Lady Lessons: Fertility
Well this welcome to the lady gang to sit at again. Things are about to change around here each week. We catch up with Hollywood's hottest girl. Posse kilty night Becca Tobin. Jack Vanik. Hello Hello Hello, everyone was so weird. It's usually doing matt welcome to the Lady Gang and welcome to a very special episode of the show this summer we've teamed up with Vince Komodo to present lady lessons a five part series here, Unladen Gang, so after wrote our book. We realize there were other topics in our lady life that we wanted to do. A deeper dive into the upcoming curriculum includes conversations about fertility finances, race, career and And Mental. Health Vince Komodo is the perfect partner for US based on their brand values of empowerment, passion, integrity, loyalty, and self expression things that we see every day with you, Our lady game, community and speaking of community, the topics and questions you here in the series will be community sourced, and we can't wait to hear what you think without further ado on behalf of Vince, Komodo we present this week's lady. Lessen The lady gay. Our guest today is the fertility specialist. We've all been waiting for. And although we've been labelled as unrelatable by TV, viewers for not being MOM's. It may be today that you find out. Some of us are actually trying. What if my eggs are really cooked as I mentioned in the book act like a lady. This is here to tell us an answer. All of our egg excessive ha question. Board Certified OB G A reproductive endocrine geologist. I'm saying that criminologist. He's been published internationally not to mention. He has a whole lot of awards, honors and recognition while being fluent in French. Spanish. Kosta and Farsi Edano that one and two more right. Yes, okay, WHOA! What's better than us? Technology Technique with IVF egg donation and surrogacy that have patients traveling from around the world to see him at the San Diego fertility. Centre please welcome to the lady. Gang Dr Donna -ment. Thank you so much guilty. Thank A. Vitamin on your show, and it's a pleasure to connect with all of your listeners. So before we Kinda, get into it. I know that what you do is something that you probably get. A lot of people are ages thirty S. you know thirtyish, Twenty Six, twenty seven yes. Yes, exactly right and and They come to because you know they've spent their entire lives trying not to get pregnant right and being so scared everytime there period was laid, and then you wake up in your thirties, and especially in our generation where career woman we have things going on, and we wait until later in our thirties to even think about a family, and then it's almost too late, and then it's hard, and so, what is the the time that you wish? All women and men went and got tested their fertility tested If they WANNA, have candy. Issue is that men continue produce firm into their. Their forties and fifties and sixties does equality of sperm decrease overtime. Yes, that's it. It affected by smoking and other potential habits excessive drinking. Yes, but they still continues to produce firm s from production doesn't end. Women have a finite period of time when the eggs or healthy and good quality and Bible so we want women to start testing their fertility at twenty seven years of age. Why is that all women are born with all the as you're going to have throughout their lifetime, it's a million of earth time. They reached puberty. There I fear. It is down about four hundred thousand. The first significant decline in the quality of the eggs occurs twenty seven years of age now most women have good quality x when he eight twenty nine thirty, but that's when the curve starts making a dip. Dip becomes more significant after thirty two, an even more significant after thirty five, so if I think women are empowered to tell their obgyn's after twenty seven. Why don't you just do one blood blood tests on me? Which is all? It takes one blood test a day or two after my period so that I am assured that I still have good quality viable eggs, my ovaries. Just like a PAP smear that patients do. Once every couple of years. Why not just learn about your egg reserve? Because in twenty one years of my practice, I have seen twenty eight struggle with fertility because of equality three-year-olds 35-year-old's forty year olds. It happens it just the percentage of twenty-eight-year-old they're going to struggle is much smaller than the percentage of thirty eight year olds. So why not sort of take the the your reproductive-health into your own hands, and and empower yourselves and just get a blood test in? If at least you know your options, even if you're thinking while, I don't WanNa to have children now. There are other options available to patients. You know, egg, freezing, option, or at least you just know you're empowered by by the knowledge that Okay I. Don't have to worry about that aspect and I can tell you that most doctors will not tell you that. I was telling Becca the other day. Had A patient right now struggling with idea because she's run out of Good Quality X. And two and a half years ago, she went her Obgyn and she was thirty seven years of age, and and she already was showing signs of decrease ovarian reserve meaning that she was having trouble. Conceiving and hormone levels were out of range, and her Obgyn said to her you know. Why don't