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We sat down with Dr. Aimee Seundamrong, Reproductive Endocrinology & Fertility Specialist at Kindbody to talk about how COVID-19 is impacting women’s health, general women’s health questions about fertility, career, expecting mothers, starting a family, and undergoing treatments during the pandemic and more.

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Transcribed Interview

Ewa
: I just wanted everyone that's listening in at this time just to know that if you want you're welcome to submit questions. I've never done this before, but supposedly that's a thing, whether it's in comments, but there's a little thing, a little question mark on the bottom of your screen that you can click to submit a question that I'll refer to later on for anyone that wants to ask something. No pressure. I know this is a tough topic. So, we'll do our best here. Great. So, yeah, as it relates to COVID-19, we had on Insta stories put up an option for people to submit their own questions. And one of the stories that really touched me was from one of our followers and she had let me know that she is several weeks pregnant, and she is going to have her first appointment, which she's really excited about to hear her baby's heartbeat. I feel like that's such an important moment for a woman in her life. And the reason it touched me so much was because of the pandemic. She is unable to have her husband there because of social distancing rules and limitations of who can enter a practice. So, as it relates to women delivering for birth, a woman's prenatal care and postnatal care, what are the changes that are happening in women's health care, if you can just go over some of that. I know it's probably different between practice and practice or even state, but just what are the general things happening?

Dr. Aimee: Yes, absolutely. It is an ongoing information source that we are really looking into. We have information from studies published in China, studies published from Italy. But our basic worry right now is the risk of transmission. So, we are certainly leaving the general medical community, OB-GYN practices, fertility practices really trying to do everything we can to limit transmission by reducing patients, exposures to each other, to us, to the general outside world. And the concern really is right now, simply that. Good news, there are a few very small series of patients who have delivered while they were infected with COVID-19. Most of these reports are from a series of patients in China, and in other places that have reported births. The infants have done very well. We do not at this time think that there is a high risk of what we call vertical transmission where the virus can go through the placenta and infect the baby. There are many ways to test for COVID-19. We can do a nasal swab. There are also antibody tests to see if the body has mounted a response to a possible exposure. And so there are some discrepancies between those two types of tests. The nasal swab is really to actually test for the virus itself. Whereas the antibodies are to test for the body's response to being exposed to the virus. So, we know that no one test is absolutely perfect. And so there are caveats to these studies that have not indicated what we call vertical transmission.

However, there are some things in pregnancy that are worse when you get them if you are pregnant, and also good news COVID 19, the Coronavirus does not seem to be one of those. Something as common as the chickenpox is a certainly more serious infection if you get the chickenpox while you were pregnant and have never had the chickenpox. But the women who have contracted the COVID-19 virus while they're pregnant did not seem to have any worse prognosis or a more serious course than anybody else. So, those two things really give us some hope that if we practice social distancing, if we as medical professionals can do our best to schedule patients visits, and we can all reduce exposure, then we can safely care for someone who is pregnant, we can still get to the visit, where we can hear the heartbeat, and you still have all of those really wonderful experiences along the way, just at a different pace.

Ewa: Okay. So, if a woman is pregnant, is she still going to her normal prenatal visits? It's she's just doing it solo right now, is that correct?

Dr. Aimee: Exactly. Right. Limited exposures and most offices are increasing time between visits. We've all been in a waiting room with multiple other women, sometimes for a long time. And one of the things that we've all tried to do is to space visits out so that you are not waiting, one for a long time, and two, with other people.

Ewa: Okay. And then for delivery, right now if a woman's giving birth, is she going to the hospital by herself? Is that correct?

Dr. Aimee: I think every hospital has its own policy. And there’s also a bit of a shifting policy. I think at the beginning of our social distancing recommendations, there were some hospitals that were really limiting the number of people in the delivery room to zero. And that's obviously so difficult. This has been something you’ve been waiting for, that your family's been waiting for and we all dream of having as many family members as we wish whether or not that's one or five in the delivery room with us. But it is something that some hospitals are allowing a single family member. And it really depends sometimes on the day, the situation and what that particular hospital’s policy is.

