When to Take the Plunge…Am I Getting Hot?

Arguably the most popular question we are asked, whether in our office or in the Women’s locker room, is when I should freeze my eggs (a.k.a. at what age). And while in our office we can give you a personalized opinion, it’s hard to tell you exactly what to do while waiting in the shower line (although we will try). But what we do tell everyone (friends, patients, and gym acquaintances) is that the reason to freeze and when is often very personal. And although there are better times to do it, there is really no best time. Here are three tips that should get you “hotter” to getting your eggs “colder.”

  1. How old are you?
    Although you may not look a day older than 25, no matter how much sunblock you use, how healthy you eat, or how many times you hit the gym your eggs don’t really care. Egg quantity declines from the moment you take your first breath (and actually even before that!). Nothing you do or don’t do (minus a bad tobacco habit) will halt egg decline, except egg freezing. Egg freezing offers you the chance to freeze a subset of eggs at a particular age, whatever that age is. And just as egg quantity decreases as you age, so does egg quality. Therefore, the younger you are when you freeze eggs, the better quality those eggs will be. So, while yes, it would make sense for us all to freeze our eggs in our twenties when our eggs are at their peak, most of us won’t need to freeze our eggs. Most of us will not experience infertility and will not need to use frozen eggs to achieve a pregnancy. With all of that being said, if you are looking for that magic age at which you are getting “hot” to the “cold,” we would suggest that you pencil egg freezing into your calendar on your 32nd birthday. For most women, 32 offers you a balance between good egg quality and adequate egg quantity at not too premature a point in your life. Happy birthday!

2. Where are you in your relationship?
While we are not asking you to check the single or married box, we are asking you to evaluate where you are in your relationship. Is it serious, are you on the same page about having children, what is your timeline (and do your timelines match up)? Although these are very rarely fun conversations to have, they are super important. Men will make sperm for nearly their entire lives. They can wait way longer than we can to pull the goalie. Make sure he (or she) knows what you want—and when. This should help you decide when and if you should freeze your eggs.

3. What happened in your past?
We are not here to judge; trust us (we went to college, too!). The past that we want to know about is your medical and GYN history (medications you have taken, surgeries you have had, the pain you feel with your period) as well as your mom’s, sister’s, aunt’s, and grandma’s fertility history. Did your mom have an early menopause? Did your sister have a hard time getting pregnant? We not only mirror our female relatives when it comes to our physical appearance but also how our ovaries function. Therefore, in many ways, before you can move forward, you need to look backwards!

By combining all three—age, relationship status, and your past—we can sum up when and if you should freeze your eggs. And if it adds up (a.k.a. you are getting “hot” to your eggs getting “cold”), the best way to kick the process off is to get real information (#trulyMD) on what the process is like. Not everything you hear or read is true. So, the best advice we can give you is to talk to your GYN, talk to a fertility doctor, or talk to us at Truly MD in the gym locker room about the process. We can help you decided when it’s time to take the plunge!

The Art and Science of IVF

As first-year medical students sitting in the back of the Mount Sinai School of Medicine lecture hall, we had no idea what to expect from the Art and Science of Medicine course. We all thought of ourselves as scientists (I mean, this was medical school!). Art was far from most of our minds. Questions like “What will this class be like?,” “Will it be lecture-based or textbook-based?,” and “Will the exams be graded or simply marked Pass or Fail?” flooded our minds. In typical Jaime and Sheeva fashion, poised with pens in our hands (we were both ferocious note takers!), we were ready to transcribe every word uttered by the lecturer to soak up and eventually memorize every piece of data shared. However, what followed surprised us: we would not be note taking, we would not be studying, and we would not be test taking.

We would learn about the art of medicine.

Art and medicine may strike some of you as odd. It did us! Medicine is a practice rooted in science and data, not color or design. The people you knew who became doctors did it because they liked facts, not pictures. However, in reality, how we diagnose a disease, how we treat a problem, and how we formulate a plan are really an art. The many available imaging modalities, medications, and surgical procedures are our colors. How we blend them to get the best outcome for you, the patient, is our art.

