Why Fertility Isn’t Fair to Women

This is Women Road Warriors with Shelly Johnson and Cassie Ticcaro from the corporate office to the cab of a truck. They're here to inspire and empower women in all professions. So gear down, sit back and enjoy. Welcome. We're an award-winning show dedicated to empowering women in every profession. Their inspiring stories and expert insights. No topics off limits on our show. We Power Women on the Road to Success with expert and celebrity interviews and information you need. I'm Shelly. And I'm Cassie. For decades women have been promised they can have it all. The career, the family, the freedom. But what no one explained is how biology fits into that equation. They were joined by a woman who's changing that conversation in a powerful and overdue way. Dr. Jamie Knottman is a leading reproductive entercologist, director of fertility preservation at CCRM New York and co-author of the new book Own Your Fertility. She's also a mother of two and a cancer survivor who brings both science and lived experience to the question so many women are quietly wrestling with. What does real empowerment actually look like? Dr. Knottman challenges the myth of balance and the false comfort of, you can figure it out later. She says true empowerment isn't pretending the biological clock doesn't exist. It's understanding it, planning for it, and making informed choices without guilt or fear. Her work is her national recognition, including Castle Connolly Top Doctor and Super Doctor's honors. She's a trusted expert featured in Oprah Daily, Wired, Vogue, Women's Health and most recently on NBC News. Kathy and I are looking forward to Dr. Knottman's insights on the burning questions so many women have to truly empower themselves. Welcome Dr. Knottman, thank you for being on the show with us. Thank you so much for having me, it's a pleasure to be here with you. We're seriously looking forward to your insight. Dr. Knottman, before we talk about women having it all and how fertility factors into that, how about you kind of give us the cliff notes on how you got started in all of this? Sure. I knew I wanted to be a doctor from a very young age. I read a story in the second grade about Elizabeth Blackwell, who was the first female physician in the United States. I was like, yep, that's what I want to do. I followed that pretty linear trajectory, went to med school. In medical school, I realized I really wanted to focus on women's health and taking care of women, which led me to a residency in OBGYN. I was fascinated by hormones and the way that the reproductive system worked. So elected to go out and train three more years in a reproductive endocrinology and infertility fellowship. That is how I got to where I am today. There's so much myths and disinformation on fertility. Of course, women want to have their careers and they're told, you can wait. All of a sudden, it's like the world crashes in on them and they can't get pregnant. Fertility becomes a real issue. I'm reading here that fertility declines earlier than most women realize. Yeah. I mean, for so long, we were told that our fertility would become geriatric pregnant at 35. So people thought, well, at 35, maybe I need to start to think about it. But there's newer data that shows that at 32, you've actually lost 90% of your eggs. We really need to be addressing our fertility at younger and younger ages if we want to have children at later ages. That's amazing. 90% of the eggs are gone by 32? Yeah. You've actually lost the most eggs. So you have about 6 to 7 million eggs when you're in utero at about 20 weeks gestation. When you're born, this has gone down to 1 to 2 million. So the greatest rate of loss is actually when you are from in utero to birth. Wow. I wonder why that is. I know. Nobody's been able to figure it out. Honestly, it's an enigma. When you get your first period, so let's say 12, 13, 14, most people are down to about 350 to 500,000. So even before a woman ever ovulates or releases an egg, she's already lost the majority of the available eggs. So it's a messed up system if I've ever seen it. Well, yeah, because men with sperm, that's spontaneous, right? Correct. Well, men make sperm every day, right? So, and most men will make sperm for most of their life. Now, yes, the quality and quantity of the sperm will also decline, but I see men come in even in like their 60s and 70s, having, you know, desiring to father a child and being successful because they're still producing sperm. That's not fair. No, it's not. It's really not. And I always tell my daughter, I hate when people like, I hate the, it's not fair, you know, but I tell them fertility is the one place I will allow them to say it. Actually, that's the first line of our book, fertility is not fair, far from it. Oh, that's for sure. And you know, I think that when women are really looking into this, it's usually when they have issues and there's so much information out on the web that isn't correct. You see things that stem cells can regenerate eggs and this and that. Is any of that true? No. To date, we have not identified a way to replenish eggs. The only thing that can halt the decline of egg loss and impending ovarian like failure is egg freezing, right? An embryo freezing. That's the only way to halt the decline. So by taking a subset or cohort of eggs and putting those eggs aside or embryo aside for use down the road, that's the only way to do it. Okay. So what's involved with