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Hi, I'm Dr. Serena H. Chen.
0:00
I'm a reproductive endocrinologist and fertility specialist, and I'm here to answer your questions on Twitter.
0:05
This is Fertility Support at Fertility Unit asks, do you know how often you should have sex if you're trying to conceive #fertility?
0:20
You don't have to have sex that much, actually, twice a week.
0:22
So have two dates a week because the good sperm will stick around in the fallopian tubes for a few days.
0:29
So if you have sex twice a week, then you always have some sperm in the tubes waiting for the eggs.
0:33
So it's a myth that you have to precisely time intercourse with the release of the egg, or that you have to have sex 10 times a day and that makes your fertility higher.
0:46
It actually doesn't.
0:46
I think you just get a little tired.
0:48
At Wonder asks, does anyone know if #COVID19 affects #fertility asking for a friend?
1:07
Everybody wants to know the answer to this question, and the truth is, COVID-19 does impact fertility.
1:07
The vaccine does not, which is why we really want you to get vaccinated.
1:07
We are asking all our patients trying to conceive and pregnant to get fully vaccinated because we know that the vaccine has been found safe in people trying to conceive, both men and women, and safe in pregnancy.
1:07
We know that COVID-19, the disease, actually does have a powerful negative impact upon your fertility, especially if you get really ill.
1:29
If you're mildly ill, you will probably feel temporarily bad.
1:33
The sperm count might go down for a couple of months, just like any febrile viral illness, but then you will recover.
1:41
You might have irregular periods for a little bit, but then again, you might recover.
1:47
But severe disease can have a more severe impact upon your fertility.
1:55
At Casus asks, okay guys, I've been watching Nova on PBS.
1:57
A fertility scientist just said on average, men today have about half the sperm count our grandfathers did.
2:02
Causes: environmental, obesity, chemicals, etc.
2:05
This is a fascinating question.
2:08
People's sperm counts have been declining, and I would say compared to like, say, the 1900s, the average sperm count is about half that of what it used to be.
2:20
We don't really know the reason why, but certainly things like toxins in the environment and our lifestyle probably have something to do with this.
2:59
Scientists are definitely working on this because we can't have sperm disappearing altogether.
2:59
The good news is people are still making millions of sperm.
2:59
I don't think we're going to completely get down to zero for everybody that soon, but I think this does emphasize that we should all try to lead a healthy lifestyle and avoid toxins.
2:59
At Egg Freezing PR asks, does freezing your eggs mean that you definitely want children in the future, or is egg freezing more about having the option later on in life?
2:59
Let me know your thoughts.
2:59
Mother Nature kind of designed us to have 10 kids by the age of 25.
2:59
That's kind of how our bodies are designed.
2:59
10 kids by the age of 25, die of exhaustion by age 35 to 40.
3:12
That's it.
3:15
Obviously, we don't do that anymore.
3:18
People are, you know, going to school, they're getting jobs, they're living life and having babies later, and that means you're having babies when your eggs are less fertile.
3:26
People are really interested in freezing eggs to try to preserve their eggs at a younger age.
3:29
At Fertility Preo asks, how come men don't have a fertility clock?
3:36
Haha emoji.
3:36
Men definitely have a fertility clock.
3:39
You cannot delay childbearing forever.
3:41
Maybe you should think about freezing your sperm before you turn 40, because once you are 40, we do see some higher risks for older men having children with schizophrenia and autism.
3:55
So you do seem to have a fertility clock.
3:58
The quality of sperm does seem to decline with time.
4:00
At Jenny Jal asks, fun fertility question of the day: what's the difference between artificial insemination and official insemination?
4:17
#actualquestion
4:17
So official insemination doesn't actually exist.
4:17
Artificial insemination is the process of putting sperm into the female by any means other than sexual intercourse.
4:17
It's artificial, you're getting the sperm in an artificial way.
4:17
Now, there's a lot of ways to do artificial insemination.
4:17
The way fertility specialists typically do artificial insemination, we wash the sperm, get rid of all the semen because the semen is the liquid.
4:17
It's like a tidal wave coming out of the penis.
4:17
It helps the sperm get out of the penis and into the body or into the specimen cup, but that liquid we really don't need.
5:00
When you have sex, all those chemicals in the semen are filtered out by the cervix and they do not go into the fallopian tubes where fertilization takes place.
5:09
We get just the sperm in a tiny little droplet of fluid, and we put it in a little syringe.
5:16
This is called an insemination catheter.
5:18
This is a particular type of insemination called IUI, intrauterine insemination.
5:30
And we actually put a speculum in the vagina and then we see the cervix and this little tube goes right through the cervix, the vagina into the cervix.
5:30
I don't know if this is actually open.
5:30
No, this is not an actual working model.
5:30
Into the uterus, and then we inject that little tiny bit of fluid in the good sperm immediately are in the fallopian tubes hanging out waiting for the egg.
5:54
And you might have a little leaking, you might have a little cramping, you might see a little spotting, but you can get right up and go.
