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Bill Klaproth: This is a special edition of Fertile Edge by Reproductive Science Center of San Francisco Bay featuring as host Dr. Michael Homer.

Michael Homer, MD, REI (Host): Hello everyone. This is Michael Homer and I'm a reproductive endocrinologist and fertility doctor here at Reproductive Science Center in the Bay Area. This is our podcast Fertile Edge. Today I want to do my first podcast with a patient, a very special patient today. Her name is Jamie Silverman. I’ll let her introduce herself.

Jamie Silverman (Guest): Hi. My name is Jamie Silverman, and I am now the very proud mother of a baby girl. I couldn’t have been more happy with this whole process or my treatment here at the Reproductive Science Center.

Host:   Yes. You can't get better than them.

Jamie:  Nope.

Host:   And we’re done. That was great. No, I'm just kidding. Okay. So Jamie came to me two years ago. Something like that.

Jamie:  Yeah. It was April of 2017.

Host:  Okay. Okay. So how old right now is your child?

Jamie:  16 months.

Host:  Right, okay.

Jamie:  Yes.

Host:  Yeah. So that makes it about right. If you do the math, that sounds about right. So about two years ago. Okay, alright. So I always have a patient for questions that I sometimes I want to ask, but it’s good to ask after the fact. So what the hell made you want to do this? Is this like a lightning bolt? Is this like a gradual thing? Friends? I don’t know.

Jamie:  Honestly it was a lightning bolt.

Host:  Okay.

Jamie:  So I was thinking about it for the longest time but never truly acted. I went to a Mexican restaurant with my parents and they just sat there saying, “What are you waiting for? When are you gonna actually do it? When are you gonna become a mom? What is it? What do we have to do? Like what’s going to be the deciding factor? You're financially stable. You have a great career. What? What do we have to do? You have us. Come on. Do it.” That’s what made me just look and see about getting my fertility checked.

Host:  Okay.

Jamie:  I found Reproductive Science Center and you offer that. It just stemmed from there.

Host:  Oh my god. Was there like…Oh, that’s awesome. That you're mom’s like on it. We all know the parents want to be grandparents.

Jamie:  They do.

Host:  But to be bluntly is great. Okay. Especially at a Mexican restaurant.

Jamie:  At a Mexican restaurant.

Host:  Okay. So when you started, I mean you had to have had some fears, right. I mean you had to have something. Or maybe not. Maybe I'm assuming something here.

Jamie:  I mean the biggest fear is that it’s not going to work.

Host:  Okay.

Jamie:  Is that you're gonna go through it and you're not gonna have a child at the end. Like I wasn’t afraid of anything else except that.

Host:  Okay, okay. Yeah. I guess there’s real no way to know until you find out, right.

Jamie:  Right. Yeah.

Host:  Okay.

Jamie:  I mean that’s what made it unique. I had no idea if I had fertility issues. I had no clue.

Host:  Because you hadn’t tried.

Jamie:  Right.

Host:  Yeah. That’s actually a key thing too is that I think a lot of women, that’s a thing for us to know too is that when they come in, when we see them, usually not having a history is actually a good thing. I mean everyone comes in my office and most people come up and say, “I have a history of trying and not being successful.” When a woman comes in and they haven’t tried yet then it’s a grab bag. It’s a wild card. It actually tends to work in your favor in terms of just what the numbers look like and everything.

Jamie:  Yeah. But then that’s what’s also my question back to you. That initial meeting. Could I have been more prepared with information you would have needed versus the clean slate of I don’t know if I have fertility issues. I just want to be responsible and have a child in the right way. Versus having a whole history of infertility issues coming to you.

Host:  Ah, I see your question. Actually so I would say that there are three blood tests that one can get in the very beginning of their cycle. Their OBGYN or doctor can order that. We also order it ourselves but having that at the first get go is great. So ovarian reserve is a very important thing to know. So that is AMH, which is a blood test that can technically be drawn at any day of your cycle, but however day three is also fine to save on blood tests. Because two other blood tests—follicle stimulating hormone, FSH, and estradiol—those also have to be drawn on your second or third day of your period. Those three tests, plus an ultrasound that I can do in the office, will give me a really good idea of your ovarian reserve. That helps us from that part.

