Dr. Cindy’s Take on COVID-19 and Vaccine Development

It has been 11 harrowing months since the dawn of COVID-19, a disease caused by the novel SARS-Cov-2 virus which has swept across the globe at wildfire speed and thrusted the entire planet into sheer distress and indecision. Truth be told, humanity has been shaken to its core! COVID-19 has crippled economies and changed daily life, as we know it, for the foreseeable future.

For medical professionals, these past 11 months have been nothing short of a nightmare! Positioned at the front lines of this pandemic, we have had to combat this invisible enemy, that we had little information about, SARS-Cov-2 virus. Since the first news about the initial outbreak in Wuhan, China, we have grown to learn more about the virus and its myriad disease presentations. Consequently, we have also witnessed a series of vaccine candidates enter the accelerated pipeline — serving as the hope and potential of a saving grace for a world that is aching for immediate relief. Unfortunately, even with the accelerated pace, vaccine development is not an overnight process.

In fact, vaccine development is a trial and error series; a long process that comes with many fundamental phases where scientists and specialists, known as vaccinologists, must first successfully test for safety even before determining the true efficacy of a candidate vaccine for clinical trials. Then, even after successfully launching a trial and finding an effective vaccine, the challenges for getting a vaccine approved and distributed do not end there. As a Virologist and Vaccine Biologist, I am the first to admit that this is the biggest challenge that we face, as we look ahead to the next 11 months of the COVID-19 pandemic.

As of this writing, more than 150 COVID-19 vaccines are in development across the world. At the same time, the World Health Organization is also actively working on coordinating global efforts for vaccine development; with an intention to deliver two billion vaccine doses by the end of 2021. Mind you, there are almost 8 billion human lives on this planet and in order to effectively create herd immunity, or close to it, we will need to vaccinate at least sixty percent (4.8 billion people) of earth’s population and ideally, vaccinate over eighty percent in high-risk populations. Without knowing these detailed figures, the public’s hope in advancing a tangible vaccine solution in the near future is high, as everyone is thinking it would immediately alleviate the ongoing global crisis. Yet, on the other hand, multiple large studies suggest that no more than 50% of people are really interested in getting the SARS-Cov-2 vaccine, if one were to become available today. What a conundrum!

To better educate the public, it is imperative to consider the key challenge in designing vaccines for this newly discovered virus, where we are still learning about its full pathogenicity and mechanisms for how it infects cells and provokes different immune responses in different people. Truth be told, the vaccine design process normally takes between six and ten years because the majority of viral vaccines are produced from scratch to address the unique pathogenic factors which are discovered as the virus is better understood. However, 6 years at our current levels of SARS-Cov-2 infection, morbidity and mortality, while also not having effective early treatments, will be catastrophic, if we were to apply this usual timeline to a COVID-19 vaccine. Therefore, vaccine design efforts have been focused on creating a first generation vaccine to, at the very least, help to mitigate disease severity amongst those at highest risk for severe COVID-19 disease and prevent infection/spread in those with more robust immune profiles; while we refine the candidates for future and more long lasting vaccines.

This first generation of COVID-19 vaccines is anticipated to get a nod before 2020 concludes or by early 2021. Multiple vaccines are already currently in phase 3 trials with efficacy in most trials assessed as prevention of virologically confirmed disease. This is progress that the public desperately wants to hear but just like with other vaccine development stories of the past, things can go south and may even require rerouting as evidenced by the recent halt of a couple of trials and recent realigning of the messaging to emphasize the benefits of therapeutic vaccines such as Regeneron’s monoclonal antibody cocktail candidate and not just preventive vaccines. 

In conclusion, despite the ongoing race to develop the right vaccine, it is important that we impress upon ourselves that the goal here is not to produce one winner. We have to recognize that in the early stages of release, different vaccines will target different aspects of this virus’s biological profile and as medical professionals who understand that COVID-19 affects different organ systems and patient groups in various ways, we also need to start tempering the public’s expectation that this will be a one and done process. Vaccinologists are hard at work identifying and accelerating vaccine candidates into production but their work is really only truly just beginning. In the meantime, and for the foreseeable next 18 to 36 months, we also need to continue to emphasize the importance of the basics: handwashing, wearing a mask and physical distancing.

Sleep and Infertility: How Sleep Disturbance Can Hurt Your Fertility Journey

As adults who are busy in our everyday lives, we tend to forget that sleep plays a major role in our overall health and well being. Oftentimes, we are so overwhelmed by responsibilities that we forget to rest. However, we should never compromise quality sleep; especially if you are trying to boost your fertility. 

Yes, as surprising as it may seem, sleep and fertility link to one another! Sleeping not only regulates the maintenance of healthy cells, it also refreshes and restores your brain and organ systems, including balancing all of your hormones; especially your reproductive hormones. 

