Egg Freezing, Sperm Donation & Fertility with Dr Zoe Williams (LIVE) | Transcript
Find the episode shownotes here!
Hannah Witton
I used to think that if I like, touched some sperm with my hand -
Dr Zoe Williams
Yeah
Hannah Witton
I might get pregnant.
Dr Zoe Williams
Yeah, you will get pregnant and die.
Hannah Witton
Yeah. Welcome to Doing It with me, Hannah Witton, where we talk all things sex, relationships, dating, and our bodies. Hello, what is this? An episode of Doing It coming out on a Monday, what is going on? Actually, this is a bonus episode because it is international podcast day. So I thought that I would treat you with another episode to celebrate podcasts. Also to celebrate, I thought I would give you some podcast recommendations for other sex podcasts because I imagine if you're listening to this, you are interested in sex, and sexuality, and all of the stuff that comes along with that.
Hannah Witton
So I would highly, highly recommend listening to the Meg-John and Justin podcast, you may have heard MJ on Doing It. Also, I have recorded an episode of Justin, which will be out soon. But if you want to get more of them, listen to their podcast. I'm actually currently reading their book, Enjoy Sex - How, When, and If You Want To, and it's brilliant, and the two of them are just so thoughtful, and kind, and considerate, and wise when it comes to sex and relationships and just how we feel in ourselves, in general. So definitely check out that podcast. And I also want to recommend Sara Pascoe's new podcast; Sex, Power and Money, which has the same title as her new book, and it's just fascinating. She has some incredible guests. I listened to the first episode, which is all about sex work. Just give it a listen. Seriously, you, you have to listen to it. If you like the conversations that we have here on Doing It, then you will love Meg-John and Justin's podcast, and Sex, Power, Money. So check them out and happy international podcast day.
Hannah Witton
So this episode was actually recorded at the London Podcast Festival, at Kings place at the beginning of September. Thank you so much for having me, and thank you so much to the people who came. I got to sit and chat with my amazing guest, Dr. Zoe Williams. She's a GP, she is the resident doctor on ITV's This Morning, and debunks the confusing world of medicine, which, for me, yes, it is confusing most of the time. Zoe specialises in lifestyle medicine and physical activity, but in this episode, we talk about fertility. Now I just want to clarify some bits; when we're talking about egg freezing, and eggs in ovaries in general, technically, that's actually follicles and an egg grows inside a follicle, which is then released during ovulation. So eggs, follicles are different things, but we basically just say eggs a lot. We will be back to our regular programming on Wednesday. So I hope you enjoy this episode. And once again, happy international podcast day.
Hannah Witton
Hello, welcome to a live recording of Doing It, with me, Hannah Witton, and Dr. Zoe Williams as my guest. And we're at London's Podcast Festival, at Kings Place, we're very excited to be here. And we are going to also have like a little audience Q&A, if you're into that, at the end. I've been told to say that if you are asking questions, just wait until the mic is at your face, before before you start saying anything. Yeah, and we're going to be talking a lot about fertility, and so questions on that would be much appreciated. And other questions as well. We have a GP in the house. So if anyone's got any, like bumps, and itches, and scratches -
Dr Zoe Williams
Take full advantage. I know there's a three week waiting list often.
Hannah Witton
So Dr. Zoe Williams is a GP, resident doctor on ITV's This Morning, and you just do the whole debunking confusing medicine stuff, and your specialism is lifestyle medicine and physical activity. But the reason that we wanted to talk about fertility, because that's more of like a personal journey for you. And so not a fertility expert, but you know some stuff, because you're a doctor.
Dr Zoe Williams
Yeah, I know, I know about stuff cuz I'm a doctor, and then my own personal journey has really helped me embellish that knowledge.
Hannah Witton
Yeah, so what has been your personal journey with fertility so far?
Dr Zoe Williams
So I'm probably the oldest person in the room. Tell me if I'm not, but I'm 39 years old.
Audience member
I'm 38
Hannah Witton
Oh, close, but no.
Dr Zoe Williams
So, yes. Thank god, the camera guy who's older than me. What's your name camera guy? What's your name? Thank you, Steven for being here. So I am 39, and childless, and single. And I find myself in a situation that is becoming more and more common for women, and for men, in that my biological clock is running out. And like many other men and women, I'm 39, I don't feel like I'm 39, I don't think I look like I'm 39 -
Hannah Witton
Definietly not.
Dr Zoe Williams
I don't behave like I'm 39, and I think we live in a world now where we do get to be so much younger, for so much longer. But unfortunately, biologically, especially for women, our ovaries don't care. And my ovaries are very much 39.
Hannah Witton
They're over it.
Dr Zoe Williams
My ovaries are over it!
Hannah Witton
That was an accident, oh my God! Um, do you think using like a term like biological clock is still useful? Because I know a lot of people have a very strong aversion to that.
Dr Zoe Williams
Oh, I'm not aware of this aversion.
Hannah Witton
I think just that like, oop, turn 30, clock's ticking, and it's like, please don't remind me
Dr Zoe Williams
Yes. Okay. Yeah, so I get that. I think that if people are using that, in a sense, it's almost quite derogatory isn't it and quite offensive, and and not very pleasant. But it is quite accurate. Because I think if you think about our biological clock, that is running slightly on a different timeframe to every other clock, you know, our psychological clock, and our possibly our educational clock, and work clock, and our finding a relationship clock. So yeah, I think it is quite accurate.
Hannah Witton
Unfortunately, as the years have passed, our bodies have stayed the same, and not caught up with society.
Dr Zoe Williams
Yeah, absolutely. Because I mean, we're born as women, were born with all of the eggs we will ever have. In fact, we have more eggs, two weeks before we're born, than the day was born, because we've already started to lose eggs. So we're born with millions of eggs
Hannah Witton
And then by the time you hit puberty, it's even less isn't it
Dr Zoe Williams
Exactly, exactly. And then menopause kicks in when you get down to about 1000 on each side, so you know, there's not a lot you can do to prolong your fertility. But there is a lot you can do to preserve your fertility, so to slow down the rate at which you lose your eggs, and you lose quality. But unfortunately, yeah, although we can keep our skin looking younger, our ovaries, they're still gonna run out.
Hannah Witton
There's no magic cream for that.
