Search for tag: "eggs"

Dr. Jones: We have so many choices in our lives now, but some things we don't have choices about and that's when is it time to have a baby and when is it too late? But there are some choices.

Today in the studio we're with Dr. Joe Letourneau, who is a reproductive endocrinologist at the Utah Center for Reproductive Medicine and director of our oncofertility program and also for fertility preservation.

Well, you've planned everything in your life just right and you kind of didn't have kids because you were looking to find the right person to have kids with or you were looking at your job, and now you're older and you find out that you don't have many eggs left. What are your choices then?

Dr. Letourneau: This is the circumstance in which having frozen eggs can be quite helpful. At that point, it would be possible to consider thawing some or all of those eggs to try to create embryos and use them for fertility treatment.

In the last 10 or 15 years, we have developed a new type of technology called vitrification. And with this process we use a safe sugar type of solution to dehydrate the egg as we freeze it. This takes the water out of it and prevents the ice crystal injury. When we then use the egg in the future, we warm it back up and we allow it to refill with water, and it's a very healthy egg. So the survival rate of eggs currently is very high. It's in the 80% to 90% range. Whereas in our own field with our best technology 20 years ago, it was probably only 1% or 2% survival rate.

Dr. Jones: That's been the biggest change in IVF. So if a woman then decides she wants to use her eggs, some of them are thawed, and then sperm are added and then the embryo grows in the labs. So they go through an IVF process once they're finally ready to make a baby?

Dr. Letourneau: That's correct. After five or six days of growth, we would put the embryo into the uterus the same way it would sort of roll out of the fallopian tube, but we actually place it through a natural opening in the cervix.

Dr. Jones: So if a woman is lucky and maybe she has 20 eggs, they'll go into the freezer. She might have more than one chance at IVF, maybe more than one chance at having more than one kid perhaps?

Dr. Letourneau: Absolutely.

Dr. Jones: And how successful is it? And that probably is a function of how many eggs you get and how old the patient is, but what's the ballpark?

Dr. Letourneau: You've intuited there that age and the number of eggs has a big impact. So one egg for any woman could make a baby. But it really comes down to a probability. So one egg in one's early 40s has a much lower chance of one egg in one's early 20s. And as such, it helps to have many eggs. So likely getting as many eggs as we can safely achieve is probably the best method to preserve fertility. But probably each egg has somewhere between a 5% to 10% chance of making a single baby.

Dr. Jones: So what happens for now a woman's 42 or 43 and she's tried a couple of times with her own eggs and IVF hasn't worked? What are her next options?

Dr. Letourneau: It's important to think of the frozen eggs as one method of helping one conceive, and it's not 100% success rate as we spoke about earlier. Not every egg makes a baby, but coupled with the idea that some people their circumstances in life may change where they're ready to try to conceive their first baby at 38 or 39, they may be able to do that.

It may be that the frozen eggs are most helpful for the second baby or some other aspect of their family building. So some people may conceive on their own, some people may require some fertility treatment, and some people may even consider fertility treatment to have that first baby if they've been trying to conceive at 42 using their eggs at that time for new IVF and then saving the eggs from age 34 for, you know, their second baby. So it's a pretty dynamic process, but in general, having the frozen eggs does involve sometimes revisiting kind of the IVF process in order to use the frozen eggs.

Dr. Jones: And then the option if for some reason none of those things are working, we have donor eggs from young women that can be an option for people who find that appealing or they're willing to think about that choice.

Dr. Letourneau: Absolutely. We've been using donor eggs for 30 years or so in our field, and it's a very normal thing to do and it's an excellent way to build a family. A common concern that patients have about the relatedness, you know, I won't be related and my partner will or I won't pass on my genes. The reality is that most of us humans have most of our genes that are exactly the same, just about and so there is certainly a uniqueness to us. Part of that comes in our genetic code and then part of it comes in the way we use our genetic code.

And what we've found in research in big studies of human populations and in other mammals is that the maternal environment during pregnancy impacts the way the baby and then even their babies and their grandchildren after that use their DNA. And so there is a big impact on genetics. There's a big biological relationship that's created between the mom who carries the pregnancy from the donated egg, and I think it's a really excellent way to build a family if that should be needed.

Dr. Jones: Well, I think that knowing that you have options, whether you can exercise those options or not, for women who are trying to think about making a family someday is important for us as providers and for women who have the questions it's good that we actually have those options here. Thank you for talking to us about it, Dr. Letourneau, and thanks for joining us on The Scope.

