# Infertility Unfiltered: Understanding Infertility and when to seek help with Dr Lizzie Glanville

An episode of [The Cyclist](https://invisiblenetwork.ai/podcast/1799823350), 8 Jun 2025, 53 min.

Audio: https://anchor.fm/s/101bd2764/podcast/play/103787468/https%3A%2F%2Fd3ctxlq1ktw2nl.cloudfront.net%2Fstaging%2F2025-5-7%2Fa6f3ef5a-0f0b-a3c1-f2ca-86730bbf45b0.mp3

This week, we’re kicking off our four-part mini-series for Infertility Awareness Month: Infertility Unfiltered. We’re joined by gynaecologist and fertility specialist Dr. Lizzie Glanville to open the conversation with expert insights, compassion, and clarity. We unpack how to navigate infertility in both the public and private system, when to seek help, and what intervention options actually look like. Dr. Lizzie also breaks down common myths around fertility, sheds light on secondary infertility, and shares how to advocate for yourself when you feel unheard. Plus, we answer some of the community questions that came through. Follow & Connect: ✨ Instagram: @wearethecyclist ✨ Website: www.wearethecyclist.com We’re so glad you’re here - hit play, subscribe, and let’s learn to cycle better together.

## Transcript

[0:06] Welcome to Infertility Unfolded, A4, part mini series by the
[0:10] cyclist, launched in light of June being Infertility Awareness
[0:13] Month. I'm Jess Quinn, your host, and
[0:15] throughout this month we're diving into the raw, real and
[0:18] really talked about sides of infertility because this is a
[0:21] conversation that deserves more light, more honesty and more
[0:25] support. This series is especially close
[0:27] to my heart. I went through my own chapter of
[0:28] navigating infertility and I know first hand how
[0:31] overwhelming, isolating and emotional the experience can be.
[0:34] So every Monday for the next 4 weeks you will hear from Trusted
[0:37] Choices, a gynaecologist, A psychologist and nutritionist
[0:41] and medical herbalist, and someone who's lived through the
[0:44] heartbreak and hope of infertility.
[0:46] All here to help answer the questions so many struggle to
[0:48] find and to remind you that you're not alone.
[0:51] Just a gentle heads up, the series includes sensitive themes
[0:54] around fertility, loss and emotional wellbeing.
[0:56] Please take care as you listen and give yourself space we
[0:59] needed. This is a space for truth,
[1:01] tenderness and trusted insight. We're so glad you're here.
[1:04] Let's get into it. I'm so excited to share today's
[1:09] guests with you. We are joined by Doctor Lizzie
[1:12] Glanville. She is a specialist obstetrician
[1:14] and gynaecologist with a subspecialty in reproductive
[1:17] endocrinology and infertility. Lizzie is passionate about
[1:20] providing evidence based patient centred care and has a
[1:23] particular interest in fertility, endometriosis and
[1:25] hormonal health. We talked about so much in this
[1:28] episode, it's almost impossible to sum it up, but to give you a
[1:31] taste, we talk about navigating infertility through both the
[1:34] public and private systems, when and how to intervene, common
[1:37] myths around fertility and infertility, secondary
[1:40] infertility and how to really advocate for yourself.
[1:43] I personally learned so much from this conversation and was
[1:46] just in awe of the way Dr. Lizzie speaks and shares her
[1:49] knowledge with such care and empathy, which I think can often
[1:52] be quite rare. So I hope that this conversation
[1:55] brings you hope and light and a bit of knowledge and information
[1:58] while you're on your journey. Enjoy.
[2:01] Hello Doctor Leslie, welcome to the podcast.
[2:03] Thank you. Thanks for having me.
[2:05] Of course, it's over here, but it's great to be here now.
[2:08] I wanted to crack and straight into talking about all things in
[2:11] fertility because that is why we're here.
[2:13] I would love to know a bit about your background and.
[2:16] What you do? Sure.
[2:18] So I am an obstetrician and gynaecologist that we spend um,
[2:23] ohh, decades of our lives training to become a specialist
[2:27] and then you can choose to go into sub specialties beyond
[2:31] that. So I chose to go into the field
[2:34] of and infertility and reproductive and criminology and
[2:38] that took another three years of equivalent of full time
[2:41] training. Sorry for me, that was long ago
[2:44] because I took some maternity leave and did some part time.
[2:47] And so in the end it took me about 23 years to get to the
[2:53] endpoint of being a sub specialist.
[2:55] So I have really, yeah, obsessed during my life in the field of
[3:01] infertility and that is my passion.
[3:03] So what I do now is I work for two different clinics, one in
[3:06] public and one that is mainly private.
[3:09] And, and yeah, I do gynaecology and general.
[3:14] I still do some obstetrics, but my preference is fertility
[3:18] subtility consults and treatments.
[3:21] Wow, that's so fascinating. I also imagine over those years
[3:25] things have evolved and changed so much you must have to be
[3:27] constantly trying to keep up with what's going on.
[3:30] Yeah, definitely to an extent, but I have to say no, probably
[3:35] not enough. No, good point.
[3:37] Yeah. So that although, yeah, there's
[3:39] lots of that as has changed in that time, I would say that
[3:43] there's a limit it feels to how much more can be achieved.
[3:47] So I'm looking forward in my career and to seeing what
[3:50] things, you know, scientists come up with to help us do
[3:53] things better. Yeah, definitely.
[3:55] I'd love to ask, how is infertility actually defined?
[3:59] Ohh so. Yeah, it's it's a good question
[4:02] because it's not a simple one. Actually, it seems simple, but
[4:06] the World Health Organisation defines it as being 12 months of
[4:10] unprotected intercourse and without conception.
[4:15] But if you think about it, there's other reasons why people
[4:18] can't conceive. And, and certainly the
[4:21] Australian and New Zealand definition of infertility has
[4:24] now extended to being inclusive of those people who can't
[4:27] conceive naturally for other reasons, such as they're in a
[4:30] same sex relationship would be the main one I guess.
[4:34] But yeah, 12 months in general of trying for pregnancy
[4:37] naturally under the age of 35, but above the age of 35, that
[4:42] can be reduced to six months of tribe.
[4:45] Well, yeah. And how common is infertility?
[4:48] I'll say that's, I don't know if there's a, a generic step for
[4:51] that, but yeah. Is it, do you think it's
[4:52] becoming more common or do you think it's just being more
[4:55] talked about within my life and my experience?
[4:57] I feel like I'm hearing about it and seeing it all the time.
[5:00] And I don't know if that's just because of the agent.
