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0:30

Welcome

0:33

to The Referral, with me, Dr. Curran. This

0:35

is your go-to podcast for evidence-based

0:38

health information without the pseudoscience.

0:40

Every week, I'll be chatting to experts and interesting

0:43

guests, bringing you updates from the world of

0:45

science and debunking ridiculous medical

0:47

myths. Are we in the midst of an infertility

0:49

crisis? Are we becoming more infertile

0:52

as a species? Today's episode is

0:54

going to revolve all around infertility

0:57

and what we can do to counteract it and

0:59

how we can improve our fertility to

1:01

give us the best chance of conception.

1:04

How much does egg freezing cost? Can you

1:06

freeze embryos? And what are the risks and

1:08

side effects of these things? Who better to

1:10

tackle this interesting subject than Dr.

1:12

Helen O'Neill, a world-leading

1:15

expert in reproductive science.

1:16

She's also a lecturer in reproductive

1:19

and molecular genetics. If you have irregular

1:21

periods, heavy bleeding, too much

1:23

bleeding, too little bleeding, those are signs that

1:25

your body is actually under distress. The

1:28

egg is so important, it's the largest cell in the body,

1:30

just saying. And the sperm is the smallest

1:32

cell in the body, just saying. Don't come near

1:34

my egg

1:35

with your sub-pod sperm. Go

1:37

on a detox. I'm going to be giving

1:39

you lots of information and asking my guests lots

1:41

of questions, but I'm not left you out. You'll

1:43

also get the chance to ask me a question in

1:45

Crowd Science. If you've got a really important

1:48

question that you're desperate to get answered,

1:50

feel free to get in touch at thereferralpod.com.

1:53

And if you enjoy my myth-busting and the deep

1:55

dives I go into on your questions, you can

1:57

get more of this if you go to the referral

1:59

show page. on Apple Podcasts and hit

2:01

the try free button at the top of the page

2:04

to start your free trial today. If you do that, then

2:06

you'll unlock the Crowd Science Extra episode

2:08

that sits right under this one on the feed. Alright,

2:11

enough of that. It's

2:12

time to see what fresh offerings we have in

2:14

the world of science, health and medicine. AI,

2:18

artificial intelligence, contrary to what you might have

2:20

heard, might be

2:22

our savior. With all the dystopian predictions

2:24

about how AI is going to turn into Skynet

2:26

and then enslave the human race, this

2:29

story might surprise you and might

2:31

help us beat cancer. Scientists

2:33

at Harvard University have created an AI

2:35

with an algorithm that can help us predict

2:38

someone's risk of pancreatic cancer.

2:40

Now, I've spoken about pancreatic cancer many times

2:42

before and the reason is it's an absolute

2:45

devil. It's one of the most aggressive types

2:47

of cancer, killing 88% of people

2:49

within 5 years of diagnosis. And

2:51

the reason

2:52

for this is it's often picked up too

2:54

late and it's asymptomatic for many months

2:56

or many years and the symptoms sometimes only

2:59

appear once it's too late and the pancreatic

3:01

cancer has metastasized or spread

3:03

to other organs. And at this point, it's generally

3:06

too late and people have a lifespan

3:08

of maybe a few weeks or months. But

3:10

these Harvard scientists have trained an AI

3:13

with tens of thousands of patients' medical

3:15

records and built this AI

3:17

which can predict someone's risk of pancreatic cancer

3:20

just by looking at their medical records

3:22

alone. And once you have someone at a high risk

3:24

of pancreatic cancer using this AI

3:26

algorithm, you can then put them forward for screening.

3:30

Now, the AI algorithm is only as good as the data

3:32

you train it on. The researchers trained their

3:34

AI on the patient record of 6.2 million

3:37

patients in Denmark spanning 41 years.

3:41

And included in this dataset were 24,000

3:43

pancreatic cancer sufferers. Now, when the AI

3:46

was looking at all of these patients' medical records

3:48

and then correlating it with patients who had suffered

3:50

pancreatic cancer, they were able to discern

3:52

certain features and health patterns associated

3:55

with pancreatic cancer. Things like anemia,

3:58

weight loss and various other medical records. conditions.

4:01

Now, the AI can dredge through millions and

4:03

millions of data points that a simply human

4:05

being or a doctor can't do. What

4:08

does this mean in real terms? The

4:10

AI is not able to look at a patient's medical records

4:12

and say for certain that a patient has an

4:14

X percent chance of developing pancreatic cancer,

4:17

but it can give a relative risk of the

4:19

disease. As an example of how effective the

4:21

AI was in this study, for every thousand

4:23

patients that the AI flagged, 320

4:26

went on to develop pancreatic cancer.

4:29

And of these 320 patients, there were 70

4:31

people who ordinarily would probably

4:33

have missed screening and wouldn't ordinarily have

4:36

been put forward for any screening test

4:38

or any sort of investigation. Now, this is very

4:40

early stage research. It needs to be trained

4:43

on global databases, ethnic minorities,

4:45

different genders. So it needs a

4:47

lot more than just a Danish population cohort

4:50

of data, but the future is

4:52

promising. And that's it with what the health for

4:54

this week. Let's get into all things fertility

4:57

with Dr. Helen O'Neill.

5:06

Why

5:25

were medieval priests so worried that women were going to seduce

5:27

men with fish that

5:36

they'd

5:42

kept in their pants? Who was

5:44

the first gay activist? And

5:46

what on earth does the expression sneezing

5:48

in the cabbage mean? I'll tell you, it's

5:51

not a cookery technique, that's for sure. Join

5:53

me, Kate Lister, on Betwixt the Sheets,

5:55

the history of sex scandal in society,

5:58

a podcast where we will be bed-hopping.