Dr Zoe Williams
There's no magic cream.
Hannah Witton
So in terms of your fertility journey, what are you doing at the moment?
Dr Zoe Williams
So so when I was 37, I'll got back a bit earlier. When I was 35, I came out of a long term relationship. And my mum, bless her, said, I know how much you want to be a parent, I know how much you want to be a mum, have you thought about freezing your eggs? And I was a bit like, well, that sounds like a bit much, I don't really think that's necessary. And she started trying to tell me some facts and figures about egg freezing and you know, my mum didn't have an education beyond school, and I'm a doctor. So I felt quite righteous.
Hannah Witton
She was schooling you.
Dr Zoe Williams
I know, but I felt quite righteous and justified in saying that look, you know, I know everything about egg freezing, it's fine, I've got loads of time, I don't need to worry. And then there's a bit of a sad bit here, my mum passed away a couple of years ago. And a few months after that happened, I was asked to do an item for The One Show, to present a piece about egg freezing, and it was really bizarre because I'd never worked for The One Show before, I work on This Morning and after I did that I was told that I'm not allowed to work for The One Show again. So there was this one opportunity to do a piece on egg freezing, and the producer got in touch and I said, how did you know that this is something that's on my radar, that I'm thinking about? She said, I didn't, it was pure chance, you know, somebody just suggested you because you're a female doctor, of a certain age.
Hannah Witton
So when you start getting served different adverts like online, and on Facebook, and on YouTube, you're like they know I've hit an age.
Dr Zoe Williams
I'm dreading next year when you know you have to scroll down to put in your age, I'm going to be in that 40 plus bracket. Um but but yeah, so I don't know if I believe in whatever the afterlife or whatever. But it did feel like it was a bit of a gift that landed in front of me because I spent a full day learning everything about egg freezing. From the reasons to, to the reasons why not, to the legalities. I met a woman who had frozen her eggs, I met a woman who hadn't frozen her eggs and was very much against it. So I spent a full day learning about it, and at the end of that day, I was sold, I thought I need to do this. There's absolutely no reason why not to.
Hannah Witton
Can you give us a quick lowdown of what you learned? Like what are the pros and cons of it?
Dr Zoe Williams
I think the main thing that I learned as a - I was 37 at this point - the main thing I learned was that if I'm really keen to be a parent, then there isn't a lot of time left. And freezing my eggs is probably, in that situation, other than going into solo parenthood, it's the only real option I had to try and preserve my fertility. And I felt that I knew the statistics of how successful it is, it's not very successful. The success rates are getting higher, and higher, and higher. But I realised, very clearly, at the end of it, I have two options here; freeze my eggs, it's a lot of money but there aren't really any other downsides to it, or don't freeze my eggs. And if I look back, when I'm 50, or 60, and think, there was something I could if I don't have children, I don't want to be able to - I don't want to look back and think there was something I could have done, and I didn't do it. So even though I recognise that having frozen my eggs, that doesn't guarantee me a family, at least I know I've done everything within my means to, at that point, to try and secure that.
Hannah Witton
So it's not covered on the NHS.
Dr Zoe Williams
No. Egg freezing is not. I think it will be in the future. I think, at the moment, egg freezing is very much marketed as fertility preservation -
Hannah Witton
But not fertility treatment.
Dr Zoe Williams
Not fertility treatment.
Hannah Witton
Because IVF can get on the NHS, in some circumstances.
Dr Zoe Williams
Yes. So yes, this is correct. So in, you know, in some ways, it's if you if you have a partner, if I had a partner, we'd been trying to get pregnant for over 12 months, and neither of us had any previous children, any children from previous relationships, and we're both living healthy lives, then I will qualify for IVF. But as a single woman, currently, I don't, which is unfair, really, isn't it. But men have it even worse, because I think, at least there is something I can do, I can freeze my eggs. Or if I want to, I can use a sperm donor, and I can have a baby on my own. But for men, their options are very limited. So I have a friend who's the same age as me, and he's in a similar position. And really, his only option to have a child that is biologically his would be to use a surrogate, and then you're looking at, you know, 25,000 pounds if you go abroad, or very, very complex legalities if you do it in the UK,
Hannah Witton
Yeah, that's a lot. And like you've been talking about this on like online and on your like platforms and on Instagram and stuff. And what is the reaction to that been? Because this is something that isn't really talked about.
Dr Zoe Williams
t's been overwhelmingly positive. Because I after I'd spent that day with The One Show, and I decided I am definitely freezing my eggs, this is something I'm going to do, I also felt a responsibility to share that with other people, because I thought well hang on a minute, if I am a 30 something year old woman. I'm a smart woman, I'm a doctor, I've got loads of friends, and we talk about everything. But we haven't been talking about this. And I thought, well, if I really didn't know the facts, and I didn't have the information I needed to make a decision, what chance do other people have? So that's when I decided, right, I'm gonna do this, and I'm going to share every step of my story and just start talking about it. Hence why I'm here today.
Hannah Witton
And it really is, I think, something that doesn't really get talked about, like obviously pregnancy does. Like, as soon as you hit like the 12 week mark, which is what is advised for like when you start sharing, that's almost like you can't go on the internet without seeing a pregnancy announcement. But it's that trying to get pregnant period that no one is, I don't see anyone like talking about that process.
Dr Zoe Williams
I think it's one of the last taboos, isn't it. And people, like you say correctly, people share the success of of getting pregnant, but they don't necessarily always share the journey that they've that they've spent getting there. As a doctor, I hear more about those journeys, and see more, and even amongst my friends, they're more likely to confide in me. But recently on social media, I have seen a few people who've got pregnant and they've actually said you know, it's great news that I'm pregnant, but I do want to share with my followers, actually, this didn't happen the first time we've been trying for two years, I had a miscarriage, this happened.
Hannah Witton
Yeah
Dr Zoe Williams
And I think we're starting to hopefully people have been a little bit more open about that side of it, because miscarriages are common, early miscarriages are very, very common. Infertility is common, one in seven couples will struggle to conceive, when they try to conceive, but those people don't necessarily talk about it. We just hear the success stories. So therefore when it does happen to one of us, we feel very much like you know, there's something wrong with us, or it's just us, or why did it happen to me?