[5:02] Stage that I met or because of social media or actually if it
[5:05] is just becoming more common yeah.
[5:08] So the general stats are it affects about one in six
[5:12] couples, but if you look at New Zealand statistics, it might be
[5:16] even higher than that and some will.
[5:19] Some stats state it's one in four.
[5:22] So be common there. Has it become more common?
[5:27] I think you're right. You look, you're at the stage of
[5:30] life and you're, you know, working in a field where you're
[5:32] exposed to it and same as me. So I feel like it's everywhere.
[5:37] Yeah. And it, I think there is a
[5:40] problem with people needing to balance their lives and choose
[5:45] when they have children. And people are taking, making
[5:49] more of an active decision in that sense nowadays, I think
[5:52] than, you know, 50 years ago or, or even less.
[5:56] And so it probably has become a bit more common because people
[5:59] are leaving starting family until later.
[6:02] And I think the most important thing to know is that as a
[6:05] woman, it's our age that really is the most important factor in
[6:10] terms of chances of pregnancy naturally and through fertility
[6:14] treatments. So I think if there was one
[6:17] message I could give today, I think that would be the most
[6:20] important one. And of course, you know, we
[6:23] still have to make the decision in terms of balancing that with
[6:27] the rest of our lives, careers and so on.
[6:30] But yeah, you have to. You have to know that to make
[6:33] those decisions. Can we dive into that a little
[6:35] bit deeper? Actually, what, what is they, I
[6:39] guess best age and how, how, how do you even start to complain
[6:43] that? Cause it's such a hard thing.
[6:44] You know, in my mind, even if I had known the best age, I hadn't
[6:47] met my partner by the time I was that age.
[6:49] I haven't even really started, at least with this part of my
[6:52] career, you know, that everyone's got their own kind of
[6:54] circumstance. So it's, it's knowing the age
[6:56] and then figuring out how you sit within that.
[6:58] But can you just break down the age thing a little bit more?
[7:01] Sure. Yeah.
[7:03] I think obviously it's completely personal.
[7:07] Younger is generally better. And so women are born with all
[7:10] the eggs they'll ever have. You can't make more eggs, you
[7:13] can't rejuvenate eggs. People are trying to do these
[7:15] things and they're so great. Well, you never know.
[7:18] And within my career I could have it, but as yet we don't
[7:22] have the ability to do that. So we have to rely on natural
[7:25] biology. So we know that your fertility
[7:29] will start to decline in from your early 30s and more so from
[7:34] your mid 30s. And if you then aren't naturally
[7:38] fertile and able to conceive naturally, chances of us being
[7:42] able to help with things like IBF are becoming becoming lower
[7:48] with age and beyond the age of 40 and that's when we really
[7:52] struggle. So the best time would probably
[7:57] be in your early 30s. That's my personal view.
[7:59] Honestly everyone's different. Some people might be ready to
[8:02] start a family in their 20s one and that would be great too.
[8:05] I mean there are other good reasons to have babies younger.
[8:08] Like I actually didn't realise this till the other day, but if
[8:11] you're under the age of 30 when you have your first child you're
[8:14] actually reducing risks of other things like having the long term
[8:18] risk of breast cancer for example.
[8:19] That's so interesting you bring that up because I got so that
[8:22] online and all those online things, you know, I as someone
[8:25] who's not medically trained, I, I find it hard to tell the
[8:28] difference between the truth and not.
[8:29] But yeah, that's really interesting.
[8:31] Yeah, but I mean, that's not a reason to have a baby.
[8:33] With no no do. Something.
[8:35] And not to alarm anyone that if they ever baby in their. 30s but
[8:38] it's just interesting. These are all just, you know,
[8:41] relative. Well, things aren't laid risk
[8:44] that. I guess the other thing that we
[8:46] have now that we didn't used to be so good at is the ability to
[8:51] say freeze your eggs or freeze embryos if you are with a
[8:54] partner. So that's just going to depend
[8:57] on your personal circumstances. But we're doing more egg
[8:59] freezing to preserve fertility. I can.
[9:02] Feeling like that's something I might.
[9:04] Hopefully we've got time to dive into a little bit more later on
[9:07] in the chat. Apart from age, what are some
[9:09] other common causes of infertility in women
[9:13] particularly? Yeah, I'd say, well, some of the
[9:18] most common causes would be things like ovulation issues.
[9:21] So if you have polycystic ovary syndrome, that would be the most
[9:23] common reason to have ovulation problems.
[9:26] Endometriosis is a really common one, although really interesting
[9:31] one because it's not, it doesn't follow that if you have severe
[9:36] endometriosis that you wouldn't be able to conceive naturally.
[9:38] Or if you have very mild endometriosis, you can, it's a
[9:41] really complex and disease and, and one that's very interesting
[9:46] to us fertility specialists and, and other things would be tubal
[9:52] issues. So that I think that would be
[9:53] the main things, population and tubes and enemy chances.
[9:57] So tubule disease, that could be that you've had a surgery during
[10:02] your life time that's caused damage to your pelvis and so
[10:06] your chips are functioning well or an infection in the past.
[10:10] So if yeah, that would be another reason to seek
[10:13] assistance or advice sooner if you have any of those
[10:18] pre-existing conditions or history of those things.
[10:22] If you do have those and you're wanting to start trying for a
[10:25] baby, should you still kind of wait a little bit and see if you
[10:27] can fall pregnant actually? Or is it best to get checked up
[10:30] by someone like yourself for these specialists to just kind
[10:34] of know your options? Well, it's.
[10:36] Difficult because you can't predict someone's fertility
[10:41] based on anything. Actually, you can say that there
[10:43] are some risk factors for not being able to conceive
[10:46] naturally. Like yes, you've got endo, you
[10:48] might find it a little more tricky, but because it doesn't
[10:51] therefore follow that you absolutely can't get pregnant,
[10:53] we usually suggest that you try unless you're not having a
[10:57] period at all, you know, then you're not ovulating at all.
[11:00] Or you already know that your tubes are blocked, you know,
[11:02] then there's, there's no point in waiting.
[11:05] But yes, if you've got, if you're known to have mild
[11:07] anatripsis or you know, having, you're having regular periods,
[11:13] but you, you've had an operation in the past, you, there could be
[11:16] an underlying problem that you don't know yet.
[11:18] It's usually best to try because always it's it is better to get
[11:22] pregnant naturally if you can. Of course, that's not an option
[11:24] for enable now. So trying or maybe you know, six
[11:27] months if people are risk factor, unless someone's
[11:30] outright said to you before, don't even bother trying to just
[11:33] completely straight away when you're ready.
