Fertility and pregnancy with Dr Raelia Lew

So, in this episode today we are discussing Secondary Infertility and Pregnancy After Miscarriage. I trust this episode will be really valuable for those who are experiencing issues in this area. And it was brilliant. To be able to chat to Dr. Raelia Lew. This is a really common issue that is historically not discussed about enough in my opinion. So, this is a really great follow up episode to a few episodes back. I spoke to Fertility Life coach Robyn Birkin. So, if you haven’t listened and if this topic does interest you after today’s episode, go back and find the two-part series with Robyn Birkin. Dr. Raelia Lew discusses the medical side of things lifestyle medical options when it comes to fertility. And then a few episodes ago, Robyn Birkin in the previous episodes discusses more the emotional coping strategies that may be helpful during this time. So, I trust you’ll find today’s episode really informative. It is value packed, and I know you’ll enjoy it if this topic is of interest to you.

Before I do dive in, I do invite you to join us inside FitNest Mama. So, if you have found you’re not exercising as much as you’d like to during pregnancy or post pregnancy, perhaps you’re busy or you’ve lost the motivation to exercise or you’re not sure how to be best looking after your body. Or perhaps you’ve got pelvic girdle pain, abdominal muscle separation and you’re not quite sure about the best exercises for you. Or you’d like to get back into running after birth and you really want the best Kickstarter for your afterbirth recovery, then FitNest Mama is for you. So, join us for these convenient short easy workouts that you can do from the comfort of your home. Whether or not that’s at the end of a long day at work or when your brother sleeps or whilst your toddler is running around causing havoc so head to fitnestmama.com and the link is also in the show notes. Alright, let’s get into this episode.

So, Raelia, thank you so much for joining me on the FitNest Mama Podcast. It’s great to have you back.

DR RAELIA LEW

My absolute pleasure. Thank you for having me.

KATH BAQUIE

You’re one of our first only ever returning guests. So, check out ladies we did a fantastic episode with Raelia in the early days of the podcast, and I will link it in the show notes. But in that episode, we talked about lubricant and we talked about all sorts of fun stuff but today we are talking about Secondary Infertility and Pregnancy After Miscarriage so thank you so much for joining me for this really important topic. Let’s start why like I know what you do, but can you explain to everyone in case they haven’t heard your first episode, what you do?

DR RAELIA LEW

Sure. So, my official title is Reproductive Endocrinologist and Infertility Sub-specialist and I’m also a qualified obstetrician and gynecologist. So, in a nutshell, I’m a CREI, qualified fertility specialist and most of my bread and butter work of my daily practice is helping couples get pregnant. And I’m also the director of women’s health Melbourne, our practice in Melbourne host along with Jody Morrison of Knocked Up Podcast, and also one of the directors of lovers, which is bespoke lubricant mac designed for women’s pleasure.

KATH BAQUIE

Yes, amazing. And I’ll put all those links in the show notes, definitely check out the Knocked-up podcast. It’s brilliant. So, let’s get started with secondary infertility because as I was saying to you off air we’ve just had, I get the time of recording, we’ve just had a beautiful life coach who she calls herself an infertility warrior. And she talked about the coping mechanisms and the emotions that can come with secondary infertility. And it’s so great to be able to talk to you today about, I guess, the medical side of things. And yeah, so can you please start off just what is secondary infertility?

DR RAELIA LEW

So secondary infertility just means you’ve had a baby before, and you’re struggling to have another, you might have had more than one baby before and you’re struggling to have a baby currently.

KATH BAQUIE

Yeah. And how common is that?

DR RAELIA LEW

It’s actually pretty common. And one of the major factors is age, because we’re all having our first babies a little bit later in life now. And it becomes harder to get pregnant as we get older. So often, when we try and have a baby, there are speed humps at any age. Most women who’ve had a baby will tell you they’ve had positive pregnancy tests that’s gone negative, and then had a period after thinking they were pregnant. That’s called a biochemical pregnancy when it’s confirmed on a blood test, and many, many women have had a miscarriage, I would say most mothers have had a miscarriage. And these events become more and more common as we get older, because eggs make mistakes more easily as we get older, and miscarriages become more common. So, while when you’re in your 20s, one in five pregnancies will miscarry. When you’re in your 40s you know, at least one or two pregnancies with miscarry. When you’re over 43 it’s even higher than that. So often secondary infertility can be associated with age.

KATH BAQUIE

Yeah, I didn’t realize the stats were that high for over 40 years.

