EP 596: Treating Infertility After Roe v. Wade With Texas Fertility Center

In this episode, Dr. Mistry and Donna Lee are joined by Dr. Kaylen Silverberg of Texas Fertility Center. Dr. Silverberg is here to discuss the recent SCOTUS decision to overturn Roe v. Wade, which established the constitutional right to abortion. While much of the has debate centered on pregnancy termination, patients struggling with infertility are also concerned that assaults on reproductive healthcare may actually impact their access to fertility treatments like IVF or embryo freezing. If you or someone you love has had difficulty conceiving or may be interested in fertility treatments, tune in! Dr. Silverberg dispels common myths about growing your family after Roe v. Wade. 

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1: 0:07

Welcome to the armor men's health show with Dr. Mystery and Donna Lee.

Speaker 2: 0:13

Hello and welcome to the armor men's health show. I'm Dr. Mystery, your host board certified urologist all around. Great guy.<laugh> here joined by my co-host Donna Lee.

Speaker 3: 0:22

That's right. Welcome to the Donna Lee show everybody.

Speaker 2: 0:24

This is not the Dr. Donna show. Mm. It is. We are going to get cited by every medical board on

Speaker 3: 0:29

Earth. I got a piece of junk mail that is addressed to Donna McBride MD. Therefore,

Speaker 2: 0:36

All Dr. Show. Well, please send any complaints to donna@naurology.com. That's right. This is a men's health show. We deal with a lot of things between the nipples and the knees, and there's nothing more nilly and knee than semen.

Speaker 3: 0:48

Oh wow.

Speaker 2: 0:49

And baby making

Speaker 3: 0:50

That's so hard left.

Speaker 2: 0:51

This show is brought to you by AU urology specialists. All complaints can be sent to the FCC. We do a lot of fertility in our practice, Donna, you know that,

Speaker 3: 0:58

That is your favorite thing under the sun.

Speaker 2: 1:01

It is one of my favorite

Speaker 3: 1:02

Things that, and getting 80 year old men hard ons.

Speaker 2: 1:04

I do love to give a 80 year old man, a hard on yes and so, but what I love to do even more is to deal with professionals,

Speaker 3: 1:10

Not unlike us,

Speaker 2: 1:11

<laugh> unlike us. Okay. So this is not my first radio experience rodeo.<laugh> this is not my first radio rodeo rodeo. My first radio rodeo was with someone who I really feel is one of the like premier physicians in Austin. Mm-hmm,<affirmative> a spectacular mentor and somebody who really, really, really helped my practice when it was just in its infancy and also a good, and I cannot thank you enough for being here. So Dr. Kalin Silverberg with text fertility center. Thank you so much for joining us Kalin. Oh

Speaker 4: 1:37

My God. What a great honor. It's an honor or privilege to be here.

Speaker 2: 1:40

I was on your show. What was the name of your show?

Speaker 4: 1:42

We had a show beyond the birds and bees

Speaker 2: 1:45

Beyond the birds and the bees. Right. And today that would be something different. That would be all transgender stuff. But back then it was a, it was, it was, it was just about, it was just about female in fertility, right?

Speaker 4: 1:54

Yeah. Basically we try to cover male tube. Yeah.

Speaker 2: 1:56

Yeah. And that's when I came in, do a show here,

Speaker 4: 1:58

We needed you for,

Speaker 2: 2:00

So, uh, one of our best jokes on this, on this show is don't pull out is not a great strategy. Get a vasectomy, what vasectomy is. And so, and especially nowadays in the United States, there's a lot of, kind of either misconception or preconception or concern about what's going to happen now to reproductive rights in the United States. It'd be awesome for you to come in and talk to us about what those implications are. Sure. Our vasectomy business has gone through the roof. I'm not gonna say that we've benefited, but I'm just saying that we've finally allowed men to understand that they have a role in their own family planning yeah. Roles. Sure. And we wanna be a resource to that. So why don't you go through kind of what you think the implications of these, uh, Roe versus Wade kind of overturning or however you want to kind of counsel it and especially how it deals with people in Texas.

