Fertility and Infertility: A Specialist Perspective

"By going to see a fertility specialist - you're already doing everything that you can do, and you need to take some comfort in that and give yourself a break"

In this episode, Dr Rangi is joined by fertility specialist Dr Sylvia Ross for an insightful conversation about fertility and infertility.

Dr Sylvia Ross is a highly experienced Women’s Health specialist who has spent more than a decade helping individuals and couples build families, while also managing complex gynaecological conditions. Dr Ross is also co-host of the popular Fertility Untamed Podcast.

In this episode, Rangi and Sylvia discuss:

•  What infertility is 
•  Risk factors that can contribute to infertility, including lifestyle and environmental factors affecting both partners 
•  Navigating the challenges of unexplained infertility 
•  What to expect when visiting a fertility specialist, including possible investigations and tests 
•  The Anti-Müllerian Hormone (AMH) test - what it measures, what it can indicate, and its limitations 
•  What trying to conceive can look like, and the importance of understanding your menstrual cycle 
•  Signs that may indicate ovulation 
• And finally - how to get an appointment with a fertility specialist

Join us for the next episode, where Rangi and Sylvia will explore Assisted Reproductive Technology (ART).

Transcript

SPEAKER_00 0:01

Welcome to Prepare, the Mimasi Pronatal podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood. Mimsi Perinatal would like to begin by acknowledging the Rawundri Wuywarung people, traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today. We'd like to pay our respects to the elders past, present and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.

SPEAKER_01 0:31

Welcome back to Prepare! My name's Dr. Rangi DeSilva, and I'm an obstetrician and gynecologist, and I'm so excited to be joined by a beautiful colleague named Sylvia Ross, who is also a gynecologist, but more importantly, a fertility specialist. And we're going to be talking about some really important topics that people often find difficult, confusing, confronting, and sometimes just don't really know where to begin in terms of the information that is out there and what's accurate and what's evidence-based. And that is talking about infertility and all of the things that someone might have to go through to deal with that. So welcome Sylvia.

SPEAKER_03 1:15

Thank you so much for having me. It's so exciting getting to talk my love language and more people.

SPEAKER_01 1:19

It's so great. And Sylvia, I should say, also has her own podcast with some beautiful colleagues of hers named Fertility Untamed. Yes, yeah.

SPEAKER_03 1:28

We just started last year to try and sort of dilute all the fake news out there, and it's been really fun and been reaching lots of people with it, so it's been great.

SPEAKER_01 1:36

Yeah, it's really important. So I think after these episodes, if you have any further questions or want to dive deeper into some of the topics that we touch on, that is a really great resource for you to refer to. Great, thanks. So firstly, I suppose one important question: what is a fertility specialist and how do you become a fertility specialist, and why would someone see someone like yourself?

SPEAKER_03 2:01

This is such a great question, and I feel like you probably don't realise how political it is, but it's really important to cover. So a true fertility specialist is someone who has undertaken the full obstetrics and gynecology training. So, you know, minimum six years of specialty training, doing obstetrics and gynecology, delivering babies, hysterectomies, lots of things you may never do again. Um then enters into a competitive subspecialty training program called CREI or the Certificate of Reproductive Endocrinology and Infertility, where you do a further minimum three years. You'll be doing very well to get it done in three years. Of um, you know, assessments, exams, research, and you know, every possible hoop you can imagine to be able to really hone down your knowledge to a very specific level. And at that point you become a fertility specialist officially.

SPEAKER_01 2:56

Yeah. And that's really a great summary. Really important to know because it means that the benefit of seeing someone like yourself or another person who's had that special training is that you really know all of the up-to-date information about what is best in current practice. Absolutely. But you've really spent a long time and a lot of effort to get to that point.

SPEAKER_03 3:20

Yes, yeah, of course. And I think you know, it's really important because when you think about your general obstetrics and gynecology training, that doesn't include things like men, which of course is half of the picture when you do infertility. So having someone who's spent the time and learning all of that is really important.

SPEAKER_01 3:35

Really important. I suppose the next question someone might ask is what does infertility actually mean? And how do you know that you should see an a fertility specialist?

