The Kitchen Diaries Podcast - Episode 2 - TTC 101 with Dr. Haley Genovese

✨ Full Transcript Below ✨

Chelle Waite
Dr. Hayley Genovese is a reproductive endocrinology and infertility fellow at Jefferson RMA, which basically means she's an expert in fertility, pregnancy, and making sense of the chaos that is trying to conceive. She earned a prestigious scholarship into medical school and went on to earn multiple awards in OB-GYN and has presented her research at major national and international conferences. But beyond all the accolades, she's deeply passionate about helping women navigate the emotional roller coaster of trying to conceive. Because let's be real, Google can only take us so far before we spiral into a black hole of worst case scenarios. My family is so lucky to have her in our lives, especially my brother, Nikki, and I'm so excited to have her here today. So Haley, welcome to the Kitchen Diaries and thanks for hanging out with us. 

Dr. Haley Genovese (02:46.334)
Thank you so much for having me. I'm so excited to be here. 

Chelle Waite (02:49.364)
Okay, so let's just get right into it. I want to start with the basics about understanding fertility in general because I do feel like so many of us grew up thinking that we could sneeze near a guy and get pregnant. Like I really feel like in health class they made it seem like if you take condom off you will get pregnant. But in reality it's not always that easy and I feel like it's something that stuck with me like when I was trying to conceive I didn't realize how much actually goes into it. So can you kind of like break down what needs to happen or like how do we know when we're ovulating? 

Dr. Haley Genovese (03:18.804)
Yeah, absolutely. So it's funny that you mentioned that because I do think a lot of people feel like, you know, as soon as they want this to happen, it's a guarantee that it will. And for most couples, it is, you know, can be or can be a quick process. You know, in the early 30s, for example, we see that about 60 % of couples who are trying every month will conceive within six months. So, you know, the odds are kind of in your favor, but it certainly can be stressful if you're not in that group and 

Dr. Haley Genovese (03:47.84)
there is a lot that needs to go on. So you have to have functional sperm is kind of number one. And that obviously comes from the guy's side. And then the female partner needs to be ovulating regularly. So most people are going to ovulate about once a month, but cycles can be shorter or longer. it's important to kind of know your body and to know when that's happening. 

Dr. Haley Genovese (04:09.46)
And then sperm needs to meet the egg, so the tubes need to be functional and open and the uterus has to be receptive to an embryo in order to implant and have a baby start to grow. 

Chelle Waite (04:18.772)
Okay, so six months, mean, it's like that feels like such a long time, especially when you are trying to do the same thing over and over. But like you said, I feel like everyone needing to know their body and understand. So let's talk about timing for ovulation. I know that people obsess over the ovulation tests and basal body temperatures and all of those things. Do you know like how much of that actually matters? Where should we spend our time? How do we understand our body? And like, what's the best advice that you would give to girls at the clinic? 

Dr. Haley Genovese (04:48.496)
Yeah, I mean, I think at the very beginning, it's not necessary to, you know, jump right in with basal body temping and like the more serious methods of monitoring your cycle, just because many people will find that overwhelming. It kind of depends on what you'd like your approach to be. And I think that varies a lot person to person. Many people do like using ovulation predictor kits, even from the start when they're trying, because it just gives them more of a sense of control and they know 

Dr. Haley Genovese (05:15.814)
okay, this is the right time and we're tagging things appropriately. Other people feel like they'd rather just kind of not have all this extra information. And, you know, in those cases, I advise people to just have regular unprotected intercourse, like every two to three days, you know, so that they can cover their bases because it's not really necessary to have unprotected sex every single day to get pregnant. if you're doing every two to three days, you're probably covering your bases. And I think 

Dr. Haley Genovese (05:43.06)
For someone who doesn't want all this extra information or feels like that's an overwhelming process, that's a good way to go into it at least at first. 

Chelle Waite (05:50.964)
Okay, and what about like if they end their period and they like so you're saying if they end their period then if they just started from the day they end every other day for the rest of the month that would be helpful? 

