Fertility, Egg Freezing, and Medical Training with Dr. Beverly Reed

That's probably another regret. People told me not to join the military. I don't listen. Are you noticing a pattern here?

Um, hi everybody and welcome to the podcast. This is Generations MD. My name is Stephanie and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Dr. Beverly Reed. Welcome to the podcast.

Hi, thank you. I'm so happy to be here. Thank you for inviting me.

Yeah, we're so happy to have you. Dr. Reid, if you want to give the audience just kind of a brief introduction of who you are and what you do.

Yes. Okay. Well, you guys may like my Instagram handle, which is Dr. Happy Eggs. I am an infertility doctor, and so that is just what I live and breathe. You know, I'm actually in Plano, Texas. I opened a practice with a partner, Dr. Amber Klimczak, about three years ago, and it's great because she and I are just both the same personality type where we are just obsessed with everything fertility related. And so we actually—it's nice to be on your podcast. We have our own podcast too. It's called Two Peaks in a Pod. The reason it's called that is our practice name is called Peak Fertility. So we say Two Peaks in a Pod, and we talk about a lot of the celebrities. fertility stories that come up in the news and then try to give the actual medical information behind it in terms of fertility and everything too. Um, and then we have a YouTube channel, Peak, uh, Peak Fertility as well, where it's like the video version of, of the podcast. But, but really our whole goal is not only to help our patients, but also to help people that may not have access to an infertility specialist, or maybe people who are just curious to learn and hear more information about fertility as well.

Well, yeah, I love that. I think that it's so important to talk about this topic and, um, get information out there, especially because it is such a hot-button topic and something that is continuously progressing and changing. So, um, I love that you guys are getting out there and getting information. I think that's so important.

Yeah, I know. One of the things that I found that's so challenging these days, and I'm sure you guys have seen this too, is we have this explosion of information, which is great with like AI and social media and everything. But it is difficult because sometimes on social media, the people giving the information are not the medical experts. Right. And so some of my patients can come in very confused because they've heard these recommendations from these influencers that have no medical background. And so, you know, one of the things we even try to just teach our patients is You know, where are the receipts, right? What studies do they have to back up what they're claiming and what are their credentials? You know, is this person a physician or, you know, what, who is this person, right? Because sometimes you don't know. This is just a random person who appears to be an expert online.

They put doctor in front of their name, whether it's true or not.

Exactly. Exactly. And so, you know, that's what we try to teach is, you know, know who you're getting your advice from and what they have to back it up. But also we need to be out there, us, right? Because, and I know we're all busy, it's so hard. Um, you know, Stephanie, you're in school, I'm sure you're studying. And Sarah, I know you're, you know, working hard in your practice and everything. It's hard to find the time to be out there, but that's why I'm glad you guys are doing things like this here because our voices need to be out there so that patients have access to good medical information.

Yeah. Yeah. I mean, I completely agree. We talk about this a lot, but I also, I mean, first of all, I, I say that they should teach scientific and medical literacy in school. I think It is so important to understand how to get information, especially in this age. But then also, it's just the truth is, is this is how our patients are getting information is from TikTok, Instagram, social media, just scrolling. So people say, oh, you know, healthcare providers, it's sticky to get on social media for various reasons. But I think it's important to get on there, build a rapport with your audience, and be able to put information out there and be there. And that's why my mom has jumped on the bandwagon as well and started posting too.

I started my own TikTok a few months ago. Yeah, it's been a learning process for me just figuring out how to do it. And you want the views, but sometimes you get the views with people giving you hate. It's, it's a lot.

There's some grumpy people out there. Yeah. Yeah. Well, I mean, I think you bring up a good point, Stephanie, when you said that there needs to be some education on how to interpret a study, but I honestly think this probably needs to be some widespread advice for people, because here's the thing, our patients are smart. They, and because of accessibility of everything, They can look up these studies themselves. That was much different than when actually Sarah and I were younger, because if you want to pull up a study, sometimes you had to go to the library and have your own special access and print off a copy and all the rest of it, right? And the average patient is not going to have the access or be able to do that. But nowadays, anybody can get any study. And so, but then how do you read and interpret that study? That's where— our training is helpful, but maybe that training should be made available to everybody these days. If you're going to be reading the studies, you need, you know, you need to have the background of what to look for. Because sometimes a patient will bring me a study and I'll say, okay, like, I'm glad you pulled up the study, but when I'm looking at it, I'm noting— noticing this bias, or they didn't have a control group, or whatever the case may be. And I think our patients are smart enough to know and understand it. It may just be that somebody's got to give them that guideline on how to interpret the study. Yeah, that's true.

Well, backing up, let's talk a little bit about you and how you decided you want to be a doctor and how you decided that this was a specialty you wanted. And tell us all of that.

Yeah, I can imagine that you've always been in love with this, with infertility and all of that. So, yeah, back up and tell us about your journey to med school and everything.

Well, I think you guys may find this kind of interesting just because it's probably so different from the dynamic that you guys had or the dynamic I have with me and my daughter, which is that I didn't have anyone in my family who was in the medical field. Um, and I know this sounds odd, like I didn't really know I could be a doctor actually growing up. Yeah. And it wasn't like my parents told me I couldn't be. It just was never even really raised as a question. Um, and my mom was a stay-at-home mom and, uh, I love how my mom was just always— I would like every week I would tell her what I wanted to be. It was something different. And she'd be like, that's great. And like, she never told me, you know, I'd be like, I'm going to be a detective. And she'd be like, that's great. You could be a great detective. And then, you know, next week, like, I'm going to be a veterinarian. That's great. You would be a great veterinarian, you know? And so I always like think back and just love that about my mom because I don't know that I'm always the same way with my kids. My kids tell me they want to do something. I'm like, I don't know if that's the best idea.

Terrible idea. Dream squasher.

