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Deborah Howell: Fertility is a booming business, but it's also a very personal journey. And this episode, we'll dig into some fertility, facts and secrets to deepen our understanding of the fertility process. Joining us today to share these facts and secrets is Dr. Elie Hobeika, a Board Certified Physician at Fertility Centers of Illinois. This is the Time to Talk Fertility Podcast. I'm your host, Deborah Howell. Dr. Hobeika, here's the first fact about IVF. Tell us if it's true or false, going through IVF does not decrease your fertility or your ovarian reserve?

Dr. Hobeika: That is correct. Going through IVF recruits, the maximum number of follicles that can be recruited in a given month. However, if you were not doing IVF, you would recruit only one or two, and the remaining ones with die way. That means doing IVF only increases the number of follicles that can be recruited without necessarily speeding up the loss of your ovarian reserve.

Host: Well, that's good news. Here's the next one. While women bear the brunt of the work for creating a child, men are just as likely to be diagnosed with infertility issues.

Dr. Hobeika: That is somehow correct. The chances that males or females are diagnosed with infertility is approximately the same to be just like a general one-third of the times the problem lies in the female, one-third of the time it lies in a male. And in one third of the time, there's a problem in both partners in heterosexual couples.

Host: Well, you can't get more equal than that. Another common error, some primary care physicians prescribe testosterone for men trying to have kids. Is there anything wrong with that?

Dr. Hobeika: There's something that's very wrong with that actually prescribing testosterone via an exogenous source, such as either by tablets or injections will shut down the production of sperm in the male. And it's very unfortunate that there's some physicians out there that are unaware of that. And they usually do not check with the men and see if they're trying to conceive with their partners or not. So definitely for all the men out there who are trying to have a child or trying to conceive, they should be off the use of testosterone, whether it's orally ingested, or injected intramuscularly.

Host: No T. Not every doctor understands PCOS either. It takes an average of two years and three doctors to be properly diagnosed.

Dr. Hobeika: That is one of the unfortunate things also that is out there. Diagnosing PCOS should not take more than two to three to two visits to make the diagnosis. It's usually initially a visit to collect the history, do an exam and order some blood work and an ultrasound. And by the time patient comes back for a follow-up visit, we usually can make a clear diagnosis and can confirm if she truly has PCOS or not. I'm not exactly sure if it is lack of follow-up or lack of training of physicians that's making those times that long, but usually whenever women seek care with a reproductive endocrinologist and infertility specialist, they should have a definitive answer within two visits.

Host: And another tricky one, endometriosis takes an average of 10 years for a diagnosis, and I can speak to that cause it took 15 to get mine diagnosed?

Dr. Hobeika: Well, and unfortunately, also this is kind of like more understandable and common to happen, that relative diagnosis of endometriosis lies in having surgery and seeing those lesions in the abdomen, biopsying them and getting a histologic diagnosis. Now, the symptoms of endometriosis are pain. Now, clearly not every woman who has pain will end up having surgery to see why this pain is there. In rare instances, women may have cysts on the ovary that look on the ultrasound that have a characteristic appearing on ultrasound called endometrioses or chocolate cysts. Those who have those cysts will have a relatively easier and faster time from symptoms to diagnosis. But unfortunately, women do struggle with this disease until a final diagnosis is made. And usually this is when they get to the point of having surgery and having those lesions biopsy then confirmed.

Host: Got it. Now there's some prescription medications that can hurt fertility?

Dr. Hobeika: Correct. We just spoke about testosterone a few minutes ago that is one of them. Other medications that can affect men include those that decrease the testosterone availability in their blood, or that prevent testosterone from binding to its receptor. And women, there are some medications that were alter their ovulation pattern and can cause them to have an ambulatory cycle, which will prevent them technically from conceiving. It's very important to whenever women who are trying to get pregnant, go to their OB GYN office or the reproductive endocrinologist office to disclose all the different medications that they are taking.

Host: Got it. Now, this is surprising. Most people don't undergo genetic carrier screening before trying for a child. Should they do that?

Dr. Hobeika: It's something that's highly recommended to be done, especially it can make you avoid transmission of major diseases to your offspring. So the whole concept lies and making sure both partners do not have a mutated gene for the same disease. And this is usually something that none of us, none of them will know that if they're carrying, if a person has a mutated gene for a disease, they're not going to be affected. And usually none of their family members will be, but once they are conceiving with a partner, and if this partner has a mutated gene for the same disease, they will have one in four children that may be affected with this disease. And usually those are major and affect the quality of life. So better, safe than sorry. We recommend that all couples get screened for those. And it is true that in the vast majority of cases, we will not end up in a situation where this risk is present.

Host: And how about chronic conditions like diabetes, thyroid, morbid obesity, if they're not managed, should you see a before starting to try for a baby?

