Name: Fertility Crash Course
Uploaded: 2026-06-23T15:16:13.694Z
Duration: 59 min
Description: Fertility Crash Course

Transcript for "Fertility Crash Course": Alright. Hello, everyone, and welcome to the fertility and summit. We have got a full day plan with topics on fertility, mental health, access to care, hormones, egg freezing, self care, and so much more. Throughout the day, you'll hear from physicians, advocates, educators, and community leaders to discuss each topic. Now because this is a live event, you can send in any question at any time, so feel free to drop them in the chat. Now let's kick things off with our very first session, fertility crash course. This panel is meant to give everyone a strong foundation on the basics of reproductive health, what symptoms or conditions may be worth looking into, what treatment options there are, and how lifestyle plays a role in all of it. So I'd love to start by having each of our panelists, briefly introduce themselves. Doctor Luke, would you like to begin? Yes. First of all, thank you for all the speakers. It is an honor to be here today. Thank you. Nice to see Donna Benedetto, doctor Sable, doctor Scafani. So it is amazing. And thank you, Destiny, for doing this. So health and wellness summit is one of the, I think, event that we start two, three years ago now. Obviously, Right. starting the half year, and it is a, form that we hope to empower our audience, not someone to just walk through the clinic doors, but something people in the community and public, and really to focus on the health education, and keep the conversation alive. Because I think, even through Facebook, through many other, avenues, sometimes hard to talk about something that is very personal, and we want great educator like you all, to chime in because it is hard to integrate. I always say, to Destiny or to my staff, there's the black and white. There's the gray area. There's lots of gray area. Is it doctor Luke, you say something, or was the OB GYN saying something versus was the acupuncture saying something? So it is not easy, to add for the person to ask three different areas the same question, but we want to have a form so then patient can get a integrated answer. So we are here today. I'm very excited to be with all of you. And. sorry. Am I supposed to yes. I'm doctor Janelle Luke, the medical director here at GenerationX and cofounder at GenerationX Fertility. So thank you for being here. Fantastic. Thank you, doctor Luke. Doctor Sabo? Oh, hello. I'm Mary Sabo. I'm a doctor of acupuncture in Chinese medicine. I have been practicing and specializing in fertility acupuncture for about twenty years now. I have an integrated reproductive health clinic in Manhattan called Lillian Horn. We're a group of acupuncturists, mental health specialists, nutritionists, naturopath, and two internal medicine physicians. We like to collaborate on care, and we support people through reproductive journeys, including fertility, pregnancy, postpartum, and perimenopause. Amazing. Thank you. Next, I'm doc? I'm doctor Benedetto. I'm the one who takes care of the patients after doctor Luke tortures them, and then I will torture them during pregnancy. I have been practice practicing OB GYN for, I don't know how many years, and I don't want to say. And I take great pride in, actually guiding the patients through their pregnancy and, allow them to have a vaginal delivery. I, take great pride in this because, especially during this time where, everybody's so afraid and is defensive medicine. I'm the one who we send patients who had C sections somewhere else, and then I try to have them have a vaginal delivery. I pretty much believe in the right of the women to actually have a natural birth. So here I am today. Amazing. Thank you so much for sharing. And doctor Scalfani? Hi. I'm doctor Teresa Scolfani. It's nice to meet everyone, and thank you so much for inviting me. I'm really excited. I'm a board certified interventional radiologist, and I'm the founder of your interventional vascular care here in Garden City. And, women's health is super important and fibroids, you know, is a is a soapbox of mine. You know, as an interventional radiologist, we're usually hidden in the background of the hospital. So it's super important for me. One of the main reasons I opened the office was to get out there in the community and just help women learn about all their options that are out there. I want everybody to know their options and be educated and make whatever decisions are best for themselves. So thank you. Thank you, Amazing. Brad. Thank you so much all of you for joining us today. So I wanna start with you, doctor Luke, because so many people are told not to worry about fertility until they're actively trying to conceive, but we know that being proactive and informing ourselves can make a huge difference. Can you educate us on what infertility is and why it happens? Yeah. This is a great question. So, let's just go by the definition. Definition. is that infertility is if you're under the age of 35 and you've been trying for a year or more, you would like to you may need to seek care for fertility care. And if you are over the age of 35 and you are, trying for six months, you would like to see, you may need to see medical care. And, why does it happen? And, and, really, I always explain to patient the four items for fertility, tube, uterus. So I, yeah, I always bring my little doll with me in the room, a little doll. I don't know. I'm hugging my doll now. I'm talking to my patient. I know they think I may be cramping. I don't know. But I will I always hold this when talking to them. But since my patient likes it. So ureth tube, ovary, egg, and sperm. So doctor Benedetto or, doctor Scafani, they will screen sometimes, they have the workup already. They would did the tube test, which is called the histoceal painiogram. They may scan the patient the uterus, and then they will scan also the ovaries. But I always emphasize, when I see that what is ultrasound for. Ultrasound is really mainly for the uterus. The tube is very hard to see from ultrasound because, you don't know if it's blocked or not blocked unless it's inflamed. So if this inflamed, I was because most of us would say, oh, you look great. Then patients are, oh my. Then they would come to me, oh, oh, my OB joints and my whole body looks great. I'm like, how did she how does she know your tubes are blocked? Well, well, she look at ultrasound and she said it was great. So everything must be great down there because she told me it was great. So I then I would define the Otisah well. It's great. It doesn't look inflamed. It's