The Truth About Fertility, Egg Freezing and IVF w/ Dr. Jaime Knopman

00:00Just because you're getting periods, right, you can be getting periods into your 50s, it does not mean that you're able to get pregnant. The quality of your egg is so far reduced that it would not translate into a healthy pregnancy. Hey, everybody, what's going on? Welcome back to The WarriorBabe Show. And today I am joined with Dr. Knopman. Is that how I pronounce it? Yeah, that was perfect.

00:31She is a double board certified reproductive endocrinologist. She is a director of fertility preservation at the CCRM Fertility in New York and the author of her upcoming book, Own Your Fertility. She's also known as the queen of egg freezing. She combines leading edge science with a deeply human approach to reproductive care, to helping women better understand these hormonal shifts that we all experience and that in the ways of how they impact fertility and including the often overlooked stage of perimenopause.

01:09So I'm excited that you're here, Dr. Jamie. Welcome to the show. Thank you so much for having me. You're welcome. Like I said, before we even hit record, I'm just stoked to pick your brain on this topic. But before we even dive into the buckets that I want to navigate with you, can you share what first led you? Like why? Why this space? What led you into reproductive endocrinology and women's fertility in the first place? Yeah, sure. So I knew I wanted to be a doctor since I was eight years old in the second grade.

01:41I read this book about Elizabeth Blackwell and I was like the first female physician in the U.S. And I was like, that's what I want to do. So I thought when I got to med school, I knew I wanted to do women's health. I thought it was probably going to be like breast cancer surgery. But then after going through rotations, I realized I just really wanted women's health, not necessarily anything surgical and went into the field of OBGYN. I was fascinated by hormones and how the whole system worked. I used to say it was like watching the philharmonic, right? Like all the conductor, the brain has to lead and all of the instruments have to listen.

02:15And that's how I picked to go to reproductive endocrinology and infertility. It's funny because like my passion with hormones, it really sort of shifted and I became a fertility preservation doctor, right? But that's how I got into the field initially. That's awesome. So it kind of took on of its life of its own into this like specific niche area. Exactly. Yeah. Okay. So let's dive into first the bucket that I have in terms of, you know, women trying to conceive while they're in this stage of perimenopause, but maybe not even knowing they're in this stage of perimenopause because I, you know, it happens later in life.

02:51But a lot of women think that it's still associated with like our early or later 40s or 50s where we started to go into like either perimenopause or menopause. But now we're seeing these hormonal shifts. I mean, even for me personally, like the people on the podcast know that I've shared like a hormonal journey that I went through last year and the year before from freezing my eggs. And then last year, I feel like my hormones, like I woke up and things were different. So I'm realizing I'm only 35. I'm realizing these hormonal shifts like begin to start happening earlier.

03:22And sometimes when women are actually too trying to conceive. So can you just dive in first and explain like what perimenopause actually is and when does it truly begin? Yeah. So perimenopause, I think it's a term we like throw around, especially now. It's funny. Last night I did a talk for like 40, 20 plus year olds. And I was like, you know, menopause is so hot and perimenopause. And they all looked at me and my friend who's my co-author is like, no, it's just hot on our Instagram because we're in menopause. I was like, yes, that's true, I guess. But perimenopause can last for, you know, anywhere from one to six to seven years because it's the changes that occur before menopause.

03:59So a lot of these diagnoses wind up being retrospective, right? Like so menopause, you need to have no menses for a year to be called to be a menopause. Perimenopause, usually we start to see it as the hormonal, there's a shift, right? So the periods which used to be regular become irregular. It's often accompanied by diminished egg quantity, diminished ovarian reserve. And this can happen, unfortunately, for some women at younger ages than we would expect. We're seeing a lot of these younger ages because we're seeing a lot of women come in to freeze their eggs, right?

04:32Let's say in their 30s and you'll pick it up because you'll say, wow, this woman's menstrual cycles are all over the place. And her egg quantity testing is quite low. And together it helps us make that diagnosis. Interesting. Why do you think that it's happening earlier than expected? As you just stated in terms of like. Yeah, I don't. It's a good question. I don't know if it happens earlier, more frequently. I think we diagnose it more because we're seeing more women have children at later ages, right?

