Knocked Up Podcast - Big Miracles and Fertility for Singles with Dr Daniel Lantsberg
With Big Miracles back on TV for 2025, we speak to Dr Daniel Lantsberg, featured in the channel 9 show "Big Miracles" with his patient, Anna.
With Big Miracles back on TV for 2025, we speak with one of the Doctors featured in the series, Dr. Daniel Lantsberg.
Dr. Daniel Lantsberg is a Fertility Specialist at Melbourne IVF. After graduating with honors from Israel's Ben Gurion University in 2008, he completed extensive training at world-class Israeli hospitals before relocating to Australia for an additional three-year subspecialty fellowship at the Royal Women's Hospital and Melbourne IVF. With special interests in elective egg freezing, age-related and unexplained infertility, male infertility, PCOS, endometriosis, and fibroids, Dr. Lantsberg maintains private practice in East Melbourne while holding public appointments at the Royal Women's Hospital where he trains junior doctors.
Anna is a 39-year-old woman pursuing life as a Single Mother by Choice (SMBC). Her journey highlights the unique medical and emotional considerations involved, from selecting fertility treatments appropriate for solo parents to navigating Victoria's specific regulations regarding donor sperm access, which differ from other Australian states. The show documents how Daniel guides patients like Anna through critical decisions about known versus clinic recruited donors while addressing common concerns about single parenthood.
Hosted by Dr Raelia Lew and Jordi Morrison
Dr Raelia Lew is a RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Find us on Instagram - @knockeduppodcast
Have a question about women's health? Is there a specific topic you'd like us to cover? Email podcast@womenshealthmelbourne.com.au. We keep all requests anonymous.
TRANSCRIPT
Jordi Morrison:
Women's Health Melbourne is an innovative, holistic fertility and women's health practice. We are world leaders in IVF and egg freezing and provide our patients with every opportunity to achieve their goals. Our handpicked expert team provides the ultimate care experience for our patients. Reach us at womenshealthmelbourne.com.au and follow us at Women's Health Melbourne and at Dr Raelia Lew. Hello, and welcome to Knocked Up, the podcast about fertility and women's health.
You are joined as always by me, Jordi Morrison, and Dr Raelia Lew, CREI fertility specialist. Today, we are also joined by Dr Kokum Jayasinghe. Dr Kokum combines extensive medical expertise in fertility and IVF with a deep personal understanding from her own fertility journey. And alongside her practice as a fertility specialist, Dr Kokum is dedicated to training the next generation of reproductive medicine specialists. Welcome, Kokum.
Dr Kokum Jayasinghe:
Thank you for having me, Jordi.
Jordi Morrison:
Thank you so much for joining us. A really exciting episode. We're talking about Big Miracles, the TV show. So Big Miracles has started.
It's an amazing TV show that is on Channel Nine, and it showcases some of the stories of patients going through fertility treatments to help them achieve their goals of having a family. And this season, Dr Kokum is a star on Big Miracles, presenting one of her patients' cases and letting the public who may not have very much insight necessarily on a personal level into IVF treatment, see a window into what goes on when we try and help people have a baby with some help.
How did you feel, Kokum, being on Big Miracles this season?
Dr Kokum Jayasinghe:
Oh, that is such a privilege to be on that show.
Thank you for asking, Raelia. And yes, as you highlighted, this is a documentary series giving viewers an insight into the journeys of couples and individuals going through and navigating their fertility journeys. And it is really a show of hope, resilience, and strength, as well as showing the human spirit. This really gives an insight and a peek into their personal life. Otherwise, we would not have the opportunity to.
And I'm very privileged to look after my patient, Christie and Perry, who were actually in season two and their stories also featured in season three as well.
Dr Raelia Lew:
That's great. And I think that also highlights for our listeners that fertility treatment does take time and it's often not like some medical treatments, one episode of care. It can be a treatment series that happened over quite a few months from when someone first meets their fertility specialist.
Ko, can you tell us a bit about how you first met Christie and Perry and how did they come to decide to participate in the show?
Dr Kokum Jayasinghe:
So I actually met Christie and Perry few years ago when they presented with, really unknown factor, infertility of many years. And you are absolutely correct in saying this is a journey. So we get to know each other, the patient and the doctor, and we try to find out what is going on. And it can take some time to get to where they want to go and understanding that it may not happen immediately.