Speaker 4: 2:44

Well, it's, I mean, it's really interesting cuz it's multifactorial, right? I mean, there's all kinds of different ways to approach this and the way that I like to look at it when I'm trying to talk to patients about it, because the hype right now is through the roof. Right? Um, I did CNN, I don't know, three weeks ago, I got a call from them and talked to them. I did did NPR two weeks ago, been called by most of the radio stations and TV stations in Austin because everybody's concerned, right? The problem is

Speaker 2: 3:06

How come nobody's calling me for anything. Nobody calls you Jesus. All right,

Speaker 4: 3:09

Continue this. Well, most of the people who are concerned really don't know the facts. And so they ask questions to really kind of nonsensical and really don't apply. When you look at what the effect is of the two laws, I'll talk about, there's actually three, there's two laws and one bill that's gonna be introduced probably in January. And if you look at the two at the effect of the two laws that are in effect now, first of all, the heartbeat law that passed. And then second of all, the trigger law, if you look at the effect of those now there's really no effect on IVF. There's really no effect on fertility treatment. The difference is and where the effect actually is, is downstream. So for example, if a couple conceives, a multiple pregnancy in the old days, six months ago, we could send them to a high risk OB doctor and they could get the pregnancy reduced. So if they started with triplet or quadruplets, they could reduce down to a single turn of twins, very effectively, very easily, very low risk mm-hmm<affirmative> can't do that anymore. So you have to go outta state for that. So that will impact our ability to do things like injectable drugs combined with intrauterine insemination

Speaker 2: 4:07

Or putting multiple embryos in because

Speaker 4: 4:09

A lot times. So we haven't done that in years. I mean, you know, we put in one embryo at a time except for extraordinarily rare circumstances. I think our last statistics, 99.7% of our embryo transfers are single embryos. And you know, there's always a split. Sure it can, but that's totally unpredictable and it's totally UN unpreventable. And so, you know, when that happens somewhere between one and a hundred times and one in a thousand times, a couple has to deal with it and make that choice. And 99.9% of the time they'll choose twins.

Speaker 2: 4:36

So when it comes to understanding how changes in abortion law might affect changes in fertility, what are some of the myths that you've heard? And some of the hype that, that you've heard because some of our listeners may not even know what that hype and

Speaker 4: 4:50

Like a myth that hype is that, you know, in vitro fertilization is gonna be outlawed. Okay. And then, you know, if you say, no in vitro, fertilization is not gonna be outlawed. They say, well, what about personhood legislation? Let's talk about that. There's actually a bill. I have the text of that bill. That's gonna be introduced in the legislature in January or February. And the bill specifically says that it doesn't apply to either fertility treatment or in vitro fertilization. So you can't be more clear than to have in the actual bill. That's gonna be debated and voted upon, uh, language that says this doesn't apply to IVF or

Speaker 2: 5:25

Infertility. So if somebody was gonna be trying to get educated on what a personhood legislation is, what we're saying is that there's going to be a law pass that says that at conception is when the entity should be considered a person. Is that, is that the general

Speaker 4: 5:37

That's, that's exactly right. That's exactly right. But I've got the bill pulled up here. It's it's um, it is Senate or house bill number 16, 23. And the language of the bill specifically says under sub chapter B personhood rights, it talks about vesting of rights. Uh, and it says if I can find the right language right here, investment of rights, 2.05, one investment of rights, the right to life for each, uh, born and pre-born human being vests at fertilization.

Speaker 2: 6:05

So the, the whole idea here of a personhood legislation is that, is that, um, is that life begins at fertilization, but, but there's going to be specific exclusions as they apply to IVF and to inter in interuterine insemination, why don't you tell me kind of, what do you think this is going to do to female fertility planning, family planning, things of that nature? Because in my opinion, I feel that because of limitations on the ability to terminate pregnancy, people are gonna take the whole idea of getting pregnant a Loter more serious.