Ewa: Gotcha. Do most hospitals at this day and age have Wi-Fi so that way you could if allowed…

Dr. Aimee: Yes.

Ewa: Just whoever else isn’t there has a Zoom meeting for your birth or something?

Dr. Aimee: Yeah, the thing we're all now very familiar with. Exactly. Yes.

Ewa: At the very least.

Dr. Aimee: At the very least, exactly. Yeah. So, it does seem to be the case that that is possible. Telehealth has exploded, thank goodness. We are so grateful for our technological resources in this pandemic that has really allowed us to connect as we are right now.

Ewa: That's at least comforting to hear. You know, I mean, I do hope that hospitals do allow at least one person from the family, but I do understand that it's an unprecedented time and I'm sure the experts are trying to do their best to be realistic on making sure that this doesn't transfer, progress or anything like that. So, I'm sure everyone's just thinking about the woman's best interest at the end of the day, you know?

Dr. Aimee: Absolutely, absolutely. And families can be known to transmit the virus within the family unit. And so, keeping as many people healthy as possible is super important.

Ewa: Yeah. So, I guess knowing that, if you're a friend or someone that just wants to lift someone's spirits that is going through that, do you have any suggestions for things that they could do to help and lighten the situation?

Dr. Aimee: Absolutely. Yeah. And things that we find encouraging; sending video messages, we've had many of our families in our clinic do the group Zoom calls to answer questions or to share special moments. You know, on a personal level, we've tried out Zoom birthday parties and things like that. So, in lieu of the baby shower or…

Ewa: That's a really good idea.

Dr. Aimee: Yeah, to schedule something

Ewa: You can still have it somehow.

Dr. Aimee: Yeah, exactly. Exactly. Send presence through the mail with disinfecting procedures, right.

Ewa: Yeah. Yeah, of course, of course. Oh, that's such a good idea. So, I guess my next question would be, so from my personal experience, going through fertility treatment, I think at the time that the outbreak really happened here in New York, it was like when I was already mid-cycle, and I was thankfully able to go through with my procedure and wrap that up with obviously cautious visits. It was exactly as you had mentioned, I don't think there's anyone else really there, maybe one person, it was separated, it was just a very calm and positive experience despite everything that was going on. So, for women that are going through fertility treatment, what does that look like now? Because I know that people that were able to conclude their cycle, that's great, but if it was not successful, or for someone that didn't get to start, but was looking to start, what do...

Dr. Aimee: Yeah, what does that look like now? That's also a bit of a moving target. Right now, we are really taking recommendations from the American Society of Reproductive Medicine. And they are looking at the data, looking at the progression of the pandemic, how many people are being infected. They're also working with the CDC, other professional societies to really keep everyone as safe as possible. And currently, their recommendations are not to, unfortunately, initiate any new treatment cycles at this moment. However, the ASRM is really reviewing all of the recommendations every two weeks. Even last week, we had a very large Zoom call with our REIs Reproductive Endocrinologist from all over the United States, China, Italy, and other medical professionals looking into the data that we have; the risks of transmission, the risks to our patients, and trying to come up with the best way forward. It is so, so hard to wait for starting a cycle, continuing treatment if things don't work out. Even waiting for diagnostic procedures, just sperm analyses, ultrasounds, things like that, that have now been deemed non-urgent. And that part is also difficult.

So, right now we're taking it two weeks at a time. And we're hoping that we can slowly move into either continuing treatment for couples that have already started initiating cycles that have not worked but trying again, or at least in a very spaced out individual way trying to move forward with treatment as long as we have adequate cleaning procedures in between patients. We are very aware of the lack of data given transmission, we don't know exactly how to prevent it. And that's one of the things that I think if we can learn enough about that we can then enact those procedures. But it is certainly something that we are actively talking about looking into, reading every paper we can to figure out what the best way forward is, but it is you know, I think really, emotionally a hard time because it's hard to wait for those answers and wait for those opportunities to try.

Ewa: Yeah, I guess at the very least for someone that isn't able to proceed with their treatment, and if they are still trying at home, let's say, what are some things that they could at least work for that would help? You know, like I think one of the things you told me is to limit drinking, workouts, try not to be stressed out despite everything going on.

