Coronavirus & Fertility: Fact vs Fiction

Hi everyone! I’m here with Dr. Cindy Duke for an episode of the Egg Whisperer show and we’re going to talk all about coronavirus, fertility, and pregnancy.

There is a reason why I have Dr. Cindy Duke on the show. She is kind of a big deal. Not only is she a fertility expert, which means she went to school for a really long time to figure out how to make a baby, but she is also a virologist.

Dr. Cindy Duke:

Thank you. Yes, I have a Ph.D. in microbiology and immunology, which means I spent four years in addition to the four years of medical school. I completed an MD PhD program or what we call a physician-scientist training program. In my four years, I worked on developing vaccines for viruses. So for four full years, all I did was study the human immune response and how you can manipulate it using viruses and different viral vectors to create vaccines and immune responses for improving health and preventing infection.

Dr. Aimee:

I mean, some people might say a sperm cell is a form of a virus infection

(Laughter)

So how did fertility medicine connect to this field of study for you?

Dr. Cindy Duke:

For me, they actually went together naturally. First of all, microbiology and immunology really span the study of all things infectious and also how DNA gets into cells. And the whole crux of fertility is understanding how DNA comes together to form a human being.

Of course, viruses are some of the oldest particles on earth. If you believe in the theory of evolution, then you’ll know that viruses have been around even before human beings. They’ve played integral roles in dictating how our DNA and our chromosomes came together. For me that was natural. Also, you can use viruses for gene therapy and that’s essentially what a vaccine is. It’s gene therapy. You’re really manipulating genes, you’re changing genes and you’re introducing them into cells, new DNA, and RNA to code for what you’re looking for and it’s very much gene therapy. So to me, that match really came together.

Dr. Aimee:

Very cool. And so tell me about your practice. You’re in Las Vegas and an awesome fertility doctor. So if a patient wants to see you how do they do that?

Dr. Cindy Duke:

Well, Dr. Aimee, you know, I have to be honest here. You are one of my mentors and that watching and seeing you in practice motivated me that I could start my own practice.

In Las Vegas, I have a clinic called Nevada fertility Institute, which was founded back in 2016 and we are a full-service clinic. We treat men and women and those who are working on transitioning and we help people get pregnant, whether it be IVF, intrauterine insemination , or for those who are looking to freeze eggs or sperm.

Dr. Aimee:

I hear you talk about your mom a lot on social media. Does she watch you when you’re doing interviews?

Dr. Cindy Duke:

You know she does when she knows about it. Actually she’s watching right now. I see her watching.

My mom is pretty amazing. She is a single mother who raised two kids.

Dr. Aimee:

Yes. And tell us who that second kid is. You have quite a remarkable brother as well.

Dr. Cindy Duke:

Yes. I have a brother who’s really done well for himself as an actor. His name is Winston Duke. I think his most famous role so far was starring in the Black Panther movie.

Dr. Aimee:

I saw he was awarded Australian GQ actor of the year in 2019.

Dr. Cindy Duke:

Yes he did. He was actually supposed to go to Australia to receive that award and then the bushfire started so he couldn’t go. We’re very proud of him.

Dr. Aimee:

I would be proud of him too.

I’d like to switch gears and talk about Coronavirus now. I want people who are listening to us to learn a lot about the coronavirus and what it possibly means to them.

And so, I’m going to ask you questions and I hope I don’t embarrass you at all.

My first question is a bit personal, but I’m curious if you’ve suggested to your brother to freeze his sperm because of coronavirus.

Dr. Cindy Duke:

I did. Let me be honest. I told my brother to freeze it. I really went through what sperm and egg freezing was with him. So he’s now been telling his friends to freeze their eggs and freeze their sperm and he’s like my little fertility preservation champion of it.

Dr. Aimee:

I love it. And then what about embryos? Do you think people should be thinking about their fertility and preserving embryos as well if they’re in a, in a relationship, or even if they’re single?

Dr. Cindy Duke:

Yes, I think for both. I actually encourage people, if you have enough expertise for women to freeze eggs and embryos, the truth is you know, when we say embryo, we’re talking about a fertilized egg, meaning you have to use sperm.

If you have a partner and you’re creating embryos, that’s wonderful.

Yet we also have to be mindful of the fact that some relationships come to a close. And so if the relationship ends, the embryos may not be useable. That’s especially true for women who have a finite time in terms of their eggs.

