Examining the Realities of Fertility for Female Surgeons with Dr. Valerie Libby

Dr. Valerie Libby discusses the issue of infertility in female surgeons

Dr. Frances Mei: Based on a 2021 study, the mean age for female physicians to first give birth was 32 on average, in comparison to median age for non physicians to give birth, which was 27. And I’ve read the JAMA surgery article from 2021 about incidence of infertility and pregnancy complications in us female surgeons. It was pretty bleak. 692 female surgeons were surveyed and 42% of them had experienced pregnancy loss, which was more than twice the rate of the general population population welcome to this week’s episode of promising young Surgeon. This week, Dr. Valerie Libby joins us to discuss the issue of infertility in female surgeons, as well as her own journey with IVF and a pilot program that offers egg freezing to surgical residents at a majorly reduced cost.

Dr. Valerie Libby started a program at Shady Grove fertility for residents

Dr. Valerie Libby is an OB-GYN in Atlanta at ah, Shady Grove fertility. She not only has her md, but a master’s in global public health as well. She went on to complete a ah residency and then a fellowship in reproductive endocrinology and fertility. She is an expert in the diagnosis and treatment of infertility and highly accomplished in the areas of fertility preservation and elective egg freezing. She is an avid traveler, tennis player and enjoys biking and cooking importantly. And we’ll dive into this majorly today, she started a program at Shady Grove fertility for residents to receive discounted egg freezing. Thank you so much for joining me today, Doctor Libby.

Dr. Valerie Libby: Thank you for having me. I’m excited to be here and meet with you and talk about the program and my journey as well.

What is the data on fertility for female physicians and surgeons that is important

Dr. Frances Mei: So Doctor Libby, in your opinion, what is the data on fertility for female physicians and surgeons that you think is really important for people to know and be aware of and will affect their decision making?

Dr. Valerie Libby: Yeah, I think that everything you just said is really important to know that, you know, women are older, when they have their first live birth, when they are a doctor in general, and surgeon, surgeons in particular are even older. So of the, of the doctors, surgeons are about four and a half years older than other doctors when they have their first child. And so along with just age comes, you know, comorbidities with pregnancy, but also difficulty getting pregnant. When you’re older, it is much harder to get pregnant. The quality and the quantity of your eggs declines with age. So oftentimes you do find yourself in situations where you have to, you know, seek help with a fertility specialist, often needing ivf and vitro fertilization and sometimes even needing donor eggs. If you happen to have gone into earlier menopause m or menopause, and you’re even older, you’re older than 40. So being able to freeze your eggs is really important because it allows you to, you know, not prevent the difficulty you may, or to try to prevent the difficulty you may have. If you do see treatment at an older age, you can use eggs from when you were younger and the outcomes are much better, than if you were to use your older eggs. So I do think that, you know, it’s really important to focus on, you know, all physicians, and all, you know, in fact, all women in, you know, professional careers that delay, you know, want to delay childbearing or decide to delay childbearing, or have to delay childbearing and, and to just, you know, bring, a lot of awareness to the opportunity of egg freezing and the benefits that it may provide you.

Dr. Frances Mei: Totally. And I love that. And I love how you talked about this is not a surgeon specific nor a female physician specific issue. I definitely would believe that it affects a lot of women in, competitive professional careers. And honestly, in this day and age, there are more and more people who in their twenties don’t find themselves in a position where, they’re seriously considering childbearing and things like that. And so, I love that this is actually a much more universal topic than it even looks like at first.

Female surgeons who operated more hours during pregnancy at higher risk of pregnancy complications

But I did want to ask you, I found it very interesting that female surgeons who operated twelve or more hours per week during their last trimester of pregnancy were at higher risk of pregnancy complications compared to those operating less than 12 hours a week. So that was wild to me. And does that affect the way that you counsel your patients? Do you have specific recommendations, for female surgeons who are pregnant? And, I mean, should they be changing operative schedules based on this?

