0:03

There's been shame and guilt

0:05

that for some reason you couldn't carry

0:08

a baby or get pregnant that there's

0:10

something wrong with you. So

0:12

I think just the fact that people are becoming

0:14

more open and feeling

0:16

more comfortable sharing their story if they want

0:18

to and if they don't want to, at least they have places to go

0:21

to read other people's stories for comfort and

0:24

eliminating the stigma around

0:27

fertility issues is a big change

0:29

that is happening and has needed to happen for a really long

0:31

time. Welcome

0:33

back to Until It's Fixed, where we explore new

0:36

ideas and work underway to make healthcare

0:38

simpler and more effective for everyone. I'm

0:40

your host, Kallie Chamberlain.

0:41

And I'm Dr. Kenny Poole.

0:46

So today we're talking about fertility. And

0:48

of course, talking about getting pregnant can be a really

0:50

sensitive topic. Fertility

0:52

is not something that I ever thought about. And

0:55

then when my wife and I went

0:57

to try to have our first child,

1:00

it was very difficult to the point where we

1:02

had to go see someone and things

1:05

ended up working out four times. But

1:07

the thing is, I remember going through

1:09

that process in the stressful moments

1:12

of it and feeling somewhat alone. But

1:14

then I remember later

1:17

having other people that had

1:19

gotten married maybe right after us or

1:21

around the same time as us or other couples in

1:23

our age group going through the same

1:25

thing. And again, it was something that nobody

1:28

had ever talked about until we were in that position.

1:30

Totally. I feel like fertility

1:32

is something that is coming into the lexicon

1:35

a little bit more and people are talking

1:37

about more openly. To your point, we

1:40

weren't having these conversations even a decade

1:42

ago. And I'm thinking

1:44

about my parents. I'm adopted

1:46

and they

1:47

had a very similar situation to

1:49

what you're describing. They tried for a really long time to

1:51

have children and they were telling

1:53

me about how all of their friends were getting

1:56

pregnant and how challenging that was

1:58

for them, right? Because they really wanted to. conceive

2:00

and they just couldn't figure out what was going on. So

2:03

they adopted me and they

2:05

told my mother that she couldn't have children and

2:07

then they were in the process of adopting a little boy

2:09

and she got pregnant with my sister and then they had my younger

2:11

brother. So it

2:13

is interesting too from a birth doula perspective

2:16

because a lot of the training that I received talks about

2:18

the impact of stress and

2:20

this whole process can be so stressful.

2:23

I think it'd be challenging not to let that interfere

2:25

with your daily lives when it's something

2:27

that you're wanting is to conceive. Yep.

2:30

Well, let's dive in to learn more. We're lucky

2:32

to have a great discussion with two guests, Gabriela

2:35

Marmalheos from advisory board to talk

2:38

about fertility from a research standpoint

2:40

and Nikki Batiste, a CBS news

2:42

correspondent to share her personal story around

2:45

fertility. Let's listen in.

2:52

Thank you guys for your time this morning and

2:54

for a topic that is

2:57

extremely important that you guys obviously

2:59

hold dear as well. So Gabriela,

3:02

we'll start with you. Can you tell us a little

3:04

bit about your current role

3:06

and

3:07

what got you interested in this topic? Yeah,

3:11

so I am a women's

3:13

health researcher at advisory board, which is part

3:15

of Optimum site. And at advisory

3:18

board, we research topics

3:20

for lots of different segments

3:22

of the healthcare industry. I look at

3:25

national trends from the women's health

3:27

space. I've been always interested

3:29

in women's health. And what got me into this field

3:31

was I

3:33

got my master's of science in public

3:35

health at Hopkins focused on maternal

3:37

perinatal and reproductive health. And

3:40

during that time, I learned

3:42

a lot about just a lot of the challenges

3:44

that women face that are not talked about. There

3:47

are just so many issues that women face that

3:49

are untreated or undiagnosed. There's not

3:51

enough research. There's a lot of unknowns.

3:53

There's a lot that we don't talk about. And

3:56

there's a lot of things that could be improved. Great.

