In this episode we offer tips for taking the crucial first steps in fertility evaluation. Understanding the initial process helps reduce uncertainty and guide you along the right path. Join Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center, and Dr. Susan Hudson from Texas Fertility Center as they talk with Dr. Esther Chung from Levy Health about investigating your fertility. Tune in for expert advice on ways to approach your journey, information you will need, and how to prepare for this process. Whether you are ready to start your journey or just gathering information, this episode helps you move forward with confidence. Every path to parenthood is unique, and this episode helps you take that first informed step towards your fertility goals.

Today’s episode is brought to you by Theralogix. 

Episode Transcript:

Susan Hudson (00:01)

You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.

Susan Hudson (00:24)

Theralogix reproductive health supplements are formulated for both women and men. These products are designed by doctors and backed by science and are recommended by the majority of IVF health clinics in the US. Theralogix fertility supplements are independently tested and certified by NSF International to ensure content purity, accuracy and safety. If you’re ready to start your family, Theralogix has you covered every step of the way.

Carrie Bedient MD (00:51)

Hello and welcome to another episode of Fertility Docs Uncensored. I am with my fair, fantastically fabulous co-host Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center.

Abby Eblen MD (01:03)

Hi everybody.

Susan Hudson MD (01:07)

Hello!

Carrie Bedient MD (01:08)

And today we are joined by Dr. Esther Chung. She is the chief medical advisor of Levy Health. She’s also a Stanford reproductive endocrinology and infertility fellow. So coming from a very fancy place. And we were just talking about Christmas memories, and Esther, yours is pretty fabulous. Can you tell everybody what you were telling us?

Esther Chung MD (01:30)

Yeah, thanks for having me you guys. Since we’re around Christmas time, it brings me back to the Christmas I spent at the airport. I was visiting my boyfriend at the time and he was living in Boston and I was living in Los Angele,s and I found out that he wasn’t going to go visit his family because they live in Korea. So I was like, okay, I don’t want you to be alone. Let me fly across the country to see you. And so I land, I think, on Christmas morning, because it was a nighttime flight. And then I fully expect this man to show up or in an Uber. I mean, he didn’t have a car granted because Boston, lot of us, didn’t have cars back then. But this guy, call him and he’s like, “The Uber was too expensive. You’ll have to Uber yourself in.” I flew across the country to see you and to be with you today and on this very special day. And then he was like, Uber’s too expensive. So I Uber myself home. I was like in the Uber, with the driver and I was telling him my story and he was like, I can’t believe that man. She was like, you’re still going to go date him. You’re still going to spend the rest of the holidays with him. was like, we’ll see what he has to say. And I get to his place. And I was thinking, OK, I’ve texted him. He knows I’m on his way. He didn’t make it out to the airport. So at least he would make it out to the front steps of his apartment. This guy was still in his bed upstairs. I think he lived on the third or fourth floor. So I remember putting his keypad in and going up by myself up the elevator. And I was like, my god, this guy is not out. But it’s okay. Just to give a spoiler, this guy has become my husband.

Susan Hudson MD (03:15)

Must’ve really had some other redeeming qualities.

Esther Chung MD (03:19)

He was very young, so I like to think the time together has made him more mature and now he picks me up right on the dot at the airport when I land, so he gets there earlier now after years of training. Seven years maybe? So clearly people can change.

Abby Eblen MD (03:37)

So Esther, sorry I called your husband a jerk because when she told us this story earlier. I’m like, what a jerk! I didn’t know he was her husband, but you know the good thing, the redeeming quality about him, he’s teachable, he’s learned, and now he treats you the way you’re supposed to be treated, right?

Esther Chung MD (03:50)

Yeah, and I’ve also, we have both to learn from each other all the things.  I’m sure if you had a separate interview with him, I’m sure you would get a different story. Maybe I’m more, money conscious, cost conscious now, like an Uber doesn’t matter. That’s the feeling and being there that counts, but it’s funny. I kind of like to think like life, you just never know what. Who you’ll who you’ll run into or what happened. And it’s just funny that he was going to be my lifelong partner, and I had no idea back then. But here we are many years later.

