Dr. Ellen Goldstein Interview. Ep 41

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Speaker 1: Hi. This is Laura Vanderkamp. I'm a mother of four, an author, journalist, and speaker. And this is Sarah hart Unger. I'm a mother of three, practicing physician and blogger. On the side, we are two working parents who love our careers and our families. Welcome to best of both worlds. Here we talk about how real women manage work, family, and time for fun, from figuring out childcare to mapping out long term career goals. We want you to get the most out of life. Welcome to best of both worlds. This is Laura. This is episode forty one. We'll be talking to doctor Ellen Goldstein on this one, who will be talking about fertility. She runs a fertility clinic on the West Coast, and so we're very excited to hear from her both about how she manages her busy life as a physician and mother, but also questions of fertility, timing children, the process of going through fertility treatments. If that becomes something that people need, we're very excited about that. In the meantime, this episode is airing in mid May, and my book Off the Clock is coming out May twenty nine, so two weeks from now, so really encourage people to check that out. I enjoyed writing it, hopefully you'll enjoy reading it. But we know that a lot of you listen to this podcast in the car while you are commuting to work, and off the Clock is going to be available on audiobook as well, and it turns out that audiobooks are a great way to spend the commute. Sarah, you don't listen to audiobooks though, right, you're don't. I don't. Before we dove in, I want to hear what is it like to record an audiobook? Is it fun's work? You have to like definitely work. So I have recorded most of my own audio books. I did not record one hundred and sixty eight Hours, which was my first time management book. And it was really funny because I actually heard from someone the other day. They sent me an email that said, you know, I really thought you had a lot more energy in you're recording of one hundred and sixty eight hours than you do any other You know, you have to just like laugh at yourself when this stuff like this happens, like okay, all right, But anyway, so that was read by an actress, So if you are into that, you can go listen to her. She does a great job. But I have read the other ones, which if you're listening to this podcast, you're already familiar with my voice, so you have made your piece with it, one way or the other. But I go into this studio. It's called Milk Boy Studio and it's in downtown Philly, and it's like a serious recording studio. There are occasional groups of musicians hanging out there. There were during the time I was recording this, doing their musician thing, because they record a lot of real stuff, like they have Grammys on the wall there, which is a really cool thing too. But I go into a booth. I have a technician there who is recording. In this particular case, my producer phone was on the phone. She's been in there in the past. I've worked with the same lady at times. And I just read through the book, and you know, there's certain things of pacing. I've recognized that I say the word conversation wrong. Apparently the conversation there could z instead of and they had to stop me every single time until I didn't ever notice that. Yeah, well I didn't either, apparently, So and you realize that there are words you've been saying wrong your whole life, but you read through it. I find it. We go relatively fast online because when I write my books, I actually think about saying them aloud, and I have usually as part of the editing process, read the book out loud before because one of the best writing tips I ever got is that when people are reading something, they are actually saying it in their heads, and so it will read better if you write for the ear. So I try to write for the ear, so I've already read it through, so I actually have practice by the time I go in to record it. I definitely think you right for the year. So yeah, that's a compliment. Like your books, like they they you feel like someone's talking to you. So if anybody hasn't read Laura stuff she she does, it's very very readable. It sounds like she's talking or listen, yeah, listenable. I am a much more podcast person. So I guess my question to you about audiobooks would be like, what is the best book you've ever heard on audio? And in particular any good like celebrity ones, because I've kind of heard that's a good gateway. Yeah, I would. I would recommend if you have not done the audiobook thing, yet why don't you check out like some of the comedians who do it. So if you think about someone like Amy, that was a polar polar Ammy Polar. So she narrates her own audiobook and she will riff off stuff and improv stuff, which is an experience that makes it unique to the audiobook that you're not going to get just reading the book. And of course she is a performer, so that's a good thing to have, and so something like that. She's won many awards for that one. I would recommend trying something like that because then you say, oh, this is I enjoy it. Once you realize like you do enjoy listening to somebody read a book while you're in your car, then you can branch off into other stuff that you might be interested in the book, but if not necessarily the narrator that you are seeking out or or something like that. But it really if you've got a long commute, this is a great way to put more reading time into your life, because you know audios are going to be slower than just reading it on your own because the speaking pace is slower than most adults reading pace. So but you use this time and you can turn it into something that would would be wasted time. And so I found out. I mean, one of the reasons I really wanted to do a podcast, and I'm so glad that Sarah put on her blog that she was looking to do a podcast, is because I know that a higher proportion of my books sales have been audio sales than a regular nonfiction and type book. And partly it's because I'm speaking for busy women right Busy women are trying to read, and they're reading stuff in their cars, and so I know that, you know, I want to give people something they can do in their car, and that's one of the reasons we're doing this podcast. But audiobook's a great way to spend the time too, So Off the Clock will be out in two weeks. If you want to pre order it, that'd be great. The