not engorged. So the OBJAR didn't see it or your I didn't see it, but it doesn't mean it's not blocked inside. And then I try to use Holland Tunnel, like, you cannot see from the outside. The tunnel looks fine, but there may be traffic. How do you know? You know? Because it's very hard concept for them to understand because you have you have vaginal exam. You're inside. You're supposed to see area. Then the the other two items is the sperm and the egg. So sperm is a little bit not to put the guys down. It's really quantitative motility. We have sperm. That's it. The quality of the sperm is really sometimes hard to be seen because, you really look at morphology. But, again, I know for audience who's surprised, you only need 4% morphology to be normal according to the World Health Organization. It doesn't really need all of them to be normal. I know. You need 4% when you need one sperm, and they're a 150 to a 100,000,000. So sperm, most important motility and quantity. Then finally is, egg, and this is other another explanation. Many of women who are coming to me now, they are very amazing. They're empowered. They come on podcast. They were like, doctor Luke, I want to see if my eggs are good or bad. I said, what do you mean? I get scared with those question because I have limits, I said. They want to look at quantity. I said, no problem. I would count how many follicles on your ovary. I would check your AMH value, to see how many eggs. you have, but I cannot see your equality. And then they're like, what? And now I said, well, but you're 25. 80% of your eggs are super very good, but I cannot predict. Would the eggs be good or bad? Because they're trying to, like, delay marriage or delay things. They will try to tell let me answer the question. Can I can I have a baby until 38? I'm like, no. I cannot do that. I I cannot predict that. So, I usually try to equate equality with their age and link with that and why infertility becomes such a hot topic because it is true. Majority of us are delaying biological like, to have a baby, into our mid thirties or early thirties versus our previous generation people are having babies in their twenties. Even earlier, people may have they have been 19, 20 years old. That's when my mom's generation or, you know, early generation. So the delay of childbirth does, affect with decline of life birth. I guess it doesn't happen just in America. I think it's around the world right now. So. that inadvertently causes the increase in infertility. So those are the things that, as we are migrating to the future, wants to talk a little bit more about infertility. But, majority of time is really age and for the audience. At 35 years of age, I usually equate the quality of x by 50% good, 50% bad. Try to kind of extrapolate the understanding, how quality does change during from 20 to 40 years of age. It is very different from a man, in terms of thinking about how the decline is, but it's a sharp decline from 20 to 40 years of age. Thank you, Destiny. Thank you so much, doctor Luca. And I think that's such a helpful foundation. Now I wanna switch things over to doctor Benedetto for a minute. Especially to hear from an OB GYN perspective. When it comes to our periods or our menstrual cycle overall, are there any things that we normalize that might actually be worth paying attention to? For example, things like painful periods or maybe heavy bleeding or maybe even the duration of our cycle itself. This is very important because when patients come to me and they come for a annual exam, general exam, many. many times they do not really, have a a real understanding about how their menstrual period is doing, in the sense that. I have patients who are super anxious, and even if they're having a normal period that comes every twenty eight days and they take probably one Advil, they are very concerned about it. And then there are patients who have been with pain for such a long time or very heavy bleeding for the two, three years, and they have no, no idea about why this is happening. So it is our job to actually probe the patient to try to really understand what's going on with them because many times, you might have patients who have not only very heavy period, but also lots of pain. They cannot go to work. They they can every six hours for three, four days. And, you might want to try to understand if they're having a problem with endometriosis or if there is anything. else that is behind that so called normal period that in reality is not. And this happens actually actually in young girls. If you read the literature, you will see that many of, teenagers, I see a lot of 16, 17, 18 years old who actually have endometriosis and they have not been diagnosed with this. And if you don't act early, you are they then have to go to Doctor. Luke later on, and they might need a lot of surgeries or a lot of treatment for infertility that is related to something that you could have diagnosed early enough. Young women are not taken are not taken seriously by dear doctors. They say, oh, it's alright. You you will be fine. You will take some Motrin and you will be okay. But it's not okay if, the patients are in pain. You have to take their pain seriously and try to actually guide their, treatment so that you you cannot negate, but you can minimize the problems later on. So when we say normalize, we don't we do not don't want to normalize anything. We want to see what is really. normal and what is not normal. And it is the our job is the job of the regular, gynecologist to help these patients before they have problem later on. You know, I love that because I think a big theme today is that people do not need to wait until they're overwhelmed or they're in excruciating pain to start asking questions about their own body. Right. Now doctor Sabo, I want to hear your thoughts from an acupuncture and integrative wellness perspective. You know, when someone is dealing with painful periods or irregular cycles or even preparing for fertility treatment, How can acupuncture help support the menstrual cycle and reproductive system? It's an incredible tool in part because all of our treatments are customized, and we look at the entire body and what's going in and on the body and how it's performing and responding to its environment. So I think of acupuncture as, like, a signaling mechanism where I'm talking to the body to kind of help it reach homeostasis. So each acupuncture treatment is really customized for that patient. I do a really long intake when I see a a patient initially anywhere from, like, half an hour to forty five minutes of chatting about their menstrual cycle, the