Dr. Aimee: So, yeah, obviously easier said than done. And yes, definitely there are things that we can do. And certainly, the recommendation is not to not try. It's just really the worry that we are interacting so much during a treatment cycle that we, or a surgical procedure or anything that involves many people at the same time, that can put you at increased risk. So, some of our patients have elected to use medications that do not require monitoring, for example, at home to try. Certainly, continuing all the precautions, reducing alcohol, maintaining exercise. And our nurses are also reaching out to monitor for ovulation, trying to help time things. And that can also be helpful because it's still a try, and it is also a way to move forward a little bit. Sometimes we get lucky and then we go forward but yeah, certainly continuing all of the recommended prenatal vitamins, healthy lifestyle habits, super important right now. And also trying to relax, it's hard to not worry about everything all at once, but certainly maintaining some sense of peace and stability is super helpful.

Ewa: Yeah, yeah, I feel like that's what is the silver lining in all this is. I do have the opportunity to have a little bit more time for myself and work on those things like meditating or working out a little bit from home and do the live streams that have been very helpful. So, I think working on self-improvement, at the very least, is something that someone could take away in focusing on during this time. And then obviously, it seems like continuing the conversations with your doctors or whoever you're working with to advise you on what is allowed week by week or every two weeks or whatever as things progress and change.

Dr. Aimee: Absolutely, yes. And certainly, the silver lining, I think that's such an important takeaway. It is a time where you know, life is not the same, but it does not mean that we can't use absolutely as you started time to add back in all of the things we always wish we had time for; learning new things. Meditation is so great. Working on stress relief, nutrition. You know, I think a lot of people have more time to think about food, food choices, all of those things that can really benefit us in the long run.

Ewa: Yeah, definitely. So, I think the last question I have in the section is, if there's anything new that came out of the Care Act that maybe a woman could benefit from. I'm not sure that there are but if there's anything?

Dr. Aimee: Yeah, absolutely. Absolutely. And I'm not a legislator, obviously.

Ewa: Right. You're not.

Dr. Aimee: I’m not, yeah, unfortunately not on my list of things. But hopefully we'll have some additional benefits. I think you and I discussed a little bit about some fertility products and medications that are over the counter that are now possible to claim for flexible spending. Some of these are things that we think about on a regular basis. But you know, I think some of that legislation, we definitely will need to kind of parse through to figure out what is super available. But there are lots of pieces of it that hopefully, will help with health care and childcare, and certainly women's health.

Ewa: Okay, wonderful. So, the next session that we'll be moving into is general women's health questions. The first one I think, that I found really interesting and I wish they taught us in school is just like what fertility means by age and whether it's true that it plateaus at a certain time or it changes. If you can just go through that for our viewers.

Dr. Aimee: Absolutely. And that's a question we get a lot. You know, fertility is something that we don't learn a lot about in school, just as you said. We learn about some basic health, which is fabulous. Maybe not as detailed as we would all like to remember it. And maybe we learned about contraception, but fertility is something that really becomes important as time goes by. And often in our 20s and 30s and 40s, we start to really think about it in a very different context that we did, then we did rather in school. The one thing that I think is so important for women to know is that fertility does change with age and time. I think a lot of us are very focused on our health, our well-being in a great way, much more so than maybe in decades past. And unfortunately, female fertility has not changed a lot to kind of keep up with that. And so, it is something that does start to change mostly due to the number and quality of our eggs over time. And that quality of our eggs, the ability to really achieve a healthy pregnancy can start to decline somewhat gradually and then eventually to a point where we really notice it in our 30s, and certainly in our 40s. So, it is something that there's no magic numbers, certainly. I mean, we do see changes with time, but it is fertility as a whole with some exceptions definitely changes dramatically between our early 20s to the time that we are in our early 40s.

Ewa: So, I guess keeping that in mind, when's the best time to think about fertility and/or building a family?

