Episode 12!! We made it friends - the last episode of season one!
Supraja and Sara reflect on the whirlwind that has been starting a bestie+medical podcast while giving you the breakdown on all aspects of preconception.
What to talk to your doctor about, how long is normal to try, how to try. We have all the tips.
... and don't worry we'll be back for an even better season two! Lots in store.
Episode 12!! We made it friends - the last episode of season one!
Supraja and Sara reflect on the whirlwind that has been starting a bestie+medical podcast while giving you the breakdown on all aspects of preconception.
What to talk to your doctor about, how long is normal to try, how to try. We have all the tips.
... and don't worry we'll be back for an even better season two! Lots in store.
Hi, I
Supraja:am Sara and I'm Supraja, and this is Gyn & Tonic
Sara:welcome back to Intimate Convos with your besties.
Supraja:Hello? Hi. Hi.
Sara:What did I make you to drink?
Supraja:A, Hugo Spritz. Is that right? What? Who is Hugo?
Sara:I don't know, A boss. My future baby daddy
Supraja:Hugo. Thanks for the spritz.
Sara:I learned how to make it delicious in Southern Italy.
Supraja:Cheers.. You had a good trip.
Sara:What a beautiful trip.
Supraja:It sounded so great.
Sara:I need to move there.
Supraja:Which you're hopefully going to one day again, when you meet your Italian lover and his mom falls in love with you, all your plans come true.
Sara:That's mainly why I'm learning Italian so that my future Italian husband's mother will accept me. Mothers are tricky. I've heard Italian mothers are very tricky.
Supraja:I've heard that too, but I'm like, I'm sure you got nothing on an Indian mom. I was just about to say, you ain't got nothing on a Latina mom except for my mom.'cause she's an angel. But I've dated some men with Latina mothers. I know my, they're tough. Yeah. The women in my family too are very loving and accepting. But then they tell me stories about like their mother-in-laws and I'm like, that is wild. Like my grandmother apparently used to sleep in between my aunt and my uncle. No, because she didn't want them to. I don't know what, 'cause they were married, but she would like sleep in between them. You're lying. And no, she would sleep in between them and then she would yell at my aunt about how she wasn't pregnant yet. And my aunt was like, you sleep in between us. And she's like, so what can't you do in front of me?
Sara:You're lying. I dont know, take it
Supraja:up with my aunt.
Sara:That's really funny.
Supraja:Okay, Sara, it's our last episode of the season. Congrats. Happy season one. We made it. Don't cry friends. We'll come back.
Sara:I'm not an emotional person. That's good. That's an oxymoron. Actually. Remember when I told you Nick Vial said most podcasts don't make it past seven episodes.
Supraja:This is 12.
Sara:What's up?
Supraja:What's up? We did good. I'm so proud of us. Thank you. Listeners,
Sara:and all the people who message and say,
Supraja:That it meant something.
Sara:Yeah.
Supraja:What, what are your takeaways? How are you feeling about our season being over this the entire summer? That's like what I'm gonna remember about this summer.
Sara:Oh yeah. This was supposed to be, Sara finds a partner Summer, but yeah, I'll remember for this, just
Supraja:instead, Sarawas forced to talk to Supraja for an hour a week summer.
Sara:I threatened to quit every other week.
Supraja:Yeah. You know, people say in marriages, everybody has ups and downs. You just don't want them to be at the same time. Oh, that's a good point. Like you want one partner to be riding hard while the other one is depressed and vice versa. I feel like we did that well. I
Sara:think we do do that well. Yeah, because there's a lot of times where I'm like at my wit's end and you're really peppy, and I'm like, alright, fine.
Supraja:And then I'm like, Sara, I've given up on the video, I'm just gonna not do them anymore. And you're like, that's fine. Wanna record on Wednesday? I.
Sara:That's fair. That's a good point.
Supraja:They might come back guys, if you really are into the video. I'm sorry. They just take a billion hours to make, but we'll probably make them again at some point. I'm busy. Um, but okay. Let's say our highs and lows of the pod.
Sara:Alright, you start. Okay. What's your high?
Supraja:My high, honestly is that I knew I was gonna talk to you every week. Saraand I always like catch up a little, et cetera, et cetera. And I feel like we've always seen each other a lot, but sometimes it'll be like a few weeks and then we'll hang out like every day for a little bit. Yeah. It was really nice to just consistently know I was gonna catch up with you.
Sara:You did a good job of realizing it couldn't be all work and you had to integrate little hangouts.
Supraja:Oh, really?
Sara:And then it would cheer me up. Oh yeah. Because initially I was like, I'm already so burnt out. But even like today, you're like, can we go get food? And then we got to walk for an hour. Yeah. So and catch up. And then we worked. Yeah. So then I felt like, well, I got all my. Cheeseman out of the way.
