Episode 45: Fertility Preservation & Gender-Affirming Care

Change is hard, especially when they involve endings of things we’re sad to see go. And we’re definitely sad to see The Whole Pineapple go.  In this very special, final (for now?) episode, Ruby, Anne, Jamie, and podcast producer Shannon Perry reflect on how difficult it can be to say goodbye. But as A.A. Milne says in the voice of Winnie the Pooh, “How lucky I am to have something that makes saying goodbye so hard.” Given how hard this is, we’ve clearly been very lucky indeed. Then stay tuned for Jamie’s meditation on letting go so you can move forward. This podcast has been a labor of love, and there has been a lot of joy in talking with amazing guests, hearing from listeners how much you’ve gotten from the episodes, and diving deeper into how fertility appears in research, books, and even popular culture. We hope The Whole Pineapple has helped listeners learn more about the fertility journey and the options that exist for those who are having challenges building their families. But we also hope it’s helped open the discussion — the stigma that still exists around infertility, and the reluctance many of us feel when talking about bodies and reproduction can make it tough to talk. But these are necessary conversations, and sharing podcasts like The Whole Pineapple can be a gentle way to introduce the topic. Finally, we have to say “thank you.” Thank you for listening and supporting this podcast. Thank you for sharing episodes and the things you’ve learned. Thank you for coming with us on this journey. Please know that the episodes will continue to be available, and our email, [email protected] is still live, if you have comments or questions. We love and appreciate you. Have a delicious week. Resources:  Kahlil Gibran: On Joy and Sorrow Find Jamie Mammenga on her website, Sound Perinatal and Fertility Counseling, PLLC: www.soundcounseling.org Audiotocracy Podcast Production: audiotocracy.com

Sorry, folks, it’s official: it’s the end of sex.* Henry “Hank” Greely, Professor by courtesy of Genetics at Stanford School of Medicine, Deane F. and Kate Edelman Johnson Professor of Law, and Director of the Center for Law and the Biosciences, is very interested in how new biomedical technologies impact assisted reproduction. He’s authored two books: The End of Sex and the Future of Human Reproduction in 2016, and CRISPR People: The Science and Ethics of Editing Humans, which published in 2021, and is Chair of the Steering Committee of the Center for Biomedical Ethics, among other impressive mouthfuls. In this episode, Ruby, Anne, and Hank dive into the changes that are already happening in human reproduction — and the possible changes to come. In addition to the scientific challenges, what are the ethical and legal questions we’ll need to tackle as the landscape changes? Many of us became aware of genetic questions with Dolly the cloned sheep and the controversy over stem cells and how they might be used to repair damaged bodies. But Hank took the question even further, asking, What happens when we can make eggs and sperm from skin cells? Does that signal the end of human reproduction as we know it? Hank can pinpoint the origin of his curiosity to October 19, 2010 in Muenster, Germany — a conference talk on how induced pluripotent stem cells (iPscs) could be used to make other cells, including, the speaker said off-handedly, sperm and eggs. Wait, what? Science fiction? Maybe not. If you’re curious about the possible future of fertility (and sex), this is the episode for you. Be sure to check out the book as well. There’s not only theory about what the future could hold but also a well-researched history of how we’ve gotten here  As always, please rate and review, and most of all, share the episode and show with anyone you think could benefit.  *Spoiler: New technologies might mean the end of sex for reproduction and the start of sex purely for pleasure. So the news isn’t bad after all.  Learn more about Hank Greely on the Stanford Law School Directory: https://law.stanford.edu/directory/henry-t-greely/ Find more episodes from Ruby and Anne at https://thewholepineapple.com.   Resources mentioned: Purchase the book from the Harvard University Press: https://www.hup.harvard.edu/catalog.php?isbn=9780674984011 Episode 29: My Embryos are Mosaic? https://thewholepineapple.com/episode-29-my-embryos-are-mosaic-interpreting-your-pgt-results/  

