Franziska Haydanek: And there's something about diminished ovarian reserve that is deeply personal, so triggering to so many women. It just makes them feel like this fundamental thing that their body should be able to do, they're not gonna be able to do it. And nothing could be further from the truth. Your egg count has nothing to do with your ability to ovulate a healthy egg. I mean, I have to just say that over and over. There are tons of people outside right now in New York City, walking around the sidewalk with diminished ovarian reserve. They'll never know about it. They'll never have fertility issues. They'll get pregnant. We just aren't looking for it. Welcome back to I Did My Own Research. I'm Dr. Fran and today I'm joined by Dr. Lucky Seacon. Dr. Seacon attended McGill for her undergrad. She went to the Royal College of Surgeons with honors in Ireland. She completed both her OB-GYN residency and reproductive endocrinology and infertility fellowship at the Icahn School of Medicine at Mount Sinai. She currently is an REI in New York City and posts at Lucky Seacon for educating on endocrinology, infertility, social justice, and providing support in those struggling with infertility. She also recently published her first book, The Lucky Egg, which means you where you're at and where you're possibly going in your fertility journey, learning. how to check your ovulation, to go through the egg freezing process, through all the different ways that you can go through IVF. Lucky, thank you so much for being here today. Thank you for having me. I'm excited to hang out with you. I'm so excited. I have learned so much from you over the years about endocrinology and fertility. And as a generalist, OB-GYN, I practice a little, I call it like REI light. And so I've learned so much from you about how I can really be. providing the most I can for my patients, especially those who don't have access to seeing an REI. And so your book is an extension of that for the whole public about really understanding their fertility, how does ovulation work? How can you improve it? Male factor, how important is that and all that, and really being a guide for those who are going through any sort of infertility. Yeah, I felt like it was just so needed. mean, I waited the first part of my career, years and years, for a good resource to come out. I definitely didn't envision that I would be the one to put it together. But I grew really frustrated, you know, with the resources that currently existed prior to this book. It was not written by OBGYNs. Primarily, you know, the most popular resources were written by people that just went through IVF themselves a few times as patients. You know, there's one in particular that's like, always kind of at the top of the list, but it's like very heavy on things like supplements and kind of magical thinking about what you can do to reverse your egg quality and the biological clock. And I think it's just filled with a lot of fluff because the person who wrote it is not a true expert. So therefore they don't have the expertise to offer. And I think people are really hungry for real guidance, which is why we're seeing so many people consume information online and try to teach themselves and bring themselves up to speed and fill the fertility knowledge gap. And that's why I, as an expert, said, okay, it's time for me to get loud on social media and write a book. Yeah, I think that's really wonderful. And you touched on this in your book as well, is that, you know, even when we spend an hour with our patients, our patients are still more hungry for a better understanding. They want to hear experiences. They want to sometimes read the studies. And even if you spend a whole hour with a patient, sometimes they're still not going to have that time. And especially for those of us who don't have an hour with our patients, right? For me, for the most part, my appointments are 15 minutes long and I'm trying to do all the medical things that I'm like trying to throw in education as you can, but I can't always. And then my patients are left wanting more. And that's where we kind of get in that of people taking advantage online because now they see patients are desperate for information and here's their window to provide some information and then also have something to sell, whether it's a fertility course, I've seen a lot of that recently. there's a lot of like driving a wedge between the patients and the doctors. I mean, any video that starts with, here's what your fertility doctor isn't telling you is a video you probably can't trust, right? Because that's just like such a toxic narrative. But yeah, what were you gonna say? I was just gonna say it just leaves room for people to take advantage of that. And you touch a little bit on them in your book saying really, especially for those who are struggling with infertility, they're desperate for answers and they're desperate for- They're vulnerable and people really take advantage of that. And so, you know, I think- I would love to see or hear from you a little bit on those patients specifically who have been affected by that misinformation. Again, you speak about this in your subject on supplements where people are using something online and in reality it's like working directly against them. Yeah, I mean, sometimes less is more. I mean, we've all heard from our colleagues in other fields even like cardiologists or liver specialists who have seen... some of the downsides of people just taking multiple supplements and really overloading their bodies and thinking, hey, well, it's a vitamin, so it can't be all that bad, right? And there's this connotation around supplements that natural is better, but they're actually not regulated by the FDA the same way that drugs are. When you prescribe a medication and it's being filled by the pharmacist, that had to go through rigorous clinical trials, and it's really hard to get something passed by the FDA. ⁓ supplements are not subject to that oversight. And so I see a lot of people get burnt out when they're trying on their own or they're, you know, experiencing miscarriages or maybe they're going through treatment and they thought that that would get them there quickly and it's proven to be more complicated than they originally thought. It's very easy for them to get sucked in. to these side conversations that they're consuming online, know, podcasts are like the