I know you have the TUSHY method, etc. Similarly, I encourage my patients to strongly consider freezing embryos and eggs.

Dr. Aimee:

So news that was trending yesterday- and I couldn’t believe this- was farting out the virus.

I mean you hear these studies showing that even when your nasal swab is negative, you could be positive in your saliva and your poop.

What do you think?

Dr. Cindy Duke:

Yes, you can have it in poop. I really don’t know exactly how many viral particles will aerosolize and come out as part of a fart. But is it in poop? Absolutely. There’ve been multiple studies that show viral RNA particles in stool. And so that’s possible. And yes, you know, it might be extreme, but I think it at least awakens people into realizing that if you aren’t washing your hands properly after using the bathroom or after your children or your loved one who you’re caring for, you might end up transmitting the virus. So yes, I’m, I’m not sure that you’ll get enough particles, but the concept, I think it’s worth exploring for how fecal matter may transmit the disease.

Dr. Aimee:

Right? I mean, your pants are kind of like a mask for your butt and then you have a mask for your face too. So you know, when I go to get groceries and then I come home and I’m looking at that, that bag, I’m asking myself just knowing how you can get coronavirus and I see news reporters talking about how you got to wipe down that grocery bag. Can you tell us why that is?

Dr. Cindy Duke:

It’s because the viral particles can remain viable. Meaning it’s capable of being infectious for different timeframes. Depending on what surface it’s on. So for example, a plastic, it can survive in plastic, well up to 24 plus hours. And so if you have plastic bags of where groceries have been delivered in, for example, if you went and you purchase them, the recommendation is that when you arrive home, you get them out of the bag right away.

Groceries in fully sealed plastic or cans, you can wipe them down with a disinfecting wipe. But the big worry here is that some people may go overboard, right?

You don’t want to contaminate your food with what you’re cleaning it with. And I think that’s where I’ve started seeing some really scary stories out there. For example, people using bleach to their meats and so forth. Don’t do that. There really aren’t that many particles and there have been no reported cases so far of someone contracting the virus from their groceries. If we’re being honest, it’s a funny question, but there’s no report so far.

Dr. Aimee:

Okay. So let’s say here’s my coffee cup. I mean, how can I get coronavirus from this? Would it be like I’m snorting the cup?

Dr. Cindy Duke:

Yes, if you you hold your coffee, you know, clean your hands. I’ve been to the Starbucks drive-through during this pandemic and certainly, they’re using gloves there, but when you get it, you know, just exercise caution.

Certainly, they’re not putting their hands on the lids anymore to seal your cup, which is good. Just make sure it’s sealed when you receive it. Don’t hurt yourself, but you know, clean your hands, have an alcohol-based sanitizer in your car if it’s the drive-through.

You need thousands, actually millions of viral particles, to really induce a full-on infection to be perfectly honest. So practice hand hygiene and wear your mask when you go outdoors. Maintaining your distance as much as possible when you’re out and you know, use common sense.

Dr. Aimee:

Okay, cool, thank you. Let’s talk about immunity, vaccines, and antibodies. Will there ever be such a thing as immunity? I mean, you hear things like, “oh you’ll be immune if you get it.” But, I wonder if that’s actually true.

Dr. Cindy Duke:

You know, on the one hand, I have to say, I’m very heartened to hear everybody talk about immunity. The vaccine biologist in me is just excited that people are using the term immunity. The problem is that immunity can take on very different shapes depending on what is causing an infection. And so right now, we’re not sure if immunity for this particular Coronavirus known as SARS part two is lasting. And that’s because Coronaviruses have been around for a while. The most common one that we all know is the common cold. When you say you have a cold, for the most part, you’re probably sick with a coronavirus.

The common coronavirus (the common cold) and the reason why people can get that the common cold repeatedly over their lifetime is that the immunity isn’t lasting. Also, the virus mutates over time. The immunity that you may have developed last year when you were infected is different from the immunity that’s specific to the virus that maybe you may be exposed to a few years later.

And so what we don’t know yet is whether the this particular Coronavirus will cause the same picture. However, antibodies are a different thing. Someone could have antibodies and not be immune, and that’s key to know because we’re about to use antibodies in the context of clinics. Certainly, here in fertility clinics, I am a huge advocate for us getting those antibody tests so we can at least start figuring out who’s been exposed.