So how this couple ended up in the show—in fact, when Big Miracles was advertised and letting the audience and the patients know that this is happening—patients actually volunteer to share their stories.
There's no pressure, and they don't get any financial reward. They volunteer to share their story, and a lot of patients could be filmed. In fact, I had three patients for season two, and only one got selected.
And this selection process happened by Channel Nine. It is not by the patients or the doctors or the clinic.
It is by Channel Nine. And the main aim is actually to represent a diverse range of infertility experience and different cases, their emotional journeys, the successes, the challenges, and their personalities, and also keep this actually interesting for the viewers and the audience.
Dr Raelia Lew:
Yeah. I think that's really interesting about how Channel Nine—and it's important to them to show a diverse range of fertility experiences because it is different for every set of patients.
Dr Kokum Jayasinghe:
Yep. That is true. That is true.
Dr Raelia Lew:
Dr Kokum, I wanted to ask you about patient confidentiality because this is so important in all forms of medical care to the patient's experience knowing they have this sacred pact with their doctor and also their dignity. Of course, if the patient's treatment is being broadcast, this has been waived. From your perspective, why is it important that the audience is given insight into what is usually kept private?
Dr Kokum Jayasinghe:
I believe infertility is usually a disease suffered in silence with stigma and misconception, and allowing our viewers a glimpse into the deeply personal stories otherwise they wouldn't see, actually normalizes these conversations around fertility, their struggles, trying to break the taboo and encouraging people to have these conversations openly and trying to get help sooner. So we really owe a huge thank to these real-life heroes for coming forward and allowing the public and the audience to see what they go through. So they are really the heroes that we should give a huge thank for.
Dr Raelia Lew:
Yeah. And there's no shame involved.
Dr Kokum Jayasinghe:
Absolutely. So the sooner we ask for help, the better, and it is a sense of courage rather than a shame.
Dr Raelia Lew:
Absolutely. And other than the privacy, what, from your perspective, are the other differences between a normal patient experience and then your patients who were being filmed?
Dr Kokum Jayasinghe:
They have a few, actually. One is having the cameras around. The cameras and the camera crew when you are having your normal conversation and clinical experience with the patients.
Initially, this was daunting for both parties, but we soon get used to it. And the camera crew and the producers just try to fit in with what we do and try not to interfere, especially with the emotional care and the support we provide in certain situations.
Another major thing I noted was the time taken to film these episodes. So we really have to—when these patients who were selected come for their usual appointments—we have to allocate a lot more time than we would otherwise.
And the repetition of things. So I may explain certain things to my patient, but the producers would want me to say the same thing, and they want to make sure the whole conversation is captured to their liking and may want me to explain that in more simple language so the audience can understand and follow.
Another logistic is some of our procedures are very time-critical, like the egg collections. So we want to allocate this filming probably towards the end of these things so the other patients don't get affected.
However, at the end of the day, we all make it fun and have an enjoyable experience for everybody.
Dr Raelia Lew:
Yeah. And I think the patients involved want to really showcase their own experience for the benefit of others. I think that's their main motivation.
Dr Kokum Jayasinghe:
Absolutely. I think at the end of the day, Raelia, the whole series is about raising awareness and trying to break that taboo and make that a normal conversation.
Infertility is another medical condition, and it is not anyone's fault. It is okay to get help, and the sooner you actually come get help, the better.
Dr Raelia Lew:
With Christie and Perry, they were diagnosed with unexplained fertility. Given that it is unexplained, how is it diagnosed?
Dr Kokum Jayasinghe:
Yeah. Unexplained infertility is a frustrating diagnosis for both doctor and the patient.
How we come to the conclusion is—it is actually a diagnosis of exclusion. So we want to look for any treatable causes.
Particularly, we look for any ovulatory disorders, and we look for any sperm problems or male contribution, and we look for any tubal factors and any structural abnormalities in the uterus.
So these are the things that we can actually exclude and look for.
And once these things are excluded, we look at the length or the duration the couple has been trying because, as Raelia highlighted, fertility can take time.
So no one would come and see us if they've been trying for one or two months.
And within twelve months, ninety-two percent of young couples would be pregnant.
