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January 18, 2020

That’s What She Said! with Dr. Diana Wang. Information for Men About Ovulation, Women’s Fertility and Menstruation

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’re thinking of the ladies this time.

Dr. Mistry: 

You know, we usually focus on men’s health issues on this show, but, 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. You are, she trained at Brackenridge when it was Brackenridge?

Dr. Wang: 

Yes. The original Brackenridge.

Dr. Mistry: 

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

Dr. Wang: 

Yeah. You know, 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: 

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

Speaker 2: 

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

Dr. Mistry: 

You 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: 

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. So 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.

Donna Lee: 

Please!

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 just have 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: 

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: 

It was kind of like the butterfly cycle.

Dr. Wang: 

Throughout my life, I really didn’t like the menstrual cycle, that kind of stressed me 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 your eventual 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 start bleeding and they start building up this lining that’s supposed to prepare for an embryo to implant. This first two weeks the lining builds up and then most women will obviously 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…

Dr. Wang: 

It’s the first day of the period that you’re counting from.

Dr. Mistry: 

…that marks, that the timing.

Dr. Wang: 

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? What does that term mean?

Dr. Wang: 

Right? So ovulation, when you think about it, it seems to 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.

Dr. Mistry: 

OK.

Dr. Wang: 

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 like robots. They don’t alternate symmetrically.

Dr. Mistry: 

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

Dr. Wang: 

Yeah, no programming us. 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. And so the goal is to have that one egg, the dominant follicle ovulate, and then 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 and 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, you know that circle on Schlitterbahn, where everyone’s like going round and round and round, and it’s not segregated. Yeah. Easy River, whirlwind 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 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 process of implantation and caring for that embryo begins…

Dr. Wang: 

Exactly.

Dr. Mistry: 

…because if it doesn’t get that signal, then you….

Dr. Wang: 

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

Dr. Mistry: 

And it starts over again.

Dr. Wang: 

It starts over.

Dr. Mistry: 

So you mentioned apps, there’s little sticks that you can pee on also to tell you, what is that stick that you pee on actually measuring?

Dr. Wang: 

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 has 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?

Dr. Wang: 

Right.

Dr. Mistry: 

And I’m like, well you just need as many swimmers in that pool as possible.

Dr. Wang: 

Exactly.

Dr. Mistry: 

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 ovluation 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, those are just a little bit harder than like you’re saying the pee sticks.

Dr. Mistry: 

Yeah, you gotta get that cervical mucus out of there.

Dr. Wang: 

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 in there as possible cause that egg could release within the next 24 to 36 hours, and you want as much sperm and that lazy river waiting for that little egg to slide down that little slide 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. Don’t miss that chance, cause that egg is only there, it’s just one time.

Dr. Mistry: 

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 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. Cause there could be two components. There could be a male factor and a female factor in 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, because we can have the male factor be evaluated immediately and that something that could be an easy fix or not.

Dr. Mistry: 

Well that was awesome. Diana, thank you so much.

Dr. Wang: 

Well of course!

Dr. Mistry: 

…for contributing to our “That’s what she said” segment.

Dr. Wang: 

That’s what she said! Yes. Thank you.

Donna Lee: 

…her voice on that, that little cutoff.

Dr. Mistry: 

Donna, 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 Schlitterbahn…and then you can send us questions to armormenshealth@gmail.com, and we will be right back.

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Amor Men’s Health Hour.

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