Dr. Haley Genovese (06:01.578)
yeah. I mean, if you if you did every other day from then until, you know, the rest of the month or for some people, they just would rather get to the point where they can confirm that they're luteal. So that's where but that's where temping could be helpful if you're someone who's like, I don't want to have to like, do the ovulation predictor kits multiple times a day. Because another thing that people might not know is, you know, some patients will have a really short LH surge. So it can be difficult to actually pick up. 

Dr. Haley Genovese (06:27.678)
the surge that is really, that's the signal from your brain to your ovary that it's time to ovulate. And in order to be really thorough with that, you may need to be doing, you know, to be peeing on these sticks two times a day. And that can be pretty overwhelming for someone that works. Yeah. So that can be a lot to deal with. 

Dr. Haley Genovese (06:44.875)
So sometimes people don't like to do that and they prefer to just cover their bases with intercourse every other day. And then once they confirm that they've ovulated, which you can do with the body temperature measurements, they can take a break. 

Dr. Haley Genovese (06:56.712)
you know, until they either become pregnant or get their period. 

Chelle Waite (06:59.57)
Okay, all right, that's helpful. Yeah. 

Dr. Haley Genovese (07:02.59)
There's definitely different ways to do it. think it's a very personalized approach based on like what someone is more comfortable with and what their person, it's kind of a personality thing. Honestly, some people want all the information. Some people want very little information and they just want to try. So I think it's up to you. 

Chelle Waite (07:18.964)
Yeah, I just feel like, you know, when you're doing all of the things and you so badly want it to happen and you've heard like, like you said, some people do just like right away get pregnant. And then sometimes it does take six months to a year and you're kind of like somewhere in the middle there. feel like doing all of the things like tracking your cycle, doing the ovulation test and temperature. Sometimes I feel like it can get overwhelming. So, mean, feel like that's a good general rule to like try every other day. If you're in the midst of it and you're feeling stressed out and you just want to like do something that will be 

Dr. Haley Genovese (07:40.062)
Definitely. 

Chelle Waite (07:48.636)
stress-free to just try every other day. Seems pretty practical to me. 

Dr. Haley Genovese (07:52.436)
Absolutely. And some people who might not be going into it with such a serious mindset of like, OK, I want to conceive in the next three months if I have in my perfect world. There's another method just called not trying, not preventing, which is basically just not even trying to necessarily cover every other day, but not using any form of birth control. And even in that situation, if you're not feeling super time pressured, the majority of couples even doing that will become pregnant within a year. 

Dr. Haley Genovese (08:21.502)
kind of about how seriously do you want to take it? How quickly are you trying to make this happen? 

Chelle Waite (08:25.876)
All right, so that actually brings to the next point, which is when to call in the experts. I know like the general advice is to try for a year if you're under 35 and six months if you're over 35, but are there any red flags where someone should reach out to a doctor sooner, like cycles or endometriosis or anything like that? 

Dr. Haley Genovese (08:47.464)
Yeah, I mean, I think with conditions like endometriosis, it's still worth, you know, putting in the normal timeframes just because not every patient with, while endometriosis can cause infertility, it's not necessarily something that will cause infertility all the time. So, you know, we see that we see it often in infertility patients, but most people with endometriosis actually do not have infertility. So I think in that case, it's fine to just try on your own. And obviously if you, 

Dr. Haley Genovese (09:16.434)
are having difficulty coming to see an REI. One situation where you might be more obviously needing help right off the bat is if you have PCOS or polycystic ovarian syndrome, because in that case, you might not be ovulating regularly. And if you know that you're not ovulating, because let's say you are one of these information people and you've been doing the temperatures and you've been doing the OPKs and... 

Dr. Haley Genovese (09:42.364)
you never pick up ovulation or confirm ovulation with a basal temperature rise, then you probably will need help to ovulate, which we can do with medications, most commonly two called Clomid and Letrazole. And those are ovulation induction agents, which just means they help you grow a follicle. So if you're someone whose body isn't doing a good job of growing a follicle on its own, those medications can kind of help you with that. 

