Insights from an Interview with Fertility Specialist Silvia Hecher from LEVY: Navigating the Path to Parenthood
Today, our focus is on the intersection of the desire to have children and endometriosis. This concern resonates with many women, and the unfulfilled desire for children is unfortunately a common symptom of endometriosis.
However, we are not only delving into the connection between wanting a and endometriosis. I am delighted to have Silvia Hecher with us today, as she is truly an expert on the broader topic of fertility.
As a co-founder of an innovative startup, Silvia is committed to simplifying and enhancing infertility diagnostics, making them more accessible to everyone. This mission, in my opinion, is truly commendable.
Interview with Fertility Expert Silvia Hecher, Co-founder of LEVY
Dr. Nadine Rohloff: Welcome, Silvia!
Silvia Hecher: Hello Nadine, thank you for having me. I am delighted to be here.
Dr. Nadine Rohloff: Could you briefly introduce yourself? Your professional journey is quite remarkable; how did you venture into the realm of fertility?
Silvia Hecher: Interestingly, my path into this realm was unplanned and somewhat serendipitous. After studying public health in the U.S., I returned to Austria intending to engage in health promotion campaigns. However, facing a lack of opportunities in that area, I stumbled into a career as a medical journalist almost accidentally.
An opportunity then arose for me to serve as the editor-in-chief for a gynecological magazine, immersing me in the fields of fertility and endocrinology – the study of hormones. I found this journey incredibly captivating, resonating with the shared experience of many women, discovering the intricacies of the female body, a realm often shrouded in mystery.
The LEVY Fertility Code is a certified medical solution providing insights into the causes of your unfulfilled desire to have a child.
It encompasses a medical fertility analysis, personalized blood diagnostics, and a comprehensive treatment plan.
Encountering the concept of egg reserve around the age of 24 or 25 left me questioning, “Why do I not know about this?” Working at NetDoctor from 2005 to 2010, where fertility, pregnancy, and related topics were extensively discussed, fueled my interest. This period marked the emergence of in vitro fertilization (IVF) as a noteworthy topic.
That is when I realized that this is a subject that will occupy us for a long time to come, and I still find it incredibly exciting today.
Dr. Nadine Rohloff: That is right! Now you have co-founded a startup with LEVY, which aims to comprehensively assist women in this regard. Would you like to share a few words about it?
Silvia Hecher: I am one of the three founders of LEVY. We are a Berlin-based startup that aims to bridge the gap in the care system, especially concerning the diagnosis of the unfulfilled desire to have children. There exists a disparity between what is offered in gynecological practices and in fertility clinics. We operate digitally, envisioning it as a digital fertility clinic, primarily for diagnostics, but progressively moving towards therapy as well. What we do is termed precision diagnostics in medicine. We have developed software that tailors the diagnosis of infertility to the woman’s particular situation.
One reason we developed this software is that many women with an unfulfilled desire to have children take years to find out the problem, only coming late – if at all – to the fertility clinic, where options are already limited, often leading to in vitro fertilization – artificial insemination – which could have been prevented with an earlier diagnosis.
Our mission is to help women and couples recognize early on why having children is not working out and offer a very individual solution.
Nadine Rohloff, MD: Very cool! You mention that many women seek help too late in the diagnostic process. For many, it is challenging to assess when to start seeking help – from you or elsewhere.
Silvia Hecher: We follow the medical guidelines published by the European and American societies for reproductive medicine. If you have tried unsuccessfully to get pregnant for over twelve months up to the age of 35, you should consult a specialist. If you are over 35, this applies after six months.
In reality, looking at studies and statistics, you see average values. Many women and couples get pregnant relatively quickly – within the first three to four cycles. However, many struggle for years, contributing to these average values.
Especially in the case of endometriosis, studies from the U.S. indicate that sometimes up to seven doctors are necessary until the diagnosis is made. If you start your childbearing journey in your early 30s, and it takes another seven years before you know you have endometriosis, you have missed the best time in terms of egg quality.
