Let’s Talk About Infertility, Part One
Welcome to Centra Scripts. Here we talk about health, wellness, and practical tips for your everyday life. I'm your host Cami Smith. Thank you for joining us today for a new episode, as well as a new season of Centra Scripts. I am your new host, Cami Smith, and each month here at Centra Health, we focus on bringing awareness to areas that impact our community from a health system perspective.
For the month of April, one of the areas that we will be focusing on and supporting is infertility. I have on the line, Dr. Christopher Williams, fertility specialist, and medical director of Virginia Fertility and IVF, and assistant professor and OB-GYN at the University of Virginia Health.
Thank you so much, Dr. Williams for being here with me today.
Dr. Christopher Williams: Yeah. A pleasure to be here.
Cami Smith: You are an expert in this area and you have come alongside so many women who have walked through this as a fertility specialist. First, tell me a little bit about yourself and how you got into this profession.
Dr. Christopher Williams: Yeah. I was a medical student at the University of Virginia, and I did a month acting internship with the fertility specialist that was there. He's since retired now, but he was starting one of the first initial fertilization programs on the east coast. And he just was doing amazing things that I thought was really exciting. And also we did a lot of surgery back then too to try to help six blocked tubes and other problems. And he did a lot of that as well. And he really inspired me to want to go into the fertility field. So I ended up going down to the University of North Carolina in Chapel Hill and did my training down there and came back to the University of Virginia in 2001, I was on faculty there for about five years and then now I private practice with Virginia Fertility and IVF, but also I do some teaching for the residents and medical students at the University of Virginia as well.
Cami Smith: So this has been a part of your professional career for a very long time. So I'm really thankful that we get to have you speak into this topic and bring some awareness because there are so many women, so many couples who are walking through this, how does a woman or a couple come to an infertility diagnosis?
Dr. Christopher Williams: There's a couple of different ways to look at this. If you're over 35, your attempts to concede for six months or more makes you have the diagnosis of infertility if you have not had success. If you're under 35, we say a year of trying gives you the diagnosis of infertility. But I do want to clarify that if you have, for instance, very irregular cycles or some other medical problem that is underlying that may cause problems with infertility, I tell those patients or couples they should come and see us immediately. They certainly don't need to wait a year if they're under 35 and their cycles are very irregular because they probably need to have some help up front. So they don't have to wait six months or a year, they can come at any time to see a fertility specialist.
Cami Smith: Okay. So it's a little bit more fluid?
Dr. Christopher Williams: That's right. Yeah. A lot of patients will start with their OB-GYN locally and begin an evaluation there. And if it's something that's more complicated than the OB-GYN can deal with, then they'll send them on us. But you can also go directly to a fertility specialist. It's completely up to couples.
Cami Smith: Okay. What would you say are those first steps for them? And then also, what are some of the causes or testing options available to them?
Dr. Christopher Williams: It's a couple's problems. So we're going to be looking at both the male partner and the female partner. So that's the first thing to point out is I always want to see both male and the female together. Although we certainly have same-sex couples that come to see us as well. The starting place for most couples is testing for each side. So a semen analysis for the male partner is usually the first test because almost 40% of the time, this is a sperm issue. We don't want to focus this on the female partner, we want to make sure that we're looking at both.
So a semen analysis is a great place to start. And then when we've focused on the female partner in terms of testing, then a physical exam to take a look and see if there's anything that we see on the exam, and certainly taking a history to try to understand what the menstrual cycles are like or any other medical issues that might be contributing to fertility problems. Some basic blood work is always done. So we want to make sure that some of the hormones are normal.
Dr. Christopher Williams: The thyroid is working well. The hormone prolactin is not elevated, which can because problems. We look at how the ovaries are functioning and the other test that's very common, has a terribly long name. It's called a Hysterosalpingogram. And that's a really old-fashioned test. And that test looks at how the inside of the uterine cavity looks and whether or not the fallopian tubes are open. It's a very simple test. It's been the same test for 40 or 50 years. Most people tolerate it very well.
Cami Smith: Yeah.
Dr. Christopher Williams: And it's just putting a little dime to the uterus and the fallopian tubes to make sure that everything is healthy and open. So those are the basic starting tests that we do for couples.
Cami Smith: Okay. So how would you suggest a woman or a couple prepare for that first initial visit? So those are the things they're going to experience. If you could speak to someone as they're prepping to come in for that day one visit, what advice would you give them?
