The Health Curve

Fertility Unveiled | Stacey Silverman Fine, MD at Maven Clinic

• Dr. Jason Arora • Season 1 • Episode 22

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Fertility is one of the most personal—and most misunderstood—parts of human health.

In this episode of The Health Curve, host Dr. Jason Arora and OBGYN Dr. Stacey Silverman-Fine of Maven Clinic unpack what fertility really means today and why challenges are far more common than most people expect.

We explore how fertility is influenced by age, lifestyle, and environmental factors; why both male and female biology matter; and what people should know about subfertility, infertility, and the modern journey to getting pregnant. Dr. Silverman-Fine also breaks down egg freezing, IVF, ovarian reserve testing, and what the emotional and practical experience of these options is actually like.

Whether you’re planning ahead, trying to conceive, or supporting someone through their fertility journey, this episode offers science-backed clarity, grounded expectations, and reassurance on a topic often shaped by silence and stigma.

Speaker 1:

Welcome to the Healthcare Podcast. I'm your host, jason Aurora. This episode is part of our Women's Health Series and today we're focusing on fertility, one of the most deeply personal and widely misunderstood aspects of health. My guest again is the wonderful Dr Stacey Silverman-Fine of Maven Clinic, and together we unpack the science behind fertility, we bust some of the common myths and we explore the emotional weight of trying to conceive. Whether you're planning now, just want to understand your own reproductive health or hope to support someone else on their journey, this episode is for you. Hi, stacey. It's really great to be back here with you, excited for our topic today.

Speaker 2:

Thank you, jason, really happy to be back here today and truly excited to talk about this today.

Speaker 1:

So today we're going to talk about fertility, and this is a much more common topic than I think I had appreciated before. We were having children, our friends were having children and we all started talking about it, and the reality is people don't talk about this very much. I think it's better today than it used to be, so let's start with. What does the term fertility actually mean?

Speaker 2:

Yeah, so fertility is really the natural ability to conceive and produce offspring.

Speaker 1:

And what do people most often misunderstand about what it means to be fertile?

Speaker 2:

I think what people misunderstand is that it is more common than people think to have fertility issues, and I think that's really shocking. I think the other thing is a lot of people don't realize that when we have fertility issues, it can come from both sides. It can come from the female side, it can come from the male side and it can also be a combination from both partners.

Speaker 1:

Do we know what the statistics?

Speaker 2:

are roughly Absolutely. The statistics are staggering One in six couples will have infertility and 30 to 50% of the time there's contributing factor from both parties.

Speaker 1:

Fertility challenges are much more common than people think and it's easy to feel alone if things don't go as expected, but in reality, many couples and individuals go through this, and there's also a difference between infertility and subfertility right, which often isn't talked about. So my next question is how common are fertility challenges and what do people need to know about the difference between infertility and subfertility?

Speaker 2:

Infertility is truly much more common than people think. It affects millions and it can be really isolating. One in six couples will have infertility, meaning the inability to. When we're looking at the medical side of things and we're talking about it, we're saying you know person's biologic ability to actually conceive a child, and this can come from both sides. It's also assessed as the ability to conceive and carry a child to term. That can also be called infertility. So one in six couples will have infertility. 30 to 50% of the time there's contributing factors from both parties. Subfertility is a reduced or delayed ability to conceive. It may not be complete infertility, but maybe conception may take longer than average or may actually require assistance in order to do so.

Speaker 1:

We hear a lot these days that human fertility might actually be declining due to modern lifestyles. We're seeing it in headlines, things to do with sperm counts, aging eggs as people have babies later in life, environmental toxins, that sort of stuff. Is human fertility actually declining over time, or are we just more aware of it? And then what are some of the variables that might be affecting it?

Speaker 2:

Those are wonderful questions, jason. Sperm counts among men, especially in Western countries, are declining, and we likely think this is due to environmental and lifestyle factors. Age quality and number when we're talking about the female also declines with age, and this has really been fairly steady, although lifestyle and environmental factors can play a role. But we do know that women are born with all the eggs we're ever going to have, and as we age, those eggs age with us and decline. So at puberty we've already lost half of our eggs, and staggering statistics are that in our late 30s we only have 10% of our eggs left. So as women are delaying childbearing and they are focusing on career and other things, we are seeing a decline in egg quantity and quality and, in addition, sperm counts are declining as well, and so there's a lot of factors here that are playing a role.