5:59

throughout time and civilization

6:02

to bring you the quirkiest and kinkiest

6:04

stories from history. What more could

6:06

you possibly want? Listen to Betwixt

6:09

the Sheet today wherever it is that you get your

6:11

podcasts. A podcast

6:13

by History Hit. What is

6:20

your favorite science expert? You

6:24

are a fertility expert or reproductive science

6:27

expert. Tell me a little bit about

6:29

who you are, what you do and one

6:32

super interesting fact about your job.

6:34

I am a molecular

6:36

geneticist so my background is in

6:39

prenatal genetics and fetal medicine and

6:41

I did a PhD in stem cell genetics and developmental

6:44

biology specifically looking at the formation

6:46

of the ovary before becoming a

6:49

lecturer in reproductive and molecular genetics

6:51

at the University College London where I lecture masters,

6:53

students and medical students about

6:55

all things reproduction, fertility, infertility,

6:59

anatomy, embryology. One

7:02

super interesting thing about my job

7:04

is the fact that

7:08

even now when I present

7:09

at conferences about some of the

7:11

cutting edge tools that we are using at the moment people

7:14

think that this is like sci-fi but the

7:16

context of it

7:18

are things that we have been doing for over 30 years. So it

7:20

amazes me to this day how out of

7:22

touch people are about modern

7:24

science practices within clinical

7:25

medicine. It seems that we probably know

7:28

more about things which are

7:30

at the bottom of the ocean or in outer space

7:32

than we do about gynecology.

7:34

One of my favorite things to say is that we have

7:36

spent more money and time mapping our galaxies than

7:38

our gynae. I wanted to do

7:40

a deep dive on fertility and

7:42

just those kind of facts

7:44

which are thrown around online about

7:46

how women are born

7:49

with all the embryo or all the eggs that they

7:51

will ever have in their entire lifetime which obviously

7:53

is true. But looking at some of the

7:55

stats and the decay curve

7:57

of how many eggs are lost over the years.

7:59

is quite a shocking read going from maybe

8:02

one to two million when a woman

8:04

is born to three, four

8:06

hundred thousand at puberty and

8:09

then one or two thousand at menopause

8:11

around the age of 50. I mean that is shocking

8:13

statistics.

8:14

It's the fastest aging organ that we

8:16

have is the ovary. So what's

8:18

more than just being born with

8:21

all the eggs we'll ever have? To me what's

8:23

more interesting is that the eggs we're born with

8:25

we've really had through generations. So

8:28

the eggs that I have

8:30

in my ovaries that

8:32

were laid down while I was in my mum's

8:35

uterus that were affected

8:37

by when her mother was... her

8:39

mother's diet, to me what's interesting is the

8:41

transgenerational impact of our

8:44

lives on our grandchildren because

8:46

of how early on our

8:49

egg cells

8:50

are formed. So, you know, conceivably

8:52

your eggs were

8:55

predetermined when your grandmother was pregnant with your mother.

8:58

Exactly. Which is crazy. I

9:01

mean it's kind of like a long rich history

9:03

of eggs being planned in advance. If, you know, now more

9:05

than ever you hear these

9:08

headlines about the human species

9:10

being more infertile compared to several decades ago,

9:15

now specifically focusing on women

9:17

and the infertility crisis that you hear about

9:19

on the news headlines, are

9:20

we becoming more infertile? Yes,

9:22

we are.

9:23

And it's for a number of reasons. So when

9:26

we look at fertility or infertility,

9:32

actually when you look at the NIH list

9:35

of reasons for infertility in women, there are 11 different

9:37

listed causes, whether it's genetic ovulatory, whether

9:40

it's uterine, whether it's chromosomal. There's

9:43

lots of different reasons. But the number one cause for modern

9:45

day infertility is age. So

9:50

we are simply waiting much later in life before

9:52

we start our families. And

9:55

as a result, that has the biggest impact.

9:59

That is really compounded

10:02

by the change over the last few decades

10:04

in our lifestyles. Women are drinking more, they're taking

10:07

drugs, they're exposed to so many

10:09

chemical compounds within

10:12

cosmetics, within just everyday

10:15

household detergents. We are constantly

10:17

exposed to both

10:20

compounds that affect our fertility but also alter

10:22

our hormone imbalance. So there's really

10:25

a lot of reasons why our fertility

10:27

has suffered. But the number one

10:29

reason is that we are giving

10:30

ourselves the worst possible chance

10:33

by leaving it later. Apart from the classic

10:36

smoking and alcohol, what are some,

10:38

you know, fiends for reproductive health that

10:41

we should take more notice of but we

10:43

don't?

10:44

Well it's interesting that they say that

10:47

both women and children are

10:49

more exposed to endocrine disrupting

10:51

chemicals, namely phthalates

10:54

which are released when we heat

10:56

plastics. And

10:58

one of the main reasons in my opinion that

11:01

that is the case, they say it's because children

11:03

chew on plastic toys and they have plastic toys. But

11:06

in reality when you look at nappies

11:09

and this direct exposure to

11:12

really not good quality plastics that are

11:14

put in the majority of nappies or

11:17

menstrual products for women and

11:19

cosmetics, we are literally exposing

11:22

our skin, which is

11:24

an organ in itself, on a daily

11:27

basis when you look at cosmetics,

11:29

whether it's hair, skin, makeup, to

11:33

applying panty liners or nappies

11:35

in babies, we are constantly exposed to

11:37

these chemicals which really do have

11:39

a known impact

11:42

on our endocrine system. As you

11:44

mentioned, they actually mimic oestrogens,

11:46

so they're known as xenoestrogens.