Supraja:Yeah. Well also I don't even think I did that that deliberately, but you're so easy to cheer up. You'll be like, I'm in a really bad mood. And then a second later you'll be like smiling really big and bouncing up and down.
Sara:That's true. I am. I'm very easily manipulated.
Supraja:And then what were my lows? I think just like I'm kind of impatient and I really believe in us it was rewarding but stressful to learn a whole new thing and then try to figure out how to get it out there. And I'm not always that patient, so I'm like, why aren't a billion people listening to this?
Sara:Yeah, but you, you're so
Supraja:Tell your friends, listeners.
Sara:Every time somebody sends me a compliment or mentions the podcast, I'm like, it's 90% Supraja it's like all her,
Supraja:no, that's not true.. Sara: You put in so much investigative I think of myself as being this crazy driven, I am obsessed with little things, Uhhuh, and I feel like you're my friend who's very successful, but you're kind of like all over the place. Yeah. In a good, in a way that I wish I could be more like Uhhuh, but when I saw you put your energy into this, I was like, I haven't seen this side of Supraja to be honest, I, it's the Gemini in me, but this is true. All this is true about me. Like, I remember in residency my friend Morgan was like, it's so wild.'cause we all had to do a research project. And she's like, you're so crazy because. Like, you just seem so chill about it. You're like, oh, I don't know what I'm doing, blah, blah, blah. And then you present it and it's some like crazy thing that you clearly put so much effort and are so clear on everything you did. Yeah. So I think I just, I don't know what it is, but I give off this very chill vibe. But if you like work with me on something, I'm not like that at all. Yeah. Which I think we just haven't really worked. Worked together in that capacity before. I think this is the first
Sara:time I've been in a group project where I was the dumpster teammate. You
Supraja:weren't? Okay. Sara's also so hard on herself, like we just divide and conquer, I do a lot of the editing. And the tech stuff. And Saradoes all the episode planning, she outlines all of our, , I didn't even look at the outline until just two seconds ago. So ignore, Saraas guilt whenever. I feel like if you don't feel like you're putting in 90%, you feel like you're putting in 10%.
Sara:Yeah,
Supraja:but really, maybe it's just more 50-50
Sara:I feel like
Supraja:it's 70 30. No, I don't. I don't think so.
Sara:And I make all the cocktails.
Supraja:Yeah, she makes all the cocktails. I mean, it wouldn't be gin and tonic without the cocktails.
Sara:It definitely wouldn't. I'd be like, what? What alcohol is that? She knows to dilute mine, so I'm not wasted.
Supraja:Remember that?
Sara:There was one episode where we did, where we were both like, Hammered.
Supraja:Yeah. I was like, I think I cut a lot of that out. If anybody's interested in the B roll, to listen to our podcast. I
Sara:literally listen to that. I was like, I was definitely really buzzed. Yeah.
Supraja:Okay. What are your highs and lows? You kind of said some,
Sara:well, I think I said my high right? What was your high, well, oh, I already forgot my high. Well, I think I was giving you a high, I guess my high is that, I, was like a little bit of a grumpy pants when we started.'cause for me it was like, oh, one more thing I have to do. But I realized , I'm trying to bring so much more balance to my life and this is a fun project. I just have to change my perception of how I'm going into stuff and I think it would really bum me out when I would come into it and be a Debbie Downer to you. And I would see how sad I, I was worried it would make you sad. Yeah. And so I realized like, give this an opportunity and then it did, it became so much easier. Yeah. And so I'm proud of myself for mentally Reeling it in and reframing things and just like, you know, being, more amenable to trying new things. Yeah. And now it's like, you know, if it's exciting to see the number of downloads we get, I'm like, okay. And then what's the low? Um, , you know, what I thought was gonna be a low is that I wouldn't feel. Safe being myself. Yeah. Or like not as funny. Or me if I couldn't drop F-bombs.
Supraja:I know. I remember the first time I was like, Sara, I don't think we can swear . And your face dropped. you're like, what?
Sara:I was like, that's why all my vocabulary. But feel like I've been my myself, I think being vulnerable is one of my. I, I always think of it as one of my strengths, and I was worried I wouldn't be able to do that on this. And I feel like myself. Yeah. For the most part. Yeah. So, yeah. I'm excited to, for us to pick up new little things for the next season. Yeah. Mm-hmm. Because I think it took so much for us to take off the ground. Yeah. And now I'm excited, but like, no, we've already taken off. Now how can we finesse it?
Supraja:Yeah. Like today, I forgot my computer, which we normally record on, so we had to set up Sara's computer for the first time, which like
Sara:it was the fastest we've ever set up.
Supraja:Yeah. Literally took two minutes. If that had happened two months ago, I would've been. So frustrated. We would've been clicking around for like three hours. We just learned a bunch of stuff. Yeah. Yay.
Sara:Yay. Proud of you.