Beyond sleep’s impact on your overall health (and of course, the healthier you are, you get a better chance of conceiving), there have been studies which implicate that one’s sleep can greatly impact one’s fertility. For example, sleeping disorders usually contribute to a lot of other health problems. Specifically, for women, sleep deprivation can negatively affect their reproductive health. 

Numerous research studies have shown that poor sleeping habits are associated with weight problems, menstrual disorders, inflammatory dysfunction, and mood issues. For those struggling with infertility, irritability, or mood issues can, in turn, strain your intimate relationships and lead to fewer opportunities for conception. 

Sleep disturbance also greatly impacts the frequency and duration of menstruation, the health of pregnancies, incidence of postpartum depression, and menopausal transition, according to this research article from the US National Library of Medicine and National Institutes of Health. 

The hormones that are responsible for regulating reproduction, sperm production, and egg quality are closely related to your sleep cycle. In fact, one’s fertility is not only affected by the quantity and quality of their sleep, but also by their circadian rhythm! 

What is the Circadian Rhythm?

Ever noticed that you tend to feel sleepy or energized around the same time every day? If your answer is yes, then you know how the circadian rhythm works! Your circadian rhythm is basically a 24-hour internal clock that runs within a special gland in your brain (the pineal gland) and regularly cycles between when you are sleepy or when you are alert. Circadian rhythm is also commonly known as the “sleep or wake cycle“. 

Many of our body’s essential hormones peak while sleeping, especially during dawn or early morning hours. The United States’ Centers for Disease and Control (CDC) and Prevention has reported that people who are sleep deprived — a reality for more than one-third of Americans — tend to be more at risk of infertility. Research also suggests that women who are struggling with sleep, tend to be three to four times more likely to experience infertility. 

The Role of Melatonin in Your Circadian Rhythm, and Fertility

Melatonin, a hormone that regulates sleep, is also closely related to the circadian rhythm. In fact, melatonin helps in signaling your circadian rhythm that it is time to be resting. People who have sleep disorders, and those who work at night, have lower levels of melatonin. This is why melatonin supplementation for infertile patients may result in improved chances of conceiving.

Since melatonin greatly impacts your sleeping habits, I have come up with a list to help you increase your melatonin hormone levels, naturally.

  1. Get Some Sunlight – Sometimes, being chronically unexposed to the sun can confuse your sleep cycle, as the brain’s programming for our pineal gland and thus our circadian rhythm, is in part determined by being able to see the rise and fall (diurnal rhythm) of the sun.
  2. No Gadgets Before Sleep – Phones, tablets, and computers have blue light. Not only will blue light affect your eyesight, it also blocks melatonin release, by interfering with your body’s normal circadian rhythm. This is why scanning through your phone before bed, does not really help. 
  3. Eat Melatonin Rich Food – Eating food that is rich in tryptophan will definitely help increase your melatonin levels. Tryptophan is found in protein, oats, chicken, and many more. 

These small adjustments might be able to help you get better sleep which, can boost your chances of conceiving. 

In a nutshell, quality sleep is highly essential in one’s overall health. The healthier you are, the higher your chances of conceiving. This is why you should never compromise your sleep. Sleeping does not only “refresh” your thoughts and your muscles but it restores your cells, allows your body systems to reboot and leaves room for your key reproductive hormones to begin to peak when they should. Lack of sleep, however, does the total opposite of this. 

***

Knowledge is like gold for any individual or couple who is in the process of trying to conceive. It is imperative to explicate the effects of sleep on your own fertility journey, by assessing your lifestyle habits. If you believe that you or your loved one may have a sleep disorder, especially if you are also struggling to conceive, addressing the sleep disorder is critically important. This includes being evaluated by a sleep specialist and completing a sleep study.

The success of your fertility journey is dependent on various lifestyle factors such as diet, physical activity, vices, stress management, and the most basic one, quality of sleep. Start winning on these checklists so that you can optimize not only your fertility but also your overall well-being!

Fibroids & Fertility – Everything that You Need to Know!

A lot of factors can affect a woman’s fertility. One of these factors could be Fibroids, which are also more commonly known as Myomas. Fibroids are not as uncommon as people might think. They affect at least 7 out of 10 women. For Black women, the statistics are higher — Fibroids affect 9 out of every 10 Black Women. 

So what are Fibroids and how do they affect one’s fertility? Let’s find out! 

Fibroids, or also known as Myomas, are benign tumors that are made of smooth muscle cells and fibrous connective tissue and usually develop in the uterus. Although statistics say that about 70% to 80% of women will develop Fibroids, not all of them will show symptoms or would need treatment. So how do we, doctors, determine when Myomas need to be addressed? 