Abby Eblen MD (04:16)

That’s right.

Carrie Bedient MD (04:24)

Well, I am glad that he saw the light and he has decided to make self-improvements so that he doesn’t end up in a ditch somewhere for his lovely wife. Susan, do we have a question today?

Susan Hudson MD (04:36)

We do. Our question for today is, hello. Want to start by saying thank you for everything you do. Finding this podcast has really helped me. Thank you for listening. I’ve gone back and listened to tons of your episodes and haven’t heard you discuss balanced translocations often. I recently found out I have this and have started my IVF journey. It feels sort of hopeless at times as not only do we have to deal with the natural funnel from egg retrieval to embryo, but then it feels like it’s practically impossible to get a chromosomally normal embryo with the balanced translocation. Do you have any tips for those with balanced translocations or anything we can do to increase our odds of having a baby?

Carrie Bedient MD (05:14)

Balanced translocations, let’s start out first with explaining what that is. Everybody’s got 46 chromosomes arranged typically in 23 sets of pairs. And what happens with a balanced translocation is patients with that still have 46 chromosomes, but instead of being 23 very even pairs, some of the pairs are lopsided. So they’re still the same amount. It’s just rearranged so that when those pairs go to separate instead of being an exact 50-50 split, you end up with an unbalanced set of chromosomes. You’ve got a little too much of one, not enough of another, and that translates to more miscarriages, negative pregnancy tests. Sometimes children survive with significant impacts from those chromosomes that are unbalanced. And when you’re going through IVF, the biggest advantage of IVF is that you can do genetic testing, PGT-A, pre-implantation genetic testing for aneuploidy, and figure out which ones are unbalanced or not, specifically if you’re using PGT-SR, which is for structural rearrangements. So that’s kind of the background of the story for our other listeners who have not had to immerse themselves in that particular part of the genetics world. Abby, what do you think?

Abby Eblen MD (06:27)

Well, I think it’s partly a numbers game. I don’t know that there’s anything you personally can do. It’s kind of like Carrie says, it’s like pulling the lever on the slot machine in the casino. You never know how the genetic lottery is gonna turn out. The more eggs that you have, so the younger you are usually, the more eggs that you get. And generally in our practice, about 70 % of the time, we’re able to find at least one acceptable embryo to transfer. Now that could mean an embryo that’s completely unaffected or it can mean an embryo that carries that same translocation. And so, certainly most people would want to have a completely unaffected embryo, but the majority of times we can do a transfer. Unfortunately, if we don’t find a normal embryo, that means that you’d have to go back through again, but that’s where age is to your benefit if you’re younger and can make more embryos.

Susan Hudson MD (07:12)

I think the biggest thing to do is prepare yourself that you may have to do more than one egg retrieval. Obviously, we’re hoping for that perfect little embryo or embryos on that first retrieval, but really going into this being like, okay, we know that we can get balanced or normal embryos, but understanding as you already do that there is a funnel effect and that may not be in the cards on the first retrieval. Psychologically preparing for the worst, but hoping for the best is a good place to be knowing that, I’ve had patients who have chosen not to do IVF, who had balanced translocations and, they might end up with lots and lots of miscarriages, but there’s a reasonable chance down the road, that they might have a child. And knowing that it is possible that normal embryos or balanced embryos are a potential likelihood, but we just don’t know if it’s gonna happen on that first retrieval. And again, knowing that you’re going to need to be stimulated pretty aggressively to get more eggs is also something to be aware of. 

Carrie Bedient MD (08:26)

I would also say that if you’re looking for a silver lining for this, it’s that you know, because there are a lot of people who don’t even figure out until they’ve gone through their first IVF cycle and then they find out and then they’ve got to completely readjust all of their expectations. And the other thing is there’s an awful lot of women who have recurrent miscarriages. And we don’t know if that’s part of your history or not, but who have recurrent miscarriages where they never get a reason why. And as far as reasons go, none of them are good, but this one is among the better ones because it truly does run a numbers game where if you get enough, you’re probably gonna get what you want. And so it’s a very different scenario than someone who’s gonna lose most of their embryos because they are 44 and a half years old or they have a sperm, their partner’s got a sperm count of two or things like that. And so if you’re looking for silver linings, this, it may be a long road, but it’s not necessarily gonna be as big and tough and nasty as it otherwise could be. And so there’s, you know, three quarters of a silver lining for you maybe.

