Interview with a Reproductive Endocrinologist

Frank 00:02
Welcome to Surrogacy Talk with me, your fabulous host and family building expert Frank Golden. I'll be talking about surrogacy, IVF, and making babies Hello, everyone, for this segment, of course, we have the, as always, fabulous Erika Daybook in the studio. And we actually have a very special guest with us today. We have Dr. Angie Beltsos, the CEO and medical director of Vios Fertility Institute.

Frank 00:30
Hello, Angie.

Dr. Beltsos 00:31
Hi. Thanks for having me.

Frank 00:33
Absolutely. We are so excited to finally have you here in our studio. So first and foremost, just kind of explain to our listeners what you are, what your profession is and a little bit of about your background.

Dr. Beltsos 00:47
Well, first off, we're in this fabulous space set at Golden Gossip. I'm so proud of what you're building Frank. It's amazing. Thank you. I am a reproductive endocrinologist here in Chicago. I have been in practice for quite some time. I would say, oh, my goodness, I hate to admit it, but around 20 years and we have built recently a new fertility clinic called Vios Fertility Institute.

Dr. Beltsos 01:16
And we have a practice here in Chicago with some amazing physicians that have joined us. And we also have Vios St. Louis and Vios Milwaukee.

Frank 01:27
Wow. Congratulations. That is amazing. So let's just kind of dive in here. What is the day to day of a reproductive endocrinologist?

Dr. Beltsos 01:38
Well, that is an excellent question. What do we do all day?

Frank 01:43
I guess the abbreviated version, because you could probably go into it for like hours, I'm sure.

Erika 01:48
And the general would be make life. Somewhere in between that.

Dr. Beltsos 01:53
Yeah. We make babies. And, you know, day to day for us is beginning typically with understanding someone's fertility in the morning. We do a lot of simple blood tests and ultrasounds to either begin the testing process and or follow patients through treatment and as their eggs are developing it, if they're doing insemination processes well, when the eggs are ready we give them a little trigger shot and we may be doing insemination in the morning and or afternoon.

Dr. Beltsos 02:29
If couples or patients are moving on to IVF, then it may involve for us, our day job is retrieving some of those eggs, mixing them carefully with sperm to create baby embryos. And then those little embryos will grow in the dish and once they're ready, transferring them into the uterus.

Frank 02:48
Wow. Fascinating.

Erika 02:49
Then you actually take the sperm and egg and create the embryo. Yeah, that's so cool.

Dr. Beltsos 02:56
Isn't that crazy?

Erika 02:57
That's so cool.

Frank 02:58
Literally creating life, right? So talk to us about patients locating the source of infertility. You talked a little bit about some of the tests. What might those consist of.

Dr. Beltsos 03:10
When you're evaluating someone's fertility there are three important ingredients to making a baby, if you will. We need a healthy egg. A strong uterus and fast swimming sperm. So the initial testing include those three essential points. To check eggs we do a simple blood test and ultrasound. Financial reserve is how much money in the bank and ovarian reserve are how many eggs are in the bank.

Dr. Beltsos 03:39
So by doing three important tests, FSH, which checks egg quality, estrogen, which will make sure there's good hormone balance and AMH which is probably the sexiest of the egg test checks, how many eggs are left from when a woman was born? So every month there are about a dozen eggs that sort of bubbled to the surface. They're like champagne bubbles.

Dr. Beltsos 04:05
So every egg is protected in its own little almost like a little water balloon. So they bubble to the surface and there are about 12. And your body gets to pick one egg to be the egg the month. So it'll say, ooh, I like that one. And that one egg will grow. And when it's ready, it popcorn's out of the ovary.

Dr. Beltsos 04:22
The rest of the eggs for this month would just get washed away. And next month, another set of eggs come down the pipeline. And so many of the eggs that a woman is born with are never used. They just pretty much just dissolve and a few lucky eggs, probably around 500 of the millions you were born with, you actually ovulate.

