Deborah Howell (Host): Are you thinking about starting a family someday but are unsure where to begin? Dr. Channing Burks Chatmon, a Reproductive Endocrinologist with Fertility Centers of Illinois, joins the Time to Talk Fertility podcast to divulge expert insights about the complex world of fertility. From age and lifestyle choices to medical conditions and environmental factors, we'll provide some essential information for anyone contemplating their future family plans. This is the Time to Talk Fertility Podcast. I'm your host, Deborah Howell. Dr. Burks Chatmon, it is so nice to have you back with us today.

Channing Burks Chatmon, MD: Well, thank you, Deborah. Thank you having me. I'm excited to be here.

Host: All right, diving in, why is it important to start thinking about planning for your future family?

Channing Burks Chatmon, MD: So, I think it's important for couples to think about it in advance, especially since for women, age definitely affects our reproductive potential. So, things for women, you know, they change with age. We are born with as many eggs as we'll ever have. So, I think that it's important that women, if they're with a partner, start to think about when might we want to have a family, discussing those things with an OBGYN.

There are also many centers that can offer fertility awareness testing, if you're interested in that as well, to help couples just to try to figure out when it might be the best time to start implementing that plan.

Host: Sure. And if you were to boil it down, what are the key factors that influence fertility for both men and women?

Channing Burks Chatmon, MD: There's a lot that goes into it. Age is important for women, even more so than men. Other factors include just kind of the standard things that we're testing for with kind of our fertility evaluation. That includes your ovarian reserve for women, uterine, different uterine factors, fibroids is major one for uterine factor or any congenital defects that you might be born with, like a uterine septum.

There's also endometriosis. Hormonal conditions like high or low thyroid, and then for men, it's, we really start with assessing the sperm.

Host: And what kinds of fertility tests are available for individuals and couples, and what can they tell us?

Channing Burks Chatmon, MD: For standard evaluation, typically we assess ovarian reserve with an ultrasound and blood work that's done at the start of your cycle. We typically want to assess structure, so both your tubes and your uterus. And that can be done in various ways, typically with a saline ultrasound or a HSG or histosalpingogram.

And then for men, we'll typically start off with a semen analysis to start.

Host: Okay, and when is the best time to undergo fertility testing, and how early should one start?

Channing Burks Chatmon, MD: You know, I think that's a very individual decision. I think there's a lot of different factors that go into it, such as are you ready to start a family or not? Do you have normal periods or not? Are you having heavy bleeding, painful periods? Have you ever had any family members that have had difficulty conceiving or a family history of women that have gone into menopause early, meaning under the age of 40.

So I think it's always better if you are thinking of conceiving in the near future to discuss it with your OBGYN or even to come in to see a fertility specialist and kind of make decisions together based on your full medical history.

Uh,

Host: Okay, got it. Now, what are some common fertility issues that individuals and couples might face and come to you with, and how can they be addressed?

Channing Burks Chatmon, MD: I think kind of some of the things that we've named. So PCOS is a common condition, endometriosis, we treat couples with low ovarian reserve. Just as many couples will have a male factor as well as some of the female factors that I have mentioned. I think that there are many different fertility issues and some couples will even, you know, have something that is attributing on both the female and the male side.

So I would just say that is why it's so important to kind of complete the full evaluation. We always want to make sure we're not missing anything that we should be trying to optimize.

Host: Okay, and earlier is better. So how do medical conditions like PCOS, endometriosis, or diabetes impact fertility and what treatments are available?

Channing Burks Chatmon, MD: For PCOS, that's a hormonal condition, thyroid is the same, so we think that if it's impacting your hormones, that can affect your cycles. And if you're having irregular cycles, that affects ovulation. And if your ovulation is affected, that can kind of impact your natural ability to conceive.

So treatments for PCOS include like ovulation induction agents. We can use things, letrozole typically is the gold standard med for PCOS, as a baseline to try to help women ovulate. For endometriosis, there's a lot of research going into this field right now. We don't have all the answers, but we think that a lot of it can be just that the endometriosis can affect the physical placement of some of your organs and your pelvis. So the anatomy is affected. So your egg and your tube and even your uterus and how those function. As far as diabetes, we know that diabetes can affect hormones as well. It can also increase risk for miscarriage and a lot of other pregnancy comorbidities.

 Everything really is, individualized. I think that's fair to say, based on the factors that we find on evaluation.

Host: And you treat each patient individually. So how do lifestyle factors like diet and exercise and stress impact fertility?

Channing Burks Chatmon, MD: Well, we know that increased weight can have negative, impact on outcomes. So it can lead to decreased likelihood to conceive or increased risk for miscarriage. So we always want, you know, encourage patients to be the healthiest version of themselves as much as possible. There's not one specific diet that's been shown to consistently improve fertility outcomes, but generally speaking, we want you to try to be healthy, you know, eat a lot of natural foods, avoid a lot of processed foods, exercise is a way to also have a positive impact on your weight, help patients lose weight, it also can help to manage anxiety and stress, and then stress, you know, a lot of it is not necessarily in our control, we all have a lot of life factors that, work and, outside family stressors or friends and things like that, that can come into play. But I think what's in your control in regards to stress, I always tell patients to try to limit and fertility treatments can be really hard. So I think anything that you can do to bring you joy, whether that's spending time with family, spending time with friends, going to your favorite restaurant.

Those are the type of things you definitely want to plan while you're doing fertility treatments to make sure you're also trying to get those joyful things in during a, what can be a stressful time.

Host: My friend is due next week and she's still doing yoga every day. She's loving it.

Channing Burks Chatmon, MD: Oh, that's wonderful for her.

Host: It's bringing her joy. So how can genetic testing play a role in family planning and what should prospective parents know about it?

