Speaker 1: Welcome back to another bonus episode of Until It's Fixed. I'm Callie Chamberlain.
Speaker 2: And I'm Dr. Kenny Poole.
Speaker 1: As we cover ways to make health care work better for everyone, these bonus episodes will draw connections between the topic we recently discussed and our daily lives.
Speaker 2: We'll talk about one thing you and I can do today related to that topic, to take charge of our health and well-being. In our previous episode, we really tried to demystify fertility. We spoke with [00:00:30] Gabriela Marjo from Advisory Board to talk about fertility from a research standpoint, and Nikki Batiste to share her personal story around fertility.
Speaker 1: Yeah, that's right. It was really helpful to hear how the research is informing the field, and then also someone who's directly impacted by that, which has been sort of a running theme. And for today's bonus episode, whether you're trying to get pregnant right now or thinking about children in the future, one thing today is how to optimize your fertility, and we're gonna get into that in a second. So to help us learn [00:01:00] more about taking charge of your reproductive health and optimizing fertility, we spoke to Dr. Lisa Saul. Dr. Saul is the National Medical Director of Maternal Child Health at UnitedHealthcare. Thank you so much for joining us as a leader who aims to improve women's health and maternal health. Dr. Saul, we're just curious to hear from you what you see being done to improve education about fertility and health support prior to pregnancy and preconception.
Speaker 3: [00:01:30] So I think what we're seeing that's different now, even as opposed to 20 years ago when I started practicing, is there is more of an interest in educating people about their health, particularly about their reproductive health. And it's been really nice to see that we're getting away from addressing problems as they arise and truly looking at prevention [00:02:00] and in the maternity space and in the fertility space. Those are two areas where that's of utmost importance. And it's interesting because typically this is a group of people who tend to be younger, tend to be healthier, and aren't engaging with health care often for the first time in a really meaningful way. And so what I'm finding is that the push towards helping people to prepare for pregnancy [00:02:30] has exposed in many ways fertility opportunities as people are planning to become pregnant and realizing that there are things that they could be doing to increase their chances and optimize fertility. So for example, as we think about preventative medicine, preventative care, regular visits with a health care provider, where certain health issues can be identified as it relates to [00:03:00] fertility, whether that is genetic issues and family history, whether it's anatomic issues or whether it really is issues pertaining to the couple attempting to conceive. Those are really interesting and meaningful ways to educate people about what it takes to get pregnant and what some of the barriers might be. And then that just feeds very naturally into the maternity process, too.
Speaker 2: I like what you said about [00:03:30] how we're seeing a lot of people take control of their reproductive health early on, you know, and that's a good thing. And that kind of goes with people being a little bit more engaged with health as they are more nowadays. And also health care being a little bit more consumer-centric. Mm-hmm. <affirmative>, here's my question though. When people have questions, where should they go? Because there's a lot of misconceptions and if you could speak to both men and women, that'd be great.
Speaker 3: Well, I think that's a really [00:04:00] interesting question and one that also has evolved over time. One of the things that we know is that the average age of first pregnancy has increased by about two and a half years over the last 20 years. So we're seeing people who are skewing older, more advanced in their careers, coming into it with a little more education, and then we can't forget the social media right. Influences on everything. And so in my practice life, we were getting a lot of these questions [00:04:30] and concerns about, I just want the head to toe body scan in every lab you can think of in preparation for pregnancy. But I think really it is a good idea to start with a primary care physician, whether it's a family medicine physician, your ob gyn, and begin to have a conversation. So the initial evaluation doesn't start with labs, it doesn't start with ultrasounds, [00:05:00] it doesn't start with x-rays or CT scans, but really just a conversation about what your plans are.
Speaker 3: Digging pretty deeply into family history, I continue to be astounded by how little families are talking about their own history related to pregnancy and childbirth. And there's a lot that can be uncovered there. And it's really just getting the basics down of how is your glucose, are you [00:05:30] pre-diabetic or diabetic? How is your blood pressure? What's your B m I? Those are three pretty key things that can definitely influence the ability to conceive and to carry a baby and then to decrease the risk in the pregnancy. But it's also even as simple as what's your menstrual cycle? Do you know? Are you keeping track of when your periods are, if they're regular, how regular? How many days apart are your cycles? [00:06:00] It's really fundamentals and basic biology that I think we have to start with before we go through a fleet of labs and x-rays and ultrasounds and things like that. It really is starting at the beginning.