you try another year year and a half, and if it doesn't work Benghazi until Dr will by the time, she came to see it for doctor. She no longer has any. Viable eggs in her ovaries, and so the only. Avenue, that's open. Tour is using donor eggs. while. I have a lot of girlfriends who who have asked their doctors. Since my journey started with the F. I've told them what you've told me and a lot of them have gone to the Obgyn and have received the exact same feedback where they're kind of brushed aside and told. Not to worry so I guess it's. Can you demand that I mean obviously our bodies. Okay obsolete. It's. It's like saying you know I was. Know I had a fall in, can you? Can you get me a tetanus vaccine or you know? Absolutely it's it's it's. It's not a particularly expensive hormone tests it's it's very easy test to get, and you can even don't have to rely on the interpretation of of of your Obgyn to potentially you take action. Don't take no for an answer. Don't say, don't take the that sort of the classic answer which I've heard now for over twenty years. Is All your Yang? What do you have to worry about it now? Don't worry about you. Don't worry about that until you're thirty eight and forty years of age will. Will by the way by forty years of age, fifty percent of women have run out of quality. Choose well, and is this a different thing? Then so I was at my obviously, this is a different thing, but I was at my gynecologist recently to get a pap smear, and during when she's doing it, she was like. Oh looks like you have so many eggs, and so for me that like give me a peace of mind. I'm going to freeze my eggs year, but that gave me a peace of mind around like Oh, I'll probably be fine, so am i. not find and why. What's the benefit for for? GotTa call just to say that or to do that. When if if it's not so it could be. They looked at the ultrasound and they found lots of these immature cysts, which are essentially each egg develops and assists every month, so magin your ovaries have all these little cysts. Every month if you're not on a birth control pill, and what happens is one of those sis rose, and becomes a large assists, and then oscillates. It's basically desists. Person releases the egg, so could that during the ultrasound? They looked at your ovaries found. These multiple says that it looks like you have lots of eggs in the overs, but that's just one aspect of the egg reserve. One. Aspect is the number of eggs you have, but the other aspect is the quality of the eggs. We have different group of patients who have an adequate supply of eggs, but the percentage of good quality is significantly. Situation when I went to go I got the blood test. This is years ago, but I was like. I'm so young. I'm so fresh. Feel twenty five. And she was like well. Let me just tested. Are You thinking about trying? And then she was like you're i. can't remember exactly what the mechanism of you know. Whatever was, but she was like. You're a one percenter. Something like your at Bat. They're like if she basically was like. If you want to have a baby, you've got to have baby now like we're not good. It was so emotional motion all because you're like it's your womanhood. It's your you've spent your whole life trying not to get pregnant. And then you know in addition to a few grey hairs. You're all of a sudden. Your body is like your old. It's just so emotional. Really is. It really is an and I think that the the issue is, and that's why the importance of sort of empowering yourself and saying well. You know what I'm Gonna I'M GONNA start this testing early, but frankly I. Think that one percents you can't really. Delineate exactly the percentage. Yeah, but but if somebody also tells you, you got to have a baby now. No, you can freeze your eggs harder. You can embryos, or if you already to children, you can have children, but it's not like you. The technology is advanced enough now that women have many options if they want to preserve their fragility and say that we're. Like seven years older than twenty seven and we haven't done the blood test. Are we screwed or is there hope there is definitely hope in other words, the overwhelming majority of thirty four year olds with twenty, seven plus seven. Hasek's a a good good number of x overs but it's just you know it's. It's a comfort to know that. I have eggs, but it's important to at least speak to someone after you have that tests on, so they can interpreted correctly, because one thing is getting that test. The other thing is interpreting it. So Darling Beca has been going through it with you. And I mean it wildly that. Could you want to kind of? Talk out fatter. Yeah, so you know. Zach and I have been trying for about two years, and our issue was never actually the ability to conceive. It was the quality of my eggs and so I- thankfully have a really great obgyn. Where after the second miscarriage she said to me you know a lot of the time your body knows when something is abnormal or a viable embryo, and it will get rid of it on its. Its own, which is what happened, and so she suggested talking to a fertility specialist, but in my mind I also had the experience that Jack did where in my early thirties I was having an ultrasound, and the doctor was like Oh my gosh look at all those eggs, and so I had a false sense of confidence in my ability to make a baby, and conceive will not conceive, but to actually get to the finish line so She said to me. If you want more than one child, I would definitely suggest freezing some embryos because that is you know peace of mind. You don't have to rush. 