That's right. So I did really love how encouraged my mom was, but I never said I wanted to be a doctor because again, maybe I just didn't have much exposure to it and I just didn't know I could be. And so whenever I got done with high school, I kind of actually just thought I would want to go into business. I was working as a bank teller at the time. Maybe I want to do this. And then what really changed my mind was biology class, and I just had the best professor. And she would start her lessons of, have you ever wondered how a fetus gets oxygen? And I'm like, yes, how does a fetus get oxygen? Right? And then she would— and I was just engrossed. And I'm like, where has this been all my life? I just loved it. And I realized I'm a nerd. And So that happened at the same time as me getting a job as front desk in the radiology department at a hospital. And when I just put those pieces together, I'm like, I have found my home. Like, I just love science. I love getting to work with patients. I love getting to help people. And so then I said, well, how can I do this? And so I— and you know what, I think this is important for our listeners too, because I know a lot of people, sometimes they've known from like age 5 they wanted to be a doctor and they went to the best school and did all the things. You know, I started at community college. Like, that's pretty rare for a doctor to have started at community college. I was poor. I had no money. Um, and so I started at community college. I did that for 2 years, and then I transferred to Texas A&M. I was a biomedical science major there. And then, um, once I got done with college, I did do— it's Less than a gap year because I graduated in August, and so I had to wait the next year to, to go to medical school. So I had a mini gap year there, and then I went to Texas A&M for medical school. I will say, during my mini gap year, I did love that because I was a scrub tech.

Um, oh, that is huge. Like, I mean, that you learn a lot doing that.

It was great. Yeah. And honestly too, Being a doctor now, these things really help me. Working front desk in radiology still helps me to this day, especially even when I'm like training my front desk staff. I'm like, guys, I used to do this. Like, you know, yeah, no one does. Yeah. And I actually like think back and laugh because I remember when I told everybody when I was front desk radiology, I was like, I'm gonna be a doctor one day. And they were like, sure you are, sweetie. Sure, honey. And but when somebody says that to me, I'm like, you can be a doctor. This is how I started too, you know. And I just love that I've gotten to go through that pathway too. But, um, but also being a scrub tech, you got to see the other part of it too, of being sometimes mistreated by the doctors, right? Some would throw these temper tantrums and throwing instruments. Those were in the olden days. I don't think they're allowed to do that anymore, but back then they did.

I don't know. I think some places they do.

I'm on my surgery rotation right now. Have not seen it yet, but that's good.

Glad to hear that. That's good. That's good. I think things have changed, but, but, um, so important for me to have been on the other side of it and just know and understand what it feels like to be in any of those positions. And just a reminder to always show respect and kindness to everybody, you know, involved in all of that. But I really enjoyed that time and I think that kind of helped, um, shape my pathway as well. And so, whenever, whenever I was in medical school, you'll have to tell me if this happens to you too, Stephanie, is every rotation I had, I loved, actually. And it was hard for me to figure out what to do. Like, do you know what you want to do yet in terms of residency?

I had kind of come in thinking, you know, I want to be just like my mom. But, and I want to do something. I feel like I'm going to end up doing something kind of general because, yeah, I mean, I've only done medicine, and now I'm in surgery. But yeah, I've been loving everything. And when my friends ask me, they're like, oh, how, like, how do you like this? I'm like, I love it. And they're like, you just seem to like everything. And I'm like, I think I will go about this year, and I do think I'm gonna end up like loving a lot of stuff.

Yeah, you're kind of in my favorite time right now. You know, first 2 years traditionally are in the classroom, textbooks, basic, you know, more basic Science kind of stuff, and that was kind of I just had to get through it. But clinical rotations like third and fourth year, I loved and just thrived it and thrived in it so much. My two big things I was trying to decide between were surgery and OB-GYN, and I ended up picking OB-GYN because I did feel like it was a good mix of surgery and deliveries and clinic and and all of that. And so I I was glad I ended up choosing OB-GYN. And I actually joined the military in order to help me pay for medical school and everything. And so once I got done with medical school, I did my OB-GYN training in San Antonio at the military program there. And that's intense. Actually, I was talking to one of my OB-GYN friends the other day because we remember when we were young and you're up all night, you know, doing your rotation. You're like, this isn't bad. I love this. I'm a night owl and all the rest of it. When you're young and full of energy, it's a lot easier. Now when you're like our age, we're like, Oh gosh, we like that. That wears on you in the long run. GYN is a rough lifestyle. It is.

Yeah, yeah, yeah. I think that is, yeah, a good point. Just, yeah, talking about, you know, and everything, especially when everything is new and it's novel and exciting and you can be up all night and it's so hard to not, especially like your 3rd year of medical school and you're like, this is so fun. But when you really think about the longevity and What do I want my life to look like? Yeah, way in the future. It's so hard to know.

It's really hard. And I will say, when I told people I wanted to do OB-GYN, many people tried to warn me. They said, oh, it's a tough schedule. I say, well, I love to work hard. I don't care about a tough schedule. And, um, they said, well, there's a lot of liability, there's a lot of lawsuits and everything. And I'm just gonna admit, this is where I was arrogant, and I said, Well, I'm going to go to the best training program and I'm going to study so hard and I'm going to be such a great doctor that it can't happen to me. Right. And now I'm like, oh my gosh, I was so young and stupid. Lawsuits happen to good doctors and bad things happen to good doctors. And also nobody's perfect. Right. Yeah. Um, and, and so now I understand a lot better. Like, it's, it's, it is a hard It's a hard life to choose.

Yeah. We had a malpractice attorney on here a while ago, and we were just asking him some of those things about, like, okay, if you don't want to get sued, what should you do? And he was like, yeah, well, maybe don't choose OB-GYN. He said it's just part of it. There's just kind of this mystery of babies coming into the world, and it's expected to be perfect. And when it's not, Everybody feels the need to blame somebody for that, whether it's their fault or not. So that, that just kind of stuck with me.

