EP #85: Muna Fertility - Why Are We Not Talking About Infertility? with Dr. Karenne Fru
Mar 05, 2024
When the journey to parenthood doesn't follow the storybook path, it's a reality that Dr. Karenne Fru of Muna Fertility understands deeply. Together, we unravel the silent anguish of infertility, a challenge that unexpectedly binds one in six adults in the most private corners of their lives. Dr. Fru, whose expertise lights the way, helps us navigate the complexities of declining birth rates worldwide and the environmental assailants that could be the culprits. Our conversation is more than a beacon for those in the throes of fertility struggles—it's a call to society, urging an end to the whispering shadows of this all-too-common human experience.
Modern family-making is rich with diverse threads, and this episode weaves inclusivity into the very definition of infertility, embracing LGBTQ+ couples and single individuals with equal fervor. We debunk the myth that it's solely a woman's burden and underscore the importance of both male and female roles in conception. As we discuss the ins and outs of seeking fertility advice or treatment, with the reassurance that no referrals are needed, we embark on a mission to empower all potential parents. This heart-to-heart isn't just about sharing stories—it's about fostering a world where the support and openness for our reproductive health journeys become as normalized as any other aspect of well-being.
When the journey to parenthood doesn't follow the storybook path, it's a reality that Dr. Karenne Fru of Muna Fertility understands deeply. Together, we unravel the silent anguish of infertility, a challenge that unexpectedly binds one in six adults in the most private corners of their lives. Dr. Fru, whose expertise lights the way, helps us navigate the complexities of declining birth rates worldwide and the environmental assailants that could be the culprits. Our conversation is more than a beacon for those in the throes of fertility struggles—it's a call to society, urging an end to the whispering shadows of this all-too-common human experience.
Modern family-making is rich with diverse threads, and this episode weaves inclusivity into the very definition of infertility, embracing LGBTQ+ couples and single individuals with equal fervor. We debunk the myth that it's solely a woman's burden and underscore the importance of both male and female roles in conception. As we discuss the ins and outs of seeking fertility advice or treatment, with the reassurance that no referrals are needed, we embark on a mission to empower all potential parents. This heart-to-heart isn't just about sharing stories—it's about fostering a world where the support and openness for our reproductive health journeys become as normalized as any other aspect of well-being.
Speaker 1:
This is the Good Neighbor podcast, the place where local businesses and neighbors come together. Here's your host, Stacey Risley.
Speaker 2:
Hello friends and neighbors. Welcome to North Atlanta's Good Neighbor podcast. Today we are here. We are back here with Dr Karine Frew, one of my new favorite people. She is the owner and founder of MUNA Fertility here in Atlanta. She is also the expert contributor to North Buckhead Neighbors Magazine. She's back with us today to discuss her most recent expert article. That is, in our February issues, our current issues. Welcome, Dr Frew, welcome back. It's so good to have you.
Speaker 3:
Thank you for having me back, Stacey. I didn't talk your ear off last time, so I'm back. You're back the month when we're celebrating love and togetherness. I'm thinking well, this is a good month to talk about reproduction.
Speaker 2:
Right, I'm thinking more reproduction happens in February. What's nice is we don't have to censor ourselves on this. The magazine itself is a family friendly magazine and there are certain things we can't really talk about too much. But here you have free reign and here we'll give listeners a warning. If you're listening and you're under the age of 18, you might hear some words you're uncomfortable with, so don't listen. There you go, okay. Well, so your article title, and we'll just start with that, because it's a question, and it's a really good one. The question is why are we not talking about infertility? So let's start there, dr Frew, all right.
Speaker 3:
So you know, it's astounding to me that there are so many people dealing with infertility and it is not more commonplace in discussion. There is a trend worldwide that they're increasing rates of infertility and over the next decade the World Health Organization is estimating that we are going to have. About one out of every six adults of reproductive age require the services of someone like myself, a reproductive endocrinologist, in order to get pregnant.
Speaker 2:
So I'm already interjecting. That's a huge percentage of the population, like one out of every six. That's correct.
Speaker 3:
Astrodurals. It made headlines for like a half a second and I was like, yes, we are going to start talking about infertility. And then it fizzled away. And what is happening in the background? What I see every day, because I have a whole job that is talking to people about having babies and how are we going to do it. And some people come in with challenges, some diagnosed, and we know about it and I'm planning for it, and others not diagnosed. But in the background, what is happening worldwide? So no country was spared. It didn't matter if it was a high income, low income, excellent medical system, not agrarian or industrial didn't matter, as the world birth rates are falling.