Speaker 1:

And what are some of the most common causes of infertility and subfertility for men and women?

Speaker 2:

Jason, this is really a combination it's age, it's lifestyle, it's genetics, it's medical conditions. Maybe we have hormone issues. When we're looking at men specifically, we can have lots of things. We can have sperm abnormalities and that may be motility. Maybe the sperm don't all swim like they're supposed to. The morphology maybe they don't look the same. Maybe the head of the sperm isn't as functional or the tail they're missing some tail pieces.

Speaker 2:

We can also have anatomical things. One of the most common, or something that we think of, is something called a varicocele, where we have enlarged veins in the scrotum. This can be present in about 40% of men with infertility. We can also have hormone imbalances that are playing a role here. We're seeing a lot of men now that are taking testosterone and don't realize that that testosterone is actually going to diminish markedly their sperm counts.

Speaker 2:

We may have genetic issues at play. Maybe we have hormonal genetic changes going on, where maybe they have a chromosome abnormality that actually inhibits the sperm concentration or the production of sperm. We can have lifestyle and environmental factors as well. We've even seen anatomic, where people are actually missing the vas deferens, which is the tube that the sperm come out through. So lots of things when we're looking at men when we're looking at the female side, or people that are born with ovaries. Really, it's this declining volume of eggs and quality of eggs as women are aging. Those are the big ones here. Although we can see genetic and chromosome abnormalities, we can see anatomical issues. We can see some other things at play too.

Speaker 1:

And if we start to get into some of the modern causes of infertility and subfertility, are we talking about things like stress, alcohol, obesity, too little exercise? Also things like environmental toxins, poor sleep quality, not getting enough sleep. What are the causes that are related to the modern world that are affecting fertility?

Speaker 2:

That's a wonderful question, jason. This is really our environmental and lifestyle that we're talking about here, and so when we're talking about trying to get pregnant, I try to emphasize with patients we really want to ensure that we're living our best possible life to improve fertility, and this includes for both the male and the female. So this is limiting alcohol, limiting marijuana and THC and other drugs, making sure that we're trying to eat minimally processed, minimally packaged and whole foods right, making sure we're not taking too many other supplements or chemicals, making sure we're limiting alcohol, making sure we are improving our diet and our exercise to limit obesity we do know that obesity does contribute to infertility and so really trying to improve from a diet and lifestyle standpoint. Poor fertility Stacey how often does this normally come up?

Speaker 2:

Is it just when people are trying to get pregnant or does it come up earlier than that, bleeding in the middle of the cycle that's being prolonged, or at intermittent times? Maybe that might be a red flag. Maybe we have a known history of low thyroid that can really inhibit the cycle, or polycystic ovarian syndrome. That's another one that can cause a problem here. Maybe we have a chronic condition like diabetes or autoimmune disease. Maybe we've gone through chemotherapy previously or we've had radiation. So sometimes we'll know in advance, but the majority of the time I think people don't know until they try and get pregnant and then it doesn't happen.

Speaker 1:

And then, when someone is trying to get pregnant or a couple are trying to get pregnant and they find out either that there is subfertility or infertility, what does that journey typically look like from there?

Speaker 2:

So it really depends on how quickly they get the care they need. We have a current definition of infertility and it really depends on age. So if you are, as a female, 35 and over and you've been trying to conceive for six months without success, then you are considered to have infertility. If you are any age other than that so under the age of 35, and you've been trying to conceive for a year without success, the personal issue I have with this, jason, is that this is really, in my mind, old or outdated definitions, and the reason being here is that a lot of women are coming to have children or trying to have children at a much later age, 34, trying to have our first child, and we've been trying for nine months without success, and so, in my mind, that person with the current definitions that are sitting in place, won't even be looked at until they've tried for a full 12 months.

