In 1989, the advocacy group RESOLVE: National Infertility Association created a movement called National Infertility Awareness Week® (NIAW) in an effort to bring awareness to the 7.3 million Americans who experience infertility. That translates to 1 in 8 couples living with infertility in the United States of America alone. But infertility is of course a global problem, too; the European Society of Human Reproduction and Endocrinology states that one in six couples worldwide experience some form of infertility problem at least once during their reproductive lifetime. The American Society for Reproductive Medicine defines infertility as a failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years (1).
Despite these statistics, infertility remains a topic shrouded in myth and widely misunderstood, which leaves people feeling isolated as they face these challenges. That’s why a movement like NIAW is so important–it’s an opportunity to empower individuals and change the conversation around infertility. So, in recognition of #NIAW2021, and the people with periods and their partners who suffer from infertility, we hosted a webinar with leaders from two incredible businesses working to change the industry and make infertility care more accessible.
We spoke with Erin Wolff, MD, FACOG, the founder of Pelex (an online telehealth fertility platform), as well as Dianna Mesion-Jackson, co-founder of KORĒ (a reproductive health and wellness platform) about topics such as the importance of having a reproductive life plan, misconceptions about birth control and fertility, how period tracking can be used to enhance an understanding of one’s own reproduction, and more. Our aim was to emphasize how Femtech and fertility go hand-in-hand.
With Clue Plus you can track your cycles, cervical mucus, Luteinizing Hormone Kits, sexual intercourse, and find out more about how fertility works with our Understanding fertility bundle!
This interview has been edited for clarity.
Dianna Mesion-Jackson: Thank you for joining us today, we're so excited for this important conversation around femtech and fertility, I'm so happy to be moderating this conversation today with Clue and Pelex.
So let's begin with a really simple question. Just to break it down–why should we track our menstrual cycles?
Dr. Brayboy: When you're interacting with a healthcare provider, and you're interested in getting pregnant, it's important to know: do you have typical, predictable menstrual cycles? A lot of people can't answer that question.
So period tracking is really important. It's your own medical record, it's your way of communicating, “this is what's happening with my body.” A lot of people think of the period as a vital sign. So if you are having a predictable, regular, normal menstrual cycle, that means that a lot of things are working together, that means that a part of your brain called the hypothalamus is interacting with the pituitary, which is interacting with the ovary, which is allowing you to menstruate because the uterine lining is able to shed. And that is something that you need to keep tabs on!
And a lot of people will have been on hormonal birth control for a very long time, and they may not remember what their menses were like before they started hormonal birth control.
Dianna Mesion-Jackson: That's a great segue into our next question. So, I know there are so many misconceptions around birth control use and fertility, is there any impact on fertility from long term birth control use? And the second question is, what should women expect when they decide to go off birth control?
Dr. Wolff: Birth control pills and how they affect the menstrual cycle is a confusing area that we deal with often. A lot of times, women are started on birth control pills for reasons that have nothing to do with contraception. A lot of times they're started to regulate their menstrual cycle or to help with conditions like Polycystic Ovary Syndrome, or they stay on it and different things change in their underlying medical health and wellness.
So if you've had an irregular period before starting birth control, and then you've been on birth control for, say, 15 years, would that be an indication that you'd have challenges with fertility once you stop birth control? No, we don't think that it should. And I think one of the other questions that you mentioned is, how long does it take for your period to come back? And that can be very variable, depending on the person and the age and what their reproductive status is underlying when they come off.
Dianna Mesion-Jackson: Let's talk about reproductive aging. Dr. Brayboy?
Dr. Brayboy: So we have a trajectory, a reproductive lifespan. And typically your ovaries are actually formed when you are fetus, if your biological sex is female. So you have ovaries that are forming while you are a fetus, and then you're born. And from that time you are actually losing eggs–it's like a bank account. Before puberty you are losing eggs in a process called atresia or apoptosis. That's called your ovarian reserve. Once you start ovulating, you continuously lose eggs via atresia and apoptosis as well as ovulation. And we don't know yet how to slow down that process, and sometimes it doesn't happen in chronological fashion in step with our age. But you should be aware that at 35, your risk of miscarriage increases while your ability to conceive decreases. So that's a very critical time. In Clue Plus, we have a bundle of articles called “Understanding fertility” where you can learn about ovulation, pregnancy and reproduction.