SPEAKER_03 3:47

Yeah, that's a great question. And it and it depends a little bit around age and your own risk factors for uh infertility. Um the the general description is a uh a heterosexual couple who have been having regular intercourse for a minimum of 12 months without pregnancy. Now, when to seek help, you know, if you're under 35, typically a year would be the time that's recommended in the absence of other risk factors. So if you're under 35 and actually you don't get periods, or you know you have endometriosis, or one of you's had chemotherapy or something, you know, pretty big, you would seek help earlier. But for your sort of healthy, no risk factors identified young couple, that would be the time frame. Um, of course, we love seeing people before that for preconceptual counselling, but that's not often um something people do. And then the other side of that is if you're over 35 or you have specific risk factors that you know of, usually six months of trying before further assessment and potential intervention would be indicated.

SPEAKER_01 4:46

Yeah, so that's good to know. So 12 months for someone with no real risk factors that they know of. Yes. Particularly if they're under 35. If they've got particular risk factors in their health or medical history, or they're over 35, six months.

SPEAKER_03 5:01

Yeah, and look, if it's something like you don't get a period, you don't also have to wait six months, you know, because you're not going to be ovulating and uh having opportunities for pregnancy in that six months. So, you know, if you're not sure, you can always seek advice early. There's no harm in being seen earlier rather than later. Yeah. And we know people are starting to try for their families a lot later now, and that will impact family sizing essentially at the end of the day. So sometimes being seen earlier is beneficial.

SPEAKER_01 5:28

Yeah, cool. And you touched on some of the risk factors just now, but what are the main risk factors that you might think of when you think of infertility?

SPEAKER_03 5:40

So the things that we see commonly would be in the female partner or the partner with ovaries, people who are not ovulating. So how do we know you're ovulating? If you get regular periods, probably ovulating. Yeah. If you don't, you're not. So that means you're not releasing an egg each month and you don't have an opportunity for fertilization and pregnancy. And we see most commonly people who have polycystic ovarian syndrome, for example, or um hypothalamic amenorrhea. So that's your group of people who potentially over-exercise, under-eat, or have high stress. Those would be the two most common reasons that you're not ovulating, but of course we investigate if other rare things were appropriate. Certainly, endometriosis is a huge risk factor for subfertility, and it can affect fertility in in all areas, really. You know, painful intercourse, so you don't have intercourse or damage to the tubes or issues with the ovaries and endometriomas and things. So that's another big one that we see. Tubal factor infertility, that's for the egg and sperm to meet, they need somewhere to trouble that. So we know that that happens within the fallopian tubes, which come off the uterus and and go to the ovaries. And people who have risk factors for tubal factor infertility would be well, have you heard a tube removed because you had a previous ectopic, for example? If you've had chlamydia or pelvic infection, appendicitis, endometriosis, they're all risk factors. And then, of course, we can't forget about the men, and we know that that's half of the picture. And male factor is a huge issue more and more these days as lifestyle and age come into it as well for men. So you see a huge number of men with an abnormal semen analysis, which can be often unexpected.

SPEAKER_01 7:21

Interesting, yeah, and that's really important to note, isn't it, that it's key to get both heterosexual partners tested. Absolutely, yeah. That's right. What are some of the lifestyle factors and risk factors that you see that are impacting that male infertility going up?

SPEAKER_03 7:36

Look, we're seeing a lot of problems with obesity. So when you have obesity, you have a shift in your hormones. So the male hormone predominantly should be testosterone, and that's involved in sperm production and fertility. When people have obesity, they shift to have a more estrogen, which is usually more the female hormone dominant situation where they essentially producing more estrogen, they have less testosterone, the sperm production can be less. It also you can have overheating of the testis if you have significant obesity, which can affect sperm production and quality as well. And of course, smoking, vaping, other drugs, they can all have a significant impact, as can alcohol. So, you know, we see these things not uncommonly. We have more and more people who now have at least pre-diabetes when we first meet them, and that can also have a significant impact.

SPEAKER_01 8:26

Okay, that's really important to know, isn't it? What about environmental factors or workplace-related factors for men?

SPEAKER_03 8:32

Yeah, look, I I think this is something that's becoming more and more important as you know society changes, and it's something which has been kind of difficult to measure, and I think it's one of those annoying things where probably our hippie parents were right all along about plastic and and all of these things that we're actually quite harmful, you know. So people who work around chemicals that have strong smells, we know there's this thing called endocrine disrupting chemicals now. And this is things like plastics, essentially pesticides, anything that you can think of that may kind of have a smell to it, or even things like makeup and perfume, cosmetics. Yeah, we were just seeing more and more of these chemicals in everyday products now. Yeah, and I think you know, we we're finding microplastics now in basically every placenta that's examined and every testis that's examined. And so crazy, isn't it? Our bodies are literally full of it, and it has a huge impact. Very difficult to avoid completely, but small changes may be beneficial.

