Doctor Kaylen silverberg.
I'm the medical director and managing
partner of Texas Fertility Center. Let's
start real general.
I mean the past year.
You know, being a fertility doctor,
how many questions have you
gotten in regards to not just
COVID and you know how does this
affect pregnancy or fertility,
but now the vaccines for the past six,
6-7 months, right? So there's
just been a nonstop barrage of
questions really that have come in,
so you know the disease comes
around and people are getting sick
and they're worried and they're,
you know, masking,
and they're getting confusing.
Contradictory, frequently information
from authorities and they don't know
really what the right thing is to do,
and so they all come in and they
ask questions, or they bombard our
telephones with questions and what we
what we tell them is what we know.
And we also tell them what we don't know.
OK, so let's kind of review what we know.
We know that COVID is real.
OK, we know that COVID can be serious,
and we know that COVID tends to
be more serious in pregnancy.
For a variety of different reasons,
but it tends to be more serious
than pregnancy.
Therefore,
even though the Center for Disease Control
and the World Health Organization went
back and forth about their guidelines,
the Center for Disease Control has
been pretty consistent that women
who are pregnant or or trying to
get pregnant should get vaccinated.
The World Health Organization
has been much more hands off.
No, no, no,
no.
You shouldn't get vaccinated and,
and that's really been a problem
because it's really transmitted,
contradictory information and confusing
information to a lot of people.
How do you clear that up with people?
I mean not even just the discrepancy
between the two organizations, but.
As time goes on and we
learn more about again,
either COVID or the vaccines, right?
You know, kind of clearing up
what is old information versus
the newest information point that
you're making is a really valid
point. Information evolves,
you know, we learned this is
a brand new disease, right?
I mean it didn't exist two years ago,
and so we've had to learn a whole
lot and a lot of scientists have
really put themselves through a
crash course to try and learn as
much as possible about this disease.
The the operation Warpspeed thing
was incredible to get a vaccine
delivered from not even knowing
about a disease to getting a vaccine
delivered against the disease.
That would protect the overwhelming
majority of people in 18 months is crazy.
And so it's really wonderful that we
were able to get that accomplished.
Now there are a bunch of
differences between the vaccines.
You have two basic different
categories of vaccines.
You have the messenger,
RNA vaccines and you have vaccines
made using the old technology
and I'm air quoting old because
it's not really old technology.
It doesn't mean that it's now
modded or not good anymore.
It's still very good technology.
But what we used to do to make
vaccines is we used to take
a particle from the virus.
We would either heat and activate
it or kill it.
In rare cases use small particles
that were live and inject those
into people and cause your immune
system to make a reaction to make
antibodies against that virus itself.
OK,
and that's what the Johnson
and Johnson vaccine is.
So it's a vaccine using the traditional
as opposed to old traditional technology.
Moderna Pfizer come along.
Brand new Earth shaking technology
where they take messenger RNA,
which codes for protein production
and what they did was they were
basically reverse engineered.
A couple of areas on the spike
protein which is part of the protein
code of the virus that allows
it to attach to human cells and
subsequently infect human cells.
And so they manufactured the RNA.
Against that those again they
would produce protein that was
on those spike proteins,
and then they inject that messenger
RNA into our bodies and that causes
our bodies to make antibodies as well.
And as it turns out,
when you look at the data,
at least so far it looks like
the Moderna and Pfizer vaccines
are more effective.
They've got broader coverage that
they are pro conferring protection in
over 95% of patients who receive it,
whereas Johnson Johnson is more
like the 70s low 70s percent.
OK,
so that kind of clarifies the
differences between the vaccines.
Is there not necessarily?
Is there a specific vaccine that
you discuss with any patients,
but is there a technology between
the messenger RNA versus the
traditional vaccine delivery?
Is there one that is?
More effective or seems to be more
effective when it comes to helping,
not just potential mothers,
but then if they are pregnant
you know whether it's a fetus or
depending on how far an embryo,
how far along they are in the pregnancy.
Right now I get all that
so there's so many
questions that are in that one question,
so it's kind of hard to unpack it,
so let me let me just tell you.
First of all, what do we think
the best way to attack this?
Let's talk about what we know.
What we don't know.
As far as the virus goes, OK.
All we knew a few months ago is
what the virus would do to a
pregnancy if a woman was infected
towards the end of her pregnancy.
OK, we had no knowledge about
what would happen if a virus
affected a woman's pregnancy in the
middle or even at the beginning.
We know if you look at chickenpox.
If you look at herpes,
if you look at viruses that we
understand very well and know about now,
we know that certain viruses
affect the pregnancy only in
certain times during the pregnancy.
