The Strong MD | Episode 4

Motherhood and Medicine: A Candid Conversation with Dr. Stephanie Gustin

Dr. Gustin is a leader at the Heartland Center for Reproductive Medicine, helping patients with fertility solutions like fertility-sparing surgery and assisted reproduction. A graduate from two of the most prestigious educational institutions in the country, Stanford and Georgetown University, she’s made the journey from higher education to her own practice, positioning herself as a leader in the field of reproductive medicine. Dr. Gustin maintains an active lifestyle outside of the office, and enjoys traveling and spending time with friends and family.

Published on
January 08, 2024

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Dr. Jaime Seeman: Welcome to today’s episode. I know you are going to love today’s guest because we’re talking about being a mom in medicine, our careers as a reproductive endocrinologist and an obstetrician, dealing with mom guilt traveling, making time for our relationships and infertility that women medicine deal with. I hope you enjoy it. Dr. Stephanie Gustin. Welcome.

Dr. Stephanie Gustin: Hi. Thanks for having me.

Dr. Jaime Seeman: Okay, tell our listeners a little bit about who you are, your background, and why you became a reproductive endocrinologist.

Dr. Stephanie Gustin: Yeah. So I knew I wanted to do medicine from probably age twelve. And within that year, I evolved to knowing that I also wanted to do obituan. Actually, I don’t know if anybody listening remembers this, but there used to be this show called the operation on the Learning channel M, and I used to watch it and was totally enthralled and saw a c section and was like, that’s exactly what I want to do. So flash forward. My uncle is an OBGYN, and so when I was in high school, I got to go and hang out with him and I really enjoyed it and I really liked talking to women about reproductive health and was just like a very open adolescent young adult about just things that happen to women. And I think I was kind of a sounding board for my sorority sisters and my friends about their periods or whatnot. And so then I went to med school and I sort of went in thinking perhaps I would do anything. But when I landed on my labor and delivery rotation, was like, fell in love with it. Yeah. The day just flew and I just was like, this is what I’m going to do. So then in my third year, we had some time to do some extra subspecialty rotations if we wanted to. And I was able to go to the NIH for a little over a month to do research. And I got slated in this REI division and saw the zebras, the ones that get you really excited. I was like, this is so cool. And then I did an away rotation to check out Stanford. And that’s when I knew for sure I wanted to do Rei. It was just like the couples and the patients that we met, I actually met, like, a 17 year old who was born with malarian agenesis. So no uterus, fallopi tube, cervix, vagina. Who had created a vagina using dilators and was then developing some vaginal bleeding. And her mom was like, are they wrong? Is there any chance that she has a uterus? Um, and it was just from trauma. She didn’t actually have a uterus. But then we had this long conversation about a gestational carrier and how she could still have babies and this, that and the other, and that just sort of sealed the deal. Like, that was exactly what I wanted to do. So then when I applied for residency, really the only places I looked were places that had fellowships. And so Stanford was that place. And I did my residency there and then stayed for fellowship and then came back to Nebraska, where I am, because that’s where I’m from. And the dream job just sort of unveiled itself and here I am.

Dr. Jaime Seeman: M just a divine.

Dr. Stephanie Gustin: Yeah.

Dr. Jaime Seeman: Yeah. Okay, so you’re in private practice. Tell me how your practice is structured.

Dr. Stephanie Gustin: Yeah, so we are a private practice with a hybrid model where we’re affiliated with the university. So we provide the resident education for the University of Nebraska Medical center ob two n residents in reproductive endocrinology and infertility. And I love that because that keeps us honest and current.

Dr. Jaime Seeman: The best of both worlds.

Dr. Stephanie Gustin: Yeah. Teaching requires you to know what’s current and our field is continuously evolving. But on the flip side, we’re a private practice, um, and with that, we get to make, um, the decisions that we want about how our practice functions in terms of the clinical medicine part. But for me also, it really allows me to use a different part of my brain, which is very fulfilling in terms of learning how to run a business, learning how important it is that if your employees, um, feel supported and nourished in their own work, that that sentiment is translated to the patients. And just working on, um, retention with employees leads to retention with patients, so on and so forth. So I think that that part of owning a business has been a huge learning opportunity for me, but it’s also been one of the most satisfying parts of my job.

Dr. Jaime Seeman: Yeah, it’s hard when you’re deciding, do you work for a health system versus being in private practice? It can be so intimidating for us because we don’t have a background in business. I mean, there are some docs with mbas, but I always wanted to go into private practice because I like that decision making aspect. And, um, I remember pulling into my garage one day thinking about the number of employees that just our practice has and that we get to provide for, but we do. You get to pick your team and you get to provide care the way you want it. And I think it is kind of an extra fulfilling role for some people, not for everybody, but that’s for sure. Um, you also have children.

Dr. Stephanie Gustin: Yes.

Dr. Jaime Seeman: I think this is a huge topic for women listening. I remember going through the process, thinking about when would my husband and I start a family? When is the best time? Is there a best time? Can you talk to us about your decision to make a family and kind of where that happened in your career?