Also if you know where you want to get the sperm. So in that particular sense we have sperm banks and known sperm donors. So if someone has an idea for a known sperm donor, that is usually a really good conversation to have before you come in to see me. Because getting a known sperm donor going and being FDA legal and all of that takes like two plus months. So sometimes patients come in and say, “Well, I have this person in mind, but I haven’t asked them yet.” Well that person sometimes needs a couple of weeks or months I've seen to get their head wrapped around it to say yes. So doing that ahead of time, those two are things.

Now, you don’t have to have those done. We can do those for you, but that’s usually the easiest thing. Okay. Yes. So now, your story though…Like did you assemble a support team for yourself? Like clearly your parents.

Jamie:  Clearly them.

Host:  They better back it up.

Jamie:  I feel like my friends already were going to support me and they were just pushing me to do it now.

Host:  Really.

Jamie:  So my two best friends had kids of their own and they wanted that for me. So they were just like dropping little hints. “Anytime you need. Anything. We’re there. We’re there.” Sure enough they have been. So it’s like it just naturally formed. I didn’t even need to go out and ask. They were just already there.

Host: Now, I've had patients who have been single parents by choice who have actually struggled a little bit because they have their friends coming up to—It’s almost like being overly supportive. Like too supportive. Like in the sense it’s almost like pushing them to do it, but the person may not feel kind of quite ready or something. Like did you ever experience any of that with your friends at all when it was just all nice and positive and you were all on the same page?

Jamie:  Oh yeah. I mean I wasn’t ready when I was in my late 20s or early 30s when they were having kids.

Host:  Okay.

Jamie:  It wasn’t until much later when their kids were much older where they're like, “Okay Jamie. You're like 39.” I was like two months shy of being 40 when I came here.

Host:  Okay.

Jamie:  So that’s kind of what triggered it. I had to also be ready and feel like I'm stable enough that I can do it.  

Host:  Yes. That is obviously a huge factor as well. The other thing though is that your story had a bit of a twist.

Jamie:  A couple.

Host:  Okay. So you can say it. Just the story.

Jamie:  I can say it?

Host:  Yeah, yeah. I mean just because it’s easier.

Jamie:  Yeah. So we tried a few IUIs.

Host:  Right.

Jamie:  We went with simpler first because I didn’t have any known infertility. So let’s not go super invasive to start.

Host:  Right.

Jamie:  Then things started to uncover itself.

Host:   How many did you do?

Jamie:  Two.

Host:  I was going to say two or three.

Jamie:  We did two, and then we started the testing and it’s like wow. Maybe there is something going on.

Host: Right.

Jamie:  So through that I found I had adenomyosis or something.

Host: Adenomyosis, yes.

Jamie:  That. Things I’d never even heard of that could have caused it. So it was an eye opener. Then when we really started talking about my priorities with a child, I never once said that I wanted a kid that looks like me. That is genetically tied to me. I just wanted a healthy child.

Host:  Yeah.

Jamie:  It was the eye opener is that well maybe your best approach is not to use your own eggs.

Host:  Right.

Jamie:  So that’s when we decided that maybe the best approach is an egg donor.

Host:  Yeah.

Jamie:  It’s safer for me because I would have had issues during the egg retrieval process, and it was just some unnecessary procedures I might have had to have. So then it was egg donor. That was tough to do. It took me a while to be okay with that. Then when I found the right donor it just kind of clicked. Then we had a couple of surgeries before—well one surgery before the procedure. Then one IVF and I'm pregnant.

Host:  And have a baby. Okay. So I'm always—I have patients in IVF right, and I'm always trying to figure out the best—You do it enough times, you thought you got kind of a good way and a good approach right.

Jamie:  Yeah.

Host:  It can always be better though right. So you went through this. You heard donor egg maybe for the first time. I don’t know if it was a complete shock to you or if it was like a total mind blown situation.

Jamie:  I just hadn’t thought of it.

Host:  Right, right.

Jamie:  Then I'm looking at these websites of these women and I'm like, “Do I want this person?” The good thing is as you can see them as an adult. With the sperm donor, it’s them as children.

Host:  Yes.

Jamie:  So they're less identifiable. With the women as adults you're like, “Why can't it be me?” Why me? Then so I just kind of found this one donor. I read about her and I just kind of instantly felt like I'd want to be friends with that girl. Then that’s what clicked for me.