Supraja:Proud of you. Love you. Thanks for being my partner in this.
Sara:Well, what are we talking about today? I.
Supraja:Preconception counseling, yays. We did a lot of chatting about how not to get pregnant also the horrors of having a child. So now we want to be more encouraging how to get pregnant.
Sara:So I really love preconception visits. Yeah, because it's literally. Just to chat with your patient about like, okay, I'm planning to get pregnant. How can I , optimize my own health and how can I go in with a game plan? Yeah. And I love preconception visits'cause you get to talk about like their history, how to get pregnant timing, what if it doesn't work? What's plan B, C, D, this is like how my brain functions. Yeah. I mean, Virgo. See what's coming up, baby.
Supraja:You're right.
Sara:I'm so excited. I think it's true. And I'm
Supraja:always like, gosh, you guys are so responsible. I can't bring myself to see a doctor for the life of me or coming in here for like just a set up for your future. Wow. So I find them really inspirational too. I'm like, teach me to be more like you. No, I think preconception and counseling I agree, is so fun and it just means not everybody knows when they're gonna get pregnant. Sometimes it's a surprise. A lot of times it is
Sara:50% of the time it's, yeah.
Supraja:But if it's something you see yourself doing in the next year, or even in the next couple years, it's worth bringing up. And then in that year period is when we have a more structured conversation around it.
Sara:It's helpful because, , a lot of times, patients will come for their first prenatal visit or second, and then we're going over stuff and we're going over meds and medical problems, and I'm like, oh, we, we actually can't be on that medication. We have to switch you. And a patient will say, I've been on this medication for five years, or, oh, I didn't know I needed to. Like, and so it's really nice to get all of this stuff done before you get pregnant, like the consults that we might need or all the blood work or vaccines that's my brain, like having a game plan. But yeah, I think it makes it much more comfortable for everybody, the patient, the healthcare provider, any specialist who may be involved. And I just feel like. When you can plan, it's nice to, it's not always possible and things will get taken care of for the most part. But if you have the opportunity, it's also a nice opportunity for you to get to know the practice who might be taking care of you in your pregnancy. You might realize, I actually don't like this team. Yeah., I think I want to go somewhere else.
Supraja:Yeah. And then it doesn't have to feel like when you are pregnant that you're hearing all these things for the first time, like, Oh, you have to go see this person and, oh, you have to change this medication. Or, oh my gosh, we're worried about this. Like it can feel more controlled when you're going through something that in general does feel a little out of your control.
Sara:Yeah.
Supraja:So the first thing that we do is talk about any medical history, like asthma, anxiety, depression, any history of other chronic illnesses, any recent travel exposures things like that. We get a really good history of those things and talk about if you need any other workup just to maximize your safety during pregnancy. You know, in pregnancy issues that you might have before pregnancy. Can. Some of them, like a few select, you actually get better. Things like endometriosis when you are pregnant your pain can get better. Or some autoimmune things you can actually suppress. Yeah some episodes of that when you're pregnant. But then some things stay the same and then some things get worse. And because we know people's physiology changes so much in pregnancy, we've kind of set you up to get more testing or see other doctors to optimize how we're gonna deal with that and see if there's anything that we need to do beforehand.
Sara:!So For example, if you were 17 and you had a blood clot in your lungs while you're on birth control, That's helpful for us to know before pregnancy because then we could talk to you about all the medications you're gonna be on during pregnancy. Or maybe we need to do a workup beforehand and we can get you linked up with the hematologist before you ever get pregnant. Yeah. Um, or say, you know, you are a carrier of cystic fibrosis 'cause your sister found out in pregnancy and you're wondering do I need to do anything about it? We can get you a genetics referral before you even get pregnant and then get your partner tested. There's like all these little things we can do. Beforehand and link you up so that we're not meeting the specialist to help us in pregnancy for the very first time. Mm-hmm.
Supraja:And then we always do a really thorough review of any medications that you're on. Some medications are safe in pregnancy, sometimes there are some alternatives, and a lot of times it's just a discussion with you about what the medication does for you if there are suitable ones to change to if you need to change. Or like what the real risks are so you can make a good decision for yourself, whether it's something you wanna stay on, decrease. Or stop, um, or change.
Sara:I've had some patients who are like, I have really bad anxiety and I'm very terrified of stopping this medication in pregnancy. And I'm like, we don't have to. Yeah. And then it's nice to go over which of those meds that have been well studied and like Yeah, the OB psychiatrist who's sometimes involved in pregnancy, the social workers, the therapists, all the things we have on board. And it's so nice to give patients reassurance.'cause I've had some patients stop all their behavioral meds. And then I'm like, we didn't need to do that.