Fertility preservation for those undergoing gender-affirming transition is an important area of reproductive medicine. In this episode, Anne and Ruby are talking with Dr. Lynn Davis about how fertility options may be dependent on age, the gametes involved (i.e. sperm or eggs) and the stage of gender-affirming care.  Dr. Davis started her educational journey with a double major in Biology and Psychology from the University of Virginia, followed by her MD from the University of Colorado and OB/GYN residency from Harvard. She concluded her training with her REI Fellowship at Stanford University, where she also completed a postdoctoral Fellowship at the Stanford Agency for Healthcare Research & Quality, and served as Clinical Instructor in the Department of OB/GYN. Dr. Davis developed and now leads SRM’s Fertility Preservation Program, a specialized approach that assists those who need assisted reproductive technology to efficiently delay family building. Sometimes it’s a question of timing. For example, those born with testicles do not begin producing sperm until puberty (a process known as spermatogenesis). So if an individual with testes chooses to go on gender-affirming puberty blockers, they may not yet produce sperm. While puberty blockers can prevent bodies from undergoing unwanted physical changes (development of facial hair, lower voice, etc.), it may also mean little or no sperm to freeze for fertility preservation.  For those who have undergone natal puberty, it is possible to interrupt gender-affirming hormones in an attempt to resume spermatogenesis and freeze sperm for later use. However, there is a chance the process may not result in viable sperm. The experience coming off gender-affirming hormones also needs to be considered; for some, it can be a distressing, dysphoric experience.  Options for those with ovaries are also dependent on puberty and stage of gender-affirming treatment. Dr. Davis discusses the options for ovary stimulation, egg retrieval, ovarian tissue cryopreservation, and all the nuanced considerations along the way. Be sure to tune in for this important and fascinating conversation.   You can learn more about Dr. Lynn Davis and reproductive endocrinology at www.seattlefertility.com.  You can also find Anne and Ruby there. Hear more episodes of The Whole Pineapple at thewholepineapple.com.

A diagnosis of cancer or other serious condition is bad enough — dealing with tests, treatments, insurance, uncertainty, as well as the illness — but knowing that the condition or its treatments can also cause infertility…. It just feels so horribly unfair. The good news is for many, that diagnosis doesn’t have to equal the end of fertility. The landscape for patients has changed. In this episode, Ruby and Anne talk with fellow Seattle Reproductive Medicine provider and reproductive endocrinologist Dr. Lynn Davis about options for preserving fertility. Dr. Davis started her educational journey with a double major in Biology and Psychology from the University of Virginia, followed by her MD from the University of Colorado and OB/GYN residency from Harvard. She concluded her training with her REI Fellowship at Stanford University, where she also completed a postdoctoral Fellowship at the Stanford Agency for Healthcare Research & Quality, and served as Clinical Instructor in the Department of OB/GYN. Dr. Davis developed and now leads SRM’s Fertility Preservation Program, a specialized approach that assists those who need assisted reproductive technology to efficiently delay family building. So, what are some of the options? Gamete freezing — sperm, eggs, maybe even embryos — may provide additional options for post-treatment family building. If the patient is pre-menarchal (hasn’t had their first period), then stimulating the ovaries to freeze eggs is not possible, but ovarian tissue freezing may allow options for future fertility and hormone function. The best option for anyone in this position is to talk with your care team and a fertility expert to learn what the possibilities are for you. As ever, please do share this episode with anyone you know who might need both the knowledge and the hope this conversation brings! You can learn more about Dr. Lynn Davis and reproductive endocrinology at www.seattlefertility.com.  You can also find Anne and Ruby there. Hear more episodes of The Whole Pineapple at thewholepineapple.com.

The Whole Pineapple welcomes back Dr. Lee Hullender Rubin, specialist in acupuncture and integrative East Asian Medicine, this time to talk about herbs and East Asian medicine in general. While acupuncture may be the most well-known, East Asian medicine incorporates many different modalities of treatment. So let's talk integrative medicine.  As Dr. Lee says, “integrative” means that many different treatments and providers come together to collaborate and support patients. In the US, we don’t always reach this goal, as Western medicine has traditionally been less open to collaboration, but with more providers welcoming alternative therapies and more patients advocating for holistic wellness care, it’s getting better! That said, because the herbal industry isn’t regulated the same way prescription medication is, you’ll want to be as informed as possible before you start adding things to your treatment plan. Some things to expect: Your provider will likely ask you to get your labs done before starting treatment. This is so they can understand how your body functions at baseline. You’ll probably answer a lot of questions. Again, your provider needs to know a lot about you — sleep, stress, diet, goals, etc. — before designing your treatment plan. There will likely be continued tweaking of your plan. These formulae can be complicated, so it takes some time to get things just right. Then as your body and/or circumstances change, more tweaking may be necessary. You should keep your entire care team apprised of all the changes you’re making and any new treatments (including herbs!) that are added or removed from your program.  There’s so much to learn in this episode, and you may want to have some of this information handy when you talk with your care team, so be sure to bookmark or favorite the episode! And as always, please share with anyone else who could benefit.  Learn more about Dr. Lee and schedule an appointment at Rosefinch Health at rosefinchhealth.com Learn more and hear more from The Whole Pineapple at thewholepineapple.com. 