audiobook should be around pretty close to the time of the actual launch too, so if you'd like to check that out, that would be great. You can listen to that a couple of days and listen to the podcast the rest of the days and hopefully keep you entertaining the whole time, and you can tell us what you think. Tell us what you think all right, so we'll move on to Ellen. Well, we're excited to welcome Ellen Goldstein to the program. Ellen, why don't you introduce yourself? Well, Hello, my name is Ellen Goldstein. I am thirty six years old. I live in Los Angeles. I have a two and a half year old and I am a fertility specialist. Fertility doctors start out as general obiguns. That's four years of general obijuyn residency, and then we go into a subspecialty, which is another three years of training in productive endochronology and infertility, which means that we are experts in disorders of menopause, disorders of puberty, and infertility. I'm really really happy to be here on this program. I think that I have a lot of information I can offer to all of you. And Laurence Sarah, I just think you guys are doing a great job with your podcast. And I was introduced to best of both worlds by one of my very best friends from college, and she I have. I have this group that we were all rowers together on the Brown Women's crew team, and we are still very much in each other's lives and we really Your episode on Friendship really resonated with us, and so I'd like to say, hid all my friends, did you make it amount of your names? Like, did you guys decide to make an acrony amount of your name? You did? Okay, we did? And that I love it. That was That was a surprising thing that I've heard from a number of people about the friendship episode. They're like, let's make an acrony amount of our friends' names. Yeah, we loved it. That's awesome. And usually you've had an exciting recent career development, right, you want to tell us about that? Yeah, So you know, basically, I think that the future of fertility care is going to be in networks of larger practices that are all kind of run with very highly standardized quality assurance controls for the embryology lab, because if you think about it, we're taking care of like future babies in embryo form. And so I really when I was looking at what kind of job I wanted out of Fellowship, I had this dream that I was going to work with one of the best practices in the world. But they're on the East Coast, and I knew they had some plans to start expanding, but they had no plans to expand on the West Coast, and I called them up and asked if I could be their first Los Angeles, first West Coast branch, and they said yes, because they are just really you know, I've found that working with these people, they're really into cultivating relationships and working with the people that they want to work with. And over the last three years, we have worked on building a brand new practice that's going to be up to the minute, state of the art. You know, our laboratory techniques are going to be all you know, check with checks and balances compared to the other labs that we run in the country and even around the world. Actually it's a global enterprise now. And it's just been a very very exciting couple of years, and it's really brought out this entrepreneurial streak that I didn't know that I had. That I've been able to, you know, be really independent and be really self assured that I could do this, and then I've also had to I've also been very lucky to find some temporary jobs in the meantime that I thought were going to be really hard to come by, but actually, just with some legwork, I was able to get a lot of experience even before the clinic opened working in my field. But also I've had to be much more independent than I think most doctors right out of training have had to be. I've learned a lot about the business side of medicine, a lot about you know, putting on my big girl pants and being an independent doctor that I think a lot of that has really helped me grow and change a lot in the last couple of years. Yeah, so you guys are open now, right, your see patients in Los Angeles. Yeah, if this episode airs on May fifteenth, we are open. We are open. So if you are in the area and are in need of such services, please give it all on a call. So yeah, and then you're obviously this is a you know, big thing to you know, obviously be a practicing physician and opening a clinic and you have a two and a half year old, so what are how do you figure out your schedule with all this stuff going on? You know? I think the biggest problem for most people is like the transition times, like the early morning in the late afternoon, like if you're going to have a nanny your childcare, especially for a doctor where we don't really have that much control over our schedules and if something happens at work, like you really you need to be able to stay late, you need to be able to go early. And actually we have this crazy situation where my parents lived down the hall from us in our condo building. We I grew up in Jacksonville, Florida, and then I moved all the way up the East coast for my training, and then my my husband actually is from Los Angeles, and we met when we were in training on the coast, and then I moved here for a fellowship and my parents initially thought they might move to LA part time at some point, and then all this stuff happened all at once. A second condo opened up in our building, and my father, who's a very academically minded pathologist who doesn't want to retire, you know. Ever, his hospital restructured and they weren't going they were going to discontinue. They were going to fire his entire group and hire all new doctors. And he got a job at UCLA back in academic medicine and training residents and fellows. And then also I got pregnant right around the same time. So my parents made this huge move in their sixties and we really joke that, like we're we're a total New York Times cliche. There's a there's a complete there's a there's a series of articles that are like baby boomers moving to the city, baby boomers downside, baby boomers, you know, taking care of their grandchildren, like and why are grandchildren closer to their mother's parents than they are to their father's parents. Like it's it's all like all of these articles that just like make like telling the story of like our recent lives and how we're a cliche in the New York Times. But you're just