11:48

So you mentioned the endocrine system, just for

11:50

those who aren't fully aware of the full remit

11:52

of what the endocrine system is, what is it?

11:54

So it's essentially, if you think about your endocrine

11:57

system, it's like an orchestra. I always think

11:59

of our hormones. as being individual

12:02

songs or a note, and the

12:04

organs that produce them, whether it's the adrenal glands

12:07

producing adrenaline, as being

12:09

the instrument and the orchestra

12:12

that is playing. When all of those play together, it's

12:14

in beautiful harmony. But when one

12:16

bum note is played, it ruins the entire

12:18

symphony. And so that really to me

12:20

is the endocrine system is like all of our hormones

12:23

that are being produced by different glands,

12:25

by different organs, whether it's in the brain, our ovaries,

12:27

whether it's our pituitary, whether it's our adrenal

12:30

glands. There are so many of these little endocrine

12:33

glands that produce hormones at all

12:35

times that are responding to different

12:37

stimuli. They're

12:37

all intermingling with each other as well. Exactly.

12:40

You get a fright. Your adrenal gland produces

12:42

some adrenaline. Your heart starts beating faster.

12:44

You start breathing more

12:47

heavily. Cascade. Exactly. It's all of

12:49

this ability for our body to essentially protect

12:51

itself. What are some

12:52

strategies that are

12:55

sustainable and easily doable just

12:57

to at least counteract some of the disruptions

13:00

to reproductive health from a women's

13:02

point of view? I think being aware is

13:05

the first thing because when you... In

13:07

reality, it's actually a little bit depressing when you become

13:09

aware because you look around you and you say, I am surrounded

13:11

by everything. Whether it's

13:14

our sofas and the upholstery, whether it's

13:16

the containers that we drink our coffee from.

13:19

But I think that level of awareness, certainly when

13:21

it comes to the things you have a choice about, right? So

13:24

cosmetics, perfumes, all of

13:26

them have high level of phthalates within them.

13:29

And so there are things that you

13:31

can buy or cosmetics and shampoos,

13:33

conditioners, etc. that have much

13:35

lower levels as an app called ThinkDirty. And

13:38

you can actually scan whatever it is and

13:40

it will tell you the level of dirtiness. In

13:42

other words, how many different chemical compounds

13:44

are in it. And that has been a real eye opener for

13:46

me to see, you know, some of the real household

13:49

brands and just how dangerous they are from

13:51

a toxicity point of view. So

13:53

I think that's kind of something you can definitely do. And

13:56

then when it comes to consumption, I

13:58

would never heat any...

14:00

I never, you know, a microwave meal, they

14:02

should be put into a glass container if you're going to eat them.

14:05

I don't ever heat, you know, in Tupperware,

14:07

I would always heat things in glass

14:10

dishes. Same with the dishwasher, even though

14:12

it's annoying, I never put plastics in

14:14

the dishwasher.

14:15

This, obviously, quality of the eggs is

14:17

another determining factor as well. And, you know,

14:19

just doing some of the sort of reading around

14:21

fertility, it looks like one

14:24

biomarker or one representation

14:26

of at least quantity or ovarian

14:28

reserve is anti-malarian

14:31

hormone. For someone who is a woman,

14:33

you know, as part of a couple in

14:35

her 20s, mid-20s, probably

14:38

issues about fertility for the average person may

14:40

not be at the top of their mind. They may not even be

14:42

thinking about kids. But at

14:45

what point

14:46

do you think women should have a sort of a

14:48

routine screening just to get a baseline

14:51

understanding of her own fertility

14:55

level or capacity should they have, even

14:57

if they're not thinking of kids for the next 20 years

14:59

or ever? Honestly,

15:00

I think this is the whole reason I started

15:02

my company, Hurtility, was

15:05

to give people that license

15:07

to look for any answers

15:10

about their body. It's very interesting that you

15:12

say they may not even be thinking about it or

15:14

may not even be in their mind. But

15:17

the reality is that

15:18

every single month we get a monthly reminder. And

15:21

when our period is late, we wonder. When our period

15:23

is early, we wonder. When we have, you

15:25

know,

15:26

symptoms associated with

15:28

menstrual dysfunction, we question

15:30

that. And so really, there's

15:32

an internal dialogue that every woman

15:35

has. And that is asking one of

15:37

the biggest questions there is, can I have

15:39

a baby? I mean, I do think we're moving

15:41

away from thinking about those questions much earlier,

15:43

but it still resides within

15:46

from a very young age, from when we give little

15:48

babies dolls to play with is this maternal

15:51

instinct about when will I have a baby? And

15:54

the fact that we are so connected

15:56

in everything we can plan our to

16:00

work, we can plan our route on holiday, we can book

16:02

and organise every single facet of our lives, but

16:04

one of the biggest game-changers within your life

16:07

is when you have a baby. And not being able to

16:09

plan

16:10

how, when and if

16:13

is so strange to me. It just goes against everything

16:16

that revolves around

16:18

being the modern human.

16:19

Fertility is also a marker of longevity

16:22

to an extent as well. I mean, if you

16:24

have more eggs and a greater ovarian

16:26

reserve, you've got more time to go until

16:28

you hit menopause, which is a significantly

16:31

deleterious state in a woman's life.

