Fertility Expert Answers Questions From Twitter

Hi, I'm Dr. Serena H. Chen.

I'm a reproductive endocrinologist and fertility specialist,

and I'm here to answer your questions on Twitter.

This is fertility support.

[upbeat music]

@FertilityUnit asks,

Do you know how often you should have sex

if you're trying to conceive? #fertility.

You don't have to have sex that much, actually.

Twice a week.

So have two dates a week

because the good sperm will stick around

in the fallopian tubes for a few days.

So if you have sex twice a week,

then you always have some sperm in the tubes

waiting for the eggs.

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.

It actually doesn't.

I think you just get a little tired.

@Wondertramp asks,

Does anyone know if #covid-19 affects #fertility?

Asking for a friend.

Everybody wants to know the answer to this question,

and the truth is, COVID-19 does impact fertility.

The vaccine does not,

which is why we really want you to get vaccinated.

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.

We know that COVID-19, the disease,

actually does have a powerful negative impact

upon your fertility, especially if you get really ill.

If you're mildly ill,

you will probably feel temporarily bad,

the sperm count might go down

for a couple of months, just like any febrile viral illness,

but then you will recover.

You might have irregular periods for a little bit,

but then again, you might recover.

But severe disease can have a more severe impact

upon your fertility.

@ksecus asks,

OK guys. I've been watching Nova on PBS.

A fertility scientists just said, on average,

men today have about half the sperm count

our grandfathers did.

Causes? Environmental, obesity, chemicals, etc.

This is a fascinating question.

People's sperm counts have been declining,

and I would say, compared to say the 1900s,

the average sperm count is about

half that of what it used to be.

We don't really know the reason why,

but certainly things like toxins,

and the environment, and our lifestyle

probably have something to do with this.

Scientists are definitely working on this

because we can't have sperm disappearing altogether.

The good news is, people are still making millions of sperm.

I don't think we're gonna 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.

@EggFreezingProj asks,

Does freezing your eggs mean

that you definitely want children in the future,

or is egg freezing more having the option later on in life?

Let me know your thoughts.

Mother Nature kinda designed us to have 10 kids

by the age of 25.

That's kind of how our bodies are designed.

10 kids by the age of 25,

die of exhaustion by age 35 to 40, that's it.

Obviously, we don't do that anymore.

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.

People are really interested in freezing eggs

to try to preserve their eggs at a younger age.

@fertilitypreggo asks,

How come men don't have a fertility clock?

Ha-ha emoji.

Men definitely have a fertility clock.

You cannot delay childbearing forever.

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.

So, you do seem to have a fertility clock.

The quality of sperm does seem to decline with time.

@jennjaypal asks,

Fun fertility question of the day:

What's the difference between artificial insemination

and ficial insemination? #actualquestion.

So ficial insemination doesn't actually exist.

Artificial insemination is the process

of putting sperm into the female

by any means, other than sexual intercourse.

It's artificial.

You're getting the sperm in an artificial way.

Now there's a lot of ways to do artificial insemination.

The way fertility specialists

typically do artificial insemination.

We wash the sperm, get rid of all the semen,

because the semen is the liquid.

It's like a tidal wave coming out of the penis.

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.

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.

We get just the sperm, in a tiny little droplet of fluid.

And we put it in a little syringe.

This is called an insemination catheter.

This is a particular type of insemination called IUI,

intra-uterine insemination.

And we actually put a speculum in the vagina.

And then we see the cervix and this little tube goes right

through the cervix.

Of the vagina into the cervix.

I don't know if this is actually open.

No, this is not an actual working model.

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.

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.

We don't believe in waiting.

That doesn't increase the pregnancy rate.

@susiesavagee asks,

why does a single round of IVF costs $15,000

in the United States, and only $2,000 in Turkey,

6,000 in Spain, 3,300 in India,

3150 in Russia, [beep] even 7,800 in Mexico.

One day big pharma will pay for their crimes.

It is way too expensive in the United States.

Hopefully, we can get better insurance coverage.

But right now it, it does tend to cost a lot of money.

The good news is, that there are

more and more states passing laws

to mandate fertility coverage.

We are seeing more and more companies cover it,

because, hey, reproduction and

problems with reproduction should be covered, right?

Why is it treated like it's like a nose job,

like elective plastic surgery, these days?

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.

@Davian_Dove asks,

So, how does a pregnancy test work?

Well @Davian_Dove,

I happen to have one right here.

You can get them from the drug store,

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.

It's actually measuring something called

HCG, human chorionic gonadotropin.

That's a hormone that's produced by the placenta.

If that is in your urine,

then it shows that you're pregnant.

You can also get a blood test at the doctor's office.

Once you, once this turns positive,

we want you to call us right away.

@OhMyMithrandir asks,

how does someone sign up to donate their uterus to somebody?

I don't want it. And transplants are possible.

Send me the sign up sheet.

Uterine transplants, is that really a thing?

Yes, it is.

It has been done in the United States.

It's been done in other parts of the globe.

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.

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.

