Interview with Dr. Lucky Sekhon, Fertility Expert Behind The Lucky Egg

Most of us grow up with one message drilled into us: don’t get pregnant. Then suddenly, often right when careers are accelerating and life finally feels like it’s taking shape, the message flips. Now it’s why isn’t this happening yet?

That gap between avoiding pregnancy and actually understanding fertility is enormous. It leaves so many women feeling blindsided by terms like ovarian reserve, egg quality, PCOS, endometriosis, AMH, IUI, IVF, embryo testing, and miscarriage risk only when those terms become deeply personal.

Dr. Thais Aliabadi and Mary Alice Haney discuss these important topics with Dr. Lucky Sekhon. She is a reproductive endocrinologist, infertility specialist, OB-GYN, and the author of The Lucky Egg. She has helped thousands of patients build families, freeze eggs, navigate IVF, and get answers after years of confusion. Alongside Dr. Thais Aliabadi and Mary Alice Haney, we got into the real basics of fertility, the common blind spots, the myths that do real damage, and what women should know much earlier than they usually do.

Table of Contents

• Why fertility education matters long before someone is trying to conceive
• The truth nobody says clearly enough: human reproduction is inefficient
• Eggs 101: what you’re born with, what declines, and what actually matters
• When does fertility start to decline?
• Can you improve egg quality?
• Why PCOS and endometriosis get missed for so long
• Why both doctors believe baseline pelvic ultrasound matters
• The four components doctors evaluate when pregnancy isn’t happening
• Ovulation tracking: useful, but only if you use it correctly
• IUI vs. IVF: what’s the difference, really?
• Egg freezing vs. embryo freezing
• Do autoimmune issues play a role in fertility?
• Fertility myths that need to die
• Yes, men have a biological clock too
• What women should know much earlier
• FAQ

Why fertility education matters long before someone is trying to conceive

Why did you feel the need to write a book about fertility?

Dr. Lucky’s answer was simple and powerful: there is a huge fertility knowledge gap. After years of counseling patients and answering the same urgent questions over and over, she realized the fear and anxiety around fertility often grow in the space where information should have been.

Women are expected to somehow know how their biological clock works, how egg quantity differs from egg quality, what age really means, and when to get help. At the same time, they are navigating education, work, relationships, and the pressure to get timing exactly right. That is a lot to ask of anyone, especially when the basic science is rarely taught in a practical way.

Her goal with The Lucky Egg was to create something comprehensive enough to serve as a fertility guide for women in their 20s, 30s, and beyond, whether they are trying now, thinking about egg freezing, or just wanting to understand their bodies better.

The truth nobody says clearly enough: human reproduction is inefficient

What is the most important place to start when talking about fertility?

According to Dr. Lucky, the best starting point is this: human reproduction is inefficient by design.

Even in your 20s, when fertility is considered to be at its strongest, each ovulation gives you just one egg. That egg only survives for about 12 to 24 hours if it is not fertilized. Even if intercourse is timed perfectly, fertilization is not guaranteed. And even when fertilization happens, only about half of fertilized eggs grow into embryos.

Then comes another hurdle. Not every embryo is genetically balanced enough to implant and continue growing. Even in your 20s, about 20 to 25 percent of embryos are genetically abnormal. That means they may never implant, or they may implant briefly and then stop growing, which is the leading cause of first-trimester miscarriage.

That is why trying to conceive can feel so emotionally brutal. It is not just about “relaxing” or “trying harder.” There are multiple checkpoints, and biology itself is not especially efficient.

Dr. Lucky uses a memorable analogy: fertility can feel a bit like playing the slots. Every month, you are hoping that one ovulated egg clears every checkpoint. That framing is not meant to be discouraging. It is meant to replace shame with realism.

So when should someone stop waiting and ask for help?

That depends on age, cycle regularity, symptoms, and known risk factors. In general:

• If you are under 35 and have regular cycles, trying for up to a year may be reasonable.
• If you are 35 or older, six months is a more appropriate threshold.
• If you are 40 or older, many specialists would prefer not to wait long at all.
• If your cycles are irregular, the usual “wait six months” or “wait a year” framework does not really apply. Irregular ovulation is a reason to get evaluated sooner.

Eggs 101: what you’re born with, what declines, and what actually matters

Are women really born with all the eggs they’ll ever have?

Yes. Women are born with a lifetime supply of eggs, roughly one to two million. By menopause, that number falls to under a thousand.