16:34

How can a woman do

16:36

things to optimise their longevity, vitality,

16:38

but also chances of getting pregnant

16:41

should they wish to next week or next month?

16:43

What are some sort of things?

16:45

To me, I think it's so important that from

16:47

a very young age, we're aware of our

16:49

reproductive health. There are so

16:52

many different elements of our life

16:54

that are affected by our hormones.

16:57

So, in a weird way, I think, depending

16:59

on your age, we should frame the narrative

17:02

a little bit more differently. If you're talking to a 20-year-old,

17:04

they may not necessarily be interested in their fertility, but

17:06

they will care about their hormones and they're so interlinked.

17:09

And they think that's why we don't test just AMH

17:11

with fertility. We made sure we take

17:13

a very significant medical history, but

17:15

also that we test all of the other associated hormones,

17:18

whether it's thyroid or uterine and your

17:20

cycling

17:21

hormones. Lutinising hormone, FSH. Stemming

17:23

it exactly. Polyclose, stimulating it. Estradiol,

17:25

thyroid function. If

17:27

we think you have PCOS, we'll test your androgens.

17:30

All of that is very important in determining

17:33

what your fertility is, but also your

17:35

overall reproductive health and therefore health. So,

17:38

we know that our menstrual cycles have

17:40

been added as one of the vital signs.

17:42

And that's a really important thing to recognise that

17:45

if you have irregular periods, heavy bleeding,

17:48

too much bleeding, too little bleeding, those are signs

17:50

that your body is actually under distress.

17:52

And to me, I find it as one of the biggest mistakes

17:55

that we've made over the last 30 years, is

17:57

that rather than listening to those body

18:00

gives us. These are very significant notifications

18:03

that we've now learned to mute. That

18:05

teenagers go with menstrual dysfunction

18:08

to their GP and they're prescribed the

18:10

pill. Painkillers

18:11

or something even. Or the pill.

18:13

So instead of just listening and understanding

18:16

and actually testing their hormones and understanding

18:19

what is the root cause of this dysfunction,

18:22

we're just going to put a blanket or put

18:24

a band-aid over it and

18:26

put them on the pill. And if you present as

18:28

a patient with severe

18:31

cramps, hormonal acne,

18:33

weight gain, weight loss, any of those things and you put on something

18:36

that will make that go away, there's no

18:38

point in your life that you're thinking, today's

18:40

a good day for that to come back. If you've been put

18:42

on

18:42

the pill to remove any

18:44

of these

18:45

symptoms that I mentioned, the

18:47

only reason you're going to actually decide maybe those

18:49

symptoms can come back into my life is because you really

18:52

need to come off it in order to start a

18:54

family. And it's then people realize, well

18:56

actually I've been on this form of contraception for the last 10 years,

18:58

I have no idea what my body is doing. And

19:00

so to me I think everyone from 18 years

19:03

on should check in on their reproductive health.

19:06

Know what their hormones are doing because when

19:08

you look at the global trends, the number one

19:10

prescribed drug in the world is thyroxine.

19:13

We have a big problem globally with hormone

19:15

imbalance and our hormones dictate

19:18

our mood, weight, skin, appetite,

19:20

metabolism, sex drive, menstrual

19:23

health. Almost every facet of our life

19:25

is controlled by our hormones and yet

19:27

when you ask people, you know, how

19:29

are your hormones? The majority just don't know.

19:31

They don't have an ability to determine

19:34

what they are. So it's part of our ethos is

19:36

that, you know, if we tell

19:39

people that you need to get your cervical smear test, right,

19:41

that's, it's kind of a narrative now where we

19:43

almost shame each other if somebody hasn't gone to get their

19:45

smear test because, you know, you're

19:47

not taking care of your health. You're not taking care of your health and the

19:50

chances of cervical cancer are 1 in 64.

19:54

But your chance of having a reproductive health condition at some

19:56

point in your life are 1 in 3. So we should

19:58

screen annually especially.

19:59

because it's such a dynamic and

20:02

changing aspect of our life that is

20:04

so susceptible to external stimuli. So

20:06

our hormones are very susceptible to changes when

20:09

we're stressed, hence why our periods will stop,

20:11

when we're under pressure, you know, there's, they're

20:14

so interlinked. Mason

20:15

Are there other things sort

20:17

of in the run-up to, you know, trying

20:20

to get pregnant? A couple are trying to get pregnant, apart

20:22

from obviously having intercourse. What

20:24

are some things pre and post

20:27

that intercourse can you do to optimize

20:29

chances of, you know, conceiving?

20:31

Dr.

21:23

To

21:26

optimize our ability to conceive,

21:28

to reduce external stress, to, at

21:30

the end of the day, stress reduces our ability to

21:32

ovulate. But also when we think about

21:35

all of the things we're putting in our body and the

21:37

fact that during our menstrual cycle,

21:39

when our, all of the follicles

21:41

in our would be eggs in our ovaries are

21:44

maturing and getting ready for that. Mason Nine

21:46

months as well. Dr. Well, prior

21:48

to any of this, that egg that is going to be released,

21:51

like you want to make sure that that egg that is released

21:53

has been nurtured in the most healthy of environments,

21:56

but prior to conception. But

21:58

when we look at, so I think that the.

21:59

The egg is so important, it's the largest cell in the

22:02

body, just saying. And the sperm is

22:04

the smallest cell in the body, just saying. But

22:06

the sperm has such an important role. It gives 50%

22:08

of the DNA. And

22:10

yet, we just think of that, the

22:12

man shows up and does the party piece. But

22:16

when I mentioned about ovarian stem cells, we

22:18

are born with all the eggs we'll ever have, right? There's

22:21

not much we can do because we've been exposed since

22:23

our grandmothers. But the sperm, there

22:26

are spermatic oneal stem cells.

