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June 20, 2020

That’s What She Said: OBGYN Dr. Diana Wang Helps Men Understand Women’s Fertility and the Ovulation Cycle

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost, Donna Lee.

Donna Lee: 

Happy Saturday, everybody.

Dr. Mistry: 

Happy Saturday. I’m really excited to have an awesome segment here on our show. What are we calling it?

Donna Lee: 

“That’s what she said.”

Dr. Mistry: 

“That’s what she said.”

Donna Lee: 

That’s right. We were thinking of the ladies this time.

Dr. Mistry: 

You know, we usually focus on men’s health issues on this show, but I think that we can also provide a service by helping men understand their ladies.

Donna Lee: 

Yes, my husband’s listening right now, intently.

Dr. Mistry: 

Hopefully taking notes.

Donna Lee: 

I hope so. There’s a quiz later, when I get home.

Dr. Mistry: 

We are really glad to have Dr. Diana Wang with Austin Area OB-GYN. Thanks a lot for joining us, Diana.

Dr. Wang: 

Hi, y’all. It’s great to be here.

Dr. Mistry: 

Dr. Wang has been in practice for how many years here?

Dr. Wang: 

A little bit over 10, 11 years now.

Dr. Mistry: 

10 or 11 years, about the same time as me. She trained at Brackenridge when it was Brackenridge.

Dr. Wang: 

Yes. Their original Brackenridge.

Dr. Mistry: 

You really started out great. You know, you were at Westlake and then UT plan too. And then for some reason, Galveston for medical school, do they still have an accredited…?

Dr. Wang: 

Yeah, the only reason I went there, and I love Galveston, is because they had the only gross anatomy lab that was above ground.

Dr. Mistry: 

OK, I’ll buy that one. I’ll buy that one. The one we had at Baylor was also underground.

Dr. Wang: 

I mean, it wasn’t in the basement, like every other medical school. We were actually…

Dr. Mistry: 

It had windows.

Dr. Wang: 

…windows, and we could watch the ocean and sail boats.

Dr. Mistry: 

It really makes the skin glow.

Dr. Wang: 

Oh, it does. It makes you feel like you’re alive.

Dr. Mistry: 

That was pretty good. That was pretty good. Diana, you are one of the busiest and really one of the most versatile OB-GYNs in this town, and you still deliver babies.

Dr. Wang: 

Yeah. I love delivering babies.

Dr. Mistry: 

And you’re taking care of women from when they’re very young to they’re very old. I naturally thought of you as someone who’s going to be able to give us great insight into kind of women’s health issues and maybe dumb it down for us guys so we can really understand what’s going on.

Dr. Wang: 

Yeah, no. Whatever we can do to help you guys.

Dr. Mistry: 

So let’s, let’s talk about something that affects a lot of our guys and that is when family planning is happening. So you’ve decided now to get pregnant. And now what, because for the guy, I mean, we just really have that one job and we’re just kind of told what to do when to do it. Maybe you could go into physiologically what’s happening during the cycle, when is the optimum time to get pregnant, and what are some tools that couples can use to help them maximize their chance of getting pregnant?

Dr. Wang: 

Yeah, no, that’s great. When we were in high school and we learned about the menstrual cycle in science class, do you remember how hard that was?

Dr. Mistry: 

Kind of like the butterfly cycle?

Dr. Wang: 

Yeah. Even in college. I mean, throughout my life, I really didn’t like the menstrual cycle that kind of stressed me out learning about that, honestly. So it is one of the more complicated things for couples to kind of wrap their minds around. You know, for me, a lot of our couples will come in for a preconceptual counseling session and pretty much we’re just talking about, “Hey, how do we, how do we time? How do we time this?” So typically one of the most important questions we ask our patients for the women are, are your menstrual cycles regular? Because if they are regular, then we can assume the timing is going to be correct. And that is during the menstrual cycle, the first two weeks when they’re bleeding, they’re, they start bleeding and they start building up this lining that’s supposed to prepare for an embryo to implant. And so this first two weeks, the lining builds up and then most women will ovulate about 12 to 14 days after they start their period.

Dr. Mistry: 

And that’s important.

Dr. Wang: 

And that’s important. Yes.

Dr. Mistry: 

It’s not the last day of the period. It’s the first day of the period…

Dr. Wang: 

It’s the first day of the period that you’re counting from….exactly. And nowadays, you know, most of our patients have apps. You can download a free app online anywhere to just calculate your period. And they program in the first day of their period. And we tell them not the spotting day, but the actual full flow. Most women have about a 28 day cycle if they’re perfectly regular. So cycles can range from 28 days to 30 something days as they get more irregular and more spread out, we start worrying that they may not be ovulating appropriately, or some women may not even be ovulating.

Dr. Mistry: 

And by ovulating, what do we mean?

Dr. Wang: 

Right. So ovulation, when you think about it, it seems so theoretical, but it’s actually a physical process. The actual ovary will release an egg, a microscopic egg that drops from the woman’s ovary, and only, typically only one egg follicle will release that egg.

Dr. Mistry: 

And somehow the body knows how to alternate which left or right egg. Right?