3:59

Thanks for that. Nikki, can you jump

4:01

in and then talk a little bit about

4:03

your journey to becoming a reporter and

4:06

then how this topic became

4:08

of interest to you as well?

4:10

Yeah. So I actually started

4:13

my journalism career as a

4:15

producer. I was a producer for about 10,

4:18

15 years behind the camera and

4:20

I switched to reporting in front of the

4:23

camera in 2017. So

4:26

currently I'm a national correspondent

4:28

for CBS News,

4:28

which means I report for CBS Warnings,

4:31

the CBS Evening News. Sometimes I

4:34

anchor our digital channel and

4:36

this

4:37

is a topic that never really crossed

4:39

my mind for really

4:41

any part of my adult life. And then I

4:44

faced my own journey with infertility

4:47

and I was in this unique place where I could

4:49

talk about it publicly and

4:51

I decided to do that. Thank

4:54

you for that. So Gabby,

4:57

I'm going to go back to you. There's a lot of question

4:59

marks into what fertility is. So

5:02

can you give us a definition?

5:05

Yeah. So I'll

5:07

give you the CDC definitions. So

5:09

the CDC defines infertility as a

5:12

lack of pregnancy

5:13

after at least a year of unprotected sex.

5:16

Fertility would be that you would be able to

5:18

get pregnant after a certain amount of unprotected

5:21

sex. That would be at least

5:23

my definition for it. Yeah. Can

5:25

you tell us a little bit more about some of the factors

5:27

that might affect fertility? There's

5:30

a lot of different factors. So an important

5:33

one that I think people talk a lot about is age,

5:36

both for men and women. And we

5:38

know that over half of people

5:40

in the United States experiencing infertility are

5:42

over the age of 35. So that

5:44

is a factor at play. There's

5:47

also factors of sexually transmitted

5:49

infections, which can cause infertility

5:51

for women. There's also endometriosis,

5:54

uterine fibroids, PCOS.

5:56

There's a lot of gynecological conditions that

5:58

can hinder

5:59

under fertility. Got it. Gabby,

6:02

can you talk about how common

6:04

infertility is?

6:07

Yeah. So based

6:09

on the data we have now, about one

6:11

in seven US women experience

6:14

infertility. The WHO says

6:16

it affects about one in six men

6:18

and women globally. So it is pretty

6:20

common.

6:21

It's men and women,

6:23

correct? Yeah. A number

6:25

of infertility cases are related to male

6:27

infertility. One third are related to

6:30

female infertility. And then about a third

6:32

are completely unknown causes. Yeah, that makes

6:34

sense. Nikki, jumping to you,

6:37

can you talk about when you started thinking

6:39

about issues related to fertility and

6:41

expand on your story?

6:43

Yeah. So I mentioned that I had worked as a

6:45

producer for many years. I met my husband when I was 32. He

6:47

got married at 36. At 37, I switched

6:50

from working behind the camera to in front of the camera.

6:53

And frankly, I thought to myself,

6:55

now's not a good time to get pregnant. And

6:58

so I decided to wait just a year

7:00

or so before we tried. And then I got pregnant

7:03

when I was 38, quickly, easily, but

7:06

miscarried. There was a chromosomal

7:08

issue. Got pregnant again

7:10

at 39, had my son at 40, naturally. And

7:14

in retrospect, that was really, really lucky.

7:18

And I did get pregnant again pretty quickly

7:20

at 41, but miscarried again,

7:21

again, a chromosomal issue. So

7:24

my husband and I continued to try.

7:28

And when I turned 42, I

7:30

tested my AMH, something I'd never heard of, a test

7:33

I wasn't aware of. And I had a low

7:35

AMH, 0.7 at the time on top of

7:37

being 42. And

7:42

I had a huge reality check. So

7:44

it was pretty gut wrenching. Well, thank

7:46

you for sharing that. And AMH

7:49

is what's called anti-malarian hormone,

7:52

and essentially corresponds to a person's

7:54

egg count.

7:55

Nikki, I wanted to hear what you wish

7:57

you would have known about fertility. So

8:01

many things, but I think logically

8:04

we sort of know that age is important,

8:06

but I think you're not really thinking specifically

8:08

about the age of your eggs. I

8:11

do think some people think that just means your body can't

8:13

carry a baby as a gazole or they can be more complications.