'cause I also wasn't necessarily ready to do one kid after the other, but we want more than one so That was when I was led to Dr John Adjustment, because, he's he's humble, but he's the best. He's the greatest and I drive to San Diego for him because that's what I do I do. It for my highlights and now I do have for my idea. Times have changed how times have changed, but I will say I had a really false sense of confidence and I started. My I got pregnant for the first time. I believe I was thinking. I was thirty three I'm now about to be thirty five and even going through IVF. He's incredible and he was able to get US viable embryos, but You know he said it himself that I. Actually got more than what he and had anticipated, and when he told me the number of what he had anticipated. I panicked because I just didn't think. I was that person and I don't think anybody ever does so. It was an incredible experience. And now we have some frozen embryos that are healthy and ready to go, so there's no better feeling. I didn't realize the weight that would be lifted just the moment that I found out that I didn't have to. Hurry up and keep trying and hopefully get something healthy. BEKKER's story is really important because. When there is a decrease in the quality of the eggs in the ovaries that could present itself different ways in some patients it presents itself as a lack of ability to conceive, but in other patients that could be miscarriages, even one miscarriage, for example why, because seventy five to eighty percent of miscarriages or secondary to chromosomal abnormalities, the embryo which is secondary to a declining equality. So. It's an infra some patients. It's just a subtle signs. Sometimes you know. Their menstrual cycles are about twenty eight days apart in overtime becomes twenty five days twenty six days, and that subtle signed tells us that the number of the quality of the exit starting to decline, so I think that could report, and can you tell us i? Have a lot of girlfriends who aren't quite. They're not married yet, but they're wanting to get. Get ahead of it and freeze eggs, but like what's what's the difference between freezing eggs and embryos, differences, eggs are more fragile than than embryos. So when you freeze eggs, subsequently thaw them. The survival rate on eggs is lower than embryo, so we expect for example when we freeze embryos, typically should be especially good quality embryos over ninety six ninety seven percents of five. Oh, wow, on eggs! It could be about sixty to seventy percents. Can you get more if you're freezing eggs versus embryos. Do you usually get more eggs in an embryo or is that? So. It's kind of an attrition process. If you think about it, we'd retrieve the eggs out of those eggs. Only a small percentage of them are going to be good quality. Here's an attrition after retrieving the eggs, only a small percentage of eggs, actually making survival embryos and depending on age of the patient, their egg reserve that can be as low as ten percents or give thirty percent, an egg donor surrender in their twenties very young. In their twenties, we expect about forty percent of those exit healthy, but even in twenty four twenty five year old. When you retreat, ten eggs is not like all good quality X. only forty percent of fifty percent are going to be good quality, and then that percentage decreases as time progresses I've equestrian BECCA. Would you share a little bit about like the process? And how you felt because I think the reason that so many people, so we wouldn't get turned off by this process is that we hear from our friends Omega I'm doing these injections and I'm feeling awful and I'm on these hormones, and then I in this way and. So maybe I. I'm happy to hear that it was not so difficult for you Would you have a bat? Yes, so I had my initial appointment and we did I. Believe we counted my resting. follicles which I think was like twenty three or something and then you know he gives everybody a very specific protocol for injections, and and how and how many days it depends on the. The person right so throughout the process of the injections every couple days I was going down to do ultrasounds where he's checking, the growth of the follicles, and so the injections for me really weren't. Weren't that bad and I'm terrified of needles. I you know like a tiny little ice cube to numb the spot a little. It's like an insulin need. Also, it's really it's a wimpy needle And Zach did it for me every night and I think I did twelve days I. Think I did twelve nights of of the injections and halfway through. We incorporated afternoon, but I have to say it was really It wasn't until the very very end of that twelve days where you actually feel. Your ovaries are like you know they're. They're bigger, so you kind of have like a heavy feeling there the retrieval was so easy I. I like you know you're. It's what fifteen minutes right? Under under for it, you do. but it still does shot. Like what are you putting in you so essentially? The two main hormones that we give patients and those to warm the same hormones that are released in the in the. From the brain to the ovaries every month as it, egg