Speaker 1

You're listening to the fertility docs, uncensored podcast, featuring insight on all things, fertility from some of the top rated doctors around America, whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Speaker 2

Hi everyone. We're back with another episode of fertility docs, uncensored. I'm one of your hosts, Dr. Abby Ablin and I'm joined by my friends, Dr. Susan Hudson from the Texas fertility center and Dr. Carrie obedient from the fertility center of Las Vegas. So it's great to be back with you guys today. Um, we were just talking before we began today about COVID-19 cause you know, that is kind of a topic on the news these days in case you hadn't noticed. And we were, I made the observation that in Tennessee, that's really interesting, depending on the part of the state you live in , um, how people react to COVID-19 in the area. And so I know in Nashville, we're kind of the area that has the most cases of COVID-19 in our state. And this past weekend, I went to visit family in the Eastern part of the state and it, you know, nobody had masks gone. Um , people were at restaurants without mask . Um, actually didn't go inside a restaurant, but I was an outdoor restaurant and nobody had masks gone. And I, I kind of not wearing my mask with all these people around. I almost felt like I was like, forgot to put my shirt on or something. I felt really paranoid. So I was just curious as to what you guys have observed in your respective areas and what your thoughts are.

Speaker 3

So Nevada is fairly heavy on mass . I mean the entirety of Nevada is essentially Las Vegas in the Southern part, Reno and the top part. And then there's a whole lot of empty space with just tiny towns in between. And there's a whole lot of, I mean the loneliest highway in the country is in Nevada. There's true story. Um, and so most of the population is concentrated in these two places and at least in Vegas, there's, there's a ton of mask wearing , uh, which I really appreciate. I mean, the ha there's a hotspot in the country. That's in Utah, Vegas, Arizona. I know it's spreading towards you in Texas, Susan. And I like, if I see people without masks, it's , it's like they're walking around without their pants on and all their bits hanging out. And I ,

Speaker 2

So Carrie, I have a question when you were in the casino this weekend, were you wearing a mask then I'm joking. She didn't tell me she was in a casino this weekend, but I was just wondering, you know, maybe, maybe she's gonna admit to something. Carrie does not frequent casinos.

Speaker 3

You never know, never put a nickel or a penny or any denomination on any kind of gambling device.

Speaker 2

He asks where every time we talk, I learned something new about you. That surprises me. What is it going to be next week?

Speaker 3

You'll just have to tune in and find out. You've never

Speaker 2

Put a single dime nickel, anything in a slot machine.

Speaker 3

Really? No. Yeah. I mean , no, I don't care this epidemic

Speaker 2

Because over, I want to be there when you put your first nickel and we're going to fly back out to Las Vegas and gamble with you, I think yeah.

Speaker 3

How much effort it took to get the two of you guys to go down to the strip and just how much hemming and hawing you were doing, if you were even going to go down there. So what we

Speaker 2

Did though, didn't we, Susan, we did go down to this

Speaker 4

So much fun . We didn't gamble , but

Speaker 2

Yeah , that's true. We didn't gamble, but maybe the three of us together could get it up, get up enough , courage to gamble. But anyway, so I digress , sorry, Carrie , you were talking in a bedded in there .

Speaker 3

Oh, but the , the strip, no grantor . I haven't gone down there, but I mean, there's the go-go dancers have masks on them,

Speaker 4

So

Speaker 2

They may not have a shirt, but they've got a mask

Speaker 3

On, oh, you better believe it. I mean, you're, you're not going to get COVID through, you know, a nipple or some other posts , but you're sure going to get it through your , uh , your face. And so, yeah, they've got masks on all the casino tables for the table games have plexiglass dividers separating the player from each other and the dealer, the chips all get washed in between. I mean, Vegas kids . Wow. They're not playing around and yet it's still a hotspot .