SPEAKER_01 9:34

Yeah, yeah. So not to alarm anyone, but it is something that is a factor. Yeah, absolutely. So trying to avoid it where possible is easy.

SPEAKER_03 9:43

Yeah, and you know, the small things that you can do, you know, don't heat your food up in plastic, don't use Teflon frying pans, avoid processed food as much as you can. Yep. These small things that we often do in day-to-day life that you can try and avoid.

SPEAKER_01 9:56

Important. If someone is trying to conceive for that time, one thing I often find, and and I certainly, from a personal point of view, found this because I had a period of time where my partner and I were trying to conceive and it was really stressful, and we went through the fertility journey, and and we've got two beautiful children who are the result of IVF, which we're very grateful for. But I had what we term quote unquote unexplained infertility, and many people will have that after all of the investigations. So we'll go on to that in a second. But something I found really difficult was the stress of it all, the whole process of the monthly trying to conceive, somewhat exhausting, it's not really fun anymore. Um, and then every month when you see a period, it's like a painful crushing. Yeah, and I know you've also had your own journey with this, Sylvia, as well. I just never got a period though, so I didn't have that crushing defeat every month. That just never came. It's still disappointing though. Yeah. Yeah. Something I often say to patients is to try and be gentle with themselves and each other and try as as best as you can not to stress too much, because I think that for me personally did really play a huge role in the whole thing as well. How do you guide people through that time? It's really difficult.

SPEAKER_03 11:20

It's extremely difficult. And I think, you know, again on a personal level, my my stress came from the fact that this is something that my body was made to do and I can't do it, and what's wrong with me? And a lot of people feel like that. And I think unexplained infertility is particularly challenging in a way because, you know, great, we haven't found something serious, but actually I can't give you an answer. And I can't give you something to help. Yeah.

SPEAKER_01 11:41

Yeah.

SPEAKER_03 11:42

That's right. And and that's really difficult. And look, I think unexplained infertility is probably less common than we previously thought. Sometimes it's potentially needs a bit more investigation, but yes, it's it's very stressful when that's your diagnosis, because it's not really a diagnosis at all, is it? Um things that I try and encourage people to do, and it may sound like a crazy word, but I think it's very powerful is this idea of surrender, you know. If you're seeking help and you have a specialist who has committed their entire life, often 20 plus years of training, to get to this point to help you, surrender to it. Don't spend your time on Google and TikTok and Facebook chat rooms trying to manage your own situation. You know, we don't expect you to be a sub-specialist as a patient. We want you to be able to trust the fact that if you choose a specialist who has these qualifications, they are going to be offering you the best. And you coming to them, you're already doing everything that you can do. And you need to take some comfort in that and give yourself a break. And I think sometimes the stress is particularly difficult where there is a specific diagnosis and it points to one member of the couple more than the other. Yeah. Because you can have a lot of guilt, blame, blame, it's pretty tricky. Relationship dynamics, yeah. Yeah, and when you're angry at someone, you don't really want to have intercourse with them because your app's telling you it's time, right? So it makes it really hard. Also difficult, yes. And you know, the other thing is in people who are actually doing fertility treatment, we also um it's actually mandatory in Victoria, which I don't think is the worst to do some counselling with someone who's trained in the area specifically. And these sessions can be extremely useful because it can help you reframe things, it can give you some strategies for you know what to expect and how to manage if you get bad news. Because let's face it, most fertility treatments, or all, are less likely to work each time than they are to work, so you have to have some resilience there and you have to train yourself for that. But there's actually some reasonably good evidence around mind-body connection and the importance of that during fertility treatment and studies that have really shown people who do these mind-body programs where they work on stress, and that can be through group sessions, yoga, all sorts of different modalities, they actually do better. And part of that is they stay in treatment because they have the resilience to do it, and part of it is this magical thing that we'll never quite understand. But we'll just go with it.

