#10: Beyond the Bump: Leslie Schrock and the Road to Healthy Conception and Fertility Solutions

Fertility Insights and Innovations with Leslie Schrock

In this episode of Biohacking Eve, host Judith Mueller welcomes Leslie Schrock, an author and angel investor at the intersection of health and technology. Leslie shares her deeply personal journey with infertility, including three failed pregnancies, and how these experiences led her to write her books Bumping: The Modern Guide to Pregnancy and Fertility Rules: The Guide to Male and Female Reproductive Health.

The discussion covers key topics including the importance of preparing the body for conception, common misconceptions about fertility, and the roles both men and women play in infertility. Leslie highlights the need for improved industry standards, shares insights on the latest advances in fertility treatments, and provides practical advice for those undergoing testing or treatment.

Timestamps:

• 00:00 Introduction and Personal Struggles
• 00:48 Guest Introduction: Leslie Schrock
• 01:40 Leslie’s Journey and First Book
• 03:23 Fertility Rules and Preconception Guide
• 04:49 Surprising Fertility Statistics
• 05:48 Male Infertility and Testing
• 06:47 Men’s Health and Fertility
• 07:40 Testing and Treatment Options for Men
• 14:56 Women’s Fertility Testing
• 23:45 Challenges in Diagnosing Women’s Health Issues
• 24:38 Future of Fertility Treatments
• 29:32 Tools and Techniques for Conception

Social Media Links

Website: https://www.leslieschrock.com

Twitter/X: @leslieschrock

Instagram: @leslieschrock

TikTok: @leslieschrock

Email: leslie@leslieschrock.com

Resources Mentioned in This Episode

1. Books by Leslie Schrock
   
   
   • 📘 Bumpin’: The Modern Guide to Pregnancy
     A modern, science-backed, no-nonsense guide to pregnancy, designed especially for working families.
     
     
   • 📗 Fertility Rules: The Definitive Guide to Male and Female Reproductive Health
     A comprehensive preconception guide covering everything from lifestyle and testing to what to expect on your fertility journey.
     
     
2. Fertility Companies & Testing Services
   • Maven Clinic – Virtual healthcare for women and families
   • Legacy – At-home semen analysis kits (U.S.)
   • Jack Fertility – UK-based male fertility testing
   • UVA – At-home ovulation and hormone tracking (including progesterone)
   • Mosey Baby – FDA-cleared at-home insemination kit
   • Conceivable Life Sciences – Automation tech for embryology and IVF labs
   • Alife Health – AI-powered fertility platform for clinics and patients
     
     
3. Medical Terms & Technologies Referenced
   • Semen analysis + DNA fragmentation testing
   • Varicocele diagnosis
   • AMH, hormone panels, and antral follicle count
   • Fertility treatments: IUI, ICI, IVI, IVF, ICSI, PGTA
   • Preconception checkups for both partners
   • Lifestyle and medication screening (e.g., impact of THC, SSRIs, steroids on fertility)

Insta/TikTok: @BiohackingEve
Website: www.BiohackingEve.com

Transcript

Leslie Schrock 0:00

My journey, like so many people's, is highly personal. I, myself, encountered several experiences with infertility. I decided, I've been working in digital health for a long time. I've been working in women's health for a long time. Working with Maven and some other companies. I was actually that company's first advisor and I thought when it came time for me to get pregnant, how hard can it be? I was 34 when I started trying. I looked around, seemed like everyone was doing it, and it was going well. Because I was new to it. Even though professionally, I knew there was a different story. Didn't seem to be anything different happening in my personal life But I had in the end three failed pregnancies I had two miscarriages and then a chromosomally abnormal pregnancy that I had to actually have an abortion to deal with it was a medically necessary abortion but it just made my head explode

Judith Mueller 0:53

welcome back to Biohacking Eve, health Optimization for Women with Judith Mueller, where we shine a light on everything that will help you reach your best self. As a woman, as unique and individual as then you can be live long and prosper my friend. Hello everyone. Welcome to today's episode. Today, we have Leslie Schrock as a guest, who's an author and angel investor working at the Convergence of Health and Technology. Her books are Bumping, the Modern Guide to Pregnancy, which mixes the latest clinical research with practical advice, and Fertility Rules, the Guide to Male and Female Productive Health. Leslie was named one of the Fast Company's most creative people in business, and her work has been featured on CNBC, NPR, and others. Time, GQ, Fortune, Entrepreneur, Wired, The Economist, and The New York Times. Welcome, Leslie.

