PRECONCPETION

005: How Can A Fertility Doctor Help You On Your Pregnancy Journey? w/ Aimee Eyvazzadeh MD

005

005: How Can A Fertility Doctor Help You On Your Pregnancy Journey? w/ Aimee Eyvazzadeh MD

Welcome to the Healthy Happy Mami podcast!

Our guest today is Dr. Aimee Eyvazzadeh, known as the Egg Whisperer. Dr. Aimee is well-known for her personalized approach to fertility care. We love Dr. Aimee because her approach begins with diagnosis before treatment. She’s developed something called the TUSHY method, which we’ll talk about today. It basically simplifies the approach to screening for the most common causes of infertility.

Dr. Aimee is a graduate of the UCLA School of Medicine. She did her residency in obstetrics and gynecology at Harvard. She’s fellowship trained in reproductive endocrinology and infertility. She has a Masters in Public Health from the University of Michigan, and she now has a practice in California. And, believe it or not, this superwoman is also a mom of four!

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In today’s episode we are talking about a conventional medicine approach to infertility.

Highlights:

  • When to seek out evaluation with a fertility specialist
  • Risk factors for infertility
  • Labs to have drawn if you want to evaluate your fertility
  • What else is involved with an infertility work up
  • AMH and why it’s an important lab
  • Infertility treatment methods and medications that are used
  • Age at which egg-freezing should be considered
  • Supplements that can be used to improve fertility and egg quality
  • Male-factor infertility and what your man needs to do get his sperm in shape for fertility

Important Links

Find Dr. Aimee online here and here

Quotes

“Early diagnosis is key to preventing infertility. And these basic things that we do once a year for some people, every few years for others, like a pap smear, don’t cut it. But people think that they do.”

“Only 25% of women can get pregnant with a healthy pregnancy over the age of 37.”

005: How Can A Fertility Doctor Help You On Your Pregnancy Journey? w/ Aimee Eyvazzadeh MD TRANSCRIPT

Dr. Maren:                          All right. Welcome back to the Healthy Happy Mommy podcast. In today’s episode, we’re talking about a conventional medicine approach to infertility. Our guest today is Dr. Aimee, known as the Egg Whisperer. Dr. Aimee is well-known for her personalized approach to fertility care. So, much like functional medicine, we love Dr. Aimee because her approach begins with diagnosis before treatment. She’s developed something called the TUSHY method, which we’ll talk about today. It basically simplifies the approach to screening for the most common causes of infertility.

Dr. Maren:                          So, Dr. Aimee is a graduate of the UCLA School of Medicine. She did her residency in obstetrics and gynecology at Harvard. She’s fellowship trained in reproductive endocrinology and infertility. She has a Master’s in Public Health from the University of Michigan, and she now has a practice in California. Believe it or not, this super woman is also a mom of four. How’d you do that? It’s amazing.

Dr. Eyvazzadeh:                With my husband. I’m just kidding.

Dr. Maren:                          I know. A good husband, right? A good partner. [crosstalk 00:01:12].

Dr. Eyvazzadeh:                Not only like that, but a husband that’s an emergency room doctor. I mean, that really helped because I worked full time, my kids are sick. I know that they’re better with him than me. Of course they love their mommy and want their mommy, but honestly they love him just as much as they love me.

Dr. Maren:                          Yes, I’m sure. And it helps… I don’t know. I have a surgeon as a husband, that would never work. Well, I have three kids, but if you added one [crosstalk 00:01:35] totally blow up. Alex is kind of in the same boat too, but…

Dr. Carrasco:                      Yeah, my husband’s a dermatologist, so yeah.

Dr. Eyvazzadeh:                There you go.

Dr. Maren:                          Yeah. It’s nice if the physician husbands understand the experience of being a physician. So, it’s nice to have that relation to kind of what we do.

Dr. Eyvazzadeh:                For sure. I mean, he doesn’t ask me what is for dinner when I get home, otherwise we would have an emergency.

Dr. Maren:                          Right. I’m sure, I’m sure. All right. Well, what we would like to sort of start with today is we want to know your advice on when women should seek out an infertility evaluation. So, most guidelines, including ACOG, suggests that women wait a year before, if they haven’t gotten pregnant after trying to conceive. Sometimes, obviously if women are over 35 weeks, lessen that to six months, but I think sometimes some women are missed. When do you recommend that women seek out help sooner?