© www.healthdirect.gov.au/fibroids

When Anemia Occurs Due to Heavy Periods

Fibroids should be addressed once they start causing heavy periods leading a person to become anemic or require blood transfusions. So how does one know that they are anemic? Signs of anemia are variable but the most common and concerning include fatigue, nausea, shortness of breath, new onset frequent headaches, muscle weakness/cramps, tiredness or sleepiness, heat or cold intolerance, and mental slowing.

If They are Causing “Bulk Symptoms”

Bulk Symptoms” are symptoms that compress on the bladder, rectum or ureters (the tubes draining the kidneys) and cause you to need to pee often or (rarely), they block the drainage of blood or fluid from your kidneys or legs leading to leg or kidney swelling. Bulk Symptoms can cause difficulty with emptying your bowels or they can make it difficult during times of intimacy because you just feel “full”. They can also cause your abdomen to enlarge such that clothes don’t fit anymore or you appear chronically bloated or pregnant.

When it Starts to Affect Your Fertility

So, how do these pesky Fibroids affect your fertility? Well, there are several ways that Fibroids could affect your fertility. Their location and size are essential in determining if it can affect your fertility or not. Fibroids that are too large or those which are sitting inside the uterine cavity can affect your fertility. This is why getting yourself checked by a professional will definitely help you determine if one, you have Fibroids, and two, if those Fibroids will affect your fertility, pregnancy, or overall health in any way. 

There are various reasons why having Fibroids could mean that you would need treatment. One of the major reasons would be to preserve one’s fertility. There are various ways we can remove the Fibroids. Let’s talk about my favorite way of extracting Fibroids! 

 Fertility preserving surgery for fibroids is called Myomectomy. The type of myomectomy is determined by your surgeon & their assessment of your symptoms and fibroid location. 

Hysteroscopic Myomectomy

This type of myomectomy is my personal favorite. The procedure basically involves two steps: using a hysteroscope (a telescope made to check one’s uterus), we determine where the Fibroids are located in the uterus, then the Myomas are carefully removed through the channels in the scope. 

Hysteroscopy is the gold standard, non-invasive procedure for looking inside the uterus. It involves no cuts on the skin and is typically performed while the patient is under anesthesia. Although a simple look inside the uterus with the camera (diagnostic hysteroscopy) can be done without anesthesia, in suitable patients at the office, operative hysteroscopy such as myomectomy, polypectomy, or lysis of adhesions is performed under anesthesia in an operating room/surgical theater!

In a nutshell, Fibroids are very common benign tumors in the uterus. Symptoms from Fibroids can vary and that depends on their location and size. Size also matters because even a small submucosal fibroid, for example, can cause heavy bleeding or miscarriage or preterm delivery. They can also recur even if you have had them removed in the past.

If you think you are showing symptoms of Fibroids, talk to your gynecologist today! It is so much better to make sure that you can take all the necessary steps to preserve your fertility earlier, rather than later. 

5 Fertility Health and Wellness Tips

Trying to get pregnant should, theoretically, be THE MOST FUN THING EVER. At the start of the COVID19 pandemic, many women delayed child bearing plans, and many infertility clinics were shuttered. But, as the COVID19 pandemic now drags on, thousands of women across the country are trying to figure out how best to protect themselves and their chances of conceiving. Trying to get pregnant is, in fact, valuable training for parenthood. When it comes to having kids, you will never have complete control again (much like everything about living through a global pandemic).

At ART Compass, we guide the “TTC” (trying to conceive) journey, so we decided to put together the top fertility tips from our experts. Once couples decide it’s time to have a baby, having to wait is quite frustrating, whether you have lost a job, income, health insurance related to COVID19, or you’ve been trying for a year or for a month and you’re still not pregnant yet.

1. Take your Prenatals, Folic Acid, Vitamin D, and CoQ10

Folic Acid is the single most recommended substance, because it prevents major birth defects in the developing brain and spine of your baby. Many different studies have pointed out the ability of Coenzyme Q10 supplementation, 600 mg/day for 60 days, to improve the ovarian response to stimulation. Although the data for vitamin D and fertility is not entirely conclusive, several studies have found that vitamin D blood levels of 30 ng/mL or higher are associated with higher pregnancy rates.

2. Track Your Ovulation like a Stalker 

Recently, Harper et. al. looked at over half a million ovulation cycles worth of data collected via the FDA Approved Natural Cycles app to enhance our understanding of the key stages of ovulation. The results demonstrated that few women have that textbook 28 day cycle, with some experiencing very short or very long cycles. The findings show that an average cycle lasts for 29.3 days and only approximately 13% of cycles are 28 days in length! In the entire study, only 65% of women had cycles that lasted between 25 and 30 days. It is very important to time your intercourse correctly when TTC. Knowing your fertile days is the first step! 