For fertility doctors, ovarian stimulation in particular (a.k.a. how you get the ovaries to produce multiple eggs) is our art. What protocol we select for a patient, when we increase and decrease medications, and how to obtain the highest percentage of mature, good-quality eggs is our art (not to be confused with ART= assisted reproductive technology!). Sure, we have scientific data to guide us in our decisions, but what can make one IVF cycle more successful than the other has a lot to do with the art of ovarian stimulation. And we bring you back day after day for blood draw after blood draw and ultrasound after ultrasound not because we like to torture you but because it helps us customize your design, your art.

Don’t get us wrong. There is a lot of science in what we do. The laboratory is our science. The embryologists, the culture system, and the genetic testing are science. And without the science, our art is just some strokes on a blank canvas. It takes both, the art and the science, to treat a patient and to achieve success in all areas of medicine.

So, if you ever wonder why we do what do and how we decide on treatment protocols, they are our art. And when they are combined with science, it can make a beautiful picture!

On the Road to Delivery…GBS

While the title may have you doing a double take (and maybe even looking for some directions on how to decode GBS), rest assured, you are not lost out there on the road. You are in your home, your apartment, your office, or maybe even in the car (although hopefully not driving and reading!) hanging with your girlfriends at Truly, MD. But if you are nearing the end of pregnancy, you are probably getting pretty good at navigating the streets between home base and the hospital. And although we may not know the quickest way to get you to the labor floor, we definitely know how to get you up to speed on all things third trimester. First stop: Group Beta Streptococcus (a.k.a. GBS).

GBS is a type of bacteria. And although it may not be on your daily bacteria radar (think strep throat or staph skin infection), it is pretty important to us OBs. GBS took center stage in the OB world of the 1970s when it was identified as a culprit in the land of perinatal morbidity and mortality—that is, newborn illness and death. The newborns of pregnant women with GBS in their vaginal canal who were not given antibiotics during labor were at risk for some pretty heavy hitters. Think sepsis, meningitis, and death. Pregnant women were not immune to the negative effects of GBS. They, too, were at risk for things like UTIs and uterine infections.

Despite its bad-guy tendencies during pregnancy, GBS lives fairly peacefully within the vaginas and the rectums of non-pregnant women. Don’t bother me, and I won’t bother you. Given its Jekyll and Hyde persona, we only start to look for the presence of GBS in a woman during the latter half of pregnancy, when it can really turn into Hyde. To uncover whose vagina/rectum is “covered” in GBS and whose is not, your OB will perform a screening test on you between 35 and 37 weeks. And although it may sound scary, it’s no more than a cotton swab test of the vagina and the rectum. Those that test positive are given antibiotics during labor. Those that test negative are not. Pretty simple.

The ACOG has made it their business to get in the business of all pregnant women when it comes to GBS because, like the old adage says, when GBS is bad, it is very, very bad. Anything that can be done to decrease the bad is a major bonus…cue screening for GBS. The universal screening of all pregnant women has done a very, very good job at stopping most widespread GBS infections in newborns, particularly in the first six days of a baby’s life. In fact, since national guidelines for screening and treating pregnant women who test GBS positive were implemented, there has been nearly an 80% reduction in early onset (the first six days of life) neonatal sepsis due to GBS. Pretty impressive stuff.

Women who go into labor before their GBS test was performed (a.k.a. preterm labor), women who have previously given birth to a GBS-infected newborn, or women who test positive for a GBS UTI during pregnancy are automatically treated with antibiotics for GBS during labor. Basically, in these cases where the risks are high, it’s better to be extra safe and add an extra layer of protection. It’s sort of like extra insurance for a driver with lots of points on his license. While he may never speed or get ticketed again, given that his chances are higher, you want extra protection—we’re not saying we know anyone like this!