We can start figuring out who amongst our staff — or say sperm donors or in particular egg donors have been exposed. We’re going to need to know these things before people start going in and out of clinics again, so we’ll use antibodies to figure out if someone has been exposed. It may not necessarily be a protective antibody in that they may not have immunity, but we’ll be able to inform our public better. Because the truth is right now, a lot of people out there have been infected but didn’t have symptoms and therefore they don’t know. They don’t know their immunity status.

Dr. Aimee:

So before this show, I did a survey. I asked 10 people, I said, no access to Google. I said, just tell me what’s the first thing you think of when I say the word antibody? And the next word they said was “screen”. So I think that we hear that term antibody a lot.

Right now, you hear the scientists on TV talking about antibody testing, but let’s say I’m in the third grade, explain to me what is an antibody? What does that really, truly mean?

Dr. Cindy Duke:

Yes, you have really smart friends. We can screen people to see if they’ve been exposed to a virus. Now, some antibodies also tell us if some people are protected from an infection. But for right now, the most correct way if I were talking to a kid is to say, “I need to check somebody’s blood to see if their body had ever seen the virus before.”

That’s really the purpose of the test. And the test is specific enough that we can even gauge for many people whether or not their body saw the virus in the last five weeks or longer than that. And so we look at different types of antibodies, but in no way does that mean that somebody is immune. And I worry that a lot of people as they hear about antibody testing think it means that they’re being tested for immunity. We don’t know that yet because actually antibodies aren’t usually the primary form of immune protection if you’re talking about viruses.

Dr. Aimee:

Interesting. So fascinating. So then now comes the vaccine part. Right? And so I think of this vaccine, I mean as something that a lot of patients are thinking of it like some superhero that’s going to come and save the day. And I have patients that say to me, “I don’t want to get pregnant right now because I just want to wait for the vaccine.”

And I’m like, I don’t want to burst your bubble but I don’t know that that’s something that we should be waiting for because the reality is it may not be fully protective. I think of it as like the influenza flu shot. So talk to us about the vaccine and what we should know right now.

Dr. Cindy Duke:

I will tell you that one of the most frustrating things about developing a vaccine for a virus is that they’re not usually protective in the sense that the general public is expecting. Usually, the purpose of a viral vaccine is to prime your immune system so that the next time it sees the virus, if you’re exposed for real, as a real infection, it can help you fight it off before you get too sick.

That’s really most likely going to be the goal in this situation with coronavirus. We may have a vaccine in as soon as 12 months, which would be awesome. Awesome. But I would tell you guys, if that happens it will be a scientific landmark story as vaccines actually take a lot longer, especially viral vaccines for the very reasons you alluded to.

Viruses mutate more rapidly usually than bacteria for example. The vaccine that you develop can really only usually targets some of the viral types that are out there. But not all of them. Many times you end up needing boosters before you can really see any immunity.

Chickenpox is a viral vaccine. We actually have to give someone a shot once and then two months later a second shot just so that their immune system is primed enough to truly recognize this virus to give them something lasting in terms of the memory or protection. And those are some of the things that still have to be figured out. Plus, as I said, the first step of designing the vaccine in a year is pretty amazing.

We do have some candidates out there, but as someone who did vaccine design for four years, I would tell you that every year people were changing the vaccines. Even for the things we were researching because new things were being discovered about the virus every day. In the context of Coronavirus, this particular virus is really new to us. It’s only been around since, you know, in terms of the media and public knowledge of it since maybe December, possibly November. So they’re still learning about it. So even the first sets of vaccines that we’re testing now may not be very effective because they were designed based on some of our early information and we’re still gaining details about the virus. It’s important to let people know that in a year there might be a vaccine, but it may not be super effective. If it is it’ll first be given to frontline workers.

Our health care workers and our elderly will get it. And then a newer version will probably have to be worked on over time. And also, like you said, with the flu, we may actually see a different version every year. They start predicting the mutation in the virus. And then we all know that sometimes the influenza vaccine hits the mark and sometimes it doesn’t as much. Exactly. Because of vaccine design for something like influenza is based on what we called predictions. Right? And so there are really smart people out there using computer models, epidemiologists who are following trends.

So, for example, here in the United States, the flu vaccines that we usually get are based on trends, looking at different countries in Asia, etc., to see which flu viruses are most predominant in the six months. So a year before the season starts they use computer modeling to predict how that virus may mutate or recombine to predict what’s the best one for us.