Speaker 2:
And that does not, and it doesn't discriminate right it's not discriminate.
Speaker 3:
It didn't matter. Pick a country, any country, and you have low capability across the world, and so what is the reason, like, what do you think is causing that?
Speaker 2:
Well your professional opinion.
Speaker 3:
It is a number of things. So with becoming more civilized and more industrialized, our bodies have gotten exposed to things that they wouldn't otherwise have been exposed to. I'm talking about, you know things like forever chemicals and our plastics, and you know the aerosols and the cleaning sprays, and we in the past, we're just not as prone to looking through what the downstream effects might be on, say, sperm production, which is a key ingredient to us reproducing, since no one can reproduce by themselves and we have falling rates of normal sperm in men across the world. So my 25 year olds now look more like 40 year olds. Did you know 15, 20 years ago?
Speaker 3:
Yeah, as far as sperm count goes as far as sperm count goes. Yeah, absolutely, and that's one thing.
Speaker 2:
Yeah, in the background, well, and I think so often infertility is kind of associated with the female, you know, like with the woman who is like it's our job to have babies, it's our job to get pregnant. You know and that's an interesting fact that you say that you're seeing you know that it's it's male sperm count is a major factor. Of course, like you said, we can get pregnant by ourselves. It does take two.
Speaker 3:
It does take two. So for for human reproduction to proceed we are not CQ cumbers, we are not asexual. We do not reproduce asexually, we are mammals it requires male and female gametes. I cannot stress this enough. It requires an egg and a sperm to make an embryo. You need two different cell types, produced by two different people, to make an embryo. We do not reproduce asexually.
Speaker 3:
However, as a community, the weight of reproduction has fallen to women because the consequences of pregnancy are born by the woman, because men are incapable of getting pregnant. I wish they could, but I wish it was an egalitarian system. You know, where are we going to have kids? Which one of us is going to be egalitarian at this time? Well, that's not the way it happens. So we have put the because women bear the consequences of pregnancy socially right. If you get pregnant out of wedlock without getting married, you get, you carry that evidence and you deal with that child and the father may not be involved at all. So because the woman bears the consequence of pregnancy, good or bad, the men have been allowed to just sort of scoot along and not be considered as part of the equation. And if we just talked about infertility more, we would realize how dumb that is. We are not against sea cucumbers.
Speaker 2:
I'm glad I'm not a sea cucumber.
Speaker 3:
I'm not a sea cucumber, I'm just going to be this way.
Speaker 2:
Well, and I have to, in fairness to the men as well here, you know like, just just like it takes two and the women have bear the you know consequences, like you say, like there's no shame in having a low sperm count. You know, like it's not their fault, it's not that, you know, like I think, so many, I think the men are afraid of being blamed or being or having to bear, like you said, the responsibility or the consequences of that, and they don't want to be the reason that they and their partner are unable to conceive.
Speaker 3:
That has been the experience, but that's because men have been left out of the equation, right, if a woman came in and said my periods happen every eight months, it's obvious to me that she's not releasing an egg every month like she should be. Right, she might feel shame out of proportion because she is expected, her body is expected, to just do this thing. And the men they almost don't wish to be considered most of the time in the evaluation as a potential source of any reproductive concerns. So when I diagnose my men with issues, they have such a much harder time understanding how they could be responsible for 50% of infertility.
Speaker 2:
That resonates with women, like if you're menstruating regularly and you're clockwork 28 day cycles and you know that that's happening. Like you said, you know that you're producing or you I mean, I would imagine, all women who are releasing there you go To help me with the terminology. I am not the expert, but you know that things are in check, right. You have a way to check that based on your monthly cycle. Men don't have that. You know. There is no way. You know they are. You know here's my PG-13 rating. You know when they ejaculate, they assume that that means everything's good, right, so there's not necessarily a connection.
Speaker 3:
All right, but if we talk about infertility, then we would. It would mean to the discussion a lot earlier and we would lessen the burden on women. Because the shame, the isolation, it does no one any good. All it does is produce mothers with anxiety out of proportion and increased risk for postpartum depression. And oh, by the way, even babies born after struggling with infertility and seeing a doctor, such as myself, are at the same risks of mortality as other children, you know. And so if you are already struggling with the idea of having been infertile and it's not normalized, think how much harder it is to get help after you have that child that you prayed for. But then who keeps you up and sleep deprived, and you miss meals and aren't taking care of yourself Same thing that every mother goes through, right, but you spend those two together and your outcomes are just worse. You're just a much more vulnerable person.
