How to Optimize Fertility and New Solutions in Reproductive Health with Dr. Asima Ahmad

Welcome back, dear audience, to another episode of the Longevity and Lifestyle Podcast. I'm your host, Claudia von Boeselager, here to bring you the latest insights and learnings to improve your health, life, and happiness for longer.

Thank you so much for being part of this tribe and wanting to be at your best each day.

Make sure to sign up for my newsletter, LL Insider, by going to llinsider.com. My guest today is Dr. Asima Ahmed, a trailblazer in the world of fertility and family building care. She's the co-founder and chief medical officer of Carrot Fertility. Dr. Ahmed is revolutionizing access to fertility care, making it inclusive and accessible for everyone everywhere. Through Carrot, she oversees a global network of over 10,000 reproductive and family building experts, transforming lives with innovative and compassionate care. In addition to her work with Carrot, Dr. Ahmed is a practicing reproductive endocrinologist and infertility specialist. Double board certified in reproductive endocrinology and obstetrics and gynecology with degrees from the University of Chicago and Harvard and fellowship training at UCSF. She worked alongside some of the biggest names in the field driving cutting-edge research and care. Named to Entrepreneur Magazine Women of Influence list and Business Insider's 30 Under 40 in Healthcare, Dr. Ahmed is also a sought-after speaker gracing stages at the World Economic Forum, Forbes 30 50 Summit and more. Her work has been featured in the New York Times, Good Morning America, and CNN, solidifying her as a trusted voice in reproductive health. Dr. Ahmed's mission is clear: to empower people worldwide with the tools and support they need to navigate their fertility and family-building journeys with confidence and dignity.

This is such an important topic. I know many people struggle or want to get ahead of figuring out how to optimize for fertility, or perhaps you're struggling. This is a really, really amazing conversation, so please enjoy. So welcome to the Longevity and Lifestyle Podcast. I'm so excited to have you on today. It's such a pleasure.

Oh, so excited to be here. I'm really looking forward to this conversation.

I'm loving it. We're just having a catch-up before coming on air right now for everyone listening and watching of our very fun last experience at the Live Long Summit in Palm Beach and how amazing it is to connect with such amazing people at these conferences and other places as well, and then continue the conversation on platforms like this one. So really, really excited to have you on and to share your amazing work with the world. So, um, thank you again.

Thank you for having me. Yeah, no, I'm really excited to just chat with you again. It's, it's, it's been a while, and, um, I feel like there's a lot to talk about.

This is— you all, I love the topic area that you are covering because it is so important and such a passion, um, area, especially for women, but also for men as well. So it's so applicable across the world. And I was so amazed by the statistic that in 2023, the WHO, World Health Organization, reported that around 17.5% of the adult population. So 1 in 6 people worldwide experience infertility. And so I'd love to dig into, Asima, just to kick us off today, like, what are the biggest challenges around fertility right now and why? Like, what is going on?

Yeah. And before I dive into that, I actually wanted to touch on the statistic that you mentioned because that statistic is based off of people who are heterosexual, like in a heterosexual relationship or different sex couples. Who have had regular unprotected intercourse for at least a year and were unable to get pregnant. And so that 1 in 6 number does not include those people who may need medical assistance to get pregnant and have no other way around it. So it excludes people who have been trying, but maybe for not a year, or people who are single intending parents, or those who may be in a same-sex relationship. And, uh, that's important because what that shows is that even more than that 1 in 6 people. Yeah, they will need to have some sort of assistance to grow their family. And so the demand for fertility treatments is even higher than that, if you take that into consideration. So that, I think, is one of the challenges is that, you know, people think about it as those who are in different sex relationships or heterosexual couples, but there are even more people that might need to do fertility treatment to either grow their family at that point in time, or even preserve their fertility, you know, through egg freezing or something like that, to be able to grow their family at a later point in time. But this was a very, very important topic for us years ago when we were starting our company, Cara Fertility, because that's what we were focused on. What are the biggest challenges? And I think one of the biggest challenges— and WHO mentioned this in the report as well— is the financial barrier in that for most people, they don't have the savings or the financial resources to be able to fund fertility treatment, especially when I'm, you know, talking about is IVF. Yeah. The WHO said that in some parts of the world, a cycle of IVF can cost more than a person's annual salary. And in the United States, 80% of people do not have coverage for fertility treatments or minimal coverage, meaning that there's definitely some improvement that can happen there. So that was one of the things that we actually focused on to start with through Carrot Fertility was to break down that financial barrier and make fertility and family forming accessible for all.

And just to ask specifically on that, like, how does that work? So people like listening, and maybe they might be able to have conversations with their employer, for example, like, how does it— what is happening there? Like, what is it that you introduced with Carrot Fertility? Yeah.

Yeah. So the biggest thing is to be able to work with employers, health plans, and health systems to provide that financial benefit to people. And when I say fertility, we don't think about fertility as just, you know, IVF. I mean, fertility is, is everything. It's a part of your overall health. And Carrot also provides services and support around pregnancy and lifelong hormonal health. So that includes low testosterone for men and menopause for women, return to work., you know, help with, you know, raising children essentially. So I mean, like what we try to do is we take a lifelong approach to when it comes to someone's fertility and hormonal health. And so in addition to the financial benefit, people get support around finding the right provider at the right time. So you want to get into the doctor that is specialized in the type of condition that you have. So if that's endometriosis, you are connected with a doctor in your area that's specialized in that. You also get priority booking and other benefits going through Carrot as opposed to going directly through the clinic. You also get online support through telehealth, so you can talk to experts in the field. That could be somebody who can talk to you about fertility, or even for male fertility, your urologist. And then through pregnancy, you can talk to lactation consultants, you can work with doulas, you can use your benefit to work with doulas in person. So it kind of goes on and on. And that's the The important thing is that it's much more than the financial piece. It's that care coordination. It's that lifelong comprehensive support that you get honestly 24/7. And we are a global company, so we have over 1,000 customers across the world. We're available in over 170 countries. So it is something that we've built on over time. And to improve access to fertility worldwide.

Which is absolutely amazing because even just the things you were listing off, and I think for like new-time parents, new-time mothers, like there's so much like blank, you know, you think, oh, you know, everyone else has figured it out, I'm sure I'll be fine. And then you have this newborn baby in front of you and it's like, you know, how do I do this? How do I do that? So having access to that kind of support, I think is absolutely amazing as well. So, so great that you guys have thought that through and figured that out and are able to provide people with that type of access to be better parents, essentially, to be able to show up as, as a better parent and not be kind of there clueless, like, you know, what do I do when they get to that stage?

