Hello Sunshine, Hey Bessies.
Today on the bright Side, economist Emily Oster is back with more data driven insights on parenting, and today we're diving deep into a groundbreaking new research on fertility.
It's Wednesday, March fifth.
I'm Simoane Boyce, I'm Danielle Robe and this is the bright Side from Hello Sunshine. Okay, it's a new month, which means it's time for a brand new pick for Reese's Book Club.
Yes, Big News.
March's RBC pick is Broken Country by Claire Leslie Hall Well. This book is all about young love and how it can shape future generations. Set in rural England, this story explores questions of morality and past lives as the characters meet, fall in love, and find each other again later in life. It's been called an evocative, sensitive and compelling novel. Well, today, our love story with data driven parenting expert Emily Oster
continues and she's back talking about fertility this time. According to the CDC, just over thirteen percent of women will have difficulty getting pregnant and just over twelve percent of women will turn to fertility services. And these aren't just statistics. I'm sure everyone listening knows someone who has had difficulty on their own fertility journey or has had difficulty conceiving themselves.
And as if navigating that journey isn't hard enough, there's so much conflicting information out there about fertility. I know so many women who struggle to determine where to turn, which doctor to go to, where to find sound advice, and that in itself adds a whole nother level of stress and frustration. So joining us today is everyone's favorite parenting expert, Emily Oster. Emily is an award winning economist, professor of Economics at Brown University, and a New York
Times bestselling author. She's also the founder and CEO of parent Data, a data driven guide to pregnancy, parenting, and beyond. We have marveled at her parenting advice, and just recently her site, parent Data published over seventy five articles and started a new weekly newsletter where they explore all things fertility, everything from IVF basics to donor conception and even exploring fertility help for queer families.
We are thrilled to have her back on the show, so let's get her in here. Emily Austur, Welcome back to the Bright side.
Thank you for having me back. I always love to see you guys.
Oh, it's so good to see you. Too. Happy to have you well.
Emily, you are such an essential voice in the parenting space. You focused on parenting for decades, but with this new research, you're specifically focusing on fertility, and so many people have questions about this. So what are some of the biggest questions that you set out to answer about conception?
Yeah, so with this.
New vertical and parent data, we were really set out to try to answer like three buckets of questions or sort of serve three buckets of things. One is for people just starting in their fertility journey, you know, just the basics of like how exactly does this all work?
And this is the one that most motivated by my experience.
I remember when I started to try to get pregnant, Like that was actually the first.
Time I really understood how the menstrual cycle worked.
And like, fair enough, maybe I should have understood this before, but like it was all really new, and there was a lot of stuff I wish I had understood about when in the cycle you can get pregnant and just.
Like exactly how it goes together.
And then there are a lot of people who are struggling with infertility in various ways, and when we looked out at that landscape, it seemed like it's hard to get unbiased, data based information about some of the basics
and then some of the more complicated questions. And so there's kind of serving people who are just starting here and then trying to help people navigate when things don't go, like when you expect they don't go, like two months in you're pregnant, but you really want to know, like what are my options?
What are the things that I could do? What would help, what would not help. So that's that's the goal going into all of this, is to answer those questions.
Infertility seems like such a broad word. This may sound like a simple question, but how is infertility diagnosed?
So it's not a simple question. So there's like two different questions.
One is, you know, when do we start thinking about asking about fertility. So for people who start to try to get pregnant, if the woman is under thirty five, you basically want to try for twelve months and then if that hasn't worked, seek help.
If people are over.
Thirty five, that tends to shorten to about six months. So that's not a diagnosis of infertility. That's just the question of like when would you want to start seeking help. In terms of like how infertility is diagnosed, it's actually
a much more complicated question. When you go into seek help, your doctors will do a bunch of tests for ovarian reserves, you have eggs, they'll do tests on sperm and ultimately sometimes there's something that can be directly diagnosed, like low sperm count or not having enough eggs, and sometimes it's just unexplained infertility, which just means you're struggling to get pregnant.
We don't really know why.
How many women are affected by infertility?
Yeah, so it's about one in five women are affected by infertility. And I think people find that very surprising in part because until you want to get pregnant, usually you don't want to get pregnant, right, So I think we spend so much time in health class in sort of the education we give people about fertility, so much of it is spent on how to not get pregnant, And it's easy to conclude from that, like, well, when I want to get pregnant, it'll be easy, Like I've
been investing so much in not getting pregnant. It must be that when I stop doing those things, it will happen right away. And I think that's that's not true for about one in five people. And we don't tell kids that certainly don't tell adults that much.
