Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. In this episode, the Docs are joined by Nicole Marchetto, MD, a physician at Shady Grove Fertility Pennsylvania, Lancaster and Chesterbrook, to talk about a topic many patients quietly wonder about—when is it time to consider a second opinion?
Seeking another perspective can feel intimidating, but Dr. Marchetto explains why most fertility doctors not only understand it but actually encourage it. A second opinion can help ensure that your treatment plan is appropriate—not outdated, not extreme, and not missing opportunities for success. Sometimes a fresh set of eyes leads to new approaches that your first doctor may not have considered.
Far from being adversarial, second opinions often confirm that you’re on the right path—or they may reveal alternative strategies that resonate more with your goals. If recommendations differ, it may be best to follow the physician whose plan makes the most sense to you, even if that means changing practices.
Bottom line: your journey deserves the best possible care, and getting another perspective can be an empowering step. This podcast was sponsored by Shady Grove Fertility.
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 MD (00:22)
Hello everyone. This is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored. I am here with my amazing, audacious co-hosts, Dr. Abby Eblen from Nashville Fertility Center and Dr. Carrie Bedient from the Fertility Center of Las Vegas.
Abby Eblen MD (00:33)
Hey everybody!
Carrie Bedient MD (00:41)
Hey guys, how’s it going?
Abby Eblen MD (00:43)
Going good.
Susan Hudson MD (00:45)
Doing good. And we are so excited. We have Dr. Nicole Marchetto from Shady Grow Fertility in the Pennsylvania region joining us today. How are you doing, Nicole?
Nicole Marchetto, MD, MPH (00:56)
Hi everyone, thank you so much for having me on. I’m really excited, I love your show.
Abby Eblen MD (01:01)
Aww, thank you.
Carrie Bedient MD (01:02)
Thanks.
Susan Hudson MD (01:03)
We’re excited to have you. We added a time zone in here.
Abby Eblen MD (01:06)
That’s true, we did.
Nicole Marchetto, MD, MPH (01:08)
Mixing things up.
Susan Hudson MD (01:10)
Absolutely, absolutely. So I understand you recently had a peach picking expedition.
Nicole Marchetto, MD, MPH (01:18)
Yeah. There is a farm not very far from my house and they do pick your own all throughout the year. So we’ve been trying to go every season to try to hit whatever is in season. So we did strawberries back in May because that’s on the East Coast. That’s when they start. And then recently we went peach picking and there were at least a couple of acres probably filled with peach trees and we picked them right from the trees. We were able to eat them directly from the tree, which was pretty awesome. They were already ripe. And then I have a whole box. Oh yeah. And we have a whole box that we’ve been working our way through with different recipes. We did do peach ice cream, which was fabulous.
My next recipe that I’d like to make is either peach cobbler or peach scones. So that’s what we’re looking forward to this week.
Abby Eblen MD (02:15)
I think you can char-grill peaches on the grill too. I’ve heard that, I’ve never done that, but it looks really good.
Nicole Marchetto, MD, MPH (02:18)
Yeah, we haven’t done that yet, but I have a recipe for that too. So we might have to go pick more because we are really actually going through them pretty quickly.
Susan Hudson MD (02:29)
In our area of Texas, in probably about early July is when peaches are ripe and there’s a town called Fredericksburg and they’re known for their peaches. Our peaches tend to be smaller that are from this area, but they tend to be very sweet. Are y’alls the big ones?
Nicole Marchetto, MD, MPH (02:47)
Yeah, they’re big. The farm that we went to had yellow peaches, nectarines and white peaches. I prefer the yellow peaches, but they are the big ones. And they had donut peaches to which are super good.
Susan Hudson MD (03:00)
What are donut peaches? I don’t know that.
Nicole Marchetto, MD, MPH (03:00)
Yeah. They look like donuts, like little tiny ⁓ like, yeah. ⁓
Abby Eblen MD (03:05)
I’ve seen those before, yeah, yeah.