Speaker 2:
Yeah, and I can vaguely relate to that, just having had my second daughter in the NICU for six weeks. She was born prematurely. Well, she wasn't in the NICU for six weeks, she was born six weeks prematurely and she was in the NICU as a result for several weeks, and that was. I was much more anxious with her when I brought her home. She was on a heart monitor for the first six months of her life. Every time that heart monitor went off, you know, and it just you know, it creates a when you're praying and you're just, you know, you're so concerned about their everything. You know you are. I was so much more anxious and most people are much less anxious with their second child. You know, this was my second child. My first child was, you know, full term and everything was fine and I was the most laid back mom ever. And then Ansley came along and suddenly I couldn't sleep without her laying on my chest. You know, like I, like she that's.
Speaker 3:
She slept on my chest for the first six weeks of her life and everyone said that I was really really anxious baseline for people who have had to track their cycles, go in to the ultrasound, take medicine, have timed intercourse, get their eggs sucked out, embryos created. What's the status of those? Get the transfer. Am I pregnant? Am I not pregnant? That is just to get to pregnancy Get exactly.
Speaker 2:
I can't. That's why I'm saying that resonated with me so much, because I was such so much more anxious with Ansley and she was, and I got pregnant and she was born and I knew she was gonna be. You know, she was okay and it's like so if I had had to go through the disappointment month after month after month after month and it's, you know, the answer is not pregnant, you know, like I had had to, I did not have, you know, that struggle, but I can imagine that that would create immense anxiety when you do conceive, you know, and so well. So, dr Free, what let's define infertility? That was another question that was in the article. What is infertility and how is that defined?
Speaker 3:
Well, the horrifying and alarming statistics I told you were based on the old definition of infertility, which is, if you and your spouse of a different gender, because we need to have unprotected intercourse for a full year straight, 12 months, and you do not get pregnant, you would be defined as infertile.
Speaker 3:
Okay, but most recently, this past year, the American Society of Reproductive Medicine, of which I'm a proud member, the REI, is REI being reproductive endocrinologist they have finally expanded the definition of who is to be considered infertile. And the first part is all the people that we would traditionally think of as infertile a couple who, for some biological reason, cannot get pregnant, okay. But then the second and third groups are all the people that we've been treating all along anyway single people, same-sex couples. If you have a reason for why you cannot conceive by yourself or carry a pregnancy by yourself, if you need a donor, a donor to your DNA or sperm, then you now are infertile. If you need someone to marry your pregnancy, you're now in that bucket. So if I was saying that this is a common condition before, think how much more common it is now, more so than hypertension or diabetes.
Speaker 2:
Well, and that makes sense. It's just a much more inclusive definition. You know, if you are a gay couple, you're not going to be able to conceive, and that's the definition. If that's the old definition that you have sex for nine or 12 or 12 months and you don't get pregnant, you know, like a gay couple can do that and not get pregnant, so yeah, they qualify.
Speaker 3:
They qualify. Yeah, it was. It was irksome to me because it was such a heteronormative definition.
Speaker 2:
They all feel traditional.
Speaker 3:
Yeah, and for not reflect who we actually take care of.
Speaker 2:
And you said that that just that definition just was changed last year, october of 2023. So five months ago, they finally decided that, well, okay, so we won't get off on that tangent too long. But, yes, I'm glad, I'm glad.
Speaker 3:
But, I'm right. Even by the old standards, this super common condition was already so common that and yeah, they outstripped diabetes in the US, for example.
Speaker 2:
Yeah, Wow, yeah, okay, no, that's a great, great comparison to make people's eyes open.
Speaker 3:
So if we talk about if a diabetic can just, you know, pull out their meter and you know, inject themselves with insulin super casual, why is there all this shame and hiding over infertility? Yeah, it's a. It's a simple and treatable condition.
Speaker 2:
I've let say that one more time. Dr Frey, Say that again.
Speaker 3:
It is a simple and treatable condition, that's. But to access the treatment, you need to find a reproductive endocrinologist, even if it's just to ask the question what is my reproductive potential or how can I reproduce given my particular circumstance? Right, yeah, you, you have to first ask the question and then it is my job to answer the question, right?
