Fertility Unfiltered

Sara from RPMG/FCOC
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Fertility is a maze of mixed messages: too clinical in one corner, too sugar-coated in another. Fertility, Unfiltered cuts through the noise. Hosted by the team at Reproductive Partners Medical Group & Fertility Centers of Orange County, this series brings you the real stories, science, and soul of fertility care...straight from the experts who live it every day. We talk about the things no one explains well: from the first consult jitters to male fertility myths, egg freezing facts, and the quiet emotions behind every decision. thefertilityunfiltered.substack.com

Episodes

  1. Sep 21

    There’s No One Right Way to Build a Family

    When Yale Scott and his husband first started thinking seriously about becoming parents, they weren’t entirely sure what the path would look like. They considered adoption. They researched fertility clinics. Eventually, they were referred to Reproductive Partners Medical Group, where they met with Dr. Andy Huang. And Yale still remembers one of the first conversations. Dr. Huang had Starburst candies spread across his desk, using the different colors to explain the basics of fertility and how the process worked. It was simple. Human. Approachable. For Yale, it was the beginning of a journey that would eventually make him a father of two daughters and, years later, bring him back to RPMG in a completely different role: helping other intended parents navigate journeys of their own. On a recent episode of Fertility Unfiltered, Yale shared what he learned about choosing an egg donor, finding a surrogate, building a family as a same-sex couple, and talking with children about the many people who helped make their family possible. And perhaps the most important lesson is this: There is no single correct way to build a family. Choosing an Egg Donor Is More Personal Than a Checklist When Yale and his husband began choosing an egg donor, they weren’t necessarily sure what they were supposed to be looking for. There were the obvious considerations: medical history, appearance, personality and background. But Yale remembers something much smaller catching his attention. Their eventual donor liked country music. There was also a childhood photo of her with her father that resonated with them. Those details created a sense of connection. Yale recommends that intended parents approach the process independently at first. Each partner can create a list of their preferred donors and then compare. That’s what he and his husband did. Out of their separate top-ten lists, two donors overlapped. Their first choice ultimately wasn’t able to move forward because of scheduling conflicts. The second became their donor. Looking back, Yale says one thing he wishes they had access to was audio of their donor speaking. Now that he has two daughters, hearing her voice would have been another small piece of their story to preserve. His experience is also a reminder that donor selection doesn’t have to follow somebody else’s definition of what matters. For one family, ethnicity or religion may be important. For another, it might be eye color, personality, interests, family history or even a zodiac sign. What matters is determining what feels meaningful to you, making the decision thoughtfully and then allowing yourself to move forward without continually wondering whether there was a more “perfect” choice. Surrogacy Begins Long Before the Match For people considering gestational surrogacy, Yale recommends beginning your research early. You may not be ready to receive surrogate profiles yet, particularly if embryos have not been created, but you can start learning about agencies, speaking with other parents and understanding how the process works. And choosing an agency involves much more than simply asking, “How quickly can you match us?” Intended parents should understand the agency’s fee structure, policies and what happens if a match falls through. Will the agency rematch you? How does communication work? Who helps when a difficult or uncomfortable conversation arises? A strong agency can become the bridge between intended parents and their surrogate, particularly when questions, concerns or complicated emotions appear along the way. That relationship matters because surrogacy is not simply a transaction. It is an ongoing relationship involving real people navigating an extraordinary experience together. For LGBTQ+ Parents, Family Building May Require More Planning Yale always wanted to be a father. He just didn’t always know what becoming one would look like. In fact, children came up on his first date with his future husband. Not necessarily children together, Yale jokes. That would have been a rather aggressive first-date plan. But they both knew family mattered to them. Years later, that early conversation feels significant. There are countless decisions involved in becoming parents, and those decisions become even more complex when assisted reproduction, donor conception, surrogacy or adoption enters the picture. For LGBTQ+ intended parents, the road to parenthood can also involve significant financial planning. Surrogacy can be expensive. Some families explore financing options, grants or other family-building routes, including adoption or embryo donation. Yale’s advice isn’t that one option is better than another. It’s to understand the bigger picture before jumping into the process. Ask yourselves what kind of family-building path feels right. Talk honestly about finances. Talk about what parenthood itself will look like. Because eventually, fertility appointments and surrogate matches give way to something much more ordinary: * Dinner. * Bath time. * Bedtime. * School. * Laundry. Being aligned about wanting a family is only the beginning. The real adventure starts when the children arrive. How Do You Tell Children Their Birth Story? For Yale, openness has always been central to the way he and his husband talk with their daughters about their family. Their girls know they were carried by a surrogate. They know they have two dads. And as they get older, they are gradually beginning to understand more about egg donation and genetics. Those conversations don’t necessarily happen through one grand explanation. Sometimes they happen unexpectedly. Yale once mentioned to a dentist that one daughter was genetically related to him and the other to his husband. He didn’t realize his older daughter was listening. A few days later in the car, she asked what he meant. And that became the moment to explain a little more. Children often tell us when they’re ready for the next piece of their story simply by asking a question. Parents don’t necessarily need to deliver the entire biology lesson at once. They can follow their child’s curiosity. Books can help. Conversations can help. Seeing other kinds of families can help. Yale’s daughters attend school with children who have two dads, two moms, single parents and many other family structures. During Pride, their family has even read books to the class about the many different ways families can look. And one of Yale’s favorite things happens when his daughters tell another child that they have two dads. The response is often wonderfully uneventful. “Okay.” And then the kids go back to whatever they were doing. There is something powerful in that simplicity. The More We Talk About How Families Are Built, the Less Unusual It Becomes * Donor conception. * Surrogacy. * Adoption. * Embryo donation. * Single parenthood by choice. * Two moms. * Two dads. Families have always been more varied than the traditional picture suggests. What is changing is our willingness to talk about it. Yale believes openness makes these conversations easier, particularly for children. When their stories are treated as ordinary parts of who they are rather than secrets to be revealed later, children can grow up understanding how they came into the world one age-appropriate conversation at a time. His journey also gives intended parents something that can sometimes feel frustratingly absent from fertility care: Someone who can say, “I’ve been there.” Today, part of Yale’s role at RPMG is speaking with intended parents who are considering their own family-building journey. Every family he talks with will make different decisions. Their stories won’t look exactly like his. They aren’t supposed to. Because there isn’t one blueprint for becoming a family. There are simply different paths toward the same extraordinary destination: becoming someone’s parent. Listen to the full conversation with Yale Scott on Fertility Unfiltered to hear more about choosing an egg donor, working with a surrogacy agency, LGBTQ+ family building and talking with children about their birth stories. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thefertilityunfiltered.substack.com