let's let's put it that way, you're on trend, right. And so every morning, actually every morning, I have to leave the house usually around six forty five, and my daughter walks down the hall and rings grandma's doorbell and says, Grandma, I'm ready for breakfast. And it's amazing, it's amazing. And then then nanny comes at eight, and so it really makes the nanny's life much easier because she gets flexed, you know, like because it's so much easier to employ somebody if they can have flexibility too. And I mean I know that that very few people get this kind of amazing gift from the heavens. But it's been really really amazing for us. Is your husband a physician too, You mentioned training for him. Yeah, you know, he is. He's an ophthalmologist, but you know, medicine is in it is kind of in a crisis these days. He had a really hard time coming back to LA and finding a clinical job, and he actually, you know, he's got a lot of talents. He's got a PhD. He's got a business mind, and so he really left clinical medicine and has been working in pharmacy, in the pharmaceutical industry ever since we got back to LA and he worked for a couple, he worked for a big company, and then he worked for a small startup and now he actually has his own startup. He has a drug that he's developing. So it's been we've both kind of really been following our dreams in that are entrepreneurial dreams, very cool within medicine. That's that's pretty cool. Well, I know, we want to definitely talk about the whole you know, fertility world. And I was kind of hoping that Sarah would lead the questions on this, and so I will let you to take it from here. Yeah, and I'm lucky enough I do get to clinically interface with you guys every once in a while. I'm a pdiendo and my my husband's a doctor too. That's why I was like, I have a special, you know, soft spot for those two physician couples. Although you guys, you guys are living the dream over there. But yeah, why did you? I will tell you that I actually, for a hot minute was thinking about reproductive interprenology and fertility just because I thought it was super interesting, but quickly realized that A I could not survive in ob residency because I hate the O R, and B I could not handle the clientele. So tell me how how did you come upon that specialty? You know, this was absolutely not what I expected to go into when I was in medical school. I actually was very interested in pediatric genetics because I'm a very I really like to get to the root problem of things and understand how everything works, and I love molecular biology genetics and so. But then I found that, you know, Sarah, I think this is tell me how you feel about this. I feel like I feel like the hospital is there's like these packs of animals and they're all like totally different species and so yes, yes, and when you're in and when you're going through your rotations and third year of medical school, I mean, honestly, medical school is kind of like it's a lot of an attack on your personality, you know, because like you're not going to fit in with every group of people, and when you're working for six or eight weeks with a group of people that you don't fit in with, it's very difficult. And for me, that's really how I felt on like internal medicine, like I just didn't get how it worked. I felt stupid. They thought I was stupid, Like I just couldn't like and I had never been stupid before, right, like you know, we're all very successful people, and so that I just didn't fit in. And then on with pediatrics, I mean I liked pediatrics but also didn't really fit in. But also things can you know, it's really interesting how the people that you work with in one short rotation can really have such an effect. And I just didn't work with such great people on my initial pediatrics rotation. And then when I was on when I went to OBI, I was like jumping out of bed at four o'clock every morning, dying to go to the hospital, loving every minute of it, and they thought I was smart, and so it was like, you go, it's really it was really about like finding this place where I really really fit in. It's just and it's just been incredible because I felt that way throughout my train that these are all very we're kind of very similar people in many ways, in many fundamental ways, and in how we care for our particular very you know, specialized group of patients and an obgun residency really is crazy, and I loved all of it. You know, we don't just catch babies. We take care of very sick gynecologic cancer patients and that's like real medicine and so but it's tough. It's for very grueling years. And I know exactly what you mean about kind of finding your people. Were there any other considerations in choosing ARII reproductive under chronology and infertility, Like, did you think about General OBI at all? Yeah? I mean, I definitely I love General ob certainly this specialty really brought me back to my initial interest in genetics and molecular biology because that's what we do all day actually, And also I found that even within obqu I n there are different subpopulations of patients, and the infertile population was a group that I really worked very well with. And I think that, you know, the anxiety and the tensions can run really high with understandably with women that are dealing with infertility, and it's never really bothered me. You know, like sometimes the general obs will be like, wow, I don't know how you deal with that level of stress all day long, you know, just and it's like it doesn't it doesn't really feel that way to me, and so I guess it just it's it's lucky that it doesn't feel that way to me. And also, you know, general ob g I N and also g I N oncology are are some of the toughest toughest fields for for work life balance, since that's what you guys talk about, and you you really we'd all need to give our our ob g I n's like major props for make their lives work around their work exactly right exactly, their lives work around their work exactly. And so you know, with this field we have we have much more predictable hours. You know, we start early in the morning, but we're done earlier in the afternoon. We have very few emergencies. You know, I have to admit somebody to the hospital, like you know, less than once a year, and so it's really it's it's a it's really kind of back to office hours. No, I totally understand that, and you know, medicine and work in general, it's about finding your