rhythm, the quality, any pregnancy history, and then any blood work they might have. We also talk about the digestive system, sleep, Mhmm. habits, and quality, energy, exercise, cardiovascular system, any and all systems. And that helps me understand their body chemistry and the imbalances in where I can go in and signal the body to make specific change. Acupuncture is also really good at prioritizing blood flow to certain areas of the body. So when we're working on, like, back pain, we're putting a lot of needles in the back, but then also other areas to to help signal change. But with fertility, Thank you. I'm putting a lot of, needles over the, uterus and ovaries to prioritize blood flow there. So when I'm working with a patient who's trying naturally or who's preparing to try naturally or who's just trying to balance their menstrual cycle, we're working on acupuncture usually once a week. And that signaling, I think of it kinda like working out on the regular where the regularity with which you do it helps create change. One or two acupuncture treatments alone might feel good. It's very relaxing. It helps kick in the parasympathetic. nervous system, which alone prioritizes blood flow to the uterus and ovaries. But to really create change in the body if you're having irregular cycles or very painful periods, regular acupuncture is really helpful. But simultaneously, I'm looking at that patient's diet, what they've been doing, and I can kind of determine based on how their digestive system and overall body is performing if they need to make some specific change. We really like an anti inflammatory diet, especially when there's. inflammation in the body, like a lot of pain, including menstrual cramps. But then I also have an herbal pharmacy in my clinic, and all my herbs are tested for heavy metals and pesticides, which is the number one thing you should be careful with with Chinese herbs. But we customize, and blend our own herbs. And so it's like a very customized approach, which makes it hard to study in western medicine, but it makes it very effective at in meeting the patient where they're at to help create change. And then, you know, over time with each treatment, we're checking in to see, you know, if a patient's trying to get pregnant naturally and they get a period, it's very disappointing, but we're always looking to make progress. And so each period, we're assessing, okay, are the menstrual cramps less intense or less in duration? Did they need to take fewer Advil? Or are their cycles becoming more regular? Whereas before, they were anywhere from twenty four to forty days. So we're always, at least the way I practice, I like to have these goalposts of, you know, as we're making as we're working together, making sure that we're making the change we wanna see, especially. as a patient's trying to get pregnant. All of that together and including some targeted supplements can also help, prepare a patient for an IVF cycle. I didn't mention, but I went through three retrievals and two transfers myself. I froze my eggs when I was in my thirties, and I had my son at 43, and that was from my frozen eggs. So I've been through this process as well. And I really love doing this integrative approach where I use my tools to help optimize that patient's body chemistry and the uterus and ovaries as doctor Luke was saying and help either, you know, help them try, get pregnant naturally or help the IVF process be less stressful and hopefully work better and more efficiently. Amazing. Thank you for that explanation. I think that really sets a nice tone for what acupuncture can do for you because I think a lot of people, when they think of acupuncture, they're thinking stress relief and relaxation, and everybody knows I do love a good Accu Sesh myself, but there are so many more benefits that you can get. So thank you for sharing that. Now I wanna bring things over to you next, doctor Scalfani, because uterine health can be a complex subject, and yet it's something most women are going to come across in their lives at some point, especially when it comes to things like fibroids. Now I'd love to hear your thoughts on it and what you think more women should really know. Sure. Absolutely. First, I wanna say I love what doctor Benedetto said. I agree 100. I think, unfortunately, a lot of women, young women, you know, our symptoms get dismissed in medicine. So I think it's super. you know, she's a 100% correct. And, you know, uterine health is one of those things. And, you know, uterine health is something that I'm really passionate about. And fibroids are such an important topic because they're so common. You know, they affect up to seventy to eighty percent of women, you know, in their lifetime, making them the most common benign gynecological tumor. And up to fifty percent of those with fibroids do develop symptoms like, you know, heavy bleeding, prolonged menstrual bleeding, anemia associated fatigue, pelvic pressure, and, you know, both menstrual and nonmenstrual pain. And the incidence of fibroids increases with age, until menopause. Usually, when menopause happens, they they do tend to regress, but not always. And they are significantly higher in in black women who have earlier onset of symptoms and tend to bear a disproportionate burden. They tend to get fibroids the most. So I guess what I want more women to know is, you know, the good news is that there are different options out there for treatments, you know, and it's great because I think a lot of women have become really more aware about the different options out there. You know, there's a whole spectrum. And, of course, the most important part is the conversation with your gynecologist first. You know, what what goals you're looking to achieve, what options you're looking for. You know, for a patient whose primary goal is future fertility, you know, mine. is main. But USC is, you know, uterine fibroid embolization for people don't know, uterine artery embolization. It is it's an important alternative. You know, it does preserve fertility, although I do recommend myomectomy first. But, you know, if there's a patient who absolutely doesn't want surgery, or a patient who isn't a surgical candidate, EFE is a viable option and then don't deserve fertility. You know, it's a it's a minimally invasive approach, that can complement, you know, what gynecology has to offer. And, you know, I work closely with gynecologists to figure out patient's goals and what what they wanna achieve. Yes. I guess, you know, what I want more women to know is there are other options and ask questions and discussions and, you know, I work with your