Dr. Shahin Ghadir On Egg Freezing, IVF, Optimizing Fertility, Family Planning, PCOS and Surrogacy
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Welcome to the pursuit of wellness.

Hi guys, welcome back to the Pursuit of Wellness podcast. Today's episode is on a highly requested topic, fertility. Many of you are around my age, you're in your late 20s, early 30s, and you might be starting to think about having kids, or maybe you want to wait till you're older, but make sure you're set up and prepared for that time in your life. I'm going to be talking about fertility today.

i've got you covered today we have dr gadir on the show he's a double board certified obstetrician and gynecologist he's one of hollywood's most trusted fertility expert he has helped thousands and thousands of women and men have babies and start families no matter their circumstance i know i was definitely taking notes during this episode there's so much good information and i'm so excited to start

this chapter in my life. So I recommend grabbing a pen because there is so much valuable information here. We are going to talk about optimal age for fertility in men and women, if birth control actually disrupts fertility, endometriosis signs and symptoms, IVF, the actual process plus the impact it has on hormones and mood, how to choose a fertility clinic, the concept of designer babies,

growing popularity in surrogacy, and advice for LGBTQ plus couples and families in terms of fertility. I hope you guys get as much value from this episode as I did. I know Fi and all the other girls in the room were freaking out. It was such a good episode. So please leave a review if you enjoyed. It helps me grow the show and keep improving. Don't forget to subscribe so you never miss a Monday episode. And with that said, let's hop into this conversation with Dr. Kadir.

okay guys today on the show we have someone who is widely regarded as Hollywood's most trusted fertility expert Dr Gadea welcome to the show thank you so much we talk a ton about hormones and women's health on this show and fertility is something that I think more women and men are struggling with so whether or not you guys are thinking about having kids right this moment there's so much we can do to

for a family in the future and make sure we're in the position to do so when we're ready. I know I'm going to be personally taking notes right now, so let's hop in. I want to start with some background on you and your clinic.

So first of all, thank you so much for having me. My name is Shaheen Ghadir. I'm a double board certified obstetrician and gynecologist. And my second credentialing is in reproductive medicine called reproductive endocrinology and infertility. One of the partners at Southern California Reproductive Center. I've been working with them for 19 years. I'm very proud that we have one of the most successful and one of the largest IVF labs on the West Coast of the U.S.,

And we really, I think, have gone out of our way to make sure that this process is as good as possible for everyone. And I have really dedicated myself to try to educate the public about the concerns about female reproduction and preservation because it's an area that is so ignored and minimally understood at this time. So thank you so much for having me here. Of course. And how did you get into the fertility field?

So I went to medical school wanting to be a doctor and then I realized, oh my God, I have a really hard time being around sick people. It like drains me mentally and emotionally. So what am I going to do? So after a lot of thought, I decided I'm going to go into obstetrics and gynecology. It's a more positive area of medicine and I actually really loved it. During my residency program, I did understand some of this and see some of the challenges of having to run and do a delivery in the middle of the night for the rest of my life and

And I did a rotation. Everyone was required. And I did an extra rotation or two in the area of fertility. And immediately, immediately, I fell in love with it. I was very fortunate. I applied to a very limited number of fellowship programs, not even understanding how incredibly difficult they are to be accepted. And I got accepted to my first choice, which was the Cedars-Sinai and UCLA program. And my clinic is the location where the fellowships

they rotate there for about six months. And when I walked in within a month, one of my partners that are currently partners with said, do you want to join us when you're done? So everything kind of just went smooth sailing and I've landed up in one of the best clinics I believe in the country and doing one of the things that I've absolutely loved and realized how incredibly fortunate and lucky I am to have given this opportunity to change people's lives. What would you say is the most fulfilling part of your job?

I just think that day that you call someone and let them know that they're pregnant is it never gets old. That first ultrasound that we do that shows that their baby is beginning to grow, it just never gets old. People would say, oh, you've done it thousands of times. It's gotten old. It's boring. It's the same. It is not. I get to know my patients really well.

I'm very fortunate and I tell all young people, when you're looking for something to do as a career, look at yourself, see what your strengths are. And I'm definitely a people person. I love just meeting people and talking to people and learning about them. And for some people that's a chore, for me it's just beyond natural and just interesting.

And every patient for me is a new story, a new chapter, understanding where they're coming from. And having been through fertility treatments, and we can talk about this later, but I have four kids, my middle two are twins from IVF because we had our own little struggles, not because we wanted to do it for fun. I can see how it changes people's lives because it changed my life. And I think just giving and being part of one of the biggest chapters in someone's life

that changes their life forever has been very, very fulfilling. Do you have a most memorable success story or a recent story you could tell us? I get that question all the time. Really? And I've had very memorable stories. You know, there's one story. I had a couple that came from Russia to see me. They had been through 10 years in multiple, multiple cycles of IVF.

They came to the U.S. and on their first cycle got pregnant. And at five months pregnant, they called me and said that the baby has a problem. So they had to terminate. Then we had to start again, got pregnant again the second time. And within a week or two, the pregnancy just went away. It's called a chemical pregnancy.

So our third round and this couple was like just beginning to like fall apart. I mean, it's just like 10 years. You know, we're lucky here in the US. Many people are seeing me within a few months of trying, within a year of trying. Not that many people like after 10 years.

So we did it again and we put two embryos and both took. Wow. And we became friendly with this couple. We were at dinner with them. She was about five months pregnant. And the next day she called me and said, I'm going to the hospital. My cervix is opening up and I'm in preterm labor. So she was in the hospital from the time she was five months until her due date. Oh my gosh. Not getting out of bed.