Dr. Nadine Rohloff: Absolutely! Endometriosis, in particular, is a significant example. Many people only find out about it through the fertility clinic because it was previously overlooked. That is, of course, bitter.
Silvia Hecher: In the startup industry, this time in between is called USP – Unique Selling Proposition – and we aim to save this time. With our diagnostics, you can find out within a few weeks what the problem actually is. What I also find super exciting, having dealt with the desire to have children for so long, is that the treatment is often not the complicated part, but the diagnostics – especially for women – are much more complex. That is why it makes sense to take advantage of that six to twelve-month rule I mentioned. If you try for eight or nine months, and it does not work, you can start to look at what the problem might be. This diagnostic pathway is quite complex.
Dr. Nadine Rohloff: And because there are many possibilities, what the cause could be, and some things are not so invasive in terms of diagnostics, as we know from endometriosis.
Silvia Hecher: Exactly.
One motivating factor behind developing this software is the prolonged duration it often takes for many women with an unfulfilled desire to have children to identify the underlying issue. Unfortunately, they may only reach the fertility clinic very late in the process, or not at all.
Dr. Nadine Rohloff: While our primary focus is on endometriosis and its impact on the desire to have children, as you rightly pointed out, the complexity extends beyond this condition. Infertility issues can stem from various reasons unrelated to endometriosis. Could you provide a brief overview of other factors there might contribute to difficulties in conceiving?
Silvia Hecher: I usually begin by considering the male partner, as it tends to be more straightforward to assess. In 30 to 40% of cases, the issue lies with the man, or it may be a contributing factor when a couple struggles to conceive. We have observed that, much like egg quality in women, sperm quality also declines with age. A simple semen analysis, or spermiogram, can shed light on factors such as sperm count and motility. If there has been no success after six months, I would recommend an evaluation to rule out any issues on the male side.
For women – given the intricacies of our reproductive system—there can be a myriad of causes. Many cases involve the interplay of hormones and the menstrual cycle, affecting ovulation frequency, regularity, or the maturity of the egg. Specific hormonal deficiencies, such as a luteal hormone deficiency, or limitations in egg reserves, particularly noticeable in women over 35, are among the factors we often encounter.
The reasons for an unfulfilled desire to have children are diverse and frequently interplay:
- Low egg and sperm quality
- Weakness of the corpus luteum hormone
- Limited oocyte reserve
- Polycystic ovary syndrome (PCOS), hormonal imbalance
- Thyroid disorders
- Overactive immune system
- Insulin resistance
- Anatomical causes, such as adhesions or blockages in the fallopian tubes; fibroids; chlamydia infection; ovarian inflammation, etc.
Polycystic ovarian syndrome (PCOS) is, in fact, the most common cause of infertility in women, affecting 30% of those dealing with infertility. PCOS involves hormonal imbalance, leading to the frequent absence or irregularity of ovulation, complicating timing in conception.
Other factors contributing to female infertility include thyroid disorders – whether overactive, underactive, or inflamed – and often overlooked immunological aspects, The body’s immune response, especially during pregnancy, can impact fertility. For instance, an overactive immune system may perceive the fertilized egg as a foreign entity, hindering successful implantation.
There is still so much we do not know, but notably, while diagnosis can be challenging, treatment is often relatively straightforward. I believe these are the key points. Additionally, issues such as insulin resistance, anatomical factors like fused or blocked fallopian tubes due to conditions like chlamydia infection or ovarian inflammation, and the presence of adhesions and fibroids in the uterus or a uterine septum (a septum within the uterus) can significantly impact fertility.
These are crucial considerations, and there are many more, including genetic factors that I will not delve into now. However, the array of factors affecting women underscores the importance of a comprehensive diagnosis to understand the problem thoroughly and enable targeted treatment.
Dr. Nadine Rohloff: It is essential to emphasize this regarding endometriosis, as it can complicate pregnancy. However, it is crucial to recognize that it might not always be the sole or primary reason. A comprehensive approach with specialists is necessary. Which of these factors does LEVY cover, and where do you begin? Whom do you reach out to, and when does LEVY play a role?
