For better or worse, maternity is inextricably linked to medicine. We’ve been talking about birth control in some form since we were teenagers, the first thing our primary care doc instructs us to do when we want to have kids is get on prenatal vitamins, and don’t get us started on the amount of meds that go into fertility treatments. But, plain and simple, even if you have a home birth or try to avoid the medical industrial complex as much as possible, there will invariably be ways you must contend with it. So we might as well understand it.
That’s why following medical professionals that feel more like friends is a great idea. Or literally listening to your gut, just in case a postpartum-related surgery is in order. Or finding simple, less intrusive ways (gummies! tea! vitamin D!) to make yourself feel better. After all, medicine comes in a lot of forms, and doesn’t always require a prescription.
I made a bunch of milk and wrote about it
Some of you know that I’ve been a food journalist for many years and, during a late-night feed with Cole, it struck me that I am now food. The tables were turned, so to speak. I knew I had to write about it, at least for me. Then I shared the essay with a few dear friends, who convinced me to pitch it out. Luckily, I got it in front of Saveur magazine editor Alex Testere (who also knows a thing or two about caring for living things!) and the piece fell into place. He rightly asked me to reach out to experts to inject some science into it, and speaking with lactation consultants and biologists really grounded the story and made something that has felt so intimate all these months into a more universal experience.
The story has resonated with parents out there feeding their babies, people nostalgic for the nursing phase, or those who have never experienced breastfeeding and appreciate it all the same. Thank you to anyone reading my writing in multiple places. It means the world. As I wean Cole onto formula and solids, I could think of no better way to cap off six months of making milk than by sharing this essay with you all. And then, I swear, you’ll never have to hear about my nipples again. —Jess Mayhugh
Outdoor toys and activities making my life easier
After a long winter indoors caring for a newborn, I will be outside this summer. Unfortunately, I identify as “pool-less” so the more fun activities I have at my fingertips to entertain my kids the better. Here are some of the things burning my kids’ energy and saving my own. —Lauren Bell Martin
Simple, yes. But have you flown a kite lately? Shit is magical, but obviously weather dependent.
The amount of bubble wands I’ve purchased in my child’s two years of life is offensive. That’s why I’ve switched over to using bubble solution. It’s pre-mixed and huge, so I can strategically pour bubbles to a reasonable time limit (because bubbles do have a time limit). Also love this Giant Bubble Wand Set for massive bubbles that really get the crowd going.
My daughter loves picking flowers—sometimes other people’s, but we are working on it—so we loved this Make Your Own Fresh Flower Necklace kit. It gives purpose to all the little buds she yanks on our walks.
The tried and true Velcro Beach Bats for kids and adults who can’t catch well.
Remember the exhaustion after-running sprints in gym class? Imagine getting your children that tired. Not only will this Red Light Green Light game wear them out, but it’s also heavy on following directions.
Do my husband and I take sidewalk chalk too seriously, like we are the next David Zinn? Yes. Does my child like scribbling on top of our work? Also yes. Fun for the whole family.
This Garland Arch sprinkler gives human car wash, and I will be going through it on scorching summer days.
Honestly, I impulse-bought this Rainbow sprinkler at Target just because it’s freakin’ cute.
I am not for the bugs, but my daughter is. This insect catcher kit from Etsy is the easiest way for me to be hands-off (but still interested), because no thank you.
Reproductive endocrinologist and infertility expert Dr. Lucky Sekhon demystifies the biological clock
Some people fangirl over Beyoncé or Bieber or Billie Eilish (all rightfully so). I am starstruck by certain reproductive endocrinologists, including Dr. Lucky Sekhon. She is the author of The Lucky Egg, a compendium of fertility knowledge and an excellent place to start for anyone looking to get pregnant. Amidst all the emotional turmoil of attempting to start a family, getting down to the nitty-gritty biology can help elucidate the process. With clear, accessible analogies (your ovarian reserve is like a pantry, chromosomes are filing cabinets), the book feels more like talking to your best friend over drinks—one who happens to cite the latest research and evidence-based studies.
