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Speaker 2Hello everyone. This is Dr. Carrie obedient from the fertility center of Las Vegas, welcoming you to another episode of fertility docs. Uncensored. I am joined by my cute cool. And um, oh crap. The other word that always comes to mind is courteous. Courteous, crazy. I'll go with crazy. I mean, both very curious, courteous and curious all kinds of seas . Um, but anyway, I am joined by Dr. Susan Hudson of Texas fertility center and Dr. Abby [inaudible] from Nashville fertility center. Hi everybody. And we are very fortunate to be joined again by Dr. Shannon ho , um, our maternal fetal medicine , uh, guests . So she specializes in high risk pregnancy. She is hailing from Columbus, Ohio. And so Shannon, we are delighted to have you back again.
Speaker 3It's my pleasure.
Speaker 2So we were just rambling on and on about various vacations that , uh, or trips that we have gone on, which that I know we have talked about that multiple times, and it has gotten progressively more challenging with all the crazy COVID stuff going on and surges and this, that, and the other thing. But have you guys gone anywhere recently?
Speaker 3We took a trip up to new Holland, Michigan, which was , um, very, it felt very safe. It felt very , um, fun and outdoorsy. We drove there, took the entire family and , uh , rented a cottage on the lake and had a wonderful time
Speaker 2When it's a new Holland, Michigan, or is it like a cute little town and there good places to like shop and stuff?
Speaker 3Yeah. They have a bit of shopping. They actually have like a real life Dutch village because of the huge Dutch. Oh ,
Speaker 2That's kinda
Speaker 3Cool. So that was really neat. They had, you could like try on the like legit wooden shoes and walk around kind of thing. Um, try some of their more kind of authentic Dutch foods and things like that. And then they're known in particular for their Rory there, which is a new Holland brewery. So that's where their headquarters is at. So if anybody has a chance to stop by with wonderful food , um, delightful beverages and very family friendly, which is always a good thing.
Speaker 2That's cool. That's cool. I remember trying to make a Dutch pancake, a Dutch apple pancake at one point. And it was, it was made in a skillet. Like you put the entire batter in a skillet and Minnesota, they call them Canada coupons . Bless you. There's this restaurant when they come serve it, just like you're talking about it's in the thing. And they come out and they're like panic, panic. It's from my
Speaker 4Man clinic days. And anybody's the middle side of , they're going to know what I'm talking about.
Speaker 5How in the world do you remember that name, Susan,
Speaker 4A reasonable amount of time of panic,
Speaker 5Panic cooking?
Speaker 2Uh, it sounds delicious. Like I remember when I tried to make it, it will go, it would up really, really high. And then you add in whatever apples or whatever fruit you were putting on it. And then the whole thing collapsed down and you had a limited amount of time to eat it before it all really got dense.
Speaker 5So that's in a skillet. You do that
Speaker 4Like a small cast iron skillet,
Speaker 5Which cast on makes me think of a Dutch oven. So maybe there's some version of that in a Dutch oven, you know , like what you cook with on a campfire and stuff. Wonder how that got its name. Maybe that's the kind of cooking you do the Dutch too . I don't know. I don't know.
Speaker 3Yeah. Experience their cuisine and its entirety, but you know, I've met few foods I don't enjoy. So
Speaker 2We're the wooden shoes comfortable cause they don't sound comfortable.
Speaker 3No, they, they are, as you imagined the key to, I guess, where in these is you have to wear multiple pairs of socks. Yeah. So we were up there in the beginning of August. So you could even for like new holiday, it was hot and then putting on all these wool socks. Uh , yeah.
Speaker 4So the kitchen comes from the socks instead of your souls.
Speaker 5Yeah.
Speaker 2I know that sounds like a really uncomfortable place to get a splinter. I
Speaker 3Did not prepare wooden clogs.