So why is it harder for some people to conceive than others? Is there anything to the genetics of fertility?
There's almost always a genetic explanation for most things. There are some things we know matter for conception, the age being the most significant for women in particular. And then there are some conditions that people can have that make it more likely that they will struggle with infertility, like pea cause or endometriosis sort of, some some kind of uterine and other conditions that will make this more difficult.
There are some known conditions for men are surrounding sperm count, but a lot of infertility is unexplained, and that correlates within family in ways that suggest that there are some genetics or some genetics and epigenetics.
But isn't that you could say, you know, here's the genetic code that tells you whether you're going to be fertile or not. We just like many things, know that there must be some some genetic.
Component when it comes to fertility testing, what does that process usually look like.
So there are a few very common things that will happen in infertility testing. So if we sort of think in general, there are like things that could be a problem with the woman and things that could be a problem with the man.
And so one way I think.
About it is, you know, in order to have a baby, you need eggs that are high qualities firm that'shih quality, a phallopian tube so the egg can get into the uterus, and a uterus where the pregnancy can grow. And when we think about diagnosing infertility, you want to they're going to try to evaluate each of those things.
Some of those are easier to test than others.
So testing for sperm, for sort of viable sperm is not that hard. Ejaculated to a cup and then you look at it, and you want to look at the sperm, and you look at how fast they swim, and how many of them there are, and what their heads look like. Sometimes there are problems where this heads are very pointy. They're not supposed to be a pointy close to be around. So male factor in fertility is something you could see. It's also possible to see, you know, do you have
a functioning fallopian tube? Is the uterus a shape that you are the issues with the uterus. The thing that's most difficult to diagnose and is often where people sort of stop and then we don't really know is egg equality. You can get some sense of counts of eggs, and there are some hormone tests that will give you a sense of how many eggs someone has, but how many eggs is not self the same is how good the eggs are, and it actually itself is not necessarily a
predictor of fertility. So those are the things you will be they will test for, and probably unfortunately, the one that you would most want to know about, which is egg quality, is something we can only see pretty indirectly.
We'll be right back with the Emily aster, and we're back with Emily Ooster.
Emily, I froze my eggs a year ago, a little over a year ago, and it's become a huge topic among my peers. And in a parent data story you recently published, I saw a statistic that I was shocked by, to be honest, there was an eight hundred and eighty percent increase in egg freezing in the US from twenty twelve to twenty sixteen, and that number is just climbing, so almost a nine hundred percent increase. So before I
froze my eggs, I did a lot of research. And the problem is is there's actually not that much research around because it hasn't been around.
For that long.
What does the research say about the longevity of frozen eggs and their eventual viability?
We don't really know, I mean the eventual viability. You know, we can see numbers like seventy to eighty percent of thought eggs we expect to fertilize, and about sixty percent of those we grow into into embryos. So one number that we quote in one of these articles is, you know, each egg has about a seven percent chance of becoming a live birth.
But those numbers are based on.
Small sample sizes, based on pretty old data, and some of the questions you want, like okay, well if I leave over five years, is that okay?
What about ten years?
Like, we really don't know, because this hasn't been around for long enough, not enough people have actually tried to sort of go through to the end of the of the eggs reising and see what happens.
I read a New York Times article a few years ago that said only three percent of women who freeze their eggs actually go to use the eggs, which is very low.
So I think one of the things that happens is if people freeze their eggs when they're young. If you've read how Old, can I ask how old you are?
Yeah?
Yeah, I like thirty three when I froze them.
So you know, say you then have a partner, you'd sort of start you're thirty six for thirty seven and you are interested in having a kid. Most providers would tell you at that point you should start trying to have a baby in this X way and see what happens. And for a lot of people freeze their eggs, that ends up being the way that they that this works out.
Because of course, the process of defrosting eggs and fertilizing them and implanting them is a full on IVF process, which is a much bigger deal medically than sex, and so people will try and then often that does work for them, and then they.
Don't end up using the eggs.
So I think there's a sort of like it's it's insurance, but it's not even if you had frozen eggs from when you were twenty six and you were thirty seven, they wouldn't tell you to start with the twenty six year old eggs.
So this is anecdotal and not data supported.
But I've had several friends who are five six years older than me. They froze their eggs around the same age I did, and then when they went to go dethaw them, none of them worked.
And so I have this.
Very complicated feeling around egg freezing right now, because I while I'm grateful that it exists, I'm not sure that the science has really like caught up with where providers are telling people it has.
Yeah, I think that's that's right.