But there is an important nuance here that gets lost in everyday fertility talk. The eggs sitting in your ovaries are not all “available” at once. Each cycle, a small group of follicles is recruited from your egg pool. One is typically selected to become the dominant follicle and ovulate. The others in that recruited group die off.

So when a doctor does an ultrasound and counts follicles, they are not counting every egg you have left for life. They are looking at the small cohort currently visible and potentially accessible, especially relevant if you need egg retrieval for IVF or egg freezing.

This is why ovarian reserve and natural fertility are related but not identical concepts.

Does egg count tell you whether you can get pregnant naturally?

Not directly. Egg count matters a lot when we are talking about IVF or egg freezing because those treatments depend on how many eggs can be accessed in a given cycle. But when you are trying naturally, you still only ovulate one egg at a time.

For natural fertility, what matters most is not simply the number of eggs left. It is the likelihood that the egg you ovulate is genetically healthy.

What does “egg quality” actually mean?

In practical terms, egg quality refers to whether an egg has the correct chromosome package. Eggs should contribute 23 chromosomes, and sperm should contribute 23 chromosomes, for a total of 46.

Dr. Lucky explains this with a filing cabinet analogy. The egg contains proteins that help organize chromosomes properly. Over time, those proteins break down. There are no repair mechanisms. So as women age, chromosome organization becomes more error-prone.

That is the biological clock in its simplest form. It is not a moral issue. It is not a failure of effort. It is a function of aging biology.

When does fertility start to decline?

Is 35 really a fertility cliff?

No, and this is one of the most important corrections in modern fertility medicine.

Dr. Lucky was very clear: 35 is not a cliff. It is not Cinderella at midnight. Fertility decline happens on a continuum.

In the 20s, genetically abnormal embryos occur at a rate of about 20 to 25 percent. In the early 30s, that may rise to roughly 30 percent. By 35 or 36, it may be around 40 percent. By 37 or 38, about half of embryos may be genetically imbalanced. By 40, around 70 percent may be abnormal, and by 45 the number can approach 90 to 95 percent.

That does not mean pregnancy at 38, 40, or even 43 never happens naturally. It absolutely can and does. It means that statistically, it becomes harder and miscarriage risk rises because healthy eggs become less common.

That distinction matters because fear-based messaging helps no one. Accuracy does.

Can you improve egg quality?

Is there anything women can do to protect fertility and support healthier eggs?

The answer is both yes and no.

Some aspects of fertility are driven by age and genetics. There are predispositions you cannot out-supplement. Conditions like endometriosis and PCOS can also affect egg quality and often have strong genetic components.

At the same time, the environment surrounding the ovaries matters. That is where lifestyle and metabolic health come in. Smoking, heavy alcohol use, obesity, and insulin resistance can all create a more inflammatory and less favorable setting for the eggs that are maturing and preparing for ovulation.

Insulin resistance deserves special attention. It is commonly associated with PCOS and can trigger the ovaries to overproduce testosterone, which disrupts normal ovulation and may worsen egg quality.

That is why optimizing general health is not some vague wellness recommendation. It is a real fertility strategy. If you want a deeper look at how metabolism, weight, blood sugar, and stress intersect with conception, this overview on how health impacts fertility is a helpful companion.

How do PCOS and insulin resistance affect fertility?

PCOS is one of the leading causes of infertility, and insulin resistance is one of the major mechanisms behind it. When the body does not respond well to insulin, blood sugar regulation suffers. More insulin circulates. The ovaries respond by producing more testosterone. That hormonal environment can interfere with normal follicle development and ovulation.

Dr. Aliabadi emphasized that she treats metabolic health aggressively in patients with PCOS, especially when they are overweight or insulin resistant. Depending on the patient, that can include supplements, metformin, GLP-1 medications, and structured strategies to improve metabolic function before or while trying to conceive.

That matters because you cannot approach every patient the same way. A 40-year-old trying to conceive may not have the luxury of delaying treatment for a year to focus only on weight loss. A younger patient may have more room to optimize first.

For women dealing with PCOS specifically, this guide on diet and exercise strategies for PCOS aligns closely with what was discussed.

Why PCOS and endometriosis get missed for so long

If PCOS and endometriosis are leading causes of infertility, why do they get missed so often?

This was one of the most frustrating and important parts of the conversation.

Dr. Aliabadi sees patients all the time who arrive at fertility clinics after years of symptoms, only to learn much later that they had PCOS, endometriosis, uterine abnormalities, fibroids, or tubal issues that were never properly worked up. Dr. Lucky said the same. In difficult second- and third-opinion cases, her mind often goes first to undiagnosed PCOS with insulin resistance and missed endometriosis because those are such common blind spots.