Dr. Christopher Williams: These days there's so many ways to keep track of cycles there're apps, ovulation prediction kits. So I think it's wonderful for patients to download an app, pay attention to their cycles, purchase an over-the-counter ovulation prediction kit, which is just a urine test and start understanding their cycles. Because a lot of times this has to do with ovulation. And so getting a good three months or six months worth of information about what their cycles look like, turns out to be very helpful for us. So that's one thing that can be done.
Cami Smith: So sometimes I would assume when a couple comes in, they're probably very informed with their body and what they've been experienced up to that moment to discuss those things.
Dr. Christopher Williams: You know, most of what goes on with infertility is silent. So it's not something anybody's going to notice. Now there're situations where the cycles are irregular. Well, that's frequently the reason if your cycles are irregular, it means you're not ovulating regularly. And if you're not ovulating regularly, there's not an egg out there consistently. So you know how to time intercourse. So that would be an obvious thing, but most people if they have obstruction in their tubes, it's something they wouldn't feel. If a man has a low sperm count, there's nothing that we can learn from talking to him or even examining him to know whether or not he's going to have a normal semen analysis. So a lot of tests are required before we understand what's going on. And that's probably good takeaway for couples as we're listening to this podcast is that we kind of have to throw the net out there and see what we learn from both sides to understand what's going on. But the good news is almost everything that's a problem we have a solution for these days. So sometimes when couples come to see me, we do all the testing and we find out it's a low sperm count.
Well, we have a wonderful fertility urologist who comes to our office here to see the male partners to evaluate why the count is low and see what can be done to try to improve that. That takes you in a totally different direction. And for instance, if there's a blocked fallopian tube, that's a whole different direction. So it really just depends on what we find, but in general, once we've done all the testing, I have couples come back and we regroup in my office and we talk about what we've learned. And then we make a treatment plan at that visit about, well, where are we going to go from here? What options do we have?
Cami Smith: Okay. What are some natural treatments or maybe some lifestyle changes? Are those even really viable options for people?
Dr. Christopher Williams: Well, again, keep in mind that it just depends on what the problem is. So if you have a low sperm count, sometimes there are lifestyle changes. For instance, tobacco use is a very strong predictor of poor sperm quality. So stopping smoking, for instance, marijuana use can dramatically improves sperm quality. So that's lifestyle changes that would be super important. Females that smoke have a 40% lower pregnancy rate per cycle. So again, we would strongly encourage people to change that. Polycystic ovary syndrome is the single most common thing that I see and it leads to irregular cycles.
And almost all of the patient with polycystic syndrome, or at least I should say three-quarters of them is a weight-related issue just like diabetes is. And as weight goes up, the cycles get more irregular and as weight comes down, the cycles get more regular. And so things like weight loss can be very helpful in terms of getting them to cycle more regularly and ovulate more regularly. And they can definitely offer some benefits without being treated by the doctor. But then there're other things if you have obstructed loping tubes, for instance, there's nothing natural that can be done to fix that. You got to involve your doctor in order to fix that one.
Cami Smith: I see. So that's a good message in and out of itself, that it's very important to have these conversations with your doctor before you do try even some natural treatment options to make sure that it is going to be something that is so specifically geared to what your body is experience seeing.
Dr. Christopher Williams: Yeah. That's a great takeaway. We always talk about all the different options and this is something that couples can then choose what they'd like to do and then go forward on their timetable.
Cami Smith: Yeah. What would you say have been some of the most common misconceptions around infertility?
Dr. Christopher Williams: I think people assume when they come to see a fertility specialist that we're going to need to do something really fancy, we're going to have to take them to in vitro fertilization or surgery or what have you. But I would say probably 80% of what we do is just much simpler. It's ovulation induction medications, old-fashioned drugs like Clomid or another medicine called Letrozole. And these are $10 at Walmart pharmacy. These are cheap old-fashioned drugs to try to get the cycles more regular. So again, polycystic artery syndrome is the most common reason. We see people and they have irregular cycles and we need to get their cycles more regular. And these simple oral medications, low cost, easy ones are often all they need to get to success. So a lot of times it's not that complicated. Now, that's not certainly all the time and that doesn't always work, but it usually does. So it's interesting to see what the problem is and then talk about potential solutions. But oftentimes, we're starting with simple things.
Cami Smith: Okay. With all of that said, what would be that one general message you would want to relay?