Host:  Okay. Oh, okay. That makes it…Okay. Now did you have friends help you select.

Jamie:  Oh, I had parties.

Host:  I was gonna say you probably had parties.

Jamie:   Yeah. I had parties. I blasted on the big screen and we just went through everything because my best friend’s a teacher. So she’s just like, “Oh that. That’s nature versus nurture. You want that. You want that about that person.” We just kind of like went through tons and tons of male profiles and female profiles until we settled on it.

Host:  Okay.

Jamie:  It kind of made it like a party.

Host:  Yeah. I imagine that gets them invested. That gets—You can do a lot of things. You need that support, right. You need that help, right. During the pregnancy, at delivery…So, I mean.

Jamie:  Yeah.

Host:  So once you were pregnant, right, maybe even before. What resources did you use to help you kind of make these decisions? Did you have any? Besides your fabulous clinical team.

Jamie:  Besides my fabulous clinical team. There is a lot of great videos on YouTube of women going through this. There’s some books as well. Like women of choice, like women having babies by choice is a very popular topic and it’s getting a lot of publicity. So there's a lot of things you can read about it. Everyone’s journey is different and everyone’s reasoning for doing it is different. I wanted to be as much informed as I can. A lot of that though is what happens after. What happens after the pregnancy, not during or when you're meeting with the fertility staff. So at that point I was just a little lost because those stories happen with couples going through it. There's not as much out there for single people going through that process and what they need or what they may be in for starting that alone.

Host:  When were you scared?

Jamie:  I was scared, I think it was like nine weeks when I started to bleed a little bit. I came in here because you guys were doing my daily injections because I wasn’t gonna do that myself. There was bleeding, and that’s the first time I was scared.

Host:  Okay. Alright. Then how were you…Then during the pregnancy, was there sort of ups and downs while you were pregnant? Like oh my god. I can't get off this train. Like this is gonna happen? Or was it all just like nestled in.

Jamie:  I was like when? Now, now, now, now. Can she come now?

Host:  Not now. It’s too early. Okay, okay.  

Jamie:  Yeah. I couldn’t wait to have her.

Host:  Okay. Then how about like after—So who was in the delivery room with you?

Jamie:  My mother was.

Host:  Okay.

Jamie:  So I think though, I had a doula. I'm very happy I had her because she was my advocate and she was able to help me through this process, which was a little scary. Because for me it was about two and a half days where I'm in the hospital going through labor. So friends were coming in and out, but she was like constant and there. She knew the questions. She knew when. She knew what to expect and how to help me. So I felt like that was—It’s nice to have for a couple, but it was super crucial for me going through that to have her there for me.

Host:  So before this, I delivered kids for seven years. So I work with doulas, I work with midwives. Midwives help train me. When I was in San Diego, we had doulas all the time. I actually had a volunteer doula program.

Jamie:  Oh nice.

Host:  Shout out to UCSD. They had a full on—Like if someone requested a doula and there was usually someone available, they would come in. Doesn’t matter the time of night. It’s free. It was fantastic. That makes so much sense to think of that in that particular situation. I think most people should get a doula. I mean c-section rates are lower with doulas. There’s been good studies on them, but in this particular scenario that makes a lot of sense.

Jamie:  It was really important.

Host:  Yes.

Jamie:  It’s really important to choose the right now.

Host:  Right.

Jamie:  And to know what to ask. I told her. I'm like if you bring out drums or incense or something I'm going to kick you out.

Host:  Like I've had some doulas come in. I'm like how’s the contractions? They're like, “We’re not calling them contractions today. They're surges.” I'm like oh. Whatever. It’s fine, it’s fine, it’s fine. I’ll call them that, but just yes. Every once in a while the room would be fully prepared. Just be careful. The longer your birth wish list is, sometimes it goes off the rails a little bit more.

Jamie:  Oh mine went completely off the rails. It’s because my birth plan was I just know I would like some drugs. Whether or not I delivered naturally or c-section, I am gonna leave that to chance. I just know I would like to have some medicine help me.

Host:  How was that first night after delivery?

Jamie:  So I had some complications after. So that was rough. Like I basically started to bleed out.

Host:  Okay.