Like a lot of things in this space, we sort of tell people like, oh, it's insurance, and then you know, you'll just have it and when you need it.
It'll be ready. And it's like, that's actually not necessarily true.
And I just share that because I think people should know.
Yes, I think people should know that, And I think part of what's hard is you don't exactly know what, like it could it could work.
It certainly like it certainly has, and you don't want to.
Tell people this will never work because that's not true, and how we don't have the data to give people really precise answers to what is a chance that you know you will get these idita will vary across people.
So for those who are interested in attempting egg freezing, what does the research tell us about how we can maximize the results of the procedure. I know that you mentioned earlier that age is the number one determinant of fertility or infertility? Is that true with egg freezing too? What's the ideal age? The ideal age is an interesting question. So when people do like research on like what.
Is the the most cost effective age of freezing eggs?
Actually pretty old. It's like thirty six or thirty.
Seven, because the idea is like you could freeze them at twenty two, but the chance you would need them is pretty small because there's a long time between twenty two and you know, when your natural fertility ends, there's like a long time to need somebody and try to get pregnant the sex way, So there's more push to kind of freeze eggs a little bit later when it's more likely that you would use them if there were sort of no constraints, and egg freezing wasn't a somewhat
involved physical process. You would ideally freeze them when you were as young as possible, because the number of eggs that you will get for a stimulation cycle and the quality of the eggs is likely to be higher because the younger you are, the higher quality are the eggs. So I think there's this trade off, Like it's not just snapping your fingers. I mean, Danielle, you did this. It's not just like you wake up one morning and
pee on a stick. Like it's freezing your eggs is an involved physical process, and like all medical procedures, comes with some risk and discomfort. And so that's why there is a trade off, and we don't just say we'll do everybody twenty two.
There's also this like unexplainable element of it. I was thirty two when I thought I was going to do it. I did all the tests and I ended up waiting. But I had more viable eggs at thirty three than I did at thirty two, which is weird.
Yes, and also basically impossible, and suggests that there is a like that's that's on.
The way eggs are.
Like, I think this is a good illustration of some of the noise in this process. So you had a test, presumably some kind of AMH or like AMA, some kind of hormone. You had an AMAH test, and the AMH tells you something about the number of eggs that you have, doesn't tell you anything about the quality of your eggs, tells you about the number, right, And it's noisy, and so that means you know, you're testing at thirty two and thirty three. You can't have more eggs at thirty three than at thirty two.
I'm sorry, Like it's they only go down over time. It's not like sperm. We're making sperm all the time.
Eggs you only get the once and so it can't be that they went up. It just means, like the data is noisy or something else, that you did change this this hormone level for you.
Oh, that's so good.
Well, speaking of sperm, I'm curious about what the research says about fertility as it relates to sperm, because I've heard recently that a lot of women think that they're infertile and it's actually the sperm, and we're not testing that as often.
Actually, something like thirty percent to half of couples with infertility. It is male factor in fertility, So there's something wrong on that side. I think part of why we don't hear as much about that is that it is actually more treatable. So it's part of why it's such an important thing to test. Because there are many things you can do to improve sperm quality different from what you do to improve egg quality. So your eggs are kind
of what they are sperm. If you're like I don't have enough sperm, there's actually a bunch of lifestyle changes that people could make that will potentially have large impacts on sperm in a relatively short period of times. The sperm's made over like a two week cycle. So like if you wear very underwear, or you like bike a lot, like Mountain bike a lot, your testicles are hot.
Sperm doesn't grow well.
With hot testicles, so like, just stop making your testicles so hot is like a good piece of advice. And then people smoke, You smoke a lot of marijuana, you drink a lot. Actually those things will also like lower
the quality of sperm and number of sperm matter. So you know, male factor in fertility definitely shows up, but there's a bunch of things we can do, and even if you don't have that many sperm, you can like take them out and spin them around and put them in closer to where they would find the egg, so that it's like it can be a more tractable problem.
I heard on TikTok that this girl was saying, yeah, I know, oh God is right, but debunk this.
I heard on TikTok that.
Potentially how women feel in their first trimester has something to do with sperm.
Is that true at all?
No, there are actually some interesting things about the sort of interactions between like the parent and some pregnancy complications. Actually, Like, so pre clampsia is like less likely if you switch partners, but like if you were a pre clamcy at a first pregnancy and then you switch to a new partner, like the risk is lower. It seems like that has something to do with men. But I do not believe that it.
Is the case that you're sorry, No, Well, I have several friends who are contemplating using a sperm donor, So what are some factors that they should consider before making their selection.