For most women, the GBS test comes and goes without a bump in the road. It’s sort of like passing a yield sign on the road. You know it’s there. You slow down somewhat, but you don’t really pay it much mind (we didn’t say that we offered good advice on driving!). Don’t fear the results. Positive or negative, we are pretty good at directing you to the right path. No one gets lost out here on this road; think of us as your GPS for your GBS!

Even Moms Need a Day Off!

As moms, we often think we can do things one-handed, backwards, and in the dark. You know how it is. You use any extremity (even teeth) to hold bags, babies, and BIG cups of coffee. Your day starts with the roosters and ends with the owls. The responsibilities are endless, the needs of others limitless, and the workload large. Motherhood is the most rewarding job—but it’s also the most exhausting. On a daily (more like hourly) basis, you want to quit. You wonder how can things get any harder or any more harried, and then your toddler empties your jewelry box into the toilet bowl—and you think, I guess it can get worse!

The only way to survive the disaster days is to allow yourself time to recharge. Even the fanciest cars need to refuel (nobody can run on empty forever). You are not a horrible person for thinking that time with your kids can be terrific and terrible all at the same time. They can push your buttons, make you want to pull all your hair out, and force you to ask yourself, Why did I ever do this? Let us remind you that you did this because even on the temper-tantrum, drama-filled, never-ending-tears days when they are finally sleeping and you stand at the door watching them breathe, you think, I never knew a love like this existed.

That’s why.

However, when you are worked to the bone, appreciating even the most precious moments of motherhood can be difficult. If you’re feeling like you can’t take another minute of the crying, you’re not alone. You are not a bad person or a bad mother. It is because of the enormity of it all, the all-consuming, all-in and all-on, that we beg you to take a break. We ask you to give yourself a rest—even if only for a few hours. Ask your partner, your parents, your friends, or a sitter to come over and relieve you for a few minutes, a few hours, or even a few days. It’s okay to need time off; we all do! You shouldn’t feel guilty because you want a day to sleep past 5 a.m., not change a dirty diaper, or not have an argument about why you can’t eat dessert before dinner.

We get that guilty feeling too when we clock out, but you gotta do it. Time away from any job is needed, especially one that’s all day and all night. Don’t beat yourself up because you can’t be on ALL the time. Nobody can (and anyone that says they can is lying to you). We moms can sort of do it all, carry a kid, a bag, a stroller, and pay for groceries all at one time. You do whatever you have to do to keep them safe, smiling, and healthy, in body and spirit.

Just because you can do it all doesn’t mean you don’t need some time to just do nothing. You’re not a machine; you’re just an awesome mom.

SPF: Don’t Let Your Bones Get Burned

Whether you opt for 15, 30, or 50, it’s rare to find someone amongst us that doesn’t lather up before laying out (or even being out on a summer day!). The sun and its rays are no joke. They can leave their mark in the form of burns, peels, sunspots, and even wrinkles—ugh! And if that wasn’t enough to scare you into some good water-resistant SPF, think skin disease and skin cancer. But while sunscreen fills the shelves at nearly every drugstore, reminding you to lather up or pay the price, what lies under your skin is much quieter. Your bones don’t tell you when they are about to burn (a.k.a. break), and the reminders to protect them are much subtler. However, if they are ignored, the burn can be just as severe as the strongest rays.

In the same way that you would protect your skin during the summer, you should protect what lies under your skin #yourbones all year round. Adequate calcium and vitamin D intake, coupled with a healthy diet, weight-bearing exercises, and estrogen during the reproductive years are the SPF that your bones need. In fact, this is the formula that makes up the SPF 70 sunscreen for your bones!

But while most of us know that milk (a.k.a. calcium and vitamin D) is “what does a body good,” you might be surprised to know that estrogen is equally as important. News flash: estrogen is not just a hormone made by your ovaries to keep your eggs developing. It is also necessary for bone buildup and bone strength. In fact, how much you take in during your adolescent and young adult years can dictate what happens in your later years. No estrogen in your younger years can cause some major breakage in your later years (think osteoporosis and osteopenia).