3. Have a Preconception Check Up

Have a complete physical, including a pap smear and breast exam, because it’s much easier to diagnose and treat problems before getting pregnant. You can have your fallopian tubes checked to make sure they are “open”, your uterus checked to make sure you don’t have fibroids, scar tissue or ovarian cysts. A semen analysis will tell you the health of your partner’s sperm. You may even have the three hormones that regulate fertility, FSH, Estrogen and AMH checked!  Antimüllerian hormone (AMH) is an indicator of how many eggs you may have left. Follicle Stimulating Hormone (FSH) is produced by your pituitary gland and signals your ovaries to release an egg every month. Estradiol (E2) is another female sex hormone produced in the ovaries that rises around ovulation.

4. De-Stress with Yoga, Meditation and Mind-Body Work

Does stress lead to infertility? Probably not but stress leads to binge eating and weight gain, drinking more, using nicotine and THC, and poor sleep and many other things that DO affect fertility. Recent research on women diagnosed with infertility, and if they take part in stress and relaxation methods—like mindfulness, some forms of yoga and other mind-body exercises— have demonstrated an actual difference in the time it takes them to conceive. 

5. Know that it Can Take Up to One Year… 

Focusing too much on what you don’t have (yet!) can become an obsession, and the more you dwell on the negative, the more you open yourself up to the possibility of depression, anxiety, feelings of hopelessness, unworthiness and more. In general, a fertile couple has a good chance of getting pregnant within a year, as out of 100 couples trying to conceive naturally:

20 will conceive within one month;
70 will conceive within six months;
85 will conceive within one year;
90 will conceive within 18 months;
95 will conceive within two years.

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About The Author

Dr. Carol Lynn Curchoe is the founder of the ART Compass App. She is also a reproductive biologist practicing clinical embryology.

Her PhD. research focused on animal cloning at the University of Connecticut and her postdoctoral fellowship (The Burnham Institute) focused on human embryonic stem cell research.

Her active research interests span reproductive biology, from basic embryology to cutting edge artificial intelligence applications for IVF.

Why Some Guys Should Consider Freezing Their Sperm!

Through the years, the media attention for egg freezing and fertility preservation has been solely centered on women. However, unbeknownst to many, men can and should freeze their sperm too! 

The process for sperm freezing is simpler than freezing eggs. All men really have to do is produce a sample and pay for the storage. 

Sperm freezing, also known as cryopreservation, is a procedure of preserving healthy sperm cells at very low temperatures for use at a future date. Sperm are frozen using a special media then keep sperm in liquid nitrogen at minus 196°C. There is no concrete evidence that shows when a sperm sample expires, but there have been babies born from 20-year-old frozen sperm samples. 

For ages, women have lived under pressure from the inevitable fertility time bomb that ticks as you age. However, according to research, this time bomb extends to men’s fertility, as well.

In an article published by Maturitas, sperm banking is highlighted as an option for men who are planning to delay fatherhood. It is also an excellent option for those persons who are planning to undergo gender affirmation surgery but desire biological children in the future.

While infertility and potential complications in an aging woman is common knowledge, similar factors have not been well studied in aging men, and because there are relatively few studies that have, the effects of advancing paternal age on sperm quality are not much discussed in the mainstream consciousness or media. However, the study suggests a decline in fertility and increased risk of gestational diabetes, preterm birth, intrauterine growth restriction, and other pregnancy complications in children conceived from sperm derived from older dads.

Furthermore, evidence shows that children born to older men could have increased risk of chromosomal and non-chromosomal birth defects and an increased incidence of childhood autism and cancers.

So, when should a man consider having his sperm samples stored and frozen? Well, I have come up with a few good reasons as to who and why some guys should consider sperm freezing method.

Guys With Only One Testicle

Men usually have two sperm-producing testicles. However, there may be a few instances where some of them only have one, or if they still have two, only one may be functional. 

  1. Cryptorchidism – This is when one testicle is descended and the other is still undescended. 
  2. Congenital – This means that some men are simply born with just one testicle. 
  3. Surgically Removed – A testicle can be surgically removed for various reasons like injuries or tumors. 

Having only one testicle rarely affects a man’s fertility. It can, however, affect a man’s sperm count, the amount of sperm a man can produce. So if you are in doubt, it might be the time to get a semen analysis and then decide if freezing your sperm for the future might be needed. 

Guys Starting Hormonal Therapies

If you are someone who is thinking about transitioning into being a transwoman, freezing your sperm would be a great preservation option for you. We understand that children are probably the least of your priorities now. However, just in case you change your mind, sperm freezing is one way to help make sure that your options for biological children will be open someday. Ideally, try to freeze your sperm before you start taking any hormonal medication. 

For some women who are transitioning from being born with testicles, the hormones you take during your transition may hinder you from producing biological children in the future. Orchiectomies, a procedure for removing testicles, can greatly cause fertility problems.

If you identify yourself as a transgender woman, or if transitioning is something you are contemplating, freezing your sperm should be an option that you consider, in order to produce children in the future.