Dr. Haley Genovese (10:08.404)
And then if you're not ovulating, then you're not even getting a chance. So that's the situation where I wouldn't want the patient to six months or 12 months of trying to get this lucky moment of ovulation if they're only ovulating maybe three times a year or less on their own. So then the other things would be if you had an obvious red flag in your history, like if your partner had cancer or had chemotherapy and you know that the sperm could have been affected by a medical condition that he had. That's a reason to go see a doctor sooner because you should at least investigate what the sperm counts might look like. Or if you know that you have risk factors for tubal disease, endometriosis being one of them, otherwise more commonly it'll be a history of certain sexually transmitted infections or pelvic infections that could have caused blocked tubes. 

Chelle Waite (11:03.092)
So I'm just wondering, sitting here, so can you make an appointment before you try to get pregnant to try and find out all these underlying issues? Or is it just something like you go six months? Because I feel like not every girl does know that she has PCOS. I do feel like, yes, if your husband had cancer and is recovering, that's a little bit more obvious. And maybe they can get an appointment. But is it true that you can't really see an RMA clinic? 

Dr. Haley Genovese (11:18.963)
Right. 

Chelle Waite (11:30.548)
before the six months, one year, or is it kind of like basically? 

Dr. Haley Genovese (11:34.909)
We aren't strict about timeline. If someone has been trying for certain amount of time, we don't refuse to see them if they have fears about conception. I honestly assume any time someone wants to come see us, it's for good reason. We don't have strict, we certainly don't ban anyone from scheduling an appointment. But I would say for a preconception visit, if that's what you're hinting at. 

Dr. Haley Genovese (12:01.714)
That's more of what a general OBGYN will do. instead of seeing a fertility specialist right off the bat, if you're just like a, of you are healthy and you're kind of just a normal couple and you don't have any reason to suspect there's a problem, you're more commonly gonna go see a general OBGYN first. And they can sometimes do like, just basic testing to make sure that you're healthy, look at your thyroid hormones, look at some other things. 

Dr. Haley Genovese (12:27.328)
and kind of give you the go ahead. The other benefit to doing that honestly is doing genetic testing. and your partner can actually do what's called expanded carrier screening. And that test will test you both for genetic conditions that are very rare, but that you might both be a carrier of. And that's to rule out the possibility that you could end up with a fetus affected by one of these rare conditions that neither of you has, but you could both carry the gene for. 

Chelle Waite (12:53.332)
Okay, that is helpful. 

Chelle Waite (12:55.214)
Sometimes I feel like knowledge is power. If you are someone who likes to know things and have more control, it might be beneficial. I felt like I was that way, especially after I miscarried. just wanted to know like why my body was not doing what I thought it was supposed to be doing. Yeah, absolutely. Doing those testing and did feel like a little bit more empowered to like keep trying and like a little bit more encouraged to keep trying. So. 

Dr. Haley Genovese (13:17.02)
Yeah, sometimes it helps to just go talk to someone and kind of see like, where am I at? And what can I be doing differently if anything? 

Chelle Waite (13:24.02)
Yeah. Okay. So here's something funny. You know the myths when you're trying to get pregnant. I feel like I talked you about this. Like when you were, when you guys are trying and I was like, need to like wear with your legs. I was do it and just need to lay there handmade style. 

Dr. Haley Genovese (13:42.024)
There's tons of myths out there, absolutely. And we hear things from patients all the time about misconceptions and things that they think they need to be doing that don't actually matter. 

Chelle Waite (13:52.148)
I felt like it did, like honestly, it doesn't do anything. But I feel like if you're that mindset, like try anything who cares? Like it can't hurt but 

Dr. Haley Genovese (14:01.308)
Yeah, 

Dr. Haley Genovese (14:01.748)
yeah, that's what kind of what we say too. I mean, the studies say that doing things like holding your legs in the air or laying there for, you know, 10 minutes after intercourse, like, they say that those things don't matter. So, you know, I don't like recommend that to patients as a fix. But yeah, I mean, if that's something you want to do, that's fine. It's not hurting your chances either. 

