Episode 51: In/Fertility and its physical and emotional toll on women with Dr. Melvin Thornton, Fertility Specialist

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an Obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone, and welcome to the Dr. Sophia ObGyn podcast. I am so excited about today's episode. I just, I can't contain it because we have a special guest, which everybody here knows how much we love having guests. And of course, I'm here with my co-host and very good friend Touseef Mirza.

Touseef Mirza:
Hello everybody.

Dr. Sophia:
We have such a treat for you all. Today we have with us Dr. Mel Thornton–

Touseef Mirza:
AKA, Dr. T, which I'm so happy that he's given us the okay to call him that way because that's so cool.

Dr. Mel Thornton:
Yes, a hundred percent.

Dr. Sophia:
So we have Dr. T and Dr. T is a reproductive endocrinologist, better known as the fertility doctor. And what's really cool about him, he's been doing this for 30 years, though of course he doesn't look like it, helping to build families. He's a medical director of the global fertility and genetics practice here in New York City. And one of the things that's extra special about Dr. Thornton is that he is one of the world's leading experts in egg donation and surrogacy. And he is among the very, very few black male reproductive specialists who are dealing with the experience of the third party in the fertility world. And last but not least, he is an obstetrician and gynecologist and also works in reproductive medicine. So without further ado, Dr. Thornton or Dr. T as we like to call you.

Dr. Mel Thornton:
Yeah, please call me Dr. T. It is a pleasure. A pleasure. Pleasure's all mine. I love this type of performance because it gives me a chance to tell everybody about what I do because everyone is so afraid of fertility. They hear the word fertility and they kind of shy away. They don't wanna talk about it. It's always in the closet. So today we get to open the closet and expose everything and talk about everything and make everyone feel comfortable about their, their own fertility.

Touseef Mirza:
It's true when, when you really think about it, when we think about fertility, we have a negative connotation or like if we talk about it, that something is wrong or else we shouldn't almost be talking about it in a way. Right. If we don't, it's not, it's not normal conversation.

Dr. Mel Thornton:
Yeah, it is, it is a good, good point. Because fertility becomes a blame game. Whose fault is it? Is it the woman's fault is the male's fault? But the women are the ones who take all of the blame because we think fertility issues are always related only to the women. But in fact, about half the couples have issues because of sperm. Wow. Yeah. And that's astounding because I see a lot of patients who will come to me, they've had their workup done. The female, they've actually taken medication to make sure they're ovulating. Some of them have actually had surgery. And I'll say, well, where's the sperm analysis? They say, oh, we've never done a sperm analysis and we do a sperm test. And all along the issue was the male. I try to teach the residents, when I see residents and say, you evaluate both the male and the female at the same time because the equal number, if you, it takes two to make a baby, it takes two to do a workup.

So we have to evaluate the male at the same time, evaluate the female. And the thing about guys, I always tell people that guys we're broken. Now this is why we're broken because we know that the female chromosome is 46 XX. Okay? The male is 46 XY. We're missing a little tiny piece on the X chromosome that we don't understand and all these different things. So when you talk to a guy and you feel like you're not getting anywhere, like we're not paying attention. We just can't help ourselves because we don't have that little piece of the chromosome. So always remember that.

Touseef Mirza:
It's the chromosome fault. Is that what you're saying?

Dr. Mel Thornton:
It is. We gotta blame on something

Dr. Sophia:
On that. I'll definitely be using that.

Dr. Mel Thornton:
Well, you know, we had guys come in and guys believe that the sperm is related to manhood. So if the sperm comes as low, that means their manhood is not as good as they thought it was. So they're afraid to go and get their sperm tested because they don't wanna find out that it's them. That's the issue. Which means it makes them less of a man. It's just, it's just sperm. Sperm is sperm.

Touseef Mirza:
Sperm is sperm. Can we write that on a t-shirt? Because it's true. It has nothing to do with the character of a human being.

Dr. Mel Thornton:
We just don't understand that. And the other thing that's important for everybody to understand is that when you have intercourse and you have the semen that comes out, that doesn't mean that you have sperm. Sperm is microscopically inside that semen. So a lot of people say, well, I'm good because I got a lot of them. And I say, well, that just means you have a lot of volume of the semen. We don't know if there's any sperm in there.

Dr. Sophia:
Right, of course.

Touseef Mirza:
So there's two levels in terms of whether or not there is sperm. And number two, the quality of that sperm.

Dr. Mel Thornton:
Yeah. That's correct. And when somebody comes in to do a semen analysis we look to see how many sperm you have, how are they moving? Because in order to get to the egg, they have to, they have to swim to the egg to make sure they have good swimmers. And then the shape and the shape of the sperm, only the normal shaped sperm are able to fertilize the egg. So those are the three parameters that we really assess. And the sad thing about it is that realistically, a semen analysis takes for a guy maybe two minutes at the most, and about a minute and 30 seconds to fill out the paperwork. Okay. But it is so hard, they, it is so hard to get the guys to come in and give a specimen. They give so many excuses. Well, I worked late yesterday, so I can't do it today. I had a fever last week. And, you know, so it's just craziness, you know? And, and the women have been through, you know, women have gone through an X-ray test. They checked their tubes, which is not the most comfortable test in the world. They've got multiple ultrasounds. Some of them even had surgery for fibroids and things of that nature. And I tell the guys, you gimme two minutes of your life to make sure that the sperm is okay.