DR RAELIA LEW

Yeah, they are.

KATH BAQUIE

And in terms of the percentage of people that come see you, I’m really interested to know like roughly what percentage are coming to see you for their first pregnancy versus subsequent pregnancies.

DR RAELIA LEW

Look, it goes both ways. Sometimes I hope people have a first baby, that’s been a real uphill battle. And they’ll have spontaneous subsequent pregnancies without needing assistance. And there’s complex reasons behind that. But often we treat pathologies that are in the way, like, for example, endometriosis, through things like surgery, and then subsequent pregnancies can be sometimes easier, especially if they’re close together, we can treat lifestyle factors, you know, obviously, there’s a lot less stress, having a baby for the second time for many people, because they have the confidence that they’ve been able to have a child and they don’t have that lingering stress that they will never have a child. So, you know, sometimes it’s actually the opposite. And it’s easier after the first time and, of course, pregnancy, I talked about pregnancy as the final stage of puberty, even though it’s not necessarily kind of a direct progression, but that’s when our body matures from a reproductive sense. You know, our breasts undergo final maturation, our uterus undergoes final maturation, our endocrine system and our immune system have final adaptations to pregnancy during pregnancy.

So sometimes we learn how to be pregnant by being pregnant. But there are couples who suffer secondary infertility. We’ve talked about age, there’s also the fact that women as we get older, acquire pathologies, just because that’s what happens to everyone. So, things like fibroids, it’s very rare to be born with, but they develop over time. Things like endometriosis might be mild initially and progress over time. If it’s untreated, you can acquire infections. Even after giving birth, you can acquire infections that can get in the way of a future pregnancy, you can have operations that cause scarring that get in the way of a future pregnancy.

It’s also important to understand that it’s not just the woman and that sometimes secondary infertility is a male origin. So, men also make better sperm when they’re younger than they do when they’re older. And men also acquire pathologies as we get older, so they sometimes get a little bit more overweight. Sometimes they get varicose veins of the scrotum or cysts of the testes has hydrates you, sometimes just diet and lifestyle factors. Things like alcohol smoking can be detrimental to sperm and have cumulative effects over time so the sperm can get worse over time. Sometimes the aging egg can’t cope as well with the burden of male factors. So, the eggs can compensate for poor sperm quality much better when it’s younger than when it’s older. So often it’s a compound situation. And there are some also random genetic problems like chromosome translocations, which you can strike it lucky the first time and then subsequently have delayed a pregnancy or recurrent pregnancy loss related to that. And that can come from the male just as easily as it does from the female. So, it’s quite complicated. And it’s important to recognize that secondary infertility isn’t one thing that every couple, and every person is an individual with their individual problems sets. Often, it’s not just one problem, but a compound situation. And there’ll be within those modifiable and non-modifiable factors. So, for example, I can’t modify your age, but I can modify your diet, you know, and I can modify medical conditions that might be making it an uphill battle for you. So, these are, these are important facts to firstly, investigate, identify, treat other problems that can make it harder to get pregnant or things like if your thyroids out of balance, and another problem that becomes more common as women get older. So, looking at all your hormones, not just your reproductive hormones, looking at whether you’re diabetic, because we know that women who are diabetic have more miscarriages, you know, all of these things are important.

KATH BAQUIE

Yeah. And I love the fact that you did bring up the male counterpart, because I think naturally as women, we tend to, we just sort of go into ourselves and get very good at guilting ourselves, don’t you think? So? It’s really good that we do talk about the fact that it’s not just us, that might be a factor. It could also be the male. And out of interest, if let’s say it’s an alcohol issue, maybe how long does it take, if they were to change their lifestyle with smoking alcohol, how long does that take to help with the sperm quality?

DR RAELIA LEW

So, it will help after three months. So, you really do need three months clean living, because that’s how long it takes a bloke to make a sperm. So, if you want to have a washout of bad behaviour, that’s how long it takes. Obviously, things like varicose veins and other surgical correction problems, it’s a little bit different than that. Because if you treat varicose veins, from the time that you treat, surgically, there’ll be a bit of inflammation around that healing time. And so that takes a bit longer sometimes. But yeah, usually, as a rule of thumb, it takes a blow three months to make sperm way to go. And that’s how long we usually look between semen analysis, in an ideal world sometimes will look a bit sooner just because of the practicalities of wanting to get a move on to treatment, maybe but you know, no sooner than six weeks between two semen analysis if you want to see an impact.