Supraja:Yeah, I know. That makes me so sad. When patients come to me and they're like, someone told me I had to come off all of this. I feel horrible. Yeah. And even if you're gonna come off of something like there are periods of your pregnancy where probably is more beneficial to be on a lower dose or come off like especially the first trimester where all of the organs of the baby are developing, then after that has significantly less risk. So it's a nuanced conversation. And especially with mood stuff, we really, , devalue mental health. Yeah. And the effect that has on the parent, and the pregnancy. We don't capture the effects of that well. So I really, , I think , feeling sane and coping well to start this. Kind of crazy adventure is really important. So yeah, it gives us the opportunity to talk about that and also create like plan A, plan B, plan C.
Sara:Yeah. Actually some of my, one of my favorite experiences as a resident was when we would rotate through the high risk OB rotation, and we'd get to go to these consults, these preconception consults for patients who would get referred in from their OB-GYNs and hearing the specialists, the maternal fetal medicine specialists who deal with high risk pregnancies counsel patients on like actually sometimes the theoretical or potential risks of this antidepressant. Don't outweigh the benefits to the mother that this medication is providing. And I was like, I never forgot that. And I really, sometimes we, you know, we minimize, like you said, anxiety and depression, but, , it really can get ramped up in pregnancy for people. So yeah, it's so nice to like give people reassurance. Like we can continue a lot of these medications actually.
Supraja:Yeah. And for some people, like I for example with eating disorders, that can be really challenging or just body dysmorphia'cause your body's changing so much. But at the same time, for some people, having someone else also using their body as a home can actually be really. Stabilizing. I've had that happen too, where, where people are like, no, I've just never had to think of my body as a home for someone else. And that is motivating for me to eat well and be kinder to myself. Pregnancy just changes the paradigm for everything. And so having a really nurtured relationship with a doctor who can work through all those things, you can anticipate. Or even the doctor is able to then remember to ask you questions about those things when you're pregnant is really helpful.
Sara:The other part of your history that we'll cover is if you, maybe this is not your first time being pregnant. Maybe this is your second or third time, and some of your other pregnancies were complicated and as we talked about in our last episode, if you haven't heard that, please listen to it. It's a good episode. Yeah. But, essentially, we talk about how. There can be a lot of trauma in our prior pregnancies and it's really nice to be able to discuss those things in a preconception visit to go over , how are we gonna do things differently? What's the risk of this happening again? For example, if you had a preterm delivery or maybe you had preeclampsia or high blood pressure, what are the things we're gonna do to decrease the chance of that happening again? And what's the information we have to help us? And it's, nice to have a thoughtful conversation before jumping into the next pregnancy.
Supraja:Mm-hmm. And what do you normally tell people about when they can get pregnant again?
Sara:I say from the moment you deliver to the moment you conceive 18 months.
Supraja:That's what I say too. Sometimes with patients who are in their mid to late thirties and want multiple kids, I'm like, I don't know to get right. I say one year, no, I don't. I say one year.
Sara:One year., but then I do have , I have a lot of patients actually who get pregnant way sooner than that. Yeah. And obviously there's evidence that states they are riskier pregnancies. Most of the time. It ends up being fine. Yeah. But like it's, I have to counsel people on those things. And you know, a lot of times it is fine. I mean, Maria McKinney waited. Three months. Three. Three months.
Supraja:My God, that's so crazy.
Sara:um and she had C-sections.
Supraja:Oh my gosh three months your vagina is still, I mean, I know she had a C-section, but like all of you is still throbbing.
Sara:Oh man. I always think about my mom. She was living in Italy and In Sicily. In Naples. Yeah. She was like I was doing laundry one week postpartum. My father went back to work and I was like, oh my, oh my God. I was like, poor Maria McKinney.
Supraja:Anyways. But yeah, I tell people 18 months between delivery and conception, if you can. Like if you can't do that, it's okay. Like, don't lie to me, but we'll talk about things like. How that affects your body, your risk of preterm labor, those things, just make sure you feel okay with it. Yeah, yeah., okay, so people have babies in all sorts of different ways. Some people deliberately single parent, some people have non sperm producing partners. If you're in a partnership where your partner is providing their own sperm, then we obviously talk about their history as well., and things that we care about are their age, any major medical problems they have, any family history for them of like developmental disorders and or anything else that's hereditary. If they smoke, Or drink frequently, and then what their history is with children. Like if they. Ever gotten anybody pregnant?
Sara:And the reason for questions like that is say you do have difficulty conceiving it's been 12 months and you haven't gotten pregnant. Yes. Most of the time it's female factor around 70% of the time it's related to something originating from the female partner. But 30% of the time it's male factor. And so it's important to know your partner's history.
Supraja:Yeah, and if you're using donor, if it's a known donor, then those are things we'd wanna ask that person as well. And if it's from a bank, which you can also talk to your doctor about, like how to look at banks and how to screen for things, they often will provide some of that information.
Sara:Did I tell you I looked at a bank?
