[SPEAKER_01]: Hey guys, welcome back to Infertilay of the podcast. [SPEAKER_01]: This is episode three hundred and thirty-four called Dr. Jane. [SPEAKER_01]: this episode is brought to you by Generation's Cryo Vault. [SPEAKER_01]: When you're navigating fertility treatments, every decision feels big because it is big. [SPEAKER_01]: But did you know that when it comes to storing your reproductive tissue, including eggs, sperm and embryos, you do have a choice?
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[SPEAKER_01]: Alright guys, you know it is my passion to normalize the conversation around IVF and family building through ART and to that and I have a second children's book out. [SPEAKER_01]: It's available for pre-order now. [SPEAKER_01]: It's called Beautiful Bird and it is a beautiful story of how my friend Helen [SPEAKER_01]: formed her very own family through ART. [SPEAKER_01]: So you can find it at infertilevgroup.com and you can also find my first book work of art there as well.
[SPEAKER_01]: I would love for you guys to check it out. [SPEAKER_01]: It's a story about IUY, it's a story about LGBTQ+. [SPEAKER_01]: It's a story about a single mama by choice, it's a story about NICU, it covers so many things and same illustrator as the OG work of art. [SPEAKER_01]: So check it out at infertilevgroup.com.
[SPEAKER_01]: Also, fertility rally is always available for anybody who needs a safe place to land who wants support groups and events and education and empowerment and people who get it. [SPEAKER_01]: So check us out at fertilityrally.com and on Instagram at fertilityrally, we would be happy to support you. [SPEAKER_01]: Okay, I'm so excited to come back with another expert mini-sode today.
[SPEAKER_01]: So today I'm talking to Dr. Narali Jane, who is a reproductive endocrinologist at RMA in New Jersey. [SPEAKER_01]: And today we are talking all about fertility preservation when you are a cancer patient. [SPEAKER_01]: Such an important topic. [SPEAKER_01]: She answers all the questions about it, covers everything you need to know. [SPEAKER_01]: So if you are a recently diagnosed cancer patient, you know anybody who is please pass this episode along.
[SPEAKER_01]: It's really important information, up-to-date information, and I want as many people to listen to it as possible. [SPEAKER_01]: Without further ado, this is Dr. Jane on Infertil AF. [SPEAKER_01]: All right, Dr. Jane, how are you? [SPEAKER_01]: It's great to talk to you today. [SPEAKER_01]: Great to talk to you, too. [SPEAKER_01]: Yes, so I was reading your bio.
[SPEAKER_01]: You earned your medical degree from Northwestern University, Fineburg School of Medicine, which is close to my heart as a Chicago Inn. [SPEAKER_01]: Great school. [SPEAKER_01]: How is your experience there? [SPEAKER_00]: Yeah, I mean, I loved it. [SPEAKER_00]: Northwestern is one of those places where you can do anything.
[SPEAKER_00]: I went to Northwestern mainly to study medicine, but I also am a dancer by training, and I wanted to do ballet in modern art, and kind of take that as far as I could, too. [SPEAKER_00]: So being at Northwestern allowed me to do that, and I love the people there. [SPEAKER_00]: Just Chicago has such a warm place in my heart. [SPEAKER_01]: So a great, and now you're in Jersey like me. [SPEAKER_01]: So we are, there's so many common threads.
[SPEAKER_01]: What made you get into this field in particular when you started studying medicine? [SPEAKER_01]: What drew you to, you know, all of this? [SPEAKER_00]: I always like to draw it back to my dance training. [SPEAKER_00]: So I was always surrounded by women growing up, going through either, I mean, initially it was all young women like myself and then I met a lot of dance teachers and other people that were a little bit older than me.
[SPEAKER_00]: Then I started being like a teenager and learning about all the reproductive aspects of being a dancer and an athlete. [SPEAKER_00]: And then I started seeing like all the bad things that came from that where [SPEAKER_00]: people were suffering from amenorrhea and all of these issues with their periods and infertility and things that I didn't even think about when I was younger. [SPEAKER_00]: So that was initially a shock to me and I didn't really understand it.