SPEAKER_01 14:02

Yeah, yeah, yeah. That connection between mind stress, whether it's hormone, whether it's something else, hard to quantify, but actually really important, isn't it? Absolutely. What would people expect from coming to see someone like yourself for their first visit?

SPEAKER_03 14:50

So I actually personally often do a pre-questionnaire so that a lot of things can be answered and I can get a bit of a snapshot before they come in, so I've got a bit of an idea about where we're heading. Um, but you have to expect it's going to be a pretty personal consult. We are going to ask you basically straight away what are your periods like, how often are you having intercourse, any problems with erections. It gets pretty personal pretty quickly. Yeah. Of course, we're going to ask about general medical history, medications, and all those other bits and pieces. Yeah. But we will really be focusing on things which can be quite personal. Um, and that's because we really want to work out where are we at and what can we do for you. And so these things are really important. Um, you know, asking someone a history, a really detailed history about their period can give you a lot of information, and that's we need to be guiding our investigations and treatment very specifically to each person. Yeah. Someone who's never had a period is going to have a completely different workout to a couple where the male partner's had testicular cancer and has no testis. Exactly. So you've got to do that. And so the questions is always going to be the first part for and thorough history, and then we would look at guided investigations. So there are some investigations everyone has. We do an antenatal screen essentially for everyone. So that's your pre-pregnancy bloods. Are you immune to the things you need to be immune to? Do you have any communicable diseases? Yeah. That'll be the same for everyone. The more specific things may be hormone tests, we may look at ovarian reserve testing on a blood test called AMH or anti-malarian hormone. We may look at hormones really guided to what the symptoms are. And usually a pelvic ultrasound will be required for more information. And that's typically a transvaginal scan, and some people find that quite confronting. So again, it's good to know in advance that that's what to expect. For the male partner or the person with testis, again, some basic blood will be done, and a semen analysis is really important. So that's going to tell us, you know, what is the sperm count? Do they swim? Do they look normal? And that will give us a lot of good information.

SPEAKER_02 16:48

Yeah.

SPEAKER_03 16:49

For some people, further testing maybe advise like a tubal patency assessment. So that's where we are saying, look, the sperm's okay, you're ovulating, what's happening? Could this be that the tubes are blocked? You know, are you a patient who's had chlamydia three times and probably you've got a problem with the tubes? And that can be done either through a specialized scan where, for example, some saline or salty water is instilled through a catheter in the cervix. And as that goes through, a scan is performed to see whether that fluid flows through the tubes. So that's one way to do it. The other way we do it would be surgically. So that would be a keyhole surgery and flush some fluid through. Now, who gets what will depend on the presentation. If someone has symptoms really suggestive of endometriosis or they have something else that needs to be treated surgically, like a uterine polyphy, we would go the surgery path. If everything else is very straightforward, then you would look at tubal patiency.

SPEAKER_01 17:40

Yeah, that's good to know. And importantly, some of these things might uncover problems or conditions that you had no idea about because a lot of them are asymptomatic, like the recurrent chlamydia infections that you just described. Often they're just completely asymptomatic and people won't know. So important to get it tested. Absolutely. You mentioned a test that we sometimes use called AMH or antimalarian hormone. And that I know has been the topic of much discussion and sometimes a bit confusing for people. But when do we do that and when is it beneficial and when might it not be beneficial?

SPEAKER_03 18:21

So there's there's a couple of groups that we would do it in. One would be in people where we suspect polycystic ovarian syndrome, and it helps with the diagnosis. This group of people often have a very high ovarian reserve, and we now know within the diagnostic criteria that can be used instead of a pelvic culture sound if it's more appropriate. So that's that's one section. And otherwise in a fertility consult, I would typically do it in people who are looking at doing IVF or egg freezing because it's going to help us guide treatment. Now, just peeling it right back though to the beginning, what is AMH? Yes. And I know everyone's probably heard of it if you're interested in fertility, but the information's not all great that's out there. So antimalarian hormone is a hormone which is secreted by the supporting cells that surround the eggs within the ovaries. Every woman is born with as many eggs as she's ever going to have. And unfortunately. Unfortunately. And we lose about a thousand a month. You know, it's people don't realise. Yeah, it's a lot more than you think. It's not just that one you ovulate, it's all the ones that were trying to join that race and didn't quite make it.

SPEAKER_02 19:22

Yeah.