Dr. Sophia:
Yeah. Agreed. Before we go on, Dr. T I wanna ask you a couple of just personal questions. How did you decide that this was what you wanted to do? How did you come to be in the fertility world?

Dr. Mel Thornton:
I had to go all the way back. Two events happened in my life. I was an only child for a long time. And then when I was 12, my mom had my brother, and I thought that was really fascinating just to see a baby. And everything was like that. And then she had my sister and I say, well, more fascinating. So then people, oh, you should be a pediatrician. And I thought about that for many years, being a pediatrician. But then when I went to medical school, I said, you know what? I really like surgery. I really wanna be a surgeon. And back in the day, the surgeons were complete jerks. They would throw knives, they would throw instruments, they cursed. I said, that's not my personality. I don't wanna be assertive. Right. Then I did my OB rotation.

I said, oh my God, there's surgery. This is really cool. And then one day I was on, I was on call and the OB attending said can you help me with delivery? And as a medical student, no one ever, you know, asked you to help. And so I said, great. And he let me help deliver the baby, which is really, really cool. But then the coolest thing happened after that is that the nurse said, can you do me a favor? Can you hold the baby while I go do something? And I held that baby and I said, wow, this is, this is life. This baby's starting a full lifetime. And I was a part of it from the beginning, and I realized that this is what I wanted to do. So when I went into OBGYN residency, I realized that a lot of women who couldn't have that hope, they didn't have that feeling of having children. And I said, you know what? I really wanna help them have children. So I went into reproductive medicine just to help these women experience the joy of having a family.

So long story. But that's why I got here. And God has a pathway for you. And he opens doors and shows you just the door you want, needs to go through. Sometimes I go through the wrong door, but eventually get to the door he wanted me to go through.

Dr. Sophia:
Yeah. That's a great story. I totally can relate because in terms of my own doctor or wanting to become a doctor, it was first started by my uncle who was a pediatrician at the age of 11. So that's a really cool connection there.

One of the things that I think in terms of, especially in the black community, I feel like we always think, well, my mom had six kids, and my aunt and my grandmother had four kids. There's no reason why I should have any problems. I could try, you know, when I'm 40. because that's the new thing I'm getting now, everybody is kind of waiting to have children. So what are some of the things that you see or that you are seeing a little bit more now in terms of some of the women of color potentially who come to see you or just all women really in general?

Dr. Mel Thornton:
I would say the, the, one of the biggest factors right now is finding the perfect guy. The most common thing that I see is, oh, I haven't found the right person yet. But it's hard to find a guy, particularly in New York, who is what they say. And because of that, they're delaying it. It goes back to fantasy. You gotta have the perfect husband. You have the perfect marriage. You have, you gotta get the house with the picket fence, and then you put children in there. And I try to express that by the time you want, by the time you get to where you wanna get to, you're 45, 46. And then you're a bit too old to have two children, never too old to have a productive life and everything like that. But fertility, a lot of women don't know this, but fertility starts to decline at age 30.

And so the average age of the patient that I see in my practice is probably about 41, 42. And when I get like a woman that comes in who's 28, I'm shocked. I said, she must be in the wrong office. Maybe she's looking for the office upstairs or something like that. But it is just difficult. And having three girls makes it hard for me because as a father, I want them to get that education. I want them to find the guy that makes them happy and through their career, and then thinking about having children. But since I became a fertility specialist, those things have changed. I'm like, okay, if you have a baby, that's great. Okay. Because I don't want you to be sitting in front of another doctor in the doctor's office, you know, with the pain of not being able to get pregnant.

And I would say the worst thing to tell a woman is that her fertility is gone. And I just had a recent, you know, cancer journey, so I can share this with you, but telling you know, when you find out you have cancer, the first thing you say is, I'm going to be the, what do I have to do to beat it? That's the first thing you say. Telling a woman that her fertility is gone. That's not the first thing they say. They feel lost. They feel there's no hope. And they start blaming themselves. You know, why did I do this? Why did I wait so long? Why did I take that job? I shouldn't have taken that job. I should have gone ahead. And then there's, you know, there's a lot of women who do get pregnant at a young age and decide it's not the right time, and they reflect upon that and start blaming themselves for that.

And so there's a lot of emotion instead of saying, okay, what can I do to have a baby? Because there's other options to have children other than, you know, natural pregnancies, other options, adoption, and, you know, egg donation and things of that nature. But they feel so defeated and they're, they're, they internalize it. And it's, it takes a long time. And I think where we're lacking as a specialty is that we don't have a lot of fertility counseling and coaching in our field. We need a really, really good fertility therapist, somebody that we can refer to. And the reason why I say that is because women will talk about everything with each other to their girlfriends. They'll talk about A through Z There's two things they don't talk about. One is fertility, and the second is miscarriages. And they feel all alone when they're not able to get pregnant, or they hide a miscarriage, feel all alone like this is, this is the only person it's ever happened to.

So when you refer somebody for counseling or therapy, they usually just go to a therapist that doesn't really specialize in fertility. And so they, now they're dealing with all the emotions of everything from their background everything. Like that's still dealing with the emotions of, I'm having difficulty getting pregnant. What does that mean? What does my future hold? I always tell people it's a bridge. And my job is to kind of get you across that bridge to either I wanna have a family, and over here is that you either have a family the natural way or maybe through other ways like egg donation, surrogacy, or adoption. And my job is to get you across that bridge to the right place for you. And there are a lot of women who are stuck. They're stuck in the middle because emotionally they can't move forward.