Speaker 2:

But this is baby number one, which means by the time they get the care for this one and they get the diagnosis for this one, they're older and then maybe they don't have that child. Now, till what? 36? And now we're saying really we need 18 to 24 months interpregnancy interval before baby number two. Now we're really having an issue. So I really feel that we need to be shifting these definitions, as people are delaying childbearing, that maybe we need to really start investigating a little sooner rather than later, to just make sure that we don't have a problem that we don't know about.

Speaker 1:

We'll get back to this conversation in just a moment, but if you're finding this episode helpful, here's a quick ask. Take a second to follow or subscribe to the Healthcare Podcast wherever you're listening, and if someone else in your life would benefit from this episode or any of the others you've heard, please send it that way. All right, let's get back to it. When people find out that they're having fertility issues, what are their options at that stage?

Speaker 2:

I think at that stage they really need evaluation and so really being hooked up with somebody who can really help them and do an initial evaluation.

Speaker 2:

The hope is that in our evaluation for infertility we find something that's completely modifiable, that we can fix and change the course. Or maybe we find nothing, which means we actually might be able to help, and a lot of people are under the false pretense that if they go to get evaluation that automatically means they're doing IVF, and that might actually not be the case. Maybe we find something that is modifiable. Maybe we find something on the male side that we can fix. Maybe we have a varicocele that we can repair and we can really improve these sperm counts. Maybe we have a hormonal imbalance because he's taking testosterone therapy and his sperm counts are none you know and so or low. Maybe the counts are a little bit low and maybe we can do intrauterine insemination. Maybe the cycle is just, maybe they're timing it wrong and maybe we need to really talk to them about when they need to actually try to conceive. So I think really, if you're having issues, I think reaching out and getting help sooner rather than later is important here.

Speaker 1:

Okay, so tell us about some of the options that people consider and what that will look like for them.

Speaker 2:

I think one of the options that we're hearing a lot about now, jason, is egg freezing, and I think the reason we're hearing about this is because we're really having a lot more attention around the fact that as women age, we start running out of eggs and the quality is not as good, and so I think, fortunately, it's getting a lot more attention, certainly far more than when I was in my early reproductive age, and truly I think what's really important to know is that really, from a biologic standpoint, women are at the height of their reproductive capacity in their twenties. However, now, with delaying childbearing because women are having careers, certainly in our 20s, this may not be something we're thinking about doing. So egg freezing the ability to take a woman at the age of 20 or really at any early age in their life we're looking 20s and 30s and be able to actually stimulate the eggs to grow and then harvest those eggs and freeze them for later use down the road is really becoming much more popular now, and I think a lot of people don't understand that this isn't as huge of a process as people think. It's a two-week time process, give or take, with injections twice a day during those two weeks and then, once those eggs get to be a certain size and number, a trigger shot is given which releases the egg into the fluid-filled space that surrounds it and allows a provider to go in and harvest those eggs under anesthesia.

Speaker 2:

We can do tests ahead of this. There is specifically a test called an anti-malarian hormone, or an AMH, that gives us an idea of what a woman's ovarian reserve is, how many eggs she has left. We do caution, people, not to really use this information out of context. If it's low, it doesn't necessarily mean you can't conceive, but it may mean that time is of the essence. So really, I think that is one of the big things that we're hearing a lot about now.

Speaker 1:

And so what happens next? Once the eggs have been harvested, they've been frozen. What will happen to them after that?

Speaker 2:

So we have a few options here. Once the eggs are harvested and frozen. Essentially the goal is that those eggs can remain there, if you so choose and if you decide to try and get pregnant in the next few years. Maybe you're in your late 20s and maybe you want to delay conception until your early 30s. Maybe you delay those few years and then you can try in your early 30s and if you don't get pregnant within a short period of time, then you know those eggs are there and you can actually thaw those eggs. They then get fertilized in the lab.