Speaker 4

Yeah. I think y'all are taking a lot more seriously than most of Texas is . Um, you know, it's, I feel like I live in two worlds. I live in my medical world where everyone, I walk around has a masks and we're all super, super careful and, and everything like that. And then when I go to the grocery store or , um, we go to a restaurant , um, it's, it's like nothing ever happened. I mean, you do see some people out with masks on and , and that type of thing. Um, but it's, it's really interesting because like there , um, we've started opening up some of the amusement parks and , uh, we have season passes to slit her bond , which is the world's greatest waterpark, according to that panel in my own little towns .

Speaker 3

And you're swearing in German, when you say ,

Speaker 4

Um, you know, we haven't, we haven't been yet. They just recently opened. And in a sense, essentially, you you're supposed to wear your mask any time that you're not on a ride. And the , it is over a hundred degrees during the day. Like , there's just like the place itself has lots of redeeming factors, but I'm like, I just can't like rationalize mask on mask off what now I would look like nasty , bad enough, you know, as they are. And um, for our listeners. Cause I always get asked by my patients , um , like how do you wear masks? Like as a doctor all the time. Number one, like when we do surgery, those masks are of a completely different quality than what all of us are having to wear in like , could our normal lives now. Cause I never have any trouble like, you know , breathing during surgery, whereas these inexpensive now, so the cloth masks or whatever you happen to wear, I feel like I'm always like almost sucking the map .

Speaker 2

Me too. Plus though ours is a lot cooler too. So you don't get so hot when you're in the mask in the, or you know, so yeah, it's that , it's not a lot of fun that is for sure. Well, yeah, it's , I , I feel the same way, Susan. I feel like sometimes I'm living in two different worlds when I go out versus at work, but , um, I'm just impressed that the ,

Speaker 3

The two of you are going out. Like I live between my office, the grocery store and my house. I have not been out anywhere else since March .

Speaker 2

Wow. Last weekend was my first four way out into the real world in a restaurant, but it was an outdoor restaurant. So , um , I felt a little more protected in an outdoor restaurant, but it's an interesting world. Well, before we proceed on , um , we're going to talk about our viewer question of the day. And so we had a viewer question , um, and she asked , um, I keep reading about supplements that help with in her case, recurrent pregnancy loss. Is there any truth or proof that Coke , U 10 D H T a and L-arginine help with egg quality, if so, how much is needed? So who wants to start with that question? You can

Speaker 3

Send SARCs like ,

Speaker 2

I'm like, do I have to call on somebody to answer that ?

Speaker 4

Yeah. You know, that the issue is supplements is with any of the supplements, the data is limited. Okay. And there there's so much heterogeneity and differences between all of our patients. It's kind of like when a patient comes in and says, in our particular situation, if I'm doing this treatment, what exactly are my success rates? Unfortunately like the data doesn't work that way. And I tend to use supplements for women , um , not including full of gas and prenatal vitamins and that type of thing. Um, but for , um, diminished ovarian reserve. And I usually use da TA and Kochi 10 in those situations. I think that those are the situations that it has the strongest evidence. Um, now recurrent pregnancy loss, because there's so many different factors. And the fact that you know, of the 50% of people who actually have an identifiable reason for recurrent pregnancy loss, 30% of them have more than one thing going on. I don't tend to recommend those , um, for recurrent pregnancy loss itself. What do you do you carry? So

Speaker 3

I am kind of in a similar boat, I tend to use the same ones that you mentioned more for decreased ovarian reserve for current pregnancy loss or RPL is our shorthand for it. I don't tend to give a whole lot of supplements. Um, oftentimes I'll start people on aspirin after they conceive and progesterone, but those, I mean, those aren't really supplements. They have a supplementary action. The data for

Speaker 2

The over the counter med tells that

Speaker 3

Aspirins over the counter, you don't want to start it before. You can see if , cause it can inhibit ovulation and even then the data is not great for it. And there have been some decent studies that show that it doesn't do any good. And so I am fully aware that I am not in well-proven ground on that one. I think sometimes I give it just as much. So it's , we're doing something . Um, the RPL is hard. I think it's one of the harder diagnoses that we work with on an emotional level too , because it's the, the joy that a lot of our infertility patients have when they see the positive pregnancy test, doesn't come for these patients. They're like, okay, here we go again. Yeah,