freezing an egg? It's a very good question. So egg freezing has become sort of prime time. It's definitely much more widespread and much more common now, but it wasn't 10 to 15 years ago. The first baby was born, babies were born from egg freezing in 1984, but then there was a massive, massive delay until really the early to mid 2010s before we started doing egg freezing, you know, more mainstream and more elective. And the technology has really improved such that now we can allow or offer egg freezing to women to electively delay their child bearing years. So is that chyrotronics? Yeah. So it's frozen. So if I was going to do an egg, let's say I decided, let's say I dialed the clock back 20 years and I wasn't almost a menopause and I came in, you know, my 28 year old self and I said, I'm in med school. I have so many more years of training. I definitely want kids, but I don't know when. What I would need to do is I need to take fertility medications or fertility hormones injections for approximately 10 to 12 days to grow multiple follicles. So just let's like go back to sort of biology. Every month when a woman is not on the birth control pill or she's not pregnant, she's not breastfeeding, she is making, she's ovulating an egg, right? So she has a group of eggs that are entering the race to be the one egg that's ovulated. When a woman does an egg freezing cycle, we want all of the eggs that are there at the start of the month to grow in an even cadence so we can recruit them all to grow, to develop and to ultimately be extracted and frozen. So those fertility hormones are given to allow this process to occur. And once the follicles, those are the shells that hold these eggs, get to be a certain size and they're creating a certain amount of estrogen, we say, okay, the time has come. It is, we are ready to take these eggs out of the body. And we do that. So we're going to do an egg-frozen, an egg-frozen, an egg-frozen, an egg-frozen. And we extract the eggs vaginally and once the eggs come out, they go into an embryology lab where an embryologist will identify the egg and submerge them in liquid nitrogen to freeze them. Now, how long can they be frozen and is the egg quality compromised at all? So eggs can be frozen as long as you want. It's not like chicken in the freezer. They do not expire. Well, expire or your ability to carry kids will expire before, right? Meaning that in this country in the U.S., we don't recommend women carrying a pregnancy above the age of 54. So if you desire to use your eggs and you are above that age, we would recommend that use a gestational carrier or a surrogate to carry that pregnancy for you. But once the eggs are submerged in liquid nitrogen, they are frozen and they will not degrade. Now, I've heard that the uterus actually does not age like the ovaries. It does not. Yeah. That's why you'll read accounts in other parts of the world, not really in the U.S. People having kids at 70 because the uterus can be manipulated to do whatever we want it to do as long as it's present. That makes no sense. So we have something that essentially doesn't have an expiration date that can carry a fetus. Yet the ovaries that generate the eggs to create that whole process have an expiration date. I don't get it. Yeah. No, I mean, it's an interesting way to think about it. You're not wrong. The uterus responds to the signals that the ovaries send out, right? So the uterine lining will thicken in response to estrogen, which is made by the ovaries, and then it'll become a hospitable place for an embryo to grow should one exist from estrogen and progesterone in the second half of the menstrual cycle. So we can mimic that with exogenous hormones, right? I can give you a pill of estrogen and the pill of progesterone to make that happen, but I can't replicate the production of eggs unless eggs embryos have been frozen. Why is it in this country are women told that they shouldn't carry with their own uterus over the age of 54 and of entries do? Well, there's more risk. The risks in pregnancy do go up as you age, right? So being pregnant at 48 carries more risk than bringing pregnant at 38. And it's largely just because the body changes as we age. So you have higher risk of pregnancy complications, right? Like diabetes, high blood pressure, C-section, early delivery. So those risks increase with age. And that's why we're all governed by different medical boards when people are board certified in this country. So for fertility offers, it's called the American Society of Reproductive Medicine, and they put out like practice bulletins to tell us what's the best way to practice. And one of them is not to allow women to get pregnant at older ages above the age of 54. You know, my good friend just had a baby at the age of 52. And she had the in vitro. They tried her and her husband to try for years and he couldn't. And the first two fetuses didn't make it, but the third did. And I thought, you know, I thought you're number one, I first thought she was crazy to have a baby that late. But number two is that how does that affect a woman to have a baby at this late stage? I'm really curious. She says she's really tired. Well, I mean, I, you know, like I was tired being pregnant in my young, like, I was tired and like, it's hard to be a mom, right? It's a physically exhausting job. I have to say, like I've done a lot of, I've a lot of careers. And I always think being a mom is the most rewarding and the most joyful, but