Fighting for Fertility with filmmaker Larkin McPhee
I am delighted to have Larkin McPhee joining me today. Larkin is Peabody and Emmy Award winning director, producer, and writer of documentary films. Her films have covered topics ranging from personal finance with Suze Orman to nuclear power to the illness of depression. Meticulous research, outstanding characters, and powerful storytelling make her films extraordinarily compelling. Her skills as a director, writer, and documentarian bring beauty and clarity to any topic.
Her documentaries impart a deep knowledge of the subject matter and provide viewers with a blueprint for positive change. Larkin is well known for her intimate sensitive portrayals of people in critically acclaimed films such as Depression: Out of the Shadows, a primetime PBS special on the illness of depression, Dying to Be Thin, a NOVA special on eating disorders, and Children By Design, one hour of an eight-hour PBS series called Secret of Life on the marvels and perils of the genetic revolution.
I have had the pleasure of working with Larkin on the upcoming NOVA special Fighting for Fertility, which is about fertility and assisted reproductive technology and its contribution to the remarkable diversity of the modern family.
Dr. Aimee: Welcome, Larkin! What brought you to be interested in documentary films?
Larkin McPhee: Thank you. I’m so happy to be here.
It’s interesting. When I was in college, I studied biology and I really liked it, but I think I liked a lot of other things. I was very curious about different topics. I’ve always had a love for people. I think it was sort of combining all of those things and liking photography and being very visually drawn to the world that ultimately translated into being a documentary filmmaker.
Dr. Aimee: Your angle on creating documentaries is unique and special. I know The Wall Street Journal described your work as powerful television that can do some good in the world. What has drawn you to the topics that you’ve worked on?
Larkin McPhee: One of the places I began was National Geographic Society, and I loved working there. I was doing natural history films, I was doing white water rafting, all these different topics, about 40 different films as a researcher.
But I was very drawn to more serious topics, like nuclear exiles, the Bikini Islanders who were left behind after our nuclear testing program and they had no home. I saw this article in the magazine and pitched it as a story, because I think I really wanted to give voice to these people. Subsequent to that, I’ve done environmental films, and I would honestly say it’s about giving voice to Mother Nature.
More recently, with eating disorders, depression, fertility, these are really kind of taboo topics. People don’t want to talk about them. There’s a stigma. There’s shame. Frankly, I just think we have to tackle them and help people, because people don’t get help when nobody is talking about things. I think that was a very strong draw for me as well, to tackle these kinds of subjects.
Dr. Aimee: Obviously, I love that you’re passionate about this topic, because obviously it’s something that is really important to me, too. What drew to specifically a documentary about fertility?
Larkin McPhee: Some friends approached me about doing this film. The more that I learned about it, I thought, my goodness, there’s a great richness, there’s a tapestry of stories, the technology is shifting, as you know, the cutting-edge side of it. So, I was drawn to it. Interestingly, I had endometriosis when I was young, and I had a severe case and I was asymptomatic, so I actually had no idea. If I hadn’t had a great doctor, I don’t know that I would have been able to have children.
I have learned through this film, through experts like you, Aimee, and others, how critically important it is that we pay attention to our bodies not when we’re ready to have a baby, but actually sooner. If you’re a young woman and you’re having irregular periods or painful periods, you should really be checked out and talk to your doctors and seek out the kind of help that you might need to get that bill of health way before. I imagine this road begins early.
I hope this film is going to encourage people to do that, but also to show the complexity of the things that can go wrong. When we’re having babies, we illustrate natural conception in the film, there are so many hurdles just to have it all go right under the best of circumstances.
One thing that I love about you is you’ve always said to me, “I don’t believe that fertility is undiagnosed, we just have to work at it and figure it out.” You’re so great about always reading new science and understanding the latest. I just think this is what this film is about.
Dr. Aimee: What are the different treatments covered in the film?
Larkin McPhee: I think one of the more powerful treatments, surprising treatments, is m-TESE, or microsurgical testicular sperm extraction. It’s a revolutionary technology for men who, in this case, have no sperm, one of our patients. This man would have been deemed sterile in a prior lifetime. I think it’s revolutionary in that regard. It doesn’t always work, but it’s out there and it’s an opportunity. I think that’s really exciting.
PGS testing. That’s very confusing for a lot of people, because do you even need this test, depending on your age and so forth. I think people have to ask a lot of questions around it, but it’s super helpful and it can bring a lot of assurance to people.
That feeds right into our story about mosaic embryos, which are these embryos that are sort of normal and abnormal, and we’re figuring that all out. We address that head-on in the film, and you help us address that with a story about some patients that you’ve had.
Egg freezing is another huge area. I think it’s important to say we tackle that in a small way in the film, but we also have a web platform where we do a more in-depth story of a cautionary tale of a woman who was one of the early pioneers of egg freezing and she was older. It’s not a guarantee, that’s the most important message to get out there, but I think we’re improving in that area.
Dr. Aimee: What have you learned about what the modern family looks like now, and how is it changing?
