What I’d Do If I Were 38, Trying 12 Months, and All My Tests Were ‘Normal’

If you’re 38, you’ve been trying for 12 months, and every test comes back “normal,” this episode is your step-by-step game plan for what to do next. “Unexplained infertility” isn’t a diagnosis—it’s a sign we haven’t found the real bottleneck yet, and at 38, time is a real variable.

We walk through the highest-yield checklist to confirm what’s truly been evaluated (ovulation, uterine cavity, tubes, and the male factor), then cover the common “hidden” causes that don’t show up on basic workups—like egg quality/aneuploidy, subtle sperm issues (including DNA fragmentation), endometriosis, and timing problems.

Finally, I lay out a clear decision tree for your next move—minimal intervention vs a time-limited IUI trial vs moving to IVF sooner—plus my hard-stop rules, what I would NOT waste time or money on, and the exact questions to bring to your next appointment so you leave with a timeline instead of limbo.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.

Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

0:01

Today we talk about is it possible to get a boy or a girl when trying to get pregnant? I'm, Dr. Mark Amols, and this is Taco about Fertility Tuesday. Since the beginning of time, humans have always been trying to figure out how to make a baby a boy or a girl. And what can you do to influence that? The good news is there is a way that you can determine if you're going to have a girl or a boy prior to getting pregnant. The question is how easy it to do that. So let's start with the things that we know don't work. There is no sex position that you can be in that will cause you to get a boy or a girl. Matter of fact, taking even a step back further, no, men only make boys or only make girls. Men make exactly the same amount of male sperm as they do female sperm. And that's because the sperm come from the chromosomes. And men have XY chromosomes, which means when the gametes split, they break into an X, into a Y sperm, and then those are copied. Whereas when women's cells split, they have XX chromosome that will split into X and X. Now, you hear some people say sperm of males swings faster and things like that, but it's just not true. And since you can't affect the DNA splitting and you're going to always have the same amount of male and female sperm, that also means no foods can cause you to have more male or female. Now, the question comes up is we all know someone who has either four girls or five boys and they're always trying for that other sex. The question is, how does that happen? If it's always 50% chance, then how does that happen? And the simple answer is, is that the sample size is very small. Meaning if you only try eight times, then yes, the chances of getting the same sex does go down. But it's really not that extraordinary of a number. If you think about it, a quarter is a 50% chance of heads or tails. And you flipped a quarter five times and you got five heads, you wouldn't freak out and think, oh, my God, what's going on with the world? These statistics are crazy. But instead you would say, well, I only flipped it five times. But if you kept flipping that quarter for, let's say, 50 times or 100 times, you wouldn't expect it to land heads every time. That would be almost impossible. And so one of the reasons why we see things like this is that it's not impossible because the sample size is small. Now, if someone did have, let's say 20 kids and they were all the same gender. I would be very shocked. But technically it is possible. So we know position, time of day of having intercourse, or even environmental things such as foods are not going to affect the gender of the pregnancy. But they have tried with other things, and one of those is called sperm sorting. Sperm sorting is a technique where they spin the sperm and by using ingredients, they try to separate the sperm into boys and girls. From a technical standpoint, male sperm are going to be less dense because of the fact that their chromosomes are less than females because the X chromosome is large and the Y chromosome is small. However, this method, sperm sorting, does not work. People have tried it for a long time, and although it may separate the sperm a tiny bit, it really doesn't give anyone a real chance of having just a boy or just a girl. It may increase your chances a tiny bit. Although that hasn't been proven completely, it does not guarantee you a gender. So that takes us really to the only method that truly works, and that is a process called PGT A, which basically means biopsying an embryo and testing it to find out if it is male or female. PGT A stands for pre genetic testing for aneuploidy. And aneuploidy means looking for abnormal chromosomes. But at the same time, we can look at the sex chromosomes and also determine the gender. And the reason why that's important is because it doesn't do you any good to get the gender you want and then have a baby that has something like down syndrome or trisomy 13 or trisomy 18 or Turner syndrome. So most places when they're doing gender selection, also called family balancing, is they'll do aneuploidy testing to make sure the embryos are good. Now, as you can imagine, to get these embryos, to biopsy them, you have to have some method to get the embryos, and that's where IVF comes in. In vitro fertilization is needed to extract the eggs from your body. And then we can put them with the sperm and make the babies and then biopsy the babies to find out what gender they are. Then prior to putting them back, we can pick the embryo that you want and put that embryo back. And it's highly successful. There have been cases where people have put back embryos and didn't get the gender they want, but that's extremely uncommon. And most of that is likely due to either some type of error or due to inadequacies of the testing as well as a test not being Perfect. It's important to remember we're not testing the baby, we're testing the placenta cells. And so theoretically, there could be cells of the placenta that don't represent the baby completely. Now, one question that comes up is, can't you test the sperm to find out what type of sperm it is before you put it with the egg? The problem is, if you try to test the sperm to find out its chromosomes, what you will end up finding out is that you will kill the sperm and then you can't use it. One thing you can be assured of is that people are always looking for methods to help with gender selection. It is probably going to be the most lucrative field, infertility, if someone can figure this out. So I can assure you, if there is something that works, you will definitely know about it. This is how I know sperm sorting doesn't work, because if it did, we would have a line out the door of people wanting to do it because it would be so inexpensive to do and so simple. But the problem is it doesn't work, and that's why no clinic is relying on it to be able to guarantee genders overall. It's important to understand that this is a very common desire that many people have. So don't feel weird because you have that. I know a lot of people feel like they're playing God, and in some ways you are, but I always point out is if you went and tried a specific position to try to have a gender, then why would someone like God care as much if you use ivf? I mean, if both of the ways were trying to circumvent God, why would he be upset with one method over the other? And so we've been doing things like that for years and years, and we've never worried. So why should we feel bad now doing something that we can that actually works in the end, obviously, that's a personal decision that you have to make with your partner. Overall, the thing that you have to take away from this podcast is that there is a way for gender selection. And if you have a family that's unbalanced, it may be a good method for you to balance your family. The only method that works is using IVF to be able to biopsy the embryos, to do PGTA on them to determine the gender. Things like sperm sorting positions, foods, unfortunately do not work. But there are things coming on the horizon, and hopefully someday we'll have a better method than having to biopsy every embryo to determine which are males in which are females. Hopefully, this podcast was helpful to some of you who may be thinking about gender selection and family balancing and have a better idea now of what really is real and what really works. As always, I greatly appreciate everyone who listens to us, and I appreciate the people that you tell you may have heard. But I'm also doing TikToks, which are smaller sample sizes of some of these discussions that you can see within less than a minute. The handle for that is amelsmd. Well, I look forward to talking to you again next week on Taco Bell Fertility Tuesday.