Intro: The Reproductive Science Center of New Jersey combines a commitment to sensitive with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. And today, we're preparing for a new year of fertility goals, your New Year fertility game plan. Today, we're thrilled to introduce someone very special and new to the RSCNJ family, Dr. Ashley Ulker. Dr. Ulker is a board-certified OB-GYN with fellowship training in Reproductive Endocrinology and Infertility, and she brings not only incredible expertise, but also a deep commitment to inclusive patient-centered care.

Born and raised right here in New Jersey, Dr. Ulker is passionate about helping individuals and families feel seen, heard, and supported on their fertility journey. She's fluent in Spanish and an advocate for expanding access to care, and she believes in empowering patients with evidence-based guidance in a warm, welcoming environment.

Dr. Ulker, we're so excited to have you join us for your very first episode, sharing insights and encouragement for anyone planning their fertility goals for the year ahead. As we get closer to a new year, and as we look at those fertility goals, what are the first steps someone should take if they hope to build their family in the coming year?

Ashley Ulker, MD: Hi, Melanie. Thank you so much for that warm welcome. I'm so excited to be here with you today. So firstly, if you're thinking about trying to conceive in the new year, if you're on birth control, you definitely want to think about ways to come off that. Talk to your OB-GYN. There's different types of birth control, obviously, that you can be on. And with certain types, you can conceive that next month, but with others it takes several months. So, it's important to know which ones you need to think a little bit further ahead to try to conceive. For example, if you're on the Depo-Provera injection, or even on birth control pills, it can take several months. Whereas with an IUD, once you remove it, you can become pregnant that next month. So definitely the first step, if you're trying to conceive in the new year.

On that note, important to know kind of what your cycles are like off of the birth control. So, tracking your cycles, using one of those apps is always a good idea that I tell patients. Even getting the ovulation home kits, just to kind of generally see when your ovulatory window is. And more importantly, identifying some potential issues. If you're someone who's not ovulating regularly, this is important to know ahead of time and important to discuss with your OB-GYN, as well as starting a multivitamin or if you're planning to get pregnant within the next one to three months, starting a prenatal vitamin and getting that adequate folic acid.

Melanie Cole, MS: What great advice. All of that is so great to start thinking about now for someone who's not quite ready for treatment yet, speak a little bit about lifestyle and wellness habits that they can start now and into the new year that can make a real difference, say, a year from now.

Ashley Ulker, MD: Yeah. Well, generally, you always just want to have healthy habits. So if you're someone who has some not so healthy habits, this is the best time to start thinking about cutting back on them. If that includes smoking, tobacco, or using tobacco products, definitely try to work on that because that can have implications for pregnancy and trying to conceive, and that goes from men and women as well. If you have a lot of alcohol or caffeine intake, trying to work on minimizing that as well would be good, because then you don't want to start only thinking about that when you're trying to conceive. It's important to start that ahead of time. You want your body to be as prepped and as optimized as possible when you are finally ready to start expanding your family. As well as diet, there's no magic diet. But in general, I talk to patients about the Mediterranean diet. And this is one that includes a lot of lean proteins like chicken, fish, legumes, you know, like chickpeas and beans. It's generally a very healthy diet. Less red meat, less simple carbohydrates. And if you can start adopting this into your daily habits, then this will carry on throughout pregnancy and will be generally healthier for a growing pregnancy as well.

Melanie Cole, MS: That's good advice for all of us, Dr. Ulker. And how do you recommend listeners protect their mental health, set those goals? We're talking about goals. And when we think of like fitness goals, we think of smart goals. Well, these are fertility goals, so understanding the expectations, I think, is just such an important thing for people starting on this journey. How do you tell them about building support while pursuing those goals and looking to build their families?

Ashley Ulker, MD: Yeah, well, I mean, in general this can be this is an exciting time, but it can be a very stressful time as well for those that are starting to think about this. I know sometimes with social media, it can make it even harder when you see everyone around you potentially getting pregnant and having children. And so, sometimes you feel rushed and you feel like you're behind, but just know that you're on your own path and do what works for you. It's important to know yourself, know what your triggers are, know what makes you happy, things that relax you, if it's a certain workout class, if it's a certain TV show, you can fall back on. Surround yourself with people who really support you and who you can bounce ideas off of. It's really important not to try to isolate yourself, even though it's a very personal and private journey. If you have even one person you can talk to about it or, you vent to, or their support groups as well, it's important to kind of identify those ahead of time and just kind of have a support plan because it can get overwhelming.

Melanie Cole, MS: It certainly can. What fertility evaluations or baseline tests, Dr. Ulker, do you recommend patients consider early, even if they're not planning to conceive until next year?