number one, you know, the number one offender of like people who are uninformed just spouting things as if they're fact. And it's like really damaging narratives that fertility doctors just want to make money and you can't trust what they're telling you in terms of their recommendations. you know, I've got the secret, the fountain of youth, take this elixir or supplement. And people will think that they need to take breaks for like six months between cycles to revamp their egg quality. And it's not rooted in science. You end up wasting not only money, but the most important resource of all, which is your time. And for a lot of people that are already dealing with diminished ovarian reserve or things like that, it's like, this is not serving them. It's a detour that's taking them further from their goal and further burning them out. I mean, talk to any fertility patient that has a bathroom counter littered with 20 different supplements. They're burnt out before they even get to my door because they feel like they've been grinding their gears doing all of these things and it hasn't been effective. Yeah, in your book you also touch about the person who was using like a progesterone supplement thinking it was gonna like balance their hormones. And I've seen that on TikTok shop where people are selling some like progesterone cream and they're like, I use this progesterone cream and in two weeks I was pregnant. I was like, progesterone is like not doing what you think it's supposed to be doing here. up a very narrow window of implantation. That's what we call it. So it transforms your lining for a very limited period of time and makes it receptive to an implanting embryo. And the only place it's supposed to come from is your ovary when you're ovulating. Or if we're emulating that process and we're doing some complex treatments like IVF, then maybe it makes sense to supplement it. But just supplementing it on your own willy-nilly is not a good idea because you might be shifting that window of implantation. And actually, it could be acting like a contraceptive where it's making your lining less receptive to an embryo and it's kind of shifting things and making it all out of whack. So it's really something that has plagued my fields because there is a lot of simplistic thinking and I don't blame the patients at all, right? It's like there's very little information that they're going off of and they're like, I had a miscarriage. I had low progesterone levels when I had that miscarriage. So progesterone is good and low levels are bad. And I think... more is more. And so, you you can get into this pattern of thinking where you do things that are actually detrimental to the overall outcome. And nothing is, I think, more devastating and upsetting to me as a fertility doctor when I have to explain that to the patient, that this whole time they thought they were helping their own process, they were actually counteracting the goal. And, you know, there's no recourse. It's not like you can go to that influencer that linked, you know, that progesterone supplement and say, hey, not only do I want my money back, but like, I want my time back. And you know, they don't have a medical license. They have nothing to lose. And it's important to remember that. Yeah, I also think it's really important for patients to hear that because they do think it's like, ⁓ it's natural. It can only be a benefit because that's the way it's sold a lot of times. But the reality, especially for hormones and managing hormones, a lot of times we have to measure your hormones to make sure that you're in correct ranges that we need for whatever we're working on. And so to add something on your own that may have hormones in it. and you don't tell your doctor, especially if you start having symptoms or you're working towards something is really not. the best for you because in the end you might be working against yourself and you don't even know it. So I really do encourage anyone who listens to have that conversation with their clinicians about these are the supplements I'm taking, these are my concerns, right? And like, it's only going to be a good thing, but you know, my husband has seen it in primary care where patients come in with all these symptoms and they do all this workup and they can't figure it out. And then it turns out that they're taking like a thyroid supplement and it put them into like hyperthyroidism and you know, they stopped it and they felt better, but they didn't tell him about it for months. And you know, I had a pediatrician on today who was saying that they're ⁓ they had a patient whose parent was giving them high levels of B12 because they thought it was gonna help with one of their conditions and it made them so ill that they like... God. You know, so it's not like a net zero here. Like, these things can harm people, especially in something so delicate as infertility treatment. I can imagine that's very frustrating for you. And I get wanting to take measures into your own hands. And I'm not a fertility doctor that's like... No, no, no, don't take any supplements. I actually go through in my book, there's a whole chapter with tables and tables, and I talk about this all the time, like this chapter nearly killed me and it was only like a quarter of the way through the book and I was like, maybe I should have left this till the end, because it was just such a laborious exercise. And it was really, I don't know, I just felt so down writing it because it's depressing to read bad studies. especially when I know what the chatter is. keep my ear to the social media streets and I know, you know, people are talking about NAD and all of these buzzy supplements. And I'm like, actually this one has no human studies and it has potential adverse consequences. And it's depressing to see things permeate, you know, social media and what my patients are kind of buying into day in day out. And then to juxtapose that with... the poor level of data and evidence. It just makes you feel like sometimes dejected, if I'm being honest. And so writing that chapter was probably the most challenging of all the chapters because I think that is the stereotypical thing. When you think about fertility expert, it's like, what are the conversations I'm having with people? Day in, day out, we're talking about supplements all day long, right? It's just very pervasive because there is this level of desperation