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Fearless Infertility with Jenica Parcell | The Doctor That Gave Us Our Miracle Twins - Dr. Russell Foulk

I am so excited and giddy to be introducing you to my guest on the show today. Dr. Russell Foulk is the doctor who gave us our miracle twins, and he’s someone who really simplified the infertility experience and brought me a lot of peace on our journey of conceiving.

 

I invited you to send me questions you’d like Dr. Foulk to address over on Instagram, and you’re going to hear all his answers on this episode. I remember sitting down with him the first time and finally feeling like somebody understood how we could get from where we were then to where we are now with our kids, and I hope listening in today helps you feel the same hope and peace.

 

Join us this week as Dr. Foulk shares his wisdom on all things infertility. He’s dispelling the most common myths his clients come to him with, his tips for what to look out for in a clinic if you’re new to the infertility experience and how to be best prepared for your first visit, and literally everything in between. 

 

Have you heard about my Morning Mindset Magic Checklist? It’s a free download I will send right to your inbox, filled with the exact things I do every single morning to set myself up for success. If you want in on it, simply click here to get it! 

 

For those of you who are looking to be coached by me and to start working closely with me, Fearless Infertility Coaching will be launching on September 1st! For more details, click here to join my newsletter!

 

To celebrate the launch of the show, I’m giving away pajama and sock sets from The Slice of Sun that I have personally designed! ! They’re the most delightfully soft things you’ll ever put on your body and I’m giving away five bundles to five lucky listeners who subscribe, rate, and review the show on Apple Podcasts.


Click here to learn more about the contest and how to enter!

 

What You Will Discover:

  • How Dr. Foulk got into this line of work. 
  • The most important aspect of the psychology of infertility. 
  • Why Dr. Foulk believes there’s always a solution to infertility. 
  • The most common myths about infertility that Dr. Foulk hears from his clients. 
  • Dr. Foulk’s recommendations for what to look for in a fertility clinic.
  • Why unexplained infertility does not equate to unknown. 
  • Dr. Foulk’s take on diets and lifestyle changes recommended when trying to conceive. 
  • How to approach differences in family goals between spouses. 
  • When to begin pursuing a gestational carrier. 
  • Dr. Foulk’s opinion on whether it’s safe to get the COVID vaccine while you’re trying to conceive. 
  • The biggest determinant of egg quality. 
  • How to be best prepared for your first visit with a fertility doctor. 




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                Full Episode Transcript:

                        Hi, friends. Welcome to Fearless Infertility a podcast for women struggling with the mental anguish that comes with infertility. My name is Jenica and after suffering in silence for too long I was able to pull myself out of the dark, take control over my mind, and create joy during my infertility experience. I’m here to help you do the same, sister. Let’s dive into today’s show.

                        You are listening to Fearless Infertility with Jenica Parcell and in today’s podcast episode I have an incredible conversation with Dr. Russell Foulk. Dr. Foulk is the doctor who helped us conceive our miracle twins after trying for so long and I love him for so many reasons. One of them being that he’s very straightforward and really simplifies the infertility experience.

                        I remember sitting down with him during our first meeting and just crying because I finally felt that someone understood how we would get from where we were to being able to conceive. And that’s exactly what he did.

                        I think after today’s episode you will feel a lot more at peace with your own infertility experience. And he did such a great job of answering all of your questions that you submitted through my Instagram story when I asked what questions you wanted me to ask him.

                        He talks about common myths and facts about trying to conceive and I learned so much. I cannot wait for you to listen, let’s go.

                        I feel genuinely giddy that I get to be the person to introduce to you, my doctor, Dr. Russell Foulk. He helped us get our miracle twins after trying for so long. And he’s the man that really, really simplified the whole process for us and brought me so much peace in so much confusion.

                        So before we get into our incredible interview and conversation where he answers all of the questions that you had, make sure you’re following me on Instagram. It’s @thesliceofsun.infertility. When I’m going to be having a new podcast guest on the podcast, I go on Instagram stories and I ask you what questions you would like for me to ask them. And you had so many incredible questions for him which really led to such an incredible conversation. So make sure you’re following me there to connect that way.

                        And then also make sure if you want to connect with other women experiencing infertility as well as to chat with me, join our private Facebook group. It’s Fertility Family by The Slice of Sun on Facebook. And it’s just a really great positive space where you can ask questions, you can answer other people’s questions and really just connect with other people in a safe, private space where you can just feel not alone anymore.

                        I think that’s one of the main sad problems in being in infertility is that it can feel very isolating at times, and I want you to know that if you’re in this space there is no reason for that. I’ve created this space for you, there are so many women who are willing to support you and wanting to support you and uplift you. And that’s what I love about this space. And would I wish this on anyone? No, but are the gifts that I’ve received from it so absolutely incredible that I don’t know how I would have gotten them otherwise? Also, yes.

                        And this leads into today’s podcast review. I give away a pair of my pajamas and socks that I sell on thesliceofsun.com every Monday when I launch a new episode and I choose a new reviewer to give those to. And the reason why it’s so important for me to continue to get five-star reviews is because there are many, many, many women out there who are experiencing infertility who are completely alone.

                        Who have no idea who I am, who have no idea about Fearless Infertility podcast or thesliceofsun.com or Fearless Infertility coaching, and they are alone and lost. And when you leave reviews, it makes this podcast easier to find. So please continue to do so and I will give away some pajamas and socks every single Monday.

                        The winner for this week is Sarahchild28, turning pain into purpose. “I love this podcast for so many reasons. First, I feel like there are tangible takeaways in every episode that have helped me during my infertility journey immensely. I am just a few years into infertility and the tangible takeaways and lessons from each episode help me to feel equipped to handle all the unexpected ups and downs.

                        Second, I love how Jenica and the podcast have created this space to recognize the hardships of infertility while also feeling empowered and hopeful rather than fearful. After each episode I feel this empowered since of community and sisterhood. And although I would never wish infertility on anyone, I am grateful to be a part of this tribe. Thank you for all that you do to lift women up and make something devastatingly hard into something beautiful and meaningful.”

                        I love this because I just echo everything she says. So Sarah, thank you so much for taking the time out of your precious day and your precious time that I know is non-renewable to help other women and to leave this review. Please email me at hello@thesliceofsun.com with your address and size and we’ll get that out to you.

                        Also, if you have not heard I launched Fearless Infertility Coaching. It is an incredible space where we are able to take the things that we learn on the podcast and actually apply them. There is a huge difference between learning something, like learning how to paint and then actually painting.

                        And I think it’s beautiful and amazing to learn and to be entertained by podcasts like this, but I think actually applying it in your life to make massive changes and create the results that you want in your life to live a life you love today is a totally different thing. And I can help you do that as your infertility coach.

                        So make sure to go to fearlessinfertilitycoaching.com to check it out. And I am so excited to get to know you better. Let’s get into today’s episode with Dr. Foulk.

                        Jenica: All right, I am sitting here with Dr. Foulk. He is my doctor and I adore him; he is like a member of our family because he helped us get Harris and Goldie and he has helped so many of our friends. He is the doctor I recommend to everybody.

                        And I’m sitting here in his office in Pleasant Grove, Utah and I’m so excited that he’s taken the time out of his schedule to sit here with us today. So welcome to Fearless Infertility podcast, Dr. Foulk.

                        Dr. Foulk: Thank you. Thanks for inviting me, this will be fun.

                        Jenica: Yes. I love Dr. Foulk for many reasons, but I just feel like he simplifies things. I remember we had already done quite a bit of treatments before we came to Dr. Foulk and I was sitting in this chair that’s sitting right next to me here and he just really simplified it for me.