Dr. Valerie Libby: I mean, I usually, as an OB-GYN, I did specialize in fertility, so I really only take care of patients until they’re about ten weeks pregnant. Then they go to their primary OB-GYN for the rest of pregnancy. Knowing that statistic, I think that’s just important to know, if they are able to alter their schedule at all, you know, decreasing, their surgical hours, you know, in the latter part of pregnancy may be beneficial. You know, anecdotally speaking, I have known, you know, I would say more, you know, people that are surgeons that have had, poor outcomes in pregnancy than others, but I probably know more surgeons as well, so it’s hard to say. But, you know, if the study did show that, you know, I would look at that study. I haven’t seen that study, but, and, you know, and validate that mean maybe with more studies. But I would say, you know, if stress definitely impacts pregnancy outcomes and, you know, when you are on your feet, I mean, for a long time during your pregnancy, even, even for an hour or two, your back starts hurting, you have a lot different weight distribution and that kind of, you know, burden that you may feel, the discomfort you may feel may actually impact the baby as well. So, you know, it’s just important to try to minimize stress and minimize, you know, and to try to like maximize relaxation techniques and stuff. So, you know, I would say that the most you can do that in pregnancy, it will be more beneficial just because, you know, surgeons do have this higher burden of infertility and do have a higher burden of comorbidities in pregnancy. So something to talk to your objoyan about for sure.

Dr. Frances Mei: That totally makes sense. So it’s tough, especially for resident physicians out there, you know, who have less control over their schedule. But I hope that this is information that, you know, people who have more control over their schedule can kind of take, take under consideration. And we can always put the link to this journal article, definitely in the show notes. It’s that JAMA Ah, publication from 2021, the incidence of infertility and pregnancy complications in us female surgeons. So we’ll definitely like provide that citation for all of you listeners out there.

Shady Grove fertility offers egg freezing for surgical residents at discounted prices

So I’d love to hear about, can you just tell us about the shady Grove fertility egg freezing program for residents?

Dr. Valerie Libby: Yes, definitely. I realize that the burden of infertility is worse among doctors in general. and I really, you know, being a, you know, an OB-GYN, considered surgeon, I, you know, really wanted to advocate for women like us, you know, in, in medicine, just, you know, because we do delay childbearing. And I personally went through this myself. So, so I started this program about a year ago with the support of my company, Shady Grove fertility, and us fertility. and we started this program called Egg freezing for surgical residents. I wanted to, you know, expand. I wanted it to be with all residents. That is my goal. but we had to start somewhere smaller because there are so many residents in this country that are female of reproductive age. So we tried to, we did the research and found out, like you did as well, Doctor Hardin, that there’s a higher burden amongst, surgical residents. So basically, normally in egg freezing, it has different costs at different clinics. some clinics are better than others, some are more expensive than others. You know, usually good clinics, you know, will charge, you know, between like eight to ten to $15,000 for an egg freezing cycle. And often you don’t have that as a resident or medical student or, even a new physician. so it’s, you know, and you’re in debt. And so, you know, this is important to try to subsidize because this is the time where you really need to focus on freezing your eggs because you’re younger than you’ll ever be. so basically, this program allows us to focus on the highest burden population, which is the, surgical residents. And, our cost at Shady Grove fertility in general for one egg freezing cycle is $8,275. we do have really cool financial packages for people that are not residents, for egg freezing that allow, you to do like an. It’s called the assure program. You can do assure 20 or a sure 30, and you get to do up to, for the assure 20, up to four egg freezing cycles until you get to 20 eggs for $13,000, and you get money back if you get to 20 eggs and four cycles. And then for the assure 30, you get to do, up to five egg freezing cycles until you get to 30 mature eggs frozen, for $19,000. And you get money back if you get to 30 eggs by your first or second cycle. So the egg freezing for surgical residence program is even more discounted than all of these programs. So it allows you to do one cycle of egg freezing if you provide evidence that you are a surgical resident or you’ve been accepted into a surgical residency. And, it’s $5,000. So, it’s a really good cost. Obviously, it’s still expensive. I, do realize that, you know, but that is, you know, the most competitive price I’ve seen out there anywhere, for egg freezing. And, you know, it’s a good opportunity to get people in the door and comfortable with this process and, you know, to allow them to at least freeze one round of eggs. And then, you know, if they want to pursue more, we can talk about, you know, our different, our other packages that are also, when you look at the fertility, the financial packages from other companies and other fertility groups, it’s just a lot higher. And because we’re the largest clinic in the country, shady grip fertility, and we have clinics and all over the United States in Florida, Georgia, Texas, Colorado, Philly, DC, Virginia, Maryland, New York, and California, because we have clinics all over. In North Carolina, because we have clinics all over, we, we do have the ability to lower our prices because we have, you know, so many more patients so, we just have awesome financial packages, and the ability to do this financial package is just so unique for, you know, this subset of patients.