@miragonz asks,

is there a law that puts a cap on the amount

of embryos doctors are allowed to implant during IVF?

This is surprisingly hard to Google.

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.

Twins can be super cute,

but a twin pregnancy is risky for both the mom and the baby.

We are usually transferring just one embryo with IVF.

IVF does have a higher identical twinning rate.

So that's probably one of the biggest risks of IVF.

You could put one embryo in,

and there's a 2% chance

that you could get two babies out.

If you conceive on your own,

the chance that your embryo splits,

the chance that you have identical twins is only 0.5%.

So we should just put one embryo in.

Those are the current guidelines,

but it's not actually regulated by law.

@Patrici15767099 asks,

what year was the first test tube baby born in America?

That was December 28th, 1981.

So she is 40 years old, this December, 2021.

Her name is Elizabeth Carr and she's a

big fertility advocate and author.

Test tube baby, or IVF baby, in vitro fertilization,

was a revolutionary treatment

that has totally transformed our field,

a field where we really struggle 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.

@JETlag91,

Ay how much they pay for semen at the fertility place?

Asking for a friend.

There's lots of great commercial sperm banks out there.

They probably have different rates.

But I do think, you know,

they compensate you well for giving the sperm.

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.

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 dollars.

@mamakmw99 asks,

how long does it take pregnancy symptoms

to go away after a miscarriage?

It usually takes about two to three months.

You still have the pregnancy hormones in your body.

And it takes about two to three months

for those to clear out.

@HRCfertility asks,

what is a fertility doctor or fertility specialist?

Well, I'm a fertility specialist.

That means I am a board certified OB-GYN,

obstetrician, gynecologist, and subspecialty trained

in reproductive endocrinology and infertility.

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.

@abMOMination asks

considering reciprocal IVF for round two.

Wife scared of retrieval. Any tips?

Retrieval, that means egg retrieval.

What is reciprocal IVF?

IVF is in vitro fertilization.

Reciprocal IVF is a way for two women to conceive,

where one gives the egg, and the other carries the embryo.

They're being reciprocal.

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.

This is a great option for lesbian couples

who want to both be biological moms.

@tapiazzy asks,

egg freezing anyone here, gone through the process?

I haven't actually 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.

We are really, really good at freezing eggs now.

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,

negative 195 degrees centigrade.

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.

Some insurance companies cover it,

most of the time, not.

It can cost thousands of dollars.

So, that's something to think about.

You give yourself injections with tiny needles

for about 6 to 10 days.

You go to an IVF center.

You get an IV in your vein.

They give you a little anesthesia.

You go to sleep for about 10 minutes.

We put a very small needle

into, through the vaginal wall.

One on the right side, one on the left side.

Then we pull the eggs out.

Five minutes for the right ovary,

five minutes for the left ovary.

All the eggs are out.

We put them in the freezer.

You wake up, you feel a little crampy,

you eat a little bit, walk around, go to the bathroom.

And then you go home.

And your eggs are frozen.

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.

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.

@annathropology asks,

can we stop calling pregnancy over 35 geriatric?

Absolutely.

Why do people call pregnancy over 35 geriatric?

You are still young.

As you get older, we do start thinking about more risks.

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 is actually accurate.

And I think probably some old,

some old guy came up with that term.

So yes, let's get rid of it.

@AshlayyyS, how much money do surrogates make?

Might be my calling.

In general, in the United States,

I think this ranges from 25, 30,000,

to over 100,000,

depending upon the surrogate, and the individual situation.

It can be a significant amount of money,

but you're doing a really significant thing.

Carrying a baby for somebody for nine months.

@Bubradox1 asks,

do couples check their fertility level

before getting married, asking for a friend.

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.

Those are all things you can talk

with a fertility doctor about,

to try to minimize your risks and optimize your health.

@TheHaneroChef asks,

sigh, why do I have a fever every ovulation week?

Like proper, proper fever.

Chills, high temperature, body pains.

Cycles vary enormously.

And there can be a lot of different symptoms

associated with your cycle.

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.

@Steppingwithen1 asks,

chronic stress can negatively impact

#endometriosis and #fertility.

Have you made any lifestyle changes to reduce stress,

to support your health and fertility? Share tips.

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.

So, getting good quality sleep,

seven to eight hours every night,

eating a lot of veggies, avoiding sugar,

getting regular exercise.

You don't have to be a gym rat.

Also, having a healthy mind.

So trying to, not to avoid stress,

but to learn how to handle stress in a positive way.

@cntrymusicfan asks,

feel like I have no control

over my emotions all day today.

I'm not on any IVF meds anymore,

so I don't understand what's going on.

Maybe my own hormones trying to regulate? #IVF #infertility

IVF is a powerful process,

and it does take a little time to recover.

It can also be kind of emotional.

Cause a lot of people going through IVF

are suffering from infertility,

which can cause a lot of stress.

So I think if you're concerned,

please give your doctor a call, and get checked out.

Those are all the questions for today.

Remember, please talk to your doctor,

because this is just information and not medical advice.

Thank you so much for watching Fertility School.