                        He just made it seem like, you know, what you probably tell a lot of people where it’s one of three problems, it’s the egg, the sperm, or the uterus. And it was just very simple and I just felt this calming energy and so that’s one of the many reasons why I think you’re so popular among a lot of people.

                        Dr. Foulk: Yeah, I definitely believe in the KISS principle, keep it simple silly.

                        Jenica: Yes, I love that.

                        Okay, so will you give us a little background on how you got into the work that you do?

                        Dr. Foulk: Yeah, it’s kind of a long personal story. So initially I was going to be an orthopedic surgeon. I grew up in the south shore of Lake Tahoe and was a big skier, still am a big skier and so orthopedics was my calling to go help people fix their bones. I think I like that type of medicine because it’s something that’s very readily apparent that you have to fix and then you have a very clear-cut outcome.

                        Jenica: Oh yeah.

                        Dr. Foulk: And so I actually trained all through my residency with that goal in mind until my last year of residency. My wife told me that she didn’t like me if I was going to be an orthopedic surgeon because I’m too intense.

                        Jenica: Oh, interesting.

                        Dr. Foulk: So I said, “Well, what field did you like me in?” And she said, “Well I can relate to when you’re in OB. When you deliver babies, come home and tell your stories.” So I started looking into obstetrics and that’s what switched me over to obstetrics.

                        And then when I was in training my wife and I couldn’t get pregnant for six years. We had two children and we could not do it again and it was very frustrating right at the time when I was choosing what sub specialty to become. Because my next goal was to become a maternal fetal physician, which is the high-risk specialty for OBs.

                        And I started looking into reproductive endocrinology and I thought, wow, this is a fascinating field because it combines medicine, which is the endocrine side of it, and surgery. And it's very hands on and it's very clear cut in terms of your endpoint. You achieve a pregnancy, a healthy pregnancy and everyone's happy.

                        So it fits with my personality, like with orthopedics, where you can see that there is a need. You find a very easy path to reach that need. And then once it's fixed everyone's happy. So that's kind of the way I've lived my life.

                        Jenica: That’s so awesome. So will you tell us what happened next in terms of your infertility?

                        Dr. Foulk: Well, we figured out what was wrong and it was right when I was getting into my fellowship. And we've had three kids since.

                        Jenica: That’s awesome.

                        Dr. Foulk: So we have five kids and they’re the joy of my life.

                        Jenica: I love that. And I love that you can relate to people that walk into your office too, because you've personally had the experience that we have had too.

                        Dr. Foulk: Yeah, for sure. I think not that every physician needs to suffer from the condition that they’re treating, but I think it certainly helps particularly with infertility because beyond the medical side of it there's so much emotional component to infertility.

                        Infertility is one of those conditions, unlike many others, where you don't receive a lot of empathy from others because it's kind of a personal, intimate type of disease. And so it makes you feel very isolated. It makes you feel like you can't reach out to folks or if you do they'll tell you these answers of just stop thinking about it, stop worrying about it and you'll get over it.

                        Jenica: Yeah.

                        Dr. Foulk: And so it's a very emotional type of condition. And unlike if you have diabetes, it’s really sad, my daughter has diabetes, you just take insulin and you muscle through it. But with infertility there's so much that's in your mind, and your spirit, and your ability, your strength to get through what could be one of the most important things in your life.

                        Jenica: That was so well explained. And I love that as well because I can really relate to it. I had a couple friends that went through infertility before my husband and I were even trying to conceive. And I tried to be sympathetic, but I don't think you can really, truly understand that emotional aspect of it.

                        And I tell the story a lot because I just feel like it was such a defining moment in my experience, but I just remember after I'd gone through several procedures that didn't work and we were just kind of on this journey for a little while, I remember just standing in my closet and crying. And not for myself, but for my friends who had experienced infertility. And I just felt like finally I could understand.

                        Dr. Foulk: What they went through.

                        Jenica: Yeah, because I think when they were telling me about it, I just assumed like, “Oh, it's fine. It'll work.” And for one of them it actually hasn’t and then this was like 15 years ago and they still don't have children. Which I don't think – I mean I don't know her whole story and all the details on why, but I just assumed that it would be this fix, you do an IUI or invitro, or whatever other thing that your doctor recommends, and then it's going to happen. And that's not always the case.

                        And so, anyway, it just opened up a whole new part of my heart for people experiencing it. Which I love that you have that too.

                        Dr. Foulk: Yeah, psychologists actually compare the diagnosis of infertility the same as being diagnosed with cancer.

                        Jenica: Oh wow.

                        Dr. Foulk: And if you think about it, one of the scariest things that any of us could be diagnosed with is cancer, because immediately you're faced with mortality and the possibility that you may not be around anymore, and your whole future flashes in front of you. And you might realize that that may not exist anymore.

                        Jenica: Yeah.

                        Dr. Foulk: And fertility is very similar. It's not your future, but it's the future of your progeny. And your progeny, your kids, is one of the most important things for all species, but especially for humans, to build our families and perpetuate our genes, perpetuate our culture, perpetuate our belief systems.

                        And so to have that vision in mind of what your family will eventually be and then have it potentially erased is psychologically devastating.

                        Jenica: Yeah, I remember feeling that exact same way where I'd had my life planned out, which I think a lot of people listening do. And, you know, you go to high school, you graduate high school. You go to college, graduate college. You get married, and then that next step eventually, after a career or whatever you choose, is to have your family.

                        And for me it had felt like I had kind of checked those boxes and all of a sudden, I ran into this brick wall and I couldn't get around it. And I'm like, I feel like I'm stuck in my progression.

                        Dr. Foulk: Yeah, because most things in life you feel like you have control over. And what's interesting within infertility is you don't. I mean, your fertility is a natural process that should happen on its own, similar to digestion, for example.

                        And yet, if your digestion is not working you just say, “Okay, I just got to do whatever I have to do to get through the digestive issue.” But you don't put a lot of emotional energy into it. However, if it's your infertility, it all of a sudden brings on feelings of your loss of self-worth, of not being able to satisfy your spouse, your family, your parents who want their grandchildren.

                        So there's a lot more burden put on it, even though it's a normal, natural biological system that just is not functioning correctly.

                        Jenica: Yeah, I love that. That’s so well said. And that's why I'm so passionate about the work that I am doing with Fearless Infertility Coaching, that I can help women with that emotional aspect of it, because it's a lot.

                        And I think even for me, I just assumed it would work right away. And I expected to share it after the success story, and that just didn't happen for a while for me. And looking back, I see the gifts in it. And what I went through was for a reason for me specifically. But it's easier to look at that in hindsight. And I didn't realize that I needed the support at the time.

                        I think that most people are fairly independent, and we are strong and we want to handle it on our own. But I think to be aware of what you just said, that it can be as devastating as finding out you have cancer and to realize that you're not supposed to do things like that alone.

                        Someone who has cancer is not going to say, “I've got it, I'm not going to tell anyone and I'm just going to handle this all on my own.” Like that's unheard of. And so I think that we need to give ourselves the support that we need and that we deserve.

                        Dr. Foulk: And that's why I'm so excited by your project with Fearless Infertility coaching because as we're talking about, there's the medical side, which is usually very straightforward, which we'll get into. But the psychological side is really a hard thing to grapple with because everyone comes at it from a different perspective and they each have different coping skills and different tools and yet there's not a lot of resources for those individuals.

                        So to actually have a coach like you're developing is phenomenal. It’s a super idea, I can't wait to tell all my patients about it.

                        Jenica: You're the best, thank you. I'm so excited. And it's so cool too, we’ll briefly explain. But I felt like I kind of knew a little bit of the model that I teach when I went through it myself, because it's kind of –

                        So the person that I got my life coach training through, her name is Brooke Castillo. And the way she describes it is that it's a truth that she discovered, but she didn't create. Like it was already just something in the universe about how our brains work.