passion, but it's also about finding a career that fits the way you like to do life. And some people love shiftwork and working at night, and other people find that that that doesn't work for that. I think you talked about that in one of your previous podcasts. Yeah, shift staying up all night is torture. Some people, I think biologically also handle it better than others, Like I don't handle it well. And that's okay. We all figure out where our talents lie, and you know everybody's also, but I would point out that, like clearly I mean obgy and this is Laura and I'm just going to pipe in here and then I'll shut up. Has changed too, as it's become a specialty that it used to be percent men and now it's ninety percent women, and many of them are moms. And what has happened is just moving to more of the group practice model. Sure you get you know, there's eight of you physicians and so you're on one night a week as opposed to like, yes, you know, but it doesn't change the fact that on that night you were right. My baby born in middle night. So some people deal better with that sort of thirty hours straight of work. I mean it sounds like not that bad, but then if you're doing it, actually some I mean some again, some people handle that. But I agree with you, Laura, like it's gotten better, but I still think it's pretty grueling for a lot of people. So okay, so I will give you you know, we we have a lot of listeners I'm sure that are dealing just because infertility is so incredibly common, that are dealing with various aspects of it. We've gotten a lot of questions about when it makes sense to see a specialist or people talking about like when they want to start their family. I will tell you I've seen an ARII physician. Because it took me almost two years to have my first I think I probably had like I think I'm super scent to like even though I've always had a normal BMI to like exercise an activity, and I think I was actually misdiagnosed with PCUS and really had hypothlomic gamin area. But that's a story for another day. And I have my daughter and ever since I've been like no problems whatsoever. But it actually took me like a year and a half to even bother seeing anyone, and I've had zero periods. So I look back and I'm like, that was dumb. So talk to our listeners about, you know, when it makes sense to see someone, and also a little bit about like how long is too long to wait, and we don't want to get people anxious, but sort of some real facts around that. Since that's right, Yeah, thanks, No, I mean you're absolutely right in what you're speaking about with there was something that was that was clearly abnormal with your cycles. And so you know, on the one hand, if you if you think and you've always been been told that you were totally normal, if you have regular, predictable periods, if you've never been diagnosed with any kind of major gynecologic problem, if you don't have any concerns about your husband or have any pelvic infections, then if you're under thirty five, you should try for about a year, and if you're over thirty five, you should try for about six months. And if you're over, if you're forty or above, you really should see an RII sooner rather than later, like proactively, like don't even try so the and but that all that being said, that you know you're if you have any issue, if your periods are not regular, if you've ever been diagnosed with endometriosis or fibroids, or if you've ever had sexually transmitted infections like chlamydia or pelvic inflammatory disease, or if you have any concern about your husband with like you know, sex drive or rectile function, all that stuff actually can be real problems. And you can actually even have more than one problem in the same couple, And so like why and we can we can address more than one problem in the same couple as long as we find all of the problems. And so why wait, if you have those kinds of issues, let's talk about normal fertility. So let's there's also you know, there are couples who don't have any abnormal testing but still have an unexplained you know, obviously some kind of like molecular issue for why their egg and their sperm or not meeting properly, or their embryos are not getting into their uterus properly. And so if you had a crystal ball and you knew that you had you had one hundred couples, and you knew actually that all of their testing was going to be normal, then actually, monthly fertility rates are actually much lower than most people think. So, oh interesting, Yeah, So when you when those hundred couples first starts trying to get pregnant, let's say they're young, let's say they're thirty five or under. In the first month, only twenty five percent will get pregnant. In the second month, another twenty five percent of the remaining group will get pregnant, and then the numbers start to go down. In the third month, it's only about twenty percent, fourth month twenty percent, with fifteen percent ten percent by the end of the year. Towards the latter half of the year, the remaining group only has a five percent chance of getting pregnant per month. And what because what's happening is you're kind of the group that's left standing is a group group that has some subfertility factors, even if we're never going to know what they are. And by the end of the year, fifteen percent of all couples will not be pregnant. So it's really really common. It's like about one in eight couples will not be pregnant. So always be careful when you're talking to your friends, like because probably you know multiple people who are dealing with this, and so by the end of that year, that remaining group only you know, we always have miracles, for sure. I mean, we have people who are struggling or we're taking care of them and then they take a break for a couple months and they get pregnant, and we're so excited about that. Like I never I never say never. But your chance after a year, even if all of your testing is normal, is only about two percent per month. Does that include patients who get pregnant and then have like recurrent miscarriages or has that actually a different problem? Unfortunately, it's a horrible problem that we deal with. That's a great overview. So I guess you would recommend, if you if you're questioning it, for people to get help sooner and later, basically, and especially the older There you are one question that I am curious about, having never gone through it myself, but having heard