Speaker 1: That makes sense. And what about for men?
Speaker 3: Well, for men it's a new day. I think <laugh>, and I say that because I recently had a conversation with my 13-year-old daughter [00:06:30] who is very forward thinking. I call her my What's next kid? Because she's always thinking about, well, what's gonna happen 10 years from now, 15 years from now? And she was very concerned about, well, what happens if I'm not able to have children? And we started to have this whole conversation about A, why are you worried about that right now? Hmm. And B, what are you thinking about along those lines? And it really came down to it her wondering, [00:07:00] would it be her fault? Wow, if she wasn't able to have children. And I thought that that was really interesting in this day and age where girls are growing up in an era of more equity, I think, than I grew up with.
Speaker 3: And yet this was something that she was really personalizing. All that being said, I think we have come a longer way in the last several decades towards understanding that this is really an issue of two people coming together to create [00:07:30] a life. And that men have a responsibility and they are very interested in understanding what their role to play is in this. And so it's important to remember that we're looking at both of the individuals who are trying to conceive and not leaving the evaluation of the man till the end. And so if there is an issue with fertility and an issue with difficulty conceiving, it really is imperative. As I mentioned before, we're looking at [00:08:00] many things, family history, the health of the two individuals. Anatomy is important. And so with that, we have to look at the sperm count, we need to look at diet and exercise and obesity.
Speaker 3: Mm-hmm. Age, paternal age is something that, you know, people tend to joke that someone who's 75 years old will father child. There are issues with how sperm is, how healthy sperm is. And so those [00:08:30] are things that a primary care doctor can start, in terms of the general history and physical, as we talked about when we talked about women. But looking at the analysis of semen is something that a primary care doctor can do. And then if there are issues in any of those areas, then they can also be referred to either a reproductive endocrinology specialist or a urologist if there are male issues that could be contributing to [00:09:00] difficulties conceiving. Yeah.
Speaker 1: Got it. That makes sense. That's super helpful cuz it sounds like the foundation is kind of the same regardless of what your gender is, so that makes sense. I'm curious, you mentioned family history. Can you just share a little bit more about how that might impact someone's fertility?
Speaker 3: Sure. Well, we talked a little bit about some of the medical complications in life that then can impact pregnancy. Diabetes. One high blood pressure [00:09:30] is another. Any autoimmune illnesses like lupus, these are factors that can impact blood flow to the organs that need to be functioning properly in order to move an egg in a sperm together to implant properly. They are also factors that can increase the risk of miscarriage. So those are things to be aware of. But oftentimes too, when people have had a family [00:10:00] history of miscarriage or stillbirth, it tends to be something that's not really talked about. Mm-hmm. <affirmative> because there's a grief process that a family is going through. And depending on cultural issues and other factors, oftentimes it's not discussed. And I've been really surprised by the number of the patients that I've taken care of in the past who only know and find out about an extensive family history of significant [00:10:30] complications. Mm-hmm. <affirmative> once it's happening to them or has happened to them. And so I think because there are certain disorders that run in families that can absolutely impact not only the ability to conceive, but to carry a pregnancy to term. I think it's just a really important thing to open up these conversations. Yeah. Just to inquire about are there anything [00:11:00] that we should know? It doesn't always mean something, but it can be really helpful for the provider that's caring for you to have that information.
Speaker 1: Yeah, that makes sense. And as we discussed this season, there's a lot that goes into what makes you healthy and for those who are looking to get pregnant, things like age, family history, lifestyle factors and general health can all play a big part. Thank you so much,Dr. Saul, for joining us. This was so helpful.
Speaker 3: Yeah, of course.
Speaker 2: Thanks for listening. [00:11:30] Join us next week for our season finale where we'll share our favorite moments, biggest takeaways and what we learn from each other.
Speaker 1: Make sure to follow or subscribe wherever you listen so you can get notified when a new episode is live. Catch you next time.