Dr. Stephanie Gustin: Yeah, absolutely. So I knew that I wanted to have kids, but I also knew that I wanted to pursue fellowship. And so more or less as soon as I started my residency, I was offered an IUD. And actually, it was my chief resident that put it in, and that was like, okay, four years, we don’t need to worry about this. But, um, thereafter, once I was in fellowship, it was very, um, expected, supported that fellows had babies. And I think part of it’s because sitting for a year as a first year fellow, seeing all these people who are the exact same age as you, struggling to get pregnant is, like, unnerving, to say the least. So it was always that, uh, unsaid expectation that the first year fellow got pregnant because it was, like, just so in our faces every day that people like to be a problem, were struggling with infertility. Exactly. And fellowship was. There’s built in time for research, and it’s just a different kind of expectation for, um, presence and call, et cetera. That, to me, was much more supportive to have kids because, let’s be honest, graduate school, um, residency, education, even fellowship is probably the most selfish you could ever be in your life in terms of the amount of time that you need to give to something. And having a child is one of the most selfless things that you can do. And so unless you have family or someone, your partner is completely able to pull way more than 50%. It’s really hard to have kids in training. And for me, I just knew that any extra time I had was going to be allotted towards pursuing my career. And so we waited until we were in fellowship. So I had my first kiddo in fellowship, and then once she was one, we sort of started trying for our second. And my hope was that I was, um. Gosh, I kind of think I wanted to be, like, delivering before I started my first job.

Dr. Jaime Seeman: Wave that magical wand. Yeah.

Dr. Stephanie Gustin: And then I had a miscarriage, and that happens. And so then I remember I actually found out that I was pregnant the day we hopped on the plane to leave California to move to Nebraska. Um, so then I had my second one in my first year of practice, and then had my third, actually, just 18 months later. The third one kind of came in rapid succession, but, um, it’s a pretty incredible thing, but it’s still, even now, doing what we do requires a village to do it.

Dr. Jaime Seeman: Well, I would say absolutely. I had so much know. One of the best pieces of advice I got a female surgeon, Wendy grant. She’s a transplant surgeon at UMC. I hope she’s listening to this, because this is one piece of advice that has just never left my mind. She said, jamie, have children in residency. Your time is protected. Have babies in your training, your time is protected. And you’re sitting over here saying, like they’re telling you, get your birth control. Do not get pregnant while you’re in your training. Like, there’s so much judgment. But I had my first daughter when I was coming into my fourth year med school, had two babies in residency. Um, and honestly, it is kind of true. Like, now I’m in private practice, my time was really protected. Um, but there is a lot of judgment for people at certain parts of their career and certain parts of their training, and there really is no right time, and it does take a lot of help and support. I would have never been able to do it had we not matched here in my home state where I had a mom and a mother in law and people and a husband that kind of almost worked an opposite job of me, and he really could pull more parenting than I could. And, um, yeah, God bless the women in medicine that somehow make it work. Did you breastfeed with your kids?

Dr. Stephanie Gustin: I did. I was lucky in that it was not something that was challenging for me. So I was able to breastfeed all of them for a year, each of them. Um, and I had a really supportive environment. I mean, obgyn should be supportive of.

Dr. Jaime Seeman: Right. They should be the most, but they’re not always.

Dr. Stephanie Gustin: Except that when we forget. So I was able to do that, and that was helpful.

Dr. Jaime Seeman: Yeah.

Dr. Stephanie Gustin: Uh, but that’s a full time job.

Dr. Jaime Seeman: Oh, yeah. I remember pumping in bathroom stalls and just trying to be creative. Or you’re on some rotation that has long surgical hours, and you’re like, uh, I need a 15 minutes break. My chest is about to explode.

Dr. Stephanie Gustin: Yeah. In fact, actually, before my oral boards for general OBGYn, maybe I had to pump in the bathroom of that little waiting area. Before you walk into the boards, it was like, wow, hand pump. Like, hot mess.

Dr. Jaime Seeman: Yeah. Like the things that you get to think back and laugh about it.

Dr. Stephanie Gustin: Right.

Dr. Jaime Seeman: Um, okay, so talk about being a mom in medicine. Do you have mom guilt? How do you be a mom and have a job?

Dr. Stephanie Gustin: Yeah. So I may be in isolation in this sentiment, but one of my favorite mentors said something to me that I can’t ever erase, which is, she said, guilt is a wasted emotion. So I really don’t lament in guilt about just about anything, quite honestly. Um, I was raised by a single parent. Um, my parents separated when I was five or six, and my mom got her master’s and PhD as a single mom. So that’s my world to live in, an environment where my parent was in higher education wasn’t at everything, um, did their very best, et cetera. So when I am not at every single event for my kids, even though I’m quite honestly able to go to the vast majority of things, I don’t feel badly about it, because I also think that it’s a gift to them to see how hard I’m working and how hard their dad is working to, a, have a job that’s really fulfilling and taking care of humans, period. But, b, like, providing for them and what that looks like. And for me specifically, I want our children to see me regardless of my gender and sex, but as an able being that can do whatever she puts her mind to.

Dr. Jaime Seeman: Absolutely.

Dr. Stephanie Gustin: And so, in our household, we really work hard to eliminate gender norms and just sort of exemplify that you can do whatever you want to do. You just have to work hard. I don’t really feel guilty, quite honestly. And I think we’ll probably talk about this. We have a.

