00:00:00 Dr. Erica Louden discusses the reproductive health of children diagnosed with cancer and the option of freezing ovarian cortex strips for their future use. This procedure, which used to be considered experimental, involves taking a piece of a girl's ovary cortex when she is young, freezing it, and implanting it back into her abdomen when she reaches adolescence. The ovarian tissue will then grow and produce eggs, allowing the girl to freeze her eggs if desired. This method provides an opportunity for children to have families despite their prepubertal status. Dr. Louden emphasizes the importance of addressing reproductive health concerns for various patient groups, including those with infertility due to the absence of essential components like eggs and sperm or a uterus. She also mentions the need for assistance for same-sex females and patients experiencing recurring miscarriages.

00:05:00 Dr. Erica Louden, a reproductive endocrinologist, discusses the guidelines for addressing recurrent pregnancy losses. According to Dr. Louden, if a woman experiences more than two miscarriages, she should consult a reproductive endocrinologist to investigate the cause and increase the chances of a healthy pregnancy. The threshold for a workup may vary between practitioners, with some waiting for three losses, but two at a minimum is recommended. Secondary infertility, where a woman has previously given birth but now faces difficulties conceiving, is also common and can be caused by various endocrine and anatomical factors. Miscarriages can occur later in life when hormonal changes and other factors make it more challenging to conceive and maintain a pregnancy. Dr. Louden shares her personal motivation for pursuing a career in reproductive endocrinology, having been fascinated by the science behind it during her time working with a reproductive endocrinologist before medical school.

00:10:00 In this section, Dr. Erica Louden shares her personal journey to becoming a Reproductive Endocrinologist. She initially planned to study OBGYN due to her interest in women's health, but her experience as a lab technician in college led her to a career in science. With encouragement from the National Institute of Health, she pursued a PhD for free. Her early exposure to The Cosby Show, featuring an African American OBGYN, also influenced her decision. Throughout her education and fellowship, she was driven by the daily challenges and innovations in the field of infertility and reproductive health. Dr. Louden's passion for the field stems from the ongoing research and the opportunity to help patients achieve their dreams of having a family despite the challenges.

00:15:00 Dr. Erica Louden then discusses the challenges of discussing non-traditional reproductive options with patients who have exhausted their natural fertility options. She explains that these conversations can be difficult as patients often hold strong desires for a biological child. Dr. Louden emphasizes that even though a patient may not carry their own biological material, they can still be the parent of the child through methods such as donor eggs or embryos. She also mentions that some patients may initially resist these options but may return later when they are ready to consider them. Dr. Louden also explains that age cut-offs for using one's own biological material exist due to the decreased quality of eggs at older ages, making it less likely to result in a successful pregnancy. She offers closure cycles, allowing patients to try one last time with their own material before considering donor options.

00:20:00 Dr. Erica Louden outlines the challenges faced by women over 40 with low ovarian reserve or diminished ovarian function. These women may undergo numerous fertility cycles, sometimes up to 20 or more, resulting in emotional distress and financial strain. The problem lies in the production of abnormal embryos due to aging eggs, which can lead to higher rates of miscarriages and chromosomal issues, such as Down syndrome. Dr. Louden emphasizes the importance of patient education and understanding the reasons behind these challenges. She uses visual aids and takes her time with patients to ensure they feel heard and informed. Dr. Louden also encourages proactive measures, such as fertility preservation, for those planning to get married or start a family in the future. She and her team provide valuable information about reproductive health and infertility through their social media platforms.

00:25:00 She discusses how patients coming to her clinic are increasingly well-educated due to social media and the internet. While this is generally a positive development, some misinformation is also prevalent. Dr. Louden emphasizes the importance of not comparing one's infertility journey to others, as diagnoses and causes can vary. One common misconception she encounters is the belief that male factor infertility is less frequent than female factor infertility. In fact, 30% of infertility cases are due to male factors, and another 20% are caused by both partners. Dr. Louden stresses the importance of both partners undergoing testing and working together to find solutions. Another challenge is the time it takes to go through testing and authorization processes for insurance coverage, which can be delayed if only one partner comes in for testing. Overall, while social media can be a valuable resource for infertility education, it's crucial to seek accurate information from trusted sources.