With duration, once we excluded all these things, we come to the frustrating diagnosis of unexplained infertility.
Dr Raelia Lew:
I always say to patients that unexplained infertility does not mean there isn't a real explanation.
It just means that the common factors that we know quite often cause infertility have been excluded. And the tests that we have in medicine that exist today can't get to the bottom of why things haven't happened for that couple.
And quite often when we go through IVF, we make other really critical observations that help us understand why a couple have taken longer to get pregnant.
Another point about infertility is it's a spectrum.
And sometimes we help patients who can or may get pregnant in some way, shape, form, or circumstance in their life, either before or after the period of time that we treat them, there's such a thing as subfertility rather than sterility.
So some people just together as a couple have a real barrier or multiple small barriers that add up that make it harder for them to get pregnant, not necessarily impossible.
But we want to help people when they need help and when they want to be pregnant.
Dr Kokum Jayasinghe:
Absolutely. Absolutely. Couldn't agree more.
And, really, I think another thing I like to highlight to my patients is some or most of these tests we do are structural tests. They are not functional.
And especially when we flush those tubes and say, hey—the tubes are open—we can't really check the functionality of those tubes.
Because in reality, what the tube has to do is take the sperm to the egg and bring the embryo back into the uterus.
So the functionality of those things—it's not possible to test.
And even though we say the sperm test is normal, the function of the sperm—does it actually fertilize the egg? And what is the uterine environment? Is it allowing the embryo to implant?
So there are a lot of factors we are unable to test when we give that diagnosis of unexplained.
You're absolutely correct in saying it doesn't mean there is a cause. With the available test at this stage, we can't work it out.
And that could be the very reason, especially the young couples presenting with unexplained, may get pregnant straight away within a very short time or the first time we try IVF.
Because a lot of these factors that cannot be tested are taken out of the equation.
The functions of the tubes and the environment—it is going to be in a different environment in the lab, very much controlled.
So we see IVF sometimes can be the answer. We're not saying it is the only or you have to, but it can take a lot of these untestable factors out of the equation.
Dr Raelia Lew:
And I also agree, Kokum, that IVF jumps over a lot of those steps. So it's almost like a get-around for things that might be the problem.
We don't know that it's definitely the problem, but we can jump over those steps and try and get to the end.
And that can help couples solve a myriad of problems without us actually even frustratingly knowing exactly what it was.
Dr Kokum Jayasinghe:
Yeah. And I also agree with your point that it is subfertility.
Pregnancy may happen. We just don't know when. And we look at the probability—if they have been trying for such a period of time, the pregnancy chances naturally happening is low.
So we need to look at the bigger picture. Well, how old is the patient and how many kids do you actually want?
Are you happy to keep trying with a small probability, or are you open to look at different options that may jump the queue and give you a higher chance?
At the same time, when these patients are least expected, they may fall pregnant naturally because there wasn't anything wrong with them in the first place.
Jordi Morrison:
Do you find this subfertility or unexplained fertility—is this a regular occurrence?
Dr Kokum Jayasinghe:
So, Jordi, in regards to the incidence, really, when we look at our couples coming with fertility problems, up to fifteen to thirty percent of couples would be going through this diagnosis of unexplained, and it is definitely frustrating.
I feel it is a double-edged sword for the patient.
So when we say there is no clear reason, it is good. So they feel happy. There's majorly nothing wrong with me.
At the same time, when the pregnancy is not happening, they feel quite frustrated.
“Well, why isn't it happening then?”
And also the fact that there's not something simple we can fix, if you like.
Dr Raelia Lew:
Yeah. It would be frustrating for both parties.
You mentioned earlier that ninety-two percent of young couples who have tried for twelve months will get pregnant.
At what stage should a couple seek specialist advice if they're struggling to conceive?
Dr Kokum Jayasinghe:
So I think there are summary points we should always give to our patients as these points we look for.
First thing is the patient's age.
If the female is over 35, six months is a reasonable time to come and seek help if she's not pregnant because it is not a secret that fertility declines with female age.
So the sooner she comes and gets help, the better the pregnancy chances in whatever method and also has the capacity to give the dream family she would want rather than just one child and taking the choices away from her.
Because this is about family size as well, not just having a single baby.