Speaker 2Good call plus decision there,
Speaker 4Stick with the surgery sheets , you know,
Speaker 5It's similar. So is it a place that you would recommend that somebody go on vacation? Cause I don't think I've ever been to . I mean, I know I haven't been to vacation in Michigan, so, but I'm sure lake Michigan is really pretty,
Speaker 3It's gorgeous. Um , the lake is beautiful sunrises and sunsets , um, are breathtaking. I didn't realize that there's like so much sand there. Um , cause they also have like this place called forgive me. I may have this wrong sleeping bear dunes. It's further north. Um , but there's these big sand dunes. Um, because that, that area around there is mainly sand. So , um , you could actually experience like the beach, but you're on lake, no cold. Um, I'm kind of a wuss I've been spoiled by, you know, travel down to the Gulf and so forth. So , um, I was not interested in , um, swimming for prolonged periods of time in the lake. Um , but um, the family really enjoyed it and it was real easy and it , and it felt safe.
Speaker 4Another cool place to go. And I think it's a Michigan isn't , um, Mackinaw island.
Speaker 5Oh yeah.
Speaker 2Best fudge ever.
Speaker 4My cousin did his residency, ER, residency in Saginaw and we went and visited one time and we went up to Mackinaw island and it's so cool because like there's no vehicles on the island essentially. And it's all pedestrian type of thing.
Speaker 5It's really pretty buildings up there too . Right.
Speaker 4Beautiful buildings. I mean, it's just one of those like get away places to kind of come down a couple layers of stress level. I mean, it's just it's it was, it was a nice place I'd like to get back there. Yeah .
Speaker 2Again , I just remember those big sand dunes. Like you were talking about Shannon that were, they were incredibly high and you had to go down them in order to get to the water and going down was not the problem coming up. What was the problem? Because every step up you took, you would go back down to . And so in order to actually make any traction and gain any altitude to get back up to the main roadway where like the cars were parked and you could actually like how you got out of there, you had to just run straight up. What , what was this really steep hill, which at age 12 felt totally fine and phenomenal. But I imagine doing that now with a picnic basket or a chair or blankets or towels or whatever. And I'm like, oh, that sounds terrible. How did my parents do that? All right. So let's look at the question of the day. What you got Susan
Speaker 4Question of the day is could you explain options for mosaic embryo disposition? I was recently told that I have two normal embryos and five low mosaic embryos. My nurse said that we will try transferring the normal embryos first, but the mosaics are able to be transferred if we need them. When we're done growing our family, it seems like I'm going to have some embryos leftover. Are there couples who would want to adopt a mosaic embryo knowing that there's a greatest, greater chance of miscarriage? Ooh ,
Speaker 2That's a heavy question. That is so we should probably start out by reviewing what mosaic is. Um, Abby, do you want to take that one?
Speaker 5That's where there may be more than one cell on and the same embryo. And so I usually tell patients weren't when we were doing genetic testing on their embryos, we already know when the embryo is only five days old, kind of what cells are destined to be the placenta and what cells are destined to be the baby. And so we don't want to die . We don't want to take those cells away, but we take the cells from what's , what are destined to be the placenta. And we biopsy those. And sometimes about one to 2% of the time, the cells in the placenta can be different than the cells in the baby. And sometimes when we get ourselves back, some of them can have a certain number of chromosomes and some of them can have a different number of chromosomes and they could be missing a piece of a chromosome that can be missing a whole chromosome or there can be addition of either. And so if we find that there's two different cell lines, we know from data from scientific data, that there's a higher risk of this carriage in those patients or in those, with those embryos, we generally don't recommend transferring those embryos first. Um , our also our kind of fear is we don't know which cells are going to be forming the baby, is that the normal cell on or the abnormal cell line . And it makes us worried that the baby could be born with an abnormal cell number. I mean a chromosome number, and that could lead to complications with the baby. If the baby is live board and makes it through the whole nine months of pregnancy, I'm trying to think of anything else, Carrie , anything I've missed on that?