Hannah Witton
And it can be like a really isolating experience because, I don't even know when I first heard somewhere like, from parents, or just society in general, where I heard they're like, oh, don't tell anyone you're pregnant until 12 weeks. And it's just this like, weird, unwritten rule that's just been like written into society etiquette.
Dr Zoe Williams
Yeah.
Hannah Witton
But it's like, okay, why, right? Because miscarriage is more likely in those 12 weeks, and it might be really difficult to tell people that you've miscarried, if you've already told them that you're pregnant. But then you're also then going through that alone.
Dr Zoe Williams
Yeah. I think, you know, it's a very, very individual decision. So for a couple to decide who they share that news with, and how many people they share it with, and, of course, that is one of the reasons couples will choose not to, is because the risk of miscarriage is higher, and if you tell everybody you're pregnant, you know, that can be very, then very difficult, when somebody comes up to you and say, how's the pregnancy going? You have to break the news that you lost the pregnancy. But, so that's one thing. And of course, it's a couple's decision to decide who they share that with. But as a society, we certainly shouldn't be shunning people and saying, oh, well, you're only six weeks, you shouldn't be telling people because, why not? You know, as long as people are making an informed decision, then why not. Also, gosh, that women I see - women suffer in those first 12 weeks of pregnancy. Not all women, but you know, the the sickness, and the tiredness, and you see women with those baby on board badges on the Tube, when they're in their second trimester, after the 12 weeks, that's when they feel great. That's when they've got the energy. It's those first 12 weeks when they have to suffer in silence.
Hannah Witton
They're just like, I really want a seat on the tube.
Dr Zoe Williams
Yeah, they want a seat on the tube, they're puking in the toilets at work, they can't have a glass of wine at a wedding, and they've got to keep it this big secret, and that they shouldn't have to, but equally, a lot of couples will want to, and that should be respected as well.
Hannah Witton
Yeah. And so you're having these kinds of conversations now, and you're in your 30s. But do you think that these conversations should be happening much younger?
Dr Zoe Williams
Yes, 100%. So I personally think that we should be learning about and talking about fertility as soon as we start thinking about and learning about and talking about contraception and not getting pregnant.
Hannah Witton
Because in school, it's like this is how to not to get pregnant.
Dr Zoe Williams
Yeah, this is how you not get pregnant. If you have sex once, and the condom bursts, you will get pregnant and die.
Hannah Witton
Yeah. Basically. It is drilled into -
Dr Zoe Williams
It's drilled into us
Hannah Witton
I used to think that if I like, touched some sperm with my hand, I might get pregnant.
Dr Zoe Williams
Yeah, you 100% will not.
Hannah Witton
Like if you're in the vicinity,
Dr Zoe Williams
If you breathe near sperm, you might get pregnant. But yeah, no, I strongly believe that the moment children are taught sex education, which is now all state schools have to teach sex education to secondary school children, they should also be taught about fertility. Not just because it kind of pre warns you and get you thinking about family planning from an early age, but also because how we live our lives, from a very early age, affects our fertility in the future. You know, decisions as to whether we smoke, as to what activities we get involved in, sexually transmitted infections, even things like pollution. Even things like the types of food that we eat, they all have a knock on effect, again, especially for women, because those eggs are there. They're all there. So how we're treating our bodies, they're living in that environment. But also for men as well, because although men aren't born with all the sperm that they have, they produce new sperm every single day in their testes, the quality of the sperm is still affected by your lifestyle, and it can be a cumulative effect. So I think we tend to think we can get away with living a certain way until we're in our 30s, to some extent is true. But actually, that is a cumulative effect. And smoking is one of the worst things that we can do for our health generally, but also one of the worst things for fertility.
Hannah Witton
I didn't know it affected fertility.
Dr Zoe Williams
Yeah. So if you smoke as a woman, if you smoke throughout your lifetime, then that can significantly impact the quality and the quantity of eggs that you have. But it can actually also make you hit menopause one or two years earlier.
Hannah Witton
I had this question as well.
Dr Zoe Williams
There's somebody sighing in the background, somebody just quit smoking in this room.
Hannah Witton
Just right this second.
Dr Zoe Williams
My work here is done.
Hannah Witton
I had a question that came from my head before, but now that you mentioned menopause again, so why is it that like I've been told, or like my general understanding is that late 30s, early 40s is when like, you're in like, danger zone of like, if you could naturally get pregnant or not. But then the average age for someone to go through menopause is 51. What happens in that 10 years?
Dr Zoe Williams
Yeah, no, that's a really good question. So in terms of fertility, your ability to get pregnant is really, you know, your early 20s, even late teens, early 20s, is when you're most likely to get pregnant, your fertility is at its highest. Throughout your 20s, you're pretty good. Once you hit 30, it starts to come down a bit more quickly. And once you hit 35, there's sometimes talk about your fertility kind of dropping off a cliff. But it doesn't necessarily, it's not that bad, but it does, it rapidly starts to decline from the age of 35 to 40. By the age of 40, the majority of women are going to have problems, you're not going to conceive particularly easily, and and that's for it's for a number of reasons. You don't have as many eggs, but also it's the quality of those eggs, those eggs have been subjected to 40 years of life, and that's 40 years of slow degradation. So we talk a lot about, within health, particularly within lifestyle medicine, we talk a lot now about chronic inflammation, which I don't know if that's, I'm seeing some people nodding
Hannah Witton
I have inflammatory bowel disease, is that - so will that affect my eggs?
Dr Zoe Williams
Potentially, potentially a small amount, yeah. So when we talk about inflammation, inflammation is a really helpful thing, if it happens occasionally, in short, sharp bursts. So say, for example, you sprain your ankle, your body has an inflammatory response in that area which helps your body helps warn you that there's something dangerous, and helps to start healing. But we're learning more and more and more now that a lot of us, particularly because of stress, pollutions, smoking, junk food, binge drinking, and unhealthy lifestyles, lack of sleep, unhealthy lifestyles, our bodies are in this sort of constant state of very low grade inflammation, but throughout our bodies. Now having an inflammatory condition is a separate thing again, but can make you more at risk of that. But also, the other factors that are causing increased inflammation can affect your inflammatory bowel condition. And that inflammation degrades cells more quickly, it causes you to age more quickly. So that's your skin as well, all the cells of our bodies who, if they're subjected to this, more of this chronic inflammation, then they degrade more quickly. It's also the root cause of a lot of chronic diseases such as heart disease, dementia, type two diabetes, and some cancers
Hannah Witton
Oh my God, everything is connected, I'm learning so much.