and racing against the clock and wanting to do anything you can to help your cause. Yeah, I think it's really important as clinicians that I would advise anyone who does any kit work within gynecology and infertility to read that chapter because I do think because people have taken supplements so far, I feel a lot of us like evidence-based clinicians get very like don't take any supplements. And the reality is, is that there's some like okay data for some things and we have to keep that in mind. And I talk about this for PCOS a lot because I take care of a lot of PCOS patients. I'm like, there are some supplements that may help you. should use this in supplementation to the other things that we're doing. A lot of my patients love though that I'm even having that conversation with them, right? So they say like, okay, Inositol may be the best that I have. It's not perfect. It's not going to cure you. May it help some? Sure. You know, and are the risks low? Yes. And so I think, you for any clinician listening, like you said, really having your ear to the ground, knowing what your patients are hearing, and then researching and being like, okay, are some of these things actually beneficial? Like when should I talk about berberine with my patients? Like this could maybe be helpful in certain situations and it just creates some trust, especially with patients who want those things. The first challenge was, which ones do I include? Cause there's so many. And so it was like going through like, what are the most... what are the highest yields, and just, know what people are talking about. And then it was like, how do I break this information down? And I think I did it in the best way that I could possibly do it, which was, here's the name of the supplement, here's the dose that is often taken or recommended or that's been steadied, all of the above. Here are the potential side effects, the potential interactions, the adverse effects. And here's what the data actually shows. That was the last column and that was the column that did me in because I'm like, how can I be saying that it's only mouse data? like, my husband read my book, he was my ghost editor. He's not in medicine. And he was like, ⁓ my God, like, I feel like how many times can you say like small poor design studies, like no placebo, blah, blah, blah. And I'm like, I know, this is the reality of the data out there. I do appreciate that you put all that effort in as hard and terrible as it was to do it. It's so necessary. And I know so many people will appreciate having that as a reference and being like, coenzyme Q10 may be worth exploring. This injectable that have only been studied in mice, OK, I'm going to let that one go. Exactly. Exactly. You have to be practical. And you know, I think COVID taught at least me a great lesson as a clinician. I feel like it really helped me mature as a physician because it was One of many examples, there's so many examples in my field where you don't have all the perfect data and you're making critical decisions that are time sensitive with the best information that you have possible. And you're kind of like trying to stay abreast of all the updates and you know, that's the landscape that I'm practicing and that so many of us are. Like there's always great areas of medicine but I feel like fertility medicine is really like there's so many blind spots. We don't have a test for egg quality. So we make a lot of educated guesses and assumptions. And so... The same is true when it comes to the role of supplements, sometimes tweaking IVF protocols. It's like not always an exact science as much as people want to believe it is. It's the art of medicine and knowing when and when to not do something. Speaking of ovarian reserve, AMH levels I think are massively misunderstood both online and in real life. And I struggle with that with my patients, right? I talk about how this is not a perfect lab. This does not mean you're infertile. I have this specific... like patient encounter, I remember why, you know, 10 minutes of talking about like what AMH is and is not gonna help with. Her level came back low and in her message back to like my nursing pool, she said, you know, Dr. Fran said that I'm infertile. was like, I never said that. It's actually really difficult to uncouple the concept of egg count and fertility. And I will tell you on a personal note, I had low AMH and low response to stimulation when I went through IVF and I did not have infertility. at least in my mid thirties, I was doing it for preventative reasons. I was like, I know better, I'm seeing all these people and I know I'm not gonna be ready to try again until my late thirties. So let's just free some embryos. And I should have mentally been able to intellectualize and say, I'm an expert. But even I struggled as a human being, as a patient to be like, wait, why did I only get two eggs? Why did my cycle get canceled? it automatically makes you feel like you did something wrong. You feel ashamed. You feel like your body is not functioning the way it's supposed to. And you feel broken. You feel, you know, worried. And that was an eye-opening experience. And one of the reasons why I made Mental Health such a huge focus on my book, because I was like, despite all of my expertise and the advice that I would give a patient in this exact scenario, I can't internalize it, what help does anyone have if they, you know, are a lay person? And so we really need to, as the experts, not only... give the medical information, but also deliver it in such a way and provide the emotional support around it because this is such a sensitive area. And there's something about diminished ovarian reserve that is deeply personal, so triggering to so many women. It just makes them feel like this fundamental thing that their body should be able to do, they're not gonna be able to do it. And nothing could be further from the truth. Your egg count has nothing to do with your ability to ovulate a healthy egg. I mean, I have to just say that over and over. There are tons of people outside right now in New York City walking around the sidewalk with diminished ovarian reserve. They'll never know about it. They'll never have fertility issues. They'll get pregnant. And we just aren't looking for it. So we don't know. So I'm not against testing. I think it's nice to know about. And I actually go a step further. And I look for underlying