[11:34] Hmm. It is really interesting.
[11:36] I have endometriosis and I found that out through my fertility
[11:39] journey and it took us a couple of years to fall pregnant with
[11:42] our daughter and again, found out that we had endo through
[11:45] that process. Whereas I have friends who
[11:47] didn't even know they had endo until post having children.
[11:50] So but I think there is, and we've seen this come up in our
[11:52] community quite a lot through comments as people saying like,
[11:55] ohh, you can't get pregnant naturally if you've got
[11:57] endometriosis. And I think there's this message
[11:59] out there, which, I mean, in my personal experience isn't true.
[12:03] When I imagine in your medical experience, it's also not.
[12:06] Yeah. Sort of chuckling cause like
[12:08] there's almost no absolute infertility unless, you know,
[12:14] you've had both of your fallopian tubes removed or we
[12:17] don't get pregnant naturally then.
[12:18] But if anyone's ever told you they are absolutely not going to
[12:22] get pregnant naturally, I've definitely seen people who've
[12:25] had that story given to them and then they have.
[12:27] And I think, well, I'm very careful to say to people, you
[12:31] know, you've got a great no chance, but it could still
[12:33] happen. There is, it is so, so it's not,
[12:36] it doesn't follow that you've got endo, you're not gonna get
[12:38] pregnant naturally. But everybody's journey is
[12:40] decant. Differently And what about a
[12:43] man? What's the most common causes of
[12:44] infertility in men? So and cash men get off kind of
[12:49] lightly, Really don't know one thing.
[12:52] In all areas. Yeah, what's it gonna say?
[12:56] We get to our podcast on the gender pay gap.
[13:00] So man, yeah, look, the most common reason is an
[13:07] unidentifiable reason why they've got maybe a less good
[13:11] sperm quality. So we don't, yeah, we don't
[13:15] commonly find a problem when we when we see a problem with the
[13:18] sperm, we don't usually address an underlying reason why it's
[13:22] it's often multifactorial. Men are less vulnerable to age.
[13:27] So like, you can keep going and keep maybe was and yeah, and
[13:33] they can keep making more sperms so they can alter their
[13:36] environmental factors. Like, you know, if they're
[13:38] smoker, they can quit smoking and improve their sperm quality
[13:42] three months later, which is not the same as I've said for women.
[13:47] So I would say, yeah, men, we, we do see things like for
[13:52] example, absolute male factor infertility, where there are
[13:56] some conditions where men carry the gene responsible for cystic
[14:00] fibrosis and they don't have the, the vast difference, the
[14:02] tube that gets the spin out. So they won't be able to
[14:08] conceive naturally, but they're still going to be fertile about
[14:11] mostly they're going to be fertile underneath that.
[14:13] They may just need some assistance.
[14:15] Right. Wow, very interesting.
[14:17] Do you touch on there? I'm just interested in this
[14:19] around how men can change the quality of this sperm in three
[14:22] months by lifestyle changes. I've heard that about women in
[14:25] terms of, you know, preconception care and all these
[14:27] things. Or can you not alter the egg at
[14:29] all? It's a tricky 1 because it's
[14:33] very difficult to study. I think there is some evidence
[14:37] to support using antioxidant supplements in women and perhaps
[14:42] improving chances of pregnancy through that, but it's all sort
[14:46] of relative and small, um, not fantastic studies.
[14:50] They don't tell us which antioxidants we should use
[14:53] necessarily health or what dose and so on.
[14:56] O usually there's no harm in and taking supplements usually and
[15:02] always check that with your doctor or fertility specialist.
[15:05] But yeah, things like people take things like melatonin, Coq,
[15:08] 10 other antioxidants and that may enhance it there equality to
[15:14] a degree. But really you're never going to
[15:16] undo the effects of ageing or other damage such as smoking,
[15:21] vaping those environmental exposures.
[15:23] So as women, yeah, we're really best to just try and avoid the
[15:26] harm and the thistles. Okay, man, I know.
[15:33] Someone came to you ready to start investigating infertility
[15:37] as a couple. What is the typical process for
[15:41] that? So usually by the time they see
[15:44] me, they've seen their GP and they've had some blood tests.
[15:47] So that would be the first step and there would have their sort
[15:52] of history reviewed, make sure they're having regular cycles
[15:54] and then we can assume they'll be relating as long as they're
[15:57] cycle is between about 25 to 35 days and from one period to the
[16:02] next. And and then so they get to see
[16:06] me and I take a more thorough history and that's where we
[16:08] start to go down different routes for different people.
[16:12] So if I'm suspecting amitosis and I or most of the time I have
[16:18] to get a pelvic culture sound or do a scan myself.
[16:22] And what we're looking for on that is any obvious sort of
[16:25] structural abnormalities and we can actually increasingly see
[16:28] endometriosis on ultrasound. So it's a really useful tool and
[16:33] and then we may proceed to testing the fallopian tubes at
[16:37] that point. Or if there's an obvious other
[16:39] reason like they're not ovulating yet, we may just go
[16:42] ahead with some trying some treatment 1st and then and maybe
[16:46] maybe able to skip that step. So the ways of testing the
[16:49] fallopian tubes for that would either be through something
[16:51] called an HSG, which is a radiological test and an X-ray,
[16:58] or with surgery, so doing lacrosse copy.
[17:01] But I'd say increasingly so we try to avoid surgery if we if we
[17:07] don't need to do it. I know when I first started that
[17:09] infertility, everybody got a hysteroscopy, laparoscopy.
[17:13] It was like a sort of very formulaic thing, I think.
[17:17] I think we've become better at personalising care.
[17:19] Hmm. Yeah, and of course the man
[17:21] needs to have less birth tested. Yes, yeah.
[17:24] My husband had that done on the day of my endometriosis surgery,
[17:27] which is still a laugh in our house, that he had a very easy,
[17:32] some would say enjoyable test and I had not.
[17:35] That and his boss was flying colours and mine absolutely did
[17:39] not. So it's quite long.
[17:41] Yeah, definitely. I wondering someone fit, what
[17:44] signs and symptoms do you find can often be overlooked or
[17:48] dismissed before someone is taken seriously?
[17:50] It's something we hear a lot about in our community is
[17:53] especially antibiosis and they've kind of been visible
[17:56] conditions, woman not often taken seriously or their
[18:01] symptoms are kind of brushed off sometimes.