Abby Eblen MD (09:35)

I want to add in real quickly is if you’re going to try, if you want to continue to try to get pregnant, you can do that. Make sure you have genetic counseling, and you probably do because there are some situations where a liveborn baby can be born that’s genetically imbalanced and have the right amount of chromosomal material. Make sure you get genetic counseling before you choose that path since you know that you have a balanced translocation.

Esther Chung MD (09:55)

I had a patient fairly recently who had a similar balance translocation. And I looked this up around the time for additional patient counseling. The studies that are out there do show that for patients who are doing IVF for this, they do have around a 40 % live birth rate. It’s not stratified obviously by age and all those things that we’ve mentioned earlier in this podcast, but that’s not a non-zero chance.

Abby Eblen MD (10:21)

Yeah, that’s really encouraging, yeah.

Esther Chung MD (10:23)

Encouraging numbers. And I would say you’ll probably get advice from the genetic counselors and things like that about numbers. But in reality, the way things shake out, the embryos that develop, there’s a good chance that some of them can be structurally normal or balanced. So just to have heart in that, it can still yield the outcome that you might want.

Carrie Bedient MD (10:23)

Yeah.

Susan Hudson MD (10:43)

One additional thing I do want to mention is even though you have a reason for your miscarriages, Please make sure you also have a complete evaluation for recurrent pregnancy loss because 30 % of people with recurrent pregnancy loss have multiple things going on and we would hate to be missing something else that we should be treating at the same time. as your balance translocation. So even though you have an answer, make sure we’ve wiped the slate of the other things that we can test for as well.

Carrie Bedient MD (10:54)

Yes. Let’s move on to our big subject for today, which is taking the first steps in your fertility journey. We’re very fortunate to have Dr. Esther Chung with us. She is the chief medical advisor of Levy Health. And tell us a little bit about Levy and how you got into this and how taking first steps is really kind of the perfect topic to go through with you in particular.

Esther Chung MD (11:36)

Yeah, so ever since I was an OB-GYN resident, I’ve always had an interest in femtech, fertility tech ways to kind of improve the inefficiencies in our world by leveraging tech enabled software and things like that, that improve the process, not only for the patient, but for physicians. And so I happened to run into the founders of Levy at a dinner at one of my favorite fertility conferences. And we got into a little debate on how this software that Levy Health created could benefit OB-GYNs versus patients versus fertility physicians. And so we got into a healthy debate about the pros and cons of this software, what it does. And basically at its core, it’s supposed to be a diagnostic support tool where instead of just ordering a full fertility panel that is not specific to the patient, the software walks the patient through a series of questions that ask them about their menstrual health, their GYN health, their OB health, tailors what the diagnostic workup will look like for that patient, and then not only explains why certain tests are ordered, after the tests are done, they also get an explanation for what those tests mean and what those results mean. So it’s a lot more comprehensive than some of the existing products out there where patients will pay $100, $150, and then they’ll get their blood drawn and they get a slew of hormones done with very little, maybe like a small little paragraph explanations of like what these things are. But it’s not really individualized. There’s not a good reasoning for why we order those things. And basically things can get either missed or over ordered.

Abby Eblen MD (13:04)

Yeah.

Esther Chung MD (13:20)

I felt like as a physician being involved in these startups and basically giving a lot of advice on what is actually useful for patients to learn what is actually useful for physicians, felt like it was a unique area that I could give my expertise and spend some of my time outside of work doing stuff that I enjoy. So this is something that I hope to keep doing like throughout my career, but basically, I wanted to work on something that helped patients understand why we as physicians order these things, but then also to help them interpret it because I think the biggest thing that prevents people from starting their fertility journey or going to go see a fertility physician is the fear of the unknown. having, yeah, just like having the words to explain, to understand what what we are telling them in that first hour of meeting, to have some understanding of what concepts we’re talking about. I feel like makes the conversation way less scary, makes the process way less gray and like scary to embark on. And so that’s what I would say Levy is hoping to bring to patients. 