  2. Aug 17

    Surrogacy, Step by Step: What Intended Parents Need to Know About Embryo Transfer

    Building a family through surrogacy can involve a lot of moving pieces: embryos, medical screening, attorneys, agencies, medications, appointments, contracts, and, eventually, the embryo transfer itself. So where do you actually begin? In this episode of Fertility Unfiltered, Dr. Kaing of Fertility Centers of Orange County walks us through the medical side of a gestational surrogacy journey, from creating embryos and selecting a gestational carrier to preparing for transfer and waiting for that first pregnancy test. And one theme comes through again and again: the goal is not simply to get to transfer. It is to get everyone there as safely and thoughtfully as possible. First, What Is Gestational Surrogacy? Today, when most people talk about surrogacy, they are referring to gestational surrogacy. With a gestational carrier, the person carrying the pregnancy does not contribute their own egg to create the embryo. The embryo is created using genetic material from the intended parent or parents and/or donors, and the gestational carrier carries the pregnancy. That differs from traditional surrogacy, in which the person carrying the pregnancy also provides the egg. As Dr. Kaing explains in the episode, traditional surrogacy is now far less commonly used. Should You Create Embryos Before Finding a Gestational Carrier? One of the most practical questions intended parents have is also one of the earliest: Do we need embryos before we begin looking for a carrier? Not necessarily. But having embryos available first can make the process significantly easier to coordinate. Embryo creation does not happen on exactly the same timeline for every patient. Depending on factors such as the egg source and whether more than one IVF cycle is needed, it may take longer than expected to obtain an embryo ready for transfer. If intended parents match with a gestational carrier before embryos are available, those two timelines may not line up. A carrier who has completed medical and legal screening may understandably be ready to move forward rather than waiting months for an embryo to become available. For some families, creating embryos and searching for a carrier can happen in parallel. The key is understanding the variables before choosing the path that makes sense for you. Surrogacy Is a Team Sport There is no single person managing every aspect of a gestational surrogacy journey. Instead, Dr. Kaing describes third-party reproduction as a team sport. The fertility clinic oversees the medical pieces: creating and evaluating embryos, reviewing the gestational carrier’s medical history, preparing the uterus for transfer, performing the transfer, and monitoring the early stages of pregnancy. The surrogacy agency often helps intended parents and carriers find one another and coordinates communication among the different parties. Reproductive attorneys help establish expectations and agreements before treatment moves forward, including discussing circumstances that everyone hopes will never occur but should still be considered in advance. Psychological counseling can also be an important part of preparation. Intended parents and gestational carriers may discuss questions such as how much communication they want during the pregnancy, what their relationship might look like after delivery, and what expectations each person is bringing into the experience. The objective is not to make the process feel complicated. It is to make sure fewer important questions are being asked for the first time in the middle of an already emotional moment. Screening Is About Protecting the Gestational Carrier, Too Gestational carrier screening is not simply a checklist that someone needs to “pass.” One of the most important points Dr. Kaing makes is that physicians are evaluating whether pregnancy is medically safe for the person volunteering to carry it. That means carefully reviewing previous pregnancies, deliveries, medical conditions and complications such as pregnancy-related hypertension or diabetes. Some medical histories may require additional evaluation. Others can make pregnancy sufficiently high-risk that becoming a gestational carrier would not be recommended. The guiding principle is simple: no one should be exposed to unnecessary medical risk in the process of helping another family grow. How Is a Gestational Carrier Prepared for Embryo Transfer? Successful implantation requires careful timing. The uterine lining must reach the appropriate stage to receive the embryo, so the fertility team prepares and monitors the carrier before transfer. Dr. Kaing explains that one common approach uses estrogen followed by progesterone to recreate the hormonal environment the uterus needs for implantation. Ultrasounds and bloodwork allow the medical team to monitor the uterine lining, hormone levels and ovaries before proceeding. By the time transfer day arrives, there has already been a substantial amount of planning happening quietly in the background. Why One Embryo Is Usually the Goal For many intended parents who have spent months or years trying to build their family, transferring two embryos can sound tempting. Two embryos. One transfer. Maybe even two babies. But more is not necessarily better. When an appropriate embryo is available, Dr. Kaing explains that the recommendation is generally to transfer one embryo at a time. A twin pregnancy carries additional risks for both the person carrying the pregnancy and the babies, including a greater risk of pregnancy complications and preterm delivery. That makes single-embryo transfer an important example of something that appears throughout fertility medicine: success is not simply achieving a positive pregnancy test. The goal is the healthiest possible pregnancy and outcome for everyone involved. And Then Comes the Wait After everything required to reach transfer day, intended parents arrive at one of fertility treatment’s most familiar experiences: Waiting. For a blastocyst transfer, Dr. Kaing explains that the clinic will generally perform a blood pregnancy test around 10 to 12 days after embryo transfer. At-home pregnancy tests may become positive earlier, but testing too soon can create additional uncertainty and anxiety, which is why the clinic waits for the appropriate point to evaluate pregnancy hormone levels. And if the first transfer doesn’t work? It does not necessarily mean something went wrong with the carrier, the intended parents, or the process. Even good-quality embryos do not implant every time. In some circumstances, after a straightforward negative pregnancy test, another transfer can be prepared for during the carrier’s next cycle. There Is a Lot Behind One Small Embryo An embryo transfer itself can happen surprisingly quickly. Getting to that moment is another story. Behind it are physicians, embryologists, coordinators, agencies, attorneys, counselors, intended parents and a gestational carrier, all working toward the same goal. And perhaps that is the most reassuring part of understanding the process. You don’t have to know how to navigate every step before you begin. You need the right team to help you understand the next one. Listen to the full episode of Fertility Unfiltered with Dr. Kaing to learn more about gestational surrogacy, carrier screening, embryo transfer and what intended parents can expect throughout the process. If you’re considering gestational surrogacy or wondering whether it may be part of your path to parenthood, the team at Fertility Centers of Orange County can help you understand your options and build a plan tailored to your family. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thefertilityunfiltered.substack.com