Chelle Waite (14:24.276)
If you feel like laying there after, more power to you. 

Dr. Haley Genovese (14:28.212)
Exactly. Whatever you want to do, girl.

Chelle Waite (14:31.252)
Okay, and what about stress? Does stress really play like that big of a role like impact on like ovulation or like does it affect your ability to conceive? 

Dr. Haley Genovese (14:41.53)
Usually no, which is a relief for most people because it's it's very hard like there's nothing worse than you're feeling stressed out and someone says you need to be you need to stop stressing out, you know, you can't you can't stop that feeling from being there, especially if you have a high stress job or you have a life circumstance that's really challenging. You're not going to be able to just make that go away. So. 

Dr. Haley Genovese (15:05.376)
I mean, the only way that stress actually does impact conception is if it prevents ovulation from happening. So that's a very rare circumstance. I mean, that's the type of situation where you could be living in a war zone or a very severe, you're malnourished, a very severe situation. 

Chelle Waite (15:24.596)
Yeah, I just going to say, like, eating, like, not taking care of your body, like, exactly, that's the diet impact. 

Dr. Haley Genovese (15:30.116)
Yeah. Or someone who's suffering from an eating disorder such as anorexia, like that type of thing can certainly prevent you from modulating. But otherwise, like regular, what we say is regular day to day life stressors 

Dr. Haley Genovese (15:44.333)
are very unlikely to actually prevent you from conceiving. 

Chelle Waite (15:47.624)
love to hear that because aren't we all just a little bit stressed? 

Dr. Haley Genovese (15:50.576)
Yeah, there's and like I said, there's sort of nothing you can do to make that go away. having someone tell you, you just need to relax is probably one of the more frustrating things for, you know, anyone to hear, let alone an infertility patient who's, you been at this for a long time. And the fact that it's taking so long is making them even more stressed. that's certainly helpful advice. 

Chelle Waite (16:12.788)
Yeah, you're doing everything that you know. I feel like it's like you're going insane because you're trying and you're doing everything and all the right things. And like every single time you're not getting pregnant, like it is super stressful. And I know that, you know, I feel like we all have the dream that it's just going to be like romantic and easy and like not realizing that it actually does take work. And the fun is kind of like sucked out of it. So, yeah, it is stressful. And it's like really encouraging to hear that that stress is not going to like affect your chances of getting pregnant. 

Dr. Haley Genovese (16:41.288)
Right, no, the stress of trying is certainly not going to be a contributing factor. you know, just the major thing is just making sure that your timing is good every month and that, you know, you are ovulating and your partner has sperm that have a chance of getting there. And, you know, we don't have any other obvious reason why the egg and sperm wouldn't be needing and wouldn't be able to implant. So, you know, a lot of the fertility testing revolves around checking those things and. 

Dr. Haley Genovese (17:08.156)
making sure that we do a semen analysis to make sure that the sperm does look normal and that looks, the numbers are good. And then we do testing for the fallopian tubes to make sure that they're open and we look at the uterus. So all of those things are focused on making sure that those factors we need are in place. 

Chelle Waite (17:27.304)
Okay, another question, because as you were talking, I was just thinking about this. Like, if you're trying and it's been like around six months, I feel like girls, take on the burden. think like it's all me and it's my body and my body's not doing what it's supposed to. But like at that point, you know, all these at home like sperm tests, like recommend their husband like doing something like that around six months, or do you feel like, you know, waiting like the full year or something like that? 

Dr. Haley Genovese (17:52.018)
Yeah, I mean, I never would tell someone not to do a semen analysis because it is the most basic part of the workup. It is the least invasive part of the workup. And it's something that the male partner can do to sort of contribute to the process. unfortunately, most women do feel that the burden of this is on them. 