Speaker 2

I do similar, I think sometimes, or at least recently I've started using cocuten coenzyme Q 10, a little bit more for recurrent pregnancy loss patients, mainly because, you know, sort of at least the biologic plausibility, nobody really knows, but we think the mechanism of action with cocuten has that it may , um, improve the powerhouse set of the sails and mitochondria may help with cell division. And, you know , there's some data that may suggest that patients with recurrent pregnancy loss may have a little bit higher chance of having , um, aneuploid embryos embryos that don't have the right number of chromosomes. And so, you know, I don't honestly have scientific data to support this, but I figure if coenzyme Q 10 helps with cell division and division of the chromosomes, perhaps that may improve chances. And I kind of figure there's no data to really show it hurts anything. So dose wise, we usually use 600 milligram, 600 milligrams, mainly because the studies that are out there have suggested that that's the correct dose, but we really don't know that either. So I always tell patients probably a little bit is better than, you know , none at all. So if you can't get in 600 milligrams, then, you know, get in what you can. And , um, so, but it's, the data is definitely limited. I think the NIH is trying to fund more studies , um , looking at , at doing randomized prospective studies on women who are using supplements, but the data is just not there. And I think there's some really limited studies that have maybe shown some benefit of some of those, but you have to really be careful because I mean, they are truly very limited studies with really small numbers of women. Some of them may vary in of one of , you know , a group of one or two women. So you really can't make sense of data when you don't have big numbers. So those are my thoughts on any, anything you guys want to add? I think we're good to start talking to our guests today. All right . So without further ado, I would like to introduce our special guest today. Her name's Candice Whelan . Um , she has conceived twins through the use of gestational carrier and she's going to share her experiences with us today. And , um, she happens to also be one of our obvious nurses at Nashville fertility, and we're very, very happy to have her. So Candace to start out, if you don't mind, just tell us a little bit about your experience and give us some insight into what it's like to conceive, what the gestational carrier.

Speaker 5

First of all, thank you for having me. I'm so glad

Speaker 2

You agreed to do it.

Speaker 5

Absolutely didn't have to twist my arm too much. Um, I actually started the process , um, knew I was going to have to start the process about 13 years ago. Um, after I had my son, I had to have a hysterectomy due to a blood clotting disorder and long story short ended up in a divorce. And when I got remarried, my husband had no kids and I knew we were going to ever have kids that we would have to use a gestational carrier.

Speaker 4

How, how did you kind of mentally , uh, cross that bridge from, I don't have a uterus to, I went to have somebody else carry my children.

Speaker 5

I think with me it was easier because of the fact that I had had a towel previously myself. Um, and because I knew for beers , I actually had my hysterectomy in 2006 and I knew that we were going to have to do gestational carrier once I got remarried in 2008. So it was definitely a, I had several years to prepare for it, but I knew I didn't have another choice. So it's a lot easier to cope than being told. When you go into a doctor's appointment that you can't have kids. So I knew that was going to be the outcome. So how did

Speaker 2

You start looking around to find a gestational carrier?

Speaker 5

So the original search started in 2011 and I actually put a message on Facebook asking if anybody had thought about, you know, ever being a gestational carrier. Um, and I'm from a town in Mississippi, so very Southern conservative. And I got a couple of responses back , um, one which was a girl I went to school with and sort of fell through rather quickly. So I realized after that, that I didn't want somebody that I knew, but I also couldn't necessarily afford, you know , $60,000 for an agency fee either. So , uh , uh , actually found my gestational carrier on a website called gestational surrogate fonder.com .

Speaker 4

Tell us a little bit about that.

