Carrie Wambach
Podcast Transcript Season 1 Episode 7
Interviewer: Liz Goldwyn
Liz Goldwyn: Hello, welcome to The Sex Ed. I'm your host, Liz Goldwyn, founder of the sexed.com, your number one source for sex, health, and consciousness education.
My guest today is Dr. Carrie Wambach, an OB GYN with a specialty in Reproductive Endocrinology and Infertility. Dr. Wambach runs a private reproductive practice in Los Angeles, where she helps patients with fertility plans, egg freezing, and hormone imbalances, as well as treating recurrent miscarriage and premature ovarian failure. In this episode, Dr. Wambach and I discuss her own struggles with infertility, surrogacy and why there's such overwhelming cultural pressure to conceive.
Liz Goldwyn: How did you get into the field?
Dr. Carrie Wambach: I wanted to do something surgical for a long time, and I was interested in mostly having female patients and taking care of women. So that's what led me to OB GYN. When I was in my residency for OB GYN, I had a lot of patients who were under 40 years old who were diagnosed with cancer. And for whatever reason, I became very interested in the field of oncofertility and fertility preservation and that led me down the path to reproductive endocrinology and infertility. And then once I got into it, I fell in love with every aspect of it.
Liz Goldwyn: What is onco…
Dr. Carrie Wambach: Fertility?
Liz Goldwyn: …fertility mean?
Dr. Carrie Wambach: It's fertility preservation for women who have cancer. So onco, oncology then oncofertility.
Liz Goldwyn: You've had your own experience with infertility. So I imagine that must have really affected your approach as a doctor?
Dr. Carrie Wambach: It changes the way I speak to patients, and certainly it changes my empathy a lot. I understand what they feel when they're sitting on the other side of the table. I started my, I guess, challenge or battle with infertility after I got into the field. So I was one of those women who never thought it wouldn never happen to me. By happenstance it happened after I had been in the field for two years. So I understand it a lot more. I understand the patience, I understand the relationships. I understand the highs, I understand the lows.
Liz Goldwyn: Can I ask how old you were when you started dealing with your own infertility?
Dr. Carrie Wambach: 33. Young.
Liz Goldwyn: So pretty young.
Dr. Carrie Wambach: Mm-hmm (affirmative).
Liz Goldwyn: And that must be-- What's a typical age of a patient who comes to see you?
Dr. Carrie Wambach: Average age is probably between 37 and 39, but in LA women are a little bit older when they start having a family because so many women are career-oriented and we push things off a little bit. But it, in general, nationwide, it's about age 34 to 35 when women start presenting, but in LA it is later, that 37 to 38.
Liz Goldwyn: I imagine you must get some women in their 20s as well who have good kind of fear that they've got to freeze their eggs right away or start dealing with their fertility.
Dr. Carrie Wambach: That's just started. In the last, probably two or three years, we're seeing more and more women in their 20s. The issue is is egg freezing still is fairly costly. So even though success rates are so high, and it's in the media, and there's egg freezing parties and it's all over, a lot of women in their 20s can't afford to do it. At the same time, most women who freeze their eggs in their 20s probably won't use their eggs. Only about 1% of women will use their eggs if they freeze them under 32 years of age. So mostly what we're seeing is probably women closer to 34 to 37 per egg freezing.
Liz Goldwyn: Can you explain the process of egg freezing? Break it down.
Dr. Carrie Wambach: The first part is just an evaluation of you. What your egg reserve is, how many eggs you have. It's not an evaluation of how fertile you are, per se, it's more or less an evaluation of your reproductive timeline. Do you have the same amount of eggs as other women your age? Do you have more or do you have less? And we do an ultrasound to count what's called antral follicles, so little follicles on the outside of the ovary, and we do two blood tests. One called AMH and one called FSH. And those three components tell us how many eggs we may retrieve if we do egg freezing and what the reproductive timeline or how long we think you have to have a baby is. After we do that, then we make a decision on the protocol. So what medications we're going to give, how aggressive we're going to be, that kind of thing.