8:15

I don't think people necessarily clearly

8:18

understand. You're born with

8:20

a finite number of eggs, you lose them

8:22

along the way, and the ones that you do hold onto

8:24

deteriorate basically over

8:26

time. So I think I wish I had just had

8:29

a better education on my body

8:31

and my ovaries and how it

8:33

all works and how critical age is. I

8:36

wish I had gotten tests sooner. And frankly, I

8:38

wish I hadn't delayed it for

8:40

my career because it

8:42

was a big risk that I didn't understand at the time.

8:45

So as you were going through this several

8:47

year span,

8:48

can you talk a little bit about the emotions

8:51

that you were feeling, number one, and then

8:53

number two, where did you go to for

8:55

support? Because this isn't something that people really

8:58

talk about until they're going

9:00

through it and then you kind of find out that so

9:02

many people have had issues with

9:05

fertility, but where do

9:07

you go when you're in the midst of it?

9:09

Yeah, it's a good question. When I got pregnant

9:12

initially, quickly, a 38, and I

9:15

miscarried, I was upset,

9:17

but I hadn't had a child yet, so I didn't

9:19

fully understand the loss, if that makes sense. And

9:22

I was shocked that I'd gotten pregnant so quickly in the first

9:24

place. And miscarriage is

9:27

a topic that so many men

9:29

and women experience that also

9:32

no one really talks about. And then I got

9:34

pregnant, had my son. And then when I

9:36

had my second miscarriage, that was really

9:38

tough. And because I had

9:41

a son and I could process the

9:43

loss more, honestly,

9:45

I didn't really talk to anyone. I didn't even tell my parents

9:47

for a long, long time

9:48

that I'd had a miscarriage and weren't quite close.

9:50

And maybe two or three friends, because my mentality is just

9:53

to keep it in. Then

9:59

I... just started talking to everybody.

10:02

I'd be out on shoots with female producers,

10:04

younger female producers, and I'd be like, guess what's happening.

10:07

Let me tell you about what I'm going through. And

10:09

in doing that, I met so many women who

10:12

had gone through it that I was just shocked.

10:15

There's this whole, it was like an underworld, this

10:17

secret underworld of men

10:19

and women who dealt with infertility,

10:22

fertility loss, the whole gamut.

10:25

What's wonderful about my job is that

10:27

I get to cover so many different topics. And so

10:30

I ended up being sort of like a mini expert in a million

10:32

things. And

10:34

one topic I'd never done a story

10:36

on was fertility.

10:39

So I just thought, wow, it's

10:41

just really not covered, at least from my

10:44

perspective, that much in

10:46

the media. And so I spoke with our executive

10:48

producer of CBS mornings and I told her what was going

10:50

on. And I had put together this series

10:53

facing fertility. So to

10:55

answer your question, the support came when I finally

10:57

started talking about it. And after our series aired,

11:00

I had at least a thousand private messages

11:02

from people I didn't know. There

11:05

were so many people that were

11:07

also feeling isolated and just want to

11:10

share their story, ask a question, anything

11:12

you can think of.

11:15

This conversation is so interesting. And I appreciate

11:17

you sharing your story, Nikki, because I'm 34.

11:21

So I'm at an age now where a lot of my

11:23

friends are talking about fertility, talking

11:25

about wanting to have children. And

11:27

I trained as a birth doula a couple of years ago.

11:30

And I felt like I got a real education in my body

11:32

that I had never received before. It's

11:35

crazy that no one talks about this stuff. Like how

11:37

is it possible that I don't understand a lot of my own anatomy?

11:40

So it really resonates with what you're

11:42

saying. And so I'm curious, what

11:44

are you seeing start to shift

11:46

that you're feeling really hopeful

11:47

about? From just

11:49

a societal perspective, I think this stigma

11:52

is slowly fading. There's

11:54

just always been

11:56

shame and guilt around it that

11:58

for some reason you...

11:59

couldn't carry a baby or get pregnant that

12:02

there's something wrong with you. So

12:05

I think just the fact that people are becoming

12:07

more open and feeling

12:09

more comfortable sharing their story if they want

12:11

to, and if they don't want to, at least they have places to go

12:13

to read other people's stories for comfort.