Dr. Jaime Seeman: So tell us, who helps with the know. You are superhuman, but obviously you can’t do everything.

Dr. Stephanie Gustin: Yeah, so we have a actually, you know, going back, our first kiddo we had in California, where we had no money and crazy expenses. We had a nanny there because we had no help. And so our whole child rearing existence has been with the utilization of nannies because my partner is also a physician. And so if we have a sick kid, we can’t just cancel a schedule of patients without feeling horrible about it. So we’ve always used a nanny. Our current one, she is like an extension of our family. She has been with our family since our youngest was three months old. He’s six. And so she is our everything. She is their second mom. And in conversations, the kids will be like, mom, April. We’re almost used interchangeably. And I think that that might threaten some women, but for me, it’s like, that’s what I want. I want my kids, if I’m not there, to be surrounded by someone who loves them. Yeah, just about as much. And so that also helps to take off that guilt, because I know that when I’m not there, that there is, like, a similar very strong maternal love that’s there with them. I love that. Um, I do, me. And I know that I can’t really do it without her. And so to go into that a bit further, she works a lot for us. Um, we have her working 50 hours a week because that’s, like, really our schedule in terms of what we do. Right? And so she comes in in the morning, gets the kids ready for school. We’re walking out the door to start our respective jobs. Um, and then she also does stuff around the house, like, she helps with laundry. Um, she does all things kid, for sure. And then where time allows, she does adult.

Dr. Jaime Seeman: Just other things for the home, but.

Dr. Stephanie Gustin: She’Ll do, like, grocery shopping, and she’ll make meals for us, um, not every day, but most days. And that’s been huge in terms of being able to come home and not at, uh, 530 or six, be like, oh, now what are we going to have for dinner? And we’ve sort of ebbed and flow in terms of do I meal plan? Does she meal plan? And I just show up and eat what’s at the table. And both of those have been effective, and I think they kind of run in seasons, depending on what’s happening for her and what’s happening for me and if I’m wanting to make some changes in what we’re having for dinner at home or change my diet or whatnot. Um, but we do have a lot of help. And when there was a time where she was temporarily kind of backing down because she also recently had a baby, and so I was like, okay, we still have these things that need to be done, and trying to find someone to kind of come in a few hours per week to just do ods and eds things, because in order to be fully present for our kids when we’re home, those things have to happen, uh, by someone else. And we’re kind of unapologetic about it at this point, because it makes our quality time as a family so much better. Um, on the flip side, I will say that our kids, we spoil them, definitely more so than what I had as a child.

Dr. Jaime Seeman: I see that in my reflection in my own childhood sometimes.

Dr. Stephanie Gustin: But at the same time, our kids are expected to put away their laundry. Our kids are expected to clean up their rooms. There’s not a magic fairy that does everything for them.

Dr. Jaime Seeman: My kids actually do their own laundry.

Dr. Stephanie Gustin: Uh, that’s amazing.

Dr. Jaime Seeman: Ours aren’t quite. There’s a lot of help involved, but.

Dr. Stephanie Gustin: It’S like those life skills doing everything for them isn’t teaching them anything. Right. But it’s probably actually even harder to make them do it and walk them through the process. It is harder.

Dr. Jaime Seeman: So much easier. Put their clothes away. But I want them to also just appreciate that there’s a magic laundry fairy. Like, every time you take that shirt off because you decided you wanted three outfits today, right, you got to hang it back up. You can’t just throw it in your laundry bin. And same goes with cooking and cleaning and putting your dishes in the dishwasher. They have to become successful humans one day. Um, okay. Yeah. What other ways do you make your life easy? So, I mean, I have somebody who cleans my house. I do not apologize for it. It is what allows me to be present with my family and be present in my job and do all the things we do. Are there other little hacks that women are not thinking about? I’ve heard of people who even have laundry service.

Dr. Stephanie Gustin: We thought about that, um, because our nanny does our laundry, but if she wasn’t, then we were going to outsource laundry for sure. We have someone who cleans our house weekly. We used to do every two weeks, and then it just felt like we got too far behind. So now we do it weekly, which, honestly, is so amazing. Um, we have people do our lawn. We have people plant flowers for us.

Dr. Jaime Seeman: Um.

Dr. Stephanie Gustin: We aren’t yet on the Christmas light train, but I know people are. But where we can outsource things, we definitely do. Um, and it’s brought us a lot of ease and joy in the moments that we have. So I’m at this point not apologizing about any of it.

Dr. Jaime Seeman: Yeah. When you’re young, in your career, and you don’t have the finances to support those kind of things, you just make it work.

Dr. Stephanie Gustin: Exactly.

Dr. Jaime Seeman: Um, we just paid for the childcare, like, keep them alive. And as they’ve grown bigger, uh, we’ve definitely done a lot of the same things. Okay. You mentioned your husband’s in medicine. Talk about making time for your marriage. I mean, we’ve talked about ways to support the kids. How do you carve out time for that?