Once we decide that, you come in on the third day of your period. You start, probably birth control pills or a similar medication to synchronize all your eggs to get all the eggs that are recruited for that particular month in the same developmental state. Once you've been on that medication for roughly about a week, then we get you off the medication, bring you back in and start a series of injections for 10 to 12 days.
Liz Goldwyn: Injections.
Dr. Carrie Wambach: Mm-hmm (affirmative).
Liz Goldwyn: In the vagina.
Dr. Carrie Wambach: No. In the belly, in your abdomen.
Liz Goldwyn: In your belly.
Dr. Carrie Wambach: Mm-hmm (affirmative). Still not as pleasant, but a little bit better than in the vagina.
Liz Goldwyn: Yeah.
Dr. Carrie Wambach: And it's about two or three injections a day. What is unpleasant at the same time as that's when you're going into clinic every other day. So you're going in for vaginal ultrasounds, you're going in for a blood test probably five or six times throughout that period. Once your eggs look mature and they look ready to come out, you take one final injection and you have a procedure two days later where we take the eggs out vaginally. That procedure you're asleep for. So, all in all, the processes is about a month. You feel a little bit bloated, you feel a little bit moody.
Liz Goldwyn: From the hormones.
Dr. Carrie Wambach: From the hormones. The hardest part is probably the emotional roller coaster. Everyone thinks it's going to be the injections or it's going to be the ultrasounds, but it really is the emotions that you feel. And sort of as you're facing your own reproduction, you start to get a lot of anxiety. Some people, on the flip side, start to feel really empowered, but it is a lot of ups and downs throughout that short two week period.
Liz Goldwyn: So it's a fairly invasive process, egg freezing. It's not for someone who's got an all natural approach to, let's say, birth control or gynecological health who doesn't want to take pills…
Dr. Carrie Wambach: Right.
Liz Goldwyn: It's a commitment.
Dr. Carrie Wambach: It's a commitment. And it is a lot of medication. You can do a natural cycle egg freeze where we follow one egg per month. We take out that egg every month and we freeze it, but it's not as cost-effective and it has a fairly low success rate because it's unfortunately all about a numbers game. You need to get a certain amount of eggs to overcome the chance that there's going to be genetic abnormalities. And getting one egg every month you would probably have to do that six to 12 months. So medications are really helpful in that regard.
Liz Goldwyn: So all natural is six to 12 months versus hormones one month process. And the cost difference?
Dr. Carrie Wambach: The cost is not that reduced from doing a natural cycle because you still have laboratory fees, you still have anesthesia fees, you still have OR fees. So the cost is actually going to be a pretty significant amount higher doing six to 12 months of retrievals than doing one month with hormones.
Liz Goldwyn: What are the biggest misconceptions or disappointments that women have when they come into you to learn about the process of egg freezing?
Dr. Carrie Wambach: First is the success rate. A lot of women still think that egg freezing is the end-all be-all. And if you freeze your eggs, you're going to get pregnant in the future. And that the typical success rate is about 35 to 40% that you'd actually have a baby from it. So that's number one. Number two is the costs, and number three is that, what I just described to you is a very smooth perfect cycle but that often doesn't happen. So there's bumps along the road, there's surprises, there's cycles that are canceled. Oftentimes, we retrieve fewer eggs than we expect, or we learn something about the eggs. So there can be quite a few, I guess, issues that come up.
Liz Goldwyn: How much is the menstrual cycle linked to your fertility and the success rate of egg freezing?
Dr. Carrie Wambach: So your menstrual cycle can tell you a little bit about what's going on with your hormones. And that goes back to that sort of reproductive timeline and how many eggs you have. If you have a fairly typical menstrual cycle and it starts to change, that may tell you that something's going on with your egg quantity, with that egg reserve question. On the flip side, there are women who don't have normal menstrual cycles or any menstrual cycle who can have a really high egg reserve. So it's more or less an acute or a new change that can be indicative of something going on, but overall, the month to month menstrual cycle may not tell you that much.
Liz Goldwyn: How is one person born with more eggs than another? How does that work out? It's just luck of the draw?
