. Can anybody tell you? Are you fertile or not just based on one or more tests? Not really, but I think the bottom line is yes, there is some basic fertility testing you can do to rule out the most common issues, but you never want to use the results of that to give yourself false reassurance that, hey, it's gonna be a short thing. Okay, good. Do you think that's gonna help Taylor and Taylor? Yeah, I hope so. They're so cute. They're so cute. I don't think they've had babies yet, but they're gonna have very cute babies. Sure. Maybe a little name. Their baby Taylor. They seem to like that name, so. Okay guys. Well, um, if you enjoyed our, um, podcast or our YouTube, if you would be. So kind to leave us a positive review, um, either on the podcast or the YouTube or even on our peak fertility, uh, website. We would so appreciate it. Hope you guys have a great rest of your day. Have good one. Bye.