Leslie Schrock 1:50

Thank you for having me.

Judith Mueller 1:52

Fantastic. So today's going to be the first part of our series regarding fertility. And today we'd like to cover everything around conception, preconception, the actual fertility part, what happens when you can't get pregnant. Welcome to the show. Can you give us a bit of an overview of your journey into the field?

Leslie Schrock 2:12

My journey, like so many people's, is highly personal. I, myself, encountered several experiences with infertility. I decided, I've been working in digital health for a long time. I've been working in women's health for a long time. Working with Maven and some other companies. I was actually that company's first advisor. And I thought when it came time for me to get pregnant, How hard can it be? I was 34 when I started trying. I looked around, seemed like everyone was doing it, and it was going well. Because I was new to it. Even though professionally, I knew there was a different story. Didn't seem to be anything different happening in my personal life But I had in the end three failed pregnancies I had two miscarriages and then a chromosomally abnormal pregnancy that I had to actually have an abortion to deal with it was a medically necessary abortion But it just made my head explode a little bit because I kept thinking to myself Wow, if this is happening to me and I'm this confused and I have You All of these people and all of this experience and all of this expertise and I can reach out to, whoever I want on their medical side and get answers. But I had no idea this was a thing. I couldn't believe it. And that is really what inspired me to write my first book, Bumpin which is really a practical guide to pregnancy that is meant to be more written for working families, since so many are these days. And also, not sugarcoat it, right? There are beautiful parts of pregnancy, there are beautiful parts of, the process of getting pregnant, and sometimes it's really hard. And I think that, anyone who's been through it will probably tell you the same, that as much as they loved parts of it, there were also parts they didn't like. And I feel like this very binary conversation where it's all sunshine and puppies and earth mamas and the rest of it is not really hard is not particularly helpful to any of us who either had, a difficult time during a fertility process or during pregnancy or in the postpartum period or as a parent frankly the stuff all trickles because it is Just a constant evolution, personally and so now then I wrote a second book about fertility called fertility rules because I recognize that so many of the issues that I care deeply about in maternal health cannot be solved during pregnancy. They cannot even be solved after pregnancy. They really have to be tackled before people get pregnant. And Fertility Rules was written to be a preconception guide, which is a very new idea for most people, but the idea that is, that in the same way that we tell people to get very healthy before they put on a big white dress and get married, you should also do that before you get pregnant, if you're intending to get pregnancy. This falls apart a little bit because about half of pregnancies are not intended. And I really want to help people not only understand if you do intend to get pregnant, here's what you do. But also how do you best prepare your body if you're thinking about it someday and understand your overall fertility and give you more information that allows you to make more decisions proactively and along the way.

Judith Mueller 5:18

This is really interesting actually, so I didn't know that half of pregnancies are unintended, which seems a surprisingly high number. What other numbers did you find surprising along the entire spectrum? Because I know that, I have heard at least, that miscarriage is actually a lot more common than you think and people don't really talk about. So what did you find surprising?

Leslie Schrock 5:39

Oh, the miscarriage stat comes up a lot is something that is shocking to people because you know We think it's maybe one out of every four Maybe it's one out of every three We actually don't know because the majority of miscarriages happen so early And they happen before a woman is pregnant that there's really no way to track it like a traditional pregnancy test Wouldn't even pick it up at that point But the main reason for miscarriage is chromosomal abnormalities. It's not because of something you did. You ate you, you fell any of that stuff. It is most of the time because the embryo simply was not viable. It doesn't have the right number of chromosomes. I think the other stat. that shocks people, even though it absolutely shouldn't is that around half of infertility is caused by problems in men's bodies because the burden of infertility has been shouldered by women for all of time. And that is another big reason that I wrote fertility rules. I am really just tired of watching women be treated as treatment surrogates for men. I think it's time for that to stop. I think it's time for men to take their place at the table Join the fertility conversation, get healthy, take responsibility for their bodies, their contributions. They're responsible for half of the genetic material. So you would think that we would, treat men in the same way that we treat women saying, make sure you're eating well, make sure you're, taking good care of yourself, moving your body. And yet we don't do any of that. So it's really a passion of mine. I also have two little boys and I see what's happening in men's health and I worry for them. I think that although I'm not personally worried about a children of men situation where there's just absolutely no sperm, I do think it's a problem that sperm counts are dropping so precipitously. They've dropped about half. The quality has dropped about half since the 1970s and we don't even know why. It seems like something we should care about even if human reproduction will be okay because sperm is a biomarker for men's overall health. So those are the two things that come up a lot when I speak to people. And if you're undergoing an infertility investigation and you're listening right now and your provider has not tested your male partner, you go into the office and you demand it because even if there's something going on for you that you know about, if you have PCOS or endo, it doesn't mean there's not also something going on for him.