Larkin McPhee: This is crazy. One of the earliest stories I came across was — everybody, bear with me — a grandmother has a gay son and a daughter. The gay son has a partner. That partner’s sperm is then injected with the daughter’s egg. The grandmother carried the baby, which was her granddaughter, and gave birth to that child. So, they kept it all in the family.
I think if you can imagine it, it can happen. IVF is allowing so much to happen today, so many options for couples.
We feature a transgender male in the story. It’s all about giving access to everybody, including the African American population, which we feature, and the LGBTQ+ community.
Dr. Aimee: What were some of the stories that resonated most with you?
Larkin McPhee: I think the transgender story is an amazing one. As we point out in the teaser to the show, how do two men have a baby? I would say you have to watch the show to see it. I think that illustrates the most astonishing revolutionary aspect of this world. Every day we sort of wake up with news that seems like science fiction, but it’s not. That’s what is really fun for me.
Then I think in terms of what resonates, all these couples are struggling and sometimes not able to get pregnant. They’re young, they’re beautiful, they’re healthy. I understand that this kind of struggle is equivalent to having a cancer diagnosis.
I personally, having done a film on depression, have been very surprised how deeply painful and devastating this topic is. Maybe as much or more, in its own way, than depression. I think maybe it’s because people feel like, “I was born into this world, I should be able to have a baby too.” When they’re not, it’s shameful, people don’t feel great about that, they feel very broken.
I think that those stories are in this film, too, but there’s always hope and there are ways forward. We try to illustrate that it may not be the path you thought you were on. I imagine that’s more typical than not. But it’s not deficient, it’s just different.
Dr. Aimee: I feel like there’s no better time to tell these stories than now. Is there something about the times that we’re in that you feel this work is so important? Tell me about that.
Larkin McPhee: Yes. As you’ve told us in the film, one in eight couples is the rate of infertility, but, as you say, you think it’s probably much higher.
One thing that we include in this film is the fact that sperm counts are dropping worldwide. We have a world-class expert in the film that tells us that a young man today has half the sperm that his grandfather had. What is going on? Certainly, it’s lifestyle factors, binge drinking, smoking, obesity, all of those things, but we spend time with her and she tells us about endocrine disruptors, which are hormone-disrupting chemicals that are ubiquitous in our environment. They’re in cosmetics that we put on our faces. They’re in fragrances. They’re in the plastic that we put in our microwave.
There are ways to reduce our exposure to these items, particularly in the kitchen and the bathroom, where you probably encounter a lot of them, or even in your laundry room. There are ways that you can reduce that exposure when you’re getting pregnant, but I think maybe that’s playing into it. Aimee, I’m sure you have your own thoughts. I think the combination of lifestyle and also delaying pregnancy is the number one reason, because the egg is aging. That was another big revelation in this film. I even spoke with doctors, female doctors who had gone through medical school, they weren’t studying OB, they didn’t know the aging egg was a factor. I thought, I’m sure that is changing, but it’s just interesting.
Dr. Aimee: I would say it’s not really changing. I have medical students that rotate through my practice, they’re fourth year medical students, ready to graduate, and I ask them, “What’s the likelihood that a 40-year-old will get pregnant naturally?” and they say 50%. That just makes me feel like my work is not yet done. We need Fight for Fertility out there.
Larkin, what is your great hope from this documentary?
Larkin McPhee: I guess what I would say is just that we all need to be really proactive about our health. If we don’t know what to be proactive about, how can we take care of ourselves? Watch a film like this that is trying to give you the landscape, just to kind of get started. It’s like a primer. Understand what is at stake here and how all these things play out, and then go from there.
My great hope from this film is that people will ask a lot of questions of their pediatricians to begin with, their OB next, and then the fertility doctor, of course. The more transparency, also, around what are the procedures being offered to us, do I need to do this, what age group works, all the algorithms that I know are starting to play into people’s chances, say with freezing eggs. Just get informed. That’s the more important thing, I think.
Dr. Aimee: How can people find the documentary, where can they watch it?
Larkin McPhee: People can find this documentary on the NOVA Science Series, it’s airing May 12th on national PBS all over the country. Everyone needs to check their local listings for times, but it’s usually primetime. It’s an hour-long documentary.
Here’s the really amazing thing. PBS has decided that this film is going to be playing in its entirety on YouTube for free because they want the young audience to access this film and not have to wait a month after the show airs to go behind the PBS paywall. So, they view this as a mission film. It’s a very important film to get out there and they want everyone to see it on YouTube as well.
We also have a web platform, so go to the NOVA website and their platform, there’s additional material there, a short piece on adoption and a cautionary tale about egg freezing that’s a little more detailed about that process, that people can tune into as well as the program.
Dr. Aimee: Thank you for all of your work. What future projects do you have in store for us to be looking out for?
Larkin McPhee: Well, I can’t announce it. But I will tell you it’s very exciting. I’m working with NOVA now to develop the next film. I’m really excited. I can say it’s another film where science interacts with humanity. Just having these personal stories and blending science, I think is a wonderful way for people to learn about a topic.
Dr. Aimee: Excellent. Thank you again for your time today. I wish you all the best. Thank you for bringing these stories to life.
Larkin McPhee: Thank you for having me. It’s been a pleasure.
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