Yeah, me too. Yeah, very difficult. Yeah. And here's one of the things that I did find to be challenging about OB-GYN that maybe doesn't just fit with my personality as well now. And now I know this is with OB-GYN, you have very little time to make very important decisions, right? You know, you could be delivering a baby, and let's say you get a shoulder dystocia, the shoulder's getting stuck, and you have probably less than a minute to figure out what do I do next, right? And of course, OB-GYNs do train for these things and prepare for these things and everything, but I'm the personality type where I really want to research everything before I make a decision. Um, and so I, you know, if let's say I have something weird come up in my clinic and I take an ultrasound image and then I go show my partner, what do you think of this? And then I show my other, what do you think of this? And then I'm looking things up and all the rest of it. I can take however long I want to make that decision. Right. But in OB-GYN, it's like, decide something now. Right. So you have no time to decide and you will be criticized very harshly no matter either way, you know, as if anything happens.

Yeah.

You know, and, and fortunately this situation never happened to me, but I've, for example, OB-GYNs I know that say they did the delivery and the baby has a broken clavicle or something. And here's the thing, that's a good outcome. That means you saved the baby's life. Okay. But then they're going to be criticized and sued and all the rest of it. And it's just, it, it is a lot, you know, hopefully I'm not being too discouraging to anyone, but you got to know the truth too.

Yeah.

It really is a lot to deal with and everything, but, um, But anyways, that's— I maybe things I wish I could have told my younger self.

Yeah. In the military, your younger self doesn't listen.

Yeah, it's true. I— that is very true. Right.

But in the— for— so you did your residency in San Antonio through the military program, and then, uh, then do you have to go be in the military after that, or how does— and how does that work?

Yeah. So yeah, and I think this is helpful too. Maybe some listeners are kind of thinking about The military and all that. Um, that's probably another regret. People told me not to join the military. I don't listen. Are you noticing a pattern here? Um, okay. So as I had mentioned before, super poor, right? So I needed some help and I was kind of like, should I take out a bunch of student loans or should I do the scholarship? And so I got the Air Force scholarship where it's a year for a year. They pay for a year, you owe them a year. But here's the thing, your payback does not start until After you're done training. That's number one. But here's where I'm just telling you, the recruiter really did lie to me about this because I said, well, how do I, how do I choose my residency and everything? Does this, does being in the military affect this? And they say, oh no, you actually have more options if you join the military. You can do a military residency or you can do a civilian residency. You get to choose. You're going to have so many options. Okay, no, that's not how it works, just in case anybody's thinking about this. So the way it works is the military decides how many doctors of each specialty they need every year. Okay, so, um, let's say I wanted to be, you know, I don't know, a radiation oncologist, and let's say that's what I wanted to do this whole time, and then the Air Force says, well, we don't need one of those right now. Okay, you don't get to be a radiation oncologist. You're gonna have to pick something else. Okay. Um, and then now fortunately they do usually need OB-GYNs. So great. Um, so it's kind of like you're applying for 2 things. Does the military have a slot available for an OB-GYN? But then also you've got to apply to residency. And when they say, oh, you can pick any residency you want. Oh no, no, no. The Air Force is going to pick who they want first into their own slots. And then if there's any leftovers, they can go to civilian slots. Right. And they didn't really make that clear to me at the time. It's not your choice. It's their choice. It's their choice. And so that's fine. I mean, ultimately, I was very happy because it was a really good program. It was, it was very hard, but I wanted hard because remember, that's back when I was like, I'm gonna be the best doctor. Right? And so, so anyways, I ended up in the military program there, and then I actually did my payback at that point. So I went to Langley Air Force Base in Virginia. I did a 4-year Uh, payback at that point. Now it is possible, and some people decide to go straight from residency to fellowship, but I didn't know at that time that I wanted to be a fertility doctor. And I think I also, you know how they have the, you have the imposter syndrome, right? To be a fertility doctor, it's a very competitive, uh, fellowship to get into.

Yeah.

And at the time I really Immediately dismissed it of like, I'm not smart enough. I'm not good enough. I would never get into fellowship anyways. And so I kind of didn't even put much into it. I just, oh, I love my fertility rotation, but oh, onto the next.

Yeah. Yeah.

And then I will say during OB-GYN, I had the same issue where I loved everything I did, cuz you do all your rotations on gynecology, oncology, urogynecology, you do all these things and I loved them all. And so I was really like, hmm, should I do fellowship? Which one should I do? And I literally came this close to doing gynecology oncology. But what just held me back is it is pretty sad. It's pretty depressing. And so I was like, I just don't think it's for me. And so I was like, let me just go ahead and do my payback and see how that goes. And during my payback is when I realized fertility is for me. And it was really a combination of one, dealing with the tough lifestyle, the tough hours, the tough lifestyle, dealing with the stress of just how I told you my personality, having to make these quick decisions and it just feeling very stressful. And And also doing some fertility as an OB-GYN and just feeling like this dopamine hit every time a patient would call with a positive pregnancy test after treatment. And I'm like, oh my gosh, this is what I'm meant to do.

Yeah.

And even though before I'd had this, like, I'm not good enough, I'm not smart enough, I'm like, okay, but I need to try and just see what happens. Fortunately, I had had some research projects I'd been a part of, and I had done pretty well on my scores and all that during residency. And so I applied and I ended up getting it. I was like, oh my gosh. And so that's what brought me to Texas. So I went to UT Southwestern and did a 3-year fellowship in reproductive endocrinology and infertility. It's rough because all the fellowships for OB-GYN are pretty long, actually. So when you—

I'm doing the math on all of this. This is, you know, we got mental things.

Yeah, 15 years really, if you add up like college, med school, residency, fellowship, and all the rest of it. So it is a long pathway and there's a lot of discussion in my field of how to shorten that pathway because it doesn't always make sense. Why do I have all these other skills that I don't use as a fertility doctor? Right. Like, you have to do OB-GYN first, but it's like, okay, well, I can deliver a baby, I can do a C-section, I could do a hysterectomy, but why did I need to learn that to be a fertility doctor?

Yeah, there's just a lot of Those need to— this residency and fellowship needs to squish down. And yeah.

Yeah, that's what I was just talking to a friend about this, and it just— OB-GYN is so broad. And, and I don't know exactly, exactly how the residency is structured, but it just seems like at some point within those 4 years, you should be able to kind of tailor down, okay, I want to get really good at these particular skills because this is what I want to do.