KATH BAQUIE

Interesting. Now, you’ve mentioned a few of the potential options for treatment. You’ve talked about lifestyle, you’ve talked about, you know, potential surgery of endometriosis, and that sort of thing. I’d love to know, the medication side of things. What are some options there, like in terms of hormone treatment, and all the rest?

DR RAELIA LEW

So, look it really does depend on the individual. So, what’s right for one person may be wrong for another. So, you I really do say, you know, there’s no one size fits all solution, you need to figure out what the issues and the balance of those issues for that person. When we talk about assisted reproductive treatment, so IVF related topics, you know, that may be very targeted for different reasons. Like for example, I’ll give you a case scenario. I had a patient last year who subsequently had a baby through IVF and she had two babies naturally without trouble. And then completely out of left field for her husband had absolutely no sperm on a sperm test in the ejaculates. So, he had acquired a blockage. What has happened is he’d had hernia surgery. And that had been either during the operation, the spermatic kind of channels were snipped, or it could have been that they weren’t snipped during the operation. But it might have been that the healing around the time of the surgery caused scarring that caused him to have a complete blockage. That was the quiet and so for her one cycle of IVF got her another baby even though she was a bit older with a lower account. No, because she wasn’t actually the issue was the fact that the sperm couldn’t get the egg and once, we took some testicular sperm she made beautiful embryos. Whereas if you have a patient who egg quality is the main issue, then you can have multiple cycles of IVF and not get pregnant because you might not be making good embryos. It’s so, you know, every person is different and even two women at the same age are not identical.

KATH BAQUIE

Yeah, that’s really interesting. What you mentioned about the, what did you call it the testicular extraction?

DR RAELIA LEW

Yeah. Yeah. Testicular sperm extraction. So, if there is a blockage, which is called destructive basis spermia. And that can happen after a vasectomy, for example. And you know that you can’t have any sperm in the ejaculate. What do you do? I take a fine needle, and I take some sperm directly from the testis. And we can use that interesting. There are ways around it.

KATH BAQIE

And this is a bit of a side note, but does that when you extract sperm, can that only be used for IVF purposes?

DR RAELIA LEW

Yeah, that’s right, because we don’t get enough to use for anything else. So, in natural conception, you need at least about 100,000 to 200,000 sperm at the egg interface for the egg to fertilize. So those sperm work like a team and dissolve the outer layers of the egg so that one can eventually get through. And one alone cannot do that. So, it’s like you’re hitting your head against a brick wall, you know, you need that kind of charging brigades to get through the brick wall, one’s not going to get through, the only way one sperm gets into one egg is with a needle to do that charge. And that’s called exceed. So, you know, when you have sex and the sperm in the vagina, you know, 99.9% of the ejaculation, it’s going to come back the other way, not going to go anywhere near an egg, it’s only a tiny fraction, that’s going to actually move forward. So, you need a really good couch to compensate for that, because it’s going to be a gradient, and there’s going to be a minority get to the finish line. So you know, that’s why sometimes techniques like IUI, which is artificial insemination, or intra uterine insemination can help because what we do for a guy with a relatively lower sperm count is concentrate the sperm concentrate the best motile sperm, use the whole redundancy of what’s in the ejaculation, not just what would reach the egg in nature, and deliver it closer to the egg so that we get a much higher concentration in the body. Now, with IUI, we have the opportunity to give what’s called a bit of super ovulation, which gives them drugs, it can be oral, it can be injectable, what we’re basically doing is trying to get the woman to ovulate a couple of eggs instead of just one. So just statistically improving her chances. And together with the malefactor treatment and getting the timing perfect with monitoring on ultrasound, a blood test that can increase the work cough accountability or chance of getting pregnant per month, I bet, you know, but it’s nowhere near what we can do with something like IVF, because in IVF, what we can do is compensate for quality with numbers and women who are capable of that. So, everyone was going to be different, you can have two women who on paper, demographically identical, you know, graduated high school, same year went to university, same year, you know, same height, same BMI, different ovaries, right? Because just like, you know, different bra sizes in that demographic, if you imagine that same scenario and have different bras as one’s a B cup, one’s a double D, you know, just like that you can have one person with a higher ovarian reserve or a low ovarian reserve, because one’s got a bigger over and one’s got a smaller ovary. No, so that’s just genetic. And so, one woman can get 10 eggs in an egg collection, no worries, one woman can get 20 eggs in an egg collection, terrific. One woman can get two or three. And that’s all she can do. And that’s just her. Yeah, you know, and so every single person is different. And to talk to you about what your prognosis is in something like IVF, what we need to do is assess all of those aspects about you. Because it doesn’t matter, you know, how the average woman of your age might perform? You’re not average, necessarily, we need to talk about you.