friends kind of talk about it is you know, let's say one of those couples does, you know, fail everything and they're up to the point of considering IVF. Some people talk about IVF like it's nothing, like, oh, just get IVF, but then those who are going through it clearly it entails a lot. Logistically, What is that like and especially what is that like for professional couples who obviously are not just sitting at home and you know, waiting for the next step. They've got stuff going on. So what is an IVF cycle? So basically, IVF is our way of taking over for as many of the steps of the process as we possibly can. The one thing we can't do is make make a good egg and as you get older, you have fewer and fewer good eggs, and even rarely, rarely, rarely, some young women don't have good eggs, but that's rare, so it's usually more a problem of age. So what IVF does is take over for everything else side egg quality. And so what we're doing is you take medications for usually between nine and twelve days, and those are injectable medications to stimulate your ovaries. The goal is to grow as many eggs as we can to increase the chance of getting at least one good egg that cycle. And so during those nine to twelve days, you do need appointments for monitoring so that we can see how your medications are working for you and make sure that we're adjusting things that we need to and that we're timing everything properly. And those appointments are quick. You only need to be seen for you know, fifteen minutes, you know, a total of four to five times ish over those so it's like every other day. It's usually like a fewer appointments at the beginning and more at the end. And really, you know, you should find a doctor's office that has early morning appointments because if you can get in and get out between six thirty and seven thirty am, nobody ever has to know that you're doing this. At the end of that time, you have to do your egg retrieval. And so that egg retrieval is a procedure. It's not a surgery where we actually use a long, skinny needle attached to an ultrasound probe to take all of the eggs out of your body. You do need one day off of work for that, and we always we can't always predict exactly which day that's going to be, So we do need a little window of flexibility from your job where you know you're going to take one day off of work. Are there practices that I mean, it's okay if it's not because work life balance and all, but are there practices that are open on weekends that kind of make that a little bit easier. So we're always open on weekends because we have to be able to see people because everything is dependent on the day of the cycle. We do timing, okay, but we have a little bit of leeway where we can try to put your appointment on a weekend if we can, but we can't exactly aim for weekends. We can get it's off feet what happens to the thay. We can aim for weekends for egg retrievals if we you know, as long as you know that your window includes you know, Friday, Saturday, Sunday, hopefully we uh will land on that Saturday. Got it. But I sense that the trouble with the professional women run into is that bit of unpredictably because if I'm trying to figure out when I need to clear my schedule for patients and I'm hoping, yeah, I can see that. That's that's that's although I get it. I get it. If you go if you aim for weekend and you block off the Monday, for example, that's probably like you're stick back with that. And then actually, you know, we are moving more and more to frozen embryo transfers because once you get the eggs out of your body, we then actually ensure that fertilization happens in the lab and then we watch the embryos growing in the in the lab, and then old school IVF used to be putting embryos back into your body either on day three or day five after the egg retrieval, and that's when sort of the uterus is ready and the embryos are ready to implant in the uterus, and it's called like a fresh cycle, right, I've heard people. And so the thing is is that we actually have a number of reasons why frozen transfers work better. Number one is that your hormone levels are actually much more normal if you come back after you've had a period and everything has reset to normal, and that we actually think that that leads to both higher SIXS rates and healthier pregnancies. And then also nowadays we're really, we really are very excited about genetic testing of embryos because you can't always tell which are the best embryos under the microscope. And instead, what we do is we take little biopsies from embryos at day five of development for just a few cells, and we actually can count the chromosomes in the embryos so that we know which ones have a chance of making a baby. So you guys are actually looking at the embryos and seeing which one has the best chance of making a baby so that you can selectively choose which one to implant, and after the person has gone back to sort of a normal level, right, And so what that does is it actually gives us, it actually allows us to prevent multiple pregnancy because if you you know, why why does everybody think that IVF makes twins and triplets, Well that's because it's such an expensive, you know, arduous process that doctors want to increase the best chance of success, and patients pressure us to give us the best to give them the best chance of success. And so we used to put in multiple embryos at a time to kind of let the embryos, you know, by natural selection, figure out which one is the best, and then if some many people would get too lucky and have twins and triplets. If you do a genetic testing on your embryos and you know that your normal ones have a seventy percent chance of making a baby, but if you put two of those in there's a fifty percent chance you're going to have twins, you're going to feel a lot better about only putting one embryo in at a time. And that's what we really strive for. And so we come back a month later once we have the genetic testing, and then we can actually plan when we do your embryo transfer, and actually the kinds of regimens that we have for hormone replacement. I mean, there's different ways of doing it, but there are ways that we can do it that we can make things fall in a certain day that works for your schedule. So when people are going through this, I mean if they've tried for a year and they're not able to get pregnant, I mean, of those people who then help, I mean, what what sort