                        And essentially, it’s that our circumstances are always neutral, but the way that we think about them determines how we feel about them. Which then determines which actions we take, and then thereby which results come in our lives because of it.

                        And so throughout infertility, for me obviously it's still going, but that initial try at getting our first baby, which ended up being twins, was that I thought to myself that every human being that comes in the world experiences trials. And for me, this was it for me right now.

                         And so luckily, because of that, I never felt resentful. I mean, it was hard and I didn't want to go through it. But I was never like, “I shouldn't go through this,” because I always went back to that thought, which I truly believe is true. And I think that literally every single human being comes to this earth and has really hard things that they experience.

                        But I didn't know how to teach that other people. It was just that simple thought that I'm like, “Well, I know this makes me feel decent and peaceful and helps me move forward.” But I didn't know how to teach people that.

                        And so the model that I teach now essentially breaks that down and helps anybody with any problem determine what thought is essentially causing them to feel terrible and keep them stuck. So it's just really exciting.

                        Dr. Foulk: I think that's a good idea, it objectifies the emotion. So instead of internalizing it you can actually say, “This is a neutral issue. Why am I letting that bother me to this degree? And then what control do I have over that?”

                        Jenica: Yeah.

                        Dr. Foulk: And with coaching, you can find those coping skills, for example, for hardship, so that you know how to navigate through that
                        trial.

                        Jenica: Yeah. Yeah, and then also, one of the other core principles is that life is 50/50. And I just see that as evidence everywhere now. It's so interesting because I rejected it at first when I heard it because I'm like, “No, I want to be happy like 95% of the time.” I'm like, “No, absolutely not.”

                        And I realized that very innocent thought was causing me to not allow myself to feel sadness when it came. I would feel it and I would just like shove it behind the closet door. And it was still there, but it was just hiding. And when we hide things like that, they don't go away.

                        Dr. Foulk: They resurface.

                        Jenica: Yeah, always. So I just started to eat gummy bears, and I felt great for 10 minutes. And it's just like, no overeating doesn't –

                        Dr. Foulk: That’s my escape.

                        Jenica: Yeah, truly. And I didn't realize how harmful that was for me. But now I realize in infertility, I don't care what goals I hit in my life, it's always going to be 50/50.

                        And so with the coaching I’m able to teach people the acceptance of what is, and yes, you can be sad, but then also still progress forward. And realize that you haven't done anything wrong because you're feeling sad, you don't need to fix something. But you can process it and then move forward in a way that benefits you and gives you the results that you want in your life.

                        Dr. Foulk: Yeah, and that's one of the reasons I like to keep it simple, because it really is not that complicated. Everyone loves to make it sound so sophisticated, or so unknown, or so unfixable.

                         But the most important thing, specifically for the psychology of infertility, is to recognize that it is fixable 100% of the time. If you understand what's broken, then 100% of the time there is a fix for it, a way to overcome it and become parents.

                        And when you can get that reassurance, then you still need to develop coping skills to get through certain challenges. But ultimately, you're going to get a baby if you stick with it and fix the problems as they present. And we'll go over a lot of those problem with some of the questions I see we're going to be talking about.

                        Jenica: Yeah.

                        Dr. Foulk: But it really is just a biological process that is meant to work. And then this is a critical point, I say it to all my patients and that is we are meant to have babies. And the truth of that is manifested by virtue of the fact that we exist. If any of our ancestors were infertile, we would not exist. So the fact that we exist is proof that all of our ancestors were fertile, and they came to us. And it is our duty to continue to transfer those genes to the future generations.

                        So nature, God purposely built a system that's meant to work. So infertility or fertility, reproduction is the most reliable system in our bodies. You can have someone who has a heart attack, for example, and that will affect that one person. But that's all it affects. Whereas if you have infertility, it affects you and your future progeny. It's a much more profound impact on your life and on disease itself.

                        And so, if it's meant to work, then we should be able to find a path by which we can bring everything together and make it happen.

                        Jenica: I love that.

                        Dr. Foulk: Which is the beautiful thing about it, we can get everybody pregnant as long as we recognize what's broken and what we have to overcome.

                        Jenica: That’s so awesome. I think that you told me that. Like you said, it's important for you to tell all your patients that. I think you told me that and I just remember feeling – I think I probably started crying, but in a good way. I was so relieved because I came in here with so much tension and anxiety.

                        And I think that one thought, like, “I want to be a mom and I don't know if it's ever going to happen for me” is paralyzing. And it can just lead to so much fear and anxiety. And just, it's awful. So when you told me that I was like, “Oh my gosh, thank you. Thank you.”

                        Dr. Foulk: Yeah, let's just find a way to make it happen.

                        Jenica: Yeah, I love that.

                        Dr. Foulk: It’s not always easy, but it's always possible.

                        Jenica: I love that.

                        Okay, so we're going to get into some questions that some women in the community had that follow me on thesliceofsun.infertility on Instagram. And we'll just go through these, these are really great questions.

                        So the first one is, can you do common myths and facts about trying to conceive that you see in your patients that come to you and kind of clarify those for us?

                        Dr. Foulk: Yeah, I think one of the most common myths is the belief that getting pregnant is easy. And I think this is ingrained in us throughout our lives because kids in high school, young adults that don't want to have children are continually told to use contraception, be careful, don't put yourself at risk for being pregnant. So everyone thinks that it's like an infectious disease that will hit you if you don't beware.

                        Jenica: Right.

                        Dr. Foulk: But the truth of the matter is that the probability of getting pregnant per month for the most fertile couple in the world is only one in five per month, it's 20% per month. It’s called the human cycle fecundability.

                        And that's important for a couple of reasons. The first is it shows that it's not easy to get pregnant, it does take time. But in time it works for everybody. So if it's 20% per month, the average person gets pregnant in about two to three months. And by one year, virtually everyone should be pregnant, unless there's a problem.

                        And that's how you actually define infertility is if you're unable to get pregnant within one year, then you know you're likely to have an issue that's keeping you from doing so. So that's when we tell people to seek out care. So an important myth to dispel is it's not easy, but it's completely fixable.

                        Jenica: Yeah.

                        Dr. Foulk: Another one that's very common is that people believe that it's all the woman's fault. And I think this is because the woman carries the baby. And usually on the woman's side of the couple is the driver of the desire to have a baby. So usually, the woman is blamed. And if you look in the Bible, for example, it's always the barren womb that gets blamed, not the barren sperm.

                        Jenica: Yeah, we don't hear that phrase.

                        Dr. Foulk: And yet the probability of infertility, or the cause of infertility is equal between men and women. There's just as many men that are infertile as there are women. In other words, there's just as many reasons on the man’s side as there are on the woman's side that would explain their infertility.

                        Jenica: Interesting.

                        Dr. Foulk: And so it's not a woman's problem, it's a couple's problem. So it's important to recognize that.

                        Jenica: Yeah, and speaking of that, just as a little detour, do you feel like – And I don't know if you talk to people about this because I know your job is to physically get people pregnant. But where do you think the shame comes from, especially with men who are going through infertility? I feel like that's very common, just to feel kind of embarrassed about it.

                        Dr. Foulk: Well, part of it is because it is such an intimate process that's usually reserved between a couple. And so, it's not often shared with people outside of that relationship.

                        Jenica: Yeah, that’s a good point.

                        Dr. Foulk: But it definitely goes way back, as we mentioned in the Bible, having a barren womb is a cause for separation from your partner. If you were unable to bear a child that was socially a disgrace in cultures. And the reason is because they again, they want to perpetuate their culture, perpetuate their population. And they can't do that if someone's not fertile.