So chicken pox, for example.
If you get infected with chickenpox
early in pregnancy, probably no big deal.
But if you get infected with
chickenpox late in pregnancy,
it's a little bit of a problem.
OK, German measles?
We know it's got effects,
different different effects at different
times in the pregnancy as well.
So what we're learning now is
because the virus has been around
for a longer period of time,
and now we have some women who are
pregnant who got infected early in pregnancy,
and maybe some who got infected,
maybe in the middle of their pregnancy.
There are collecting that data now.
To see what's going to happen.
But the biggest problem with
that is some illnesses and some
diseases may not arise at birth.
They may not present at birth.
It may be that God forbid children,
get developmental delay or things
start to show up three years from now.
Five years from now 10 years from now.
It's not likely,
but it's always a possibility,
and so we have to be honest with our
patients and tell them what we know.
What we don't know.
The second question that you asked
was about the technologies, right?
So there was a report that circulated
very widely on the Internet.
Some guy in Germany there's a
scientist came up with a theory
that the messenger RNA against
the spike protein and the virus
has some structural similarity to
the messenger RNA that's found.
It produces a specific protein involved
in the placenta called sensation one.
And his theoretic concern made it
all over the Internet, saying hey,
wait a minute,
if you take this message RNA vaccine,
you may make antibodies to placental tissue,
which would render you sterile.
There is absolutely no evidence
that that's true.
In laboratory studies have been so
done so far. It's flat out not correct.
There are very few human trials
or even ongoing looking at this,
but some people are actually
interested in looking at this and
evaluating it further.
No data has come out yet regarding
the results of those trials.
About a year ago is when we
first met again over zoom.
We were talking about COVID-19,
the virus itself and how they were
just first studies coming out of
Italy and coming out of China.
I think it was about COVID-19 and
you know newborn babies or fetuses.
You know the how far have we come?
Just in the past year when it
comes to studying this I mean.
It's been such a widespread virus,
how far we come with the research.
Well, so there's there's different
types of research and research into
viruses is pretty difficult to do,
and let me tell you why.
If a new pharmaceutical drug comes out,
we design what's called a
prospective randomized placebo
controlled study in English.
What that means is we take
two groups of patients.
One group we give the
actual drug we're studying,
and one group we get the placebo.
And we don't tell the patient
what we're giving it to them or
which one we're giving to them.
They've consented to that
they understand that,
and then we can evaluate the data
downstream and find out if that
drug made a difference or not.
With viral infections, you can't do that.
You can't say OK,
I'm gonna infect this group
of people with a virus,
and I'm not going to infect this group
of people with the virus or I'm going
to give this group of people a vaccine,
and I'm not going to tell him,
but I'm going to give this group
of people a placebo vaccine.
Those were done under very,
very small sample sizes early on
to try and determine if in fact
the viral vaccines that they were
looking at were even effective.
OK, but it's hard to do long
term studies like that.
So what we're doing more now
or what are called registry.
Studies,
so they're following people who were
pregnant and they're following them.
If they got infected at different
points during the pregnancy,
and they're following not
only them and their health,
but they're following the
outcome of their pregnancy,
so were their babies smaller
than they should have been,
where they bigger than they should have been.
Do they have a greater likelihood
of being admitted to the
intensive care unit or not?
Did they have any evidence of
getting infections or diseases
in the first year of life?
And they'll follow these kids longitudinally?
And it'll take years for us to really
know and have that data analyzed
and know what that what it shows.
Have you faced any challenge with?
Having to convince people one way or
another throughout the past year,
I mean because there's been so much
information because so many people have
taken it upon themselves to do their
own research, for better or worse.
And then you have.
You know, this constant changing of
guidelines throughout the pandemic as well.
Have you got a challenge?
Just kind of convincing people
whether to what the right or what
the best advice is absolutely.
And there's no and no
one knows the right answer.
You know anybody who tells you that.
They know the exact right answer with
the disease that's been known to
mankind for 18 months is fooling you.
They don't know, we just don't know.
We have no idea what the long term
effects are going to be, if any.
We have no idea if booster doses of the
vaccine are going to be needed, if any.
You know. I mean, think about
vaccines that we know already, right?
I mean, we know that the flu shot you
have to get every year a tetanus vaccine,
you get a booster every 10 years.
A German measles vaccine.
You get it once when you're a kid,
you never get it again.
You never have to get the
vaccine booster again,
so the fact that we don't yet know with a
virus that's been around for 18 months,
what the ultimate treatment course
is going to look like is expected.
It's not a surprise.