And I think a fertility coach can help them through that. Just somebody you can talk to to say, Hey, I had a hard day at work today, and this crazy doctor wants me to take fertility drugs tonight. I don't know if I can do it. And they're not gonna call me to say that they're not gonna call their friends. So they sit and struggle with it. Like, you know, you're faced with, I got this injection, can I do it? I don't know if I can do it. And you know, there's so many women, I, I'm just so, I don't wanna say proud, but I'm just amazed at how women do it. I mean, they go to work, they do all the things they have to do. They do their fertility drugs, they go through the injections every night. If they're doing IVF and I always say, if guys have to do this to have children, the wife would say, Hey honey, how'd the doctor's visit? Go? And he would say, yeah, we just, we're not gonna be able to have children. I'm not gonna go for all that.

Touseef Mirza:
That dream is gone.

Dr. Mel Thornton:
Yeah, yeah. That dream is gone. Forget about it. Let's take your vacation. Let's go somewhere else. But it's just women, they're very strong. And sometimes when you're strong, particularly black women, when you're strong, we were always taught as, you know, people of color, African Americans that, you know, especially men, you gotta be strong. You can't show your emotions. And so women that come home every day dealing with their emotions and not speaking out and talking to someone about how they feel and stress itself will affect fertility. You know, there's some women who get so stressed out that they start skipping periods and they stop ovulating and they have different perceptions just because of that. So having a fertility doula would be amazing. Something I can say, Hey, talk to this person here. As you go through the treatment and not go through the treatment, they can walk you through everything. That's the biggest thing I wish that we had in this field. I mean, there's some people that do it, but we need more, more people to dedicate themselves to that.

Touseef Mirza:
So I wanted to go back a little bit in terms of the basics. When should the woman come and see you? Like usually you said, women come and see me when they're 40, 41, because now they're realizing that it's time, but they're having trouble conceiving. In general, what is your recommendation of a woman to, to come almost like a rough routine checkup, if there's even one when it pertains to fertility?

Dr. Mel Thornton:
I would say bet the most important thing is before they see me, they should see their PCP or their obgyn. Okay. And when somebody goes to the obgyn, you get an examination, your heart and your lungs, you get a, a full check. How is your body doing? But what I'd like to see is that GYN do a special test called the anti-Mullerian hormone, or AMH. And the AMH is a hormone that lets us know what number of eggs do you have? Do you have a good number of eggs, or low number of eggs? And I just think that should be part of the annual examination for a, a woman of reproductive age. Because there are a lot of women walking around that have low egg numbers and don't know it. And by the time they wait three or four years from now to get pregnant, they're not able to get pregnant because the egg numbers are too low. So I always say it is best to see somebody else before you see me, because by the time that you're seeing me, that means that there's something wrong.

Touseef Mirza:
Okay. And when you say a woman of reproductive age, what does that mean for you? What is that range?

Dr. Mel Thornton:
Well, I mean, technically anytime somebody's ready to have a baby or thinking about having children, to come see me, but reproductive age is any age. I know there's age for consent and things of that nature, but people who are 21, 22 come in, have a low egg reserve because they say, I wanna be an egg donor. So the first thing we do is we check their egg reserve with a MH test. And many times it comes back low. And if they weren't coming in because they wanted to donate eggs, they would never know. They'd be walking around with a little egg reserve, not ready to have a baby. And by the time they turn 35, 36, I'm ready to have a baby. Then at that point, when they come to see me, I wouldn't be able to help them because the egg reserve is too low.

Dr. Sophia:
So I love the fact that you mentioned the A MH test. I love the fact that you say that they should see your OBGYN, because me as an OBGYN generalist, it's something that I speak to my patients about. It's more than just when I see a 20-year-old, it's kind of like, or, or someone who's in their twenties, for example, who's coming in, let's say for birth control. The conversation also is, well, you know, I'm glad you're coming in. You're thinking about your fertility. Do you know when and at any point would you like to be a parent? Or would you like to get pregnant? And for us to help us decide just in terms of even the contraceptive journey that they'll be on, is it one that's a short one, perhaps with a short course of things like birth control pills versus a longer acting one, let's say with an IUD or an intrauterine device for longer periods of contraception. But it's with the understanding that at some point, do you wanna have children or don't you? I think it's important to ask that question. And doing these kinds of testing on, I for sure, if I see a woman at the age of 30, usually in my practice who's never been pregnant, I 100% ask, well, when are you thinking about having a baby? And I think we should do a baseline fertility test.

Dr. Mel Thornton:
You know, a woman would go to a gynecologist and she not taking birth control and this, this gets overlooked. Like, okay, you're not using birth control. You're sexually active. And they say yes, and say, well, I've been sexually active without birth control for two or three years. That should go off as an alarm that there's an issue because something should have happened. And a young woman not using birth control, who's sexually active, and if nothing happens, at least the evaluation should be started.

Doesn't mean treatment has to be initiated, but the evaluation has to be started, which means that all of this should take place before they come to see me. Because a lot of times, by the time they come to see me, it is, it is a bit too late. So I think the obgyn, the general, the PCP should do a lot of the work just to kinda identify women who may be at risk for fertility issues and can get them a referral sooner than later. So now I'm seeing them in their early thirties and we're making a decision not to have a baby right now if they're not ready. But, now we start talking about, well, should we freeze your eggs or not? For the chance of maintaining your fertility for the future?