also the hardest. And so I look at people who had kids at older ages and 100%, I agree with you. I'm like, wow, I can't, I was so tired. I might get a 32. I can only imagine how somebody feels at 52. My mom was closer to 50 when she had me. Really? Yeah. She thought I would, she went to the doctor and she said, I think I have a tumor. And the, yeah. And the doctor said, yes, and it's going to be screaming and yelling in about night and on. Oh my gosh. I remember seeing a picture of her holding me and she looked so exhausted. You know? Yeah. And I think she was, you know, it would be really tough. Oh, Sheila, you are a handful. Yes. And I screamed the loudest in the nursery at the hospital from what I heard. Oh, I'm not surprised. They fed me first. So. Stay tuned for more of Women Road Warriors coming up. Dean Michael, the tax doctor here. I have one question for you. Do you want to stop worrying about the IRS? If the answer is yes, then look no further. I've been around for years. I've helped countless people across the country and my success rate speaks for itself. So now you know where to find good, honest help with your tax problems. What are you waiting for? If you owe more than $10,000 of the IRS or haven't filed in years, call me now at 888-557-4020 or go to mytaxhelpmd.com for a free consultation and get your life back. Welcome back to Women Road Warriors with Shelly Johnson and Kathy Takarov. If you're enjoying this informative episode of Women Road Warriors, I wanted to mention Kathy and I explore all kinds of topics that will power you on the road to success. We feature a lot of expert interviews. Plus we feature celebrities and women who've been trailblazers. Please check out our podcast at womenroadwarriors.com and click on our episodes page. We're also available wherever you listen to podcasts on all the major podcast channels like Spotify, Apple, YouTube, Amazon Music, Audible, you name it. Check us out and bookmark our podcast. Also don't forget to follow us on social media. We're on Twitter, Facebook, Instagram, Pinterest, LinkedIn, YouTube and other sites. And tell others about us. We want to help as many women as possible. Women can pretty much have it all. But biology does not always work in our favor. There are key things you need to know if you plan to delay motherhood. Today we're talking about fertility, ambition, partnership and why women deserve honest, science-based information. Not pressure or shame. When it comes to their bodies and their futures. We're talking with Dr. Jamie Knoppmann, one of the country's leading fertility experts and co-author of Own Your Fertility. How many women are told they have endless time to figure out careers, relationships, marriage and motherhood, but biology doesn't always cooperate. Dr. Knoppmann is helping women cut through the myths and understand the realities of fertility and make informed decisions without fear, shame or pressure. Dr. Knoppmann, you have so many women today who are delaying having children. Yeah. A lot of them. I mean, what is the average age now where people get there? In this country, it's about 30, 31. For comparison, in 1970, it was 21. It's gone up a lot over the past 50 years. If you look around the world, we're seeing the same statistics. Even in some countries that Japan and South Korea, it's close to 33. As we push the age of first birth, we're going to see increased rates of infertility because of aging of aging eggs. The only way to avoid age-related infertility is to have frozen some sort of reproductive tissue, eggs or embryos at a younger age. That helps a woman psyche a whole lot because they have options. When they go to a doctor and they have not done that, the amount of insecurity that they experience is tremendous. I feel like, well, in even the terms, over the age of 30, what you said, 36, you're a geriatric pregnancy? 35, it used to be called advanced maternal age. That was the cutoff or the line in the stand where we would offer women invasive testing to confirm that the fetus was chromosomally or genetically normal. That was the age where the chance of having an abnormal pregnancy was greater than a risk to doing an invasive procedure like an amniocentesis or a CVS. Now we offer such testing to all women, but that term has stuck. People still say, oh, I'm a geriatric pregnancy. The reality is, I think women are healthier in their 30s than we probably have ever been, but our eggs don't care. I'll see women who are incredible shape fitness instructors or very clean eaters and sleep and low stress and their egg quality will still be subpar. I'm often asked, but I'm so healthy, I don't get it. What I say is, but our eggs really don't care. Our eggs are on their own journey and nothing we really can do other than smoking cigarettes can change that. Is it your genetics that determines the egg quality? Most likely, yeah. The rate of egg loss, the rate of egg decline in both quality and quantity, it's probably largely due to genetics. I say, the field of fertility medicine is pretty young. I always joke around that I'm the same age as the first IVF baby. We almost have the same for a time. We're turning 48 this year, but that's a pretty young field of medicine if you think about how long pulmonology or cardiology you've been around. We've made amazing strides, but we still know very little about the genetics as they relate to infertility. Why does some women have low egg quantity at 30 and some women have good egg quantity