Dr. Carrie Wambach: If you figure out you'll win a Nobel Prize. No one can figure it out. Women are born with one to two million eggs which is a huge variation when you think about it. And we have no idea why some women are born with fewer eggs and are going to go through menopause at age 40, compared with other women who have that two million who go through menopause at age 55. We don't know.
Liz Goldwyn: It seems like egg freezing has become a really big business especially in the US. And I'm wondering what you feel about this cultural pressure for women to have a baby to feel complete, and, you know, how much you see that in your practice or with patients that are maybe unsure and their decision to freeze their eggs is possibly not based on their own desire, really in their heart, to have a child, but the kind of pressure they feel from society.
Dr. Carrie Wambach: No. If I see a lot of women who come in because of societal pressure with the exception of those who have coverage for it. So some of the larger companies, especially in Los Angeles, cover egg freezing. And that is when I will see this group of women come in that say, "I don't really know why I'm here. I have benefits so I might as well use them, but I don't know if I want a child." And I don't think they're there begrudgingly or they feel forced to do it. I feel like most of them do it because they don't want to have the regret, but those are the women who it's not going to be a big financial burden. I don't see as much in the population as women who come in and feel like they have to spend this money and they have to freeze their eggs or else they're going to be out of the norm, or they're going to regret it, or people aren't going to talk to them, and maybe it's just because the bar is set too high and they can't do it.
There was a lot of discussion when Google, and Apple, and Facebook started covering egg freeze. Even though this is a great benefit, is this sending the wrong message to women? Is it sending the message to women that you have to freeze your eggs, or that you should push your fertility, or that having a child should be the number one thing in your life? And there was a lot of discussion on it, but I don't know what has really come from that, but I don't see it as much.
Liz Goldwyn: And what exactly is IVF? Can you explain?
Dr. Carrie Wambach: IVF is fertilization outside of your body. That's the simple bottom line of it. So it's taking eggs out, fertilizing them in a lab and then putting the embryo back in your uterus, circumventing the tubes. It was originally created for that reason alone. So only for tubal factor and fertility. So the first baby born from IVF from England was basically born because her mother didn't have any tubes or any functional tubes. IVF has since become very widely popular and used for many different things, but all it is, is just fertilization outside the body and putting the embryo back in.
Liz Goldwyn: And I'm wondering where adoption fits into the discussion that you have with your patients or your thoughts on it as there's so many unwanted babies in the world and then there's this big desire to use science and medicine to create our own.
Dr. Carrie Wambach: For a lot of women who come in who have that lower egg reserve, who are coming in 40 and older, especially 42 and older, adoption is one of the first things we talk about. You know it’s… I think some women feel this innate need to try everything with their own eggs first. There's always an exception to every rule, but the majority of women I see feel this, maybe even pressure, maybe going back to what you talked about before, less so with egg freezing than trying to get pregnant with your own eggs. But it is a phenomenal opportunity and an available option for women who are a little bit older, who will likely not be successful with IVF, who shouldn't put their body through the medications or shouldn't put their body through a pregnancy.
The issue I hear with adoption, and I don't know so much, is that it is almost as hard if not more difficult than using a donor egg. So when women no longer have the opportunity to get pregnant with their own eggs, it seems that the emotional roller coaster, and the waitlist, and the financial burden of adoption sometimes outweighs getting an egg donor and getting pregnant themselves. And I've seen that being the big barrier, but it's always something we talk about.
Liz Goldwyn: I'd love to know if you feel comfortable a little bit more about the various methods. You have three children.
Dr. Carrie Wambach: Mm-hmm (affirmative).
Liz Goldwyn: And sort of what you went through in that process.
Dr. Carrie Wambach: The first child, I realized I was going to need help because I had stopped birth control pills, and about eight months had gone by and I didn't get a period. There's various reasons for not getting a period. Mine wasn't that I was in menopause, mine was that my hormones just simply weren't working to make me ovulate. So for the first child, I went through about three or four months of medications and insemination. And he was-- I got pregnant, I would say, fairly easily at that point. He delivered at 25 weeks, which is about five and a half, six months and he was about a pound and a half and in the NICU for four months. And that's when I learned that maybe something else was going on with me.
