Interview with Dr. Sachdev from OC Fertility on Infertility and Family Planning in South Asian Communities

Meet Dr. Nidhee Sachdev, a double board-certified and fellowship-trained reproductive endocrinologist and infertility expert at OC Fertility in Newport Beach, California. In honor of AAPI Heritage Month, she tells us a little about her passion for caring for her patients and fertility and family planning issues impacting the South Asian community.

Tell us a little about yourself and your work at OC Fertility.

My name is Dr. Nidhee Sachdev, and I'm a reproductive endocrinology and infertility specialist, also known as a fertility doctor.  I practice at OC Fertility, a boutique IVF clinic and lab here in Newport Beach, California. There's two physicians, Dr. Moayeri and myself. We practice together, but it's also pretty individualized. So what's cool about us is that every time a patient comes in, they're scanned by either myself or Dr. Moayeri. But I would say 85-90% of the time you see your own doctor.  So I see my own patients, and she'll see hers. And then sometimes we do see each other's patients, which is nice, because you get a second perspective on things. And we always talk about each other's patients. We have our own in-house lab, OC Biogenics. There's a lot of great practices out there, but ours is kind of smaller, more boutique and high touch. So I think patients get a more personalized experience that we take pride in.

What inspired you to choose reproductive medicine?

Part of the reason I became a doctor was because I liked the idea of taking care of people. There's something about not just helping them, but taking care of them. And I initially was really drawn to pregnant patients, helping someone have their baby.  Then I did my residency at the University of Chicago, and we had a really diverse population. There were a lot of people there who just, due to their circumstances, weren't able to get prenatal care. They would show up having had no care, about to have their baby. And they'd still have these beautiful, healthy babies, even though they got no prenatal care.

And I realized that pregnant patients are a great population, but they don't necessarily need me in the same way as the patients who were having a harder time getting pregnant. And through my experiences in residency, I would help deliver babies to people who used IVF or some other fertility treatment to get pregnant, and just kind of talking to them, and the relationships I formed, I realized that that was the patient population I liked.

Then I did research, and I just thought it was really exciting what we were doing and how technology is changing things. It's really cutting edge what we do and the more I learned about it, the more interested I became in it, and here I am.

May is AAPI Heritage Month. What are some of the ways infertility impacts the South Asian community specifically?

I think a big part of it is just physiology. PCOS is not uncommon, not only in the infertility population, but in the South Asian population. PCOS stands for polycystic ovarian syndrome, meaning patients may not ovulate. They may be predisposed to diabetes and high blood pressure, and they may also have signs of excess hair growth. And culturally, you may find South Asians, we have darker colored hair. And we may present with having excess hair growth. But depending upon your social situation, patients may start early with the removal of hair. And so some of the early signs of PCOS may be masked by the methods that we use to remove hair.  

But also on the flip side, patients may not have excess hair growth– that just may be genetically how they're predisposed. And we may be categorized into the bucket of PCOS when we don't necessarily have PCOS. But you have darker colored hair, and so you may present with having excess hair growth. So it's kind of both sides. A lot of patients do have it and that affects fertility. But also I think we may be prematurely diagnosed with PCOS because of some of cultural things.

When it comes to fertility treatment– and I don't think this is limited to South Asian people– but I think that the importance of building a family is ingrained in the culture. And in our culture, marriage and arranged marriages are something that are widely talked about and really popular. And I think as a result of that, women are married, or considered of an age to be married, earlier on. So many people will be in a position to try to conceive earlier on.  You know, my mom was in her early 20s, and most of my friends’ moms were in their early 20s, when they got married and tried to conceive.

So it's a stark difference because our parents may say, ‘you're in your mid to late 20s and you're not there.’ So I think whether it comes from a good place or a different place, the pressures behind having kids on a certain timeline are there. And I think that affects people's desire to conceive and when they want to conceive, and that can bring increased anxiety and stress. And it affects how people view treatment.

As a fertility professional are there any health trends or risk factors that you see affecting certain ethnic communities that might impact fertility?

