Figuring Out Fertility

Speaker 1: There's been shame and guilt that if for some reason you couldn't carry a baby or get pregnant, that there's something wrong with you. So I think just the fact that people are becoming more open and feeling more comfortable sharing their story if they want to and if they don't want to, at least they have places to go to read other people's stories for comfort. And eliminating the stigma around fertility issues is a big change that is happening [00:00:30] and has needed to happen for a really long time.

Speaker 2: Welcome back to Until It's Fixed, where we explore new ideas and work underway to make health care simpler and more effective for everyone. I'm your host, Callie Chamberlain.

Speaker 3: And I'm Dr. Kenny Poole.

Speaker 2: So today we're talking about fertility and of course talking about getting pregnant can be a really sensitive topic.

Speaker 3: Fertility is not something that I ever thought about. Mm-hmm. <affirmative>. And then when my wife and I went to try to have our first child, [00:01:00] it was very difficult to the point where we had to go see someone. Mm-hmm. <affirmative> and things ended up working out four times <laugh>. But the thing is, I remember going through that process and the stressful moments of it and feeling somewhat alone, but then I remember later having other people that had gotten married maybe right after us or around the same time as us, so other couples in our age group going through the same thing. Yeah. And again, it was something that nobody had ever talked about until we were [00:01:30] in that position. Totally.

Speaker 2: I feel like fertility is something that is coming into the lexicon a little bit more and people are talking about more openly. To your point, we weren't having these conversations even, you know, a decade ago. Mm-hmm. <affirmative> and I'm thinking about my parents, I'm adopted and they had a very similar situation to what you're just describing. They tried for a really long time to have children and they were telling me about how all of their friends were getting pregnant and how challenging that was for them. Right. Because they really wanted [00:02:00] to conceive and they just couldn't figure out what was going on. So they adopted me and they told my mother that she couldn't have children and then they were in the process of adopting a little boy and she got pregnant with my sister and then they had my younger brother. So it is interesting too, from a Bert doula perspective, cuz a lot of the training that I received talks about the impact of stress and this whole process can be so stressful. I think it'd be challenging not to let that interfere with your daily lives when it's something that you're wanting is to conceive.

Speaker 3: Yep. [00:02:30] Well, let's dive in to learn more. We're lucky to have a great discussion with two guests — Gabriela Marjo from Advisory Board, to talk about fertility from a research standpoint, and Nikki Batiste, a CBS news correspondent, to share her personal story around fertility. Let's listen in. Thank you guys for your time this morning and for a topic that is extremely important that you guys hold dear [00:03:00] as well. So Gabby, we'll start with you. Can you tell us a little bit about your current role and what got you interested in this topic?

Speaker 4: Yeah, so I am a women's health researcher at Advisory Board, which is part of OptumInsight. And at Advisory Board we research topics for lots of different segments of the health care industry. I look at national trends from the women's health space. I've been always interested in women's health. [00:03:30] And what got me into this field was I got my masters of science and public health at Hopkins focused on maternal, perinatal and reproductive health. And during that time I learned a lot about just a lot of the challenges that women face that are not talked about. Mm-hmm <affirmative>, there's just so many issues that women face that are untreated or undiagnosed. There's not enough research, there's a lot of unknowns, there's a lot that we don't talk about and there's a lot of things that could be improved.

Speaker 3: Great. Thanks for that. [00:04:00] Nikki. Can you jump in and then talk a little bit about your journey to becoming a reporter and then how this topic became of interest to you as well?

Speaker 1: Yeah, so I actually started my journalism career as a producer. I was a producer for about 10, 15 years behind the camera and I switched to reporting in front of the camera in 2017. So currently I'm a national correspondent for CBS News, which means I report [00:04:30] for CBS Mornings and CBS Evening News. Sometimes I anchor our digital channel. And this is a topic that never really crossed my mind for really any part of my adult life. And then I faced my own journey within infertility and I was in this unique place where I could talk about it publicly and I decided to do that. Great,

Speaker 3: Thank you for that. So Gabby, I'm gonna go back to you. There's a lot of question marks into [00:05:00] what fertility is. So can you give us a definition?