gynecologist. We work together. You know, it's a collaboration between position, Yeah. figure out, you know, what your goals are, what you wanna achieve, and there are other options out there. Yeah. Thank you, doctor Scalfani. You know, I think uterine health is one of those areas where people may know something is going on but not always know what questions to ask, so I really appreciate that advice. Now, doctor Luke, I wanna zoom out a little. You know, we've talked about cycles and symptoms, acupuncture, uterine health, and being proactive. Can you give us an overview of the different fertility options people should know about, And how can someone know when it may be time to see a fertility doctor? I'm going to, talk about it from different angle and different. perspective from patients. So sometimes, I do get lots of, even us, we have this AMH event where. patients will heard this letter AMH, which stand for anti Mullerian hormone, which produces by the granulosa cells that surrounding the oocyte. So each oocyte has lots of cells that produce AMH. And the more oocytes you have, the more granulosa cells you have. So the more AMH you have because they produce AMH. So we do lots of our quantity testing, and patients really benefit from it, one way or causes unnecessary anxiety in a different way. So for example, we will have this AMH event or many patients out there, they will go to OB GYN, like, Doctor. Benedetto. They will run to me with tears, screaming and crying, doctor Luke. And AMH for the audience is usually around 2.5 at the rate around 30 years of age. I usually use one number, but it's a huge range, but then it's easy for patient to memorize. Okay? So 2.5 is a a bad number. Okay. So the audience, if you got 1.9, don't cry. You're fine. You're not in for all. It's a huge range. You usually go for one point zero over, but, yes, some pages may be 0.6. But for the audience to know, AMH does not equal to quantity does not equal to quality. So it's. true. Your quantity is low. And so but you don't don't it's not you're not in referral. Majority of the patients when they have not majority, but certain patients, they may not understand the context of this number. But let's say you are together with a partner, you're ready. to have a baby, and your AMH is 0.7, and you're just having sex for one month. And I still remember that patient crying in tears, came to me, sick care. And I said, not to worry. It only been four months. Come on try. And they they got twins two months later. So, spontaneous, I didn't help. I just say, go home and have lots of sex. That's all I did. I'm like, go and try. And but this number is also so then this is, you know, a number that causes, I think, a little bit unnecessary anxiety for those couples. But at the same. time, it does cause a little bit, how to say, empowering a number for patients who does may have less eggs. And for the audience out there, you have low AMH doesn't mean I've seen this couple times. Doesn't mean your follicles are low. So you do need couple of variables or couple, characteristic factors affecting certain things. So I know life is very confusing. It's just it's like a car, I always say. There are different ways to look at a car, the speed, the leather in the car, I don't know, the brand, electric car versus electric car. So ovaries, same thing. There are different ways to look at ovaries, the quantity, the quality, how well regular your cycles are. So like I say to my patient, yes. This AMH is a little bit lower. May give you conscientiousness about your biological clock as if you yeah. Women averagely menopause at 50. You may be 43 or 44, 45. And most women don't care. Like, when they come to me, like, thank you and no thanks. I don't need that information. Because they just tried to be a baby. So I said, since you don't really care about the menopause here, you just have to be aware that, yes, they have a little bit less eggs. And if I do IVF or do egg freezing, I may not get as many eggs. So that's number one point. Number two, yes. Eggs freezing can be can be a reason, that a treatment for someone with lower eggs, but that should not be the reasoning. The reasoning is I have lower AMH. I've decide not to have a baby for five to six years. So how long you delay for you to have a baby is more important the primary reasoning than the other factors around you. Because the way how high your quantity is, your quality does decline regardless. And, yes, when any age, we only need one egg. Any age for men, same, one sperm. So I think that is sometimes a very interesting variable where patients may get lost because of the right now, there's not much quality test. And, yes, one more time, there are just no quality test. There's only quantity test out in the public at this moment in time. So I want to, think through where we are in terms of, as a as as women, on the on the same different fertility possible for your options. Yes. There's egg freezing. And finally, this is where I'm passionate about, where Generation X started, is mild stimulation, where patients will because the whole idea of fertility, if you don't mind me, I have one more minute. I don't want to take the time from other speakers. But, basically, it's more large tickets to win the lotto. I know. It sounds really blunt and science, but in some ways, IVF is like this. Yes. Sorry, doctor Sable. I know you improved the equality with all your acupuncture and, supplements. But sometimes when you think about the IVF world, when I was taught, was more meds, more eggs, and that would be great. So people who have less eggs may not have as high the success rate as a patient with lower eggs, and that's not true, number one. Number two, because of different type of ovaries, we always like to have good number of eggs. I always say I want to maximize your ovarian potential, but you don't have to force it with oversaturated meds because I do believe there's quote, quote, overcoat. So within the last, ten years, I'm getting all the last decade, I have been practicing, that we have is that we'll be talking about different way of stimulating the ovary. One is, we we cut cost because medications is expensive. Second is we learn how to not over, saturate the eggs with of the ovary with unnecessary medication, and to work with and this where doctor, Mary Sable came in is how to work with the system of the ovaries, and to get a bet possible better quality. Right now, randomized control hasn't shown one is much better than the other. We are trying to carry out this, research in this coming year, but you would need enough number in each group, to make it verify. But one is definitely