Dr. Frances Mei: yeah, that’s incredible. I am shocked because I’ve definitely just from, you know, reading the news and, and things like that, I’ve seen rates up to 15,000 for one cycle of freezing. I mean, how many mature eggs could someone hope for or on average, get from one round?

Dr. Valerie Libby: It really, really depends on their age and some other blood tests that are basically telling us your ovarian reserve. So, like your amh, your day three fsh, and your antral follicle count, which is from an ultrasound. So if we know those things and we know your age, we can plug your numbers into an IVF predictor model that will tell us kind of how many eggs you may get from one round of IVF and how many mature eggs as well, or one round of egg freezing. but in general, you know, I see people get anywhere from zero to three with, you know, in people that are poor responders or have low amh levels to up to, you know, 40 or 50. So it really depends on, you know, a lot of factors. But on average, I would say, you know, egg freezing patients get anywhere between, you know, seven and 15 eggs per cycle. Oh, you do want about 20 to 30 mature eggs for every child you want, so it might require you to do multiple rounds, but even having some eggs frozen takes a relief off and, you know, to be able to get through residency knowing you have some eggs frozen is just really nice.

Dr. Frances Mei: Oh, absolutely. And, you know, I’m a couple years out from residency training, but if this had existed when I had just matched into ent residency or, as a new resident, I absolutely would have done this. And I think that it would have helped a lot with peace of mind over the, over the whole training experience in the past several years. And so that I’m so happy that it exists now.

Only a portion of locations are offering this program

And, I did want to ask, I know that you’ve mentioned, of course, your practice is enormous, tons of locations all around the country, but I know that only a portion of those locations are offering this program. So can you list again the locations where residents can go?

Dr. Valerie Libby: Yes. So, Georgia, Tampa, Colorado, DC, Virginia, Maryland, Philadelphia, those are the current places that are offering this program. So if you live close to one of those clinics, then definitely consider inquiring about this program. If you don’t live close to these clinics, you can consider flying and doing a cycle with us. It’s just a lot harder in residency. So, hopefully this program is really popular and, we prove its benefits so that we can expand this program to all the rest of our clinics, as well as to more residents in general. But for now, we have limited it to these clinics just to kind of see how it goes. Yeah.

Dr. Frances Mei: And I think that even for medical students to hear about this would be really critical because I guess, you know, once they have their match day documentation and they’re moving forward, they kind of have, like, that spring of graduation, which is usually a fairly low key time. and that would be so wonderful to go into residency then July 1, knowing that even if you did have to fly and travel a little bit to your nearest location, that this is taken care of before the chaos starts.

Dr. Valerie Libby: Yeah, I agree. I love seeing patients that just got accepted into residency. Cause I know this is such a good time for them to do it.

Dr. Frances Mei: So when do you foresee, I mean, I guess, how long is this pilot program going? And then when do you think that it may expand to all female residents?

Dr. Valerie Libby: Yeah, so, I mean, I know that the next step of expansion will probably happen at the end of this year, 2024. I just don’t know if the next step is expanding to all of our clinics or expanding to all of. All female residents. We have to kind of figure out how we want to do that. And I have to get permission from my larger, organization. But, But that should. That should be coming.

Dr. Frances Mei: Oh, awesome. Switching tax a little bit.

Recent Alabama Supreme Court ruling could affect access to reproductive health care

But on a very related note, for those who haven’t heard about the recent Alabama Supreme Court ruling, in February, it was decided that embryos held in a cryopreservation tank were legally equivalent to living children. This, of course, has serious implications and could affect access to reproductive health care. there was a subsequent ruling that did pass in Alabama about IVF protection laws, but I guess, of course, there’s a fertility subspecialist. I’d love to know your thoughts about the ruling and protections in place, you know, the future of IVF.