Dr Raelia Lew:
That's right. We want to keep the dream family a reality. So coming sooner allows all these options.
Dr Kokum Jayasinghe:
If the female patient is under 35, it is reasonable to try for twelve months, given within twelve months, ninety-two percent of patients are pregnant.
Having said that, if there are red flags in the background—like the patient has irregular cycles or there's known endometriosis, fibroids, heavy periods, painful periods.
If there are any red flags or there's known tubal disease already in the past, it is common sense to come and get help early because these things would not disappear just because you waited longer.
Jordi Morrison:
How does the emotional impact of an unexplained diagnosis differ from a known diagnosis?
Dr Kokum Jayasinghe:
Unexplained empirically—as I explained, Jordi—I feel there are two sides.
On one side, the patient should be happy that there is absolutely no bad diagnosis.
On the other side, they feel frustrated, certainly feel emotionally drained because there's no clear direction of where we can take them to—if you like—within inverted commas, “to fix the problem.”
Patients, I feel, they often have a sense of helplessness, and that is where the emotional support from the treating team and the clinician is very important.
At this point, I like to highlight the positive side and say, “Hey, there's nothing wrong with you.”
So there is a very good chance with the treatment available, we can take you to where you want to go, rather than fighting with a difficult diagnosis—something that is even harder to overcome with treatment.
Dr Raelia Lew:
I think that is an amazing point.
So one important thing about IVF and unexplained infertility is the stat that we can help well over eighty percent of couples with unexplained infertility get pregnant within two IVF cycles.
And that just means that compared to all patients who have IVF—because IVF is a therapy where we do a lot of important work to try and improve people's chances of getting pregnant—but not every patient is an equal candidate for IVF treatment.
The more burden of disease and difficult factors that a patient brings for us to try and overcome, the harder it is, unfortunately, for IVF to do that work of overcoming their underlying fertility barriers.
Whereas with couples where infertility is unexplained, we are likely to win most of the time with IVF.
Dr Kokum Jayasinghe:
Yeah. I feel sometimes the struggle is the patient coming to terms with that—“Yeah, I need IVF,” because they feel, “Look, if there's nothing wrong with me, why do I need IVF?”
So that is half the battle and the struggle to accept, “Well, I need treatment, and this is the treatment with the highest success.”
And more often than not, these patients are the ones that get pregnant straight away with their first transfer.
Jordi Morrison:
Over your careers—this is for both of you—how has the understanding of unexplained fertility evolved?
Dr Kokum Jayasinghe:
I think we've gained a deeper appreciation of the complexity of this condition.
For example, there are a lot of subtle factors we may not be able to test—like the egg quality, the sperm function, the embryo development, and the immune environment and the receptivity of the uterus.
So these can certainly play a big role, and they are not simply able to be tested with current available methods.
So some of these factors currently play a big chance in their pregnancy rates and sperm and egg fertilization.
And these things can repeatedly happen in the body, but we are totally unaware of those.
When we take the eggs and sperm to the lab, this is a unique opportunity to observe these things.
Some can be diagnosed, and some are totally overlooked.
As Raelia said, we just bypass a lot of these factors that we were blissfully unaware, and the patient is pregnant.
And then these things—certainly, we are seeing more and more advancements, pregnancy rates—as the science evolves.
And certainly with the team we are working with, it is amazing to see more and more research going into these fields to, in the end of the day, give patients the highest pregnancy rates.
Dr Raelia Lew:
And I agree that we are getting more and more insight into what might be going wrong the more we look.
So it’s one of those fields that's very exciting to work in because there's constant progress and evolution.
And as you asked about—you know—kind of changes across our careers.
One of the most exciting things that I think both Kokum and I have witnessed in our careers, which have occurred in parallel, is that our pregnancy rates are getting better and better in IVF.
And it's really exciting.
When we both first started off in IVF, it wasn't unusual for embryo transfers to happen on day two or three after fertilization.
We've seen amazing assistance in developing early life embryos to the blastocyst stage in the lab.
We're better at freezing embryos.
We're better at stimulating the ovary.
We've got safer medications now that help us help women with less risk of things like hyperstimulation syndrome and other complications of IVF.
So IVF has become a lot safer. It's become a lot more effective.