Speaker 5

So there's , um, I worked as a gestational carrier intended parent nurse coordinator , uh, previously. And so I would always tell my patients and fan that there's three ways to find a carrier through an agency, a sister, a friend, somebody that, you know, already or finding somebody that you don't know. And there's actually several websites that are found for this purpose. Uh , so you go on to almost like a match.com. So you create a profile , uh , sort of telling your story, what you're looking for, what you want , the values, just like the dating profile. Once you're matched , then an email, like a , um , secure email is being sent. So you're not exchanging information or anything to start with. And then you talk through the website and then eventually you can exchange information if you decide to move forward.

Speaker 2

So Candace put on your head as a nurse at IVF nurse, what do you think are the important things for people to ask of their gestational surrogate? Ho how do you, how do you go through all the profiles and figure out which one's the right one for you?

Speaker 5

Um, so when I started that , which was before I ever became an IVF nurse at all, so I was doing all this blindly , uh, I actually had a four page questionnaire. I think it was 110 questions. And

Speaker 2

So , so if everybody made it through the whole questionnaire, they must be pretty interested, right?

Speaker 5

Yes. Uh , so I actually sent it to the girl that ended up being my gestational carrier and she filled it out and then she sort of turned the tables and sent it back to me and said, okay, now I want you to answer them before we actually could look at each others . Um, I think the

Speaker 2

Most interesting

Speaker 5

Yes, that I tell my patients are there. I told my patients previously is the biggest thing is you want to know that they're in it for the right reason, they can't be money motivated. Um, they need to have children of their own, that they have birthed and didn't have any issues with their pregnancies. Uh, you want to make sure you're on the same page when it comes to terminations. Cause you never know what's going to happen. Even with the CZs normal embryo, PGT, normal embryo, you never know what's going to happen. Um, so you wanna make sure that all of those boxes are checked upfront and that you're meeting on the same page with the big things. So the little things were to fall into place.

Speaker 2

So did you meet personally with your , um, gestational surrogate before you guys started working on the contract? Are we in the same state?

Speaker 5

We were not in the same state. I lived in , uh, Memphis, Tennessee at the time. And she lived in Southern Alabama. Uh, we started talking in October the 26th , uh , met her the second week of November. I did, I had not actually completed IVF yet. So I did my IVF , uh, in February. Our contract was done in January and we train , sorry in March the first time,

Speaker 4

What happened with that transfer?

Speaker 5

Uh , she got pregnant and then miscarried at eight weeks and three days.

Speaker 2

Bet . That was a tough, tough one to go through a bit.

Speaker 5

'cause , I'll be honest. I wasn't expecting that. I had had two children previously, which were quite a bit older, obviously this time. And my issue was I didn't have a uterus, so my eggs were good. My husband's done was great. So it was like the doctor did not think we'd have any issues. We had the embryos, they were tested, transferred, got pregnant. Like all of a sudden this is great and then went for an ultrasound and it wasn't. So it was absolutely the hardest thing I have ever went through.

Speaker 2

No .

Speaker 4

How did you and the carrier kind of deal with that loss? Both physically and emotionally?

Speaker 5

Uh , when we found out I'd actually went to an appointment for the ultrasound with her. So we were there together when he found out and as crazy as it seems to look back on it, I was actually comforting her when we found out, because I guess I was trying to beat the shrunk we're at the point and she had never experienced loss and wasn't expecting anything different. It sort of, I think, took her by surprise in the long run. It definitely made us closer than what we ever could've been. Uh , I think if we hadn't have went through it.