Sometimes the computer gets it just right. Other times it’s off. That’s usually when you hear people say, Oh, vaccines don’t work. That’s not true. They work because for most people, if you’ve been vaccinated, you don’t get so sick that you end up in the hospital needing to have a tube down your throat and a machine helping you breathe. I think it’s because we’ve simplified what vaccines mean. People assume “vaccine equals preventive”. And when it comes to viruses, it’s not that it’s preventive, but it’s more what we call therapeutic or blunting the response making you more likely to just be mildly symptomatic and not severely ill.

Dr. Aimee:

Right. So it might not be that superhero that’s going to come in and save the day. And so it’s just important for people to know that. I tell my patients not to let the pandemic take away their joy and that the vaccine isn’t going to bring back the joy if it’s lost.

So you have to find ways to bring back that joy. I should come up with that bumper sticker to put on my car. So here’s the other thing that just fascinates me and I want to hear your input. So if I’m at home, I’m not going anywhere and I haven’t been anywhere for like four weeks.

Do I need to be washing my hands when I go from my computer to my bathroom, to my TV? I’m alone at home.

I hear people, I’ll just say maybe a family member of mine who might be watching, so I’m not going to call her out. She’s like, “Aimee — I washed my hands so many times today. I went to the bathroom, I washed my hands, you know, I’m like, okay, I get it. You’re washing your hands every five minutes. Do you really need to, if you’re home alone, haven’t seen a human being for like the last two weeks, to be washing your hands that much?

Dr. Cindy Duke:

I would say it’s good habit, right? It’s just a good hygiene habit of practice to be developing. And so we know practice makes perfect. If you’re doing even home when you finally had back to work head back out into the world, you’re more likely to keep doing it. And so that would be my response to it. I wouldn’t get into a deep argument. You’re still shedding the virus. I would say this, right? We know that people who actually were infected with a virus and have been tested for evidence of the viral particles, they found it 21 to 39 days later that they were still shedding at least viral RNA. And so, while you may be home and asymptomatic, you might be shedding virus, but can you re-infect yourself at the same time? We don’t know that yet, but I would say let’s just practice the habit that way when you’re outside, it’s easy to remember to clean your hands if you were doing it at home.

Dr. Aimee:

Okay. So then this other scenario. Let’s say this person has been at home this whole time and then let’s say I’ve been at home this whole time, so we’re both quarantining. We are separately sheltering in place in our own homes. Neither of us has seen anyone for the last four weeks now, and we want to come together. Would you say don’t do that? Or if you did would you have to stay six feet apart or would you say, yeah, it’s okay for you guys to give each other a hug now?

Dr. Cindy Duke:

You know, and that’s where the antibody screening comes in. Because if we can screen people, we can give a little bit better of what each person’s status is.

This question is even pertinent to me, and I’m sure many others. My mom is a diabetic who also has high blood pressure. She has been locked in for two months at this point. I haven’t seen her for three months. And usually I see her weekly and yet my big worry is if I see her and I’m an asymptomatic carrier. In that case, I may be shedding virus without knowing. That means if I go visit my mom I could expose her to the virus even though we both have separately been isolated. I’ve now been isolated for two weeks, but I don’t want to run that risk until I know more. So I’d like to see that she’s been tested. What is her antibody status? And the same for me because we don’t yet know if someone is asymptomatic, does that mean they’ve truly cleared the infection in two to four weeks or is it that their body has developed a happy medium with the virus and they’re still making it, shedding it, but not symptomatic? We’re not sure yet whether that’s the case.

Dr. Aimee:

Yeah. totally random question. Do you hug your patients?

Dr. Cindy Duke:

I was before and I have to tell you this has been the hardest part because usually, I hug my patients, I hug the pregnant ones. I definitely help patients who are experiencing loss. And I often joke because back in early March, that was my challenge. Like I had a patient, I turned three times because I kept wanting to go in for the hug because it’s so much a part of my practice.

Dr. Aimee:

Yeah, I had a feeling. Same thing. It’s really tough. It’s so hard. I’m like I want to come in for that hug right now. And it’s hard not to be able to.

Other than, you know, I think that this pandemic has shown us is we’re all way more social and way more touchy-feely than we probably even recognize about us.

I feel like they should really have a smiley face mask design. So we’re just walking around with smiley faces.