Women can spend years being told their symptoms are normal, stress-related, or not severe enough to investigate. Heavy painful periods get dismissed. Irregular cycles get normalized. Pelvic pain gets minimized. Then they try to get pregnant and discover the problem was there all along.

Dr. Aliabadi put it bluntly: if every 20-year-old got an informed, thorough gynecologic evaluation with proper education, many fertility clinics would be far less crowded.

How does endometriosis affect fertility?

Endometriosis can create inflammation, scar tissue, tubal damage, ovarian cysts, pelvic pain, and an overall hostile environment for reproduction. If it goes undiagnosed for years, it can damage the tubes, reduce ovarian reserve, and compromise egg quality.

Not every patient with endometriosis needs surgery immediately. But many do need earlier recognition, symptom-based diagnosis, and a thoughtful plan. Sometimes treatment means surgery. Sometimes it means medical suppression. Sometimes fertility treatment helps overcome the inflammatory effects without surgery. The key point is that pretending it is not there does not help.

Why both doctors believe baseline pelvic ultrasound matters

Should every woman get a baseline pelvic ultrasound?

Both doctors made a compelling case for yes.

Dr. Lucky said she cannot count the number of times she has been the first doctor to perform a vaginal ultrasound on a patient in her 30s or 40s. That first scan sometimes reveals fibroids, large ovarian cysts, uterine anomalies, polyps, or clear signs of endometriosis.

And often, those findings come after years of annual gynecology visits.

The argument against routine ultrasound is usually that guidelines do not require it and not every scan finds something important. But their counterpoint was straightforward. A pelvic ultrasound is quick, low-risk, and can reveal issues that a manual exam can easily miss.

For women planning pregnancy, both felt a baseline pelvic ultrasound can be incredibly valuable. It may identify a uterine septum, a cavity-distorting fibroid, or other anatomic issue before miscarriage, failed implantation, or pregnancy complications force the discovery later.

The four components doctors evaluate when pregnancy isn’t happening

What does a real infertility workup include?

Dr. Lucky breaks it down into four basic components:

1. Sperm
2. Fallopian tubes
3. The uterine cavity
4. The ovaries and eggs

If pregnancy is not happening, every one of those areas deserves attention.

What tests are most important?

• Semen analysis to assess count, movement, and shape of sperm. Male factor contributes to about half of infertility cases in some form.
• Pelvic ultrasound to evaluate the uterus and ovaries.
• HSG, or hysterosalpingogram, to check whether the fallopian tubes are open and to outline the uterine cavity.
• Hormone testing including thyroid and prolactin, along with ovarian reserve markers such as AMH when relevant.
• Saline sonogram in some cases to look more closely at the uterine cavity.

One of Dr. Lucky’s strongest points was that tubes still matter even if a patient plans to do IVF. Tubal inflammation can negatively affect implantation and miscarriage risk, so skipping tubal evaluation just because IVF bypasses the tubes can be a mistake.

If you want a practical summary of this kind of fertility workup, this resource on how fertility testing works mirrors many of the same principles.

Ovulation tracking: useful, but only if you use it correctly

How should someone track ovulation?

Start simply. Track the first full day of menstrual flow each cycle, not spotting. Over three or four cycles, look for a consistent interval between periods. If your cycle is regular, you can estimate ovulation by counting back roughly two weeks from your next period.

Then add ovulation predictor kits if you want more precision. These detect the LH surge, which usually signals ovulation within about 24 to 36 hours.

The most fertile days are the few days before ovulation, because sperm can survive three to five days, while the egg only lasts 12 to 24 hours. In other words, getting sperm there before the egg arrives is the goal.

When does DIY tracking stop being enough?

If cycles are irregular, calendar tracking becomes unreliable. Ovulation strips can also be misleading in women with PCOS, who may have elevated LH levels and multiple false positives. That is why Dr. Lucky says irregular cycles are a reason to see a specialist sooner rather than later.

IUI vs. IVF: what’s the difference, really?

What usually comes after basic fertility testing?

If all testing looks normal and pregnancy still is not happening, treatment often falls into one of two buckets: a more laid-back approach or a more intensive one.

What is IUI?

IUI stands for intrauterine insemination. Dr. Lucky describes medicated IUI as “speed dating for the reproductive tract,” which is honestly perfect.

The goal is to slightly improve the odds on both sides:

• Use oral medications like Clomid or letrozole to encourage the release of more than one egg.
• Wash and concentrate the sperm sample.
• Place the sperm directly into the uterus near ovulation.