Levy at its core is not just a consumer product. The main point of Levy is to work with existing fertility clinics, existing OBGYN offices where you get all of this work up done, you bring this work up, or the clinics will have all of this information as well as soon as a patient goes through this on the Levy portal at home, on like they can access it through their phone or at home on their computer. 

But basically all that information, all the diagnostic workup tests, the physician will also have access to. So the really nice thing about this is that it’s not just letting a patient interpret things all on their own, right? The idea is that we will provide patient education through a Levy lexicon learning portal where patients can look up under every single question that we ask them. We write down the reason for why we asked this question.

And then if they want to learn more, there’s more information that they can educate themselves on. And all of those written things have been reviewed by either OB-GYNs or fertility specialists. And so there’s that component. But then the other component is that When they come to see you guys or whoever their fertility physician is, and if they are a partner of Levy, that physician, when they meet you, instead of having a very general conversation about fertility, your ovarian reserve, all this stuff, it becomes a very tailored conversation, very individualized to that person or that person and their partner, if there is a partner involved at the time of consultation. That initial conversation builds a lot of trust because your doctor already knows you before they are talking to you about what your fertility experience may look like.

Susan Hudson MD (16:12)

When people are thinking about diving into getting help for their fertility challenges, what we’re going to focus on today was what are those first things to do? When should somebody start thinking I might need help?

Esther Chung MD (16:30)

Yeah, it’s that question I feel has evolved over the years because a while ago I would have said, as you’re thinking about building a family, the year or two before, it would be a great time to like go see your OBGYN or make an appointment with your fertility physician, to understand what goes into this process before you actually embark on it.

But then there’s also the world of fertility preservation. There’s been way more education about that. I feel like a lot more women, a lot more people know about that as an option. And so even if you’re just curious about that, I would say there’s no right age at which point I would say you need to see a fertility physician.

Just having that initial conversation can really help you, even if it’s like five years out that you’re not even thinking about having kids for the next five years, just having that conversation ahead of time is powerful. It’s beneficial to how you want to plan out your fertility journey. The earlier the better, if you’re curious, if you’re listening to this podcast, there’s obviously some level of curiosity. Just try to learn more. Even as a fertility physician myself, I find it really hard to commit and go see my own friend who would be my fertility physician. It’s a daunting journey because it’s not something that we’ve talked about our entire life growing up. There seems to be a age at which people really start thinking about it. And most of my friends are in their thirties.

It comes up a lot over dinner conversations with me because they know my job, but I reckon people don’t often talk about it that freely amongst friends either, because it could be a very sensitive topic. So having a trusted fertility physician who can counsel you in the very early days of it all, it’s going to be really, really helpful. And I’m sure you guys feel the same way, both in your personal lives, but also with your own patients too.

Susan Hudson MD (18:17)

There’s definitely power in knowledge. That’s really what we’re trying to bring to people. We spend our whole youth learning how not to get pregnant. That actually learning how to get pregnant thing is not necessarily taught to us as well. And so I think it is good to get that education.

Esther Chung MD (18:29)

Right.

Susan Hudson MD (18:37)

Of course, if you’ve been not preventing pregnancy, and that does not mean testing your temperature or peeing on sticks or anything like that. If you have not been preventing… that by definition is been trying. So if you’ve been trying to get pregnant for somewhere between six months to a year, and you haven’t gotten successful, jumping into this is probably a reasonable thing to do.

Esther Chung MD (19:04)

Yes, definitely. Yeah, for sure. If you are actively not using any protection and hoping to have kids in the next year or two, but nothing’s been happening for the last year, then definitely, definitely seek some professional help through your fertility physician or if you want to start with your OB-GYN, that would be a really good place to start.

Carrie Bedient MD (19:22)

When people come in, one of the biggest, obstacles is just the sheer volume of information that they get at these appointments. I frequently tell my patients that talking to me is kind of like trying to take a sip of water from a fire hydrant. And it’s overwhelming. And so one of the things that I appreciate hearing is that you explain why we do what we do.