                        And they put the burden on the woman, unfortunately, in the Bible, which is obviously wrong in retrospect. But I think it's just such an important element of our lives and it seems so natural and so easy for a lot of people that are fertile, that if you're unable to, you're embarrassed by it. And you feel like, “Well, maybe I'm not living a righteous life. Or maybe I'm supposed to be infertile. Or maybe I'm not supposed to have children.”

                        And you start reading into it more than just understanding that no, this is like indigestion on my digestive system. I have no control over it, I didn't cause it. I didn't want this to happen and so it's not a result of some action that I've done in my life.

                        And so that's changed a lot. When I was first practicing in the 80s shame was far more prevalent with infertility. Now, a lot of Hollywood stars talk about it's, it’s far more open than it was 30 years ago. And there's still an element of it, but not as much as it used to be.

                        Jenica: Yeah. I love that and that's such a good point because I think that because it's such an emotional thing and we want it so bad, I think we make it mean things that it doesn't mean. And I love that you pointed out that that's truly a choice, it's not true. You can make it true for yourself if you want to be miserable, but it doesn’t make it mean anything about you as a person or your self-worth.

                        Dr. Foulk: Right, I mean, you shouldn't feel shameful to have developed cancer or shameful to have a hangnail. I mean if you have a hangnail, it’s nobody's fault.

                        Jenica: Right, you're not like, “I'm a horrible person.”

                        Dr. Foulk: “I’m a horrible person, I deserve this. I'm going to get more for being such a bad person.” That has nothing to do with your behavior.

                        Jenica: Put some moisturizer on your hands, man.

                        Dr. Foulk: Maybe it is your fault.

                        Jenica: I’m just kidding. Okay, love it. Okay, so what is another myth?

                        Dr. Foulk: Another common one, and this is funny because it's different between men and women, is that timing is a big cause of infertility. Meaning if you don't have relations frequent enough, then that is the cause of infertility. And I say that between genders because when I have a couple in front of me, it's always the husband says, “Well, we just haven't tried enough.”

                        Jenica: Oh, how funny.

                        Dr. Foulk: And I say, “Well, how frequent do you have relations?” And they say, “Oh, about every night.” I say, “Well, how often do you need to try?” But obviously he needed more and she didn’t need more.

                        Jenica: Yeah. Right.

                        Dr. Foulk: But no, timing is actually not that critical. The sperm can live within the female reproductive tract for up to six days.

                        Jenica: Oh wow.

                        Dr. Foulk: And when you ovulate, the egg is available to be fertilized for about 24 hours. So you have about a full week, where you're potentially able to get pregnant. That's where those definitions of fecundability come. Because if you take an average couple, and the average in the United States is intercourse once a week, that’s the average in married couples.

                        Jenica: Okay.

                        Dr. Foulk: Then that defines what fecundability is, what the probability of getting pregnant is for unprotected relations. So if you have intercourse anytime within a week of ovulation, preceding ovulation then you're as fertile as anyone that hits it on that one day.

                        Jenica: Wow, I did not realize that. And actually, that makes me feel so much better. Because sometimes I'm like, “I don't know, maybe I'm just not tracking my ovulation well enough.” But that's so good to know for people.

                        Dr. Foulk: Right, it happens so often. And you actually get some humorous stories where the wife is doing her ovulation kits and it turns positive, and she like, calls her husband at work and says, “Meet me in the janitor closet, we got to do it right now.”

                        Jenica: “Hurry up, right now.” Yeah.

                        Dr. Foulk: Yeah, “This is the moment, do not wait.”

                        Jenica: Oh, that's a very common, I think.

                        Dr. Foulk: And it will create conflict when he says, “Well I'm at work, I can't.” “Well meet me in the car, get out of work.” It’s like come on. So it's not that critical, don’t put pressure on a process that doesn’t need it.

                        Jenica: Okay, that is literally such a relief. And I actually can't believe I didn't know that. This is like what I do, I help people with infertility. So that was very good to know, I think a lot of people will be very relieved to hear that. Thank you. Thank you for the myth busting.

                        Dr. Foulk: Don't add pressure on top of an already difficult process.

                        Jenica: Right. Okay, what's another myth?

                        Dr. Foulk: Another one, all fertility treatments are expensive.

                        Jenica: Okay.

                        Dr. Foulk: And this is a big one and unfortunately it's one that keeps people from pursuing treatments because they think, “Oh, it's too expensive. I can't afford it. I'd rather go adopt.”

                        Jenica: Yeah, so they don't even look into it probably because they think that.

                        Dr. Foulk: Yeah, but what's interesting is the majority of causes of infertility do not require expensive treatments. The most common cause of infertility is the lack of ovulation, which is a very easy problem to fix. Clomid is one of the first line pills that we give for ovulation induction and it costs maybe $20 a month.

                        Jenica: That's awesome.

                        Dr. Foulk: So the majority of people can get pregnant for less than several thousand. Remember it’s like 20% per month, so it may take several months. But for less than several thousand most people are able to achieve a successful outcome.

                        Jenica: That's amazing.

                        Dr. Foulk: The reason why I think that myth exists is because invitro fertilization or the more complicated sophisticated treatments do cost more. But even that is reasonable related to most complicated medical treatments.

                        My wife had a thyroid removed from thyroid cancer and she had a one-and-a-half-hour surgery, it cost $18,000 for one and a half hours.

                        Jenica: Wow, yeah.

                        Dr. Foulk: Whereas an IVF cycle for six weeks of treatments is 10,000 for the clinic and then the meds. So total cost is around 15,000 for six weeks of treatment versus an hour and a half.

                        Jenica: Yeah, that’s a good point.

                        Dr. Foulk: So when you compare it to most healthcare it's reasonable. Still expensive to the individual. But it's not expensive compared to most medical treatments.

                        Jenica: That's a really good point. I love that. And so I think thinking that will maybe help people's mindsets in pursuing it. Because I like the way that you said that. I think that as human beings, we have health issues. I think probably all of us at one point or another in our lifespan will experience something like that. And so this is just it for some people.

                        Dr. Foulk: Yeah, I mean, it's your health and you have to invest in your health, whether you have a lesion on your arm or you have to treat your infertility.

                        Jenica: Yeah, I love that. Well, it helps – Sorry to interrupt, I feel like it helps me accept it more too. I hate the words should and shouldn't. Those are words that I'm trying to remove from my vocabulary because I feel like it resists the current reality.

                        And so I think that, for me, it's so interesting going the second time around trying to conceive again, I had a lot of weird resentment that came up for me. And I think the thought that was causing that emotion was, “I shouldn't have to experience this again, because I already did. And I should get a normal pregnancy.”

                        But I love you explaining it like this because it provides a lot more peace and acceptance that like, yes, it's infertility, but a lot of people experience health issues and it’s just part of the human experience.

                        Dr. Foulk: Yeah, you just have to, unfortunately, find a way to get past it.

                        Jenica: Right.

                        Dr. Foulk: But yeah, the issue with cost always is, it's a huge barrier. And so understand that it's usually not a barrier, there's always a path to get through that challenge.

                        Jenica: That's awesome. Are there any others?

                        Dr. Foulk: There’s another one, and we can talk about it a little bit later because I saw there’s another question about unexplained infertility.

                        Jenica: Okay.

                        Dr. Foulk: But it's important to recognize that unexplained does not mean unknown. Because a lot of people think, “Well, I want to know why I'm not getting pregnant and it’s unexplained, which means nobody knows why I'm not getting pregnant.” And that's a complete myth.

                        Unexplained infertility simply means when you do the basic testing, which is a semen analysis, hormone checks to see if you're ovulating, and a dye test to see if your tubes open, everything looks normal. Well, the fact that they look normal is good, it means everything's present. But the fact that you're not getting pregnant is still indicative that there's a problem.