Carrie Bedient MD (03:09)
If you’re a nerd, they look like red blood cells with the hollowed out in the middle. They don’t have the full hole. Yeah, they don’t have the full hole right in the middle. It’s just that kind of dimple. And so…
Nicole Marchetto, MD, MPH (03:08)
That’s right, with the divot, yeah. We’re all nerds here.
Abby Eblen MD (03:21)
There you go. So did they get a bigger yield this year? Because I know at least in Tennessee, we got tons of rain and I have a fig bush and I’ve never in all the time I’ve had it for 10 or 15 years had this many. Every day I’m taking five or six figs off of it. And we even made fig jam. So that might be another thing you do with peaches.
Nicole Marchetto, MD, MPH (03:38)
Yes, yeah, yeah, I thought about Peach and jalapeno jam. That was something that was on my list too. Yeah, we do, I think that they had a very good year. So I’m looking forward to the Apple season too, because I think it was a good year for everything.
Abby Eblen MD (03:41)
Ooh, that’d be really good. ⁓
Susan Hudson MD (03:50)
That is fun. Very yummy. I wish I lived in a place that you could go and pick fruit that easily.
Carrie Bedient MD (03:58)
We just, we went to Oregon this summer and picked blackberries on the side of the road. And everyone in my family made fun of me because I asked a local guy who was probably, I don’t know, he was like 20 years old that we just happened to run across like, hey, where do you find blackberries around here? Can you like pick them off the side of the road because the bushes are everywhere? And he’s like, yeah, sometimes I see old people out there picking them. And he said it with a completely straight face.
Absolutely no idea what he said and my husband and my mother are sitting on my
Abby Eblen MD (04:27)
But he didn’t think you were old though, Carrie. He didn’t think you were older. He wouldn’t have said it.
Nicole Marchetto, MD, MPH (04:29)
Yeah. Right.
Carrie Bedient MD (04:32)
No, he 100 % was implying whether he meant it or not, which I don’t think he did because he was a very sweet young man. But I have not heard the end of it and it’s been well over a month.
Susan Hudson MD (04:45)
You’re generationally a part of the Blackberry Pickers.
Carrie Bedient MD (04:49)
Clearly, but I made a really good cobbler, so I’ll take it.
Abby Eblen MD (04:52)
There you go.
Nicole Marchetto, MD, MPH (04:53)
Awesome.
Susan Hudson MD (04:54)
Good stuff. Good stuff.
Susan Hudson (04:55)
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Susan Hudson MD (06:02)
Well, let’s get to a question. Our question for today is, Hi docs, love your podcast. We’re preparing for our second embryo transfer after a successful one in 2022. They have six untested embryos, a day five, 4BB and a 3BB, and four day six, 4BBs. I’m anxious about failure.
Would you recommend PGT testing now or is the thaw refreeze risk too high? Also, a 12 millimeter polyp was found on saline ultrasound. I’m awaiting hysteroscopic removal and wonder if transferring the following cycle is okay. I had a C-section and my REI noted significant scar tissue. Thanks for your help.
Carrie Bedient MD (06:46)
All right, Nicole, What do you think?
Nicole Marchetto, MD, MPH (06:48)
I would say, some of the answers depend on how old the patient was when they underwent the first cycle. She had success with the first transfer, which is great news. And, if it were my patient, I would say, we should go ahead and potentially try doing another transfer because there’s no reason at this point to necessarily
Nicole Marchetto, MD, MPH (07:09)
biopsy and test with risking the damage to the embryo with the thaw, biopsy, refreeze, rethaw. What do you guys think about that?
Abby Eblen MD (07:17)
I think if they’re younger, that’s really good advice. Sometimes in our state, we see people that are really uncomfortable having six frozen embryos. And also it’s dependent on if they’ve had a baby or two, if they’ve had a couple of babies, just had a couple like this that thawed, tested and refroze. And ironically, all the ones that we tested, five, were all genetically normal after they did all that. So I think most of the time, I think for a young patient, it’s reasonable not to thaw and refreeze.
