Male Factor, Not Male Failure: Finding Hope in the Fertility Journey

Infertility conversations often center on women, but roughly half the time, male factors play a role. In this episode, Dr. Jeff Deaton joins us to break down what male factor infertility actually looks like, why it's so often overlooked, and what treatment options exist today. We talk through the emotional weight it carries for men and couples alike, and why a diagnosis isn't the end of the story. If you or someone you love is navigating this, this conversation offers both clarity and hope.

Dr. Jeff Deaton is Associate Professor and Division Director of Reproductive Medicine at Wake Forest University, where he directs the Center for Fertility and Reproductive Surgery. With over 40 years in reproductive endocrinology and infertility, he's the author of When Waiting Becomes Life, a collection of stories and compassionate guidance for couples navigating infertility.

Transcript

Unknown: 0:00

So we're okay with samples that most of the sperm are not moving. That's okay, actually. And then the final one we look at that's important is called morphology. That's how many sperm look normal. This one's the most complicated one for patients to understand because we do most programs do what's called a strict morphology. It's called a Kruger strict morphology, and that means taking a lot of sperm, looked at them very carefully, and if you do that, you'll find that most sperm, even in fertile men, have defects. Welcome to Perinatal and Reproductive Perspectives. This is a podcast where we empower birthing individuals, partners, and health professionals with evidence-based insights, holistic strategies, and relatable stories, hosted by a healthcare expert, this podcast fosters understanding, equity, and growth in perinatal and reproductive health. Here's your host, Becky Morrison Gleed.

Rebecca Gleed: 1:03

Welcome everyone to another episode of Perinatal and Reproductive Perspectives. We are at the edge of our seats today because we get to speak with a reproductive endocrinologist and fertility specialist, Dr. Jeff Deaton. For anyone debating whether or not to finish this episode, maybe you're thinking, "Well, why do I need to know about male factor? I wanted to make sure to emphasize that Dr. Jeff Deaton was part of the first wave of babies being born through IVF. He was a medical resident when several of the babies were born in the Northeast, and he was in the room. Welcome to the show,

Unknown: 1:44

Becky. Thanks so much for having me.

Rebecca Gleed: 1:47

Can you tell us a little bit about what brought you into this field and some of your practice?

Unknown: 1:53

Would love to. I think my story is a little unique. I am with students all day, every day. I always have a third-year student with me and a fourth-year student, and I always talk to them about their journeys. And I've learned that I think mine is unique. So when I was a second-year medical student, which is long before you know what you're going to do when you grow up, I got attached to a mentor, one of the true pioneers of fertility. Her name was Dr. Ann Wentz. She was at Vanderbilt. She was trying to become the first woman in the country, the first person in the country to have an IVF baby, so it was a the race was on, as I like to say, and I was a student watching this, and I did research with her, and I just fell in love with the field. So from second year medical school, I never wavered. I was always going to do this, and as you probably know, it's a kind of a little bit of a longer journey. So I had to do residency first, and then the fellowship. And the residency was a good time, but it was tricky because I knew I was going to do repro, and so I wanted to get to my love, so to speak. So I think I'm going to be unique. I knew early on this is what I was going to be doing for a career. My practice now-I think you asked my practice now. My practice now-I'm the medical director, the IVF director of the Wake Forest Center for Fertility and Reproductive Surgery in Winston-Saddam, North Carolina, we're obviously attached to Wake Forest University, and I've been here almost nonstop for over 30 years. I did take a little break in the middle of it all and did private practice for 10 years, and then came back. So I kind of came back to academics, which is also a little bit unique.

Rebecca Gleed: 3:20

Yeah, that does sound unique. Can we go back in time and do you have any stories of what solidified some of your interest in repro?

Unknown: 3:28

Well, yeah, the best story is one I wrote called "The Gift of Encouragement, and so again, I was a I was a third year medical student now on the rotation for OB/GYN. So when you're a student, you go through all the different rotations. You spend a little time on everything, but when I was a third year on the OB/GYN rotation, again Vanderbilt was trying to become the first program in the country to have an IVF baby. They were kind of working alongside against whatever the word would be with the Jones Institute, which was the institute up in Virginia that actually did have the first baby, but the Joneses were retired; they were in their mid 60s, and someone said, "Y'all need to come out of retirement and start an IVF program because no one had ever done in this country. And they said, "Sure. And so they came out of retirement. Well, their protege was Dr. Wentz, my mentor at Vanderbilt. She was their first fellow, and so there was a tight connection there. It also happened that Dr. Jones's son was an oncologist at Vanderbilt, so there's this weird kind of commingling, so to speak, of these personalities. So the Joneses were trying to get the first baby. Dr. Wentz, who was their first fellow, was trying to get the first baby. Dr. Jones's son, Doctor Jones, was at Vanderbilt. I'll never forget the day I was in the conference room with Doctor Wentz and a bunch of people. And Doctor Jones walked into the conference room and held his hands up and did a fist pump and said, "My parents did it, and it was just captivating. I was a student; I didn't know anything, and I was just watching this come about. So, and then when I. On to fellowship. I was a fellow up in Vermont, and they did not have an IVF program, but they knew they needed one. Actually, they had one, but they hadn't had success yet. And so, as a first year fellow, they said Deacon kind of likes that stuff. Send him around the country. Let him learn how to do it. And so, that's kind of unique too. Fellows don't tend to start programs and be in charge of programs. They just sort of learn, but they sent me around the country with our IVF nurse and the lab director, and we watched people do this, and came back and revamped the program and had an early success. And so that was my career, kind of getting started.