true, is, cost. Cost is much cheaper in one way and side effects because it's natural. It's much less medication. So, those are the things that I want to be Mhmm. very clear as we are migrating to the new generation where medication may not be the answer, to, to every patient. Thank you for that, doctor Luke. And I think it's really important for all of us to know that we have options where ever we may be in our family building journey. You know, doctor Benedetto, since we're talking about all these treatment options, what do you think is the most important for patients to consider as they're looking into family building? So when a patient I had patients come to me and they are in their, thirties, and, they say, can I have some hormonal test to see if my ovarian reserve is good? And I said, yes. You can have that, but, are you planning to start a family in the next few months? Are you planning to start a family in the next two years? Because that makes a difference. I tell my patient that most of the time, if I see from their history that, I don't see any red flags, I tell them, you do not need any tests right now, because social media are all teaching them that they have to have that test, that number. They have to see a certain number of, in the AMH or the FSH number two or either in day number three or whatever. I say, you know what? Go home, have fun with your husband, your partner, whatever that is, because this. Great. most. of the time, you are going to be pregnant without having anything. I see a lot of women who are fixated with the ovulation prediction kit. And guess what? They have sex only when the ovulation prediction kit says that they are in the ovulatory phase. And I tell them very clearly, if you are 15, you try once, you get pregnant. But if you are 32 or 33, you have to apply yourself a little more. Aren't you happy to have fun with your husband? Please don't go crazy about it because that's what's happening. And I don't know if this is New York or it's, it's all over the world. I have to be really, very convincing. They look at my patients look at me and say, do you have three heads today? Because this is not what I read. And I said, no. What this is what you should be doing. If nothing happens in the next six months, then call me, and I will go over with you about what we can do to make the life of doctor Luke easier because I'm going to do some testing to see if your ovarian reserve is good. I'm gonna do an hysterosalpingogram if to see if your tubes are open. And first of all, I'm gonna check your husband because, you know what? He needs only one test, which is the semen analysis. Once we know that the semen analysis is good, then we do other tests for you. And if necessary, I'm gonna send you to the reproductive endocrinologist. Now not to, with all respect to doctor Luke, whom I really love and I think she is a wonderful reproductive endocrinologist, not all the patient need to go to a reproductive endocrinologist. They may need simple treatments that can be, given in my office without so that they don't get overwhelmed. The important thing is not to get overwhelmed, but there are patients who need to go to without to look because if you have a patient who has severe endometriosis and you know about it, it's very unlikely that that patient can get pregnant spontaneously. She needs serious help. If you know that that patients might have adenomyosis already because you did ultrasound and you saw it, that patients might need more help. So you have to, really the medical care should be individualized to that particular patient. We do not want to practice factory medicine. We want to actually listen to our patients and see what is the problem that we are going to solve for them and with them, actually. So I don't know if that answer your question. Yes. It did. It did. Thank you so much for that, doctor Benedetto. Now, doctor Sabo, I wanna bring this over to you. For those of us out there who are planning on or currently undergoing fertility treatments, many may want to know what can you do to support their bodies throughout the process? What do you find to be most helpful when it comes to your supporting your patients through this type of treatment? I think it depends where they are in the process. So. as I was saying, if you're trying to conceive naturally, I can use the full breadth of my tools, supplements, herbs, as long as they're, you know, willing to take those things and, modify their diet and look for food sensitivities, anything that may be causing their system to be overly stressed, work on sleep hygiene. You know, we make a lot of subtle changes that sometimes helps the body function better and be more fertile. But when patients are either in an IVF cycle or egg freezing cycle, IUI, anything where the reproductive endocrinologist is using their tools, I take a back seat and I just work on supporting them with acupuncture and also some diet changes. But I really think about how my tools can support that process. So I don't tend to use supplements or herbs unless the reproductive endocrinologist is on board with that. And I really like to work collaboratively. I see patients from every IVF clinic in the city, and I've really, guided my career in that integrative approach. So figuring out what's appropriate to use at each stage of that process, whether it's with Clomad or Letrozole or, you know, the full the full breadth of the IVF medications. And we really focus more on the acupuncture piece to enhance, blood flow to the uterus and ovaries. If we're if we're preparing for an embryo transfer, we're working on blood flow to the uterus to, thicken the uterine lining and help with receptivity. There is some preliminary data that shows when patients combine acupuncture or work with an acupuncturist in the months leading up to and including an IVF, they have better life birth outcomes. And I think that's because we're working on the entire system. You know, we work on digestive health and making sure the patient has the right diet so they're assimilating nutrients, and they're able to feed their whole body. So it's not just the acupuncture piece. It's the whole view of the body and how we can help it be more fertile and healthier. And so I think I like doing this medicine too because it teaches patients in a moment where they tend to have a lot of motivation to make change and giving them very specific customized advice for their own system not only helps them, you know, get pregnant hopefully and have a healthier pregnancy and live birth, but then they take that knowledge with them, for the rest of their life through perimenopause and