But I don't know. Yeah. I mean, in my opinion, I think they should split it into obstetrics and then everything else because it's really— I mean, I think it could probably help each group of people become more of an expert in the details of each of those fields. But yeah. Now, one question I have.

So you were doing your payback, and then at the end of that, that's when you applied To fellowship. Does it help you or hurt you to be that far out from your residency applying to fellowship?

I think both. But I think what was nice is on the interview trail, a lot of people did appreciate that at that point I was already board certified, because that's something that sometimes they struggle with. If you've got somebody during fellowship and they're also trying to obtain their board certification, that takes away or distracts them from fellowship. So I think they liked that I was board certified, um, and that I did have more experience at that point. Um, I also, and I know they're not supposed to factor these things in, but at that point I had had 2 kids. And, um, and so I think they were kind of like, okay, she already has 2. She's probably not going to be taking much time off during fellowship. Although I did, I had one more fellowship. Um, but, um, yeah, so I mean, I, I think that overall it, it probably helped more than it hurt, but I'm sure there were some, some questions of like, okay, but why didn't you just go straight into fellowship? Straight through, and you know, and then I really just kind of explained just what I explained to you guys too of the why I just wasn't sure at that time. You know, yeah, well, and you had to do that payback at some point. So yeah, right, that's true. Yeah, yeah, yeah. And I don't know that the Air Force needed many more fertility doctors at that point too, because that would have been the other thing is did they have any slots for fertility doctors that were needed? And you know, their slots were pretty. Hard to come by as well.

But yeah, it's always so ironic to me that, you know, in OB they don't want any pregnant residents or fellows.

Yeah. You know, it's just— In the olden days, that's, I mean, pretty much like you day 1, like, what form of contraception are you using? Like, you know, and I didn't, I really, I, the pressure was on not to have a baby during residency and I didn't because I really felt like I would be in trouble if I did. And honestly, I wouldn't have been a good mother because those, that was back before the enforcement of the 80-hour workweek and all the rest of it. So it just honestly, I don't think it would've been—

I don't know how people do it.

Yeah, feasible. But, um, but yeah, so, um, but anyways, when I went to fellowship, now that was a nice time of my life because, um, you know, one of the great things about fertility is we don't have many emergencies. Okay. We're not up at 2:00 AM. We're not working holidays and things like that. Um, and so this is where, Stephanie, I need to try to convince you to be a fertility doctor. It is the best specialty to go into, as long as you get through that OB-GYN residency first. Um, but what is amazing is you get a good mix of procedures and clinic. If you want to do surgery, you can. If you hate surgery, you don't have to do it. Um, you get to help patients and establish a relationship, but then also you get to graduate them and send them on their way to their OB-GYN once they're 8 weeks pregnant. And And, um, and right now we actually have a shortage of fertility doctors because what's happening is some of these big companies are realizing they need to offer fertility treatment coverage for their workers if they want to attract the best workers. And so we are seeing a huge explosion of patients who are now able to afford our bigger treatments like IVF when they weren't able to afford them before. And so that's great for patients, but now we don't have enough doctors and clinics and labs and everyone to take care of all these patients. And so it is a great field to go into right now. Um, but, but also aside from that is, you know, again, just nice for lifestyle. You know, it's, it's, um, you know, easier hours and, and again, not many emergencies. And I have all the time to think about any decision I want to make.

And yeah, no, it honestly sounds That sounds awesome. But tell— can you talk about, like, I don't know, what a day looks like for you? And you talk about procedures and surgery, it's like, what does that really look like?

Yeah, yeah. Um, yeah, so, um, I will say morning times are probably when we start with our procedures. Um, usually we'll do a couple of egg retrievals. So patients that are doing IVF, they've been taking their fertility injections to stimulate their ovaries to make eggs, but then we have to pull out the eggs at the proper time. So, so we usually have maybe a few egg retrievals and then a little later in the morning we might do some embryo transfers. And then really all the other times are just seeing patients here in the clinic, you know, new patient visits, follow-up visits, and then lots of just more minor procedures, ultrasounds, inseminations, HSGs. These are X-rays where we're checking fallopian tubes to make sure they're open. saline infusion sonogram procedure where we're checking for things like polyps. So, so yeah, I mean, our days, it's nice. There's a lot of variety. And really, I do, I enjoy it quite a bit.

Go ahead, Mom.

Oh, no, I just was thinking about the insurance coverage too. Yeah, what a big difference that makes, because I was thinking about the fact that if you don't have insurance coverage for this and patients are having to pay out of pocket, you really have to be recruiting patients all the time or really advertising your practice or kind of like cosmetic surgeons do or other cash pay things. But that's a really game changer when you have insurance covering those things.

Yes.

But I don't know, I was just thinking about that. But what were you going to say, Stephanie?

No, you can go ahead, Dr. Reed, if you have anything.

Well, I mean, I think, yeah, it's been wonderful. Now, of course, and I think you understand the struggle, Sarah, being actually concierge medicine too, is insurance often does not reimburse what is really needed to pay for these expensive equipment and supplies and everything. And so we kind of chose a hybrid route where our structure is we've got a clinic and we've got a lab and our clinic accepts insurance for all those things like ultrasounds and HSG and SIS and all those things. Our embryology lab is actually intentionally out of network, which I would almost consider almost— it's kind of like a concierge lab, right? And it's because we want the best equipment and the best supplies and the most experienced embryologists and everything. And those things all cost a lot of money and not well reimbursed by insurance. And so when patients do IVF with us, we can give them an itemized receipt and they can try to get reimbursement from their insurance company, but there's no guarantee of reimbursement, or it could be for way less. And probably the easiest example that even, you know, my patients can understand as far as the cost is a semen analysis, a sperm test. We charge $150, and everybody thinks that's a very reasonable price for a semen analysis. Um, if we accepted insurance, insurance would reimburse us $6. A semen analysis. Okay.

That's just insulting.

A couple of different ways to do a semen analysis. One is you can have, um, a computer do it now, but the cartridge to do a semen analysis is $20, and that's not including the cost of the machine, which is over $10,000. So it's like you can't make the math work. Like, I shouldn't have to pay for my patient's semen analysis, right? And so that, you know, that On a bigger scale is essentially what IVF is too. And so in my field there, we're really kind of seeing a divergence of clinics at this point of like, what do you want to be? And because the only way to make that work is if you were going to be what I call an IVF factory.