Dr. Haley Genovese (18:12.402)
you know, that's because it's their body that ovulates and that carries the pregnancy. So they're the ones tracking everything and they really feel the mental load of the process much more than the male partner tends to. So, you know, I think doing a semen analysis is a very easy first step for a couple that is just wondering, you know, we'd like to make sure everything is okay. Could it maybe it's only been three months, but you know, that's something that's not at all. 

Dr. Haley Genovese (18:36.806)
invasive or difficult to do. So I do think that there's never sort of a wrong time to take that first step. In terms of more thorough testing, just because these procedures can be invasive and expensive, we recommend that someone actually wait until they have the diagnosis of infertility before moving forward with the rest of the workup. 

Dr. Haley Genovese (18:59.034)
Exactly. It could just take some more time. Yeah, it's the hardest thing about that process is patience because you do, you know, from the way that they teach things in school, you do kind of think that the second you have unprotected sex, you'll get pregnant. And when that doesn't happen, it actually can be quite jarring for people, like they're shocked. So sometimes it takes a few months to just come to terms with like, okay, this is actually quite normal. 

Dr. Haley Genovese (19:23.496)
The chance of conception each month, even in a younger, healthy person, is at most just 25%. So it's really not a high odds of it working, even though in your mind you might think that the second you do this, you're going to get pregnant. 

Chelle Waite (19:39.166)
Not realistic girls. Take a break. 

Dr. Haley Genovese (19:40.948)
Time is your friend and over time it's quite likely that you will conceive on your own if you're a healthy couple trying for the first time. 

Chelle Waite (19:51.508)
Okay, great. I do wanna pivot a little bit into the pregnancy itself. I wanted to talk a little bit about bleeding in pregnancy. I feel like it was so encouraging for me to hear you, like, cause I experienced bleeding with my miscarriage and with my successful pregnancy. And I just wanna hear and like, have you explained to the girls out there, like what happens if they do experience bleeding? What is normal? Is it normal to bleed? Is it like more common than we think and when should we call our doctor? 

Dr. Haley Genovese (20:22.556)
Yeah, so I think I wouldn't say it's ever normal quote unquote to have bleeding in pregnancy because it can be a sign of something being wrong. You know, the things that we worry about are things like miscarriage and ectopic pregnancy. So, you know, I think bleeding in pregnancy does always require evaluation by a doctor and it's certainly reasonable to take that step if you're having bleeding. That being said, the majority of the times that I see someone having 

Dr. Haley Genovese (20:51.784)
bleeding, if it's light or spotting, it turns out to not actually be an issue with the pregnancy. So yeah, so I mean, and I guess you kind of have had this experience as well because your daughter is full term and healthy. 

Chelle Waite (21:07.316)
when they told us like she was, I was bleeding a lot like heavily. I swore because I had just had the failed pregnancy a month before. And when I went to the doctor, it was just so much blood. And he was like, yeah, I mean, it probably is going to be another miscarriage, but let's give it a fair shot and let's see what happens. And, you know, here she is today. So it is really, but you know, I'm always like, when I see blood, I'm like, I want to go to the doctor. Some girls like to wait it out. When would you say, I mean, 

Chelle Waite (21:36.648)
Definitely don't wait it out. Like what is like the rule? 

Dr. Haley Genovese (21:39.686)
Yeah, if you have, so the situation that you should never ignore is bleeding with pain. Like if you have severe pain, because this is the classic signs of a ruptured ectopic pregnancy. And an ectopic pregnancy is when the embryo unfortunately implants in the fallopian tube instead of in the uterus where it's supposed to, because in the tube it's unable to grow. That pregnancy can never become a healthy baby. 

Dr. Haley Genovese (22:05.02)
So that is an emergency if it grows enough to actually break open the tube and cause heavy bleeding inside the belly. And that needs to be treated with surgery. So usually if that happens, you will have pain. You might feel dizzy because you're having internal bleeding, lightheaded, and a lot of people will also have vaginal bleeding. So you should know if you have pain and bleeding in early pregnancy, that is an emergency and you should go to the ER. If it's late, you should to ER. 