It is less invasive than IVF and can make sense as an early step, especially for unexplained infertility. But it is still a modest nudge, not a guaranteed solution.

What is IVF?

IVF is much more involved, but also much more efficient. With injectable medications, the ovaries are stimulated to mature multiple eggs in a single cycle. Those eggs are then retrieved in a brief procedure under anesthesia, fertilized in the lab, and cultured into embryos.

There is still a funnel. Not every retrieved egg matures. Not every mature egg fertilizes. Not every fertilized egg becomes an embryo. Not every embryo is chromosomally normal. But IVF gives doctors and patients something they never get in natural conception or IUI: a much larger group of eggs to work with at once.

That is why egg count matters much more in IVF than in natural conception.

What about genetic testing of embryos?

This has changed fertility care dramatically. Once embryos reach the blastocyst stage, a few outer cells can be biopsied and tested for chromosome number. That helps identify which embryos are more likely to implant and become healthy pregnancies.

Dr. Lucky noted that many patients become pregnant on the first transfer of a chromosomally normal embryo, though not all. Even excellent embryos do not implant 100 percent of the time.

Still, IVF with embryo testing can be an extraordinarily effective option, especially for older patients, those with recurrent miscarriage, or those trying to preserve fertility strategically.

Egg freezing vs. embryo freezing

Is embryo freezing better than egg freezing?

Dr. Lucky hates the oversimplified version of this question, and for good reason.

Embryo freezing does give more information upfront. You know how many eggs fertilized, how many became embryos, and often which embryos are chromosomally normal. That clarity can be reassuring.

But embryo freezing also requires a sperm source, and that is not a small detail. You cannot “unmake” an embryo later if the relationship changes. Legal, emotional, and ethical questions around embryos are very real.

Egg freezing, by contrast, preserves potential and flexibility. You may know less upfront, because eggs have to survive thawing, then fertilize, then grow into embryos later. But for many women, especially younger women who are not ready to make embryos with a partner, that flexibility is invaluable.

The bottom line from Dr. Lucky was nuanced:

• Younger women are often excellent candidates for egg freezing because outcomes tend to be more predictable when egg quality is presumed to be stronger.
• Women 38 and older may need a more personalized conversation about whether eggs, embryos, or a combination makes the most sense.
• The best fertility preservation strategy is the one you can actually live with and use later.

Do autoimmune issues play a role in fertility?

What about lupus, thyroid disease, or other autoimmune conditions?

Yes, they can matter, although not always in a simple or direct way.

Dr. Aliabadi shared that when she sees patients with endometriosis, she often checks for autoimmune markers because autoimmune conditions can cluster. Dr. Lucky agreed that significant autoimmune disease can affect fertility directly or indirectly, especially if inflammation is not well controlled.

She emphasized multidisciplinary care. If a patient has lupus, rheumatoid arthritis, thyroid disease, or another autoimmune condition, fertility planning should involve collaboration with the appropriate specialists and a focus on getting disease activity stable before pregnancy when possible.

She also made a larger point that feels central to good medicine: sometimes guidelines lag behind what experienced clinicians already know. A thoughtful doctor does not always wait until someone fully “qualifies” for concern before looking deeper.

Fertility myths that need to die

Does IVF guarantee pregnancy?

No. IVF is powerful, but it is not magic. Success depends on egg quantity, egg quality, sperm quality, embryo development, and the uterine environment. Sometimes it takes more than one retrieval or more than one transfer.

Does IVF use up your eggs or cause early menopause?

No. IVF does not deplete the lifetime egg supply in the way many people fear. The eggs retrieved during IVF are part of the recruited group for that cycle, and most of those would never have been ovulated anyway. In that sense, egg retrieval is more like salvage than waste.

Does bed rest after embryo transfer improve success?

No. There is no strong evidence that bed rest helps after embryo transfer, and some data suggest being overly sedentary may even be counterproductive. The embryo does not “fall out.” Patients typically get up and resume normal movement.

Does IVF cause cancer?

According to Dr. Lucky, no. This is one of the most damaging fertility myths.

She was unequivocal that IVF does not cause breast cancer. The hormonal rise during stimulation is temporary, not a chronic years-long exposure. Large studies have not shown a meaningful link between IVF and breast cancer, even after multiple cycles. The same broad reassurance applies to ovarian cancer as well.

Does birth control cause long-term infertility?