Dr. Sophia:
Can you talk to us, walk us through a little bit of what egg freezing is, what it's like? Does that mean that they have to do the same kind of fertility treatments? As far as IVF, I think the barrier is, many women think that this is going to be not just expensive, but very taxing on their bodies. If you don't mind just kind of walking us through what is egg freezing or some pre fertility conservation?

Dr. Mel Thornton:
The biggest thing that's happened to our field is the ability to freeze eggs. And there's a procedure called vitrification, which is basically rapid freezing, right? That came about in around 2012. Before 2012. Egg freezing was experimental. And the reason why it's experimental is because when we froze eggs, we didn't think they were gonna thaw very well. We didn't think they would lead to a baby. So only women who need it, such as someone diagnosed with cancer, have no other choices to preserve their fertility. We would freeze the eggs. Over the advent of vitrification, we showed that in a healthy egg, if we freeze it, that egg in the future has the same chance of being successful as a fresh egg. Mm. So that was a big deal and, and that's what, 13 years ago that's why I love this field.

Dr. Mel Thornton:
Because it is forever. It is changing quickly, quickly. Basically it is taking fertility, drugs, the commitment of the hormone injections, about 10 to 12 days. The office visits to monitor how the eggs are growing is probably like about three or four visits. So it's about a two week process from the time that you start your period to the time that we're able to retrieve the eggs and the egg retrieval. But they get a nice little nap and it takes about 15, 20 minutes, depending upon how many eggs they have from start to finish. Recovery is maybe like about 30, 45 minutes, maybe a little bit of mild cramping, but before you leave the office that day, you know how many eggs that you were able to retrieve.

Dr. Sophia:
Wow.

Dr. Mel Thornton:
That, I would say the biggest drawback to egg freezing is the cost. because you know, the insurance game is the worst game around because somebody says, well my insurance covers egg freezing. But then when you look further into it, it'll say only for medical reasons and technically what we call social freezing or just preserving because you wanna preserve is not a medical reason to freeze your eggs. So the insurance company says, yeah, we covered, but only if you are diagnosed with cancer or some catastrophic events happen, you need to freeze your eggs, which is not what happens to most women. So cost is the biggest factor. I would say in New York City, you'll see it costs anywhere between 5,000 to up to $13,000 to freeze your eggs. The medication may run anywhere between two to $3,000. So you know, you're looking at about, you know, anywhere between eight to $10,000 just to freeze one cycle of eggs. And it's all about the quality of the egg, which means the age, the younger you are, the better the quality. So you don't need that many eggs. But as you get older, you're gonna need more eggs. So you need more cycles of going through the IVF, maybe two or three cycles to freeze enough eggs for the future. And it gets very, very expensive if a lot of women just can't afford to do it

Touseef Mirza:
These days. What is the average age of the woman that you are seeing that wants to have their eggs frozen?

Dr. Mel Thornton:
Unfortunately, 38. And we can definitely freeze the eggs, but the big issue and egg freezing is controversial because some people say, well, if they freeze their eggs, they have a false sense of security. In other words, they will delay getting pregnant longer because they feel like they can fall back on the frozen eggs. So that woman comes in with 38, 39, I would say, instead of freezing your eggs, why don't you get pregnant? And most of them are not ready to get pregnant, they don't have a partner, et cetera, and they don't wanna use donor sperm. So now you freeze their eggs. But the big issue is that if they come back and we say 43 and say, okay, now I'm ready to use those eggs, and I froze. And egg freezing is not a hundred percent, so not a hundred percent of women will get pregnant now if they don't get pregnant. And they're 43 now. They're trying to get pregnant with eggs at 43 years old instead of eggs that were 38 years old.

Dr. Sophia:
So Dr. T I guess one of the things I'm definitely getting from our conversation, and it's something that I've said here on the podcast before, our fertility is really the biggest function or the biggest factor I should say, is our age. Would you say that that's true?

Dr. Mel Thornton:
Oh, definitely. Definitely. And this was, this is, this is a part that I love because people don't know this. The most eggs a woman ever had in her lifetime was when she was five months inside her mother's belly. So before she was born, she had the most eggs, and that's about 5 million on average. By the time she's born, it goes down to 2 million. And as a little girl growing up, even though she's not getting her menstrual cycle, she's still losing eggs. So by the time a woman hits puberty, she starts off her reproductive years with about 350,000 eggs. Now people say, well that's a lot of eggs, 350,000 and I only use one every month. But in fact, you use about 700 eggs just to make one egg, isn't It is a crazy attrition. And by the time a woman's 25, she's down to about 150,000 eggs. Now back in the day, it didn't really matter because our grandparents and great-grandparents, they had children in their teenage years, which is when the eggs are the most fertile. So by the time they were 30, they were done having children. But now by the time a woman wakes up and says she's 35, she may only have about 8,000 eggs left. And that may not be enough eggs for her to actually, you know, have a baby.

Touseef Mirza:
Wow. So can you talk a little bit about that? You're saying that even if you have 80,000 eggs, you might still not get pregnant. It almost feels like the opposite. If you have 80,000 eggs, then you have 80,000 chances of getting pregnant. But that's not the situation.

Dr. Mel Thornton:
I always tell people fertility is a reverse pyramid. You always have to start off with a lot to get down to a few, because as humans we are very sophisticated. It takes a lot to make a human. And so for example, when a woman goes through an IVF cycle, say, you know, she takes the stimulating medication, she's doing the hormones, we do the ultrasounds. And we may say she starts off that month and there may be say 24 resting eggs there. Okay? The fertility drugs may get 20 of those eggs to grow. And the thing that's important to know is that we're not taking those eggs away. In other words, we're not depleting her egg stores any further. If a woman starts off at 24 eggs at the beginning of the month, 23 of those eggs are gonna die off and only one is gonna grow.