Dr. Aimee: So, it is something that is a very individual choice. And some couples, some women decide to start family building in their 20s. And through their late 20s. Some women really start thinking about it in their early 30s, and that's a great time when life has kind of sorted things out if you haven't started family building. Ovarian reserve is often very robust. There are many options for either fertility treatment, fertility assessments, fertility preservation. As we move into 35, 36, 37 years, things really start to change as a whole. There are always exceptions. There are women who have babies at 50. But by the time we get to our late 30s, really, some consideration of fertility is super important, mostly because we still have the opportunity to alter the course of our family building choices. But there may be some important changes to really think about so often, we do a lot of our thinking between 30 and 40, and find that it is helpful. Once we get into 40 to 45. Super, super helpful at that point if we can go forward with thinking about it, but sometimes you're disappointed in our ovarian reserve by that time.

Ewa: Okay. I think that's right. really helps to know because I didn't realize that the time periods that are important in thinking about all of this. So, I guess the next question would be how is fertility check and how can male partner’s fertility be evaluated?

Dr. Aimee: Fertility checking, so there are a couple of ways to go. The ovaries themselves are fairly time dependent. So, we often look at those first off, and we can evaluate them very easily in a very non-cycle dependent. Meaning, it doesn't matter what time of your cycle through a blood test called an AMH and an ultrasound, which is to look at the ovaries and actually look at some of the spaces where the eggs live called follicles. So, that's usually our first check. Now, fertility can be a-- well, it is a group effort really between the ovaries and the uterus, the fallopian tubes, and the sperm. So, checking sperm through something called a sperm analysis is always a really great start as well if you're having any trouble. Mostly because the sperms are super important in fertility, obviously. But there are very few symptoms for poor sperm counts or poor sperm motility. So, we usually start out with looking at the ovaries and the sperm. But certainly, a complete fertility evaluation is helpful if you're having trouble. Now, checking for fertility, checking your general health is always important. So, going to annual exam visits, making sure everyone’s had their pap smear, talking to your OB-GYN, about your reproductive health, how your periods are. This is always something we promote in terms of women's health because there are things that we can see and check for along the way that we may not really pay attention to in our daily lives that can be important for later.

Ewa: Oh, that actually stems another question. I think it'd be worth asking at this point. At what point does a woman go from seeing an OB-GYN to see a reproductive endocrinologist?

Dr. Aimee: Yeah, that's a really great thought in that traditionally, reproductive endocrinologist were accessed only after you had officially started trying for pregnancy and have not been able to get pregnant for a year if you are under the age of 35, or if it's been six months if you are over the age of 35. And we do really find that to be helpful but sometimes it is a long year to wait. And it is also, even at six months, it can become super frustrating, especially if you're worried at all about your timeframe or your ovarian reserves. So, certainly talking to your OB-GYN early on about your family plans, thinking about doing some early fertility assessments with blood tests or even an ultrasound can be helpful. A lot of women are very interested in seeing a reproductive endocrinologist early on, even for preconception planning, to get a sense of how to go about it. It is something that reproductive endocrinologists can often spend a little bit more time going over specifics. And so, it is definitely not an only for fertility or infertility assessment that reproductive endocrinologists can be accessed.

Ewa: Okay. That's something good and I had no idea.

Dr. Aimee: Yeah. It's a lot of information sometimes to kind of put together. So, it's helpful to spend a little bit more time with it.

Ewa: Yeah, definitely. So, let's pretend I'm a very-- Okay, I am a very career-focused woman. But in general, let's say I am in my 20s or 30s, and I am not ready to start a family at all. It's not something that I'm interested in at this point in time in my life, but I do know that I would want that option to be there for me, let's say 5, 10, 15 years down the line. What are some measures that I can take knowing that I just want to educate myself and make sure I don't put myself in a position where I can't have the option of a family?

Dr. Aimee: Absolutely. It is, first and foremost being healthy. So, that's so great to always think about. Things that can change one's absolute length of time with peak fertility includes smoking, heavy alcohol use, acquisition of other medical problems like diabetes or hypertension. Maintaining all of those areas of life are, are really helpful. Medically speaking, there are options for both fertility preservation and also for fertility treatment later on. And many women really think of having the opportunity to have a child with their own egg. And with that, if one is not either at a point where having a baby right now is an option for any reason, or one wishes to try to build a family later on, then a couple options include what we call freezing eggs, or Oocyte cryopreservation, where we grow eggs in the ovary, but take them out of the body to prevent them from being dissolved on their own, which is the normal course of an egg and a follicle. We save them for later. And at a later point in time, we can choose sperm or use partner’s sperm at the time to fertilize the eggs and then grow them in the laboratory through in vitro fertilization, and then use them to put into the uterus for pregnancy with your own egg at a time where ovaries may not have any good quality eggs readily available.