Once he had been home for about a year, a year and a half, my husband and I tried again and I went through three miscarriages and an ectopic pregnancy. And I have every resource at my fingertips and we just couldn't figure it out. And my last miscarriage was fairly late, about 10 weeks. And I found out the gender and found out that the chromosomes were normal and that sort of put me over the edge. And so I said, "If we're going to do this, we're either going to adopt or we're going to go through surrogacy." And because I did have the resources we decided to do surrogacy.
I went through IVF, I went through, really a beautiful, beautiful journey with our surrogate who I love dearly, who's still part of our family. And when she was about six or seven months pregnant, I found out I was pregnant. And I had stopped trying, and stopped my medications, stopped my baby aspirin. I stopped everything and I found out-- I was sort of at the end of my first trimester when I found out. Apparently all you need to do is be happy, but I don't know how to tell everyone that. And so I used modern medicine; I had a cerclage, I had progesterone shots-
Liz Goldwyn: What does cerclage mean?
Dr. Carrie Wambach: It's a stitch in your cervix to sort of hold it together because my first one was so early. And that was my biggest fear. It was not only can I get through first trimester with a miscarriage, can I get through the rest of pregnancy? Because even if I get through a miscarriage, my baby came out so early and we're lucky because he's okay. But, somehow, got to 34 weeks even with a newborn baby at home and now I have all three.
Liz Goldwyn: Wow. So you had one via surrogate and one naturally, literally back-to-back.
Dr. Carrie Wambach: Four months apart.
Liz Goldwyn: That's a miracle if we can call it that.
Dr. Carrie Wambach: A miracle, yes. A little bit of a shock and a fear for a while, but it, yeah, it all worked out. So it's a blessing.
Liz Goldwyn: Speaking of blessings and miracles, I wonder because of your background in your business, seeing the data and the percentages of people who are able to have a baby naturally, do you-- you've had a miracle in your own life, does that exist in your field? Is there that ray of hope?
Dr. Carrie Wambach: Absolutely. Fertility is not black and white. And 30% of couples will come in and we can't figure out why they're not getting pregnant. So if you look at the data, there is basically the same chance that a couple will get pregnant if they just try on their own for five years versus doing IVF. The problem is, if they don't get pregnant and that five years has elapsed, oftentimes age becomes the biggest barrier. And that's why so many people go on to do treatment, but I've seen it over and over again. If patients aren't having good cycles or they're not responding, I simply say, "You need a break. Get out of clinic, go somewhere for three to six months." More often than not, they get pregnant. A lot of people have said that I'm there ray of hope, that sort of knowing my story and seeing it. If it can happen to me, it can happen to anyone. But it does. It happens all the time because we obviously don't know everything yet.
Liz Goldwyn: And stress must play a big part in gynecological health overall.
Dr. Carrie Wambach: I think so. We don't know how to quantify it yet, but you see it.
Liz Goldwyn: You advocate holistic modalities like a vitamin regime and diet. What are some of your top suggestions to increase fertility?
Dr. Carrie Wambach: So number one is diet low in saturated fats because they create free radicals and that can damage any growing cell such as an egg. You also want to try to focus on antioxidants. So blueberries, dark chocolate, acai berries, pineapples. All sorts of different things that can act as antioxidants and fight the free radicals in our body. Vitamin D is really important. So you, if you're not outside in the sun for 20 minutes a day, you want to take a supplement. You know, ideally, less alcohol is better than more. So less than four or five drinks a week. Calcium supplementation. About a third of women carry a mutation where you can't process folic acid that much and you need extra folate. And so I think just taking one milligram of folate a day is also really beneficial.
Liz Goldwyn: What do you think about taking prenatal vitamins is, in general, as your vitamin regime whether you're a young woman taking vitamins?
Dr. Carrie Wambach: Prenatal vitamins is, the main difference prenatals have as opposed to multivitamins is the folic acid or folate. So really good for you, great for your hair, great for your nails. I don't think it ultimately makes that big of a difference, but if you are going to take multivitamins then I do suggest adding that folate or folic acid back.
Liz Goldwyn: So might as well be taking vitamins for two or three? (Laughs)
Dr. Carrie Wambach: Mm-hmm (affirmative).