Speaker 2

Yeah. I think the times when we've had gestational surrogates at national fertility that have miscarried, it's really, you know, I think because all of them are in it for the right reasons. It's amazing how really sad they are devastated. They are, that it doesn't work. And they almost feel like they've led, you know, the intended parents down because they had a miscarriage. And it sounds like that's the experience that you had to ,

Speaker 5

Yes, my gestational carrier, her name's Heather. And she will tell you to this day that she felt like such a failure because she was trying to do something. She knew we wanted so bad and she wanted to do for us. And then to know that she wasn't able to give that to us at that point. And we had to go through that was almost more than she could handle cause she wasn't expecting it. Um , and like I said, it ended up turning out fantastic. That's why I ended up getting into being obvious nurse to start with. So I'm thankful in hindsight that it actually did happen because I don't think I would have ended up where I'm at now if I hadn't been through that. So how long did it go with that for ? We had [inaudible] two really good quality and one not so great quality embryo. So we ended up the first one, which was the best one didn't fall . Uh, the second one they thought, and a doctor actually advised us to transfer the third one as well, which would have been two in that case we were transferring because it was such a quality embryo. So once that ended, we actually had to start the whole process over again and go back through the IVF part as well. Um, we moved that all happened in may of 2015. We moved to Colorado and December of 2015, my husband got deployed in February , uh, 16. So we had to wait for him to get back from deployment, to be able to start the IVF process again, to go back into it. So we actually had a break from 2015 when she miscarried until 2017, when I went back through for the second round of IVF and transfer ,

Speaker 2

But she still wanted to be your carrier and you still wanted her.

Speaker 5

I could not have imagined going through it with anybody else. And if she would've told me, no, we probably would not have the two kids that we have now.

Speaker 2

So when you went back through you, were you in Colorado then when you went back, sorry , or did you go back through and Memphis

Speaker 5

And my IVF treatment and Memphis, but I was already working in Colorado when I ended up going through the second time.

Speaker 2

Was there anything that you guys talked about the second time around before you started about what happens if this, if the, I mean, were you more nervous about doing it the second time around

Speaker 5

As far as stuff between me and her, all that stuff had been settled in the beginning. So I will say the second time around, I was a lot more reserved and I was on pins and needles the whole entire time, because I realized from my own experience previously, plus all my patients now that I was seeing, coming through and things happening that you just net , there's never a guarantee, but

Speaker 2

That's right. And then you always are nervous when you're pregnant because you just never know that's right. So when did she finally deliver then? When, when, when were your children born and tell us about the delivery and sort of the , since we've heard the sad part, tell us the happy part in the delivery room.

Speaker 5

Uh , so we transferred an April of 2017 as she delivered in December of 2017. And she had a pretty easy pregnancy the whole time. She did get mild preeclampsia toward the end. So she was in the hospital for a couple of weeks leading up to it and we'd actually went down early to stay with her so we could be there. Um, the hospital had never had a surrogate pregnancy before we were nervous, but I will say they did an outstanding job. They had everything. One of our attorneys had all the paperwork ready to go. We had went previously and met with the hospital just so they would be familiar with what was going on. And so I actually had named bands for the baby and me with my name on it, which doesn't always happen in a surrogate delivery. Um, I had induce lactation, so the hospital was very like supportive and making sure that I had a room and a breast pump and oh, wow.

Speaker 2

That's impressive.

Speaker 5

It was fantastic. Like the whole experience was absolutely amazing. Um, she delivered vaginally , um , both babies.

Speaker 2

Wow.

Speaker 5

But , uh, they actually allowed my husband to come back to a viewing window so he could see from the outside so he could still see what was going on and it was perfect. Great .

Speaker 4

And it's so amazing. What words of advice would you give to somebody who was thinking about needing to use a gestational carrier?

Speaker 5

I tell people it's not coming into it expecting to have to use one. I , when they get the news, that the most important thing is to make sure that you're okay with having to use a gestational carrier and that you've accepted that once you get to that point, actually the most important thing is first of all, enjoy, it's a very stressful process. It's a long process. There's no guarantees. You don't have a lot of control. You have to be able to give up control that, you know , you normally have and almost say most obvious patients. We're good with that because they're having to give up some control for no IVF to get pregnant, to start with, but it's definitely, you have to put trust into somebody else. And it's part , meaning don't have to go through it. I think realizing that there can be somebody out there that wants to do something like that, really just because they want to do it. Not because there's an ulterior motive to it. And it's finding somebody that you have that gut feeling about that, you know, is the right person, because it's a big deal. My gestational care and I are best friends to this day. I talked to her about four times a week, still family.