Dr Zoe Williams
So to reduce inflammation, it comes back to those lifestyle factors, you know, eating good nutritious diet, regular exercise, good sleep, low stress, meditation, all those types of things, and having good people around you. Being lonely also increases your inflammation.
Hannah Witton
Is inflammation just like the medical word for just bodily stress
Dr Zoe Williams
Essentially, yeah. It is essentially bodily stress. Yeah, that's a really nice way of putting it. I'm going to take that
Hannah Witton
You can have that. There you go, when you're communicating to us plebs.
Dr Zoe Williams
And bodily stress is very much intertwined and linked with with mental stress. Simple things, like, has anyone heard of forest bathing?
Hannah Witton
Nope. Tell us.
Dr Zoe Williams
So there's a lot, there's some new evidence emerging around forest bathing. And if you immerse yourself in a forest for a whole weekend, then that can reduce your stress levels, by a little bit, for the next month.
Hannah Witton
So like if you go camping -
Dr Zoe Williams
Camping, yeah. So but in London, busy, busy lives, what it means is leaving your phone behind, and just going to a London park, but immersing yourself in it. So that means using all of your senses, if you can. So it means actually looking at the trees and the flowers, smelling whatever you can smell, picking up a flower and smelling it, listening to the sounds, if you want take your shoes off and feeling the grass underneath your feet. So then, so you're not distracted by your phone, you're not with anybody -
Hannah Witton
Just being like completely present
Dr Zoe Williams
Just being in nature.
Hannah Witton
I love that. I wanted to get back to what we're taught in school.
Dr Zoe Williams
Yeah.
Hannah Witton
Around fertility, because I don't, I don't remember like when I learned that it is difficult to get pregnant.
Dr Zoe Williams
You probably, yeah, I don't think you're taught that
Hannah Witton
Like I don't know when I first became aware of that.
Dr Zoe Williams
We certainly weren't taught that at school, and we've got - I've got a video that we're going to show in just a moment. But yeah, sex education in school, we're very much - it's very much about sex, and doing it safely, and not getting pregnant. And over the years, over the past 10 years in particular, teenage pregnancy rates have come down, and down, and down, and down.
Hannah Witton
I've heard this is because of the internet. People are like at home, online. and not out and about, having sex with each other.
Dr Zoe Williams
Yeah, it's probably not necessarilyy just because of education in schools. But the rates of women and men who go throughout life and don't have children is going up and up and up. So it's now one in five women, we couldn't find the statistics from men, interestingly -
Hannah Witton
Yeah we were doing a big google before.
Dr Zoe Williams
Yeah, but one in five women now will not have children. Now, some of those women, that will be by choice, which is great, but a significant number of those women, they wanted to be mothers, and they didn't end up being mothers. But yeah, no, it is interesting, because, you know, often people will say, okay, so when you are trying to get pregnant, how do you do it?
Hannah Witton
Yeah.
Dr Zoe Williams
Not how do you do it? Well, actually, how do you do it? You would be surprised. Anyway, moving on, often people say, when is the right time to have sex, when is that fertile window? And for most couples, there's only around six to seven days per month that you actually can get pregnant. And it's tricky, because there are different markers, there are different methods you can use to determine when that is. There are fertility sticks, there are apps, but I always think you have to be a little bit careful. Because if you put all of your faith into whatever one of those methods you're using, and either it's not quite right, or you're not getting it quite right, or actually you're just different, then you may not be having sex at the time you get pregnant. So I generally say to people -
Hannah Witton
Just have sex all the time
Dr Zoe Williams
And GPs will generally say all the time, just have sex, two or three times a week, just have sex. And yeah, and that's, that's the best way. But actually, people will want to use these methods.
Hannah Witton
Yeah, because for years and years and years, people have been using fertility awareness as a way to try and get pregnant.
Dr Zoe Williams
Yeah.
Hannah Witton
And to like track the cycle. But in recent years, a lot of people have been using it in reverse. And there's also like apps that like, are a contraceptive as well.
Dr Zoe Williams
Yeah.
Hannah Witton
And I feel like a lot of people are a bit, or at least people who have who are like, who follow me online and are talking about this, a bit scared, a bit wary. They've heard like all of the horror stories of like, I use this app, and then I got pregnant.
Dr Zoe Williams
Yeah.
Hannah Witton
But you're a doctor. So like, tell us, the final word on this?
Dr Zoe Williams
Well, I think I think to sum it up really succinctly, there's an app called Natural Cycles that some of you may have heard of. And that app, it requires you to take your basal body temperature, so you need a special thermometer to do that, that's very sensitive. And you take your body temperature, the same time every morning, ideally, but before you get out of bed, first thing you do, before you brush your teeth, before you go to the loo, and then it uses an algorithm, and it tells you which days are safe, you can't get pregnant, which days are danger days, and then sort of amber days. And initially they were saying that if that is used properly, if you abide by the rules, then it's as effective as using the contraceptive pill, so 99% effective. That's what they claimed they made initially. But then after a few years of it being used, they've had to significantly dropped that. I don't know what figure it's down to now, but it's quite a bit lower.
Hannah Witton
But was that because there's like the difference between like perfect and typical use, because, and also, there's a lot of education, I think is missing around how you use that, and like who it works for.
Dr Zoe Williams
It's kind of, I would describe using that particular app, or there's the Ava bracelet as well, which is now used as a fertility device. But at some point in the future, they want that to be a contraceptive as well. And I do think in the future, people will walk around wearing something, and it'll give them the information
Hannah Witton
Like ping, ping, ping, ping, you're ovulating.
Dr Zoe Williams
Yeah. Go, go, go for it, pin him down. But I think, at the moment, the way I tend to think of it is it's, it's using the rhythm method, the old fashioned rhythm method, with a bit of extra advice and data. And the rhythm method was always old fashioned, in old fashioned terms, it was always kind of a acceptable method if you were married. And it's kind of like because it's quite an effective method, if you do it perfectly, if you're good at it, and if you're very good at abstaining, or using condoms when there is a chance. And for some couples, depending on the woman's cycle, that could be 16 days every month that you have to abstain or use a barrier method. But if you're very very, very good, then it is effective. But then there are so many things that, you know, if you're travelling on different time zones, that's going to put it out of kilter, if you're unwell, if you've even just got a cold, if you've gone out and have a big meal.