Dr. Beltsos 04:46
So that one's really important. And you do those blood tests along with an ultrasound. And on the ultrasound you can see the little eggs bubbling around in the ovary.

Frank 04:54
Wow. So it sounds like a serious battery of tests. And then at the end of the day, it gives you a really good idea of the prognosis, right, for that patient.

Dr. Beltsos 05:03
Yeah. And get the pulse of their fertility and at our clinic at Vios fertility, we have the Vios pulse. And so for $99 they can check their eggs, look at the uterus and along with that sperm test to check how many sperm and how fast they swim along with their shape.

Frank 05:22
That brings me to an important question. At what age do you feel a woman should really look into doing something like that to to really preserve her fertility, right? Or at least find out what her fertility looks like?

Dr. Beltsos 05:35
Absolutely. Those questions are often not asked, not asked by the OB-GYN doctor. They're not asked by the patient and they're not maybe asked even by partners where you do want to kind of know where you stand. Do you have a lot of time left as a woman because you are only born with so many eggs, so over time, they disappear.

Dr. Beltsos 06:00
And I think being very proactive about that is very relevant. You might be thinking, well, you know what? I'm not going to have kids for a long time from now. It would be important to say, well, let me just see where the eggs are today, how many eggs I have left? Some couples are going to delay having children, and they may be like, well, we're not quite ready.

Dr. Beltsos 06:22
So from the female perspective, knowing your fertility is very important. We take charge of our careers, we take charge of our education, and it's important to take charge of fertility.

Frank 06:35
Wow. And so would you say like early thirties?

Dr. Beltsos 06:38
I would say early thirties is an excellent time, even in twenties. And then women who are 40 and are still interested in having a child, it still can span all of the ages. The ideal time to preserve eggs would be early thirties or late twenties.

Frank 06:57
Great information. Wow. I feel like that's something women should learn.

Erika 07:03
Well, yeah. I mean I think it would bring people reassurance that they knew that they still had viable eggs in there. And they're they're still fertile because there's a lot of pressure on women starting at my age.

Dr. Beltsos 07:14
I get it.

Erika 07:15
You're making me feel good.

Dr. Beltsos 07:18
Like, take it easy. But, you know, now is the time. If you've got great eggs, they work the best and thaw the best when they're young and strong. So it is a great time to consider, even though you're like, whoa, wait a minute.

Erika 07:33
Right.

Frank 07:33
So that's really fascinating, too, because egg freezing is becoming more popular. So for all of you out there listening, younger the better, right? As your is your word of advice in terms of egg freezing if you had to pick one or two infertility reasons or causes of infertility, what would you say you see the most in your patients.

Dr. Beltsos 07:58
Well there are a couple common ones in the female side of the equation. It could be that someone's not ovulating. That has become more and more common where instead of getting a period once a month and ovulating, they skip periods and that most commonly is due to polycystic ovarian syndrome or PCOS. Another really common one is tubal factor, where the fallopian tube and there's one on the right and one on the left.

Dr. Beltsos 08:30
Sometimes those can get blocked or scarred and that can also make it difficult for egg and sperm to meet because usually they meet in the fallopian tube and if that tube is blocked, that could interfere. But it takes two to tango and 40% of the time in couples it could be male factor as well.

Frank 08:50
And that brings me to my next question labeling some of the common misconceptions of infertility. And I think one of those being male factor, right? The female component of the relationship might always assume it's on its her that is the leading cause of the infertility struggle but really it's the male factor if you'd like to speak to that.

Dr. Beltsos 09:12
Well you know it is a very important topic and I think it does often get brushed aside and I think it could be done where we do pay a little bit more attention to the sperm and what could be some of the issues. Well, let's talk about working out so heat can be have a negative impact on sperm.

Dr. Beltsos 09:37
And so, you know, hot tubs, Jacuzzi, steam rooms or if people are really into working out, that extra heat can affect sperm parameters. The environment in which we live is one that could be negative to sperm. So plastics where for example, you heat up your spaghetti in the microwave that has fake estrogens in it. And those are not good for men.