Guys Undergoing Chemotherapy or Radiation Therapy

Certain types of cancer and cancer treatments can affect one’s fertility. If a person with cancer decides to have a child, a plan must be made before taking any action. And this involves sperm preservation for men. 

Before starting chemotherapy or radiation therapy, you should speak to a fertility doctor to discuss preservation options. Your fertility doctor will help you preserve your sperm samples so you can have the option to produce a child in the future. It is essential that your fertility doctor knows the type of cancer and the medication plan you will be on so your doctor could determine if those put your fertility at risk. 

Guys Born With Small Testicles

A man’s testicle is an oval-shaped, sperm-producing organ with the scrotum. And its size varies from person to person. Usually, the size has little to no effect on one’s fertility. The average size for a testicle would be 1.8 inches to 2 inches. Small testicles have a size of less than 1.4 inches.

The testicles are there for two reasons: (1.) Sperm production, (2.) Testosterone production. Since sperm cells come from your testicles, your sperm count would be dependent on the size of your testicles. Having small testicles would likely mean that your sperm count may not be as high as those with average-sized testicles. However, smaller sized testicles can still yield normal fertility when compared to larger-sized testicles. 

There are many reasons why men should start preserving and freezing sperm. In this article, I’ve listed a few major factors that people consider when planning and building their families. Guys should definitely consider freezing their sperm just to make sure that you have your options wide open when the time comes. Although having kids may not be your priority now, who is to say that it will not be your priority at a later date. 

In a world where career advancement and innovation are primary goals, choosing to conceive or have kids much later in life has become commonplace. Whether infertility is caused by older age or not, about 7% of couples experience infertility related to sperm fitness/health. The first part of this article tackled the possible implications of older age to the risks of various conditions in the future child. These risks may be small, but men can find peace of mind in freezing their healthy sperm now for use later — a convenience you should never pass up!

Menopause Happens: My Take On the “The 7 Habits” and Menopause

Menopause!!! No one likes to talk about it, but it happens whether we talk about it or not. We whisper about the “m word” and only feel comfortable when we are around another woman having a hot flash. Then we exhale, let our guards down and bond over our shared misery. 

The “peri” aspect of menopause sucks and can be a long, drawn out, crazy, topsy-turvy time of hormonal fluctuations with physical, mental and emotional health manifestations; many of which impinge on your quality of life. It’s like puberty (hello pimples, irregular periods, mood swings and hair in weird places ) all over again except you have a mortgage, job and a lot of responsibilities. Unfortunately , the “moody” menopausal woman doesn’t have the luxury of brooding in her room. For many women in their late forties and fifties, this is a time of full career commitments while sandwiched between raising children and caring for aging parents.

Menopause was early for me (like it was for my mother) and fortunately the “peri” lasted less than 2 years. My biggest symptoms were drenching night sweats, horrid hot flashes worse with coffee and wine (my favorites) and insomnia, which may have made me a tad irritable at home and at work. I was single during my transition so I didn’t have to worry about the impact on my sex life which I know many women have to contend with. For many women, symptoms are more severe and the mental health impact goes beyond mood swings. Depression and anxiety can occur. These are serious and should be discussed with a professional. 

Nowadays, I talk about the menopause transition, laugh at myself and even offer advice to friends going through menopause. I have read the Steve Covey book, ”The 7 habits of highly effective people” a few times and try to apply the habits in my daily life. As a confident post- menopausal woman, here is my take on The “Covey 7“ and menopause. These 7 habits are broken into personal victories (habits 1-3), public victories (habits 4-6) and renewal/sharpening the saw. 

1. Be Proactive: Since we know menopause is inevitable, you can start planning. The median age for entering menopause is 52 years but maternal history matters. If you have access to your mom’s age at menopause that is helpful. Menopause usually doesn’t happen suddenly, in the absence of surgical or other therapy induced menopause. You actually will have time to research symptoms of perimenopause, best management options, what to expect. Research natural ways to manage symptoms. Talk to friends who have gone through menopause. Talk to your health care provider or gynecologist about what to expect and the best ways to manage your symptoms. Talk to your spouse or partner about what may happen as the process begins. They deserve a heads up about fluctuating thermostat settings, a libido that may be cool and damp sheets that may come from excessive sweating!

2. Begin With the End in Mind: The perimenopause- menopause period (pun intended) however short or long it seems will be done soon enough. The drenching night sweats, hot flashes and mood swings will stop. Your concentration and libido will return though you may emerge a few pounds heavier. Soon enough, you’ll be able to talk about it, laugh about it and drink wine without breaking into a sweat. You will be able to travel without tampons or pads, no more PMS and you never have to worry about unintentionally getting pregnant.  *Infectious Disease (ID) doc alert – you still need condoms to protect against sexually transmitted infections (STIs) and consider prophylactic treatment (PrEP) for HIV prevention if you are not in a monogamous relationship. 