05:02So let's say, let's go back to like my grandmother. They all had their kids in their early 20s, right? So they didn't experience infertility the same way because if they went through perimenopause at 38, which is abnormal, it didn't like they didn't think anything of it because they're like, oh, I had my two kids. I may be just having early menopause. But it didn't like clash with their fertility like it does now because so many of us have our kids later. Yeah. Okay. So on that point, in terms of someone having a regular cycle, if someone's having a regular, still having a regular cycle, but she feels and she feels like she's doing everything right.

05:36It's still shocking to learn. Sometimes the fertility may be shifting and it's not and it's not as easily happening as she thought that it would in terms of getting pregnant, like later on in life. And like being 35 or 40 years old, how does, how does perimenopause impact the fertility in that respect? You know, even before it's irregular. Well, number one, if your ovulation is irregular, it's harder to time when to have intercourse, right? So like whether or not the egg quality is good or not good, if you don't know when you're ovulating, because those ovulations are not coming at regular cadences anymore, timing can be challenging.

06:10But the biggest hit that we see is the quality of the eggs that we're releasing have so much less potential than they did 10 years before. Yeah. I want you to dive in a little bit about that because that was something that really like egged me on in terms of freezing my eggs because I don't have children yet. I want children. But being 35 years old, I know that that's when your quantity and quality starts to decrease and ovarian reserves start to diminish. So can you just elaborate on what that actually means a little bit further?

06:40Yeah. So we as women are born with all the eggs we're ever going to have, right? We never make new eggs. And most of us start to see a fairly significant decline once we start to hit into our 30s, right? There's this stat that at 32, you've lost 90% of your eggs. And it's not just that you have less eggs present. It's that the quality of the potential, the egg that's there, has a way less chance of making a healthy pregnancy. And so these two things tend to align right when most women are trying to start their families.

07:10What would you say are the biggest misconceptions that women have about their fertility window? Oh, that it's inevitable, that it just goes on and on. I coined this slogan when I was in fellowship. It was menses does not equal motherhood. Just because you're getting periods, right? You can be getting periods into your 50s. It does not mean that you're able to get pregnant. The quality of your egg is so far reduced that it would not translate into a healthy pregnancy. Interesting. How can one make the quality of their eggs better? If you figure that out, you and I will be sitting on a peachy and not, I don't know,

07:42St. Bart's, we'll be like, sorry, we retired. We don't work. No more Philly. No more New York. We're done. Or you'll buy the Eagles and go and watch all the games. Well, let me ask this, because I know there's a lot of women that have stress or burnout too as well. Like, could that be a cause in that? Or is it just from our genetic makeup? I think, you know, we're an amalgamation of a lot of different things. I think the primary cause is definitely genetics, right? I always say I had got breast cancer at a young age and I'm very healthy.

08:12I watch what I eat. I exercise. I do all of that. I got breast cancer because of my genetic makeup, right? It had nothing to do with my lifestyle. Now, that doesn't mean that there's not something maybe that I did to push that forward. I'm certain there probably was, but we are limited by our genetics, right? We can't overrun our genetics. Now, that doesn't mean that we don't want women to be healthy versions of themselves when they're trying to get pregnant or when they're getting pregnant, right? Because the healthier body leads for healthier pregnancy. But unfortunately, it's become this motto where people have said, oh, eat right, take this

08:50supplement and your egg quality will get better. We know that that is not true. That's a nice statement to be made on this because a lot of people will think, oh yeah, if I do all these things right, then that will make this happen. Well, I think also we want control in an uncontrollable process, right? I like I'm a control freak, right? I look for how can I like make this better, that better? And unfortunately, there's a lot of times you can't and you just have to sit back and be so uncomfortable in that process and just say, I'm doing everything I can, but unfortunately,

09:23I can't control this. Yeah. Yeah, no, I appreciate that. I'm the same way too as well, try and control everything. And it's just like you can't control genetics. It's just what it is. Yep. So for anybody that is going through hormonal shifts, experiencing early symptoms of like for me, like I got my blood work done last year and I have low testosterone, low DHEA. My thyroid is low and I have a couple other things that are a little bit off. I'm working to make that better because obviously I want to be able to conceive naturally.