No. Hormonal birth control prevents pregnancy while you are using it, but it does not cause permanent infertility. Ovulation returns after stopping most forms. The Depo-Provera shot can cause a longer delay in return to ovulation than the pill, patch, ring, or IUD, but that is not the same as long-term infertility.

One subtle point Dr. Lucky made is that long-term hormonal contraception can temporarily suppress what the ovaries look like on ultrasound. In some patients considering egg freezing, she may have them stop the pill briefly and rescan later to get a more accurate read. But that temporary suppression is not damage.

Yes, men have a biological clock too

If men make new sperm all the time, why does paternal age matter?

Because “possible” is not the same as “neutral.”

Men do continue making new sperm throughout life, and that is why an older man can still father a child. Unlike eggs, sperm are continually regenerated. But as men age, mutations can accumulate in sperm DNA, and that can affect fertility and offspring health.

Advanced paternal age is not talked about nearly enough. While there is no single universally agreed age cutoff, studies often point to the late 40s and beyond as the time when risks begin to rise more noticeably. Associations have been seen with miscarriage, poorer embryo quality, autism spectrum disorders, and some other health concerns in children.

Dr. Lucky even raised an interesting question: if sperm freezing is so much easier and cheaper than egg freezing, why are more men in their 40s not thinking proactively about it?

What women should know much earlier

If you could change one thing about how women approach fertility, what would it be?

The spirit of the entire conversation was this: women deserve earlier, clearer, more practical information.

That means understanding:

• that fertility is not guaranteed in youth
• that 35 is not a cliff, but age still matters
• that painful periods and irregular cycles deserve real evaluation
• that sperm matters just as much as eggs in many cases
• that ovarian reserve and egg quality are not the same thing
• that IVF is powerful but not magical
• that birth control does not ruin fertility
• that pelvic ultrasound and thoughtful workups can uncover missed diagnoses early

Most of all, women deserve to become their own health advocates before they are in crisis mode. Fertility care is incredibly time-sensitive. The more informed someone is in her 20s and early 30s, the more options she may have later.

FAQs

When should I see a fertility specialist?

If you are under 35 with regular cycles, many doctors use 12 months of trying as the benchmark. If you are 35 or older, six months is more appropriate. If you are 40 or older, or if your cycles are irregular, it often makes sense to get evaluated much sooner.

Does a low AMH mean I cannot get pregnant naturally?

No. AMH reflects ovarian reserve, not a direct measure of whether you can conceive naturally this month. It is more useful for predicting how many eggs may be accessible in treatments like IVF or egg freezing.

What are the biggest hidden causes of infertility that get missed?

In this conversation, PCOS with insulin resistance and undiagnosed endometriosis came up repeatedly as common blind spots. Tubal disease, uterine abnormalities, fibroids, and male factor infertility are also frequently under-evaluated.

Should I get a pelvic ultrasound before trying to conceive?

Both doctors strongly favored a baseline pelvic ultrasound, especially before pregnancy. It can reveal fibroids, ovarian cysts, uterine anomalies, polyps, and other structural issues that may affect fertility or pregnancy outcomes.

Is IUI or IVF better?

They serve different purposes. IUI is less invasive and can be a reasonable early option in selected cases. IVF is more involved but much more efficient because it allows multiple eggs to be retrieved, fertilized, and developed into embryos in the lab.

Is egg freezing worth it?

For many women, yes. Egg freezing preserves flexibility, especially if you are not ready to create embryos with a partner. The younger you are when you freeze, the more predictable outcomes tend to be. The decision should always be individualized.

Does IVF cause breast cancer or ovarian cancer?

The doctors were clear that IVF does not cause breast cancer, and the overall data on ovarian cancer are also reassuring. The hormone exposure during IVF stimulation is temporary and very different from long-term chronic exposure.

Can men be too old for fertility?

Men can continue to make sperm throughout life, but paternal age still matters. Older sperm are associated with some increased risks, including miscarriage, lower embryo quality, and certain health concerns in children. Male fertility ages differently, not infinitely.

Does birth control make it harder to get pregnant later?

No. Birth control does not cause long-term infertility. Ovulation generally returns after stopping it, though some forms like Depo-Provera can take longer than others for cycles to normalize.

Dr. Lucky’s larger message stayed with us: fertility should not feel like a secret language women are forced to learn only once they are hurting. The earlier we understand the basics, the less likely we are to be blindsided by them later.

This article was created from the video Everything You Were Never Taught About Fertility ft. Dr. Lucky Sekhon | SHE MD for Dr. Thais Aliabadi’s website.