Speaker 4: 6:41

Yeah. I hope that they will. I mean, they should have been doing that too. They should have, right? Yeah. Um, you know, we see people it's, it's kind of mean, hopefully we'll talk about pro-choice and pro-life cuz I can tell you my new definitions of pro-choice and pro-life, they're not the political definitions, but hopefully people are gonna be able to pay a lot more attention to what they're doing. They'll be a lot more intentional about what they're trying to do. Um, I think that, you know, when you joke about the fact that your vasectomy business is going through the roof, I think that that's going to happen. I honestly think our in vitro fertilization business is gonna do the same thing for all the wrong reasons. You know, I think that a lot of people are gonna say, gosh, you know what? I don't wanna run the risk of having a baby with a birth defect or a chromosomal abnormality. I don't even wanna run the risk of getting pregnant with an embryo. That's gonna have a CHSO abnormality because then what do I do? I've gotta go outta state to terminate that pregnancy as long as there's a heartbeat. So I think that what a lot of people are going to do is they're gonna say, you know what, they're gonna come in and maybe they would've easily gotten pregnant with pills or maybe they would've easily gotten pregnant with some minor surgery to fix a problem. They're gonna say, you know what? I don't want that I want in vitro fertilization because I want you to test my embryos before you put them in. So that I'll know that I'm not gonna have a risk of carrying a baby with, you know, a down syndrome or Turner's syndrome or chromosomal abnormalities, or if I've got a history of certain types of genetic illnesses in my family, I wanna be able to screen those out in advance. So I don't have to worry about doing anything later.

Speaker 2: 8:06

I think that that concern along with the fact that people are having children older and older, I think that, uh, you know, there's so many things that are coming together when it, uh, with reproductive rights and what are the true impacts that these changes in laws are really gonna have on people that they may think that they're, you know, that they may be overthinking?

Speaker 4: 8:25

Sure. Well, I can tell you, first of all, every state's different and what the Supreme court did when they struck down Roe versus Wade in this Dobbs case, this Dobbs decision, they threw the issue back to the states. And so we can potentially have 50 or 51 different approaches to the legislatures of how they're gonna approach this and what they're gonna do and what laws are gonna implement in their own states. So I can really just speak to Texas because I'm pretty well versed in what goes on here. Uhhuh it's basically hype. The bottom line is there is nothing in any of the legislation that's currently passed or any of, of the legislation that's gonna be introduced in pending in the new legislature. When it starts in January. There's not a single thing that inhibits our ability to do fertility treatment as we've been doing it. There's not a single thing that prohibits in vitro fertilization as it's currently practiced. All these laws do is they try and limit abortion. Or in fact now in Texas eliminate abortion, um, from the time of fertilization. So what this means practically is, you know, we only put in one in one embryo at a time with in vitro fertilization Uhhuh. So the risk of multiple pregnancies is somewhere between 0.1 and 1%, which is very, very low. And those are almost always twins. Rarely can you have a, an embryo that splits twice? But what would happen is if God forbid a patient conceives with some other type of fertility treatment and they have tripled or quadruplets, potentially they'd have to go outta state to get that pregnancy

Speaker 2: 9:38

Reduced. So let me kind of clarify for some of our listeners that may not be as versed. So we are not talking about the impact that Roe versus Wade decision is having just on an ability to get an abortion, because that has been limited in Texas, correct. And the laws, as I currently understand them is if there's a heartbeat, that's detected that an abortion's not allowed. And then something that you mentioned, the trigger law, right means that abortions in Texas are simply outlawed, correct?

Speaker 4: 10:03

Correct. From the moment of fertilization

Speaker 2: 10:05

From moment of fertilization. Now what we're talking about you and I is really just, uh, the medical response that, that if you are out there and you're suffering from infertility, what do these laws mean about how your pursuit of having a family is going to be impacted? And what you're trying to assure us of is that it's unlikely to greatly affect our ability to help with couples get pregnant.