matures and develops up until the time of ovulation, so it's one is called follicle stimulating hormone, which is h and the other one is called Lou nizing. L. Age so we giving these medications in roughly. The same percentages as as the brain does every month. but we increase the dosage those because if we give a low dose, which is what the brain does, bring us a very low dose of these hormones, and the reason is because humans are mono obviates most of time. The Avi didn't WanNa get a tone but we're not interested in in BECA making one egg, because then you dare mono. Girl. So we giving it in a higher dosages, so they can make tennis fifteen when he eggs so that we have a higher chance because we know out of those ten or twenty, only small percentage are going to be great, so then the we have the retrieval It was really easy and a lot of women. You know we're doing this during covid where everyone's working from home, which I honestly. I was so grateful because I didn't know how I would feel. I know if I would want to be around people, but to be honest, I definitely could have done that as busy as as we've ever. been. You know the final day you don't want to be physical or like. The last couple of days and I completely stopped working out because you have to. but emotionally I am so sensitive to hormone changes and I. Really didn't experience much at all and I'm curious as to. Is it just because of the way that I'm? Taking the hormones, or is it just? A fluke and I got lucky. I think most patients will say that this the side effects or the symptoms are. Not. Terrible. Medications. the most common side effect from these medications feeling tired on them. Up the second most common is feeling bloated, because the ovaries enlarge because you'd suddenly haven't said at one egg up ten eggs, or fifteen x and then you can have breast, tenderness or some vacation headaches and but I do think the experience of each patient is is different. It's much much like if you were to take birth control bill. The birth control pill in one patient could cause nausea and some symptoms and other patients. At effect. But I think already patients do well he bekker's experience in terms of side bags is more the. Majority and how long is the entire process from start to finish because I've heard different things like for greasing for examples like two weeks to six weeks or four weeks, so is it different for every person typically in in in most cycles, though the whole process two weeks in other words from the time you start the medications time we retrieve yet gets completed within. Within two weeks now there are some clinics at US older types of of medication regimens, and those can be new those longer sometimes three weeks sometimes for weeks sometimes five weeks. We don't use those older type of medication regimens. Why because they're been published studies including ours to show that the shorter cycles shorter, a medication treatments are more effective and give us yes. To win out for girls that are not in southern California. Who can't go to you? What would you find like? What would you tell them? As far as finding the best fertility specialist but for? One of the most important things is is word of mouth. In. The experience of others in a forum such as such as this in terms of how other patients have experienced because you know if you obviously every fertility centre markets itself as a great center, wicked pregnancy rates in great doctors and I think there are two things that are important I think the experience of others in terms of they felt that they really were cared for and that the doctor spent in a good amount of time explaining everything in detail because anytime, a patient has a question. You have to make sure you address the question, so the well informed because if they're well-informed that they're in power. that's the first thing and the other thing is make sure the lines of communication are always open, so a patient needs you. They have to deal to reaching. The other factor I. DO think is that if you then look at fertility centers now, not just fertility doctors, but also in any profession, then you get into the upper echelon. Those who do research into who publish. Then you're in this sort of the upper echelon of a minority of fertility doctors that are on the cutting edge of research. Because if you do research, you're constantly around people who are doing research causing ramp people innovating. Creative protocols to improve the quality of the X and so with this research we gain more information out of better treat patients at a better and how to make idea for example safer Outta make it more effective at actually brings me to a question. I got an email from the clinic and it actually was very comforting about pregnancy during covert. And that was I think that that was really insightful. We have so many women who listen who are thinking about conceiving or are already pregnant Really close to their due dates and very scared, so can you tell us a little bit about what you guys have found out absolutely, so we've been sort of following the latest research publications on on Covid nineteen as it relates to fertility and pregnancy. So the. Studies in publications on on pregnancy been very reassuring, and on two fronts number one There was actually several papers published in the New England Journal Medicine at one in