Hannah Witton
If you have a different amount of hours sleep.
Dr Zoe Williams
Yeah, if you if you work shift patterns, it's not going to work for you. And also you've got to really be dedicated at the start. So the first three to six months, you've got to use another method because it's going to take you that long to really understand what your cycle is, and what what the signs are.
Hannah Witton
Do you think men, or people with penises, are having these conversations too? Because I feel like this is such a like female heavy topic?
Dr Zoe Williams
Yeah. No, I agree. I think it's a female heavy topic. I think it's something that, that women talk about much more. But I think men are talking about it more and more and actually, a reflection of the room, it's, I think there's more men in this room than women.
Hannah Witton
Damn.
Dr Zoe Williams
Which is interesting, isn't it? Which is very interesting. You guys knew this was all about fertility and stuff, right? Oh, you just thought it was about sex. Okay.
Hannah Witton
It's still about sex.
Dr Zoe Williams
Yeah. I think especially younger men are talking about it much more. I think men who are older don't really see this - is not where they should be sticking their nose, and it's none of their business. But it 100% is. But I think men almost need to be invited to the conversation sometimes. I think men will talk about it, if the topics been brought up in there in the room, they will contribute, but they're not likely to raise that topic. That's my experience.
Hannah Witton
Yeah, that that makes a lot of sense. I think especially because even just like in society, reproduction has always just like - and contraception, like in order to get pregnant and and also in order to not get pregnant - it is like the womb bearers responsibility to do the things, and also just think about it. The amount of mental energy spent on it as well.
Dr Zoe Williams
Yeah. And I think it's, it's been that way, because when the pill was first invented, it's about 50 or 60 years ago now. It was, the pills always been for the woman. They've been trying and trying and trying to create a male pill, they keep getting closer. One day, they'll crack it. But most of the methods of contraception, apart from condoms, it's always been the woman, the woman's responsibility.
Hannah Witton
Condoms or vasectomies, it's like, the two extremes.
Dr Zoe Williams
Exactly. But yeah, so the the race to find the male hormonal contraceptive pill. Um, the latest is actually it's not hormonal. Interestingly, whenever they, the scientists get close to finding what works as a male contraceptive pill, they do other clinical trials, and then the first trials, and the second trials, they get to the point where they actually try it on a large number of men, and they find that the men have too many side effects. They like get skin problems, and mood disturbance, and bloating, and you know, that type of thing.
Hannah Witton
Part of me likes to think that it's because we have higher standards for our medicine now than we did in the 60s.
Dr Zoe Williams
That's true
Hannah Witton
And because like we already live with the pill. Like if someone tried to take that away from us, there would be riots.
Dr Zoe Williams
Oh, there would be riots. Yeah, I think a lot of a lot of women, again, younger women, don't want to take hormones, they don't want to take the pill, and that's fine. We have so many methods of contraception, that most you know that usually there is another method that will work for somebody. But it is still the most popular method of contraception that women, that women want to use today.
Hannah Witton
Before we go to a little Q&A, so if you have any questions, do have a little thinkaroo, I wanted to just jump back to your like personal story.
Dr Zoe Williams
Oh yeah, I never finished.
Hannah Witton
So you've frozen some of your eggs. Is that like a one time, like how, how does that work? And what does it mean?
Dr Zoe Williams
Okay, so I made the decision to freeze my eggs, and I did it about this time last year. So that process involved, it's the first bit of IVF, so involved for two weeks, I gave myself injections into the tummy, that was to get as many eggs to mature as possible, so that I could harvest as many as possible.
Hannah Witton
Harvest, what a great word to use
Dr Zoe Williams
I know, harvested my eggs. So and then they and then they removed them by, they put an ultrasound probe into the vagina, with two long needles on it.
Hannah Witton
What?
Dr Zoe Williams
And then those needles go out and into your ovary
Hannah Witton
What?
Dr Zoe Williams
I was sedated, so it's fine
Hannah Witton
Like but like drowsy sedated, or like numb sedated.
Dr Zoe Williams
Drowsy sedated, so I don't remember it.
Hannah Witton
Okay.
Dr Zoe Williams
Yeah. So they got seven eggs, which for a woman of my age is just below average, which I've never been told just below average in my life. So seven eggs, and that means that if I was to come to if you know all other methods failed, I didn't meet anyone, I came to use those eggs, got a sperm donor, fertilised them, there's about a 30% chance that I will get a baby from those eggs. So to me that's not, that's not good enough. So now I'm one year on from there, and I've kind of decided that I'm happy to go it alone and be a sole parent. So I'm now just in the phase of letting that settle in. And yeah, so the next step will be donor sperm and, and going it alone.
Hannah Witton
How does that work? How'd you pick the sperm daddy?
Dr Zoe Williams
It's just like looking through a catalogue. It really is. So, so yeah, I mean, it's really quite complicated because the sperm that they take, it goes through so many checks, and then they'll want to look at my genetics, so they're not putting anything incompatible together. And then it's kind of down to you, how much you want to know. So it might be the, I might just say that, you know, I want somebody healthy.
Hannah Witton
Healthy sperm.
Dr Zoe Williams
It's all healthy sperm really. But you can get to the point where you can listen to the messages that they've left, as to why they're donating sperm. They write letters. So yeah, it can be quite an emotional process.
Hannah Witton
But what if you listen to it, and it was just like, needed the money? You're gonna be like, cool, fair play
Dr Zoe Williams
Yeah, I get that. You're never gonna come looking, not that they can't anyway. And so essentially, is a catalogue. But yeah, so I've already been thinking, you know the ethnicity of my baby is something that comes up a lot. My friends say what you're gonna you know, what you can, what you can do, what ethnicity you're gonna go for?
Hannah Witton
It's like a cocktail.