Liz Goldwyn: I'm wondering what's your opinion on IUDs and birth control? I know you use, you know, a form of birth control in the hormonal treatment for egg freezing but ...
Dr. Carrie Wambach: I'm not the right person to ask because I clearly didn't use mine appropriately, but I think IUDs-- I love all the data associated with IUDs. With risk of a scarring and infection and sort of negative consequences in the future, that was all long ago. So IUDs are a really good form of birth control pills or birth control --not birth control pills-- because you can use them and forget about them. A progesterone IUD is actually also really good. It can prevent endometrial cancer. It gets rid of your period for almost two to five years.
Liz Goldwyn: Do we think that's a good thing to be getting rid of our period?
Dr. Carrie Wambach: It's okay. Yeah, because it's usually preventing ovulation and it's keeping your lining really thin. So both of those things are actually beneficial for decreasing chance of endometrial cancer and ovarian cancer. The only issue is, if you remember what I said sort of 20 minutes ago, changes in your menstrual cycle can be indicative of something going on with your hormones and your overall sort of fertile health, and you miss those changes when you're on some form of birth control. So whether it's an IUD, whether it's birth control pills, whether it's a patch, if you have something that's changing the pattern of your periods and you're missing them and you're not seeing them, you may miss premenopausal symptoms, you may miss changes that may affect your future, but they're not bad for you. And there's been really no negative long term data that has come out except for very long use of birth control pills which may be linked to breast cancer or may not be, we don't know. But overall the benefits outweigh the risks.
Liz Goldwyn: What about decrease in libido over time, which there has been a significant amount of studies?
Dr. Carrie Wambach: They do. They absolutely do decrease your libido. Because as-- so every woman goes through a really cyclic changes in their menstrual cycle and those cyclic changes are hormonal. So when you start out right at the beginning of your period, your estrogen is low. As your period ends and you get closer to the middle of your cycle, not only does your estrogen rise, but so does your testosterone and that rise in estrogen helps with virginal lubrication, the rise in testosterone helps with libido. It's all physiologic, probably. So we want to have sex right, when you're most able to have a baby or conceive, but when you're on birth control pills or any form of hormones, it basically prevents that cycle from happening. So even though you feel like you're taking estrogen, you're taking a much lower dose than your peak estrogen would get to and it's preventing that testosterone from rising. So you get vaginal dryness, you don't have that increase in libido. You-- often, people complain because of the vaginal dryness of painful intercourse. So it absolutely can affect libido.
Liz Goldwyn: Seems like we should have figured it out by now, right? With female birth control and female research on female sexuality in general. You mentioned endometriosis a few minutes ago and I'm wondering what you think of preventative hysterectomys.
Dr. Carrie Wambach: So it depends where you are in your life. A preventative hysterectomy is probably going to relieve the pain of endometriosis for a long time because it will drastically decrease the symptoms. That being said, a hysterectomy is a rather large procedure. So you can also have pain from that. And it really depends. If you're getting close to menopause, it may not be beneficial to you. If you're young and you're done with childbearing or you know you're not going to want children, and you have 18 years of cycles ahead of you that are debilitating, it may be beneficial. You just have to be careful that you're not going to regret taking out your uterus or going in that direction if you're young because a lot of people will change their mind about families in a five year period.
Liz Goldwyn: I'm wondering on that note, what age typically does it become difficult to conceive? Or does it vary from person to person?
Dr. Carrie Wambach: It varies from person to person. It starts to become a lot more difficult after the age of 37 and a half, and it really starts to become difficult after the age of 40. So regardless of IVF and regardless of other tools that are out there to help, rates of conception around the age of 40 are somewhere between 10 and 15%. As compared to rates of conception when you're 25 to 30, which can be upwards of 80%.
Liz Goldwyn: What's the oldest patient you've seen give birth?
Dr. Carrie Wambach: Give birth or get pregnant with their own eggs?
Liz Goldwyn: Get pregnant with their own eggs and give birth.
Dr. Carrie Wambach: 47.
Liz Goldwyn: So I've been hearing stories of people who have a friend who was 50 and gave birth or I know a couple of women who are in their late 40s who gave birth naturally. So I don't know if they're just extremely lucky.