[18:03] What are the common signs and symptoms that you see that might
[18:06] have been overlooked? I think the most common thing is
[18:10] that women with painful periods are told or heavy periods are
[18:14] told or this is, you know, this is more we're just get on with
[18:18] it. And, and I think, you know, the
[18:21] two degree we're moving away from doing quite invasive
[18:24] testing for things like endometriosis because of course,
[18:27] endometriosis can give you a painful periods, pain during
[18:30] sex. And, and we're, we're moving
[18:32] more towards trying to treat it first, then go straight in with
[18:36] surgery. So there can be a place for not,
[18:38] you know, jumping in and doing an operation straight away, but
[18:41] normalising it and saying, you know, just get on with it is
[18:45] yeah, that I think, you know, it's, it's that's something that
[18:50] I don't think we're as bad at that nowadays.
[18:52] And when I say we I don't see myself primary care generally, I
[18:58] think increasingly there is awareness and especially through
[19:02] all the advocacy of endometriosis dealing and tell.
[19:05] So I think painful periods. Yes, I think one thing that
[19:09] really bothers me is when young women go to to be checked and
[19:13] they're told where yall so you know, just keep trying and it's
[19:18] gonna happen eventually. It was chill out and I think,
[19:21] well, normalising fertility in the younger population because
[19:26] of course as we get older it's going to be less likely going to
[19:29] conceive naturally. But if you in your 20s, you
[19:31] should be getting pregnant quite easily.
[19:34] So yeah, normalising and fertility and the younger
[19:37] population obviously a lot. That's really interesting.
[19:40] We've spoken about IFA little bit and it's something that I
[19:43] think is kind of commonly heard about these days.
[19:46] That included what are the first lines of treatment, often for
[19:49] infertility? Yeah.
[19:51] So as I sort of alluded to before, the ovulation induction
[19:56] would be your sort of life simple.
[19:58] So that's I, I, is that what it's called or is that different
[20:00] gear? It's different again.
[20:01] Ohh, okay. Yeah, wow.
[20:03] And even if we go back and another step before that,
[20:06] sometimes I see couples and they may have the wrong idea about
[20:11] when they should be trying for pregnancy.
[20:14] And so there's some really quite well for me it seems very simple
[20:19] education to give and sometimes just timing intercourse is is
[20:24] all that's needed. I think we grew up thinking we
[20:26] could just get pregnant all the time, right?
[20:28] And it wasn't until I was trying for a baby.
[20:29] I mean, I had a bit of an idea because I was so deep into the
[20:32] woman's health world, but that ohh, there's actually only, what
[20:35] is it four or five days of the month that you can really exact
[20:38] can see it on? Yeah.
[20:39] So that's the. Thing we grow up using
[20:41] contraception you know obsessively and thinking the
[20:45] minute we stop we're going to get pregnant straight away
[20:47] differently and that's something I'm really interested in my
[20:50] career is to to be able to educate younger people to
[20:55] empower them to make decisions about when they'd like to start
[20:58] a family and you know what are their chances according to aim
[21:02] so I think that's really important and so yeah some
[21:04] simple education and then we sometimes we move on to
[21:07] ovulation induction so that's usually tablet medication like
[21:11] clomiphene letrozole right to to improve the chances of
[21:16] lobulation we generally use that in conditions where relations
[21:19] not happening naturally because if ovulation is already
[21:22] happening and there's no advantage to using those so in
[21:25] the olden days again it was quite formulaic people turn up
[21:28] to their GP can't get pregnant here have some clomiphene you
[21:31] it's not gonna help you if you're already on the lighting
[21:33] and. So sorry, that just encourages
[21:36] the body to ovulate exactly right.
[21:38] Yeah. And we just do a series of blood
[21:40] tests and maybe a scan to check that that's happening.
[21:43] And so if that isn't working, or let's say you're already
[21:48] ovulating, literally you've got fallopian tubes that look fine
[21:53] and your partner's sperm quality is good that it still don't
[21:57] happening. So unexplained infertility and a
[22:00] reasonable first line treatment for that is actually trying
[22:03] insemination. I and and that's, that's a
[22:08] quite, quite a good step before I F for people who have got time
[22:13] on their side, who prefer to avoid the invasive nature of
[22:19] idea because as you may know, it's, it's got a huge burden
[22:24] physically and mentally too. And that's not to say that I, I
[22:28] also doesn't, you know, carry a huge burden for couples, but
[22:32] it's, yeah, it's just less invasive and, and it may, and
[22:36] also it's less expensive if you're paying yourself for
[22:39] treatment. But yeah, the chances of each I
[22:44] cycle working, we say on average for a 35 year old with Alex
[22:48] explained, infertility is about 15% per cycle, right.
[22:52] So it's not, that's not super high.
[22:54] So you may need to go through 3 or 4 cycles.
[22:56] And that's a lot, you know, that's three or four months of
[22:59] blood tests and scans and hope and, you know, disappointment
[23:03] often so many people do choose to move on from that sooner than
[23:08] that. And then of course, I BF.
[23:11] Yeah. Do you want to display this,
[23:13] please? Yeah.
[23:14] So yeah, almost sort of technical, um, treatment that we
[23:20] have. And it is, generally speaking, a
[23:23] series of hormone drug injections to cause the ovaries
[23:27] to make multiple follicles. So usually each month your one
[23:32] ovary or the other will make one follicle and you'll release an
[23:35] egg. So what we're trying to do is
[23:37] just get a bunch of eggs, ideally somewhere like 10 to 15,
[23:42] but we can't be precise with that because your body will do
[23:45] what it will do no matter what we try.
[23:47] And, and then the eggs are collected through a procedure,
[23:51] usually under sedation. And, and that involves internal
[23:56] ultrasound and little needle that goes into each ovary to
[24:00] aspirate the follicles and get the eggs out.
[24:03] And then they go off to the lab with the embryologist.
[24:06] The embryologist takes over and does the magic, and of course,
[24:11] now partner needs to produce the sperm.
[24:13] It gets prepared, and then the eggs and sperm either get mixed
[24:16] together in the Petri dish and cultured in the lab to be grown
[24:19] into embryos. Or if there is a male issue and
[24:25] the sperm's not good enough quality just to mix together
[24:28] with the eggs, then each egg has one sperm injected into it, and
[24:31] that's called Eggsy. Wow.
[24:33] Yeah, that's the Super cool stuff.
[24:35] I've never heard of that. You've never heard of it.
[24:37] So it's Ian micromanipulation procedure.
[24:39] So I mean embryologists are incredible and they basically
[24:43] strip the outer cells off the eggs so that they can make sure
[24:46] the eggs suitable to have a sperm injected into it.
[24:50] So it has to be has to have gone through its full maturation
[24:53] process to be suitable to have a sperm injected.