Speaker 4: Yeah. So I'll give you the CDC definitions. So the CDC divides infertility as a lack of pregnancy at at least a year of unprotected sex. Fertility would be that you would be able to get pregnant after a certain amount of unprotected sex. That would be at least my definition for it.

Speaker 2: Yeah. Can you tell us a little bit more about some of the factors that might affect fertility?

Speaker 4: [00:05:30] There's a lot of different factors. So an important one that I think people talk a lot about is age, both for men and women. And we know that over half of people in the United States experiencing in fertility are over the age of 35. So that is a factor at play. There's also factors of sexually transmitted infections, which can cause infertility for women. There's also endometriosis, uterine fibroids, P C O S. There's a lot of conditions that can hinder [00:06:00] fertility.

Speaker 3: Got it. Gabby, can you talk about how common infertility is?

Speaker 4: Yeah. Um, so based on the data we have now about one in seven U.S. women experience infertility. The WHO says it affects about one in six men and women globally. Okay. So it is pretty common.

Speaker 3: Hmm. It's men and women, correct.

Speaker 4: Yeah. One third of infertility cases are related to male infertility. One third are related [00:06:30] to female infertility and then about a third are completely unknown causes.

Speaker 3: Yeah, that makes sense. Nicki, jumping to you, can you talk about when you started thinking about issues related to fertility and expand on your story?

Speaker 1: Yeah, so I mentioned that I had worked as a producer for many years. I met my husband when I was 32. We got married at 36. At 37, I switched from working behind the camera to in front of the camera. And frankly, I thought to myself, now's not a good time to get pregnant. And so I decided to wait real just [00:07:00] a year or so before we tried. And then I, I got pregnant when I was 38, quickly, easily, but miscarried, there was a chromosomal issue, got pregnant again at 39, had my son at 40 naturally, and in retrospect that was really, really lucky. And I did get pregnant again pretty quickly at 41. But miscarried again, again a chromosomal issue. Mm-hmm. <affirmative>. So my husband and I continued to try. Um, and I turned 42, [00:07:30] I tested my AMH, something I'd never heard of, a test I wasn't aware of. And I had a low AMH, 0.7 at the time, on top of being 42. And I had a huge reality check <affirmative>. So it was pretty gut wrenching.

Speaker 3: Well, thank you for sharing that. And AMH is what's called anti-malaria hormone and essentially like corresponds to a person's egg count.

Speaker 2: Nikki, I wanted to hear what you wish you would've known about fertility.

Speaker 1: [00:08:00] So many things, but I think like logically we sort of know that age is important, but I think, you know, you're not really thinking specifically about the age of your eggs. I do think some people think that just means your body can't carry a baby as a result or they need more complications. I don't think people necessarily clearly understand you're born with a finite number of eggs, you lose them along the way and the ones that you do at hold onto deteriorate basically over time. So I think I wish I had just had a better education [00:08:30] on my body and my ovaries and how it all works and how critical age is. I wish I had gotten tests sooner, and frankly I wish I hadn't delayed it for my career. Yeah. Because it was a big risk that I didn't understand at the time. Yeah.

Speaker 3: So as you were going through this several year span, can you talk a little bit about the emotions that you were feeling, number one, and then number two, where did you go to for support? Because this isn't something that people really talk about until [00:09:00] they're going through it and then you kind of find out that so many people have had issues with fertility, but where do you go when you're in the midst of it?

Speaker 1: Yeah, it's a good question. When I got pregnant initially quickly at 38 and I miscarried, I was upset, but I hadn't had a child yet. So I didn't fully understand the loss, if that makes sense. And I was shocked that I'd gotten pregnant so quickly in the first place. And miscarriage is a topic that so many men and women [00:09:30] experience that also no one really talks about. Mm-hmm. And then got pregnant, had my son, and then when I had my second miscarriage, that was really tough. And because I had a son and I could process the loss more, honestly, I didn't really talk to anyone. I didn't even tell my parents for a long, long time that I'd had a miscarriage and we're quite close. I told maybe two or three friends because I just sort of, my mentality is just to sort of keep it in.