Speaker 2:
And so with solutions. Yeah, yeah, so you know the the new inclusive definition, that that should have been the definition a long time ago, in my opinion. Um, you know, like if you're a you know a gay or lesbian couple and you already know that you're not going to be able to conceive within that year, you don't have to wait a year, no, and can the reproductive.
Speaker 3:
Surprising, mostly to women, is that you don't need a referral.
Speaker 2:
You don't.
Speaker 1:
And again, dr Fru it's a simple and treatable condition and you do not need a referral.
Speaker 2:
There you go.
Speaker 3:
You put it up for Dr Fru. Yes, like, like you could if if you were, you know, tooling around online and you're going oh my gosh, I'm thinking I'm going to have a kid in the next year, but I'm not quite ready. Um, let's see if I can just freeze these eggs, so we can have that discussion later. I just want to have a talk about it. You can just go to moon infertility and fill out a request for a consult. It's that simple, and people keep waiting for permission from other doctors taking care of them to seek out reproductive care. And I'm like you don't need permission from anybody except for yourself If you wish to become a parent. Someone like myself is part of the equation.
Speaker 2:
And I want to. You know, I, when I was just speaking a moment ago, I was saying you know gay and lesbian couples, but this is also women who want to have a child and they don't have a partner. You know, like, had I not had a partner? Like, motherhood is definitely something I knew I wanted to be a part of my journey, you know. So I want to be sure to also include them, because I kind of feel like I love them. I left that out.
Speaker 3:
I didn't want to Single parents by choice male and female.
Speaker 2:
Absolutely Okay. Yes, and I did say women just then. So, yes, men too, like you, don't have to be in a relationship to have a child there you go, you do not, you do not, you do not.
Speaker 3:
Our economic circumstances, our social circumstances, the amount of support you get from friends and family and your chosen family. It's so great that people can do it, they can absolutely do that, but they might not feel like they're allowed to if we don't talk about infertility.
Speaker 2:
Absolutely. I'm so glad we're having this discussion. I really am, because I just caught myself, you know, and I feel like I am a very inclusive person in general. I really do, and I said if I'm a single woman and I want to have a baby, I don't need a partner. But it didn't even occur, because we don't have these conversations I did. It didn't occur to me that a single male who it doesn't matter your gender, if you want a baby and you can't make one like it's not happening in a year then you're like oh, find a reproductive endocrinologist.
Speaker 3:
Oh, find a fruit. Yeah, If. I'm nearby, I'll see you view the internet, but it's a conversation I'm happy to have as many times as necessary and which is why I ended the article with let me start. You know I'm Dr Fru. I had five years of infertility. I understand the challenges.
Speaker 2:
Share a little bit about that with us If you don't mind, just because I think it makes it makes you so much more qualified, really, for your position. I mean to have been through it, and maybe qualification isn't the right terminology, but it would be a huge if I was struggling in this area, if this was something that I needed help with. To know that my doctor had been through her own struggles that were similar to mine would bring me great comfort and that would it would make, in my eyes, you more qualified to be my doctor for sure. So share a little bit about that experience if you don't mind.
Speaker 3:
So I'll give you the super brief version because, like I said, it spanned five years. But I'm on the other side of that and I will start at the good part, which is I have two beautiful living children.
Speaker 2:
I love that you started with the end in mind. It's pretty good.
Speaker 3:
Because the story was convoluted and painful to live.
Speaker 2:
Yeah, I imagine you have two healthy, beautiful baby girls. Right yeah, baby girls Not baby.
Speaker 3:
But A lot of people think that I got into infertility because I had reproductive trouble, but I did not consider reproducing until after I was a reproductive endocrinologist. Ah good, so I had already chosen that this was going to be my life's work, and then I proceeded to have challenge after challenge, which, in summary, is, you know, six miscarriages and two IVF cycles, one of which yielded no usable embryos, hence the second one. And then you know an embryo transfer, that is, you know, my daughter, but the older one was pregnancy number four, and a spontaneous pregnancy, complicated pregnancy, but spontaneous. So it I'm like whatever way I can do it, I'm like whatever way the story can end, I think I've lived it as a woman. As a woman, it was after I had all the tools available to me to try and prevent it.