  3. Jul 27

    Before You Assume IVF: What Fertility Care Actually Looks Like

    When people imagine walking into a fertility clinic, they often picture one inevitable next step: IVF. It is an understandable assumption. IVF is the fertility treatment most frequently represented in news stories, social media posts, celebrity interviews, and conversations between friends. It can begin to feel less like one possible treatment and more like the entire definition of fertility care. But fertility treatment rarely begins with a predetermined answer. It begins with questions. What is happening with your reproductive health? How long have you been trying to conceive? What are your family-building goals? Are you hoping to become pregnant now, preserve fertility for later, or create embryos for the family you hope to have in the future? In this episode of Fertility Unfiltered, Dr. Ambartsumyan of Reproductive Partners Medical Group joins us to talk about what patients should understand before beginning fertility care, including some of the most common misconceptions about IVF, clinic success rates, online research, age, and the pressure to move quickly. The central message is simple: the right fertility plan is not the plan that worked for someone else. It is the plan built around you. IVF Is Not Always the First Step One of the biggest misconceptions patients bring into a fertility clinic is the belief that IVF is the only way a reproductive endocrinologist can help. For some patients, IVF may ultimately be the most appropriate treatment. For others, the first step may be fertility testing, cycle evaluation, medication, ovulation support, intrauterine insemination, fertility preservation, or another approach based on what the initial evaluation reveals. That is why coming in for a consultation does not mean committing to IVF. It means gathering information. A fertility evaluation allows your physician to look at the full picture before recommending treatment. Rather than fitting every patient into the same protocol, the goal is to understand the specific factors that may be affecting fertility and build a path around those findings. Waiting until you believe you “need IVF” can sometimes delay an evaluation that might have uncovered other options earlier. Success Rates Need Context Clinic success rates can be helpful, but they can also be surprisingly difficult to interpret. Patients may review data from national reporting databases and assume the clinic with the highest number is automatically the best choice. Unfortunately, fertility statistics are not always an apples-to-apples comparison. Success rates can be influenced by the types of patients a clinic treats, their ages, diagnoses, prior treatment histories, and family-building goals. They may also be affected by how a clinic defines and reports a treatment cycle. For example, a patient may complete more than one retrieval not because the first cycle was unsuccessful, but because they hope to create additional embryos for future children. Another patient may be pursuing fertility preservation rather than an immediate pregnancy. A single percentage cannot explain all of that. Statistics can be part of your research, but they should not be the only factor guiding your decision. Ask what the numbers represent, which patients are included, and how the clinic approaches cases similar to yours. Choose a Clinic You Can Trust The quality and experience of the embryology laboratory matter. So does the medical expertise of the physicians. But fertility treatment is not experienced only through procedures and laboratory reports. It is experienced through portal messages, phone calls, early-morning monitoring appointments, medication instructions, scheduling, financial conversations, unexpected questions, and the people who help you navigate each step. Your relationship with the clinic matters. Do you feel comfortable asking questions? Does your physician explain the reasoning behind the treatment plan? Do you trust the nursing team? Does communication feel clear? Can the clinic reasonably accommodate the realities of your work, family, and daily life? Some fertility journeys are shorter than others, but even the shortest journey can feel emotionally significant. The right clinic should offer more than impressive numbers. It should feel like a place where you are seen, informed, and cared for. Age Matters, but It Does Not End the Conversation Age is an important part of fertility care, particularly when discussing egg quality, treatment success, pregnancy risks, and the use of a patient’s own eggs. But age alone does not determine whether someone is welcome to have a conversation about building a family. Different patients may have different options available to them, including the use of donor eggs or a gestational carrier. The purpose of a consultation is to have an honest discussion about those possibilities, the medical considerations involved, and what may be realistic for that individual patient. Fertility care should provide clarity without removing hope. The Internet Can Give You Questions, Not Your Treatment Plan The internet can be an enormously helpful place to begin learning about fertility. It can explain terminology, introduce treatment options, connect people with shared experiences, and help patients prepare questions for their physician. AI tools can also make complicated information feel easier to understand. The problem begins when general information is mistaken for individualized medical advice. A friend’s successful protocol may not be appropriate for you. A stranger’s experience in an online forum may not reflect your diagnosis. An AI platform does not have access to your complete testing, medical history, examination, goals, or the clinical judgment that comes from evaluating all of those pieces together. Use online information to become a more informed participant in your care, not to pressure yourself into following someone else’s path. Bring your questions to your appointment. Ask why a recommendation applies, or does not apply, to your situation. Good fertility care should welcome that conversation. Moving Quickly Is Not the Same as Rushing Many patients arrive at a fertility clinic feeling as though they are already behind. They want answers quickly. They want testing completed quickly. Most of all, they want to be pregnant quickly. That urgency is real, and it deserves compassion. A responsive clinic should make every reasonable effort to schedule consultations, complete evaluations, and communicate next steps efficiently. But efficiency cannot come at the expense of thoughtful care. Skipping evaluations or moving into treatment before the necessary information is available may not save time. It may lead to a treatment plan that needs to be changed or repeated, costing more time, money, and emotional energy. The goal is not to create unnecessary delays. The goal is to move forward with intention. Your Fertility Journey Should Be Built Around You There is no universal fertility timeline. There is no single treatment that every patient needs. There is no statistic, online story, or AI-generated answer that can fully capture your individual circumstances. There is only the process of gathering the right information, understanding your options, and choosing the next step that makes sense for you. In this episode of Fertility Unfiltered, Dr. Ambartsumyan offers an honest look at what patients should consider when beginning fertility care and why personalized treatment matters at every stage. This article is intended for educational purposes and is not a substitute for personalized medical advice. Treatment recommendations and outcomes vary by patient. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thefertilityunfiltered.substack.com