potential risk factors and causes like a lot of young patients in their 20s and early 30s who have very low AMH levels. I'll test them for things like fragile X pre-mutation. That's one example of a concrete genetic underlying risk factor for diminished ovarian reserve and going into menopause early. And so I use my critical thinking skills and do what I would want to be done for myself or my sister. Like what are the things I would search for? But you might not have anything found on that testing. And it doesn't mean that... It's a problem necessarily. It's just, I'm trying to look for red flags that could tell me, are you on a trajectory where you could go into menopause early? But there are many people with low reserve where it stays at that low stable level for quite some time. And it's not an accurate predictor of when you're going to go into menopause. And it certainly isn't a predictor of your egg quality or your ability to ovulate a healthy egg and get pregnant. Yeah. But I'm sure despite those sentences, people are still going to hear, I am doomed, I'm infertile, and I can never have a baby. And that must be really hard. Absolutely. It is, it is. There's a whole section in my book about the mental health struggle of someone dealing with diminished brain reserve. And I'm telling you, like, I've been there and I've been inside the minds of all my patients. Like, every week, it's like, people get so emotional and they cry, they're upset. And I always tell them my story. I'm like, I feel for you. I understand what it feels like. I get it. I'm a human being. I'm a woman. I get it. But whatever, I just like... sound like a broken record. I'm like always trying to uncouple the two, but it's impossible. And that's why I'm very much against doing like home testing where you're just like the finger prick, you know, checking on the blood work and then getting some report. Yeah, sure. Maybe a nurse will call you. Maybe they won't. Maybe there'll be a portal message. But I think that when you're talking about something so sensitive, it requires nuance. And the clinician that's ordering that... that blood draw really owes it to you to be able to also speak to what the results mean. And that's why a lot of my OB-GYN colleagues were like, I don't know if I can get into that whole discussion. They will send the patient to talk to me, you know? And that's not necessarily wrong. It might be the more responsible thing. Yeah, especially if they can have like a full consultation with you where you really do a full assessment of like, if there's a couplet, like the couplet, if it's a single person or a single person and really, you know... Some of us aren't trained in it. Some of us don't like doing it. Some of us don't have the resources. You brought up a point about the home testing. What I've seen a lot online is people doing like at home semen analysis kits. How like, are these like at all a reasonable thing for people to do? I've never like told my patients to do that because I have the ability to get a semen analysis done for my partners of my patient. But I assume for those who live in, you know, areas that don't have the resources that you and I do, is that like a thing at all? Is there any like good evidence behind that? I wouldn't say that it's validated, but it's always a nice to know, right? Like the big thing that you're asking is, you know, is there sperm? That's the first question, right? Most men are gonna have sperm in their sample. So you're ruling out a very small proportion of the population. That's not insignificant, but it's not the most likely problem that you're not gonna find any sperm. But I think that it's not as standardized and it's just not validated. And also then there's user error. So like, I would never make any sort of clinical judgment of, this parameter is at a level where the only good solution is IVF based on a home test. I think that that would be really irresponsible. But it might be nice for those patients who are like maybe just curious or they're like six months in and they can't get in anyone to just see like... Is there anything at all? And then if maybe that's abnormal, now you know to like go see a urologist quicker, you know. I think that's great answer. Exactly. I think that it's good for ruling out extreme situations. I think for those more nuanced decisions, you're gonna wanna get an official semen analysis at a lab and have a validated result to go off of. Yeah. Every month I share the Green Journal on my Instagram stories because in a way... I love when you do that. in a way to show people that we as physicians have continuing medical education all the time, right? We get journal articles, we read them and so on. And a couple of months ago, there was an article talking about this like natural reproductive medicine. And this was like NAPRO technology. And this was all very new to me. And Dr. Natalie Crawford messaged me and she was, this is such a big problem in our community. know, it's a hard balance because it's like very polarizing. While of course there are some like lifestyle modifications and supplements that may help. to take such a firm stance against especially like IVF is very problematic. Do you find similar, like this is a big thing in your community right now? Yeah, I mean, I would say it's frustrating because it is touted as this new way of thinking about fertility medicine, it's revolutionary. And in reality, it's all the conversations, the preliminary conversations I'm having with every single patient. We talk about... Lifestyle, we talk about diet, we talk about exercise, the importance of maintaining a healthy weight, controlling chronic medical conditions. So when you actually read through what is restorative reproductive medicine, RRN, it's kind of like, it feels like we're going backwards in time because it's just shifting all of the focus heavily on everything that you can do up until the point where things might get more complex and you need to rely on technology. And I just think it's wrong because, you know, the narrative that they're selling is, well, conventional fertility doctors just want everyone to go straight to inseminations or worse, straight to IVF. And that's not true. That is absolutely not true. We offer the full range of treatments and we're also doing a very thorough workup. I mean, another big part of the narrative is, well, they're not looking at tubal disease. They're