Dr. Beltsos 10:06
They've looked at diapers you know, they're great, the diapers that are super absorbent. But you're really wrapping this young testes in plastic and keeping it extra warm. And that has been examined. The EPA looks also at the effect of water. There's a lot more estrogen in our water. They've examined fish and the male fish look more like female fish than they've ever looked before.

Dr. Beltsos 10:31
And and so these I'll call it contaminated waters, genetically modified fruit, all of these products may not be good for sperm production. A woman is born with all her eggs. A man is not born with sperm and he has to make sperm. It takes about three months for the baby's sperm to become an adult sperm. And so it is anything that can affect a man physically.

Dr. Beltsos 10:59
He has a fever. He stayed up all night working on a project. He ran the Chicago Marathon. Any of those physical factors can impact sperm production. And they did a really interesting study of fertile men. So guys that have children and they said every month for one year, give a sperm sample and the numbers were all over the map.

Dr. Beltsos 11:20
There were times where the sperm looked terrible and the shape was off or it wasn't swimming very well or the numbers were really fantastic. So this very dynamic number changing. It's a little bit like the stock market bouncing up and down it. You'll see a lot of that with with sperm testing. So a lot of times if you come and see a doctor for sperm testing, they're going to have to do more than one sample because of that noise.

Dr. Beltsos 11:46
That's very typical for a guy. What about the anti-aging? You know, a lot of couples have gotten remarried and sometimes you're on baby number two with a new partner and sometimes it's the aging fox. So you know, the silver fox, as they say, you know, men who are 50 do have continued to make great sperm. But the risk of having psychiatric disorders now has been shown to be slightly higher in men over 50.

Dr. Beltsos 12:19
And finally, in anti-aging, I was starting to say some guys want to take the testosterone you see among the billboards, the low t testosterone will drop the sperm count dramatically, even to take it to zero. So it's a great contraception but they think, oh, it's going to help my sperm. So they take it and that's not a good thing.

Frank 12:38
Wow. So men out there listening, you are a crucial piece of the puzzle and so, Dr. Beltsos, couples out there who are attempting to naturally conceive. At what point would you recommend they need a consultation with with you if they're trying to conceive on their own and they're just not having any luck.

Dr. Beltsos 12:58
As far as time goes? I would say if a couple has been trying for one year and their younger like 36 or younger, then maybe one year, and if nothing has happened to come in, if the time has been six months and you're in that late thirties, early forties, then wait only six months to come in. Other things, though, our you may have had some concerns already in your health.

Dr. Beltsos 13:26
Let's say someone had chemotherapy and they were concerned about their sperm or their egg. They might want to come in sooner rather than later or a ruptured appendix when they were 13. And in that case it could cause tubal disease. So you're like, you know, you're probably more at risk for some scar tissue. You probably should come in sooner rather than later and just make sure everything's okay.

Dr. Beltsos 13:50
And if it is great and if not, then you're kind of not spending that whole month or that whole year chasing.

Frank 13:56
Wow. And again, men out there, you need to be a part of the appointment as well. Very important. Well, great. I just learned so much listening. I'm like, oh, my goodness. I thought I had a basic grasp of things, but clearly not so switching gears here in terms of surrogacy, what is the role of a reproductive endocrinologist in a surrogacy journey?

Dr. Beltsos 14:21
Well, surrogacy is involves a whole team of people. And as much as each individual element is critical, Surrogacy cannot be done, even by definition without everyone kind of holding hands in this process and helping a couple find their way to baby. So from what I do is sometimes I'm in the beginning of that, I may have a couple who's been attempting pregnancy without success, and they're uterus just doesn't seem to be able to either achieve a pregnancy.

