Episode 116 Dr. Drew Tortoriello Demystifying IUI: What You Need to Know

Episode 116 Dr. Drew Tortoriello Demystifying IUI: What You Need to Know

In this episode of Dismantling You, I sit down with Dr. Drew Tortoriello, Medical Director at Sher Fertility, to demystify one of the most misunderstood options in reproductive medicine: intrauterine insemination (IUI). We dig into why IUI is often the right first step for couples facing unexplained infertility, how a thoughtful, non-aggressive approach can lead to better outcomes, and why knowing your numbers matters long before you ever think you'll need a fertility specialist. Dr. Tortoriello brings both deep clinical expertise and a refreshing honesty about the limits of medicine, reminding us that even the best science cannot guarantee outcomes.We also explore what proactive reproductive health really looks like in your 20s and 30s, the role of egg freezing as a hedge against future infertility, and why stress alone does not cause infertility (despite what the headlines say). Dr. Tortoriello shares his perspective on the emotional grieving process so many couples experience, the importance of patient education, and what genuine self-care looks like for a physician at the top of his field. Whether you're actively trying to conceive, planning ahead, or simply curious about what reproductive endocrinology really involves, this conversation will give you a clearer, calmer framework for understanding your options. Key Highlights 🩺 From Maternal Fetal Medicine to Fertility: Dr. Tortoriello shares how a residency rotation and personal family experiences pulled him into reproductive endocrinology, where he found both intellectual challenge and deep human meaning. 🔬 Routine Fertility Testing Explained: We walk through the standard workup every couple should expect, from hormone panels to imaging, and why getting answers early is itself a form of relief. 💡 When IUI Is the Right Move: Roughly 20% of couples have unexplained infertility, and Dr. Tortoriello explains why this group often responds beautifully to intrauterine insemination before escalating to IVF. 🥚 The Case for Proactive Egg Freezing: More young women are using fertility preservation as a hedge against future challenges. We discuss the science, the timing, and how this choice is reshaping reproductive planning. 🧘 Stress and Fertility: Separating Myth from Truth: Dr. Tortoriello pushes back on the popular narrative that stress directly causes infertility, while acknowledging the very real emotional weight couples carry through the process. 💞 The Grieving Process Most Couples Don't Talk About: Trying to conceive without success is a form of anticipatory grief. We discuss why naming it helps couples feel less alone and more equipped to move forward. 🌱 Hard Work, Good Research, and the Next Generation: Progress in fertility medicine doesn't come from shortcuts. Dr. Tortoriello reflects on mentorship, research discipline, and the steady work of teaching the next wave of physicians. Resources & Next Steps 🏥 Sher Fertility-helping patients all over the world. (where Dr. Drew Tortoriello serves as Medical Director) 👤 Follow Dr. Drew Tortortiello at Sher Fertility New York @sherfertilityny on Instagram and his work in reproductive endocrinology 🎧 Subscribe to Dismantling You on Apple Podcasts

Episode 115 Dr. Stephanie McNally: The Truth About Fertility, Perimenopause, and Menopause

In this episode of Dismantling You, I sit down with Dr. Stephanie McNally, a women's health physician affiliated with the Katz Institute for Women's Health at Northwell Health. We pull back the curtain on the parts of women's health that so often go unspoken: fertility, perimenopause, menopause, and the hormonal shifts that shape how we feel at every stage. Dr. McNally explains why so many women misread their own bodies, how the birth control pill can mask underlying hormonal patterns, and why regular cycles do not automatically mean everything is fine underneath. We also talk about the importance of listening to your body and getting curious instead of dismissing symptoms as just stress or aging.From there we go deep on hormone therapy and why the science has been so badly misunderstood for decades, including what newer research suggests about heart and cognitive protection when therapy starts at the right time. We unpack the truth about menopause weight gain and metabolism, why sleep should be treated as a vital sign, and how mood, anxiety, and hormones are far more connected than most of us were ever taught. Dr. McNally also speaks candidly about access to care, the cultural silence around women's health, and why she has had to unlearn parts of her own training along the way. It is an honest, myth busting conversation that will leave you better equipped to advocate for yourself and ask sharper questions at your next appointment. Key Highlights 🧬 Fertility and menopause are connected: Understanding one helps you understand the other, and your cycle is often telling you more than you realize .💊 What the pill can mask: Hormonal contraception can hide underlying patterns, so knowing your baseline hormonal needs before starting matters.🩺 Regular cycles are not the whole story: A predictable period does not guarantee everything is fine underneath. Women have to listen to the fuller picture their bodies give. ❤️ Hormone therapy, reframed: Decades of fear were built on misread data. Newer analysis points to cardiac and cognitive benefits when therapy starts at the right time in the right patient. ⚖️ The menopause belly and metabolism: Why weight changes happen, the role of insulin resistance, and why estrogen alone is not a magic fix 😴 Sleep as a vital sign: Vasomotor symptoms disrupt sleep, which cascades into fatigue and mood, so sleep deserves real clinical attention 🧠 Mood, anxiety, and hormones: You cannot cleanly separate mental health from hormonal change. Resources & Next Steps 📱 Dr. Stephanie McNally Instagram @stephtmcnallymd 🏥 Katz Institute for Women's Health at Northwell Health 🎧 Subscribe to Dismantling You on Apple Podcasts