Dr. Carrie Wambach: Extremely lucky. They're on the very, very tail end of the spectrum. Most women who are getting pregnant after the age of 45 are using donor eggs. But no one talks about it.
Liz Goldwyn: Why don't they talk about it?
Dr. Carrie Wambach: It’s, you know, even 20 years ago, infertility was very hush-hush. People felt ashamed, they didn't want to speak openly about it, they didn't want to admit it. I think we've come a really long way in society where people can talk about that, they can talk about miscarriage. They don't feel like they're so outside the norm that they have to feel ashamed about it, but I still feel that when people move to donor eggs, it is a sense of failure or it's a question of identity. How am I going to relate to this child? How is everyone in society going to look at this child? Are they going to see this child as mine? So a lot of people don't want it to be open.
Liz Goldwyn: It's kind of very sad how much shame we have around all these issues.
Dr. Carrie Wambach: Yeah, it's shame. Because with adoption, for some reason people don't feel that as much as from what I've seen. People are less hesitant to say, "Oh, my daughter's adopted or my son's adopted," but they're very hesitant to say, "My children are of donor eggs."
Liz Goldwyn: What is considered premature menopause?
Dr. Carrie Wambach: A menopause before the age of 40.
Liz Goldwyn: How common is that?
Dr. Carrie Wambach: Rare. Less than 5% of women.
Liz Goldwyn: What's the typical age for menopause?
Dr. Carrie Wambach: 51.
Liz Goldwyn: What can we expect from menopause?
Dr. Carrie Wambach: Changes. (Liz laughs) So that pattern that I told you about estrogen, that starts to go away. So your estrogen falls, your testosterone falls. The reason women complain of hot flashes, of vaginal dryness, of decreased libido, of weight changes. All of that is from those two hormonal changes. Some women go into menopause and feel very little. The majority, however, feel those effects from the estrogen withdrawal and it's really hard. It does happen over a period of seven years. So you slowly get used to it, but it's a big change.
Liz Goldwyn: What can you do to ease into that change?
Dr. Carrie Wambach: Take Estahormone replacement. So there are some natural supplements. Primrose oil is one that a lot of women use. A couple others but I have to refer to my acupuncturist friends-
Liz Goldwyn: Vitex?
Dr. Carrie Wambach: Vitex.
Liz Goldwyn: Which is chasteberry.
Dr. Carrie Wambach: So vitex is most helpful, I've seen, for people who don't ovulate well or don't have a strong luteal phase. A luteal phase is the second half of your period. Vitex increases the hormone LH, LH does increase testosterone. So that may be how you're-- where you're hearing it from. Maybe it does help libido and it helps well being a little bit, but I haven't seen as much of an effect in people who are struggling with hormone withdrawal. I have seen an effect with people who have relatively unexplained infertility, or egg quality issues, or those short luteal phases. And that's where I've seen vitex used most often. But I can understand how it would help with testosterone. And then other than that, there's SSRIs which are antidepressant. They're not given for mood enhancements, but they're given to sort of less than the effects of the hot flashes and the vaginal dryness. There's lubrication you can use for vaginal dryness which helps with libido because it doesn't hurt so much.
A lot of women are on some sort of hormone replacement. It's just been very controversial in the past 10 years because of the studies that came out that hormone replacement lead to increased heart attacks, and breast cancer, and different obvious negative adverse events. But if you're started on hormone replacement really early, it seems to negate the risks of those events happening. So a lot of women will start working with a physician when they're 47, 48 and starting to feel the symptoms and start hormone replacement and ease into menopause that way.
Liz Goldwyn: So like taking prenatal vitamins preemptively should-- do you suggest bringing in things like primrose oil or other natural supplements into your diet premenopause?
Dr. Carrie Wambach: They don't hurt you for sure. It's just a question of how much they help. And some people swear by them and some people don't. But yeah, anything that you can start on the earlier side so you're not chasing your symptoms, that's going to be better.
Liz Goldwyn: For women who are just listening to this or curious about how they can find more resources, maybe they don't have the money to come in and see you or see someone in that area, what would be the first thing you would suggest to them? That they could do some research themselves online or where would you direct them?