Dr. Beltsos 14:58
So the woman may not ever have a positive pregnancy test or she may have had a miscarriage and multiple miscarriages or complicated birth. So in those cases, I may be the source of saying, Hey, you know what? Maybe we should think about surrogacy. Others couples may come from agencies like Golden Surrogacy where they contact you first. They also contact attorney.

Dr. Beltsos 15:21
So a lot of attorneys may be on front of the conversation or psychologists, but wherever they start their journey, we begin by helping number one, check the egg source. So whoever is going to be the person giving the eggs, we want to help navigate the test so understanding the ovarian reserve could be an egg donor or it could be the woman herself.

Dr. Beltsos 15:48
Number two, once a surrogate has been identified, we want to make sure she's healthy and that some of that legwork can be done by her OB-GYN or even the surrogate agencies help look over records and make sure that she's a good candidate. And by law, she must have had have had a baby. But when I come into the play, I'll make sure her uterus is the right shape.

Dr. Beltsos 16:14
It should be kind of like an upside down triangle. We want to make sure that that uterine lining where the baby embryo will land is fluffy, like a nice pillow and sticky like honey so that rascal will land on there. We do infectious disease screening to make sure the surrogate and the intended parents don't have any conditions that could interfere with and have concern about infection.

Dr. Beltsos 16:45
And we also make sure all the important people are part of this, which includes psychology, legal, the agency, the source of sperm, the source of eggs. So kind of bringing all that together. And then once everybody's ready, we give medicine to make eggs grow, collect the eggs, put the egg and sperm together in the dish and create the baby embryo.

Dr. Beltsos 17:08
A lot of times that front part is done potentially at a separate time than the implantation phase. So a lot of couples will do sort of the embryo creation part first. Nowadays, pre-implantation genetic screening, which is PGS, is a very common popular addition to in vitro fertilization. It's not always done, but it allows us to understand the health, the genetic health of an embryo.

Dr. Beltsos 17:40
You say, well, like how accurate could that be? It's about 90%. 90 to 95% accurate. And it looks for things like Down Syndrome embryos that might miscarry. So you can have some of that information with genetic health also is the identification of sex. So we do understand whether it's a female embryo or male embryo, and then those embryos are often frozen to keep them safe.

Dr. Beltsos 18:07
And then we find the surrogate.

Frank 18:10
Wow. That is wonderful. Just listening to you go through that entire process and you answered a lot of my questions, I was going to ask. I was going to know it's great. I was going to ask about the importance of screening for a gestational carrier. And you went through all of it. And so what is one piece of key advice that you always give couples that come to Vios and they're having the consultation with you and you have to tell them that or make the recommendation that they should have a gestational carrier.

Frank 18:38
It can't always be an easy thing for especially the female component to hear.

Erika 18:45
Definitely.

Frank 18:45
Right?

Dr. Beltsos 18:47
Yeah, it is certainly a very big decision for some situations. And when we look at at this process and as some people may already know, I am the mother of a baby from a surrogate and so I had three children naturally. And then the fourth rascal came with our amazing surrogate. But it is a physical decision in regards to if that uterus could not carry a pregnancy or physical in the sense there isn't a uterus, for example, same sex male couples.

Dr. Beltsos 19:29
And then the other side is the emotional element. And for some women it is a really big deal not to be the one carrying. Some of our conversations work around that it really is a means to an end. So if I could, you know, snap my finger and have that baby in my hands and hand it to her, I don't think she would love it any less.

Dr. Beltsos 19:57
Had she,

Frank 19:58
That's a really great way of looking at it.

Dr. Beltsos 20:00
You know, if I said, here's this baby and it's your baby and it's just a blink of an eye as life always is, time goes through our hands like water. And before you know it, it's October in Chicago, you know, but time goes by quickly and I think you have to embrace this process. And one of my patients said you really have to just surrender, you know, and sometimes in life it's important just to kind of let go a little bit and let the process take care of you, too, and help you get to really what you want.