Judith Mueller 8:04

And that's also much easier to treat in many cases, in my understanding. What are the tests that you would recommend that men take? And I guess it would really would be a case of, obviously you want to be testing both parties, but on the treatment option, it's probably easier to start with the men. What sort of test do you think they should take?

Leslie Schrock 8:22

The easiest thing is just go get a semen analysis. It's not painful. In fact, it's the opposite. It's not that hard. You can do it from home. There are mail in kits that you can use. I personally don't think that the quality of the, iPhone tests are quite as good as just doing a traditional semen analysis. You can also add DNA fragmentation testing to that, which will give you a little more information. But the way a semen analysis is performed right now is that you submit a sample, which is exactly what everyone thinks, Less sticky couches and weird magazines these days, usually something festive on TV, but you submit your sample and someone looks at it under a microscope and evaluates it for five different criteria that have to do with, the way it moves and it's form and function, and then they score it. And there's a very wide range of what is quote and quote normal for sperm. But really that is the best way to get an idea. The other thing for men though is that in about, it's a little under 20 percent of cases, the problem is something called a varicocele. It's basically a swollen vein in the testicles and that's correctable too if you catch it. But it requires a physical examination. So what I like to tell people is if you're thinking about getting pregnant, You need to go to the doctor, whoever your primary practitioner is. You don't have to find somebody new, just go to that person. If, like most men, you don't even have that person, just find someone, find a primary care provider, and go in for a preconception check. Talk to them about your reproductive goals, talk to them about your lifestyle. Don't fudge the details, don't lie, they can't help you if you lie, and they're also going to go through how you live, what you eat, what kinds of medications you're on. And this is really critical because prescription drugs are not labeled the way that they are for women. They don't come with reproductive health warnings for men you know how you see pregnant lactating women shouldn't take this. There's nothing on there that's very prominent. It's always buried all the way down in the fine print says may have an impact on semen parameters. One example of this is there's a hair loss medication that causes a transient hit on sperm quality. And most men who take it don't know because it's not obvious. And it's not always something providers tell them either. It's really important to go through all of your medications even the ones you think your doctor may not need to know about, like anabolic steroids, those impact sperm quality as well and also your drug use. THC has a huge impact on sperm. If you are a THC user and you are trying to conceive, you need to stop for at least three months, preferably longer, before trying to conceive to let your sperm get its new normal. That's the thing for men. Three months is a great timeline, that's about as quick as it can be. You turn things around for three to six months and your sperm quality can improve a lot. Whereas for women, once an egg is chromosomally abnormal, it cannot be fixed.

Judith Mueller 11:23

Okay, this is really interesting. You mentioned THC, obviously CBD as a sort of partner substance as aware is very much on the rise at the moment. Has that caused any issues at all?