Dr. Christopher Williams: You know, I think just in the 2020 something years that I've been doing this, one of the things that's wonderful and relates to this podcast is that people are much more willing to come and meet with the fertility specialist or the OB-GYN. There isn't as much of a stigma anymore to fertility problems. I think people are much more open to talk about it with friends and family, and they're willing to come and see the fertility doctor and men used to be a little shy about semen analyses and what have you that doesn't seem to be the case anymore. So I would just continue to promote that.
And it's just a wonderful thing to come and sit down with the fertility doctor, just do some basic testing and understand where the issue's coming from, because we should be able to fix it in most cases and get these couples to their goal of starting their family or expanding their family.
Cami Smith: Yeah. You know, I find it so interesting. You get to be a part of, yes, a difficult journey, but also in a lot of cases, a really rewarding journey for couples. Where have you seen that played out? Do you stay in contact with any of these couples? What does that relationship look like long-term for you?
Dr. Christopher Williams: Well, it's a wonderful niche. I feel very blessed and honored to be able to do what I do because we get to help people have kids, truly it's life-changing.
And it's not uncommon that people will come back after they've had their baby. Every week I get a letter from somebody with a picture enclosed with a thank you, and what have you. But sometimes they'll come by the office too, so we can see them and get a picture with them. And it's super rewarding, and you're right, it's emotionally difficult. There's a lot of ups and downs with fertility care and every month is not a successful month and it can take a while to get to success. And so that's the hard part, is part of what I do. And I've got a wonderful warm staff here, part of what they do is we're just trying to keep everybody up long enough so we get them to the finish line here.
So there's a lot of positivity, there's a lot of hugs and jokes. And what have you that go on the office just to keep everybody's spirits up until they get to the finish line. Because when they come in, they're pretty unhappy. You know, it's a stressful thing, it's a disappointing thing. And so we do a lot of that as well. And we've got a nice counselor group that works with us as well for support. And there's also a good group in Lynchburg. I'll put a plug-in for them, the Motherhood Collective, you can Google Motherhood Collective, and there's good support there locally in the Lynchburg area as well.
Cami Smith: It has to be an honor to be invited into these moments with these couples and with these women. And thank you for being here with me today. I appreciate you taking your time out.
Dr. Christopher Williams: Well, it was a real pleasure. Thank you for having me.
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Cami Smith: Absolutely. We're going to transition a little bit here. I am here with Erin Baird, who is a midwife here at Central Health. And Erin, tell us a little bit about yourself.
Erin Baird: Thanks, Cami. I am a certified nurse-midwife and have been so for about 15 years. I have lived in Lynchburg for the last 11. I am the medical director of women's and children's services for Centra. And I work at the central medical group for Women's Center and at Southside Community Hospital birth center.
Cami Smith: So much, that is wonderful. So how did you step into being a midwife?
Erin Baird: It was quite by accident. I actually was intending to be an equine veterinarian.
Cami Smith: That's a little different.
Erin Baird: Yes. And I wasn't quite ready for college when I started. So I took some time off and decided to become a nurse and then had one of those epiphany moments in my clinicals as a nurse and saw a birth and time stood still. And like, you could see the dust moats and I said, I want to do this for the rest of my life. And that's what I've done.
Cami Smith: Wow. You know, it's interesting. I took time off after I graduated high school and did not end up in school to be a nurse. That's a very ambitious thing to do when taking time off. So I commend you.
Erin Baird: Well, at the time I thought, oh, I'll just go become a nurse. It will be easy. Let me make sure that was not the case. That was not how that worked out at all.
Cami Smith: But here you are, the stars have aligned and it led you exactly to where you're supposed to be, which is wonderful.
So we are going to be talking today about infertility and the journey that that looks like for women, because I think instead of just seeing a diagnosis on a piece of paper that a lot of people don't understand and they don't know what to do next. I would love to give this, not bird's eye view, but down a little bit more granular as they're walking through it, what can they expect? How would you lead them, guide them, as they're anticipating this journey that they're coming up on. So, first thing we're going to talk about is, as a woman is seeing that, okay, I have this plan for my family. I want to have children, we're ready. And then things are not happening. It's not coming to fruition. How would you advise them out to their first step if they're maybe wondering, am I dealing with infertility here or do I just need to be patient? How would you advise them?
Erin Baird: So the first thing is to make sure you have your information ready, because the diagnosis of infertility is for someone under the age of 35 that they've been trying to conceive for a year and have not been able to. And so that's on paper.