Dr. Lee Hullender Rubin wants you to understand acupuncture and how it can aid all kinds of issues, including infertility.  The founder of Rosefinch Health, Dr. Lee is an award-winning doctor of acupuncture and a leader in the field of integrative reproductive medicine. She blends compassionate care with over two decades of clinical experience specializing in fertility, IVF support, pelvic and vulvovaginal pain, and cancer-related support. She is also a teacher and researcher in acupuncture and integrative East Asian medicine and founded Rosefinch Academy to help other providers learn more.  But about that “being poked with needles” thing: In unskilled hands… well, just don’t be in unskilled hands. Acupuncture can seem random to the unfamiliar, but it’s a highly specific process developed, literally, over thousands of years.  If you’ve avoided acupuncture because you’re needle-phobic, here’s a big tip: acupuncture, in the right hands, doesn’t and shouldn’t hurt. In skilled hands, you won’t feel the needle going in, only the results.  So, here are a couple of tips for assessing an acupuncture provider: Ask to see their license for your state or look them up on your state’s medical board.  Your specialist will perform an assessment of you involving lots of questions. You should do the same. Ask about their training and experience until you’re confident about their professionalism. Your acupuncturist is part of your care team. Make sure this provider is complementary to and cooperative with the rest of your care.  Your acupuncturist should understand your goals and have experience dealing with fertility issues, so ask about their work in fertility in particular. Check with aborm.org (aborm.org) but realize not everyone who is qualified has taken this optional test. Ask: if this isn’t the cycle for me, how will you support me? What can acupuncture do for you? At the very minimum, acupuncture can help you feel more relaxed and have better energy. And that can be super-helpful at a difficult time. Acupuncture may increase your chances of a clinical pregnancy or live birth. Acupuncture can relieve stress and help you sleep better. Acupuncture may help your body ovulate more consistently.  Acupuncture may help control blood sugar levels. This is just the tip of the iceberg of this conversation among Ruby, Anne, and Dr. Lee, so be sure to listen to hear all the science behind acupuncture. This ancient treatment method has so much to offer us here in the present! Learn more about Dr. Lee and schedule an appointment at Rosefinch Health at rosefinchhealth.com And as always, learn more and hear more from The Whole Pineapple at thewholepineapple.com.   The Acupuncture and TCM Board of Reproductive Medicine (ABORM): aborm.org

Note: This episode contains news on the future of The Whole Pineapple podcast, so be sure to tune in! There’s a difference between “letting go” and “giving up,” right?  Giving up is relinquishing control; letting go is making the decision that this path isn’t serving you right now and it’s time to make a change. But even if letting go is your decision, it isn’t necessarily easy or painless. In this very special snack, Ruby joins Anne and Jamie to talk about balloons and balls and dandelions and whirligigs in a way that we promise will make sense when you hear it. And they remind us that letting go of something that isn’t working leaves a hand free to take hold of something else. And of course, the discussion is followed by Jamie’s gorgeous voice giving us the peace to let go, even if just for this moment. As ever, find more meditations and more information at thewholepineapple.com, and find more from Jamie at soundcounseling.org.

For women athletes, it can sometimes feel like the playing field is so tilted, they’re constantly running uphill to reach their goals. (Seriously, could this analogy BE any better?) There’s been progress, say our guests for this episode, OL Reign players Lu Barnes and Nikki Stanton, but parity is still a long ways off. The way women are (mis)treated in sports is a microcosm for the way women are often treated generally. So even for the non-sporty among us, the stories Lu, Nikki, Ruby, and Anne share will probably feel familiar – and the life lessons to be gained relate to us all! In this episode, we hear the realities of being an athlete in a female body: not just the realities of dealing with a cycle or having a more limited window for having a family, but also the cultural limitations (just wait until you hear Nikki’s story about the “shared” ice/hot baths in Chicago, oooof). The biggest battles often aren’t against an opposing team. Players in women’s sports generally make considerably less money than their male counterparts, they may not get the sponsorship offers men get, and their access to the best resources in terms of arenas, gear, coaches, medical support, health insurance, etc., is much more limited, generally. It’s important to understand how the barriers and inequities impact performance on the field; when you have to work year-round to pay the bills, you simply don’t get the time to recover. This episode is rich in great advice from players who've been around a while — how to stand up for yourself, how to have a life outside soccer, how to forge ahead while still protecting your health mentally, emotionally, and physically. It’s time to take gender out of the equation when it comes to paying ALL people fairly and treating people fairly, and we thank women athletes for helping bring attention to this issue! Learn more about Lu and Nikki and the OL Reign:  olreign.com  Nikki Stanton bio Lu Barnes bio Hear more from Ruby and Anne and listen to all the episodes of The Whole Pineapple at thewholepineapple.com.