Bones reach their peak mass by about age 30. However, to reach the “summit,” they need estrogen during your teens and twenties. Therefore, women who are not on hormonal contraception and don’t get regular periods (a lack of periods because of continuous pill usage does not count!), is sort of standing out in the sun without sunscreen. When your bones don’t reach peak bone mass, there is nowhere for them to go but down later.

And as most of us know, the estrogen story does not end at age 30. Your bones continue to rely on their fountain of youth for years and years to come. Estrogen production is essential deep into our 40s and even 50s. Therefore, for women whose periods bid them adieu early it’s important to make sure that you speak to your GYN about hormonal replacement therapy.

While postmenopausal hormone therapy has gotten more bad press than both Democrats and Republicans making a decision combined, it’s actually not bad for most women. In fact, estrogen supplementation, started at the right time in the right woman, can be the key to reducing your chances for heart disease, bone disease, memory loss, and serious vaginal dryness. So, don’t listen to everything you hear on TV; this is one decision for which you should hear what your doctor has to say.

It’s really no different than sun damage. Burns sustained in your younger years make your skin way more susceptible in the later years. And while freckles and sun spots may be cute at age 15, they’re not so much at age 55. Additionally, they pose a risk for skin cancer at age 50. The same goes for how you treat your bones then and now. So, don’t forget to lather them in milk, vitamin D, calcium, and exercise: this SPF will save you big-time breakage in the future.

Don’t Worry, It’ll Be Fine: The Power of Peers

Hearing those five (or five and a half, depending on how you look at it) words brings a feeling of “Ahh” and a sense of calmness over most of us. With reassurance, our shoulders drop, our jaws loosen, and our minds are put at ease. This is not CBS’s “Survivor”; no one wants to be left on the island alone. In real reality, we want to be surrounded by others who are also fighting the elements, trekking through the same terrain, and battling the same villains. Fellow soldiers on the field make the foxhole a lot less scary.

Oprah made the “Aha” moment famous; we want to make the Ahh moment famous. While we certainly want you to have your Eureka moments (they’re great!), our primary goal is to help you find that moment of peace—that moment when you realize you are not alone, you’re amongst millions of other women facing similar struggles, and you realize their strength can help you achieve your goal. No matter what we look like, what clothes we wear, or where we live, we ladies are all trying to make it as far as we can in those horrible high heels (Why do we do that to ourselves? They hurt so badly!). And while we can’t help you find ones that are cute and comfortable (trust us, we’ve searched everywhere), we can help you find and build a community of fierce women.

We talk a lot, not only to our patients but also to each other (you would be amazed at how many text messages we send to each other a day!). We are very open about our own experiences,  struggles, and failures. Our personal and professional goals have not only centered on helping couples make families but also creating a community of openness, honesty, and empowerment. Admitting our weaknesses and advertising our fallibilities is never fun; it takes a ton of courage. But it makes us human. And when you take it back to the basics, we are all people trying to survive, find joy, and make our footprint on the world.

While we recommend you letting stuff out and finding your Ahh moment, we don’t recommend turning your life into a Bravo reality TV show (although we do love those Bravo-lebrities!). Sharing your experiences will not only help you but also your fellow femme fatales. Believe it or not, even the most soft spoken amongst us can scream—our voices can empower someone else to make a change, seek support and conquer her fears. We are stronger together than alone. Collectively, we can make a difference.

We are often asked about the obsession with group fitness studios like Soul Cycle and Flywheel. Why do they hit it out of the park repeatedly? In many ways, their popularity is a direct result of the community, camaraderie, and unity their classes create. I mean, why else would you sit in a dark and sweaty room at all hours of the day spinning your legs? It’s because riding next to you are a group of kickass women (and some men) who struggle with the same problems. Their energy and strength will help elevate you to another level. They will inspire you to not be scared about what’s over the next hill. They will motivate you to not hold back because you think you can’t do it. They will encourage you to not limit yourself to only try what you know you can achieve. The fact is that we push harder together, we push longer together, and we break barriers together. Next time you see someone struggling, tell them, “Don’t worry; it’ll be fine.” And then add our three favorite words:  “I got you.”