Leslie Schrock 11:35

Great question. What I tell people is we have not done enough research yet to know definitively whether or not THC and CBD have the same impacts on sperm. CBD lives in a grayer regulatory, area and it is in all kinds of things. Also, there's no warning on there for male fertility, even though we frankly don't know, they are CBD doesn't get you high. But, if you look at the structure, it's pretty similar. So I think that I'm always a fan of better to be safe than sorry with drugs, with anything elective, really. Anything that you can control that you don't need for your health and I think some people do feel that they need CBD. So it's just a discussion best had with your doctor. If you're taking CBD for mental health, And it's between that and an SSRI or something else that has known impacts on fertility or pregnancy. It's a very important discussion to have with your doctor because this is another area where things get complicated. There's often a risk benefit analysis that needs to happen and it's not one size fits all. I'm sorry if you're a hard drug user, that is not a thing. You need to stop. There's no reason to be doing that when you're thinking about, conceiving. But I think because marijuana has more clinical practice it's the same and it's the same for substances like Botox. If you're doing Botox because of your crow's feet, if you're a woman, they're going to tell you to stop. We don't know if it has any impact on sperm. It's doubtful. But we don't know, but if you're getting Botox for a medical condition, it's really important to discuss that with your provider because there may be a very good reason to stay on it. So I also want to be clear that I'm giving this guidance like smoking and hard drugs Absolutely not. THC, absolutely not, unless it's for a very good reason, but even then, for men, it's a terrible idea. It really negatively impacts sperm.

Judith Mueller 13:28

Okay. And in terms of the testing, I guess you got a range of at home test kits, primary care provider and specialist doctor, especially looking at the medication, especially if there's nuclear warning sign. I think even most doctors probably wouldn't be aware of it. Because they're not really dealing with the fertility questions. You probably do want to actually go to a fertility clinic and ask them that. In terms of the reliability of the tests, how many false positive, false negatives, just on the male side for now, would you normally expect?

Leslie Schrock 13:58

It's not about false negatives and false positives for men, it's more about the quality of the sample that they submit. So if you're doing it at home, the sample's just inherently not going to be as fresh as it would be. If you like walk into a clinic and you submit in person there, typically what they'll do at a clinic, some clinics will let you do it at home and then bring it to them immediately. If you're more comfortable, doing that in the comfort of your own home, you can do it, get to the clinic, go drop it off. Some clinics allow that. Some do not. It's very provider and clinic specific, but, if you're mailing in a sample, and for example, if it takes too long, if the weather was really cold, things can impact the sample quality. That said, they have a lot of The logistics companies generally do a pretty good job with it. And I think there are great testing companies everywhere. Really? There's 1 in the U. S. called legacy. And then I think what's the other 1 Jack is Jack. The 1 in the UK that just launched. So Jack fertility, I think. Which is, a little crass, but here we are. Anyway, it's less about that for men. But I do believe that for men, it's not just about the semen quality, because you can have these other problems like varicoceles that are impacting it, and it's much easier to just go in person, go see a doctor, see what they say, have a physical exam, let them check everything down there out, make sure there's nothing going on, and then just submit a semen sample, and be done with it.

Judith Mueller 15:23

That sounds like the best option. So coming to testing for women and I think for now we'll look at in clinic testing, actual fertility testing versus what we, something we've previously talked about as sort of general biohacking, tracking your data, et cetera. But sticking with testing for women, what does the process look like? What are the things that you should really be looking out for and making sure you're actually asking your doctor. So making sure you're actually comfortable with the doctor, because especially if you're going for a fertility journey, this is someone you're probably going to have to be interacting with for a couple of years.

Leslie Schrock 15:53

It's very important to find a provider that you trust, that you can openly communicate with because that is very key if you are struggling with infertility, you have to be honest. You have to be honest about, what's going on, what you're doing, what your lifestyle is like. And when you go in for an evaluation, they're going to get a whole host of information about how are you eating? What is your sleep like? What are your lifestyle factors? Do you exercise? They're going to ask for family history of medical conditions. They might ask for information about your partner and then Preconception appointments are interesting. In some cases, they will do a hormone panel for you and they'll order it and they'll code it correctly in the U. S. This is very critical because, that's how they get reimbursed and if they can't code it, they're not going to do it. It's a little difficult sometimes if you're fertility curious to go into a doctor's office and say, Hey, I just want to know where I am. I find this kind of ridiculous because I think everyone deserves to understand their fertility. But I also understand that in the eyes of the medical system, it is not quote and quote, a necessary test. And what you want to do is if that happens, if your doctor says, yeah, I'm so down to do a check, but I just can't order all these blood tests. You can do it on your own. There are at home testing companies that Somewhere you would go into a lab in the same way that you would with your doctor's office, and then some that use a dried blood spot test where you use a lancet, you prick your finger and you mail it in. And those can work really well too. Again, like if something goes wrong while you're mailing it in, you wait too long, you don't have enough blood on there. There can be user error. But in general, they're pretty good. I think that there's a little bit of a marketing narrative in that space at the moment that I don't particularly find useful, which is that you should be measuring these blood markers, you should be doing this every six months or a year. And I think for most people, it's not that useful. First of all, if you're on birth control, some of the readings are not going to be accurate. So that's just right off the bat. If you're still on birth control, a doctor will tell you like. Yeah, this is not going to tell us that much. Some markers will be accurate and some will not be because of course birth control changes your hormone levels. I think the other thing that is fairly infuriating to me is that we have this idea that AMH, is the single most important marker when it comes to female fertility. If your AMH is low, it means you will never conceive naturally. And it's simply not true. AMH is an indicator of your ovarian reserves, meaning how many eggs you have left. It does not tell you anything about the quality of those eggs. It just tells you how slow you are. soon you're going to be entering, perimenopause. And I look at it more as like a clock. I think it's a really good indicator of if you're thinking about this, if you're thinking about freezing eggs, if you're thinking about having a baby, if you're thinking about anything related to future fertility. I think it's a great way to understand how long you may have left. But it certainly does not mean, if you have a low AMH reading, that you're going to require IVF to conceive.