And on the other hand, one can also freeze embryos earlier on. And that usually does involve having a choice of sperm, either a partner’s sperm, donor sperm. And that is also a very similar process. But it does require that one pick sperm. So, those two choices, egg and embryo freezing can actually save eggs for later. Certainly, maintaining a healthy lifestyle and making sure that we're doing everything that we can to be healthy, does help with not reducing eggs pasts when they would normally not be available. But it does not, unfortunately, no matter how healthy we are, it does not prolong our natural ovarian clock past the time that it was meant to stop.

Ewa: Okay. I think that's helpful information to know. What are the things that we look at to see, I guess what your reserve looks like or quality? I don't know if that's a thing that you can check, but what are the types of things that you look into?

Dr. Aimee: Yeah. So, unfortunately, egg quality is so important. But yeah, we don't have a great way or really any reliable way to check how many eggs in any group of eggs are good quality. We can't really individually query eggs either until we take them out of the body, we can't look at them. We can't see if their quality allows them to divide properly once they're fertilized, that's really the mark of a good quality egg that they can turn into an embryo that has the right number of chromosomes. So, it is so, so important and so not really checkable. We can't really look at that. Egg number, really the, what we call ovarian reserve is really based on the blood test, the ultrasound that we talked about earlier. And that does give us kind of a sense of really what we call a snapshot of time. But the other part that's really, really, really impossible to predict is the rate of change. So, how long our eggs will remain in our ovaries, at what rate they are decreasing in time, and then also what we really wish we know is, or we could know is how long it will be until our eggs are no longer of good quality. And that rate of change is also not something we can really assess at this point.

Ewa: Hopefully, in the future.

Dr. Aimee: Yeah, one day in the future hopefully we’ll be able to make sure every egg, you know sticks around, and then if they don't, at least, that they can maintain their quality but that is also something that is not yet available. Hopefully, one day. Yeah.

Ewa: Okay, so I guess the next question I have here is, what are some things women tend to have wished before they knew before they became pregnant?

Dr. Aimee: So, there's probably a long list of things one wished they knew. I think most women would probably find it true that everything changes once one's pregnant. Now, medically, what that really is, is that every system in our body undergoes some form of change in pregnancy; our hearts, our kidneys, our lungs, obviously, the shape of our bodies, the structure of you know, our, everything really changes. So, pregnancy is a wonderful, but very, very dynamic time in a woman's life and you know, as a medical event and a very natural event but things that we think about for pregnant women are really health changes. So, making sure our hearts are healthy beforehand, preparing for pregnancies.

Certainly, there's no perfect time but maintaining good cardiovascular health. It's really important to do that both before pregnancy, during pregnancy, and after. It is a time where because of the changes in the body, there are changes in energy levels. And often the first trimester is very exhausting. The second trimester is great and the third trimester is a lot of waiting. But I think the other thought that I have heard women, both women who have had trouble getting pregnant or not had trouble getting pregnant and always reiterate is that the time after pregnancy is also filled with change. And the more you can kind of roll with change, there's a lot to be stressed out about, there's a lot to worry about. And basically expecting the unexpected and being able to kind of roll with the punches is one of the best ways to really prepare yourself because it’s a new change every day, and it isn't always what you expect it to be. And that can be a lot to process.

Ewa: Yeah. So, I guess that's something everyone at home right now can work on is finding the zen in life, you know?

Dr. Aimee: Exactly. Yeah, probably a good thing to prepare for in the next couple months, right?