3. Put First Things First:  This is about YOU. Yes, millions of women go through menopause each year but they are not you. Focus on yourself.  Are you healthy? Are your symptoms just menopause or is something else going on. How is your mental health? Make sure your health screenings are up to date. Schedule and complete your routine health exams like knowing your body mass index (BMI), getting your Colonoscopy, mammograms, gynecological exams and checking on your bone health are especially important if you find yourself considering hormone replacement therapy. This is a time to prioritize your self care and what you need to make yourself comfortable. If you need special expensive sheets to help with the sweats or to feel cooler at night,  get them. If massages help, then treat yourself guilt-free. Your mental health is important too. If you need therapy, get it. Eating healthy and exercising helps to attenuate the weight gain. This is about YOU. 

4. Think Win Win: When this is done you will be post-Menopausal. This is a new stage for you and the start of the next phase. Benefits – no periods, no possibility of pregnancy and you will save so much on tampons and period care products. It is also a time of maturity and growth where you can pursue hobbies and interests with renewed vigor. Embrace this as becoming older and wiser with so much to offer the younger generation.

5. Seek First to Understand then be Understood: This is a tough one to do… realizing that people who have not gone through menopause may not understand. Some women who had little or no symptoms may think you are overreacting and may not be as empathetic. People only see the outward manifestations. This means they react  to your irritability or mood swings without understanding what’s going on. For close people like spouses, partners or grown up children, a heads up or talk could help. Many times, once they know what’s going on, they are more likely to want to “get” to know how you feel. My daughters teased me about the hot flashes but that just brought some levity to the situation. 

6. Synergize: Bond with other women in the perimenopause or menopause stage and unite forces. Share tips on things that helped you as you transitioned to this new phase. Share recommendations and resources knowing that it’s not a one- size fits all. Stop whispering about menopause, it’s a natural part of living and aging… No shame or stigma. Take all the hugs you can get.

7. Renewal: This is emerging from the transition as a confident, older and wiser woman who is now post-menopausal. This is you taking care of yourself. Reflecting, renewing, refreshing, restarting, resetting as you embrace this new stage in life. You are amazing and have so much to conquer and accomplish. 

Change is hard EVEN when it is inevitable. The transition can be rough but you’ve got this sis !

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About The Author

Toyin Falusi, MD is an infectious disease physician, author, and podcaster. Follow her on IG: @doctortfal

Her book is “The Decade After: Thriving after Divorce”

www.thedecadeafter.com 

Podcast: “10mins with TmFal” is on iTunes/Apple/Spotify/Anchor 

Eggs Over Easy: Black Women & Fertility

A couple of years ago, during my annual exam, my gynecologist looked at my chart, smiled and said, “You have a birthday coming up. Your eggs are turning 40! Do you want to do anything with them? It’s not too late for you to have a baby, but we’d need to start now.” That one jarring question became the catalyst for Eggs Over Easy: Black Women & Fertility, a documentary that focuses on Black Women, our fertility options, and the reasons we don’t talk about it. 

It is heartbreaking to know that for most women who suffer from infertility, the choice to carry a child is virtually non-existent if they don’t have a six-figure income because insurance companies don’t provide coverage for infertility treatment. So, instead of being able to pursue the traditional routes towards motherhood, these women stay silent… and take care of nieces or nephews or cousins whose own parents can’t take care of them. This is such an interwoven concept in our community that we rarely even look at it as “adoption”, even though it is.

The actual act of having IVF (in vitro fertilization) and Oocyte Cryopreservation (Egg Freezing) isn’t as “taboo” as discussing it is. In the Black community, we tend not to talk about fertility. Period. Since slavery, there’s been an idea that Black women are naturally fertile. The price of a woman of childbearing age was more than that of a woman post-menopause on the auction block. So, of course, there are 400-year-old stigmas attached to our fertility in the US but also in our own community. These deeply rooted notions keep mothers and aunts from talking to their daughters about fertility issues like Fibroids, which affect 80% of Black women by age 50. 

So, we don’t talk about fertility. In addition to the historical implications of fertility conversations, there is also another, bigger elephant in the room: Costs. Infertility treatments are not covered by most insurance companies, unless a company requires a fertility rider for their respective staffs. This means that the average middle class woman can’t afford a $20k IVF cycle, which may or may not require multiple cycles to achieve a successful pregnancy. This means that the average woman doesn’t have an extra $15k to freeze her eggs. And by the time she reaches a salary level that can support the weight of these out-of-pocket costs, she’s late 30s or early 40s, which greatly diminishes her chances at a successful process because of the dramatic drop in egg reserves after age 35. [The suggested age for Egg Freezing is before 36]. These costs affect women of every race, but when compounded by the fact that Black women earn 61 cents for every dollar earned by white men, the goal of motherhood seems all the more difficult.     

