The Whole Pineapple

Change is hard, especially when they involve endings of things we’re sad to see go. And we’re definitely sad to see The Whole Pineapple go.  In this very special, final (for now?) episode, Ruby, Anne, Jamie, and podcast producer Shannon Perry reflect on how difficult it can be to say goodbye. But as A.A. Milne says in the voice of Winnie the Pooh, “How lucky I am to have something that makes saying goodbye so hard.” Given how hard this is, we’ve clearly been very lucky indeed. Then stay tuned for Jamie’s meditation on letting go so you can move forward. This podcast has been a labor of love, and there has been a lot of joy in talking with amazing guests, hearing from listeners how much you’ve gotten from the episodes, and diving deeper into how fertility appears in research, books, and even popular culture. We hope The Whole Pineapple has helped listeners learn more about the fertility journey and the options that exist for those who are having challenges building their families. But we also hope it’s helped open the discussion — the stigma that still exists around infertility, and the reluctance many of us feel when talking about bodies and reproduction can make it tough to talk. But these are necessary conversations, and sharing podcasts like The Whole Pineapple can be a gentle way to introduce the topic. Finally, we have to say “thank you.” Thank you for listening and supporting this podcast. Thank you for sharing episodes and the things you’ve learned. Thank you for coming with us on this journey. Please know that the episodes will continue to be available, and our email, thewholepineapple@gmail.com is still live, if you have comments or questions. We love and appreciate you. Have a delicious week. Resources:  Kahlil Gibran: On Joy and Sorrow Find Jamie Mammenga on her website, Sound Perinatal and Fertility Counseling, PLLC: www.soundcounseling.org Audiotocracy Podcast Production: audiotocracy.com

Sorry, folks, it’s official: it’s the end of sex.* Henry “Hank” Greely, Professor by courtesy of Genetics at Stanford School of Medicine, Deane F. and Kate Edelman Johnson Professor of Law, and Director of the Center for Law and the Biosciences, is very interested in how new biomedical technologies impact assisted reproduction. He’s authored two books: The End of Sex and the Future of Human Reproduction in 2016, and CRISPR People: The Science and Ethics of Editing Humans, which published in 2021, and is Chair of the Steering Committee of the Center for Biomedical Ethics, among other impressive mouthfuls. In this episode, Ruby, Anne, and Hank dive into the changes that are already happening in human reproduction — and the possible changes to come. In addition to the scientific challenges, what are the ethical and legal questions we’ll need to tackle as the landscape changes? Many of us became aware of genetic questions with Dolly the cloned sheep and the controversy over stem cells and how they might be used to repair damaged bodies. But Hank took the question even further, asking, What happens when we can make eggs and sperm from skin cells? Does that signal the end of human reproduction as we know it? Hank can pinpoint the origin of his curiosity to October 19, 2010 in Muenster, Germany — a conference talk on how induced pluripotent stem cells (iPscs) could be used to make other cells, including, the speaker said off-handedly, sperm and eggs. Wait, what? Science fiction? Maybe not. If you’re curious about the possible future of fertility (and sex), this is the episode for you. Be sure to check out the book as well. There’s not only theory about what the future could hold but also a well-researched history of how we’ve gotten here  As always, please rate and review, and most of all, share the episode and show with anyone you think could benefit.  *Spoiler: New technologies might mean the end of sex for reproduction and the start of sex purely for pleasure. So the news isn’t bad after all.  Learn more about Hank Greely on the Stanford Law School Directory: https://law.stanford.edu/directory/henry-t-greely/ Find more episodes from Ruby and Anne at https://thewholepineapple.com.   Resources mentioned: Purchase the book from the Harvard University Press: https://www.hup.harvard.edu/catalog.php?isbn=9780674984011 Episode 29: My Embryos are Mosaic? https://thewholepineapple.com/episode-29-my-embryos-are-mosaic-interpreting-your-pgt-results/  