[SPEAKER_00]: So I think my goal in the background was always just to understand why do things like this happen and how can I learn more to not only prevent it for myself but also my colleagues and my best friends and my family members and things like that. [SPEAKER_00]: That's where my main passion for women's health came from and I still stick to it by the stay. [SPEAKER_00]: That's kind of who I am. [SPEAKER_00]: A doctor, I'm a dancer and a mom.
[SPEAKER_00]: So I really support all of it in terms of really being able to understand your body and predicting the things that could or could not happen to you, obviously. [SPEAKER_01]: Yeah. [SPEAKER_01]: How is your sex education growing up? [SPEAKER_01]: What did you learn about fertility and fertility reproduction? [SPEAKER_01]: What's going on in your body?
[SPEAKER_01]: You know, a common theme you said you have been listening to the podcast so thank you and you probably picked up on the common theme that we didn't learn much. [SPEAKER_01]: It was like, don't get pregnant. [SPEAKER_00]: Yeah, period the end. [SPEAKER_00]: That's the thing.
[SPEAKER_00]: It's like we learn all these things about how to not get pregnant and don't have sex or you're going to get pregnant and all the negative connotations around sexual health that almost make it like difficult for us to even cope with infertility when that time comes. [SPEAKER_00]: So my education was so limited in middle school and high school and all those things. [SPEAKER_00]: I remember like to this day when I got my period on like, what is this look?
[SPEAKER_00]: I never learned like what I should even expect. [SPEAKER_00]: So yeah, I do feel like the system failed us a little bit and I tell all my patients too when they come in to see me for their first visit. [SPEAKER_00]: I'm like, you're entire life. [SPEAKER_00]: You've learned how to not get pregnant and you never thought you'd be sitting in this office.
[SPEAKER_00]: Learning about timed intercourse and timing your sex and timing your like figuring out when you're ovulating and I go through the basics. [SPEAKER_00]: I go through the menstrual cycle. [SPEAKER_00]: I go through for the men that come in that really are very removed from this education. [SPEAKER_00]: I go through really the details and I'm like, you might hate me for the next ten minutes to talk to you about like period documentary.
[SPEAKER_00]: I want to one, but I think it's helpful to know and it's important for us to know. [SPEAKER_01]: Absolutely. [SPEAKER_01]: Somebody deemed it the banana condom generation. [SPEAKER_01]: They were just like, brought in the banana. [SPEAKER_01]: They showed how to put a condom on. [SPEAKER_01]: And that was kind of it. [SPEAKER_01]: But I think for the women coming behind us, we owe it to them to like, you know, not like you have to scare them about infertility.
[SPEAKER_01]: But just be like, this is a thing. [SPEAKER_01]: I never even heard that term until I was in the midst of it. [SPEAKER_00]: Yeah. [SPEAKER_00]: Same. [SPEAKER_00]: I feel like I didn't even learn about what it would be like to try to conceive until I actually tried.
[SPEAKER_00]: who in a four year old that are very spunky and honestly, you know, my whole world, but I can't even imagine, you know, having to cope with trying to get pregnant and not having any education about what to expect and then going through this journey and feeling isolated, feeling alone and feeling like, like, why didn't I learn about this when I should have? [SPEAKER_01]: Absolutely.
[SPEAKER_01]: So let's pivot over to something I know you're very passionate about, which I think is really important is talking about fertility preservation and for cancer patients in particular. [SPEAKER_01]: Why is that issue so important to you and why do you want to talk about that today? [SPEAKER_00]: Yeah, I had a lot of close family members and friends that suffered from breast cancer and other types of cancer.
[SPEAKER_00]: And when they received the diagnosis, they were shocked and they were in their reproductive years. [SPEAKER_00]: And they didn't know where to go. [SPEAKER_00]: They didn't know what to do with that information. [SPEAKER_00]: And for them, that was basically the end of the road for their reproductive and family planning life. [SPEAKER_00]: or so they thought they just didn't have that education to be plugged in to know what to do where to go and what resources to look out for.