Dr. Eyvazzadeh:                I think a year is just old school. It’s an old school way of thinking. I think back then when we made that recommendation, it was when these kinds of tests that we’re going to talk about today were very expensive, hard to get. And now that the cost of these tests have come down, I feel like we need to educate women about seeing a doctor, it doesn’t have to be a fertility doctor, when you’re ready to start your family.

Dr. Eyvazzadeh:                I mean, having a baby is one of the wildest trips of your life. You guys know what I’m talking about. And when people plan a cruise or a safari, most people go to a travel clinic and get all the maps out of where they’re going to go, what’s going to happen and what to prepare for and what vaccines they’re going to get. Pregnancy should be the same way. And early diagnosis is key to preventing infertility. And these basic things that we do once a year for some people, every few years for others, like a pap smear, don’t cut it. But people think that they do.

Dr. Eyvazzadeh:                People think that if they go in for their pap smear, their doctor is looking at their fertility at the same time. And they’re shocked and surprised when it’s like, “Oh my God, I have a fibroid that’s been sitting in my uterus and no one’s picked it up for the last 10 years that I’ve been going to the doctor.” That’s why I’m screaming at the top of my lungs and trying to educate people about what I call my Egg Whisperer golden rules. But these are just basic things that you can do to prevent infertility.

Dr. Maren:                          I love that.

Dr. Carrasco:                      Yeah.

Dr. Maren:                          I think one year is kind of old school too, so it’s good to hear. So, [crosstalk 00:04:05]. Take a year to prep. Totally. Get your new-

Dr. Eyvazzadeh:                Don’t wait. [inaudible 00:04:11] figure out.

Dr. Maren:                          And I think too some women have some intuition. If you have an intuition that something’s wrong, then go with that. Go get a workup.

Dr. Eyvazzadeh:                Right. Talk to your mom, talk to your siblings. Maybe your mom used fertility treatment for you and you didn’t know that. Those are the kinds of people that should get their fertility levels checked. If you had surgery on your ovary as a kid, don’t wait. If your husband’s balls are small, maybe you weren’t told by his mother, your mother-in-law that he was born with an undescended testicle. You don’t want to wait a year to find out that his sperm counts are really low and he’s been just barely functioning on one testicle. Those are the kinds of things to look for; family history of fibroids, endometriosis, early menopause. And then there’s tests that you can do to figure out if you’re at risk for those same things that we’ll talk about.

Dr. Maren:                          Okay. If a woman goes to her PCP or OB-GYN, what kind of labs should she ask for, for an initial eval? And maybe this is even if she plans to go see a fertility doctor as well and she wants to just have that be a more productive conversation. What kind of labs do you like to see?

Dr. Eyvazzadeh:                Great. This is the thing. People go to their doctor and then they come to me and they’re like, “I went to my doctor for preconception counseling appointment.” And I look at the test that they had done: HIV, hepatitis B, and a blood count. I’m like, “How is this a fertility evaluation?” For me, I want to know blood type and screen, a blood count, make sure you’re not anemic, your vitamin D, your prolactin level, your TSH, AMH level. If your doctor is savvy enough and it doesn’t like… You want your doctor to work within the field that they’re a specialist in. Sometimes checking a day three FSH estradiol just might not be something that they’re able to do because the concept of day three and when your period starts and stuff like that isn’t something that they can counsel you about.

Dr. Eyvazzadeh:                But an AMH is key. MMR titer, not just rubella, to see if you’re immune or not. Varicella titer, same concept. We lose immunity over time for some of these very common viruses that are still out there. And you want to make sure that you’re immune before a pregnancy. That’s my basic preconception panel. And if you’re a little bit on the curvier side, do other things. Hemoglobin A1C, lipid panel, comprehensive metabolic panel, make sure your liver function tests aren’t elevated.

Dr. Eyvazzadeh:                And then when you go into your fertility doctor or your OB-GYN, super efficient appointment. Your doctor can look at the levels and be like, “Yeah, it looks like you should have healthy eggs for women of your age. It does not look like you’re going to go into early menopause. And I think based on your family size goals, you would be able to get pregnant now and maybe again in two years without much help.” Of course, no one has that kind of crystal ball, but that’s the kind of information you want early on in your fertility journey.

Dr. Maren:                          Yeah. You’re going to love if you get any patients from Dr. Alex and I because you’ll have lots of labs, and our thyroid panel will be totally teed up, but talk to us about AMH just a little bit. Can you just tell our listeners what is AMH? How accurate is it? What should they expect from that number?