Fertility preservation for those undergoing gender-affirming transition is an important area of reproductive medicine. In this episode, Anne and Ruby are talking with Dr. Lynn Davis about how fertility options may be dependent on age, the gametes involved (i.e. sperm or eggs) and the stage of gender-affirming care.  Dr. Davis started her educational journey with a double major in Biology and Psychology from the University of Virginia, followed by her MD from the University of Colorado and OB/GYN residency from Harvard. She concluded her training with her REI Fellowship at Stanford University, where she also completed a postdoctoral Fellowship at the Stanford Agency for Healthcare Research & Quality, and served as Clinical Instructor in the Department of OB/GYN. Dr. Davis developed and now leads SRM’s Fertility Preservation Program, a specialized approach that assists those who need assisted reproductive technology to efficiently delay family building. Sometimes it’s a question of timing. For example, those born with testicles do not begin producing sperm until puberty (a process known as spermatogenesis). So if an individual with testes chooses to go on gender-affirming puberty blockers, they may not yet produce sperm. While puberty blockers can prevent bodies from undergoing unwanted physical changes (development of facial hair, lower voice, etc.), it may also mean little or no sperm to freeze for fertility preservation.  For those who have undergone natal puberty, it is possible to interrupt gender-affirming hormones in an attempt to resume spermatogenesis and freeze sperm for later use. However, there is a chance the process may not result in viable sperm. The experience coming off gender-affirming hormones also needs to be considered; for some, it can be a distressing, dysphoric experience.  Options for those with ovaries are also dependent on puberty and stage of gender-affirming treatment. Dr. Davis discusses the options for ovary stimulation, egg retrieval, ovarian tissue cryopreservation, and all the nuanced considerations along the way. Be sure to tune in for this important and fascinating conversation.   You can learn more about Dr. Lynn Davis and reproductive endocrinology at www.seattlefertility.com.  You can also find Anne and Ruby there. Hear more episodes of The Whole Pineapple at thewholepineapple.com.

A diagnosis of cancer or other serious condition is bad enough — dealing with tests, treatments, insurance, uncertainty, as well as the illness — but knowing that the condition or its treatments can also cause infertility…. It just feels so horribly unfair. The good news is for many, that diagnosis doesn’t have to equal the end of fertility. The landscape for patients has changed. In this episode, Ruby and Anne talk with fellow Seattle Reproductive Medicine provider and reproductive endocrinologist Dr. Lynn Davis about options for preserving fertility. Dr. Davis started her educational journey with a double major in Biology and Psychology from the University of Virginia, followed by her MD from the University of Colorado and OB/GYN residency from Harvard. She concluded her training with her REI Fellowship at Stanford University, where she also completed a postdoctoral Fellowship at the Stanford Agency for Healthcare Research & Quality, and served as Clinical Instructor in the Department of OB/GYN. Dr. Davis developed and now leads SRM’s Fertility Preservation Program, a specialized approach that assists those who need assisted reproductive technology to efficiently delay family building. So, what are some of the options? Gamete freezing — sperm, eggs, maybe even embryos — may provide additional options for post-treatment family building. If the patient is pre-menarchal (hasn’t had their first period), then stimulating the ovaries to freeze eggs is not possible, but ovarian tissue freezing may allow options for future fertility and hormone function. The best option for anyone in this position is to talk with your care team and a fertility expert to learn what the possibilities are for you. As ever, please do share this episode with anyone you know who might need both the knowledge and the hope this conversation brings! You can learn more about Dr. Lynn Davis and reproductive endocrinology at www.seattlefertility.com.  You can also find Anne and Ruby there. Hear more episodes of The Whole Pineapple at thewholepineapple.com.

The Whole Pineapple welcomes back Dr. Lee Hullender Rubin, specialist in acupuncture and integrative East Asian Medicine, this time to talk about herbs and East Asian medicine in general. While acupuncture may be the most well-known, East Asian medicine incorporates many different modalities of treatment. So let's talk integrative medicine.  As Dr. Lee says, “integrative” means that many different treatments and providers come together to collaborate and support patients. In the US, we don’t always reach this goal, as Western medicine has traditionally been less open to collaboration, but with more providers welcoming alternative therapies and more patients advocating for holistic wellness care, it’s getting better! That said, because the herbal industry isn’t regulated the same way prescription medication is, you’ll want to be as informed as possible before you start adding things to your treatment plan. Some things to expect: Your provider will likely ask you to get your labs done before starting treatment. This is so they can understand how your body functions at baseline. You’ll probably answer a lot of questions. Again, your provider needs to know a lot about you — sleep, stress, diet, goals, etc. — before designing your treatment plan. There will likely be continued tweaking of your plan. These formulae can be complicated, so it takes some time to get things just right. Then as your body and/or circumstances change, more tweaking may be necessary. You should keep your entire care team apprised of all the changes you’re making and any new treatments (including herbs!) that are added or removed from your program.  There’s so much to learn in this episode, and you may want to have some of this information handy when you talk with your care team, so be sure to bookmark or favorite the episode! And as always, please share with anyone else who could benefit.  Learn more about Dr. Lee and schedule an appointment at Rosefinch Health at rosefinchhealth.com Learn more and hear more from The Whole Pineapple at thewholepineapple.com. 