And then she delivered beautiful twins. And she actually asked me if I could be in the delivery room. And I was the one in charge of photos. So one day as a joke, she said to me, if it wasn't for you, Dr. Gadeer, I'd have no twins and I'd have no photos. So it turned out to be beautiful. And they're now, their twins are 12 years old.

And I see their pictures popping up on my social media all the time. So it's been very, very, very rewarding. And to see a family's life change from having no kids whatsoever to having beautiful twins that are just out of this world and watch their story has been for me very eye-opening.

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For other people to hear that story, it adds a lot of hope because I do know so many people struggle. So amazing to hear. What do you think most women come to see you for? In the beginning of my career, maybe more than like 15 years ago, people were coming because they were struggling to get pregnant. Just struggling to get pregnant. They'd been trying for quite a while. But now it's kind of changed. You know, I've been trying for quite a while.

You know, we have people that have been open about it, have talked about it. We've gotten out into the communities, into, you know, the U.S. population, understanding that fertility is a big problem and a big issue. So people are now coming to me for two main reasons.

One is to preserve their fertility because it's a major problem that women are not trying to have a baby anymore like our moms did when they were 22, 24, 25 years old. And now women are seeking careers as much as men and they are thinking about getting married in their 30s. They are thinking about starting families in their mid to late 30s and they still want to have it. But the biological clock of a female is absolutely different than a man's.

And things start to decline significantly. Once a woman is 27, 28 years old, things start to go down for the average woman. So that's why people are now coming in a lot about fertility preservation. But at the same time, people are very open now about their fertility struggles and have become much more open and much more accepted. So I'm seeing people earlier when they're actually having problems.

I'm actually, the idea of surrogacy is growing. We're helping people there. And also the area of like egg donation when a woman's own eggs aren't working. It was very difficult for someone to accept that, you know, 15, 17 years ago, but now much more well accepted and accepted.

We are helping families and the LGBTQ community that, you know, maybe 15 years ago, it was just novel. It was for a select few, but now it's open and anyone can have a beautiful family. Amazing. And so what is the optimal age for fertility?

So optimal age for female fertility is something between 20 and 27. Okay. Some studies say 26, 27, 28, the average woman starts to have a little decline. It does not mean you become infertile at 29, but it means that you start to have a little bit of a decline. Sadly, I have seen women that are 31, 32 years old, and their fertility is already so poor and so down that they've had to use egg donation.

And I've also seen women that were 44, 45, freeze their eggs in my clinic, came back at 46, 47, use those eggs and had a beautiful baby. So this is just generalizations. I mean, that's the person winning the lotto of the fertility world. And on the other hand, that's the woman that really sadly had very poor fertility genetics. So we see it in all levels. The average female in their 30s, mid 30s starts to have a significant decline.

So that's why I think it's extremely important. And I'm sure you're going to ask me this, but around the age of 30, if you're not ready to start your entire family and you have to also think like, do I want to have four kids and I'm 30 or do I just want to have one or two and I'm 30?

So if you're even thinking and you're ready to start a family, but you want to have three or four kids and you're around 30, well, you better think about baby number like three, maybe four, which are going to happen in your late 30s. And it may not be as easy as it is now. And I think that's another reason to plan your entire family. Yeah.

It's very difficult to think so far ahead, but give some really good thought of what you want to do, what you want to have in terms of children. Planning ahead and being overly cautious and well-prepared only is going to be helpful.

This might be a bit of a specific question, but let's say I want to get pregnant right now, age 29, but I want to have three more kids in the future. Can I go about trying to get naturally pregnant but also freeze eggs in a similar window of time or should they be completely separate?

It's impossible to do both at the same time. Okay. So you can't be trying to get pregnant this month naturally at home and be freezing your eggs this month. But what I recommend to patients is

do the preservation first. So come and freeze a batch of eggs. Most people in a committed relationship actually freeze an embryo, which is the egg and the sperm together, because it allows us to genetically test and let you know from now how many healthy males you have, how many healthy females you have, if you want to know the gender. If you don't, we don't conceal that. But it tells us how many genetically tested healthy embryos you have from now. And then you can say, okay, I have six, I'm good.

then I can go and try the next month on my own if I want to. Or if you have an overabundance of healthy embryos, many people at that point will just say, put one of the healthy ones in me. Wow.

And that makes it a more sure chance of getting pregnant. Versus if you were to get pregnant right now, then the earliest you would be able to do the process is after you're done breastfeeding. So it's going to be a year to a year and a half from now after you've gotten pregnant, delivered, breastfed, and you don't need to breastfeed anymore. And then you can accept external hormones. So that's why like, you know, throwing your fertility off for one and a half years for every single woman affects their fertility. Mm.

But I think it's better to do it now and before when your fertility is great than later. Okay. If we're looking to conceive in a year or two, what are some things we could be doing right now, diet, exercise, lifestyle-wise to improve chances of getting pregnant?

That's an excellent question. And I've been talking a lot about that on my social media because I realized it's something that people really want to do. Be as healthy as possible. So like things, external environmental things that affect fertility in a very negative way,

For example, smoking, excessive use of alcohol, any kind of drug, any, including weed and marijuana, these things definitely affect fertility in a negative way. Excessive heat for men, anything that takes testicular temperature up like jacuzzis, steam rooms, saunas,

It's not good for you. And actually, to be honest, I think excessive amounts of that even for a female hasn't been proven as much because the testicles are outside of the male body for a reason to keep the sperm cooler, but I don't think it's good for anyone. I think eating diets that are really rich in antioxidants, so foods like the blueberries, all kinds of greeny leaf vegetables and just being overall healthy and well-balanced is great.