at 40? It's just probably different genetic variants that we've inherited. There's so many misconceptions about infertility too. That really can mess with a woman's head when they're trying to get information on it. Basically you'd say a lot of the infertility, is it genetic like you said or what other things can cause infertility? I think a lot of it is genetics. Then there's different gynecologic pathologies like endometriosis or PCOS, having different ovarian cysts and needing to have those cysts removed, or a woman who has cancer and needs chemotherapy, certain medications, autoimmune diseases. All of this affects one's fertility as well. It's just that probably there's so much more fertility that is related to genetics than we'll ever know. Now, women will have miscarriages. What causes that? Most miscarriages are caused because the embryo is chromosomally abnormal. It's just not genetically healthy. The body recognizes that the pregnancy stops growing and a miscarriage occurs. Oh, wow. So the body's actually purging the egg? The body recognizes that it's not going to be a good embryo and the development of the fetal tissue stops. Oh, wow. I guess I didn't know that. Did you know that, Kathy? No, no, I didn't. Okay. So, yeah, and of course, all of these things, when women are going through all of this fertility treatments and they have miscarriages, that is so emotionally draining. Yeah. Women, not to mention the kind of treatments and stuff. It's not fun. It's certainly painful. Physically, all of the above, women have to go through so much just to have a child. So much. Yep. Yep. They really, really do. And for some women, the journey is so long and so arduous. It's amazing that they are able to find the resilience to stay in it and to keep going. You know? The emotional toil that it has on some women, however, could be very dramatic and awful and tragic. Some women don't recover when they are unable to reproduce. I've known a few women in my time that wanted so desperately to have children and they just couldn't. That's devastating. Yeah, it really, really is. And the issue is that it's so antithetical to everything we think. Right? Like growing up, I think most of us just assume, right, at some point, we are going to be moms or be parents. And so when a woman is faced with being told, hey, listen, we think that your egg quality is so reduced that you are not going to be successful, I think that's so hard to even comprehend that it oftentimes, it just hits people like a ton of bricks. They feel like they're less than. Yeah. You know? And is there really a support system for women when they're going through that? There are. There are many more support groups than there ever were before. And I do think, you know, while I don't like the credit, the internet or social media with that much because I have teenagers and I think it's a lot of it's just not good. I do think that the social media has pushed forward sort of the conversation about fertility and made a community where there may have not been one before. Which is really important. Yes. Yeah. And I've seen this before and women who didn't have children quite often if they had to adopt, people kind of looked down on them like you're less than. Exactly. Like it was your fault. What do you do? Now, listen, there's still a lot of blame and guilt and finger pointing, right? And we, people say, oh, you know, you're having infertility, just go and relax, right? If you relax and go on a vacation, you'll get pregnant and that's a whole bunch of BS and we know that infertility is a disease and must be treated as one. But I do think that there is much more awareness and openness about struggling with fertility. Stay tuned for more of women road warriors coming up. Dean Michael, the tax doctor here. I have one question for you. Do you want to stop worrying about the IRS? If the answer is yes, then look no further. I've been around for years. I've helped countless people across the country and my success rate speaks for itself. So now you know where to find good, honest help with your tax problems. What are you waiting for? If you owe more than $10,000 of the IRS or haven't filed in years, call me now at 888-557-4020 or go to mytaxhelpmd.com for a free consultation and get your life back. Welcome back to Women Road Warriors with Shelley Johnson and Kathy Toccaro. We're here with Dr. Jamie Knottman, renowned reproductive endocrinologist fertility preservation expert and co-author of Own Your Fertility. We've been talking about the realities women face when it comes to fertility, timing and the pressure to have it all. The truth is, many women simply were never given the full picture about how quickly fertility can change. Dr. Knottman says real empowerment begins with knowledge, not fear. And understanding your options before crisis or regret enter the conversation. This is an important discussion for women of every age. Dr. Knottman? So some of the things you hear about the positions and all of that when you're trying to conceive, that's not true. Oh, positions to be more likely to have a baby? Like sexual positions? Yeah, no. No. I mean, I get it. People think I'm going to lay on my back and put my chin up in the air. But sperm is in the female reproductive tract within seconds. So whether you lay there or get right back up, that sperm is already on its way up there. I knew instantly when I became pregnant with my daughter. The second it happened, I knew it. I told