09:53As you get older, like what are some encouraging words that you would tell women that are going through or potentially being, you know, geriatric pregnancy or like, what would you encourage them to like? I'm definitely not a fan of that geriatric pregnancy term. I'm like, oh God. Neither am I. But like that's literally like it. Because it makes you sort of, you sort of feel like crap. You're like, oh, it's like, don't be such a hater. You know, I think that that was a term that we use to describe pregnancy in women above the age of 35 because once you cross the threshold of 35, your risk in pregnancy was

10:30greater than that of having invasive testing like an amniocentesis or a CVS, right? So we used to say, oh, once you're 35, you're geriatric, you should have invasive testing. Now we offer invasive testing to everyone. And so that line in the sand isn't there necessarily. Yeah. That's nice to know. Because like literally someone in my family found out they were pregnant and they called in to do an OBGYN appointment. And just because she said their age and it was a first pregnancy, they were like, oh, we'll see you like tomorrow. It makes you feel like, you know, that that's just what it is.

11:04I mean, the reality is you do need more surveillance as you get older and you're pregnant because you're more likely to have, you know, diabetes in pregnancy or high blood pressure. So we do want to be more closely monitored. But a lot of women who get pregnant in their 40s do just great. Okay. So let's go. Let's talk about what you're the queen at, which is this egg freezing. Where did you get termed that title? How did you get termed that title? Because I was so I graduated. I was a fellow around the time that egg freezing was like coming out.

11:34And so I was very fortunate to write a lot of the papers with people that were starting the process. And then I left my fellowship and I went to work at a practice where I was I'll never forget the senior the senior guy in the practice was like, you're 35 and you have ovaries. You can be the head of egg freezing. I was like, OK, cool. And then it just became that was my thing. And I saw so many young women freezing their eggs that it just I think it just became my jam. OK, I love that. OK, so as you just said, it became more visible in more recent years, especially in like, you

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13:44we first started egg freezing were in their 40s, right? It was out of desperation and there was no other option. The problem was those initial studies were like, oh, egg freezing is terrible. Egg freezing was terrible because the quality of the egg was already terrible, right? Now egg freezing is done for women in their 20s and 30s. And that's empowerment. We're like, yeah, I'm going to take control of my future as opposed to my future taking control of me. So if I had my way, and of course, everyone's going to be like, of course, that's how she makes money. Every single person would freeze their eggs in their 20s, right?

14:17Because it would give everyone optionality down the road. And that's really what the name of the game is. It's optionality. Yeah. And I'm not saying that if you don't freeze your eggs, you're going to have infertility. I'm not making that leap. I'm just saying if you don't do something, you are more likely to face fertility struggles as you get older. Yeah, absolutely. Because what do you feel like are the biggest mistakes that you see women make when it comes to waiting or assuming that they have the unlimited time? Because then they sit here in my office and they're crying at age 38 because they're like,

14:49what happened? Where did this all go? And I'm like, it's just normal. Like it's a natural part of aging, right? So it's like, then you're so far down the road that it may be hard to get what you want. Yeah. And then is that where a lot of people come to your office and they do IVF? Ladies, are you feeling frustrated with body changes you're experiencing during menopause? It's time to take control. If you're between 45 and 65 years old and tired of struggling with body fat and muscle

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15:56That's warriorbabe.com forward slash apply. All right, let's get back to the show. So if women have not frozen their eggs and they come in and they're struggling to conceive with a partner, frequently we'll do IVF now pretty early, like sooner rather than later, because we know that IVF offers the best success. If women come in and they don't have a partner and they're electing to be a single mom by choice, right? Be a mom.