Judith Mueller 19:00

And coming back to the AMH, what's a good value? What's a bad value just to get some guidance?

Leslie Schrock 19:06

all of the tests have, it's also by age. They look for different things by age. So really it's something you'd want to review with your provider. But obviously, when it's low, it means you have less eggs. And when it's higher, it means you have more eggs. But there are different stratas based on age that they would look for. So like at 41 for me, for example, my AMH would never be in the same range of someone who's 22.

Judith Mueller 19:29

That makes sense. So coming back to the list of tests they need to have. So normally going to the clinic, you have an ultrasound, you will have a hormone panel done, you'll have minerals, vitamins, etc. done. What else should people be looking out

Leslie Schrock 19:42

So this is if you go to a fertility clinic because you're not getting pregnant, you will never go to a fertility clinic for preconception testing. They're not going to take you on because there's just simply not enough supply. You're fine going to a primary care provider, your OB, your gyne, someone who can help you with those tests. You're probably not going to see a reproductive endocrinologist if you're a woman and a reproductive urologist for a man, forget it. There are only like 200 of them in the entire United States. So you're not going to get an appointment with them either, which is why just going to someone, a primary care provider can give, really give you a lot of information. for your question. They can guide you through a lot of that for men. If you need to see a urologist to do a more in depth exam, if something's going on or to treat a varicocele, for example, like they would be the ones to do that. I am a big fan of starting with less intervention and moving up slowly because I believe that there's a lot of over treatment happening in the fertility industry right now. I think that there's a lot of unnecessary IVF. I think IUI is a terrible treatment in a lot of ways it's done for very specific use cases and so I'm really a fan of starting with, the basics. What do we know about lifestyle? What can we control? What can we not control? Getting a really good grip on your overall fertility just by, these simple lifestyle things. Cause frankly, it's what they're going to tell you in a fertility clinic anyway. If you talk to a reproductive endocrinologist and they know your partner's taking steroids, the first thing they're going to say is stop doing that. And it's going to take. Six to nine months, really minimum if they've been taking them for a while for everything to be restored there. And some cases it never comes back. That's a thing that a lot of men who take them over long periods of time don't know is that it really negatively impacts your testicular function and thereby your sperm production. But again all doctors should know these things. They all should know that, here's the list of things. And if yours doesn't, you can find someone else, but really start low and then you seek care on a ladder. And if you've been trying to get pregnant for six months and you're over 35, that is the time that you would make an appointment with a reproductive endocrinologist. If you're under 35, you would do that at one year. And the reason is that the vast majority of time, like over 90 percent of the time, Most people get pregnant within that timeline. It just doesn't always happen on the first shot. For a whole host of reasons. But, it's better to wait and not seek invasive treatment and try on your own first. Unless you know for a fact that something is wrong or there's a, medication or something else that's impacting your fertility.

Judith Mueller 22:18

Okay, so if you're under 35 and you literally just have Setting out just if you're literally just setting out and trying. Is there anything in particular as a basic blood work or anything else that you should be having tested? Just to know, make sure you're okay.