Speaker 2Well, I think that's the big stuff. I mean, it's, it's just, it's different than a clear abnormal cause . A clear-cut abnormal means that the majority of cells that we biopsy or abnormal mosaic is that just like Abby said, there's a mixed number. Some, some read as normal, but some don't and it's a higher percentage than what we want to see to call it truly normal.
Speaker 4So in our clinic and I think we probably all have different guidelines. I , I, I , I honestly don't know what y'all's guidelines are. Kind of what we do at TFC is we , we break up the decision-making between there's high and low mosaics, which you mentioned that your mosaics were low and that has to do with the percentage of cells that are abnormal. The way we kind of look at it is we know we have better pregnancy rates and less miscarriage rates with low mosaics. I would prefer to transfer a low mosaic.
Speaker 5So a lower number of abnormal sales basically is what you're saying,
Speaker 4Right? But we don't say you can't transfer a high mosaic. We make our decision-making factor based on the actual chromosome that's involved. We have this little chart that essentially has green light, yellow light and red light mosaics in our clinic. We will transfer anything. That's not a red light mosaic with the appropriate counseling and that type of thing. So it really, to the heart of your issue is can you donate a mosaic embryo? And I would say, I think there are potentially couples that might consider a mosaic embryo. Um, there are lots of different systems, at least in the United States for embryo adoption types of processes. And you'll meet to see what, what all is involved. And so I don't think we can, I could give you a hard and fast. Yes, you could do that. Yeah.
Speaker 5My overall feeling is it would, I mean, yes, you could try and donate them, but I don't think a lot of people would probably take those embryos just in my experience. Um , a lot of clinics wouldn't take those embryos because it's less likely for, for couples to choose those embryos in our clinic. We just want to make sure if you decide to transfer an embryo like that, that you have appropriate genetic counseling to prepare you , you know , as best we can for what would happen if you had a lot more baby with some, with that genetic abnormality, with the abnormal cell on .
Speaker 2So Shannon, this is actually a great question to have you on with us for, well , because we're, we're doing all this testing before there is any baby. There you do this testing when you're doing an amniocentesis and CVS
Speaker 5Actually it's called the CVS and your Ram .
Speaker 2When do , how often do you see mosaic results after there's a baby that's in gestation and what do you do
Speaker 3When you see them ? It's not that uncommon. Um, we do tend to pick this up more with the CVS or chorionic villus sampling , um, that can be done in pregnancies. That's one of the forms of genetic testing to kind of figure out what's going on with the baby. And sometimes certain families want to know as soon as possible. And CVS can be done a little bit earlier than some of the other forms of genetic testing, which would be something called an amniocentesis. A lot of times, if we get this mosaic, we have a genetic counseling team, we sat down and we talk with the patient. And just like, you kind of mentioned the green light, yellow light, red light. There's not all mosaicism is created equal. So I think that's the first thing to kind of have that discussion. It also kind of brings into play. Some of the patients may realize they may be a carrier of the said mosaicism theirselves. So that's always interesting and kind of leads to some kind of genetic fact-finding on their end for us to kind of get a better handle on what's going on with the fetus. We will usually recommend an amniocentesis, which we do those a little bit later, closer to , um , 16 weeks and beyond. We like ideally the amnion has to have fused , um, with the uterine wall for us to get that needle in and to collect that fluid that contains the baby's actual skin cells. Um , so a direct form of us testing genetically what's going on with the baby. Um, cause as we said earlier, the different cells for the placenta different cells for baby. Um , so that's how we come to get a handle on that. And unfortunately with kind of some of the rules, boundaries, limitations that's going on in our current state families only have till about 20 weeks to try to decide how they're going to handle this and what they're going to do. And what does this kind of mean for the life of their baby? I practice in the Midwest. So there's not a lot of termination that is happening for the mosaicism, but down the road, it does lead to more growth restriction. We can see more preterm , premature rupture of membranes. We can also just see more preterm delivery, more preeclampsia that kind of crops up in some of these mosaic placentas. Cause they're just, they're not quite right. They've got a couple cell lines going on in there and that can have impacts on the pregnancy as well.