Rebecca Gleed: 5:38

I got to tell you, I did not expect to hear that today, and I have goosebumps as you might be able to see on the camera because you read some of this these stories, but to have someone who was in the conference room being mentored by the it just it's a totally different magic.

Unknown: 5:56

Yeah, I feel like I've grown up with IVF, and because I was a third year student when the first baby in this country was conceived, I actually delivered. I didn't didn't help it with the conception, but I delivered the first IVF baby in Connecticut when I was a resident, and then I was part of the first baby in Vermont, and so I've I've just kind of watched the field go from nothing to a very major part of medicine right now. When I started doing in vitro, the number of babies born in this country, the percent was virtually zero. There were no IVF babies in the early days. Now, 3% of all babies born in America are IVF babies. Yeah, it's gone from zero to 3% in a short time. And about every five to seven years, I've watched something major happen to the field that just totally transforms it, and it's kind of fun to run through those. I won't do that right now, but again, every few years something major happens that just makes the field even better and just transforms it.

Rebecca Gleed: 6:52

Yeah, and I think that's a beautiful segue into maybe what we talk about this next topic of the male factor because something I was thinking about. I went to the Congress, the ASRM, one of the meetings in Greece, and what struck me was, whoa, we this technology is moving very fast. Sperm washing, for example. I was just reading and learning more about some of the technologies to address male factor. If you're up for it, let's let's talk about the male factor, which is, I think, really underrepresented.

Unknown: 7:27

Yeah, the men often kind of get forgotten, and even early on in the early research days of IVF, the wrong opinion was it's it's probably the woman's fault, right? It's what we often do, and so the men kind of got ignored, and the research wasn't done on the men. That's all changing now, luckily. But I remember the early days of IVF from 1981 until 1992. You would take these male factor couples and do IVF and have like 30 eggs and dishes, put the sperm in there, and not a single egg would fertilize. It was devastating. And then in 1992, a man in Belgium figured out or discovered how to inject a single sperm into an egg. It's called Ixie. You probably have heard about that. And again, that's one of those major things that overnight just changed the field because until 1992, we couldn't take care of these malefactor couples, and a lot of the couples back in those days, when they got ready for IVF, they didn't do it. They did donor sperm, and there's nothing wrong with that. But now the techniques are so good that testicular sperm gets the same success rate almost as using normal sperm. So our techniques are so good now, we can take one sperm, inject into an egg and get the same success rate as letting sperm do it naturally, and so 1992 on, the whole the world opened up to the male factors, and about half our couples that do in vitro are male factory. It's probably the number one diagnosis in the IVF world. It's not the number one diagnosis when you come into the office to get worked up and find out why you can't get pregnant? But when you get to IVF, it's the number one reason we do it, and so it's become a huge part of what we do.

Rebecca Gleed: 9:08

And I'm glad we're shedding light on that today because I really don't think a lot of people know that you're right. The assumption is, well, what's wrong with the woman or female born at birth? What would be for someone who really knows minimal about male factor. Can you kind of walk us through what you're looking at, like motility, morphology?