12:16

And I think eliminating the stigma around

12:19

fertility issues is a big change

12:21

that is happening and has needed to happen for a really long

12:24

time. So let's go back to the issue

12:26

of male infertility that we touched on just

12:28

a little bit ago, which doesn't get a lot of attention.

12:31

I'd love to hear a little bit more about that from

12:33

both of you, because I do think that's something

12:36

interesting that we're not talking a lot about.

12:39

When we're looking at fertility from a research

12:41

standpoint, the focus is usually on the woman.

12:44

So that just goes to show we

12:46

need more work done. I think that because

12:48

physically women carry a

12:50

baby, the burden falls on us. But

12:52

I think that men have to realize that

12:54

it's important to be educated, because I think there

12:56

are a lot of men are just like, man, my sperm's great. I

12:59

have a billion sperm. Your sperm is good forever.

13:02

It's actually not. It declines at

13:04

a much slower pace than a

13:06

woman's eggs in general. But

13:09

your sperm begins to decline, I

13:11

think, after about the age of 40 slowly. So

13:13

I think that there's a lack of education

13:16

on the male side too.

13:17

So for someone who is thinking about their

13:19

fertility and wanting to understand

13:22

where they're at, what are some things

13:24

that someone should be thinking about?

13:26

The fertility doctor has interviewed suggested

13:28

women start to understand if you have any

13:30

issues that could impact your reproductive health.

13:33

Men can have their sperm checked at any

13:35

point as well. So if you go for your

13:37

annual physical, talk to your OBGYN.

13:40

And hopefully OBGYNs

13:43

will talk more to

13:45

patients about what's available

13:47

and just educate women

13:49

and men about

13:51

reproductive health and thinking ahead.

13:53

Yeah. Family planning plays a role as well

13:56

when you're receiving your well-woven visit if

13:58

you're a woman.

13:59

sometimes they'll ask you if you want to have

14:02

children and if so how many children do you want to have

14:04

and things like that. Just thinking about

14:06

what your personal goals are, your

14:08

family's goals are, it could

14:10

also come up with your primary

14:12

care position.

14:13

Just like anything, the healthier

14:16

you are in terms of just general

14:18

healthy habits that increases

14:21

the likelihood of a better outcome.

14:23

But at the same time there's no hard fast

14:26

rules and that's what makes something like this extremely

14:28

difficult. So thanks for making those recommendations

14:31

and what recommendations do you have

14:34

for someone who is looking for support in this area?

14:36

For example, if they're struggling

14:38

or having issues with fertility and

14:40

they're looking for resources.

14:42

Having a support system, I've done

14:44

a lot of research for it shows, you know, your family

14:46

support system plays a big role and

14:48

also just seeking behavioral health services

14:51

as well. Like mental health is important and you

14:53

don't really think about mental health in relation

14:55

to infertility, but it's very much related.

14:58

Yeah, absolutely. And Nikki,

15:01

I wanted to ask you as well, if someone

15:03

is listening and they know someone

15:06

who's struggling with their fertility, what

15:08

is a way for them to show up and support?

15:12

I think just to show up and to ask

15:15

your friend struggling, you know, do you want to talk about it?

15:17

Do you not want to talk about it? What can I do to help you?

15:19

I think what we should never do is

15:21

say it's going to work out because

15:24

no one knows. I had a friend who

15:26

had said, Nick, it might, you have to know it might

15:28

not work. You have got to hold on to hope and just

15:31

be prepared for either outcome. And

15:34

you know, what can I do with you? I'll come go for a walk with you.

15:36

Do you want to go out to dinner? Do you not want to talk about it? Do you want

15:38

to talk about it? And it depended on the day, what I

15:40

felt like, and I sort of

15:42

didn't realize how much it impacted me until

15:45

after the fact, because I was just sort of trying to survive

15:48

and it's a rough roller coaster. But I

15:50

think just show up for your friend.

15:52

Ask how you can be helpful. Thank

15:54

you. All right. Let's move into the

15:57

lightning round. The first question

15:59

is what gives you. you hope? Well,

16:03

the experience I just had gives me hope across the board

16:05

because I had barely any left at the end.