There is a range of available fertility treatments for a range of medical conditions. IVF is a process whereby an egg is removed from a woman’s body and turned into an embryo using sperm taken from a man’s body. There are less invasive processes, like IUI and Clomid pills for women who don’t need advanced treatment to conceive. Egg Freezing is the recommendation for women who aren’t at a place in their lives where they are ready to have a baby, but still want to be able to conceive when the time is right—even if that time is later in life. For Black women who are climbing the ladder in their careers or waiting later for marriage, this is a viable option—if they can afford it.

And for women who are fortunate enough to be able to afford infertility treatments like Surrogacy, IVF or Egg Freezing, they are then met with almost complete erasure from medical offices that have few patients who look like them and even lesser representation in brochures or commercials. The thought is that black women don’t have fertility problems, so we’re marginalized and rarely given a second thought within the reproductive industry.

Over the course of this past year, I have spoken with women who have experienced the full range of fertility challenges. Did you know that women who are childfree by choice have some of the most agonizing conversations with their own mothers who want to see them birth a child? It takes courage to be childfree these days. Did you know that you should never ask a woman whether or not she’s planning to have a baby? You have no idea what her struggle may be. And, it’s none of your business if you aren’t her spouse or physician. The documentary addresses this topic with women who suffered debilitating symptoms from fibroids– including infertility, as well as doctors, both board certified and holistic, on what treatment options work best. One of the more astonishing topics focuses on women who suffer miscarriages and the stigma that causes many of them to suffer alone. They don’t talk about it because, in many cases, they feel ashamed

Great strides have been made in the space of fertility, which is evidenced in so many celebrities bucking the norm and having healthy pregnancies past the age of 40, but the reality for many women without millions in the bank is that the process to motherhood is sometimes a daunting one. 


Take-Away: Don’t wait to have the conversation with your physician about your reproductive options. Ask for a fertility test if you don’t know your numbers. Specifically, ask for an AMH, FSH, and antral follicle (ultrasound) test. These tests are simple blood tests and an ultrasound. This will let you know the state of your egg reserve. Knowing these numbers will help you navigate your priorities in regards to becoming a mother. Also, don’t panic! There are many ways to become a mother, if that’s your desire. You can adopt children. You can also adopt donor eggs and embryos if you want to carry a child. The goal is to be equipped to make decisions about your body, which means that knowledge is power. For any woman over 25 who may one day want to be a mother, be proactive in gaining knowledge so that you can make informed decisions about your future. This means that maybe you choose to work for a company that provides fertility treatments in their insurance plans, instead of a company that doesn’t. “Prepare for your body the same way that you prepare for your career.” (~ Phylicia Fant, Executive Producer Eggs Over Easy Film)

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About The Author

Chiquita Lockley is producer and director of the forthcoming documentary, Eggs Over Easy: Black Women & Fertility (2020). She is also the producer of the award-winning documentary Kunta Kinteh Island: Coming Home Without Shackles. She holds a BA in English from Spelman College and an MA in Film Studies from Emory University. She currently resides in Atlanta, GA where she continues to give back by serving on the Boards of AIR Serenbe (an artist-in-residency program) and the Black Women Film Network.

You can follow the film’s progress and join the conversation at: www.EggsOverEasyFilm.com, www.facebook.com/eggsovereasyfilm or IG: @EggsOverEasyFilm.

OMG, the Positive Pregnancy Test – What This Doctor Wants You to Know!

When infertile patients, who have been trying for some time, get the positive pregnancy test result, they go through a roller coaster of emotions where their fear of “Will I get pregnant?” quickly turns into “How do I stay pregnant?”. 

These fears and mixed emotions are totally understandable. A lot of infertile patients that get a positive pregnancy test result usually feel anxious about what they can do to help keep the pregnancy. This is why most of these patients often turn to spending hours diving down the internet rabbit hole, researching how they can keep the pregnancy safe. 

Although doing your research and getting yourself educated is great, I really want you to know that it is so much better for you to simply enjoy your victory (it’s a big deal!) and directly ask your doctor questions about how you can keep the pregnancy safe. This way, all the tips are tailored to fit your particular situation and are not based on some generalization that you find on the internet. 

To help ease your mind, let me list the top 10 things that I tell my patients and friends to do, during the first trimester. You can go over these tips with your doctor so that they can help guide you through the things you should and should not be doing. At the end of the day, we all want one thing: for you to get your dream of being a parent! 