[24:56] And then yeah, with like the tiniest needle imaginable.
[25:00] That microscope, they suck up one sperm, pop it in the egg.
[25:04] That must be the tiniest needle in the world.
[25:06] Wow. With things like it's absurd.
[25:08] It's an absolute. Like at every time I see it, I
[25:11] just think, wow, it's so incredible that they're really
[25:14] incredible. And then that's kind of what all
[25:18] you can do. I mean, obviously the lab
[25:19] environment has to be perfect for embryos to grow the right
[25:22] temperature, the right pH and so on.
[25:25] And, and then we just hope that, you know, the egg and sperm do
[25:28] their thing and grow into an embryo.
[25:30] And then the embryo is placed into the uterus either three
[25:34] days later or five days later. And again, we just cross our
[25:37] fingers and hope it worked. So you can know or they can know
[25:41] at that point if the embryo has been a success, but that doesn't
[25:45] always mean that is going to be a success in your body.
[25:47] Absolutely so. In general, if you put an embryo
[25:52] in on day. 5. There's approximately 40% chance
[25:55] of implantation for a good looking embryo.
[25:58] So it's incredibly inefficient human biology.
[26:03] Yeah, we, well, if you're trying naturally, obviously lower
[26:06] chances than that each month. But yeah, if every time you put
[26:10] an embryo and there's less than half a chance it's going to
[26:12] implant. Wow.
[26:13] And people, So the thing that people often ask me after an IVF
[26:17] cycle is, you know, why hasn't it worked and what can you do to
[26:19] make it work? And unfortunately, quite often
[26:23] the answer is that it's just down to chance.
[26:26] Well, and, and the fact that we haven't yet perfected the art
[26:30] because it, you know, it's very sciency, but it's still just
[26:34] and. Are you multiple things have to
[26:36] go into play as I'm really interested to ask this, is this
[26:41] where multiples are often commonly spoken about an IVF
[26:44] Because do people put multiple embryos in to increase their
[26:47] chance of success? Is that how multiples?
[26:49] Or is the whole multiple thing about?
[26:51] Well, good question. So it used to be that because
[26:57] IBF was even less successful than it is now for various
[27:00] reasons, just because, you know, the science has improved and and
[27:05] also embryologists weren't as good at freezing embryos.
[27:09] They used a different technique that is used nowadays.
[27:12] So they didn't want to waste the embryos for one thing.
[27:14] And also putting the embryos in the kind of thought, well, you
[27:18] know, chucking a few and one of them might imply.
[27:20] So yes, in the olden days, multiples were more common.
[27:25] I say olden days probably like 20 years ago or something.
[27:30] But the and nowadays we aim only for a single embryo, but it's
[27:34] actually a rule across the whole of Australia and New Zealand
[27:36] single embryo transfer. So you can only do one at a
[27:39] time. One at a time because we don't
[27:43] really want multiple pregnancies to happen.
[27:45] Ideally they are much higher risk of pregnancy very commonly
[27:49] get asked can you just put 2 and then just get one pregnancy both
[27:53] babies with one with Dan and we think we would you really want
[27:57] to have one healthy baby at a time in that safe and because we
[28:01] can freeze the other embryos safely then that you know you're
[28:06] you're keeping your same chances of utilising all of your embryos
[28:10] out of it and putting them all in your uterus at once and you
[28:13] know being an octane mum yes October.
[28:16] One so people who are getting twins from my BF and I, I their
[28:20] chances on any different from okay?
[28:22] So so for IVF, the embryo could still split and become right an
[28:28] identical twin pregnancy. We do see that it's still rare,
[28:32] but we're going to say that's the load.
[28:33] That said, yeah, for IUI it's a little bit different.
[28:39] So the exact process of IUI is to also take the ovulation
[28:44] induction medications that I've mentioned before.
[28:46] Usually we give clomiphene or letrozole and we aim to get two
[28:51] or three follicles in the age race and then track the cycle
[28:57] until the woman's ovulating or maybe trigger ovulation with an
[29:00] injection. Get the male partner to provide
[29:03] the spam sample. Sperm sample gets washed and
[29:05] then just the best sperm get put in the uterus.
[29:08] So they're a bit closer to their eggs that are being released and
[29:11] they, we know they're getting in there at the right time.
[29:14] And with that, obviously if you can release more than one egg,
[29:18] there is a chance of multiples. So we try to keep that as low as
[29:21] possible by avoiding using I if there's more than two or three
[29:25] calls. And that's generally kind of
[29:27] individualised to the circumstance, age, the patient,
[29:29] how long they've been trying. Gosh, that's so interesting.
[29:33] Ohh. My last question on that is
[29:35] would I VF, you said people we're just implant 1 now and you
[29:39] can freeze the other embryo. Does that mean if someone wants
[29:43] to have another child they don't have to go through that first
[29:45] stage of IVF again, they just go through the planting stage?
[29:49] Exactly. Yeah.
[29:50] So that's advantageous obviously for not having to do lots of
[29:55] injections again. And also you know, if you if you
[29:59] do an IF cycle at a given age, your embryos then are frozen in
[30:04] time for that age. So your risk of things like
[30:07] abnormal number of chromosomes in the in the embryo is relates
[30:12] to the age you were when you froze those embryos.
[30:15] So you were 30 and then you came back when you're 40, you have
[30:19] the same aneuploidy. So that's abnormal chromosome
[30:23] number risk as a 30 year old mother, 40 year old.
[30:26] Well, it was the advantages freezing embryos.
[30:29] Very interesting. And I, I keep saying it's my
[30:32] last question on this topic and it's not.
[30:33] I'm so fascinated. It's silent.
[30:35] I do wanna touch only really briefly on egg freezing just
[30:37] because I know we've had it come up a lot and we are planning on
[30:40] doing more content on that in the future.
[30:41] But just why are we here? Is there egg freezing process
[30:45] the same process as someone going through IVF?
[30:48] Because I know people get eggs frozen for multiple reasons.
[30:51] Yeah, that's right. It's basically you're I VX cycle
[30:55] and up until egg collection and then the eggs have to be checked
[30:59] to see if they're mature and suitable to be frozen.
[31:02] So, you know, you might get, I don't know, there's no, well,
[31:06] actually I learned that there's an average number of eight eggs
[31:09] obtained in any egg collection. But you know, you might get two
[31:13] eggs or you might get 20 eggs and they have to just be checked
[31:17] to make sure they're mature to be poisoned.