  4. Jul 20

    The IVF Questions Everyone Googles, Answered by a Fertility Specialist

    Fertility treatment comes with an entirely new vocabulary. Aneuploidy. Euploid embryos. PGT-A. Embryo banking. Fresh transfer. Frozen transfer. And somewhere between the medical terminology, online forums, supplement advertisements, and late-night Google searches, it can become difficult to separate what is possible from what is promised. In a recent episode of Fertility Unfiltered, Dr. Eric Han of Reproductive Partners Medical Group answered some of the questions patients ask most often about egg freezing, embryos, and IVF. His message was both hopeful and refreshingly honest: fertility treatment can create extraordinary opportunities, but there is rarely one universal answer. The best decision depends on your age, medical history, timeline, and the family you hope to build. Is There a “Perfect” Age to Freeze Your Eggs? From a purely biological perspective, earlier is generally better. As we age, the chance of chromosomal abnormalities within eggs increases. These abnormalities, known as aneuploidy, are one of the most important factors affecting whether an embryo can lead to a healthy pregnancy. But biology is only one piece of the decision. Someone who freezes eggs in their early twenties may preserve younger eggs, but they may never need to use them. Egg freezing also involves medication, monitoring, a retrieval procedure, storage expenses, and emotional considerations. That is why Dr. Han encourages patients to look at the full picture. What are your family-building goals? When do you think you may want children? Are there medical, personal, or professional circumstances influencing your timeline? For many people considering elective egg freezing, having the conversation before age 35 may provide more options. It does not mean there is a magical birthday when fertility suddenly changes. It means that earlier information can help you make a more informed decision. Are Frozen Embryo Transfers Less Successful? This is a common concern, but frozen embryo transfers are now routine and may offer advantages for many patients. During a fresh transfer, an embryo is transferred shortly after an IVF stimulation and egg retrieval cycle. During a frozen transfer, embryos are frozen and transferred during a later cycle. One reason frozen transfers have become more common is the growing use of preimplantation genetic testing, or PGT. Because embryos undergoing PGT must be biopsied and tested before transfer, they are frozen while the results are processed. A frozen transfer can also allow the body time to recover after ovarian stimulation. For some patients, including certain patients with endometriosis, additional treatment or suppression before transfer may be beneficial. The right approach is not determined by whether “fresh” or “frozen” sounds more natural. It depends on the patient’s medical situation and treatment plan. What Does PGT Actually Tell Us? PGT-A, or preimplantation genetic testing for aneuploidy, screens embryos for large chromosomal differences. During testing, a few cells are taken from the outer portion of an embryo, which later develops into the placenta. Those cells are then analyzed for chromosomal abnormalities. PGT-A can provide useful information, but it is important to understand its limits. It is not a guarantee of pregnancy. It cannot guarantee that a miscarriage will not occur, and it does not guarantee the birth of a healthy baby. It is one tool that may help patients and physicians identify embryos with the expected number of chromosomes. Other forms of testing may be used in specific circumstances. PGT-M may help families at risk of passing along certain single-gene conditions, while PGT-SR may be used when a parent carries a structural chromosomal rearrangement. Whether genetic testing makes sense should be discussed with your fertility physician and, when appropriate, a genetic counselor. How Do Embryos Survive Being Frozen? Embryos are remarkably resilient. Modern fertility laboratories use a rapid-freezing process known as vitrification. Dr. Han explains that more than 95% of embryos are generally expected to survive the thawing process. Embryos may also remain frozen for many years without losing viability simply because of the length of time they have been stored. Eggs can also be successfully frozen and thawed, but they are more delicate. An egg is a single large cell with a high water content, so outcomes can vary more than they do with embryos. This is one reason the conversation about freezing eggs and the conversation about freezing embryos are related, but not identical. Why Doesn’t Every Egg Become an Embryo? One of the hardest parts of IVF is watching the numbers change. A retrieval may produce several eggs, but not every egg will be mature. Not every mature egg will fertilize, and not every fertilized egg will continue developing into an embryo suitable for transfer or freezing. Dr. Han often tells patients