Speaker 2

So Candace tell us for patients that are going through now from a nursing perspective, sort of give us a summary of if you met with somebody for the first time. And they said, okay, what are the steps I have to go through to have a gestational surrogate, kind of the legal stuff and the FDA stuff. Just give us kind of a brief summary of all that stuff.

Speaker 5

The question . So I did all my backwards is I would recommend that patients have embryos to transfer first and they know that they've got something to actually go for. Um , the first step is decide . You want to do an agency. Who's going to do most of your legwork for you. It's gonna be more expensive, but they're definitely going to make sure all the little pieces are put together. And if I have a patient that most of you get by them , you know, themselves and absolutely supportive of that because it's cheaper and it can be done. It can be done flawlessly to do it that way. So it's finding out the way that you want to do it. Um,

Speaker 2

Tell him to tell us about the steps that you have to do.

Speaker 5

So once you find out how you want to find the gestational needs to find one , uh, legal is the second part that's going to come in and that's a big part. They both need their own attorneys. You can't have a joint attorney. And one attorney does have to be in the state where the baby's going to be delivered at , um, also check and make sure that the state is surrogate friendly. Um, the next step is once legal's in place, then it's getting them in to do their workup with their , uh, fertility clinic. Make sure that they're cleared to go and then doing the transfer. I would say the process takes probably six months to a year.

Speaker 2

So they need like blood work and things like that to make sure that everybody's healthy, like HIV and that kind of stuff.

Speaker 5

Well, that depends on the clinic. And I say that because I've noticed from Colorado to even here and from where I did mine, there's a big difference on the requirements. But with anytime you use a third party, there is extra steps with , um, FDA paperwork and stuff that has to be done. So there's a little bit more blood work that has to be done to make sure that the GC and her spouse don't have any, you know , sexually transmitted diseases , uh , is an extensive work at a work up for a gestational carrier to make sure that she's okay to be able to be, you know, gestational carrier.

Speaker 2

And then I know in our state and probably in other states as well , um, a lot of times our gestational surrogates and their intended parents will meet with the attorney a month or so before the baby's about to be born so that they can drop a legal contract. And so that everybody knows who the actual parents are, because otherwise I know in the state of Tennessee, the woman who delivers the baby's name will actually go on the birth certificate, unless there's a legal document to say otherwise us , was that the case with you? Or?

Speaker 5

Yeah . So each state is different. Um, some states do parent drops. So you go in , uh, in the third trimester of you meet with an attorney and they draw up the paperwork it's submitted to the court before you ever deliver. And that saying that at delivery, you and your husband will be on the , uh, together on divorce certificate. Otherwise you do have to adopt a baby per se, from a gestational carrier.

Speaker 2

So it sounds like if you had to sum things up, it sounds like you had a really great experience. Are there any last words of wisdom that you would want to tell our listeners about gestational surrogacy, if they're out there and they're trying to decide if that's something they want to do or not,

Speaker 5

When the baby or babies arrive, it doesn't matter how they got here. They're still yours and you're going to love him just as bad ,

Speaker 2

I guess, make I spent . Aw , how sweet. Well, this was so great to have you today, Candace , I think from your nursing perspective and from your own personal experience, I think you've shed a lot of light on conceiving through gestational surrogacy and , uh , you know, I think many of our patients have had great experiences like your , so I think it's a wonderful thing and we really just appreciate you being in here today. And so to our audience, we're going to say, thanks for listening. Be sure to tune in next week for more and also be sure to subscribe and leave us a review in iTunes. We would really ,

Speaker 3

You can also visit fertility docs, uncensored.com to schedule an appointment with any of us or submit specific questions that you have about infertility. And all the questions will be answered on our podcast anonymously for asset doc segment . So don't hold back the more embarrassing, the better. We'll see you again next week and stay safe and be well take care guys. Bye. Bye [inaudible] .