00:30:00 In this section, Dr. Erica Louden discusses the complex issue of infertility and reproductive health disparities among Hispanic mothers. She explains that the issue is multifactorial, with lack of access to quality healthcare being a significant factor. Institutional racism and bias within the healthcare system also play a role, leading to mistrust among minority communities. Historical incidents, such as the Tuskegee experiment and the case of Henrietta Lacks, have contributed to this mistrust. The lack of trust, in turn, leads to a lack of engagement with the healthcare system, which can result in morbidity and mortality. The shortage of minority doctors further exacerbates the issue, leaving many patients feeling uncomfortable seeking care from doctors who may not understand their cultural backgrounds. The conversation highlights the need for increased access to quality healthcare, cultural sensitivity, and trust-building efforts to address these disparities.

00:40:00 Dr. Erica Louden discusses the complications that can arise from a miscarriage, including scar tissue formation in the uterus that may prevent future pregnancies. She also explains how cancer survivors may experience infertility as a result of cancer treatments. Dr. Louden's interest in this area was sparked during her graduate research on the jackstack single transduction pathway, which is linked to leukemia and can lead to infertility. She goes on to describe how the Uncle Fertility consortium was formed to ensure that cancer patients receive information about the potential impact of their treatments on fertility and to offer preservation options. The consortium, which includes nurses, urologists, researchers, and reproductive endocrinologists, works to connect oncologists with fertility specialists to provide patients with quick access to fertility preservation options.

00:45:00 She then discusses her passion for helping cancer patients preserve their fertility. She mentions various pharmaceutical programs that offer discounted fertility medications to cancer patients, allowing them to conceive using their own biological material instead of donor eggs or sperm. Dr. Louden's interest in this field stems from her background in cancer research and her observation that many people do not consider fertility preservation when diagnosed with cancer. She emphasizes the importance of raising awareness about this issue and implementing guidelines for discussing fertility options before cancer treatment begins. The conversation also touches upon the challenges of preserving fertility for children diagnosed with cancer, with current options including freezing ovarian cortex strips for girls and testicular sperm extraction for boys. Research is ongoing to explore potential solutions for boys, as some chemotherapy agents can destroy the tissue responsible for sperm production.

00:50:00 Dr. Erica Louden explains the importance of counseling patients about the potential impact of certain medications on their fertility. She mentions that while cancer is a well-known condition associated with fertility preservation, other conditions such as rheumatological disorders may also require fertility preservation due to the toxic effects of certain medications. Dr. Louden notes that the relatively new field of reproductive endocrinology (REI) means that some doctors outside of this specialty may not be aware of the potential fertility implications of the medications they prescribe. She also highlights the challenges of advocating for infertility coverage, particularly in the context of high costs and limited state mandates. The conversation touches on the need for education, collaboration between medical professionals, and advocacy to address these issues.

00:55:00 In this section, Dr. Erica Louden discusses the latest technologies in the Reproductive Endocrinology (REI) field that can help individuals dealing with infertility. While there is ongoing lobbying for infertility treatments to be covered under insurance, Dr. Louden moves on to discuss some cutting-edge techniques. For patients with diminished OV reserve and poor egg quality, non-traditional treatments like IV infusions of glutathione and NAD+ can be beneficial. Intralipid infusions can help with uterine growth, and inti uterine nupen can aid in implantation. Granulose-stimulating factors can be infused into the uterus before embryo transfer to improve implantation and reduce miscarriage rates. Omnitrope, a growth hormone, is used in infertility to help with egg quality during IVF cycles. Calcium ion treatment can help with fertilization of eggs when sperm is not able to do so effectively. Physiological ixie is used to select healthier sperm based on the presence of a specific protein. These techniques are not used by every clinic but can lead to more embryos and better outcomes for some patients. Invitro maturation, originally developed for women with polycystic ovarian syndrome, can now be used to mature eggs aspirated from patients and increase the number of viable embryos.

01:00:00 Dr. Louden, a reproductive endocrinologist, discusses the importance of persistence in infertility treatment. She uses the analogy of a marathon to describe the process, emphasizing that it can take multiple cycles to achieve the desired number of children. Dr. Louden encourages patients not to give up too soon, even if they have experienced failed cycles or immature eggs. She counsels them to seek second opinions and to consider the emotional and financial aspects of the process, which can be as challenging as the physical aspects. She also acknowledges the trauma and anxiety that infertility can cause, comparing it to the emotional impact of a cancer diagnosis. Overall, Dr. Louden emphasizes the need for support and advocacy for those experiencing infertility.

01:05:00 Dr. Erica Louden discusses her future plans in the next five years. She expresses her desire to get back into research, as her current role in private practice limits her research opportunities. She also aims to expand her footprint in the infertility field and create better programs for patients. Dr. Louden emphasizes the need for more efficiency in the industry and plans to focus on these goals while also ensuring she has a family of her own.