22:29

And they turn over every three months. So

22:31

you have a significant ability

22:34

to increase the quality, quantity,

22:36

concentration of sperm on the men's side, 50% of

22:38

the DNA here, by

22:42

just improving preconception care

22:45

and not drinking, not

22:46

smoking, no drugs. And the reason

22:48

I emphasize drugs here, even though it seems so obvious,

22:50

is that when we look at our database

22:53

of the last search

22:55

we did of 230,000 women, of

22:58

those trying to conceive, 8% were taking

23:00

drugs, which I found fascinating.

23:02

But 40% were still drinking. And of the 40% who

23:04

were drinking,

23:06

about 10% were drinking way above the national

23:08

limit. So there's still a very

23:11

important conversation to be had here about the

23:13

do's and don'ts of getting ready for pregnancy. I

23:16

mean, it's shown that alcohol affects

23:18

sperm motility and function as well. So

23:20

clearly, on the male side,

23:22

but also the alcohol will have some effect

23:25

on the female reproductive health as well, right?

23:26

Right. And it does so in a significant way, depending

23:29

on the time of the month, right? So

23:32

we often tend to separate

23:34

out.

23:35

It's very convenient for us to say that alcohol

23:37

affects your liver, or it affects

23:40

your kidneys. But actually, when you think about the fact

23:42

that you lose

23:43

balance, it affects your cognitive

23:45

function as well. And it affects your ovaries too.

23:47

So I often think of our ovaries being pickled.

23:50

But we know that when

23:52

you are drinking at certain times. So a big study

23:55

was carried out, and it looked at your

23:57

chances of conception depending on when

23:59

you're drinking. you drank. So if you were drinking

24:02

in that follicular phase when all your wonderful

24:04

eggs are getting ready and maturing,

24:07

if you're drinking you're much less likely

24:09

to conceive then if you drank

24:12

during your menstrual phase when I guess

24:14

you're getting a bit of that effluent.

24:16

I see. The egg that's

24:18

maturing, so that's within the

24:20

run-up to conception and sexual intercourse,

24:23

that's the kind of preconception part where

24:25

you need to almost do that prehabilitation

24:27

to ensure that there's a nurturing

24:30

rich environment for that egg, the seed,

24:32

to mature. So it's as optimized as possible,

24:34

but also the male factors as well that's optimized as

24:37

possible. Exactly. Don't come near my egg. You're

24:39

subpar sperm. Yeah, until you're suited

24:41

and booted. Go on and eat us. Exactly. Is there any science,

24:44

I should ask, then, during

24:46

a woman's menstrual period,

24:49

presumably, one of the key moments

24:52

is that mittleshmirtz period, that point of ovulation

24:54

where you get a rise of the luteinizing

24:57

hormone, the LH. In the

24:59

run-up to that and around that time,

25:01

is that the most fertile window for

25:04

increasing the chances of conception?

25:06

Yes. So it still amazes

25:08

me that we actually will have couples coming for IVF.

25:12

So two extremes. One is

25:14

that they've just been trying for a year, and

25:16

then we say to them,

25:18

have you been timing your intercourse? And they're

25:20

like, yeah, I

25:22

mean, at 11 o'clock at night? And they're like,

25:25

no, at a specific time. So

25:27

they're

25:28

actually been, they've been trying to conceive for 12 months,

25:31

but maybe eight of those, they've been having

25:33

sex at the start or end or menstrual

25:35

time of their period. And they haven't really looked

25:37

to say, this is when I'm ovulating, and this

25:40

is when I can have sex. The other extreme is that

25:42

we've had people who still have their hymen intact and they're

25:44

not having sex halfway at all. But there's

25:47

many other cultural elements to just lack of education.

25:49

But that to me shows you the level of education

25:52

that we have to account for when it comes

25:54

to asking someone about their fertility journey, that

25:57

many people are just so

25:58

uneducated.

25:59

about their bodies, about conception, about

26:02

ovulation, about when you can, and more

26:04

specifically when you can't get pregnant. But

26:07

we know that typically, around 14

26:10

days after the start of your period,

26:13

that is that real fertile window.

26:15

But I will say this, we assume

26:17

that everyone is... There's a textbook

26:19

man for which the world of medicine has been

26:21

built on, but there's also a textbook woman

26:24

that assumes that we all have a 28-day cycle

26:26

and we all be late on day 14. And actually

26:29

very few people,

26:29

only about 30% of women do ovulate

26:32

on day 14 and a half... Such a variable range,

26:34

isn't it? Exactly. And that's

26:37

where I think statistics can do a real disservice to people because

26:39

they rely on that golden number

26:41

to get pregnant. And I think what we need to be

26:44

doing is investing more time in understanding our

26:46

own body signals. It's actually quite amazing

26:49

when you start to listen to your own body and understand really

26:52

noticing, like you said, middle schmartz, which literally

26:55

means middle pain, that painful

26:57

release of...

26:57

That being popped and one egg

27:00

re-being released. That's exactly

27:02

it. But also the cervical mucus that will change

27:04

to accommodate that, so that pre and post... So that

27:07

will become thinner, the mucus during that

27:09

fertile... Quite literally like an egg yolk.