Lancet, which is a major British Medical Journal showed that there was no evidence of vertical transmission of the virus, meaning the the virus being transmitted through the Placenta vitas causing formations or other effects. So that's that's one piece of good news that we have thus far on the virus, the Second A. A piece of news came out from Columbia University. which now is doing universal screening on all pregnant patients what they did was they tested pregnant patients, and those that tested positive eighty seven percent of those patients who tested positive for Kobe nineteen, either had no symptoms or Mount Simpson's and the percentage of patients that went on to having more severe symptoms was no different than the general population, because one of the initial worries about the virus was Oh my goodness. Immunity is altered. It's not weaken. Most people think Oh, pair. Pregnant patients have weaker immunity. It's not weaker immunity. It has to do with helper cells and the percentage he helper cells, versus the other t cells immune south. It's altered. So our concern was are pregnant patients more prone to this virus, and if they get, are they more prone to having severe symptoms in the Columbia University study showed that note. That wasn't the case it was. It was the same as the general population so far that data has been reassuring. Of course we tell patients who take all the precautions right and and make protect yourself sell now that the the potential babies. No that embryos are done, and they're frozen in their their on ice. They're waiting. Is there a time when your uterus has a past due date, or is it just the eggs? Interestingly enough? The uterus doesn't age distinguish overs do. So for and how do we know this? Because patients who run out of quality expectations in their forties when you use an egg donor for someone for a was in her twenties, and you create embryos transferred them into a a patient. WHO's forty five? They have the same rate of pregnancy as somebody. WHO's thirty five PAS, but that doesn't. That doesn't last the whole way through Typically, we don't recommend for patients to to get pregnant beyond forty nine years of age. A couple of reasons for that number one. The US doesn't start to show some level of aging specially if menopause occurs because. Estrogen levels, drop, and so blood supply the uterus changes, but also above above the age of forty nine, the risks and complications during pregnancy are much much higher, and these risk could be as as as grave as a stroke. High Blood Pressure Diabetes her birth. placental abnormalities started to increase significantly after forty years of age. That could you feel so good? You have fifteen years I now. It actually I never knew that. It would feel this good. I think that first of all I should say after the retrieval. It is a stressful time because every couple days you're getting updates and you're finding out the attrition rate as he said it. You're losing eggs, and you're losing embryos and they're testing them. Some of them are not actually healthy So that those two weeks because I would say. Isn't it about two weeks? If you do the PG T testing, which not exactly right now. Big Seventies, Emerald developed to that mature stage blouses and typically wait another five five to seven days for the genetic test results right so that period of time was a little scary. Just because you know that there's a there's a chance that you could end up with none and I had a point in my in my I think I was on day five and only one fertilized egg embryo as a three. Only maybe one one embryo was showing that it was going to be viable I guess though I was really nervous about that because you know, but then the others caught up. Add some late bloomers. It is stressful, but then as soon as we found out our results, and now that they're just on ice waiting for whenever we're ready to implant, it's like it's a really crazy liberating feeling and I mostly just want every woman i. just feel like I. WanNa shout it from the rooftops, because we aren't given all the information for some reason and You think that your Obgyn especially a female obgyn. You would think that they would be really well versed in this, but I'm finding that that's not the case and a lot of the time, and so that's why we want to talk about it here because it's like you know it, it's it's really the one of the most important things I think. When sure at this point in your life to be empowered by the information and know that you have options, and then I have another question if if you go to implant. That embryo if someone has had an abortion before, if someone has had a miscarriage before, if someone. Does that affect how well the embryo will take or is every kind of new implementation like a new period cycle. It's actually every new implantation is like a new period cycle. abortions miscarriages should not have should not have any impact. On the ability uterus to allow plantation in a healthy pregnancy tap and are. Are you able to expand on You had asked me at one of my ultrasound. My my lining was a little bit thinner than normal, and you asked if I had had it and I. And I did so. Can you tell me a little bit about that? That's a great question why you got. You got a good memory. So what we see here everything. We never got. It's interesting that one of the things that we actually this one of