So we try to keep as many of those eggs there so we can retrieve them to use them. So we're not depleting anyone's eggs stores when we go through the IVF process or we freeze eggs. But if she has 24 resting eggs there, we give her the fertility drugs, 20 of those eggs are growing. Now, statistically, not every follicle where the egg is sitting contains an egg. So we may get 18 eggs. Now you have 18 eggs, but see how many are able to get fertilized or what's called mature. So now you may be down to 15. Okay. And then the fertilization rates, even with good healthy sperm may be anywhere between 60 to 80%. Right. And then of those that fertilize, 50% will become what's called a blastocyst, which is an embryo that has to potentially become a baby. And of those, depending upon a woman's age, you may see one or two that are a healthy blastocyst or healthy embryos that become a baby.

So outta 24 eggs, we may end up with one or two embryos that are healthy enough to lead to a baby. And then those one or two embryos that we have, if we transfer them and she's under 35, the live birth rate may be between 50 to 60%. So not everybody gets pregnant. And we put an embryo back. A woman who's thirty eight, thirty nine, that live birth rate may be down to 30%. So what you see is there's a big attrition because you gotta get to the best of the best. So, the whole goal is to pass on your best genetic information, which means the best egg and the best sperm. I always educate my patients to come in. I say, you know, as humans, we are allowed to reproduce all the time, every month we can reproduce when we're operating.

And that's because we select out our abnormal embryo before they implant. Okay? And sometimes in women under 35, it may take 12 months before they actually get pregnant women over 35. It takes longer because it takes longer to find that one good embryo that can lead to a healthy baby. Whereas you look at the animal kingdom, like, you know, dogs and cats and they'll have a litter because it's easy for them to get pregnant. But then when they deliver the litter, half the litter is abnormal. So we avoid that by selecting out abnormal embryos before they even implant. So that's why it takes us a long time to get pregnant when we're trying to conceive.

Touseef Mirza:
So when the women come and see you, like what you've just explained to us, it almost feels like, you know, if you finally do get pregnant is kind of a miracle almost. Right?

Dr. Mel Thornton:
It is a miracle. Lemme tell you, it is a miracle.

Touseef Mirza:
With everything that we talked about then the upside down pyramid situation. So when women come and see you, they must feel, oh my God, this is my last resource and this man is going to make magic happen and I'm finally gonna be pregnant. Like, how do you like, talk through this? Because it must be still hard for them to fully grasp at this point if they, like you said, if they've come and seen me at this point, there's officially a problem. So how do you start that conversation to help them understand the stakes that are in front of them?

Dr. Mel Thornton:
I would say the first thing that I do is I want them to be comfortable. Okay. Because I know that 95% of the information I give them, they're not hearing me. Okay. Because they're sitting in front of me thinking, why am I here? I shouldn't be here. They're getting so much information from everybody else that they're very overwhelmed. So the first thing I always do is say, let's not talk about your fertility. You know, let's talk about you as a person. You know, what, what, what's your goal? You know, if this is the perfect world, you have the perfect family, how many children would you have? You know? And I always say, let's look five years from now, it's a beautiful sunny day and year in Central Park. How many children do you see with you? And depending upon that answer kinda gives me an idea of what her expectations are.

And if she says, I would be happy just for one, then I'm happy to hear that. But if I hear somebody say that, well, I want four or five kids and they're like 38 years old, then that means, okay, I got a lot of work here to kinda make sure they understand. But we try to focus on fertility for a little bit and then get down to maybe the root of why they're not getting pregnant. And the most common thing that I see is that women don't have sex at the right time. I will say, so how do you know when to have sex when you're fertile? You know, I don't know, we just have sex. I said, no, no. How do you know when you're ovulating? Well, I don't know. And that's important because when a woman ovulates the egg can only be fertilized for 24 hours.

Wow. After 24 hours, it's gone. It goes away. So you got one day of the month where you get pregnant and everyone thinks that magic day is day 14. Now, the reason why I think it's day 14 is because women think the average person has a 28 day cycle. Okay? But if you have a 30 day cycle, your magic day is day 16. So you may have sex on day 14, skip day 16. And that's the reason why you're not getting pregnant. So, you know, the first thing I wanna do is just say, Hey, let's make sure you're having sex at the appropriate time. Talk about ovulation kits to make sure we know when you're ovulating and talk about all these different things. Natural assessment of their fertility. In other words, cervical mucus monitoring, temperature monitoring, to kinda get an idea of when you're actually elevated.

That's the most important thing. Then we'll start talking about, well, these are different tests that we wanna do. Okay. And explain why we wanna do this test. And then say, we're gonna do the testing and then you're gonna come back to see me to go over the results. Because I could probably know that, that 38, 30 9-year-old, let's say a 42-year-old woman walks in my office. I know the treatment I'm gonna recommend is IVF because of her age, but I want her to do the testing so we can kinda review everything and say, what is your overall fertility? What's your ability to get pregnant naturally? And then say, well, this would be your ability to get pregnant with IVF. So you see that there's a big difference. So they say, wow, I never thought I had to do IVF, but IVF seems like the best choice for me.

Touseef Mirza:
When you say the testing, are we talking about AMH or something else?

