Transcription:

Deborah Howell: You know, we're taught at a young age about how not to get pregnant, and that's why many people are surprised to find out how difficult it can be when they're ready to grow their own family. It's so important to understand fertility if you want to have kids someday, and getting fertility testing is a great first step towards understanding your own reproductive health.

Today, Dr. Allison Rodgers, who is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, joins the Time to Talk Fertility podcast to share some important and sometimes surprising facts about fertility and fertility testing. Welcome, Dr. Rodgers.

Dr. Allison Rodgers: Thank you so much for having me.

Deborah Howell: Let's jump right in if that's all right. Why is fertility awareness so important?

Dr. Allison Rodgers: Well, I think we are taught in sex education throughout school all of the ways not to get pregnant, and we're taught very little about what we need to do to get pregnant. And I think there's a lot of lack of awareness of your own fertility potential. And in a day and age where we're pushing off fertility to, you know, grow our careers and go to school and all the other amazing, wonderful things we like to do with our lives and pushing our fertility often into our 30s and potentially even later into our 40s, egg quality declines through time. And so, understanding where your fertility is today can really help empower you to make decisions about reproductive care and whether you want to pursue fertility preservation.

Deborah Howell: Sure. And can you share any fertility facts that are often surprising to a patient?

Dr. Allison Rodgers: It is very interesting that, by the time we're in our 30s, we have only about 10-15% of the eggs we ever started out with. And by the time we're 40, it's only 1%. Now, that is a drastic difference from men who have sperm and, because the sperm numbers, you know, might decrease a little bit with age, but really nothing dramatic like there is in women.

Deborah Howell: Right. And so, when is the best time then to get your fertility checked out?

Dr. Allison Rodgers: Well, now, of course. Your fertility is never going to be as good as it is now. So when we do get a fertility check, this is a snapshot of what your fertility looks like today. It's really hard to predict what it's going to look like in a year or five or 10 years from now. But knowing what your fertility looks like right now will help you pick up if there's any abnormalities or help you make decisions about fertility preservation?

Deborah Howell: And then, that of course leads me to ask what fertility tests are performed at FCI as part of the fertility awareness check and what do they tell you?

Dr. Allison Rodgers: Yeah. So, this is a super amazing compilation of tests. So for people with sperm, usually, we'll do a semen analysis, that gives us information on the number of sperms and the concentration, how many sperm per milliliter of fluid. It tells us about motility, how many are moving. And it tells us about morphology, so how many have normal shapes. When we think about people who have eggs, we will do an ultrasound. That ultrasound, we will look at your uterus. We will count your eggs on your ovary, this is what we call an antral follicle count. And we will do some blood tests, so an estradiol level, follicle-stimulating hormone and an anti-Mullerian hormone level. And these are some blood tests that tell us if your egg count is in the normal range.

Deborah Howell: That sounds very thorough. Now, can you identify conditions like PCOS and endometriosis with fertility testing?

Dr. Allison Rodgers: That is a great question, Deborah. So, PCOS is usually a diagnosis of what we see on ultrasound and clinical symptoms, like irregular cycles or extra hair growth. So, we can't just do blood work and an ultrasound and be able to tell you if you have PCOS. But if we see something kind of suspicious on ultrasound or blood work that makes us think you might have that, then seeing a doctor, potentially getting some additional testing that might be able to help us with the diagnosis. The ultrasound and blood work alone can't, but it certainly can help give us clues.

For endometriosis, remember, endometriosis is a situation where you have cells from inside the uterine lining that end up where they're not supposed to be, so in the pelvis. And sometimes in severe situations, they can develop into blood-filled cysts on the ovary called chocolate cysts. And we can see chocolate cysts on ultrasound. Now, there's lots and lots of people with endometriosis who never develop chocolate cyst because it's pretty advanced disease. So if you have an abnormal cyst on your ovary that looks like it could be endometriosis, we may be able to pick this up on ultrasound. But it's important to remember a lot of people with endometriosis don't have anything abnormal on ultrasound.

Deborah Howell: Right. And what should you do if you get tested and have an atypical result,

Dr. Allison Rodgers: Well, if the results were atypical for a variety of different reasons, really the best thing to do is get more information, right? And make sure that, you know, any additional testing that needs to be done is done, make sure you get all the appropriate information and then try to decide if it's something that you need to be worried about or not, right? Because sometimes we find some atypical results that's nothing to worry about. So, it's important to probably schedule a followup consultation with one of the Fertility Center of Illinois doctors like myself, and we can go through your history and order all of the additional potential tests that we would need to diagnose any, you know, atypical results.

Deborah Howell: Sure. And let's get a little bit more specific now. What are some of the options for someone who gets tested and finds out that they have low ovarian reserve?

Dr. Allison Rodgers: So just like we talked about earlier, we're not going to increase the number of eggs that you have. So, you don't get more eggs in life, unfortunately. They only go down. But if you do find out that you have a lower egg count than you were expecting, that is an opportunity to freeze eggs now, so that maybe when down the road when you're ready to have a family, that you have frozen eggs available to you. Or if you're someone with a low egg reserve now and you want to have a family now and maybe you want two children, then sometimes we'll freeze eggs or embryos now for baby number two and then work on baby number one, so really do what we call fertility preservation. And then also, if you do have a lower ovarian reserve, it's probably a good idea to make sure you don't have any autoimmune conditions, any genetic conditions that may cause this. So, some additional evaluation is recommended.