Dr. Wang: 

Well, it’s not alternating. It’s random. So some women may ovulate from one ovary, their left ovary, for example, the majority of their life and not ever really ovulate from the right ovary. We’re not, we’re not like robots, they don’t alternate symmetrically. And so…

Dr. Mistry: 

That’s for sure. You can program a robot.

Dr. Wang: 

Yeah, no programming us. Honestly, you know, most women do think they ovulate left and right though. They always tell me, “Okay, is it my, this side or this side?” And I’m like, “Well, you know, you’ve been ovulating from your left side of this for the past four months.” And we can monitor that. And the purpose is to have only one egg ovulate. We weren’t created to have eight babies at one time. The goal is to have that one egg, the dominant follicle ovulate. The sperm somehow has to find that egg.

Dr. Mistry: 

So on day 12 is that egg released? Or is that on day 12 is the egg in the fallopian tube?

Dr. Wang: 

So on day 12, the egg’s released. And then the sperm has to find this egg floating in her body, fertilize it, and the fallopian tube has to pick that up and carry it down to the uterus. So it’s a miracle of life because if you think about it, this microscopic egg is floating in the woman’s body. The sperm, and that’s why they’re semen, they have to like swim with all this fluid to be able to go float around in there. It’s like Schlitterbahn, you know, that circle in Schlitterbahn where everyone’s like going round and round and round, and it’s not segregated. Yeah, Easy River. [Inaudilbe] there, they have to find each other match up, and then the fallopian tube has to grab one of them. I mean, grab the fertilized embryo and carry it down to the uterus. So it is a miracle. All those steps are the miracles of life. Yeah.

Dr. Mistry: 

And once that happens, the body releases a hormonal signal telling it that there’s been some sort of conception. And then the…

Dr. Wang: 

And then the…

Dr. Mistry: 

…process of implantation and caring for the embryo begins. And if it doesn’t get that signal then you…

Dr. Wang: 

Then you have your period. Everything releases and you say, “Hey, let’s try again.”

Dr. Mistry: 

And it starts over again.

Donna Lee: 

It starts over.

Dr. Mistry: 

So you mentioned apps. There’s little sticks that you can pee on also to tell you…What does that stick that pee on actually measuring?

Dr. Wang: 

Um, so those sticks are measuring the LH surge, which is a surge of the luteinizing hormone, right before a woman ovulates. So it’s predicting that she is going to ovulate. It’s not the actual ovulation.

Dr. Mistry: 

So she pees on this stick, it turns a certain color. And then she knows in the next day or so…

Dr. Wang: 

That she will have a high chance of ovulating.

Dr. Mistry: 

And you mentioned, you know, your illustration of the lazy river is a good one because a lot of guys will ask me, how should they time sex during this time? And I’m like, “Well, you just need as many swimmers in that pool as possible.” So you should try to have sex, you know, in my opinion, the advice that I give is maybe a couple day abstinence, maybe right before, you know, you think that she’s going to ovulate and then really try to get as many swimmers in the pool as possible. So whether that, so I don’t usually advise men to skip days in between. I just have them do it as often as they can.

Dr. Wang: 

Yeah, no, I agree with you completely. If you see that LH surge or that positive, and you can use a pee stick or there’s actually a lot of ovulation predictor kits that are easier to use than the actual…Well, you know, a lot of women will test their pH or cervical mucus, and those, or their temperature, and those are just a little bit harder than like you’re saying the pee sticks. Yeah. [inaudible] It’s just hard to time it more naturally. But like you said, with ovulation kits, they can figure out, “Hey, guess what? I have a positive on my ovulation stick,” to their husbands and say, “Hey, let’s go for it!” And I agree with you, you know, get as many sperms there as possible cause that egg could release within the next 24 to 36 hours, and you want as much sperm in that lazy river waiting for that little egg to slide down that little slide to get in there. You know, it’s harder to like chase that egg down the slide. You want to be in the lazy river, and then as you said, those subsequent days, you want to keep having intercourse consecutively and not miss that chance, because that egg is only there, it’s just one time. It’s yeah.

Dr. Mistry: 

And so, for just a random, healthy couple that has normal kind of everything about them, what do you quote them as the chance of getting pregnant every cycle?

Dr. Wang: 

It’s only about a 10% chance per cycle.

Dr. Mistry: 

And that’s why we tell them that if you’ve been trying for a year and you haven’t been able to get pregnant, then you should see a fertility specialist.

Dr. Wang: 

Exactly. Because there could be two components. There could be a male factor and a female factor, and the female factor can include an ovulation problem or a physical problem. So that’s why it’s so nice to have you guys, you know, cause we can have the male factor be evaluated immediately. That’s something, that’s something that could be an easy fix or not.

Dr. Mistry: 

Well, that was awesome. Diana, thank you so much for contributing to our “That’s What She Said” segment.

Dr. Wang: 

That’s what she said! I hope that helped. Yes, thank you.

Donna Lee: 

Have her voice on that little cut out.

Dr. Mistry: 

That’s right. Diana…Diana? Donna Lee, you want to tell people how to get a hold of us?

Donna Lee: 

You can call us during the week at (512) 238-0762. I love that we compared the miracle of life to Schliterbahn. That excited me. And then you can send us questions to armormenshealth@gmail.com and we will be right back.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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