5:59
We don't believe in waiting, that doesn't increase the pregnancy rate.
6:08
At Susie Savage asks, why does a single round of IVF cost $15,000 in the United States and only $2,000 in Turkey, $6,000 in Spain, $3,300 in India, $3,150 in Russia, even $7,800 in Mexico?
6:14
One day, Big Pharma will pay for their crimes.
6:21
It is way too expensive in the United States.
6:23
Hopefully, we can get better insurance coverage, but right now it does tend to cost a lot of money.
6:28
The good news is that there are more and more states passing laws to mandate fertility coverage.
6:35
We are seeing more and more companies cover it because hey, reproduction and problems with reproduction should be covered, right?
6:42
Why is it treated like it's like a nose job, like elective plastic surgery these days?
6:52
Reproduction is essential for the continuation of the human race, so I'm with you, it shouldn't be so expensive, it should be covered.
6:52
At Daven Dove asks, so how does a pregnancy test work?
6:59
Well, at Davian Dub, I happen to have one right here.
7:05
You can get them from the drugstore or at your doctor's office, and usually the urine pregnancy test works by you give a small sample of urine, you follow the directions, you dip this into the urine and then wait for it to turn either positive or negative.
7:22
It's actually measuring something called HCG, Human Chorionic Gonadotropin.
7:34
That's a hormone that's produced by the placenta.
7:34
If that is in your urine, then it shows that you're pregnant.
7:34
You can also get a blood test at the doctor's office.
7:34
Once this turns positive, we want you to call us right away.
7:34
At Om My Mithan Mythra Deer asks, how does someone sign up to donate their uterus to somebody?
7:50
I don't want it, and transplants are possible.
7:54
Send me the sign-up sheet.
7:58
Uterine transplants, is that really a thing?
7:56
Yes, it is.
7:58
It has been done in the United States.
8:00
It's been done in other parts of the globe.
8:02
It's still kind of experimental, so you have to go to a big fancy center, University of Pennsylvania, Cleveland Clinic, where they are have a big team to do this type of thing.
8:11
Oh, maybe this uterus needs to be transplanted, but yes, uterine transplants are possible, but most people that don't want their uterus just go see their doctor to discuss that.
8:23
At Miron's asks, is there a law that puts a cap on the amount of embryos doctors are allowed to implant during IVF?
8:31
This is surprisingly hard to Google.
8:33
So ASRM, the American Society for Reproductive Medicine, recommends that we transfer only one embryo at a time because one baby at a time is the healthiest type of pregnancy.
8:46
Twins can be super cute, but a twin pregnancy is risky for both the mom and the baby.
8:50
We are usually transferring just one embryo with IVF.
8:52
IVF does have a higher identical twinning rate, so that's probably one of the biggest risks of IVF.
9:01
You can put one embryo in and there's a 2% chance that you could get two babies out.
9:06
If you conceive on your own, the chance that your embryo splits, the chance that you have identical twins, is only 0.5%.
9:13
So we should just put one embryo in.
9:19
Those are the current guidelines, but it's not actually regulated by a law.
9:19
At Patrice 576799 asks, what year was the first test tube baby born in America?
9:19
That was December 28th, 1981, so she is 40 years old this December 2021.
9:34
Her name is Elizabeth Carr and she's a big fertility advocate and author.
9:49
Test tube baby or IVF baby, in vitro fertilization, was a revolutionary treatment that has totally transformed our field.
9:46
A field where we really struggled to help people conceive and did not have very much success to a field where we can say if you can stay positive and healthy in mind and body and stick with the program, we can help almost anybody have a healthy baby.
10:18
At Jet L 91A asks, how much do they pay for semen at the fertility place?
10:18
Asking for a friend.
10:20
There's lots of great commercial sperm banks out there.
10:22
They probably have different rates, but um, I do think, you know, they compensate you well for giving the sperm.
10:31
You do have to be prepared to give some blood work and sign forms so we can make sure you don't have HIV, hepatitis, things like that.
10:40
We also want to make sure that your sperm is healthy and looks good and has good sperm counts and seems fertile, and then I think you're paid a pretty good rate, a few hundred.
10:58
At Mama KW99 asks, how long does it take pregnancy symptoms to go away after a miscarriage?
10:56
It usually takes about two to three months.
11:07
You still have the pregnancy hormones in your body and it takes about two to three months for those to clear out.
11:07
At HRC Fertility asks, what is a fertility doctor or fertility specialist?
11:17
Well, I'm a fertility specialist.
11:19
It means I am a board-certified OBGYN, obstetrician gynecologist, and subspecialty trained in reproductive endocrinology and infertility.
11:29
I see people who want to have a baby but are struggling, people who want to be proactive about conception, or people who want to freeze their eggs.
11:29
At Abomination asks, considering reciprocal IVF for round two.
11:29
Wife scared to retrieval, any tips?
11:29
Retrieval, that means egg retrieval.
11:29
What is reciprocal IVF?
11:29
IVF is in vitro fertilization.