Dr. Mel Thornton:
There's four things that we wanna do. Number one is her egg reserve, which is the AMH test. Number two is the sperm analysis. Number three, wanna make sure that she's ovulating every month. And then number four, we wanna assess to make sure that her fallopian tubes are open so that she can't get pregnant. So those are the four basic tests that we do. I always say there's a fifth test, and the fifth test is a good history. Because sometimes it could be other factors that are going on, such as why they're not getting pregnant, not having sex at the right time, or I would say 85% of the time, I only see the female come for the consultation. I never see the male partner. How do we know that male partner is really ready to have a child? You know, you know, all things to say about man, we're smart.

And many times we know when our partners are ovulating and we may be working late that day, or we may be really tired. I can't have sex today because they may not be ready to have a child. So I like to see both the male and the female at the same time, just to make sure we're all on the same page. Because the worst thing is for a woman to say, I'm ready to have a baby. But for her partner to say, I'm not really ready. So now she's gotta make some life changing decisions. It's just the right person for me. What do I do at this point? So it's really, really complicated. It's a lot of therapy we do at the same time.

Touseef Mirza:
Yeah, I was gonna say you're like a therapist at the same time. Yeah, a couple therapists.

Dr. Mel Thornton:
Yeah.

Dr. Sophia:
Yeah. I think that's a, probably a very big portion of the woman's health world requires you to have a certain level of just real empathy for where they're coming from emotionally. Right. Dr. T.

Dr. Mel Thornton:
Absolutely. Because you just never know who you're gonna see or why they're there. And many times they need that conversation about is this the right guy for you? You know, because I'll see so many women come in and say, well, I'm ready to have a baby, but he's not ready. So I say, well, you gotta be selfish, because typically men can have children as long as they want, where you have a limited time. So I need you to start being selfish and think about yourself. If he's not ready to get on board, then you may have to, you know, get him off the train and get somebody else on the train, or maybe go to a sperm bank and think about using some donor sperm to help you get to your goal. Because I don't wanna see you in my office at 45, and I'm saying, I'm sorry, I can't help you have the baby and you feel devastated.

Touseef Mirza:
Dr. T dropping truth bombs left and right. I mean, but, but you know, like, because as women sometimes we, when we want something, we really want it in a bag and we keep it inside and we don't talk about things like you said. And so finally, I think when they come and see somebody like you, you are just, they finally have to see things as they are. Because if they've come and seen you, you have to tell them the stakes. And so, like, you place such an important role around that. I'm sure the women, at a certain point, get a certain sense of clarity and at the same time probably a sense of devastation because it means that, okay, I gotta make decisions like now and maybe I need to stop thinking about this dream that I had. And the reality is something different.

Dr. Mel Thornton:
Yeah. You know, they really appreciate that. I've had a lot of people come back and say, you know, even not everyone gets pregnant and they come back and say, I didn't get pregnant, but you know what, my journey was a good journey. Because many, many times, if you're not able to have a baby, it's about having closure and some women never get. And they go through life wondering, what is this? What is that? So, you know, our goal is to help you have a baby, but if you are not able to have a baby for whatever reason, we want you to get closure so you're ready to move on to your next phase in life. Maybe I can say that's adoption, egg donation. Maybe you need a surrogate. So now you're ready to move on mentally to that next phase.

Dr. Sophia:
I wanna switch gears from not just the ability to get pregnant, but the women who have what we call recurrent pregnancy loss, or the women who are constantly losing babies. It's really one of the things I've had to deal with just, just this week in my own practice. As a woman who's had her sixth loss she gets pregnant and the pregnancy is positive. We see the embryo, she gets to about seven weeks and then boom, she has a miscarriage.

Dr. Mel Thornton:
Those are hard. First of all, the definition of recurrent miscarriages back in the day, it used to be three miscarriages. Then we do an evaluation. And the reason why it used to be three is because the next time getting pregnant, if she has three miscarriage, it is about a 60% chance she'll have a baby. Okay? So because someone's having multiple miscarriage doesn't mean that they won't have children on their own. But now it's down to two because of the emotional toll that you go through by having losses. And the problem is that 98% of the people that you evaluate for miscarriages, everything is normal. Hmm. You can't find anything wrong.

Dr. Sophia:
It's exactly like this patient of mine.

Dr. Mel Thornton:
Yeah. You just can't. And usually the reason for the miscarriage is due to the embryo itself. Most women don't realize that by six to eight weeks, all the organs are formed and functioning. So if there's something that goes wrong in say the development of the heart, the body senses it’s not healthy as a result of a miscarriage. So there are many things that we can't test for that may be causing it. But we try to, you know, make sure the male and female chromosomes are normal. Make sure her uterus is healthy, make sure there's no fibroids, make sure there's no thyroid issue. A lot of different things, the blood clotting issues, and the majority of times we don't find anything wrong. It's so frustrating because the patients have lost hope. They internalize everything.

Dr. Mel Thornton:
They don't talk to anyone. And the first thing I say is, listen, talk to your mom, talk to your friend, anybody that has children, and ask them if they ever had a miscarriage. And probably about two thirds of them will say yes. And now they don't feel like they're alone. This is the only one that's happened to. But there is, there is hope though. I don't want women out there to think that there's no hope. There is hope. So see your gynecologist, see your reproductive specialist, get an evaluation, see if there's anything wrong. But don't be disappointed if everything is normal. And this is the funny part is that I always tell women with miscarriages or something like that, I say, if I were a cardiologist and I say, all your results are really good, you would be really excited. But as a reproductive specialist, when I say all your test results are normal, everything looks really good when we get disappointed because they want me to find something. And, many times we don't find anything.