That's a very clinical diagnosis. So when women come to see me with this question of if a problem, or do I not have a problem, the thing that I want them to have with them is their menstrual cycle history for the last year. I love the fact that we have technology now, we have all these free apps you can download.
Cami Smith: Yes.
Erin Baird: And they help work you through. You don't have to think about anything. It's fantastic. I need that. I need to know about frequency of intercourse. I need to know about their partners sexual history to some extent and their medical history and any substances that they take. And then I need to sit down with them and we just need to do a deep-dive into the data.
Cami Smith: Okay.
Erin Baird: Because many times women come in and don't necessarily understand fertility.
Cami Smith: Yeah.
Erin Baird: They don't necessarily understand the menstrual cycle and when fertility is the most optimal portion of that and sitting down with someone and just dissecting that can take time.
Cami Smith: Yeah.
Erin Baird: But sometimes when you do that, you realize there is a problem, it's a matter of timing or opportunity, or their husband travels six months out of the year and things like that. But sometimes there is a problem and that's when we can figure out initial steps for diagnosis.
Cami Smith: Okay. So would you suggest a woman or a couple to come in when they're first saying or having that thought of, okay, it's time. Let's go ahead and start trying to have a family so that they can maybe get all those ducks in a row on the front end.
Erin Baird: I absolutely love preconception meetings. I think that having the opportunity to sit down with a couple as a women's health provider before they start the journey, before they stop the birth control, is a great opportunity to talk about getting as healthy as possible and about all the nutrition and vitamins and things that they can and shouldn't be doing that will optimize their fertility and getting a chance to explain that because we all want a family life.
Cami Smith: Yes.
Erin Baird: We all blocked family life out also. So now very few people who don't work in this business can really talk about the menstrual cycle.
Cami Smith: Yes. Yes. It's almost taboo. Now, I think we're coming into a season just in our world where it's becoming a little less to taboo, which I think is wonderful because it's opening doors for people, but even so, let's talk about the couple who has been trying. They have their data, they sit down, what does that conversation look like?
Erin Baird: Well, I think it needs to have time. First of all, this is not a five-minute visit and sometimes it's not just one visit, but the first visit is a lot of unpacking the information that they've brought and where they are emotionally in the process.
Cami Smith: Okay.
Erin Baird: All right. Because generally speaking, when a couple decides that they're going to conceive and that they would like to start their family, they would like it to happen round one.
Cami Smith: Yes.
Erin Baird: Round two is maybe acceptable when it's been months and they've been trying and that day when she sits down and there's blood. Every time that happens, it's just more amplified and devastating. So usually by the time we see a patient, they are in a state of emotional distress or depression. It's not going to happen. I'm broken, there's something wrong with me, and you need to address that too in that meeting.
Cami Smith: Yeah.
Erin Baird: You need to have time to talk about how are you feeling about this? And so when we sit down, I let them tell their story. I take lots of notes and I want to hear about what have they been doing? Have they been tracking? Have they been doing temperatures? Have they been doing ovulation predictor kits? Things like that. I want to talk about their medical histories, both them and their partner. And then I take it all in and I tell them that we're going to... I'm going to get all your data first and then let's talk. And then I want to understand emotionally where they are in the process.
And because I'm a midwife and I'm not Dr. Williams and a fertility specialist, I think it's important to know with your patients where they are and whether or not I should be their person.
Cami Smith: Yes, yeah.
Erin Baird: Yeah. So one of the questions I ask them is how upset and how emotionally devastated are you that you don't have a baby in your arms already, or one on the way? Are you in the process of this is okay, it takes time. I'd rather stay here and try a few things before I go north and see Dr. Williams and his group, or are you, I need a baby six months ago? Because that guides what we do next.
Erin Baird: Because at this point, they're so emotionally tangled in this then perhaps starting with me is not the best thing. Then perhaps immediately going up to the specialist is the best thing.
And let's just let everything go there. But if they're still in that phase of I wouldn't mind just trying a few things here. We're doing really well. We understand that it's going to happen or it's not and things like that, then I'm happy to start the workup.
Cami Smith: Okay.
Erin Baird: And start trying to tweak things.
Cami Smith: Okay.
Erin Baird: But I really think, and I tell them, they have to be honest with themselves and they have to be honest as a couple. Right? Because they need to be on the same page for this. Because if she's not sharing perhaps that this has been devastating and this is encompassing everything in her life or the same thing for him.