Speaker 4She say, despite those complications, most of the mosaics turn out to be when you actually have baby in hand
Speaker 3Outcomes. Yeah. I would say the vast majority usually do they tend to , to bring home babies. I would say there's probably a slightly higher amount of first trimester miscarriages associated with holes , but it seems like once things kind of set up shop, it tends to go, okay. Um, I'll be at , we do screen for those issues that I described.
Speaker 5Well, and to be clear, I just want to be clear that, you know, the embryos that a patient has that are mosaic, you know, once they implant and grow and then you see them, it's a little bit different than our counseling and saying the likely, I mean, in my experience, it's very rare for mosaic embryo to even implant and get to the point where there's a baby with a heartbeat, but you're saying once they get to that stage and they get to you, then a lot of times the baby does okay. At that point. So they've already, the embryo has already had to go through a lot of hurdles to get to you.
Speaker 2Absolutely. All right. So what we were planning on talking about today is we've done a couple of episodes on COVID and just how, how it looks from an epidemiological perspective, how it looks from
Speaker 4Been , it's been six months since we did this.
Speaker 2Yeah. It's been a while since we looked at it. And so now , um , we are fortunate enough to have somebody with us who is seeing it more on the front lines. I mean the , the three of us REI see it when patients come in with it and then we promptly cancel absolutely everything because we're typically, you're typically at a stage we're like, oh, you're sick. Okay. Well this is not going to work. We're just going to stop. And you let us know when you get better and we move on with it. Well, for Shannon , um , her patients are pregnant and there is no canceling anything. She
Speaker 5Has to deal with them and see them, no matter what.
Speaker 2Yeah. So Shannon what's , what has your experience been? I mean, you, you mentioned that , that you're having, I mean, not you're having, we are all having , um, in all the parts of the country that we're in a surge right now. So what, what are you seeing in your day-to-day life and rounds?
Speaker 3So we, we are seeing a lot of the unvaccinated pregnant women are becoming severely sick with COVID. They are ending up in the hospital, they're in , uh , intubated, the lucky ones make it and get better. But it's a struggle. I mean, one of, from my standpoint, as a maternal fetal medicine doctor right now, if I was looking at any friend or family member who was contemplating pregnancy, the one piece of advice I could give them would be please get your COVID vaccination. It is life saving , not only for you, but also for your baby. We are seeing a huge rise in preterm labor, preterm delivery associated with COVID. This isn't an infection that does cross the placenta. It causes more blood clots or what we call infarctions in the placenta. So it makes the placenta that doesn't work as it should, which causes growth restriction in babies. We are seeing more stillbirth.
Speaker 4I think that was the first thing that I picked up on last year when this all started was I started hearing from all my OB colleagues of stillbirth, stillbirth, stillbirth, I mean silvers or something that, oh my goodness. I can remember in residency, like just horrible. Oh, there really is almost nothing worse. There's a few things that are worse, but almost nothing worse. And we live in a L in a world where at least in the United States, we shouldn't see many and it's, it's heartbreaking.
Speaker 5And I think a year ago, you know, we were, we were taught, we , I remember I was talking about it, but I think back then, there wasn't a true link for sure, between COVID and stillbirth . But what you're saying now is there is so we can tell our patients, there is a true link between COVID and stillborn babies, preterm delivery, placental insufficiency,
Speaker 3Poor growth, growth restrict
Speaker 4More preeclampsia, you think?