27:11

Oh, okay. Sorry, the whites of an

27:14

egg rather. So quite literally like cracking

27:16

an egg, which is like, ow, that middle schmartz, the

27:18

egg has been released and you will have

27:20

quite the egg

27:22

white... Watery. ...notary and

27:25

then quite sticky cervical

27:27

mucus. I love talking

27:28

about cervical mucus. So that will be

27:31

a correlative factor for thinking, okay, thinner

27:34

cervical mucus with... It's more sticky,

27:36

the middle schmartz pain and possibly

27:38

body temperature changes. Body temperature

27:40

changes exactly, which are much more subtle

27:42

and I think they're harder to measure. To

27:44

me, it's much more around noticing that

27:47

cervical mucus and the change that you have.

27:49

I mean, there are other dynamic factors

27:51

that you are generally much more energetic.

27:54

You have more energy. Estrogen is the most amazing,

27:57

probably powerful chemical on Earth.

28:00

matched with testosterone. But the

28:02

effects that it has on our overall

28:05

wellbeing for starters, but during

28:07

ovulation, you're more likely to be more

28:10

outgoing, confident, have care of focus

28:13

because of its link with collagen and our skin. Collagenative

28:15

health as well. Well, also collagen and our

28:17

skin. It literally makes us feel better. Yeah, glow. Mother

28:20

Nature wants us to get pregnant and she's doing everything in

28:22

her capacity to say, let's

28:24

get you pregnant, let's make you

28:26

better looking, more confident and obviously more

28:29

aroused.

28:29

You mentioned there that you're dealing with couples

28:32

wanting to go ahead down the route of IVF

28:35

in vitro fertilization. Now,

28:37

obviously, again, this is something which

28:39

I

28:40

suspect has a lot of misinformation and myth

28:42

around it because of Hollywood and stuff

28:45

we see on TV and general nonsense

28:47

you see online as well. What does it

28:49

involve and what are the costs like for IVF?

28:52

IVF is a technology that has been

28:54

around for 40 years now, just over 40 years.

28:56

And it still amazes me that the cost

28:58

has not gone down and

29:00

that ironically, the success rates

29:02

for it haven't really gone up so significantly.

29:06

And I guess that's because we're dealing with quite

29:08

a multifaceted journey to

29:10

conception, right? We often think of it, but that

29:12

exactly a sperm and an egg in addition,

29:15

we make the magic and we transfer it. One

29:16

segment of the whole process. That's exactly it.

29:18

But actually, there are so many different aspects

29:20

to that, namely the

29:23

preconception health that the individual is

29:25

undergoing. And I don't think we do enough thorough

29:28

triage into patients prior to

29:30

undergoing a fertility journey. Again, as part

29:32

of what we've built into her utility is that really

29:34

comprehensive triage to understand. Do the control bit first.

29:37

That's it. Let's understand all of the possible

29:39

reasons why you might not be getting pregnant before

29:41

you ever embark on a fertility journey. And

29:43

then once you have that result, then you say, okay,

29:46

let's go for it.

29:48

But the different aspects

29:50

that are involved, there's a stimulation process where

29:52

you are essentially mimicking

29:54

a normal menstrual cycle and

29:57

maturation of one egg, but your time's 20.

29:59

times 30. You're trying to essentially say, how

30:02

can we make this, or times 10? You're trying to make

30:04

sure that you have enough hormones

30:07

to make sure that not one of those eggs matures,

30:09

but that actually multiple eggs, as many

30:11

as possible. You're ramping up the internal biology

30:13

to make it as fertile as possible. Exactly,

30:16

to mature as many eggs as possible

30:18

so that you can then do an

30:20

egg collection and retrieve them.

30:22

That's also why with IVF you can get

30:24

multiple pregnancies. It's frequent to get

30:26

twins and triplets and...

30:27

Exactly. I think historically

30:30

the reason for multiple pregnancies in IVF is

30:32

that traditionally clinics would actually transfer

30:34

more than one embryo. They

30:37

would put two or three in in the hopes that

30:39

one would take. And then you would see...

30:41

It's quite dangerous. Quite dangerous, exactly. You

30:43

had incidents of Octomom

30:46

where they had all eight embryos.

30:48

Can you imagine transferring that many, hoping one

30:50

would take? And guess what? They've all implanted.

30:54

Now the law has really changed to say actually that

30:56

there's a real emphasis on

30:58

just transferring one because

31:00

there's no difference actually in your success, ironically.

31:04

But the other reason is that embryos

31:06

tend to, even when you transfer one embryo

31:09

and one pregnancy, you still might get... There's

31:11

still a much higher incidence of twins because

31:14

whatever it is about that, the process

31:16

of fertilization in the lab, the embryo

31:19

is much more prone to splitting into

31:21

identical twins. And I think that's probably

31:24

likely because instead of... When you

31:26

said we put an egg in addition with

31:27

some sperm and we

31:29

hope for fertilization, actually the majority

31:32

of cases we put an egg

31:34

in addition and we take one sperm and we inject

31:36

it in to ensure fertilization. And in

31:38

that injection process... You're

31:40

cleaving the egg potentially. Absolutely, really

31:42

injecting that egg. If you ever watch the process

31:44

of what's called ICSI, which is intracytoplasmic

31:47

sperm injection, the egg is really

31:49

fighting against that needle going

31:50

in. It's like a bubble that's about to burst, isn't it? It really

31:52

is. So it could be that that process

31:55

really just kind of weakens the zona-pollucida,

31:57

which is the external cell wall.