Jamie:  So that was kind of rough. My blood pressure like spiked, but a few days after it was great. Because my best friends were in the room because someone had to stay with me. So I always had someone there. I’d wake up and I'm like, “Oh, you're here.” I’d see like my best friend’s just there holding my child and comforting her. So it was amazing. It truly felt at that point these girls were more than just offering to help. They were here helping.

Host:  Wow. That’s fantastic. That’s the story. How’s life now?

Jamie:  Oh, it’s so good. I love it. I couldn’t be more happy. I have to work, but my work is just so tolerant and so amazing. My parents take care of my daughter, and I have a nanny that comes in. So if the nanny can't make it, my parents are there, and they can cover. So I haven’t felt like it impeded on anything I need to do to make us financially stable. When I get home and she’s there and I just see this big smile on her face, I'm just like instantly in love. Everything just like, amazing. It’s perfect. It’s perfect.

Host:  Do you have—And this is almost a slight question, but I feel like do you have a lot of people coming up being like, “She looks just like you?”

Jamie:  Oh my gosh. Completely and utterly. I'm just like that’s great.

Host:  To the audience, you can't see her daughter but it’s really cute. Kind of does look like Jaime, but I think you choose donors maybe that are gonna be in the same…I don’t even know. Was your donor kind of looking like you a little bit?

Jamie:  No. No. She was like an Irish red head. The dad had super dark hair. She’s like a completely fair blonde curly hair, blue eyes. So I'm not sure. I'm not sure.

Host:  So imprinting and epigenetics is a real thing. I'm not gonna say it’s kind of full blown things, but here’s the one key thing is that women—especially using donor egg situation—is that your body carrying actually will turn on and off specific genes. So you don’t, it’s called epigenetics. So it’s on top of the genetics but like on top of. You actually do have the ability to switch things on and off. So you will see traits that get sort of passed through from carrier to the child. Now, the genes are still gonna be dominant. Like if the donor was Asian—Like we’re having a chit chat right. But there are things that one can and even personality traits—obviously because that’s a bit of nurture thing as well—but there are some things that can be switched on and off definitely in utero. So it’s a key thing as well.

Jamie:  Yeah. You know it took three people to have her. I mean that’s pretty amazing, right? Most people just have two. My daughter has three.

Host:  Right. Right, right, right. So I know this is a generic question, but it is important. Like are there two or three things that you feel like that are like…Say someone’s listening right now and they're kind of like, “Oh, I'm interested in this. I don’t really know if this is for me or whatever.” Like what do you think would be like two or three things to sort of focus on to kind of help that decision, that it kind of rides on. You mentioned one before because you said like I just realized I want a child. Like that was a priority. By identifying priorities, I always tell my patients to pick one thing.

Jamie:  Yeah.

Host:  What do you think or feel like are priorities to identify for yourself?

Jamie:  For me it was is my life set up where I can have a child and be a successful mother? The career that I was working on, it wasn’t. Like I was in film and gaming. I was working 70 hours a week. There's no way I could have had a family. So I had to change that. Like I had to reshape my life so I could be as much of a full time parent as possible.

Host:  Okay.

Jamie:  So not everyone has to go through that, but I felt that was important.

Host:  Okay.

Jamie:  I also needed to know that financially I could support her and us.

Host:  Right.

Jamie:  There's a lot of expenses that come along with having a child, and I wanted her to have everything. So I needed to know that I was stable enough that I could do that for her.

Host:  Okay.

Jamie:  Also I was kind of looking at nannies and situations before I had her and before I went through the process because I knew that there's no chance that I'm going to be able to work from home or not have to work and raise her. That wasn’t going to be an option. So I had to look at the situation of when she comes, what is that going to look like? What is the situation with au pairs or with live in nannies or nannies that come in. So I did a lot of research on that to be aware of the cost for it and what the situation looks like because I needed to have a plan when she came.

Host:  Yes. Yeah. I do feel like childcare—as a father of three, right—stable childcare is a huge thing for life stress right. Now hopefully if the nanny can be stable in terms of staying in there for a while. You never know. Sometimes they kind of come and go. Au pairs have a certain time frame, right, but at least they're sort of set and you know, right? But that’s good, right. So making sure that you can support them. Making sure that there's someone there to help you take care of them, I think, is the priority, right.