just bypassing the tubes and telling you to go straight to IVF or they're not trying to fix the underlying root cause. And you know as well as I do, root cause are two words that are very triggering to me, because it's like, hello, like this is the bread and butter of what we do. Yes, we're always thinking about root causes, but we also are trying to come up with a solution at the same time. we're, it's just really asinine because it's telling a story that's false. It's saying that we are only hyper-focused on one area when, and it's very much band-aid solutions is the messaging. And it's not true. mean, we're having these conversations day in, day out. We're doing thorough fertility workups. I can't speak for every single fertility expert out there, but I can tell you what's evidence-based, recommended, and what will get you to pass on your boards to become a board-certified REI. And none of it involves omitting these really important, crucial steps and starting with the basics. Yeah. I think it's also, you know, from my early understanding of this, a little religious base, where we're playing a little bit like... Anti-IVF, anti-IVF. Anti-IVF, IV embryos are persons. Fear mongering about the risks associated with IVF, even though that's been shown time and time again to not be true. Like, you know, the risks of stimulation causing things like breast cancer. Like, this is really, really safe treatments and technology. Nothing is without risk, but we have gotten to a place in our field where we are able to now, more often than not, transfer one embryo at a time. We're able to lower the risk of miscarriage. We're able to help people preserve their fertility. And I think, not to sound like a conspiracy theorist, but you have to look at the people that are pushing this RRM narrative. And a lot of times, their belief system and their platform and the things they stand for are also concurrent with this idea that we don't want to give women choices. We don't like the idea that women are now freezing their eggs and... you know, maybe have the option to wait to find the right partner or the right life situation. It's all about kind of taking agency away from women. And I think a lot of this RRM movement is rooted in misogyny, just from my assessment of, you know, the messaging that they're giving. I think they're really trying to take options away from women, which is the opposite of what we should be doing. they're so good at it. They're so good at making people, like, hear the things that are, like, already believed about, like, doctors. So, for example, I did this video maybe a year and a half ago about Casey Means' brother was on a podcast with Casey Means, and they were talking about how doctor who, how REIs don't ever talk about diet because they're trying to make you go through IVF, which will make you money. And if only you did the keto diet, and then you could just get pregnant on your own. And of course, doctors aren't going to tell you this because then they can't sell you IVF. And I was so offended on behalf of my REI colleagues because I know that couldn't be further from the truth. If we had just a simple diet to do for eight weeks and we cured your PCOS, then amazing. There's no like lack of patience. We have, I'm sure your wait lists are probably months long, right? All of us have like... our patients are struggling to get in. There is no lack of patience. And if we could just do something simple and say like, ⁓ just go do keto and then you'll get pregnant, we would love that for you. But in the bigger picture, then you see like... Casey Means is on podcasts talking about how birth control is bad for you and it suppresses your feminine energy or whatever. And you're like, and then you're in an administration who wants the birth rate up, who has restricted access to all forms of reproductive healthcare. And that's like the bigger picture. It starts with those little podcast clip. It seems like not that dangerous, but in the bigger picture, it's terrifying. It is. And as someone who has made this their life's work, and I talk to patients all day every day, It's infuriating because it's like, well, do you even know the number of patients I've helped get pregnant by just inducing their ovulation or getting them hooked up with our nutritionist and helping them with weight loss and their insulin resistance? mean, there are so many of those success stories that happen well before the person gets to the point where they need to rely on technology like IVF. And I think, you know, what it's doing is really prolonging the inevitable for some people. Some people are going to have... to need IVF no matter what because of their diagnosis. And making them jump through all these hoops because you're saying it's kind of a moral failure to then have to rely on that final step when that is often the most effective, efficient treatment option for people dealing with problems like age-related increased risk of miscarriages, recurrent pregnancy losses. I mean, telling someone that they can't utilize technology like IVF to test their embryos. to be able to select that one healthy one out of the sea of many that would result in miscarriages after they've been through such a devastating journey, I think that it's criminal. Yeah, absolutely. And really like puts them in an even worse space. And it's almost insulting to them as if they didn't think to do any of these things first. Like if there's like one day we're like, okay, I'm gonna get pregnant, the next day I'm not, so I'm gonna just go spend $20,000 on IVF. Like it's insulting to their intelligence really. the focus on things like... let's repair damaged tubes that are inflamed and just so beyond repair and put you through an invasive surgery that your insurance may or may not cover because it's something that's so fallen out of touch with evidence-based medicine that is current. And these are things that recur, right? Inflammation, all of that, like that focus of inflammation is going to still be there and still going to harm your overall chances. so, The mainstay of dealing with that is to say, let's disconnect the fallopian tubes from this environment of the uterine cavity. Let's bypass this. And IVF is probably the most effective approach for severe tubal factor infertility. But having someone go through an invasive procedure to, quote unquote, repair a tube that you know is very likely to close back