Speaker 3:
So there are some things that we cannot science our way out of, and I'm a big one, for if there's a problem and I can science my way out of it, I'm gonna do that. So the big thing in talking about infertility and just treating it like any other medical condition is that there is a solution. It may not be the one you want, but there is a solution. A solution exists for each and every person wanting to have a child. It may not be the one you want, and we just need to talk about it until you decide what is more important to you if you want to pass on genetic material or if you want to be a parent.
Speaker 2:
Absolutely Well. Thank you for being willing to share that story. I can't imagine how difficult that was and I love that you chose I mean so often. Frequently we have guests on the show who go into their chosen field because of a situation that they had gone through and they wanted to help others through that situation. The fact that you had already chosen this as your passion, this was already what you were passionate about doing about helping others in this very specific industry of medicine or industry of medicine is probably not the right terminology, but specialty. Thank you, you find my words for me. I love it, but you know that's a very, it's very specific right. And then to have the struggle yourself to be going through that and then still, if anything, it makes you more passionate and more compassionate right For your patients, I think I just love. I love Dr Fru, if you can't tell, I love that you just feel the same way For those of you who haven't have not had the pleasure of meeting her, you absolutely will feel comfortable.
Speaker 2:
I can tell you that, like you, have just such a warm energy, such a very kind and caring and compassionate person. It just exudes from you.
Speaker 3:
So now I'm going to blush.
Speaker 2:
We'll go ahead and blush, because it is just true, and I don't say that about everyone.
Speaker 3:
I consider it a privilege and I only want to care for people who wish to be cared for by me. My, maybe I'm not the best person for you, and I just encourage anyone for whom that is true to find a doctor that they trust and feels they feel comfortable with. This is, this is too important, this is what we leave behind, right? No, I always want my patients to to feel empowered to make decisions for themselves and really, really educated on their specific condition so that they can partner with me to make decisions, and that, to me, gives me as much joy as seeing an antherian bloom in the winter.
Speaker 2:
And for those of you who don't know what that is like, it is a pledge. She also says botany.
Speaker 3:
You have a minor right, At least a minor at this point.
Speaker 2:
I know I'm thinking you do have a full extra degree. On that qualification, we need to add some extra letters behind your name. Well, dr Frew, I can't tell you what a pleasure it has been to have this discussion with you.
Speaker 3:
I hope that that infertility becomes a commonplace discussion between both partners or or single individuals who would like to have their own children or talking about it with their friends and not in that invasive, you know when are you going to have kids way, which is a lot, a lot judgey. Not that that's not a conversation. I'm encouraging. I'm just encouraging people to talk about what's going on with them and what their plans are for future fertility. People put it off and then they don't talk about it and then they think they're scared that by themselves. When you've got two friends sitting right next to each other going through the same thing and they meet in my lobby.
Speaker 3:
That shouldn't happen, you should come together.
Speaker 2:
Yeah, right, and it removes the shame. I mean, there's absolutely no shame, there should be no shame.
Speaker 3:
If you're not ashamed talking about your high blood pressure, you should not be ashamed talking about infertility.
Speaker 2:
Absolutely. I could not agree more Well your. I believe that they're you're. We're kind of alluding to your next, next expert article, but I think that we had discussed possibly talking about reusing. Do you want?
Speaker 3:
to do that? Yes, absolutely. So. The next article is going to be going into some of the details around. How do I defer reproduction to later?
Speaker 2:
Wonderful, and that involves freezing eggs and sperm. Okay, oh, here I am again thinking I'm all. Let's not forget the boys. I'm really men. I love you. I'm sorry, I'm really not anti men.
Speaker 3:
No, no, no, no no, we need, like I say we need, we need the men, we need sperm, we absolutely, absolutely.
Speaker 2:
Let's get them. Let's get those sperm while they're they're still plentiful, exactly, exactly. Well, dr Frew, it has been such a pleasure having you on the show again and I can't wait till our next conversation. So thank you so much for being here today.
Speaker 3:
Thank, you so much for having me and encouraging this open, honest discussion.
Speaker 2:
Beyond welcome. Well, that's all for today's episode, atlanta. I'm Stacy Risley with the Good Neighbor podcast. Thanks for listening and for supporting the local businesses and nonprofits of our great community.
Speaker 1:
Thanks for listening to the Good Neighbor podcast North Atlanta. To nominate your favorite local businesses to be featured on the show, go to GNP North Atlanta dot com. That's GNP North Atlanta dot com, or call 470-946-7007.