Dr. Lee Hullender Rubin wants you to understand acupuncture and how it can aid all kinds of issues, including infertility.  The founder of Rosefinch Health, Dr. Lee is an award-winning doctor of acupuncture and a leader in the field of integrative reproductive medicine. She blends compassionate care with over two decades of clinical experience specializing in fertility, IVF support, pelvic and vulvovaginal pain, and cancer-related support. She is also a teacher and researcher in acupuncture and integrative East Asian medicine and founded Rosefinch Academy to help other providers learn more.  But about that “being poked with needles” thing: In unskilled hands… well, just don’t be in unskilled hands. Acupuncture can seem random to the unfamiliar, but it’s a highly specific process developed, literally, over thousands of years.  If you’ve avoided acupuncture because you’re needle-phobic, here’s a big tip: acupuncture, in the right hands, doesn’t and shouldn’t hurt. In skilled hands, you won’t feel the needle going in, only the results.  So, here are a couple of tips for assessing an acupuncture provider: Ask to see their license for your state or look them up on your state’s medical board.  Your specialist will perform an assessment of you involving lots of questions. You should do the same. Ask about their training and experience until you’re confident about their professionalism. Your acupuncturist is part of your care team. Make sure this provider is complementary to and cooperative with the rest of your care.  Your acupuncturist should understand your goals and have experience dealing with fertility issues, so ask about their work in fertility in particular. Check with aborm.org (aborm.org) but realize not everyone who is qualified has taken this optional test. Ask: if this isn’t the cycle for me, how will you support me? What can acupuncture do for you? At the very minimum, acupuncture can help you feel more relaxed and have better energy. And that can be super-helpful at a difficult time. Acupuncture may increase your chances of a clinical pregnancy or live birth. Acupuncture can relieve stress and help you sleep better. Acupuncture may help your body ovulate more consistently.  Acupuncture may help control blood sugar levels. This is just the tip of the iceberg of this conversation among Ruby, Anne, and Dr. Lee, so be sure to listen to hear all the science behind acupuncture. This ancient treatment method has so much to offer us here in the present! Learn more about Dr. Lee and schedule an appointment at Rosefinch Health at rosefinchhealth.com And as always, learn more and hear more from The Whole Pineapple at thewholepineapple.com.   The Acupuncture and TCM Board of Reproductive Medicine (ABORM): aborm.org

Note: This episode contains news on the future of The Whole Pineapple podcast, so be sure to tune in! There’s a difference between “letting go” and “giving up,” right?  Giving up is relinquishing control; letting go is making the decision that this path isn’t serving you right now and it’s time to make a change. But even if letting go is your decision, it isn’t necessarily easy or painless. In this very special snack, Ruby joins Anne and Jamie to talk about balloons and balls and dandelions and whirligigs in a way that we promise will make sense when you hear it. And they remind us that letting go of something that isn’t working leaves a hand free to take hold of something else. And of course, the discussion is followed by Jamie’s gorgeous voice giving us the peace to let go, even if just for this moment. As ever, find more meditations and more information at thewholepineapple.com, and find more from Jamie at soundcounseling.org.