Dr. Stephanie Gustin: Yeah, we do our best by traveling quite m honestly. Um, and we get a travel edge pretty frequently. That’s kind of where we really exhale and kind of fall into what it was like when it was just the two of us without our kids. Uh, not that long ago, actually. I remember my husband saying, I love being a dad, but I really miss when it’s not just us. It’s interesting. Right. Um, so that’s kind of how we just really reconnect. Um, it’s been hard. I bet you would agree. But as our kids have gotten older, um, their schedules are becoming out of control.

Dr. Jaime Seeman: Totally out of control.

Dr. Stephanie Gustin: And so it’s like we’re ships passing in the night in terms of like, okay, you’re going to this basketball game, I’m going to this soccer game, and we’ll reconnect at the end of the day. Um, but we go on date nights or go out, um, without our kids every week, um, because that’s just, like, intentionally important for us, um, because otherwise, our kids always want our attention and we love them and we want to give that to them, too.

Dr. Jaime Seeman: But I think it’s good for them, too, to see what a loving, bonded relationship looks like. Right? I remember our daughter was like, you’re going on vacation again. Why aren’t you taking us? And I looked her straight in the face and I said, because your daddy and I need time without you. She was kind of like. But she kind of got it at the same time. Um, and so I totally agree. And as an obgyn, honestly, if you don’t leave town, it’s really hard to unplug.

Dr. Stephanie Gustin: Yeah.

Dr. Jaime Seeman: When we are just constantly, like, inbox and voicemail and text message and phone call and we’re pulled in all these directions, um, by our job and our family and our kids and everything. So it is just sometimes you literally just have to go off the grid. Um, what are maybe the top two places you and your husband have escaped to if women are looking for?

Dr. Stephanie Gustin: M we. So we did our residency and fellowship in the Bay area, and wine country is, like, our favorite place in the continental us. We go every year, if not more than once a year. Mother’s, um, day is, like, a really interesting holiday for me because while I’m a mom, it’s like a really special time to be celebrated by my kids. But I also lost my mom when I was young, and so it’s. It’s kind of, like, bittersweet. And I am a mom, like, 365 days of the year. So on mother’s day, I would prefer just being. Doing exactly what I would love, which isn’t necessarily being with my kids, quite honestly. So we go to wine country, um, every mother’s day weekend, and it just feels like an exhale. I love being there. I think it’s one of the most beautiful places, and I love to geek out about the science of how wine is made and how it tastes and et cetera. So we do that, and I don’t know anybody that hasn’t loved it when they’ve.

Dr. Jaime Seeman: Incredible.

Dr. Stephanie Gustin: So that’s one of our favorite. Um, then you know, something very simple, too. But we’ve been going to Colorado more often, especially now that the kids are older. But my husband was like, I feel this is sort of, I don’t know, maybe transcendent, but I feel the closest to heaven when I’m in the mountains. It’s just like one of the most beautiful places. And again, it’s like an easier place to unplug. Um, we’ve traveled internationally a lot. Like, I love going to Europe and all those things, but there’s so many gems. Uh, yeah, there’s a lot more hoops to jump through than just places that are not as far away.

Dr. Jaime Seeman: Well, I always joke I love Nebraska. I’m biased. I’m born, I’m raised. I’ve actually never lived out of the state, but I think that traveling is so awesome when you live in Nebraska because we don’t have oceans and we don’t have mountains, and so you get to go to these places that are so incredible and all the things they have to offer because we don’t have them.

Dr. Stephanie Gustin: Exactly.

Dr. Jaime Seeman: It’s still a great place to live and raise your children. But, uh, um, yeah, I just had a friend that relocated to Hawai when you said this transcendent feeling, she just felt like she was, like, every time I was there, it just felt like me and I was alive. And, yeah, sometimes you can’t ignore those feelings. Um, how do you take care of yourself mentally and physically? A huge problem for a lot of doctors.

Dr. Stephanie Gustin: Um, I exercise, like, most days of the week, six to seven days.

Dr. Jaime Seeman: How do you fit it in?

Dr. Stephanie Gustin: So Zach and I, my husband, when we got together, we both were people who exercise regularly. And actually, I was a dancer growing up, so going to the gym or running was not something that I was keen on. But in allotting time to take a break from studying for med school, like, going on a run seemed like a reasonable reason to take a break. And so that’s how I got into running. Plus, if you haven’t run in DC, you need to go because there’s some of the best running routes where you can run in front of the monument. It’s just like, I mean, the best running. So I got into running then, and we would run together, he and I, actually. And so then when we got married, and even before we got married, we had some really honest conversations about the future. M and just sort of like, I married you as is not like 100 pounds heavier and whatnot. And so what can we do to be who we, uh, maintain indefinitely? And so we made this promise that if one of us wanted to work out, the answer was always yes. That the other person would always just prioritize that and just make it possible to say yes. And that was when we had kids and so on and so forth. And so it’s always been something like an unwritten rule that if one of us needs to move our bodies, we’ll figure it out.

Dr. Jaime Seeman: Yeah.

Dr. Stephanie Gustin: So now how do I do that? I used to be an afternoon worker outer. Um, like that. 04:00 430 time. But then life and work bled into that, and so I had to really embrace the early morning exercise, which I remember. That transition was so painful. It just felt like, just even harder. But now you’re used to it. Oh, my God. I just, like, I can’t not do it. Um, it’s so amazing. So I’m like, get up at five, workout, and then ready to rock and roll.