beyond. Amazing. And I think those are some fabulous options. So thank you so much for that, doctor Sabo. Doctor Scalfani, I wanna come back to the topic of pain for a minute because a lot of us deal with pelvic pain, heavy periods, or even pain with intercourse for years. Is there a link between pelvic pain and infertility? And if so, what options are available to treat that? Yes. Sure. Absolutely. There there's definitely a meaningful connection between pelvic pain and infertility. And, you know, this is really this is important where collaboration between, you know, Mhmm. these really makes the difference for patients. Of course, you know, we know fibroids. We've discussed fibroids that causes pelvic pain. You know, location of fibroids can, affect, you know, implantation or uterine receptivity for for the eggs, you know, endometriosis, which is not something that, unfortunately, I can help with. That's more of a surgical. But adenomyosis, which is endometriosis, you know, within the uterine cavity, is something that also, we do uterine audit embolization for. We can help with that. And then a very common, condition that, is more common than people realize it, but frequently underdiagnosed, which is a chronic cause of pelvic pain is pelvic venous insufficiency, formerly known as pelvic congestion syndrome. So a lot of people know it as that. And, basically, if you never heard of it, it's it's varicose veins of your pelvis. Yeah. Yeah. And and many women, I think as women, we're all conditioned to live with pain once a month, you know, as there are cycles. And sometimes we just think that's the norm, and it isn't necessarily the norm. Now pelvic venous insufficiency, it's primarily a pain syndrome. And the current literature, just to be clear, there is no established direct link between PVI and infertility. Although there was a small retrospective study of about 12 women who they couldn't find any other cause of their infertility, and they did have pelvic venous insufficiency. And they underwent an ovarian vein embolization, which is something that I do. And after that, eight out of the twelve women were able to to get pregnant, and and they had complete pain relief after the embolization. So. there is to be clear, there is no established in literature connection between the two. But, they think that the mechanism or the proposed mechanism is that the the hemodynamics of the pelvis are, they're altered, and and ovarian perfusion is altered because of these varicose veins that are in the pelvis. So good news is, you know, both are treatable. All of it is treatable. Fibroids, adenomyosis, the pelvic venous insufficiency. You know, they're outpatient procedures that I do in the office. And, of course, you know, you're the gynecologist. You guys stay at the center, and and we're here to help fill out that plan and and help with the with the pain. And, you know, again, pelvic pain is insufficiency. You know, you need to work up all the other possible causes. And if there's there's no other possible causes, then maybe that's the cause. And, unfortunately, if you're if you're not looking for it or if it doesn't, you might you may just skip over it or not see it or, you know, not realize it. So that that's why collaboration really is super important between all the specialties to to help figure that out. So yes. That that goes to. the valley. that. I think there's a connection. I, sorry. Hi, Silfani. I I actually have a question about this. This is fascinating. And, I want doctor Benedell and and and Mary Sable, doctor Sable too because, I have reason so I in as I told you, I've been practicing for a while, and now it's really so when I was at Brigham, I was working with one of the, doctors there on MRI, ultrasound, fibroid. Means, you don't need surgery. They use MRI sound wave to burn the fibroid away. Okay? It's a microwave, and and they did it on certain patient. It has to be, I think it's a new technology going to be again. But then my patients is presenting lots of things on pamphlets and, you do an arterial embolization and other technology that comes into play. And, it's so funny, intervention radiology as well. It's only for histoneal painiogram, for HSU. No. It's involving women's health care in such a integral moment. So as I was taught, and please correct every doctors here, is that if you do this procedure, if you are advised to have a baby, none of this procedure should be done. You should do a myomectomy. You cut and open the uterus and not the procedure with the MRI, ultrasound guide, the focused, five myomectomy or doing a u-two or two embolization. And there are many other ones now. I heard there's a microwave, like, a couple of really amazing technologies out there, which is interventional radiologists are doing it and not going to surgeons because the women really like to have their belly open with a long recovery day. So I think you guys know where I'm get at is how can I counsel my outpatients or OB GYN enzyme and, number one? Number two is so far, it seems to me and looking at review articles, I have ACOG review, and I have all those things to do is that there's still lots of live births from patient doing those procedures. So there's still a gray area, not the way I was taught black and white when I was younger. So I would love to hear from doctor's governing office, doctor Bernadette, because. this. Agreed. You're you're absolutely correct. The way I was trained also was that, you know, you see the the literature wasn't out. The studies weren't out. We weren't sure about fertility. And if a patient the way I counsel a patient is if a patient comes to me and, you know, under the age of 40, the incidence of becoming amenorrhea after a UFE, or UAE is less than one percent. Over the age of 45, of course, that it becomes about five percent. So if a younger patient comes to me and we discuss the whole thing and I say to them, basically, if I were to do UAE on you and you were to come amenorrhic and weren't able to have children, would that be absolutely devastating to you? And if the answer is yes, then I tell them myomectomy. You know? You know, the benefits of UAE or UFE is that, once those fibers are treated, they die and they don't come back. You know? I I know the myomectomy, they can grow back, you know, so you'll have a window. There was actually a paper that was just presented at our society meeting in March showing that, it's the research that they've done so far is that actually fertility is quite preserved and it has the same, correct me if I'm wrong, but after myomectomy, there's a few months before, you can get pregnant or implantation can occur. I