But Claudia, you're, you're reminding me of like, so when I was, I was an OB-GYN resident and it's a 4-year program. And, and when you're doing residency, for a lot of trainees, you're not sleeping, you're working over 24-hour shifts, 30-plus-hour shifts. And so going through that training, I was like, you know what? Like, people talk about babies and lack of sleep. I got this. Like, this is not gonna be a problem. If I'm an OB-GYN resident, I can do it. This is not, But I got— I was— I had a rude awake after having a baby. So it's true, it's like no matter how prepared you may think you are, like, it is a completely new experience that you've never had before, a lack of sleep that you've never experienced before. And I, I bring that up because even if you've had multiple children, and I've had 4, uh, children, it's different every single time. Every child is different, their needs, their— they, they come out with a different personality into this world. And, uh, and so with my fourth one, I I actually worked with a doula, and that was the first time I had done that. But it was really helpful because, I mean, I'm good at some things, but when it comes to sleep training my children, I've never been good at that.

Because you're sleep deprived as well. So I feel like compassion for the mother, like, you're just in such a zombie state that it's like, now I'm supposed to sleep train? Like, I don't even know how to sleep myself.

So I did work with a doula, and she really helped me put my son into a much better pattern of sleep than I had as I was getting ready to go back to work than, you know, my other children. So I do think that even if it's not your first experience, there is benefit to having support like that to help you through, you know, every possible journey because no two are alike, right?

Yeah, no, 100%. And I think just to make a point on that as well, like, there's no shame to it. I feel like some people feel like they need to be the super mother, super whatever, but as they say on the airplane, like you have to put your oxygen mask on first. And if you are totally depleted and I'm speaking to my first-time mother, first 3 months self where I was like 1 hour of sleep at a time, like I'll be fine. I was a total mess, like honestly. And people were, my friends were too polite. They're like, oh, you know, I'm sure you're okay. Like I needed someone to be like, no, this is not okay. Like, you know, you need to change things or whatever as well. And so yeah, just having support, even if it's for like 1 day a week or something, like a professional to just check in on you and make sure you're okay is just such a game changer. And to be, you know, know where, where to go to, to get good access. Sorry, my light is falling over here. Um, is, is super helpful too. Um, Asima, I want to touch on also the challenges around fertility, right? And so why do you think there are more and more, or like, is there more and more challenges around fertility? Because maybe we weren't tracking the statistics properly in the past. Like, is— do we, do we know that for sure? Is it, is it obviously rising, right? And then what is going on, like what is happening around the fertility issues that we see today?

Yeah, well, there's never going to be a perfect way to capture that statistic because the way that you're obtaining data from different locations of the world, what works well one place might not be the perfect way in another place. So there's, there's always going to be some estimation where it's not perfect, right? Yeah. I do think that fertility is even more important now than ever because people are living longer and they're also waiting longer to start having their children. And in some cases, maybe even fewer children. And so it's important to know how age impacts fertility and how being healthy overall also affects your fertility health, because fertility is a part of your overall health. It's all connected. And I think there are things that because we're living longer, because our lifestyles are changing, because we have different environmental exposures and toxins and everything that are a part of our daily lives, there are ways that it impacts our hormonal health and our fertility. So it's important to— and this is something that I've been thinking of a lot— it's just important to focus on your overall lifestyle, what you're putting into your body, how you're taking care of your body, because that affects not only your ability to grow your families, but let's say you are the person who's going to become pregnant, it affects your pregnancy, it affects how you will be after you deliver. So, again, all interconnected. And I think that because we are, you know, growing our families at different ages, because we're living longer than Yes, you will see that more people may be challenged by infertility because for women, for instance, like your fertility potential declines with age, the quality of the eggs, the genetic quality, your ability to get pregnant per cycle. So if you're waiting till 40 to grow your family, you will have more fertility challenges. Someone that started growing their family at 20 or 30.

And so we talked about— you talked about there are a few like lifestyle things. Obviously nutrition, toxins in the environment, microplastics, right, is probably, you know, something are you seeing as an issue as well? Like, I just want to dig into a little bit so people can realize, like, there are so many different contributing factors. Would you say, like, what would be top 3 that you see regularly? I mean, stress, what would it be that are impacting?

Yeah, there are so many. I think you hit on one thing is just nutrition, right? What you're putting into your body. And this is something that I spend a great deal of time talking about with with my patients even in clinic, because I do continue to see patients, is that when you're shopping for groceries or you're preparing a meal, try to use more whole, organic, fresh ingredients as opposed to just grabbing something off the shelf. I tell them, like, look at the box that you're grabbing off the shelf. If you can't— if you don't understand what those ingredients are, then you probably are better off not putting them into your body. Again, there's no perfect way because of trying to balance what's affordable, what's going to be able to last them long enough. Are they able to go to the store frequently to get those items? So you have to balance all that and talk to people on an individual level and see what's actually possible. The other thing is, what are the things that you're preparing your food with, right? So again, a lot of stuff on the news about this, and I'm glad that they're educating the public. But when you have pans that have a lining, that black Teflon, right? Like, that's something that's going to come off as you're scraping your food off as you're cooking it. Yeah. Um, plastics— you shouldn't be warming your food in plastics. I've, over the years— and again, I'm not perfect, but I'm trying— um, have been trying to remove plastics from my kitchen so that we're not using them on a day-to-day basis. They are so readily available and easy, um, so I don't know when the point will come where we're not using it, if that point ever will, but I just think trying to minimize those things is important. So when you're thinking then about like different things that affect your fertility and lifestyle, right? So smoking, right? Smoking accelerates ovarian aging. So you're going to go into menopause sooner. Um, it also affects sperm if you're smoking. Um, excessive alcohol use, not sleeping well, right? When we know that when we're not sleeping well, whether that's not long enough or better quality sleep, that affects our hormones. Our hormones are tied to fertility. For men, heat exposures, so sitting in a hot tub or using the sauna, or even high fevers if the person was recently sick in the past 3 months, all those things can affect their sperm and their, and their fertility. So there's honestly, the list is endless. It's hard to pick the top 3, but I would say nutrition and how you're preparing your foods, your overall lifestyle, um, and just limiting exposures to different types of toxins if you can.

Yeah, I know. And speaking of the plastics as well, like, I recently had a plastic cutting board. I was realizing that, like, you cut, probably microplastics going in. I'm like, okay, gone. And I have a wooden one now.