31:59

of the of the egg. So you're more prone

32:02

to identical twinning. Considering

32:04

that you said that IVF hasn't changed

32:07

much in terms of its success rate and cost

32:10

over the decades it's been around, what

32:12

can someone expect in terms of cost? And how

32:15

long would the process of IVF take from the

32:17

moment they sit down with someone in a clinic and

32:19

say, you know, I want to do this IVF process?

32:21

What's the timeline and cost sort of in the sort

32:23

of several thousand pound range?

32:24

Oh, in terms of cost

32:27

at a minimum seven thousand pounds. And that's like

32:29

if you're lucky with everything, no bells and whistles,

32:31

that's just straight up. The reality

32:33

is certainly in the UK anyway,

32:35

I mean, in America, you add a zero

32:37

to everything. You're talking 70,000 by

32:41

the time you have a baby. But they say on average it

32:43

takes three rounds of IVF. So if you

32:45

think that on average a basic

32:47

cycle of IVF is 7,000 pounds, you're talking 21,000 pounds by

32:52

the time you've...

32:52

And how many weeks would one cycle

32:54

last of that whole treatment phase? Per

32:57

cycles, it depends on whether you're considering

32:59

a cycle. So a treatment cycle would

33:01

be stimulation, taking the eggs, fertilizing,

33:04

transferring, and then actually transferring everything

33:06

from that is considered one cycle.

33:09

So it could be many, many months by

33:11

the time you've...

33:12

So one cycle could be many months? Yeah. Wow.

33:15

Typically it could occur within a month whereby

33:17

you do the stimulation. Within two weeks you've

33:20

procured the lusitis, you do the fertilization,

33:22

and then you would do the transfer a few days later. We're

33:25

really moving away from fresh transfers,

33:27

actually. A lot more clinics are doing frozen

33:30

cycles whereby they would freeze them. They

33:32

might do a second stimulation cycle, freeze them, and then

33:34

start to transfer. What are the sort of, you know,

33:37

the signs behind egg freezing? And again,

33:40

how effective can that be to almost

33:42

put pores on that egg and still

33:44

have that egg fresh that's maybe 10

33:47

years frozen? It's still fresh. What's the science

33:50

of that?

33:51

So the science is that it's actually very successful, but it

33:53

really does depend. Everything depends on

33:55

the age that you froze that

33:57

egg. So if you're...

33:59

to start thinking about freezing at 39,

34:03

40. In fact, our clinical team

34:05

did a big study looking at 10 years worth

34:07

of data of women who froze their eggs and

34:09

nobody over 40 who went back to

34:12

transfer those fertilised

34:14

eggs actually was able to conceive. The

34:17

quality and the age in which you

34:19

freeze your eggs is the most important thing. But freezing

34:21

eggs at a young age has actually quite a significant

34:24

success rate in terms of being

34:26

able to fertilise and transfer later.

34:27

Just speaking to you for the last hour

34:30

or so, just learned so much about fertility

34:32

and I'm sure we could talk for a lot more. But

34:35

before I let you go, you have one question for

34:37

me. I have no idea what it

34:38

is. Okay, so given that we can

34:41

now re-derive any

34:43

cell type and potentially make it into

34:45

a gamete, sperm or an egg, and

34:47

if you were to take your own skin

34:50

cells or whatever it is and re-derive

34:52

them into a sperm cell of your own, you'd

34:54

technically be cloning, right? So you're taking a

34:56

clone of yourself.

34:58

Would you do it? To then grow

35:00

a clone? Would you create a

35:03

human using your own sperm?

35:05

If I could ensure that

35:08

there would be no hitches along the way

35:10

which would result in some

35:12

horrible Frankenstein experiment being

35:15

ended up so there was this kind of like zombie current

35:18

or some weirdness happening to that

35:20

embryo, then

35:23

I would consider it. But also, maybe

35:27

call me old fashioned or

35:29

just... I love to sometimes

35:32

leave things to nature. You know, I watched

35:34

this film, which is one of my favourite films with Ethan

35:36

Hawke called Gatsika. You've seen it?

35:38

Yes, of course. I make my

35:40

MSc students watch it because

35:42

we're moving towards that.

35:43

So, you know, when you've... And essentially,

35:46

you know, making one of my skin cells into a sperm

35:48

cell and cloning myself, that's going towards this

35:50

dystopian future where everyone is, you

35:52

know, you get these super designer babies.

35:55

I almost want to leave it up to nature, but

35:58

I

35:58

like the fact that

35:59

that we're able to look at

36:02

genetic mutations in these cells and

36:04

see if anything could go wrong to screen for it. So

36:06

if I could screen for it and

36:09

make sure, you know, the natural

36:11

embryo is okay, I'd prefer to go down

36:13

that route, but I would definitely give a

36:15

lot of consideration to a clone of myself

36:18

because-

36:18

Wouldn't the world be better with more Dr.

36:20

Karens? Well, yeah, arguable,

36:22

arguable, I don't know. I already

36:25

have a clone. I have an identical twin sister. Yes,

36:27

yeah. So technically she's my biological clone, so- Oh,

36:30

wow. Definitely. I'm already living in

36:32

a universe with another version of me.

36:35

Helen, thank you so much for coming

36:37

down today, having a chat about fertility and infertility,

36:39

more importantly, and I think

36:42

people listening to this, watching this, are

36:44

going to be a lot more aware of something

36:47

they probably should have been from the beginning, not just from,

36:49

you know, wanting to have babies, but just for

36:51

their health and understanding their biology

36:53

a bit more.

36:54

Yeah, I think there's a big education piece that just

36:56

goes back to the basics that we should all learn from a very

36:58

young age. Thank you so much. You're welcome.