my ex-husband at the time, my husband, I said, oh my God, I'm pregnant. He says, yeah, right. I'm like, I'm telling you, I'm pregnant and low on the hold. Yes, I was. That's so funny. Yeah. I mean, a lot of women are very in touch with their body. They know like, oh, I have a sense of my smell is different, my breast feel different. I will technically, we can't pick it up that early. We have to wait for a pregnancy or more to be detected in the blood or the urine. But some people, you know, some people feel it's suitor. So I'm going to ask a really odd question. How fast does sperm swim? Very fast. It does. It swims fast. Those buggers get there today. They get there. So we're talking miles per hour, the nanosecond. Even faster. Yeah. Wow. That's amazing. Speed of light. And the speed of light, there you go. What would you say most women misunderstand about fertility timelines? From what I was reading, you should be thinking about fertility in your 20s. Yeah. I mean, most people think it's sort of like the never ending road, right? That you can do it as long, you know, you can keep on going and you can just, it's never ending and that's not true at all. And that's why we need to spread awareness and bring attention because if we don't, women are going to be faced with very hard decisions as they're older without the ability to have the children that they may have desired. Is it true that the chances of getting pregnant in vitro wise, the chance of having twins and triplets is greater? Historically, it was because we would transfer multiple embryos into the uterus in order to achieve success. However, now that is no longer the case because now we pretty much put one embryo back in at a time because our embryos are genetically tested or screened for chromosomal abnormalities. And this allows us to achieve high pregnancy rates without having to get multiples. Okay. Because a girl I went to a nursing school with when we graduated the first year, she got married and then what they went for in vitro and she ended up with twins. She was saying that a lot from her experience that a lot of the women that were along there with her all had twins and I'm thinking, oh my God. Back in the day, that was true. The standard. Yeah, this was in 1998. Now our regulations that keep talking about it, now it's really frowned upon to put back more than one embryo, particularly in younger patients. Okay. So Dr. Nauman, you recommend people plan for fertility, do fertility planning? How does somebody go about that? I mean, a woman in her twenties may not even have a prospective husband or mate. This is just, should be part of her plan down the road. Yeah, because the reality is you don't even, you don't need a mate. Honestly, a lot of the patients I see, they say to me, you know, Jamie, I don't even know if I want to have kids. I'm like, yeah, that's great. But you know that you don't want the choice to be taken away from you, right? So by freezing eggs, it doesn't mean you must come back to use them. It just means you have them should you need them. It's really like it's an insurance policy. Now, just like other forms of insurance, flood insurance, you know, life insurance, it may not pay up when you go to use that insurance, right? So you may go to use your eggs and they may not work, but you're going to go through life a whole lot more comfortable knowing you have it. Sure. How much does it cost and can you get insurance to cover it? So that's a good question. So nowadays, many more insurance companies cover it than they ever did before. So back in the day, no, it was a completely out of pocket expense and that's why it was so the access was limited. But now there's been a huge uptake in employers covering it for their employees. It started with the tech companies like the Google, the Metas, the Apple, and now it's, I would, you know, one in five large companies cover it for their employees. It's more acceptable. Well, I think there were a lot of things insurance didn't necessarily cover for women. Yep. Mm-hmm. It wasn't that long ago that pap smears and that kind of stuff was considered elective. Well, a lot of, for so many years, women's health has gotten the short end of the stick, right, where people are like, oh, no, it's okay. They're just like, but now I will say, for menopause too, right, we see this all the time, it's really getting center stage. Well, women are being more vocal about it, which is a very good thing. When you're talking about menopause, that begs the question. You'll see women who are postmenopausal and all of a sudden they're pregnant. How does that happen? Well, because, again, like they can get pregnant as long as there's embryos or eggs that have been frozen or they're going to use a donor egg. We can get their uterus to be accepting of an embryo with exogenous hormones as long as they have another egg source. But I've actually heard of women that had no plans on getting pregnant and didn't do that and they actually got pregnant. Well, then they probably weren't really in menopause, right? In menopause means you're done. There's no more ovulation, it's over. You could have not had a period for nine months and been like, oh, I'm in menopause and then spontaneously ovulated and gotten pregnant. Now, that means you're just warring fully yet in menopause. Okay. All right. Now, see, there's so many misconceptions people don't know and a lot of this stuff you hear from someone else. Yeah. And an urban myth or