Dr. Sophia:
Yeah. I mean, even the treating doctor, I mean, me as the obgyn who has a patient who walks in the office with this kind of condition and having done all the workup basically that you described, looking to make sure they don't have something called the thrombophilia looking to make sure that their chromosomes are normal for both them and their partner looking at their partner's sperm and all the things. And then everything comes back normal. And I feel just as I do, I hate to use the word hopeless, because I'm not that person. I, I'm like, Nope, there's gonna be something else we can do. We've gotta keep looking. And we've gotta keep trying, but it's very disheartening.

Dr. Mel Thornton:
No. And when a woman gets pregnant, the most joyful thing is to do their home pregnancy test and see it turn positive. Right. But for women who have miscarriages, it's the worst thing ever because now the agony begins, and it could be a healthy pregnancy, but they're always looking over their shoulder like, okay, when am I gonna miscarriage? When is it gonna happen? Even through the whole pregnancy and to the point where the baby's delivering, then they finally realize, okay, it didn't happen this time in my field. It's the hardest diagnosis to treat and take care of.

Dr. Sophia:
Yeah. I have another one just last week that I actually delivered who'd had five losses, and she told no one, she was pregnant. Literally no one knew except for her and her partner until she had that baby. Because she didn't want to go through it again. She just couldn't go through telling people that she was pregnant and then, you know, for them to like, be looking for this, this baby nine months later. Right. And there's no baby. And then having to go through the pain of describing whatever she went through or the process. And so it wasn't until she literally was having the baby that she told her family, like, like siblings or like , you know, aunts and uncles. And so, like, as you say, the thing that should be the most joyous in women who have had losses is just a constant, almost like a monkey on their back.

Dr. Mel Thornton:
Even in women trying to get pregnant, there are triggers that people will say and not realize they're saying anything. And women have so much pressure on them. So, you know, when a couple's been together for more than two or three years, they never asked a guy, oh, when are you guys gonna have a baby? They always ask the woman, when are you gonna have a baby not realizing that she may be trying to have a baby is not able to conceive. And now she feels more pressure because the mother-in-law is asking, when are you guys gonna get pregnant? And she can't, you know, she can't give that answer to her, her mother, her friends. And I just wish people wouldn't ask that question. You know, let the person come out and say, Hey, we just started trying to get pregnant, or Hey, we are thinking about having a baby a year from now, or something like that. Because I think sometimes the work that you can say, you know, when are you guys gonna have a baby?

Touseef Mirza:
How do you remove that shame and realize that it's biology? You know, it's not something that you're controlling. I mean, maybe there's certain things that you do, like if you're smoking or if you're always under stress, that does have an impact. But in the better part of things, like that's just biology, if you're getting a miscarriage, it's because the body has decided that it's not a viable embryo. It's actually protecting you. And, and I'm not saying this is easy, I'm just saying like, we get so caught up in one perspective, it's like, how do we open up that conversation more?

Dr. Mel Thornton:
It's education.

Dr. Sophia:
It's doing this.

Dr. Mel Thornton:
Doing this. If you think about it in high school, they teach you how not to get pregnant. They don't teach you anything about your reproductive cycle. When you're fertile and all these different things, no one even teaches you how to change a diaper. You have a baby, you come home. What I do here, you know, they don't teach you that.

Dr. Sophia:
That's true.

Dr. Mel Thornton:
But it is all about education, particularly for women. So podcasts like this are so important. Maybe even just doing a podcast on just basic biology, when your most fertile time, how to test. If you fertile,

Touseef Mirza:
We might have to bring you up a second time, then you're just coming up. , we'll have to do the biology of fertility now.

Dr. Mel Thornton:
I would love it. You know, I would love it because I, I'd rather not see her in my office and have her come to this wonderful obgyns office and, and deliver the baby. And I never meet her. That makes my day, listen, I gotta go to work, right? But I'd rather not go to work, and I wish I could go to work, and maybe I had two or three patients on my schedule, because the majority of people are just getting pregnant on their own. Then, then that means that I made a big difference in the world. So until then, you know, we gotta keep educating.

Touseef Mirza:
One thing that I was thinking about when both of you were talking in the sense that when Sophia, you were saying when a woman is there, especially in the early thirties, you ask, do you wanna start a family? I'm 53 now. I've never had any obgyn asked me if I wanted a family. They asked me, are you sexually active? Are you pregnant? But they've never asked me, do you want.

Dr. Sophia:
Birth control.

Touseef Mirza:
If I'm on birth control? But they've never asked me, do you wanna start a family? Is that something that, you know, for the women who are, and for the men, like for for anybody, is for the women to actually be proactive and to tell themselves to the obgyn when they're 25, 28, that I wanna have a family so they can start having that conversation if the obgyn doesn't bring it up.

Dr. Sophia:
Absolutely. I would say that that's a major part of why we are here is so that women always know that they have that level of agency that they can advocate for themselves and ask the appropriate questions to whoever their provider is, even if it is just their primary care doctor to say, I'm thinking about having a baby. How do I go about this or that? I want to have a baby in the future. How do I go about this? And I think we just need to keep getting the word out that women can actually advocate for themselves whenever they go in to see any provider.