Yeah, it's like on a day-to-day basis you realize, you're like, oh, this spatula that I've been using for the last couple of years.

It's crazy, you don't even see it if you've had it for a while. You forget that you have it. So it's like slowly like picking up the ceramic pans, like finding out the ones that are like the good quality. And I know for some people it sounds overwhelming, but it's just like bit by bit, just chip away at it and just to have that awareness as well.

And I want to ask around— sorry to cut up to cut you off, Claudia. The other thing that I was thinking about is just learning about your fertility. I don't think it's ever too early to just learn about it, whether that's through education or through testing, just to know where you're at if you're curious. Because for some people, and they might not even have a family history or any known risk factors, the reason I see them in clinic is because they had some testing done that showed that their ovarian reserve was much lower than expected for their age, and that changed their timelines or how they wanted to proceed with their family building. And so even just doing some education or testing or what your fertility may be. And again, there's no perfect test to tell you exactly if you will have infertility because there's still the unexplained component, but at least having an understanding of where you stand right now may help you plan for your future.

That's really helpful. So, A, what would be kind of tests that you would encourage people to ask for if their medical professional isn't offering it already? And then also to look at or I'd love to hear sort of what should every male and female know before starting their fertility journeys? Like, how can people prepare in the best way possible?

So for testing, if you were to say what's the easiest, most non-invasive way to just understand what sperm counts and egg supply look like, for, for the male, it would be to do a semen analysis. And for the female, it would be to check your anti-Müllerian hormones, the blood test, as well as maybe your follicle stimulating hormone and your estradiol. Estradiol. Um, usually if you're checking that, the, it's the shorter way of saying it is FSH or estradiol. But if you are checking those, those are usually done at the start of your menstrual cycle, usually between cycle day 2 to 4, some day 1 being the day of your period started. Um, and for men, we usually say to abstain from ejaculation for about 2 to 5 days. So because if you wait too long, you're going to see a lot of sperm that are not doing much. And too close together, your counts might be a little bit lower. So that 2 to 5 days gives a nice window. And that could just be like the start. I think that's a great place to start. It tells you a little bit about the numbers. Obviously, if you have a medical history or surgeries that could have impacted your reproductive organs— for women, for instance, if they've had an ovary removed because they had a benign tumor on the ovary, or for men, if they had a history of what's called Mumps Orchitis, meaning they had mumps and it affected the testicles— those things are very important to know so that the doctor who's doing that evaluation can keep that in mind and order any additional tests that may be necessary.

Really, really helpful.

And then as you're getting ready for your fertility journey, again, I think the biggest thing is looking at your overall health, right? Where are you? You know, are you in a healthy weight range? Are you— do you have any chronic medical conditions? And especially if you do, are you taking any medications? How are those medications when it comes to being able to use your eggs or sperm to grow your family? Do they affect your eggs or sperm? If you are the person who is going to get pregnant, can they potentially affect the baby, potentially cause birth defects? So those are all that— like, focusing on those things beforehand can not only help you optimize your fertility as you're starting that journey, but also create a situation where you're— it's almost like preconception planning where you're trying to create an environment where if you are the person who's going to get pregnant, that, that baby can also be healthy. Um, because if you're healthy and you're, you're doing it in a way where you're taking medications that are safe or treatments that are safe for you and the baby, that will create a healthy pregnancy overall. And then again, thinking about what your timelines are, what your fertility goals are, looking at your age. For instance, if someone's thinking that they want 5 kids and they're starting at 20 and they're female, that's going to be different than someone who's starting that journey at 38. Um, and then trying to optimize your goals in that way, you know, like what are your options if you're starting at 38 and you want 4 children? Maybe you might be somebody who might do fertility preservation, uh, do IVF, freeze embryos in advance, and then use them in the next several years, uh, one at a time to try to get pregnant and grow your family. So I think like going into it, optimizing your health, understanding how to create an environment for a healthy pregnancy and postpartum, and also figuring out what your timelines are, what your family building goals are. Those are all really, really important.

I think that's really helpful too, in terms of the timelines and the plans as well, because I think people are just always focused on like the next milestone. So like the next child, but like, it's true. Like if it's like, okay, I want 3 or 4, what are different options available? And I wanna dig into that too. Shortly as well. But I'd love to take a step back and ask you about your personal journey, Asima, and like what inspired you to co-found Carrot Fertility and, you know, what has on your personal journey as a reproductive endocrinologist shaped your mission as being part of Carrot Fertility?

So I knew pretty early on that I wanted to do something in women's health. I had an aunt who Lives in Pakistan and she suffered through multiple stillbirths. She actually had a baby that she did, her first baby that delivered in the hospital, but was unable to receive higher level care and it passed away. And with one cousin that survived her last stillbirth, she actually had a postpartum hemorrhage and passed away on the way to the hospital. And so I knew that there was so much to do in women's health. Yes, women's health is not just reproductive health, but because of her, I was inspired to go more the reproductive route. And as I was looking into reproductive and women's health, I realized that there was a lot of conversation around family planning, which when people traditionally think of family planning, they think of contraception, which is a very, very important topic. And there should be a lot of attention paid there, but not as much on family building. So family planning and family building, um, and infertility. And so That's when I really started to focus in on that space. And as I spent more time in clinic, in training with the patients that came through, you would see them on multiple occasions. And so you would get to know them and you would talk to them about their journey. Like, you know, when did you think about starting your family? Um, this, I see this is your third treatment. Like, how do you, you know, how, how does this journey feel? What were some of the obstacles that came along the way? And one of the recurring themes was that people couldn't afford care. A lot of them had maybe come in for an initial appointment several years ago. They realized that they might need to do IVF because that was the only way to grow their family. Maybe their tubes were blocked, or maybe there weren't enough sperm, and they knew that they wanted to use that partner's sperm and not a sperm donor. And so then they took that time to figure out how they could financially afford it. For some people, they, took out loans, they, or they mortgaged their home, or they moved back in with their parents, um, or they borrowed money from their parents. I mean, there were, there were so many things that people were doing, or they were putting it on a credit card. And to me, you know, my personal belief is that the amount of money that you have will not dictate whether or not you will be a good parent. And why is this a barrier for people? People to be able to grow their families. And I actually, one of the biggest reasons I wanted to go to my program was they, they did focus on treatments that were cost-effective. Like, what are the different ways that you can do treatments where you can still have a very good outcome, but maybe you don't need to use the highest dose medication, which is a large portion of the cost, or maybe you don't need to do a full IVF cycle. Maybe you could do, you know, a minimal stimulation or a natural cycle. So I was learning all about that. And it was during that time that I met my co-founder who had gone through multiple cycles of egg freezing. And in her case, again, she realized that she wasn't getting any benefit. And luckily she had the financial means to be able to, um, proceed with those treatments. But we both aligned on the fact that this is one of the biggest barriers that exists out there. Um, and, Throughout determining what might be the best way to build the company, we went through multiple iterations of like, what are the other barriers? Why is there friction in this whole process? What can, how can we make this all better for the patient? And honestly, on the clinic side as well. And so that's how we came up with the concept and how we wanted to tackle this.