Dr Zoe Williams
I know. So, I don't know. So I've kind of, at the moment, I thought I'm not going to base it just on that, because there are so many different things. But actually, if it does come down to that, then I'm half Jamaican, half English. So I thought if if my child isn't going to know their father, I'm going to be a sole parent, maybe it would be nice if they looked as close to me as possible. So maybe I would go for mixed race sperm, but who knows? Then I thought, why not mix it up a bit, how about Asian or -
Hannah Witton
The world is your oyster
Dr Zoe Williams
As long as it has afro hair - no I'm joking.
Hannah Witton
Do we have any questions? We have a roaming mic at the back. Don't be shy. Yes, this first hand up here. Hello.
Audience member
Hello, I have a lot of questions.
Hannah Witton
Oh my god.
Audience member
I'm gonna pick one.
Hannah Witton
We have time
Audience member
When you say the quality of the eggs, can you talk a little bit more about that? Because I'm I'm thinking like, is that the likelihood of that the egg is gonna result in a human baby? Not that -
Hannah Witton
It'll actually result in a cat
Audience member
As in like a baby, or is it more like the kind of kid you're gonna get? I don't know if that's a stupid question. But I don't know anything about that.
Dr Zoe Williams
I don't think it's a stupid question and -
Hannah Witton
No stupid questions in this
Dr Zoe Williams
There's no stupid questions. So the better the quality of the egg, the more likely that once conceived, that will become a baby and be born. So the egg contains genetic material, and the sperm contains genetic material. Now, if there's an error in genetic material in either, then usually it wouldn't even, you know, they come together, they make something, and you know, it doesn't even last a few days. If it's got just a small amount of error, then you might, that's when you might have a miscarriage. So people often think that a miscarriage comes down to something that's happening in the woman. But a lot of the time, it's because there was some thing, it's to do with the quality of the sperm or just, you know, bad luck, that particular sperm that made it had something that was a little bit untoward, and it's genetic. So usually, unless the genetic material is perfect, then it won't get to the stage of being a foetus, and being born. And now there are some exceptions. So Downs Syndrome is the commonest genetic abnormality, atwhich a baby can, you know, can survive and can thrive, and can have a healthy life. But mostly, so when we're talking about quality of the egg, the older it is, and the more it's been exposed to an imperfect environment, the more likely there is going to be some genetic abnormalities.
Hannah Witton
Should we go to someone else then we can come back to you again, for more of your questions? Yeah.
Audience member
Hi! Um, I just wanted in terms of, like conditions that women have, like polycystic ovaries, for example. How would that affect the eggs? And also, you know, you're talking about lifestyle, is there something, I mean, I know it's hard because it's literally something that your body does so you can't exactly like stop doing that because in 10 years, I want a baby. But is there something with polycystic ovaries or something like that, where you'd say, maybe introduce this into the way you eat? Or maybe do a little bit more exercise? And also, how does that work in the body in terms of when you're talking about the condition of the eggs and things like that? Does it affect it straight away? Or is that just it goes with ageing and things like that?
Dr Zoe Williams
Okay, really good question. So polycystic ovaries, very, very common. One in five women have polycystic ovaries. And we were talking about this a little bit earlier. A lot of women get told that they have polycystic ovaries and believe that they can't get pregnant.
Hannah Witton
And then my sister's friend got pregnant and didn't find out till five months, because she was really ill and was like, what's wrong with me? They're like, could you be pregnant? No, I've got PCOS. No, turns out she was pregnant.
Dr Zoe Williams
Yeah, yeah. So you can get pregnant with PCOS. But for some women, your fertility is lower because you're not ovulating. So in order to get pregnant, you have to ovulate, you have to release an egg, which has to make it to the womb, meet a sperm to get pregnant. So if you're only ovulating once every three months, so you're only ovulating four times a year, rather than twelve times a year, then already, you know, your chances of conceiving, you can see why they're much less. So what can you do about it? So polycystic ovaries, so we're learning more and more about how you can actually have specific lifestyle behaviours that can help combat PCOS. So we know that and again, it's not everybody with PCOS, but in women, particularly who are having problems with fertility, your hormones are different. And one of the hormones that's different is insulin, often your insulin levels can be higher. And taking a drug called Metformin, that helps increase insulin sensitivity, which means your body doesn't need to release as much insulin, that can actually help with fertility, with PCOS. Oh, she's showing, oh she's making notes.
Hannah Witton
She's taking notes, I love it
Dr Zoe Williams
And, and, and then, so then, thinking, extrapolating from that, we think, well, actually, how can we regulate our insulin through diet. So there's emerging evidence around having a low carbohydrate diet for polycystic ovaries. And that is not for everybody. And some, for some people, that means a life of misery. But for some people who try low carb, they actually really like it, and really enjoy it, and find that that is acceptable. So again, but that is one thing that that you can try, because having a low carbohydrate diet means that your level of insulin generally is lower and more regulated throughout the day,
Hannah Witton
What's the connection between the insulin and fertility?
Dr Zoe Williams
So insulin, well all of our hormones, this is where it gets really complicated. We have so many different hormones, and some of them are released by our brain, some are released by our pancreas, some are released by fat cells in our body, some are released by our ovaries, and they all communicate and interlink with each other. They're all like little messengers. And what we find in people who have polycystic ovarian syndrome, often they have high levels of insulin and and that can be therefore communicating with other hormones, and disregulating them. And that can prevent, it's not the insulin on its own, but it's one of many factors, that means that it's you need your hormones to be in a perfectly balanced state in order to ovulate each month.
Hannah Witton
Right.
Dr Zoe Williams
And if things are out of kilter, and insulin's played a role in that, then that might reduce your, your ability to ovulate in that any given time. So low carb is is an option. And then again, it's other lifestyle factors. So people who start to regularly exercise who have PCOS, even if they don't lose weight, their weight stays the same, their diet stays the same, but they just start regularly exercising, that can actually help to manage it as well. Again, that may be because that's helping to manage insulin. But it's a really interesting area, with a lot of emerging evidence. The biggest thing to say is, with PCOS, you can get pregnant. And if you are having difficulties getting pregnant, then there are medicines that we can use when you get to the stage that you're trying to help you increase the chances of you ovulating. So yeah, does that answer your question?
Hannah Witton
There was one at the front here, I think.