Well, cultural trends, right, what we eat, Indian food is for the most part primarily plant based. It's a lot of vegetarian stuff, but there are oils, fats and a lot of carbs that are staples.  I am a grown person, but I still need rice for most of my meals, that’s just how I was raised. And so what we eat and how we are eating play a role in our overall health, especially if we are predisposed to things like PCOS and diabetes. So I think those are some cultural trends that could affect our overall health, which ultimately could affect our ability to ovulate, which could affect our fertility.

Are there any cultural biases related to fertility treatment within the South Asian community?

That's a good question. I think people are becoming more open with not only their peers, but older generations about their fertility treatment. So I think, maybe there were biases in the past about how people conceived, whether it was with IVF or other treatments.

Egg freezing is also becoming more comfortable for people to talk about as an option. But, in just talking to some patients, I think there can be some hesitation or even some delay in treatment because of concerns of how their parents might feel about it. Just because someone freezes their eggs doesn't mean that they don't have a desire to get married in the near future, or they're not able to get married in the future. It doesn't equate to quitting or giving up. And I think that stigma is slowly going away. It's just an opportunity to help build families in the future.

I do think that– and some of this is just making assumptions based on the opinions of a small number of people, so this doesn’t apply to everybody– but I think that donor eggs are not something that are as openly spoken about. I think in just society as a whole, not specifically South Asians. But as a result, patients who are looking for South Asian donors don’t have very many options. And I think we just don't educate people about how that's a beautiful way to build a family.  The more we educate people, the more comfortable people will feel about it. And then ultimately, maybe more people will decide to become egg donors. And I think that'll kind of open up the whole thing.

What do donor egg options look like for South Asians?

So, the options for donor eggs for South Asians are the same technical options for any ethnicity. You have the option of using frozen eggs, meaning somebody has already previously done an egg freezing cycle. And those eggs that were retrieved from that person are then grouped into groups of 6, 8, 9, however many, and they're frozen and available. So all the testing, screening and legal stuff has been done. Patients look at profiles, they find what they like, they choose it. We can be using those eggs within a month.

A fresh cycle can be either a known donor, so somebody that you know, or a de-identified cycle.  We used to call them anonymous, but we now call them de-identified because anonymity can't necessarily be maintained in the future with technology and laws changing. What that means is that oftentimes patients will use an agency to find a donor, where they then can see different profiles. And that donor will then undergo an IVF cycle.

There are less available egg donors that are of South Asian descent than there are that are Caucasian. And so yes, depending upon what specific things my patients are looking for, from a numerical aspect, it is limited. But it really depends on what's important to somebody. For some, it might be important to just have the same complexion as them. Whereas for others, it might be important to choose a donor who is the same ethnicity as them because they feel like the physical features may match more. So it just depends on the person.

When it comes to family planning, how far ahead of time should someone see a fertility specialist?

Good question. I don't think everybody has to see a fertility doctor if you're trying to build a family. But I do think if there are underlying factors that you think might contribute to your fertility, it could be a good idea. If you're not having regular menstrual cycles, or if you have a hard time keeping track of your menstrual cycles, you might be somebody who might end up needing treatment or maybe some advice on how to conceive. So seeing somebody a few months before you're ready to start trying would be helpful.

But if you're somebody who just never gets periods and it's been that way a long time, I would go sooner rather than later, before you're ready to start trying to conceive. And those are patients who will say, ‘hey, I never ovulate, maybe it makes sense for me to freeze eggs, because at some point, I may need fertility treatment, which may end up in IVF.’ So those are patients for whom it makes sense to freeze eggs early, because there's a higher percentage of chance of needing it.

But in general with preconception counseling, it's never a bad idea to talk to somebody if you're curious about it. Because one, we just talk about optimizing your health, how to track your cycles. We can also do some preconception testing to make sure you're immune to certain viral communicable diseases before you get pregnant, like chicken pox, measles and rubella. And why does that matter? Because if you're not immune, to get a booster for it, that's a live vaccine you can't get while you're pregnant. So we can pick up on those things.