KATH BAQUIE

Okay, well, you just took the words out of my mouth for the next question. That’s exactly what I was going to ask is what, and I know you’ve just said it’s hard to answer because everyone’s different. But do you have any steps that you can share around prognosis?

DR RAELIA LEW

Well, look, it depends on your age. So yes, I do. You know, if you are, you know, in an IVF context, if you are under 30, every time I put a nice looking blastocyst, which is the type of embryo we like to transfer that one and two is going to be pregnant from that, you know, if you’re 35, it’s going to be more like one in four, one in three to one in four, you can’t have half a baby. So, you know, it’s it’s one of those steps that somewhere between 35 to 39. You know, either one in three or one in four embryos makes a baby, if you’re 40 to 42 is going to be at the very most one in five embryos that makes a baby and if you’re over 42, it’s going to be less than one in 10 embryos that makes a baby and that’s because we put an embryo back in IVF at a very, very early stage of life. It’s got a lot of boxes, too tick to get to being a baby. And it’s just loaded with an increased risk of making a critical error as we get older. And the reason for that as women is we make all our eggs when we are babies ourselves in fetal life. So, by the time you’re 20 weeks, and you’ve had your 20 week, ultrasound, when you’re pregnant, if you’re having a daughter, she’s made all the egg she’ll ever have for the rest of her life. And all the eggs that might contribute to your future grandchildren are already there.

KATH BAQUIE

Isn’t that incredible to think that?

DR RAELIA LEW

It is. it is unbelievable, but it’s also a real challenge with, you know, the timeframe of modern life. Because like if you were, for example, imagine a world before contraception. Imagine a world and the jungle, you know, were cave people going to have babies, when your teenager for the first time, probably not going to live beyond your 30s. in realistic terms. That’s what our life expectancy was back, then. That’s what we’re biologically designed to do. You know, and it hasn’t been that long, in an evolutionary sense, since that’s what we were made for, you know, and so, we’ve changed the way we behave radically even in two generations, like if you think about when your grandma was having babies, likely, if she was mid-20s, she was probably, you know, kind of tapped on the shoulder by parents said, listen, love, you’re going to be an old maid, you know, that this is a way and it’s not necessarily politically correct to say, but you know, that’s what happened in that generation. Our mothers pushed the boundaries a little bit, you know, and kind of, you know, probably in the 70s and 80s, the average age of baby was like 25, compared to their mothers’ generations, where it was more like 20. And in our generation, the average age of first baby is about 33.

KATH BAQUIE

Is it really?

DR RAELIA LEW

And when you think about average, it is. And when you think about averages, 50% of people are spread around the mean, it means 50% of women are taking longer than average to have their first child. So, it’s no surprise from a biological perspective, that secondary infertility is becoming more and more common. Because we’re having babies at the age where in the natural world, our babies would be happy.

KATH BAQUIE

And that’s why we’re just so lucky that we have medical technology. And, you know, we’ve This is enabled us to have this choice in our life, whether or not we do have babies, so yeah, brilliant, thank you for sharing.

DR RAELIA LEW

Some people, it’s a choice some people, that isn’t a choice. You know, some people technology won’t save the day. And that’s really important to acknowledge, you know, IVs not a silver bullet, I can’t help everybody with their own egg. You know, it’s one of those things that if eggs are not able to make babies anymore, I can still help you have a baby, but your native donor egg, and you can have a donor egg from somebody younger, whose eggs are still fertile. And many people do choose to do that. And you know, what we need to destigmatize that given the way that our society is going. And we also need to destigmatize egg freezing, because that’s something younger women can do to create a resource for themselves that they can use later if they need it. So that they’re, you know, quote, unquote, their own donor that they can use those younger eggs, you’d have the same prognosis with, say, a 30-year-old egg as a 30 year old woman. Even if you use that 30-year-old egg when you’re 40.

KATH BAQUIE

Yeah, amazing. And I have heard in the last few years, a lot more people have are freezing their eggs, which is brilliant. So yeah, if someone’s listening and suddenly thinking, oh, maybe I need to investigate this how, what’s the first step to investigate freezing eggs?