don't know if it's immediate. And they're finding that the same time, is also for for UAE. So fertility is preserved, but I always I always tell patients, you know, if if it is something that you if it would be absolutely devastating to you, I still think myomectomy is first one. You know? I I recommend myomectomy, but there are patients who just you know, they're not surgical candidates or they just absolutely don't want, you know, surgery. And, you know, it is it's a viable option. So I will perform it as long as, you know, the patient understands, you know, all the risks. And if you're 45, there's a higher risk of becoming a menorrhic versus if you're 40. So that's how I tend to counsel. And, of course, you know, I collaborate with their gynecologist because you're you're you're you're the most important. You're the center. Right? And so especially if it's if it's discussing fertility. So have a question for you, doctor for you, doctor Spafale, because, in some of these patients are also at risk even if they resume their periods and they are able to conceive. There were reports in which, it was emphasized that these were patients who were at higher risk of preterm delivery. Have you found in your experience that this is the case? Because most of the time, obstetricians actually discourage patients from having, interventional radiology procedures if they want to get pregnant. But it's a kind of gray area, and I would like to know if either you or doctor Luk have any experience with this. Go ahead, doctor. For me, I just, I I basically canceled similar to, doctor Scafani, but I I don't deliver bait. So I do I no. I I want to know if there's any complication, but so far, majority of my patients come back to me. We have to get MFM clearance, you know, OB GYN before we do the embryo transfer. But that is but I don't, stop it now. I don't use that as a criteria to use gestational carrier if that is where you're getting at. Like, if there's a danger, should we not even have that person carry? But I don't know how, doctor Benedell, you counsel. Do you say no? You have UAE. You should not have sex. What if they go on sex and get pregnant? It's honestly, I try to discourage them from having, any kind of radiological, procedure if they want to become pregnant, and I prefer that they have a myomectomy. But I want to know from Doctor. Scafrani if she has a different experience. I mean, I don't, and yet I don't deliver babies, so I don't know. I can't speak about the preterm. I do know that most recent research literature that's been put out there that there is no fertility is preserved. I have had patients who get pregnant after UAE. And I tell and I tell all my patients after it gets done, this doesn't mean that you can't get pregnant. So, you know, you have to use protection with your partner. That's not something you're looking for, you know, and it has happened. You know, again, I'm not a GYN, so I don't see a lot of patients, you know, after they get pregnant, but I have done UFEs on patients who have had terrible fibroids, and they weren't surgical candidates. And we did the UFE is understandable. That is understandable. Yeah. yeah. Right. So, you know, it does it has shown that was the older thought, and that's how I was trained. You know, when I trained at NYU, the thought process was if it's a woman who wants to preserve their fertility, that you should not do your e. But we've moved on that. It's not it's been proven not to be true. Fertility is preserved. Amazing. Thank you so much. I want to get started with some audience questions because I know we are getting close to our time. So let's dive in. First question, as medicine is advancing, any tips with women who are dealing with PCOS, acupuncture, trying more of a natural based diet? Thank you. I'm assuming I'll take this one. at first. I think. so. I mean, I see a lot of women with PCOS. It's very common. We're actually calling it PMOS PMOS? now, Yeah. because it is finally being recognized that it's more of just an ovarian issue. PCOS stands for polycystic ovarian syndrome, but now we're looking at polymetabolic. Right? It's polymetabolic. Mhmm. Meaning it the origin is more in blood sugar insulin sensitivity management, and the ovaries become sensitive to that as well. And, typically, there's a a ton of follicles. And instead of, you know, doctor Luke was talking about too few follicles in the ovary. When there's too many, it can cause, excess androgens, testosterone, and ovarian dysfunction where sometimes women are not ovulating and it's more of a gray scale. I'd like to describe it as a gray scale where, you know, the extreme, advanced is anovulation no period, but there's milder cases especially in people who are taking steps to manage their glucose levels with diet, exercise, Mhmm. supplements, or medications. And those people often ovulate. They just have a lot of follicles. So I think depending on where you are on the spectrum, especially if you're more of the milder case, acupuncture can be extremely helpful. And there are some studies to back that up in helping regulate ovulation, shortened cycles sometimes. These patients, I think, often go off the pill after being on it for a while. They, like, went on the pill in their youth because their periods were so irregular, and then they come off and they might have, you know, a twenty eight day cycle and then a thirty five day cycle and then a forty day cycle, and they just keep getting longer and longer as the ovary wakes back up and starts kind of, its abnormal rhythm. So acupuncture can be really helpful for, helping to establish a more regular ovulation. But we're also counseling patients on diet changes. So I like more of a paleo style diet for this where it's low, especially in processed foods and processed carbs and sugars and focused on plant fats and proteins, animal protein, high fiber, low in sugars and carbs. And. then there's some supplements too that we like to work with. Awesome. Thank you so much. Okay. Next question. I've been to so many doctors for endo. I never got formally diagnosed, but was told to just continue. birth control. Does that actually help? I still deal with pain. What happens if I wanna have kids and need to get off birth control? Who would like to take this one? Doctor Luke? Doctor Benedetto? Yeah. Doctor Bernadette, do you want, to so it's very difficult to cancel a patient like this. But, if I don't know why she said that she has never been formally diagnosed. It seems to me that if she had, if a, abdominal cramps and, heavy bleeding, and she has been with that for a long time. Most probably, she does have endometriosis. We