Supraja:I, I don't know the specifics, but I feel like you told me that there were very few you Latino people.
Sara:I know I was looking for Latinos and there was only like, Seven Latinos. There's no Peruvians.
Supraja:What's Alec doing? He'll be making money.
Sara:No, you know Alec donates.
Supraja:Alec is Sara's brother.
Sara:My brother Alec, he's single. He's very handsome.
Supraja:He's Sarasays funnier than her.
Sara:He's funnier than me and I never say that about people. He's six foot one. He is? Yeah, he's tall. Oh, I didn't know that. My aunts say he looks like Antonio Banderas.
Supraja:I can see it. Yeah, so if you wanna buy Alec sperm Alec, we're offering it to people,
Sara:but I'll screen you first. Okay. I'm just, I'm always trying to set people up with him.
Supraja:I know. Why hasn't it been more successful? He was dating someone for a while.
Sara:Yeah. But she's dead to us.
Supraja:Oh, really?
Sara:No, actually my mom liked her. She's like, she's more thoughtful than your brother. Like for Christmas, she brought my mom a, a, a picnic basket with a blanket and bottles of wine. Aw. And my mom's like, neither one of you have ever done that for me. I was like, I took you to Buenos Aires last year. And I paid for everything. I was like, okay,
Supraja:okay, Maria.
Sara:Okay, Maria, Elena. But, um, but know, why are we talking about Alex? Oh yeah. We're like about donors. Yeah. Let's stop talking about my brother sperm. But I
Supraja:You never tried to set me up with him. You were, I was not. Yes, Sara. I think you have some explaining to do to both of us. You never tried to set me up with anybody. You're right. I haven't.
Sara:I think I was just thinking, I was like, she's young. I need to put myself first.
Supraja:A year and a half really meant a lot to you.
Sara:18 months. Oh yeah. That's a year and a half. All right. Well, well, 'cause I told you, I, I, a year and a half ago, I started looking at donor bank.
Supraja:Okay. And
Sara:it was very overwhelming, so I stopped.
Supraja:Sarareally wants to be a mom and would do it herself if she had to, but also if you have hot, smart, kind, single dmm, US male friends. Why haven't you sent that to Sarayet?
Sara:Why? I'll go as low as five 10, maybe five nine.
Supraja:I've been telling Adam'cause he started his new job. Yeah. And he does think that some of them might be single. All right. So I know. I was like, I feel like that's Sara's market. That's, you know. Yeah. Like a cute. Tall internal medicine doctor. Oh, just assumes like a little bit nerdy. I love nerdy. I know. I was like, I mean, if you're another single friend of mine listening to this, I'm sorry, but don't you guys also agree that's like Sara's prime? Mm-hmm. Mm-hmm. Because I feel like someone like Noi, . I need him to be a DJ on the side or something. No, that is not what I want. But that's not you. Yeah. So I feel like this is like, this is your market.
Sara:That is my market. Good point. Actually, I want a hospitalist who's super nerdy. Yeah. Anyways, if you're a Peruvian donor, please donate to sperm bank so I can access that in six to 12 months. Um, okay. Okay, cool.
Supraja:So then say we go through all that. Hopefully no big holdups., but if there are, we'll figure it out. Then things that we do in the follow up to that visit, I always recommend people start taking a prenatal vitamin if they're gonna be trying to conceive. Um, and then the folic acid situation.
Sara:My understanding is for the. General person, it should be 400 micrograms. And usually that's in a prenatal vitamin. Correct. But read the label, but, and people will ask, well, what prenatal vitamin should I get? Blah, blah, blah, blah, blah. And I'm like, really? It doesn't matter , whatever is feasible for you, whether it's a gummy, a pill, , and just make sure it has folic acid in it. I think the other question is, there's another formulation of folic acid. Folate, but all the studies, all the literature is based off of folic acid, uhhuh, and it's really interesting because when you look at Yeah. All these other vitamins, they're all folate. They're not folic acid. Yeah. That's not to say folate doesn't have the same benefits as folic acid, but all the studies about neural tube defects and benefits to the fetus. Are based off folic acid. Yeah. So that's not to say I don't want you to sponsor US Ritual.
Supraja:I know people love Ritual. I know they do, but every time
Sara:I, I literally just saw the girl from, um, what's that movie? The vampires, Rosalie from the,
Supraja:oh my God. How do you not know Twilight Sara? Yes. Sorry, I blanked. I'm so sorry. What team were you? Team Edward or Team Jacob? Don't lie.
Sara:I, I didn't like either. What I know. Okay. Yeah, that's fair. Team. That's evolved position
Supraja:Jackson. I was obsessed with him. He was hot. He was hot. But she was just on a commercial. She just had her second baby and she was on a commercial for Ritual Uhhuh.