DR RAELIA LEW

So, look, I always had, the first step is going along to your GP, because to see a specialist, you need a GP referral, or you don’t necessarily need one. But it’s easier under Medicare in Australia if you have one because you’re entitled to a Medicare rebate with the GP referral. And your GP can also give you some initial information and organize some initial investigation. So, things like and this goes for infertility as well. If you’re if you’re over 35, it’s been more than six months, and you’re worried that you’ve got secondary infertility or primary infertility for that matter. But once you GP there are some baseline tests that can be very helpful. Remember, it takes two to tango, your partner should have a semen analysis as of their minimum. And he might require other tests depending on what that shows. But for yourself, you can have a pelvic ultrasound, you can have routine antenatal screening tests, including a baseline hormone assessment to see what’s happening with your cycles or with your hormones. And I’m not just talking about your menstrual cycle hormones, but also your global hormones. You can have a check-up of your sugars and your cholesterols. So, all of those, those investigations are helpful. You can have a pelvic ultrasound to see if there’s an anatomical concern. And there can be quite commonly anatomical concerns that are really easy to treat like a polyp, for example. Which can be removed quite simply with a minor procedure.

So, you know, there are there are things to discover. And often when I see patients, I’ll also offer them the opportunity to have their fallopian tubes flushed with contrast imaging because that can help me; a. understands if they’re working or if they’re blocked, and they can become blocked through different mechanisms. So, one is through inflammation and scarring. And endometriosis is, is a very serious culprit when it comes to that as our pelvic infections like chlamydia, gonorrhoea, and infections that you can have after having a baby like endemic traders. But also, you can have a blockage that’s functional, like have a blockage with mucus plug or skin cell build-up that can actually be cleared by flushing and that can help. But I decide who gets a tubal flush by ultrasound compared to who gets a tubal flash at laparoscopy, which is only do a keyhole surgery and a really classical investigation of the open surgically based on that first pelvic ultrasound, which tells me, you know, are they likely pathologies there that we would need to co treat at the same time? Or am I suspicious of serious endometriosis? So, kind of use that first ultrasound to check out well hey, what’s going on in the pelvis. And then in terms of flushing the tubes, we can decide whether we do that through imaging in a less invasive form, or whether we do the whole shebang in one procedure to try and fix everything, depending if we find other problems on the skin. So those are the kinds of the kinds of issues with fallopian tube or patency. If your tubes are blocked, you can’t get pregnant. So that’s important. Some women have had an ectopic pregnancy in a tube before that was managed without removing the tube. And that can cause scarring and blockage and an increased risk of a secondary infertility and be future egg topics. So that’s also part of some people’s backstory.

KATH BAQUIE

Yeah. Okay. That’s Interesting. And if someone’s listening today, and they’ve had a previous miscarriage, and they’re wanting to get pregnant, again, at what stage, like how long like what stage should they seek help? Or is there anything they need to do after the miscarriage to help with a future pregnancy?

DR RAELIA LEW

Sure. So let’s talk about firstly, just setting the scene for what I’m going to say next monthly fecundity. So that’s your chance of getting pregnant per month. So statistically, we talked about when you’re 20, your chance of getting pregnant per month is about one in five, when you’re 40, it’s about one in 20. And in between, it kind of goes down. So, we know that 80% of couples who are going to conceive will get pregnant in the first six months, trying. So, you know, if you’ve tried for more than six months, and you’re over 35, for any reason, whether it’s related to miscarriage or not, it’s very relevant to check out all the modifiable factors and try and, and seek help because, you know, time is the biggest contender, and it’s your biggest risk. So really, we want to extend that can be fixed quickly. So, it’s not necessarily about put your foot on the pedal straight to IVF. But it’s about you know, try not to waste time, which is your most precious asset as a woman over 35 in terms of your prognosis for actually successfully being pregnant again.

In terms of, you know, miscarriage, miscarriage is a broad kind of term, it can refer to, you know, kind of having a period that’s a week late, and not having any ultrasound signs of pregnancy, or it can refer to losing a baby at 19 weeks. So obviously, those two scenarios are extremely different. There are also mental health aspects that are, you know, obviously, some people feel really shattered by losing a pregnancy, even if it was a faint line on a pee test and then disappears. So, when you’re ready to try again, emotionally is obviously very different. And I am not talking about that. Right now. I am talking more about what, when you’re ready, physically, when you’re ready physically, is when you have your next natural cycle, you know, don’t have to do delay, trying, it’s an urban myth that you have an increased risk or decreased risk of getting pregnant in the months after pregnancy. That is simply not true. So, you know, you can try again, as soon as you want to, as soon as you’re ready to and as soon as you ovulate again. Um, some women do have a delay to ovulation returning. And that is because the HCG hormone in our bloodstream, has quite a long half-life and it can take a bit of time to get out of our system. And it is only when it does get out of our system that we’re going to really ovulate again most likely, but also some women have extreme stress and that can also delay their ovulation. So, you know, it’s one of those things that it can it can be variable when your period comes back after a miscarriage, and that’s okay.