of success odds do you see? Well, it really depends on your age. So if you look at the so first of all, a genetically normal embryo tested normal embryo has over a seventy percent chance of making a live born baby, no matter how old the mom is. And the issue is that getting that normal embryo gets harder and harder as you get older. So that's that's when the question of potential donor eggs or as we've been hearing about in the news a lot, but the potential of having frozen your own eggs years ago is that I'm curious what your thoughts are on that. I mean, we certainly, I swear like I get a pitch from a new like egg freezing related something every every year. Don't they know you already have for me? Not for me, okay to write about them? Right? Want me to write about that? I do not well, my should not be present at this point forty years old. They'd be useless for anyone. But now to write about it, like, what do you think about that? Egg freezing is a really fantastic option. So basically, an egg freezing cycle is everything that I just described to you, up until the point of fertilizing the eggs. We use medications for nine to twelve days, we monitor you by ultrasound, and then we do egg that egg retrieval. Now, everybody's body is different, and some women are going to get more eggs and some are going to get fewer from a stimulation cycle. But the thing that really matters as far as ultimate chance of success is how old you are when you went through it. And so one statistic, one article that I really like that came out that was really is really showing a projected chance of live birth no matter at whatever age you are that you freeze your eggs. So to give you some perspective, when you're thirty five or below, if you freeze eggs for ten mature eggs, that's about a seventy percent chance of making a baby. And most thirty five year olds will get at least ten eggs in an egg freezing cycle. And the numbers really matter because if you happen to get twenty mature eggs, you're up at a ninety percent chance of having a baby from that group of eggs if you are forty. However, when you do your egg freezing cycle, that same ten eggs only gives you about a twenty to twenty five percent chance of having a live birth from that group of eggs. And it's Also, the number of eggs you can get in a cycle goes down as you get lower, so you might as you get older, so you may actually not even be able to get ten mature eggs in one cycle. You may have to do lots of cycles even to get that group of ten eggs to give you that twenty five percent chance of having a baby in the future. So things really go down quickly after age thirty five. Well, Sarah, you and I both you know, got out there. We're done, last kid just in time, age thirty six, thirty seven, right. And I also don't want to scare people. I mean not everybody is going to have trouble, you know, like there was there was this very there was this article I'm sure you guys have read it in The Atlantic a couple of years ago where a woman talks about how, you know, all the fertility doctors want to do is scare you. Well, I had babies at you know, thirty eight, thirty nine, and forty one with no problem at all. Well great, that's you know, your end of one. You didn't have any trouble, you know, like called or data. Yeah, thanks for your personal story. Is not a reviewed study, and we had you know, and we have friends who like, they got married when when she was thirty eight, I said, don't you wait one second, and they got pregnant on their first try, and the husband got so mad at me. He was like, waiting, it could have gone differently. So the thing is is that the older you get, it's really any issue that you have just gets harder and harder to treat. Like if you're starting to have trouble at thirty eight, it's probably not going to get better at thirty nine. Or no, no, we well there was. I mean you you weren't very scary there at age thirty five. I mean, I think people are aware of the fact that as one gets toward forty one's fertility might decline. I think the more scary stuff for people, of course, is seeing that like age twenty seven or something. I think there was an article that was out about that is I don't know what happens at twenty seven. You clearly don't shrivel up at age twenty seven, so I think I don't know, I forget what exactly that was, but maybe that's the peak. Maybe that's I don't know, fertility that could be I always thought would be like nineteen or something, but maybe Ellen, can I can tell us the answer around that, so that even in your early thirties there's not really any real difference. I wouldn't really worry about the years between twenty seven and thirty five. There's also there's also been a very interesting cost effective analysis for like optimal timing for elective egg freezing that I think people might be interested in. And basically what it said was that if you're looking at it from a personal standpoint for when is this most likely to work for me, then the best age to freeze eggs is around thirty three thirty four, because if you because there's still an excellent, excellent chance of it working for you, like only marginally better than if you were twenty seven, honestly, And so why do it at twenty seven when you know you may very well not ever have any trouble getting pregnant, or you may find a partner when you're twenty nine and get pregnant thirty one and not have any problem at all. The cost effective in this analysis said that people really shouldn't be freezing eggs until age thirty seven because that was when the greatest probability of live birth compared with egg freezing versus no action was when the there was the greatest improvement with egg freezing. But the problem was, Yeah, the problem was because the thing is that if you freeze too early, then plenty of people are not going to need their eggs and there's going to be like this, They're going to have paid all this money and never need their eggs. But the thing is is that at thirty seven in this analysis, YEAT, the probability of life birth was still only fifty percent. So like, if that's not acceptable to you as yourself, what do you care about a population based you know, cost effective. Wow, you've just made me feel so lucky about my third kid. Well, you know, it's interesting, we I mean, because sometimes we do get questions from young women who are sort of considering like when they should have their kids, which of course I say