Speaker 3Yes. And it seems to be , um, a much more kind of , um , rapid onset and severe preeclampsia. Again, we think that goes back to this infection, definitely infects the placenta. It impacts placental function. Not placenta is really the go-between between mom and baby. And when you damage that link, it has far reaching implications. And you know, when this happens, if you're lucky, you're in the hospital, in the ICU, and unfortunately you meet me and it gets to a point that finally, you're so sick that we say we have to deliver you. Then you're looking at having a baby that's born premature and then has to go to the NICU and then also has to fight this infection. So to anybody who's going to be dealing with their prima , you know, that's the last thing in the world you want these babies to deal with is anything on top of, of the prematurity that they're having. Thankfully we know when moms get back sedated , you share your immune system with your baby . So when we are testing this cord blood, we are seeing that these babies are getting an antibody. So they're getting protection against this disease. That's
Speaker 5Fabulous. That is fabulous.
Speaker 4If somebody gets vaccinated before they're pregnant or they still sharing their antibodies with mom, or is it only when vaccination happens during pregnancy, that's something I wasn't completely clear on.
Speaker 3You have been vaccinated over this past year and we've been checking your , um , antibodies. We have been picking up antibodies. Now we're still in this game and we're talking to one of the bigger public health pitchers is , you know, should we do a booster shot to those are that are eight to nine months out. And that very well may become a thing, but , but we are eating and still able to pick up some of those antibodies. So I know it's scary being pregnant, but I think it's even scarier. Once you have a newborn and a small child,
Speaker 4We all have so many questions.
Speaker 5Let me ask one quick question about antibodies. What about breast milk for breastfeeding moms? Does, does the antibody go through the breast milk?
Speaker 3Yeah, we are picking it up in breast milk. Um, so that's a definite , I've had some , um, of my mom's who have like specifically like, you know, in one pregnancy they like pump like crazy when they were vaccinated and kind of stored up some of this breast milk. And they're now giving it to their kiddos. They're not having to go to like preschool or having a second baby. And they kinda got their like COVID stash.
Speaker 2That's brilliant. Yeah. I didn't
Speaker 3Have that . That's awesome. Yeah. So, you know, if you were to ask me hands down, what is, what is the number one thing right now that you would ask of a pregnant woman? I would say, please get your vaccination because you're not only impacting your own life, you're impacting the life of your baby. And we just don't know. Long-term what it means to these kiddos that experienced this infection in utero. We know that there's a certain subset of adults who, when they experiences infection, they become what we call long haulers, meaning they have cardio and pulmonary mean and heart and lung issues that are still chronic and going on and they never bounced back. And so we don't know what that means for that developing fetus to get that infection in utero .
Speaker 2Yeah , that can be scary. So the million dollar question that I feel like I am facing more and more is I tell people like, if you don't get vaccinated and you do get COVID and you do get pregnant, there's this really long laundry list of problems that can happen. But the next thing that they ask is, well, what happens to the baby? If I do get the vaccine and , and I can answer some of the fertility questions, at least based on the information we know, we don't think it impacts your fertility at all, but you're in the best position to see this. Cause you take care of the really sick ones and you get called in all the complications, complicated cases. And I remember when we were recording the last episode, you were like, you're referring to, I think twins. And you're like, oh yeah, we don't really bat an eye about that. As I was thinking high bat , all my eyes about that. And so are you getting called in with a higher frequency on women who have been vaccinated and then are subsequently getting complications in other areas that are affecting their babies?
Speaker 3No, hands down, the people that I have in my ICU right now did not get vaccinated.
Speaker 2And any other complications, like, are you seeing more incidences of babies with three eyes, two heads and a tail?
Speaker 3No. You know the technology of this vaccine, it has been around for awhile the last time. Um, I worked on SMFM. I think we have data now on 140,000 vaccinated moms, none of them had any complications that was related to the vaccine, the vaccine, small amount of liquid. It basically goes in your arm. It primes up the maternal immune system to recognize I real specific part of this virus is called the spike protein. And so there is no live virus in this. So it cannot give you COVID. If you get a COVID vaccination in pregnancy, the vaccine is readily absorbed. It basically tells your immune system, Hey friend, this doesn't belong here. So then if you this unsavory friend, your body's like, no, no, no, not today, devil. We're not going to do that. And it's already got a jump on it and it goes after this,
Speaker 5I think you and Shannon are related. That sounds exactly like something. You'd say, Hey friend, you're unsavory. Get out of here. Sorry, Shannon. I didn't mean to interrupt you, but you got sound like you're identical twins. I think
Speaker 4There's a reason we've been friends since like day one.