Dr. Eyvazzadeh:                Super. The first thing to know is your AMH level does not define you. You are not defined by this number. The other two things I call it… it is, medically speaking, Anti-Mullerian hormone. It’s a hormone secreted by cells that surround the eggs: the higher the level the more eggs you have, the lower the level the earlier you’ll go into menopause, okay? But I also call it Always Meandering Hormone and Always Mean Hormones. It fluctuates, and your eggs, they don’t disappear overnight, they disappear over time.

Dr. Eyvazzadeh:                If someone tells you, “You have a low level,” don’t freak out and think you’re going into menopause tomorrow because you’re not, because if you’re someone who’s 30, that level can stay perfectly stable for several years before it starts going down. And inevitably, we all run out of eggs. Most of us run out of healthy eggs, it’s actually the age of 37, right? Only 25% of women can get pregnant with a healthy pregnancy over the age of 37. And people look at me like I’m an alien when I say that because they see within the magazines and People Magazine, for example, of all these celebrities having babies.

Dr. Eyvazzadeh:                But if you’re a patient of mine and you’re over the age of 37, especially over the age of 40, you get it. That’s how AMH can help. And the thing is that if you’re on birth control pills, they can trick you into thinking you’re fertile when you’re not. So, checking your AMH is super important every year, for example. If you have an IUD in, same concept. You might not have any periods or think that it doesn’t matter that you’re not on your period and you have no way of knowing if you’re running out of eggs or not.

Dr. Eyvazzadeh:                Then postpartum get your AMH level checked. The first thing that happens when we go into our postpartum visit, we’re all looking at each other really tired and exhausted, and we have that mom look. And then the OB-GYN is asking you what kind of birth control pill to use, right? But if you were my patient, I would ask, “What’s your AMH and how are we going to plan your next pregnancy? Should we consider freezing eggs, embryos, sperm, or all three?”

Dr. Carrasco:                      That is such awesome info.

Dr. Maren:                          Yeah, agreed. Okay. One of the things we both love and have been sort of tuned in on with your work is what you call the TUSHY method. I think that this is a great way to really simplify an infertility workup, so it’s not like speaking French. Can you walk us through how you use that and what the most common causes of infertility are?

Dr. Eyvazzadeh:                For sure. Life’s difficult enough, fertility challenges are so hard. Getting your fertility checked is easy and it should be easy. And there are five things that you can do to get them checked. The T stands for fallopian tubes, and the test that we do most commonly is called the hysterosalpingogram, HSG. Uterus stands for… Sorry, ultrasound, I gave it away, checking the uterus. The S is a sperm test, semen analysis. H is for the hormones, the labs that we just talked about, and then the Y is your genetics, and people don’t do enough genetic screening. And I think it’s so important that people do a carrier screen and even a chromosome analysis now. These tests used to be so expensive, so cost-prohibitive. And now they’re hundreds of dollars versus thousands. That’s why I like to get these tests early on so that you don’t find out years later you should have done them at the beginning of your journey.

Dr. Carrasco:                      Yeah, I know.

Dr. Eyvazzadeh:                And then the other thing you asked, the most common causes of infertility, I mean, tubal factors. We know chlamydia rates are pretty… I mean, a lot of people have chlamydia. It’s not a big deal, but they can affect the patency of the fallopian tubes. Sperm counts have been going down every generation. Everyone’s smoking weed and pot and drinking too much, especially now more than ever.

Dr. Maren:                          Yeah. [crosstalk 00:10:44].

Dr. Eyvazzadeh:                Exactly, especially during COVID. So, getting a sperm check is really easy. And then as we wait longer to have babies, age-related infertility is common. That’s kind of what happens as we get older for everybody and it doesn’t matter how amazing you look on the outside or how much Botox you’re doing. I use J-Lo as the example.

Dr. Eyvazzadeh:                If you were to ask someone, does J-Lo look fertile to you? She looks fertile. Girl should be able to have babies right now, right? She’s not. I mean, she’s over 50 years old. She doesn’t have a single egg in her body that can turn into a pregnancy. And I don’t mean to offend J-Lo.

Dr. Carrasco:                      Yeah. [crosstalk 00:11:22].

Dr. Maren:                          We love her.

Dr. Eyvazzadeh:                I love her, but that’s the reality. And I feel like people expect me to have this superpower and be able to like regenerate eggs that they just don’t have, and the science isn’t there. We’re just not there yet.

Dr. Carrasco:                      For our listeners who are 40, or between 40 and 45, who maybe waited a little bit to have their first child, what would you say, percentage wise, what’s the chance of having a healthy, natural pregnancy and getting pregnant on your own versus needing infertility support?