16:07

I'm

16:07

currently expecting a daughter

16:10

in July. So I don't know

16:13

if I get emotional talking about it because it's just

16:16

my husband and I are incredibly lucky, really,

16:18

really lucky. Beautiful.

16:21

Having even a tiny bit of hope was critical

16:23

in waking up every day and getting

16:25

out of bed and carrying on.

16:27

Hearing Nikki's story that is hopeful.

16:30

It's just nice to know that there are people who are speaking

16:32

out about this issue, using your platform,

16:35

Nikki, to connect with a lot of people

16:37

is hopeful. And even you guys

16:39

having this podcast, I've seen more

16:41

momentum.

16:42

I've seen more people talk about it.

16:44

Who is someone who's inspired you or had the

16:47

biggest impact on who you are today? I've

16:49

had so many mentors over the years. So I just

16:51

feel bad calling out one mentor. Probably

16:54

one of my mentors at Hopkins, she'll

16:56

be your biggest cheerleader, your supporter. And

16:58

I just love people like that, that can

17:00

touch so many lives in the smallest ways.

17:03

So she comes to mind right now.

17:05

Nikki, what about you? I mean,

17:08

it's probably the most common answer, but really,

17:10

my parents were so wonderful.

17:13

I had a great childhood and a great life. They taught me to work

17:15

hard and dream big and be independent,

17:18

which is largely how I ended up where I am. But I think

17:20

now today, interestingly, my son inspires me

17:22

to take a seat, put the career over here

17:25

and be present and enjoy the simple moments in

17:27

life, which is just to be with your family and love

17:30

the people you love and live each day. So

17:32

it's come full circle. Awesome. Thank

17:35

you both so much for joining us.

17:37

Thank you. Thank you. Thanks for having me.

17:42

That was a great roundtable. What

17:44

I really appreciated was Nikki's openness

17:47

and transparency as she shared her personal

17:49

story with us. And then Gabby

17:51

really brings a unique point of view as

17:54

a researcher in this space. Something

17:56

I thought was interesting about this

17:58

and probably worth it.

17:59

exploring a little bit more is

18:02

that there's a lot of discussion

18:04

and at least recognition now about the

18:06

stress and the emotional toll

18:09

that this takes on women. But I don't think that

18:11

has been fully explored in men and

18:14

how they feel. And when you talk about masculinity

18:17

and concepts of traditional masculinity

18:19

and what that can do psychologically,

18:23

emotionally to a male.

18:25

Totally. I mean,

18:26

my experience in just observing

18:29

pregnancy and childbirth and motherhood is

18:31

that there's so much shame involved

18:34

for women specifically as it relates

18:36

to conceiving and then the way that they parent

18:38

all the way through. And I think

18:40

having this issue be

18:43

examined from both sides is really

18:45

helpful so that it doesn't just feel like

18:47

it's a woman's issue because it's not. And I

18:49

don't think we're talking enough about that.

18:52

And then I think the emotional impact is

18:54

also not discussed. So like you're sharing,

18:56

I have a friend who was trying

18:58

to conceive with his wife and

19:01

the amount of emotional distress that it caused

19:03

him and the shame that he held

19:05

that he felt like he couldn't share with other people was so

19:08

heavy. I think that was really isolating.

19:10

And part of what made it feel hard for him is that

19:13

he felt ashamed and isolated

19:15

from his community to be able to share his

19:18

feelings and also potentially look at his own fertility.

19:21

So I think

19:22

this is a really important conversation and I

19:24

really appreciate the expansive way that

19:26

we're talking about this issue. So

19:29

thank you so much for joining this conversation.

19:31

There's going to be some additional resources

19:33

in the show notes. So if that's interesting or helpful

19:36

to you or your loved ones, please check

19:38

those out. Next week in our bonus episode,

19:40

we'll be talking more about how you can take charge

19:42

of your fertility. That's it for today.

19:44

Thanks for listening. Make sure to follow and subscribe

19:47

wherever you listen so you can get notified when a

19:49

new episode is live. Catch you next time.

20:00

you