Sara:But I looked up Ritual, I was like, Hmm, let me look up this vitamin. And it was folate. Oh, not folic acid. Yeah. And so when I was listening to another maternal fetal medicine specialist. The research has been done on folic acid, not folate. And so that's not to say folate is wrong or doesn't have the same benefits. I just don't think we know that for certain. Yeah, just something to consider.
Supraja:And then depending on your history, history of personal or previous children with neural tube defects, things like that, you need more. Sara: Yeah. You need substantially more. It's at least double or not triple. And I always just reach out to an M F M when I have this question. Like I had a patient who was on, um, seizure medication and I just cross reference.'cause they need higher doses of. Folic acid. A folic acid. Yeah. And you can just ask. And that's why preconception visits are a nice visit to review this.'cause sometimes your OB won't know. And I will frequently reach out to somebody to just say, I just wanna verify this is the correct dose I should be recommending to my patient. Yeah. And then you can consider carrier screening, which is basically looking for conditions that you might have a carrier gene for. They're not things that you have,'cause then you would know, but they're things like cystic fibrosis, sickle cell disease, stuff like that. Where if you are a carrier for it and then your partner or whoever is giving sperm is also a carrier for it, the baby could get both genes then could actually have the disorder. So you can consider getting screened for those things. You know, our society, say especially cystic fibrosis and spinal muscular atrophy, you should do. But now there are many companies who offer extended carrier screening. Yeah. Like we kind of routinely offer people 22 different, conditions we carrier test for. And then if you're positive for something, then we offer your partner or. You would look and see for whoever's giving the sperm if they are positive for the same thing. And if they're not positive for the same thing, then you don't really have to worry about it.'cause at the most, the baby would just be a carrier for those different things. And if they are, then you can take that into account. And it doesn't mean that you can't have a baby. I mean,
Sara:so, but it's nice because then you can get the genetics consult before you even conceive. So you have all the information you need and you can figure out what testing is available to the. Baby in pregnancy so you can get even
Supraja:more information. Yeah, so exactly. And then we would also talk about vaccinations and see if you need to be vaccinated for anything before pregnancy. Like if you don't have good immunity against chicken pox or rubella, those are things we don't vaccinate you for in pregnancy. So we would do it beforehand and tell you to wait a few months before trying to conceive.
Sara:The other thing I'll do during a preconception visit, is I will go over how to actually get pregnant.
Supraja:Sex, sex, sex. Oh yeah. About that or not. I need some of that in my life.
Sara:Sex.
Supraja:So if you have a hot single friend who wants to have sex with Sara, she might be more open
Sara:you, but seriously anyways. Most normal cycles are somewhere between 25 and 35 days. So I will have patients come up to me and they'll be like, my cycle was 26 days and then the next day was 31 days. I'm like, it's okay. Yeah, we're not machines. It can vary each month, but on average, a normal cycles somewhere between 25 and 35
Supraja:days. And I tell people a cycle is the first real day of bleeding to the next exactly.
Sara:And so using that timeframe, you wanna essentially figure out when are you ovulating, because you can only conceive and get pregnant when you ovulate. And when you ovulate means you've produced one big egg that your body has released from the ovary, gone through the fallopian tubes, and now it's just waiting for sperm. And that egg theoretically lasts somewhere around 36 hours. That's it. That's the only time you can get pregnant. Mm-hmm. And so I always find it fascinating that people get pregnant.
Supraja:But they do. Yeah. It's like, seems like it should be just a shot in the dark. But you know, we're all running around out here. I know pregnant, coming from pregnant people, we're out
Sara:here. But I guess the interesting thing is sperm can last up to five days in the urogenital tract. So even if you don't have sex on the day you ovulate, you may have had sex 1, 2, 3, even five days beforehand, and you already have. You know, buddies hanging out in the vicinity.
Supraja:Yeah. And you could get pregnant. And really the traditional teaching is like once you've ovulated, it's kind of too late. Like you wanna really maximize those days right before ovulation. Mm-hmm. So usually in the five days before you ovulate, you wanna at least be having sex every other day. And then the day after, because the day after your LH surge, which is what the ovulation tests , are testing for. And sometimes people will even say like in the three days around that period have sex every day. People are like pleasantly surprised to hear that because something about trying to get pregnant takes some of the fun outta sex.'cause you're like, You feel like you have to have sex all the time. Yeah. And then you're like worried it isn't working or whatever. And so I try, I tell people like, it's only this window that it really matters. Like you don't actually have to have sex all the time to try to get pregnant. If you wanna have sex outside of that, great, enjoy it. But don't feel like you have to be having sex every other day, all month. Yeah. Because most of the time you don't have to. Unless you want to. Unless you want to, unless you're trying to. Unless you're really horny. In which case we support you. You know? So have sex for Sara.