Unknown: 9:29

Yeah. So the basic workup, one of the four to five key tests all couples should go through is a sperm count, a semen analysis. We call it where they drop off a specimen, and the results are complicated, but there are some important things. They look at volume. Volume is important. Volume is what gets the sperm to the woman's cervix with intercourse. And so some guys have low volume, and the sperm are all down in the vagina. So volume is important. Obviously, the count is important. Count is how many. Sperm for every one cc. Most guys will have at least one and a half to two cc's of fluid. Some guys have four or five. Over five is kind of abnormal. Under one and a half is abnormal. But then every one cc has a certain number of sperm. That's the count, and that number needs to be at least 15 million for one cc. And then the motility is important. That means how many are moving. We want to have at least 30 to 40% that are moving. So we're okay with samples that most of the sperm are not moving. That's okay, actually. And then the final one we look at that's important is called morphology. That's how many sperm look normal. This one's the most complicated one for patients to understand because we do most programs do what's called a strict morphology. It's called a Kruger strict morphology, and that means taking a lot of sperm, look at them very carefully, and if you do that, you'll find that most sperm, even in fertile men, have defects. We only want 5% to look normal. That's all we want. So we're okay with 90-5% of the sperm looking abnormal, but a lot of the guys that are male factor have 1% normal, 0% look normal, and there are all kinds of defects you find. But this one's hard for couples to understand because they get back report that says 5% normal, and they think that's they think that's bad. It's perfectly normal.

Rebecca Gleed: 11:15

Okay, and can you describe some of the defects?

Unknown: 11:20

Yeah, so when they look at sperm, you often find neck defects. So the sperm has a head and kind of a neck and a tail, and you'll often find these neck defects where they're it's not on trade, so to speak. Sometimes you'll find tiny tail. Sometimes you'll find head defects. All kinds of defects in the sperm.

Rebecca Gleed: 11:36

Okay, and if you've determined, hey, this is there's some issues here. What would be some examples of what treatment would look like?

Unknown: 11:46

So, if we have a severe male factor, when I say severe, everyone has a different definition for that. But when I see a guy that has less than 10 million total modal, so total modal is a very important number. So, when you look at the volume multiplied by the count multiplied by the motility, that's your total motile, and that means how many sperm in the entire specimen are moving. When that number gets below five or 10 million, that's significant. Those people need in vitro. They do well with in vitro. Don't get me wrong; they do great. But when they get to that level, I like to have a male factor fertility specialist see the guys if they have 20 million total motile and just motility is a little bit low. I don't make all those guys, but if they want to, they can. We have male fertility specialists that work here, and they can always see a male fertility specialist. But I don't find it that helpful unless they're in the severe category. In that situation, you'll often find anatomic things. There are things called varicoceles, which are swellings around the testicles that can lower motility, lower count. Some men have medical problems that lead to low sperm. It's almost a biomarker of a man's health in a way. So, if you look at these guys that are dealing with a lot of stress in their life, cancer care, you'll often find terrible sperm counts, and we don't know that it's so much the disease they're struggling with as much as the stress. Men are very sensitive in terms of fertility to stress. So you take a guy that's got a lot of stress, whether it's because they're dealing with a medical issue or something else, you'll find low sperm counts. A lot of the things that you would think would hurt sperm do hurt sperm. Smoking is not a good idea. Drug use not a good idea. Heavy alcohol intake is not a good idea. So all those things we kind of look at. We talk to the guys about it, but I often do see a malfertility specialist if there's a severe male factor.

Rebecca Gleed: 13:34

Yeah, and what does that look like in terms of kind of coaching or providing some evidence based information to promote healthy sperm. What would be some? Because we could go into the wild west of you do testicular cooling, or you do this, or do you do that? But what would be coming from a board-certified fertility specialist in terms of recommendations?

Unknown: 14:00

Yeah, so I cover kind of the big ones, and if they want to get deeper, I'll often have them see one of the male fertility specialists. They know more about that. I don't treat men. I don't examine men. I, you know, I we get sperm and we use it, but I don't actually treat and examine men. But the big picture would be avoid unhealthy things in your life. Avoid cigarettes. Avoid alcohol in excess. Avoid drug use, avoid marijuana. Obesity leads to malfeasance, so try to get into better shape. Studies have shown that if you are a primarily a meat eater and don't have a good amount of fruits and vegetables in your diet, those guys have malfertility. So we often tell them to either get a better diet, or they can go to a vitamin store and pick up one of these fertility blends. So we now know that certain things are important for sperm, zinc, magnesium, vitamin E, and now these companies all make these blends. So you just go pick up one vitamin that takes care of it. So I talk to the guys about their eating habits, of their lifestyle. Stress is a hard one because. It's hard to have someone decrease their stress. It's a hard one to deal with, but I do talk about stress with the guys. I've also learned that just the fact of being infertile leads to pretty significant stress in their life. So that's why I hate to bring it up too much because often being in my office means that stresses them out. But I do talk about stress because it's an important part of the journey.

Rebecca Gleed: 15:20

Yeah, what do you think is that pushes someone over the edge where they know, like, if someone who's listening to this episode, where to gage? Okay, this is more manageable, falls within normal range of stress, and where do you see it being as something that could jeopardize fertility?