Jamie:  Yeah.

Host:  Then also kind of like hey, what do I want? You know what I mean? Like when patients come in thinking of single parent by choice, I have some patients come in and they’ll come in for fertility preservation. So everyone—most people—have heard of egg freezing, right.

Jamie:  Yes.

Host:  Like great. I also let them know like fertility preservation is the umbrella term. That includes egg freezing and embryo freezing, right. Embryos are better to freeze. They're a higher chance of success—much higher with an embryo versus and egg because all of the variability that can happen when the sperm and egg meet is kind of figured out now just not in the future. So each egg has a 70% of a child. Each embryo maybe like 60% or more, depends upon the situation that we have. So that’s an easier time as fertility preservation, but it ties you to a sperm, right. So someone has to be kind of okay with that versus freezing eggs for a possible future partner.

Or I've also had patients come in and freeze their eggs. Then maybe like four months later they're like what am I doing? Like no. Like I want a child. So I think right around when you were going out and graduating, as we like to say, another woman was coming, and it was very similar to that. She did egg freezing. It was something like six months later she’s like no. Like yeah, this is what I want to do. So we did IVF and then thawed her eggs and did another IVF round because it was available and that was also successful. Part of also coming in is that I also let patients know freezing eggs, you can also consider pregnancy now. That is put in a situation of single parent by choice. So knowing all of those options, and there's tons of them.

Jamie:  Yeah. There's too many.

Host:  I know. There kind of is. Like in IVF—I used to be an engineer and I always think about it’s kind of silly about decision trees. When you have these options in freezing and the ability to preserve fertility, then you have this huge, all these new doors open up. You're right. It can be completely overwhelming from the beginning.

Jamie:  It is, which is why I was so happy I was here, and you were able to help me make those calls. Because I had no idea. I was about to do this crazy expensive package with the egg donor bank. I guaranteed you--

Host:  Yes.

Jamie:  You're like Jamie you don’t need that. You're gonna have a good success rate. Think about it. You would need to have three failed attempts before that was cost effective.

Host:  Yes.

Jamie:  So it’s like having that support and really talking to your medical team is so important because, I mean, I have so many things I have to try to like answer for, all these questions. I don’t know what to do. So it’s like having that trust and really opening up and asking your doctors like the medical staff for help is what you need to do.

Host:  Yes. Yeah. It also helps we have a—plugging time—an aware winning egg freezing/thawing clinic. So it was, just throwing that out there.

Jamie:  Yes. That is very true as well.

Host:  It’s always helpful. You want to thaw your eggs at a place that can handle them. Also, in general, anything that you do—Now it comes for everyone listening. When it comes to IUI—intrauterine semination—clomid’s, letrozoles, or pills or things like that, success rates amongst clinics are basically gonna be the same, which is great. Because they can be successful. When you talk about IVF or invitro fertilization or using eggs or something’s happening outside of the body, you really want to make sure you check with your clinic, their numbers, their success rates. SART.org is also a good resources for clinic comparisons. It’s not a perfect comparison because different clinics take different patients and clienteles, but at the same time it gives you a good start as well as reviews.

Okay. So in the interest of keeping this under 25 minutes so no one’s asleep. I mean you don’t have to, but do you have anything else you want to let us know? Enlighten us with your wisdom.

Jamie:  Oh it was just the best thing I ever did. There's a lot of things I missed out on. The whole husband thing and marriage thing and I wasn’t going to miss out on this. I am so happy I did it. Even though there were some complications—like during the end of pregnancy—I am so glad I felt what it is like to be pregnant and having this little life inside. It was everything I could have hoped for. I would do it again if I wasn’t 43.

Host:  I was actually going to say. I'm like don’t we have extras.

Jamie:  We do. I can't do anything with them. Like they're still here. I can't bring myself to do that but yeah. They're here.

Host:  Okay. I think we’re gonna end on that one. Okay. So, again, this is Michael Homer. I'm here at the Los Gatos office at Reproductive Science Center. We’re here with Jamie Silverman, a fantastically successful patient here. I really appreciate you. If you want to get anymore information, rscbayarea.com is a good place to get information. Thank you so much for listening.

Jamie:  Thank you. Good luck.

Host:  Bye.