I'm a reproductive endocrinologist and fertility specialist and I'm here to answer your questions on twitter.

This is fertility support at fertility unit asks do you know how often you should have sex If you're trying to conceive hashtag fertility, you don't have to have sex that much actually twice a week.

So have two dates a week because the good sperm will stick around in the fallopian tubes for a few days.

So if you have sex twice a week, Then you always have some sperm in the tubes waiting for the eggs.

So it's a myth that you have to precisely time intercourse with the release of the egg or that you have to have sex 10 times a day and that makes your fertility higher.

It actually doesn't.

I think you just get a little tired at wonder tramp asks, does anyone know if hashtag Covid 19 affects hashtag fertility.

Asking for a friend.

Everybody wants to know the answer to this question.

And the truth is Covid 19 does impact fertility.

The vaccine does not which is why we really want you to get vaccinated.

We are asking all our patients trying to conceive and pregnant to get fully vaccinated because we know that the vaccine Has been found safe and people trying to conceive both men and women and safe in pregnancy.

We know that COVID 19.

The disease actually does have a powerful negative impact upon your fertility.

Especially if you get really ill if you're mildly ill, you will probably feel temporarily bad.

The sperm count might go down for a couple of months, just like any febrile viral illness.

But then you will recover.

You might have irregular periods for a little bit.

But then again you might recover but severe disease can have a more severe impact upon your fertility.

At Casey asks, okay guys, I've been watching noVA on PBS.

A fertility scientists just said on average men today have about half the sperm count our grandfathers did causes environmental obesity, chemicals, etcetera.

This is a fascinating question.

People, sperm counts have been declining and I would say compared to like say that like the 1900s, the average sperm count is about half that of what it used to be.

We don't really know the reason why.

But certainly things like toxins and the environment and our lifestyle probably have something to do with this.

Scientists are definitely working on this because we can't have sperm disappearing altogether.

The good news is people are still making millions of sperm, I don't think we're gonna completely get down to zero for everybody that soon.

But I think this does emphasize that we should all try to lead a healthy lifestyle and avoid toxins.

An egg freezing project asks, does freezing your eggs mean that you definitely want Children in the future Or is egg freezing more about having the option later on in life.

Let me know your thoughts.

Mother nature kind of designed us to have 10 kids by the age of 25.

That's kind of how our our bodies are designed 10 kids by the age of 25 die of exhaustion by age 35 to 40.

That's it.

Obviously we don't do that anymore.

People are, you know, going to school, they're getting jobs, they're living life and having babies later.

And that means you're having babies when your eggs are less fertile.

People are really interested in freezing eggs to try to preserve their eggs at a younger age at fertility prego asks, how come men don't have a fertility clock?

Ha ha emoji men definitely have a fertility clock.

You cannot delay childbearing forever.

Maybe you should think about freezing your sperm before you turn 40 because once you are 40 we do see some higher risks for older men having Children with schizophrenia and autism.

So you do seem to have a fertility clock.

The quality of sperm does seem to decline with time.

At jenny, Jayapal asks fun fertility question of the day.

What's the difference between artificial insemination and official insemination?

Hashtag actual question.

So official insemination doesn't actually exist.

Artificial insemination is the process of putting sperm into the female by any means other than sexual intercourse.

It's artificial.

You're getting the sperm in an artificial way.

Now there's a lot of ways to do artificial insemination.

The way fertility specialists typically do artificial insemination.

We wash the sperm get rid of all the semen because the semen is the liquid.

It's like a tidal wave coming out of the penis.

It helps the sperm get out of the penis and into the body or into the specimen cup.

But that liquid we really don't need when you have sex.

All those chemicals in the semen are filtered out by the cervix and they do not go into the fallopian tubes where fertilization takes place.

We get just the sperm in a tiny little droplets of fluid and we put it in a little syringe.

This is called an insemination catheter.

This is a particular type of insemination called I Ui intra uterine insemination.

And we actually put a speculum in the vagina and then we see the cervix and this little tube goes right through the cervix.

The vagina into the cervix.

I don't know if this is actually open.

No, this is not an actual working model into the uterus.

And then we inject that little tiny bit of fluid in the Good sperm immediately are in the fallopian tubes hanging out waiting for the aec and you might have a little leaking.

You might have a little cramping.

You might see a little spotting, but you can get right up and go, we don't believe in waiting.

That doesn't increase the pregnancy rate at susie savage E asks why does a single round of IVF cost $15,000 in the United States And only $2,000 in Turkey, 6000 in Spain, in India 31 50 in Russia, even 7800 in Mexico one day?

Big pharma will pay for their crimes.

It is way too expensive in the United States.

Hopefully we can get better insurance coverage.

But right now it does tend to cost a lot of money.

The good news is that there are more and more states passing laws to mandate fertility coverage.

We are seeing more and more companies cover it because hey, reproduction and problems with reproduction should be covered.

Right?

Why is it treated like it's like a nose job like elective plastic surgery these days, reproduction is in sexual for the continuation of the human race.

So I'm with you.

It shouldn't be so expensive.

It should be covered at Davian Dove.

Ask so how does a pregnancy test work?

Well at avian dub, I happen to have one right here.

You can get them from the drug store or at your doctor's office and usually the urine pregnancy test works by you give a small sample of urine, you follow the directions, you dip this into the urine and then wait for it to turn either positive or negative.

It's actually measuring something called HCG human chorionic gonadotropin.

That's a hormone that's produced by the placenta.