Speaker 4: 10:25

That's correct. There's really nothing in here. Certainly it's explicit that there's nothing in here that prevents in vitro fertilization.

Speaker 2: 10:30

And in fact, if you really have to think about it, I mean, having healthy children is what we want

Speaker 4: 10:36

That's right. You know, if you eliminate the political implications of saying you're pro-choice or pro-life, we're both, you know, we're, pro-choice because we want people to be able to choose, to have a family when they want to. And we wanna be able to be able to have them choose, to have whatever type of family they want to when they want to. And we're pro-life because what are we trying to do? We're trying to,

Speaker 2: 10:54

We're trying make life, we're trying to

Speaker 4: 10:56

Make life. I mean, there is nobody more pro-life than a fertility doctor.

Speaker 2: 10:59

Absolutely. And so just so that I can be, uh, clear because a lot of our listeners may not know, but sometimes, you know, it's dangerous to have more than one baby at one time. Right? Absolutely. I mean, we, I, we get couples all the time that tell me they want to have twin and I'm like, oh God, are you sure? Because you know, they're like, yeah, I just wanted to like do it at once. You know what I'm saying? And just have my entire family at one. And I'm like, this is not a cow lady. Right. You know, one at a time is probably okay,

Speaker 4: 11:27

Well, I can tell you it's Saturday, right? I mean, I saw 35 patients this morning. I'm on call this weekend. I saw 35 patients this morning, five of them, five of them, or trying to convince me that they really want twins and even triplets. No. And I'm like, you know what? They look really cute when they're dressed alike and you know, Christmas cards when they're in the mall, you know, that's great.

Speaker 2: 11:44

They're TikTok on their kids. Oh

Speaker 4: 11:45

Yeah. But it's,

Speaker 2: 11:46

It's tough. And so what happens sometimes is that sometimes when you do an assisted reproductive technology, when you give them drugs, so they drop more eggs, right. Something like that, they can have more than one baby developing. They could. And so currently sometimes we reduce the number of fetuses growing so that the other ones can live. Correct. So it's, it's an effort to make it more safe. Correct. And what you're saying is that will not be allowed in Texas.

Speaker 4: 12:08

That is correct. That will not be allowed in Texas because there's a heartbeat, you know? So the original heartbeat law prevented that from happening. But then this Texas trigger law actually reverts back to pre versus Wade when abortion of all type was

Speaker 2: 12:21

Illegal. Now what's interesting is that, uh, whereas changing laws on the federal level is almost seems like climbing Mount Everest. Mm-hmm<affirmative> in Texas. I mean, we know our people here and we can convince them, we can talk to them as the medical community in Texas, where we have a lot of say, there may be a lot of opportunity to help kind of guide and shape these rules so that they make sense both from an ethical standpoint, as well as a medical standpoint.

Speaker 4: 12:46

Yeah. Totally agree with

Speaker 2: 12:47

That. Totally. And so I think it's really important that that people don't get hyped up. They kind of understand what the truth is so that we can shape things in the right direction.

Speaker 4: 12:54

Yeah. We have to just lower the temperature in the room because you know, you have to understand the, the couples that you deal with and that I deal with on a daily basis who are trying to conceive all they want is what they've wanted ever since they were little boys and little girls growing up, and that is, they want to have a family. They would like to be able to have a family with their partner without you or me getting involved. Right.

Speaker 2: 13:13

I'm not allowed to get involved. That that's how I get in the news.

Speaker 4: 13:16

Yeah. I, I have no choice to get involved and I know my role, I get it. I'm kind of a necessary evil in certain situations. Right?

Speaker 2: 13:22

Absolut, they're never happy to see us. No,

Speaker 4: 13:24

They're never happy. They happy first day is when they graduate and they get to leave us. That's right. The first tell people, I tell people all the time, you know, we're one of the only practices of medicine that we succeed when we lose our patients.