Speaker 2:

This is the in vitro fertilization with sperm and then, once we've created embryos, now we can test the quality of those embryos. We can't test the quality of the egg. We know nothing about the quality of the egg until it's fertilized. But this is the IVF component, where we're actually fertilizing those eggs in the lab, creating embryos and then transferring back the embryo. Now this may not be something we do for baby number one, but maybe we get pregnant quickly with baby number one, but now baby number two, baby number three, future childbearing or future family building, Maybe now that's when we're actually thawing those eggs, fertilizing them and then transferring the embryos.

Speaker 1:

So let's talk a bit about IVF. It's a big topic. You mentioned it there with egg freezing, but of course it's a bigger topic than that. Right, it's used out of that context as well. So can you tell us a bit about IVF?

Speaker 2:

What is it, how does it work, and capture eggs in the follicles and then going in and retrieving those eggs under anesthesia, fertilizing those eggs first in a lab with sperm and then transporting back embryos into the uterus. So that's what IVF entails, and there might be lots of reasons that we're doing this. We might be doing this because we have infertility. We might be doing this because we're a same-sex couple and maybe we're using donor sperm or donor eggs. Maybe we're using donor egg for various reasons. Maybe the egg quality is poor and we need a better quality egg. Maybe we are using a gestational carrier, and so that's happening in the lab as well, and then transferring to a gestational carrier for one reason or another. So lots of reasons why we might be doing IVF here.

Speaker 1:

And what we don't tend to talk about as much on this podcast, because it varies so much by geographical region and this is meant to be globally relevant for as many people as possible is coverage and cost and, of course, something like IVF, egg freezing, etc. The access to these things varies significantly around the world and even within places like the US, as we know, but we know that the cost of these things can be very high. Can you give us a rough ballpark for how much these things cost, in the US at least?

Speaker 2:

Absolutely, jason. So the cost of these you're right can be really exorbitant. When we're looking at an egg freezing cycle, generally about $10,000 per cycle, and that number of cycles may increase. So, for instance, we know that on average it takes double digit eggs for one embryo. So if we aren't getting enough eggs we may have to do multiple cycles for egg freezing. When we're looking at IVF, we're really looking at $20,000 on average, so for egg freezing, but then we're later going to thaw those eggs and fertilizing them we're getting to that $20,000 about. I think it's important to know here that there is starting to be increasing insurance coverage for this in this country. I think some employers are actually providing benefits here around egg freezing and infertility benefits as well, which can be really helpful. So I think really important to figure out if you do have benefits and, if you do, how to access them, and many times providers can help with this.

Speaker 1:

Can you tell us a bit more about what it's like to go through the process of egg freezing and IVF? Of course the woman has to take hormones. There are all sorts of things that are involved. That can be quite difficult as a process. Can you tell us a bit about what that process looks like?

Speaker 2:

So I think egg freezing and IVF look really different, because I think egg freezing is a conscious choice and a lot of women are doing this and feel really empowered that they're able to change the course, that their body is able to do something so magical and they can really help for their fertility later on. So I think when we're looking at egg freezing, yes, people are always nervous, and that's because they're having to self-administer injections, or people administer injections at home and with the hormones. Sometimes we can get some moodiness and some breast tenderness and some headaches, but sometimes people feel really good with estrogen and actually have all this energy and feel great.

Speaker 2:

When we're looking at IVF, this can really be a difficult time, especially if we've struggled with infertility for quite some time. It can feel isolating. We may be looking at other friends that are having babies and not looking like they're having issues at all. They might look like they're seamlessly having children and yet you're struggling and needing to investment for many and it really can be a quite stressful time, and so we'll sometimes see a whole different situation here when it's a male factor infertility issue, and so really having the support of loved ones and family members if you feel comfortable discussing it can be really helpful. And remember, this affects one in six couples, so super common here. Hoping, with keeping the conversations going, that we'll be able to really provide more support for people here.

Speaker 1:

And that's partly why we're doing this podcast. These are topics that we feel everyone should just know more about. You know wherever they are in their health journey. It affects communities everywhere all the time. So, Stacey, thank you so much for joining us. This has been another great conversation and, as we get more questions in when we record our next session, we may revisit some of these topics in the future. So thank you so much for coming back again.

Speaker 2:

Thank you, jason, wonderful to be here.