Transcription:
When to Consult a Reproductive Endocrinologist

Prakash Chandran (Host):  If you’re trying to have a baby or just thinking about it, it’s not too early to start getting ready for pregnancy. But what exactly do women need to know about their fertility and reproductive health along the way? Today, we’re going to talk about it with Dr. Deborah Wachs, a Reproductive Endocrinologist at the Reproductive science Center of the San Francisco Bay Area.

This is Fertile Edge, a podcast by the Reproductive Science Center of the San Francisco Bay Area. I’m Prakash Chandran. So, Dr. Wachs, what exactly can you tell us about what you do as a reproductive endocrinologist?

Deborah Wachs MD, REI (Guest):  Reproductive endocrinologists are trained first in OB-GYN, so we do a four year OB-GYN residency and then we do a subsequent fellowship that focuses only on reproductive endocrinology and infertility. So, that’s an additional three years focusing only on patients who either have endocrine issues related with the reproductive system or are trying to get pregnant and we focus on different modalities of fertility treatment.

Host:  And I’d love to ask a clarifying layman question. What is the field of endocrinology?

Dr. Wachs:  So, the endocrine system in a person’s body is a collection of glands and those glands produce hormones and those hormones have downstream effects on our bodies. There are two systems. There’s medical endocrinology and reproductive endocrinology. And the medical training to go into each of those is very different. So, you may see your medical endocrinologist if you are being evaluated for diabetes. Because that is part of the endocrine system and the pancreas. But you would see a reproductive endocrinologist if you have an issue with your pituitary gland and the hormones that are being secreted that influence the uterus and the ovaries.

Host:  Okay, thanks so much for that. And as a reproductive endocrinologist, what kind of patients do you see?

Dr. Wachs:  We see a big range of patients. We see patients who are ready to get pregnant now. We see patients who are planning for potential future pregnancies. We see single women who want to become pregnant and want to learn options using donor sperm. We see heterosexual couples who maybe have just started trying or have been trying for years. We see same sex couples who are going to have other elements that play a role in terms of their ability to get pregnant and other factors that we’re going to need to consider to help them get pregnant. Everyday is a combination of all of the above which is what always keeps it interesting.

Host:  Yeah, I can absolutely see why it would. But just asking a baseline question, when a woman decides that they want to get pregnant; what are some of the questions that they should be asking their OB-GYN to start the process?

Dr. Wachs:  So, we find that many of our patients have a nice relationship with an OB-GYN doctor who sometimes they’ve been seeing for years and years. This is the doctor who most likely over the years has been doing an annual PAP smear or a gynecologic exam or who they’ve been seeing over the years anytime they’ve had a gynecologic issue. So, it’s a nice smooth transition when they are ready to start their family to talk with this doctor and say we’re starting to plan and often your OB-GYN can go over the basics with you.

What’s the fertile window? How do you know when you are ovulating? How do you know when you should be trying to get pregnant? Based on your age, should there be labs that are being drawn? Should you have an AMH level drawn which is a hormone that can measure the overall pool of eggs that you have? Should you have your FSH and estradiol levels measured? Those are also markers of responsiveness of your ovaries.

Your OB-GYN can do a lot of the initial testing which would then allow you to know, are you fine to start trying or to continue trying or do you need to move forward and see the reproductive endocrinologist for an additional evaluation?

Host:  Okay so, you mentioned measuring the AMH levels and an FSH test as well. Can you talk a little bit about some of the other tests that OB-GYN might do to determine fertility in a woman?

Dr. Wachs:  So, ovulation is really the key. And a woman herself, can figure out is she ovulating regularly mostly by assessing does she have regular periods every month. The factor that leads to regular periods is regular ovulation. So, when a woman ovulates midcycle; it leads to regular periods. If a woman notices she’s having periods only every other month or three or four times a year; she very likely isn’t ovulating regularly and so that should be one of the very first things that she talks to her OB-GYN about. And in fact, if a woman isn’t having regular periods; most likely that’s the thing we need to help fix and so rather than trying on her own for a few months; she can be seen far earlier to start to work on making sure she is ovulating every month.

Then in addition to ovulation, we know that women have fallopian tubes and we want to make sure that the fallopian tubes are open and there are times where a test for the fallopian tubes called an HSG, it’s an x-ray test that can be done to make sure that the fallopian tubes are open. We also can have an ultrasound done and that looks at the uterus and the uterine lining and based on where a woman is in her cycle; we know that the lining should look differently based on what stage the ovaries are and how close to ovulation she is.

If a woman has a male partner, we will often order a sperm test as part of the evaluation because we know there’s a subset of couples where it will be a sperm factor that can be addressed with treatment.