Unknown: 15:41

That's a tough question to answer. I think the first step is always a semen analysis, always. And if a couple's having any trouble at all, they can get someone to do a semen analysis. If the semen analysis is good, then we kind of check off. Doesn't mean they're always it's always good, but we kind of check off. There's no male factor, so that's the first step always. Because I have a lot of guys that are worried about something in their life, and I say, "Well, let's find out. And we find out they're perfectly normal; they're good to go. But I also like to think of infertility as a couple problem, not an individual problem. And so I've had way too many couples where I told them it's a male factor, and then they would break up and the guy gets his next wife pregnant. So you know it's a couple thing, even though we often focus on factors that we can treat, but it's often seen as a couple thing, not an individual.

Rebecca Gleed: 16:33

Yeah, I really like that perspective. That's something similar that I, and we'll get to your book. Of what I so appreciate is you include the emotional, the relational pieces. You don't just ignore what I view as very important. But do you see some of that shame or self blame pop up with any of the male factor? Do you see that in your room?

Unknown: 16:59

I don't see the shame issue, and I'm glad you brought this up because I do want to talk about that. Shame is an enormously important part of what I do in my in my daily practice. I face the shame question all the time. It's primarily on the women. Men react differently, in my opinion. I don't I don't sense that they have the shame of it. Shame basically just means I don't measure up, and so when you don't, when you think you don't measure up, you often want to hide. You don't tell people what you're going through because you don't want people to see who you really are because you think you don't measure up. So it's kind of a vicious spiral. Some of the men do feel that way. That's why I think there's some hesitation on on Mel's part to get a sperm count. Some guys don't want to get sperm count, which I don't have that happen a lot. But you do have it, and so some guys I think are afraid to know. They're just afraid to know. But I don't think men respond primarily in a shame way. What I see in the men, and if I get them alone and kind of say the right words, they'll often open up because men are, I think, in their nature, very emotional people. I think society has,

Rebecca Gleed: 18:07

I agree, crushed

Unknown: 18:08

it. But I think men, at their core, are very relational, very emotional. I think just society has kind of driven out a lot of men. But if I get a guy alone and we begin to talk, what I find is they have, they feel like they're losing their first love. I mean, the guys often get married not to have children. They get married because they're in love with their wife, yeah, and they enjoy that intimacy with their wife. And people come to my office all the time. It's kind of it's not funny at all, but people come to office all the time, and their gynecologist or somebody's told them from day 10 to day 20 having their course every other day because they want to make sure they cover the ovulation event. Well, I'm just telling you that's craziness, and it's out there though. So people coming all the time having done that, and if you talk to the guys, every guy I've ever talked to, 100% hate that. You think they would like it? They hate it because it's taken

Rebecca Gleed: 18:58

yes a

Unknown: 18:59

fun, joyful act with their spouse and turn it into a job, and when I kind of go through the fertile window with them and kind of, if you're trying on your own naturally, if you don't need to come see us, you just want to try on your own. If I go through the fertile window and explain how that works, you just feel the pressure coming off of them. You just feel it, and so that's a huge part of what I think the men struggle with. Their lives have been totally taken away from them because now they're focused on only having a child, and the fun of the relationship seems to be gone for some of them.

Rebecca Gleed: 19:29

Yeah, and maybe that's a message to send is take the pressure off and just keep having fun. It doesn't have to be such a job so prescriptive. I'm glad we're going there.

Unknown: 19:39

When they get to our office and we begin to treat them and kind of get into the issues of helping them. I tell them all the time, we'll worry about telling you when to have intercourse, or we'll put the sperm in the right time. You can just have intercourse for fun now. Don't worry about it. And so again, you just feel the pressure come off these guys when you say it.

Rebecca Gleed: 19:56

Can you speak to a little bit about genetic testing? And what goes into it, or your perspective on