Nicole Marchetto, MD, MPH (07:46)
Yeah, the times that I would think about having a patient thaw and test if it was untested to begin with is if they’re failing multiple transfers. So if I’m worried that maybe there’s something else going on, maybe they have a higher rate of abnormal eggs, abnormal embryos, then at that point I would recommend taking the risk. Depending on the lab, each lab and each practice will have different rates of what the impact of a biopsy and then…refreeze, rethaw, that kind of thing. Ours is not a significant reduction, even with a double biopsy. So if somebody comes back with PGT, a no result or a no call and they get rebiopsied, we say it’s maybe a five to 10 % decrease in success rate. But yeah, you got to have to weigh the risks and the benefits and make sure that the patient understands what the outcome options are.
Carrie Bedient MD (08:33)
Yeah.
Susan Hudson MD (08:33)
I completely agree with that. I would probably transfer one or two of these other embryos. And if we weren’t successful, then talk about, I mean, we’ve got six embryos there. That’s a good number of embryos. And sometimes people want that information for trying to plan how many children are we going to have, kind of mentally preparing. Wow, I didn’t expect to have this many embryos frozen. I really need to know the number of chromosomally normal embryos. But I would, as much as I love PGT testing, at this point, because you didn’t opt for it at the beginning and you’ve had a successful transfer, I mean, that’s very reassuring.
Abby Eblen MD (09:09)
I have a question for all of you. So if say the patient, which would be really unusual if she had six untested embryos, but say she was 38 or 39 and had six untested, what would you say then?
Susan Hudson MD (09:20)
Because she was successful with her first transfer, I would probably transfer one or two more embryos to see if we can get another pregnancy before incurring not only the risk to the embryos, but that’s going to be a significant financial cost. It is more expensive to test embryos that have already been cryopreserved because you’re adding lab expense. And so if we can ride the wave of success, then that’s great. But I wouldn’t transfer all of those embryos without at least having a conversation. Some people may choose never to test them, but then I might, if she was 38 and we had a couple of unsuccessful transfers, then maybe going to a two embryo transfer, though I don’t do very many of those nowadays.
Carrie Bedient MD (10:05)
So I have a question for you. The first one in line is for sure going to be that day five 4BB because it’s the best quality embryo on day five. Let’s say that she transfers that one and for whatever reason needs to transfer another one, either because that first one doesn’t work or because she is now looking for a third child. And she has the option between a day five, but a 3BB versus a day six or one of the 4BBs. So which would you choose and why?
Susan Hudson MD (10:36)
I’d discuss with my embryologists because they’re going to have a very strong opinion on that and probably a stronger than opinion than I’m going to have.
Nicole Marchetto, MD, MPH (10:44)
Same
Abby Eblen MD (10:45)
I would argue that it probably doesn’t really matter either way.
Carrie Bedient MD (10:47)
The one thing that I would think about, especially if it’s a three BB, I would say if it’s a four, five, six BB, then whatever, nobody cares. People are gonna transfer the day five. With a three BB, because it’s an earlier stage, that may be the thing where somebody pushes it.
Where an embryologist is going to have a different view of that. But a lot of that really is going to depend on the individual lab. So like for our lab, for me, the big cutoff is did it get frozen or not? Because if it got frozen, I don’t really care about the grading because that tells me everything I need to know is that they thought it was enough to freeze. There are other labs where they will freeze everything and those grades make a much bigger difference. And neither is right or wrong. It’s just what your lab happens to be. And so I’m always curious how people approach those types of questions.
Susan Hudson MD (11:37)
What about the part of the question regarding hysteroscopy? How long would you wait?
Nicole Marchetto, MD, MPH (11:41)
So I would tell her that she could, if everything came back normal, or if there was like a singular polyp and the pathology was back and the cavity looked otherwise good, I would say that we could roll right into a transfer cycle in that following menstrual cycle. So let her get a period and then potentially start the medication if it’s a program cycle. Or if she cycles regularly and is doing a natural cycle, we could do that next cycle.
Abby Eblen MD (12:03)
Agreed
Carrie Bedient MD (12:04)
Yeah, would agree with that.