Dr. Valerie Libby: Yeah, it’s definitely a very scary time. and it’s, you know, very sad. What, you know, the legal, proceedings that have transpired over the last several months. and, you know, I do think that, you know, our colleagues in Alabama, we don’t have shady growth clinics out there, but my friends that are fertility doctors there, they are scared, but they also are very hopeful and advocate frequently. And like you said, there have been things that have been able to protect IVF to an extent. In Georgia, we do see a lot of Alabama patients, because of everything that’s been occurring and it’s not too far away, I can say that it’s important to know that this exists and this may be coming, expanding to other states as well. And, it’s important to go to a clinic. It’s, you know, my clinic is great because we have clinics all over the country, New York, philly, like, way up north, where if something were to happen in Atlanta, we can easily ship your eggs or embryos, you know, right up north. And, you know, and that’s free. It’s within our, you know, clinic. So. And shipping eggs and embryos is easy and safe, and we do it all the time. And I’ve shipped my eggs all over the country, you know, coming from different residency programs and stuff. So. So I think that’s important just in case something were to happen. I’m very hopeful that it will not happen in my state, but I do know that, you know, there’s a possibility that it may, So just think, you know, talking to your provider about, you know, what the current status is in your state and what they think, you know, that, will occur if it does happen in their state and what they plan to do with your absurd embrace is going to be important.

Dr. Frances Mei: And, you know, as a non expert, as an ent, I’m so pleased to hear that it is really safe to ship your eggs. Like, I would not. I have not known that. And, I could see that causing anxiety for people, but that totally makes sense. And as you said over your long medical career, like, we all move usually a couple times, and so that’s so fascinating.

Dr. Valerie Libby: Yes.

Could you share with us your own IVF journey during your medical career

Dr. Frances Mei: Could you share with us your own IVF journey during your medical career and now as a practitioner?