up and scar again within three months, I think that's criminal too. And it's just really misleading people down a path that waste time. and subjects them to procedures and things that they don't necessarily need. It's very surgery heavy. And guess what? Our field used to do mainly surgery back in like the 70s and 80s because we lacked other tools. And the game has changed. And I think RRN is not about keeping us in the future. It's about moving us backwards into the past. Yeah, that's so disappointing to hear, especially for, again, the most vulnerable patients that are out there and who are seeking those... You know, they want, they wish that their tubal factor could just be corrected with just a little cannulation. But the reality is, is you might, you might cannulate that tube, but then in two months, they're in my operating room with a ruptured ectopic because their tube can't carry that, you know, blastocyst down. That's the unfortunate part, right? And now they're going through even more surgery. And, you know, I want to say something. As a physician in this field, I'm not like a robot that's like, must do IVF and must, you know, accelerate the science. I think that... If someone comes to me with religious concerns about having extra embryos, we talk about their age, their statistics, and I have had patients where we have only fertilized a limited number. I counsel them that this may lower their overall chance of success. It may increase the number of cycles they need to do. You it may not be the most cost effective approach. But we respect our patient's religious autonomy. And I think you have to have a conversation. So don't automatically assume if you go to a doctor that does IVF that they're gonna only do it their way and they're not gonna consider your personal belief system and your comfort level. There's a way to meet in the middle. And I think it's just about being really honest and open about what your concerns are. Yeah, I mean, I think that's like the perfect example of meeting your patient where they're at and like... really respecting their choices and what is important to them in their life. And especially in something where they feel maybe a little more out of control than they normally would have, giving them control back as much as you can is like the best thing you can do for them. And so I think it's so wonderful that you say that for people to hear, that you write that for people to hear, and that you continue to share that message on social media because that's where us as other clinicians are gonna hear that, know that if I have a patient who comes in the office and who has those concerns, I can say like, These are things that's not black and white. These are conversations to have and there's flexibility with everything. Exactly. Okay, I wanna get into a little rapid fire with you. Let's do it. Okay, true or false? There is nothing you can do to improve your natural fertility. False. You can definitely focus on, you know, the fundamentals, the basics. To keep it simple, I always say whatever is better for heart health, for your cardiovascular well-being and health, tends to be better for fertility. For example, The best steady diet, and this is a hard thing to study in isolation, right? Because it's not just like we're rats in a lab. We have all sorts of behaviors. And so there could be a confluence of different variables that impact ⁓ how your lifestyle can influence your ability to get pregnant and other health outcomes. But a Mediterranean style diet, which is known to be the best for heart health, it's very balanced. This is very common sense information. You're eating the rainbow, fruits, veggies. lean proteins, healthy fats, trying to reduce your intake of ultra-processed foods. Like, this is not sexy advice, but it's good advice. And when people say keto diet or carnivore diet or Atkins, anything that is so harsh and restrictive, mean, keto is basically you're telling your body that it's starving. And so therefore it's going into a state of what we call ketosis. that is not healthy. That is not the balance in homeostasis that we are aiming for when we think, hey, what is a less stressed environment for someone's body to say, nothing bad is happening to me. Let me continue to ovulate and like support, you know, a potential future pregnancy. That's what we're thinking. So anytime someone is being overly restrictive with calories, expending more energy than what they're taking in, your brain, it's like a... a defense mechanism, it's gonna stop sending the signals to your ovary to tell you to ovulate because it's like, we don't even have enough energy for us, like let alone getting pregnant, right? And so it's always good to think about it that way. Like what is going to help me to support a pregnancy? And so when we think about exercise, traditionally, you know, our mom's generation, our grandmother's generation, they actually gave each other poor advice. And there was this like... thought process that we were these fragile human beings and we should all be sedentary and bed rest for everyone. And we actually know that that's not true, right? There's tons of data now that there are better pregnancy outcomes when you are conditioned and you're someone that works out regularly, you're taking care of your heart health. And the same is true when we think about fertility outcomes. We know that regular cardiovascular exercise typically like 150 minutes per week, however you wanna break that up. resistance training where you're building muscle, especially for women with insulin resistance. When you build muscle, you're making your body more sensitive to the effects of insulin. And a lot of people don't realize how important insulin resistance is to our natural fertility. I diagnose women with insulin resistance every day, each week. And it's something that's chronically under-recognized because a lot of times I find clinicians might be looking just for very specific lab thresholds, but... I think that we have to also kind of think about the person more holistically. Like, do you have a strong family history of type 2 diabetes? Do you have symptoms that suggest that you have excess androgens, which are testosterone-like hormones, like skin changes, hair changes, difficulty losing weight, especially around the midsection? There's a lot of different ways to think about insulin resistance, but you can pick it up in the labs, you