Leslie Schrock 22:33

I think most providers, if there looks to be a reason to do we'll help you with a hormone panel. And if you have not reached that stage yet, no one's going to look at your follicles, no one's going to do an antral follicle count or do ultrasound until you're actually in the middle of an infertility exploration or you're looking to freeze eggs. One thing you can do if you are really curious about this. You can go into a clinic and say, Hey, I'm thinking of freezing my eggs. Help me understand where I am and what my odds are and how big of a bank I would be able to build. And then, how many retrievals it would take. That is one way. That's like kind of a hack if you want to try to do it that way, but it probably, it's not going to be free.

Judith Mueller 23:15

That's true. It's usually quite expensive. I've just undergone two rounds of egg freezing and it was around 5,000 euros. per session as aware that obviously have storage costs. And if you ever go for IVF, that's when the fun basically starts both on the hormonal and the financial level. Let's see about that. So sticking with the topic of testing, what are the, so for example, if you are having to go to a fertility clinic for whatever reason it might be, What are the limitations and the tests that people should be aware of?

Leslie Schrock 23:44

I think AMH is such a big one. It's actually a combination of markers that they look at. There also can be physical issues for women, right? So you can have blocked fallopian tubes, you can have fibroids, you can have issues like PCOS causes and ovulation, which means you're just not, releasing an egg every month. Oftentimes that is actually the cause for women. Rather than, messed up hormone levels. So again, this is why it's so critical to go see someone who, knows what they're doing, so that you can talk through all of this. PCOS and endometriosis are notoriously difficult to diagnose. It can take up to In some cases, it can take up to 10 years to diagnose both of those and they're experienced collectively by one in five women. So it's pretty inexcusable. There's some interesting things happening in endometriosis right now with testing with diagnostic testing. But because they present in many different ways, it can be very difficult and they can sometimes look like other conditions. So it's hard, right? All of this stuff is hard because there's so much we don't know and there's so much that we need to research and we need to, really put our money behind that because I don't know, is there much in medicine that's more important than human fertility if we all want the human race to continue?

Judith Mueller 25:01

That's a very good question. I think to give us a little bit of hope, where do you see the industry going? What sort of developments are you seeing in terms of research, in terms of product, either in research or come into the market, and that could be for endometriosis, for PCOS, for fertility treatment, for the entire space, if that makes sense.

Leslie Schrock 25:19

I am personally very excited about companies that are doing seemingly unsexy things. So there's a company that I recently invested in called Conceivable Life Sciences, and they are fixing embryology. So embryology is the step during IVF or egg freezing, frankly, where a human takes the retrieved gametes or oocytes in the case of egg freezing and freezes them or then goes on to perform the fertilization step and, turns them into embryos. So right now, embryology clinics are in general understaffed. If you saw photos of what happens in them, it's pretty shocking. There was an expose on KindBody recently, which frankly, I found to be boring because I said, of course, this is what happens in these clinics. Like it's, they use dry ice and, styrofoam coolers and all kinds of crazy stuff. Eggs are lost. There's just a lot of mismanagement of frankly, genetic material and in, in a lot of clinics it's very unfortunate. There's just not a lot of regulation, but, what really surprises people to hear is that if you are perfect, if you do everything right, you remove all these bad things from your life get a decent retrieval, your partner's sperm is good. But if your embryologist is hung over, guess what? You may end up with nothing because it's so much human error. And so what conceivable life science is doing is actually taking that away. They are stringing together different pieces of technology to really automate the process of handling this very fragile biological material. And everything from helping to identify more eggs that are retrieved. So right now, about 20 percent of eggs are actually lost during the retrieval process. They're in the dish, but there's other stuff in there. And just because you rely on a human to find them with their eyes, it's not always identified. And so now they're using, AI and machine learning and better microscopes to do that. Also ISI, which, Intracytoplasmic Sperm Injection, where you take one sperm and you inject it directly into an egg, has become very popular. I personally think it's being used too much, but that's me.

Judith Mueller 27:35

Why is that?