Dr. Eyvazzadeh:                Yeah. My general recommendation is if you’re 40, interested in having a baby, see a doctor right away, and don’t delay. I tell women who are over 40, who are seeing me, “Think of this as work,” and that’s it. You got to take the emotional part out of it and let go all those regrets from your past. You made a choice to have a family at 40, and you made a choice to do that at a time where most of your eggs will not be viable.

Dr. Eyvazzadeh:                And when any woman says, “I choose pregnancy,” you also have to accept, “I also realized that I could have a miscarriage or a pregnancy that might result in a baby with other abnormalities, for example, like autism.” Okay? We got to be real with these women. We got to tell them the truth. And when I also tell them it could take four to six IVF cycles to even get one healthy embryo, and no matter what your hormone levels are, you may not have a healthy egg left.

Dr. Eyvazzadeh:                Age is the most accurate predictor of pregnancy rate over any of your hormone levels. And you can’t take it personally. I mean, you got to control what you can and surrender all the rest. And I feel like if a woman’s ready to have a baby at 40, what is she? She’s successful. She’s smart, she’s ready, but she might not have viable eggs. And that’s really hard because you’ve controlled all these other things in your life. And then you’re like, “Well, what can I do? What can I eat?” And I’m like, “You can’t.” It doesn’t matter who you are. If you’re Jennifer Aniston rich or Celine Dion rich. It doesn’t matter who your doctor is. It doesn’t matter what protein shakes you’re drinking. You’re either going to have an egg or you’re not.

Dr. Eyvazzadeh:                And there’s so many amazing ways to build a family. It doesn’t have to be with your own egg. And at some point, most of these women have to choose, but what I’m trying to say is they have to pick having a baby over doing it with their own DNA. And then they soon realize that their own DNA really doesn’t matter, and it’s just a matter of having a baby.

Dr. Eyvazzadeh:                But it takes time to get there. And so I truly believe in the fertility of every woman who comes to see me, no matter her age. At 45, a chance of a woman getting pregnant is about 1%. At 44, it’s about 2%. At 43, maybe 4% to 7%. At 42, maybe 7% to 14%. At 41, depending on your hormone levels, maybe at most 10% to 15% with IVF, and at 40, maybe 10% to 15% as well. But of course, if your AMH is, let’s say, less than 0.6 and your FSH is over 12, you’re in the less than 5% category. Even at the age of, let’s say, 38.

Dr. Maren:                          Wow. But still lots of hope because there’s a million other- [crosstalk 00:14:28].

Dr. Eyvazzadeh:                Oh, for sure. The thing is, when a man shows up to my clinic, I’m not like, “Well, there’s these sperm banks.” If you have one sperm cell. So, when a woman shows up here and she’s like, “I got an egg,” I’m like, “Well, let’s go get it.” But at the same time, it’s devastating to go through treatment that doesn’t work.

Dr. Maren:                          Yeah. They’re costly, right?

Dr. Eyvazzadeh:                Yes, they’re costly. So, if you went in saying, “Well, I expected you to turn one egg into 10 eggs, Aimee. [inaudible 00:14:52] can give me a blastocyst that was normal.” And I’m like, “No.” I feel like in order to have a good experience through the treatment, you have to know what the right expectations are, and you have to know what all your options are if something doesn’t work.

Dr. Eyvazzadeh:                I want people to spend time as parents, not as patients. I don’t want people to be on this IVF path six cycles, 12 cycles. And now they’re 48, spending five years of their life doing IVF when they could have spent that time being pregnant and raising their kids.

Dr. Carrasco:                      Yeah.

Dr. Maren:                          And the emotional toll is so high. I mean, there’s the financial expense, but then there’s the emotional expense as well.

Dr. Eyvazzadeh:                Right. It causes anxiety, depression, worsening of anxiety depression. And then right now in COVID, it’s the worst, especially if you’ve experienced a negative pregnancy test after a transfer or, even worse, a miscarriage right now. It’s really hard on my patients who are going through that.

Dr. Maren:                          Yeah, totally. I want to dive into hormones just a little bit. You mentioned checking a day three estradiol and FSH. What other hormones do you check besides from thyroid hormone? What about progesterone?

Dr. Eyvazzadeh:                Yeah, progesterone’s an easy test to do. It’s typically done about eight days after ovulation. That’s when it peaks. So, if you just Google image, for example, hormones during a menstrual cycle, you’ll kind of see how your hormone levels have changed over the cycle.