                        And so it merely means that there's a dysfunction in one of those systems. And that's what people don't recognize. They think that unexplained means unknown and there's no reason for it. When in reality we can decipher the reason simply by removing the functional steps required to achieve a pregnancy.

                        And that's the way you treat it is you say, “Well, let's start by removing this group have problems. And if you're pregnant, we know we fixed the problem. And if you’re not pregnant, then we know the problem is in the steps that we have not yet fixed.”

                        And by doing that path, you get the answer in everybody. So there's no such thing really of unexplained. It's just a definition we use for those that have done the testing and all the tests are normal.

                        Jenica: Oh, okay. I love that. Because, yeah, I think that can cause a lot of frustration and confusion and hopelessness when you're like, “Okay, we can't figure it out and it's unexplained.” Because I've had quite a few people say that to me. So I love that definition of it, because it means that there are still answers, we just need to keep going.

                        Dr. Foulk: Mm-hmm.

                        Jenica: That’s awesome. Okay, anything else or should we move on to the next question?

                        Dr. Foulk: There's tons of myths, but let's move on to more questions.

                        Jenica: Yes.

                        Dr. Foulk: I can on for hours.

                        Jenica: I know, he's like, “We can we can go on all night about that.” Maybe we should do a separate podcast on that one day.

                        Okay, so somebody else asked, what would you recommend looking for in a clinic when they are trying to find a doctor for them?

                        I'm going to first answer this myself. If you are local, I would highly recommend coming to Dr. Foulk. He's not paying me to say this, he doesn't – I just have seen him help so many of my friends and myself conceive and I trust him and I feel like he really thinks outside of the box and simplifies it.

                        And so first, I guess, tell us where your clinics are. And then you can answer the question on if people aren't local or can't make it here, what would you recommend looking for?

                        Dr. Foulk: So we treat patients along the Wasatch Front. So we have an office in Idaho Falls, Ogden, Murray, Pleasant Grove, and St. George. But I also work in Reno, Nevada, and in Las Vegas. So pretty much the Intermountain West.

                        Jenica: So in Reno, Nevada, and Las Vegas is it something different called than the Utah Fertility Center?

                        Dr. Foulk: Yeah, the one in Reno is called the Nevada Center for Reproductive Medicine. The one in Las Vegas is called the Nevada Fertility Center.

                        Jenica: Okay.

                        Dr. Foulk: The one in Utah is the Utah Fertility Center.

                        Jenica: Okay, awesome.

                        Dr. Foulk: The one in Idaho is the Idaho Fertility Center.

                        Jenica: I love it, it’s easy to remember. You guys, he likes to simplify everything in life, that’s what I love about him.

                        Okay, so what would you recommend for people who don't live close to any of your clinics?

                        Dr. Foulk: Well, first of all, you asked about what do you look for in a clinic.

                        Jenica: Yes, yes.

                        Dr. Foulk: In other words, if you're a new patient, how do you know you're at the right clinic? And that's an easy answer. And the answer is, answers. What you want is an answer because you want to understand why you're not getting pregnant.

                        You are paying that clinic, that doctor for their knowledge, their expertise to understand why you're not achieving a successful pregnancy. So you should be able to in the first, or the latest the second visit, understand why you're not getting pregnant. And if you don't get that answer, either ask the doctor or move on to another clinic.

                        Jenica: Okay.

                        Dr. Foulk: Because what's fascinating to me is a lot of doctors don't educate their patients. They don't tell them, “Oh, this is what's wrong and this is how we're going to fix it.” They just say, “Oh, let's just do a battery of tests and see you in a week or see in a month.”

                        And so it's critical for you to understand what's going on so that it helps you with the psychology we talked about before, cope and deal with the ongoing treatments. Otherwise, it’s running on a treadmill and you're not moving any distance.

                        And so it's critical to understand why you're not getting pregnant. So, number one thing is get answers. And you should get them, the majority of the time, in your first visit.

                        Jenica: Okay, I love that.

                        Dr. Foulk: if you don’t, just ask the doctor, “Why am I not getting pregnant?” And if they can't answer that, then you're in the wrong clinic.

                        Jenica: Okay. That's really good to know. Very good to know, especially for people who are in the beginning stages of this experience. That's very good to know in going into any new clinic.

                        Dr. Foulk: Yeah, and that will help with your coping, your psychology. And it really is the right way to treat it because there's always an answer. It's just a matter of understanding where it is and then finding a resolution to that problem.

                        And then the other question you asked is, how do you find – I mean, the nice thing about medicine these days is with telemedicine, we treat patients from all over the world.

                        Jenica: Awesome.

                        Dr. Foulk: We're helping patients and we saw a patient today from Germany.

                        Jenica: Oh wow, that's amazing.

                        Dr. Foulk: Saw patients from Spain yesterday and we were treating someone from Australia earlier in the week.

                        Jenica: Oh, that's so cool.

                        Dr. Foulk: And then I just did a telephone consult with a couple from New York this morning.

                        Jenica: Oh my gosh, that’s so good to know. So in order to schedule that, do they just call like everybody else and just say, “Hey, I don't live in Utah, or we're Nevada or whatever but...”

                        Dr. Foulk: Yeah, if you live in Florida you say, “I live in Florida, is there a way we can do telemedicine?” And then we set up the telemedicine video consult. And we can do most of our testing at local hospitals or their OB/GYN’s office. And then come up with a protocol or a way to overcome it.

                        And in some cases, the stuff that does not require a lot of intervention, we can help the local doctors provide that for them. And things that are far more sophisticated or complicated, we can then arrange for certain days we have to travel.

                        But no, we treat everyone in the world now, it’s amazing.

                        Jenica: I love that, it’s so cool. Well, I actually just had a friend that did that. She's an Instagram friend, we met online. But she lives in California and she just came to visit you here a couple of months ago and she got pregnant. And it's her second time. She got twins the first time and she's pregnant with a singleton this time. And that's what she did with you, so
                        it's amazing.

                        Dr. Foulk: So yeah, distance, fortunately, is no longer a big barrier.

                        Jenica: That’s so awesome, what a relief. And also, just a tidbit of advice, everyone can take it with a grain of salt. But for me it takes sometimes a couple of months to get into a good doctor. Dr. Foulk, typically, what would you say? A couple months, two?

                        Dr. Foulk: Yeah, I think it’s six to eight weeks.

                        Jenica: Yeah, it's worth it, trust me people. Because if you're seeing someone else, and it's not a doctor that – And I don't want to talk bad about doctors, right? But let's be honest, there are people that know what they're doing and are really good at what they do, and there are people that aren't. And so for me, it's worth waiting to get in, in my opinion.

                        I called him, I can't even remember, a few months ago. I waited my two months and I got in. And I honestly probably could have texted you and been like, “Hey, get me in earlier.” But I'm like, “I'm going to wait it out.”

                        And I just think it's so worth it because that time is going to pass anyways, so if you're working with a doctor that doesn't understand you and isn't giving the answers that you need, that time is going to pass anyway, you're not going to get pregnant either way.

                        Dr. Foulk: Yeah, and once you're in then there's no more delays.

                        Jenica: Yes, exactly.

                        Dr. Foulk: It’s not like every time you have to be seen, it's just that first visit.

                        Jenica: Yes. Yeah, once you're in it's quick. They get going.

                        Dr. Foulk: Once we get a path going then it’s not like stop and start, stop and start.

                        Jenica: Right, absolutely.

                        Dr. Foulk: It’s just in order to not overwhelm the team that we have treating we have to limit the number that come in.

                        Jenica: Yeah, of course. Awesome. So next question is, are there any evidence-based diets or lifestyle changes recommended when trying to conceive?