Having your body mass index, your weight in a very ideal zone, I think is really, really important before pregnancy. People don't understand that as your weight goes up, your fertility goes down. As simple as that. Of course, we see people that are overweight, pregnant and got pregnant easily. But generally speaking, being overweight and not having a normal body mass index can affect your fertility in a very negative way.

For men, it's a little different. Sperm quality generally is really good, you know, up to like the age of 40. Men make sperm until the day they are alive and until the...

we didn't have a lot of data, but we have now seen that every generation, sperm quality is going down and down and down now in the world. The environment has things in it that we just do not know and is making sperm quality poorer and poorer as time goes on. And for that reason alone, we encourage men to have kids before the age of 40. And if you're not, to possibly freeze sperm.

because after the age of 40, there are higher risks of aneuploidy, which is abnormalities in chromosomes of fetuses and in babies like Down syndrome and other chromosomal problems. And there are some links that have not really been

I completely confirm that there may be some links with advanced male age and autism. I just rather err on the side of being safe than waiting for research to say this 20 years from now. So for me, I think it's just smarter to do things earlier. I know a lot of men are taking TRT nowadays. Do you recommend...

freezing sperm before you start taking something like that i saw a couple questions about this on my instagram 100 okay so it is the best male contraceptive that you will find if you start to give yourself external testosterone testosterone replacement therapy trt whatever you'd like to call it within a couple of months your sperm count will go down to zero

So the brain will realize that it has a lot of testosterone in it and it will stop producing its own endogenous or human-made testosterone inside your body and that's the fuel for making sperm and your sperm count will go down to zero.

Some people can get their sperm counts back by stopping for three months. And that's generally about 72 to 90 days is the time it takes to make sperm. But there are some people that are on TRT that go off of it and struggle both physically, emotionally, and to get their sperm back to normal. So I would highly recommend to do that beforehand. Have you noticed an impact on female birth control on fertility? No. No.

Really? Yes. So there's two parts to that answer. So being on female...

birth control does not destroy your fertility and it does not preserve your fertility because women have asked me well, you know I didn't ovulate for you know 20 years because I was on continuous birth control for 20 years But your eggs still die off as they're in your body. So you're not helping yourself However, there's one little thing to this if you were on birth control for a really long period of time like 5 10 15 years straight

When you want to go to try to have a baby or freeze your eggs, there's going to be a little bit of suppression. Your ovaries are really quiet. Like they have been put to sleep for a really long time. It's going to take a while to wake them up. So we recommend anywhere from one to three months, even six months of trying to let things come back to normal. You know, if you are in your late 30s, I don't say just sit there for six months and wait. I would go straight for it.

But if you went on it when you were 18 and now you're like 30 and you're thinking about having a kid, I would come off of it for a little bit. Let your body come back to normal. If you're thinking about freezing your eggs, I would for sure give yourself one to three months off of anything to get your own hormones to come back to normal. It took me a full year to get my period back and I was panicking. I think that's the reason I actually called you initially because I was like, oh my God.

it's never coming back. I want to have kids. So yeah, for anyone listening who wants to have kids,

have that in your mind. And by the way, I hear that a lot. So I tell people, you know, one to three months, it sometimes takes up to six. But I get calls all the time that it takes people who have been on birth control for quite a long time, a longer time for the period to come back. I think it's worth mentioning because people have this conception that when they're ready to have kids, oh, I'll just come off the pill next month, period, back to normal. It does take time. So

There are a group of people that get pregnant very easily, very quickly, and are also the people that talk about it all the time. Oh, I got pregnant the first time I tried. It was so easy. And those are the people, like, you don't really hear at a dinner party, oh, I...

it was so fun for nine months we tried and on the ninth month it just happened it was so great no one really goes around a dinner party talking about that somehow the person that got pregnant the first time i'm so fertile my husband just looks at me and i get pregnant you know i love those comments they're probably just best saved for yourself because there are so many people around you that aren't sharing the story about how it's been like 25 months of trying and it's very painful to hear those

Unless it's said in an encouraging way to help people, which I think sometimes it is, sometimes it's not. But it's not that common. I think online too.

there's people have to be more sensitive to the fact that so many people are struggling to get pregnant even myself I get hundreds of questions about when am I having a baby what are we thinking are we trying I think people are so personal with the questions and there's really no thought behind it because you never know what someone's experiencing.

I think people have learned. I learned one of the biggest lessons ever. I was in Crate and Barrel just doing my thing, walking around on a weekend. And I said to this lady, oh, my God, what do you do? You know, I'm a fertility specialist thinking I can say whatever I want to people. And she's like, oh, I'm not pregnant. I had a kidney transplant. Then that's my kidney. Oh, no. And I learned after that to keep my mouth shut. Oh, no.

Oh, no. I have an employee in my office who I think she's pregnant. I've never asked one person. And the other day I saw that they had a baby shower for her in my office. And at that point. And I finally said to her, congratulations, I didn't know you were pregnant. She's like, how did you not know? I said, I just didn't want to assume.

So I've learned a really hard way as a fertility specialist to kind of keep my comments to myself. Now, on the other hand, many, many people are very open to me. I'm the first person in town to get a text message saying my pregnancy test was positive and I don't talk about this to anyone and I've helped and supported people throughout this whole process. But at the same time, you've got to be very careful. It is a very, very difficult time for people.

After my first daughter was born, we got pregnant again very quickly and easily. And then we had a miscarriage and then for two years didn't get pregnant. And that's when we did six months of IUIs and Clomid and all those fun things that nothing helped and eventually had to do IVF. So I saw the other friends of ours that were pregnant at the same time deliver. Their kids were almost like walking and we were still struggling. Wow. So I've been on both sides. Yeah.