Dr. Eyvazzadeh:                I give progesterone out like water to a marathon runner. I believe that there’s no unsafe amount of progesterone. It can only help, unless of course it makes you super dizzy and that’s usually because your natural levels are so high. So, I don’t check it because I give it to everybody. If I’m prescribing progesterone to my patients who are trying to get pregnant, there’s no need for me to check it unless of course you’re in treatment and certainly we do check it in those kinds of scenarios. But for patients who, let’s say, have a doctor that doesn’t “believe in progesterone checking,” there are do-it-yourself test that you can… Actually, I think I have a kit here.

Dr. Eyvazzadeh:                There’s a test called Proov, P-R-O-O-V kit. And that’s like an LH test that you can do that looks to see if you’re making adequate progesterone, it measures the metabolite of progesterone in your urine, just like an LH test, and then a test for ovulation. So, I think progesterone testing isn’t something that I do as a diagnostic tool, but I do listen to my patients. I have patients who come in and they describe cycles that seem like maybe they’re not making enough progesterone, and then I’ll check it. And then testosterone is another hormone as well that I check, especially for patients who might have symptoms of PCOS.

Dr. Maren:                          Yeah. And then what about DHEA? Because I know, obviously with too much DHEA, we’re more concerned about PCOS, but is there a role for low DHEA and using DHEA as a supplement with fertility?

Dr. Eyvazzadeh:                I think so. Yes. I don’t know… And that’s not necessarily a screening test that we do for everybody. However, I do use testosterone, for example, as a marker, especially for older women who have a low egg count. We do use DHEA as something that could potentially improve egg quality, but I don’t use it on everybody.

Dr. Eyvazzadeh:                And the reason is as the DHEA levels rise, so do your testosterone levels, and I don’t think that high testosterone is good for egg quality. And I know a lot of clinics, we all have our own special sauce and our way of doing things. Just because I’m sharing how I do things doesn’t mean if another doctor, let’s say, really believes in having patients take a lot of testosterone doesn’t mean that’s necessarily bad. It’s just not something that I like to do.

Dr. Carrasco:                      Yeah.

Dr. Maren:                          Yeah. Alex, do you want to add any questions? I want to talk about some treatments, but…

Dr. Carrasco:                      No, I think we can dive into that. This is just such a… I love everything that you’re sharing, Dr. Aimee.

Dr. Eyvazzadeh:                Thank you, Alex.

Dr. Maren:                          Obviously, fertility treatments are very individualized sort of personalized thing that you make after you see a patient, you know their diagnosis, but can you just give our listeners an idea of what do infertility treatments look like? What kind of treatments exist?

Dr. Eyvazzadeh:                Mm-hmm (affirmative). There’s three questions that I ask patients at the beginning and it’s, “What do you want? What is it going to take to get what you want? And are you willing to do it?” And so based on the diagnosis, then we can answer those three questions and then I can talk them through the different treatment options, what their pregnancy rate will be, and then whether it will help them reach their goals.

Dr. Eyvazzadeh:                First, we have the Turkey Baster approach, also known as IUI or intrauterine insemination. So, you can do intrauterine insemination with or without fertility pills. I generally recommend doing it with fertility pills because then you could ovulate more than one egg. And that’s two tries in one cycle, but we don’t like three or four tries in one cycle, depending on your age, though. For some patients who are, let’s say, over the age of 42, I actually want them to ovulate as many eggs as I can safely get them to ovulate, if we’re using the IUI approach, and that’s because we know that the egg viability is so low at that age.

Dr. Eyvazzadeh:                However, if you’re 33 or 32, I don’t want you ovulating three or four eggs. The goal is really to help you ovulate two or one, not to give you the highest chance of having twins or triplets, but really again, to help you achieve one single healthy pregnancy. You can do IUI with fertility pills and you can also include injectables, also known as fertility shots. So, aside from IUI, then we move to IVF.

Dr. Eyvazzadeh:                IVF is a technology that allows us to create embryos. An embryo is an egg and sperm combined together. So, through a system of taking shots every single day for about two weeks, extracting eggs from the ovary, that’s called an egg retrieval, it’s kind of like a blood draw in your ovary. It’s done usually while you’re asleep at most centers. Then about five days later, you have two options. One option is to put an embryo back in your uterus and that’s called a fresh embryo transfer. And the second option is to freeze the embryos, let your body calm back down, get back to normal, and then we do something called a frozen embryo transfer.