Unknown: 20:05

it? Yeah. So first of all, eggs are not genetically tested. Embryos are. An egg is a one-cell structure. A sperm is a one-cell structure. So it comes together, and then from that one cell, it divides into billions of cells, obviously, to become a person. So an embryo that we genetically test has about 120 cells. That's how you can do it. You take about five cells out. So we can't test eggs and sperm. That's unfortunate. We can't test eggs and sperm. There are basically three kinds of genetic testing that we in in my field. The most common one that's getting all the attention now is called PGT, and that stands for preimplantation genetic testing, and PGT dash A is simply a karyotype on the embryo. What that means is you're simply looking at how many chromosomes an embryo has. People that are here tend to have 46 chromosomes. Obviously, two Xs means you're a female, and X and Y means you're a male, but we all have most of us have 46 chromosomes. There are exceptions to that. Obviously, trisomy 21 people are around and they have an extra. They have they have 47 chromosomes, but most people have 46. So you can actually test the embryo for how many it has. Even young women, about 40 to 45 percent of their embryos in a young woman have genetic defects that are incompatible with life, and so and that number rises exponentially in your late 30s and 40s, which is why women in their mid 40s don't tend to have children naturally. They're getting pregnant. They're just all genetically abnormal, and they all they all don't implant or miscarry. So we can now test embryos for that, and so it's called PGT dash A. PGT dash M is when you're looking for a specific gene, like if a couple like BRCA, the BRCA genes that cause breast cancer. That's a dominant gene. If that's in your family, we can test embryos for it and use embryos that don't have it. So one basic type of genetic testing is on embryos. That's the most common one we do now. The second one we do, though, at the new patient visit, is called recessive gene testing of the couple. So recessive genes means that both you and your partner have to carry the same defective gene to cause the disease. The best example is cystic fibrosis or sickle cell. They're both recessive conditions, and so if one of you carries a cystic fibrosis gene, for example, we test the other one. If they also carry it, well, you can test the embryos and use embryos that don't have both the copies of the genes. That's recessive testing. The third type is done in couples that have recurrent pregnancy loss, and they actually need a care type on themselves because they can carry what's called a balanced translocation, which can lead to pregnancy losses. But that's more of a unique group of people that come in, haven't had three or more miscarriages. But the most common genetic tests are those genetic tests on embryos, and then the recessive tests that we do at most new patient visits.

Rebecca Gleed: 23:00

And

Unknown: 23:00

couples often confuse those two. It happens almost every week where someone will say, "Well, I did the I did the genetic test. Why do I need to test the embryos? Totally different things. The test they did is for recessive genes. The embryo is just for a karyotype to know that it has 46 chromosomes.

Rebecca Gleed: 23:16

Yeah, what a helpful kind of description of how you approach this with genetic testing. Thank you. Are there any conversations around ethics as technology continues to progress from your perspective?

Unknown: 23:31

Yeah, yeah. I mean, I could go on and on. I've I've had some fascinating cases in ethics, and I've sure I could talk a lot about this. But yes, definitely, just the concept of in vitro. Some people have ethical problems with, to be honest with you. Freezing embryos. I have a lot of Catholic couples who struggle with that, and so their ethical things have been in the field since 1981. So we've been dealing with it. The ones that are getting attention now, though, have to do with embryo testing, and so there's a company doing, and I don't, I don't even hate to get into this because I'm not sure I'm, I'm buying into it yet. But there is a company that's doing what's called PGT-P, and the P stands for polygenic. So what they're learning is that some diseases that don't have a gene associated with them have a grouping of genes that cause a disease, like for example schizophrenia, they've shown that if you look at populations of people, that you'll find certain gene clusters that happen, and so they can now test embryos and give the embryo a ranking of what is its likelihood of having some of these diseases. We're not sure we totally believe this technology, and so I just bring it up because if you're out there listening, you might come across this and it's highly controversial. And as we get better at gene testing, we're going to be able to genetically test for things that maybe we shouldn't be testing for height, intelligence. Who knows? Who knows? Sure. So that's the danger. Not the danger. I don't. I'm not. I don't think I'm not fearful of it at all. But that is where it may be going eventually, where you can start to test embryos for genetic things. If that were to happen and it became and were to become widespread, then you'd have fertile couples coming out of the woodwork for in vitro, which doesn't happen much now. We're we're mainly treating infertile couples, but if you can test embryos, I wouldn't be shocked if you see fertile couples desiring that. It's like now we don't like to get into it here, but it's controversial. But you can do IVF for gender selection. We like to have a policy where we value all genders, and so we don't do IVF for gender selection. But there are people who want it done for gender selection. They have three girls, they want a boy, or three boys, they want a girl. We don't like to get into that because we think it means you're devaluing some genders, and we like to know that all genders are valued.

Rebecca Gleed: 25:54

Thank you for pointing to some of those ethical considerations. I think the dialog hopefully will continue and figure out what ethics are going to be like in the next decade as technology just continues to soar.

Unknown: 26:07

It's why it's such a fun field. Though I'll be honest with you, it's such a great field. And what drew me into it in the early days was partly the ethical dilemmas. I could tell it was going to be a field that's going to have a lot of ethical dilemmas with it, and I kind of like it. I kind of like that. And so I'm not at all afraid to discuss these. I have a lot of religious couples that come in, Christian couples, Muslim couples that get into ethics a lot, and I'm very comfortable talking about it. I like talking about it, and it's a it's really a fun part of the field.