For women athletes, it can sometimes feel like the playing field is so tilted, they’re constantly running uphill to reach their goals. (Seriously, could this analogy BE any better?) There’s been progress, say our guests for this episode, OL Reign players Lu Barnes and Nikki Stanton, but parity is still a long ways off. The way women are (mis)treated in sports is a microcosm for the way women are often treated generally. So even for the non-sporty among us, the stories Lu, Nikki, Ruby, and Anne share will probably feel familiar – and the life lessons to be gained relate to us all! In this episode, we hear the realities of being an athlete in a female body: not just the realities of dealing with a cycle or having a more limited window for having a family, but also the cultural limitations (just wait until you hear Nikki’s story about the “shared” ice/hot baths in Chicago, oooof). The biggest battles often aren’t against an opposing team. Players in women’s sports generally make considerably less money than their male counterparts, they may not get the sponsorship offers men get, and their access to the best resources in terms of arenas, gear, coaches, medical support, health insurance, etc., is much more limited, generally. It’s important to understand how the barriers and inequities impact performance on the field; when you have to work year-round to pay the bills, you simply don’t get the time to recover. This episode is rich in great advice from players who've been around a while — how to stand up for yourself, how to have a life outside soccer, how to forge ahead while still protecting your health mentally, emotionally, and physically. It’s time to take gender out of the equation when it comes to paying ALL people fairly and treating people fairly, and we thank women athletes for helping bring attention to this issue! Learn more about Lu and Nikki and the OL Reign:  olreign.com  Nikki Stanton bio Lu Barnes bio Hear more from Ruby and Anne and listen to all the episodes of The Whole Pineapple at thewholepineapple.com.

If, unlike Anne, you’re not already a season ticket holder for the OL Reign, and you do live in the Seattle area, maybe consider grabbing your seats now. Like most women’s sports, tickets are less expensive than the men’s and certainly less than they’re worth! In this episode, we hear from OL Reign players Lu Barnes and Nikki Stanton on the joys and challenges of being a professional athlete. This episode came about because Seattle Reproductive Medicine is the OL Reign’s official fertility partner, providing education, fertility advice and care to preserve fertility options. Chances are, if you’re listening to this podcast, you know why it’s important for players to have a fertility partner, but if you don’t, for women, peak fertility years often coincide with peak athletic years. Options such as egg freezing can extend a female athlete’s career by enabling her to postpone family building. So what are the challenges of being an athlete in possession of a uterus? (And heads up – these issues often affect the careers of any professional, not just athletes!) Depending on her cycle, there are times when women’s bodies are more injury prone. Uniforms often don’t take into account the realities of women’s bodies — white shorts, y’all? Really?? Unlike for men, a woman’s sports career usually has to at least pause for becoming a parent. Double standards exist. And they generally suck for women. Society often “expects” women to simply quit their sports careers in favor of family. Men have never EVER had to deal with “the period lady.” Just like the fathers, mothers would like their kids to be able to see them play and to provide that same inspiration. And this isn’t a fantasy that biology makes impossible; more research, more investment, more conversation on the subject has already resulted in improvement — there’s no reason to assume the status quo is “good enough.” Nikki and Lu are brilliant on and off the field, so once you’ve listened to this awesome conversation, check out their bios at the OL Reign: Nikki Stanton bio and Lu Barnes bio, and then buy those tickets! Get Tickets HERE! And as always, help us end the stigma around infertility and bodies with uteruses and vaginas by sharing this and other episodes. You’ll find all the episodes at thewholepineapple.com.

First, we’d like to apologize for the joke that starts this episode. This is what happens when good vegetables go bad…. ;) In this delicious snack, Ruby and Anne are chatting with Judy Simon and Angela Thyer about their new book, Getting to Baby: A Food-First Fertility Plan to Improve Your Odds and Shorten Your Time to Pregnancy. If you are considering starting or building your family, it’s great for everyone involved to get in their best possible health, whether you’ll be carrying the child or not! And this plan can help everyone attain optimal health. Get your answers to: What is a “food-first approach” to fertility, and does it actually help? How do nutrition and lifestyle affect fertility? Is nutrition a one-size-fits-all? (spoiler alert: no.) Should I focus more on plants? (spoiler alert: probably) Are you all about weight loss? (nope) And so much more.  One thing we love about this plan is that it focuses on making progress, not on being perfect. And there’s no shame here: nutrition can be challenging, especially when life is busy. But the great thing is even small improvements can yield great, noticeable benefits.  Cooking and eating well don’t have to be stressful, and that’s what this book is all about. Let Angela, Judy, and your own body guide you to explore new foods and reach your health goals! As always, we hope you’ll share this episode with anyone who could benefit! More about our guests: Angela Thyer, MD, is a reproductive endocrinologist and infertility specialist and one of the founding partners at Seattle Reproductive Medicine. She is triple-board-certified in reproductive endocrinology, infertility, obstetrics, and gynecology, and lifestyle medicine, and her special interests include polycystic ovary syndrome (PCOS), nutrition and fertility, lifestyle medicine, and reproductive aging.  Judy Simon, RDN, is a registered dietitian nutritionist who specializes in reproductive health. She is the founder of Mind Body Nutrition, LLC, clinical instructor, and staff dietitian at the University of Washington. Judy has held leadership roles in the American Society of Reproductive Medicine Nutritional Special Interest Group, and is a Fellow of the Academy of Nutrition and Dietetics. Resources: Book website: gettingtobabybook.com Judy’s website: mind-body-nutrition.com  Instagram: @fertilenutrition Order on Amazon Judy’s previous full episode: Disordered Eating & Fertility  Snack: Health & Fertility at Every Size  Find more from Anne and Ruby at thewholepineapple.com.   