that approximately 70% to 80% of mature eggs may fertilize, while roughly 40% to 60% of fertilized eggs may develop into usable embryos. These are broad estimates, not promises. Some patients will have higher results. Others will experience a steeper drop-off. This process is often called IVF attrition, and it can feel deeply personal. But it is not a sign that someone did something wrong. It reflects just how many complex biological steps are involved in creating an embryo. IVF does not create that inefficiency. It allows us to see a process that normally happens invisibly inside the body. What Is Embryo Banking? Embryo banking means creating and freezing embryos now for possible use in the future. Some patients bank embryos before undergoing chemotherapy, surgery, or another medical treatment that could affect fertility. Others choose embryo banking because they are not ready to become pregnant yet but know they may want children later. Some patients complete more than one retrieval because they hope to build a larger family and want to preserve embryos created at their current age. The number of embryos someone may want to bank depends on many factors, including age, embryo testing results, medical history, and desired family size. There is no single “correct” number. Is One Embryo Enough? When patients hear that they have one or two embryos, it can be easy to focus on what they do not have. But one embryo is not “nothing.” One embryo may still provide a meaningful chance of pregnancy. The way the result is interpreted should depend on the embryo itself, whether testing was performed, the patient’s age and diagnosis, and their family-building goals. For someone hoping for one child, one embryo may be the embryo that gets them there. For someone hoping for several children, the conversation may include whether another retrieval should be considered. Numbers matter in fertility treatment, but they do not tell the entire story. The Biggest Misconception About IVF IVF is powerful, but it is not a guarantee. Patients often hear success stories, see pregnancy announcements, or encounter advertising that makes treatment appear more predictable than it is. Age remains one of the most significant factors influencing IVF outcomes, particularly because of its relationship to egg quality and chromosomal abnormalities. A person may have a strong ovarian reserve and still face age-related challenges. This is why early conversations matter. You do not need to know whether you want IVF before meeting with a fertility specialist. You do not need to arrive with a treatment plan already formed. A consultation can simply give you a clearer understanding of your fertility, your timeline, and the options available. What Should Patients Stop Googling? Dr. Han is not opposed to patients researching their care. Informed patients often ask thoughtful questions and participate actively in decision-making. The problem is not information. It is information without context. Search engines and AI tools can produce enormous amounts of data, but they cannot always tell you which information applies to your body, diagnosis, age, or treatment history. Dr. Han is particularly cautious about supplements being presented as a fertility cure-all. Supplements may play a role in some treatment plans, but an over-the-counter product rarely addresses the underlying reason someone is having difficulty conceiving. Research can help you prepare questions. It should not have to replace a personalized medical evaluation. IVF May Feel More Manageable Than You Expect Many patients feel understandably nervous about injections, side effects, appointments, and the egg retrieval process. Yet Dr. Han says that many patients reach the end of a cycle and tell him it was more manageable than they anticipated. The first injection may feel intimidating. By the third or fourth day, many patients have developed a routine they never imagined they could handle. Patients are also monitored closely throughout an IVF cycle. Bloodwork, ultrasounds, and regular communication allow the care team to adjust medications and respond to symptoms as treatment progresses. You are not expected to navigate the process alone. The Question to Start Asking Earlier One of Dr. Han’s simplest recommendations may also be one of the most important: talk about your fertility goals with your OB-GYN. You do not have to wait until you are actively struggling to conceive. Your OB-GYN may be able to help you understand when testing is appropriate, identify potential concerns, or refer you to a fertility specialist sooner. The goal is not to create panic around fertility or pressure anyone into treatment. It is to make fertility part of routine health planning, so patients have the opportunity to make decisions with more information and, whenever possible, more time. Fertility Care Is Still Evolving From advancements in embryo testing to emerging uses of artificial intelligence, reproductive medicine continues to change. The te