[SPEAKER_00]: So my goal when I was a fellow and now it's an attending in this infertility world is really to focus on fertility preservation that is urgently needed in the setting of a cancer diagnosis. [SPEAKER_01]: Mm-hmm. [SPEAKER_01]: So what does that look like? [SPEAKER_01]: If I go in and I get a diagnosis, what can I expect in terms of, you know, the fertility preservation? [SPEAKER_01]: Did they talk about that usually? [SPEAKER_01]: Did they say before you do this treatment?
[SPEAKER_01]: You should think about XYNZ. [SPEAKER_00]: So it really depends on where you go for your treatment, but our oncologists, these days, are so well trained and so well-versed in the basics about fertility and infertility and what chemotherapy agents are, but you had a higher risk for [SPEAKER_00]: decline in your equality or your egg number even years after chemotherapy.
[SPEAKER_00]: So I do think that we're getting better and better by the year in terms of knowing at least who to talk to and referring out to the right providers at the time of the cancer diagnosis. [SPEAKER_00]: So we can get involved as soon as possible before cancer treatment even starts. [SPEAKER_01]: Mm-hmm. [SPEAKER_01]: So what do I need to know if I'm in those shoes, you know, as a patient? [SPEAKER_01]: Like, what are the kind of the first steps that I should do?
[SPEAKER_00]: Yeah, I think the first thing to do, whether you are, you know, twenty or forty and either have children at home or partner, not partnered any time in the setting of a new cancer diagnosis, I think it's a really good idea to just talk to a fertility specialist by your options.
[SPEAKER_00]: So asking your oncologist for referral, they will definitely aren't called just our amazing, especially I'm based in basking region of Jersey, which is our headquarters of RMA and we have a center around the corner from us that we get referrals from all the time and we work very closely with the oncologist. [SPEAKER_00]: Sometimes I think this stigma is, it's going to take me forever just to get into talk to a fertility specialist.
[SPEAKER_00]: Like my focus should be my cancer diagnosis and that's true. [SPEAKER_00]: But there's this aspect where you can do both at the same time and you leave it to your fertility specialist to talk to your oncologist and have this collaborative group setting [SPEAKER_00]: which we have every day for our patients that come in with cancer diagnoses.
[SPEAKER_00]: But I think just knowing that you can take the stress off of yourself, like you don't need to go down a rabbit hole of Google and chat GPT and all these things thinking about what the outcomes are going to be. [SPEAKER_00]: I have patients that just come in saying, I got a cancer diagnosis. [SPEAKER_00]: I was referred to talk to you, tell me what my options are. [SPEAKER_00]: And we can take that and run with it.
[SPEAKER_00]: And it's pretty amazing how quickly we can get things moving in the ball rolling to at least talk to you about your options before you start. [SPEAKER_01]: Yeah, I love that whole like knowledge's power thing, right? [SPEAKER_01]: So aside from, I guess the obvious which would be a freezing your eggs, what are the other options? [SPEAKER_00]: So there's a couple things. [SPEAKER_00]: It depends on whether you're partnered or not if you're in a same sex relationship or not.
[SPEAKER_00]: And you can either freeze eggs or freeze embryos. [SPEAKER_00]: So I like to tell my couples that are partnered or in a committed relationship that freezing embryos has better outcomes when it comes to coming back to use those embryos. [SPEAKER_00]: And by the way, like patient shouldn't feel like, oh, if I'm using freezing, and freezing membros now or freezing my eggs, I have to come back and use them, or I will have any left after chemotherapy.
[SPEAKER_00]: That's not necessarily the case. [SPEAKER_00]: We're just taking a screenshot in time, taking out the eggs from that cycle that would have died off anyway if you weren't going to get pregnant and freezing those in time.