OK, we knew the human gut had one of these, but the vagina too? What’s actually going on in there? Microbiomes are incredibly diverse ecosystems: we are more bacteria than we are human. Yep. Read that again — there are more bacteria in us than human cells. You, my friend, are a moving, breathing microcosm that is incredibly cooperative when you’re healthy. Don’t panic. Katy Bradbury is back to explain what all this means and how we can use this knowledge to be healthier. Things to know: A healthy gut is NOT free from bacteria. We need the friendly bacteria to survive. Yes, it’s a bit icky to think about, but it’s important.  “Bad” bacteria is opportunistic, like weeds in a garden, says Katy. You need to keep your “good bacteria” healthy and plentiful so the bad can’t get a foothold. We want a diversity of good bacteria in both the gut and the vagina, but these are not the same critters. Lactobacilli are best for the vagina, so knowing how to protect lactobacilli by keeping the vaginal environment at the right pH is a good thing. This is important for fertility but also for avoiding infections like yeast infections and UTIs, so care is a life-long need. Douching and using other “cleaning products” is NOT vaginal care unless you have a specific medical reason. These products disrupt the natural vaginal pH and aren’t necessary for this self-cleaning organ. There’s so much good information in this episode, so please give it a listen and share with others. While it may be difficult to overcome the traditional shame around our bodies, this shame is, frankly, not helpful. Sharing information and talking openly are the best way to erase the shame and be healthier. Ready to learn more? Listen up! More about Katy Bradbury: Katy is founding member of the Fertility Nutrition Centre, a clinical advisor at Fab Fertile, a content provider for women’s health platform Xena, and a clinical supervisor for nutritional therapy students at the University of West London. You can find her at Katy Bradbury.com. Be sure to check out the robust back catalog of episodes from her podcast Fertility and the First 1000 Days: katybradbury.com/podcast To hear more from Anne and Ruby, find all their episodes at thewholepineapple.com.

Scheduling to record with this guest was a bit of a journey of its own, but the end result was totally worth it!  Registered Nurse, nutritional therapist, and former fertility patient Katy Bradbury understands the fertility journey as thoroughly as anyone can. But her own difficult experience had a genuine bright side: it led her into her career in fertility-centered nutrition. As nutrition often isn’t included in fertility advice or treatment in many places (looking at YOU, USA), this episode can be particularly useful for those who want to optimize their health and physical condition to support a healthy pregnancy. Fertility treatment in the UK is, as Katy says, a bit of a “postcode lottery” meaning that where you live can determine the level of treatment you receive, and there’s not a national level of service. Some people may wait a year or longer to start, which can be really tough when age is such a factor. Fortunately, improving nutrition can start (and ideally should start) well in advance of that first round of IVF or before treatment begins.  Here are some tips to keep in mind! Those first 1000 days — conception to age 2 — are so important to a child’s development and health. It’s best to work with all partners to fully understand the issues and be proactive about health and nutrition. Get ready to work on your gut! Gut health is so important and often so ignored. “Bespoke” nutritional guidance is best: bodies, lifestyles, tastes, etc. are all different. A fertility nutritionist can help you learn the foods that work best for you.  Ready to learn more? Listen up! More about Katy Bradbury: Katy is founding member of the Fertility Nutrition Centre, a clinical advisor at Fab Fertile, a content provider for women’s health platform Xena, and a clinical supervisor for nutritional therapy students at the University of West London. You can find her at Katy Bradbury.com and be sure to check out the robust back catalog of episodes from her podcast Fertility and the First 1000 Days. To hear more from Anne and Ruby, find all their episodes at thewholepineapple.com. Resources: Fertility Nutrition Centre: fertilitynutritioncentre.org Xena: xena.life Katy’s website: katybradbury.com Fertility and the First 1000 Days podcast: katybradbury.com/podcast