If, unlike Anne, you’re not already a season ticket holder for the OL Reign, and you do live in the Seattle area, maybe consider grabbing your seats now. Like most women’s sports, tickets are less expensive than the men’s and certainly less than they’re worth! In this episode, we hear from OL Reign players Lu Barnes and Nikki Stanton on the joys and challenges of being a professional athlete. This episode came about because Seattle Reproductive Medicine is the OL Reign’s official fertility partner, providing education, fertility advice and care to preserve fertility options. Chances are, if you’re listening to this podcast, you know why it’s important for players to have a fertility partner, but if you don’t, for women, peak fertility years often coincide with peak athletic years. Options such as egg freezing can extend a female athlete’s career by enabling her to postpone family building. So what are the challenges of being an athlete in possession of a uterus? (And heads up – these issues often affect the careers of any professional, not just athletes!) Depending on her cycle, there are times when women’s bodies are more injury prone. Uniforms often don’t take into account the realities of women’s bodies — white shorts, y’all? Really?? Unlike for men, a woman’s sports career usually has to at least pause for becoming a parent. Double standards exist. And they generally suck for women. Society often “expects” women to simply quit their sports careers in favor of family. Men have never EVER had to deal with “the period lady.” Just like the fathers, mothers would like their kids to be able to see them play and to provide that same inspiration. And this isn’t a fantasy that biology makes impossible; more research, more investment, more conversation on the subject has already resulted in improvement — there’s no reason to assume the status quo is “good enough.” Nikki and Lu are brilliant on and off the field, so once you’ve listened to this awesome conversation, check out their bios at the OL Reign: Nikki Stanton bio and Lu Barnes bio, and then buy those tickets! Get Tickets HERE! And as always, help us end the stigma around infertility and bodies with uteruses and vaginas by sharing this and other episodes. You’ll find all the episodes at thewholepineapple.com.

First, we’d like to apologize for the joke that starts this episode. This is what happens when good vegetables go bad…. ;) In this delicious snack, Ruby and Anne are chatting with Judy Simon and Angela Thyer about their new book, Getting to Baby: A Food-First Fertility Plan to Improve Your Odds and Shorten Your Time to Pregnancy. If you are considering starting or building your family, it’s great for everyone involved to get in their best possible health, whether you’ll be carrying the child or not! And this plan can help everyone attain optimal health. Get your answers to: What is a “food-first approach” to fertility, and does it actually help? How do nutrition and lifestyle affect fertility? Is nutrition a one-size-fits-all? (spoiler alert: no.) Should I focus more on plants? (spoiler alert: probably) Are you all about weight loss? (nope) And so much more.  One thing we love about this plan is that it focuses on making progress, not on being perfect. And there’s no shame here: nutrition can be challenging, especially when life is busy. But the great thing is even small improvements can yield great, noticeable benefits.  Cooking and eating well don’t have to be stressful, and that’s what this book is all about. Let Angela, Judy, and your own body guide you to explore new foods and reach your health goals! As always, we hope you’ll share this episode with anyone who could benefit! More about our guests: Angela Thyer, MD, is a reproductive endocrinologist and infertility specialist and one of the founding partners at Seattle Reproductive Medicine. She is triple-board-certified in reproductive endocrinology, infertility, obstetrics, and gynecology, and lifestyle medicine, and her special interests include polycystic ovary syndrome (PCOS), nutrition and fertility, lifestyle medicine, and reproductive aging.  Judy Simon, RDN, is a registered dietitian nutritionist who specializes in reproductive health. She is the founder of Mind Body Nutrition, LLC, clinical instructor, and staff dietitian at the University of Washington. Judy has held leadership roles in the American Society of Reproductive Medicine Nutritional Special Interest Group, and is a Fellow of the Academy of Nutrition and Dietetics. Resources: Book website: gettingtobabybook.com Judy’s website: mind-body-nutrition.com  Instagram: @fertilenutrition Order on Amazon Judy’s previous full episode: Disordered Eating & Fertility  Snack: Health & Fertility at Every Size  Find more from Anne and Ruby at thewholepineapple.com.