Episode 114: Dr. Jennifer Kulp-Makarov Revolutionizing IVF for Women Over 40

In this episode of Dismantling You, I sit down with Dr. Jennifer Kulp-Makarov, a Board-Certified Reproductive Endocrinologist and founder of Fleura Fertility, trained at Johns Hopkins and Yale. We dig into how traditional fertility clinics often rely on a one size fits all approach to IVF, and why that can actually backfire for women with low AMH or those trying to conceive over 40. Dr. Jennifer shares the patient experience that changed everything for her: a woman who gave up on growing her family because she thought aggressive, high dose IVF was her only option. That moment became the catalyst for her to build a practice centered on personalized protocols and her signature Goldilocks approach to stimulation, finding the just right dose of medication rather than defaulting to the highest one. We also explore cutting edge fertility innovations including ovarian PRP, which is showing promise in improving markers like AMH and antifollicle count, and rapamycin, an emerging treatment that may help protect egg reserves and delay menopause. Dr. Jennifer breaks down how FSH dosing plays a critical role in egg competence and why monitoring it throughout the cycle, not just at baseline, makes a real difference. We talk about how fertility care is evolving to better support LGBTQ individuals through inclusive language and treatment design, and how AI could soon help standardize ultrasound data and embryo analysis. We wrap up with Dr. Jennifer's rapid fire answers on the most underrated factor in fertility, the biggest mistake patients make when choosing a clinic, and the one belief she had to dismantle in her own career. __________________________________________________ Key Highlights 💊 Dr. Jennifer developed a middle ground between high dose IVF and mini IVF called the Goldilocks approach. By adjusting medications through the cycle based on real time hormone levels, she optimizes egg growth without overwhelming the body. 🔬 For women over 40 or with low AMH, pushing more medication can actually cause eggs to stop growing altogether. Many patients labeled as poor responders simply needed a more nuanced, individualized approach rather than aggressive stimulation. 🩸 Ovarian PRP is showing improvements in AMH and antifollicle count, though large studies on pregnancy outcomes are still needed. Dr. Jennifer has seen clinical promise in her own patients, particularly those with low egg reserve. 💡 Early research suggests rapamycin may help protect egg reserves and delay menopause. A promising study also showed improved IVF outcomes for patients with endometriosis, though the data is still limited. 🧬 After 35, egg quality declines sharply, becoming more dramatic past 40. Dr. Jennifer monitors FSH levels throughout the cycle, not just at baseline, treating it like fertilizer that needs careful dosing. 🏳️‍🌈 Fertility care is moving beyond a heteronormative infertility model, and Dr. Jennifer emphasizes the importance of inclusive intake forms, vocabulary, and recognizing that LGBTQ patients may be perfectly fertile and seeking family building support rather than treatment for infertility. 🤖 AI shows promise in standardizing ultrasound measurements and analyzing embryo time lapse videos, reducing operator dependency, though the final clinical decisions should still rest with the reproductive endocrinologist. Bio Dr. Makarov is a fellowship-trained reproductive endocrinologist with training from Johns Hopkins Hospital and Yale University School of Medicine. With extensive experience treating complex cases including decreased ovarian reserve, recurrent pregnancy loss, and multiple failed IVF cycles, Dr. Makarov is committed to providing personalized, patient-centered care. She works closely with individuals, couples, and LGBTQ+ families, helping them achieve their dream of parenthood. Resources & Next Steps 🌐 Visit Fleura Fertility 📸 Follow Dr. Jenn Fertility on Instagram @drjennfertilityfriend, TikTok, and YouTube

Episode 113: Kelsey Bates On Helping Women Heal Chronic Illness and Medical Trauma