SPEAKER_03 19:22

And so unfortunately, age is the biggest factor that we just cannot control, isn't it? That's right. And I, you know, I love the term age as queen, because when people ask you, you know, what what's important, it's age. Um but you know, essentially this is a hormone which is used as a surrogate marker for ovarian reserve. The number does absolutely not correlate to fertility. It absolutely does not correlate to the actual number of eggs, which I have seen in some other podcasts, which is a bit sweet. Yeah, yeah. Um really important stuff. So if you get an AMH of 10, it doesn't mean you have 10 eggs. You just have to look at your age versus where other people on average would be, and that will give you an idea of whether it's low or high for your age. Yeah. And in a couple who have a good chance of conceiving naturally and are not doing treatment, you don't necessarily need to do it. You only need to do it if you're in a position where you would be considering treatment essentially, or you're using it for some other diagnostic purposes.

SPEAKER_01 20:17

That's really important to note because I think a lot of people might present to say their GP or with Delia specialists saying, I really want to get an AMH to gauge how much time I might have to do.

SPEAKER_03 20:29

And we don't know the rate of decline. It's not a test where you can say, well, if it's 20 now, in five years it's going to be five. It doesn't work that way. You know, it's still a bit of a mystery, and and women's bodies work in different ways. Yeah. Um, and so you've got to be really careful about just doing it for the sake of it. Because I see a huge number of people for egg freeze consults where they ask the GP to do it, it's come back a bit lower than average, and now they're absolutely freaking out, they don't know what to do about it. Well, you've got to work out before you do the test, what are you going to do with the result?

SPEAKER_01 20:57

Yeah.

SPEAKER_03 20:57

If it's not going to change what you do, don't do it. Don't do it.

SPEAKER_01 21:00

Yeah. And similarly, I'm sure you see people who have a falsely reassuring result and they might not pursue what they were planning on doing, like egg freezing based on that result. But as you said, we don't know the rate of decline.

SPEAKER_03 21:15

No. And a high AMH doesn't mean you're fertile. You might have a high AMH and a partner with no sperm, or you've got blocked tubes. So you can't use it for reassurance. It's something which needs to be used for very specific reasons.

SPEAKER_01 21:27

Yep.

SPEAKER_03 21:28

Important point. Thank you.

SPEAKER_01 21:30

The other thing that I find is important is just to advise people on exactly when to actually have intercourse in terms of timing, what that window is, you know, do they have to have intercourse every single day? What does actually trying to conceive look like?

SPEAKER_03 21:47

So knowledge about the menstrual cycle is relatively poor. You know, we've taught all through high school don't get pregnant. You can have sex once and you will be pregnant. That's it. You can sit in a spa with someone and then get pregnant. Somehow. Exactly. And we kind of need to flip it now and start teaching people actually, if you want to get pregnant, it might be harder than you think earlier.

SPEAKER_01 22:10

It's so true. We we don't really have enough full reproductive education, do we? That's right.

SPEAKER_03 22:16

So understanding your own menstrual cycle is really important. So a menstrual cycle doesn't have to be 28 days, that's just often the term that's used. And a full cycle is from the first day of your bleeding of your period to the next first day. So that's your number, that's your, you know, 21, 28, 35, that's your main number. How many days is that?

SPEAKER_02 22:36

Yeah.

SPEAKER_03 22:37

And then you've got sort of your days of bleeding as well, which is less important. There's how many days you bleed for is not as important around fertility. Everyone's a little bit different. And we know that ovulation happens roughly 14 days or two weeks before your period. So if your cycles are a little bit irregular, pinpointing the exact day can be difficult, but you don't need to know the exact day. Evolution wasn't quite that bad. There's so many humans around it, can't you don't have to be that perfect. But essentially the time that you're wanting to be trying or having intercourse would be leading up to ovulation. So for example, in a 28-day cycle, ovulation probably occurs around day 14. And I would say in the week leading up to that, you want to have intercourse two or three times. It doesn't have to be every day. It's and if you want to, that's fine. But most people, once they start timing their cycles, are past the point of wanting to, it's become a thing. And so, you know, knowing your cycle from that point of view can be quite useful. And it doesn't have to be exact, it doesn't have to be the exact day of ovulation. The egg will last for around 24 hours. Sperm can last up to seven days, probably on average more around three to four days. But if you're hitting, you know, a couple of times in that time frame leading up to ovulation, if you're going to conceive that cycle, you probably will.