Mm-hmm.

Meaning you try to squash in as many patients as you can and you pressure them all to do IVF, the treatment that you have make the most money on or whatever. And I think it's terrible, but unfortunately, guess who likes that? Private equity clinics, right? So private equity likes to come buy up all these fertility clinics and then they force their doctors to high-pressure sell IVF to everybody. I hate it, right? And so we, we're private practice, we're more boutique, um, and all the rest of it. Now because of that, um, we get— we lose some patients, right? Some patients may say, oh well, I can't use my insurance and lab, I want to go somewhere else, and that's okay. But the one, the patients we often attract are more complex patients. They've already been to the IVF factory. Like sometimes we call ourselves, we're the clinic you come to when you're mad at your first clinic. Right. And so, because we're just, we're not seeing that high of a volume. So I have more time to spend with my patients. I can talk with them. I can kind of come up with a more custom plan. We can take more time in the lab on their case and all the rest of it. Um, and so that's why I think it's probably more similar to the concierge kind of type of treatment overall there. Um, but I guess it brings up the whole other thing of private equity, which I just hate, you know, because I have so many patients that come to see me for a second opinion. I said, well, why did they say you needed IVF? And they say, well, I don't really know why. Maybe not for anything else. Yeah, because you don't need IVF, right? Um, there's such a conflict of interest there.

Well, talk a little bit about somebody, because I mean, just at a baseline level, when we talk about infertility, our brains kind of jump to IVF and these sort of things. When is IVF a good option for somebody and maybe when is it not? Also in regards to physicians in training, if there's an option to freeze your eggs for later on, is that a good option for somebody like that? If you want to Sure.

Yeah. Well, um, let me start with the first one. And, you know, I think the question of like who needs IVF or not is a bit more complex. And I think this is a good point. If you're on your first appointment with a doctor and they've done no testing on you and they're telling you you need to do IVF, that's already red flag number one, right?

Mm-hmm.

Because when I'm seeing a patient, it's usually because they've been trying to conceive and they can't. And really, the first question should be, why can't you conceive? Right? Let's do some testing to help you figure it out. You know, the top three reasons are usually there's an ovulation problem, or there's a sperm problem, or there's a fallopian tube problem. So which problem is it? And once we identify the problem, is it something we can reverse for you? Because sometimes it's as easy as oh my gosh. Maybe we fixed this for you and now you don't need us anymore. You can get pregnant naturally, right? This is what the private equity clinics hate.

Yeah, that's terrible.

The private equity clinics, they track their doctors on what is your IVF conversion rate. You saw a new patient, what percentage of those patients did IVF? Okay, I hate that. I'm like, your metric should be how many patients were you able to identify the problem and help them get pregnant naturally? That's what People want is to be able to naturally get pregnant, you know. Um, so anyways, I think part of it is just aimed at that. Now, admittedly, you know, let's say you do the testing and the fallopian tubes are blocked. Okay, the tubes are blocked. Yes, you're likely going to need IVF, or the sperm is dramatically low. They've checked for everything. They can't get it back up tomorrow. Yes, you're going to need IVF. So there are certain indications where you know that you'll need that. But oftentimes you do all the testing, it comes back normal, and there's other more natural options you can try first. We can try some fertility pills and an insemination. And so usually you would try something like that maybe up to 3 times. If it works, great. If it doesn't work, then sure, we have this great backup plan of IVF. But, but what I think is so amazing is it's been frustrating for me to see the private equity clinics because I see them as so shady and like trying to take advantage of patients. But our patients are smart. I told you that before. Our patients do their own research. They're smart. They're finding these things out on their own, and they are the ones asking the questions. And I think that's so great because if your doctor's not going to answer those questions for you, they find a different doctor that will. And ultimately, that sets them on the right path. So as far as fertility preservation for physicians, such a big issue. A large portion of my patients are doctors, lawyers, engineers, dentists, Um, and it's because we spend such a big part of our adult life, um, you know, trying to get our education and training done and everything, that by the time we're ready to conceive, sometimes it is too late. And so, yes, we always recommend, um, that patients in that circumstance seek some fertility preservation. Now, I do think it's funny, and Sarah will probably think it's funny too. A lot of people ask me, Dr. Reed, Did you freeze your eggs when you were younger? And I say, they didn't have that back then. Because truly, when I was in college and medical school, egg freezing was considered experimental. And the reason why is the egg freezing technology back then was not good. They did something called slow freeze. And with the slow freeze, Ice crystals would form. Now remember, an egg is a single cell, and so if an ice crystal damaged that single cell, you're done. It's you can freeze it, but it's not going to thaw and be able to do anything that's worth worth it. And so back then, they really only did it for like emergency cancer cases and things like that. Now everything changed when they came out with vitrification. Vitrification is a fast freeze. It's able to take the egg to the freezing stage so fast that ice crystals don't have time to form. And because of that, it's less damaging to the egg. And, and they also do this for embryos when they freeze too. And so that's when everything changed. And then initially, yes, they had it, but it was very expensive. And now it's still expensive, but it's becoming more accessible. For example, some of the big employers, to attract top talent will have egg freezing benefits and everything.

Residency programs are starting to offer it too. Um, but yeah.

Yeah. So I think it's great. Um, but what's not only challenging is the cost, but also needing to be off for those appointments and everything. Um, you know, the egg freezing process, like the most condensed part of it takes place over about 2 weeks, but during that 2 weeks, you're usually needing to be seen almost every other day. And that's hard when you're in residency. Taking that time off and everything. Um, so I always think it's great when program directors are aware of fertility concerns and very supportive during that time, because it can otherwise be, um, definitely a big issue.

Um, it'd be kind of nice to freeze your eggs 4th year of med school when you got all that time.

You're right. I agree. I think that's a great time. Yes. Yeah. But I think—

Except you don't have any money.