11:29
Reciprocal IVF is a way for two women to conceive where one gives the egg and the other carries the embryo.
11:29
They're being reciprocal.
11:29
Normally, IVF is done in one person, you take the eggs out and then you put the embryos in, but this way you have two people involved, one's giving the eggs and the other one is carrying the embryo.
12:09
This is a great option for lesbian couples who want to both be biological moms.
12:28
At Tapia Izzy asks, egg freezing, anyone here gone through the process?
12:26
I haven't frozen my eggs, but I've been on the other side of it for a lot of people, and egg freezing is becoming more and more common, and that's because first of all, egg freezing is much better than it used to be.
12:41
We are really, really good at freezing eggs now.
12:43
There's a new technique or a new technology called vitrification with a V that's literally like plunging these eggs down to super freezing cold temperatures, 195 degrees centigrade.
13:03
At that temperature, the molecules are literally stopped in their tracks, and now the eggs yield pregnancy rates that are basically the same as using fresh eggs because we have figured out how to press the pause button.
13:03
Some insurance companies cover it, most of the time not.
13:03
It can cost thousands of dollars, so that's something to think about.
13:03
You give yourself injections with tiny needles for about 6 to 10 days.
13:03
You go to an IVF center, you get an IV in your vein.
13:03
They give you a little anesthesia, you go to sleep for about 10 minutes.
13:03
We put a very small needle into through the vaginal wall, one on the right side, one on the left side.
13:03
Then we pull the eggs out, 5 minutes for the right ovary, 5 minutes for the left ovary.
13:03
All the eggs are out, we put them in the freezer.
13:51
You wake up, you feel a little crampy, you eat a little bit, you walk around, go to the bathroom, and then you go home and your eggs are frozen.
13:59
I do think all women who are concerned about fertility, concerned about getting older and not ready to have a baby, but think they might want to in the future, to think about egg freezing as an option for preserving their fertility.
14:19
It may give you more options because your eggs are their most fertile when you're under 30, and we think the ideal time to freeze eggs is somewhere between your late 20s and early 30s.
14:35
At Anthropology asks, can we stop calling pregnancy over 35 geriatric?
14:43
Absolutely.
14:43
Why do people call pregnancy over 35 geriatric?
14:46
You are still young.
14:49
As you get older, we do start thinking about more risks.
14:52
So age of the pregnant woman is associated with certain risks, and doctors like to know that they have to do different things to lower those risks when they're treating somebody over 35, but I totally agree with you, geriatric seems kind of insulting and I don't think it's actually accurate, and I think probably some old, some old guy came up with that term, so yes, let's get rid of it.
15:27
At Ashley S asks, how much money do surrogates make?
15:24
Might be my calling.
15:24
In general, in the United States, I think ranges from 25, 30,000 to over a 100,000, depending upon the surrogate and the individual situation.
15:38
It can be a significant amount of money, but you're doing a really significant thing, carrying a baby for somebody for nine months.
15:53
At Buradoc One asks, do couples check their fertility level before getting married?
15:53
Asking for a friend.
15:53
Commonly, this is not done, but what if you have chronic medical conditions, like what if you've had cancer in the past or you've had pelvic surgery or you have a family history of infertility, polycystic ovarian syndrome, endometriosis or a genetic issue?
15:53
Those are all things you can talk with the fertility doctor about to try to minimize your risks and optimize your health.
15:53
At The Habanero Chef asks, sigh, why do I have a fever every ovulation week, like proper fever, chills, high temperature, body pains?
15:53
Cycles vary enormously and there can be a lot of different symptoms associated with your cycle.
16:38
Having said that, I think if your cycle symptoms are really bothering you, you should talk with your doctor about it, and your doctor should listen and try to address things and not dismiss you because you should find out what's going on and I don't think you should suffer every month.
16:59
At Stepping With N1 asks, chronic stress can negatively impact #endometriosis and #fertility.
17:06
Have you made any lifestyle changes to reduce stress to support your health and fertility?
17:12
Share tips.
17:14
The tips that I give my patients with infertility and endometriosis is you want to in general live an anti-inflammatory lifestyle, a healthy lifestyle.
17:30
So getting good quality sleep, 7 to 8 hours every night, eating a lot of veggies, avoiding sugar, getting regular exercise, you don't have to be a gym rat.
17:35
Also having a healthy mind, so trying to not to avoid stress but to learn how to handle stress in a positive way.
17:41
At Country Music Fan asks, feel like I have no control over my emotions all day today.
17:49
I'm not on any IVF meds anymore, so I don't understand what's going on.
17:52
Maybe my own hormones trying to regulate #IVF #infertility.
17:57
IVF is a powerful process and it does take a little time to recover.
18:08
It can also be kind of emotional because a lot of people going through IVF are suffering from infertility, which can cause a lot of stress.
18:10
So I think if you're concerned, please give your doctor a call and get checked out.
18:14
Those are all the questions for today.
18:17
Remember, please talk to your doctor because this is just information and not medical advice.
18:22
Thank you so much for watching, Fertility Support.