Rebecca Gleed: 26:35

Yeah, and I've I've tried to at least from my perspective stay out of a gatekeeping role because I've it's a really tough ethical considerations and conversations of if I'm providing the psychological testing as I don't know if gatekeeping is the right word I've tried to stay out of it and I just generally work with couples going through infertility and I think this is a segue into your book which is when waiting becomes life, and I know this isn't your only book. We can shed light on other publications and books, but this idea that the waiting can be so difficult for couples, whether it be the diagnostic testing or the two the two week wait, and we know from the recent research is getting an infertility diagnosis is akin to receiving a cancer diagnosis. We also know this two-week waiting period is highly distressing for couples and individuals. So why don't we pivot into your book and this idea that is so beautiful around hope.

Unknown: 27:45

Yeah, it's funny about the title. The publisher actually suggested a title, "The Two Week Wait. That's what they wanted to call it. Okay, but I had some say in what it was called, and so we set her on when waiting becomes life because we spend we spend a lifetime waiting. We're always in its grip, right? From mundane things to momentous things, we're always waiting for something. And I think in the waiting, not only might you be pregnant and have life there, but also you can learn about yourself and grow and become a better person due to the waiting. The waiting is important, and I think that's part of that-the double play on the word, on the title. When waiting becomes life, it could mean that you get pregnant, or it could mean that in that waiting process you become a stronger person.

Rebecca Gleed: 28:31

Tell us more about the waiting period, what you see, and how do we move away from, without it becoming toxically positive, away from anxiety, into more of the hope.

Unknown: 28:47

Hope is what gets us up every day, right? If it weren't for hope, we wouldn't get out of bed. So hope is immensely important. I want every couple to leave my office hopeful. I sometimes have to have those hard conversations where they have to begin to grapple with the fact they may not have a genetic offspring, but doesn't mean they lose hope. And so the waiting, everything we do is waiting. It's it's really frustrating, but I'm a big believer, big believer, and I tell this to my couples all the time. Continue to live your life in the midst of your infertility. Don't put your life on hold because you're infertile, and they do it all the time. They don't want to take that new job because they may lose benefits. They don't want to take that trip because what if they can get pregnant that month? They don't want to whatever. There's always a reason to put your life on hold, and it'll it'll destroy you. You need to keep living your life in the midst of your infertility, and so that's one that's one thing I try to get into them, just keep living your life. Don't let infertility bring you down. It's not who you are. It's just something you're facing. It's a struggle you're going through. You'll get you'll get through it. You'll get through it. No storm lasts forever. All storms come to an end, and so know that you will get through this. I hope you get through it with a pregnancy, but you will get through it. And when you get through it, you will go on to the next season of your life. And so, don't despair in the waiting. Don't despair in what you're doing. You're in control. You can always choose a path that'll get you the family you want. It may be through other means, such as donor eggs or adoption or whatever. But don't despair, and you will get through this and onto the next season.

Rebecca Gleed: 30:23

Yeah, I see this a lot with couples where they're just at a point of exhaustion, but they still carry that hope. So, what we talk about maybe a pause or maybe a few months rest is in order, and then get back to the drawing board. I don't know if you see that a lot.

Unknown: 30:42

Yeah, often the discussion to take a pause for three or six months-that one is often a little tricky. But that one's not the hardest one. That one I could often get couples to do, especially if they're having to pay out of pocket and they can they can still possibly get pregnant on their own or with an insemination. They don't want to rush to IVF because they got to pay for that. I'll often tell them to kind of talk to each other, kind of bargain, kind of pick a day in the future. Whereas if you're not pregnant, then you move on. Often the partners, the husbands, or the male partners often are the ones, sometimes looking more at the financial side of things, and they don't want to rush into IVF. The female will do it in a heartbeat, right? She'll be happy to do it. So often, I get-I have to get them to. I feel like a marriage counselor sometimes. Y'all need to talk and kind of negotiate a little bit and come up with a date in the future, four months from now, six months from now-that if you're not pregnant, then you'll move on. And they seem to like that. So I can often get them there. The hardest one of those couples that are probably not going to have a genetic offspring. That's those are the harder couples to get them off this emotional roller coaster is often the hardest discussion of all because we can always do something else. We can always do something else. Yeah. So it's hard sometimes to get a couple that's just emotionally drained. Their marriage is on the rocks. They're in depression. I know they need to get off this emotional roller coaster and get onto something else, but they're not there yet. That's the hard discussion.

Rebecca Gleed: 32:06

Yeah, from a medical provider, how do you know when you've reached the point of there's not a lot of chance that there will be a live birth or successful pregnancy?