Dr. Beltsos 20:37
You don't really want just to have in those emotional pieces to say, oh, well, there's a baby in my womb. You want a baby in your arms. And if we can get you there quickly and safely and quickly, meaning nine months, I think that is most important to helping a couple find their way through this journey.

Erika 21:01
That's a beautiful way of saying that.

Frank 21:03
It's that's a really great perspective.

Erika 21:05
I've never heard it quite phrased like that.

Frank 21:07
And that's why and that's really why we love that's why we love Dr. Beltsos really so flipping gears here, back to your your career in your profession. What would you say is one of your most memorable experiences in your career so far?

Erika 21:25
I'm sure there's a million. You know what you do.

Dr. Beltsos 21:28
Yeah, that is that is true. You know, we have so many humbling moments in in life and a lot of people have cool jobs to be able to help people have a family. And you take this like seemingly just a piece of dust size thing and you see it under the microscope and place it in someone's uterus. And to see, you know, nine months later, years later, this baby is a tremendous experience.

Dr. Beltsos 22:07
And some of the fun parts are to hear how they told their spouse or, you know, how how this experience led to their family. And I remember one person said they had tried for literally they had been married for 20 years and they had gone through all kinds of therapy and in different clinics. And he said, listen, when I when you want to tell me that we're pregnant, get me a Jagermeister.

Dr. Beltsos 22:40
And so we had done done done and now she comes over and draw her blood, and it's a positive pregnancy test, and she's like beside herself. So she called and told him to meet her for lunch. And she's like, all right, I got you this. And she got this brown paper bag and she hands it to him and he's like, What's this?

Dr. Beltsos 23:01
You got me a Jagermeister it's like lunch. and he's like, No. No way.

Frank 23:06
Zoom in on him. Oh my goodness.

Dr. Beltsos 23:08
And she's crying and he's crying. And he's like, no, it's just like, yes.

Erika 23:15
I have goosebumps.

Dr. Beltsos 23:17
It was that was one of so many fun stories. And I got to put my

Dr. Beltsos 23:23
little

Dr. Beltsos 23:24
Beatrice as an embryo into my surrogate.

Erika 23:27
Whoa!

Dr. Beltsos 23:29
Which I wasn't expecting. And my doctor said, Well, why don't you just do it? And I go, really?

Frank 23:34
That's something I always wondered but I didn't know how to ask. I was always wondering, like, so do her own embryo transfer.

Dr. Beltsos 23:41
I touched my little Beatrice. I put her in her uterus and I dropped her off and I said, All right, good luck in there.

Dr. Beltsos 23:50
Good luck. Stick!

Frank 23:52
My goodness.

Frank 23:53
That's so special.

Dr. Beltsos 23:55
It was so crazy. It was amazing. I was like, That was a pretty cool experience, too.

Erika 24:00
Really cool. Now, does your daughter understand that yet or not?

Dr. Beltsos 24:05
She's two.

Erika 24:06
Oh, then never mind.

Dr. Beltsos 24:08
And we and we talk about Miss Jodie and Miss Jodie if you're ever listening to this, we love you. So we talk about her and I say, you know, Beatrice, you're in Miss Jodie's tummy. And she goes, Miss Jodie? I go, Yeah, she was. I love her. I go good!

Frank 24:25
That's so sweet. Oh, my goodness. I just love hearing that. So two more questions. Really, and then what I'd like to know is first, what would you say is the most challenging part of what you do and then the most satisfying part?

Dr. Beltsos 24:46
The most challenging is when you're working so hard and everything seems to line up and it doesn't work and you know why a perfect, beautiful, A-plus quality embryo that's PGS normal in this perfect uterus in a surrogate and you got nothing and you're like, Oh, and then there's the other side where you're like, Oh, this embryos kind of, you know, not looking so great.

Dr. Beltsos 25:13
And the lining looks really thin. And you put it in, you get a baby. So, you know, in order to do this, it requires incredible science.

Dr. Beltsos 25:24
Cutting edge clinical medicine and then the miracle of life, you know, and they all come together in not so clear, mysterious sometimes ways. So I think that sometimes continuing to push this envelope and try to find new ways to help a couple have a family.