Speaker 3It does not. This vaccine doesn't cross the placenta and attack the baby. It doesn't cause any increase in miscarriage. It can only help. And we're still collecting data, you know, for, in my world. One of the high risk conditions that we deal with a lot is something and auto immune disease called lupus. And we are finding in some of these moms who are infected with COVID, they actually make a lupus anticoagulant, which does attack the placenta. It does attack baby. You know, anyone who kind of is in my realm, you say lupus, we all kind of set up a little straighter. There's a lot more pregnancy complications with that. So we think that may be driving some of this miscarriage rate, some of the placental abruption, and we call it thrombosis or blood clots that were seen in the placenta. So if you could do anything to avoid this infection, you want to do that. And especially with this Delta variant , it's really hitting moms a lot harder. Cause I know myself and my colleagues included when this whole pandemic first started, we really didn't know what was happening with pregnant women because we didn't have a lot of data. So we were like, maybe we're going to get lucky, dodged a bullet. And maybe this , this type of respiratory disease is not gonna really hit our moms super hard. But as it's kind of evolved , we're really seeing an intense ahead of attack on the maternal lungs from this particular variant of this virus. And the good news is our , our vaccines work , the Moderna , um , vaccine Pfizer vaccine, I mean even Johnson and Johnson. I basically tell my patients whatever you could get your hands on, take it that will help you and protect you.
Speaker 4So I have two questions. One, if somebody has the choice between an MRI and a base vaccine or Johnson, Johnson, do you have a professional preference? And my second question is if somebody gets COVID, are we seeing a difference between first, second and third trimester exposures? Because we all know we have lots of viruses that if you get exposed at a certain point, you're kind of okay, but if you're at other points, you're not. So those are my two questions.
Speaker 3Yes. So I would say ideally I would probably go with a Madonna or Pfizer. Um, there's just overall , um, better data on those that being said, if it was no vaccination or Johnson and Johnson get Johnson and Johnson. So that's why I kind of tell my mom's like what you could get your hands on. Then the next part of the question. So from the standpoint of looking at the placental pathology and stillbirth, it doesn't seem to really matter what trimester our first trimester moms are still seeing. We're seeing the burden of this and the placenta, especially those that had kind of the natural course of the infection. And just kind of went through that and dealt with that. Third trimester is unique to the changes in the maternal body. Your , your rib cage has expanded by up to three centimeters. You have this big uterus is now pressing up on the muscle that helps you breathe called the diaphragm and it just can't work as it should. And this virus very characteristically will make moms breathe super, super fast. So we're talking like 60 times a minute. So our normal respiratory rate is 12 to 20. I don't even think I can make myself breathe 60 times a minute. And you know, we, you struggle to get the right amount of oxygen, not only to mom, but also to baby, because we know that babies need it , an oxygen nation on the maternal unit of 95% or better, that is optimum for those growing tissues and that fetus to stay oxygenated. And that's what really becomes the hurdle in that third trimester is we can't keep the oxygen up and we can try to do things like the high flow nasal cannular. We really try to avoid intubation. One of the big things with COVID is the Cronin , which means if you flip it over kind of like a pancake and put you on your belly that lets your lungs actually work better, but can't do
Speaker 5That in pregnancy
Speaker 3Uterus. That's like, you know, 30 weeks, 35 weeks, you just can't do that. And so that's when we're having to step in and deliver these babies early to keep , um, keep mom on the mend. And sometimes despite our best efforts, I mean, we're, we're losing moms, unfortunately. Yeah .