Ashley Ulker, MD: Well, definitely, start talking to your OB-GYN. I would make them aware, you know, "I'm thinking about trying to conceive in the next year or so." And again, they'll talk about tracking your cycles, making sure you're someone that ovulates regularly. Talking about the importance of that and if there's anything else you need to be addressing with regard to your cycles. If you're someone who does not ovulate regularly, then you might be someone who needs to see us a little sooner than other. So, just having that in your mind, so it's not a surprise. General health testing. Be up-to-date on your pap smears. If you have diabetes or hypertension or thyroid disease, definitely you want to optimize all those medical problems ahead of time. If you're someone who struggles with weight and is trying to address that, definitely try to work on that ahead of time as well, whether That is just diet and exercise or if that's utilizing some of the medications we have available to us. Oftentimes losing weight ahead of time can even improve your ovulation, make you more regular. And so, that can improve your fertility in that way as well.

As far as kind of just testing, a general pelvic ultrasound can be helpful to identify structural abnormalities, things like fibroids, polyps, any other rare abnormalities within your uterus that we might want to address before actually trying to conceive. If you are someone who has any risk factors for tubal disease, any history of pelvic inflammatory infections, or sexually transmitted infections and even having an earlier tubal patency test might be something to do ahead of time because surgery might be required prior to trying to conceive. So, that can be important. As well as things like carrier screening, testing for recessive diseases that might be carried within your family. If those are identified within you and your partner, for example, then your offspring might have a 25% risk of being affected by that disease.

And so, in some cases, this is important to know ahead of time and might also require earlier consultation with a fertility specialist to kind of discuss what your options are, why this is important, even seeing a genetic counselor. So, these are things I would think about ahead of time.

Melanie Cole, MS: Wow, that was a great list. Listeners, I hope you'll rewind and rewatch and write all those things down because those were all very important tests to consider and to speak with your provider about, because that can really help along this journey.

Now, Dr. Ulker, are there specific situations where planning now is especially helpful, such as those who start and are having later pregnancies after 35 or individuals? You mentioned a pelvic ultrasound so that we can see if there's any structural things. Will anyone who knows that they might have a reproductive concern or LGBTQ+ community, tell us a little bit about some special circumstances and why it's so important in those situations.

Ashley Ulker, MD: Sure. Certainly, there's some special circumstances that I would recommend earlier intervention or early at least consultation. You know, those with advanced reproductive age. Those that are 35 and older should definitely start thinking about their timeline a little bit Sooner because age is the single most important factor when it comes to fertility far and wide.

And so, you need to kind of start thinking about this, have your timeline in order, And we generally recommend seeing a fertility specialist if you've been trying for already six months. I often recommend patients in this age to really go ahead and schedule that consultation maybe at the three-month mark, just to kind of get that education on board. And then, if it doesn't work out after six months, you already have done the testing, you've already had the conversation, you kind of know what to expect, you have your mindset in order, and you can go ahead and get started rather than maybe trying to get an appointment, not being able to be seen for a couple months, and you're already at that six month mark and maybe getting stressed out. So that's something I would recommend.

It's just important to have a general understanding of ovarian aging and what that means in that age group. For those who have specific maybe anatomic concerns or health concerns, something that happened in their past that they're concerned about, coming in for an initial evaluation doesn't mean that we're going to tell you, "You need treatment tomorrow." I think it's important to know that we take everything at your pace, and just generally being educated is the best thing you can do for yourself and for your health. Overall, patient empowerment is the most important thing.

If I can tell you more about what to expect, what you can do, and you truly understand that, then I've done my job, right? So, the more that you know, the better you will feel prepared to get on this journey and proceed with whatever is necessary in the future. So if You know you have fibroids or you know that you only have one tube, or you don't have any fallopian tubes or you just want some information about what is out there, it's never looked down upon to just schedule that initial consultation and just have that conversation.

For those in the LGBTQ+ community, sometimes depending on your goals and how you want to approach it, it can take a lot of legwork. And that can take time and that can be frustrating, because I know usually when you come in to see us, everybody, you know, wants to conceive tomorrow. But it might take lawyers, it might take therapists, it might take searching through different donor agencies, whether that's sperm, donor egg, surrogacy, things like that. So, any education you can do for yourself ahead of time is useful. Looking through those websites ahead of time is helpful as well. And if you want to come and just talk about what the requirements are for your specific desires and then you can start doing that legwork, I think that's very helpful as well.

Melanie Cole, MS: That was such great advice and certainly preparedness helps with really setting those expectations. Now, we talked a little bit before about mental health and things that you can do to kind of get yourself ready. But emotional wellness, these kinds of journeys can take a real toll on our mental health. They can cause all kinds of hormonal ups and downs. So, speak to patients for a minute about that emotional wellness and preparing and setting those expectations, so you understand what to expect and how they can reduce those stress levels as they move forward into the new year. Because I mean, you did mention a few things, exercise, television shows, a good support system. But kind of expand on that a little because I think that's such an important part of a really good fertility goal.