That's exactly what I was going to say is that's when you're poorest, right? It's so hard. Um, and, but it is such an investment. I mean, I think that's the thing. But here's the other challenging part with egg freezing is number one, it often can take multiple cycles of egg freezing to get the number of eggs that makes you feel confident. Um, and number two is some people say, oh, this is my insurance policy. This is my guarantee. It's never a guarantee.

Yeah.

And this is where it's nice. Some, some celebrities have actually even been open, but I think it was Khloe Kardashian, maybe one, maybe one of the Kardashians had frozen their eggs. She went to thaw them. None of them worked. You know, you can't know if an egg is gonna work or not until you go to try to use it. So imagine how frustrating that could be. Um, if let's say you did 3 eggs or 3 rounds of egg freezing, you spent all this money, all this time, all this stress, and you go to use them years later and then And then nothing. Right. That's the uncertainty of my field, which is actually very difficult.

Do you— if I'm just thinking about the conversations that I might have with my patients. Yeah. If, like, okay, let's say that the cost is not such a big issue, but they— I mean, I have some of these young women who are like, you know, I haven't found my life partner yet. Like, what age would you say I should maybe start having those conversations with them?

Well, one thing we say is if the patient is asking, it's time. You know, if anyone's concerned, they should, because it is sad that sometimes I've talked to patients who said, you know, I asked my doctor about this. They said I didn't need to be worried. And at that point, then they're out of eggs at that point.

Right.

So I know, and there's no way to predict who is going to run out of eggs and when that can be. Um, for sure, if somebody is approaching 35, we're like, okay, like you've really got to start thinking about it, but really the younger the better. Sometimes people say, well, should I monitor my egg count level? There is a blood test, AMH, anti-Müllerian hormone level, where you can just get an idea of what your ovarian reserve looks like. And the average level is a 2.5 to 3 or something. Can I check my levels and be reassured by that? And the hard part is not really, because your level may be normal and then the next year it could totally have tanked and you had no idea, no indicator, no clue, right? Um, and the other hard part is sometimes people can be falsely reassured by their AMH. So let's say you check your level and you're a superstar, you're like a 4.5, and you're like, I'm great. Okay, but it doesn't tell you about the quality of your eggs. We have no test for egg quality. We know as we get older the quality goes down, but that's why it's also better to freeze when you're younger, because that's when your eggs are going to be at their best. Um, so really The younger the better.

And just, I know, very, very roughly, what is kind of the range of cost of egg freezing?

So I, yeah, I've seen quite a bit of a range. I mean, I would say probably around $7,000 or so, um, each cycle. And then I think it's reasonable to say the average woman might need maybe 2 to 3 cycles, but it depends, you know. Of course, if they're younger and have higher reserve, they might be able to to get a good number all in one cycle. And sometimes the reason we see people is maybe they were checking their ovarian reserve and it's already low. Well, it's just such a double whammy at that point because when your ovarian reserve is low, your yield every time you do a cycle is lower. So for example, the average woman might be able to give us 10 to 15 eggs in one cycle of egg freezing. If you have a low AMH, your egg counts are low and your body's trying to conserve the eggs that are left. So your Your ovaries are more stingy when you're trying to freeze eggs. And so let's say somebody with a low AMH of, let's say it's like 0.3, they might get 2 eggs every round of egg freezing, right? And so then they're having to do way more rounds of egg freezing than somebody else, right? And so it's, yeah, can be rough.

How do you like handle these conversations with— well, um, did you— I listened to that podcast with, um, Monica. It was called like Race to 35. Do you know what I'm talking about?

Oh, I know what you're talking about.

Yeah. It was a if you know Dax Shepard, he has a podcast with yeah, yeah, yeah. So it's his like co-host, and it was like her and a friend who did egg freezing together. And I remember listening to it and her talking about she was always a straight A student. She always got perfect grades, and I'm sure that is so many people who are. coming into your clinic who are, you know, these high-achieving women who have always gotten A's on their tests, and now they're going through this process where, yeah, their score is a 0.4, they get 2 eggs, and then, you know, they're like, why? Like, what's wrong with me? How do you— how do you just like handle those conversations?

Yes, it's, it's so difficult. And actually, it's funny you bring up grade Grades too, because there is one part of my field which involves grading, and that's embryos. Okay, so when a couple does IVF, they make their embryos, and we grade their embryos from A to D. And I'm telling you, our physician patients hate it because they are expecting straight A's. Okay, but like an average person probably makes more B's and C's on their embryos, right? And there's no way that they have no control over that. That's just they are what they are, right? And so it's it's so true. I think I see a lot of high achieving women, and it's very difficult. And even personally, I feel like I dealt with this with breastfeeding. Like breastfeeding for like for example, for my mom was so easy, and I see it be so easy for everyone else. I when I delivered my own child, he was in the NICU. I'm sitting in the NICU trying to breastfeed. I have books, highlighters, Post-its, this and that, and I literally look over and there's like a teen mom. Dumping so much milk and everything. And I'm like, why is this not working for me? What's wrong with my body?

Yeah.

It is so frustrating when we're not able to achieve these things. And I will say that is probably why some people actually— fertility has kind of a reputation of having sometimes difficult patients overall because I have a lot of high anxiety patients. And, you know, some with trust issues even too. Probably especially me because I have a podcast. I have a lot of education material out there, so they find me through that. And so it's probably a subset of patients that are maybe like very uptight and everything too. Now, I do well with these patients because I'm the same personality type and I get it. I'm like, we are the same. They make spreadsheets of like their own hormones and I love it. I'm like, you made a spreadsheet? That's my favorite. So patients like that, I identify well with them. But if you're a more laid-back type of doctor, it can drive you crazy because you're like, oh my gosh. Yeah. But some of it is just conversations of, look, our science and technology have advanced so much, yet we still don't know why. In fact, right before we started this podcast today, I saw a 32-year-old woman, and I had to tell her, I don't know why, but you have run out of eggs. You're in perimenopause right now. You're not in menopause yet because you still have a period every now and then, but you're almost there. And she's crying with her husband. Why did this happen to me? What did I do to cause this? And obviously she didn't cause it herself. Most of the time it's genetic or— I mean, we're going to do some testing to try to help her figure it out. It's, it's pretty awful, especially when we don't have a treatment for that. I can't make her eggs come back even with my strongest medication, even with IVF. There's nothing I can do to, to fix that, you know?

