My conversation with IVF Real Talk Breaking down barriers

I recently had the privilege of joining Lucy and Yaelle on their fantastic podcast, IVF Real Talk, to discuss some of the most pressing questions in fertility medicine today. As someone who’s trained and practiced across two continents, I’m passionate about making fertility information accessible and empowering patients through education, which aligns perfectly with what Lucy and Yaelle are doing to break down stigma around fertility challenges.

The global perspective: What I learned in Israel

During our conversation, I shared insights from my 13 years practicing in Israel, where fertility medicine is essentially a national priority. Israel leads the world in IVF cycles per capita, with a remarkably pronatalist society where families of five, six, or more children are not uncommon. The funding system there is extraordinary, and any Israeli woman is entitled to almost fully funded fertility treatments to achieve two children, however that’s achieved – perhaps a successful first treatment resulting in twins, or potentially tens of IVF cycles.

This generous funding creates both opportunities and challenges. While treatment is incredibly accessible, it can sometimes lead to a more impersonal, assembly-line approach. The contrast with Australia’s system highlights how different healthcare structures impact patient care, and this focus on patient care is something I keep front of mind in my practice philosophy here at Genea

Why treatment plans vary between specialists

One question that really resonated was about why the same test results might lead to different treatment recommendations from different specialists. This happens for several reasons:

The concerning reasons:

• Not all IVF companies are equally proficient at everything. Some have particular areas of specialty, and others have things that they either don’t do or do, but not very well. Some doctors or clinics may design treatment plans to, to avoid things that their company doesn’t do well or doesn’t do at all. I am proud to be part of Genea, who have been leaders in fertility medicine for decades and support excellence in clinical care – whatever type of treatment is required.
• Varying levels of specialised training and ongoing education.

The legitimate reasons:

• Multiple appropriate approaches often exist for the same situation.
• Much of what we do isn’t fully evidence-based, particularly regarding add-on therapies.
• Personalised care requires understanding not just your numbers, but who you are as a person.

This is where patient-centred care becomes crucial. No two patients are identical, even with identical test results. Understanding your desires, priorities, and vision for your family is just as important as understanding your medical parameters – and something I always prioritise in my clinical approach.

Secondary infertility: More than just age

We spent considerable time discussing secondary infertility, when couples who’ve successfully had one child struggle to conceive again. While age is often blamed (although an important contributor), there’s usually much more to the story.

Male factors are often overlooked: Studies show that sperm counts deteriorate over time, and high levels of sperm DNA fragmentation tend to be more common in secondary infertility. Previous paternity doesn’t guarantee ongoing male fertility, an updated semen analysis including DNA fragmentation assessment is absolutely essential.

Female factors can develop: Caesarean sections, particularly emergency ones, can cause scarring which can block the fallopian tubes. Infections during or after birth can impact the uterine cavity. Time itself brings increased risks for polyps, fibroids, and inevitable ovarian aging.

Life circumstances matter: Having a toddler often means irregular sleep, increased stress, processed food consumption, and less time for quality nutrition and exercise, all factors that impact fertility.

The power of lifestyle medicine

One area where I believe I differ from many colleagues is my focus on lifestyle medicine. During patient intake, I routinely discuss exercise patterns, dietary habits, stress sources, and sleep quality. There’s mounting evidence that these factors impact not just conception chances, but pregnancy outcomes and even the health of future children through epigenetic mechanisms.

This isn’t about perfection – it’s about optimisation. Sometimes, focused lifestyle changes alone can achieve the desired pregnancy. But even when IVF is necessary, by discussing and trying to optimise lifestyle factors, we’ve still improved outcomes and long-term health for both parents and future children.

Genetic carrier screening: Knowledge is power

We discussed the importance of genetic carrier screening, using the Ashkenazi Jewish panel as an example. While each ethnic group has different disease risks, the principle remains the same: we all carry genetic variants, and some combinations can cause disease in children.

The core Medicare-funded panel (covering cystic fibrosis, spinal muscular atrophy, and fragile-X) identifies about 1 in 240 couples at high risk. Expanded carrier screening panels which look at somewhere between 500 and about 900 genes identify between 1 in 50 and 1 in 35 couples as being high risk. This means that about 80% of at-risk couples are missed by basic screening alone.

Where finances permit, expanded carrier screening provides crucial information and more options for family planning. This discussion should be part of routine preconception care.

Recurrent pregnancy loss: Beyond bad luck

For couples experiencing recurrent pregnancy loss, comprehensive evaluation is essential. My approach includes:

• Male assessment: Sperm DNA fragmentation testing (often overlooked but crucial)
• Genetic evaluation: Karyotyping both partners for chromosomal translocations
• Anatomical assessment: 3D ultrasound to evaluate uterine structure
• Targeted blood work: Thrombophilia screening, thyroid function, and metabolic assessment

Even with thorough investigation, about 60% of cases remain “unexplained”, likely due to random chromosomal abnormalities, a factor that does increase with age. For those where we find answers, targeted treatment can make a significant difference, and even where no obvious underlying cause is found, lifestyle modification may be beneficial, and the use of IVF with embryo chromosome testing may have a role.

Moving forward with confidence

The overarching message from our conversation was about empowerment through education. The word “doctor” actually means “teacher,” and I believe giving patients knowledge and information is critically important. It puts people in a position to make decisions that are appropriate for them.

Time isn’t on our side in fertility, and getting evaluated sooner rather than later will inevitably result in better outcomes. So seeing a specialist sooner rather than later is really important… something that some people seem to find threatening and scary. But seeing a good fertility specialist shouldn’t be a scary experience. At the end of the day, it’s about you and trying to make your desires a reality, which means putting you at the centre of care, focusing on your goals, desires, and boundaries.

Listen to the full conversation

Lucy and Yaelle asked thoughtful questions that allowed us to dive deep into these topics and many more. Their mission to break down barriers and reduce stigma around fertility challenges is truly important work.

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If you’d like to discuss your fertility journey, I consult at Genea in Sydney CBD and Bondi Junction, as well as via telehealth. You can also follow my educational content on Instagram, Facebook and YouTube where I share evidence-based information about fertility and lifestyle medicine.