That's a good perspective to have and something to keep in mind. I want to ask about PCOS. I had so many questions. How much does PCOS affect fertility? So I was very fortunate. The chairman of obstetrics and gynecology when I was a fellow at the Cedars-Sinai Medical Program was Dr. Ricardo Aziz. He is one of like the grandfathers of polycystic ovary syndrome, who dedicated his life to research and

and doing lots of areas of research. So during my three years of fellowship, I learned a lot. I did my own thesis in the area of polycystic ovary syndrome, and I've had hundreds, if not maybe thousands of patients that have consulted with me about it. It's a stubborn, stubborn disorder. The way I like to describe it, that it's really a spectrum. It is, there's this extreme of PCOS and this extreme. For people that don't really know what PCOS is, it's polycystic ovary syndrome.

One of the characteristics of it is that your ovary, when you do an ultrasound, it has little bubbles all over. Those are called follicles. In the polycystic ovary patient, we just look at them as lots of poly, you know, ovarian cysts.

Generally, they are at the periphery of the ovary. They sometimes have been called a string of pearls. A healthy young woman with lots of follicles all over the ovary is a little different than that polycystic patient that has a lot of ovary in the center and a lot of cysts all around the edge of the ovary. So that's one characteristic of

Other characteristics are if your blood work shows that you have elevated male hormones like testosterone, like DHEAS, those are male hormones if they're elevated or your blood work doesn't even have to show it, but if you have symptoms of it, like if you have hair growth on your chin,

The upper lip does not count because in many different cultures and nationalities, it's normal for women to have hairier upper lips, so that's not part of it. But the chin, for most women, is not part of the normal growth of hair. And on the body, it's not as well. And also male pattern baldness, and if you're losing hair kind of in the male pattern areas, those are all signs that you have excess levels of male hormones.

So the ovary thing is one thing, and then the male hormonal abnormality is another, whether it's in your blood or you can just see the symptom. And then the third characteristic is also just having abnormal ovulation and abnormal periods. So if you have two of those three things I described, by definition, you're diagnosed with polycystic ovary syndrome. Now, here in LA, the typical woman that I would see from a mile away and I could tell has thinning hair,

acne, abnormal hair growth, is generally overweight, some darkening of the skin around the neck, maybe under the arms, under the breasts, anywhere where the skin touches the skin and it looks kind of dark. It's not dirt. It's just that their insulin isn't working well. And that's one of the first signals of someone having abnormal insulin sensitivity in their body. Polycystic ovary syndrome, the root of it is from insulin receptors not working well.

And the insulin receptor and the testosterone receptor are very similar. So there begins to be an overlap. And that's where we get all this problem. So I see a lot of patients that you could never tell

That woman that I just described to you who gets irregular periods, overweight, hair loss, acne, all of the things I just described and on ultrasound has lots of little follicles. And you can see this woman, everyone's seen someone that looks like that and has polycystic ovary syndrome. And then there's a woman who is absolutely the normal weight,

no acne, no abnormal hair growth or has done something about it so you can't tell and also has it. So it's a big spectrum. Some people respond very easily by giving them some medications like a Clomid or Letrozole which help you ovulate. You ovulate, you're pregnant and you're good. And some women, no matter what you do, have a very, very, very hard time with fertility and ovulation. And that's a good candidate for IVF.

It's a good candidate for IVF if nothing else has worked.

It's a good candidate for IVF if like you want to have three, four kids and you don't want every single pregnancy go through the challenges of artificial insemination, Clomid, checking all of this. You know, there's things you can do to make it better for some people like metformin, which helps your insulin work better, helps people. For some women, weight loss, just this quick weight loss and real weight loss helps them a lot.

so

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completely different issue that affects fertility a lot. So endometriosis is when the lining of your uterus, the endometrial lining, actually is growing in areas outside of the lining of the uterus. So it can be on your fallopian tubes. Generally speaking, it's all over the inside of your pelvis. Some women get it in one spot. Some women get it as a cyst on their ovary. When it's endometriosis is formed as a cyst on the ovary, it's called an endometrioma.

When it's on the pelvis, on the bowel, on the intestines, on the appendix, then it's called endometriosis, lesions, and you just have it randomly in different places. Some people have a lot and have zero symptoms. Some people have very little and have horrible painful periods and symptoms.

The major symptom of it is extremely painful periods. Now, some people do laparoscopy where they put a camera in and go look and their entire pelvis as a result of this becomes scar tissue and it causes the fallopian tubes not to work well.

But endometriosis is one that becomes very stubborn. And when there is endometriosis floating around in the body or near the ovary, it starts to affect egg quality as well. Just like polycystic ovary syndrome. When there's male hormone floating around your body or endometriosis floating around the body, they affect the eggs in a negative way. And I think for many of these patients, IVF is a better route to get pregnant.

I was listening to Peter Atiyah yesterday and he mentioned with the fallopian tube, if you're looking to get pregnant, you can go and get it opened. Is that true? So it's not that you can get it opened. However, there is a test. I'm licensed and I do it in my clinic. If not, radiologists do them all the time in their places. But it's a test called a hysterosalpingogram. Many people call it an HSG.

The HSG is a test we do where we put, you're basically in the pap smear position. We put a speculum in and we put a tiny little catheter into the cervix. And that allows me to push a dye in. The dye is totally clear. And then we do an x-ray, like a continuous x-ray video. It's called fluoroscopy. And we can watch this dye go up into the uterus, out the fallopian tubes and watch it pour out.