[31:19] No. And and then that's, that's
[31:20] where that ends. So then when you come back to
[31:22] use the eggs, and I think the biggest risk with egg freezing
[31:25] is you've done it, you've spent the money, you've done the,
[31:27] you've spent the time doing it, but you'll never use the eggs.
[31:30] So we know that less than half of people will come back and use
[31:34] their eggs. But when you come back and use
[31:38] them, you do have to go through that process of Etsy that I
[31:40] described with more, which is different types of insemination
[31:43] of the eggs and interesting. Now when I was trying for a baby
[31:49] I got called told all the time just stress less.
[31:52] Just. Don't stress about it.
[31:53] Really easy to. Do just stop stressing and it
[31:56] will just happen. Which is really helpful advice
[31:59] from someone who basically sneezed and fell pregnant
[32:02] because that doesn't sound very stressful to me.
[32:04] But years of this is stressful. Is can stress cause infertility
[32:10] or is that an outdated belief? Do you have any thoughts on this
[32:13] conversation? Yeah.
[32:14] So yes, I mean, it could, you'd have to be really, really
[32:19] stressed to, to basically to stop having population.
[32:24] And that does happen. Some people manage to completely
[32:27] suppress their hormonal release from their brains and not really
[32:31] sex. So yes, you could be infertile
[32:33] from stress, but most people don't have that degree of stress
[32:37] and, and a minor or, you know, less so degree of stress will
[32:41] not stop you from getting pregnant.
[32:45] Of course, stress though isn't good for many reasons.
[32:48] So I still think it's useful to try to explore ways of managing
[32:54] stress because, you know, it's a horrible journey for some people
[32:59] anyway. So you really need to be kind to
[33:01] yourself and think about ways that you can manage your stress.
[33:05] But that's not because it's going to make it more likely
[33:07] that the the treatments can work.
[33:09] You're going to get pregnant easily just because, you know,
[33:11] you just chilled out. No way.
[33:14] Okay, that's very, I think very helpful for a lot of people
[33:17] because it is something that I just hear so often that it's not
[33:21] helpful with a with a draw or not it's not out we.
[33:24] Can hear it too and I hear it between couples too.
[33:27] I'll be sitting talking to a couple and he usually it's the
[33:31] male saying to the female she ought to me.
[33:35] She just needs to chill out and thinking well no actually
[33:39] there's a problem so we shouldn't minimise the issue.
[33:43] Infertility often is a medical diagnosis.
[33:46] It's not just that you're uptight and can't get pregnant.
[33:49] You need to go on holiday, You need to stop thinking about it.
[33:53] None of those things will fix the problem for most people.
[33:57] Now it's just a distraction. But you know, distraction can be
[34:00] good for other reasons for your overall health.
[34:03] Ohh, thank you for saying that. Cause I feel like yeah, that's
[34:06] what I needed to hear on my journey.
[34:08] But you often hear the opposite and that is really hard to come
[34:11] to terms with. They think because you are
[34:13] trying to do everything. And I think if you haven't been
[34:15] through infertility, you just can't understand how heart
[34:18] breaking it is having that kind of hope ripped away from you
[34:21] each month, you know? So yeah, I think that's going to
[34:24] be really helpful. Thank.
[34:25] You so lovely. And the other thing I think is
[34:27] that we have a lot of control over a lot of our life
[34:30] decisions. And the one thing that I think
[34:32] is really hard is that there's that feeling of loss of control
[34:37] that now there's nothing you feel that you can do.
[34:40] So of course you do cling on to the things that people tell you
[34:43] that may help. Sure.
[34:44] And, and, and that also makes often women, but couples are
[34:49] quite vulnerable to, you know, we all know that social media is
[34:54] really good in some ways, but also can be can put a lot of
[34:58] pressure on people to, you know, explore this latest thing that
[35:02] might work that actually scientifically doesn't have any
[35:06] proof of benefit. And then also you got your
[35:10] family members around you and your friend who who, yeah, just
[35:14] sneezed and got pregnant and, and they, they've all got advice
[35:17] for you. And I think the best thing you
[35:21] can do is just go and talk to your GP or a fertility
[35:25] specialist and just just get the absolute truth.
[35:29] And then just stick to your, your story and you know, talk to
[35:32] people if it helps you, but be careful who you listen to.
[35:36] I think that's very great advice.
[35:38] I did just want to ask you mentioned at the beginning you
[35:40] work a bit in public in a bit in private.
[35:43] I was really fortunate enough to be able to go through the
[35:45] private system. They ended up falling pregnant
[35:48] naturally in in the long run, but I was able to seek care
[35:51] through through the private system for that journey.
[35:55] What does what does it look like?
[35:57] If that isn't affordable for somebody, how do you seek help?
[36:02] Yeah. This is where, you know,
[36:04] unfortunately there is going to be disparity in care due to
[36:09] access or funds. But we do have limited funds in
[36:14] New Zealand for public fertility treatment.
[36:17] And if you've been trying for pregnancy for 12 months, if
[36:23] you've got no reason or no known reason why you shouldn't get
[36:26] pregnant naturally, or six months if there is or even
[36:29] shorter, if you know, you know that's a problem already.
[36:32] Your GP can refer you for a public fertility consultation
[36:37] and it takes off in about four months to be seen, which is not,
[36:42] you know, given how the public health system is in the moments
[36:44] actually. It's actually I've had worse.
[36:46] I've had worse than private for other conditions sometimes
[36:49] that's actually yeah. So then you'll get, yeah, you'll
[36:52] get a full fertility workout. You'll be, if you're in
[36:55] Auckland, and I know it's different around the country,
[36:57] but in Auckland you'll be assigned to one of three clinics
[37:00] because all three of the clinics in Auckland do some public care.
[37:03] And yeah, you get the same treatment as someone who's
[37:06] paying and, and you'll get assessed to see if you're
[37:10] eligible to get publicly funded fertility treatment.
[37:14] And that's where the problem comes in because we can't offer
[37:18] treatment until you've been trying for five years.
[37:21] If you've got unexplained infertility, if you've got
[37:24] something severe that's preventing you from getting
[37:27] pregnant, maybe short of all that and and then you do have to
[37:32] meet some criteria. For example, you neither of the
[37:36] couple can smoke and, and there's some criteria in terms
[37:40] of BMI and age. The woman has to be below the
[37:44] age of 40 to be referred. Hmm.
[37:47] So if you meet all those criteria and, and do you, you
[37:51] can get assessed that, yeah, we just have to see each case and,
[37:55] and figure out when you might be eligible for publicly funded
[37:58] treatment. Very interesting.