Dr. Valerie Libby: Yeah, definitely. Happy to. So, you know, when I was in residency, I was 28 and in Dallas, And I was, like, dating, but, you know, wasn’t sure if I was going to end in, you know, marriage and stuff like that. And I knew that my. I wanted to become a fertility specialist, so I’d have to do three more years after residency, and I was in my intern year, I believe. And luckily, I had been expensive, exposed to egg freezing and ivf just because that’s what I was interested in. But we didn’t learn about that in medical school. So that was something I’m just thankful that I was exposed to at the time. I think now medical schools are talking about it more in training a little bit, so that’s good. But but basically I froze my ex starting at 28, in residency while I was an OB-GYN resident, I found that doing it while I was on night shifts was much easier because I could just like, work my night shift. And then right after night shift, just go in to the office for monitoring because you do have to inject yourself every evening for two weeks. And during that two week period, you have to come into the office every other day for ultrasound and blood work to make sure you’re responding appropriately and to titrate your medication. So, being on night shift really, you know, it was exhausting. But you just go straight to the office, get your ultrasound, go to sleep for the day, wake up and, you know, inject yourself and go, you know, do your work. And then, you know, I was able to have my egg retrieval. you’re not supposed to operate or make any important decisions, you know, for, until the following day. so, you know, that was, that’s something that you have to work with your residency director about. But, yeah, so basically, you know, I did that. I, ah, got about like six or seven eggs. The first time you learned from every cycle, that the doctors learned from every cycle, you know, what you did well on what you didn’t do well and how they can improve. So the second cycle I got more eggs. I believe I got like eleven or twelve eggs. And then, I did it. And that was like when I was like 30 and then when I was. And every couple of years, you know, I found myself, okay, I’m still single or I’m still not, you know, in a serious relationship, and I would go through the egg freezing cycles and they really, every time it provided like such a relief for dating and for my career to really focus on my career, not settle for the wrong person, like, you know, I knew so many people were doing because it’s easier to do, you know, and so, because as you get older, you want it, you want your family to start and all those things. But knowing that I had eggs frozen really did take a lot of pressure off of me. And so I ultimately did this five times. I did also in fellowship. I ended up getting about 35 mature eggs or so, 35 eggs, I believe, like maybe 28 mature eggs. And then at the age of 36, I met my husband. I met, we were dating, we got engaged when I was 37. And we, I had an IUD in place. We thawed my eggs and shipped the eggs from, you know, all over the country to where it was Atlanta. And we thawed them. now, it’s interesting, my older eggs, from m when I was 35 in fellowship, that I had frozen, actually did a lot better than my 28 year old eggs. now, they were frozen at different facilities, one in Dallas, one in, Cleveland. But I think the more important difference was that, the technology has evolved so much over the last ten to 15 years of egg freezing. It used to be something called slow freezing. and now we use rapid vitrification, rapid freezing, and that dehydrates the eggs, which eggs are actually the biggest cells in our body and even bigger than embryos. So when they’re an embryo, it compacts. So, to freeze an egg, and egg is mostly composed of water. And so to freeze an egg, you do have ice crystals form. So they had to come up with a technology where the ice crystals wouldn’t form, because ice crystals do tend to fracture the eggs and you can’t use them. So they found this technology called rapid vitrification, where you dehydrate the eggs first and, and then you freeze them, and then you rehydrate them to thaw them. And so using the older technology with the older eggs, that did not work as well as the newer technology. So I have a lot. I had a lot more eggs survived the thaw of my older eggs. So then we. We thought the eggs, I think I ended up having of, like, let’s say 28 mature eggs. I had something like, you know, 15 eggs survive the thaw, which is not a great thaw rate. You usually, usually 99, 95% should survive a thaw at this point with this technology right now. So, you know, but I think it was really related to older technology. So, regardless, we had 15 eggs. We ended up creating three, normal embryos, three euploid embryos of the 15 eggs, because they then have to fertilize normally. They then have to grow out to become an. A blastocyst or a day five embryo in the lab. that’s the stage of the embryo development that you can actually biopsy and take a few cells off of. You don’t have to biopsy the embryos to make sure they’re normal. I did this on all of my eggs and embryos because I thought that it was important for me, it was important to know if it was normal or not so I could start family planning. Do I need to do more rounds of IVF if I only have one embryo? That’s normal, you know, do I? And I also don’t. I personally, and this is a discussion you’ll have with your doctor and your partner. But you know, what do you want to spend the time going through a miscarriage? You know, do you want, if your embryo, if your baby ends up being abnormal, if you get like your nips testing that, the blood test that you get at ten weeks to see if that baby is normal, When you’re pregnant, like, do you want to go through that decision making process? So for me, it was important to do the PGT testing, the pre implantation genetic testing to test the embryo. So testing the embryos only got three normal embryos and we decided to do another round of IVF and do fresh fertilization. So we did, while we were, you know, engaged. So, we did another round of IVF. I got six embryos to biopsy. Just great with one round, And all six were abnormal and I was 36. That was, that was really sad. I was so sad. I thought, you know, I thought I was doomed. But then, you know, I took out my IUd, I was like, let’s just try on our own. And we didn’t have success. We did two IU is just because I wanted to speed up the process. And then, you know, I ended up trying one more cycle, before or right before the wedding or right after the wedding. And I got, I was, did so poorly that we canceled the cycle, because it was. I was only going to get a few eggs and I knew that I could do better. Thought I usually dead. My amh was dropping this whole time.

I’m 15 weeks pregnant after egg freezing and I don’t regret it

You know, like, As you get older, it drops at an even more rapid rate. So it was dropping, it was like 0.5 the last time I did my cycle, which was like last October. And so I just got married last October at 38 and that cycle was canceled. And we went on our honeymoon. I turned 39, we got pregnant spontaneously. I’m pregnant now, I’m 15 weeks pregnant. So I’m so happy. And we do have those other three embryos frozen. We obviously did a test to make sure that baby was normal. the non invasive test that you’ll do when you’re ten weeks pregnant, even if you did do PGT and did an embryo by an embryo transfer of a normal embryo. But yeah, so, you know, I think, egg freezing is, is great. It takes a huge relief off of you. You can focus on meeting the right person and not settle and focus on your career, but it is not a guarantee. and you may not ever use your eggs, you may not get any normal embryos. You, You know, it just. So many things can happen and there’s a huge drop off every step of the way. But it is nice because it does provide you the ability to kind of focus on yourself and your career. And so it was really helpful for me. I definitely don’t regret doing it at all. And, yeah, and I can. I can answer more questions, more specifically about my cycle, if you have, about egg freezing and stuff too.