Dr. Hobeika: A hundred percent. I mean, some of our patients are more focused on the fact of getting pregnant, but there are major diseases that one, decrease the chance of patients getting pregnant and then increase the chance of miscarriage and diabetes is one of them. Uncontrolled diabetes increases the chances of pregnancy loss in the first trimester. It increases the loss of having children with congenital anomalies, mainly heart anomalies. And it's also increased the chances of having pregnancy loss later in pregnancy, other major diseases as well. We should have a holistic approach technically, and think of the body as a whole. If the body is diseased or has a certain illness, one should control the sickness in the optimal way possible before trying to conceive, because pregnancy in itself will cause an additional stress on the body and the body needs to be prepared for it.

Host: Absolutely. Now we all likely know several people with infertility and those who are open with their fertility journey are always kind of surprised by how many people close to them also need help.

Dr. Hobeika: That is very correct. I mean, fertility affects approximately 15% of the population. And right now, in this day and age, a lot of people are sharing their journey and the more people they share it, the more surprised they're going to realize how many couples out there have gone through that journey, even though they may not have, they would not usually disclose it, but they will. Whenever they find another couple that has gone through that journey.

Host: Genetic testing of embryos certainly was not covered by insurance, but a new change can help some people. How so?

Dr. Hobeika: Yeah, it's actually something that we as fertility specialists just has been discovering recently. Genetic testing has been something that is usually out of pocket and not part of the insurance plans of a lot of patients. But right now, surprisingly insurance have been bearing a big cost of that test and making the out-of-pocket costs for couples significantly reduced. So it could be something that a lot of patients may benefit for. It is still unclear for us what the reasons of that coverage is. But over the year of 2020, we have been seeing approximately, based on the insurance, of course, approximately 60 to 70% of those biases being covered.

Host: This is an easy one, true or false you'll be seeing and talking to your care team a lot during treatment.

Dr. Hobeika: Oh, this is very true. Our patients will be closely talking to us, talking to our nurses, talking to our front desk for appointments. They will be updating us on how they're feeling. If anything comes up with them, they will talk to the nurses, to the physicians. And a lot of times it's the teamwork that happens on the side of the, a care team where the nurses reconvene with the doctors and then communicate the findings of the results with the patient. So we're definitely a lot of communications going on and we strongly encourage patients to be proactive and to take the initiative into asking questions if they have, or requesting to talk to their doctor or their nurses, if they need to.

Host: Speaking about being proactive, can consuming a diet, rich, whole grains, fruits, and veggies, seafood, and plant-based proteins, improve success rates after IVF?

Dr. Hobeika: That is very true. And it should be started at any point during the process, even if someone found late that this is the best diet to use, it's never late to start it. This is the most recommended diet that improves fertility of couples, either spontaneously or those undergoing treatment.

Host: This is my favorite one. Eating yams does not increase your likelihood of having twins.

Dr. Hobeika: That's true. It does not. I mean, there's some old, they're like an old myth about some tribes that ate a lot of yams and the rates of twins in those tribes was extremely elevated. Other theories are that yams increase your natural progesterone level. Unfortunately, none of those have any scientific evidence that backs this data.

Host: The more myths or secrets, COQ10 supplementation may improve egg quality, right?

Dr. Hobeika: That is correct. I mean, COQ10 one of the supplements that have the most evidence in terms of improvement of fert quality. If they can have the right dose, this is where a lot of patients miss, and the correct dose is 200 milligrams taken three times daily.

Host: There's no secret supplement that will make you fertile quote unquote?

Dr. Hobeika: A hundred percent correct. There's no secret supplement that will turn the switch on or off from fertility to no fertility among the many minerals and vitamins that are being studied, maybe as we mentioned, a few seconds earlier, COQ10 has the most evidence. There is another vitamin that has been shown to have an increased rate of recruitment of the ovaries during IVF and women who have a low reserve. And it's called DHEA

Host: That's for a lot of uses.

Dr. Hobeika: Correct.

Host: Okay. How about taking a prenatal vitamin before you get pregnant? Very important?

Dr. Hobeika: It is very important and it's suggested that women start pre-natal vitamins three months before trying to conceive. And the main reason with it is to build a store, the source of the body in terms of vitamins and nutrients, cause the pregnancy will absorb all those nutrients from the woman's body. And another main reason for prenatal vitamin supplementation is providing an adequate amount of folic acids to prevent any neural tube defect that may occur during pregnancy

Host: And Dr. Hobeika, you see patient’s day in, day out through their whole journey. Can you share some words of hope with our listeners?

Dr. Hobeika: Well, I always tell my patients that in fertility, it is a journey, we definitely know when it starts, but we do not know when it's end, but I can tell them to be positive and hopeful because the end is worth waiting for. And eventually they will end up getting the result that they want.

Host: Well, Dr. Hobeika, we can't thank you enough for being with us today and for letting us learn all these new facts and secrets about the IVF process. It was very, very fascinating.

Dr. Hobeika: Thank you for having me, Deborah.

Host: That was Dr. Elie Hobeika, a gynecologist and reproductive endocrinologist at Fertility Centers of Illinois and board-certified in OB/GYN. Find out more about the services FCI provides for patients by calling (877) 324-4483 or head on over to FCIonline.com to schedule a tele-medicine appointment with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library and be sure to give us a like, and a follow if you do. This has been The Time to Talk Fertility Podcast. I'm your host, Deborah Howell, have yourself a terrific day.