    The IVF Questions Everyone Googles, Answered by a Fertility Specialist

  5. Jul 7

    We Had No Trouble the First Time. So Why Is This So Hard Now?

    There is a very specific kind of shock that comes with struggling to get pregnant after you have already had a child. The first time, maybe it happened quickly. Maybe you barely had time to download an ovulation app before you saw two lines. Maybe pregnancy felt like something your body knew how to do. And then, when you decide you are ready to grow your family again, nothing happens. Month after month, the math gets louder. The calendar becomes a tiny courtroom. You start wondering if you are timing things wrong, if your body changed, if your partner’s fertility changed, if you waited too long, if something happened after birth, if everyone else is moving forward while you are quietly stuck. This is where the emotional confusion of secondary infertility begins. Secondary infertility means having trouble getting pregnant or carrying a pregnancy after having been pregnant or having had a child before. And one of the hardest parts is that many people do not expect it. You may have proof that pregnancy was possible once, which can make the current struggle feel even more confusing. In this episode of Fertility Unfiltered, Dr. Jackie Ho joins us to talk about why getting pregnant again is not always as simple as “it happened before, so it should happen again.” Fertility is not frozen in time One of the biggest misconceptions about fertility is that your past fertility automatically predicts your future fertility. It can be comforting to think that way. It is also not always true. Bodies change. Time passes. Hormones shift. Medical conditions can appear or evolve. A prior pregnancy, delivery, infection, surgery, or diagnosis may change the landscape. And sperm health can change too, which is why secondary infertility is not automatically “a female issue.” That last part matters. A lot. When couples are trying to conceive, the focus often lands on the person carrying the pregnancy. But fertility is a two-person equation when sperm is involved. Sperm count, movement, shape, hormone levels, health conditions, medications, lifestyle factors, and age can all play a role. So if you are going through this, the takeaway is not “something is wrong with you.” The takeaway is: something may have changed, and it is worth looking at the full picture. Why secondary infertility can happen Secondary infertility can happen for many of the same reasons as primary infertility. Sometimes there is one clear factor. Sometimes there are several small factors. Sometimes testing does not reveal one obvious answer, which can be deeply frustrating, but also very common in fertility care. Possible contributors may include: * Changes in ovulation or menstrual cycles * A change in egg quantity or egg quality over time * Endometriosis, fibroids, polyps, or other uterine factors * Blocked or damaged fallopian tubes * Scarring or complications after prior surgery or delivery * Changes in sperm count, motility, morphology, or overall sperm health * Thyroid issues, prolactin changes, PCOS, or other hormone-related conditions * New health diagnoses, medications, or major weight changes * Recurrent pregnancy loss or difficulty carrying a pregnancy to term * No single identifiable cause after evaluation That list can feel like a drawer full of tangled chargers, but the point of an evaluation is to untangle it piece by piece. Fertility testing is not about assigning blame. It is about getting information. When should you ask for help? A good rule of thumb: if you are under 35 and have been trying for a year, it is reasonable to seek a fertility evaluation. If you are 35 or older, many experts recommend seeking evaluation after six months of trying. If you are over 40, or if you already know there may be a fertility-related concern, it is worth talking with a specialist sooner. And “trying” does not need to mean quietly suffering through month after month while pretending you are totally chill. You are allowed to ask questions earlier. You are allowed to want information before you feel desperate. You are allowed to say, “Something feels off, and I would like to understand what is going on.” That is not overreacting. That is self-advocacy. What a fertility evaluation may include A fertility evaluation after having a child often looks at the same major areas as any fertility