Dr. Frances Mei: Yeah, well, certainly, first off, congratulations.

Dr. Valerie Libby: Huge congrats and thank you.

Dr. Frances Mei: Happy for you and your family. And, that’s all really helpful information. Cause I’m definitely more of a newbie to this world and these, this journey.

Dr. Valerie Libby: Yeah.

Is it risky in any way to do embryo biopsies

Dr. Frances Mei: And so one question I have is, is it risky in any way to do the embryo biopsies?

Dr. Valerie Libby: So, I mean, there is a risk. It is less than 1%. So, you know, there is a risk like tip damage to the embryo, and, you know, losing the embryo. I’ve personally never seen that in my lab. I guess it depends on the lab and the embryologist there. but if you’re at a good lab, the risk should be less than 1%. And so it is a conversation to have with your doctor. We generally have found that doing PGT a testing, so looking for chromosome abnormality, is beneficial if you’re 35 and older at the time of egg freezing or doing IVF, if you’re younger, because the rate of miscarriage is so much higher and the egg quality is so much worse after that age, that if you do select the normal embryos, your time to pregnancy will be shorter, you’ll have decreased chance of miscarriages, you know, but I do think most, I would say, you know, 80, 90% of my patients do PGTA, even if, regardless of their age, just, you know, to know, to be able to plan their family better.

Dr. Frances Mei: Yeah, that definitely makes sense and I definitely believe it. But awesome to hear about the technological advances, like, over the past 15 years. Yeah. For. For people, for the next generation of docs like you who are going through that type of journey, because I was shocked to hear when you said that the 35 cycle did so much better than 28.

Dr. Valerie Libby: Yeah, I know, it’s crazy. I mean, technologies is advancing so rapidly in this field. and so, I mean, it’s going to be even more advanced in ten.

Dr. Frances Mei: Years, but, yeah, and OB-GYN, like, as field, I’m very aware that, you know, of course, you guys are the experts at this. And so culturally, I think in OB, I would assume that during your training, there was a lot of, like, great knowledge base about this support for it. But did you have to do anything special, or is there advice that you would give to a resident who does have to advocate for themselves, like, especially if that person isn’t in OB because, like, other, you know, some other specialties?

Dr. Valerie Libby: That’s a good point. Yeah. I mean, I. Luckily, I knew that even though I was nob, it was early times of ivf and egg freezing. And, you know, when I told people I was 20, neck freezing, they’re like, oh, my God, that’s crazy. You know, but now it’s, like, so much more common in your. In your twenties to do this. But. So I personally try to, you know, maybe I told my residency director, but I tried to make it so that it wouldn’t really impact my colleagues and that I would do night shifts and, you know, the one day of my egg retrieval, you know, I did work that evening, but I just didn’t operate. so, you know, technically, you probably shouldn’t because you have high anesthesia. Make it, you know, making important decisions. So just talk to your residency director about what they’re comfortable with and your colleagues, like, hey, would you mind covering me if I. Or just, you know, making sure that I’m making the right decisions, you know? but it’s minor anesthesia, at least in my clinic. It’s just, It’s just iv anesthesia. Anyway, so. To advocate for yourself, though, I think it’s important, you know, to be transparent with your residency director as much as you can. you don’t necessarily need to tell your colleagues, or all the staff, you know, but I think just telling. Asking them, you know, advice, like, hey, I’m planning on doing this. When. When do you think would be a good time? I’d like to do this as soon as possible. And, And, you know, if they’re not supportive, then, you know, that’s really unfortunate because it doesn’t sound like that’s a really good program, but obviously it’s hard. It’s hard in surgical residency, you know, especially if a man is your, residency director to, you know, to advocate for yourself. But so, you know, night shifts are really helpful. And, you know, if there is a female lead physician in your, you know, in where you work that, you know, you could talk to about this, you know, that may be helpful, too. And you can always reach out to me and I can try to give you some tips. But, yeah, that’s awesome.