Susan Hudson MD (12:04)
And if somebody saw something else like adhesions or a septum or a little fibroid, maybe letting it heal for a month or two more, just depending on size and circumstances.
Nicole Marchetto, MD, MPH (12:18)
Yeah, exactly. Yeah, they had mentioned maybe some scar tissue from a C-section. So, depending on what that looks like on the saline sonogram and whether or not she’s able to make a nice lining, If there was concern for Ashermans, I would probably, take her back for a lysis of adhesions, potentially use a balloon, allow things to heal before moving forward and making sure even doing a second look saline sonogram.
Carrie Bedient MD (12:39)
Yeah. But usually with just a plain old polyp without the concern of, of adhesions that you mentioned, usually for that, we’ll just take it out and immediately cycle, be able to go forward. It’s the adhesions here that bring up the what if and choose your own adventure of balloon or hormone. Yeah.
Susan Hudson MD (12:57)
I’d like to comment also for our listeners. If you’ve had a C-section, relatively speaking, most people don’t have a lot of adhesions in the uterus, inside the endometrium from a C-section. And what most commonly happens is that they may have other adhesions in their abdomen.
And so even when I was reading this question, was like, hmm, did the REI comment on the OB-GYN’s operative report from the C-section that she had lots of pelvic adhesions or were there adhesions that were noted in the saline ultrasound? Because realistically, if you have adhesions outside of your pelvis and you don’t have any hydrosalpinx or swollen fallopian tubes, we really don’t have a big feeling about that being really concerning for success rates and it’s really the adhesions within the lining of the uterus that make us more concerned.
Abby Eblen MD (13:50)
It really surprises me how rarely we do see adhesions. I’ve seen adhesions sometimes when people have had IUDs put in, like maybe right after they had a baby shortly thereafter. I just saw a patient in the office last week though, who had a manual extraction even after C-section, and she had a little calcified chunk inside the cavity of what looked like just a small piece of placenta, but it was really obviously there.
Susan Hudson MD (14:11)
Yeah, I think anytime that you have instrumentation, whether it’s manual extraction of your placenta or having to have some sort of D&C, those are the times I think all of us get the little palpitations of, no, hopefully we don’t have something in the uterus that’s adhesion-wise going on. All right. Well, let’s move on into our topic for today.
Susan Hudson MD (14:32)
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Susan Hudson MD (15:09)
Today we’re gonna talk about something I think we have probably only once talked about on our podcast and it’s been a long time. We’re gonna talk about when should you go get a second opinion. Now, a lot of people are never going to need a second opinion, but it is kind of a sticky subject.
It means you’re winning somebody else’s opinion and that’s okay, but we’re gonna talk about what exactly is a second opinion, how can you get a second opinion, and when should you be weighing that as an option? All right, so Nicole, let’s start off with the basics. What exactly is a second opinion? What does that mean?
Nicole Marchetto, MD, MPH (15:47)
Sure. So a second opinion is when somebody is interested in input from a third party, like maybe another practice or another physician, where the patient is curious about alternatives and treatment approaches or their opinion about what has been done and what could be done in the future. So it usually involves seeking out another practice or another physician and bringing along your records and that second provider will take a look at what’s been done and give their input about what could be going on diagnostic wise or treatment wise, what your options may be. And they could weigh in on what might be a different route for you.
Susan Hudson MD (16:28)
When you’re looking for a second opinion, do you actually have to leave the practice that you’re at?