Yeah, so this is an issue that comes up for both couples where there is a male partner but they are not able to produce sperm, or more commonly, when there is no male partner in the couple or there's no couple, and the choices here we have on parent data a number of really great pieces written about this choice. One piece of this choice is do you want to.
Know the person or not?
And that's actually not so much a data question but just a like basic question of like is that you know anonymous versus known donors are a different experience, and some people want to have a relationship with the donor and some some people do not.
So that's kind of the first important decision, which also has a cost element. So sperm is expensive.
It's like fifteen hundred dollars a vial, and you know that's not as expensive as IBF, but it is expensive, and a known donor will often give you their sperm for free, and you can get more bites at the
apple with the donor. So the question is really like in some ways, it is somewhat easier in the moment to have a known donor because you can have this ferm right away self and Semite do it a few times in a month, increasing the chances of it happening you don't have to buy the sperm, but there are complications down the line depending on what kind of.
Relationship you want to have with the person.
We'll be right back with Emily Oster. And we're back with Emily Oster. One of the greatest articles I've read on parent data was about the impact stress has on fertility, and I think this is a really interesting connection. What does the data say about stress and infertility and is it at all a myth?
So this is I would say, like one of the most common claims that things that you hear about stress and infertility, and I think it's it's also one of these like very frustrating things that people hear because it's like I'm struggling to get pregnant and then I'm stressed out about that, and then it's like, we'll just relax. Did she just relax? Like just relax, and it's like the stress is making it worse. It's like, well, but now I'm stressed and I'm stressed because that's making it.
That's making it worse.
So you know, it's a hard, hard question to answer in the data.
We have a little bit.
Of evidence from some meta analysis data that suggests that there's a small association between sort of stress and IBF outcome, which is the kind of simplest way to study this because you know, people are trying to get pregnant. But the effects in these studies are mixed in their size
and generally on average very small. There are, of course, some like very extreme things when people are very extreme stressful situations in which they don't have enough to eat, or there's like you know, kind of like large scale physical stresses on the body that can impact fertility. But if we're talking about like being anxious, being stressed out about things in your life or about the fertility, at most those effects are very very minimal.
That actually is really wonderful to hear.
No, really, because when I was going through my egg freezing process, everybody was like, you need to do acupuncture and make sure you're not stressed. And it's like, it's so hard to be going through that or IVF and function in your life and then think, oh, I need my stress levels down.
It makes you more stressed.
Yeah.
I think what's really hard in this space is we want there to be things that people can do because there's so much loss of control, particularly in fertility treatments that you know you in some ways, you kind of wish you could say, well, if you only did these six things, you know, it would work better. But for the most part, there isn't a lot of data suggesting that those things are helpful.
And I worry that when.
We tell people about those things and then they're not doing them, then that stresses them out. And even if that doesn't impact fertility, to make your life worse. Yes, so it might almost be better to say you don't have that much control over this process, and you know the main things you can do, or pick a doctor that you're comfortable with, and then it's largely out of your control.
Yeah.
Well, in this vein, there was a question that was posed on parent data from a woman in her forties. She'd been trying to conceive for almost three years, and she asked what she could do to improve her egg quality.
Is there anything that she could do?
There is really nothing that we know of that can improve your egg quality. It is mostly your age. So eggs decline with age, they acquire chromosomal issues, which makes it more difficult to conceive. There are a lot of things people are told about their egg quality. Coenzon Q ten is like the one I hear the most about, and in some ways there's no reason to think that would be harmful, but the data on these is not very compelling and certainly does that suggest any sizeable or
significant effects. And again that like, that's so frustrating as a message.
Emily, you have this gift for making inaccessible information more accessible. You've created these guides for queer couples who are trying to build their family outside of traditional family structures. And I'm curious, what are the most common questions that you get from queer readers, like how do they hope to see themselves reflected in these topics?
I mean, I think the set of questions that that queer readers are facing in the fertility space are I mean, actually many of them are the same, and then some of them are different. And I think making sure that people's experiences are seen is one of the things that we think a lot about at parent Data and something that I think a lot about because, you know, I because I want whatever is the information we're able to translate. I wanted to be out to as many people as possible.
And Maria Goodman, who did a lot of the writing for us in this you know, they work with a lot of couples who are going through this, and so that was like very useful. They were an amazing resource for trying to figure out what people are, what people are asking. I think the big questions there are just in some ways that choice set is much larger at
the top. So if there are two women in the couple, you have to figure out how to get sperm, but then one person could carry, the other person could carry.
There are options for reciprocal.