Dr. Jones: So you're 34 and the clock is ticking and you haven't met Mr. or Mrs. Right yet and you want a baby someday but not now. What are your options to protect your eggs because you can hear them getting older in your body?

So women around the world have been told they can have it all, and although I may not get agree with that completely, there is a time when you make babies and there's a time when you build your career. But, in fact, the making babies and chief career building tends to overlap, and sometimes we put something off and what gets put off, as we're learning about the increasing age of women having their first child in this country, is the baby making. But your eggs are getting older and what are you going to do to save them?

In the studio today with us is Dr. Joe Letourneau, who is a fertility preservation specialist and reproductive endocrinologist at the Utah Center for Reproductive Medicine. Thanks for joining us, Joe.

Dr. Letourneau: Thank you for having me.

Dr. Jones: So a 34-year-old is really looking for her next big job and she hasn't found the honey yet, but she wants to have kids someday. She's got your name. She knows you're the fertility preservation guy. What are you going to tell her?

Dr. Letourneau: That's a very common presentation that we see in our clinic now, and it's becoming more common. We've certainly become more sensitive over the years to the idea that women are building their families later. There is an intersection with, you know, family timing and ovarian and an egg physiology that that can be important. And the way it can manifest is that, you know, achieving a pregnancy becomes incrementally slightly more, you know, difficult with time.

One thing that I like to tell patients is that there's not really a fertility cliff. I think there must be many websites on the internet to suggest there is a fertility cliff where you're fertile one day and then not the next, and it's really a gradual change with time. But for some people if they anticipate many years elapsing before they plan to build their family, it may make sense to consider freezing their eggs. Essentially freezing them in time with a higher reproductive potential that they may have at their current age and that they may have in the future.

Dr. Jones: So is there a time when you're too old to save your eggs?

Dr. Letourneau: Age is quite predictive of a quality for women in one way in particular and that's having a normal number of chromosomes. The way that I like to frame this for patients is to, one, give them an understanding of how many eggs there are in the body at a given time and, two, what percentage of those eggs are normal.

So at birth, average women are born with about 1 million eggs, and by puberty there are around 300,000. It turns out that the egg comes in a unit with something called the follicle, and the follicle is what provides support to the eggs so that it can become fertilized. It also helps to regulate the menstrual cycle and provides estrogen. So the absence of follicles is what defines menopause, which is typically around age 50 or 51. So there is a decline from the start of puberty in the early teens until age 50 of about 300,000 eggs down to the end of the egg supply.

Interestingly, in this time, only 400 or 500 eggs will be ovulated or released from the ovary because, as humans, we release one egg per month because it's difficult to raise a human baby. So most eggs in the ovary are actually not released. Most of them are sort of selected for or against in a way that we don't understand well and many of them die off.

Each month, the egg that is released has a certain probability of being normal or being abnormal. And the normality of it I'm really talking about the chromosome number. If the chromosomes that come out are abnormal, the embryo that may be created will be missing some of the instructions for it to grow.

Most typically that manifests in the absence of a pregnancy. Occasionally it manifests in an early miscarriage, and more rarely it manifests as chromosomal abnormalities that the baby may have at birth. But really most commonly these chromosomal abnormalities make it hard to become pregnant. These go up with time raising pretty steadily, but rather rapidly in the late 30s and early 40s, and that's really what drives age-related fertility concerns. So freezing eggs earlier results in more normal eggs.

Dr. Jones: So ladies, as you're thinking about planning your life, understanding that women plan and God laughs. But if you're thinking about planning your life, there are some options about freezing your eggs, but you should know what's available and decide what's right for you. And thanks for joining us on The Scope.

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Justin Knox is a physician assistant who works in urgent care. He knows first hand the importance of younger men not taking their health seriously.

It’s common for men in their 30s to assume they will be healthy forever and put off the life changes they should be doing now. These men typically do not have a primary care provider. They wrongly assume they get enough physical activity in through occasional recreation in the summer and winter. They drink too often and a healthy diet is low on their priorities.

Most of these men will only start caring when health problems start happening when they reach their 40s.

Justin cares about his health, but he admits that healthy lifestyle choices can be difficult. Justin is a socialite, so he often goes out with friends, which means drinks and bar food. It can be easy for him to stray from a healthy diet.

Staying healthy is a battle. Your choices may wax and wane, but it’s important to stay focused and make the best choices when you can.

For most men, an urgent care is the first stop for acute problems like a cough or cold. But often, patients will go to an urgent care just to be told there’s nothing the doctor can do. So when should you go in, when should you wait, and when should you just stay home?