Amazing. Thank you. Coming from such an important place, right? For some people, I think everyone knows friends and has stories where they struggled. And my first time, it took a bit longer as well. And all the thoughts come up, like, it's like binary, like, oh, we're, you know, not pregnant this month, so we're never going to work again, right? That's always that kind of dramatic thing. So yes, it takes time, but you kind of worst-case scenarios. And I've had friends like crying, like devastated, thinking this is it. They'll I've had a child, etc. And it is such a personal thing and heart-wrenching thing. So to know that there are solutions and that money doesn't necessarily need to be the, the blocking point of it, there is ways around it, is, is so beautiful. So yeah, thank you for making this mission, um, you and your co-founder as well.

As long as it helps people, I mean, at the end of the day, that's— it's all worth it.

I'd love to touch on male fertility, and it's often overlooked in conversations regarding reproductive health. Um, so what do you think are the key factors that are affecting male fertility? And in relationship, um, for people to know how they can, you know, better support, and how can they take proactive steps to improve it as well? So not just women, because a lot of the times it's just focused on them, but for them as well.

So you brought up a very important point, uh, in that male fertility and male infertility is very, very important because traditionally and historically the blame has been primarily placed on the woman or the female. And it's unfortunate because it affects both the male and the female. Actually, about 40 to 50% of cases may have a component of male infertility. You know, what we usually see—

almost half, essentially, right?

So like a third of cases can be female alone, a third can be male, and then the remaining third can be unexplained or a combination. So that could— that means about 40 to 50 can have a male factor component. So it's really, really important. And because of that, there have been— and I'll say even with some of my patients— cases where the female partner will come into clinic, we'll do the whole workup, and we'll be really engaged in the process, but for whatever reason, the male partner is not as interested, or, you know, it does not want to do the testing or does not want to get his blood drawn. Now, I have seen that changing over time, which is great. I think more and more people are coming out and talking about the male infertility component, but that has always existed.

And I think there's a bit of a— I guess it's shame, right? That they're like, oh, it can't be me and whatever. But I think, um, you know, there are different modalities available. Um, I know my, um, some people like they use even alternative therapies, obviously giving up alcohol you were mentioning is a big thing, smoking anyway, but even like acupuncture, things like that. How much do holistic therapies come into play that you see as well?

I think there's— look, those, those types of therapies have been around for thousands of years. There's definitely something there that they exist. So there are, for example, let's just, let's talk about acupuncture for instance. There are studies that have shown that having acupuncture done around the time of embryo transfer can have a potential positive impact on implantation rates, meaning that the embryo attaches itself to the lining and can result in a positive pregnancy. So when people are interested in it, I do have colleagues that I know around the area that I may refer them to and say, you know, I've, I've worked with this colleague. And, and it's important to like also maybe refer and have them work with a known entity because that way they know what you're comfortable with in terms of treatments that they might do while that— while your patient is in a fertility treatment cycle. For instance, the person that I know that practices Chinese traditional medicine, he knows what, you know, herbs or whatever that I'm okay with them taking before they start their cycle or during their cycle. So I think that there definitely is some something there. And I think if people are interested, as long as they're doing it in a way where I think that there's data to support it, or they're not doing something that could potentially affect the pregnancy, like meaning reduce the chance of success or actually affect the pregnancy itself, maybe, maybe causing birth defects or, you know, affecting babies. I think then it's as long as that's discussed and that risk does not exist or it's very minimal risk, I think it's okay to combine those. And again, that goes back to like the lifestyle and all that is that it's not just gonna be what you do in the clinic with your doctor, it's what you're gonna be doing outside the clinical setting as well.

Yeah. 'Cause that's 99% of your week, right? So it's like all of everything around it as well. Yeah. So I saw an interesting statistic that in 2022 that the birth rate among US women in their early 30s was higher than those in their 20s. And the number of babies born to women after the age of 40 was, went up considerably between 2021, 2022. I think it was like 6%. For women aged 40 to 44 and 12% among women over the age of 45. So that's a big number. So many women are choosing to have children later. So for women maybe in their 30s and thinking, you know, oh, I'm at a pivotal point in my career, like, do I still have chances of having children at 40, after 40? What are some strategies, effective strategies and maybe medical advancements that we can touch on for extending fertility for women so that they have that choice during their career or for whatever reasons it might be to be able to know that they can still have children at a later point, hopefully.

What would you say?

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Well, the thing that we're doing in the clinical setting, and that's has more data around it right now, is fertility preservation. Meaning if someone thinks that at some point, some later point in life, they want to get pregnant, or maybe even have children using their eggs and work with a gestational carrier, that they have the option of freezing their eggs. Or if they're in a relationship and they know the sperm source, like be that a partner or somebody that will be co-parenting in some way, or a donor, a sperm donor who's a known donor, they can also freeze embryos to use later when they're ready to get pregnant or grow their family. So I think those are things that we do, and there's a lot of data around it. There's a lot of, um, clinics that offer that. It's a known entity in a way and, um, has pretty good outcomes, especially the earlier you do it for a woman, like the higher the chances of success. Obviously there are things that you can do to try to optimize your chance of success for embryo, like genetic testing of the embryo to make sure it has a normal number of embryos before you implant it. But But again, that's, you know, something that you discuss on an individual basis. Now, extending fertility, you know, again, going back to making sure you live a healthy lifestyle, that you're not doing things that accelerate your ovarian aging or affect your sperm, that's going to be very important. Again, if you, for example, smoke, you will go through menopause sooner. And if, for example, you've had chemotherapy or certain types of treatments on the ovaries or on the testicles, that will also result in affecting your fertility. There are definitely studies out there on how to extend your fertility. There's research being done on, uh, if by taking recombinant anti-mullerian hormone, or AMH, we can reduce the amount of follicles that are being lost over time, or eggs that are being lost over time. Because for females, you're born with your eggs, the number declines with age. There's research being done on if you can take ovarian tissue out at a younger age, obviously balancing the amount that you're taking out so you don't go through early menopause, but a certain amount of ovarian tissue out and then transplanting it back over time to extend your fertility and even delay the onset of menopause. So there's, there's definitely work being done. I think that it's not quite the standard of care yet to undergo those types of treatments. But at some point in time, especially if the results are promising, um, that may be something that may be done to extend fertility. There's, yeah, there was another study. It's being done at Columbia where they're using rapamycin. Yeah, exactly. So there's, there's a lot of interesting stuff out there, but I would say that the current standard of care for someone who is trying to extend their fertility is obviously making sure that they maintain a healthy lifestyle, that they stay away from things that can accelerate the aging of the ovaries or affect sperm production. And then if they have the means and are interested, that they can do fertility preservation, whether that be freezing eggs, sperm, or embryos.