something like that, you're not real sure what's really going on here. Well, even though like this internet and social media can provide us a lot of, like we were talking about community and support and that's great, but there are a lot of, there's a lot of false information there too. And I think as a consumer or a patient, it can be hard to weed through what is true and what is false. And not everyone is honest with their journey. That's true. That's very true. And then you can say something, but doesn't mean that like it's true. And then you have a lot of people who don't know anything about it and they've got lots of opinions. Yes. That is very true. Or theories on how to get pregnant. Oh, yes, yes. That they tell you just to do this and it'll work. And that's the thing. We want to share our own experiences. So someone will say, oh, I, you know, I had sex in this position at this time of the month and it worked. And everyone's like, oh, okay, that means it's going to work for me. And that isn't always the truth. You want to hear something crazy? I lived in the Yukon for about three years. And every year, sometimes I can't forget, I think it was February or March. A lot of people from China would come and visit because it was their belief that if you had sex underneath the Northern lights, it would ignite fertilization. You would get pregnant. Yeah. They had tours and everything up there. It was crazy. That's so crazy. Right? So what were the actual percentages? Do you know? Oh, I don't remember. That was in 2005 when I lived up there. I don't know. That's just not, it was really strange because he had actual tours that, yep, come, come sleep in the underneath your, underneath Northern lights and you'll get pregnant. Oh, sir. I mean, the thing is we want to believe sometimes that, right? And I mean, belief is good, right? How do you get through the day if you don't believe in something? But I think some of it is off base or unfounded. Sure. You know, and reproductive health. Well, when you think about it, well, I remember in school, basically biology, when you looked at the human body, it looked like a male, not a female. It's been based more on the male body versus the female body. It's almost like we're space aliens and people are just finally catching up to how our bodies work. Yes. So it leaves women unprepared when they're going through life. The whole concept of having it all and being a career woman and all of that, that really is kind of misleading, isn't it? It's completely, I mean, listen, like, I know this is, this is sort of the crux or the podcast, but you really can't have it all, right? It's not possible. Or it's not possible without a lot of assistance. So I think we have to be, you know, we have to recognize that and make what having it all or somewhat of it all just a different, it just has to be looked at differently. Stay tuned for more of women road warriors coming up. Dean Michael, the tax doctor here. I have one question for you. Do you want to stop worrying about the IRS? If the answer is yes, then look no further. I've been around for years. I've helped countless people across the country and my success rate speaks for itself. So now you know where to find good, honest help with your tax problems. What are you waiting for? If you owe more than $10,000 of the IRS or haven't filed in years, call me now at 888-557-4020 or go to mytaxhelpmd.com for a free consultation and get your life back. Welcome back to Women Road Warriors with Shelley Johnson and Kathy Takaro. We're back with Dr. Jamie Knopman, director of fertility preservation at CCRM New York and co-author of the powerful new book, Own Your Fertility. This conversation is resonating because it touches something deeply personal for so many women. The challenge of balancing dreams, careers, relationships, health, and the realities of biology. Dr. Knopman believes women deserve honest information so they can make empowered decisions for themselves and their futures. Dr. Knopman, when a woman wants to have a child, it's important to have a good support system. What roles should partners and workplaces play in the supporting reproductive planning? I mean, I think this is, you know, just number one, offering such benefits to your employees is shows you're in the game, right? Shows you're in the conversation and you want to support your female and male employees. And I think that that's honestly a beautiful thing. And I do also think that it makes people stay at their job longer than they might because they feel like important to their workplace. And it is important. And I'm glad that companies are starting to be more accommodating. It really is necessary because just because a woman wants to work, it doesn't mean she has to give up her life. If she wants to be a mother, you can do that too. Yep, I agree. I agree. And I think we need to support women and men too, where they are and what they want to do because it's a new world out there. Your book also talks about surrogacy. That's kind of a difficult decision sometimes for couples. Does that involve maybe your own egg or is the surrogate? If the woman does not have a viable egg or enough of them, does that mean that the surrogate is going to provide the egg and then? No, no. So the surrogate in the surrogacy that we do, traditional surrogacy, yes, but that is not practiced anymore. So with surrogacy, it is not the egg of the woman who's carrying the pregnancy. The egg and the sperm come from