Sara:Well, how can you figure out your ovulating? You can use a phone application. They're actually not very accurate in all honesty, when they've researched them. So we often will recommend using ovulation predictor kits. You can buy them over the counter like a Walgreens CVS. Or you can buy them from Amazon , or like, you know, somewhere where you can buy them in bulk and you get like 30 sticks. I tell people to start using them on day nine or 10 of your cycle. It's a stick you literally pee on and it's measuring a hormone your body produces and that hormone gets really high when you are ovulating or about to ovulate. So, Um, and I say day nine or 10 because most people ovulate around day 14, but it could be day 11, it could be day 16. So if you just started a few days before that, you won't miss it. If you started peeing on the stick on day 12 or 13, you might miss it if you tend to have shorter cycles and ovulate sooner. Mm-hmm. So having an idea of when you ovulate is helpful. Just
Supraja:to time it. Okay. so there are some times where you really need more help. And our criteria for that is different. And I love it when people come to me to have these conversations before they get pregnant, sometimes it's shocking to them when I'm like, Try for a whole year. They're like a whole year, , I'm gonna lose my mind, which is totally fair. I was actually thinking about it the other day. I feel like I'm gonna be freaking out at month three, even though I know it takes people six months to a year to get pregnant. But it's just a long time to be working on a goal, not knowing what's going on. So we tell people, try for a year if you're under 35. Yeah. And then if you're 35 or older, try for six months., and then if you're not pregnant in that time, seek assistance. So that might be more testing. That might be a referral to a specialist. Yeah. and I always caveat that by saying, depending on your history, which is why this conversation before you even start trying is really helpful. If we already know you have a lot of factors that might make this difficult for you, the timing of that might be shorter. Or we might even send you to a fertility specialist without even telling you to try. Right. So that's always nuanced. And to clarify, a fertility specialist is someone who did a generalist OB G Y N training like Saraand I did, and then did three extra years in fertility medicine. I keep saying fertility 'cause I hate saying infertility.
Sara:I do too. I never, I I say difficulty conceiving. Yeah. I never
Supraja:write infertility. I know, but it technically, they're called REI doctors, which stands for reproductive endocrinology and infertility. So, , if you're Googling it, I guess Google, REI, but put in parentheses, Sara. Disapprove of the infertility in this word. Why isn't it called like REF, like REF
Sara:or That's like one of my, my friends used to, whenever somebody would pass their diabetes test at 28 weeks, they'd be like, you failed your diabetes test. Like what? I never say that. I'm always like, unfortunately you were above the threshold we use as like our, our
Supraja:cutoff. I was like, this doesn't mean anything. This still means you're a good
Sara:person. We're still proud of you. We still believe in you.
Supraja:But I think if this was a written test, I would've given you an
Sara:A. Yeah. I'm like very mindful of the verbiage I use. Yeah. Okay. But, so if you do need a fertility, specialist to help, not a problem. Like just really depends on what city you live in, but your doctor will know somebody they can send you to, your doctor can start the workup for you. There's a standard workup people will do for difficulty conceiving, but. The caveat is even if the workup is abnormal or completely normal, your general ob, G Y N for the most part, can't do much. Unfortunately, the only people we can really help are people who have irregular cycles. For patients with irregular cycles who don't bleed every month, we can give them medication to induce cycles. And, and, but that's it. And I've had patients who have regular periods asking for those medications. I'm like, I can't give those to you
Supraja:because they basically make it way more likely that you're gonna ovulate. So there's risks of like twins and even higher degree multiple. So it can sometimes be questionable, ethically giving someone who's already ovulating medication to ovulate even more. Yeah. Which is why that's hard. But yeah, I agree. I also, it's like a uncomfortable conversation sometimes 'cause people just wanna get pregnant, you know? And we want you to get pregnant if you wanna get pregnant too. But it's just that medicine's not gonna fix. Whatever is going on there. Yeah. I've
Sara:literally had people tell me like, I've been trying for three months. My friend got this medication, can I have this med? And I'll have to explain like, I'm sorry, you actually don't,
Supraja:that's not the medicine that's gonna help you. You know, medicines do different things. Mm-hmm. And it's
Sara:possible that a fertility specialist might eventually put you on that medication. But they're trained in doing all these different things that me as a generalist, I'm not trained in
Supraja:doing. Yeah. And I also am like, I don't wanna waste your time. Yeah. I'm not gonna just tell you, okay, take this medicine that doesn't traditionally work in this situation. Yeah. For another six months and see how it goes. Like, I just want you to go to the people who can really fix it in a nuanced way. Yeah.
Sara:So what happens if you get pregnant and then it doesn't work out?