Host:  Okay and you mentioned a couple of different things there and from what I’m understanding, the most important thing is making sure that a woman is regular. So, if a woman is not regular, talk about what kind of treatments an OB-GYN can provide to help fix that along with any other things that a woman might be experiencing.

Dr. Wachs:  So, sometimes a woman will have irregular menstrual cycles because of something else that’s going on in her body. So, thyroid is a good example. Sometimes if a woman is hyperthyroid or hypothyroid, she can notice a change in her menstrual cycles. So, often, your doctor will order some additional tests if you report that you have abnormal periods to try to assess why do you have abnormal periods and is it something that could be easily remedied. There are conditions however, that lead to irregular ovulation that aren’t necessarily treated themselves, but the result of those conditions and that result in this case is the irregular periods is what we directly treat.

And there are oral medications that can be given to a woman that can very commonly help her start to ovulate every month. And the OB-GYN doctors are sometimes comfortable being the ones to prescribe those medications and a woman takes the medication at the beginning of a cycle and most commonly, it will lead to a ovulation a couple of weeks later and as soon as she is ovulating, she should resume regular cycles and once she’s doing that, then she knows that she can be trying to get pregnant with each one of those ovulations.

Host:  Okay, but say a woman is listening to her OB-GYN, following all the instructions, the ovulation cycles are regular; I’m curious about when is the right time to seek a referral to an infertility specialist?

Dr. Wachs:  So, the right time really varies. Many women right from the beginning say I would rather be doing this with a specialist and the nice thing about fertility and most insurances is this is not a field where you need to have a referral from a doctor. So, patients can call and schedule an appointment with an infertility specialist just because they want to. So, a large subset of patients that we have are busy looking on the internet, they see that there are treatments out there, they are looking up doctors and they are contacting us on their own. Other times, they’ve worked with their OB-GYN for a little bit and they say to their doctor I think I’m ready to move on or their doctor says to them look we’ve done what we can do together, I really think you need to be working with a reproductive endocrinologist at this time.

Another subset of patients I would say should consider a referral or should consider booking an appointment is if you have insurance benefits for fertility treatment; often if you can start doing your fertility treatment with the reproductive endocrinologist; you may have a more effective use of those insurance dollars. So, there is a big subset of patients who we see who have great coverage, mostly because their employers are generous with the benefits that are offered, and I would say if you know through your employer that you do have good coverage for fertility treatment; I would ask sooner to be referred to the reproductive endocrinologist to start your treatment there.

Host:  Yeah, that makes a lot of sense. So, in wrapping up here, I’m just curious about if there is anything that women can do naturally like diet or lifestyle or anything like that to enhance the reproductive health?

Dr. Wachs:  That’s the question every single patient asks because I think they would be thrilled if we told them eat these foods, do this every day, and you’ll be able to get pregnant. So, the shorter answer is, maintaining a healthy lifestyle with most of what is common sense is one of the biggest factors. So, being at a healthy weight, believe it or not, sleep is a big one that is overlooked. You want to make sure you really are getting enough sleep every night. And most of the time, that’s a good eight to nine hours of sleep a night. Trying to reduce stress in areas of your life where you are able to. Having a exercise routine and regular balanced diet is also a great idea.

Making sure you’ve taken care of any other medical issues you have going on when you know you’re going into a pregnancy. You want to make sure that you don’t have lingering appointments or tests that are going to need to be done because once you are pregnant, everybody is hesitant to be doing additional testing that isn’t related to the pregnancy itself. So, I always tell my patients this is time to follow up and do that ultrasound or that dental work or the mammogram. Get it all done so that you can be focusing on your pregnancy.

There’s been a lot of studies that have looked at is there a specific diet that’s better and that’s a very common question we get. The short answer is no, there’s no magical diet that has shown to be more effective for helping with pregnancy, but we do have a lot of patients who will make dietary changes to see if they feel better. Patients will sometimes give up dairy or go gluten free or make adjustments that sometimes can actually make them feel better and often you’re feeling better if you are reducing inflammation. And we know that there are a lot of diets that can reduce inflammation. So, while I wouldn’t say there’s a single diet that I would recommend; I certainly do look to making dietary changes as something that a person can do on their own that can potentially improve their chances.

Host:  All right Dr. Wachs, well that’s very sound advice and I really appreciate your time today. that’s Dr. Deborah Wachs, a Reproductive Endocrinologist at the Reproductive Science Center of the San Francisco Bay Area. Thanks for checking out this episode of Fertile Edge and for more information please visit www.rscbayarea.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.