Ewa: Yeah, yeah. So, I think that's really helpful information. I guess for you, how has the obstetrics industry changed since you've entered the field? Or has it at all? I don't know

Dr. Aimee: Yeah. A lot has changed. A lot has changed. So, I think that one of the biggest pieces, having a baby is still the same. That has not really changed at all. It's still a wonderful and exciting time. But as we just talked about, so filled with change. There are a lot of diagnostics that we can really do now that we could not do before. When I first started in this field, even ultrasound was not quite as specific. We know so much more about pregnancy, we know so much more about embryos. You know, we could barely see a first-trimester ultrasound at the time when I first started, that was a long time ago. But technology has really improved our ability to know both about the embryos before we put them in if we're doing assisted reproduction or babies as they grow inside our uteruses, it is a lot of information. There's a lot of information that's now available. So, I think that part has both allowed us to be more prepared for any emergencies, but it does really add a little bit of stress. There's so much to know, there's so much to process, just getting genetic information about the embryos, about the fetuses, genetic testing. All of that is so available, and yet so much information to process. So, I think that's really changed over time. As a benefit, though we-- I mean, there were times in residency where very rarely, but a couple times people-- But at one point, the protocol was actually not that everybody got an ultrasound. There were times where people did not have a single ultrasound throughout all of their pregnancy. And so, there were things that we didn't know, that we wish we had. So, I think technology, the availability of diagnostic testing that can often even be noninvasive now has really changed how pregnancies are managed or processed. As a person, you can know about the gender of the baby. You know, just the fact that there is something called a gender reveal was probably not available 30 years ago, right?

Ewa: Yeah, yeah.

Dr. Aimee: We didn't even know that we could do that. So, it's amazing.

Ewa: And has the time been bumped up I guess since you can do that, like find out the gender weeks before?

Dr. Aimee: Absolutely.

Ewa: What week number is that usually around?

Dr. Aimee: Yeah. So, little history. Back in the old days, we had to wait until the baby was big enough and actually had you know, the parts that we could see by ultrasound before we could really tell if it was a girl or boy. And an invasive test was an amniocentesis, and that's easily done at the earliest, between 15 and 18 weeks. But now we have the non-invasive prenatal testing, which is a blood test which looks at something called cell-free DNA. It's really done at the end of the first trimester to look for ongoing pregnancies that may have down syndrome, trisomy 13, or trisomy 18. So, things that would still allow a normal pregnancy or pregnancy to appear normal but not be normal, and only be able to test for that, at that time point using something called a chorionic villus sampling where we actually had to take a few cells from the placenta and test that. So, now we can use a very non-invasive test at a very early stage to check for gender. But even before that, if one must do in vitro fertilization, one can also do preimplantation genetic testing. Mostly that is to check that the embryo is chromosomally normal and has the right number of chromosomes. But with that does come gender information and many families elect not to get that information where they just want to transfer a healthy embryo, but it is information that we do get. So, it is possible even before the pregnancy is established to know that information.

Ewa: Yeah, that seems like a lot of change in even a short span, I guess medically that’s a short period of time.

Dr. Aimee: Correct. Yeah. If you think about it, in all the world, that's a very short amount of time to go from not knowing anything to the gender reveal party that can be planned months in advance.

Ewa: Now virtually.

Dr. Aimee: Now virtually, yes, exactly. Virtual gender reveal party. Exactly. Exactly.

Ewa: Awesome. So, I guess, talk me through some of the support systems that a woman could have. There are, from my understanding, there's a doctor, a midwife, a doula, all those different things. I know that that might look different on who you can have obviously, available at this time during COVID-19. But just in general, what's the differences between those three things? Yeah. And any advice that you have for someone looking for either?

Dr. Aimee: Yeah, that's a great question because they're, all the words sound the same; who does what and what is their job. And in general, the obstetrician who delivers, this is the person who makes the overarching medical decisions. And often in the prenatal care period midwives and obstetricians can both care for pregnant women. So, they can care for you through your pregnancy. Often midwives will have a backup OB-GYN in case one develops a complication, diabetes, hypertension, if there is any other concern that your fetus is not growing properly. All of these are really done in consultation with an OB-GYN. At the delivery, generally, midwives can deliver vaginal deliveries, anything, any situation, concerned problem that is more complicated than a vaginal delivery, if it requires an operative vaginal delivery using a vacuum or forceps, if one needs to see section, if there's a complication in pregnancy, then often an OB-GYN will back up a midwife who is often a very highly trained nurse. And so, the educational tracks between midwives and OB-GYN is different. OB-GYN will have gone through medical school or residency. They are officially a physician. A midwife is an advanced practice nurse who has had extensive training in nursing and then in obstetrics specifically, but they have not been trained in operative deliveries.