Leslie Schrock 27:37

Because there's no proof that it improves overall live birth outcomes. The only time it actually improves that metric, which is the only one in IVF that matters is when there's male factor infertility in play. That's it. The rest of the time. Traditional IVF is actually better. But it gives people a sense of control. It gives people a sense of agency That's a huge thing during an infertility journey, right? It's the same reason that PGTA is so popular Even though PGTA genetic testing, you know testing for the right number of chromosomes for aneuploidy is so popular Is because it gives people this sense of security Even though you can't guarantee anything. PGTA is a flawed technology too. But if it's not done, it's the first thing that's blamed when a transfer fails and I think the same is true of ISI it's, providers feel like they have more control, but if you talk to enough of them, they'll say, yeah, patients like it because they feel like we're choosing the best sperm. But the truth is you look under a microscope. It's very subjective, what looks best may not be the best genetic material that might be DNA fragmentation. So I think that, there's a lot of flaw in the process of actually, doing that work and conceivable life sciences is really trying to, move that away. I think the other thing it allows, we don't have enough reproductive endocrinologists. And it is known and this is going to enable more people to become fertility doctors means maybe you can go to your OB and they can refer you out to one of the clinics and you can just keep your care with your OB and have that step done a different, like a more hub and spoke approach to all of this. So that is one thing I'm particularly excited about. I think that. It just makes a lot of sense, a life is doing some really great things. I'm an advisor to a life as well. They're doing, AI and machine learning for, stimulation protocols, embryo selection, some of the other really, kind of software processes that will help us determine, based on millions of data points at this time. I get very excited about automation and removing human error, which just seems so obvious, but yeah, it's a big problem.

Judith Mueller 29:54

That makes sense. I think there's a lot of improvements to be read there on the individual side, the patient side. What are any techniques, gadgets, tools that you've seen recently come to the market that you know are supposed to be coming to the market soon? That will give people a bit more hope.

Leslie Schrock 30:12

I don't know if hope is the way that I would put it, but I think that, many studies have shown that people are more satisfied with the way they give birth when they perceive control, when they perceive themselves to be in control of their bodies, what's happening to them. And control is a huge factor during conception as well. You want to feel like, It's happening on your timeline the way you want it to work, you know where you want it to work Your baby's born in the right month all of these things that are inherently not controllable by the way And also once you're a parent good luck with that I have a two year old and a four year old and i'm here to tell you Any sense of control you might've had during that period is all gone when that baby comes out because they are who they are. So I think that there are some interesting, there are connected thermometers that can help you with your basal body temperature measurement. That'll tell you, when you're approaching the time of ovulation. There are fertility bracelets. There are some other, gadgets that are helpful. I'm still a big fan of the old pee on a stick method because I think that it's very, easy for people, you do it first thing in the morning before you, dilute your pee with anything. It's also how you take a pregnancy test. You want to just take it, first thing. And I think that's a really valuable thing. The caveat there though, and this is something a lot of people don't know, is that the drugstore varietals of that test, of an ovulation test. Do not test progesterone and progesterone is the marker that tells you whether or not you actually did ovulate. So you'll get an LH surge before you ovulate typically, but not everybody ovulates, especially if you have PCOS or another condition. That impedes that process. But if you get a progesterone spike after, you think you ovulated, you can have reassurance that you actually did. And fertility clinics will test this. They'll do blood tests. There are at home tests now. There's a company called UVA that started doing this where they actually do test progesterone. So if you really want to go for it, it's not cheap, but it is really great. And another thing that I want to give a shout out and I have no relationship to them at all, but I'm a huge fan of a company called Mosey baby. And it's going to sound very unsexy, but it is basically an FDA cleared device that takes the turkey baster method to the next level. So traditionally that has been done using a syringe and shooting sperm straight up at the cervix. And. Has been done by, lesbian couples for quite some time. And also in some other cases if there's a sperm donor or whatever, and you can't pay to go through, fertility treatments, you want to give it a shot, but this is an FDA cleared device where the outcomes with it's called intravaginal insemination. There's also intracervical insemination. It's done slightly differently. There's a company in the UK called Bayer that does ICI. But ICI and IVI are fairly close but it's the same principle. You shoot sperm up there, you get it as close to the cervix as possible. You can use a cervical cap to hold it in place and then you let nature take its course. So it just makes it a little easier on the sperm to get where they need to go. It also takes, in some cases, it takes. Pressure off of a couple that has been trying to conceive for a while. So something that no one wants to talk about but a lot of people experience Is that when you're struggling to conceive sex really starts feeling like a job. It's Okay. My fertile window is opening now. So let's have sex every day every other day until I ovulate That can start to feel like a lot of work, and it is a lot of work, and you can really start looking at sex a little differently than perhaps you did before. It's true for many people, it's true for parents, new parents, old parents, your relationship with sex just changes. And sometimes it happens on the first shot, and it's great, and no problem. But for other people who are on, maybe you're 32, you're on month 10 of trying to conceive, you're not quite at that point. Break even point. Maybe you're calling clinics and starting to interview clinics, but you're not quite there yet on actually going into a clinic. why not try this? So basically your partner just, gets a sperm sample ready and then you just have to use it within 24 hours with the MOSI device and. That's it and it can really take that pressure off for a lot of couples and also You know just make it feel less like work so for couples who can't even with the time sex it's becoming very common and they've had great outcomes the outcomes you know for ici and ivi and iui which happens in a clinic when they you know Put the sperm all the way up into the uterus are actually about the same So it boggles my mind and it's so much more expensive, like out of, it's, I have one, it totally depends where you go. IUI can be like 1500 bucks. It can be more, it can be less. It just depends where you are, what you're doing. If you're on any drugs, all of these things can change the costs a lot, but I think Mosey's like a hundred bucks. It's just to me, such a no brainer. There are, cases where if it's like, Kinds of male factor infertility. It's not a good idea. They, and they have a guide, they have a guide on the website that'll tell you like whether or not you're a good candidate for it. But honestly, I would love to see more people try that before they start going to fertility clinics, try that as a last resort and then go spend thousands of dollars on these treatments. But in a lot of cases, it ends up working. Sometimes it is just You know, you got two people who like are just so sick of Oh, I'm ovulating. I'm ovulating. Come over here. That's not sexy anymore.