                        Dr. Foulk: So it's a common question I get from a lot of patients, what diet should I do? What special pill should I take? What homeopathic remedy should I begin? And what's interesting is your body is pretty smart. If you eat a well-balanced diet, like we learned in kindergarten, then your body is smart enough to know what it needs to extract from what we're eating.

                        Now, that doesn't mean you can just eat everything. So there are some things that you should avoid such as caffeine. Caffeine has been shown in women to decrease the blood flow to their ovaries. So there has been some studies showing where if you drink more than one cup of coffee or a soda a day, then it could constrict the response of your ovaries.

                        Jenica: Okay.

                        Dr. Foulk: Interestingly, the opposite is true in men, caffeine actually helps men.

                        Jenica: It's not fair. What the heck?

                        Dr. Foulk: It actually makes the sperm swim far stronger.

                        Jenica: Interesting.

                        Dr. Foulk: You see sperm on caffeine, and they're ready to go.

                        Jenica: Wow, that is fascinating.

                        Dr. Foulk: So I tell my patients the guys can do their jolt cola, but unfortunately women have to do decaf for that.

                        Jenica: Yes. Boring. No, I’m just kidding.

                        Dr. Foulk: And then the others are just obvious things. Smoking is horrible for both men and women. Marijuana is okay for women, but horrible for man, it can really affect sperm adversely.

                        Jenica: Interesting.

                        Dr. Foulk: So lay off the weed. But other than drugs and such, most well-balanced diets are fine.

                        Jenica: Yeah.

                        Dr. Foulk: There's certain body types that people have, such as polycystic ovarian syndrome where you tend to have insulin resistance, where like a keto diet or a low carb diet is more helpful for that group of people. But in general, don't spend too much energy on your diet in terms of adjusting it. Eat what you like and as long as it's well balanced.

                        Jenica: Yeah.

                        Dr. Foulk: And of course, take prenatal vitamins and such to make sure you get all the elements that you need.

                        Jenica: Amazing. Okay, what would you recommend if there are differences in family goals between a husband and a wife, for instance, that come in?

                        Dr. Foulk: Yeah, it's actually far more common than you think because quite often, particularly in today's world where a lot of people go to school, they're pursuing their careers, they're building their vocations, people are delaying their childbearing. And women have this acute sense of, “Oh no, I might run out of eggs as I get older,” which is a real fact. The biological clock is true.

                        But the men may not appreciate that. So you might get a husband wife that might mutually share the desire to have a baby, but not the timing. And you just, I think, have to educate both parties to understand that, yes, there is a real thing as running out of eggs in a woman's life. So you do not want to delay if you can avoid it.

                        Now, that's circumstantial in regards to their specific situation. But there are other couples that they really just don't share the same vision of having a child. And that's important to discuss because if you're going to have a baby, it's good to know that you're all on the same page.

                        Jenica: Yeah, definitely.

                        Dr. Foulk: And I don't know, besides communication, how to resolve that. You just have to be open with each other and honest with each other and tell them what you expect.

                        If you really want a baby and the other partner does not want one or would rather go buy a Harley Davidson, then you have a conflict in your relationship. And it's better to recognize that now than later, when you might have a baby between you and then you've got to grapple with that challenge.

                        Jenica: Yeah, I love that. And this is the type of thing that I can help with in Fearless Infertility Coaching in helping to have positive communication with your spouse and really just approach it from a way that will get good results for both of you. So, I got you girl.

                        Dr. Foulk: Yeah, just be honest and truthful.

                        Jenica: Yeah.

                        Dr. Foulk: And if they don't want to hear it, then you have a bigger problem than just that disagreement.

                        Jenica: Right.

                        Dr. Foulk: And that's true not with just fertility, it's true with everything.

                        Jenica: Right, yeah exactly. After how many losses should I start looking for a gestational carrier? Someone asked.

                        Dr. Foulk: So that's an interesting question because there's so many different reasons for losses. So, if you found a reason for the loss to be that your uterus is unable to carry it, then one. No more than one.

                        Jenica: Right.

                        Dr. Foulk:  Whereas if you find that it has to do with the egg, then never. You can still carry a baby; you just need to find a healthy egg. So, it really depends on the circumstance.

                        Jenica: Yeah.

                        Dr. Foulk: So it’s not really a question of when should you pursue a gestational carrier because of losses, it's the reason for the losses that would prompt you that direction. Gestational carriers are wonderful individuals that help others carry the baby for them. And they're always in need for one reason, and that's if you can't carry yourself.

                        So if you've had a hysterectomy, obviously, you can't carry the baby. If you have conditions that have scarred your uterus, or the uterus isn't capable of carrying it, then that's when you need a gestational carrier. But for most people with recurrent pregnancy loss, you don't need gestational carriers.

                        Jenica: Okay, thank you. The next question is that I've gone in for a confirmation ultrasound and I have had an empty sack three times. That's in their ovaries, right?

                        Dr. Foulk: No, no, an empty sack means a blighted ovum. It means they’re pregnant but there's no fetal pole and no baby can be seen.

                        Jenica: Okay.

                        Dr. Foulk: Basically, it means the placenta developed but the baby did not.

                        Jenica: Okay. All right. Do you know what causes that could come from that?

                        Dr. Foulk: Yeah, the majority of reasons is genetic. So if there's a genetic abnormality that allows the placenta to develop but the baby does not, then it results in an early loss. It's just a type of an early miscarriage.

                        Jenica: Okay.

                        Dr. Foulk: So a good thing that people will do is if you do pass that sack you can do genetic testing on it and confirm where is the genetic problem and then discover the cause.

                        Jenica: Okay, that's really good to know. Okay, the next question that I have for Dr. Foulk from one of the people in our community is, what exactly does it mean to have a PGS normal embryo? And does that mean a healthy baby?

                        Dr. Foulk: So PGS stands for pre-implantation genetic screening. We've actually changed the nomenclature to be PGT now.

                        Jenica: Okay.

                        Dr. Foulk: It means pre-implantation genetic testing, because there's two different types. There's one that tests for what's called aneuploidy, which is when there's an imbalance in the chromosomes of the cells. Then there's another type where there's a single gene defect, like cystic fibrosis or galactosemia, or some disease, sickle cell anemia, those are the single gene defects that could lead to disease.

                        Jenica: Okay.

                        Dr. Foulk: So we call it PGTA and PGTM to designate those two types. So when you have a normal PGS or PGTA embryo, it means you have a normal looking or healthy embryo that is genetically normal.

                        It doesn't always equate to a normal healthy baby because you still have to go through the gestation. So it has to implant and then grow through those nine months and during those nine months, things can go awry. Such as you can have developmental problems like clubfoot, or a harelip, or different issues that can occur with the baby as it's growing inside your womb.

                        Jenica: Okay.

                        Dr. Foulk: So they don't always equate but it does tell us that they're a genetically normal blastocyst and they have a really good chance of making healthy baby.

                        Jenica: Okay, awesome. That's really good to know. All right, this is a hot topic lately over the last year and a half. And I bet everybody can guess what I'm about to say, the Covid vaccine. So what are your thoughts on it as far as are they safe? Or is it safe to get the vaccine while you're trying to conceive?

                        Dr. Foulk: Yeah, it's actually encouraged by every organization that treats pregnancy, from obstetricians to maternal fetal, to reproductive endocrinology.

                        Jenica: Okay.

                        Dr. Foulk: And the reason, even though Covid – I'll talk about Covid. First, the vaccine.

                        Jenica: Okay.

                        Dr. Foulk: The vaccine is a new technology, it's a new type of vaccination, but I've studied it intensely. And it's actually a very eloquent way to help with vaccinating people on a large scale. So it's going to revolutionize the way we vaccinate people in the world.