Dr. Haley Genovese (22:34.8)
Yeah, it's sort of different if it's a very light spotting, especially in the context of an already confirmed pregnancy in the uterus. So like if you've already had an ultrasound and the doctor said, OK, everything looks normal, the baby's in the uterus and it's developing and growing, then vaginal bleeding is a little bit less of an emergency because we know that the pregnancy is implanted in the right place already. 

Chelle Waite (22:58.65)
If they have an ectopic pregnancy, will they get a positive pregnancy test? Like are these calls one to know that they're pregnant usually and they're getting to like week six, seven, eight and then. 

Dr. Haley Genovese (23:09.588)
Yeah, so it's very scary because, you know, they'll test positive around the same time that anyone else would. So you really don't know until you've had that first ultrasound to confirm that the pregnancy is in the uterus. That being said, this is rare. Only 2 % of pregnancies are ectopic. So, you know, the odds are in your favor. We're really 90, you know, 99 times, 98 to 99 times out of 100, you're going to be the person with a pregnancy in your uterus. So. 

Dr. Haley Genovese (23:35.016)
But if you are that 1 to 2 % of people, then you need to keep an eye out for this because it can be very dangerous. But you will get a positive pregnancy test, and then the pregnancy will continue to grow in some cases up to a pretty high pregnancy hormone level and can actually then rupture and bleed inside the body. 

Dr. Haley Genovese (23:58.256)
No, not to terrify everyone. mean, these things are rare, but those are the warning signs that you really need to look out for. 

Chelle Waite (24:05.0)
Right. And it's all about like educating. We're not here to like scare anybody. It's just, feel like some of these things are just like not common knowledge. And especially when it comes to bleeding, I feel like it's always a little bit scary, but I do feel like these are really good, important guidelines that we should listen to our body and pay attention. And there's so much unknown with pregnancy in general. So there's no harm, no foul calling your doctor. 

Dr. Haley Genovese (24:27.122)
Yes, we'd rather you call and ask these questions if you have a concern and you know if we know that the pregnancy is in the uterus we're probably going to be more reassuring and you know okay let's just take well you know we'll do a follow-up ultrasound because at that point your diagnosis is more just is this pregnancy going to progress or not and shell that was the situation that you have you know the pregnancy was already confirmed to be in the uterus but you know, you were having bleeding, so they were unsure if it was going to be a miscarriage or not. And thankfully it wasn't, but you know, that's a different situation. 

Chelle Waite (25:02.836)
Okay, so while we're talking about bleeding a little bit, I want to move into sex with pregnancy. honestly, once you get pregnant, I feel like I was so afraid that sex was gonna like cause me to have a miscarriage or that it wasn't safe anymore. And I know the doctors are like, no, it's fine. But I'm like, how is that possible? It feels like very violent. I feel like the baby's not safe in there. 

Dr. Haley Genovese (25:24.082)
So yeah, I mean, I'm glad that you brought it up in the context of bleeding because one of the most common things when I was a resident working on labor and delivery, one of the most common things I'd see people coming in with was bleeding after sex in pregnancy. And that's usually not blood that's coming from the uterus where the baby is. More often that is blood that comes from the cervix. So the cervix becomes more, or we say we call it friable in pregnancy, which it's basically more vascular. So it bleeds more easily. 

Dr. Haley Genovese (25:59.454)
So if there's any kind of contact with the cervix during intercourse, then that can lead to some bleeding, which scares people, of course. And they come in and they get checked out. But it's really unlikely that you would be having aggressive enough sex to cause any kind of problem for the baby. The baby is actually very well protected inside the uterus and inside the amniotic sac. And it's more of just your own personal preference, honestly. 

Dr. Haley Genovese (26:28.244)
I certainly tell patients if they feel like they wanna have sex in pregnancy, go ahead, assuming this is an uncomplicated pregnancy and we aren't worried about other things like a short cervix or a placenta previa, which is when the placenta covers the inside of the cervix. Those are situations where we would actually say you shouldn't be having sex in pregnancy and you always wanna talk with your doctor to make sure that you're an uncomplicated case and there isn't any restriction. if... 