So for some people, it can unblock a fallopian tube that was maybe blocked with like some mucus or just whatever debris the body may form there, a little blood clot or something. But if you really have tubal blockage as a result of scar tissue or true damage, it is not going to open your fallopian tube. Okay. So it has been also shown that for some women that get their fallopian tubes flushed and everything looks good, for the next maybe –

two to four months, they have a higher rate of pregnancy on their own. And I've done that many times when I did an HSG and the next month the patient called me and said they're pregnant. So that's in my eyes, I look at it as maybe there was something like just mucus or something just causing a little blockage, but it does not unblock a real tubal blockage. So maybe it's worth doing if you're like actively trying to get pregnant and want to just make sure you're all set.

If you're young and you don't want to worry about like maybe three or four later on when you're old and you just want to try things naturally or just want to know and you're about to start or you've been trying for a couple of months, I think it's a great test to do. Is 29 young?

29 is very young, especially compared to me. But 29 is young, but it depends for what. So 29 is young in the world of fertility. Okay. 29 is young in every aspect of fertility, to be very honest. Is 29 really young for freezing eggs? I'd say no, but it is a bad and worrisome age to start thinking about these things. No. Okay. Okay.

If someone's having fertility issues, at what point do you recommend them coming to see a specialist? Excellent question. So the American Society of Reproductive Medicine gives two definitions for fertility. If you're under 35 and you've been trying for a year, they call you infertile, you have the diagnosis. If you're over 35 and it's been six months, then they give you the diagnosis and tell you to see someone.

I agree with that 100% in helping with a diagnosis. However, this is the thing. Let's say you're 26 years old and you know you have polycystic syndrome, polycystic ovarian syndrome, and you know that you are not ovulating every month. There is no purpose in waiting for one year to go see a doctor. You should see a doctor right now.

If you send your partner and he checks his sperm and the sperm count is low or it doesn't look perfect, well, then you should see a doctor now. There's no purpose in waiting and trying for one year.

And if you are 35 years old that just got married and want to try and you want to have three kids, there's zero purpose in trying on your own for six months. To be honest, if you got pregnant and delivered at 36 and came back at 38, 39 to start your baby number two, you actually shot yourself in the foot there because you lost a lot of opportunities of having embryos frozen at a younger age.

This is the perspective that I have worked very, very hard to try to explain to people. And it's been a challenge trying to explain to someone the purpose of trying to preserve your fertility in an advanced age. Because I do this all day long and I see that patient that's like, I got pregnant so easily at 38. And now I've been trying for like a year and it's not happening and she's 42 now. Yeah.

So might as well freeze the embryos while you're in that moment of your life. I think so. Okay.

So I want to talk about the test that Greg and I had done because I thought it was really interesting and I'm so happy I did it. It was called the Horizon Carrier Screen Test, which showed the genetic diseases I'm a carrier for and the one that Greg's a carrier for. And the goal is to make sure there's no overlap between them. And I thought it was a really interesting thing to do. Do you recommend that for everyone? Everyone. Hmm.

So if you could do a quick blood test that tells you what you have from your ancestry inherited in you and tells you what you're a carrier of, it's really important, I think. You will not have that disease. This is just things that we have inherited. They're in our system. We're gonna have them to the day we die. The way that it becomes a problem is if two people are gonna be having a kid together and they don't check and they're both a carrier of something,

it causes a major, major, major problem because if it's an autosomal recessive, which means not one that causes the disease, just carries in there, if two people have it, one out of every four of their kids can actually have the disease.

It has been a very, very sad situation where I have people come into my clinic and say, I didn't know I carried this very extremely rare thing and so did my wife. And now we have a child with this disease. And this screening test can help prevent that. Absolutely. So if you do see an overlap, what do you do? So the most common genetic disorder that people carry is cystic fibrosis.

one out of every about 19 to 29 Caucasians. But if you're African-American or a different nationality does not mean that you don't carry it. But on average, the Caucasian population, about one out of 19 to 29 people are a carrier. So that's actually a lot of people. So you could be in a big room of people, meet Mr. Wright or Mrs. Wright, and the two of you try to have a kid. You have a kid, if you both passed it on, one out of every four of your kids is gonna suffer from cystic fibrosis their whole life.

until they usually pass away earlier and it's a devastating, uncomfortable, horrible disease. So if you know in advance, we will take egg and sperm like the IVF process, make and create your embryos, not only check them to see that they're 46 chromosomes like Down syndrome and other things are totally normal, but also check to see which embryo is a carrier, which embryo has no carriership and which embryo is diseased.

So we can avoid putting a diseased embryo back into the female and we can just put carrier embryos or we could just try to avoid and get rid of a disorder that's in your bloodstream once and for all.

Wow, that's pretty amazing. It is. And any two people that are having unprotected intercourse with each other that may result in a pregnancy, whether you're married or not, but open to being pregnant, should be doing this test with each other. It's a quick blood test. Horizon is a great option. There are many other ones out there. We have one in our clinic right now that checks you for 400 different disorders. The panels keep getting better and better and better.

If you are not actively at risk of being pregnant now or trying to have a child, I would say wait until you are ready. But if you're having unprotected intercourse and it's an option to be pregnant, 100% you should be doing that test. Yeah, I can say firsthand it took 10 minutes in and out. It's a quick blood test. Within two weeks, we get the results and you know exactly what you carry or not.

Let's talk about IVF. I have some questions. What is it and what does it do? So IVF is in vitro fertilization. The word in vitro means outside of the body. So basically, we are creating and fertilizing embryos in our laboratory, which is called an embryology lab.

We take sperm, we take eggs, we put them together, and outside of the human body, we are fertilizing an embryo that later on becomes a baby and a fetus and becomes a human being. So this is the process where we stimulate a female with about 10 to 12 days of tiny little injections that go into the belly. And then at that point,

About 10 to 12 days later, an average woman with good fertility has something like 10, 15, 20 eggs growing. We take them into our surgery center and under a really light sedation given by my anesthesiologist, I place an ultrasound vaginally with a special little needle inside. It goes into the ovary and it helps me retrieve all the eggs that grew that month.