Wow. Yeah. I, I mean, one, with— there's, you know, obviously difficulties in every field, you know, having these tough conversations and, you know, dealing with this subset of patients. But I also feel like as you were talking, having patients that are motivated I must be a good thing and must just increase job satisfaction. That's something that I think about a lot. So that must be good.

Yeah. Our fertility patients, they are such good patients. They will do everything, anything. It's their Everest, right? And yeah. Very, very good and motivated patients for sure. I think that is helpful.

I will say just being a concierge doctor, and you know there's things you can control and things you can't control, and sometimes people try to overly control different things. And I bet you, I bet you have that a lot where they say, okay, well, I'm not going to have any sugar, and I'm not going to do this or that. And and you're like, okay, no, no, no. Like you can, you can eat a normal diet. There are lots of things that you it's perfectly fine to do, but they're just like, okay, there's only I can't control these things, so I'm going to control all of these other things that. Then they make themselves crazy.

That is exactly. And honestly, something even personally I've tried to sort that I've had to sort through because I have patients that research all the doctors. They do consults all across the city, and then they'll say, "Dr. Reed, I interviewed five doctors and I chose you." And I'm like, "Wow, that's great. Thank you." You know, but then they choose me and I say, "Okay, here's my protocol I came up with you came up for you," and they're just like, "Okay, but I read." I polled my Facebook group and I decided instead of this medicine you recommended, I want to take this medicine. I'm like, okay. I'm like trying to understand it and just, you know, because I'm like when I go to the doctor, you know, I let's say I go to the allergist and he says you need to take this and I just say okay great and I just do it because I'm like surely he knows what he's talking about. Like right, just don't even question it, right? Um, I would never go on a Facebook group and be like my allergist said to do this. Let me find somebody with no medical Training on Facebook and take their opinion instead. Like that seems so bizarre to me, and so I try to understand: Do my patients not trust me? But then I'm like, but they did all this research to find me, and that you know, and what I have sorted out, which is exactly what you alluded to, is they're in a situation where it feels so uncertain; they have no control, and it really helps them to feel. Some sort of sense of they get a say in it too, that they control it. And so I really realized my role in that is to not take it personally, not get offended, but really say, is it— does it really matter if I said they want to take letrozole and they want to take Clomid? Is that okay? And if it is, fine. And if it's harmful, I'll tell them. If I say, no, I chose this for a reason, you shouldn't take this other one because of that, you know, that's fine. But if it doesn't make that much of a difference, sure, you know, shared decision-making and Yeah.

Yeah. Yeah. I, I have lots of those come up as well, you know. Yeah. Kind of, um, you know, when you're, you, you think through like, okay, wait, I think you should do this. Wait, is that just my ego talking? Do I just want them to do what is my plan? Um, or is it, is this really, really a better plan than what they're suggesting? And, um, you have to really just like think it through yourself. And a lot of times I'm like, okay, fine, let's just do it your way. And they come back and I'm like, can we do my thing now?

Yeah. Right.

Okay.

Yeah, yeah, exactly. Yeah. But, but, you know, also I think what's amazing is science is changing every single day. Medicine's changing every single day. Uh, in the fertility field, multiple major guidelines changed this year. They changed how we diagnose endometriosis. They changed the name of—

Yeah.

To PMOS. They changed the recurrent pregnancy loss guidelines, you know. So also So saying, look, sometimes my recommendations are based on the current data we have and I could have a different recommendation next month. So also understanding that and knowing it may be reasonable to sometimes think a little outside the box. I definitely acknowledge that too.

So that's one question I was going to ask is just like, A, what are the biggest shifts you have seen since you started being interested in infertility during your OB-GYN residency to now? And then also how do you manage Yeah.

Well, I think really the biggest shift is kind of back to that whole just access to care. I think in the past, fertility care was only available to people that were well off enough to afford it, and now it's available to most people, which I love. I think another big shift that I see, which is just interesting, is the fact that people are more aware of fertility. Males are more involved than they used to be. The men, oftentimes it was just kind of the women, and now the guys are coming in really wanting to be involved in the situation. And the guys are really asking for a lot of testing on their own. Um, this is— sometimes we get guys who just call. They don't have a partner at our clinic or anything. They just want to do their own testing. They want to have their sperm checked. Sometimes they want to— you know how you freeze eggs? They want to freeze sperm and all the rest of it. So I'm seeing a lot more of that too, which I think is actually good.

Yeah, as a— I mean, going into OB-GYN, you think that you're never going to talk to a man again, so— or a male patient again.

Exactly. I know that is true. Yeah. Um, and, and so, you know, but I, but I think it's great. More— we're seeing more awareness, um, and, and all of that, which of course we highly encourage. Here's the biggest limitation though that patients don't really understand even to this day is is IVF at some point still does not work. Okay.

Yeah.

So, and I didn't even understand this. So kind of my biggest misconceptions when I was a medical student, because people would say this to me, oh, you probably need to worry about your family. Oh, I'm fine. My mom had 5 kids. Okay. What was I talking about? It doesn't matter if my mom had 5 kids. That's my mom. That's not me. Okay. It doesn't matter if you have a very fertile family, you can be infertile. Right. And then even when I was an OB-GYN, people would tell me during residency, because one of my colleagues was infertile and she would say, you really need to, if you want to have kids, you need to have them. Oh, I'll just do IVF. I'll just do IVF. I'm not worried about it. Okay. And now I look back and say, what was I thinking? No, IVF at some point does not work. So IVF for women 40 and above is very difficult. And even you know, okay, 41, 42. Okay, we've got some pregnancies. 43 and above, probably not going to happen, even with IVF, even with multiple rounds of IVF. Okay. Now, does that mean those patients won't try? No, it's their individual journey. They have to. You try to tell them, look, your chances of this working are less than five percent at that point. Okay. But that's kind of interesting too because. Women in that role always say, well, but it's going to work for me, right? And so they've got to keep trying, trying, trying. And ultimately it doesn't work for many, for many women. Now, the patients in that position can use an egg donor, but nobody ever wants to hear that. You know what? No, I don't need an egg donor. My eggs are going to work. And usually what happens is they try, try, try, it doesn't work. And then at that point they say, well, use an egg donor or you're not going to have a baby. Um, but I think this is the biggest misconception. Most people don't realize that really about 43 is the stopping point there. And so I have many physician patients that was a shock for them. They got through everything, they found their partner and everything, and they show up, okay, I'm a physician, I'm here, I'm ready for my IVF, I'm 43. And I'm like, I don't know if this is going to happen. I mean, we can try, but— and so that ends up being a really big Shock.