Dr. Eyvazzadeh:                And then you have two options with that. One is to do it with genetic testing or without, so you can find out for example, which embryo has normal chromosomes first, and then kind of similar to IVF, there’s egg freezing. And I just call egg freezing IVF without the F, right? For some people, they don’t want to have fertilized embryos, or they want both; they just want eggs and embryos, or you want to preserve your fertility, maybe you’re not too into your husband anymore. Don’t tell him that. You can tell me that, but I won’t tell him that. So, you don’t need your husband’s permission, people, to freeze your eggs.

Dr. Eyvazzadeh:                And sadly, there are relationships that sometimes end and patients do see me in that situation where they’re like 39 years old. They don’t have a child yet, but they’re married and they’re thinking that maybe this relationship won’t last. So, egg freezing is something that younger women can also do, even as young as 20 to 25, to preserve their fertility. And it’s the same process that I just explained. Then we also have donor egg IVF where we use the eggs of someone else combined with the sperm source of your choice. And we just get your uterus ready for a transfer.

Dr. Eyvazzadeh:                And you could be, and I’m not asking anyone to be 70 years old to do this, you just need a uterus, that’s it. We can mimic pregnancy by giving you hormones. And I think that’s… I call it menopausal pregnancy and I want to educate women about it because a lot of people feel like, “Oh, donor egg is not for me. Donated embryos aren’t for me because I’m not having regular periods.” And the thing is, that’s not true. I take control. I tell your uterus what to do when, and we get that embryo in and you can certainly have a healthy pregnancy without even having ovaries. So, that’s just a quick rundown of all the options.

Dr. Maren:                          Yeah, there’s a ton, right?

Dr. Eyvazzadeh:                [crosstalk 00:22:04].

Dr. Carrasco:                      Last year, it came out a story of a… Wasn’t there a woman here in the United States who had a child for her son and his husband? She was 65. It’s just so awesome.

Dr. Eyvazzadeh:                Right. Totally. I love that.

Dr. Carrasco:                      One question that I have for you is, at what point would you tell a woman that she needs to freeze her eggs or that she should consider it? Because I think that we are probably seeing a lot of patients in that category and it doesn’t come up necessarily often during a patient visit. So, who should we be advocating for or asking these questions to, and then sending them on to think about doing that?

Dr. Eyvazzadeh:                Great. Don’t be afraid to talk to women as young as 21 about it, especially if their mom had them through IVF or fertility treatment, if they have symptoms of endometriosis, if they’ve had chlamydia, for example, that might be a sign that they have blocked fallopian tubes or decreased supply of eggs. Get their AMH level checked and see where they’re at. And then you can decide if it’s something that they should be thinking about now, or can they wait until they’re, let’s say, 25 years old?

Dr. Eyvazzadeh:                I think every woman should have her AMH level checked at the age of 25 to ask those same questions. Is this a good time for her to do it depending on our family size goals? Or should she wait? And then at the age of 32, I recommend egg freezing for every woman who wants at least two kids and doesn’t have one already. Just think about it, talk about it. And then she can make a decision that’s right for her. And then based on her hormone levels and her goals, then she can decide if that’s something that she wants to do now or wait.

Dr. Eyvazzadeh:                And then at the age of 37, if you already have one baby and you want a second, I highly recommend that you strongly consider going right to a fertility doctor getting your levels checked to consider embryo freezing or egg freezing.

Dr. Carrasco:                      That’s excellent information. Thank you.

Dr. Eyvazzadeh:                You’re welcome.

Dr. Maren:                          Yeah, agreed. Okay. So, I want to pick your brain a little bit about the BALLS Method. We interviewed Geo Espinosa, who’s a naturopathic doctor focused on urology and male fertility, but I want to know your approach because I love the way you break it down, just like you did with the TUSHY method. So, walk us through like what you think about with that sperm piece.

Dr. Eyvazzadeh:                For sure. And I feel like we sugar coat sperm results all the time. I see women, they come in and they’re like, “I have unexplained infertility,” and then I go through their situation. They’re like, “Yeah, the sperm is slow, but they said it was good enough.” I’m like, “Huh? You just told me your explanation and why are we sugarcoating it and making it seem like this isn’t a big deal when it really is?”

Dr. Eyvazzadeh:                I came up with the BALLS Method to help people understand what they can do if they have a low sperm count. It’s really easy. The B stands for background genetics. There’s a test called a sperm DNA fragmentation test that can help clarify what’s going on with sperm. I think of it as a traffic light. So, if the sperm DNA fragmentation is really high, then that tells me yellow or red light, let’s figure out what’s going on. If it’s good, despite having a low sperm count, then I say green light. You can still move forward with treatment. If it’s, let’s say, really good, but the sperm count is low, you’re definitely greenlight for IVF, but maybe skip over natural conception or IUI if the sperm count is low.