our abstracts that we just sent research abstracts. American study reproductive medicine is one of the things. We realized that some patients who had a history of argued. It has a lasting impact on their uterus, lasting negative impact on uterus. And how do we in the oval? Because when we start to to prepare the uterus, allowing plantation to occur the you're supposed to get thick with estrogen administration and that lining years. If it doesn't get vic than one of the things that we think about is okay well. Did you have an udine place at some point, so that is? Unfortunately what we're discovering is, it could be a long lasting effect of the. and. That's something that has not been talked about. If you go on the website, if you look at studies on all Ud's it save is no issues. Yes, it's very safe. however there should be a little bit of caveats, a little bit of sort of glamour that this could have an effect under fragility. We even eat his station. Surrogates who were very fertile was for example. gets carry a pregnancy for someone who can't and they've had his juvenile ud. They struggle would be able to have a uterus. That's receptive to implantation. And is that all ideas because there's the copper, and then so you think so, it's been all. It hasn't actually the marina. Ud which has progesterone tends to be the biggest culprit. We think that perhaps the reason is because with Marina. Ud with the way they work, it's it's sort of a mechanical structure that prevents implantation buds on any copyright you for example, copper is also toxic to this firm as well so it's not just implantation issue, it makes the lining uterus less receptive for the embryo implants, but also has a toxic effect on sperm as well, and we think that progesterone may be lingering in the uterus and. On a microscopic level for a long time after the promote. Now not been studying now. Girls who are who are trying to get pregnant right now and not and having trouble who've had an IUD? There is a solution right absolute. There is a solution sometimes we have to wait. Sometimes the solution is you gotta wait, but most of the time we can counteract that with different types of estrogen estrogen can be given for example Badgley be given to a patch orally by injection, so we can most the time overcome it in a small percentage of patients. What has to happen is we have to wait? We have to wait until the effects of their professional gone. Mariah are sometimes for some patients I've seen that even. Up to yours Oh. Wow, wow, we have to take a break and when we come back, we have fan questions for the doctor owns great. Isn't this so fun? You guys? We're GONNA, take a quick break now to say, thank you Vince Komodo for pardoning with us on lady lessons We love this series and we think it's. We know it's to be great. Not We think we know in a manifest events Komodo dot com, you can find stylish, covetable and quality shoes, handbags and accessories at a great price point right now. They have some gorgeous heeled sandals that have become our summer. Go To's. To's, but if you need an S., Pedro, a pump, booty or sneaker, they have those two plus handbags jewelry, and so much more, and of course it wouldn't be the lady gang. We didn't have a great deal for you right now. Use our code lady at Vince Komodo Dot Com for twenty percent off your purchase of seventy five dollars or more just use code lady at checkout. At Vince, commuter dot Com for twenty percent off and don't forget to share your styles using the Hashtag Vince Komodo happy shopping. Some exclusions apply. They can be found at our page. Vince Komodo DOT com slash lady. You're listening to the Lady, gang? Okay and we're back, so we had our lady gainers sending some questions that only you can answer, because usually we do this with the three of us, and if we try to answer any of these questions, it would be an actual disaster. Okay, so first question comes from towel and she says I've been on birth control since I was fourteen years old. Does that affect my fertility later in life, I've heard so many different things. So on birth control bill should not have any impact on your fertility What it does do sometimes is, it can hide signs of decrease egg reserve, so it may be a good idea. Sometimes take a month or two break sort of assess your ability if if you're concerned about it or cure at that age where you should test it. And then get back on the trouble. That was actually what A friend of mine went to a doctor asking for the F.. S. H. Hormone test. And the doctor flippantly told her. Oh, it's not worth it because you're on the pill, so it wouldn't be accurate anyway as opposed to telling her. Come off the pill for a month or two and just test. Right, and there are some hormones that that the birth control pill doesn't affect the anti malaria hormone that gives us an idea bouts. A counts is not as affected by the build, plus you can always do an ultrasound on the ovaries. That shouldn't have an impact, but it. The best thing is if you truly want to have an information under fertility stopped at birth for two months. Use Different type of of a contraception for that. It was a couple of months and get your hormones tested. Get your ultrasounds done in terms of overs. To now okay, so the second question comes from Koran. She doesn't I'm trying to get pregnant. And I have three different periods slash