Cami Smith: Yeah.
Erin Baird: We need to get that on the table and that needs to be out.
Cami Smith: Yeah. And I think that can be maybe the hardest part is that ruthless honesty that you really have to have at this starting point, but it's so vital.
Erin Baird: Yes, and I try and explain to them that just going to see the fertility specialist does not equate inter IVF. They're not the same thing. Right. So there's so many different levels, but sometimes you need the next level of expertise.
Cami Smith: Okay. So let's say that they're in a good place and they're wanting to see what they can possibly do maybe some like natural options. And they choose to stay here in Lynchburg and work with you. What does that look like?
Erin Baird: Well, normally we do a little bit of an assessment of their diet and their exercise, and their overall health.
Cami Smith: Okay.
Erin Baird: You know, if you have a woman who is overweight or obese, which is an epidemic we have, if you have that, then that's something we do talk about with weight loss, because weight loss does increase fertility. If you have a partner that smokes or you smoke yourself, if you consume large quantities of alcohol or any alcohol, frankly, and if you participate in the use of my marijuana, which affects fertility also, we start working on bringing us back to a center of health.
Cami Smith: Okay.
Erin Baird: Also, I do, like I said, I have a very detailed conversation about their menstrual cycle and when fertility is most optimal and things that they can both do. A good example is if they're using certain lubricants for intercourse, some of them are not good for sperm. And so you got to think about things that you wouldn't necessarily put in the package of fertility.
Cami Smith: Yes. It's a different view. It's a different pair of glasses that you have to put on.
Erin Baird: And so we do some of that. And then I also do blood work and other evaluations. We do some medical things just to say, look, you are ovulating. And look, we do a semen analysis on the partner. Look, he has all of the right things. He has right quantities and they are mobile and they're shaped right. So you guys have all the good building blocks. And then we can talk about moving into more aggressive things like medications. But generally, for the beginning, it's talking about, let's see, are you in a place where you're optimally healthy to conceive?
Cami Smith: Yeah.
Erin Baird: Is your partner in that same place?
Cami Smith: Mm-hmm (affirmative). Both mentally and physically. Yes.
Erin Baird: Yeah. Yes. Because I mean, people who know me know that I make a lot of analogies. I'm an analogy person.
Cami Smith: I am too, very visual. I love that.
Erin Baird: So I remind people that we are mammals underneath all of it. And a lot of it mammals don't breed in captivity and stress. And so when you just moved and you've just started a graduate program and your husband's going to be deployed in three months, these are not optimal times to conceive. And it's so hard for women who knows someone who accidentally conceived. And there's so many stories of how easy it is for some people, but for the rest of us, perhaps it's not.
And so understanding that you have to be in a good place, sometimes that's all it needs.
Cami Smith: Yeah.
Erin Baird: You know, there are stories of women who went through fertility treatments and everything, and they adopt a baby and get pregnant.
Cami Smith: Oh gosh.
Erin Baird: Just the relaxation of like, I have a baby and everything's okay. So there is some of that. There is some psychological component, but that's not always a controllable factor.
Cami Smith: Yeah. So I love that there is this option close to home. If you here living in Lynchburg or the greater Lynchburg area, and I think that's a misconception. I think that most women think like, oh, I need a fertility specialist. I need to go to UVA immediately. So now looking at that's not the only option, what other misconceptions have you met up with as you've met with different couples over the years?
Erin Baird: I think that one of the most common one is that it's just a female problem. The women always come in and they've convinced themselves that it's them. And so I think that's a complete misconception.
Cami Smith: Yeah.
Erin Baird: And I'm not sure what statistics Dr. Williams quoted, but it's about 40% women and 40% men and then 20% that we don't know. And so that's how I explained it to them.
Cami Smith: I started to do the math in my head. I was like, wait a minute. Yeah.
Erin Baird: Yeah, this needs to add to a 100. So yeah. And I try to explain that it's not just us, we're equally complicated. And sometimes somewhat for different reasons too. You know, I try and explain to women you were born with your fertility to some extent and men make their fertility over and over again. And that just changes the approach of what you can fix and what you can't.
I also think that there's a misconception for women that if they don't conceive within six months, that there's a problem. And I try to remind them that under the ideal circumstances, if you take two perfectly healthy people, there is still a little bit of magic involved.
Cami Smith: Yeah.
Erin Baird: And I try and explain to them with all of my analogies, what her body has designed itself to do so that only the healthiest sperm make it to the egg.