16:27I might say to them, okay, let's just do IVF, but fertilize with donor sperm. It depends on what the timing or the situation is. Okay. Got it. So I've also seen a few people go through IVF multiple, multiple times. Can you talk about the process of what happens in terms of, okay, IVF happens, egg doesn't take when they go to implant it with the sperm? So usually what happens when people do multiple cycles is one of two things. Either number one, they don't get any healthy embryos, like they're doing genetic testing of

16:59their embryos and all the embryos are abnormal, or they do get a healthy embryo. We transfer it and maybe it doesn't work. So you could have failure. I don't like to use the word failure, but you can see failure in either of those places. It's rare that you are somebody who's going to go through IVF and like not get any eggs. That doesn't happen frequently. What happens more frequently is I go through IVF. I wound up getting eggs, but those embryos didn't chest chromosomally healthy. Gotcha. I'm seeing somebody that's gone on like our sixth or seventh time.

17:30Yeah. It's horrible. Yeah. Cause it takes a lot for the body. Well, it's also like so emotionally taxing, right? Like it's, it's hard to stay in the, like, it's hard to stay in the process. I often do say like, there will be times where I'll say to patients, like, I don't actually think this is going to work. I don't have a crystal ball. It's not a hundred percent or zero, but I'm, I've watched you go through several rounds of IVF without having success. And I want you to be a parent. So we have to think about a different way. And it may not be a way that you ever dreamed.

18:01It may not fulfill your initial hope or destiny of being a parent, but it will get you to be a, have a child. And that's really the end of the end of what you want. Yeah. Um, I want to like backtrack a little bit and ask you in terms of, you know, women that do want children one day, when should they start getting like testing or gathering information? Or you mentioned a couple of times genetic testing. Yeah. I mean, I think it should be a part of the OBGYN checklist, right? We go to our OBGYN and he or she does pap smear, breast exam, STD testing, contraception.

18:37That fifth pillar should be fertility planning, right? Oh, okay. You're 27. What are you thinking about for kids? Right? It's, it's not like a shameful question. Like, oh, what do you mean? You don't have kids and you're, you know, it's, it's more of how do you see this future going and how can we help you? Yeah. Can we talk a little bit about the egg freezing journey? I feel like I'm having a little bit of PTSD though. Um, well, so can you just talk like high level? Cause I, when I was on this journey, I got a lot of people reaching out being like, um,

19:10wanting to know the science behind it. I don't know. I know the science behind it because I asked questions to, to the person, the doctors that I was working with, but I would love for you to be able to explain the science of like the ovarian stimulation and what's going on and how you're gathering all the eggs. I ended up with like 20 follicles at one point. I was, and also, can we talk about and explain what happens in terms of the hormones that are shifting and changing? Because by the end, my estrogen was like 6,000 and I was a raging, like, I don't even know who I was. So like, yeah. So, I mean, everyone has a different reaction.

19:43I would say when they go through egg freezing, um, some women are going to get to have an estrogen of 6,000 and some women are going to have an estrogen of 600, right? It only can only stimulate in the ovaries. What is there? We can't make new eggs. Most young women, right. Who are coming to freeze their eggs. The egg freezing process takes about two weeks. They will come into the office, the fertility clinic every two to three days for blood work and ultrasound so we can see how their body's responding to the fertility medications. When do we need to increase the meds? When do we decrease the meds?

20:14And when do we take the eggs out? The medications that we give are subcutaneous, which means you have to inject them into your abdomen, right? And then you take a final shot and that final shot triggers maturation of the eggs. And then the eggs are extracted in an operating room 35 hours later. So that's like the high level of how it goes. In terms of how many eggs you get, the more eggs you get, the more you're going to feel it. So if your estrogen was 6,000, it makes sense that you felt pretty crappy by the end.

20:47Yeah. What a fun journey that was. But all for the greater good and vision of what needs to be done. Let's talk about that. You said this phase can quietly derail mental health and relationships. And I think it's such a powerful statement because so many women internalize these changes as like personal failures, as we were talking about a little bit earlier in many different facets, either egg doesn't take or the egg freezing isn't as easy or it's hard getting pregnant.