Abby Eblen MD (19:35)

Yeah.

Carrie Bedient MD (19:46)

What are other resources and how can people break it down in their brains because some people are readers, some people are listeners, some people do stories best, but how can people pull in all that information besides some of the obvious like, hey listen to our podcast more.

If you’re working with Levy health, click on all the buttons, read on all the explanations, but how do you suggest people approach that when it really is information overload? I mean, there’s a reason that it took all of us 15 years to get to the point where we can practice infertility medicine.

Esther Chung MD (20:18)

Yeah, I mean, I think that you’re totally right. The whole drinking from a fire hydrant or being blasted by one really is how I would describe that one hour, that first hour of meeting someone goes. And I also feel like sometimes I talk at the speed of light to like try to fit in all the information.

Abby Eblen MD (20:34)

Yeah, I’m very guilty of that.

Esther Chung MD (20:36)

Right, I feel like I spend two, three minutes on each topic that I want to talk about it because there’s so many components to it. And, and I think when I think about resources that are out there, there’s a lot. And so I want to be cautious when I say this, but personally, even as a physician, I know what’s accessible to patients out there and what is accessible is obviously Googling. You have your Instagram followers or TikTok influencers who may have a platform who know this space really well or went through something very similar. There are other podcasts where people come and tell their stories. And I have found all of that to be helpful from a building a community perspective, understanding that it’s not just you out there. But the scientific information, what information that you really need. I honestly feel like the best starting point really is to speak to a fertility physician because they can give you the break down for you in terms of the concepts of what it is that we’re talking about. So one thing is your ovaries, that other thing is your tubes, the other thing is your uterus, then do we have sperm available and are you getting good exposure to it?

There’s a lot of these components and there’s genetic carrier screening. So much of this stuff is having a framework for thinking about that might be best coming from a professional who talks about this on the daily. But at the same time, if you want to dig deeper and learn a little bit more, I personally find the newer search engines these days, so like Chat GPT or Perplexity.

They organize information in a way that is really easy to digest. Obviously they’re not 100 % accurate. I don’t want you to believe everything that is put out there, but they often do pull from sources that are research-based. And I find that they organize information in a way that is much easier to digest than just Googling and seeing a whole bunch of websites come up.

I find that to be personally very helpful, but again, always verify that information with somebody you can trust. And generally I find that for trustworthy information, I like to go to my physician. So that’s my two cents on what’s out there, and how to educate yourself, but also verify the information that you find.

Susan Hudson MD (22:49)

You can ask Carrie and Abby, I have a special place in my heart for Chat GPT as does my husband. So I love chat GPT but really when we’re talking about things like this, a nice thing that I do think about using something like Chat GPT is it takes the emotion out of it. There’s a lot of resources that are out there for the general consumer that you may not realize have a lot of emotion attached.

If you’re getting data from a source like that, one, it’s not going to have the innate personal emotional bias that a lot of other resources are going to have. And you can also, if you’re wanting to dig deeper, you can ask deeper. Well, what kind of study did this come from? What kind of where did this information come from? And you can dig deeper without having to actually dive into things like PubMed, which are databases that we as physicians dive into, but honestly are even a little unwieldy for us to navigate at times.

Esther Chung MD (23:56)

Yeah, true. I like that point about the bias because, for example, I had a patient the other day that told me there’s this new approach to treating endometriosis related infertility through a massaging of the reproductive organs called Mercier therapy. And I was like, okay, let me look this up. I have no knowledge. And honestly, the person who came up with this therapy, herself, went through, her own journey with infertility and endometriosis. A lot of, emotional biases can happen when you look at websites like that or go see people like that. And so trying to be objective because this stuff is, sorry, this stuff is based on each individual person has their own medical history. And so you can’t really say that you’re like somebody else who benefited from this specific treatment. That’s why seeing an expert helps because an expert has seen so many different types of infertility, so many different types of people and medical histories that we have a lot more scenarios than just one. That really helps to bring in more color to the situation.