It's not that people aren't
doing their research,
and they're not doing their work.
We don't know.
And there's a lot of other things
that we don't know either.
We don't know if the right thing to do is
to tell people to get vaccinated or not,
because we don't know if there are going
to be any long term effects of the vaccine.
Vaccines have been out for 910 months.
There's no way for anybody to
be able to predict the future,
or even with animal studies.
It looks highly unlikely that they're
going to be down the road problems,
but again, nobody,
nobody knows the answer to that question.
We just don't know.
The studies that have been done
recently in regards to the
vaccine suggests that there is no.
Harmful effects on the from
the vaccine on fertility.
Have you is this are these studies that
you have looked at specifically as well,
or is this something that is
still so new that you are kind of
waiting for even more to come out?
You know before.
Talking about it with the clients,
or with patriots. Yeah,
great question, great question.
So the studies that have come out
or preliminary right and what you
have to understand is studies.
Let's look at male fertility for example.
OK, there's studies that come out
that have come out that have suggested
that there's no change in sperm count.
There's a couple of small studies
that have suggested that there
is a change in sperm count.
But what these studies don't take
into account is it takes between 90
and 108 days from the time that sperm
cell starts to develop an amount
in a man's body until it comes out.
So anytime during that 92108 day period,
if a man gets infected,
gets a fever and get some other
some other problem,
you can still see an effect.
So we're going to need longer term
studies to be able to determine number one.
Is there an effect on sperm count and #2?
Is it long lasting and #3?
Do this firm counts if there is an effect,
do they recover?
And one of the studies that I sent
over to you and actually prompted
this interview in the first place.
It said that they only tested like
45 men or something like that.
Is that research like that?
I'm not going to say that it's
not helpful because you know,
we need as much as we can get right now.
But 45 men is not a big
population to be testing at all.
Correct, yeah, any study looking
at a worldwide pandemic cause or
worldwide worldwide infection?
Any study that reports on 45 people
you gotta take with a grain of salt?
OK, because we're going to have
thousands 10s of thousands,
maybe hundreds of thousands of people
that are eventually going to be
studied and eventually reported upon.
And 45 you know all that can do
at the beginning is scare people.
You know, it may be that you maybe you've
got a small study that's reassuring,
but the numbers are so small
you can't know with certainty
that that's really reassuring.
It just.
And conversely,
if a study is involving involving 45 people,
and it suggests that five
people have a problem,
you know that you don't know if
that's going to be real or how
that's going to be borne out
when larger numbers come out.
Having all the research that we do right now.
What do you tell a what do you tell patients?
What do you? What do you tell couples
that come to you and say, hey,
we're thinking about getting pregnant
or we're trying to get pregnant,
but we have not been vaccinated yet.
Right, what I tell people is they've
got to make their own decision.
We don't have all of the answers.
Any doubts that they have are reasonable,
because again, we don't have all the answers.
But what I tell them is based on the best
available evidence that we have on July 2nd,
2021 they should get vaccinated.
If they're pregnant,
they should get vaccinated.
If they're trying to get pregnant,
they should get vaccinated.
I strongly believe they
should get vaccinated.
I got vaccinated.
So I mean, I tell people you know,
and and I can't,
I can influence what they think.
But I can't order them to get vaccinated.
They need to do what they think is right.
That's the only questions I had for you.
Is there anything else that
you wanted to add about?
You know the research that's
been done so far in regards
to the vaccine and fertility,
or is there anything that I missed?
Anything important to talk about?
No? I mean there's you know there's
just a lot of stuff I hate to keep
saying it over and over again, sorry.
I hate to keep saying it over and over again,
but there's just so many things
that we still have yet to learn.
But what I want to emphasize is that.
I would encourage people
to do their own research,
but I wouldn't encourage them to speak
to medical professionals and get that
research validated because there's so much
misinformation coming out of the media.
So much misinformation
coming out on the Internet,
and it's very important that people
know how to assess scientific studies.
You know, the average person can't
really assess a scientific study,
they can read it,
they can read the conclusions,
they can understand it.
OK, but they don't know if
that study is scientific,
scientifically valid or not.
They don't know if there is
bias that's been introduced,
or if there's not bias.
It's been introduced,
or if it's been limited,
and so a lot of scientific
studies that come out,
especially in a topic this important,
I would encourage people to go to your
physician and talk to your physician and ask,
especially if you have any questions.
If you have any doubt about what
you should do, ask.
And doctors will tell you to the best
of their knowledge where we are today,
but unfortunately.
Things have a way of changing over
a period of years and we don't know
the long term effect of either the
viral infection or the vaccine.