I'd love to touch briefly on the rapamycin studies out of Columbia University and your thoughts on that. And then after, I'd love if maybe for people who haven't understood exactly how the egg freezing process works or embryo freezing, I mean, I would assume that that's then similar. But just to walk through that process just so people can get their head around it as well, that would be really helpful.

Yeah. So it's not just around ovarian aging that rapamycin is being considered. I think it's a drug that's being studied when it just comes to longevity medicine overall. So there's a lot of interest in it. It's an immunosuppressive drug. Honestly, I am not the expert when it comes to rapamycin. I will not go into the details. Don't worry. Yeah, I won't be drawing out pathways here. But the thought is that it can influence, for example, the number of eggs that are maturing every month, maybe reducing those. And then in that way, extending ovarian function. Now they have studied in mice, that's what they've seen. So they are conducting a study to see if that's what's occurring in women as well. I'm trying to remember the age group, but I think When I was reading about the study, they were thinking that maybe this could be something for women age— I think age range was like 35 to 45. And there is a blinded component of the study. So they are seeing initial results where some people are reporting that they're having better energy or that they feel that their skin looks better or mood. But I think once those— once they unblind the study, they'll be able to determine how many of those people fell into the control versus versus the treatment group. But I, I don't know the person running the study personally, but I, I definitely have been following it with whatever's been released online and shared publicly.

Yeah. I mean, I've always been a mutual friend with, um, Jennifer Garrison, Dr. Jennifer Garrison, who's been on the podcast a few times too. And I know she's focusing on this and she won competition for having the XPRIZE. So that's going to be coming out too as well around, um, very enabling women's health at et cetera. And I really like what Jennifer also says around it is that it's not just around the fertility aspect, but actually empowering women to be able to make different choices in their 20s and 30s, knowing that their window of opportunity in terms of having children is open to them a little bit later if, you know, everything is functioning well and they're taking good care of themselves, et cetera. So I think that's really exciting in terms of, you know, scientific breakthroughs and advances in research. Do you guys actually do your own scientific research as well out of curiosity?

Do any trials? We, we do like to see how our interventions, our guidance, our education affect outcomes. So we have collected internal data on the impact that we're having on, you know, improving IVF outcomes. For example, the number of people who are having single embryo transfers is higher. The number of the success rate. So the percentage of people who end up getting pregnant through treatment using care benefit versus doing it on their own is higher. So we are doing some of that. We are always interested in research, obviously. Um, you know, I, I had done a lot over the years, especially during my training. Um, so always looking for ways to collaborate with others and to be able to try to do things that can improve outcomes for people. But you asked another question about the egg and the sperm freezing.

Exactly, the egg freezing, essentially, so that people who might be considering it could better understand what the process is, what the ideal age is, etc. So if you could maybe walk through that process, that would be great. Sure, sure.

So I think it's good to just take a step back and understand like why someone would even freeze their eggs. What's really interesting is that a female will have their most eggs about halfway through their mother's pregnancy. So when they're about 20 weeks old, they have about maybe 6 to 7 million eggs. By the time they're born, they've actually lost the majority. They have about 1 to 2 million. By the time you have your first period, or what's called menarche, about 500,000. And then by the time they are getting close to menopause, like maybe at a couple hundred. Now, these are not perfect statistics, meaning this is not going to be a copy and paste. Well, but that just gives you a sense of the decline in just the quantitative decline, uh, over time. And over their lifespan, they're going to release— because they're going to be releasing one egg per month typically. There's some women that don't ovulate on their own, I need a little bit of assistance, but the average woman will release one egg per cycle.. And so that's going to be several hundred that they're going to end up in some way being able to use. So there's going to be hundreds of thousands of eggs that never get used. Now, what egg freezing entails is that although your body's releasing one egg that it matures fully, there are several eggs that we're trying to grow for that month. And when you go into your doctor's office and your fertility doctor's office, they're going to be Assessing your ovarian reserve. One of the measurements they're going to do is called an antral follicle count, meaning at that point in time in your cycle— and this is just like, let me just give a sample number— there's, you have an antral follicle count of 20. So there's 20 eggs that we're trying to grow this month, but you're going to ovulate one. You're going to be able to use that one egg. 19 of them will go away. And those are the ones that can potentially be captured or what my mentor said, rescued by doing either egg freezing or IVF. So what happens is then you will take over the period of maybe about 8 to 14 days injectable medication, maybe some oral, but mostly injectable to try to get those other, those other eggs that were there at the start of your cycle to also grow as well and to get to that level of maturity. Um, what, and during that time you're going to have some blood tests and you're going to have ultrasounds done to see how you're responding to the medication. At the end of the treatment, you'll have what's called an egg retrieval in most situations. The person is sleeping, like they're given medication so they're not conscious, um, and that they're comfortable. And in most cases, the eggs will be retrieved what's called transvaginally, meaning that there'll be an ultrasound that'll go inside the vagina, a needle that'll go through the vaginal wall into the ovary, and that's how they aspirate the eggs out. In most situations, by the time you're leaving the clinic that day— and again, you'll probably be leaving within a few hours of the egg retrieval— you'll know the number of eggs you have and maybe within that day or the following day, you'll know how many were frozen because most clinics will typically freeze the mature eggs, not the immature ones. Though there are some clinics that are doing IVM, which is in vitro maturation. So when you're thinking about doing that and, and if you should do it, one thing to know is that it's not 100% guarantee. There is no 100% guarantee whether you freeze eggs, sperm, embryos, whether you do fertility treatment or not, that you will get pregnant.. So you have to keep that in mind. If you're thinking about what age to do it, again, this is a personal decision, but the younger you are, which the more eggs you'll have and more of them will be genetically normal. Because as we, as we age, not only is there a quantitative decline, there is a qualitative decline. More and more of those eggs will become genetically abnormal as we get older. So if someone were to say, should I do it at 25 or 35? And they had the option, I would say do it at 25. You'll probably have more eggs. You'll probably need to do fewer cycles to freeze the number of eggs that you want. And then in terms of planning purposes, also what I would say is like, think about how many children you would potentially like to have in the future. For some people, they know that they might want one. If they want one, the amount of eggs that they might want to freeze will be different than someone who says, I've always wanted 4 children., and I wanna do whatever I can to optimize those chances. So that'll help your doctor and you come up with a decision on how many treatments you may need to do and what number of eggs you might typically expect per treatment cycle.