Touseef Mirza:
I think there's this misconception, or the way that we've been brought up, and that's not just from a patient perspective, but also from a provider perspective, is if you're gonna go see a provider, there's something wrong that you're trying to get fixed. But when you're actually talking about a family that's more in terms of your life goals, right? Like, so it, it's not maybe something that a provider will bring up. And especially a patient's like, well, you know, I, you know, why am I bringing this up? You know, agree. Because there's no, there's nothing wrong. But my point is, is that we should, considering the critical things that can happen even just five years down the line, if you haven't started to talk about it when you're 30.

Dr. Sophia:
Yeah. It's part of preventative care. It should be anyway. What do you think Dr. T?

Dr. Mel Thornton:
It has to be brought up. The provider can do so much because the provider is under a lot of pressure here herself to see as many patients as they can today. So we can all do so much as providers, but we should do what we can. And I think we just have to educate the public for good reasons, bad reasons. You know, young women listen to people in pop culture, whoever the influencers and all these people on social media. We need somebody who's an influencer on social media to put out the right information to say, Hey, no matter how old you are, do you want a baby? Go get an AMH. Let's talk about your fertility. Talk about your fertility at the next doctor's visit, talk about your fertility. Make an appointment to see a fertility specialist. Just to kind of keep putting it out there. So one day it becomes like standard, oh, I'm 18, let me check my AMH to make sure I'm able to have a family in the future.

Dr. Sophia:
I can't agree with you more, Dr. T, it's definitely a major reason why I was so excited to have you here. What are your last words for us, for our audience? What is something that's burning that you feel like you really wanna get out there that we haven't talked about?

Dr. Mel Thornton:
I hear women who don't go see a doctor because, oh, it's, if God's willing to get pregnant, I'll get pregnant. We got to take that away because God has given us so much technology that he can always help. So see a doctor, talk to your friends, do AMH. Just advocate for yourself, find you know what it is, find out your personal information and then take that personal information and decide what to do with that information.

Dr. Sophia:
Thank you for that little nugget. Because I definitely think, not to say that we can't bring in our spiritual selves into this, but we forget if we are taking into account our faith, right? That so much has been brought about because of it, the access to new technology using us physicians or providers as a vessel to help women get to their ultimate goals. And so I love that you, you bring that point out.

Dr. Mel Thornton:
It's just, it is heartbreaking for me to see that woman in her forties and having a very poor prognosis of having a child. And, and then the emotions come up and, you know, it's always anger. And then they start blaming themselves about, you know, it is because I did this, it is because I drank too much coffee. Is it because I did this? And don't be afraid to talk. Don't be afraid to ask questions and don't be afraid to move on because if you get the wrong guy who's not on the same train as you are, kick him off the train and find somebody else that can't get a ticket to the train that you are on.

Touseef Mirza:
Amen.

Dr. Sophia:
Amen to that. Amen to that. Oh my gosh.

Dr. Mel Thornton:
And the same thing for guys too. Yeah. Because some guys wanna have a baby and their partner doesn't wanna have a baby. So if your goal is to have a family, find the right partner that can also meet your goals.

A little ending for me, for my fellow guys out there, about 40% of people I see in my office now are single men who wanna have a family. What? And it's the same single man. Wow. 40%. And because they can't find the right partner to have a baby with.

Dr. Sophia:
Wow. Okay. Ladies, they're 40% out there. 40% they're looking for you.

Dr. Mel Thornton:
And let me tell you, for a guy that wants to have a baby, it is crazy expensive. There's an egg donor, there's a surrogate. Right? So there are a lot of guys out there, and these guys are well off because they're working with an egg don and working with a surrogate. So we gotta get everybody together and say, Hey, I got this guy over here. You want to have a baby? You wanna have a baby?

Touseef Mirza:
We need a fertility mixer, happy hour thing.

Dr. Mel Thornton:
There you go. A fertility matchmaker. You know, .

Dr. Sophia:
Wow.

Dr. Mel Thornton:
Yeah. Believe it or not, you have 40% of the people I see are single men.

Dr. Sophia:
Now is that single man looking for women? They just can't find a partner.

Dr. Mel Thornton:
That's what they told me. Yeah. They, they, they said it's very difficult to find a partner, and they decided, they, they say, they say the same thing. I'm getting too old. And for a lot of them, the single man I see there, and they're like, mid forties, they said, I'm getting too old. I don't wanna be like 80 years old and being a, you know, a young, I, you know, with a young, a young child. So they decided to have children on their own.

Touseef Mirza:
And this is more of a recent trend you started to see in the past few years?

Dr. Mel Thornton:
Yeah, I would say in the last five, six years. Yeah.

Dr. Sophia:
Interesting.

Touseef Mirza:
Wow. Well, Dr. T, I wanna thank you. I mean, aside from all the information you gave us, but thank you for your humanity and thank you for the beautiful heart in which you operate and talk with people. This was very special to me.

Dr. Mel Thornton:
I really appreciate that and I enjoyed being here. Dr. Sophia, keep doing what you're doing. Both you ladies are educating women and that's the most important thing. And you are making my job so much easier by just having conversation, real conversations with them. I thank you for letting me be here and be a part of this.

Dr. Sophia:
Yes. Thank you so very much for being here with us. It was really quite enlightening. For all of our listeners, thank you for listening. Thank you for being a part of the Dr. Sophia O-B-G-Y-N podcast and always embracing your body. Embrace yourself. Bye for now.

Dr. Sophia:
This is General medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.