Audience member
Hi there, I just want to ask, based on the story you're saying of, well your story, because I didn't quite understand it, I don't understand it now. When you say there's a 30% chance of success of IVF, is that done each egg that's taken out at a time? So you could essentially you have a 30% chance in any one of those seven, so each has a 30% chance, or overall the chance, that might be the same mathematically, I'm not a mathematician, but it - would they do that individually per egg, or do they try and sort of -
Hannah Witton
Do they put all seven in -
Dr Zoe Williams
No, I think it's a really - I think it's a really good question.
Audience member
I mean, it might be more difficult with bigger numbers. But yeah.
Dr Zoe Williams
Yeah, no, it's a really good question. And and I'm not sure what the chances are per egg. But essentially, all I know is that if there were 100 women, exactly the same as me, we would all manage to get seven eggs, who were my age, and if we were to have to - even if we use if we used all of them, then about 30 to 35 of us would manage to have a baby, and the majority of us wouldn't. So I think that's a really key point about egg freezing that I often try to drive home. It's not an insurance policy, and it doesn't guarantee you a pregnancy, it doesn't guarantee you a baby, and it is expensive. It's about 4000 pounds. So.
Hannah Witton
And some people will do like more than one round of that
Dr Zoe Williams
Yeah, and then it's a 300 pounds a year storage fee. Which sounds a bit harsh.
Hannah Witton
Egg storage
Dr Zoe Williams
Keep them on ice. So yeah, so it is a it's a huge financial investment. And and it's, you know, I think people, I think very, it depends on your financial situation. If you have loads of money, it's a bit of a no brainer. But you know, that's a deposit on half a house for somebody, isn't it? So you have to be careful. You have to think carefully.
Hannah Witton
Yeah. Did you have any other questions? At the front here, hello.
Audience member
So I'm wondering if hormonal contraceptives maybe could help fertility because they stop ovulation, and then in the end, when you are older, and want to get pregnant, you have more eggs technically. So -
Hannah Witton
I always think this
Dr Zoe Williams
Good question.
Hannah Witton
Surely you're saving up your eggs, rights? But I don't think that's how it works
Dr Zoe Williams
It's not how it works. So unfortunately, it's a nice idea, but it doesn't work that way. Because you, okay, so you're saving one egg per month that you would have ovulated, but you're losing hundreds per month anyway. Because at the rate at which they're you're losing your eggs,
Hannah Witton
Oh in terms of just the ones in the ovaries just dying away.
Dr Zoe Williams
Yeah. So actually, that one doesn't make a difference. So actually taking hormonal contraception doesn't increase your fertility later on. But it doesn't decrease it either. Often people worry about it reducing their their ability to get pregnant later on. So yeah, it doesn't do either.
Hannah Witton
Okay, this is great. This is like a mini clinic. There was some questions over here, we can go around.
Audience member
Hi there. So you talked a bit about a bit before about how, like stress, exercise, diet, all of that can affect it, and obviously Hannah was saying about your ulcerative colitis and how that would affect it. But I was wondering if there's ever been any studies about, like mental health, and obviously, that has an interaction with stress and loneliness, but sort of specific mental health conditions or in general, whether there's ever been studies of that interaction with fertility or anything like that.
Dr Zoe Williams
Okay, so as in mental health diagnosis. So we're talking about, you know, depression, anxiety, or even more severe mental health conditions? And I don't know, actually, I don't know what the answer to that is. I could hazard a guess, and that would be to say that if you're suffering from any mental health condition, that is an inflammatory condition to some extent, that is a stressful condition. So therefore, you can assume that there would be a knock on effect, but you know, in the context of of everything, that might not be huge. That might not be to say that you are significantly less likely to get pregnant if you have a mental health condition. If you're doing other things, you know, to combat that, if actually, you're healthy weight, and you exercise regularly, you have a good diet. But all these things, they all add up to what your optimal fertility can be.
Dr Zoe Williams
Some things we have power over, some things we don't, and there isn't too much point getting stressed about the things that we can't see, if you have a stressful life, and actually, you're doing some meditation, you are doing some things to combat that but you're still stressed, then, you know, to some extent, we can affect it, but we can't completely eliminate that stress. If we have a mental health condition, or we have PCOS, or whatever, I think it's thinking about what can we work on, and focusing on those things, and optimising whatever our health can be. But what what I see often in clinic is when patients are on their fertility journey, when they're actually in the midst of infertility, and they're trying, desperately trying to get pregnant and they're struggling, it's such a motivator. I've seen couples go on these health journeys. I've known people pack in their job, because they know that their job is what's stressing them out, and they and they pack in a job, three months later, you know, they get pregnant. So it's a really, it's really motivating for people when they realise that there is something they can change to improve their chances. And then weight, weight often comes up as well. So being overweight is an independent risk factor for infertility, and bariatric surgery, weight loss surgery, is now one indication for that is fertility. So so you know, people who are really really struggling, and they haven't been able to lose weight through dietary interventions, then surgery, some some people will have surgery for that intervention.
Hannah Witton
Oh wow, I didn't know that.
Dr Zoe Williams
And it's very effective.
Hannah Witton
Any other questions? In the middle here. One of you take it, go on
Dr Zoe Williams
I love it, we've got men asking questions.
Audience member
So earlier we mentioned about how women lose their fertility quite exponentially, late 30s about then. Is it the same for men? Is there a age where there's like a male menopause?
Dr Zoe Williams
Good question. So it's different for men because you know, you can continue to produce sperm and you continue to produce sperm way into your 70s. But the quality of that sperm is less, and it's from about the age of 45, you can expect that your fertility decline. And that's because if you do a sperm count, when you look at a sperm count, you're looking at different things. You're looking about the concentration of sperm, how many million sperm per mil, loads a little bleeters. You're also looking at their morphology, so are they normal in how they look? Their motility, are they able to swim well? And all those factors decline as you get older, but it tends to be about, in women, it's 35 that things start to go downhill really quickly. In men, it's more like 45 and probably don't go downhill quite as quickly. But there isn't, is there male menopause? I mean, you do, you produce less testosterone and we do hear about men getting kind of like menopausal symptoms.
Hannah Witton
Yeah, I guess menopause has like the side effect of you're not fertile anymore. But then also all of those other symptoms.