Dr. Lucky is also an excellent follow on Instagram, and seemingly reads our minds with her content. Curious about GLP-1s in fertility? She’s got a reel for that. Want to learn more about endo? She just posted an interview. She also just started a women’s health podcast with perimenopause expert Dr. Alicia Robbins called “Call Your Doctor.” Somehow, between all of that and caring for her patients, she made time for us to discuss what is true and misunderstood about the biological clock, how supplements can be snake oil, and what lessons from being an REI she’s taken into motherhood. —JM
On egg quantity and quality
I always start with quantity because it’s tangible and can be measured with an ultrasound and blood work. In an ultrasound, we’re only seeing a very limited subset, but it does give us a relative snapshot of what someone’s egg quantity looks like. We are in fact born with a limited stockpile of eggs, about 1 to 2 million. What’s interesting is that when we’re a five-month-old fetus in our mother’s womb, we have the peak number of eggs and no one really understands why. Typically, our 20s to very early 30s is when we start seeing the gradual shift in how many eggs we’re losing. And we don’t have the ability to regenerate eggs, like our skin or hair cells. Eggs are perishable items but, if we freeze them or turn them into embryos, we’re able to maximize utilization. Not every egg turns into a baby, obviously, but at least you’re starting out with more than one long shot.
Everyone always thinks your body knows how to choose the best [quality] egg, but it’s completely random. So you’re going to ovulate an overwhelming majority of eggs that are abnormal as we enter our mid-40s and beyond. That’s why miscarriages are much more common and one of the major factors that limit our reproductive potential at that age. An egg and sperm are supposed to come together and contribute 46 chromosomes, or one embryo with 23 pairs. And a lot of eggs have typos or errors in them. Basically, on the assembly line of the egg, it’s getting pushed through different stages of development and undergoing massive genetic reorganization, and that’s where things can get shoddy and you could end up with an embryo with missing or extra chromosomes. That’s something that can happen to anyone in our 20s—when things are “as good as it gets.” Even then, we know 20 to 25 percent of embryos are expected to have these chromosomal imbalances and errors, which generally means it’s usually not going to have what it takes to even get to the wall and implant in the uterus.
On the biggest myth of the biological clock
A common misconception is that the biological clock also refers to the embryo’s ability to implant in the lining of the uterus. And that actually hasn’t been shown in the data. We see relatively flat rates of success with embryos that are being transferred at varying ages. Think of the biological clock being more centered around eggs versus the lining of the uterus. Your uterus is pretty amazing and resilient, and even well after menopause, women can get pregnant. Of course, as you get older, you have much higher rates of problems in pregnancy. Because of the wear and tear on your blood vessels, you’re more prone to chronic medical conditions that can predispose you to things like pre-eclampsia, high blood pressure, and diabetes in pregnancy.
So I wouldn’t say that it’s not completely benign, but the ability to get pregnant when it comes to your biological clock is really more egg-related. A common myth is like, well, if I come back at 42 and use these embryos, I’m probably going to have a lower chance of success. And the truth is that’s not what the data shows. If people go into menopause early or have to have their ovaries removed, they should still feel hopeful because I know I can get you pregnant, either with eggs that you were able to freeze, embryos you were able to freeze, or a donor egg.
On why we should talk more about men’s biological clocks
Men do have a biological clock. Yes, they are making new sperm all the time, but they can accumulate mutations and pass that on to their offspring through their sperm. We know men can father children even in their 60s and 70s, but it doesn’t mean it’s completely benign. “Advanced paternal age” is not an agreed upon definition and the overall risk is still low, but we do see some associations between certain medical issues in children being more prevalent in older fathers. They can get people pregnant, but there are increased rates of miscarriage,neurodevelopmental issues in children, and even some papers have found a relationship to childhood cancers in older fathers. That’s an important discussion to be had.
Think of the biological clock being more centered around eggs versus the lining of the uterus. Your uterus is pretty amazing and resilient.
On maintaining egg health
This is where all of the common sense healthy lifestyle recommendations come into play. People tend to have fewer chronic medical conditions when they’re eating a healthier diet, exercising, and [more when they’re] exhibiting behaviors that result in wear and tear on your body—smoking, heavy drinking, eating a diet of processed foods, being sedentary. That is never going to be good for your fertility. And while we may not have a direct way to say that these are the behaviors that decrease your egg count by this additional percentage, these behaviors are thought to not promote reproductive longevity.