As anyone born with a uterus will tell you, living in a body equipped with one of these and all that goes with it comes with a special set of challenges. And many of us don’t really know all we need to know, so think of this episode as a sort of Owner’s Manual. So what do we need to know through the decades of our life? TEEN YEARS: Irregular periods are normal, but if they’re super problematic or painful, a discussion with your primary care provider or a gynecologist might be in order. Time to start screening for sexually transmitted diseases if you’re sexually active. TWENTIES: Is it time to consider protecting your future fertility? This is prime time for fertility, but if you’re not ready yet, it might be good to at least consider what’s ahead. THIRTIES: Do you know how large of a family you want? As you get into your mid- and late-30s, fertility can be more challenging — definitely know your options! FORTIES: Celebrities having babies in their 40s should not convince you that you have plenty of time, especially if you’re wanting to use your own eggs to conceive. “Time is eggs!” as Anne says. HINT: talk to a menopause specialist at this point – perimenopause is a critical stage of life for protecting your future health! FIFTIES: Pregnancy is still possible, but celebrities at this age are most likely using frozen eggs or donor eggs.  SIXTIES: Pregnancy is probably not a concern, but STIs are, so protect yourself! Obviously, this is just a hint of what Ruby and Anne have to share at each stage, so make sure to listen and share! And find more from our hosts at thewholepineapple.com.

Ectopic pregnancies may be rare, but given how devastating and dangerous they can be, taking steps to prevent them is never a bad idea! For those worried about ectopic pregnancies, remember they generally amount to only 1-2 percent of pregnancies. For those who have had an ectopic pregnancy, that number may go up to 10 percent, but it’s still unlikely. That said, it’s understandable that those seeking to be pregnant want to ensure the safest, healthiest, and most viable pregnancy. Guest Dr. Amy Criniti suggests taking a look via tubal imaging, called an HSG. This procedure can give the doctor an idea of the status of the fallopian tube. Listen to our previous episode on uterine/tubal evaluation for more details:  Snack 6: The Camera Goes Where? Assessing the Uterus and Tubes  Additionally, an ultrasound can tell you which side you’re going to ovulate on, so you can aim for trying to get pregnant when the egg is traveling on the side with a functioning, healthy fallopian tube. Patients may also opt for IVF, which has a lower (but still not zero) chance of resulting in an ectopic pregnancy. Quick quiz: True or False: ovulation switches sides each month, so if it’s the left fallopian tube in January, it’ll be the right one in February.  True or False: smokers have a higher chance of ectopic pregnancy. True or False: if you’ve had an ectopic pregnancy, there’s nothing doctors can do to decrease the risk next time. True or False: a fallopian tube can be repaired and returned to full function after an ectopic pregnancy. True or False: having your “tubes tied” for contraception is an easy surgery to reverse. Listen up to hear the answers! If you’ve had an ectopic pregnancy and would like to share your story, we’d love to hear it. Please send us a message at thewholepineapple@gmail.com.  As always, please be sure to share this episode with anyone who can benefit, and please subscribe, rate, and review. You can find more information about our medical team at seattlefertility.com, and you can hear more episodes at thewholepineapple.com.