the intended parents. And then the gestational carrier just gestates the pregnancy for a couple. OK. Now, how does that work? How do you get a surrogate pregnant? So you take the embryo that was created from the intended parents and you transfer the embryo into the surrogate's uterus. And this is done through what? Some sort of hormone therapy to prepare the uterus or? But again, so you'll give the surrogate, you'll give the same hormones that we were talking about to a woman who's in menopause, right? You'll give those same hormones and that will allow the uterine lining to thicken and then we'll add progesterone. And then at a specific date, we'll transfer the embryos. Fascinating. No. Is there any possibility the surrogate could change her mind? And so there's legal contracts in place. People, you know, this has been for a while, people feared that. But there are illegal contracts, which are in place, which are binding, which require the surrogate to give the child to the intended parents. OK. Yeah. But isn't there like true stories where those surrogate mothers don't want to give up the baby at the end and they kind of go nuts? Like, you so many movies about that. That's more fictional than anything. And yeah, that's such such movies to exist. But it happens very infrequently. I think for a long time, people have thought, oh, it's like it's much more dramatized, but but it really doesn't. Most surrogates are doing it out of the goodness of their heart. Of course, they do want to make money, but they want to, you know, to do right by those intended parents. Michael did it for her sister, which was really cool. That's really a beautiful thing. Yeah. Her sister couldn't have children. So she says, you know what, a year ago, I'll do it for you. And she did. That that is a gift. A gift of love. Yeah. Absolutely. Yeah. So how much does it cost to have a surrogate? Are we talking thousands and thousands of dollars or 100s of thousands? Yeah, I usually have had $150,000. Oh my God. That's a lot of money. Because I mean, it's a big ask, right? It's not like a small cast. Wow. So that's over the course of nine months that the surrogate gets paid 150,000. Well, no, no, no, the surrogate doesn't get paid. That's how much the intended parent will pay the agency. And then the surrogate gets paid some portion of that. I see. OK. All right. Now, egg freezing, how much does that cost on an annual basis? Well, egg freezing cost about $12,000 to do the treatment, right? So but then you'll have to pay to keep the eggs frozen every year. So it cost about $1,000 a year to keep those eggs frozen. OK. So you really have to plan ahead. Is there any way a woman, say, in her 20s, can get some sort of insurance policy to pay for this? I mean, not everybody has $12,000 to put in bed area. No, they definitely don't. That's a great point. But that's why the companies that are covering it now, which are growing every year, it's really, really beneficial because it's allowing so many people to do egg freezing that may not have been able to do it before. OK. So this is actually something when a woman is looking for a job, she needs to find out if this is important to her, what the company covers. Because that will be a benefit. Yeah, 100 percent. Wow. Yeah. And that's not something that was even discussed or even thought about even 10 years ago, I don't think. No, yeah, you're right. So we've come a long way, baby, right? We've come a lot. Yes, I like that. We've come a long way, baby. So, Dr. Knottman, what else does your book cover? This is something that prospective parents, women who want to have children, it's really important for them to read about. What else does your book cover? Yeah, I mean, we talk a lot about all aspects of one's fertility, right? We talk about fertility preservation. We talk about infertility treatment. And then we talk about the mental fortitude and the resources one needs to stay on the journey. So it covers the fertility process, really, I say, from A to Z. And it's an emotional process. And if somebody's having to go through fertility treatments, that is not inexpensive. And because I've heard of people actually getting, say, a helonk on their home getting a second mortgage just to pay for this sort of thing. Yeah, again, like I do think we're doing better with the coverage that is out there, right? We're used to not. I we didn't have any resources for people in the past. But I do think at this at this point in like, you know, fertility in the world, we are getting much better. What is the average cost for fertility treatments? For an IVF cycle? Mm hmm. It depends where you live in the country, but it's going to cost usually up about 15 to 20 thousand dollars. OK. And that's just one cycle. And am I correct? That is one cycle. Yeah. OK. And one cycle is how long? It takes a couple of weeks. It's it's not as long as you think it's going to be. People often are like, oh, it's going to take months a month. And it actually doesn't. It takes about two weeks to know what you have and if you're going to get pregnant. So do people go through multiple cycles? They often do. Often they need several cycles. OK. Wow. So it's not an inexpensive process. No, it is not. But but I will say that from where we have been to where we are now, the coverage has expanded dramatically. That's a good thing. Yes. Yeah. And I think, you know, it's honestly because people have brought this to the forefront and said, hey, like we need to this