                        And from all the data that's been around for 20 years, and this technology has been shown to be safe. And as you've probably seen, hundreds of millions of people have already received the vaccine and very little complications are realized. But it is still new and so we can't say with 100% certainty that, “Yep, it's safe,” as you can imagine.

                        Jenica: Right.

                        Dr. Foulk: But when I look at vaccines, whether you should do it or not, you look at the risks and benefits. And the risk of getting this experimental vaccine exists, but it's a theoretical risk. There's no real proof that there is one yet. There might be in the future, and we can change our recommendations.

                        But you look at the risk of not getting the vaccine, and that is if you were to get Covid, which is a respiratory illness, while you're pregnant, which is where you have a large uterus pushing up on your diaphragm, that could be life threatening. And so the risk is known and extremely dangerous if you get Covid while you're pregnant.

                        So that's why we say get vaccinated. Don't get Covid while you're pregnant, it's an additional type of risk that you don't need to take. So I encourage all my patients to get it just for that reason alone, even though I recognize that it is a new technology.

                        Jenica: Okay, amazing. That was very well explained, thank you. What is the success rate of IUIs?

                        Dr. Foulk: So IUI stands for intrauterine insemination, and it's a treatment where you basically just place the sperm closer to the egg. Normally with intercourse the sperm are placed on the top of the vagina, and they have to swim through the vagina, through the cervix, through the uterus, through the tubes.

                        Jenica: That’s a long swim, man. You better drink caffeine guys.

                        Dr. Foulk: That’s a huge swim. That's right. When you do an intrauterine insemination, you're placing it just inside where the tubes are, where they connect to the uterus. So it's about half the distance to where they need to go. The purpose in doing them is to help sperm that may not be able to swim otherwise. So the purpose of doing them is to fix a problem where sperm can't swim.

                        Now remember I said earlier that the cycle fecundability, the ability to get pregnant per month is 20% per month. So if your sperm can not swim the distance, you have a 0% chance of getting pregnant per month.

                        Jenica: Yeah.

                        Dr. Foulk: But then if you put them where they belong, now you're back to 20% per month. And that’s exactly what the success rate should be with inseminations.

                        Jenica: Oh, amazing. Okay, awesome.

                        Dr. Foulk: So that's why most doctors will do three of them, because if it doesn't work the first time, that's normal, that's common.

                        Jenica: Right.

                        Dr. Foulk: But most people do it three times, when the majority of people should be pregnant.

                        Jenica: Okay, I love that. That's good to know because, essentially, you're giving people the same chances like everybody else.

                        Dr. Foulk: Like everyone else when you're fixing that one problem.

                        Jenica: Okay. Awesome. All right. Next question is how to improve egg quality at 43? Is that possible?

                        Dr. Foulk: So the biggest determinant of egg quality, unfortunately, is your mom.

                        Jenica: Okay.

                        Dr. Foulk: It’s your genetics. You get egg quality or your perseverance of having healthy eggs through your life is determined genetically. It’s determined mostly by when your mom went through menopause and when she ran out of good eggs. And so there's not anything you can do to improve them. But there's lots of things you can do to keep them healthy.

                        Jenica: Okay.

                        Dr. Foulk: So that's a big distinction because in one case you have bad eggs and you try to make them better, which you can't do. But in other situations, you have good eggs and you want to keep them good. And that's where a lot of these supplements have been shown to be helpful, like coenzyme Q, and maca root, and l-arginine and all these things that improve blood flow to the ovary, they decrease oxidation at the ovary.

                        So there are a lot of supplements out there that have been shown to maintain health in your tissues, including your ovaries. But unfortunately, there's not a lot you can do if you don't have good eggs, then unfortunately, that's the end of the game. It's like not having sperm or not having a uterus.

                        Jenica: Okay, all right.

                        Dr. Foulk: It’s a tough challenge because when you do wait a long time to have your baby at 43 it's a big challenge.

                        Jenica: Yeah. Well, thank you, that's good to know because, I mean, I think knowledge is power and so to not go down a road where you're thinking you could improve the egg quality and just – It's just good to know, so thank you.

                        Dr. Foulk: Now there's a new treatment out that a lot of people are talking about called platelet rich plasma, which I've been doing for the last year and a half. And I've done it a lot with the attempt to inject it into the ovary and hopefully invigorate or use these stimulants to enhance egg quality. And I haven't seen a lot of positivity with PRP with ovarian injection. It doesn't mean it doesn't help somebody, but for the majority of people it hasn't been shown to be helpful.

                        Jenica: Okay, awesome. I mean, not awesome, but thank you for sharing that information, that was very helpful. Just want to clarify that. All right. Okay, somebody asked, how do you prepare for a first visit or what would you recommend having ready for a first visit with your fertility doctor? By the way, do I call you an endocrine –

                        Dr. Foulk: So you usually call them reproductive endocrinologists.

                        Jenica: This is the kind of stuff where I'm like, “You know what? I should really know this but it's fine, I can ask.”

                        Dr. Foulk: It’s a long term, I know. So just to expound on that, because a lot of people have infertility, they treat infertility in the phone book or on the websites. And anybody can do infertility, but reproductive endocrinology is the sub-specialty that specifically treats infertility.

                        Jenica: Okay, thank you.

                        Dr. Foulk: Because it treats the hormones, everything that has to do with it. And you have to be careful, back to choosing the right doctor, because there's some doctors even in our town here, where they've not done any training in reproductive endocrinology and they're out there pretending like they can do everything that REIs, that reproductive endocrinologists can do.

                        Jenica: Wow.

                        Dr. Foulk: So you have to be very careful, particularly in our state here, there's two people that do that.

                        Jenica: Yikes.

                        Dr. Foulk: Yeah, it's been frustrating a lot of patients and a lot of providers.

                        Jenica: Yeah.

                        Dr. Foulk: But how do you prepare for your first visit? The most important, I mean, you want your first visit to focus on the reason why you're not getting pregnant.

                        So try to supply your doctor with as much information as you can. Not to the point of overwhelming them, but make sure that you have your records in place. And that means a tabulated version of what treatments you've received, what tests you've done. Have all that available so that can be reviewed before you speak. And then you’re not focused on what's already occurred, and what tests you've done, and recounting past failures. But instead, “Here's what we did, what is our next step?”

                        So information, get your information in order about your history, summarize it and make it easy to follow. And that just might mean sending records to your doctor or what I've seen some very effective patients do is they literally write down a chronological history of exactly what they've done.

                        Jenica: Oh, that's smart, saves lots of time.

                        Dr. Foulk: You go through that and then I can find out within minutes where we have to go from there.

                        Jenica: Oh, that's awesome. Yeah, that'll save time and get you the answers that you're seeking.

                        Dr. Foulk: Yeah, instead of going into the doctor's office and then just recounting what you've done with your life, instead you can say, “What are we going to do tomorrow?” Not what we did yesterday.

                        Jenica: Oh, I love that, that's awesome. All right. What are your thoughts on moderate exercise in between egg retrieval and embryo transfers?

                        Dr. Foulk: I think it's fine. The concern, of course, is when people define moderate.

                        Jenica: Okay.

                        Dr. Foulk: Because I've seen long distance runners that just come in from a marathon and consider that a moderate jog.

                        Jenica: Not me, you won’t find me calling that a moderate jog. I’ll tell you that much.

                        Dr. Foulk: So I always used the rule of thumb that it's good to maximize blood flow to your ovaries. So always behave in that time frame, the way you would right after a big Thanksgiving meal.

                        Jenica: Okay. Oh, that's a good suggestion.

                        Dr. Foulk: And then you can walk around, but don't get to the point where you're shunting blood away from your reproductive system.

                        Jenica: Okay, I love that. I'm like, “Okay, I'm going to sit on the couch.” I’m just kidding.