Is an optimal ratio of fertile egg to chance of, uh, pregnancy later on, is it like 1 to 6, 1 to 8? Knowing that there's no 100% guarantee, but is there like a ratio?

Well, this is a very, very important question, Claudia, because a lot of it depends on the lab. And when you're thinking about going to do treatment, there's 3 things that are really important. One is like, you know, if there is a financial piece to it, like what can you afford, right? People sometimes will go to a clinic because they have some sort of discount. They'll say, we'll give you 3 cycles for the price of 1 or whatever. I get it. I get it. You know? Um, but yeah, or like maybe it's closer. Maybe there's a clinic that's closer. There's one that's that's maybe 2 hours away. But almost as important as the doctor that you're working with, if not more honestly, is the quality of the embryology lab. Because sometimes someone's drawn in because of maybe the price or maybe something else, but if that lab is not the best quality lab, it doesn't matter how many eggs you freeze, you might not have what you want at the end of the day when you go back to use them. This is really important. And that's what, like, what we do at Carat is so important is that we do that assessment. We're looking at the results, we're looking at their outcomes. And again, there's no perfect way to do it, but with that information, we can help you understand which clinic might be the best fit for you. Again, maybe because of your cultural background or what language you speak or the type of provider you're looking for and their expertise. But we also know, given the outcomes that come out of that clinic, what those embryology labs may be like. So I think it's very, very important to really think hard before just deciding to go with a certain clinic and really do that background research and understand what the outcomes are, not just, you know, going into that treatment, but coming out of it when you actually go back to use your eggs, your sperm, or those embryos.

So this is an amazing point, and I know that Carrot Fertility is global, but I assume you're not speaking with every single lab and clinic around the world. So how could— what would you advise if people are not able to access a local clinic via Carrot Fertility? Like, how can people gauge if their success, or what are the questions they should be asking to know that it is a good standard and the chance of success is higher than elsewhere?

Yeah. So ask— I mean, be very honestly like that. Consultation is your time to ask the questions as well as your doctor asking you about your health. And it is really important to go in with a list of prepared questions. If this is of value to you, which of course if you're doing it, it is, ask them how many cycles they've done. Like, how many, how many people have frozen their eggs here? How many egg freezing cycles have you completed? How many years have you been doing this? Where do you store the eggs or the embryos or the sperm once they're frozen? And then, which I think is one of the most important parts, is asking the percentages of success. Because those— I know you were asking me that, but it's hard to give you a ballpark because every lab, countries, I mean regions, like you're going to get different, different results there. So ask them like, you know, what is my chance of success using my eggs? What, like, what is your freeze-thaw survival rate for the eggs? What is your freeze-thaw survival rate for embryos? What are your— and if you're thinking about using your embryos and not just egg freezing, what are your success rates for embryo transfer to people in my age group? How about your success rates overall? Um, what are your success rates for people who have genetically tested embryos? So all those questions are going to be really important, and it is important for the clinic to give you that information. If they might not have it at that moment in time, that they get back to you and give it to you. Because again, that is one really, really important piece of your, your success rates, is just knowing the quality and the outcomes of where you're going.

Yeah, that's really helpful because I think it is a big investment for the majority of people, no matter which way people go. And so to ensure that you are going to quality clinics that know what they're doing is is really helpful.

Yeah. Yeah. I mean, like, let's say you find a clinic that's 5 minutes away, but their outcomes are not as great as the clinic that's 2 hours away.

Maybe that 2 hours is worth the drive, right? Yeah. Yeah. What are some legal concepts that people should think of? And I'll, I'll give a bit of background to this. I was, um, in Mediterranean once and I was talking to different friends from different places. One was living in the US. And remember, she said, if you freeze your eggs in the US, they're considered United States property. So you cannot— she's not originally from the US, but later on, if she were to relocate back to her country of birth, she wouldn't be allowed to, if I understood correctly, where in other countries it's much more flexible and free. So do you also advise around legality and legal restrictions of re-freezing of, um, freezing, as freezing, etc.

What are some things people should look out for? I love that you brought this up because it's one of my favorite things that we do, because we knew from day one that we wanted to be global. And just think about, like, I'm sitting in the US right now with the way that things have shifted here recently. My ability to access different types of reproductive treatments is different from state to state, right? And so imagine how different it may also be from country to country. So that's something that we've all— we've focused in on the very beginning, and, and I think it drives a lot of value for the people that use Carrot, is that understanding the— all those nuances when it comes to cross-border care, whether it's the freezing of eggs or even if it's it has to do with adoption or working with a gestational carrier. We have teams that are working on this all the time and trying to stay ahead of potential changes that are coming through so that we can inform our members in advance so they can plan in advance for those things. So, I mean, you're right, there's going to be some countries where a person cannot use donor sperm or eggs. If like those, the egg and the sperm may have to come from a couple that is heterosexual and married, or they cannot work with a gestational carrier in that country. Or if they do, it has to be altruistic. Like there can be no payment. It has to be done out of the goodness of their heart. So I mean, like there's, there's a lot of things like that. And they're constantly changing. So So I think it is really important to understand what your options are. And if it is, like, let's say that the type of treatment you want to do is not available in that location or region, if that country allows you to do it somewhere else and bring that child back. And that's what we're working on day in and day out.

Yeah, that's a big, big topic. You must have a big team to have to cover that too. Asima, can you share one of your craziest or most inspiring stories that you've encountered in your work with fertility patients?

I feel like I see that every day.