21:17What happens hormonally that contributes to that mood instability, that depression, that anxiety? Well, I think a baseline fertility is such a weighted topic in terms of because like most of us as women, like when we're little kids, like little girls, we like play house, right? We like put a pillow in our abdomen and make like we're pregnant. It's just something that we think is inevitable. So if somebody takes that away from you, it's very hard to sort of to conceptualize that. So I think it's such a heavy topic that you're right.

21:50The hormones are all over the place. Your estrogen goes high. Your estrogen goes low. Your progesterone. So it makes the process so hard to endure on top of everything you're going through emotionally. How does it affect the like our brain specifically? Well, there's a lot of receptors for different hormones in our brain, right? So when our estrogen is high versus when our estrogen and progesterone are high versus when everything is low, we're going to feel that differently. Yeah. How do how do fertility struggles like how do they combine with these shifts?

22:24It impacts somebody's like identity, like a woman's identity and sense of identity, especially for someone that doesn't isn't is this is hard or it's or I think you feel like you can't do what your body is supposed to do. And you find you get mad, right? You're mad at your body. You're like, what the F, right? You're supposed to do this. And then that anger is often put off on other people. So whether it's your physician, your friends, your partner, and that can be hard. I mean, I'm very I have had several patients be very mean to me and I usually can take it

22:56until a point. Right. And then I'm like, I understand this is so hard and I'm so sorry you're dealing with this. But you can't be mean to everyone here because we are really trying to help you. And I can say that as a physician, but that's I mean, relationships can fall apart, right? Because if you're with somebody and then this occurs, it can be challenging to stay in the relationship. 100%. I want to think and bring it lighten it up a little bit in terms of what do you what is like your coolest client like testimony that you have with with the egg freezing journey or even IVF

23:32either or? Well, I think I what I find the coolest is how many people send me their friends, right? Like that's me. There's no bigger compliment than sending a friend or a colleague or a sister family member, because that means that like I did a good job. Um, and that to me is very rewarding. Yeah, sure. Like the positive pregnancy test, the babies, all that makes you feel good. But I think it's people trusting in you and then telling their friends to trust in you. That is really a pretty big compliment. Do you love getting like seeing the people that have the success of the babies and seeing the

24:05babies being born and stuff like that? I mean, that pushes you forward, right? Because without a reward, it's hard to do what you do a day in and day out, right? It's not the easiest being in health care. It's not the easiest job, right? We take all it's a big burnout. So I think seeing the wins on the other side, it helps us all push forward. If there was one thing that you could, um, like a change about how women are educated in this topic, what would it be? Oh, that's a good one.

24:36But I, I think we need sex ed health class needs to be redone, right? We teach people how not to get pregnant, but we don't teach them how to get pregnant. And trust me, I have teenage daughters. Like I'm not psyched for them to run around and be like, Oh, my mom taught us how to get pregnant. Um, but we need to teach them that there is a finite period for when their fertility is around. And if they don't address it, it's going to be lost. Yeah. For, okay. Another question in terms of the labs, like, let's say someone's struggling to get pregnant,

25:11right? And that could be a hit on them personally. Like, Oh, I wonder what's happening. Why me? What, what, what my body isn't doing when I thought it would be doing. What are some labs that people should get tested if they're struggling with this? I always say, if you're struggling with fertility, infertility, you should go in to see a fertility doctor. It's hard to, you know, we, a lot of times we want to Google or Reddit it or chat GPT it. Right. And those resources are great, but they don't like, this is what we train to do for unfortunately a kabillion years.

25:41Right. So like, I'm always like, I went to four years of med school, four years of residency, three years of, like it took a long time to get. And yeah, chat GPT can break it down, but there's things that I know because I spent so many years doing this. So you really want to go in and get a fertility evaluation. And when women go in and do this, how would you encourage or, you know, lean on your clients or patients that you've worked with? What language women be using to advocate for themselves when they're talking to the providers

26:15in this, in this topic? That you want an evaluation, right? Even if someone's like, oh, you're 28, you can wait. Don't worry. Your eggs are good. Be like, no, I want to do this. I'm, I'm in charge of my own body and I want to do this. Yeah. Yeah. That was alarming for me last year when I got my lab work done. My ovarian reserve was actually low. Yeah. And I was kind of like sad and shocked at that because I'm like, I want kids. Like that hasn't happened yet. But yeah, definitely getting checked because you could feel great on the outside.