Ectopic pregnancy is when the pregnancy implants outside the uterus, most often in the fallopian tubes. As much as 1-2 percent of pregnancies end up in this category, even when the pregnancy results from IVF. In this episode, Ruby and Anne talk with Dr. Amy Criniti, another member of the Seattle Reproductive Medicine team, about some of the questions (and myths) out there about ectopic pregnancies.  Why are they so dangerous? If not caught early, the embryo can grow inside the tube. Unlike the uterus, the fallopian tubes aren’t meant to stretch to accommodate a growing embryo. Eventually, the tube will rupture and cause internal bleeding. Left untreated, an ectopic pregnancy can endanger the life of the pregnant person. Can an ectopic pregnancy be “relocated”? Despite wishful thinking among some non-medical persons, no. An ectopic pregnancy, once disrupted, cannot reimplant elsewhere. Does a “pregnancy of unknown location” always mean an ectopic pregnancy? Not necessarily, says Dr. Criniti; sometimes blood work can indicate there’s a pregnancy, but it’s not yet visible on an ultrasound. If the embryo can’t be located, the patient will be closely monitored until they’re sure the fertilized egg has implanted where it should. How does an “implanted” pregnancy (like IVF) end up in the wrong place? We don’t entirely understand how the fertilized egg moves around before implantation, and short of attaching a tiny Go Pro, we may never know. But even an “implanted” pregnancy can move before attaching, though like ectopic pregnancies generally, the risk is pretty low. In this age of conflict over reproduction, it’s important to know about the risks of ectopic pregnancy and what your choices are if you find yourself in that 1-2 percent.  More about Dr. Criniti: Dr. Criniti joined the medical team of SRM in 2006. Her clinical interests include fertility assessment, PCOS, age-related infertility, as well as the entire spectrum of fertility treatment. She currently teaches University of Washington medical students and is the Medical Director of the donor egg team. She was recognized in 2013, 2015, 2022 and 2023 as one of Seattle Magazine’s Top Doctors in infertility, as well as Seattle Metropolitan Magazine Top Doctor in 2014, 2015, 2018, 2019 and 2021. Be sure to share this episode with anyone who can benefit, and please subscribe, rate, and review. You can find more information about our medical team at seattlefertility.com, and you can hear more episodes at thewholepineapple.com.

x Sooooooooo…. Whether it was your choice or not, whether it’s for a happy reason or a difficult one, starting over can be one of the most difficult things we do as adults.  New job, new home, new realities can mean uncertainty and disruption. So how do we get our heads and hearts ready to take on the challenges of change? In this episode, Anne and Jamie are discussing exactly this topic, as Jamie announces a big and exciting change in her life (and yes, you’ll have to listen to find out what it is, but it’s good).  One big takeaway here is that there are two coping strategies most of us tend to fall into when confronted with big change: avoidance and control. Do we duck the change that’s coming until we realize we really can’t breathe with our heads in the sand? Or do we take control (maybe a bit too much, sometimes)? Or do we vacillate between the two, making ourselves and those around us a little bonkers? And how is any of this related to The Good Place? (If you haven’t watched it, we recommend you do, and you’re welcome.) There are stages of change when starting over, and it’s important to give yourself grace and acceptance. You might be, as Jamie talks about, “solidly moving forward,” only to find yourself set back and frustrated.  But knowing your strengths under stress can be so helpful. Concentrate on those to get your self-confidence back and make progress. Or take a break! Let your energy renew, so you can re-engage from a healthy place.  Hear more about the ways you can stay afloat during the chaos of starting over in this episode, get the mental headspace from Jamie’s soothing meditation, then go back and listen to all Jamie’s episodes at thewholepineapple.com.  Stay tuned for more information on Sound Perinatal and Fertility Counseling and how you can work with Jamie!  

Phew! Ruby, Anne, and counselor Suzi Mohn are going to fix All The Things today, so the rest of us can relax by the pool. OK, maybe not, but they certainly can help, so listen up! Today’s question is: How can you support your partner in a difficult fertility journey? Often, the one who will not be carrying the baby feels a little helpless and useless during the process. (For ease of communication, we’ll call this person “the partner.”) Partners want to support the one who will bear the child, but they don’t know how, and it seems everything they say gets tangled up with all the big emotions and the hormones and does nobody any good. Though attention generally focuses on the one hoping to get pregnant, partners are suffering too. They’re sad and scared and hurting, but their attempts to help are perhaps a bit clumsy because they often can’t understand the ramifications of fertility treatment on the body, the heart, and the psyche.  And the one going through the fertility treatments may not have the time or language or mental space to teach their partner how to help. Because of this, a couple of Suzi’s therapy groups undertook the task of creating a list — a list of what those hoping to carry a child wanted to hear so that their partners could truly be as supportive as they wanted to be.  All the points on the list are powerful and valid. Here are some of the highlights: “Tell me you love me and know why I’m sad.” “Share with me your vision of our child.” Take my fears and doubts seriously, but also remind me that we're a team and we'll work this out.” If you want someone to climb into the cab and stare at the ground with you (and that’ll make a lot more sense after you hear the episode), ask them to listen to this episode. Share with them the list (with your own additions and subtractions) to help open those critically important lines of communication and mutual support.  You can find out more about Suzi Mohn and get her contact information at the HERE. You can find more from Ruby and Anne at thewholepineappple.com