  1. You May Not “Feel” Pregnant. This is a fear that some newly pregnant persons can experience and it unnecessarily leads to a lot of stress. Not experiencing major changes in your body or how you feel, overall, is perfectly normal! Not everyone feels a definite change in their body during the first trimester, even if you have been pregnant before. 
  1. Your Appetite. Appetite during pregnancy differs from person to person. Even though many people use the analogy of ‘eating for two’, you definitely do not need to eat more than what you are comfortable with. As a matter of fact, some pregnant persons experience a drop in their appetite, while some others experience early and very specific cravings. 
  1. Minimal Bleeding is Okay. Light to moderate vaginal bleeding is normal. For some women, this is their first sign of pregnancy. So, do not panic if you experience minimal bleeding. However, if you are pregnant and the amount of bleeding is excessive, you should notify your clinic as soon as possible. A general objective rule of thumb: we consider bleeding where you are completely soaking through two normal maxi pads per hour, for greater than 2 hours, as excessive.
  1. Avoid Raw Seafood. During pregnancy, there are some seafood that you have to avoid, even when they are cooked. Eating raw seafood can expose your baby to mercury, harmful bacteria, and parasites. If you regularly eat fish high in mercury, this heavy metal can accumulate in your bloodstream, cross the placenta into the fetus’ own circulatory system and then damage your baby’s developing brain and nervous system.
  1. Take Your Prenatal Vitamins. If you can tolerate it, I suggest you take your prenatal vitamins daily. If you cannot tolerate the vitamins, at least make sure you take folic acid. You need at least 400 micrograms of folic acid per day. However, if you are pregnant with two or more babies (i.e a multiple gestation), or if you have a history of a seizure disorder, or if you have a prior pregnancy, or had a baby that was born with signs of a folate deficiency (e.g a baby born with spina bifida or meningomyelocele), your doctor will want you to be on a higher dose of folate in subsequent pregnancies. So, check with your doctor before choosing between prenatal vitamins or starting higher doses of folic acid.
  1. Stop Herbal and Non-prenatal Supplements. There is not much data available on Herbal supplements and their impact on a pregnancy or the fetus. Therefore, we recommend discontinuing all non-essential herbs, vitamins, and supplements, including CoQ10 and DHEA, during pregnancy. If you are not sure whether your supplement is essential, contact your doctor to confirm, right away.
  1. Continue Taking Your Thyroid, Diabetes, Blood Pressure, Prolactin, or Heart Medicines. Managing these medicines is highly essential for a successful pregnancy. If you have not told your doctor about these medications before, let them know as soon as possible. Patients with poorly controlled thyroid, diabetes, blood pressure or prolactin levels are at increased risk for miscarriages, stillbirth, small (growth restricted babies), certain special birth defects and poor neurological development in the fetuses.
  1. Exercise Heartily. We suggest moderate exercise during pregnancy. However, you should always first verify what type of exercises and the level of intensity you should be doing, with your doctor. For certain underlying medical conditions in the person carrying the pregnancy, your doctor may even recommend against any exercise at all. 
  1. Continue Taking DHA or Fish Oil and Only Consume Pasteurized Milk Products. DHA (Docosahexaenoic acid) or fish oil intake can help prevent preterm labor and delivery, lower the risk of preeclampsia, and may even positively increase the birth weight of your baby. Consuming only pasteurized milk products can help protect you and your baby from harmful bacteria. 
  1. Avoid Hot Tubs or Saunas. It is advisable to avoid hot tubs and saunas because they may cause dehydration, overheating, and even fainting. Exposure to elevated internal body temperatures, like what occurs with soaking in a hot tub or sitting in a sauna for a while, during the first trimester, can also lead to some genetic changes in the developing embryo which, in turn, can result in certain congenital birth defects in your baby. In one study, special heat shock proteins are produced in the fetus as a response to exposure to stressful events such as prolonged high temperatures and these negatively affect your fetus’ development, during the critical period of organ formation and result in anatomical malformation.
  1. Avoid Alcohol and Limit Intake of Drugs like marijuana, cocaine, heroin, other opiates or other chemicals. These substances are known to cause serious malformations in different organs as well as severe mental disability in babies who were exposed to these drugs while they were in the womb.

All these tips that I have listed above are meant to help you keep your pregnancy safe. However, you should still go over them with your doctor so that they can help safely guide you through your pregnancy. It is also important that you do not let your fears interfere with celebrating your pregnancy. Enjoy this joyous moment and make sure to follow your doctor’s instructions, throughout your journey. 

“The Talk, Part 2”: The Red Flag of Grooming

With the proliferation of social media and ready access to the internet, sexual harassment and exploitation are at an unprecedented rate across the globe. We hear stories about people meeting up with strangers and the aftermath escalates to something heinous.  The #MeToo tsunami exposed the mind-blowing scope of sexual exploitation …

Why is the U.S. Healthcare System Still Struggling with COVID-19?

Allow me to be straightforward and begin with some important reminders. Our initial conservative estimates were that without any restrictions or social distancing, 50% of the American population will be infected with the novel SARS-Cov-2 coronavirus, in the absence of strict nationwide exposure-reducing measures. This was based on consistent numbers …