Dr. Eyvazzadeh:                Then we have A, which is anatomy. Don’t Google image varicocele just because you’re just going to see a bunch of saggy balls with lots of little veins on it. You’ll be horrified. So, trust me and don’t Google varicocele surgery either. And especially don’t show that to your husband, unless he’s being a douche. Then you can show it to him. But a varicocele is a really common finding. Some studies say 15% or 30% of all guys with low sperm counts will have a varicocele, just like a varicose vein in our legs. Guys get them in their balls. They can just develop over time. There isn’t necessarily a risk factor like being overweight or not. I’ve seen really fit guys have it, I’ve seen overweight guys have it. And so, removing a varicocele can improve sperm quality and count.

Dr. Eyvazzadeh:                But the thing is, you’ve got to look at the couple together. If, let’s say, a guy has a varicocele, but the wife is 43. I mean, we don’t have time to fix it, right? We just got to see if the DNA fragmentation is good. Maybe add other things to the IVF cycle, like ZyMot or [inaudible 00:26:16], other things that can improve embryo quality and screen out abnormal sperm cells during that IVF process.

Dr. Eyvazzadeh:                And then the L for BALLS is labs. So, just like we check hormones for women, we got to check hormones for men. Look at the testosterone, look at the thyroid, look at the glucose. Make sure that the guy is as healthy as he can possibly be, so he can give us the most amazing sperm cell on the day that we need it most, which is when we’re ovulating, when we’re doing our IUI or when we’re doing the egg retrieval. I don’t like sperm emergencies. Don’t give me bad sperm.

Dr. Eyvazzadeh:                And then the other L is lifestyle, right? I mean, we’re constantly telling women, “Take supplements, exercise every day, sleep at least seven to nine hours. Take your vitamins.” We need to tell guys the same thing. It is so important they decrease stress, have a plant-based diet, try and minimize animal protein and processed foods. I lecture this to my patients all the time and I want everyone to hear this as well. Guys, you can’t just sit at home, drinking your beer and eating your pizza and have your wife hopped up on hormones and have her not hate you, if you don’t change your lifestyle. She will love you if you say things like, “What can I do for you? How can I help? Are there any supplements I can take?” I promise you, she will adore you even more than she already does.

Dr. Eyvazzadeh:                And then the S is sex life. We got to talk about it, right? I mean, I see patients where I’m, “When was the last time you had sex?” And they look at me, and I swear I can hear the crickets. And I’m like, “Last month? Two months ago? Three months ago? Four months ago?” And it’s like they’re trying to conceive, but it’s really, they’re so stressed out they’re not having sex. I think having those honest conversations with people, and the BALLS Method will allow patients to go into their doctor and being like, “I’m not having sex. This is what’s going on. I don’t know why I can’t get it up. Help me.” There could be a medical reason why, it can be psychological. And there are doctors that can help with all of these different causes.

Dr. Maren:                          100%. I want to pick your brain a little bit on medication. Tell us about, I don’t know, the four or five most common medications you use. What are they? What do they do? When are they contra-indicated?

Dr. Eyvazzadeh:                For sure. First, Clomid. Clomid is one of the most commonly prescribed medications in this country, and I would think that there should be a huge warning and say, “Talk to Dr. Aimee first before you take this drug.” I swear to God, it should be nicknamed Clomonster. Or there should be an insert inside the Clomid prescription to a local Catholic church for your exorcism once you’re done with it.

Dr. Eyvazzadeh:                I feel like people don’t talk to their patients enough about their other problems like anxiety and depression, and Clomid can exacerbate and worsen those symptoms. And especially if you have endometriosis, it makes your estrogen levels skyrocket, and it can also potentially worsen endometriosis. There definitely is a role in some places for Clomid, but it’s not a medication that I use in my practice for the reasons I just described to you, that it can affect your mood, it can worse endometriosis, it can also thin out your linings. Now, in some cases it could actually be an anti-fertility pill when it’s intended to be used as a fertility pill. That’s Clomid for you. Anybody want a prescription? That’s a joke.

Dr. Eyvazzadeh:                Okay. Then we have Femara, and I was trained on Femara. We started using it around 2005 from Canada. Femara is used to prevent breast cancer. Obviously it doesn’t cause cancer if it’s being used to prevent breast cancer. So, that’s a win. It’s really cheap now. The generic version is called Letrozole. It’s easily accessible. It’s generic. It used to be super expensive, but now it isn’t. We use it similar to Clomid and it doesn’t thin out the line, doesn’t make you feel like a crazy person.