The more fertile you are with a little bit of medicine, you're going to grow a lot of eggs. The less fertile and the older you are and the less eggs you have, a lot of medication is needed to get you to grow a few of them. So this might be a dumb question. Is IVF something you have to do before egg freezing? Yes. So that's a good question. People get confused.

For the female, let's say you wanted to do IVF or egg freezing. For you, it's identical. So it involves you coming to the clinic, doing 10 to 12 days of injections with about three or four ultrasounds and blood tests in my office, and then your eggs come out. Now, then it changes. If you're egg freezing, at that point, we examine your eggs. All the mature eggs are frozen and you're done.

If you're doing IVF, at that point, your eggs are examined. All the mature ones are no longer frozen. They are going to be introduced to sperm.

So we can either pick the sperm and inject each one into the best sperm we find into each egg, which is called intracytoplasmic sperm injection. It's also what's beneficial for people with low sperm counts, and it has other benefits as well. And then we watch these embryos grow for about five to seven days. We put them in incubators. We have some really cool advanced incubators that take 1,000 pictures a day.

and they also look at every abnormal division and let us know by observing which ones grew beautifully and which ones did not. It also keeps the embryos from being exposed to air, to light, to movement or temperature change. And it's been proven to give higher pregnancy rates because it works like your fallopian tubes. For five to seven days continuously, the embryo is undisturbed as it grows. It's called the embryoscope. We're very fortunate to have them in our clinic.

Unfortunately, we don't have enough for everyone. So it's an add-on, but we offer it and it's first come, first serve and whoever wants to use that. But by the end of the five to seven days, whether we use a regular incubator or embryoscope incubator, the embryo grows beautifully. And then the ones that have grown well, has to grow well, are eligible to get a tiny biopsy and then the embryo is frozen.

The biopsy goes out to a genetic testing company, and usually within about an average a week, we find out the genetic testing results of each embryo. Embryo one, normal male. Embryo two, normal female. Embryo three, Down syndrome. Embryo four, chromosomal abnormality. And if you're doing additional genetic testing on disorders, it tells you which ones have and don't have the disorders as well.

So that's the difference between egg freezing. But for the purposes of growing your eggs and for what the female does, it's identical. It's just some things are different afterwards inside of our lab. Okay. And I always hear women who are doing IVF speak about the mood struggle and the hormonal struggle. What is that like? What's actually happening? It's another area that I've noticed that

Women that had mood changes or felt uncomfortable for some reason are very, very vocal and social and let everyone know everywhere about how horrible egg freezing and how horrible IVF was. Very rarely...

Do I get the 95% of patients that went right through this process and did really well with no major emotional ups and downs and really did well, get out there and say, this was so easy and I did really well? You know, I gotta be very honest, Lauren,

was talking about this with some people on the Skinny Confidential, that the people that are, you know, they don't complain, the ones that go through this. And she's like, that's interesting, because those are the people we need to have talk more about this and say it out loud. That, you know, it's not that bad. I think, yeah, it's almost become scary, because I've only been told

negative experiences. And you're right, the people who complain are the ones who had a problem and they're more vocal about it. So the more eggs you make, the more uncomfortable you're going to be. Oh, wow. So the more successful you are. Right. Okay. So I tell patients, please be aware that you may be really uncomfortable towards the end of your egg growth because you're getting really full. Your ovary is

are usually the size of maybe like two apricots. And then we want them and our goal is to get them to become two grapefruits. So as these ovaries get very large and have a lot of eggs growing on them, you will feel bloated. It's impossible not to. If you do not feel bloated at all during your entire cycle, sadly, you're not making a lot of eggs. So that's an ideal situation to feel bloated.

bloated to an extent. And afterwards, during the recovery of your ovary, people have something called ovarian hyperstimulation syndrome. It can be extremely mild or it can be very extreme.

But the week after your eggs come out, while the ovary is trying to figure out how to heal itself and go back to normal, some people have some challenges. Some people get very bloated. Some people get uncomfortable. Some people cannot move around and do the normal things they did. Again, the more eggs you make, that week of recuperation, or sometimes for people that made a lot of eggs, the second week of recuperation can be a little challenging. But

People go back to normal. Generally speaking, within two weeks later, almost 99.99% of the patients are back to where they were once their period has come. Is there anything that you can do during IVF to help the process and make it more successful? Or is there anything you shouldn't be doing? Absolutely. And to answer just one more aspect of what you asked about the emotional state,

I've had women tell me they feel great. I've had women tell me I got a headache. I've had women tell me I felt tired. I've had women that are also in very challenging life situations where emotionally, physically, financially, this has been one of the hardest things they've ever had to deal with.

Dealing with their natural desires of wanting to be married and have a relationship and do this with a partner and not having it has been a little bit more challenging for some of my patients at older ages doing this versus someone who's doing this for all the right reasons at the age of 30. But there are things that someone can do to make themselves feel a little bit better.

During this process, you know, I tell patients, you know, your ovaries as they get larger can leak fluid. And then people get a lot of fluid just floating around their abdomen. And having more protein in your body or more electrolyte balanced beverages like coconut water, vitamin water, things that maybe have a little bit more salt. You know how we have salt and then we get swollen the next day because our blood is

keeping the water in our fluids and into our bloodstream. So it's actually a good thing during the time of your egg retrieval when we keep the blood in our bloodstream and don't let that extra fluid aspect of our blood leak out of the ovary. So a little bit extra protein,

And I'm not telling people to over drink, but if you're going to drink, drink an electrolyte balanced beverage. Those keep the fluid aspect of our body in our bloodstream and not leaking around the ovary. You do like a lymphatic drainage or is that like too invasive? I mean, you could do a lymphatic drainage massage, but I don't think it's going to resolve all your problem. Okay. Good to know. Can you still miscarry with IVF? Yes, you can.