In this episode of Dismantling You, I sit down with Kelsey Bates, Licensed Mental Health Counselor and Founder of New York Women's CBT, to talk about the emotional weight of living with chronic illness. Kelsey shares how her own chronic illness shaped her decision to leave a 9 to 5 model and build a telehealth practice that meets women where they are. We dig into the difference between chronic pain and chronic illness, why so many women fall through the cracks of the medical system, and how stigma, racism, and cost combine to leave patients without a coordinated quarterback for their care.We also get into medical trauma and medical gaslighting, two terms Kelsey unpacks in a way that finally puts language to experiences so many women have lived through. Kelsey explains how repeated dismissals show up in the body (fight or flight, hypervigilance, freeze), and why third wave CBT approaches like ACT and DBT can succeed where traditional CBT often feels invalidating. We close with Kelsey's take on radical acceptance, the distress tolerance menu she gives every client, and the realistic version of self care that has nothing to do with facials and everything to do with PT and anti inflammatory food. __________________________________________________ Key Highlights 🩺 Chronic pain versus chronic illness: Kelsey draws a clear line between single injury chronic pain and the ongoing, no cure reality of chronic illness, and explains why each needs a different therapeutic approach. 🏥 Why women fall through the system: We discuss the missing quarterback in care, the cost barrier of private pay specialists, and medical racism including the myth that Black women have a higher pain tolerance. 💔 Defining medical trauma and medical gaslighting: Medical trauma is repeated, invasive pain you cannot escape. Gaslighting can be overt (you look fine) or covert (is it really that bad), and both erode patient trust in their own bodies. 🧠 How trauma shows up in the body: Kelsey explains the amygdala on overdrive, hypervigilance versus hyperarousal, and why patients can present as frozen and shut down or panicked and pacing in appointments. 🌱 Why third wave CBT works for chronic illness: Traditional CBT frames trauma responses as irrational thoughts. Kelsey uses the stuck point language from Cognitive Processing Therapy plus ACT and DBT tools to honor what patients have actually lived through. 🕊️ Radical acceptance is not giving up: Acceptance is acknowledging today's reality while still tracking the committed actions (PT, meds, stretches) that build long term stability. It is a journey, not an on off switch. 📋 The distress tolerance menu on the fridge: Kelsey has clients map out low, medium, and high pain day tools when they feel most stable, then post the list at home so partners and family know exactly how to help. 🤝 Loved ones want to help and need a script: Spouses and parents often freeze because they do not know what to do. Clear, concrete asks turn that helplessness into real partnership during flares. 👶 Chronic illness, IVF, and medical burnout: Living with conditions like endometriosis adds layers of fear about fertility, parenting, and overwhelm from stacked appointments. Self compassion and pacing are essential. __________________________________________________ Resources & Next Steps 🌐 New York Women's CBT website 📸 Follow Kelsey Bates and New York Women's CBT on Instagram & YouTube  @womenscbt  [https://studio.youtube.com/channel/UCrLbf-0mgtRCAmOgXxUULRA] 🎧 Subscribe to Dismantling You on Apple Podcasts

Episode 112: Dr. Randi Goldman The Truth About IVF, Egg Freezing, and Fertility

In this episode of Dismantling You, I sit down with Dr. Randi Goldman, a fertility specialist, to have an honest conversation about what the fertility world actually looks like today. We dig into the realities of IVF success rates, why one cycle does not equal one baby, and how age remains the single most important factor in fertility outcomes. Dr. Goldman shares what she wishes more patients knew before walking through her doors, from the importance of early education to the limitations of egg freezing as a backup plan. We also explore endometriosis and its often silent impact on fertility, the difference between ovarian reserve and egg quality, and why so many people are caught off guard by their own biology. Dr. Goldman breaks down the role of lifestyle factors like nutrition, sleep, stress, and environmental toxins, and explains what patients can actually control in a process that often feels completely out of their hands. This is one of those conversations that cuts through the noise and gives you clarity you can act on. __________________________________________________ Key Highlights 🔬 The Biggest IVF Misconception: Dr. Goldman explains why one IVF cycle does not equal one baby and how success rates are often misunderstood by patients starting their fertility journey. 🥚 Egg Freezing Reality Check: Egg freezing was likely "over-promised" for years. Dr. Goldman discusses who it actually benefits and why it is not a guaranteed insurance policy for future fertility. 🩺 Endometriosis and Infertility: Many patients do not realize endometriosis can silently affect fertility. Early diagnosis and treatment can make a significant difference in outcomes. 📊 Ovarian Reserve vs. Egg Quality: The number of eggs you have is not the same as the quality of those eggs. Dr. Goldman breaks down what testing can and cannot tell you about your fertility potential. 🥗 Lifestyle Factors That Actually Matter: From nutrition and sleep to stress management and environmental toxins, Dr. Goldman shares what patients can control in a process that often feels uncontrollable. ⏰ The Power of Early Education: Dr. Goldman emphasizes that knowing your options sooner can change everything. Many patients say they wish they had started the conversation years earlier. 💡 Embryo vs. Egg Freezing: There is a meaningful difference between freezing embryos and freezing eggs, and the right choice depends on your life circumstances and timeline. __________________________________________________ Resources & Next Steps: 👩‍⚕️ Follow Dr. Randi Goldman on Instagram @randihgoldman_fertilityddoc and LinkedIn for fertility education and updates Bio: Dr. Randi Goldman is a reproductive health and infertility specialist at Northwell Fertility and the Program Director for their Reproductive Endocrinology and Infertility fellowship program. She is an Associate Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and is the Chairperson for the Patient Experience Committee for Northwell Health Physician Partners.   Dr. Goldman’s clinical and research interests span a broad range of reproductive health topics, including endometriosis, Oncofertility, fertility preservation and treatment outcomes, and patient experience. She has authored more than 40 peer-reviewed publications, and her research on oocyte cryopreservation has been featured in The New York Times, The Washington Post, Boston Magazine, and TODAY, among others, and has been translated into a web application by MDCalc.Dr. Goldman completed her residency training in Obstetrics and Gynecology at Brigham and Women's Hospital/Massachusetts General Hospital and Harvard Medical School in 2015, and her fellowship in REI at Brigham and Women's Hospital and Harvard Medical School in 2018.