Dr. Cindy Duke:

There is some mask out there that has a transparent covering for mute people who can’t talk.

So that you can still see the emotion on their face. Because certainly for most of us, one more time talking and thinking about our masks, we’re not considering the people who are unable to speak. And so someone was creative enough to think about serving these people.

Dr. Aimee:

There’s another photo being shared on facebook I’ve seen which sows transmission is 1% if two people are wearing masks and six feet away from each other. Is that really true? That it’s almost impossible for us to infect each other with masks on?

Dr. Cindy Duke:

The risk of infection is way lower. Yes, if you’re six feet minimum apart. But notice it’s a combination. Maintaining physical distancing and wearing the mask correctly are both important. So that risk of that decreased risk of transmission is dependent on you wearing your mask correctly, meaning you seal it off here. There’s no leak around the sides and both people are wearing it appropriately. It also means they’re washing their hands. The whole general surroundings are clean. But yes, you can significantly decrease the risk of transmission. And so the single digits really, especially if you’re greater than six feet apart.

Dr. Aimee

Yeah, I think I need to reach out to the mask makers to make special ones for big noses!

Dr. Cindy Duke:

But it’s so important, you know, I’ve seen so many people’s pictures. That’s like my new hobby on social media is looking to see if people are wearing their masks correctly. Yesterday I went to the supermarket and told my attendant that they were not wearing their mask correctly. He had the mask on but it was under his nose. And I was like, “oh no, you’ve become that lady.”

Dr. Aimee:

And I’m sure they know who you are so they’re going to listen to you. So do you think in the future we’ll have movies, rock concerts, graduations and weddings, and if not, when is that going to happen and how?

Dr. Cindy Duke:

I think it’ll be at least 12 months to two years away. I think, if we’re being perfectly honest outbreaks will continue to happen even after we have containment and every modeling has shown that.

But also we’re starting to see outbreaks in places that previously said that their numbers were zero. We’ve seen outbreaks in Singapore. We’ve seen outbreaks across the world even after people have control. And that’s because we don’t know about immunity like I was just talking about. So I know a lot of people are using the term, herd immunity. The herd isn’t immunized yet, so we don’t have herd immunity just yet. But even if we were to apply the context of herd immunity, it may not have worked for this virus because we may not have lasting immunity to begin with. And so yes, in the next 12 months to two years, I foresee us limiting those large gatherings, which I know it’s hard for a lot of people.

I like my Coachella. I grew up the Caribbean. I like going to Carnival. But I do think that we need to prepare to have a new normal for the short term. And so that probably means schools too.

Dr. Aimee:

Do you predict that kids are going to be going back to school in the fall?

Dr. Cindy Duke:

I think yes. But do I predict the kids will be going to school wearing masks. Probably teachers for sure.

And it’s scary to think of. And I don’t want to be alarmist because we will get through this, but I think it’s important to plan. But yes, even when school resumed, you know, kids though will be retaught about distance and friends and socializing and even what the long-term consequences of even those things might be on the kids.

Dr. Aimee:

Wow. Okay. So I want to just move on to covid andpregnancy.

What are you telling your patients right now?

Dr. Cindy Duke:

You know, I’m telling them that the data so far suggests that Coronavirus isn’t equating to increased risk of bad things if you’re generally healthy. Some of my patients are what I would call high risk. I have patients who are diabetic, those who are still working on convincing to quit smoking, that sort of thing.

I explained to them what this might mean for them if they were to become infected. We know so far from studies some small, but now even bigger studies are starting to come out that being pregnant doesn’t increase your chance of getting infected with a virus. We know that. But what we do know is pregnant women who have an underlying disease, if they were to become sick from their infection, they can have really bad outcomes. That ranges from miscarriage, stillbirth all the way to needing to be on a ventilator themselves, either in labor or shortly after labor. And so my recommendation to patients is really in line with what the CDC has said to patients, which is if you’re pregnant, whether you’re a healthcare worker or not, you should avoid anyone who, you know to be infected while they’re infected. Avoid them and avoid people who have been exposed.

So if you know people who have tested positive, they were in their close proximity, et cetera, then you should practice social distancing. If you live with that person, then isolate, they should be isolated while they’re recovering or going through quarantine.

Dr. Aimee:

You hear of women who deliver a baby and they require everyone who comes to visit the baby to have had a whooping cough vaccine.