Dr. Eyvazzadeh:                Once in a while, a patient will have hot flashes, similar to the hot flashes that they get from Clomid. The most common side effect is maybe a dull headache in the beginning. Clomid can cause really bad headaches the whole time, and maybe some lower leg cramps. And it doesn’t mean you’re forming a blood clot.

Dr. Eyvazzadeh:                The other medications that we use are the injectable forms like Menopur. I joke and call it Menopur because it’s way more fun than saying Menopur. And then there are other forms of gonadotropins, like Gonal-F and Follistim. They all basically do the same thing. These are hormones that talk directly to your ovary to get the eggs to grow, whereas when you take the pill, they tell your brain to send the FSH signals to your ovaries to get the eggs to grow. So, the injectables are going to be a little bit stronger than the pills.

Dr. Eyvazzadeh:                And then there’s the other medication that I think should be renamed. It’s called the trigger shot and it induces ovulation. And I wish that there was a better name for it because I mean, if I wasn’t in the fertility world and someone said, “I’m going to give you a trigger shot.” I’m thinking it’s something that’s violent and then my ovary is going to explode. And I always tell patients, “It’s just a very small injection that literally will help with egg maturation and I’m sorry that it’s called something so horrible.”

Dr. Eyvazzadeh:                That’s a very common medication that we use to best time egg retrieval, to best time IUI. And even to help patients time their natural intercourse or timed intercourse at home. And then there’s progesterone and we talked about it that we prescribed typically after ovulation, up until about 10 weeks of pregnancy, depending on your situation.

Dr. Maren:                          Awesome. So, I want to know too if there is any supplements that you like or recommend for women who are going through fertility treatments.

Dr. Eyvazzadeh:                Absolutely. I have a special sauce for the different types of fertility diagnosis, or for example, women who have PCOS. If you have high testosterone, for example, I recommend inositol, myo-inositol, N-acetylcysteine, lipoic acid, CoQ10, and I’ve also seen some more recent studies looking at melatonin as helping women with PCOS to help with egg maturation.

Dr. Eyvazzadeh:                And then my basics are always prenatal fish oil, vitamin D for everybody. And then in addition, add these other things that I just mentioned. For endometriosis, same thing, anti-inflammatory CoQ10 for both PCOS and endometriosis, but also adding an N-acetylcysteine. Studies have shown that might slow the progression of endometriosis. And then I have my special sauce, so to speak, for women who have poor egg quality, low egg quality, or are older and still just want to take advantage of whatever they can that’s available to them to help their egg quality.

Dr. Eyvazzadeh:                So, that includes supplements like acai berry, Pterostilbene, it starts with a P-T-E-R-O stilbene. NAD, I use and I’ve no professional relationships or business relationships with any company, but I recommend the brand TRU Niagen. And then I also prescribe HGH, that is prescribed. It’s not available to every patient in every state, but HGH has been shown in some studies. Again, I use “some” in air quotes. I don’t know why some patients respond better to it than others, but it might help egg quality for some women. And that’s an injectable medication that you would use maybe a month or two before your IVF cycle or also within your IVF cycle.

Dr. Maren:                          Awesome. That’s gold right there.

Dr. Carrasco:                      Yeah.

Dr. Eyvazzadeh:                Yeah.

Dr. Maren:                          Well, we have enjoyed talking to you so much. You’re a wealth of knowledge and truly a freaking superhuman.

Dr. Eyvazzadeh:                Thank you. Back to you guys.

Dr. Maren:                          So, tell our listeners where they can find you.

Dr. Eyvazzadeh:                I’m easy to find. DrAimee.org, D-R-A-I-M-E-E.org. You can find me on YouTube, just put in Egg Whisperer on iTunes. Same thing, just put in Egg Whisperer Show. You’ll find my podcast there. You’ll find my YouTube show. And I’m on Instagram as well, under Egg Whisperer. And I love hearing from people, answering fertility questions. I’m that person that’s like, “You have a problem? Find me, I’ll help you with a solution. And if I can’t be that solution, I’ll definitely find a doctor in your area who would be able to help you.”

Dr. Maren:                          That’s amazing. Wonderful. Thank you so much.

Dr. Eyvazzadeh:                You’re welcome.

Male fertility issues contribute to about 50% of all infertility cases. So knowing how to support fertility and better sperm health is important for healthy conception.

Our guest today is Geo Espinoza, ND, a naturopathic functional medicine doctor who is recognized as an authority in urology and men’s health.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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