Dr. Jaime Seeman: Same way. It’s the only time of the day that’s, like, protected. I’ll occasionally have a gallon labor, but I wake up, my kids are still in bed, and it’s my time. I always call it, like, pay yourself first. It’s just like, okay, I’ve poured into myself, and now I’m ready to go. Now I’m ready to go to work. And honestly, it kind of gets your brain fired up, gets everything going, so I love that. Do your kids exercise with you?

Dr. Stephanie Gustin: Not at 05:00 a.m.

Dr. Jaime Seeman: But, I mean, they know that you guys work out. Is it part of, kind of like the family culture of move your body?

Dr. Stephanie Gustin: Yeah, they all play sports and are expected to move, and we’re not really a sedentary family. Um, we have bikes and go on bike rides. I’d love that. Our little block that we live on is a third of a mile, so there’s been times where my husband is out of town, and so I didn’t have a sitter, so I had to run, like, uh, twelve laps around the block to get 4 miles. And so I just put those kids and I was like, join me on a lap, and they would just run with me and take breaks. And, uh, it’s been really fun.

Dr. Jaime Seeman: Okay, so you wake up at 05:00 a.m. To work out. Tell us more. Just, like, about your job. What’s the daily life of an Rei?

Dr. Stephanie Gustin: Yeah, it’s pretty variable, um, depending on the day of the week. But for the most part, I need to be in the office somewhere between probably seven and eight. So get up, work out, shower, pass off with a nanny, head to work, and then I’m usually there until five. Um, how many days a week?

Dr. Jaime Seeman: Five days a week.

Dr. Stephanie Gustin: That’s just because I really like my job.

Dr. Jaime Seeman: Okay, we’ll allow it. You seem to be doing it okay.

Dr. Stephanie Gustin: Um. I don’t know. I love it so much anyways, so, yeah, I’m usually there till five, but quite honestly, our patient care stops before that. It’s just as, you know, calling patients with results and then just, like, business stuff. That also has to be decisions that need to be made. I leave at five, home by 530, and then either there’s dinner on the table or dinner ready, or it’s almost ready. This is what I need to do to finish it. Or it’s like my night to make dinner and I’ve already planned that out. Um, and then we have dinner as a family, and either depending on the season, if it’s soccer season, we’re like, schlapping kids all over.

Dr. Jaime Seeman: Totally.

Dr. Stephanie Gustin: Now that we’re in mostly basketball season and only one of our kids is playing, it’s a little bit more. We’ve been able to engage in carpool, so we’re a little bit more present at the moment. Um, but then we like to engage our kids. I don’t know. We’re not really, like a huge screen family, so we avoid screen time for our kids and would know, do legos with them or talk to them, know, just play with them, um, read with them, and then they get ready to go to bed. And then, quite honestly, once they’re ready for, like, that’s my time to also start getting ready for bed. Because we’re up at five, I can’t be scrolling on the interwebs. Totally at night watching Netflix that’s not in my wheelhouse. So I usually try to make my way towards getting ready for bed between 830 and nine. And then I have a book or something that I’ll read until I’m ready to fall asleep, but usually I’m out by, like, 930, and then, uh, next day also. Because sleep is so important. So important.

Dr. Jaime Seeman: Yes. For all the reasons and so many points in our career now, there’s our restrictions and whatnot. But literally, I mean, physicians for so long, it was just like, you’re not allowed to sleep. You have to be on all the time, and you’re going to work these 36 hours shifts or 48 hours. I mean, it used to be a lot longer than that, but yeah, it’s so important. Like, you cannot function. I don’t know what the statistic is. I’m going to make it up off the top of my head, but something along the lines of being awake for 24 hours is like being the blood alcohol of multiple drinks. We’re supposed to be saving people’s lives. And being a parent, I know if I have one middle of the night delivery, it takes me about 24 to 48 hours to recalibrate, I guess is what I’ll call it, from being awoken in the middle of the night. It’s a big deal. Um, okay, so, um, let’s talk about your job, literally, in the sense of infertility, because we’ve kind of touched on it. When do you have babies and things like that? Define for us what infertility is for males and for females.

Dr. Stephanie Gustin: Sure. Um, I mean, infertility in general is, especially if you’re less than 35, is twelve months of unprotected sex and no conception. It’s really that kind of. For all people, if you will. But we recommend earlier evaluation if you’re over 35 and less than 40. So if a, uh, female is over 35 or less than 40, then they should be seen within six months. If they’re over 40, they should actually be seen immediately. And that doesn’t mean that they need to immediately start into treatment, but they should be seen and evaluated. Make sure there’s nothing wrong. Like you don’t need to do a trial run, at least just make sure that all the players are at the table. And then if you want to proceed with attempts on your own, great. Or if you’re like, we decided to start later and we didn’t do any fertility preservation and we know we want two kids, then your treatment needs to be geared at not only conception now, but fertility preservation for the future. Things like that. So that just like early evaluation allows those conversations to be had in a way that still allows people choice. Um, and for men it’s the same thing. It’s unprotected sex. There’s just less of like an age cut off, per se. Um, but then with men, if, certainly if they don’t have any sperm, or if they have a history of cystic fibrosis, or if they’ve previously had a vasectomy or significant trauma surgery, et cetera, then they need to be seen earlier as well.