Do you think that that’s going to be the new thing that like before you can come to visit my baby, you’ll need your antibody test maybe?

Dr. Cindy Duke:

Yes, I think so. I definitely think, you know, right now the hospitals themselves are implementing things like that as we speak. So for example, if a woman shows up to most labor deliveries across the country right now she’s being tested.

So is her partner. They’re restricting visitors. And I think if you go home, you should do the same. You should restrict visitors for now, while we’re telling people from all the data that babies seem to be doing better, when you compare them to adults and elderly who are exposed to the virus, it doesn’t mean a baby cannot get infected.

And so you need to still practice those precautions when you’ve delivered. Yes. Eventually, when testing becomes widespread, I would say, yeah, they should be tested. You know, if you haven’t had your vaccines for chickenpox or whooping cough, et cetera, you should not be visiting anybody and their baby in the first year of their life. At all. That’s just a personal responsibility. And I think the same goes for coronavirus. If you know you haven’t been tested, you haven’t checked, then you know you’re only helping the family by not visiting them.

Dr. Aimee:

What about eggs and sperm? Can an embryologist and IVF lab give it to an embryo?

Dr. Cindy Duke:

I tell patients, no they can’t. That’s not going to happen. I don’t see that happening. So far studies of semen from men who have recovered from COVID-19 have not shown them passing on the virus. It’s worth noting that the sperm of a man currently experiencing symptoms has not been done, but the hope would be that man would not be visiting a fertility lab to donate sperm.

Dr. Aimee:

Yeah. I mean, you’re not having sex if you’re having symptoms of COVID.

Dr. Cindy Duke:

Well, I think that study is very helpful because it gives us some reassurance that it’s not in the testicles. Nobody has looked at the ovaries because let’s be honest, ovaries and eggs are very, very precious. We’re not going to just start biopsying ovaries of women. Based on what I know about Coronavirus they don’t integrate into DNA. It’s not like, say HIV, et cetera. That puts its DNA into your DNA. It’s not going to be even in what we call the nucleus of the cell, which is where the genetic material is stored in the egg or the sperm. So no, I don’t think so. Please let everybody know that embryologists practice what we call universal precautions in the laboratory anyway.

Dr. Aimee:

Yes, those in labs are already wearing masks, hats, and scrubs.

Dr. Cindy Duke:

Everything. Plus most labs have what we call positive pressure. So it actually has a special air system that’s pushing any particles out of the lab and not drawing it in. And so I think patients should be reassured that laboratories were designed to cope with something like Coronavirus long before we even knew this was coming.

Dr. Aimee:

Right. Absolutely. Okay. Cindy, thank you for joining us today. I really appreciate all your time. I know that I was cracking jokes. I know this is a very, very serious subject and I’m not trying to make light of something that’s super serious. So thank you for humoring me at times and sharing your wisdom.

So for people who are watching you and say, “Wow — I really want to see Dr. Duke and have her be my doctor.”

How can they find you? Can you tell us?

Dr. Cindy Duke:

I’m always social media, so you can find me as Dr. Cindy M Duke on Twitter, Instagram, and Facebook. You can go to my website, or to the clinic’s website. I’m doing telemedicine. That’s a big thing for me. And so you can see me by video right now or in person. And you can also call for an appointment at (702) 936–8710.

Dr. Aimee:

And if there’s one thing that you could tell a fertility patient right now, what would that one thing be?

Dr. Cindy Duke:

I would say that right now I know it feels like hope is lost, but the truth is we’re coming back, we’re bouncing back. And all of your fertility doctors, including those like me who actually also studied viruses, have been working very hard to make sure that your embryos, your eggs, your future babies are safe and we will be back.

Some clinics actually are backlogged already. At my clinic, we’ve started doing some treatments again as of this week, but hope isn’t lost and your safety is the number one priority in everything that we do. I know you love your patients and so do I. This truly is a passion. It’s not just business. We went into this because we believe in it and we believe in families.

Dr. Aimee:

Sometimes I would say that I have a Ph.D. in toxic positivity and not letting any pandemic getting in the way as a fertility specialist with some of the most hopeful people alive. Someone called me a hope dealer once.

Dr Cindy Duke:

Yes, I believe that we traffic hope a little bit.

Dr Aimee:

Thank you for joining us. Thanks, everyone for watching the show! You can catch more of me and fertility topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too! Sign up for my next class at the Egg Whisperer School.

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