If that is in your urine, then it shows that you're pregnant.

You can also get a blood test at the doctor's office.

Once you, once this turns positive, we want you to call us right away at oh my my Fran Fran dear asks, how does someone sign up to donate their uterus to somebody.

I don't want it, transplants are possible.

Send me the sign up sheet.

You don't transplants.

Is that really a thing?

Yes it is.

It has been done in the United States.

It's been done in other parts of the globe.

It's still kind of experimental.

So you have to go to a big fancy center University of pennsylvania Cleveland clinic where they are, have a big team to do this type of thing.

So maybe this uterus needs to be transplanted.

But yes, uterine transplants are possible.

But most people that don't want their uterus just go see their doctor to discuss that at mira gagne's asks is there a law that puts a cap on the amount of embryos doctors are allowed to implant during IVF.

This is surprisingly hard to google.

So a srm the american society for reproductive medicine recommends that we transfer only one embryo at a time because one baby at a time is the healthiest type of pregnancy, twins can be super cute.

But a twin pregnancy is risky for both the mom and the baby.

We are usually transferring just one embryo with IVF.

IVF does have a higher identical twinning rate.

So that's probably one of the biggest risks of IVF you can put one embryo in and there's a 2% chance that you could get two babies out if you conceive on your own.

The chance that your embryo splits the chance that you have identical twins is only .5%.

So we should just put one embryo in.

Those are the current guidelines but it's not actually regulated by law at Patrice E.

5767 oh 99 asked what year was the first test tube baby born in America.

That was december 28th 1981.

So she is 40 years old.

This december 2021.

Her name is Elizabeth Kerr and she's a big fertility advocate and author test tube baby or I.

V.

F.

Baby in vitro fertilization was a revolutionary treatment that has totally transformed our field a field where we really struggled to help people conceive and did not have very much success to a field where we can say if you can stay positive and healthy in mind and body and stick with the program, we can help almost anybody have a healthy baby at jet lag 91.

A how much they pay for semen at the fertility place asking for a friend.

There's lots of great commercial sperm banks out there.

They probably have different rates.

But um I do think you know they compensate you well for giving the sperm.

You do have to be prepared to give some blood work and sign forms so we can make sure you don't have HIV hepatitis.

Things like that.

We also want to make sure that your sperm is healthy and looks good and we have good sperm counts and and seems fertile and then I think you're paid a pretty good rate.

A few $100 at mama K.

M.

W.

99 asks how long does it take pregnancy symptoms to go away after a miscarriage.

It usually takes about 2 to 3 months.

You still have the pregnancy hormones in your body and it takes about 2 to 3 months for those to clear out at H.

R.

C.

Fertility asks what is a fertility doctor or fertility specialist?

Well I'm a fertility specialist.

That means I am a board certified O.

B.

G.

Y.

N.

Obstetrician gynecologist and subspecialty trained in reproductive endocrinology and infertility.

I see people who want to have a baby but are struggling people who want to be proactive about conception or people who want to freeze their eggs.

At ab mama nation asks considering reciprocal IVF for round two wife scared retrieval any tips retrieval?

That means egg retrieval what is reciprocal.

IVF IVF is in vitro fertilization.

Reciprocal IVF is a way for two women to conceive where one gives the egg and the other carries the embryo there being reciprocal.

Normally IVF is done in one person you take the eggs out and then you put the embryos in.

But this way you have two people involved ones giving the eggs and the other one is carrying the embryo.

This is a great option for lesbian couples who want to both be biological moms at tapia.

Izzi asks egg freezing, Anyone here gone through the process.

I haven't actually frozen my eggs but I've been on the other side of it for a lot of people.

And egg freezing is becoming more and more common.

And that's because first of all, egg freezing is much better than it used to be.

We are really really good at freezing eggs.

Now there's a new technique or a new technology called vitrification with a V.

That's literally like plunging these eggs down to super freezing cold temperatures negative 195 C at that temperature.

The molecules are literally stopped in their tracks.

And now the eggs yield pregnancy rates that are basically the same as using fresh X.

Because we have figured out how to press the pause button.

Some insurance companies cover it most of the time.

Not it can cost thousands of dollars.

So that's something to think about.

You give yourself injections with tiny needles for about 6 to 10 days.

You go to an IVF center, You get an I.

V.

in your vein.

They give you a little anesthesia.

You go to sleep for about 10 minutes.

We put a very small needle into through the vaginal wall one on the right side, one on the left side.

Then we pull the eggs out five minutes for the right over five minutes for the left ovary.

All the eggs are out, we put them in the freezer.

You wake up, you feel a little cramp e you eat a little bit, you walk around, go to the bathroom and then you go home and your eggs are frozen.

I do think all women who are concerned about fertility, concerned about getting older and not ready to have a baby, but think they might want to in the future to think about egg freezing as an option for preserving their fertility.

It may give you more options because your eggs are their most fertile when you're under 30.

And we think the ideal time to freeze eggs is somewhere between your late twenties and early thirties at anthropologie asks, can we stop calling pregnancy over 35 geriatric?

Absolute.

Why do people call pregnancy over 35 geriatric?

You are still young as you get older.

We do start thinking about more risks.

So age of the pregnant woman is associated with certain risks.

And doctors like to know That they have to do different things to lower those risks when they are treating somebody over 35.

But I totally agree with you.

Geriatric seems kind of insulting and I don't think it's actually accurate and I think probably some old, some old guy came up with that term.

So yes, let's get rid of it at Ashley?

S how much money do surrogates make?