And then genetic testing. If you're the same ethnic background as your partner, you can be at a higher risk of being a carrier for the same genetic disease. And that's important to get tested for before you get pregnant. Because should you both be positive for the same genetic disease, you might have a desire to do IVF and screen the embryos for that. So does everybody need to see somebody? No, I think it depends on what your medical history is, what your goals are, what your timelines are. But it definitely can be beneficial.

What are some available treatments that individuals could seek at OC Fertility?

We see patients for a wide variety of things. So in terms of preconception counseling, we do a basic ultrasound, look at the uterus, look at the ovaries, we'll get a blood panel, make sure you're not anemic, we'll check out your endocrine panel, thyroid, prolactin, vitamin D, make sure you're immune to things.

And we offer genetic carrier screening. Screening your blood to see if you are a carrier for diseases you could pass on to your kids. And we're not talking about adult onset diseases, like Alzheimer's or MS; we're talking about things like cystic fibrosis or muscular dystrophy that are gonna affect the lifespan and longevity of a newborn or child.

And by screening for that, we might be able to tell if you and your partner are both carriers for the same disease. Then you're going to have a 25% chance of having a baby affected with that disease. And in that case, patients may opt to do IVF to screen the embryos for that disease or consider doing testing while they're pregnant to figure that out.

In terms of treatment, we offer less invasive treatments like ovulation induction, and inseminations or intrauterine inseminations. And then we do IVF, egg freezing, embryo banking with genetic testing, and other diagnostic things for patients with recurrent pregnancy loss, counseling them. So we do a wide variety of diagnostic and therapeutic treatments here.

When should one start egg preservation?

So when should somebody freeze their eggs? There's no right or wrong answer. Ideally, the younger you are, the more likely we are to be able to utilize those eggs. And so when deciding whether to freeze your eggs, ideally, you want to be under 35. And really under 33 is what I recommend.  Do patients come and freeze their eggs at 38 or 39? They do. But their outcomes may not be the same as somebody who's 31 to 33. I like to think of egg freezing as an investment. People used to call it an insurance policy, but I don't think that's accurate. So an insurance policy, you pay for fire insurance, and your house burns down, we might get some money, I pay for part of the house. Well egg freezing doesn't work like that– I can't get someone a part of a baby.

And so I think of it as an investment. So when should you freeze your eggs? Well, it depends, right? Because we're talking about when are you going to get the best return on investment or ROI?  The younger you are and the more eggs you have, the more likely you are to get a return on that investment. So in an ideal world, it'll be patients from like 26 to 33. Is it a bad idea to freeze your eggs too early? Not necessarily but again, it's an investment right? The younger you do it, the less likely you are to need it. And for some patients just having that allows them the flexibility and freedom to pursue their career, travel, whatever they want. And that way, whether they use them or not, it's still a good investment for them. And so I think just looking at things with a different lens is really important in deciding when it's best for you to freeze your eggs.

Any last words of advice you would give on how to stay on top of one's reproductive health?

I would say to pay attention to your body, if you feel like your menstrual cycles are off, you feel any sort of pain, discomfort that comes in a cyclical fashion. I think for patients who are on birth control, but are not necessarily using it as a contraceptive, sometimes it can be helpful to just go off it for a month or two to learn about your menstrual cycles. Just kind of gaining more information, especially for people who are thinking about conceiving, that's important information.

So pay attention to your body and just try to put your best foot forward in terms of your health. As you are getting ready to start trying to get pregnant, start taking a prenatal vitamin, monitor alcohol intake. If you are somebody who smokes or uses marijuana or CBD, I would eliminate that from your lifestyle.  Try to eat a well balanced, plant-based diet. And if you have a male partner, same for him. You can always have them get a semen analysis in advance, just to make sure that we're not missing something. So when time comes, we're not spinning our wheels.

Dr. Nidhee Sachdev favorite Indian food dishes are Paneer Tikka Masala and Chana Masala! Her favorite holiday is an Indian holiday called Holi – a celebration of the start of spring with the use of colored powders and color! You can read Dr. Nidhee Sachdev’s blog on What Asian/Pacific American Heritage Month Means To Me.

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