Unknown: 32:21

Yeah, so often the discussion centers around what is the woman's egg quality. There's a test we do now called for egg quality called AMH. It's a marker of how many eggs a woman has, and so low AMHs are not good. Obviously, that means the woman's going to run out of eggs before she should normally run out of eggs, and if her AMH is zero and her FSH is elevated, that means she's out of eggs. And so I work with couples every week that have low AMHs or borderline high FSHs, and the chance of them having a genetic offspring is very, very low, if not close to zero. Those couples often move on to donor eggs. It's often not their first choice, but I've learned in life we all have a first choice, but often the second choice is not so bad. And so I often have to get them to realize that yeah, everyone's first choice is to have a genetic offspring with your child, to have your genes and your child. But when I go through donor eggs, I can again, it's often a conversation that couples are willing to have because the there was a study done years ago where they looked at kindergarten kids, and they had parents fill out surveys about the kids, and they then tracked which ones were donor egg babies and which ones were not, and they show that the donor egg babies, the parents didn't even mention it. It's like they forgot about it because the woman carries it, she delivers it, she changes the diaper, she's the mother, and she kind of forgets that it was a some other woman's egg. So I can often get them to a donor egg discussion, but then I have couples sometimes for religious and ethical reasons just shut that down. They can't go there. Then those are tough. Then you got to talk about the adoption route or perhaps an embryo adoption. Those can be very hard conversations, and that's where I often use people like you. We have professionals in our region that work with infertility couples, and it's a good partnership. I have two in particular that I use a lot, and it's a really good partnership because we're not counselors. I mean, I've dealt with a long time, but I'm not a counselor, and I often in my in my day don't have a lot of time to spend doing that. To be honest with you, and so yeah, we love our counselors in our region that help our couples.

Rebecca Gleed: 34:25

Do you think there's a better way other than just referring out that we can intersect the medical and the psychological? I think it feels so splintered, and I also feel for you all because it's a high workload, probably having to play multiple roles, whether you're trained or not, with emotional support or couples counseling, but how could we do a better job intersecting this support?

Unknown: 34:50

Great question. You probably have better ideas than I do. I'm a big believer in groups, though. I like groups partly because groups get men there, and. I've I've seen success in our area. Don't know if it's still going on right now or not, but I've seen success in counselors who ran these six week groups. Once a week, you come, you pay a little bit for it, you have skin in the game, so to speak, and then after six weeks, it's over. And I've I've seen success there because in those six weeks, often the guys come and they open up, they make a friend, they can talk to somebody, and then often after the six weeks, they continue in counseling. So it's often an avenue to get them into counseling where they're not ready just to go straight to counseling. So I think that may be one thing. Again, it's great question, and I would love to hear your thoughts on it. To be honest with you, because I don't know that we do the greatest job connecting resources to patients. I wish I could even have a group in my office here, and we're talking about it, but we don't have it yet. So we're couples who know just come back here every Tuesday night or whatever, and they would have a group here.

Rebecca Gleed: 35:50

I think you're right. Like having an in-house or maybe an office in the same office building really removes the barriers. It's like you're already familiar. You're you know that they can do a doc to doc discussion, and I like the idea of the six weeks. So it's not perpetual. You get something out of it, maybe have some social support, and then keep it moving. Tell us more about your book. What is in it? Why should someone read

Unknown: 36:17

it? Oh, thanks for asking. I felt like it was like delivering a baby, to be honest with you. I like to write. I've always written. It's one way I kind of perhaps deal with some of my stress or things I'm dealing with. I like to write, and so I've written for a long time. And I decided about 10 years ago I'd start writing some of my favorite stories in my career, and so I just started writing these stories, and I learned that the stories had often a life lesson attached to them. Maybe it's just the way I think about things. I just think there's always a life lesson staring us in the face. And so when I wrote these stories, I realized they often had a life lesson. So I wrote the stories, and then someone suggested at the end of each story I put a sort of a prescription into what are you going to do about this story, and how are you going to apply this to your life? And so that's the second part of the book, where there's a story. So it's 12 of my favorite stories, and then after each story, there's a Doctor Deaton's prescription, like what are you going to do with this story? And then I sent it to a publisher years ago who said he would publish it, but then he chose not to at the last minute, and he said that some patients like the emotions of a story, but some patients want science. He said, "Give them

Rebecca Gleed: 37:27

both. Love that. So

Unknown: 37:27

then I decided to write a chapter after each story about the infertility journey, and I tried to do it in a sequential way. I started more simply, and then I kind of got more complicated as the book went on. So there are 12 stories, 12 Doctor Deaton's prescriptions, and then 12 chapters on the infertility journey.

Rebecca Gleed: 37:46

Can you give us a taste of what a prescription might sound like?

Unknown: 37:50

Yeah, I'll just read the first. Can I just read the first one to you?

Rebecca Gleed: 37:53

Get a sneak peek so we can all buy our copy.