There's no—

what a nice space to work in, right? Yeah, I mean, it's so— it's such a fulfilling, you know, it's such a fulfilling— I'm not like— I don't even want to say job. I don't feel like it's a job. I'm lucky to be able to do this. This, uh, for people. I think the ins— I'm inspired every day with my patients and with, with our Carrot members and hearing their stories and, and sharing that experience. For instance, like with my, my clinic patients, when they get pregnant and we see that ultrasound, you know, usually it's around like 8 or 9 weeks where we call— we call it the— I joke with my patients, like the gummy bear, like the, the fetus looks like a gummy bear, um, and it's wiggling around and it has like a visible, has visible cardiac activity. That's one of my favorite things. Or when they send me updates like, oh, we did our, you know, our pregnancy announcement. Or when they have the delivery and they send me the newborn baby. I mean, all those things, they just make my day, right? Like, it's hard to just pick one story. I feel like I'm inspired by them every day. I feel so much joy and happiness with seeing them being happy and being able to achieve their family building goals.

It's, it's so rewarding. Oh, so beautiful. I love that. I'd love to touch on perimenopause and implications around menopause as well. So how do perimenopause and menopause impact fertility and overall health, and particularly around perimenopause? Because depending on the research you look at, it can, can kick off from the age of around 35.

Right.

So for many women who are thinking of getting pregnant later, you know, this is something to understand. And I love if you could talk to that. And, you know, what are some proactive steps that women can do to better manage the transition? And later, I'd like to touch on HRT and its implications also with fertility as well. But I don't want to stack the questions too much.

So let's start with perimenopause. So I think it is really important that you mentioned perimenopause and not just menopause. And I think that's what we're seeing shift over time is to start. I'm very happy that in the last few years that we have started talking more about menopause. But I think the shift happening now is understanding that menopause is when your periods have stopped for an entire year. So 12+ months. Perimenopause starts even before that. And like you mentioned, sometimes for some people in their mid-30s, for some people, those symptoms that they feel related to perimenopause can last 14 to 20 years. The average, I think, or the median is like 7.4 years. So it can occur over an extended period of time. And I think it's important for people to know that and prepare for it in advance and understand what those symptoms are so they're caught off guard and really can prepare for it. So we did our, our third annual menopause in the workplace survey this year. And our findings are very interesting because we had a lot of millennials complete the survey. And we found that about a third of them were considering using hormone therapy, that a significant portion of them were interested in learning about menopause. And even I think like 70% of them would consider switching their jobs if they weren't getting support through the workplace. So it's really nice to see that the— I think like now the term they're calling this is millenopause, but that this generation of women are thinking about it even in advance. I think, again, it was like close to a third of them reported having some symptoms already. But that even those that weren't, like, they are actively thinking about it, preparing about it, thinking about how the workplace can support them. Um, and even considering hormone therapy as a possible treatment. Whereas if you looked at the generation before them, I think only 15% of them were considering it. Uh, so I see that the approach, the mindset, and the trends around what they're considering acceptable or what their expectations are changing, which is great.

That's really great. And how would I know? HRT is a big topic, I think, so important. Um, thankfully that the breast cancer risk has been debunked, that people understand, hopefully now people listening. But if you don't, it's good to know about the, the study that was falsely interpreted. Et cetera, around the bioidentical hormone replacement therapy and able to support women. But let's say women have decided to look at, you know, estradiol and testosterone replacement therapy, progestin, et cetera, for support around perimenopause. How will that impact fertility, for example? And, you know, if there are still chances of them to get pregnant if they feel that they already have perimenopausal symptoms.

Okay. So you were cutting in and out. So I'm just going to try to repeat the question. Um, you were asking about like how historically people weren't using hormone therapy as much because of that study, how they are considering it more now and how people can understand perimenopause when it relates to their fertility.

So if people are taking HT during the perimenopause, years because they are having symptoms.

Yeah.

Will that impact their ability to still get pregnant? So choose, you know, what are some factors that they should consider during the perimenopause in terms of fertility and in terms of if they're taking HRT, bioidentical HRT?

Okay. So when someone is considering taking hormone therapy to start, it's just important to have a really in-depth discussion with their provider to determine what all their, like, what all their treatment options are. Because for some people it may be safe, or for some people there may be other options that can alleviate their symptoms and might be safer for them, right? So I think that's the starting point. For those people who are going through perimenopause and are taking hormone therapy, hormone therapies are hormones. They're, they're estrogen. They can be estrogen with progestin, and those hormones can, just like a birth control pill, which is estrogen, affect your ovulation and your reproductive, right? So if you are taking it, it doesn't mean that if you're perimenopausal, you cannot have children, but you may want to discuss with your provider what your timelines look like and when you may want to start trying to get pregnant and what your treatment options are available. Um, again, fertility declines with age for the females. So really having that discussion on timeline is important because the sooner you are trying to get pregnant, the higher your chance of success. But if you are perimenopausal and you are on hormone therapy, as long as it's not menopause and you're still ovulating, um, there is a chance for pregnancy, but you may need to be taken off that, those hormones to allow yourself to ovulate, or you may need to be taken off of them so you could do fertility treatment to get pregnant if you need it.

Wow, that's helpful. What does the future of fertility look like and fertility care look like in your view in, say, the next 10 to 20 years?

Again, I'm really interested in seeing how these, these studies pan out. So if there is a way to prolong fertility, does that mean that the— and ovarian function— does that mean that the age of menopause, which is again, when someone's not ovulating, not having periods for 12 months, is that going to shift to a later point in time? Which means, are we going to start, continue to see an increase in age for people as they start to try to grow their families? And people will maybe older when growing their families. Of course, there's that balance. You want to make sure that the person's healthy overall, because even though the ovaries age faster than the uterus, you want to make sure that their uterus and their body is otherwise healthy to be able to carry that pregnancy? Because you can technically get a woman in her 70s or 80s pregnant, but is that really the safest and best thing for that person, right? So, again, I'm really excited to see the outcomes of these studies. I think another thing that I'm also really interested in is the research that's being done on in vitro maturation, where a person may not have to do as intensive of a treatment, meaning taking all those high-dose medications to try to mature their eggs while they're still inside their body and maybe retrieve them at an earlier point in time, which means, again, cost reduction and less of that physical and emotional burden on a person going through the treatment and be able to get eggs that way. So, I mean, honestly, the list is endless, but I'd say those are some of the really exciting things that I'm looking forward to. And again, I say this almost every single time, is the genetic testing aspect on what you may be able to tests in the embryo to be able to pick the highest quality and healthiest embryo for, for transfer so that you can have a healthier pregnancy and healthier baby.