Abby Eblen MD (25:05)

Esther, can you give us more detailed information about the types of tests that you recommend for patients and if it involves things like drawing blood and doing procedures like HSGs, how do you get that accomplished if they’ve not seen a fertility physician at that point?

Esther Chung MD (25:22)

So the way Levy does it is typically with a relationship with an existing fertility clinic. It typically happens after the patient calls the clinic to make their first appointment. So it requires the patient to make that first step generally. And then they get a link from Levy Health that has them sign up with their email and then ask them a series of dynamic questions. So it’s a questionnaire, but it’s a dynamic one, meaning not every person gets the same set of questions. It depends on how you answer. It depends on whether you do have regular periods. And then we double check and make sure what regular periods mean.

Abby Eblen MD (25:51)

Yeah, that could be a tricky question to ask and answer.

Esther Chung MD (26:03)

It’s a very tricky question. And so the fact that it’s a fluid dynamic questionnaire really gets to what is this person’s particular menstrual history? Does this person have anything else that might make me suspicious for endometriosis, that might make me suspicious for PCOS? So it goes through all those questions, tailors it, and then at the end of those probably 10 minutes of going through those questions, it pulls through its algorithm what labs we should order for that patient through a local LabCorp or Quest or whatever lab is, you or if the clinic wants them to draw it at their own clinic, that is also an option. And so at your own time, if you are able to go to lab, you’ll get the blood work. So most of it is blood work to start. A lot of the imaging, we wait for the physician to order for that patient. We’re not ordering imaging to test your fallopian tubes. That comes later when the physician sees you and actually recommends that test. So initially, it’s a lot of blood work. And then we also organize it so that if you do have a male partner, you can also have them sign up through a separate link, ask them similar questions that are related to fertility, then have that partner go get a semen analysis done at either again, local lab or at the clinic that we work with. So that’s typically how that goes. And I do like it in that it is very personalized to that particular patient. And then again, explains why are we ordering it. You answer x, y, z on this questionnaire. And that’s why the triggered the software to recommend this lab. And then after you get the lab done, it explains what that means.

That is really helpful. And obviously a physician oversees all those recommendations before they release it to the patient. So it is at least via MD or DO or nurse practitioner before it gets released to the patient. So I find that really helpful in terms of having patients be informed even before they come to see you in that way.

Carrie Bedient MD (28:05)

I always appreciate how there are many OB-GYNs who, because I would say the majority of patients start with their OB-GYN at least a little bit. And OB-GYNs come in a couple different flavors. There are some that absolutely love infertility and the evaluation and the workup. And if they had had to choose a specialty, that’s the one they would have chosen. And there are others who want absolutely nothing to do with it because it is just not their corner of medicine. And most of those docs are very aware of who they are. I can point to the docs in my community. I know the ones who really like doing it, and I know the ones who really don’t want to do any of it. It’s really helpful when you do go talk to your OBGYN, ask them, hey, do you like this stuff?

Abby Eblen MD (28:42)

Yeah.

Carrie Bedient MD (28:50)

Or do you prefer that I see a specialist? Because, and especially if you ask it in a non-confrontational way, not like, hey, do you suck at this? But, ask them in a non-confrontational way. They’ll tell you. Docs know what we like and we know what we don’t like. And we want the best for our patients. And so that’s kind of another little tidbit as you’re thinking about poking your toes into this is how do you find your doctor? Well, in some ways you just ask hey, do you like this? No? All right, who do you want me to go see? Because they probably know who’s really good because they want nothing to do with it. And they know who comes back pregnant versus not.

Susan Hudson MD (29:27)

Another thing also is knowing your personality and how much time you personally need to spend with your physician at the beginning of your journey. Realistically, Your OB-GYN is going to be able to spend 10, 15 minutes with you. Whereas a reproductive endocrinology and infertility specialist is probably going to spend about 30 plus minutes with you, if not more. And so, Some people want something brief to the point and that is completely fine. But if you know you’re the type of person who may need a little bit more handholding, a little bit more explanation, that you may have more questions, that’s a person that probably starting out with an REI is probably a better thing. Nowadays, even if you’re geographically limited, know that a lot of times you can do a telemedicine visit for your initial visit. You’re eventually going to need to come in because you’re going to need an ultrasound and different things like this, but at least you can kind of knock that first part out. And honestly, that first appointment is the hardest step to take, but the most important.