Dr. Haley Genovese (26:54.768)
If you're someone who doesn't have any issues with the pregnancy and you want to have sex, it is certainly safe to do so. You just should be aware that you might note a little spotting afterwards and that's not necessarily a sign that anything is wrong if you're not someone in a high risk category already. 

Chelle Waite (27:09.63)
Okay, so if a little bit is bonding, if they start bleeding like. 

Dr. Haley Genovese (27:13.628)
Anybody that bleeds heavily, would say, especially if you're farther along, you should be checked out. Yeah. OK. 

Chelle Waite (27:21.972)
So your specialty is IVF, which I know is a huge topic and can feel overwhelming for people who might be considering it. So for someone who's just starting to think about IVF, what does the process actually look like? 

Dr. Haley Genovese (27:34.674)
Yeah, so IVF can be really scary for patients to kind of come to terms with. I think a lot of people that come to see us really aren't necessarily ready to give up the idea of quote unquote doing this naturally. can be a challenging thing to realize that you might not have very good odds of it happening naturally for whatever reason. And deciding to kind of take that big step of medical intervention can be hard. But I think when people get to the point where they are ready for it, they're very grateful that it's an option because it's far more successful than some of the other choices that we have. 

Chelle Waite (28:17.19)
Right, especially when you feel like your body has betrayed you, like how much of a relief it is to go somewhere and there's so many more options out there. That doesn't mean that your journey of trying to grow and start your family ends just because it's not working out for you. And I'm just like, it's really, really awesome. 

Dr. Haley Genovese (28:35.336)
Yeah, exactly. And I think people deal with that all in different ways. And it's important that you have the right support, whether that's family or a therapist or mental health. We have a mental health team at our clinic that helps support people through the process. So I think those are all important resources just because everyone might deal with it differently. But once you get there and you're ready, people tend to say, this is not nearly as bad as I thought it was going to be. It was actually pretty straightforward. 

Dr. Haley Genovese (29:05.134)
So a lot of this is how good are the instructions that you're getting and you know our nurses are amazing and put so much time and effort into making sure that patients know what's going on and have instructions every single day. But roughly the process involves giving yourself what's called subcutaneous injections. So these are injections that go just under the skin into the fat around your belly button. So you know everyone has like a little bit of belly fat right there that's kind of where we advise people to give their shots. 

Dr. Haley Genovese (29:33.46)
and you just pinch the skin and place the needle there and then the medication is actually just injected usually through like a, almost like if you think about a pen clicking, when you click a pen to like, bring the ink down. So it's often like a pretty straightforward procedure. If you're using something like Folistim or gonal-f, those are the medications we use to give follicle stimulating hormone, which helps your follicles grow. And the point of IVF is to get, 

Dr. Haley Genovese (30:02.0)
as many follicles as we can to grow that month. So instead of having just one follicle grow and ovulate like you would have in a natural cycle, we try to get as many of your small follicles to grow to a larger size so that we can go in and actually remove them from the body. And that's called a vaginal egg retrieval. So that is a surgical procedure. Most people, it is quick and minimally invasive, but most people will give the shots for about 10 to 14 days. 

Dr. Haley Genovese (30:31.634)
and then they'll give a trigger shot. The trigger shot tells all those mature follicles it's time to ovulate. And that causes the eggs to complete their maturation process. And then we have you go come in for a 10 minute procedure. It's under anesthesia so you're asleep, you don't feel any pain. And use a very small needle to go through the vaginal sidewall and actually suction the fluid out of the follicles and the egg is in that fluid. So then. 

Dr. Haley Genovese (30:59.954)
We take the fluid over to our embryology lab and the embryologist can actually look through the fluid and find that microscopic egg. So that's kind of from the patient's perspective what they have to do. The rest of it is actually done in the lab. So once we have the mature eggs, the embryologist will use the partner's sperm to fertilize the eggs. And then we grow them out over the course of the next five to seven days until they're at the embryo or blastocyst stage. and that's when they're ready to be implanted back into the uterus. 