And that we are designed to make this difficult.
Cami Smith: Yeah.
Erin Baird: And so that they come in, and they've been trying for three or four months and they're convinced there's a problem. And I say, you know what? No. As of right now, there's no problem.
Erin Baird: There's none, but let's still do the analysis. Let's still deep-dive into your data. Let's talk about what's going on and then come back and see me if nothing's happened in six months. Now, this is for people under 35. Now, once you hit 35, you have graciously obtained the diagnosis of advanced maternal age.
Cami Smith: Oh goodness.
Erin Baird: Which I had a few children above that.
Cami Smith: Okay. So I think that is another misconception.
Erin Baird: As soon as you hit 35, your fertility is completely gone.
Cami Smith: Yes. Like my chances are over, the ship of sailed.
Erin Baird: Yes, nothing. No, I had three of my kids over the age of 35.
Cami Smith: That's beautiful. Yeah.
Erin Baird: And they're all as fine as children can be. So I think that they think that if they don't get all of their children out by the time they're 34, that they're doomed.
Cami Smith: Yeah.
Erin Baird: But when you are over 35, that window of how long until we get involved, narrows down to six months. So if you've been trying and it's been six months and you haven't successfully conceived, then it's time to see someone.
Cami Smith: Yeah.
Erin Baird: And it may be just a conversation. It may just be a dive into the fact of those six months your husband works for a refund and has been gone for three of them.
Yeah. And so, well, that's three months, you know? So I think that's also a misconception is that advanced maternal age is the kiss of doom for everyone.
Cami Smith: Yeah. Okay. So as we're coming here to the end of our time, if you could say anything, if you could relay any message to a couple, to a woman, or even to a man who is seeing his wife walk through this, and he is like, what do I do? How would you advise them? What message would you want to give them?
Erin Baird: All hope is not lost. Let's start there. And that this is so emotionally tangling. It's an interesting situation in medicine where this is something you think you have perfect control over. It could be a true medical condition that you will somehow manage to still blame yourself for.
Cami Smith: Yeah.
Erin Baird: Right? And we don't do that. We don't blame ourselves for breaking a leg when it just spontaneously happened.
Cami Smith: Yes.
Erin Baird: I have seasonal allergies. It's not my fault that I have seasonal allergies. I just don't like pollen.
Cami Smith: Yeah.
Erin Baird: And so I think, I would say, sit down, decide where you are emotionally, come in and see someone, make sure you have an appointment that has enough time. Make sure that when you make your appointment, you say you want to talk about fertility. You want to have a fertility conversation.
Remember that our schedulers don't do medicine. So maybe tell the scheduler what's the longest appointment you have. We want that one.
Cami Smith: Yeah.
Erin Baird: And then bring in all the information.
Come together if possible, because that's great. That's wonderful. So that you can hear the message. The man can hear the message from the women's healthcare provider and the woman doesn't have to go back and try and repeat it all. Come in. It's okay to come in early.
Cami Smith: Yeah.
Erin Baird: It's okay to come in early if you're worried, just know that intervention may not be necessary yet.
And know that it's okay to start with us in town with all of the women's health providers in town, the midwives, the women's health nurse practitioners, some of our PA colleagues, and our wonderful OB-GYNs. It is absolutely okay to start with us and then we can help midwife you through and get you to where you need to be.
Cami Smith: Yeah.
Erin Baird: And then once you are pregnant, we will welcome you back with open arms. You already know your provider.
Cami Smith: Yeah.
Erin Baird: You know someone and you're coming back to your safe place.
Cami Smith: Oh, I have not even think about that. You already built a relationship.
Erin Baird: Yes, and nothing pleases me more than those first-trimester ultrasound reports from my fertility group in Charlottesville. It's a celebration. So if someone is coming back to me with a baby and then I am happy and willing and all of us are ready for you and we'll take care of you then.
Cami Smith: That is so wonderful. So it's just the icing on the cake.
Erin Baird: Yep.
Cami Smith: And then I'm sure they bring their babies back.
Erin Baird: That's the whole reason we're in this job, it's for squishy babies.
Cami Smith: Oh, I love it.
Erin Baird: I mean, nothing smells better than a fresh baby.
Cami Smith: Yes. It's so true. Well, thank you so much, Erin, for coming in and for talking through this and for the approach of the physical and the mental because I think that's so important.
Erin Baird: It was my pleasure.