Silvia Hecher: This is a crucial question because, in essence, we find ourselves still in the early stages of this journey. Recognizing that diagnostics should form the starting point so that individuals have a clear roadmap is integral to our approach. We have the capability to offer a comprehensive set of 24 potential diagnoses or suspected diagnoses. Endometriosis, for instance, is a preliminary diagnosis determined through an interactive questionnaire tailored to the woman’s situation. However, the definitive diagnosis and assessment of the severity of endometriosis must be conducted later in a clinic or by a doctor.
Beyond this, we can provide similar preliminary diagnoses in cases like polycystic ovary syndrome (PCOS) where ultrasound diagnostics may not be essential. Subsequently, we offer precise recommendations for additional diagnostics needed to reach a conclusive diagnosis. It is important to recognize that, as you mentioned, it is often not a singular diagnosis but a combination of factors. Our goal is to provide clarity on the issue within one to two months.
Dr. Nadine Rohloff: Do you collaborate with fertility clinics and gynecologists, or is this something patients can navigate independently?
Silvia Hecher: Currently, our primary focus is on women seeking online assistance, and there are many of them. However, we are actively establishing a network of gynecological practices and fertility clinics for collaboration.
Dr. med. Nadine Rohloff: Because it streamlines the process for them.
Silvia Hecher: Absolutely, and as an online fertility clinic, we do not cover ultrasound examinations and other imaging procedures, which are particularly crucial in endometriosis cases.
Dr. med. Nadine Rohloff: Exactly, and surgeries cannot be performed online.
Silvia Hecher: That is a valid point. We provide guidance to women with a suspected endometriosis diagnosis or those already aware of their condition. If they desire to have a child, determining the duration of attempting natural conception, when to opt for alternative treatment, and whether surgery would be beneficial becomes crucial.
Dr. med. Nadine Rohloff: Individualized assessments are essential. What are the symptomatic challenges that women desiring children face with endometriosis?
Silvia Hecher: Concerning the desire for children, pain becomes less prominent, and the focus shifts to understanding why conception is challenging. Although this is not groundbreaking information, endometriosis remains an insufficiently researched area. Physically, endometriosis lesions impact reproductive organs. Depending on the degree and size of the lesions, they can affect the uterus, fallopian tubes, and ovaries. They may hinder the release of a mature egg or impede its transit into the fallopian tube—a crucial step in the natural fertilization process.
If endometriosis is present in these locations, it can prevent the egg from being fertilized. Even if the egg enters the fallopian tube, issues may arise, such as the egg not being transported further or sperm cells failing to reach the egg due to fallopian tube movement limitations.
If the egg is successfully fertilized, there are numerous potential points of failure in the subsequent developmental stages. It is conceivable that because of endometriosis, the embryo might encounter challenges in implantation and subsequent growth. This complexity arises from the physical presence of endometriosis lesions and the potential influence of endometriosis on the immune system and inflammatory processes. In the field of medicine, we find ourselves at a juncture where the exact connections in this regard are not yet fully understood.
In the realm of fertility coaching and reproductive medicine, the challenges of conception often stem from a combination of factors. It is rare to pinpoint a single reason for unsuccessful attempts at pregnancy. Instead, there is typically a nuanced interplay of various elements contributing to the difficulties encountered in achieving conception.
I strongly advise seeking guidance from a specialist well-versed in endometriosis, as they can offer tailored advice that acknowledges the unique circumstances of each individual. There is no one-size-fits all solution for couples dealing with endometriosis; the approach varies for each woman.
Dr. Nadine Rohloff: It is crucial to address endometriosis comprehensively. Not only does it pose challenges to conception due to immunological factors and inflammatory processes, but it can also impact fertility when it spreads to other areas. Removing the lesions, especially on the peritoneum, can sometimes be beneficial
However, the decision for surgery must be individualized. In cases where adhesions cause the fallopian tubes to stick together, there is an increased risk of ectopic pregnancies. This emphasized the importance of seeking prompt medical attention if severe pain in the lower abdomen occurs during pregnancy.