is entirely personal to them. But let's say that they do have a partner relatively early in the grand scheme of things. So let's say they have met, you know, mister or miss wright, depending on what they're going for in their mid twenties, Like, so they've got some time to play around with Are there reasons to be starting earlier or is it? Are most people okay if they wait till, you know, mid thirties, I mean what I honestly, I don't think people should wait till mid thirties. I think if you, if you're lucky and you have a partner, and you can start around thirty two or thirty three, it really is a much better time to start, so that if you have a problem, it gets uncovered a little earlier, and that probably also gives you an option in terms of the size of family more so. And I guess if at thirty two you're like, I know, I do not want a baby right now, I really want to push my career five years, then that would be a perfect Kennedy personally for egg freezing. Right yeah, all right, well cool, this is This has been very interesting for you know, I'm sure a lot of food for thought for people thinking about and it's good to know what the what the schedules were, like, what people are looking at when they're they're looking at fertility treatments, like what that's going to involve with their lives. It sounds from you like it's you know, difficult for a bit, you know, it's it's sort of a time limited for at least for each cycle that you're attempting, and the odds have gotten better right over over the years, we've really made lots of you know, huge strides in the chance of success with that. You well, that's happy news, all right, Well, Sarah, do you have any other questions on this? No, but we should definitely get a love of the Yes, let's do our love of the week, so every week we talk about something that is really rock in our worlds at the moment. Sarah, what do you have this week? It doesn't have to be related to the rest of the episode at all, so it could be anything you want. Mine is so I think I talked about I used to say I was reading The Atlantic to get my news because it was nice and cerebral and it was, you know, not panic inducing, like looking at CNN all the time or something. But I don't have time to do that right now, or at least it's not a priority party. So I have been enjoying nprs up first, which is about twelve minutes long, but I played at one point five speed, so it's like eight minutes a day, and I feel like that's enough. I know, what's going around in the world enough for me, and that's like a nice little new routine. Like when I get in my car, that's my first podcast, and then I usually move on to something more fun. That's fun. Yeah, so mine is this is I'm you know, people who listen to this podcast have probably figured out, like my ability to figure out how things work and where things are is like completely limited. So I didn't even know on my phone I had Apple Music. Apparently I was paying for it, but you're the perfect cut of my customer. I was playing for it, wasn't using it that I realized, like I can download all these albums like all this. So I've been listening to all these albums that I had, you know, probably on CD and like nineteen ninety two, but and then then that was like my big CD buying age, and then I never did afterwards. But I've been listening to all these albums from that time, and I am somewhat of an anxious fire. So when I get on the airplane, I listened to the music, and I just listened to these albums from like high school, give us at least one example album. I've been listening to Indigo Girls stuff, like and write some perfect there hadn't been some Dave Matthews stuff, the Whole Crash album and Under the Table and Dreaming or whatever that one is. Yeah, so those whole high school albums are really they really take you back. Love listening to those. Yeah, for sure, check you back. You know. I've doing at social media this week, just the like I think it scares like technology kind of scares me, like our kids growing up in this world, and like we really I think that that we all. I've heard you guys talk a lot about being in this generation where like we're not. I don't feel like a millennial because I remember growing up without the internet, but I hate that they call me a millennial. But at the same so I'm nervous about what this is going to do to our kids. But at the same time, like the connectedness has just been so cool. The fact that like you guys found each other and started this podcast, and that like my friend found your podcast and sent it to me. And then you know, also like my husband is really like gregarious on the internet, and he like has all these friends and he was on Facebook that he doesn't really know and he was able to like like hook me up with like other groups of women who are also interested in talking to me about fertility that like I never would have found And it's just really cool the world we live in. If we if we use it for good, yeah, let's use it. Love it. Yes, Well, thank you so much for being on the program. It's really a pleasure. I love talking to you guys. That was good, good interview. So bringing us to our Q and a part of the episode, we got a question on Sarah's blog that if people aren't reading that you should. It's the shoe box dot com. The shoe Sahu like Sarah's initials box dot com and Sarah has been blogging about her lack of sleep because Genevieve is just monstrously cute, but also eating like a fiend and up in the night and all that, And of course Sarah is seeing patients all day, which requires a lot of energy as well, and so one of her commenters asked, how do you function during the day when you are up at night feeding a baby and then need to be on during the hours you're at the office. What are some tips you have for other sleep deprived new moms on how they can power through too. It's such lovely timing because we had a wonderful night last night where Miss Genevieve unfortunately has a little bit of croup and there was not a lot of sleep, and I was finishing up a call week, so I got a lovely you know, finally got her down again at ten thirty, and then the er calls me like eleven thirty, and then she was anyway, So good timing for this question. I think, well, first of all, I say, don't focus on it too much. I almost wonder if maybe, and this is totally non scientific, maybe there's a little bit of a hormonal ability to function on less sleep for new moms. I mean it