Dr. Carrie Wambach: You can do research online. There's also lots of seminars that are offered that are free. There are also a tremendous amount of financial aid options that are available. They're not easy to find on the internet so it's worthwhile calling fertility centers, calling different clinics finding out what's available, what programs, what scholarships, what loans, et cetera, that are available because there's lots of different programs. There's Compassionate Care Programs which will give you 75% off of your medications, there's, you know, different loans you can apply for. So there are ways to get around it, but they're not easy to find.
Liz Goldwyn: So you got to dig.
Dr. Carrie Wambach: You have to dig. No one advertises it.
Liz Goldwyn: What are you still learning about sexuality and infertility?
Dr. Carrie Wambach: They don't really go hand in hand. So by the time most couples come to me, they have been trying to conceive for well over a year. So, so if you-- I think it completely depends on how you define sexuality, but when I hear sexuality, I don't necessarily think of that as sex for conception. I sort of think of that as more sex for pleasure or sex for intimacy, sex for, regardless, relationships. When you have taken that from the relationship and it's now been boiled down to sex for conception month, after month, after month my definition of sexuality doesn't necessarily seem to exist anymore with a lot of these couples. It removes the surprise, it removes the intimacy, it puts a big burden on both, you know, to be ready, and to have sex at the right moment, and it puts a lot on-- You know, you're looking at the end result of it right? So you're not having sex for the moment, you're having sex for this outcome in the future.
A lot of couples struggle. They struggle to find intimacy again, they struggle to have sex for pleasure again. It does, it becomes really, really difficult for a lot of couples. And I think it's one of the things that I noticed right away that it becomes this wedge in between people coming in because they're not that couple that, you know, two years ago was racing off to their bedroom or kitchen or wherever it was to just enjoy each other. It's simply becoming mechanical and it's affecting relationships.
Liz Goldwyn: Do you find that as well with gay couples who come to your practice? Same issue?
Dr. Carrie Wambach: With men, no, because men don't have any-- they're sort of sitting back and they're giving samples and everything is sort of happening outside of their bedroom. With females I think we tend to-- sex for females, from what I've seen, is more emotional too. And if you're starting to go through this roller coaster, I think it's not that two women have to have sex, you know, to have a baby, but if one woman is struggling to get pregnant, I think that ultimately, that becomes an emotional divide and that, from what I've heard, has affected the bedroom a little bit. But I haven't seen it as much in gay couples, whether two men or two women, as I've seen it in heterosexual couples who have had to focus on sex as a means to conception where you haven't had to focus on sex as a means to conception in any other relationship.
Liz Goldwyn: Something to be said for same-sex partnerships. (Both laugh)
Dr. Carrie Wambach: They say that. My female patients say it all the time in their list of why having a wife is better than having a husband, but yes.
Liz Goldwyn: Is there anything that surprises you still?
Dr. Carrie Wambach: Everything. Yeah. You learning something new every day. You know, am I surprised by the 45-year-old who comes in who I think is about to go through menopause and she has twins or the 26-year-old who has more eggs than anyone I've ever seen who can't get pregnant. So medically, I'm surprised by things all the time. Yeah. I mean, each day is new.
Liz Goldwyn: Thank you so much.
Dr. Carrie Wambach: You're welcome.
Liz Goldwyn: This has been amazing.
That was Dr. Carrie Wambach, OB GYN and fertility specialist. To learn more about Dr. Wambach's medical practice, please visit reproductivepartners.com.
Thanks for listening to The Sex Ed. If you enjoyed this episode, please subscribe, rate, and review us wherever you listen to podcasts. And be sure to visit us at the sexed.com. The Sex Ed is hosted by me, Liz Goldwyn. This episode was produced by Isley Grundy for the Media Mob. Jackie Wilson is our line producer, Jeremy Emery is our sound recordist and editor, and Bettina Santa Domingo is our coordinator. Lewis Lazar made all of our music including the track you're listening to right now. Until next time, The Sex Ed remains dedicated to expanding your orgasmic health and sexual consciousness.