What no one teaches you about fertility before you need help [PODCAST]

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Fertility specialist and Montgomery Fertility Center founder Oluyemisi “Yemi” Famuyiwa discusses the article “What no one tells you about fertility, from a doctor.” Yemi discusses the article through a compassionate look at the emotional, biological, and practical realities patients often discover only after struggling to conceive. She explores fertility myths, reproductive timing, menstrual cycle awareness, egg health, sperm production, male factor infertility, patient anxiety, and the hope and grief that often coexist during the fertility journey. This episode examines why being healthy does not guarantee pregnancy, why both partners need evaluation, and why fertility care must address the human soul as well as the science. It is a reassuring conversation about replacing silence and shame with understanding, support, and choices that help patients feel less alone.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Oluyemisi Famuyiwa. She’s a fertility specialist. She has a new book, The Quest for Fertility, and there’s an excerpt from that book on KevinMD titled “What no one tells you about fertility, from a doctor.”

Oluyemisi, welcome back to the show.

Oluyemisi Famuyiwa: Thank you. Thank you so much for having me.

Kevin Pho: All right. Congratulations on your new book, and of course we’ll be talking about that, but let’s start by jumping into the excerpt that you shared with us. Why did you decide to share this particular excerpt on KevinMD?

Oluyemisi Famuyiwa: Right. So I think that before we jump into the thick of it, before you start talking about fertility treatments, people think, “Oh my gosh, needles and blood draws and ultrasound and IVF,” and they just get so emotionally overwhelmed even before they need it. So I wanted a little quiet, a little start to put things in perspective. It’s the same thing I start with all my patients.

So patients need that little quiet, that little perspective, and that’s why I thought that would be a good place to start.

Kevin Pho: So tell us what patients should do and what families should do in that period of quiet before they come see you, or before they get on that journey to fertility. What does that look like?

Oluyemisi Famuyiwa: So for me, I think that before people hit my door, they’ve already tried. They’re starting to feel, “Oh my gosh, we can’t even get pregnant.” And you hear about teenage pregnancies. They start to feel a loss of identity.

There’s a little bit of anxiety. There’s a little bit of relationship strain. And sometimes their fear just runs amok even before they get to the doctor’s office. They are feeling vulnerable. So a little bit of perspective, a little bit of pause, and saying, “It’s not all that bad.”

Maybe what you need to do is get some information before you start fearing for the worst. And so even this book really is my gift to young women and to men, for what you should know before things even get to the point where you’re getting to a fertility office.

Kevin Pho: Now of course, aside from reading your book, just give us the highlights of what you wish people and patients understood before trying to conceive.

Oluyemisi Famuyiwa: I think that what people need to understand is just the basics of getting to know your biology first. We are taught how to prevent pregnancy. We’re taught about STDs and all that, but no one’s really teaching you how your body works when you’re talking about fertility. Just getting some knowledge of that, and seeing how you can use that knowledge to improve your chances of fertility.

Kevin Pho: Is it a misconception that you find a lot of patients believe, that pregnancy should happen automatically?

Oluyemisi Famuyiwa: Isn’t that something? Yeah. A lot of people just automatically assume that whenever they’re ready, they should automatically get pregnant. And so there’s a little bit of disappointment when they’re not getting pregnant right as soon as they think they should.

People are always surprised that, “Wait a minute, it’s not happening right away?” And so I think there’s that gap in understanding that it may not happen right away.

Kevin Pho: What are the things you should put in place if you’re trying to conceive? Where should you understand your whole body? What do you need to know if you’re trying to get pregnant, before things get really bad?

Oluyemisi Famuyiwa: Just putting your knowledge together, trying to get a better understanding of what’s going on. Just simple things that you can do before things get bad.

Kevin Pho: Now, can you give us a little bit of context in terms of how often it takes longer than expected to conceive? What kind of numbers are we talking about in terms of the proportion of the population that find themselves in this situation?

Oluyemisi Famuyiwa: Right. So most patients that are trying to get pregnant, I would say 20 percent will conceive within the first month or two. But that success is cumulative. The cumulative success rate is month over month. Then, I would say within a year, 80 percent or more people will succeed. So it’s going to be that 10 percent or so that are not getting pregnant.

So those are the true infertility patients that may need additional workup, may need additional investigation to see what’s going on. So I think most people first try to figure out, how can you educate your body first? What do you need to know?

Most people don’t even know that, for instance, the egg ages. Most people don’t really understand that. They don’t understand that as you get older, your eggs may get older. So you see a lot of professional women who think that they will stay fertile forever and a day, and it’s always a surprise when they find out at 44 or 45 they cannot get pregnant, because they thought it was always easy.

They don’t know that the egg ages. So it’s not just a matter of the egg quantity going down, but the egg quality also goes down. So most people really don’t know that, and I’m talking about well-educated women. It has nothing to do with educational level. They just don’t know. And it takes someone saying, “Hey, listen, let me explain the whole biology of fertility before it gets worse.”

Kevin Pho: So it sounds like this education is needed to manage expectations, right? Because if they go in not having this education and expecting one thing and getting another, that can really affect patients. And you alluded to this earlier, but it also strains the relationship as well.

Oluyemisi Famuyiwa: Yes. It does strain people’s relationship. The whole idea is to move the fertility conversation from intervention to prevention. And the only way you can do that is if you know what’s impacting your body now that you had no clue about. So I would stop getting patients who are 45 years old and just never knew that those changes would impact them in the future. They simply had no idea.