                        Dr. Foulk: Exactly, be a couch potato.

                        Jenica: Oh, that's awesome. Okay, what is your opinion on transferring certain abnormal embryos? That's all we have. Somebody asked that.

                        Dr. Foulk: Is that the question?

                        Jenica: Yes.

                        Dr. Foulk: So it depends on how abnormal. There's some that are simply non-viable. So we would transfer that if someone wanted it, but they have to understand that you're almost wasting your time if they're not viable.

                        Jenica: Okay.

                        Dr. Foulk: But there are some that are what are called mosaics, and those may be viable. And so in those cases you just need to be counseled and understand what the risks are and what the potential benefit is.

                        Jenica: Okay. Okay, that's good to know.

                        So we have seven embryos, or we had seven embryos, which we got initially when we did the egg retrieval in 2015. And we didn't do genetic testing then. But we did, what was it, like two months ago? And two of them weren't the greatest, but five were genetically normal.

                        One of the two that weren't was a mosaic, I believe. So obviously, we'll choose the ones that have a higher chance of not resulting in a miscarriage or whatever. But that's good to know if that's your only option, just that there's still a chance that you can use them depending on what the abnormality is.

                        Dr. Foulk: Yeah, and some of the mosaics for example could have lethal conditions. And so, for example, if one of the mosaics is a trisomy 18, those can actually result in live births. And then those poor babies will all die within six months of life. So those are not the ones you want to experiment with. Whereas if someone had a trisomy 22 mosaic, then often we'll use those because if the good cells outnumber the bad cells, then you might have a healthy baby in that.

                        Jenica: Okay.

                        Dr. Foulk:  And if the bad cells outnumber the good cells, then almost everyone will miscarry those.

                        Jenica: Okay, awesome. That's really good to know. “Do you have any suggestions on how to better prepare for egg retrieval day?” She says, “I'm so scared.”

                        Dr. Foulk: Oh, that's why, okay.

                        Jenica: Yeah.

                        Dr. Foulk: I was going to say get a good night's sleep. I think for fear, always the best answer is education.

                        Jenica: Yeah.

                        Dr. Foulk: Just learn that there's really nothing to fear. It's actually a relatively minor procedure. And the amount of trauma to your body is a needle poke, which you've already probably experienced through your shots you're given to stimulate the ovaries.

                        Jenica: Yeah.

                        Dr. Foulk: And so it's really nothing to fear it, but you have to learn that. And so look on YouTube, talk to your friends, talk to the doctor, talk to the nurses and understand really what you're going to encounter. And you'll realize, “Oh, wow, this is actually a pleasant experience.” Most of our patients wake up and they actually like the medications that the anesthesia gives them so much they’re like, “Can you give me more of those? I want a little bit longer nap please.”

                        Jenica: You just kind of relax a little bit. You've had like some anxiety, it's like all the anxiety is gone. I felt like very relaxed. Oh my gosh.

                        Dr. Foulk: So true.

                        Jenica: That's a good point. And this specifically is something that I can help with in Fearless Infertility Coaching as well because yes, there are certain things that are unknown that do come up that cause fear. But identifying what thoughts are causing your specific fear and then asking yourself, is that true? Do I believe that? Is that something that I want to hold on to? And examining the results that it's getting for you. And I can help you with that.

                        Dr. Foulk: Yeah, it's really just a matter of – It's like everything in life, everything is scary when you don't know about it. And all you can do is learn about it. And then once you experience it, then you can have your own perspective.

                        Jenica: Yeah.

                        Dr. Foulk: And one thing that's dangerous in today's world with the advent of social media is that the loudest voices tend to be the negative voices, unfortunately. And so it's amazing, if you looked on how to drive a car and looked on the internet, you would realize that everyone dies from these terrible maiming accidents if you learn how to drive. So you'd never drive.

                        Jenica: Right.

                        Dr. Foulk: So you don't go to the internet and just randomly look up those kinds of questions because I’ll have so many patients come and say, “Well, I read on the internet that this does that.” And it may happen and maybe one in 1000 people, but that's the voice that everyone hears.

                        Jenica: Right.

                        Dr. Foulk: So do put it into perspective, like everything.

                        Jenica: Yeah, I love that suggestion. And speaking of like safe places to go, I have a private Facebook group called Fertility Family by The Slice of Sun. And that's really cool because it's a lot of women in our community who are currently experiencing certain procedures and things like that. But I've found it or I've created it to be a really positive space where it's not fear driven. I feel like people come they're maybe concerned about certain things and all the other members chime in and give them their real examples that are more soothing than not, for sure.

                        Dr. Foulk: Reassuring rather than scary.

                        Jenica: Yeah, definitely. Okay, so the last question tonight before we jump off is, “Is there hope for couples with genetic carrier PGTM?”

                        Dr. Foulk: Yeah, for sure. So PGTM is that second type of PGT or PGS that we spoke of before.

                        Jenica: Okay.

                        Dr. Foulk: The M stands for monogenetic, so it just means one gene.

                        Jenica: Okay.

                        Dr. Foulk: The hope is that you can actually identify what the gene is in the embryo and then select which embryo does not contain that gene and have healthy embryos transferred rather than one that might contain it.

                        So a classic example is cystic fibrosis.

                        Jenica: Okay.

                        Dr. Foulk: Cystic fibrosis is a devastating disease that affects little kids’ lungs and often can compromise someone's life so much so that they die in their 20s and 30s.

                        And there's a simple gene test that you can do to select which embryo has the disease and which one does not. And that's what PGTM does. And so if you choose you can say, “Well, we can have now a baby that does not have to live through that suffering rather than have a baby that might be affected through their life.”

                        Jenica: Okay, amazing. Thank you. Well, thank you so much for your time tonight. This has been so incredibly helpful. And I will make sure to link Dr. Foulk’s information in the show notes and on the website so that you can reach out to his clinics and make an appointment with him. Which I would recommend because I just have found him to be the best. And he's not paying me to say that I promise.

                        Dr. Foulk: You’re too nice.

                        Jenica: He's very, very humble. But I will definitely link his information there. And thank you so much for your time.

                        Dr. Foulk: My pleasure, it's been fun. I think this is always good to talk to the world about something that means so much to me and to you, clearly.

                        Jenica: Okay. Thank you so much. We will see you guys next week on fearless infertility.

                        I truly believe setting yourself up for success and managing your mental and emotional health can be so much easier when we set ourselves up with great routines. So I am so excited to share with you my free Morning Mindset Magic Checklist that I have perfected over the last several years.

                        Throughout my own battle with infertility these seven simple morning habits have helped me regain control over my thoughts. They give me power over my feelings and emotions. They clear out shame, guilt, and anxiety from my mind and prepare me to win each day, no matter how tough things get.

                        You will learn how to make sure you start your day on your own terms without any hint of negative comparison or shame. Where you should go first after getting out of bed to clear your mind and prepare for the day. My magic trick for accessing the uplift I need to make my day great on my own terms. How to get the direction and support you need to get through even the toughest days when everything seems to go wrong.

                        The do it first happy chore you should always finish as soon as possible to give yourself momentum. It literally takes about 20 seconds but nothing gets me ready to conquer the next thing and the next thing like getting this done first. How to keep your momentum going once you complete tip number five. It sounds super simple, but trust me, once you add this to your routine, you're telling your mind that you're in control.

                        And why checking in with your gut each morning sets you up for success. You can easily get messed up if you're not careful with this one. Make sure you listen closely to your body as you follow tip number seven. Head to thesliceofsun.com and click on Morning Mindset Magic to get the free checklist.

                        Thank you for listening to Fearless Infertility. If you want more tools and resources to help you during your infertility experience visit thesliceofsun.com. See you next week.


                         

                         

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