Silvia Hecher: Absolutely. The activity level of endometriosis, how rapidly it progresses, plays a significant role. I strongly recommend consulting a specialist familiar with endometriosis for personalized advice. They can guide you on whether surgery is advisable in your specific situation and whether subsequent artificial insemination or natural pregnancy is more viable. There is no one-size-fits-all solution; it varies for each woman.
Die Gründerinnen von LEVY:
Caroline Mitterdorfer, Silvia Hecher und Theresa Vilsmaier (v.l.n.r)
Dr. Nadine Rohloff: Absolutely. Fertility centers with an integrated endometriosis center offer an ideal approach. It is crucial to seek out a “combination center” where collaborative efforts are effective. The ongoing exploration of immunological factors in both fertility and endometriosis is particularly fascinating.
Silvia Hecher: This might sound a bit cynical, but I believe two reasons why immunological are not extensively researched yet are, firstly, the mind-boggling complexity of the immune system. Secondly, the ease and cost-effectiveness of treating an overactive immune system might limit research efforts. When therapies with significant financial returns are available, research tends to be constrained.
Dr. Nadine Rohloff: Unfortunately, that is often the case! Could you briefly explain again how diagnostics work concerning immunological factors? Is that also a service you provide?
Silvia Hecher: Diagnostic processes at LEVY involve an interactive questionnaire, creating risk profiles, and recommending laboratory diagnostics based on identified biomarkers. For women with special risk profiles, such as those with recurrent miscarriages, immunological diagnostics may be advised, focusing on essential blood biomarkers.
Dr. Nadine Rohloff: Easily remediable conditions are a positive aspect for women, emphasizing the importance of seeking specialized advice early. Do you have additional recommendations for women with endometriosis and an unfulfilled desire for children?
Silvia Hecher: It is crucial not to delay seeking help and to consult a specialist familiar with endometriosis. Experience and expertise, especially in fertility doctors who also perform endometriosis surgeries, are essential.
Dr. Nadine Rohloff: Valuable advice. While this combination might be rare, looking for such specialists is worthwhile, and there are lists available to guide individuals in finding them.
For women listening with an unfulfilled desire for children, and those just starting their journey, what guidance would you offer?
Silvia Hecher: To be candid, there is no universal recommendation because every couple approaches the desire to have children differently. Some couples are incredibly relaxed, adopting a “let us see what happens” attitude, while others may take a more planned approach. It is crucial to involve your partner in the decision-making process, especially when delving into precise ovulation tracking and fertility tests. Over time, the novelty of strictly timed intercourse may wear off for men.
A helpful tip is to discuss your approach as a couple beforehand. Whether you are opting for a relaxed or more structured plan, it is important to ensure that both partners are comfortable with the chosen strategy, particularly if professional reasons are a factor.
For those who prefer a more proactive approach, ovulation tests based on the luteinizing hormone, available at most drugstores, can ve a valuable tool. Additionally, wearable cycle trackers paired with apps can provide precise information about ovulation timing.
In terms of general advice for all women, maintaining a healthy diet rich in fruits, vegetables, and cereals is crucial. Ensuring an adequate supply of folic acid, a B vitamin essential for pregnancy, is also important. Since it can be challenging to get enough folic acid from natural sources, consider taking supplements three to four months before attempting to conceive. Folic acid supports the maturation and development of oocytes, a process that begins three months before ovulation.
In summary, good communication and partnership are key to finding an approach that suits both individuals.
Dr. med. Nadine Rohloff: That is a wonderful conclusion, Silvia! I truly appreciated hearing your insights.
Silvia Hecher: Thank you very much!
If you have any questions or comments about family planning or endometriosis, please do not hesitate to reach out to us. Join our Facebook group, “Understanding, Observing, and Changing Endometriosis,” or send us an email.
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