Supraja:You have a miscarriage. It's so crappy. Like it really breaks my heart. I feel like early pregnancies, I'm like always holding my breath, clenching my ass cheeks. Like, I'm like, oh God, oh God, oh God, oh God. Like I just know too much. But it's just a fact. Unfortunately that still around 10% of all pregnancies end in miscarriage. And that
Sara:number varies based on how old you are. Mm-hmm. It was actually helpful to go over these numbers ' I'll tell people the numbers when they do have a loss and it's never, you know, enough like, yeah, it feels bad. There's nothing I can say to lessen the. The sadness of that visit. You come in for your first OB visit, we do the ultrasound and it's a loss. And that's such a bummer. Yeah. But it really is common, you know, for women are my age, 35 to 39, the loss could be as high as 17%.
Supraja:Did you correct? From our To my, yeah.'cause of
Sara:my, because you're in that under 35
Supraja:range. I'm 34 guys. Okay.
Sara:But women over the age of 40, it can be up to 33%. So that's why oftentimes I will tell people about one in five pregnancies may end up in
Supraja:a loss. Yeah., And we don't exactly know. Also because sometimes people don't know that they were pregnant. Mm-hmm. Or they're not coming to the doctor, you know, they realize they were pregnant. They have a miscarriage before, they have a doctor's visit., so all of that, it's probably higher than we think. And miscarriages can look like a lot of things. Like sometimes it's just , you have serial ultrasounds and , it hasn't grown into. What it's supposed to. Sometimes it's like the traditional, what you see on TV of like people bleeding, you know, it can be a lot of different things and it's really sad. Some people have
Sara:no symptoms. Yeah. And it's just, you know, it's hard., most of the time it's in the first trimester, , in a very small percent of people, it'll be in the second trimester. So after 14 weeks.
Supraja:Mm-hmm. That's like less than 1%, so very unlikely. And then once you've had a miscarriage, Hopefully none of you do, but if you do, your risk of having another one is slightly increased, but really after two is when the risk goes up a lot and when we recommend testing for other causes of miscarriage.
Sara:But even with that, I have many women who have had two back-to-back miscarriages. We do the workup. And the workup is negative. Yeah. Less than 5% of the time. Has the workup ever come back positive for me? Like where it was, there's a specific reason why somebody keeps having a miscarriage. Yeah. Most of the time it's just unfortunate luck. And then the third pregnancy ends up being normal.
Supraja:Yeah.
Sara:So you know, if you do, end up having two back-to-back losses, in that case, usually a workup is warranted. And so some of the things we'll be looking at your anatomy, like at the uterus you have huge
Supraja:fibroids. Do you have a septum like tissue dividing the uterus, those sorts of things. And often we can fix that to improve your chances. We look at your genetics sometimes to see if you have in your karyotype, in your chromosomes, if there's anything that would lead you to have a higher risk of miscarriage. And often then we look at the partner,, chromosomes too, to see if those together result in a higher risk of miscarriage.
Sara:And then we can look for rare diseases like antiphospholipid syndrome. Yeah. Where that can cause recurrent miscarriages. And we are gonna. Go over some of these things a little bit more thoroughly in other episodes on the next season. Like, okay, what does happen in an infer, like a difficulty conceiving workup or, Supraja: and recurrent pregnancy loss. Yeah. And if you guys have more questions, always send us a message.'cause we wanna have our friend Emily, who's a R e I, doctor on. Yep. And we have other friends. We do. Yeah. We're gonna make other friends. You have friends besides me?
Supraja:No, but we are, we're gonna make them and ask them to come on the pod. You know I added the pod to my cv. You did? I did. Oh, I wrote like co-founder, co-host, co-producer. Oh, a co-producer. Damn. I can't put down co-producer. Yes, you can. You do the outline. Oh yeah. That's
Sara:producer, that's production. Yeah. I'm, what's that guy from, um, American Idol. Ryan? Yeah. I'm Ryan
Supraja:Seacrest. You're Ryan Seacrest. Yeah. I'm gonna be, yeah, baby. That's what's up. You're gonna bleach your hair blonde. Gonna get frosted
Sara:tips. Yep. And I'm gonna never be in a committed relationship. I'm just kidding. Love you, Ryan.
Supraja:Love you Ryan. Hire us. I'll be Ryan Seacrest. He's like a multimillionaire. I, I
Sara:messaged my friend. I was like, this man hustles. Yeah.
Supraja:You're still hosting American Idol when you own like the Kardashians.
Sara:Well, and he's also gonna do, he's the new host of, um, what's that Vanna White Show? Who's ? Remember
Supraja:would hold up the letters for that. Oh yeah.
Sara:What's that show called?
Supraja:Um, wheel of Fortune. Yeah. He's the new person of that show. What? Yes. Oh my God. I mean that man don't stop. Yeah. Okay. Ryan, Sara's you. I don't know who I am. I'm like the tech Indian kid in the background that doesn't get any credit. The tech Indian kid who's like, yes, I was on American Idol. I made it show up on the tv. Anyway, happy season one. Happy season. uno, cheers.
Sara:Proud of you guys. Proud of you. Bye.