Speaker 1: Then I [00:10:00] just started talking to everybody. I'd be out on shoots with female producers, younger female producers, and I'd be like, guess what's happening <laugh> and lemme tell you about what I'm going through. And in doing that, I met so many women who had gone through it that I was shocked. There's this whole, it was like an underworld, this like secret underworld of men and women who dealt with infertility, fertility loss, the whole gamut. What's wonderful about my job is that I get to cover so many different topics. And so [00:10:30] I end up being sort of like a mini expert in a million things. And one topic I'd never done a story on was fertility. So I just thought, wow, it's just really not covered, at least from my perspective, that much in the media. Mm-hmm. And so I spoke with our executive producer of CBS Mornings and I told her what was going on and I had put together this series, Facing Fertility. So to answer your question, the support came when I finally started talking about it. And after our series aired, [00:11:00] I had at least a thousand private messages from people I didn't know. Mm-hmm. There were so many people that were also feeling isolated and just wanna share their story, ask a question, you know, anything you can think of. Mm-hmm.

Speaker 2: <affirmative>, this conversation is so interesting and I appreciate you sharing your story, Nikki, because I'm 34, so I'm at an age now where a lot of my friends are talking about fertility, talking about wanting to have children. And I trained as a birth doula a couple years ago. [00:11:30] And I felt like I got a real education in my body that I had never received before. It's crazy that no one talks about this stuff. Like, how is it possible that I don't understand a lot of my own anatomy? So it really resonates with what you're saying. And so I'm curious, what are you seeing start to shift that you're feeling really hopeful about

Speaker 1: From just a societal perspective? I think the stigma is slowly fading. There's just always been shame and guilt around it that if for some reason you [00:12:00] couldn't carry a baby or get pregnant, that there's something wrong with you. So I think just the fact that people are becoming more open and feeling more comfortable sharing their story if they want to and if they don't want to, at least they have places to go to read other people's stories for comfort. And I think eliminating the stigma around fertility issues is a big change that is happening and has needed to happen for a really long time. Yeah.

Speaker 2: Mm-hmm. So let's go back to the issue of male infertility that we touched on just a little bit ago, which doesn't get [00:12:30] a lot of attention. I'd love to hear a little bit more about that from both of you because I do think that's something interesting that we're not talking a lot about

Speaker 4: When we're looking at fertility from a research standpoint, the focus is usually on the woman. Mm. So that is just goes to show we need more work done. Mm-hmm. <affirmative>,

Speaker 1: I think that because physically women carry a baby, the burden falls on us. Yep. But I think that men have to realize that it's important to be educated because I think there are a lot of men are just like me. My sperm's great; I have a billion sperm [00:13:00]. Sperms good forever. It's actually not. It declines at a much slower pace than a woman's eggs, in general. But your sperm begins to decline, I think, after about the age of 40, slowly. Mm-hmm <affirmative>. So I think that there's a lack of education on the male side, too.

Speaker 2: So for someone who is thinking about their fertility and wanting to understand where they're at, what are some things that someone should be thinking about?

Speaker 1: A fertility doctor I interviewed suggested women start [00:13:30] to understand if you have any issues that could impact your reproductive health, men can have their sperm checked at any point, as well. So if you go for your annual physical, talk to your ob/gyn and hopefully ob/gyns will talk more to patients about what's available and sort of just educate women and men about reproductive health and thinking ahead.

Speaker 4: Yeah, I think family planning plays a role as well. When you're receiving your well woman visit, if you're a woman during that [00:14:00] time, sometimes they'll ask you if you want to have children and if so, how many children do you wanna have? And things like that. Just thinking about what your personal goals are, your family's goals are. It could also come up with your primary care physician.

Speaker 3: Just like anything, the healthier you are in terms of just general health habits, that increases the likelihood of a better outcome. But at the same time, there's no hard, fast rules and that's what makes something like this extremely difficult. So [00:14:30] thanks for making those recommendations. And what recommendations do you have for someone who is looking for support in this area? For example, if they're struggling or having issues with fertility and they're looking for resources.

Speaker 4: Having a support system. I've done a lot of research where it shows, you know, your family support system plays a big role. And also just seeking behavioral health as well. Like mental health is important and you don't really think about mental health in relation to infertility, but it's very much related. Mm-hmm.

Speaker 2: <affirmative>. Yeah, absolutely. [00:15:00] And Nikki, I wanted to ask you as well, if someone is listening and they know someone who's struggling with their fertility, what is a way for them to show up and support?