Dr. Frances Mei: It definitely makes sense. I I’m thinking back, because when I was a resident, I had a co resident who was awesome, like, very competent resident, very tough person. And she was doing a long head and neck case with, like, a really high up there attending. Like a head. But, you know, like, what you’re referring to, it was an older male, and, she actually had to take one step away from the surgery. Actually, partway through, she, like, was feeling slightly ill. She knew she was pregnant, had not told a soul yet at work. It was very early on, but, like, so she just kind of did have to take a beat, which would be unprecedented for her. And, and afterwards, he went up to her and he was like, wow, well, you know, what’s up? Are you pregnant or something? Like, what’s wrong with you? I saw that, and she was like, yeah, I actually was going to tell you for, like, planning purposes, but I am pregnant. Like, so. And he was like, you know, it just is like a foot in the mouth type of thing because he was kind of, like, jeering at her.

Dr. Valerie Libby: Yeah.

Dr. Frances Mei: And that’s the culture in a lot of, I think, like, surgical training, especially if. If it’s not very, like, cognizant of female fertility importance or issues surrounding that.

Dr. Valerie Libby: I agree. It’s really unfortunate. In my training, you, we grew up thinking that, you know, it doesn’t matter if you’re pregnant. It doesn’t matter if you are, you know, whatever you’re going through personally, like, you, you. We are all equal, and we are all here together, you know, and so you gotta pull your, you know, you gotta pull yourself up and, like, just be on an equal playing field. But now being pregnant and also, you know, being a huge, you know, advocate for women, it’s totally different. And you just, you do have to advocate for yourself and, and find women that are gonna be supportive of you and of, the pregnancy and stuff. And that, that may be rare in your field, but hopefully, you know, the more we talk about this and the more everybody’s doing it, these men’s wives are doing it and men’s daughters are doing it, you know, the more, you know, they’re going to be more comfortable with it as well.

Dr. Frances Mei: Yes, definitely looking forward to that paradigm shift, like, continuing to happen. It’s always evolving.

Dr. Valerie Libby: Yeah, it’s definitely.

So one question I love to ask everyone is, do you believe in karma

Dr. Frances Mei: So one question I love to ask everyone is, do you believe in karma and why or why not?

Dr. Valerie Libby: That’s interesting. I definitely do believe in karma. I think I do, because I just always have, I feel like you try to put out, you know, out there, and it will eventually come back to you. And, I don’t know. I think I just always have felt that way, growing up. I mean, I am jewish. I don’t know if that has anything to do with it. There’s some, like, jewish mysticism, and, I’m not, like, into that mysticism stuff, but I just. I think that I do believe in karma. I do. I don’t know how it’s impacted my egg freezing process. I would say. I wasn’t a great kid, maybe I, like, it’s biting me in the butt. But I’m also very thankful that I got pregnant. I got pregnant, you know, and, And, you know, it so far, so good, and I’m just so thankful for that. You know, helping women every single day, you know, is a struggle when you yourself are going through it. Infertility and, And you know, how you have to, you know, you have to put out all of the empathy and. And excitement for your patients, you know, when they’re pregnant, and you want to, you know, but it’s hard. It’s still difficult, you know, to go through it when you’re going through it yourself. So I do think that all the, you know, all the support I give other women is, you know, finally, hopefully coming back to me.

Dr. Frances Mei: I just. I think it’s an interesting idea. I do believe in karma, or the way that I describe it, is that I do need to believe that karma is real. It doesn’t happen on the timeline that we want it to happen on, maybe. But, you know, definitely, I was raised Catholic, so certainly just in terms of, like, there being, like, some kind of bigger picture.

Dr. Valerie Libby: Yeah, yeah.

Dr. Frances Mei: Can be helpful, especially if you deal with anything difficult, which I would put the entire process of becoming a surgeon over the course of a decade into that bucket of, you know, just difficult things. You start to think, okay, well, what. What frameworks do I have in place? Like, what. What are my true values and belief system? Just things like that.