26:46You could feel like all things are going well, but until you get the marker of the quality, the quantity and how well it is, right? There's like the main things. And then also blood work. You don't really know the true story. Yep. A hundred percent. Is there anything that I didn't ask you yet that you'd talk about every single day to your patients? Oh, I talk about, well, I'm going to pull it over. I talk about, this is the book that came out on January 13th. So I always tell people, I'm like, I wrote the book because I'm very loud, but I'm not, I'm only as loud as the four walls of my office.

27:17So I want to share the message that I've seen and what I know with everyone else. And I also, I say like our title of our book is called Own Your Fertility. And now I like, even though my initial title was Wear Sunscreen and Freeze Your Eggs, which I thought was an amazing title, but the publisher didn't think it was as amazing as I did. It's a chapter title, but I do love the title now because it really is true. It's like, own it, like own it. You own it. Don't let it own you. Right. And that's not to say like, you don't have to have kids. You don't have to have, you freeze your egg.

27:49You don't have to have, you know, your path can be whatever you want your path to be, but you should be nav, me marking that path, paving the way, not being done to you. Yes. Amen to that. When did that come out? I thought that was upcoming. Oh no, I think we had to reschedule or something. That was January 13th. Oh yeah. Congratulations. Thank you. I've learned that it is exhausting selling a book, right? I'm like, I feel like I'm back to my days of being an OBGYN intern where I'm like, I don't even sleep. There you go.

28:20Hey, you're, you're conquering what things all the time growing. That's good. On there with surrogacy. So I'm interested really quick before we hop off, just to ask you a question around that. How do you, how do you encourage your clients to go down that route? Um, and how do you navigate dealing with a mom that may be struggling? Like, Hey, I'm not the one that's holding my baby. Um, but I'm choosing to put it inside of, you know, another, another woman. I mean, surrogacy is a beautiful way to have a family. Right. And first of all, the surrogates are like gifts from God. I mean, as somebody who hated pregnancy, not once, but twice, like every minute of it,

28:54I am always like, wow, you are an angel. Um, and it's beautiful that we can offer this and that we can offer this successfully to women who can't carry or single men or male, male couples. Right. It's a beautiful thing. And I, I think we have to remember, like, we all come to being parents in different ways, long gone are the ways of like, you know, my parents, the 1950s, like it's very different now. So you're going to be a mom or a dad and it may be in a non-traditional way, but that doesn't make you any less of a mom or dad.

29:25In fact, it probably makes you more because you wanted that kid so bad that you would do absolutely anything to get him. Love that. That was a beautiful answer. Well, thank you for being here. Thank you for bringing a lot of clarity. And also I can just feel your compassion and your passion for this topic. Oh, thank you. It's really cool to see how it brought you and landed you into fertility. And I feel like, you know, this is a topic that a lot of women are navigating quietly. So thank you for the work that you do every single day and bringing more encouragement

29:56to this field of things. You know, I think anybody that's listening to this, if it resonated with you, I'm going to ask Jamie, where can, where can women find you or find more information about you? Yeah, sure. So you can find the book and Amazon and Barnes and Noble. I have a website, Dr. Jamie Notman and an Instagram, Dr. Jamie Notman. I spell my name J-A-I-M-E. I would kill my parents for doing that because I'm like J-A-M-I-E Notman is getting a lot of emails. And I work at a fertility clinic in New York City.

30:28It is called CCRM New York. Always happy to help in any way I can. Awesome. Yeah, if anybody is on the East Coast, go check her out. Thanks, Jamie, for being here. I appreciate you. Thank you so much. Have a great day. Thank you. Real quick, if this episode resonated with you or gave you the push that you needed, I'd love for you to pay it forward. Drop a quick rating and review, share the podcast with someone who might need it and help me keep spreading the word. Your feedback not only helps the show grow, but it might just be the nudge someone else needs

31:01to kickstart their transformation. Thank you so, so, so much for your support.

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