SPEAKER_01 23:56

Yep.

unknown 23:56

Yeah.

SPEAKER_01 23:56

So the trying to get the sperm there before the egg ovulates because it lasts for a bit longer. I I always think let him wait for you, you know. That's a good way of thinking of it. Yeah. Great. So as you said, it's really important to know and be aware of your menstrual cycle. Some people might be aware of even when they're ovulating. Some what are some of the symptoms that you can look out for to tell you ovulating?

SPEAKER_03 24:21

I would say the most common one is prior to ovulation, when your estrogen starts to rise, you will get that sort of egg white vaginal discharge. So it's kind of sticky, it's clear, it's not just sort of sitting on your underwear, you'll, you know, you'll notice that it's quite different. So we see that prior to ovulation, that's sort of your fertile time. Um, some people will do temperature testing, but that's harder to get right. It's got to be exact time each day. You know, you've got to sort of wait in bed and not get up and do it before you get up, and you know, it it's kind of difficult to do. Discharge is probably the easiest one to do. People talk about things like feeling the consistency of your own cervix. I don't know how many people can do that right now.

SPEAKER_01 24:59

Yeah, I don't know anyone that's been able to do that properly in real life.

SPEAKER_03 25:03

Yeah, that's probably your most, you know, your easiest one. Yeah. Okay.

SPEAKER_01 25:07

And there's lots of over-the-counter tests that you can get to potentially help with that. Yeah. What would you say in your experience is the utility of those?

SPEAKER_03 25:16

I find this to be quite personal. For some people, it just causes so much stress and it makes it so much harder that maybe they should just throw it out and forget about it. For some people, they find it very useful. Yeah. And for some people they don't work. So, for example, if people have polycystic ovarian syndrome and they have a very high level of that hormone, LH or leucianizing hormone, which is the one that these strips detect, as a baseline, it's just going to be positive all the time, or maybe it never changes. Yeah. So there's some people they just don't work for. Yeah. There's some people that they work really well for, but you have to be doing it over quite a few days, and they can get quite expensive. So, for example, someone might start testing from day 10, and then they either get that smiley face or that double line, depending on the test, and that will tell you your LH is rising, which is the hormone which surges and gets really high, and then ovulation occurs. So it can be used if you're really trying to pinpoint timing. The people that I think it's probably got the best benefit in are people, for example, who have vaginismus, so people where intercourse is actually very difficult and they struggle and they want to really pinpoint that time and get it as accurate as possible. Look, it's not something I recommend to everyone to use. I think some studies have shown shorter time to conception in those who do use them regularly. But these are people who are probably pretty aware of their cycle and what's happening anyway going down that path.

SPEAKER_01 26:38

Yeah. But yeah, that's a good point. But the key is really trying to be aware of that cycle, isn't it? Yeah, that's right. Yeah. But great. So I think we've had a really great overview of what to expect in terms of a first consult and what are the things that we're thinking about, and some of the more reassuring features of being worked up for infertility. If someone did want to go and see a fertility specialist, how is the best way to go about it?

SPEAKER_03 27:05

So there's a number of ways. I mean, in Australia, obviously we have Medicare benefits. So if you want to be able to access rebates, then going through your GP and getting a referral is probably your best way. Some clinics like ours, we actually have a GP that works with us. So if a patient, for example, doesn't want to go and see their GP, they can just see our GP first and get some work up done and be referred internally. Every now and then you get a patient who's who doesn't feel comfortable telling their GP they want to see a fertility doctor. And so they'll often do that. You can self-refer, but then you obviously wouldn't be eligible for the rebats on consults and things. So people can do that. Some people will self-refer and get an appointment, and then in that downtime, we'll collect a referral to help as well.

SPEAKER_01 27:48

Yeah.

SPEAKER_03 27:48

Great.

SPEAKER_01 27:49

So first step is to get a referral if possible. Yes. And then make an appointment with your chosen fertility specialist. Yeah, absolutely. Great, awesome. Thank you so much. That's been such an informative episode, I think, talking about the main important points to do with fertility and infertility. And we're gonna be looking forward to chatting more in our next episode. Perfect, thanks so much for having me. See you next time.

SPEAKER_00 28:15

Every pregnancy is unique. The information provided in today's podcast is for educational and general purposes only. It is not intended to be substitute for professional medical advice. It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.