[38:01] Thank you, what do you wish more Gp's and maybe OBGYN knew about
[38:07] early and fertility signs? Ohh, well I think I mentioned
[38:14] before about the age factor. So I think that's a real sort of
[38:20] hobby horse. My if you're young, you're not
[38:22] getting pregnant, you know, that's more of a worry than the
[38:24] person who's not getting pregnant in in later years.
[38:27] So I do, I do wish that Gp's and this is complete generalisation
[38:33] because there's lots of really excellent consumes, but I do
[38:36] wish that there will, that they wouldn't tell people were you
[38:39] young. Don't worry, actually, it's a
[38:40] great time to get seen when you're young because if you've
[38:43] got a major problem, then we're more likely to be able to have
[38:46] success through treatments at a younger age.
[38:49] Um, I think, I do think in recent years we've had, we've
[38:54] made significant progress with identifying Ametria Isis as an
[38:59] underlying condition. And so I think, ohh, I would
[39:03] have said, you know, that GPS need to realise that, you know,
[39:07] painful periods aren't just normal and there may be
[39:10] underlying endometriosis, but I think we've got better at that.
[39:14] I guess the other one is occasionally I do see people in
[39:17] there and the primary care providers given them some
[39:19] ovulation induction medication that already ovulating and I
[39:22] think, well, you've just wasted that time.
[39:24] So and yeah, I think those would be my main thing.
[39:28] Now we got some community questions through which I always
[39:31] like to cover because this is what the people are really going
[39:36] through and I would really like to help them on their journey.
[39:39] The first question is around secondary infertility.
[39:42] It's something that I have heard a lot about, maybe people who
[39:45] didn't have fertility issues at the beginning.
[39:49] Can you break that down? For us, well sure.
[39:51] So I think secondary and fatality is like a surprise for
[39:56] people, right? And and you know, you just
[40:01] expect, well, you. You got pregnant after two or
[40:04] three months the first time it's gonna happen again.
[40:05] So for that reason, it can be even more frustrating and, and
[40:10] often you've got people just like when you're trying for a
[40:13] baby the first time, you've just got married and everyone says
[40:16] when's the baby? Coming.
[40:17] Once you've got one child, people go when you gonna have
[40:19] the second one. So it's just as stressful and in
[40:22] many ways, or sometimes people might minimise it by saying
[40:27] we've already got a child so you know, should be happy with that.
[40:30] But you know, it's your deepest desire to have a bigger fan like
[40:34] so I guess secondary and fatality we do, we can still
[40:39] offer some public funded treatment.
[40:41] Also, it's only once you've got two children and that you're not
[40:44] going to be entitled to any publicly funded alternative
[40:47] treatment. And of course, yeah, completely
[40:49] individualised as to when you might be entitled to have that
[40:52] treatment. I guess perhaps it's going to be
[40:55] age-related more often because you're older when you try for
[40:59] your second child then you first and and there may be factors
[41:04] that relate to your your first pregnancy or delivery like if
[41:08] you had complicated surgery the first time round could be
[41:11] related to that. It's gonna be very individual.
[41:15] I mean it's just like primary infertility and that you should
[41:18] seek advice within the same duration time and we do take it
[41:22] just as seriously. And this question included if
[41:26] there's recurring miscarriage happening within that second
[41:30] infertility as well as there are different consideration and
[41:33] that. Yeah, so recurrent miscarriage
[41:37] is it's slightly different entity.
[41:39] Yeah, it it's still just as you're going to get seen in the
[41:46] public system. If you've been trying for
[41:48] pregnancy, you've been getting pregnant, but you're having
[41:50] miscarriages, that doesn't mean you can't get referred to a
[41:53] fertility specialist because you know, the important outcome
[41:56] isn't getting pregnant, right, is having a baby.
[41:58] So yeah, you can still get seen CGP, they can actually initiate
[42:03] some tests for you. They're, they're a pathways for
[42:06] GPS to follow in terms of test they can do sometimes.
[42:10] I think we're getting better at this.
[42:13] Women and couples really need to be empowered to ask the right
[42:18] questions and, and to and sometimes need to be pushing for
[42:23] a referral to be made. We're really lucky in Auckland.
[42:25] We've got a publicly funded recurrent pregnancy loss service
[42:29] where couples can be seen, but you could, you could see
[42:33] somebody in the private sector if you choose to.
[42:36] All you have access to that is. Can having a posterior cervix
[42:42] impact fertilisation? So it's a shame for women to
[42:48] feel that they're abnormal because they have a variation of
[42:51] what is normal anatomy. Okay, so we're not all the same.
[42:58] And sometimes if you've had an examination by a medical person
[43:03] and, and they pointed something out to you, like your cervix is
[43:09] very posterior, um, you're made to feel like that's a problem or
[43:13] an abnormality at all. It is, is the angle that your
[43:17] room sitting at and sperm are actually incredible, um, often
[43:22] and. Go, man.
[43:29] And they can, they can find their way into that cervix.
[43:33] And so no, you don't need to worry.
[43:35] It's not going to stop you from getting pregnant.
[43:38] There may be other reasons you're not getting pregnant.
[43:40] But on its own, it's not like, you know, gosh, you've got a
[43:43] posterior cervix. Good luck.
[43:45] No, it's. Yeah, it's just a normal
[43:48] anatomy. It's just how you were in this
[43:50] position. And therefore, where your
[43:51] celebrity? You touched on VMI around IBF
[43:56] before we had a question come through.
[43:58] What are the chances of fertility with a high BMI?
[44:01] Ohh. So I guess it's proportional to
[44:07] the degree of elevation of the PMI.
[44:10] And we do know that BMI unfortunately does whether with
[44:16] advancing and with very low BM I.
[44:18] These are both going to impact your chances of natural
[44:22] pregnancy because if you're very underweight or if you're quite
[44:27] overweight, then you may not be ovulating regularly.
[44:30] And that's often something that we see as a consequence.
[44:33] And then there are ways that we can help ovulation happen as
[44:37] long as you're within a sort of safe, what we think is a safe
[44:40] limit to to become pregnant. There are studies that look at
[44:46] whether IVF is impacted by VMI. This is quite separate to our
[44:55] criteria for accessing public care.
[44:57] Now you could argue that there are access to public I, VF is
[45:04] too restrictive, but the main reason for that, I would say is
[45:08] that we've got such a small pot of funding that, you know,
[45:12] someone decided that BMI was a criteria to limit it and that's
[45:17] how it was set. But that's not to say that if
[45:19] your BMI is above that, that it definitely won't work for you.
[45:23] We just know that there's an optimal BMI.