Judith Mueller 35:53

Yeah. And I think it really changes the relationship dynamics as well. If nothing else. Okay. Any last advice for people? Anything that surprised you when you started researching into the topic of fertility preconception?

Leslie Schrock 36:06

I think that the lack of industry wide best practices in fertility care was pretty shocking. If you talk to enough reproductive endocrinologists, they all call it it's more of an art than a science. And It's really not that, it's just science. There, there is a bit of an art to handling patients. There's a bit of an art to understanding what's going on and to diagnosing. But in the end, we have a lot of data on all of this. We need more, but it is biology., That's it, there should be best practices, for specific patient phenotype. There should be a stimulation protocol that is universal, and they should be very specific and personalized to each person, but you'd be shocked at how different everyone's opinions are. Some providers just use ICSI for every single cycle. Some only use it for male factor, which is what I think should happen based on all the research that we have. So there's really a lot of variance based on the clinic that you go to. There can be a lot of variance even within a clinic because one doctor might do things one way and one might do things another way. So I think it's really important to answer all of the questions that you have in those interview sessions. I would always interview more than one clinic before you choose one, but then every step along the way, unfortunately for all of us, we still have to advocate for ourselves. We still have to go into appointments and say, Fascinating. You want to use this stimulation protocol. Tell me about that. Why do you want to use this IVF add on? Like, why are you doing, what is it, embryo gluing or something like that? There are all these it's like a menu. It's like ordering from a very expensive menu of items. 1, 500 for this, 1, 000 for this, 500 to watch your embryo on an iPhone app. Developing in a petri dish. You know what I mean? It's quite crazy but, it's not a very well regulated industry. Again, it's because the fertility industry lives outside of the context of traditional medicine it's not really subject to the same rules, unfortunately.

Judith Mueller 38:10

That makes sense. Super Leslie. That was very enlightening as well. Quickly before you go, actually, we have you back for our next episode on pregnancy. But before you go, just tell us where we can find you.

Leslie Schrock 38:23

You can find me online. I'm on Twitter X, whatever it is these days. Leslie Schrock, and then I'm also on Instagram. A lot of my readers get me that way. I'm begrudgingly on Tik TOK, not super active over there, but you can always email me leslieschrock. com. And I love to hear from readers. I love to hear the feedback. So yeah,

Judith Mueller 38:48

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