There is also evidence for certain amounts of stress at the cellular level, in the egg, that we don’t understand necessarily what makes it better or worse. But we do know the rationale behind why so many people will take CoQ10, because that is thought to better support the mitochondria of the egg. There is good data to suggest that supplement does seem to correlate with better outcomes.
On what to be skeptical of
Supplements are the most talked about and they get so much airtime, yet the data on them is awful. It’s super biased and cherry-picked from tiny studies. People are spending thousands and thousands of dollars, and it’s not without harm because of how they could interact with other medications. Similar to appealing to weight loss, there is lots of oversimplistic, magical thinking. In life, we all want the easy quick fix, especially in a situation where we feel like time is running out. Often, these are like promises that are too good to be true, but it’s very easy to manipulate women who are trying to conceive because they are by definition a vulnerable population.
There are also experimental, add-on [fertility] treatments that get advertised online like, for example, ovarian PRP, which is this idea of injecting growth factors into the ovary and trying to regenerate eggs. I don’t disagree that we should be studying novel treatments and trying to come up with ways to help mitigate the biological clock, but the problem is this is being marketed as proven when there are no actual large-scale, randomized controlled trials. Now with social media, it’s worse because there is direct-to-consumer marketing based on false pretenses.
On GLP-1s and fertility
Sometimes all those lifestyle measures we talked about are not enough because of how you’re metabolically wired. There are a lot of people that could benefit from weight loss and treating insulin resistance. It’s a vicious cycle where it’s even harder to lose weight when you have more adipose around your midsection, which is a hallmark of insulin resistance. So sometimes we use medications on top of all the lifestyle measures to be more effective, especially when you think about how time-sensitive fertility is. You don’t want to tell someone to take a year or two and go lose weight; sometimes it’s better to have an accelerated path.
Insulin resistance is extremely common in a high proportion of patients with polycystic ovary syndrome [recently renamed PMOS], which is the case for about one-third of my patients, where they just don’t ovulate regularly. It’s also being set up for insulin resistance and being metabolically wired in such a way where it’s not as healthy of an environment for those eggs to mature in. And so it can affect egg quality; it can also affect how receptive the uterine lining is to an implanting embryo. And so I tackle insulin resistance aggressively when I find it in patients.
You generally want to be off of GLP-1s for at least two months prior to getting pregnant to wash them out of your system. So I see them work really well for women who are trying to get pregnant with IVF because they can continue the GLP-1 up until the egg retrieval, optimize the ovarian environment, get better eggs, and maybe improve outcomes in terms of their yield from that cycle. And then we can keep them off of it and have these embryos frozen [and] move forward swiftly as soon you’re out of that washout period. I usually stop it at least a week or two before the egg retrieval because of anesthesia risk, but you can be on it pretty close to that time and then just stay off of it if you’re going straight into a transfer after.
On the best lessons she’s taken into motherhood
Whether you’re thinking about just trying to get pregnant, there’s a lack of control. As a patient who went through fertility treatment myself, it’s very eye-opening and gives me even greater compassion for what people go through. There is this overestimation of what science can control and help you achieve, and I see that all the time with my patients. And compartmentalization is huge, making sure you’re [aware of] the mental toll that some of these things can take on you. Just be flexible and be ready to adjust your mindset. Just learn to embrace the fact that you can’t control everything, there are going to be unknowns, and you have to roll with it.
Being sans gallbladder. Did you know that it is very common to encounter gallbladder issues postpartum? I did not, and unfortunately had to get rid of mine this past week. As scared as I was about anesthesia and recovery—shout-out to my mother-in-law for coming into town to help with the kids—I am already feeling much better.
Like we said, PCOS has a new name, and the health ramifications are myriad.
I’ve finally found a milk suppressor tea that actually tastes good. Plus, after you add a little milk, it’s a lovely lilac color.
Maybe it’s a placebo (or the calming effects of amino acid power couple GABA and L-theanin) but the Olly Goodbye Stress Gummies really get the vibes right. Woosah.
“As I was headed out the door to a baseball game, I couldn’t find my keys. I soon realized I had left them in the stroller in the trunk of my locked car. As I researched and called locksmiths, Cole peed his onesie (and on me) and then was screaming in his carseat. One change of clothes and an astronomical bill later, I freed my keys and we still made it inside the stadium for first pitch. Oh, and did I mention it was Mother’s Day?” —JM