Ewa: Okay. And then…

Dr. Aimee: And then the doulas, yes. The doulas are very helpful in the stage of preparing for birth and preparing mostly for vaginal deliveries. And they are also actually really active in the progression of labor. So, they will often be a person who, not in this state of the pandemic, but they can sit with you specifically in your room. They can often coach you through contractions, keeping one focused on ways to reduce pain without medications, and kind of be an advocate for you. And so, they're really great for that purpose. But they are not able to actually deliver the baby itself. There can be many complications that can happen right at that moment. And so, doulas generally are helpful for labor, but they are not necessarily delivering the baby directly in official terms. And as we always say it takes a village. And so, each member of your care team is really important. I think it's really helpful to have someone who can coach you through labor. Sometimes women will bring their mom, sometimes they'll bring a spouse, sometimes they'll bring a friend, and all of those people are super helpful too. But doulas, I think are trained in the actual method of labor. They've seen it before, they're guaranteed not to faint on the floor. But yes, everybody does have a job to do.

Ewa: Okay, wonderful. I think in the interest of time, I'm going to move us into the “Name your Favorite” section. So, this is the park Dr. Aimee and I will take turns naming one or two things we recommend for our viewers for each category. Sorry. I'll let Dr. Aimee lead with each category. The first one is a book you recommend and why?

Dr. Aimee: Well, I love books. But I'm reading a book right now that I find absolutely fascinating. I just thought maybe my favorite book of all time. That's actually A Wrinkle in Time by Madeleine L'Engle. I love that book. But this book is called The Gene and it's written by a professor at Columbia named Siddhartha Mukherjee and it is fascinating. It's a fascinating history of genetics, which is something we just talked about. And it is really a study of genetics, which originated and all of the questions we have about reproduction, how does it happen? How does it work? All of those questions really lead to the discovery of genes and genetics. And this book is really a story about it. So, I've really found that fascinating.

Ewa: Awesome. So, mine is Expecting Better by Emily Oster. I listened to it on Audible I think when I was first beginning to try just to learn a little bit, I think Emily Oster is either an economist or statistician or something. But she has a very analytical perspective. And she took a lot of research studies and spent time analyzing and comparing them to answer things like is it okay to drink wine when you're pregnant, things like that? That I feel like a lot of women wonder. So, I thought that book was really helpful for that reason.

Dr. Aimee: It's super helpful, 100%.

Ewa: Yeah, yeah. And the next category is your favorite podcast?

Dr. Aimee: Oh, I love RadioLab. It's an NPR podcast. They did an amazing series a few months ago. I think it was actually called Gonads. It was also about fertility and reproduction. And they take a great tack on scientific discoveries and linking all sorts of people and putting context into things that they've learned about. I just love their ability to kind of fill in the blanks around an idea. You know, who discovered it, why, how it's important what people think about it? I look for that in that podcast.

Ewa: Awesome. I'll have to bookmark that one for myself.

Dr. Aimee: It’s produced by NPR.

Ewa: Awesome. So, the one that-- I had actually two, I get the two confused. But I've listened to both Birth Hour and Birthful. I think that they both have birth stories, which I think is really helpful as a patient or as someone trying is just to hear other people's perspectives that they're going through infertility, whether they're just going through different birth scenarios, like a c-section, a twin birth, whatever. I just think hearing the stories from a woman's perspective of going through that, what labor was like delivering, whatever all that stuff.

Dr. Aimee: I’ll have to check that one out. I love those stories. And it's amazing how, just anecdotally, it's so different for everybody, right?

Ewa: Yeah, and that's the one thing that I learned and took away from it all is whatever you think's going to happen is not going to happen.