Dr. Valerie Libby: Yeah, yeah.

Dr. Frances Mei: But I appreciate you saying that, because I didn’t even think about until you brought it up, but that just must have been enormously difficult to see. like, your patients have these successful results when you were going through, you know, experiences of your own as a patient, but then you’re also the physician, you know, for so many other women, like you talked about, but, yeah, but.

Dr. Valerie Libby: It’S really important for me to have that. I have had that experience because now I’m so sensitive to other women’s experience of me being pregnant, you know, and I wouldn’t, I wouldn’t want to advertise to my patients this or anything, you know, some, at some point, it’s going to become super obvious, you know, and, you know, just having experienced that myself, like, it’s really important, you know?

Dr. Frances Mei: Yeah, we’ll, like, make you a, an even better physician for it.

Dr. Valerie Libby: Absolutely. And having gone through egg, freezing makes me a better physician. I mean, having injected myself every single night, you know, learning how to mix the medicines is really, really hard, even as a doctor. Okay. Like, yes, we all did ap chem. Yes, we all did, like, you know, biochem and all this stuff. But you, I mean, I don’t mix medicines and, like, you have to, like, mix m powder and liquid together and make sure that the dilution is accurate, and then you have to inject yourself, which we don’t often do as physicians, so. And, you know, we’re usually the biggest ones anyways when it comes to needles. So it’s just, it was such an important process for me to go through so I could really have the ability to counsel my patients and, you know, about really what the experience will be. I’ve done it so many times, six times, you know, and then a 7th failed cycle. So, I mean, I feel pretty comfortable with, with the process.

Dr. Frances Mei: Yeah. And do you tell patients that, like, you’re like, hey, I identify with what you’re saying. I can relate. I’ve, done it.

Dr. Valerie Libby: I try not to make it, like, focus on me, but I definitely think that it’s really. People do really appreciate when I say, like, I totally know what you’re going through, what you’re going to go through. and I show them pictures of myself when I was injecting myself and my, my follicles and my eggs and what it looks like, you know, my amh levels dropping as I got older, you know, just so it really hits home, you know, and that we can be on the same playing field and they know that. But, yeah, I think it’s really helpful. And I gear people towards my Instagram account because I do have, like, a lot of videos that have, like, you know, inject how to inject yourself, how to mix the medicines and all that stuff, too. And people find that helpful.

Dr. Frances Mei: Awesome. Thank you. And, yes, we do. We’re having, your handle all your information on ways to find you and your educational videos in the show notes as well.

Dr. Valerie Libby: Awesome. And the, and I’ll definitely send you the link for if someone’s interested in the egg freezing for surgical residence program, how to, how to, you know, inquire about that?

Dr. Frances Mei: That’s perfect. Is like a consultation free or is that part of the whole package that they’re paying for?

Dr. Valerie Libby: So all egg freezing consultations typically are free. The first one, because, you do get some like blood work before, I believe, but I’m not sure if in the egg freezing for surgical residence program is free. If it’s not free, it’s $300 if you’re self pay. A lot of people do have coverage for egg freezing, for diagnostic testing and so that will uncover, that will cover for any fertility treatment. So, definitely if you do have coverage for egg freezing, use that coverage. Don’t use this program, you know, because that wouldn’t make sense. but if you don’t have coverage at all, any coverage, then it’s dollar 300 for a consultation in general, and then, you might have coverage for diagnostic testing, which includes the initial consult fee.

Dr. Frances Mei: Oh, yeah, that makes sense. Well, perfect. Thank you. We’ll include all that information below. I so appreciate you joining me today, doctor Libby. It’s been a real pleasure to chat with you and learn from you about this incredibly important topic.

Dr. Valerie Libby: Thank you so much for having me. I really appreciate it.

Dr. Frances Mei: Next week, we will have Doctor Laura Vater on the podcast a oncologist to discuss medical error. Follow me on Instagram at francesmay, MD and rethinkingresidency. Visit my website, rethinkingresidency.com to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I cannot wait to connect with you on the next episode of, promising young surgeon.