So if you're thinking of having a child, you should really have what's called a reproductive life plan (2). Every person should really think, how do I want to have children? Do I want to have children? Do I want to conceive naturally? Do I not want to conceive naturally, what do I want to do? You can start having that conversation so you don't get to your 40s and say, “Oh my gosh, no one told me. No one told me that there was something called reproductive aging, and that I needed to make a decision early on in life.”
Dianna Mesion-Jackson: So with this reproductive life plan, where could we start? Where do you start? Can you kind of spell that out for us?
Dr. Brayboy: Sure. Actually, we put in the chat the link to the CDC workbook in case anyone's interested.
So the first thing is make a plan, right? So talk to your healthcare provider about what you'd like to do within the next year. Are you planning to get pregnant in the next year? That's the question that most of your healthcare providers should be asking. And if the answer is yes, here's a great time to start tracking, especially with the Clue app, because it is centered on people with periods and it's non-binary and trans-friendly, it's wonderful. There's no fluff and puff. It's just the facts. It's just science; we lead with evidence. And so you can start tracking your menses right then and there. And you will at least have that information. You can also start tracking when you might see changes in your virtual secretions or your cervical mucus, right. And so you can also track different aspects in terms of your luteinizing hormone kit to see if you're actually ovulating. And that's wonderful. But before you do any of that, you should really have a conversation with your doctor.
Dianna Mesion-Jackson: Can you define infertility for us?
Dr. Brayboy: Actually, infertility has two definitions, depending on age. So if you're under 35, it's 12 months of trying to conceive without being able to (and that could mean intercourse or that could mean donor inseminations). And then if you're over 35, it's six months of trying to conceive. Age is everything in fertility so we don't wait that long when you're over 35.
Dianna Mesion-Jackson: If you are over the age of 35, are there any circumstances in which you would recommend seeing a fertility specialist right away?
Dr. Brayboy: If you already have been diagnosed with something like endometriosis, hypothyroidism, hyperthyroidism, or you've had perhaps several miscarriages, this is the time when you want to visit a specialist, because there could be something else happening. I think it's really important to have a conversation.
At Clue, what we try to do is not have the stigma that surrounds people with periods, right? We try to normalize menses, we try to normalize issues with periods and we try to normalize infertility, because infertility, frankly, it's very common. And the more you don't speak about it, the more people feel isolated. A third of the time, it is female factors, but a third of the time, it's male factors, and third of the time, it's because there's male and female factors, it's usually unexplained, which just means we don't have enough research yet. And that's hopefully changing with more and more people going into the sciences and studying reproductive biology.
Dianna Mesion-Jackson: Absolutely. So in choosing a fertility specialist, or clinic, what are the important factors to consider, Dr. Wolff?
Dr. Wolff: So it's interesting, because as a doctor, I'm going to say that one of the most important things is not the doctor, it’s actually the IVF laboratory. And that's everyone behind the scenes, the embryologist that handles the eggs and the sperm and keeps the incubators in exactly the right temperature and makes sure the medium and everything is pristine and precise and very well controlled. And that really has the biggest impact on pregnancy rates and success rates in general IVF.
Beyond that, if you came to Pelex, we could talk to you about what your goals are, what you like in a physician, what you would like to avoid if possible. And I think matching personalities is a really important thing–that you have the right fit.
Dianna Mesion-Jackson: How do we help people who are not able to have kids to accept and live with it? I think that's a really important question to answer.
Dr. Brayboy: You know, it is not always the case that you might be able to have a biological child. And a lot of people feel as though there's some failure associated with that. There is not. I think that people don't realize that there are other ways of becoming a parent, or you could elect to not have children at all. So one of the other ways is with a donor egg, one of the other ways is potentially with a donated embryo, and another way is to adopt. There are all different ways to become a parent. And it doesn't change your relationship or your bond with your child, if they're biological, or if they're adopted–whether they be an adopted embryo or adopted child. And I will tell you, as the granddaughter of someone who adopted a child, I am grateful that adoption exists, because I wouldn't be here giving you this webinar.
Dianna Mesion-Jackson: Okay, thank you. That was terrific. I just want to say thank you for joining us tonight and for being open to these very important conversations and being part of this community. We hope you found this very helpful. And a huge huge thank you to our co-hosts, Dr. Brayboy and Dr. Wolff, for their insights and support and for bringing us together tonight.
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