Carrie Bedient MD (30:40)

The other thing to know about yourself is also how the staff plays into this because with a general OBGYN’s office, that staff reflects what they do, which is everything, as opposed to a fertility office where, let’s say I’ve got 30 minutes to talk with you and we finish our 30 minutes and you still have questions.

If I know you have questions about how does this work or how do I get these labs or whatever, I know exactly who on my staff I can send you to because they can go through it in a ton of detail. And in some cases, they’re going to be way better than I am because they’re going to say, okay, you’re going to go to Quest, but you’re going to call now and you’re going to do it this time and you’re going to plan this general area. And they can give you the details that make your life a little bit easier in dealing with some of these specialty things that we do that they’re not hard, but they’re also a lot easier if you can have someone say, yeah, Quest only does that semen analysis from seven to 10, Monday through Friday, at this one office at this specific address. And that makes a difference in your frustration factor, right? Because when people tap out of fertility treatment, it’s more likely to be because of the psychological and emotional reasons than because of even the financial. And so if you can cut some of the crap with how you get there, that can be really helpful.

Abby Eblen MD (31:53)

And that’s think, where Levy Health can really help because for the people who really do want to know, well, who, why, when, why did they do this? Why didn’t they? I think that’s really helpful. As a physician, it was great if a patient did that because then I would have some labs, number one, right when they walked through the door. Another thing would be, it’s just they would have a little bit more education about why these tests were done and why we might be worried about X, Y, or Z. That would be a great way to keep people from having the the fire hose in your face feeling when you go to the first visit.

Esther Chung MD (32:23)

Yeah, it’s even the smallest things. Sometimes we’ll get labs, if they were ordered elsewhere, completely out of context. You’ll see what we call FSH (follicle stimulating hormone) or an estradiol level that we can’t even interpret because it wasn’t done on the right day. And imagine as a patient, going to go get labs is hard. It’s an extra step out of your day. But then to know that you have to do it on a certain day is stressful. And so we do have patient support, a physical person, not just software, but a physical person who will help Levy patients on board and get their labs done at the right place at the right time, I think makes a big difference. I was like a human Levy, I would say, for my clinic at Stanford for the past year where I would host these seminars, every Monday night so that people who were very busy could come to the seminar and then I would talk to them about the workups, explain the things that we would like to order before we go through all their results, but then also then email back and forth to figure out where and when they could get those labs done. And then so there were some patients who had an IUD in and so…then they had questions about, can I be a random check or do I need to be done on day three? So all these little questions come up as you’re doing this initial workup and it can feel stressful all at once. And so we don’t want that to be the case because it is a lot of stuff for sure. But if you have both the knowledge from either software or online learning, all the stuff in one place, plus a human person who can help you go through that, it’s just way more easier to navigate in the beginning and not to get scared away by the process and not learn because of that.

Carrie Bedient MD (34:05)

Yeah, absolutely. Well, thank you so much for coming to talk to us and for helping to kind of tease out for our patients, especially the ones who are at beginning of everything, some of the ways that they can pick up some of this information in a way that’s less overwhelming. So thank you so much for joining us. We appreciate it.

Esther Chung MD (34:23)

Thanks guys for having me. This is great.

Carrie Bedient MD (34:26)

To our audience. Thank you so much for listening. Be sure to tune in next week for more Be sure to subscribe leave us a review in Apple podcasts or Spotify or wherever you’re listening to this. We’d love to hear from you. We’re on Instagram Facebook and YouTube. So hop on by leave us a like and hello and let us know what you’re thinking

Abby Eblen MD (34:43)

You can also visit us in fertilitydocsuncensored.com to submit questions. All questions will be answered on our podcast for the Ask the Doc segment. Leave us a like or episode idea. We’d love to hear from you.

Susan Hudson MD (34:54)

As always, this podcast is intended for entertainment and is not suitable for medical advice from your own physician. All right, we’ll talk to you soon. Bye.

Susan Hudson (35:07)

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