So exciting space to watch, which is amazing. I heard, and I haven't looked at the research on this, but I heard that actually having children later in life, so into your 40s, can actually help to to extend longevity.

Have you seen research on this? I've, I've, I will say that I'm not an expert on that specific topic, but what I have read about and learned about is that they have seen that people who go through menopause at a later point in time may be living longer. And the question is, is it because they are in a state of health or their, their body is a certain way that's resulting in both their, their ovarian function and their lifespan being longer, or is it because their ovarian function is lasting longer that is resulting in their lifespan being longer? And again, there are some preliminary studies. Some suggest that even women who have taken hormone therapy might be living longer.. But again, it's just not, it's not, I wouldn't say quite conclusive yet where we can, you know, just slap something on there saying like 100% guarantee, you take hormone therapy and you'll live 5 more years. I think there's still a lot more to be studied there, but there definitely is a connection. I think there was like another study that also showed that for women who go through menopause later, they're like, they're seeing that not only are they potentially living longer, but they're, their genetic siblings also, like the male siblings, also look like they had a slightly longer lifespan. Again, I'm not the— I'm not an expert on that aspect, but just some interesting studies out there, and I'd love to learn more about how those two are connected. And like, I think one of— I think the medical director of the Menopause Society said this, like, the chicken or the egg, like what's causing what, you know?

Yeah, it's trying to find out. What does your daily routine look like, Asima? Because You are a physician, an entrepreneur, a mother, a thought leader. Like, how do you balance it? What is your daily routine?

How do you stay in optimal performance and still have a smile on your face? Well, I have a smile on my face because I get to talk to people like you and take care of these wonderful patients and help people through Carrie. I mean, that, and of course, like my babies, but truth be told, I am human. Thanksgiving was last week, so I am not in a perfect place right now. In terms of my routine. But generally speaking, what I do, I do, uh, follow the early to bed and early to rise. Um, I try to go to bed early so I can wake up early and give myself that time. Um, my ideal situation when I'm not post-Thanksgiving is going to bed by 8 or 9 and waking up at 4 to 5 in the morning, making sure I have time to do a daily workout at that time. For me, that's the perfect time because most people are still sleeping, so I don't have children to attend to. And children, exactly. But also, like, when I have the ability, I do love going for runs in the morning because I just feel like the energy at that time of day, the air, it just, it's, it's my, it's almost a meditation for me. I really, really enjoy it. And that gives me that me time, which I think helps me get through the rest of the day. And also, I know that I've done something to contribute to taking care of myself that I feel better about it the rest of the day. Um, I do try to look at my macros and make sure that I'm eating balanced meals as much as possible. I think, um, with the way that the American diet and things that are easily accessible are, you end up eating a lot more carbs than other things.. So I try to really keep an eye on my macros. Um, and I do have a blended job in that I do see patients in clinic, but I also am the chief medical officer of Care Fertility. So I have the ability to go into clinic and see patients, but also be able to work remotely from home like I'm doing today. Um, and, uh, I think that also helps a lot with like the, the day-to-day balance. I have learned over time to ask for help when you need it. I, um, and that was a big thing for me because I usually just try to do things by myself. But through that, I have built my support system and we have, um, I have a nanny that I love to death. She's been with us for 7 years. Um, and she really helps us with being able to balance everything with the children because in many situations, both my husband, who's also a chief medical officer of a company, um, have to travel. And so it really helps to make sure that, you know, there's someone around for them any time of the day, which was one of my concerns when, you know, going into a career that requires a lot of time.

But again, it's just very, very rewarding. Oh, beautiful.

Amazing.

For people watching or my listeners interested in understanding more about fertility and improving fertility, what resources, maybe books or online resources, would you recommend they start with?

I think this is, again, a very important question because there is a lot of misinformation, disinformation out there. Again, social media is really easy because you just type in something and all these videos pop up. But you really have to be careful because not everyone who claims claims to be an expert is an expert. If you're really looking for the data, I think it's important to— and as you know, and actually, like, um, these journals have created social media accounts to make the information more accessible and just easy to grasp. And just a lot of it, you know, you don't want to read a whole abstract if you don't understand, um, all of it. But, um, for me, I would say Fertility and Sterility is a really good journal to look at when you're trying to get information the Endocrine Society. There's, there's so many of them out there. Um, but if you're looking at websites, again, this is me from the United States just giving you some examples. Um, the Mayo Clinic has some really accessible, easy-to-read information. Um, Cleveland Clinic, Medscape. Um, but if you have any questions, you can always send me a DM and I'm happy to send you information as well. Again, And this is something that we spend a lot of time on with our Carat platform is making sure that all the education, all the information that reaches our members is up to date. And if there are newer studies that came out that show that a type of treatment might not be as effective as it used to be, or there's a newer treatment that is better, we make sure that our members have access to that information. So with whatever you're looking at, you wanna make sure that it's scientifically backed, that the research is, done in a way that provides evidence-based guidelines and, you know, clinical guidelines that you can follow.

Where can people follow what you are up to?

And can fertility social media handles, website, and we'll link everything in the show notes.

Excellent, thank you.

Can you share your, your social media handles and website where people follow you?

Oh yeah. So my, um, I have a couple, I'm on a couple different social media websites, um, or sites. For Instagram, it's Dr_Azima. Carrot Fertility also has an account there. I'm also on LinkedIn and on X. And, uh, if you go to carrotfertility.com, you'll be able to get additional information about what we do.

Yay. Amazing. So we'll link all of those.

Do you have final ask or recommendation or any parting thoughts or message for my audience today? Yeah, I think, again, I said this earlier, but what I think is really important is that it's never too early to learn about your fertility. If you're curious, reach out to your doctor, get that information, because you will learn where you are at that point in time, and it will really help you understand and prepare for the future. Uh, for some people, like I said, that's when they initially learned that there might be something going on, like a low egg count or a low sperm count, that they can then address at that point in time. Um, and really understand that fertility is a part of your overall health. So just try to give yourself that time, dedicate that to yourself to focus on your health and be as healthy as possible, because in the end, that will affect not only your fertility, but if you are the person trying to get pregnant, your pregnancy outcomes and your, your, um, and the health of the baby as well.

Beautiful. Thank you so much, Jasmine, for coming on today. Thank you everybody for listening and tuning in.

It's been such a pleasure to have you. Oh, thank you for having me, Claudia. This is great. Such a pleasure.