[45:25] We know that below that and above that, that you're probably
[45:28] going to have a slightly less chance of IVF working out for
[45:33] you because in like a big database study looking at embryo
[45:37] transfer pregnancy rates, they did seem to decline with
[45:42] movement away from that optimal BMI in either direction.
[45:48] Short luteal phase. Can this impact fertility?
[45:52] That's just like a real old chestnut, that one, really.
[45:58] I don't think anyone. Really has the answer to that
[46:00] OK. And I've certainly never come
[46:03] across any research that says with certainty that our yeah,
[46:07] you gotta shortly to your face, you're never going to get
[46:09] pregnant naturally. So my short answer to that is
[46:13] probably not, but I think you do need to see your GP or
[46:19] specialist and just figure out is it that you'll be too face is
[46:24] short or are you ovulating when you think you're ovulating?
[46:26] Like maybe have a chat and figure out whether there's
[46:29] something else going on. Because most of the time the
[46:32] luteal phase is fixed at 14 days, but it can be normal as
[46:38] little as sort of 9 or 10 days actually.
[46:40] So what is a short luteal phase? Yeah, it's tricky.
[46:44] And Kirk? What's your advice on recurrent
[46:48] chemical pregnancies? So chemical pregnancies would be
[46:53] biochemical pregnancies would also be classified as a
[46:57] pregnancy law, right? Just like a miscarriage.
[47:00] So in the definition of recurrent will seal off
[47:03] biochemical pregnancies are included.
[47:05] So if you're having recurrent pregnancy loss, you you probably
[47:09] need to have further investigation.
[47:11] So after two pregnancy losses, I haven't a series of blood tests
[47:15] recommended because there can be underlying reasons.
[47:19] Ovulation, pain and fertility, Is that something to worry
[47:22] about? Hmm, well ovulation pain can be
[47:28] related associated with endometriosis.
[47:31] So I guess depends what the other symptoms are.
[47:36] I mean when its own, I'm not familiar with any research,
[47:39] research that says ohh, you get painful ovulation and so you're
[47:42] less likely to conceive. In fact, I would say, well,
[47:45] you're really in tune with your body and you know when you're
[47:47] ovulating and that can have some benefits.
[47:50] It just depends how painful it is I guess.
[47:52] It's so painful you can't have sex then obviously that's not
[47:55] ideal. But no, it's not like an
[47:57] independent, you know, association with not getting
[48:00] pregnant. It just could be associated with
[48:02] endometriosis. Feel Does heaving and ovarian
[48:08] cyst impact the ability for the egg to release into the tube?
[48:14] I'm very incest are really common and they're really varied
[48:18] and some cysts are, you know, just kind of a variation of law
[48:24] or physiological cyst. They come and go, don't need to
[48:26] worry about them. They're cysts might be ginormous
[48:30] and completely distorting your natural anatomy and therefore,
[48:35] you know, the tube might be blocked or hindered.
[48:38] So I guess that really depends on how big the sisters, what
[48:41] kind of assist it is. Is it an endometriosis cyst,
[48:44] which would be, and the more concerning perhaps and yeah, so
[48:49] very much individualised. But if it was a small cyst that
[48:54] disappeared on its own, I really wouldn't worry about it.
[48:56] Yeah. Now this was my last community
[48:59] question before we wrap up fertility after an ectopic
[49:03] pregnancy. Bizarre question.
[49:06] Or no, that was just a statement that.
[49:08] One. So I guess OK.
[49:11] Discussed. Just what is, Yeah.
[49:14] Do you have any thoughts on that one?
[49:16] And OK, so if you've had an ectopic pregnancy it then you
[49:20] may have had surgery to treat it.
[49:22] So you may have one less tube now or you may have had medical
[49:25] treatment or you may have just it may have just resolved
[49:28] itself. Either way, if you've had a lift
[49:31] topic that sort of suggests that there could be underlying could
[49:35] be not certainly underlying damage to the other fallopian
[49:40] tube as well. So.
[49:43] I. I'm generally if I'm seeing
[49:46] somebody and I do see people acutely at Auckland Hospital who
[49:50] have an ectopic and we may need to remove the tube, I'm
[49:53] generally very reassuring to those people that they've still
[49:56] got a really good chance of having a natural pregnancy.
[49:59] However, it would be completely personal because if that person
[50:03] has had a surgery and the other tubers, it's not looking
[50:07] healthy, then obviously they may need to see a fertility
[50:10] specialist and talk about their other options.
[50:12] Or they may not have had surgery, it may have just
[50:14] resolved naturally. So they have no idea about the
[50:16] state of the other fallopian tube.
[50:17] I would just say, look, it's probably a bit of an alarm bell.
[50:22] If you've had an at topic and then you're not getting
[50:25] pregnant, have within sort of six months of trying, I'd
[50:29] probably put you in that category of getting seeking
[50:32] assistance or some further tests a bit sooner.
[50:35] But there are tests we can do like I described earlier to
[50:38] check on the other fallopian tube or if you've had an ectopic
[50:43] and that's being treated or it's got better on its own, you know,
[50:48] check growth fallopian tubes, make sure they're working.
[50:50] I'd just be a little bit, I'd see my doctor a little bit
[50:53] sooner in that situation. Now I'd like to Rep just with
[50:57] one question. What's one thing you always tell
[51:00] your patients who feel like they've had dropped?
[51:03] Well, I look, it's really hard to reassure people that there is
[51:12] light at the end of the tunnel and I'm generally quite sort of
[51:17] blunt speaking actually, if I always use our or use, I always
[51:25] offer our councillor support because they are incredible and
[51:30] they have mostly seen it all before.
[51:34] So I guess what follows that is that I, I do tend to tell
[51:40] people, you know, you're not alone.
[51:41] It feels very lonely. You feel like you're the only
[51:45] person who's ever experienced this.
[51:48] And I often have people asking me that too.
[51:49] There's anyone ever had this situation happen and it turned
[51:53] out to be OK. So yeah, again, it depends on
[51:57] the situation, but sometimes they do offer those stories of
[52:00] hope because I think that can be depending on the situation, can
[52:06] be useful to know people have been through what you've been
[52:09] through and it turned out OK. But I think, and I do think it's
[52:14] really valuable for couples and individuals to know that they're
[52:19] not. Alone.
[52:20] Thank you so much for your time, Doctor Lizzie.
[52:22] That was incredible. I know that's going to help so
[52:25] many people out there on their journey.
[52:26] Definitely. Thank you.
[52:39] Thanks for listening to The Cyclist.
[52:41] To join the community, follow us at We Are the Cyclist, Your
[52:45] Cycle Decoded.

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