Kevin Pho: So assuming that a lot of patients, like you said, don’t have education when it comes to fertility, when they come and see you for the first time, just walk us through what that initial visit is like with you.

Oluyemisi Famuyiwa: So that initial visit is going to be, “OK, let’s do the basics. Let’s check your hormones that control your ovaries.” Those hormones are typically evaluated on the second or third day of your menstrual cycle. So you want to check the hormones that may control your menstrual cycle. You want to do a basic thing like having your semen analysis checked.

If you check it sooner rather than later, then you will know if you have diseases such as abnormal sperm count. Oligospermia, we call it, or decreased motility. And by the way, some of those findings with men may give you a hint that this man may have chronic diseases, such as diabetes or liver enzyme problems or high blood pressure. Those things actually have a secondary effect on the sperm. So a lot of times, just by evaluating the man, I’m able to catch chronic diseases that they would have missed if they hadn’t gone to see someone.

So what do people need to know? You’ve got to evaluate the woman, you’ve got to evaluate the man, at the same time together. There are certain factors in your environment that you need to be aware of that may affect your fertility. Prevention is always better than trying to fix it.

Kevin Pho: How much time do you spend managing patients’ anxiety? Because I know that this is a very anxious time for patients when they come see you. And how much time do you spend on what to expect during the fertility journey?

Oluyemisi Famuyiwa: What I’ve narrowed it down to is I’ve prepared video tutorials where I go into detail. So I work with my patients in a step-wise fashion. What are they expected to see when they first encounter the clinic? What are the things they expect to see when we talk about, not even medication, but what kind of workup are they going to expect to get? What’s involved in that?

So before I even do that, if I’m constantly teaching them what the ovary is, what the uterus is, how this egg comes out, where sperm goes in, how it fertilizes the embryo, and then the division of the embryo, how it implants in the uterus. So I noticed that I used to spend about 30 minutes just teaching biology, 30 minutes before I even got to the fertility part.

So what I now do is I have created several mini videos in great detail, and I make them mini so that I don’t bore people to death, but I ask them to please watch this video before we get started. Because this is a lot of education that I have to do if I want these patients to be able to benefit from my help. They need to know why. They need to understand the biology before we can move forward.

So I find it very instrumental, teaching them. And when I noticed that I spent 30 minutes out of one hour just teaching that biology, I moved it to videos where I go into really detailed videos on both the egg and a separate detailed video on the sperm, and then I send that to my patients before we even get started. I say, “Please do me a favor. Watch this series of videos. It will help you understand what we’re trying to do.” So I do spend a good amount of my time just educating.

Kevin Pho: It sounds like the message that I’m hearing is that if a couple thinks they may be infertile, there’s a bridge, of course, a bridge of education before they come see you. Whether it’s videos or reading your book, it’s that education, of knowing what to expect and understanding the biology, that can make this journey a little bit easier for them.

Oluyemisi Famuyiwa: Exactly. You hit it on the head. It’s a lot of educating and gradually explaining this in a simple fashion.

So my book is my gift of knowledge to my patients. This is where you start. You can really break down the understanding, remove the element of fear, and then it no longer sounds hard. It’s not as bad if you get understanding first.

Kevin Pho: So we talked about the education component. Now for those reading your book, tell us some of the other key messages that you would like them to come away with.

Oluyemisi Famuyiwa: Oh, so I do a lot of myth-busting in my book. For instance, in my book I dedicate two separate sections to the supplements that people get. Everybody’s talking about, “I want to use that supplement, and I found this on Instagram, and I found that on TikTok.”

So I actually explain what those supplements are doing, what the mechanism is, which one is safe and which one isn’t. So a lot of people don’t know that there are certain things that are harmful. So my job is to dedicate two sections. One on nutrition, one on the supplements, because everybody has heard of so-called supplements.

And I also talk about which supplements may benefit certain disease conditions, such as PCOS. Which one would be better for that condition versus just a general supplement? So I created that as a sort of appendix that people can constantly reference and pull at any time.

Kevin Pho: So give us a little bit of a sneak preview in terms of what are some of the most common myths that you want disproved.

Oluyemisi Famuyiwa: Sure. The most common one is that it’s always a woman’s problem. It’s not. It’s 50 percent men. And just as women need evaluation, men also need evaluation.

And then I also get some people saying, “Well, I thought I’d just start with me first, and then we’ll go work up my partner later.” No, don’t do that. Work both people up at the same time. Because if you wait, you may just simply be delaying. It may take you a month to get one person worked up, and then you move on to the next person and find out that there are serious issues. So that just throws in more delay. So fertility is not women only, it’s 50 percent men.

Kevin Pho: And just to give us some context, what percentage of infertility issues are solely due to the man?

Oluyemisi Famuyiwa: 50 percent. 50/50. Equal opportunity striker.

Kevin Pho: We’re talking to Oluyemisi Famuyiwa. She’s the fertility specialist and author of the book The Quest for Fertility. Today’s KevinMD article is “What no one tells you about fertility, from a doctor.” Oluyemisi, as always, we’ll end with some take-home messages that you want to leave with the KevinMD audience.

Oluyemisi Famuyiwa: Please get information as soon as you can. It’s not all scary. So if you just simply understood your biology a little better, it removes the fear factor.

Kevin Pho: Oluyemisi, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Oluyemisi Famuyiwa: My pleasure. Thank you so much.

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