Justin says you should trust your instincts. You will will never be turned away from an urgent care. Even if your symptoms end up being nothing serious, an urgent care doctor can still provide reassurance.

Major part of Justin's job is education and reassurance. Educating patients on when to wait, when to seek help, and what they can do at home makes up a majority of his cases.

Fear is a great motivator for patient. When someone is hurt, bleeding, or scared they seek treatment. And turning to the internet for health diagnosis has a way of scaring people more than anything else.

If you have any major health concern, seek professional help. Even if the doctor is unable to provide treatment, they can provide education and reassure you that everything is fine.

You’re suffering from what you believe is a sinus infection. You had one years ago. The doctor prescribed you an antibiotic. The symptoms went away a few days later. Now, the doctor is telling you he’d rather wait than give you antibiotics. What gives?

This is the classic mindset of “transactional medicine.” A patient comes in seeking a medication that has worked to treat their symptoms in the past. They pay the copay and assume the doctor will give them the drug that has worked in the past.

More modern practices and newer providers often take a more conservative approach to treatment. They rely on the latest research and clinical data as a guide for best practice rather than relying on the strategies that anecdotally work in the past.

The over-prescribing of antibiotics and pain medications have had serious consequences. Doctors are now dealing with antibiotic strains of diseases and the impact of the opioid crisis. As such, modern treatments are more conservative. Most colds and sinus infections will go away on their own without antibiotics, so modern best practice is to only prescribe antibiotics if the problem becomes more severe.

Trust your doctor and don’t approach your visit to an urgent care as a transaction for medication.

When trying to determine whether or not you should go to an urgent care, it’s easy to think of your symptoms in terms of time. You may assume that if a cough lasts longer than five days, you should seek help. Unfortunately, diseases don’t work that way.

According to Justin, there is no definite time frame for any symptoms to get better. A common cold can last seven to ten days in one patient. It can last up to two weeks in another. A persistent cough may last anywhere from five to ten days before there’s any improvement.

Instead of thinking of your symptoms in terms of a timeframe, look for these signs to determine if you need to seek treatment:

• Has there been a significant change in your symptoms?
• Are there any new symptoms forming?
• Are the symptoms getting worse over time?

If you notice any of these, seek help. At the very least, a checkup with your doctor can screen for any underlying problems and provide reassurance if they detect nothing serious.

When is something serious enough for an emergency room and when can an urgent care help?

First and foremost, “remember your ABC’s.” That stands for airway, breathing, and circulation. If you are experiencing any trouble with those three systems, go to the ER immediately.

For other situations, Troy and Justin explain what is and isn’t an emergency:

Asthma attack - Where you should go depends on the severity of the symptoms. If you’re seriously struggling to breathe, go to the ER. An urgent care can handle minor breathing difficulties, but they are limited on medications, specialists, and equipment to treat more serious asthma attacks.

Sprained ankle - Most sprains are easily managed in an urgent care setting. An urgent care is able to take an xray and determine how serious the injury is. They are able to give you a brace and instructions for recovery. If they detect anything more serious with your injury, they can send you to get more help.

Broken bones - Like sprains, an urgent care can handle the diagnosis and treatment for most fractures. If they determine the fracture requires a specialist or emergent care, they will get you to where you need to go. However, if you can see the bone, go to the ER.

Lacerations/cuts - If you are suffering from severe blood loss, you’ve severed a finger, or there’s a chance of losing a limb, go to the ER. For all other cuts, it’s best to start at and urgent care. They can handle a majority of cuts in house. If they determine your injury is more serious, they can send you to the ER.

Stomach pain - Stomach problems can be very subjective, so it’s important to pay attention to you body. If the pain is so severe that you can’t stand up or you feel an intense pain localized to your lower right abdomen, go to the ER. These are potential signs of appendicitis.

For less severe stomach pain, start at an urgent care. They can diagnose your symptoms and decide how best to proceed.

Concussion - If you lose consciousness, vomit, or are severely confused after a head injury, go to the ER immediately. These are symptoms of something very serious that needs emergent care.

For a minor bonk on the head, an urgent care can diagnose and treat your head injury.

Numbness in right arm - It’s best to go to the ER. General arm numbness can be complicated to diagnose. It can be caused by all sorts of things, some more serious than others. It’s up to a clinician to rule out whether or not it’s a stroke. However, most urgent care’s do not have the equipment necessary to diagnose a stroke.

On this episode's Just Going to Leave This Here, Scot can’t help but imagine the worst case scenario when people wear flip flops while riding a scooter. Troy is fostering twelve adorable cats in his home, which remind him of an old YouTube video, Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.