Deborah Howell: Okay. And on the flip side, what are the options for someone who has low sperm count or atypical motility or morphology?

Dr. Allison Rodgers: And again, some low sperm counts or abnormalities with motility or morphology are sort of just like things are at the low end of normal, but probably not too severe. A lot of times we'll use supplements like CoQ10 or a multivitamin to sort of help get all the antioxidants. Other times if the counts are very low, we have people who have sperm go see our reproductive urologist, Dr. Sam Ohlander, and he can do some additional testing. Sometimes, we'll do hormonal testing, genetic testing to see if we can identify and treat that low numbers in terms of count or quality.

Deborah Howell: Sure. And will a person's results change over time?

Dr. Allison Rodgers: Absolutely. So for people with eggs, like I said, we lose our eggs through time. So, this is a situation where your egg count, you know, can stay stable for a while, but over time will go down. And on the flip side, for people with sperm, sometimes we see it back five or 10 years later or two years later and everything's fine. But sometimes we see dramatic changes, and this is typically due to some other health problems that you can have or issues like if you had fever or if you started taking a medication that might affect it. So, there's other medical conditions that can cause, you know, significant changes in sperm quality.

Deborah Howell: Got it. Now, who should get tested?

Dr. Allison Rodgers: That's a great question. So, I really think that if you are listening to this and you or somebody you know is wanting a family in the future or even thinking about wanting a family in the future, there is no downside to get tested. If you think that you're somebody who's going to be ready to start trying soon, even if you're young, if you're thinking about starting that family soon, great reason to get tested. And if you are somebody who may be a single, you weren't hoping to be single right now, this is great to see where your egg count is.

Deborah Howell: And also, what about if you're in a same-sex relationship?

Dr. Allison Rodgers: Absolutely. So, I think that if you potentially want children in the future, this is really important. It doesn't matter who, you know, who you're in a relationship with, if you have eggs, they're on their way down over time. And being able to know where your egg count is and potentially cryopreserve them or freeze them for future use is important for everybody.

Deborah Howell: And I'm wondering should someone get tested if they're not sure about having kids in the future?

Dr. Allison Rodgers: Well, you want to leave that door open. So if you're somebody who, you know, you're really confident you would never have kids-- I mean, obviously, you know yourself best. But if you're somebody who doesn't think they want children, you may still want to freeze eggs, because I see, unfortunately, a lot of patients who didn't think they wanted kids their whole life come to see me typically, and their egg count is so low, you know, and this is usually something that happens in the 40s, but certainly can sometimes can happen earlier, and egg count can be so low that we're not able to be successful with their own eggs. Now, there's other treatment options, donor eggs, that kind of stuff, but nobody really wants to be doing that. So I think if you want to leave that door open, it's really an insurance policy, right? So, freezing your eggs has really no downside. You don't ever have to use them, but if you don't save them, your eggs are going to leave you.

Deborah Howell: It's an insurance policy for sure. There are several home kits available for fertility testing. What's the difference between using a home test and going into FCI or your doctor's office to get fertility testing?

Dr. Allison Rodgers: Yeah. So, the nice thing about the FCI test compared to one of the home kits is that it combines the blood work or the semen analysis, which is really, you know, the home kits either do blood for people with eggs or do a semen analysis for people with sperm and we are able to combine that with an ultrasound. So, we really can take a look at the uterus, see is there fibroids, are there problems, count the eggs on ultrasound. And it really adds so much more than doing any sort of home kit and for, you know, about the same price, or even less money.

The other thing is that those home kits don't include your partner. So if you're somebody without a partner, you know, this includes the ultrasound. But if you're someone without a partner, then you'd have to pay for their testing too, and this combines both.

Deborah Howell: Right. Okay. So if you go through fertility awareness testing at Fertility Centers of Illinois and then decide to pursue treatment, do you have to do the testing again?

Dr. Allison Rodgers: So, it depends on when this testing was done. So usually, this testing is good for about a year. So, we wouldn't necessarily need to repeat this testing. Some insurances require every six months, but you know, you don't necessarily have to repeat this particular. Now after getting your history, there's likely other testing we would want to do because remember, this is really just a preliminary skim in the surface, are their eggs, are their sperm? And we would probably want to do some additional testing, but not necessarily repeat the same testing.

Deborah Howell: Okay. Just have a couple more for you. How much is a fertility awareness check at Fertility Centers of Illinois?

Dr. Allison Rodgers: So, it is amazing. I don't even know how we're able to do this. It's $99 and that includes the ultrasound, the blood work for eggs, as well as the semen analysis. It's amazing.

Deborah Howell: incredible. All right. And does the test go through insurance?

Dr. Allison Rodgers: No, this is, this particular testing does not go in through insurance. It is a $99 just self-paid fee, so you don't have to worry about the insurance side of it.

Deborah Howell: Okay. And then, anything else you'd like to share before we wrap up?

Dr. Allison Rodgers: well, you know, if you do go through fertility awareness check and spend the $99 and something's abnormal, you come see us and you do treatment, you actually get that $99 credited to your account. So, it's actually free if you end up doing treatment, which is amazing.

Deborah Howell: That is definitely something I'm glad you added. Dr. Allison Rodgers, thank you so, so much for all the great information as always.

Dr. Allison Rodgers: Thank you so much for having me.

Deborah Howell: That was Dr. Allison Rodgers, who is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility at Fertility Centers of Illinois. You can schedule an appointment to talk to a fertility specialist at 877-324-4483 or visit fcionline.com for more information. 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.