ovulation, tracking APPs, and the all predicted different times from my ovulation during my cycle, and I don't know what to trust. How do I know when I'm truly ovulating? I got a simple method for you, so you take the total length or the interval between your two periods, and it's a simple formula, because a lot of these APPs are inaccurate, right? The what happens is you say? Say Okay I the interval between one period the next. It's about twenty eight days. You subtract fourteen days each talk, so you're ovulating on day fourteen. When's the best time to have an force? The twelve and fourteen so two days before your ovulation ended ovulation. That's going to be most fertile time and remember the sperm is going to be active, and it's going to be alive sometimes for days. That's why we say have in it worse before ovulation. Just in case you Avi Legal, but early this firm is there. but take the total length of your from one period to knock to the other subtract fourteen days, and that's when you oscillating right I'm GONNA go into my boo Joe Career Tracker Hero. Relation in there, but what if you don't have a twenty eight day cycle? It's just fourteen days from that started. You have a thirty day cycle. You're ovulating days sixteen, and if it varies then kind of make a formula, so if you say well I have periods about twenty eight to thirty two days, okay, so that means Rog between Dave. Fourteen today eighteen, so having of course starting on Day twelve day until. The, eighteen, okay last question comes from Kristen. She said last year I found out that year. Insist and that it could be a sign of Andrew Mitri endometriosis I'm in the process of figuring out. If I do in fact, have this, but what could this mean for fertility? Could this? This cause issues later online when we have tried to have kids and twenty six, not even close ready to have kids some kind of freaking out. Well endometrial is one of those few syndromes or conditions that actually can have a significant impact on fertility, and what isn't betrayals. Every time a patient has her menstrual cycle period. What happens is the lining of the uterus, sheds with blood and comes outside his period, but in some patients. In fact, many many patients, some of those cells can flow backwards through the twos and then. Then in a small percentage of patients, those little cells can start implanting in attaching to the ovary uterus to bladder now for some patients that causes pain for them every month when they have their periods significant pain for some patients, their asymmetric. They don't have any pain at all. In the first time they discovered. We get an ultrasound. We see assistant looks like an enemy versus. Three effects of endometriosis that we have to be very careful number one endometriosis because of the inflammation it creates the in destroy this firm before this from has a chance to fertilize. Number two. When when when the body sees the endometriosis, the immune cells get activated immune cells come in to destroy enemy materials, but just like in rheumatoid arthritis. Not only does it destroy the good cells that sells what else for destroys a good cell, so Haitians with enemy choices can run out of good quality much faster. The third thing it can cause is scarring because his constant inflammation repair inflammation where every month every month What happens is create scarring around the flow. Can Tubes around the ovaries? Juice be free to be able to pick up an egg so when they're scarring around below Kim tubes, it needs ability to locate to pick up an so three of facts, and so with patients with endometriosis. We just have to be more vigilant specially with equality, and so I would recommend to that particular patient is every year. Get your egg reserved on to make sure that the enemy chose is not having significant impact on your account and equality. Well if you're GONNA, have to come back because we have about fifteen more question I know i. I'm usually we need to yeah. Pleasure if you want to check out Dr d, You can visit the San Diego Fertility Center we're GONNA post. His instagram is personal instagram as well but essentially it's ass, and then his last name, Dhanush Mend D., A. N., e., S. H. M. A. N. D.. WE'RE GONNA post to sue. Can Swipe up and follow along and we'll keep you You know we'll keep you in the loop. When back decides to implant the embryos? Now that it's out there citing I might wait. I might wait till forty nine. A lot of work to do for lady gangs, so that would honestly that works for my. Okay fine fine. Thanks for coming on Yes, thank you so much. Kelsey. In Beca I would say this was an absolute pleasure, and I think you're doing incredible work in educating women out there so Kudos to you and and more power to you. Thank you. All right here in southern California to make the drive. It's worth it guys. and. Thank you. The annexed Tuesday next Tuesday next. Thanks for listening and make sure to rate and review this podcast wherever you go, go your podcast. We have new episodes lady gang. Every Tuesday and Thursday follow the Sun Social Media at the Lady Gang follow US personally at Kelsey most importantly at Becca and at Jack Bannock. The gang network is produced by will sterling Steve Delegator, hurston Woodward and Elizabeth fake thinks were rating and reviewing wherever you get your podcast and tune in for new episodes single week.