workup, while also taking your prior pregnancy and birth history into account. Your doctor may want to understand: * How long you have been trying * Your menstrual cycle pattern * Your age and reproductive history * Your prior pregnancy, delivery, miscarriage, or postpartum history * Any pelvic surgeries, infections, or known conditions * Ovulation patterns * Ovarian reserve markers, such as AMH or antral follicle count * The uterus and fallopian tubes through imaging or other testing * Semen analysis * Medical history, medications, and lifestyle factors for both partners For many patients, this part can feel intimidating. But answers can also bring relief. Even when the answer is not simple, having a plan can quiet some of the mental static. The emotional part is real Secondary infertility has its own emotional weather system. There is grief, but sometimes people feel guilty naming it because they already have a child. There is gratitude, but gratitude does not erase longing. There is love for the family you have, and sadness for the family you imagined. Those feelings can exist in the same room without canceling each other out. This is one of the most misunderstood parts of secondary infertility. People may say things like: “At least you already have one.”“Just relax, it happened before.”“Maybe you are meant to be done.”“You should be grateful.” Most of these comments are not meant to be cruel, but they can land like tiny paper cuts. Wanting another child does not mean you are ungrateful for the child you have. Grieving a struggle does not mean you are missing the beauty in your current life. Hope is allowed to be complicated. Treatment is not one-size-fits-all The right next step depends on what testing shows, your age, your timeline, your medical history, your emotional bandwidth, and your goals. For some people, treatment may involve medication to support ovulation. For others, it may involve IUI, IVF, surgery, sperm evaluation or treatment, genetic testing, embryo banking, or donor options. Some people need a relatively simple adjustment. Others need a more advanced plan. The important thing is that secondary infertility does not automatically mean IVF. It also does not mean waiting indefinitely. A fertility specialist can help you understand what path makes sense based on your actual situation, not a generic internet flowchart with ominous fonts. Questions to bring to your doctor If you are trying again after having a child and something is not adding up, these questions can help start the conversation: What could have changed since my last pregnancy?Should we test both partners?Do my age, cycle pattern, or medical history change how quickly we should evaluate?What tests would you recommend first?Could my prior pregnancy, delivery, surgery, or miscarriage history matter?What are the most likely causes in my situation?What treatment options would be reasonable before IVF, if any?How should we think about timing if we hope to have more than one child?What emotional support resources do you recommend during this process? You do not need to know the perfect question. You just need a starting point. The bottom line Secondary infertility can feel especially lonely because it does not match the story many people expected for themselves. But it is real. It is valid. And it is worth evaluating. Having one child does not make you immune to fertility challenges. It also does not make your pain less worthy of care. If you are struggling to get pregnant again, this episode with Dr. Jackie Ho is for the part of you that keeps thinking, “But it worked before.” It is also for the part of you that is tired of holding the whole thing quietly. You do not have to wait until you are at the end of your rope to ask for help. Sometimes the kindest next step is simply getting more information. Listen to the full episode of Fertility Unfiltered for a deeper conversation with Dr. Jackie Ho on secondary infertility, what may change between pregnancies, and why you are not alone if growing your family has become harder than expected. This article is for educational purposes only and is not a substitute for personalized medical advice. If you have questions about your fertility, speak with a qualified reproductive specialist or healthcare provider. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thefertilityunfiltered.substack.com

    We Had No Trouble the First Time. So Why Is This So Hard Now?