But it's less likely? It's less likely, but you have to be smart about it. So if you are a person that has an autoimmune disorder, a blood clotting issue, or anything about your body that is going to cause a miscarriage, putting an embryo into your body doesn't reduce your chances of having a miscarriage. So you can still have a miscarriage like anyone else in your own situation. However...

we check people for a lot of things like this. So before putting an embryo back, I evaluate everyone's uterus to make sure that their uterus is great and has no abnormalities that can cause a miscarriage. We also check, our clinic decided years ago, you know, we used to do, if you didn't get pregnant, we would check you for all these panels of blood afterwards. And my partners and I once sat around because I had a patient who told me, well, why didn't you do that blood work on me before?

And that just, a light bulb went on in my head and I brought it up at one of our meetings. And from then on, all the partners at my practice, before putting an embryo back, we check your implantation failure panel before we put an embryo in you. If there's a tiny chance of having a blood clotting factor or you have it in your family, we check you for all those things before. If there's any autoimmune testing that comes up positive, we evaluate and use the help of our rheumatology colleagues to get medications that help you beforehand.

So we do all these things before putting an embryo back. And the genetic testing that maybe 99% of our patients are doing these days, and we are very pro-genetic testing, have really reduced our miscarriage rates. Do we still see it? Sadly, yes. And we are a clinic, and I want to just talk about this for a second.

If you're going to a clinic that tells you, oh, the genetic testing is going to destroy your embryo, or yesterday I did a consult and the patient said, the doctor put my embryos back on day three, fresh cycle, did not let the embryo even grow to day five to see if it has the capability of getting there and did not offer genetic testing. And guess what? She got pregnant and had a miscarriage.

I would be very, very, very weary about working with a clinic that thinks genetic testing is going to destroy your embryo or is just putting an embryo back without genetic testing. I believe firmly that genetic testing weeds out all your bad embryos. No one needs to be pregnant with a bad pregnancy. And having a healthy pregnancy is our number one goal. So genetic testing done in the right hands

And in a lab that has the capability of letting an embryo grow beautifully up to day five, six, or seven, which is really important because if a lab can't do that well and is encouraging you to put an embryo back blindly on day three, I would question how good their lab is.

If someone's looking for a fertility clinic and they want to make sure it's a good one, what should they be looking for in certifications or services? This is a hard question because we have certain societies that we are supposed to be putting our results on. I can tell you

Our clinic is finding some of the methods on how they want us to upload and how they want us to give our results is getting cumbersome to a point that it's not helpful. And the way they want us to do these reporting is getting very difficult to the point that it's not making sense.

the reporting agencies like the American Society of Reproductive Technologies or SART, which reports, you know, I believe in a lot of things that they say, but some of the reporting ways are getting to be a little bit much. So I would, in the past, people would look and see, oh, their success rate is this, but they're not so clear cut anymore. And not every clinic can follow them and not every clinic is following them. I think that

Talking to people that have gone through the process who can tell you my doctor was excellent, their staff was excellent, their success rates are high, they have a reputable IVF lab are really important. If you're going to a clinic where you are not thriving with the service you're getting, that's inappropriate in this day and age. You know, my team is excellent. I find the people in my office that are working there excellent.

You know, it's taken us years to be able to get to that point. Our IVF lab is run by one of the most brilliant lab directors, Dr. Jason Barrett, that I've ever worked with and who's excellent. So we've worked a lot. There's a reason why many of the doctors at the Cedars-Sinai Medical Center and also UCLA Medical Center and doctors in our community come and do their procedures in my lab. So these are things to look forward to. If you are in a town that does not have a lot of services available to you,

I would highly, highly recommend doing a consultation by phone or telemedicine with one of the top clinics like ours or someone that you think is excellent. And then figuring out how can I just do the basics like my ultrasounds and blood tests in my hometown and maybe just flying into the clinic where I could just do the procedure in one of the best labs. Because I think the lab where you do the work is extremely, extremely important.

I want to dive into egg freezing. Sure. I think there's a conception that it's kind of a bougie thing to do because we hear from high profile celebrities freezing their eggs. Is egg freezing something that is accessible to everyone? Are there payment plans? Like, how does it actually work?

So I tell a lot of young women when you're looking for a job and you got two great job offers, take the one that has fertility coverage and take advantage of that because that's worth a lot of money to you. And I think it's worth a lot that a provider and your new employer thought it was important enough to give that to their employees. So that's one thing. There are financing plans that can get it as low as under $200 a month.

to do it. It is not a bougie thing to do. Okay. It is a smart thing to do for any woman that has even a 1% chance that she wants to have a child in the future. And I still have patients saying, I don't even think I want to have kids, but I don't know something could change in me. And it does. We see this all the time when someone gets into their late thirties and like,

I never thought I really wanted to have kids, but I'm realizing now I do. So I think it's the best insurance you're going to have for your family building in the future is to freeze your eggs, whether it's financing, whether it's getting a special kind of medical loan, whether it's taking advantage. Like right now we have a summer egg freezing special going on. There's these specials that are going on in different places. These are all really, really important things, but one way or another, I think there

They're all very, very, very important and a reason to do. Yeah. And if you think about it, one of the best things you could invest in for yourself. 100%. I want to ask about this concept of designer babies. There's sort of a rumor that you can freeze your eggs and as you mentioned, know the gender, know that it's a healthy embryo. Can you know the hair color, the eye color, what the baby's going to look like? Are people like selecting?

the best of everything? Does that make sense? No. Okay, that's not happening. So I've heard about it as well. Yeah. And in the medical community, I don't see it existing. I haven't really heard about it being really done. I don't know what people are telling their patients about this, but we are able to do genetic testing on 46 chromosomes. As a result, if you would like to know, we are able to tell you which ones are males and which ones are females.