can pick it up in someone's history, even their family's health history. And what it means is your body is less... to insulin, and so you tend to make more of this hormone produced in your pancreas, which sits up by your stomach. And insulin actually affects how your ovaries function. It actually can lead to overproduction of testosterone from the ovaries. It can create an unhealthy imbalance around the eggs where they're being matured. And so I have actually made a concerted effort to treat, detect and treat insulin resistance in all my patients. And for those who are going through treatments, whether they're freezing eggs or going through IVF, I've seen a direct correlation in terms of improving the degree of maturity of the eggs that are retrieved, which makes a lot of sense if you think about women with polycystic ovary syndrome and insulin resistance, which are often correlated. I've seen improvements in the quality of the embryos that are resulting from those cycles, which also makes sense. And also in patients with recurrent losses or who have implantation failure, and uncontrolled insulin resistance and they're coming to me for second opinions, that's something that I really focus and target. And that's not something happening in an IVF lab. That's exercise, diet, weight loss, if that's something that you could benefit from, and sometimes medications like metformin or even GLP-1 agonists. I think GLP-1s as we continue to have them on such a broad market, we're really gonna learn a lot. I say that a lot for PCOS, because as you know, we have no singular treatment that's made just for PCOS. But I think, especially with the GLP-1s, I think we're gonna see that. patients with PCOS are really gonna benefit long-term from that. I always call this rapid fire and we never actually rapid fire. we're gonna go a little... I love it. I do it. I'm always like, tell me more. tangents. Oh, rapid fire, rapid fire. Okay. What is the highest order of multiples that you've seen just in your career? Triplets. Yeah, I posted about this recently and I'm grateful to be able to say that because I'm sure many of my predecessors, my mentors would be able to tell you higher than that. But it's really, really rare even nowadays to see triplets. This was actually early in my career. I was following the guidelines. I just want to preface the story by saying that this was a 43-year-old patient who I said, I think if you're going through IVF, it makes sense for us to genetically test the embryos. She was counseled. Ultimately, patient autonomy wins out. She was appropriately counseled, she said, for cost reasons and also just my belief systems. Like, I don't want to know the quality of the embryos. I just want... you to do whatever you think is gonna help me get pregnant. And the American Society of Reproductive Medicine says, if you don't know the genetic status of these embryos, we know that there is an increasing, overwhelmingly high proportion of embryos that are gonna be genetically abnormal at 43, coming from 43 year old eggs. And so, and that's like 80 to, know, 80 % or so of embryos will be abnormal. So it could be permissible to put up to three embryos into the uterus because a lot of those are gonna be abnormal. And this is giving this patient the best chance of success. And it's very rare that all three or even two out of the three would be normal based on her stats. All three implanted, all three were normal and she had a full term triplet delivery. But the problem was she moved back to Germany where she was from like right at the tail end of her treatment with me. Like I normally monitor these pregnancies. I monitor any pregnancy until like near the end of the first trimester. And she kind of ghosted us and was like, I'm leaving to Europe. And I was like. No, I want to know what's happening with you. It was so nerve wracking. So I posted about it because it's one of those things I'll never forget. But in reality, nowadays, the only way triplets is usually happening, because it's so rare to put back more than one embryo. Most people are doing the genetic testing, is if you're inducing ovulation and someone over responds. And you do see this from time to time, especially in clinics where maybe they don't bring the person in for an ultrasound. to see how they responded before deciding whether to move forward with the next step. But usually, even with medications like Clomid and Letrazole, you're only going to have the risk of twins most often. And it's like a 3 8 % risk, depending on a person's age and other factors. Yeah. Triplets is also my highest number. It was not an REI patient. Probably most obstetricians at this point aren't seeing higher than triplets either. OK, true or false? We aren't paying enough attention to male factor infertility. I think it's still true. We're definitely moving towards the right direction. There was a time early in my career where the male partner would be like, a lot of the time, don't, well, why don't we see if it's her first and then I'll get tested and, ⁓ yeah. Since old I try having a straight face during those consultations. I'm like, well, let me tell you, 50 % of couples with infertility have a male factor. It is so silly to not do the workup concurrently, especially when you consider... that a semen analysis is so non-invasive, it's so cheap in the grand scheme of all the tests and treatments out there, and it could save someone a lot of time. I think it's really bad medicine and not a good idea for the female partner to start doing things like taking medications to ovulate regularly or boost her ovulation. And all the while, we have no idea that, you know, is there a severe male factor? And it's a missed opportunity because men are always making new sperm cells. They regenerate every 74 days. So there's room for improvement and there's actual lifestyle and even medical management that we can employ to try to improve that quality. So I think it's something we should be working up concurrently. And now, and I'm sure you've seen the data on this, because it's so interesting, we have a lot of information about how male health habits and uncontrolled chronic medical conditions, things like that, obesity. can actually factor into the functioning of the placenta because there's a lot of paternal genes that build the placenta. And that is so important for pregnancy health. And there are also health outcomes that have