Individual and family couples counselor Suzi Mohn has helped families navigate crises for years, and she knows how important support can be during a fertility journey.  Infertility can put a huge strain on relationships — stress, financial worries, blame and guilt, turning pleasure into obligation, differing expectations or goals, etc. etc. are all legitimate concerns. Ironically, in the quest to build a family, the family you already have can be put at risk. Fortunately, there are counselors and therapy groups to help couples overcome the difficulties, together. In this episode, Suzi, Anne, and Ruby discuss the struggles people face when dealing with infertility. Couples may find infertility one of the first major crises they face together — they may not have been married long; they may not have dealt with the trauma of losing a parent or losing a job — and suddenly something they thought would be simple and natural … isn’t.  Also, people may believe they’ve done All The Things right: they waited until they were financially and emotionally ready. They established their lives before preparing to welcome children into it. And their reward for such responsibility? Trouble conceiving or maintaining a pregnancy. Couples may be on different timelines, too. One partner is ready to go to the doctor TODAY; the other isn’t feeling the same urgency. And that can make both of them feel like they’re taking this journey alone instead of together. What do you do when you’re facing so much, and the one person you turn to in difficult times is dealing with their own concerns? What do you do when the person who is usually a big part of your solution is suddenly a big part of your problem? (or so you think…) There’s help! Listen up for ways couples can navigate the challenges of infertility. Then, please share this episode with anyone you think could benefit. You can find out more about Suzi Mohn and get her contact information HERE. You can find more from Ruby and Anne at thewholepineappple.com.

July 25, 1978 was a great day, and not just because July 25 is Ruby’s birthday. This particular day in 1978, the first IVF baby, Louise Brown, was born! IVF is a lot different now than it was then — a lot was learned on the way to this first successful human pregnancy, and a lot has been learned since. In this snack, Ruby and Anne are talking about the research and experimentation that got us where we are now. One of the biggest changes (and dare we say, improvements) from the experience of Lesley and Peter Brown is how much less invasive (physically and frankly, of the Brown family’s privacy) the process is now than it was then.  Early hurdles included getting past people’s notions of whether or not IVF was ethical. And IVF cycles were so much more involved, including blood draws every four hours. Egg retrieval was a surgical process back then, it involved a single egg, and it was much more often unsuccessful. Transfers were done in the middle of the night until one didn’t and it worked out fine, and that was (thankfully) abandoned. The fact that Louise Brown was later able to conceive without medical intervention helped allay fears that IVF would create a generation of people unable to reproduce on their own.  So Happy Birthday, Louise Brown, and thank you, Lesley and Peter Brown and Elizabeth Carr (first IVF baby in the US) for going through so much to get us where we are today.  Learn more about All Things Fertility at our website: thewholepineapple.com!

With laws and regulations changing so fast and all over the place, it can feel overwhelming and futile to try to do anything at all. But it’s important that we don’t give up and let decisions be made for us. What can people who aren’t professional lobbyists do to make our voices heard? According to Sean Tipton, you can do exactly that – you can make your voice heard. Register to vote and then vote. Talk to candidates for political offices, especially when they’re in an election season, as they’re most likely to listen at that time. You have a right to be heard, so get in there and get talking. Have anecdotes to share (with permission, of course): if you can tell a relevant story, that is often much more effective than straight data. Faces, stories — those are the ways to get folks to listen. Showing how your policy position will solve problems is also effective. Most of us don’t like being presented with problems, so come at policy makers with solutions. Be sure to check out the Resolve website (resolve.org) for tools to help you get started. Please share resources, including this episode, with anyone who is looking to help preserve medical fertility assistance and reproductive rights in general. Sean’s organization, ASRM (American Society for Reproductive Medicine), is also a great resource: asrm.org. And of course, please rate, review, and share this podcast to help others be informed about All Things Fertility, including advocacy. thewholepineapple.com.