So yeah, that is really— that's painful. Stephanie, is this conversation stressing you out? Are you gonna go and try to get pregnant like this week?

I'm like, yeah, maybe with your multiple.

Here's the thing too, like, wouldn't that be amazing? Like, for, you know, for some people they haven't found their partner, but, you know, I've been with the same person since high school, right? And maybe I would have loved to have kids earlier, but I never even thought about it as an option because our society doesn't support that. I was always told, don't get pregnant, that'll ruin— you'll never get to be a doctor if you get pregnant. You're, you know, and it's true. Like, how would I have taken care of kids? How would I have afforded childcare and everything? Wouldn't that be amazing if we lived in a culture that was supportive of women who wanted to be young mothers while also pursuing higher education and training? You know, so I really— that would be the best fix for it. But the second best, I think, is for women just to be educated and aware. And if they have the opportunity to freeze eggs so that it does take some of the pressure off, although it's not a guarantee, at least it, you know, gives you some additional options should, should that, you know, be an issue.

But I asked ChatGPT at one point, I was like running the numbers on what, what if you had like hiring a night nurse, like during residency versus doing however many rounds of IVF. After residency. And it was kind of like, obviously there's a lot of unknowns there, but you kind of start to say, like, okay, now obviously you don't necessarily have the money during residency to hire this night nurse. So there's lots of issues there. But it's like, that would be a much better use of your money, having that paid early and then just being able to hire lots and lots of help if that's possible.

Yeah. And we also talked about this on the podcast before. It's like, okay, these residency programs are now offering this egg freezing, but That's still not solving the issue that these programs are not built for women having children. And I mean, you talked about your experience in residency and how we're scared to have— yeah, be pregnant, be carrying a baby, because like, you know, you didn't want to be in trouble. And it's just not built for women. Yeah. And people wanting to have families.

Well, and even aside from the leadership in residency program, also just letting down your Colleagues too, right? And well, and actually, I'm ashamed to say I was on the other part of it. Like in the rare circumstance when somebody would go on maternity leave, and then I'm thinking, gosh, this is so hard. Now I'm having to be on call every other night now because you know, and I hate that.

You're not happy when somebody tells you they're pregnant and they're one of your co-residents.

Yeah, I hate that because of course I want to be so supportive of women, and then it made me feel bad when I was pregnant because I was like. Oh gosh, now my colleagues are gonna have to cover for me. Like, I do— I hate that, you know? Yeah, yeah.

Again, it, it's kind of a system problem though. It is, right? Why are we in training responsible for running these entire hospital systems?

Yeah, yeah, yeah.

Well, um, I could just keep talking to you forever. We, uh, I wish we had all the time in the world, but, um, as we're kind of wrapping up here, I always ask our guests this as somebody in my third year of medical school now. But, you know, our listeners are people on all levels of the education journey. What advice do you have for a young aspiring doctor like me and our listeners?

Okay, probably 2 pieces of advice. And the first is make sure you're doing this for the right reason, which is that you truly want to help other people. Because if that is the You will always be happy. There are people who've done it for the wrong reasons. You know, sometimes their parents have forced them into it, or they think they're going to make a lot of money, or they want respect or something like that. And that's not going to cut it. You'll burn out, you'll quit. But truly, if you are like, no, I just have the heart to help other people, then you will do great no matter what. Um, but the second thing is You have to prioritize self-care, and this is a huge mistake that I've made. Like I really did kind of give my all, and that meant not sleeping and at times not eating, and you know not giving enough to relationships in my lives and everything. And and those things I do regret, and I still struggle with to this day because there is no shortage of. patient demands sometimes. And I always, because I love my patients so much and want to help them as much, sometimes it's hard to draw those boundaries. And I don't have the answer. I'm still trying to figure it out myself. And I'm just now starting to work on self-care and making sure I'm getting good sleep and good nutrition and all the rest of it. But really looking back, I, I'm like, I wish I was doing this even in medical school. And I will say, even in medical school, I was always trying to do so much. And I look back and I'm like, why was I doing all this? I was the president of this club and the president of that club. I'm putting on this fundraiser and this and that. And it's like, great. Like, I'm glad I was doing all those things, but why? Like, I should have just been here. You gotta sleep.

Yeah.

You've gotta eat. Like, these are basic needs that need to be get— that need to get done. Right. And for some reason, I, those were always last priority for me. So, yeah.

Well, maybe I can also add to your story that when people give you lots of advice, you might want to consider it.

Exactly. Exactly. Well, this has been just lovely. I really appreciate it, Dr. Reid. Do you want to one more time plug your podcast and social media?

Sure. Yes. So the podcast is Two Peaks in a Pod, and it's on Apple, Spotify, all those major ones. It's also on YouTube under our Peak Fertility YouTube channel. Our practice page is peakfertility.com. And then my Instagram handle is Dr. Happy Eggs. I'm on Instagram Awesome.

And you guys know where to find us at generations.md on TikTok, and my mom is at DrDavisPGY30. And you can email us at askgenerations.md@gmail.com, and we will talk to you guys soon. Bye.

Bye.

Bye.

Well, this was, this was so fun. Thank you so much.

This is awesome. Thank you so much. I really, really appreciate it.

I feel like I learned a lot.

I learned a lot too. Yeah. So much.