Q&A With Fertility Specialist Dr. Wendy Chang

Tell us about yourself and your background?

I'm a board certified reproductive endocrinologist, or fertility doctor, at the Southern California Reproductive Center (SCRC) in Beverly Hills. I'm grateful to have been practicing here for almost almost twenty years. I chose to enter the field of reproductive health because, on a personal level, I think that becoming a parent is truly one of life's most rewarding experiences. And on a professional level, I think ours is a field that is always improving and evolving. It's incredibly stimulating and rewarding to learn and apply all the continual advances in technique and technology that can help our patients.

How important is it to prep your body for pregnancy?

It's essential to prepare one's body for pregnancy, and this applies to both the egg and the sperm source. Over the past 10-20 years, we've learned so much about the impact of prenatal health, lifestyle and vitamins on egg and sperm quality, and this literally translates into the baby's health and development.

What do you think are the biggest factors in egg and sperm quality? 

Many causes of infertility like ageing, infections, surgical history and genetic/hereditary limitations on ovarian function are beyond our control.  But fortunately, many important factors are within our control.  I strive to inform and empower my patients to optimize those “volitional factors.” It should come as no surprise that what we put in our bodies by way of high quality food, nutrition and vitamins can improve ovarian and sperm function, embryo quality and pregnancy rates. Conversely exposure to toxins like heavy metals, recreational drugs, excessive alcohol and even endocrine disrupting compounds (chemical that can adversely impact our natural hormone secretion) may reduce egg, sperm and embryo quality, and even impact the baby’s future neurocognitive development.

You have some of the best results for getting women pregnant in the country! Why do you think that is? 

First and foremost, I have an incredible and experienced clinical team! Kimberly, Maria, Christine and I share the same dream: to do our best to help the patients achieve theirs! Equally importantly we share the same commitment and attention to detail.  And I think that engenders a very reassuring environment for everyone. It also frees us to focus on our patients, free of distractions and dissonance. That’s an incredible luxury in the workplace. Secondly, we are blessed with one of the finest embryology lab directors in the country, Dr. Jason Barritt. I always call him our “jewel in the crown” because his keen intellect and meticulous attention to detail enabled us to truly up our embryology game. In addition to his strict protocols, SCRC doesn’t cut corners: we use only the best egg and embryo media, platforms, and have invested heavily in technology that can improve success, such as time lapse embryo imaging. Thirdly, we’ve also learned so much about the importance of taking a holistic approach to the patient. At SCRC we coined the term “NEST” for our approach to patient care: emphasizing nutrition, exercise, stress management and toxin reduction. We collaborate with acupuncturists, nutritionists, mental health providers to optimize our patients. So I think our success exemplifies the mantra: Teamwork makes the dream work!

For those who are more holistic and not quite ready for IUI or IVF what do you recommend they do to boost their fertility?

One of the most important and positive steps any fertility patient can take is to educate themselves. Make an appointment to speak with a fertility doctor to learn about optimal nutrition, vitamins, exercise, lifestyle, and potential pre-conception genetic testing to reduce risk to their children. Ask all your questions about ovulation monitoring, intercourse timing, menstruation tracking! Find out if any of the medications you’re taking can impact fertility or convey risk to baby during fetal development.

Why do you think it is that couples today are finding it much harder to get pregnant?

Age and time delay are probably the most common reasons. I think that the American Society for Reproductive Medicine, our Ob/Gyn colleagues and the media have all done a terrific job educating women about the impact of age on female fertility. We know that female fertility suffers a progressive and inexorable decline as we age. For example, a woman’s monthly chances of achieving a pregnancy is about 25% per menstrual cycle in her early to mid-20s, but drops to about 5% per month at the age of 40. In our parent’s generation, it was the norm to start building a family in the early 20s or even earlier. But the past three decades have witnessed a gradual rise in average maternal age at first pregnancy: climbing from 21 to 27. So there has been increasing delay to fertility. The average age of women undergoing IVF at SCRC is 39 years old! But another important factor is declining sperm quality. What’s not often known or discussed is the significant and relatively dramatic drop in sperm numbers and total swimming sperm in both fertile and infertile men over the past decades. To me this drop in overall sperm quality speaks to environmental factors. And these changes are much more discernible in sperm because sperm is easier to obtain for testing and there are clear parameters for quantifying quality.

What are your thoughts on egg freezing? And when is the best time for this? Are there payment plans available?

I think egg freezing provides an extremely effective means for women to preserve their fertility for the future. Fifteen to twenty years ago, the majority of our patients over the age of 43 had to rely on donor eggs to conceive. The development of and refinements in egg freezing technology now enable women to harness the egg numbers and quality they possess currently, for use in the future. So ultimately, a 45 year old woman could use the eggs she had frozen at 35 and enjoy a ten-fold increase in IVF pregnancy and live birth rates. In egg freezing, our maxim is “sooner rather than later,” because we know egg numbers and quality and pregnancy rates are higher in younger women. But we know that historically, it’s much harder for young women to afford to do egg freeze. Fortunately, this is changing. There are a number of payment plans, loan programs, and financing available to enable more women to freeze their eggs. There are also many companies large and small that now cover egg freezing for their employees. So women contemplating egg freezing should definitely inquire with their HR team as well as with their fertility practice about all the options.

What supplements do you recommend (other than Seedlyfe of course) for women and men trying to get pregnant?

I love the incredibly rich blend of superfoods and plant protein in the Seedlyfe Fertility Smoothie, many of which have been shown to improve fertility and even enhance IVF response and outcomes. Plus it gives very busy patients the convenience of so many antioxidants in one scoop! For all patients trying to conceive, I recommend a prenatal vitamin with methylfolate, methylcobalamin, iron, vitamin D, omega fatty acids. Ubiquinol or Coenzyme Q10 is also something I routinely recommend to all women trying to conceive, although we do stop it after conception due to limited data of its use during pregnancy. I also do a detailed nutrition/dietary review to try to identify any major restrictions or omissions in macro and micronutrients. 

1 in 3 women miscarry do you have any explanation for this or advice about how to prevent miscarriage. 

Miscarriage rates definitely increase as women get older, and can exceed 50% in women 43 and older. Chromosomal abnormalities in the egg (and less commonly the sperm), uterine abnormalities, thyroid imbalance and immunological abnormalities are some common causes. Studies have shown that vitamin D deficiency is associated with a higher risk, so we always try to normalize vitamin D levels. In addition, studies have shown that higher folate supplementation or folate along with iron supplementation may be beneficial as well. One of the most powerful and proactive things and woman who has suffered a miscarriage can do is to try to have the embryo tested for chromosomal abnormalities using technology that can distinguish between maternal (the mom’s chromosomes) and the embryos/fetuses. It’s an underused technology after miscarriages, and conveys extremely important information. When a women miscarries an abnormal embryo, that is an expected outcome because the embryo did not have the correct chromosome/genetic makeup to continue to develop. But if she miscarries a normal embryo, that often means a search for other non-embryo causes should be done. And anyone with two or more miscarriages would be urged to see a fertility doctor for evaluation.

Are there any last minute thoughts?

Yes! Congratulations on your well-deserved success! I would love to do a clinical trial using your smoothie to prep our patients preparing for IVF!

You can follow Wendy on Instagram @bhfertilitymd

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