37:41

I'm

38:00

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38:02

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38:47

Thank you very much to Dr. Helen O'Neill. Hopefully

38:49

some of those insights on fertility prove

38:52

useful for you too. Now, onto

38:54

the myth section of our podcast, If

38:56

It Ducks Like a Quack.

39:00

If It Ducks Like a Quack.

39:02

So the first myth in light of my episode

39:04

next week on all things breast and breast

39:07

cancer, is it a myth or

39:09

not that you only get breast cancer

39:11

if it's been in your family or if it's hereditary?

39:14

This one is a total myth. Whilst

39:16

family history and hereditary factors and

39:18

certain gene mutations, which may be in

39:21

your family, for example, the BRCA2

39:23

gene, that's only one part

39:25

of various factors which can contribute to

39:28

the development of breast cancer. If you have a strong

39:30

family history for breast cancer, you may be

39:32

offered

39:32

earlier screening and even sometimes

39:35

what's known as a prophylactic surgery.

39:37

You might be offered surgery to remove

39:39

part of or all the breasts if you

39:41

are particularly high risk. In some cases,

39:43

you might be offered prophylactic surgery or surgery

39:46

before something bad has happened if you are

39:48

particularly high risk. But there are various

39:50

other factors which contribute to the development

39:53

of cancer. For example, there are several common

39:55

carcinogens which people are often exposed to, smoking,

39:58

alcohol, viruses. sometimes can

40:00

contribute to cancer or even exposure

40:03

to other carcinogenic chemicals. So whilst

40:05

it is important to be aware of your family history,

40:07

it's also equally important to do regular

40:09

self-examinations on breasts which I'll be

40:12

covering next week and also if you

40:14

notice something abnormal or something that's suddenly

40:16

changed and you're concerned, you should

40:18

go check it out. Our second myth

40:20

today is something that I came across on

40:23

TikTok and loads of people message

40:25

me asking if it was true. It

40:27

was a viral hack online

40:29

showing people

40:29

how to remove a hickey or a bruise

40:32

in the neck area just by using

40:34

an eggbeater. To set the scene, this

40:36

video got over 30 million views

40:39

and shows a young woman with a

40:41

large bruise on her neck which she had

40:43

got from her partner who had presumably

40:45

sucked on the area and caused a massive bruise

40:48

and then she could be seen using a whisk

40:50

to try and whisk away and break away

40:53

this collection of blood clots underneath the

40:55

skin and then she showed an after picture

40:58

where the bruise seemed to have disappeared. Now

41:00

when you're dealing with bruises, there are a few

41:02

things that you can do based on evidence

41:04

and science. You could leave it alone and your

41:06

body will get rid of it naturally within 10 to 14 days

41:10

as it reabsorbs the blood. Other effective

41:12

measures include using some sort of concealer

41:14

or makeup to hide the bruise. When you first

41:17

get the bruise and you've knocked yourself or you've sustained

41:19

the injury, this is the moment not

41:21

to use any invasive measures or anything

41:24

which can cause any external trauma, like using

41:27

a whisk. In that first 12 to 24

41:29

hours, it's likely that there will still be

41:32

some inflammation and irritation and

41:34

any additional inflammation or irritation

41:36

could make that bleeding worse. What

41:38

you want to do in that initial phase is actually use

41:41

some cold compresses or ice or anything

41:43

cold. This causes the blood vessels which are

41:45

leaking the blood out, they cause them

41:48

to narrow and vasoconstrict thus

41:50

limiting the size and severity of any hickey

41:52

or bruise. As 24 hours has elapsed,

41:54

then you can't use any more cold,

41:57

at this point you need to start to switch to using

41:59

some heat. Using heat after the 24 hour

42:01

mark increases the blood flow to that area,

42:04

which increases the dispersion and destruction

42:07

of those old blood globules and increases

42:09

the reabsorption of that blood.

42:13

And now for Crowd Science, the chance

42:15

for you to ask me questions. My

42:17

first one is from Sarah in Suffolk.

42:19

Hi Doctor, in 2021 I was involved

42:22

in a head-on car crash with a drunk driver. Since

42:24

the crash my neck pops and cracks with movement

42:26

and feels like it's grinded. And

42:28

it aches. Why is this? Is

42:30

it the old fashioned whiplash? So

42:32

if you're listening to this, you probably won't be

42:34

able to see what I can see. But Sarah

42:37

has actually sent in a picture of

42:39

the car after the car crash.

42:42

And it's safe to say that the car

42:44

was left in a pretty horrible

42:47

condition. Now whilst it's difficult for me to give you

42:49

any specific medical advice on

42:51

your specific condition about your neck

42:53

making this popping and cracking sound

42:56

every time you turn your head because I'm not

42:58

able to examine you. I don't have any of

43:00

your x-rays or any other

43:02

imaging you may have got or you know, I

43:04

don't have this background details on you. What

43:06

I would say is if you sustain a pretty

43:09

horrible traumatic injury, particularly if it's a chronic

43:11

injury that predisposes you to things

43:13

like osteoarthritis in any joints

43:16

that were affected. So if you've got a chronic wrist

43:18

injury from punching something, it increases

43:20

your risk of chronic wear and tear

43:22

and developing osteoarthritis in your joints. Similarly,

43:25

after your horrible car crash, you

43:28

may have got a degree of wear and tear and

43:30

damage to the cervical spine, the

43:32

region of your vertebral column near your

43:34

neck or in your neck. And this may

43:37

predispose a faster development