IVF if you go through IVF where it's somebody's eggs and somebody else is the carrier, So like the range of choices are much larger. If there are no uteruses in the relationship, then there is this question of adoption versus a gestational carrier, question of who's ferm to you is a question of where to get eggs. So there are a bunch of pieces of logistics, each of which
are also surrounded by some emotional valance. And what those pieces in the parent data really try to do is talk people through here are the choices, Here are the things that you're going to face. Here are the things you're going to want to think about so you can make good decisions and here's some data that you might incorporate in your choices. But I think it almost is starting with like, where does one start with this set of questions?
Emily, I want to do a little factor fertility myth with you.
Okay, let's do it.
True or fall Certain foods cause infertility? False, You shouldn't consume caffeine while trying to conceive.
False.
When trying to conceive, it's best to have intercourse every other day.
It's very important to hit the day of ovulation or the day before because those are the highest chance of getting the sperm to be waiting for the egg when it arrives in the Philippian tube.
Sometimes people will.
Hear you don't do it every day because the sperm there's like less sperm, but that is not well supported by data.
Sperm comes back within about twenty four hours.
So if you want to do it every day, that's fine, But doing it every other day is also fine.
Okay.
Prolonged use of birth control can affect fertility.
There is no evidence that prolonged use of birth control effects fertility.
Like all these answers, how about timing of conception during ovulation? How does that potentially impact the gender?
If at all, it does not impact the gender.
So many people have the perception that male sperm is fast but dies soon and female sperm is longer lasting. And so if you want to have a girl, you should have sex further away from ovulation, because then only the girl sperm will be left. And if you want to have a boy, you want to have sex right at ovulation.
This is a myth.
It's called the Shuttle's method, and it does not work. It does not result in having more boys or more girls or anything like that does not work.
So that's not a way to impact the gender of your child.
Okay, setting all the data aside for a second, which I know you love to do, right, that's like your favorite thing is just ignoring the ignoring the data. Yeah,
it's like totally ignoring the data. But if we were to do that for a second, I know that you encounter people who are experiencing the human side of this, the human toll of this, right, like the pain of month after month not being able to conceive and throwing their hands up and trying to understand why, why me, why is this happening or why is this not happening? What would you say to someone who is struggling to get pregnant and feels hopeless.
I'm so sorry that you're going through this, and I hope that it resolves in a way that makes you happy. I mean, I don't think there is very much. I think it's a very strong temptation in a setting like that to be like it's all going to be great, it's gonna like it's totally gonna work for you, and
I hope that's so much for everybody. But I also think that when we are talking to people about what they're going through, particularly when there's a lot of grief involved, to just say like, I see that you're doing this, and I'm so sorry that this is happening for you, and I hope that better days are ahead.
I love how Brene Brown talks about grief and not looking away from someone's pain, like look them directly in the eyes and sit in the pain with them.
Yeah, I mean, I think that's like, that's true for so many kinds of grief. And I think that that we sometimes don't think about grief as much in this fertility space. But there is a real I mean, there is real grief, particularly and an infertility and it's the same, the same grief. That's the experience and loss, and you know the kind of same way. Telling people, oh that
you know they're in a better place is not very helpful. Yeah, saying you know, I'm sure it's gonna all work out or worked out for my friend, you know, she did fourteen rounds of IV aff like that. That's not helpful to just say, you know, hey, like I see you and I am sorry.
Emily.
For those who want to learn more, you have this great weekly newsletter set up for anybody navigating fertility treatments or family planning. Where can they subscribe and how can they submit questions to parent Data?
So if you go to parent data dot org, we have a section on trying to conceive and in that section we have all of the content for the next couple of months. It's all free, and there is a newsletter of Lane there where you can sign up to get the newsletter, and there's a question box where you can ask your questions.
So Paradata dot org trying to conceive, that's your answer.
Thank you so much.
Oh, thank you guys. This is awesome.
Thank you, thank you so much, Emily.
Emily Austur is an award winning economist, Professor of economics at Brown University, and New York Times bestselling author. She's also the founder and CEO of parent Data, a data driven guide to pregnancy, parenting.
And beyond Tomorrow.
People Magazine Special Projects Director Andrea Labenthal is back. This time she's giving us the scoop on spring trends. Join the conversation using hashtag the bright Side and connect with us on social media at Hello Sunshine on Instagram and at the bright Side Pod on TikTok oh. And feel free to tag us at Simone Voice and at Danielle Robe.
Listen and follow the bright Side on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
See you tomorrow, folks, Keep looking on the bright side.