Unknown: 37:56

So the first one says,"This is this is a story about it's about when I was a resident, actually, and I delivered a baby that got placed for adoption, and it's very emotional story. In fact, when I still read it now, I still cry a little bit. So it was about the unconditional love of this young woman who placed her child for adoption, and it says, "Dr.

Deaton's prescription: 38:16

Even when things do not go your way, love has a way of taking you to a better place. Love that you give unconditionally does not demand a response. Love should be received as it is given, imperfect, tarnished by the world, but given freely from an honest heart who is like you, learning to love. My prescription for you is to give love recklessly and receive love gratefully. How will you follow this prescription?

Rebecca Gleed: 38:43

Oh, so good, so good.

Unknown: 38:47

I like the prescription. In fact, I'd say at least a third of the people that read it and and let me know they read it say that was their favorite part about it-the prescription. And I'm going to one. I got to read one more. This is one of my favorite stories about two men that came to see me have a child,

Rebecca Gleed: 39:02

yeah.

Unknown: 39:03

And one of the guys was kind of quiet. He was the one that wasn't the in charge person. He didn't arrange the surrogate. He didn't arrange the egg donor, but he was often there, but kind of quiet. And so after the embryo transfer, I went out to the waiting room, and he was the only one in the waiting room. I said it went great, and he looked at me and said, "All I've ever wanted was be a dad, and it just kind of pierced my heart. So after that story, I said, "Fathering is a gift, a calling, and a lifelong challenge. Acting like a father is not gender specific. The idea of shepherding someone or something applies to all genders. We are made in a way that enables us to be fathers, if possible, dream big, dream against all odds, dream of ways you can be a father figure to your own children or to those in need of a father. Is there someone or something in your life that needs a coach or a shepherd? Do you feel drawn to be a mentor to a younger person or a fledgling organization? Go be a mentor.

Rebecca Gleed: 40:00

I can't think how special the timing of this is. Is Father's Day being yesterday of the timeliness of this, but how beautiful! You also mentioned loving recklessly. Like, what do you mean by that?

Unknown: 40:13

Yeah, I should be able to answer that shit because I wrote it. I just think

Rebecca Gleed: 40:16

with Brittany Brown, like this idea of vulnerability and just this unconditional. I don't know if that's what you were going for.

Unknown: 40:24

Yeah, I mean, again, it's it's tied to this story, but it really struck me that this young girl-I mean-was willing to carry a pregnancy and then deliver it and then never see it again. It just struck me as that is the epitome of unconditional love-that she loved this child for nine months, and never got a thank you from it. Never got a Mother's Day card. Never got anything. But then I write that unconditional love does not need a thank you card. You know, it's just so I think that's what it kind of is. You don't you don't expect to get anything back. Unconditional love means you're not getting anything back. There there are four kinds of loves, and that kind of love you don't you don't get anything from it, and so that's hard. Though we all kind of want things back, you know, and so I think that's what it kind of gets to. Just kind of walk around every day thinking, how can I love recklessly? Is there something I can do that I don't expect anything back from it? I don't know if that gets at your answer or not. It

Rebecca Gleed: 41:22

does. I think it's a beautiful message, and maybe that's a good stopping point to share. Where do people find your book? Where did they find you?

Unknown: 41:33

The books on all the all the major players is Amazon, Barnes and Noble. So you can. Last I looked, it was there still at Amazon. In terms of they often run out, they have to order some more, but they had it. So Amazon, it's when waiting becomes life. My website will link you to it. My website's easy. It's jeffdetonmd.com Jeff Deaton MD, all one word, all lowercase. jeffdetonmd.com That'll link you to Amazon, and you can see other things there. I also have a podcast which I launched this month with two other people, and it's called Podology, where science collides with culture without the complicated jargon. It's not just about fertility; it's about anything, a lot of things scientific. And you can't get my book off the off the podcast. I just wanted to mention it, but you can go to Amazon to get the book.

Rebecca Gleed: 42:20

Yeah, I'm gonna listen right after this for some of the episodes. I'm excited for you, and thank you. I feel like we got a history lesson, some education. These beautiful stories are such a gift, and then I'm sure people will support your book. And thank you for coming on,

Unknown: 42:36

Becky. Thank you so much. I've enjoyed this conversation. I like talking about what I do, and my staff will tell you I like to talk a little too much, but I do like to talk, and I appreciate your inviting me to come on.

Rebecca Gleed: 42:46

Yeah, thanks for coming. If

Unknown: 42:52

you would like to learn more about how we can help, visit our website@perinatalreproductivewellness.com And while you are there, check out the latest edition of our book, Employed Motherhood. We also invite you to follow us on social media at Employed Motherhood. Finally, if you enjoyed listening to the show, please subscribe and rate it. Thank you.