been related from the male partner to the future health of the children. And it shouldn't be a surprise because it's a 50-50 job. Family building is a 50-50 endeavor. But I think because women carry the pregnancy and because we have this biological clock. It just, so much of the pressure has been placed on us at the level of, you know, how society views the contributions. absolutely. And I think there's also so much misunderstanding of ways that you can improve, like, male factor or like, like, I'm on testosterone, it's gonna make me more fertile. And it's like, that is doing the opposite. Basically, male birth control. Yeah, terrible idea. Okay, what one household habit would you recommend changing for the sake of improving your fertility? Definitely using plastics to... drinks or food and especially heating and plastics. I mean, that would be my number one. And I think that we have to think about toxins in a holistic way. Like, I don't think that you need to buy expensive air filters or, you know, depending on where you live, you don't necessarily all need a water filter. But I do think that the exposures are more insidious in our day-to-day, like how our foods packaged. Like, plastics are all over place. It's difficult to actually study the role of microplastics. not even just when it comes to fertility, but general health outcomes, because where are the controls of human beings that have no microplastic exposure, right? And we know, we know that that is not good for us. I'm trying to think what else. I mean, I guess fragrance is a big one. It's hotly debated, but it just seems like this frivolous, excessive thing that we know there can be endocrine disruptor or endocrine disrupting-like chemicals, like phthalates, that you find in fragrance. And... it's not a need to have, right? It's not like an essential item, maybe it sparks joy, but there are also other general health outcomes that are known to be worse because of fragrance, whether it be like asthma, skin irritation, things like that. So especially as the mother of two young girls, like I have really scaled back on the use of fragrance in my home and even in my cosmetics and what I put on my kids' bodies. I'm really careful about that. Yeah, and I really appreciate everyone who has those conversations in a very, like, balanced way. I think what most people see are the people who go, like, crazy online, but I've learned so much from, you, Dr. Crawford, other OB-GYNs who talk about plastics a lot, where I'm like, okay, there is reasonable things that you can do in your day-to-day life. We as doctors should have those conversations and make it more public because... We don't know the long-term health implications, but if it's a small, small change, or like really hardly any change at all, but it can be better for your health, I'd like, why wouldn't you do those things? Exactly. For your book, The Lucky Egg, I want to know, how long did you have the title of this book in mind before you wrote it? Well, it was the title of my long-running blog, which I started in 2019, I wanna say, like right before COVID. So it was already a thing and actually it evolved from an inside joke because me and my two co-fellows who were really, we are really close. They were like, one day we'll all start our own clinic and we can call it the lucky egg. And we were like, ha ha ha, so funny. And then I started thinking about it when I wanted to create a blog because I realized like, I felt that there was a need for long form content because so much of what I talk about is so nuanced and complex that I'm not gonna fit it in a three minute video or whatever. And so I said, okay, I'm gonna do this blog. And I thought about the name and I was like, you know what, it has a deeper meaning for me. I think that as a fertility expert, I have access to all this technology, all of this cutting edge science, but there are always those cases that bother us where we're like, why didn't that patient get pregnant? And then in between cycles, they all of a sudden got pregnant on their own. Or like, now we were at the level of surrogacy and it was like this crazy case of recurrent implantation failure, but then. The surrogate's pregnant, they're pregnant, like everyone knows about these cases. And at the end of the day, I think what it illustrates is it's very humbling and it's important for all of us to stay humble and be honest with our patients and the greater public that science can get you very far and it's very important, but there's always room for hope. And I think that people get too boxed in, speaking of low AMH or even age, right, into these categories or stats. And at the end of the day, you can get pregnant without my help in your late 30s or your early 40s. Do I want everyone to rely on ovulating a lucky egg and just say, let's just leave it up to luck? Of course not. But I want people to feel hopeful and not feel labeled or that, you know, it's just this cold clinical thing where, okay, you're 43, so you go in this category. It's like, no, we don't know, we don't even have a test for egg quality. So let's admit the things that we don't know. And that's really why I called this book, The Lucky Egg, because I believe that... Everyone has every reason to be hopeful. It's all about having the right information so you can move forward with that confidence and hope and a sense of realism as well, you know, and it's really about having that balanced, honest viewpoint of my field. Yeah. Well, Dr. Seekon, thank you so much for sharing so much with us. I've learned so much. Thank you for sharing your personal stories. I think it always takes a lot to be vulnerable when we share our own medical stories with people. And I don't think that's always appreciated enough that when doctors share their own struggles that it actually takes a lot out of us. So I appreciate you sharing with us. For the people not following you, where can everyone find you online? Well, I'm mainly on Instagram at Lucky.Seekon. S-E-K-H-O-N. I'm on TikTok at DrLuckyEgg. I don't know how you post on both. I'm like better on Instagram than I am on TikTok. But I'm trying to... Be better about that. I got my blog, theluckyegg.com, and then obviously my book of the same name, and it's everywhere, and there's an audiobook that's narrated by me as well. That's amazing. Thank you so much for being here and sharing with us today. Thank you for having me. I had a blast.