KATH BAQUIE

Yeah. Okay. Thank you for sharing. You’ve been a wealth of information. We have dived into a lot of things here. So, thank you to finish up with, do you have any final pieces of advice, words of wisdom to women who are listening today who are either pregnant or trying to conceive?

DR RAELIA LEW

Yeah, look, I think one thing we haven’t talked about is recurrent miscarriage for medical reasons. So, there are some people who have developed a syndrome called antiphospholipid syndrome. where they have an autoimmune cause of recurrent miscarriage related to blood clotting problems around forming a normal placenta. It’s really important to recognize women with that problem. It’s also really important to recognize women with other issues that can cause recurrent miscarriages like fibroids inside the uterine lining that need to be removed. Because otherwise they might have miscarriage after miscarriage after miscarriage. So, you know, it’s hard to in general practice and I, you know, and also, I guess it’s so hard for women to realize that miscarriage you know, when it’s a pathology that’s underlying that needs further investigation and when it’s an unfortunate fact of life because of advancing age or baby making a mistake. We know that in 50% of miscarriages, it’s a baby making a mistake, nothing to do with the mother, you know, so, no attributing blame to yourself in that situation. You know, it doesn’t make any logical sense. It’s a baby that made a mistake. And no matter what you did, it wasn’t going to endear you says things like chromosomal random error. Okay. Yeah, but then there are some factors that we can address, and we have to identify them. So, things like luteal phase deficiency, where as we get older, we don’t make as abundant as supply of progesterone. It is not necessarily something that happens every cycle, not every corpus luteum, which is the ovulating follicle resultant progesterone making factory on the ovary for early pregnancy support, but every corpus luteum is equal. But every club has the term is going to be as functional or as good as every other. So, you can have a luteal phase defect in a particular pregnancy or a particular cycle, as opposed to in general. But for some women supplementing progesterone luteal phase can help. And I certainly do that a lot in my sister reproductive treatment practice or my patients having IVF get luteal phase support or my patients having IUI get luteal phase support as a belt and braces approach. I would say my take home message is every woman is different, every couple is different, every situation is different. The recommendation for investigation of recurrent miscarriage is after three consecutive losses. It sounds incredibly harsh, but that’s because miscarriages incredibly common. And most of the time we don’t find an issue if we investigate thoroughly after one or two miscarriages.

But you know, if you are older, if you are, you know, feeling time pressure, come and see a fertility specialist and have a thorough workup. You know, we don’t have to wait you having three consecutive losses to do that. And it might give you reassurance and it also might just highlight other pathways, alternative treatment methods that might come onto your radar that you might want to.

KATH BAQUIE

Amazing! Thank you for all that information.

DR RAELIA LEW

You are very well.

KATH BAQUIE

It’s really important topic to discuss which I think historically we haven’t spoken about as much. So, I do appreciate taking your time out of your holiday chatting so thank you.

DR RAELIA LEW

You’re very welcome. Anytime.

KATH BAQUIE

We’ll chat to you soon.

And before I sign off, remember my team and I will be putting together the show notes for this episode with all the links including how to connect with Dr Raelia Lew and myself at fitnestmama.com/podcast. Have a fabulous day everyone and I look forward to you joining me next week for another episode of the FitNest Mama Podcast.

Thanks so much for listening to the FitNest Mama Podcast. Brought to you by my Free Pregnancy Mini Pelvic Floor and Core Masterclass which you will find at fitnestmama.com/free. Be sure to subscribe so you don’t miss an episode. And come and say hi, DM me on Instagram. I would love to hear from you. It said FitNest Mama. Until next time. Remember, a healthy pregnancy, confident birth and strong after birth recovery is something that you deserve. Remember, our disclaimer, materials and contents in this podcast are intended as general information only and shouldn’t substitute medical advice, diagnosis, and treatment. I’ll see you soon!