Dr. Jaime Seeman: Yeah. Um, are you aware of any statistics amongst women in medicine? Is there higher infertility? Are they kind of similar to their age match peers?

Dr. Stephanie Gustin: So the data is one in four female physicians experiences infertility.

Dr. Jaime Seeman: Wow.

Dr. Stephanie Gustin: So, like, a large fraction of us. Yeah. And I do believe that it’s mostly because we’re delaying childbearing to get there. I don’t think it’s because there’s something that we’re exposed to. Um, but I think that that is relevant in women who are pursuing medicine. Women do make really amazing physicians and surgeons, and they have really excellent outcomes, and I think women should definitely be at the table. Um, and I think women can have babies along the whole way. But I also think that if the timing is not right, then there are really great technologies that exist to help sort of pause the clock so that you can do what you want to do, to be where you want to be, and then revisit the ovaries age. Um, unforgivingly, I would say we’ve gotten really good at maintaining our health in a way that our parents probably weren’t when they were the same age, but our ovaries haven’t caught up to that. The uterus is less, um, fickle about the age. Exactly. So you can be older and carry a pregnancy, um, with perhaps some elevation of risk, but not, um, the staggering statistics that we see. If you start trying when you’re in your forty s. M mhm.

Dr. Jaime Seeman: So expand on these technologies. There’s a 35 year old woman listening right now who is deep into her career in medicine, and things are going well, but maybe she doesn’t have a partner or something like that. What options does this patient have?

Dr. Stephanie Gustin: Yeah, so I would say most of us recommend pursuing oocyt cryopreservation or egg freezing. That is kind of m the most open ended potential to freeze your fertility or preserve your fertility without committing paternal lineage to your future fertility. The other option, if you have a partner and you’re like, without reservation at all, um, about the future of your relationship, you could freeze embryos. But we also know that 50% of couples in the United States don’t continue their marriages. Exactly. And so even couples who are married, quite honestly, I typically say, I know that you’re married and I know that you love each other, but if we’re.

Dr. Jaime Seeman: Going to have a plan, what are.

Dr. Stephanie Gustin: We going to do? All your eggs in one basket, quite literally, you might want to either save half as just eggs, just in case, or, um, just freeze eggs.

Dr. Jaime Seeman: Interesting.

Dr. Stephanie Gustin: And then go to use those later on. And there’s really nice, um, calculators that exist, uh, based upon data and science that can kind of estimate your ods of a live birth based upon your age and the number of eggs that you had at that age that were frozen so that you can freeze eggs to a point that you feel like you have a decent insurance policy.

Dr. Jaime Seeman: Yeah. What’s like the upper age limit? Maybe there’s somebody listening that’s 40 or 45 or what’s the cut offs? Or are there cut offs?

Dr. Stephanie Gustin: Um, yeah, so I would say egg freezing, you can do it as you get older. It’s just your egg quality and quantity goes down and it’s less efficient and it feels like, um, potentially an unfulfilled promise. If you’re past in your 40s trying to freeze eggs. Okay, you absolutely can. Um, I would say in general, from 44 and above, you should be looking at pursuing utilization of an egg donor. Quite honestly, um, the calculators don’t even exist for 45 and above. So there really isn’t a recommendation to be freezing gametes for fertility preservation at that age. You can do it younger as long as you are eyes wide open about what that might look like when we go to use those eggs. Um, but I don’t have a problem with letting patients make autonomous decisions as long as they feel well informed.

Dr. Jaime Seeman: Yeah. What about like a really young gal that’s listening right now? She’s just graduated college, she’s 22, 23 years old and she’s going to medical school and she has no idea what the future holds. Is it a good idea to pursue that when you’re really young and then not knowing what will be down the road? Or is it kind of like. No, just see where life takes you and come back when you’re 30 or what advice do you have for like a young girl listening?

Dr. Stephanie Gustin: Yeah, I mean, a couple of things. I would say the benefit starts to come in when you’re in your mid thirty s and you’re still not sure what that’s going to look like. But you know, at the end of the day you want to become a parent. And really it’s even more helpful if you know that you’re not going to start trying until you’re in your late 30s, early 40s, like if you know you’re going to delay childbearing because let’s say you’re in a surgery residency that also is going to have another long fellowship and you know it’s going to be well over a decade addition. That makes sense even if you’re young, quite honestly. But I usually don’t tell all 21 to 23 year olds, you absolutely freeze your eggs. There’s a lot of life and a lot of reserve left, I think it’s relevant to anyone who’s having that inkling of getting some ovarian reserve testing and just sort of doing a check in. And if everything looks age appropriate, then I think it’s okay to say, let’s regroup in a couple of years, and if you’re still not where you want to be, let’s do it. And then on the flip side, if ovarian reserve testing is abnormal, not that that insinuates infertility, but that may change how she proceeds and she may decide, well, gosh, if my egg supply is lower than what I expected, maybe I should be freezing now, just in case. And I think that that’s a helpful piece of information that makes sense.