[SPEAKER_00]: You can definitely go down the egg freezing route where we freeze eggs and we keep them safe and sound until you're ready to use them once you're in remission or you can create embryos with a partner or if you have a high enough number you can do both you can do eggs and have embryos and it really just depends on personal preferences.
[SPEAKER_01]: Okay, so if you're doing this is kind of like one-o-one question, but for people listening might not know, if you're freezing eggs versus freezing embryos, is it pretty much the same protocol, except for obviously embryos have sperm involved as well? [SPEAKER_00]: Yeah, I mean, you're exactly right. [SPEAKER_00]: So it's the same protocol. [SPEAKER_00]: Okay. [SPEAKER_00]: about a two week commitment upfront where you're giving yourself nightly injections.
[SPEAKER_00]: And the dosing is usually the same. [SPEAKER_00]: We do a special protocol for our cancer patients really to limit the exposure to estrogen, depending on the cancer type you have. [SPEAKER_00]: But whether you're freezing eggs or embryos, it's going to be the same upfront two weeks. [SPEAKER_00]: And then after your retrieval, our amazing embryologists do all of the work on the back end.
[SPEAKER_00]: So they either freeze the mature eggs or they fertilize and freeze the embryos once they're ready. [SPEAKER_01]: I have talked to cancer patients over the years who weren't given the option to talk about, you know, preserving their fertility and in retrospect, they're like, I wish somebody would have talked to me about that. [SPEAKER_01]: So obviously, you're trying to make a difference and have it more normalized and just part of the whole conversation.
[SPEAKER_01]: Tell me a little bit more about what you're doing to that end. [SPEAKER_00]: Yeah. [SPEAKER_00]: So as a practice, like as RMA, we work really closely with Memorial Sloan Kettering, which is we actually have a satellite location around the corner. [SPEAKER_00]: And some of our doctors go over and do talks for our oncologists. [SPEAKER_00]: So I think the biggest drive here is education, not only for patients, but for the physicians.
[SPEAKER_00]: So being able to spread that education and understanding a pathway in terms of understanding how to place a referral, who to contact, who are like, you're going to go for utilities specialist. [SPEAKER_00]: That's kind of like my path that I'm paving for myself. [SPEAKER_00]: I think that there's a lot of fertility providers that are willing to do that and to work with oncologists.
[SPEAKER_00]: So my biggest thing kind of summing up that point is educating our oncologists that this is an option, all patients that are reproductive age that are male, female, whatever it is should be referred to us for at least a conversation and that can be done pretty quickly. [SPEAKER_00]: The biggest thing is I think a lot of cancer patients, it feels very overwhelming and [SPEAKER_00]: So have a cancer diagnosis.
[SPEAKER_00]: It's kind of a hard stop for a lot of patients where you feel like I can't even think past this. [SPEAKER_00]: It's like a black screen in front of me totally. [SPEAKER_00]: And I can be so scary. [SPEAKER_00]: So I think that the biggest from from my experience and my research in this like my biggest takeaway is light your fertility specialists and your own colleges do the work for you.
[SPEAKER_00]: So really all you have to do is go and say in an office and [SPEAKER_00]: Just listen to your options. [SPEAKER_00]: I think that's my biggest piece of advice. [SPEAKER_00]: Like, don't be afraid to have conversations, especially when you're at one of the scariest times in your life. [SPEAKER_01]: All right, thank you so much for listening. [SPEAKER_01]: As always, you guys are the best. [SPEAKER_01]: Thanks for always passing along the episodes.
[SPEAKER_01]: Go back in the archives too and check out some ones that you may have missed. [SPEAKER_01]: There are three hundred and thirty four episodes now. [SPEAKER_01]: So there's some really good ones from back in the day when we first started in twenty nineteen, but they're all still really relevant and so many kinds of stories. [SPEAKER_01]: So you can search for them wherever you listen to your podcasts.
[SPEAKER_01]: Thanks again to Dr. Jane and everybody at RMA and I will talk to you guys very very soon.