Speaker 5So I have a question kind of related to that if the patient's listening and they say, gosh, I just had COVID last month. Maybe I should wait three or four months before I get pregnant, just to make sure that all the bad humors are not hanging out in my system. Is there any data, do you guys have any recommendation for, if somebody wants to conceive, should they wait for a certain period of time or are in , in , in our case to , should we wait to transfer an embryo until somebody has been COVID free for three or four months to avoid these complications?
Speaker 3If you have the luxury of time on your side, I don't think that's a bad idea because there are these different acute phase reactants that are getting generated by the immune system when it's kind of trying to deal with this infection from a maternal fetal medicine standpoint, you know, th this is a pretty severe infection. And I think you should probably add to your point, give yourself a three to four month grace period to kind of get the evil humors out and get everything optimized because the maternal physiology changes so much in pregnancy. We ask a lot of our bodies to carry these babies. It's it's work. It's hard. It's the most dangerous thing we do. And you know, like the culmination of this is a process called labor. It's called labor for a reason for it's not. Okay. So , um, anytime that you can, you know, come into this and you, you you're, you know, geared up and optimize , that's always going to be better outcomes for your baby. Most recent data that's coming out of the journal of morbidity and mortality. It looks like patients who have had a native, like, you know, they got COVID, they didn't get vaccinated following them over this past year and looking to see, do you get COVID again? And having had a COVID infection increases your likelihood by about fourfold of getting COVID again. Wow.
Speaker 5I know that that doesn't make sense. You would think that you would have some natural immunity now after getting it once, or maybe the virus knows its way in your body. Maybe it's maybe you've got some specials , genocide qual that the virus lives .
Speaker 3Exactly. So, you know, I talk with my patients about that as well. You know, when I have people say , well, I ha I've already had the infection , so it doesn't matter. Um, you're , you're going to be at risk for getting it again. I would still recommend getting vaccinated. Even if you, you know, you felt like you had COVID back in November, you know, and you're looking at pregnancy, I would get vaccinated. I also talk to my patients about having close contacts around the baby vaccinated, kind of to, this is the curious husband's , uh, field , uh, here in the classic world. I mean, you really don't want people around your newborn that have been unvaccinated . So I kind of give dads homework to and explain to them that they should get vaccinated because they're a close contact with mom and whatever job they do, or, you know, whatever social circles they're running in their midst for bringing this home to mom. Cause I've had bombs , who've done everything right. And tried to protect themselves in a bubble, but you know, their husband went out and was exposed and then brought it back.
Speaker 5Another question, I think all of us have gotten. And I think I know what you'll say, but I'm just curious to hear what, what your thoughts are with the vaccine. I saw three people last week that said, oh, so you really think I should get the vaccine? And I'm like, yes, you need to get the vaccine. And then the next question is, well, should I wait till after the first trimester? Or should I get it with , you know , in some patients it's like, should I get it now when I'm not pregnant or if I'm pregnant Nash and I'll wait until after the first trimester, is there a better time or is now a great time? That's what I keep telling. Get it now,
Speaker 3If not before. Yes, it's a great time. The one thing, if you just grabbed me off the street and was like, Hey, what can I do right now to have a good pregnancy outcome? I always say, get yourself vaccinated. This is a very low hanging fruit. We know the vaccine works. We have some of the best data on this vaccine. I mean, we normally don't have outcomes for about 140,000 pregnancies to base any of our advice on, we kind of work in the field of smoking.
Speaker 4I mean, realistically information about the vaccine at this point is the biggest study of the human race. Yeah , absolutely .