Dr. Jaime Seeman: Okay. I’m 35 years old, I am unpartnered, and I want to come freeze my eggs. What does the process actually look like? This is like a female physician. How much time am I going to take off work? What is this going to cost me? Can you give us some kind of.

Dr. Stephanie Gustin: Yeah, absolutely. So in general, it takes about twelve days, plus or minus two to stimulate the ovaries to grow the small follicles that you have in your ovaries so that they’re big enough that when we go to retrieve the eggs, the eggs are what we call mature. And so while you’re in that twelve day period, um, you’re doing more or less probably daily or twice daily injections. And then you’re having intermittent ultrasounds and blood work to monitor your response to said medications. And what that looks like for individuals varies to some degree based upon their protocol, but I would anticipate having three to five appointments. Um, these are quick appointments. These are like quick ultrasound, blood work. You get a call later in the afternoon and most REi clinics are scanning people or seeing patients by like 6630 in the morning. So you can get in and get out. Um, and then your retrieval is done under general iv anesthesia for most practices. So propofol, so you need a sober driver. Can’t work that day, then most people are okay to go back the next day. The only thing is just kind of you got to let someone in your team know that you’re doing something that’s going to require you to, without much notice, not be able to present to.

Dr. Jaime Seeman: Work because there could be complications or. No, just more pretty low risk.

Dr. Stephanie Gustin: Yeah, the complication risk is super low. It’s more just like we don’t know exactly when we’re going to turkey you until we. And that’s like a moving target could.

Dr. Jaime Seeman: Be Tuesday, it could be Wednesday. You need some sort of flexibility.

Dr. Stephanie Gustin: Exactly. And so for most of us who have patients who have been scheduled months in advance, it’s challenging to do that. So some people in training, for example, will call me and say, I have vacation this week. And so then we will plan it so that their estimated retrieval falls in that week. M so that they can do this without a huge burden. And we can do that for other physicians. I mean, I think probably most physicians listening to this, um, I think it’s really important to care for each other with that. I mean, I treat all of my patients with TLC. Right. But there’s just. I don’t know. I think because we all know what we went through to be where we are, there’s that additional grace that’s allotted to other physicians. And I think, um, we do whatever we possibly can to make it doable.

Dr. Jaime Seeman: Yeah, we help out our colleagues, that’s for sure. I’ve taken care of a few patients who have been in a place in their career where they’ve just decided to be a single parent by choice. Um, tell us what that process is like for somebody coming to see you.

Dr. Stephanie Gustin: Yeah. Um, so that person would still undergo some version of basic infertility testing just to figure out, are their flopping tubes open? What is their ovarian reserve? Are we going to need to use medications? I mean, the best thing, if they’ve never tried to get pregnant, we assume that they’re not infertile. Right. Um, but they still have to buy donor sperm. Right. Which is like, not inexpensive. Quite.

Dr. Jaime Seeman: What does donor sperm cost? I would have no idea.

Dr. Stephanie Gustin: 2000 a vial. And one vial works for one insemination. And if you’re 35 and you have no infertility, your chance of getting pregnant is 20%. So there’s an 80% chance that first file isn’t going to get you to the goal line. So to me, I would rather know that everything’s in working order than to start spending money that then will start to rack up if we don’t know that everything is capable of functioning the way we expect. So anyways, basic testing. Just check the fallopian tubes with, um, a test that’s called a hydrocepinggram. Check ovarian reserve. Um, the other thing with donor sperm is that sperm donors are screened for a large quantity of genetic mutations, um, to get information. And so offering that similar genetic testing to, um, the person attempting treatment so that she knows that the donor she’s selecting doesn’t increase her risk of having a kiddo with an incurable genetic disorder, et cetera. But then once that gets started, I think depending on her age, her reserve, if her cycles are still cold normal, then really all we need to do is monitor for ovulation, put sperm in the right place in the right time, check a pregnancy test two weeks later. Um, I think I see a lot of patients who get impatient doing that.

Dr. Jaime Seeman: Mhm.

Dr. Stephanie Gustin: And so they’re like, can we just add some drugs into this? And then I have to remember people. Sorry. Remind people that that’s how we increase our risk of multiples. And how do you feel about being a single parent and having twins, for example? What support system do you really have? So we have those conversations, but, um, that’s definitely a viable option. And I actually think that I’m seeing, I’m curious if you are, but I’m definitely seeing more women who are like, I’m ready to be a mom, and that partner is just not in my wheelhouse and I’m not going to not be a mom.

Dr. Jaime Seeman: So let’s just definitely seen it more in the last couple of years than I had early in my career. Yeah, for sure. And they always seem to be very professional women. They’re kind of in these high achieving jobs and careers, and they know they want a family and they know that their fertility has a time clock on it and they’re ready to do it. And same thing. I talk to those patients too. Okay. What’s your support system? Because I knew what it was like and I leaned on my partner heavily when the girls were really little. So you definitely need that in place, um, to backtrack for just a second cryopreservation. What would somebody expect to pay for that if they went through like one cycle of freezing their eggs?

Dr. Stephanie Gustin: Yeah, around 8000, 8500 is pretty national average.

Dr. Jaime Seeman: Okay. Is there an outcome difference if you freeze eggs versus freezing embryos?