Chelle Waite (31:31.036)
So it's like a two part. 

Dr. Haley Genovese (31:32.82)
two part process, yeah. 

Chelle Waite (31:34.642)
Okay, I thought it was on one day, so okay. 

Dr. Haley Genovese (31:37.3)
No, 

Dr. Haley Genovese (31:37.88)
yeah, so it takes about two weeks to do the first part of the process. And then you're going to hear, you're going to wait for your results to kind of hear about what happened to the eggs that we fertilized and to get information on genetic testing, if that's something that you opt to do. And then, you know, what we do at our clinic is we recommend genetic testing on the embryos so that we can we know if they have the right number of chromosomes or not. 

Dr. Haley Genovese (32:03.368)
And then it takes about two weeks to get all of that information back and we freeze the embryos while we're waiting for that information so that we can in a subsequent month do a transfer cycle and thaw that embryo and put it back into the uterus. 

Chelle Waite (32:17.14)
Okay, so after the transfer, is there any pain? 

Dr. Haley Genovese (32:20.964)
No, so transfer is actually like a very straightforward process. That's not, there's no anesthesia involved in that. just, it's a speculum exam. if you've had a pap smear, it's very similar setup to that. And we just use a really small catheter to take the embryo and place it through the cervix into the uterus. And then the embryo is left to continue the implantation process itself. And we test for pregnancy about a week later. 

Chelle Waite (32:47.582)
Wow, that is so cool. my God. We can do things like this. 

Dr. Haley Genovese (32:52.948)
I'd say the more uncomfortable, difficult part of the process is that part one, the first part that I talked about where you're actually just because daily injections are, you know, while most people say they're actually not painful because the needle is very tiny, it's just a lot, you know, there's a lot of bloating involved and it's a lot more work to be doing injections every single night. And then after you have the egg retrieval, people will often have cramps and bloating for a few days. You know, you might have pretty bad constipation. So there's more symptoms with the retrieval. But that being said, I'd say the majority of patients are feeling amazing within 48 hours of their retrieval. There's gonna be some portion of people that feel like they need a little more time to recover, but that's probably the harder part of the two. 

Chelle Waite (33:37.0)
Wow, this has really been so helpful. And obviously I feel like you and I can talk for hours. But I do want to wrap up with this. So what would be one piece of advice that you could give to someone who's feeling discouraged in their fertility journey? 

Dr. Haley Genovese (33:49.596)
Yeah, I mean, I think just give yourself grace. It's a really hard process. And when you want something very badly and you could be someone who's really used to just working hard for what they want in their life and in most other areas, hard work equates to results. And this is something where it's just not the case. There's sort of nothing you can do about the biological cards you were dealt. So don't be hard on yourself. Recognize that. 

Dr. Haley Genovese (34:16.308)
you're doing everything you can and know when it might be time to go seek help and to get specialists involved. And find someone that you trust and click with so that you can have a successful journey with them and kind of just keep your mind open to everything that's gonna happen because it's unpredictable and it can be a really challenging process. But most patients do end up having success and I certainly hope that for everyone that I see. 

Chelle Waite (34:44.308)
Haley, thank you so much for being here and for sharing all of this. Where can people find you if they want to follow along with your work? 

Dr. Haley Genovese (34:51.314)
Yeah, so I'm currently finishing up my fellowship in New Jersey at Reproductive Medicine Associates. So I work out of the Basking Ridge office. We have so many amazing providers there. But for my California girls, I'm moving to San Diego in the summer. So I will be starting at the same group, Reproductive Medicine Associates. But in San Diego, we are opening up an office there in La Jolla. So I will be there. I will be seeing patients from September onwards. So I would love to see anyone that needs help. 

Chelle Waite (35:24.712)
Don't see her. All right. So if you found this episode helpful, make sure to subscribe and share it with someone who might need to hear it. And as always, you can find me over at thewaite.com or @the.waite on instagram.

And thanks for listening. I'll see you next time.