is a medical issue. It is not an, you know, an elective issue. We don't elect to have infertility. You don't elect to have cancer. We need we need assistance. And it's amazing how so many things with women in their health, the insurance companies would say it's elective. They wouldn't they wouldn't pay for, say, birth control pills, but they'd pay for Viagra for a man. Well, we see that all the time, right? It's so unbelievably unfair. It's like, OK, if you don't pay for the Viagra for the man, then you won't need the birth control pills, right? Yeah. It's very funny. Yeah. But I'm glad that we're starting to level the playing field, which we need to do because women have different issues than men. And in order to really address everything that they need, there needs to be the accommodation by the insurance companies. Yeah, there really does. And by employers, right, to recognize what their their employees want on their benefits and what is important to keeping their employees happy, just like they would do for any, you know, for anyone. So what would you recommend in terms of women if their company doesn't have maybe the insurance coverage that covers this? Should they go to the HR department and maybe, yeah, I've had a lot of people that sort of incredible who have told me that they have gone and said to their HR department, you need to put this, you know, you need to give us this coverage. This is not fair. And it's true. It really is. They're trying to accommodate more people across companies. Well, then they need to accommodate this as well. No, they really do. Where do people find your book? Own your fertility from egg freezing to surrogacy, how to take charge of your body and your future. Thank you for saying all of that. So the you can find it on Amazon and you could also find it on Barnes & Noble. And you have a website as well? I do. I have a website at Dr. Jamie Knottman. My first name is J-A-I-M-E. And I also have a social media platform. I have an Instagram page, a TikTok, which is just at Dr. Jamie Knottman. If people reach out to you, do you answer questions or? Yeah, I mean, I'm happy to see new consultants that come in. We do. I do a lot of telehealth. And I sort of like that because you then have the ability to see people from all over the country. Oh, that's neat. So yeah. And you know, that's kind of maybe less risky to begin with. It's not even good. Good people like to hear like they'll say, hey, can I present you my case? You know, like what's going on? And then that helps me say like, hey, I think you should make the trip out to New York or I don't think you should. So it does allow us to sort of get like a overview. And where are you located? Manhattan. OK. So people can come and visit you and actually see you in Manhattan. Then you can do what? Fertility treatments and all of that in your office. Exactly. Exactly. Wonderful. And your website is Dr. Jamie Knottman, K-N-O-P-M-A-N. Correct. K-N-O-P-M-A-N. Yep. And my first name is J-A-I-M-E. Your knowledge is phenomenal. And I think you're giving a lot of women some hope because... Well, thank you. When women want to get pregnant and they can't, hope is something that seems to be fleeting and they're really hard on themselves. Yeah, they really, really are. You are so correct. And our job is to, you know, make people feel not alone and to really spread good information, information that is like well researched and will help guide women. And the fact that you're a woman and you've been there done that, that's huge. I think when you kind of want to have that kind of security blanket too, it's like if it's a guy, well, honestly, I've been to an OBGYN before who said, oh, you're going to feel a little pressure. It's pressure hack. How about you try this, buddy? You know? So funny. Yeah, I have said that. I've always said I'm like, I wonder what a guy would feel like if you really had to put a speculum inside his vagina or like push a kid out of your vagina. It's naughty. Oh yeah. Just a little pressure. I personally, I personally believe whoever designed that whole contraption for Pelvix didn't like their mothers. Come on guys, let's me need something new. Thank you so much for having me guys. I really, really appreciate it. You're very welcome. Thank you, Dr. Noppen for being on the show. If you're getting value from our show, Women Road Warriors, be sure to hit follow on Apple podcasts or Spotify or wherever you listen to podcasts. So you don't miss out on what's coming next. We hope you've enjoyed this latest episode. And if you want to hear more episodes of Women Road Warriors or learn more about our show, be sure to check out womenroadwarriors.com. And please follow us on social media. And don't forget to subscribe to our podcast. On our website, we also have a selection of podcasts just for women. There are a series of podcasts from different podcasters. So if you're in the mood for women's podcasts, just click the power network tab on womenroadwarriors.com. You'll have a variety of shows to listen to anytime you want to. Podcasts made for women. Women Road Warriors is on all the major podcast channels like Apple, Spotify, Amazon, Audible, YouTube and others. Check us out. And please follow us wherever you listen to podcasts. Thanks for listening. You've been listening to Women Road Warriors with Shelly Johnson and Cathy Takaro. If you want to be a guest on the show or have a topic or feedback, email us at sjohnsonatwomenroadwarriors.com.