Dr. Stephanie Gustin: Yes. Freezing eggs is the most versatile way that you can preserve your fertility. Uh, but there’s the least amount known about the reproductive potential of those eggs. If we make embryos and we even go to the point of testing those embryos to assess chromosome content, and we know that you have euploid or embryos that have two pairs of 23 chromosomes, then your ods of implantation go up, or like pregnancy, light birth are like 65 plus percent. So that’s a huge different amount of information that you have when you have embryos versus eggs. Eggs thaw at about 90% of eggs will recover. And then we inject, um, with sperm for fertilization and then culture them and watch things play out. And beyond that, once they survive the thaw, they should behave as the age they were when they were retrieved, et cetera. But there are young women who go through IVF who have a higher percentage of anuploid embryos than what we would expect. And if we hadn’t tested, we would have assumed that there was something else wrong with her, or she would have assumed that she had six embryos. That’s enough for two kids, right? But she found out that there was only one or two normal, and then she’s like, now she’s 42.

Dr. Jaime Seeman: Absolutely.

Dr. Stephanie Gustin: So I think the other thing that’s starting to come up is the advantage of fertility preservation. I always counsel patients. These are for backup for second or third baby. So try. If you haven’t ever tried, go, try, freeze, whatever. Try. And if you can’t get pregnant, of course we’ll use these. But if you can, then this is so that you can complete your family in full. And you’re not needing an egg donor for second later on. Exactly.

Dr. Jaime Seeman: I love that. The technology just blows my mind. I mean, just delivering babies is magical to me every time, but the thought of, like, freezing an embryo, untying it, putting it into the uterus, and that it turns into a human life just literally blows my mind.

Dr. Stephanie Gustin: Yeah. I just did some embryo transfers right after my clinic, before I came here today, and it’s, like, magical.

Dr. Jaime Seeman: So crazy. You literally just created life. Well, and you’re keeping me in business, so that’s lovely, too. Okay. Technology, though. What is the new hot things? I mean, AI is taking over the world. What are the new cool things in Rei that would blow our minds? Is there anything that comes to mind?

Dr. Stephanie Gustin: There’s a lot sort of still, um, in the works. Nothing that’s really kind of said for sure. I think big things right now are AI for maintenance of crowd preserved gametes and embryos to make sure that the right embryo is placed in the right patient. Um, everyone probably rarely, and it’s not common, but when it happens, human, yeah, it’s a big deal. So that’s in the pipeline. And then there’s AI for so a while back. God, it’s been probably at least ten years. Um, timelapse imaging came out where embryos would incubate in an incubator that would have this special equipment that it could watch the embryo as it divided and get more information about that. Now. They’re interesting. That’s just really cool. We have incubators like that, and it’s just really neat to see it all happen. But the science of what does it actually tell us? We’re still learning.

Dr. Jaime Seeman: Does the patient get that video? I can just imagine that they’re like high school graduation. You’re like, and here you are.

Dr. Stephanie Gustin: So definitely clinics do offer that at a charge. I know, of course. Um, but now they’re adding on AI to, um, that evolution of the embryo to help to choose the first. Um, even amongst embryos that have been tested for chromosomes versus not. And I think what we’re all trying to do is how can we learn more information about the embryo without biopsying it? I mean, we do embryo biopsy all day, every day, and the embryos do great, but it is traumatic. And so if there’s a way that we can take culture media from where the embryo is growing and get genetics from that, or if we can learn more just based upon how the cells are dividing, great. But all of that.

Dr. Jaime Seeman: Scan it or ultrasound it or some less invasive way.

Dr. Stephanie Gustin: Yeah. All those things are still, um, in evolution.

Dr. Jaime Seeman: Wow.

Dr. Stephanie Gustin: But it’s really cool. Wow. And then the other thing is, I actually just talked to a patient the other day. It was like, so your ods of success are about 65% with a euplant embryo, which is awesome. Ivf success rates 30 years ago were, like 20%. It’s like, really evolved. And now we’re giving those statistics with one embryo at a time. And it used to be that people are this embryo.

Dr. Jaime Seeman: Here’s your chance. Here’s your chance.

Dr. Stephanie Gustin: Yeah.

Dr. Jaime Seeman: Incredible.

Dr. Stephanie Gustin: But still, it’s not 100%. And people are like, so what’s keeping it from m being successful? That’s where we’re still also just spending a ton of time and energy is trying to understand either why certain euphoria embryos aren’t making babies or what is involved in implantation. That’s know, the uterine environment, microbiome, all the.

Dr. Jaime Seeman: Well, this has been so fun. Dr. Gustin, tell people where they can find you. Your social media handles your clinic.

Dr. Stephanie Gustin: Yeah. So my social media is Instagram at Stephanieguston, uh, Md. And then our clinic is the Heartland center for Reproductive Medicine. Our website is ww

Dr. Jaime Seeman: I know. I’m so honored to share patients with you and be one of your colleagues. And thank you so much for all your incredible information today.

Dr. Stephanie Gustin: Thanks for having me.

Dr. Jaime Seeman: Thanks, steph. Thank you for listening to today’s episode. I really hope you enjoyed it. If you could do us a little favor and share it with your friends and family that you know would find it helpful. Just go ahead and, like, subscribe and share. We appreciate you.