Medical Director and co-founder of Twig Fertility, Dr. Rhonda Zwingerman is the clinic’s head physician and a reproductive endocrinology and infertility (REI) specialist. Having gone through IVF herself, she understands first-hand how difficult it is to need the help of a fertility clinic and to undergo treatment. She is committed to modernizing fertility care through the use of best-in-class technologies and providing people with comprehensive and compassionate fertility care.
How long does it take the average cis-heterosexual couple to get pregnant and when should you seek the help of a fertility specialist?
On average, 85% of heterosexual couples conceive within a year of trying. That said, typically we recommend couples see a fertility specialist if they have been trying for close to a year when the person with eggs is under 35.
For those who are between the ages of 35 and 40, we recommend seeking fertility support after six months of trying; for those over 40, even sooner at around 3 months of trying.
That said, if you have any known medical conditions that may potentially hinder conception, such as irregular periods or are on medication that makes it harder to get pregnant, then it’s recommended to see a fertility specialist as soon as you’re thinking about trying to conceive.
What about single individuals or people in a same-sex relationship? When should they seek the help of a fertility specialist?
Those who are single or in a same-sex relationship should visit a fertility specialist whenever they're ready to start learning more about how to build a family.
After listening to your medical history and learning about your family-building goals, your fertility specialist can walk you through any initial testing that may be recommended or required and then guide you through the process of using donor sperm, donor eggs, and/or a gestational surrogate to build your family.
What advice would you give to those waiting later in life to conceive?
When we talk about waiting to conceive, it’s important to remember that people with eggs are born with all of the eggs they’re ever going to have and that number naturally declines with age.
Since we can’t stop the aging process, one piece of advice I can give people with eggs is to be aware of age-related fertility decline and, if circumstances allow, not to wait too long to try to get pregnant.
If you are a bit older when you start trying to conceive, don’t hesitate to ask your physician for a referral to a fertility clinic sooner rather than later. And if you know you might be delaying starting a family into the future, it’s worthwhile to consider freezing eggs (or embryos) in case you do run into challenges down the road. That being said, it is important to remember that even egg freezing is not a guarantee.
What are the most common fertility myths that you encounter?
Unfortunately, there is a lot of misinformation out there when it comes to fertility. Here are my top 3:
- One of the most common misconceptions I deal with is this idea that you can always do IVF, that IVF can always overcome age-related fertility decline and that it is a guarantee of your future fertility. Sadly, this is not the case. While in many cases IVF can be very effective in helping people with infertility get pregnant, including people who are older, age is still the most important predictor of a successful outcome.
We’ve come a long way but there is still a limit to what science and technology can achieve and unfortunately when it comes to our eggs, there is no match against aging. - Another fertility myth that I would like to address has to do with polycystic ovarian syndrome, a common metabolic condition which is the most common cause of irregular periods and infertility due to what we call “ovulatory dysfunction.” To set the record straight, people with PCOS, contrary to what the name would suggest, do not have ovarian cysts! The ‘polycystic’ of PCOS simply refers to the fact that, when looked at via ultrasound, the ovaries of people with PCOS tend to have a high number of small follicles in them. Follicles are little fluid-filled sacs that contain eggs within them - they are not cysts.
- The third misconception has to do with how normal menstrual cycles work. Many people believe that ovulation occurs from alternating ovaries alternating months - if you ovulate from the right ovary one month, it must mean you will ovulate from the left ovary next month. In reality, however, that is not the case. Each month, there is a 50% chance you’ll ovulate from the right, and a 50% chance you’ll ovulate from the left. What happened last cycle doesn’t impact the odds of the current cycle in any way.
What should people be looking for when choosing a fertility clinic? Do all clinics usually offer the same treatments or the same approach? Do they see similar rates of success?
When it comes to seeking fertility assistance, you first and foremost want to find a clinic and physician that feels like a good fit. Yes, you want to look for a clinic that has a good reputation for doing high-quality medicine, one that has a lab that operates to the highest of standards. But you also want to find a team that will communicate with you in a responsive, transparent way so that you can feel confident in what is, without question, an emotional journey.
As far as treatments go, you’ll tend to find similar offerings from clinic to clinic within the same geographical area. That said, there are a lot of things in this area of medicine where there isn’t necessarily a consensus or an agreed-upon best practice. So you will see some amount of variation between clinics and between physicians.
It’s so important to ask lots of questions in order to determine what clinic and physician will be the best fit for you. Wherever you end up going, you should feel comfortable and supported in your care.
What can people expect from their first visit to Twig?
All of our initial consultations are done via Zoom for ease and efficiency. In advance of that, we have people fill out an intake form so that by the time of the meeting we’re learned of any past treatments and your medical history, and can focus on your reproductive goals.
The first visit to the clinic is usually when you come in for some initial testing following your consultation. That’s also the time when people realize that our clinic is quite different from a lot of the clinics out there. It's purposefully designed to be not only beautiful but also calming and intentionally welcoming.
In many ways, we've tried to make it feel less medical by focusing on creating a calming, comfortable space to put people at ease. We understand that when people come to us it is often a particularly anxious or stressful time, and we strive to do everything in our power to alleviate some of that stress and support people as best as we can.