And it's a team effort—not just with your fertility doctor, but also with our entire team of nurses, laboratory scientists, the uptake of technology and the evolution of thought and the investment in science and the lifelong learning commitment of your specialists and your entire team to take on those lessons from science.
Jordi Morrison:
Such an exciting field. I love it when we have to redo an episode because there's new findings.
We love a bit of myth-busting on Knocked Up.
So I have to ask, what are the most common misconceptions that you both encounter when it comes to unexplained infertility?
Dr Kokum Jayasinghe:
I think one of the common ones is unexplained means there's no hope.
So certainly that is not the case.
Unexplained in a young couple is one of the easiest to treat.
And as we've been going on for the last ten, fifteen minutes, these would be the patients who get pregnant quite easily, actually, depending on how old the female is.
Dr Raelia Lew:
I love that. Unexplained actually doesn't mean difficult.
Dr Kokum Jayasinghe:
Yeah. That is very true.
And another myth I see with unexplained patients—coming to the conclusion, “It could be all the stress I'm going through.”
And certainly, stress could affect your overall well-being. It is rarely the whole cause of infertility.
Dr Raelia Lew:
And self-blame, I think, in general. Because people blame themselves when things aren't working, and they blame their efforts—in diet, in lifestyle, in how often they're having sex, in what position they're having sex.
“Am I doing something wrong?”
“Am I not ovulating?”
It's almost like people worry about things that aren't there, in terms of—“There must be something wrong with me.”
And that is a myth, actually.
And I think it stresses a lot of patients out.
And in this age of media and Internet and social media, we often see people going down dark rabbit holes on the Internet, trying to figure out what may be actually the real problem with them, and imagining that they have conditions that they've read about online, which they actually don't have.
Part of our workup in unexplained infertility is excluding lots of different problems.
And quite often, it's just a mixture of the fact that together as a couple, they have a lower probability of success per month through complex interactions of factors.
And that's one of the things that—we just don't really know why that is for some people.
But IVF can help overcome it. Because when we go through an IVF treatment, we actually ask a woman's ovary—instead of making just one egg a month, just one chance in the cycle—to make 10 to 12, often sometimes even a few more eggs if she's lucky.
And so she can have the chance of a year in a single month.
So one of the ways that we overcome these barriers that might just mean that a couple has a lower chance of success than average as a couple is through sheer numerical advantage, which we can create in IVF.
Dr Kokum Jayasinghe:
And another question I often get asked is, “What else can I do? What am I not doing?”
So I really, really feel sorry for the patient when they ask this question.
And I give the question back to her and say, “Well, do you think you are in the best shape you possibly could? Are you following the diet, the exercise, and overall health, and you are staying away from the toxins and environmental poisons?”
And what is the answer to that?
And often the answer is, this is the best shape of health she possibly could.
So I often tell the patient, “Well, you should take credit for that. Don't forget that you are doing all these things correct. It is not that you are missing out on anything or you are not doing anything right. This is unfortunately a medical condition. It is out of your control, and we can help you.”
And this is when they would consider going through treatment.
And the best part is—when these patients, especially when they come with unexplained infertility, and they're pregnant and all happy, happy tears and they're leaving me—I often remind them, “Remember there was nothing wrong with you. And please be careful with contraception if you are not ready for the next baby because you could be in for a surprise.”
Dr Raelia Lew:
And the other thing that I point out to women—and men, obviously, it takes two—with unexplained infertility is: if you just think about the way medicine was fifty years ago, there were so many conditions that we didn't really understand the reason for.
And you just think back just to history—we didn’t know why people died of infection once upon a time.
We didn't know why people had heart disease. We didn't know why people had kidney disease.
You know, we're still learning.
And it is amazing where we're at in medicine. There's also a long way to go.
When we recognize the problem, we don't always know the causation.
But we're very lucky in IVF that we have really amazing solutions that can help so many people.
Jordi Morrison:
Lovely place to end. Thank you both.
Big Miracles is on Channel Nine. Channel Nine on Wednesdays at 9:00 PM.
Dr Kokum Jayasinghe:
Thank you very much for having me, Jordi.
Jordi Morrison:
Or recommend to a friend.
Join us on Instagram at @knockeduppodcast and join Raelia at @drraelialew.
And email us your questions to podcast@womenshealthmelbourne.com.au.