Speaker 3Yes. And you know, you're, you're protecting your baby. You're, you're giving them a leg up because like I said, you know, I'm dealing with children who are my own children are not of an age that I could get them vaccinated and that's scary because they still have to go to school and do things like that. And again, our , our game is I want moms to be happy and healthy. I want them to have happy, healthy babies. And I mean, COVID is here to stay. Um, it is not going away anytime soon. And the fact of the matter is we're in a pandemic. So, you know, I still recommend all the things, all the hand-washing wearing a mask , um, and getting vaccinated and that's going to protect you and your baby. I mean, this is so rarely do we get an opportunity where we can vaccinate two people at one time. It's really an amazing thing to my moms who are doing it in the third trimester. You know , that's typically when we will give the , what's called the teed up, but 10 minutes and a cellular for testis , ideally with the COVID vaccine, you should not have had any other vaccines for two weeks. Um, so I do have some questions with some of my moms in the third trimester who are like, well, it should, which one should I do? I want them to do both, but I would say, go ahead and grab that COVID and get started on the COVID.
Speaker 4And now that we're heading into flu season, if somebody is thinking, cause I'm sitting here going, I need to get my flu vaccine. It's almost September, but I'm also hoping to get my six month booster. And I'm hoping to get my six month visit or about September 23rd is when I have my appointment. Hopefully you already have an appointment. I'm impressed . Well, I made an appointment with the assumption that by that time it's going to be approved. That's a great idea. I'm going to do that. That is a good idea. I'm a planner. So is it one of those situations where like I should, if I'm wanting to do that, like plan to get my flu vaccine, like as soon as possible, or would you put off your flu vaccine? It's not one of those where rubella and varicella, you can get them both at the same time. Right? So ,
Speaker 3So as of right now on the first set of vaccinations, one of the questions that they ask and is necessary is that you've not had any other vaccinations in the prior two weeks. So yeah, I would try to go ahead and get that. Then I'm a big believer in the flu vaccination as well in my pregnant patients . So to me, there's no wrong time to get this vaccine. Um, anytime you can get it, I think is ideal. Now we don't have any guidelines. As of right now about the booster. I don't know if it's going to be different for our moms. Who've already, like, let's say been through this vaccination series and it's now coming on nine, 10 months and they want to get a booster. I don't have data on that. I can't speak to that. I don't know if they're going to put that kind of, you know , no vaccines two weeks prior, hold on that. Cause I know one of my partners was pregnant and delivered this past March and she was really bummed out because she had gotten her T death and then went to get her COVID vaccine. And it was a week later and she had to kind of get pushed down the queue a little bit to get that because they did want a two week period without any other vaccination. I don't know if some of that was just because they didn't want to kind of cloud the picture. If somebody was complaining of any type of symptoms, they just wanted it to be straight. You've just had your, your COVID vaccine only. Um, but you know, if any of your patients are listening and have questions, any, any MFM or REI and we can help you kind of sort out this vaccination schedule, you can make that happen because I know, you know, a lot of people who are listening to this podcast are kind of dealing with infertility and walk in that journey. And you know, again, I would say that's one of the most important things to make sure your cycle doesn't get canceled or anything like that. You don't want to bring this infection in an infect , people who are dealing with your embryos and things like that. So definitely get it. It's not going to hurt anything from a fetal standpoint. It does become interesting in our moms who are super sick and end up hospitalized with this particular disease process. And then they recover and we're putting some of them on aspirin and a blood thinner called Lovenox to try to treat some of these potential complications of some of these blood clots and things like that in the placenta. We're recommending some antepartum testing because we are seeing this impact fetuses and you know, the big thing we just, we want to avoid stillbirth. We don't want anybody to lose their baby over something that's so preventable.
Speaker 2Thank you so much for , um, for sitting with us and talking with us, Shannon. It is a delight to see you and talk with you and hang with you. And, and so it is just a place
Speaker 3Not honor was mine. Thank you guys for having me. It's always fun to hang out with you guys
Speaker 5To our audience. Thanks for listening and tune in next week. For more also be sure to subscribe and leave a review, not tunes we'd really ,
Speaker 4You can also visit fertility docs and sensor.com to schedule an appointment with any of us to submit specific questions you have about infertility. All questions will be answered on the podcast anonymously that he asked for that segment. So don't hold back. We love to hear from you next week.