  6. 10/13/2025

    Fertility Fact or Faction

    There’s a lot of advice floating around online about fertility — some of it helpful, some of it… pineapple-core questionable. You’ve probably heard them all:“Eat pineapple after your embryo transfer.”“Your fertility falls off a cliff at 35.”“Relax and it’ll happen.” At Fertility, Unfiltered, we decided to play a little game of Fact or Fiction with the doctors of Reproductive Partners Medical Group to find out what’s real, what’s hype, and what’s actually worth your energy. Because when it comes to fertility, clarity shouldn’t be so hard to find. Myth #1: Eating pineapple helps with implantation. Verdict: Fiction. Pineapple contains bromelain, an enzyme that some believe can reduce inflammation and help embryos “stick.” But here’s the truth…there’s no clinical evidence that eating pineapple makes implantation more likely. If you love pineapple, go for it. But it’s not a fertility treatment, it’s just fruit. Myth #2: Fertility drops off a cliff at 35. Verdict: Fiction (but with a side of fact). Yes, fertility declines with age, but it’s gradual and not a sudden drop.Dr. Han explained it best: “Your fertility doesn’t fall off a cliff at 35; it’s more like a steady slope. The biggest difference is the time it can take to conceive.” So, while age matters, panic doesn’t help. Understanding your body and your timeline does. Myth #3: Stress causes infertility. Verdict: Mostly fiction. Stress doesn’t cause infertility — but infertility can definitely cause stress. The two often get tangled up, making people feel like their emotions are the problem. Our take? Give yourself grace. You can’t out-meditate a hormone imbalance, but you can make space for both the medical and emotional parts of this journey. Myth #4: You have to try for a year before seeing a fertility specialist. Verdict: Fiction (and outdated). If you’re over 35, have known conditions like PCOS or endometriosis, or just feel something’s off, you don’t have to wait.Early information is power and talking to a fertility specialist doesn’t mean you’re signing up for IVF tomorrow. It’s about understanding your options, not committing to treatment. Myth #5: Fertility care is only for couples. Verdict: Big fiction. Fertility care is for anyone who wants to understand their reproductive health: individuals, couples, people planning ahead, and those preserving their fertility for later. Your family story doesn’t have to look like anyone else’s. Why It Matters The internet is loud. But the truth about fertility deserves more than clickbait and old wives’ tales. Fertility care is changing becoming more accessible, more inclusive, and more human.And the more we talk about what’s fact and what’s fiction, the easier it becomes for people to make decisions with confidence, not confusion. Listen to the Full Episode Fertility, Unfiltered: Fact or Fiction: What People Get Wrong About Fertility This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thefertilityunfiltered.substack.com

    Fertility Fact or Faction

  7. 10/06/2025

    Your Fertility Consult: The Good, the Awkward, the Misunderstood

    Ever wonder what actually happens during a fertility consult? Spoiler: it’s more conversation than exam table. In this episode, we unpack the myths, the moments that make people squirm, and the questions your doctor actually wants you to ask. From bloodwork basics to what to expect after the call, we’re pulling back the curtain on one of the most misunderstood steps in fertility care. Think of it as your consult before your consult...minus the awkward silences. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thefertilityunfiltered.substack.com

    Your Fertility Consult: The Good, the Awkward, the Misunderstood

  8. 03/24/2025

    Endometriosis & Fertility

    Trying to conceive with endometriosis? You’re not alone—and you’re definitely not crazy. In this episode, we sit down with Dr. Brower, a leading reproductive endocrinologist, to talk honestly about what endometriosis is, how it impacts fertility, and why so many women feel dismissed or confused when seeking care. We cover: * Why endometriosis is often missed or misdiagnosed * The real impact endo has on hormones, inflammation, and fertility * Surgical vs. non-surgical treatment options * What to consider before jumping into IVF * How to advocate for yourself and build a care team that gets it This conversation is filled with insight, validation, and real talk—because you deserve to understand your body, your diagnosis, and your options. Sponsored by RPMG and FCOC, this episode is part of our mission to provide free, accessible fertility education to the community—no selling, just support. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thefertilityunfiltered.substack.com

    Endometriosis & Fertility
  • 8 Episodes

About

Fertility is a maze of mixed messages: too clinical in one corner, too sugar-coated in another. Fertility, Unfiltered cuts through the noise. Hosted by the team at Reproductive Partners Medical Group & Fertility Centers of Orange County, this series brings you the real stories, science, and soul of fertility care...straight from the experts who live it every day. We talk about the things no one explains well: from the first consult jitters to male fertility myths, egg freezing facts, and the quiet emotions behind every decision. thefertilityunfiltered.substack.com

Information

  • Creator
    Sara from RPMG/FCOC
  • Years Active
    2026
  • Episodes
    8
  • Rating
    Clean
  • Copyright
    © Sara Zuboff
  • Show Website
    Fertility Unfiltered