sort of would make evolutionary sense. And sometimes if I don't fixate on how poorly and how caught up my lack of sleep was the night before, I find that the day actually goes okay. So I guess my number one thought is maybe don't think about it too much. Also not sanctioning this in any medical sort of way, but man, does coffee help because I've been getting up every day and I'm again not saying everybody needs to do this, but in order to match my supply to her demand, I get up at five am and do a morning pump and I usually feel utterly miserable when I start it, but I drink coffee while I'm doing it, and usually by the end I don't even feel like I need to go back to bed. I can kind of put her around and get some stuff done before she wakes up, and that makes all the difference. I don't think I could really have that lucid feeling so early in the morning without it, So you know, take advantage of the fact that you're not pregnant. It doesn't seem to affect her at least during the day. She naps fine, even if I've just drank a cup and fed her, So that is another way. And then my third thought is to just go to bed as early as you possibly can. I do. There is scientific evidence that the early hours of the night's sleep matter. They're deeper sleep, so missing out on those is more detrimental to missing out on the late in the night sleep. So if you're able, and you probably experienced this, you know, if you're able to kind of go to bed early and sleep from maybe nine to one, sometimes you feel so good at one that you're like, oh my god, I'm like insomniac at this point because you've gotten that nice deep sleep. So when you're in a period of deficit, as much as you possibly can, force yourself to go to bed, get off your phone, get off the TV. And I've definitely been doing this as much as I can. Yeah, and then during the day, because obviously you have to be on and you're dealing with difficult situations. What do you do to sort of maintain your energy during the work day. Maybe it's because I'm an extrovert, or maybe it's from the coffee, but it's not like I like, you know, the only thing that I find challenging during the work day on less sleep is charting. And sometimes I've said to myself, you know, I'm so inefficient on the computer. I'm not inefficient with the patients like I somehow, I guess enough adrenaline kicks in when when you're actively like in the room and giving them advice and answering questions. It's when you have to type that all out what you did that's hard. So sometimes I just say I'm not writing it out right now. I'm just gonna like zone out whatever and I'll batch this for you know, the weekend when I can do it right after I've had my coffee. So you know, this isn't a forever thing for me. I don't really enjoy doing a lot of work on weekends or at nights or early mornings. It's not really a goal of how I want to have my job right now, But right now it's it's survival and that seems to work. So yeah, that's that's hard. I mean, if I had a job, I guess it was a little more passive. I think I'd run into two more problems. So I would do what you can to keep it as active and as exciting as you can in the chunks that you can. And then if there are parts that really require a lot of focus but are kind of boring, maybe save those for for the you know, your brightest times of the day, whether that's right after you've had the coffee or a chunking it on the weekend during during a free period. You have tracked your sleep, right, So I have a little bit of wisdom to impart on this topic as well. Well. I mean, I you know, working from home, if it was ever too bad of a night, I would try to nap for a little bit during the day, which is a luxury that I know a lot of people do not have. So I did. I did that. But I think you also mentioned that like the fact that you see that your average is pretty much the same allows you to not stress up, because I think sometimes people just like they fixate, oh my god, I only got six hours, and like by thinking of that, it actually makes it worse. I think. I think that is definitely true. I can see from my time logs that I, over the long haul hit around, you know, between seven and seven and a half hours per day again average over the long haul. That doesn't meet and I sleep you know, fifty one point five hours per week or whatever it is. It just means that over the long haul, that is what my body is aiming for. And so now that I know that, I don't feel as worried about a short night, Like I know, if I get six and a half hours on a day, like, yeah, I'm not in perfect shape, but I'm not bad. And I know that I will probably hit eight hours another night by going to bed earlier or you know, purpose like my little guy won't wake up some other and he still does occasionally. It's really you know, it's been a rough thing with him, but he's better now, but still and so knowing that that there is that catch up impulse really removes some of the psychological torment from the whole, like oh no, I'm up at three am. It's the end of the world because it's that comforting to think, you know what your body will Yeah, well, that can astrophic mindset is what makes it worse than anything else. It's like, yes, I will get back to my average over the long haul, so I'm not going to worry about it. And yes there is there is coffee, and coffee is a beautiful thing, so we stick with that too. All right, Well, this has been best of both worlds. We've been talking to Ellen Goldstein most of this time about fertility questions. If you have comments on the podcast, please do share. You can go to either of our websites. I'm Laura Vandercam dot com. As we said, the Shoe Box the Shoe s h u box dot com. You can always email me el vanderkamat yahoo dot com. Please rate this podcast, review it, share it with a friend. We are trying to reach as broad an audience as possible, and we really appreciate when we hear from people like, oh, my friend told me I should check it out. That means a lot. We are flattered to have those recommendations. So if you feel you can recommend this podcast, we would really appreciate you doing so and that will help us grow our audience. Thanks so much, Thanks for listening. You can find me Sarah at the shoebox dot com or at the Underscore shoe Box on Instagram, and you can find me Laura at Laura vandercam dot com. This has been the best of both worlds podcasts. Please join us next time for more on making work and life work together.