Erika 25:48
You know, Frank's personal story, I'm not sure if you're familiar with it, but Silas was very difficult to conceive.

Frank 25:53
Oh, absolutely.

Erika 25:54
And we were talking about how there is a very it's very science scientific, obviously, but there's also this very spiritual component to it and that maybe those embryos failed because Silas was just meant to be here.

Frank 26:06
I always tell people that I can.

Erika 26:07
I can't imagine life without Silas.

Frank 26:08
Yeah. I always tell people I think it's like 80% science and 20% just pure magic.

Erika 26:14
We don't know how that all works. No. Just failed embryo transfers until Silas stuck. That little embryo stuck.

Dr. Beltsos 26:21
Right. But truly like, you know, when you find your partner in your life and and you're like, oh, it was supposed to, you know, as things happen, whether it could be a job, it could be your love, it could be this child. But sometimes you got to let life happen. And what I hate to be to say, oh, it's meant to be, but sometimes what's meant to be will find its way.

Dr. Beltsos 26:47
Though I strongly believe that we have a hand in our own you know, blueprint and and our where where we want to change our path. But I think there's that element of he was supposed to be here.

Frank 27:02
Yes, absolutely.

Erika 27:04
Exactly.

Frank 27:05
So any additional advice that you'd have for our listeners.

Dr. Beltsos 27:11
Don't give up. That's we have the ability to guarantee you a baby. Now, it might be your egg, might be a donor egg, might be donor sperm, might be a donor uterus. But the technology is here to help you have your family so most couples that stop treatment and are not successful are people who leave us before we get a chance to complete our work and help you have your family open your heart and your mind to the possibilities that are exist in in front of you and just brush yourself off if you've fallen down and continue to have just a little bit more courage and encouragement to keep going because if you want a

Dr. Beltsos 28:04
baby, if that's important to you, don't give up.

Frank 28:09
That is amazing advice, right there, right? Nothing else needs to be said about that. Don't give up. I really love that. Dr. Beltsos.

Erika 28:17
Especially in this day and age, there is.

Frank 28:18
Just don't give up. So I really think this podcast has been very informational and insightful and we really had a great opportunity to hear about your profession, your career, your background.

Erika 28:32
We're so grateful you were able to make it in, Dr. Beltsos. We scheduled this a long time ago. She's a very busy woman and was gracious enough to make time to come into our office. And we're really thankful.

Frank 28:44
And I really think you provided some really great perspective, and insight into what you do. And we really dabbled in in a little bit of everything, right? Egg freezing, surrogacy, those of you out there who are listening, if you'd like Dr. Beltsos to really hone in on a specific topic write to us, send us your your requests at [email protected].

Erika 29:06
So basically Frank is saying we'd like to have Angie Beltsos back again.

Frank 29:09
Oh absolutely.

Erika 29:10
If possible.

Frank 29:12
If possible, yes. But once again, Dr. Beltsos thank you so much. It's been an honor having you here in our studio today. Once again, everyone, we've had the honor of having Dr. Angie Beltsos the CEO and medical director of Vios Fertility Institute locations in Chicago and

Dr. Beltsos 29:32
St. Louis and Milwaukee.

Frank 29:33
St. Louis and Milwaukee. Again, congratulations.

Dr. Beltsos 29:36
Thank you. And congratulations to you this place is amazing. And if anyone needs any assistance in surrogacy, call Golden Surrogacy. That's my plug for you. But he's a he's an amazing professional and contributor to building families. And it is really an honor to be here with you. Thank you.

Frank 29:56
Thank you. Thank you so much. And thank you, everyone out there who's listening. And as always, please be sure to follow us and we're on Facebook, Instagram and Twitter. Thank you.

Erika 30:07
Thank you.

Frank 30:08
This is Frank Golden, reminding you that Everyone Deserves a Family.