Dr. Aimee: Exactly. Rolling with the punches just as…expect the unexpected.

Ewa: Yeah, it's really going with the flow and just finding peace in chaos.

Dr. Aimee: Absolutely, absolutely. And a good motto for now.

Ewa: Exactly, exactly. Yes, it's very appropriate too. Okay. So, the last thing that I have is your favorite social distancing activity?

Dr. Aimee: Oh, hands down puzzles. We've done so many puzzles. I've always loved them, but we broke them out again. And my favorite are the really, really complicated ones that are 1,000 pieces or more. And we even discovered these wooden puzzles that have-- they're actually wood and they have amazing little pieces that are related to the picture. So, there’s one about butterflies and the pieces actually look like butterflies.

Ewa: Oh, cool.

Dr. Aimee: Super fun.

Ewa: Mine was playing board games. The one I'm playing right now a lot is Azul. It's these little Portuguese tiles, you piece them together. It's a little bit of strategy. It’s like 15 minutes, you can play with one person, which most of us probably don't have two people near us all the time.

Dr. Aimee: Definitely a good game right now. Yeah.

Ewa: Yeah. That’s great.

Dr. Aimee: I love board games.

Ewa: Oh, the last thing I want to ask, I realized I didn't ask is what app do you recommend? One of our customers asked that. So, I want to make sure to address that one.

Dr. Aimee: So, there's so many apps. The ones that are best for trying, we’ve had a lot of patients who really liked the Flo App. We want an app where we can really track all of the important time points, days, and that kind of thing. Of course, the Kind Body App. We have an app now.

Ewa: Okay.

Dr. Aimee: I that's my favorite one too. There's a period tracker, that sort of thing. But as far as trying and fertility, there are many, they all do a good job. But I think the Flo one seems to be really helpful.

Ewa: Cool. Yeah. A few of my friends use Flo right now. And we found it really helpful and not even ones that are trying just in general just to be aware.

Dr. Aimee: Exactly. Yeah.

Ewa: I find that one's really intuitive and easy. The other one that I like is Mindful, which is for meditation. I know that's not related, but I guess, in getting into calm and just you know.

Dr. Aimee: Yes, exactly. I also like the Calm App. That one’s a great one. And then one of the companies that helps us with medications has been called Ferticalm which is very specific to fertility.

Ewa: Oh, awesome. I'll have to look that up.

Dr. Aimee: Yeah.

Ewa: Great. So, we have three minutes left and I don’t want it to cut us out. So, to conclude our conversation tonight, Dr. Aimee, for any viewers that want to get in touch with you or want to dive deeper into their own health, could you kindly let us know how they can get in touch and where they can learn more?

Dr. Aimee: Yeah, absolutely. So, again, my practice is called Kind Body. Our website is KindBody.com. There's a lot of information there that you can use to kind of get started. And we are also doing virtual visits at this time. So, if you want to speak with myself or any of my colleagues, we're also available, although not in person right now. So, I'm certainly taking a look at that, it’s super helpful. The other website that's really great is the American Society for Reproductive Medicine, ASRM. It is our overarching professional organization with very expert, very accurate, and super concise information that's really helpful. And then the last is American College of Obstetrics and Gynecology ACOG. Also, not just for reproductive endocrinologists like myself, but for all OB-GYNs, that is our overarching professional organization. And it has a lot of great information, updates on COVID, updates on every question about reproductive health, women's health. They are the overarching voice for us. And it is such a pleasure to speak with you.

Ewa: I know. Thank you so much for taking the time to walk us through everything. I'm sure people have taken away some valuable information. I know I have. Perhaps I can add a podcast episode.

Dr. Aimee: Thank you.

Ewa: Thank you so much, and I hope to see you in person hopefully, once this all passes. And I really appreciate you taking your time to do this. And then lastly, I just want to thank our audience for tuning in. so appreciative of everyone's support in this live series. We hope to continue it with an episode next week. And thank you, everyone, who has supported our small business during this time. I know it's so hard. So, for everyone that has purchased anything in the past two weeks, honestly, thank you so much from myself and from our team. It means so much. Thank you, doctor. Really, appreciate your taking your time.

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