have to say that, I explained to the patient that the gold standard for the diagnosis of endometriosis is laparoscopy. It's a diagnostic laparoscopy, Right. you take a biopsy. But do you want to do that in a young woman as a first thing? No. If you suspect that the patient has endometriosis, the first line therapy is birth control. And the reason why you. give them birth control is that you put the ovaries at rest, and generally that kind of control the endometriosis, and they should be on birth control until they are ready to actually conceive. Generally, I tell them it. to stop the birth control, just the cycle when they are ready to try to conceive. And I tell them to try to conceive for three, four months, and if that is doesn't happen, then we have to go to the next step, which is doing some test or refer them to Doctor. Lu. But yes, I would advise her to continue being on her control until she is ready to, conceive. As far as the pain, I'm a little surprised that she's still in pain even with the, with the birth control. That makes me a little concerned that probably the endometriosis in. her case is a little more severe. And if that is the case, I would go ahead with a diagnostic laparoscopy. Amazing. Thank you so much for that, doctor Benedetto. Next, question. Yes, doctor, Luke. Did you wanna add have. endometriosis, I do want to, tell the audience endometriosis is a very, wicked disease because I know with the social media again, it's like more empowerment. Which way does it go? Is it to more anxiety or really building health and information? So, really, empowerment, I think, with good information and to understand the information is very important, not just information Yes. out there. So and then we should agree to doctor Brendello even though we have something called the Receptiva, which is a new test that just came in the last couple years. It is the goal stand is still laparoscopy. Pain is the indication for further evaluation. I also want to emphasize the point that it is abnormal to have pain during periods. You're not supposed to have pain. Life shouldn't struggle, like this every every month. And I know there are different grades of pain. I know all of us women here, I certainly have cramping, but certain women, cannot go to work. Certain pain that try to disrupt. that that need to rely on NSAIDs to where they get ulcers. So those are the pain that you need to speak up and talk to your provider. And, yes, endometriosis is one of the, fascination is where I will get back to doctor Mary Sable. I'm very into East West, with okay. That's why my Gong boss. Yeah. I need that, intermittently every three hours, in my office. Is that sometimes there are lots of diet changes, and habits that can make change. And, yes, life work balances is very important. So oh, harmony. I I I don't know. I learned new work. It's life work harmony. You don't have to sacrifice one for the other. Balance means you have to sacrifice one to the other. But the harmony, how do you, harmonize both life and work? So I think those are very important, factors as we are, thinking about the pain of endometriosis in not just regarding fertility. I think it's, again, with age. Never most women are fine. They have pain during 25, 24, but then they're not fine as they get older. So age, endometriosis, or both, that's, synergize and causes a problem. So I think being aware, understand their pain, and live a really good life as without pain or with pain, it's very important to be aware that pain should not be part of the standard for a woman. So I think that's very important statement together. Agreed. Agreed 100%. I jump, can I, jump. in? Yeah. I think it's also important to state that not everyone even with known endometriosis has trouble getting pregnant. So just because you may have that. diagnosis in your history or have intense menstrual cramps, it doesn't mean you're gonna be infertile or struggle. But sometimes, you know, especially with egg freezing, if I have a younger woman who I think may have end endometriosis and is open to freezing her eggs, I think that's the best thing you can do, to get your AMH tested. If it's on the lower end, I think that's another check mark in the box of potential endometriosis and that it's worth looking into freezing your eggs. And I like to work with those patients for two to three months before they do that to lower inflammation and optimize body chemistry to get really good eggs out. But also I see a lot of cases with endometriosis and no symptoms. And I think we're getting better at identifying, you know, who might be a candidate for laparoscopic surgery, and all kinds of, you know, different techniques to help lower inflammation and optimize receptors or, you know, how we get the eggs out or, you know, even natural fertility, with the potential of endometriosis. The guidelines just changed on, diagnosis. It used to be only diagnosed through laparoscopic surgery, but now, correct me if I'm wrong, but it seems like we can diagnose just based on symptoms now according to ACOG. Right? Mhmm. That just changed. that's why you don't you don't take them. for an laparoscopy just from the very beginning. You treat them with birth control and see if that really helps them. Yeah. Yeah. I agree. I actually but as a holistic doctor, I really like the breath control pill, especially for endometriosis. I'm always I'm always I think the take home for at least for me is, you don't have to do wellness or Western medicine. We should think about when to use what and how to optimize where you are and your goals in the moment. And that integrative approach is really important. Thank you so much. And I wanna thank you all, for being here today. This is such an important conversation and a really helpful start to the rest of the day. You know, we've covered fertility from so many different angles. Now we're gonna continue building on this throughout the summit, so stay with us for the next session. And, again, a big thank you to all of our panelists for being with us here today. And if you'd like to connect with our speakers, please visit the docs section. Up next, we'll discuss one of the most important but often overlooked aspects of fertility and wellness, and that's mental health. So stay tuned. And I know we have a lot of questions from the audience for this session. So I'm gonna be hopping off, heading to the next session, but you guys can please feel free to stay along and, answer some additional questions if that's okay with you. Alright? Good. Thank you. Thank you so much. Thank you. you for everyone for being here. Thank you. Thank. you. Thank you. Bye bye. bye. Bye.