Channing Burks Chatmon, MD: I think for genetic carrier screening is what you're alluding to; it is something that is optional, but I think that it should be available to all couples that are looking to conceive. And with genetic carrier screening, it doesn't test for any gene or any genetic condition, but it does try to focus on conditions that are what's called autosomal recessive.

So that means that if you are a carrier for that genetic condition, you actually are asymptomatic. So the gene is silent. So an example would be cystic fibrosis, or sickle cell, or different blood disorders like alpha or beta thalassemia. So in order to have a child with these types of conditions, both mom and dad, both have to be carriers of the gene.

But the main issue is that if you're a carrier, you don't have any symptoms, so you wouldn't know. So often when patients come in to a fertility clinic, this is something that we offer to them. Do they want a screen through a blood test to see if they, so the both parents are carriers of the same condition.

If they are, let's say both carriers of cystic fibrosis, then they have options that they can decide to proceed with such as IVF and genetic testing of embryos, if they decide that that is a condition that they would like to avoid passing on to their children.

Host: Got it. Okay, so a lot of young couples are like, sure, we want to have a family someday. What options are available for preserving fertility and who should consider them?

Channing Burks Chatmon, MD: I think our main option and technology that has come about in the past 15 years or so for women is egg freezing for fertility preservation. And it is a way for women to freeze eggs that they can come back and use later.

So you see a fertility specialist, you do testing, and then you decide to go through a stimulation where we're kind of taking advantage of a cycle, trying to use medications to get multiple eggs to grow in that month, outside of the normal one egg. And then you undergo what's called an egg retrieval.

And now we're able to retrieve or obtain eggs and then freeze them for the future. And I think the most important thing women should know about this is that it serves, yes, as an insurance policy but also there's no negative impact to your future fertility by doing egg freezing. Every month, we lose a group of eggs.

 And so, with egg freezing, we're kind of allowing eggs to grow, saving them for later. But with that next period, those eggs would have been lost anyways. So, by doing egg freezing, want to make sure everyone understands, no negative impact on your future fertility.

Host: Got it. Thank you for clearing that up. A lot of people think otherwise. So what specific factors affect male fertility and what tests and treatments are available for men?

Channing Burks Chatmon, MD: You know, there's a lot of factors that can affect male fertility. So, varicocele is a common one, that's dilated kind of veins, near the testes. There is hormonal conditions that can affect males just as they do females. So the brain and the testes function together, communicate back and forth. Just like in women, the brain and the ovary communicates back and forth. So we can do hormone testing as well to try to identify those issues. We also know it's very common for men to as they age or from certain medications to even notice changes in sex drive, or even ability to try to conceive at home. Those things can also change. So those are all things that want to talk about and kind of address when we meet so we can make sure we're doing all of the proper testing.

Host: And looking at all the possibilities for those who want to create a family, what are some alternative family building options like surrogacy and what should prospective parents know about them?

Channing Burks Chatmon, MD: So as you mentioned, we do have many paths to parenthood. I always encourage my patients, if it looks like we need to go down an alternative path, even though it might not be the path that they imagined; we're still trying to achieve the goal of parenthood, and for most patients, they come to see that that's what's most important, even if the path looks a little different.

So things that we offer, so donor egg, for those that might have had early loss of eggs or what's called diminished ovarian reserve. There's donor sperm; if low sperm sperm counts, are found and we're not able to optimize sperm. There's also, as you mentioned, gestational carriers. There are also donor embryos, embryos that have been donated from other families that are no longer using embryos. So, there's a lot of different options and there's many paths to parenthood.

Host: Great. It's so good to know and so reassuring. I have just two more questions for you. How is technology advancing the field of fertility and family planning? And what innovations should we be aware of?

Channing Burks Chatmon, MD: We're always trying to improve. We're always trying to have new technologies that can be more successful, but it also means that we want to make sure that, something is reliable or routinely going to help couples before we start to introduce it in everyday medicine.

 The technology that comes to mind when I think about recent advancements in our field is something called pre implantation genetic testing, or PGT for short. It is something that has gone through a lot of changes in the past, 10 years or so, and it is a technology we use to screen embryos.

The goal is to try to screen the best embryos for transfer, to rule out things like random chromosome error, such as Down syndrome; or if a couple has a condition that they would prefer not to pass on. So this helps us to improve pregnancy rates in some couples and it has been found most helpful in perhaps couples that have females greater than 38 years old, or as I mentioned, can also be used to screen for genetic conditions if either one parent or both parents are carriers for genetic conditions that they do not want to pass on.

Host: And finally, what are some emerging trends and future directions in the field of fertility and family planning?

Channing Burks Chatmon, MD: We're always trying to improve. Right now, I think a focus for a lot of us is trying to spread fertility awareness. I think it's something that is not really discussed enough, when we're in school and when we are, you know, in our teens or twenties, especially for women to just understand that, unfortunately things reproductive wise do change for us with age. But the more we can kind of spread the word, right, about that and educate women about this; then they can have that knowledge, feel empowered to make decisions that would give them the most options for the future. I think that also, right now we're trying to all advocate for increased access to fertility care.

We know that infertility impacts one in six couples, and we all feel that it is a medical condition that should have coverage just like other medical conditions do; high blood pressure, diabetes. So I feel like that is something in our field we're all really advocating for.

Host: 100%. Well, this is such wonderful information, Dr. Burks Chatmon. Thank you so much for being with us today to share all your expertise. We really appreciate it.

Channing Burks Chatmon, MD: Yeah, thank you. Thank you guys so much for having me and it's really been a pleasure.

Host: That was Dr. Channing Burks Chatmon, a Reproductive Endocrinologist with FCI. 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 make 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 great day.