Dr Zoe Williams
And in women, it tends to come, well you have the perimenopause, but then everything stops. Whereas in men -
Hannah Witton
You go into withdrawal.
Dr Zoe Williams
Yeah, exactly. You do. You go into oestrogen and progesterone withdraw, whereas in men, it's much more gradual. But you know, men do start to feel the consequences of having less testosterone. So less able to build muscle, it can affect mood as well, fat redistribution, etc, etc. So the answer to your question is, men are fertile for longer, probably 45 it really starts to decline, but doesn't rapidly decline in the same way it does for women. But the risk of miscarriages is goes up.
Hannah Witton
Okay, yeah. And that it's impacted by the, like the sperm and eggs and everything.
Dr Zoe Williams
Yeah.
Hannah Witton
Do you want to pass it back, there we go.
Audience member
Um, kind of a good follow on from that, actually, with the whole idea of freezing eggs also like with idea of freezing sperm as well, after vasectomies, anything like that kind of thing. Chances wise, if you freeze your sperm after a vasectomy, like are there higher chances for that to survive compared to eggs. And also on that as well like, with sperm donors, like how long does sperm last with sperm doners? Is there a cut off point? Is it okay, we'll keep the sperm donor for five years, ten years, whatever, especially with men sperm kind of, not regrow, but is constantly growing in that sense, like, is there a level of a cutoff point when it can only be frozen this long, can it be kept in a sperm donor for certain length?
Dr Zoe Williams
Yeah, again, a really good question, which I really wish I had the answers to. This is why -
Hannah Witton
I have no idea
Dr Zoe Williams
I will say this again, I am not a fertility expert. But I do know a little bit about, the only reason I know is because I've started exploring sperm donor. And I believe that if I think I might want to have more than one child, and I want them to have the same biological father, I can buy all the sperm. So if somebody has donated, I can buy all the sperm, the whole vial -
Hannah Witton
Oh, so you have the monopoly on that sperm. You're like, no one else -
Dr Zoe Williams
It's mine.
Hannah Witton
But can you buy half of the sperm?
Dr Zoe Williams
So you don't have to buy it all, which means that then, you know, essentially, somebody else could buy some. But I think there are certain rules around which clinic, it maybe has to go to a different clinic.
Hannah Witton
And when you're flicking through this catalogue, does it tell you how much of their sperm, like who else has taken some of that sperm?
Dr Zoe Williams
I mean, I haven't got that far down the line.
Hannah Witton
Because, for instance, say you live in Manchester. And then the catalogue goes, half of the sperm has already been taken by someone in Manchester, you might then choose not to take that sperm, because -
Dr Zoe Williams
I'm from Manchester. Yeah, that's a good point. Yeah, or say to the child, just be careful if you ever meet somebody who looks a little bit like you.
Hannah Witton
Just check if they're also a sperm donor baby.
Dr Zoe Williams
So therefore that leads me to believe that you can, if you were to freeze some of your sperm, you must have a few years in it, right? Because if I was gonna have three children, they're gonna be spaced out. So but that's that yeah, that's all I'm basing that on.
Hannah Witton
We have maybe just time for one more question. If there is one. Oh, yeah, you go on. You've said at the beginning had loads, go on.
Audience member
Okay. It's not about fertility, am I still allowed?
Hannah Witton
Sure.
Audience member
It's a question for you as a GP, just because this has been like, something that's kind of infuriated me lately and has like, nobody has any answers to this, and I don't trust my own GP -
Dr Zoe Williams
Oh God, I'll try
Hannah Witton
Are you just you just struggling to get an appointment with your GP and you're like, great, I'm here?
Audience member
No, no, no, it's about speculums and if you know if we are any closer to finding an alternative to them, because that would be wonderful.
Dr Zoe Williams
Yeah, that's a really good question. Okay. Um, so, yes and no. In terms of doing the current cervical screening, if I was to do that, or nurse was to do that for you, I'm not aware of anything that is better than a plastic speculum. But, with the whole HPV testing, and the way we're moving forward with that, which means that HPV can be an initial test, and if your HPV test is negative, then you don't necessarily need cervical screening. They are, the NHS are hoping to roll out self swabbing for HPV.
Hannah Witton
Jaws dropped. That is a big change.
Audience member
That is very good news
Dr Zoe Williams
So we're not, we're not there yet. But if you've had bad experiences with cervical screening, and this is actually how we first met, we were on a panel talking about cervical screening. If you've ever, if you've ever found it painful, or uncomfortable, or you've had a bad experience, my advice is always tell the person that you've had a bad experience. And they can do things to try and make it more comfortable for you. I've had a patient who had to have a sedation to have a smear. It's that important that you know, the only way she was going to have it was if she was, and that was because she'd had you know, things terrible things that happened to her when she was younger. But it's that important that we'll put somebody through sedation to have it, so whatever it takes
Audience member
Can you request a sedation? Because when I had my first one, I had three nurses hold me down.
Dr Zoe Williams
That's not good.
Hannah Witton
I think maybe if you explain that situation, they might offer you one.
Dr Zoe Williams
I'll leave you, I'll leave you with with this, just little anecdote. So a friend of mine, another GP, a guy called Keith Grimes, he's very much into virtual reality. And he's used virtual reality for people who are having dressing changes when it's extremely painful, people with needle phobia, and of course, you'd have to make sure, because it's an intimate examination, you'd have to make sure that there was a trusted person with you or, but actually using virtual reality as a distraction can be really effective.
Hannah Witton
I love it.
Dr Zoe Williams
In medical healthcare. So I'll leave you with that one to ponder.
Hannah Witton
That's a great thing to ponder. Well, thank you all so much for coming out on a Sunday night. And thank you so much to Zoe, please give her a big round of applause
Dr Zoe Williams
Thank you for having me, thanks for coming, guys.
Hannah Witton
I feel like I learned loads.
Dr Zoe Williams
Oh good.
Hannah Witton
Oh, my goodness. Thank you!
Dr Zoe Williams
Thank you, bye!
Hannah Witton
Thank you so much for listening to Doing It. If you enjoyed it, I would really appreciate it if you left a rating and a review. You can find show notes at DoingItPodcast.co.uk, and do go follow us on social media and I'll catch you in the next episode. Bye.
Hannah Witton
This was a global original podcast