Ashley Ulker, MD: Yeah. I mean it's difficult because, a lot of times, it's something you can't measure. And a lot of times, it's something that people don't love to talk about. But if you are able to kind of approach this process in the healthiest mindset you can have, that will pay dividends in the future when we start doing treatments and talking about realities of what's going on.

I think sometimes it's a delicate road to talk about realistic expectations. Sometimes this is a difficult conversation. You want to be optimistic, but you want to be realistic. And as a patient, you want to be excited, but you also don't want to be too excited because you've had maybe a poor outcome in the past. And we get that. I guarantee you that what you've gone through, maybe it's not exactly the same as what someone else has gone through, but I guarantee there's someone else who's been in a similar situation. And so, there's a lot of support groups out there. I think it's something that's becoming a lot more readily discussed amongst friends, family, and I'm happy that that's the case because it used to be much more of a taboo issue.

So I think just if you can know that you're not alone, try not to isolate yourself. And just know what things can bring you back to center, whether, again, like I said, if that's an activity, if that's a person, if that's a place that you need to go to, if you are feeling like things are moving too fast, you are in the driver's seat. And I know this can be frustrating, because you feel like you've lost control over something that you feel like you should have control over. But anything that you can kind of regain control with is something that will help. And that's what I found with my patients in the past.

Melanie Cole, MS: Well, it certainly helps, and being your own best health advocate helps to really set some of those goals as well, asking the questions that we're talking about here today. Dr. Ulker, you're really a great guest. And I'm so glad that you're at RSCNJ. As we're getting ready to wrap up here, if a patient wants to begin their plan starting in January of the new year, what does a first appointment really look like at RSCNJ, and what should they bring or be prepared for? And I'd like you to add in your best advice, kind of summarize everything you've said here today to give us the best hope for those fertility goals in the coming year.

Ashley Ulker, MD: Sure. So definitely, if you want to come in for your first visit, don't be scared. The first visit is really information gathering. We want to get to know you, we want to get to know your partner, if that's someone you have with you wanting to know your support person. And so, we want to know your goals. Everyone has different goals. And I think that's the most important thing to be aligned with, is to be open and honest about that. We'll just ask you kind of questions about your history, your medical history, your fertility history, any treatments you've had in the past. If you have any records of those treatments or of surgeries, always helpful to bring those and any labs. Those are great to have. We can review them. If we can review them ahead of time, even better. We really just want to be able to get as much information as we can because, while there are certain testing that are pretty universal for everyone, there are some nuances and there are things that are more appropriate for a certain patient population than others. So, any information you have, number one, is helpful.

Again, any person who you want with you to hear us speak or to help you maybe recall your history is welcome to come as well. If you are going through this with a partner who will be involved, bring them along. If it's a female-male partner, it's important for him to have his testing as well. I know sometimes they don't think they're as important, but it takes two, okay? So, important to have him there and to understand that his testing is just as important as the female testing,

So, really, it's information gathering. The first visit, we'll often do a transvaginal ultrasound, and that will help us identify those structural abnormalities potentially, things like fibroids, maybe a polyp, any structural abnormalities within the uterus itself, anything that could potentially impede a growing embryo. If we can see it at that visit, you know, then we'll address it at that time.

And then, we'll talk to you about just general kind of lab work that we would like to get. If you have ovulatory dysfunction, we might get a couple more hormones to evaluate. And so, a lot of it is just kind of, again, information gathering in the beginning. And then, we'll talk to you about what that workup entails. It may also entail usually a cavity evaluation to look inside the uterine cavity, as well as a tubal evaluation, if that's something that is going to be involved in your care as well.

And then, after we have all that information, then we'll talk about the results of that at your next visit and treatment options at your next visit. So, it's not kind of too much information at once, because that can get very overwhelming. We also have informational packets that we can provide as well because, a lot of times, goes in one ear, out the other. So, we want you to be able to retain that information as well. And having that person with you also helps because if you say, you know, "Oh, I forgot they said I needed this, and what was that?", they might remember. So, it's always helpful to have two set of EARS at this type of visit. And that pretty much is what entails the first visit, is really just getting to know you guys and you getting to know us just as importantly and making sure it's a good fit, and that our goals align.

Melanie Cole, MS: Great information, Dr. Ulker. You're so lovely. And I'm so glad that you've joined the team at RSCNJ. And sharing your expertise with us is always a plus. So, thank you so much for joining us today. And for more information, you can always visit fertilitynj.com to schedule an appointment with Dr. Ulker or any member of the team and to speak to one of our fertility specialists. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole