Rita Black: Have you or someone you love been wanting to conceive, but have been challenged? In my insightful interview with top fertility specialist, Dr. Serena Chen, we explore how weight can impact fertility and look at the important role of managing your diet and exercise through the process of conceiving, pregnancy, breastfeeding and more. Dr. Chen dispels some common myths, gives hope and sound advice for those considering or in the process of starting and or expanding their family. Snuggle up with your baby blanket and come on in.

Rita Black: Did you know that our struggle with weight doesn't start with the food on your plate or get fixed in the gym? 80% of our weight struggle is mental. That's right, the key to unlocking long-term weight release and management begins in your mind. Hi there, I'm Rita Black. I'm a clinical hypnotherapist, weight loss expert, best-selling author, and the creator of the Shift Weight Mastery Process. And not only have I helped thousands of people over the past 20 years achieve long-term weight mastery, I am also a former weight struggler, carb addict, and binge eater. And after two decades of failed diets and fad weight loss programs, I lost 40 pounds with the help of hypnosis. Not only did I release all that weight, I have kept it off for 25 years. Enter the Thin Thinking Podcast where you too will learn how to remove the mental roadblocks that keep you struggling. I'll give you the thin thinking tools, skills, and insights to help you develop the mindset you need. Not only to achieve your ideal weight, but to stay there long-term and live your best life. Sound good. Let's get started.

Rita Black: Hey, everyone, come on in. We have just started the Spring Shift 2022, and I'm really excited to have a new community. And I feel like all the newbie shifters are all my little babies, so exciting to see everyone getting started on their journeys. And my biggest baby just turned 20 last month and lots of babies today, cause today, I have an interesting interview with Dr. Serena Chen, who is a fertility specialist and we're talking about weight and getting pregnant, being pregnant and beyond. And she has so much to share. I hope a lot of inspiration for anyone who's been struggling or thinking about starting the process.

Rita Black: Dr. Chen graduated from Brown University and Duke University School of Medicine. She trained in gynecology, obstetrics, reproductive endocrinology, and infertility at John Hopkins Hospital and now serves as director for the division of reproductive medicine at Cooperman Barnabas Medical Center and the Institute for Reproductive Medicine and Science as well as clinical associate professor, this is like a tongue twister, as well as a clinical associate professor at both Rutgers Medical Schools. She's been voted a top doctor for many years in reproductive medicine by publications, including US News and World Report, Inside Jersey Magazine, New Jersey Monthly and New York Magazine. Dr. Chen feels privileged to be trusted with the reproductive health of so many people in different situations - infertile couples, LGBTQ and single people who want to conceive, women wrestling with PCOS, endometriosis or recurrent miscarriage, patients with cancer who want to preserve their fertility, women concerned about their reproductive options who wanna freeze their eggs, and she strongly supports her patients right, to be informed and involved in their own care and knows that knowledge about health and wellness can make a positive impact upon fertility and pregnancy outcomes. So please welcome Dr. Chen.

Rita Black: Thank you so much for joining us today. Dr. Chen, I I'm really honored to have you here. I, it is so great that you came across my path and you have such an interesting field that you work in. And I guess my first question to you is how did you get into fertility medicine? Like what drew you into that arena?

Dr. Serena Chen: So that is a great question. I really love the energy and the department of OBGYN. Like when I was training in medical school, you rotate through all the different departments. And the people in OBGYN seemed to be the most energetic and the happiest, like really enjoying their jobs probably cause they were, you know, delivering cute babies. So that really attracted me to the field. And then when I did residency in OBGYN, I kind of loved everything, but infertility and in vitro fertilization were really just taking off when I was training. And it was very, very, it was still very new and very cutting edge. And I just thought, you know, this is like a miracle being able to grow, you know, embryos in a lab. This is amazing.

Rita Black: Right now. Were you drawn into the research part or were you drawn into seeing people wanna, I mean, I know you do both, but what, like what was your first like, Hmm, that's so fascinating cuz you were talking about,

Dr. Serena Chen: I, I really thought thought the science was super, super interesting and, and the technology. I mean, I, you know, OBGYN in general, you're working with women and you are, you're doing a lot of stuff where you can instantly help people with surgery or treatments, but you also have a little a relationship with them as well. You also follow them over time. So that was, it just seemed like the best of all worlds. You get to do really fun, immediate things, but you also can also have a, you know, a more of a, a long term relationship going. And that was cool about fertility is there was a lot of connection and interpersonal chances to have interpersonal, interactions and, and really help people, but also to use some serious, seriously interesting research in science. And it's still like that today. Right. So, you know, it's, it's amazing like the, the technology that's going on, but you, but it's a very, it it's very humanistic also.

Rita Black: Yes. Making such a huge difference. I mean, what, what a huge difference you're making. So in your practice now, tell us, you know, talk to me a little bit about the weight and you know, this is how we first met was through the challenge women have with weight.

Dr. Serena Chen: Yeah.

Rita Black: Fertility. So tell me from a doctor's perspective, a fertility doctor's perspective, like how weight impacts fertility and what we can do.

Dr. Serena Chen: So, as we all know, excess weight is a big struggle in, in the United States and many other parts of the world. And people know that it's not healthy and yet they, they can't get to where they wanna go. And it's, and, and a it's a big proportion of people and the proportion is growing in, in the infertile population. It's, it's even higher. So the prevalent, it's the majority of my patients struggle in one way or another with excess weight. I have some people who struggle with not enough weight, but that's much less common. So it is something that's extremely prevalent in the infertility world. And fat is not just weight. It's a very active inflammatory organ that releases a lot of chemicals called cytokines and things like that, that, that increase inflammation. And also it is hormonally very active. So, you know, so for a reproductive endocrinologist, it, you know, it's, it's very disruptive in terms of your hormonal balances and it can impact fertility in all kinds of ways. And then there are certain types of diseases that are made worse by weight and certain types of diseases like polycystic ovarian syndrome that the weight problem to begin with. So we're, we are dealing with excess weight on all different from all different angles and it it's really tied into what we do. And it's a real challenge.

Rita Black: Yeah. So once somebody comes to you and they have a fertility issue and they have they're challenged with weight, what, I mean, what kind of tools do you give them or is there are, do you just give them some advice to lose weight? Like what, what are you working with right now? I know we,

Dr. Serena Chen: So right now, what I do, I think the most important thing is to be, is for people to feel really well informed and to, and it's not, I don't do things sequentially. Like we don't usually say things like, okay, go out and lose weight and then, then we'll talk. We like to dive in and address everything that's concerning the patient right then, you know, like a lot of these patients come to me, they wanna be pregnant yesterday. Some people come and they're thinking about getting pregnant and they know they're having, they might have issues and they wanna address those things proactively ahead of time. So, you know, we wanna address those things too, but as part of addressing those things, weight is part, weight is often part of the conversation.

Dr. Serena Chen: So I think, you know, we can work on healthier lifestyle, weight management and fertility. I like to kind of work on all those things at once. I mean, we have data, we know that, you know, healthy weight is great, but taking time and fertility treatment in order to lose weight, doesn't necessarily pay off because for all people, especially women, men and women, but women, especially the biological clock ticks very loudly and very quickly and weight loss can often take some time and we, so you could lose valuable time losing weight. So we'd like to address everything at once and try to get empower people with information and knowledge about their fertility and about ways to address their weight. And, but you know, I'm not a nutritionist, so I, I don't do, you know, I don't do that part.

Rita Black: I understand. So what you're saying is they may come to you and the weight may have been an issue with inflammation, with as some of the reasons why they might not be able to get pregnant, but once they come to you, you can then give them the tools and start to take them on the journey of getting pregnant irregardless of their weight. Even though releasing weight would probably be very beneficial, not

Dr. Serena Chen: So we try. Yeah, we try. And because it is, it is possible to have a healthy diet and to even have healthy weight loss while in a, in a healthy way, while you're trying to conceive while you're going through fertility treatment, and even if you have a lot of excess weight to have a healthy diet during pregnancy where what we know about pregnancy physiology is if you have a lot of excess weight, it's not necessary all the time to gain weight, that the Institute of Medicine has set out guidelines that a safe amount of weight gain for somebody who is very overweight might actually be very, very little weight gain. And you are still able to very much nurture your baby without ballooning up and without, you know, getting diabetes and things like this. So I think it's like five kilogram. You know, if you have a lot of excess weight, it's about like five kilograms they say to gain through the whole pregnancy, which is maybe about 11 pounds. So that could mean, you know, it can be normal to lose weight in the first trimester, as long as you don't get dehydrated, losing weight can be totally normal in the first trimester. And then gaining a little weight in the second trimester and then gaining most of your weight in the third trimester. But, you know, 11 pounds is very little weight, but that can still be safely done.

Dr. Serena Chen: It's challenging. So I usually recommend my patients that are overweight at the start of pregnancy, have some professional help, like, you know, a dietician nutritionist, somebody who's going to, you know, reassure them that yes, yeah. What you're doing is safe because that's what everybody worries about. They worry about, you know, the baby being safe and pregnancy is tough. It's very emotional. Your hormones are going up and down. It's probably changing your taste, how you taste, how you smell, your appetite, all of those kinds of things, your body's changing. And, and meanwhile, everybody wants to, everybody's in your business. People, everybody somehow knows exactly what the pregnant lady needs in order to feed her baby. And a lot of it is crazy stuff like the future grandmothers really big culprits for overfeeding the pregnant woman. It's, you know, and so she needs to be armed with good professional information and she could say, you know, that's so wonderful that you made 10 pound pasta dish for me. And you want me to eat for three, but I, this is what my nutritionist told me. I'm gonna follow the professional's advice.

Rita Black: Right. And how about breastfeeding too? Like once, once a baby is born, women tend to, you know, what are the wives tales around breastfeeding as well as like, you need to continue to eat as much, or, I mean like, is there...

Dr. Serena Chen: So breastfeeding? So if you're normal weight at the start of pregnancy to the increase in calories is only 300 calories a day during pregnancy, but it's almost twice as much for breastfeeding to produce adequate milk. It's 500 extra calories a day.

Rita Black: Okay.

Dr. Serena Chen: So you do need actually more to do breastfeeding than for pregnancy.

Rita Black: Yeah. Interesting. That is interesting. It's nice to have that calorie number, like 300 calories a day. It's not a lot, is it? Although, you know,

Dr. Serena Chen: It's very little yeah.

Rita Black: Right. Yeah.

Dr. Serena Chen: Like it's a few, like two, like three handfuls of nuts. It it's really like very little. And yet we have, so, you know, so many myths in our society about, well, you're eating for two now.

Rita Black: Right. And I think a lot of women even, I mean, I, I've had number of thin friends who never had struggled with their weight, but the moment they got pregnant, I don't know. I'm sure you see this all the time in your practice that it's like that's permission to eat and gain all this weight during their pregnancy, cause they're finally allowing themselves to eat the hamburger and French fries and the milkshake. Do you know what I mean? Like it's

Dr. Serena Chen: Yes, absolutely. Absolutely. And I, I, I think, I think it's, I think that's hard. I think that's hard. It's hard to know what the right thing is to do because there is so much misinformation and so much mythology and emotions sounding surrounding pregnancy eating.

Rita Black: Yeah. And there is emotions like you, you want to feel like, well I'm special. This is a special time. I, so I deserve

Dr. Serena Chen: Yeah.

Rita Black: To have my husband go out and get me ice cream when I have the craving. So it's it's and it is like, I was gonna say to you, I was gonna ask you, do you find with fertility and when you're working with somebody who's new or you've been working with for a while, that's struggling. I mean, what are the, the stress of that? How do people manage that? Because first of all, it's stressful. You want, you're on a timeline. You wanna get pregnant ASAP. So that's stress, obviously stress impacts your ability to get pregnant. Right? I mean, maybe it doesn't what, what the research,

Dr. Serena Chen: So it, it probably has some impact. But the thing that we worry about the most is that is how much infertility raises people's stress levels. You know, when you look at the data only super extreme stress, like wartime famine can be directly linked to say, oh, that causes fertility issues.

Rita Black: Okay.

Dr. Serena Chen: So just normal every day you, our stressed out lifestyles, we can't really say that's actually causing your fertility, which is good because I think then we would be kind of be blaming the victim. And what we really see is that when you measure stress of infertility patients, their levels of stress are just as high as the levels of stress experienced by someone with a cancer diagnosis.

Rita Black: Oh wow.

Dr. Serena Chen: Because you know, they do have a disease, they have a severe disease that, is, is maybe not going to cause death, but is profoundly, potentially profoundly life altering. Right?

Rita Black: Right. Yeah.

Dr. Serena Chen: So, it's not surprising that they experience that level of stress, but, but our society doesn't treat infertility patients that way. We, we really poopoo it. And you know, if, if somebody has a diagnosis of cancer, they get an enormous amount of support from society. You know, people are running marathons for you. They're bringing you casserole. You're, you're really getting a lot of support and empathy. And that's not really true for infertility patients. People are, you know, don't understand, they can make jokes about it. They can make light of it. And, and you know, and patients themselves also make light of it because, you know, they're not dying. They seem fine on the outside. And I think we all need to be more empathetic and more supportive for infertility patients, including infertility patients themselves. They need to be less hard on themselves. They need to realize that this disease does cause an enormous amount of stress. And they have to figure out ways to find a supportive environment and, you know, a good community and good information and find ways that they can rest and restore so that they can support a healthy minded body, so they can have a healthy pregnancy. Because this is the thing, Rita, that technology is crazy amazing. Like basically we're at this point where we can kind of make a baby for anybody, if they have access to all the treatments and you know, and they feel comfortable with all the treatments, cause obviously not everybody feels comfortable with all this technology, but if you can, utilize all of that and just keep going until you get to the baby, you know, most everybody will get to the baby. But we have a huge dropout rate in the United States from fertility treatment. So a lot of people that should get to the baby don't because they drop out of treatment because they lose hope. They get discouraged. They get stressed.

Rita Black: Do they have shame? Like, is there a large amount

Dr. Serena Chen: Yeah. There's a lot of that because this is, you know, this is something where you're just supposed to do with your eyes closed between the sheets, you know, like, boom, go to take a vacation. You know,

Rita Black: You probably look around and you see all these people who don't seem like they should be good parents being able to get pregnant. And then you feel like I really want this baby so much. And

Dr. Serena Chen: Yeah, there is enormous amounts of shame because people feel broken. They're like what? You know, what's wrong with me? Why can't I do this thing that everybody else can do? I don't. But I think once people start reaching out for support and help, they will hear a lot of stories and realize that this is really, really common, millions and millions of people in the United States right now struggling with fertility issues.

Rita Black: And, and people drop out. So how, I mean, when, when you see these dropout rate, like where, at what point are they dropping out? Is it after one or two treatments? Is it

Dr. Serena Chen: At all points? I, I think I see being very active on social media, and on a lot of online communities, I do see that a lot of people never get to the doctor. 50%, apparently 50% of people that are struggling with fertility that could benefit from seeing a doctor, never see a doctor about it. And a lot of people that see doctors maybe, you know, don't have a great interaction and don't get the response they need to keep going because physicians, you know, I don't think we're, you know, we're not so great at the handholding. We're trained a lot of times to be like, okay, here's your diagnosis, here's a treatment go. And, and because of the enormous emotional burden that infertility places on a person, that's often not enough. People, you know, need to feel heard, they need to feel to, they need to feel understood. And, and physicians, we are not so well trained in those things.

Dr. Serena Chen: I think the, we're starting to realize that that's a huge part of medical care. That's important beyond the science and the medicine. So I think medical school, well, as these days are getting better at training people to do those kinds of things. But I always tell, I always like people to know that in our very complicated and overly busy, over burdened, somewhat broken healthcare system, it is important no matter what you're struggling with to be an advocate for yourself. If something doesn't seem right, you don't feel quite comfortable, you know, you probably need more information. You need to speak up, you need to ask questions, you need to, you know, demand to be understood and heard. I think I do think that's, and I, I think that's especially true for women. We have strong data showing that women are not taken as seriously by the healthcare system. And we see, especially women of color not taken seriously by the healthcare system and, and really that can like literally kill you. So, I do tell all my patients, I think, you know, women's health, there's so many, so many things we don't have answers to. There's not enough research, not enough money for research. You know, it's definitely still very male dominated world healthcare and medicine. And, and we, so, you know, you, we do have to look out for ourselves.

Rita Black: Right. Do you see a growing, like field of, like or a companion field of therapy for women or mental healthcare for women trying to get pregnant, like fertility therapy, like is, I bet you're a bit of a therapist with your patient, right.

Dr. Serena Chen: Yes. Therapy is part of it. I'm not a professional therapist, but I do try to provide support. And I do wish that on, you know, there's, there's this big stigma around mental health and, and therapy, but I feel that all people going through a fertility journey, infertility journey could probably benefit from at least a few sessions with a mental health professional. And we do have like wonderful organizations that support patients like fertilitywithinreach.org, resolve.org that will have local support groups and communities. And, and all these groups are online. They're, they're, there are a lot of good online support communities. And so, and you know, groups on Instagram and things like that, that help, that provide support and information. And there are mental health professionals that specialize in the infertility arena and, and, and Dr. Ali Domar, I think has, is doing a lot of cool programs and there's even an app, fertility support app.

Dr. Serena Chen: So there are a lot of communities out there that are trying to provide more support. So I, I do think that mental health professional therapy, those are all good things for anybody going through this, through this journey. And it doesn't, it doesn't mean that anything's wrong with you. It just means that, you know, you're, it's one of the ways you can support yourself, because if you have, if you can get to this point where you're hoping for the best, preparing for the worst, balancing that out, you keep your, if you could keep your head in the game, you know, the science and the medicine can get to the baby. That's, that's what I always tell people. But that's the hard part, keeping your head in the game because it's, it's physically and mentally it's strenuous, stressful.

Rita Black: It'd be so demoralizing. I know I tried, probably for nine months to get pregnant for the first, when I was 37. When, when I had my, or I was, no, I was 36 at the time, but I was a late bloomer with regards to getting pregnant. And it was, it was, you know, and you know, this, every month you do, I did it. I'm like pregnant or am I not. And that time between not knowing and getting your period or what have you, it's, it's full of hope. It's full of fear. And then you have your period and, and it's like, Ugh, again. So the cycle, it's so horrible. I remember finally going, my husband had his fertility looked at, and then I went to the doctor and I literally, on that day, I went to her. She said, you are ovulating right now. And if, because they did those ovulation things were not working for me. She said, if you go home and have sex with your husband, if you do not get pregnant, then you have a problem. And I went home and I had, I, I did get that.

Dr. Serena Chen: That's wonderful

Rita Black: If I was like, if I didn't have somebody saying, oh, now get pregnant. It was, it wouldn't have happened, so I'm very grateful to her. So, but yeah, I know that nine months was excruciating and, and, you know, I'm, I had a supportive partner, you know, like I could imagine not, you know, not having a supportive environment. So I'm glad to hear now, you know, 20 years later, there's one, a huge advance, right? There's a huge advance in fertility treatment from 20 years ago. But also, just what you're saying, these support groups, these advocacy groups are,

Dr. Serena Chen: We are, because of social media, we, we are opening up, this is one of the positive things about social media people. We are opening up the conversation more, which I think is good. We should, you know, we should shine a light on all these things. So people know that they're, you know, they're not alone and they're not broken. And there are, you know, solutions.

Rita Black: And more and more people going on social media and telling their stories of fertility.

Dr. Serena Chen: Absolutely.

Rita Black: From a broad, diverse background that.

Dr. Serena Chen: Yeah

Rita Black: Could be fantastic. Is there like if somebody was, you know, struggling, um, if they, uh, you know, they came to you, well, I guess it just really depends doesn't it? But I was gonna say, what, you know, if they were gonna take a first step, what would that first step be? Is there a,

Dr. Serena Chen: So I usually just start with a conversation, you know, like, usually we set up an appointment, a virtual appointment, like this kind of. Only, you know, we use a, a private compliant platform. And, you know, we just talk about their history and what they're looking for and, try to figure out what's going on with them. And then, if they feel comfortable, have them come in to do a full physical exam, heart, lungs, breast exam, a vaginal ultrasound, we check the guys' sperm. We do blood work for both partners, for the female partner. I do a lot of, not just fertility testing, but also general health testing because, you know, we talked about diabetes is a huge risk. I check everybody for diabetes. I check everybody for vitamin D deficiency, everybody for anemia, you know, general, you know, check your liver, check your, check your kidneys, just like a lot of general health testing, just to make sure that there's no big issues there.

Dr. Serena Chen: And, you know, and then we recommend a treatment and, you know, sometimes couples feel comfortable moving forward right away. Sometimes they don't. Sometimes they want, you know, feel comfortable with some aspects of treatment. Some not. So it's about, you know, figuring out a plan that everybody can feel comfortable with the patient, her partner, she has one and you know, the doctor and then we move forward and usually whatever treatment we try, hopefully it works the first time, but we, you know, the human body's really inefficient. Like a lot of exits sperm are just no good. So even if everything goes perfectly and even if the patient does everything right, sometimes it, you know, you have to try a few times. And, and then if, usually we start with lesser treatments like artificial insemination and fertility drugs, and then if that doesn't work, we might go more technical with things like in vitro fertilization. Some people need really high tech things like, you know, donor eggs, donor sperm, surrogacy, things like that. But, so that's kind of a general overview,

Rita Black: Right. Wow.

Dr. Serena Chen: And during this process of assessment, we try, we try to address things like healthy diet, weight, exercise, sleep. I do feel that the more the, the man and the woman can do in terms of optimizing their general health, that has a strong, positive, epigenetic impact on the eggs and the sperm. And we know that ultimately that helps improve pregnancy outcomes and may even have a positive impact on the child's health. You know, possibly even through adulthood. We, you know, we definitely have some evidence for that. So this whole thing of, well, try to eat veggies and get eight hours of sleep, you know, it does, it does make a difference

Rita Black: And exercise too, right? Like, it's like fertility and, and pregnancy moving your body, getting exercise.

Dr. Serena Chen: Yeah. And for women, a lot of women that think about weight loss do have this very linear thinking, the more calories I burn and exercise, the more weight I will lose. And you and I both know, it's not like it's not really that simple. And, and I really, you know, I want both men and women to do all four aspects of exercise. You want some cardio, you want to improve straight, especially for women core and upper body,

Rita Black: Right

Dr. Serena Chen: You wanna work on flexibility. You wanna work on balance. And the good thing about building up strength and building up muscle mass is you are then changing your metabolism in a way. You're, you're going to that muscle burns more calories than fat while you're sleeping, or while you're running around.

Rita Black: It's proactive.

Dr. Serena Chen: It lowers insulin resistance. And also, you know, more muscles will help you carry the pregnancy, will help you deliver the baby, will help with postpartum recovery and help you, you know, run around after the little one too so it's, it's like, it's like such a great thing. And yet women spend so much time just doing more and more cardio. And I don't, you know, I don't think that's necessarily answer. Like weight, weight loss is exercise is not going to doesn't directly help you lose weight. It helped, you know, it's a good adjunct, but

Rita Black: Right.

Dr. Serena Chen: You can't just run all your calories off. That's not, that's just not possible, cause you're gonna, you know, you'll raise your appetite, then you'll eat more. It's a whole thing.

Rita Black: What are some myths about diet that you've had people like diet and trying to get pregnant? Like I was told, you know, when I was trying to get pregnant unsuccessfully, cause I was, I think, I believe I was a vegetarian or partially vegetarian at the time. They're like, oh no, you have to eat meat. And, I mean I, not that that, because I'm sure plenty of vegetarians and vegan,

Dr. Serena Chen: There's plenty of fertile vegetarian. Yes

Rita Black: Just fine. But you know, like why, myths about, you know, what you should be doing, what you shouldn't be doing as far as eating and diet is concerned. Have you heard some crazy from people?

Dr. Serena Chen: Well, you know, for a while there, the keto diet was super, super popular. And, you know, we want you to have plenty of protein and we don't want you to have, I mean, you know, carbs, like, vegetables are full of carbs. Like those are the kinds of carbs. We want you to have a lot of carbs, but we'd like you to have 'em, you know, in vegetables, not processed, you know, grains. So I think, you know, we, we really like stuff like the Mediterranean diet. We do like intermittent fasting. There is some, you know, you have to, you definitely wanna talk to your doctor before you do any of these kinds of things. But, for a lot of people, a little bit of intermittent fasting can definitely, you know, lower your insulin levels, lower inflammation, reset, reset your appetite, things like that. And, but you don't want to, while you're doing the non fasting part, just eat whatever you want. We still want you to eat healthy. And then I feel like a lot of people don't drink enough water. So hydration is very important, especially when you're on fertility drugs. So fertility hormones and pregnancy hormones tend to make your blood vessels kind of loose which will, if you're dehydrated, which will drop your pressure and you, you will feel yucky and then you are not gonna be profusing your organs very well. So, that's hydration is very important with, you know, we like people to be drinking like two to four liters of water a day usually. People always think like diet soda, that's a, that's a big myth out there that diet soda, you know, you're saving calories when diet soda really can reek havoc with your insulin system and actually is associated with higher rates of diabetes and weight gain. But I feel like a lot of my patients are, you know, I feel like they have good reasonable knowledge about what's healthy and what's not healthy. I think the hard part is where you would come in, Rita

Rita Black: It's the application.

Dr. Serena Chen: Is, you know, they know what they're supposed to do, but how do they actually do it?

Rita Black: Yes. That is the key.

Dr. Serena Chen: That's the, that's the challenge.

Rita Black: Yeah. Most, most people know. I joke, I say most people who struggle with their weight know probably more than nutritionist and doctor, because they've been on diets, right. Like they're very knowledgeable,

Dr. Serena Chen: They've lived it.

Rita Black: It's not a lack of knowledge. They could write a book and have other people lose weight. It's not that, but it is really yeah. Habits, beliefs and stress, all of that. It all.

Dr. Serena Chen: Absolutely. There we go with that word stress again. Yeah. So, you know, I think, and excess weight and infertility are very similar in that way because there, you know, there is a, a lot of shame and a lot of stigma and you know, and people I think do need to be kind kind to themselves and supportive of themselves. And you know, this journey we wanna try to make, you know, make it less, less torturous and you know, maybe, well, especially with, with healthy eating, hopefully you can actually make it enjoyable because that's how it would, it would be able to continue.

Rita Black: Yes. To create an, a way of life, a new way of a healthier way of living that allows them to live at a healthier weight.

Dr. Serena Chen: Yeah. And I think a huge part of the stress within fertility is this sense of loss of control. And if people, you know, can do things like eat a little bit healthier, get a little more sleep, get a little more exercise. They, they know that they're taking good care of themselves and they know that that's making a difference. I think, you know, that alone can help you gain back that sense of control.

Rita Black: Right.

Dr. Serena Chen: You know, and I, I like, I like stuff like, you know, not just therapy, but also things like yoga and mindfulness meditation, acupuncture. A lot of my patients are doing acupuncture. There is a little bit of data showing that we don't like to using herbs, but acupuncture may help with implantation rates and IVF might help with pelvic blood flow which might help as well. So, and acupuncture phenomenal for nausea and vomiting of pregnancy.

Rita Black: Oh, right.

Dr. Serena Chen: Yeah.

Dr. Serena Chen: It's just, can be really, really wonderful for, you know, a drug free way to really help with that. So a lot of my patients also find that their acupuncture sessions are really stress reducing so, you know, there's, you don't have to see a therapist if you don't want to. I think there's a lot of different ways to help support mental health. But I do think it's important to think about it. It's important to realize that even though you seem fine on the outside, there's an enormous amount of stress for both you and your partner, your partner, you know, a lot males and females, obviously can process things very differently, you know, or even if you're not male and female, male and male or female and female, you know, everybody processes stress differently. So you do have to find ways to as a, as a couple to.

Rita Black: Cause that can be very stressful for relationships.

Dr. Serena Chen: Reduce stress and then individually, you know, manage your stress.

Rita Black: Yeah. I mean, I wonder if I'll ask you this cause I, I wanna let you go, I don't wanna keep you too long, but I, I wonder when somebody gets a diagnosis of infertility that sort of brand, that identity that they're like, oh, I'm infertile that can start to get in the way of. That starts to create this like limiting belief system that then becomes hard for them to step outside of, you know, as it, I mean, do you?

Dr. Serena Chen: I think that's a very, I think that's a very good point because you're, most people are not truly infertile. Most people are not truly sterile. It's, it's really just, we give this label and it really just means you haven't conceived in six to 12 months of unprotected intercourse. And most people that have this diagnosis of infertility, a lot of people could possibly conceive on your own. It's just that your fertility rate is lower than the average. And what we wanna do is make you more efficient. So that's what we're doing for a large portion of people. So you're right. I, I feel like, like I said, that Rita, that really, if, if patients can figure out how to stay healthy in mind and body and stay positive, then, usually, you know, we can get there and we are, we are fighting for more access, a lot of these advocacy groups that I work with, like Fertility Within Reach and Resolve and our National Society of Reproductive Endocrinology Physicians, American Society for Reproductive Medicine, asrm.org. We're fighting for better insurance coverage because that is a big source of stress and a barrier is that, you know, here's like a primary life activity reproducing and for some reason our healthcare system often treats it like it's, you know, you're getting a plastic elected plastic surgery, it's, it's kind of crazy because, you know, if we don't reproduce, that's the end of the human race. Like how much more essential could we get, right?

Rita Black: Yeah. And

Dr. Serena Chen: It is getting better, more and more companies are offering fertility benefits. More and more states are having a mandates. And, and there are, so there's a lot of resources out there. There's a company called Fertility Answers. They have an online app where people can actually get talk to doctors directly, you know, for free and the app. So there's, they're all it is getting better. The access to advice and care is getting better. But many times the patient does have to reach out for it. Our, our healthcare system is not so user-friendly.

Rita Black: Right. They have to really advocate for themselves. Yes. I think it's so wonderful. All that advocacy work that you are doing. And what I will do is I will put those links to those websites or those resources also in the show notes for anybody listening, who was like, wait, what did she say? I didn't heard that. I'll, I'll put them in there for you. Is there anything else for, you know, you would wanna say to anybody out there, I mean, you've said so much, so much valuable stuff for somebody who, you know, knows somebody trying to get pregnant or trying to get pregnant themselves, or has a child who's trying to get pregnant.

Dr. Serena Chen: Well, I feel like everybody listening right now should pat themselves on the back because obviously they're, you know, they're working hard to educate themselves. And I think that's the first step is, you know, getting information. So, you know, give yourself a pat on the back and keep looking for information and seeking answers and try, you know, you, if you're not comfortable with your current plan or your current doctor, you know, just keep, keep looking. Sometimes it can be a process. So don't, I think the biggest thing is don't give up.

Rita Black: Yeah. That's great advice. Don't give up. And, and I, I think keep a, you know, I don't know if hope is a word, but keep that open mind that it's possible.

Dr. Serena Chen: Yeah. Hope

Rita Black: From what you're saying.

Dr. Serena Chen: Positivity. I think, I think that's, that is part that is part of, a big part of the success rate is hanging in there. Cause we, we do know that for most people that are struggling with this, the biggest, the biggest obstacles does seem to be the, the dropout rate. That seems to be the number one cause for failing fertility treatment these days, because we do have a lot of great technology out there.

Rita Black: Which is amazing. I wasn't aware that it was so much better and so accessible

Dr. Serena Chen: It's that's astounding,

Rita Black: Right. It is. But you, it seems like you do need, in some cases, fertility grit, you need to just, you know.

Dr. Serena Chen: I like that. I, I like that fertility grit.

Rita Black: Yeah. You need to kind of end and belief belief in yourself, right? Yeah. So reframing yourself from being, oh, I'm infertile to I'm, you know, fertility, I'm on my fertility journey or something like that.

Dr. Serena Chen: You on the fertility warrior

Rita Black: Yes. On, on the way. Yes. I like that. A hero you're on the hero's journey of fertility. Well, thank you so much, Dr. Chen, I have really enjoyed learning from you. And like I said, I really appreciate what you're out there doing and creating some amazing human beings, you know, and, and helping people in such a great way. So thank you so much for being on our show today.

Dr. Serena Chen: Thank you, Rita.

Rita Black: Thanks Dr. Chen. I just love how involved she is in making fertility accessible to everyone. If you need more information about the advocacy groups or want to reach out to Dr. Chen, all the links are in the show notes. Also in the show notes is the link to my free video series: The Three Mental Shifts to End the Weight Struggle Once and For All. So sign up today and get started. Have an amazing week and remember that the key and probably the only key to unlocking the door, the weight struggle is inside you. So keep listening and find it.

Rita Black: Thanks for listening to the thin thinking podcast. Did that episode go by way too fast for you? If so, and do you want to dive deeper into the mindset of long-term weight release? Head on over to www.shiftweightmastery.com where you'll find numerous tools and resources to help you unlock your mind for permanent weight release, tips, strategies, and more, and be sure to check the show notes to learn more about my book From Fat to Thin Thinking: Unlock Your Mind For Permanent Weight Loss. and to learn how to subscribe to the podcast so that you never miss an episode.