We cannot make you a male or a female. So if you suddenly make all females, well, guess what? We can't make a male. You have to do it again and hope that your body makes a male. So we can reveal to you the gender of your embryo and if it's healthy or not, and that's it. Okay. Is there a cutoff age for freezing your eggs? We don't have a cutoff age. So I have had 46-year-old women make like 18 eggs.

I have counseled her and told her that the chance that those eggs are healthy and work well are extremely, extremely low. But I think there are patients that rather have one egg frozen and keep the door open mentally and emotionally than closing the doors on themselves. And we have had patients that have froze one egg and used it and it worked. We have also had patients that froze 30 eggs and used them and none worked.

So we don't have an age cutoff. I think it involves a lot of counseling between your doctor and yourself, understanding really the truth and understanding

understanding and being accepting of what your statistics are because sometimes they're extremely low and as long as a patient I feel that it's educated and is really understanding me, I'm happy to help them try because sometimes it's a path that you have to take to get to using an egg donor or using a surrogate. And if you don't try on your own, for many people, they can't move on. Okay. How long can you freeze eggs for?

Theoretically, there's no time limit. So when you freeze an egg, you just stop it in time. So theoretically, there's no time. We've only been doing egg freezing for less than, I want to say less than 15 years. Do you have an egg frozen from the beginning of your clinic? Yeah. So as soon as we started doing egg freezing, we still have eggs of people that have not used them. We have frozen embryos and used them 15 years later and had a beautiful pregnancy.

And I think I have the world's record for freezing sperm that was frozen 31 and a half years earlier. And it led to three beautiful babies. No way. Yes. This is such a random question. If a couple freezes an embryo together, assuming that they will be together, and then they divorce legally, can one or the other partner still use that embryo? Does that make sense? Yes, they cannot. Unless...

When you were signing your paperwork, if one of the partners states in their legal documents, if we get a divorce, I am giving all permission to my spouse, even without me permission to use them. That's the only time they can do that. But if two people go into it together and they divorce and one wants to use it, you cannot use it without the other person's permission. So that's why I tell people,

If you are 99.999% sure that you are going to have a child with someone, you freeze your eggs. Only when you are 100% sure that that is the only person you're having a child with in the future, that's the only time when you should be freezing embryos. So if you freeze eggs and you freeze sperm...

And then a couple years later, you thaw them. Can you make an embryo still? Of course, you can make an embryo then with the egg and the sperm 100%. You just don't know the well-being of the embryo until you make the embryo. So if you freeze the eggs and freeze the sperm, it's blind. You just know you froze sperm and eggs and that's it. You will only know if they're genetically healthy and normal once you make an embryo because we cannot check a sperm or an egg alone. Okay, and how many eggs...

survive the thawing process? Do some die? The die-off process of eggs not making it has gone down extremely low, but sometimes they can and sometimes they're not usable later on. Okay. I want to ask about surrogacy as well. How much more common is surrogacy now compared to when you first started? Huge.

It was a rare patient here or there that would use a surrogate before. And now it is a very rapidly growing area of my medicine that I practice all over the world. And in many places, it's very limited and it still has lots of restrictions. California is very open to it and we do it in a very, very organized and healthy way. And it's growing a lot.

What do you find is the mental and emotional experience and how is it different to carrying your own baby? I think people do it for many different reasons and it's important for them to do it the reason. If you've had multiple miscarriages, if you're older, you know, there's reasons why surrogacy is definitely better for you. I think that many people that are okay with it have no problems at all.

And I think if it's something that's just being done electively for no reason whatsoever and you have challenges with it, it's not for you. Mm-hmm.

I wanted to ask about your experience with same-sex couples and how surrogacy has helped that community. I know you spoke before about the LGBTQ community. How has surrogacy helped them build their families too? Tremendously. I've been very, very fortunate in my practice to have had a lot of same-sex male couples as my patients. And it's a beautiful thing to see

Patients that may not have ever had a child have a gorgeous family.

And helping them with egg donation and surrogacy has been a really beautiful opportunity for me to make beautiful families for lots and lots of people that I think were extremely well deserving and amazing parents. What is a final piece of advice you'd give to a couple, a same-sex couple, a woman who is struggling with their fertility right now? Any question you have or any struggle you have, talk to a specialist. Learn. Learn what your options are.

I think just doing Google research is really not the smartest thing to do. There's no loss in educating yourself. Even if it's the beginning of your marriage or the beginning of where you think you are with your thoughts about fertility, consult with a smart specialist and learn more because knowledge is power. Yeah, I absolutely love that advice. Dr. Gidea, thank you so much for coming on the show. Where can people find you and the clinic online?

So my clinic is Southern California Reproductive Center. Our main office is in the heart of Beverly Hills, but we have offices in Pasadena and Santa Barbara and also Ventura counties. My handles are Dr. Shaheen Ghadir on Instagram and on Facebook, TikTok. My podcast is called The Fertile Life.

And if I can be of help to anyone, we also have complimentary webinars that we do through my clinic that are free. People from around the world join and learn about different topics. And they're all on our YouTube channel as well. Fantastic. Thank you for listening to today's episode. Go comment on my last Instagram at Mari Llewellyn with the guest you want to see next.

I'll be picking one person from the comments to send our Bloom Greens to. Make sure you hit follow so you never miss my weekly episodes. If you enjoyed the conversation, be sure to share and leave a review. See you next week.