Speaker 1: I think just to show up and to ask your friend struggling. You know, do you wanna talk about it? Do you not wanna talk about it? What can I do to help you? I think what we should never do is say it's gonna work out. Cause no one knows. I had a friend who had said, Nick, it might, you have to know with my network, you have gotta hold onto hope [00:15:30] and just be prepared for either outcome. And you know, what can I do with you? I'll come go for a walk with you. Do you wanna go out to dinner? Do you not wanna talk about it? Do you wanna talk about it? And depending on the day, what I felt like. Yeah. And I sort of didn't realize how much it impacted me until after the fact because I was just sort of trying to survive. And it's a rough rollercoaster, but I think just show up for your friend, ask how you can be helpful.

Speaker 2: Thank you. All right, let's move into the lightning round. The first question is, what gives [00:16:00] you hope?

Speaker 1: Well, the experience I just had gives me hope across the board because I had barely any left at the end. I'm currently expecting a daughter in July, so I know, look, I get emotional talking about it cuz it's just my husband and I are incredibly lucky. Really, really lucky.

Speaker 3: Yep.

Speaker 2: Beautiful.

Speaker 1: Having even a tiny bit of hope was critical in waking up every day and getting outta bed and carrying on.

Speaker 4: Hearing Nikki's story that is, is [00:16:30] hopeful. It's just nice to know that there are people who are speaking out about this issue. You know, using your platform, Nikki, to connect with a lot of people is hopeful. And even you guys having this podcast, I've seen more momentum. I've seen more people talk about it. Yeah.

Speaker 2: Who is someone who's inspired you or had the biggest impact on who you are today?

Speaker 4: I've had so many mentors over the years, so I just feel bad calling out one mentor, probably one of my mentors at Hopkins. She'll be your biggest cheerleader, your supporter. And I just love people [00:17:00] like that, that can touch so many lives in the smallest ways. So she comes to mind right now.

Speaker 3: Nikki, what about you?

Speaker 1: I mean, it's probably the most common answer, but really my parents were so wonderful. I had a great childhood and a great life. They taught me to work hard and dream big and be independent, which is largely how I ended up where I am. But I think now today, interestingly, my son inspires me to take a seat, like put the career over here and be present and enjoy the simple moments in life, which is just to be with your family and [00:17:30] love the people you love and live each day. So it's come full circle.

Speaker 2: Awesome. Thank you both so much for joining us.

Speaker 1: Thank you. Thank

Speaker 4: You. Thanks for having me.

Speaker 3: That was a great round table. What I really appreciated was Nikki's openness and transparency as she shared her personal story with us. And then Gabby really brings a unique point of view as a researcher in this space. Yeah. Something I thought was interesting about this and uh, probably worth [00:18:00] exploring a little bit more is that there's a lot of discussion and at least recognition now about the stress and the emotional toll that this takes on women. But I don't think that has been fully explored in men and how they feel. And when you talk about masculinity and concepts of traditional masculinity and what that can do psychologically, emotionally, to a male.

Speaker 2: Totally. I mean, my experience in just observing pregnancy and [00:18:30] childbirth and motherhood is that there's so much shame involved for women specifically as it relates to conceiving and then the way that they parent all the way through. Yeah. And I think having this issue be examined from both sides is really helpful so that it doesn't just feel like it's a woman's issue because it's not. And I don't think we're talking enough about that. And then I think the emotional impact is also not discussed. So like you're sharing, I have a friend who was trying to conceive with his wife [00:19:00] and the amount of emotional distress that it caused him and the shame that he held that he felt like he couldn't share with other people was so heavy. I think that was really isolating and part of what made it feel hard for him is that he felt ashamed. Mm-hmm. <affirmative> and isolated from his community to be able to share his feelings and also potentially look at his own fertility. So I think this is a really important conversation and I really appreciate the expansive way that we're talking about this issue. So thank you so much [00:19:30] for joining this conversation. There's gonna be some additional resources in the show notes, so if that's interesting or helpful to you or your loved ones, please check those out

Speaker 3: Next week weekend, our bonus episode, we'll be talking more about how you can take charge of your fertility. That's it for today. Thanks for listening. Make sure to follow and subscribe wherever you listen so you can get notified when the new episode is live. Catch you next time.