Speaker 2: 13:32

That's right. And every single one says, I don't want IVF. Right. You know, like, that's the first thing I said, well, you know, I mean, this is kind of what you're here to. This is the journey that we're on, right. To try to help. You have to have children when people are thinking about how these laws might affect their ability to get pregnant in the future. You mentioned something in our last segment about, uh, perhaps people using IVF in a, in a wrong way, because they're trying to avoid genetic anomalies in their children. Now you seem to put kind of a, a negative spin on that. And I, in my brain, that's such a great thing. Like let's just get every 20 year old woman out there just to freezer her eggs tire tubes, and then she can make a baby later. But now I say that, that sounds very, very, very, very bad,

Speaker 4: 14:14

Right? Well, don't get, don't get me wrong. Right. I mean, I think that it's great for women who are forward thinking they're on the career path. They may not have met Mr. Wright yet. And they want to go ahead and they want to try and get some sort of insurance policy that they know they can rely on to at least raise the likelihood that they'll be able to successfully conceive when they're ready. And so they want to come in and they wanna talk about freezing the rigs. I'm, I'm totally fine with that. I'm less fine. When they come in at 44, 45, 46 years of age, I see, I wanna freeze their legs, their rigs, cuz it's too late. It's too late. But when they come in in their early thirties, I, I think that's great. The concern that I have is is that laws like this, you know, there's unintended consequences of everything. Absolutely. And, and one of the unintended consequences of laws like this is it is going to raise significantly the cost of fertility

Speaker 2: 14:57

Treatment. Absolutely.

Speaker 4: 14:58

Because more and more patients are going to elect much more expensive, much more complicated.

Speaker 2: 15:04

Absolutely. Absolutely. And, and maybe you create even more distance between the haves and the havenots out there. Yeah. Because you know, you're gonna have a, the people that have the insurance or have the capability, you're gonna be able to do it. Right. You know, on the mail side, I have our vasectomy business exploded. Almost 40% of our patients are now doing vasectomies that don't have children. You know, I wonder if we should be encouraging them to store sperm for the same. Maybe, maybe these young kids aren't as young boys, aren't as forward thinking as their, you know, female counterparts. Correct. And they're gonna end up without any children, but you know, that being said, I get paid more for the, the reversal. So I don't mind, I don't mind

Speaker 4: 15:37

So much. Okay. Well it depends how you look at it.<laugh> and I know you well enough to know you're joking

Speaker 2: 15:41

Around

Speaker 4: 15:42

Your listeners may not right.

Speaker 3: 15:44

Oh

Speaker 2: 15:44

My gosh. Maybe if it's the first step. No. So do you think that there are, um, steps that people should be taking right now to help kind of navigate some of these, some of these different decisions? How can people educate themselves?

Speaker 4: 15:57

Well, first thing they need to do is exactly that educate themselves. They need to read the laws. You know, the laws, these laws are really actually short. You know, when you read the, the text, these don't go on for 20, 30, 40 pages. Like some of the legislation does, there are several paragraphs it's not written in complicated English. I mean, it's written really pretty straightforward. You know, as much as I'm not in favor of some of the legislation that's been passed, at least the legislator, consol legislature consulted with somebody who knew what was going on because the language that they're using is really appropriate language. I think it's being misappropriated, but it's appropriate language. So they didn't consult with me. I don't know who they did, but they, they consulted with somebody who really does understand the field.

Speaker 2: 16:37

They didn't consult with me either.<laugh> Kalin. I cannot think thank you enough for joining us. This is Dr. Kalin Silverberg with Texas fertility center. Uh, what's your website? Kalin

Speaker 4: 16:46

It's www DOTTX fertility.com

Speaker 2: 16:51

And Donna, how do people get a hold of us? They want to ask us or Dr. Silverberg a

Speaker 3: 16:55

Question you can reach out to us through armor men's health.com. That's our website, or call us at(512) 238-0762.

Speaker 1: 17:01

The armor men's health hour is brought to you by urology specialist for questions, or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.