Nicole Marchetto, MD, MPH (16:35)
No. So great question. So I actually love second opinions. Sometimes I do recommend that my patients go look for a second opinion. If I’m stumped and I feel like we really have exhausted everything, I’ll talk to them about it. And actually at Shady Grove in my region, we offer free second opinions too for patients if they’re looking for just advice or somebody else to talk to. But I think that it’s a good idea for somebody that is really wanting to learn more about what’s going on and about the approach of what has already been worked up and done. There are a lot of different benefits to seeking a second opinion, risks as well, which I’m sure we’ll kind of get more into. One piece of information I usually give my patients about when to look for a second opinion is thinking about where you’re going for care and what are the strengths and weaknesses of that center. So is it a really small center where you got along really well with the provider, but maybe their lab is really small and not very high volume and it’s limited what they can do? Do they do their egg retrievals at an outpatient surgery center and is there anesthesia? Are there certain requirements for that outpatient center that…are limiting to you and are you thinking about maybe seeking a care that a center that has maybe like a hospital setting for a retrieval. Is cost an issue? Is there a special program within a different practice that may be more financially reasonable for you? So these are all different things logistically that might be a reason to go seek a second opinion.
Carrie Bedient MD (18:08)
How often do you guys have, so there’s the cases where we can say, I’m at the end of new things that I can think of to do here. And sometimes that’s okay. Like sometimes really the next best thing is just to keep doing what you have been doing and wait for it to work. And while the definition of insanity is doing the same thing over and over again, expecting different results, in IVF that is not necessarily a true statement. So if you’ve got someone where you’re telling them, go get a second opinion, that’s easy, right? Because you’re telling them they don’t have to feel awkward about it all. What about patients who bring it up to you as an option or patients who don’t feel comfortable because they feel like, oh my gosh, she’s going to hate me if I talk about going on a date with somebody else. How do you guys see that and how do you feel about someone who says, hey, I’m thinking about going somewhere else to get a second opinion or I did go somewhere else versus someone who just ghosts you?
Nicole Marchetto, MD, MPH (19:14)
I’ll take that one. I had a recent experience with a patient who really, really wanted to read and do as much research as she could about what she was going through. And I was really happy that she was doing this. She felt very empowered to look all of these different things up. We met frequently throughout her cycle to go through all of these different things that she was asking about. Different treatment protocols, different things in terms of ICSI, not ICSI, testing, not testing, sperm factor, why potentially egg quality may have been an issue. And she did mention that she was interested in the second opinion. And I encouraged her because I wanted to allow her to explore what other practices may do. One thing she was really set on was potentially doing a day three transfer, which we don’t do at our center. And so I said, please go, these are some other centers that may do that. This is something that if you really want to explore. This is why we don’t do it at my center. But, we had a very open conversation. She told me when her appointments were, she wanted to be sure that she got information from these other centers before we ended up finishing her cycle. So I think it’s the relationship between the physician and the patient is really important. And trusting your physician to be able to ask whether or not this the third party, what their answer was for something, it was an opportunity to go through and share why we do things differently. And I think she appreciated that.
Abby Eblen MD (20:38)
I think the challenge for patients is there’s really no one source you can go to and go, okay, is my doctor doing things that are middle of the road? Is she way over to the right or is she way over to the left? And so there’s really no way for patients to really know. They may trust you, but they’re like, okay, well, my friend did this, this and this. Why is my doctor not doing that? Is she not reading the literature like this other doctor is?
That’s why I really like patients to have a second opinion because I think then they’re able to put things in perspective and realize that, yeah, maybe two of their transfers didn’t work, but it wasn’t for lack of something on our end that we should have done and didn’t do.
Susan Hudson MD (21:13)
A lot of it has to do with how much, I mean, without a better term on the edge you want to go. I had someone recently who there is a certain network of IVF centers that does theoretically almost everything you could possibly think of a la carte and they’ll let you do it just per request, whether it’s medically wise or recommended and has data behind it, or it’s the newest fad that’s out there. And this patient, realistically, she goes, I started off there because I wanted to dictate what I wanted when I wanted. And unfortunately, at that situation, she didn’t get pregnant. Then she came to us as a second opinion. I explained the things that I thought had been done well, the things that I thought might need to be done differently and the reasons behind that.
And everybody’s going to have their perspectives. That’s one reason we love doing this podcast is that we’re in different parts of the country. All four of us trained at different places. We’ve all had different clinical experiences. But the thing is, is in infertility medicine, I would say 90 % of what should be done, we’re all doing. It’s that 10 % that you have to fit into is this the right science? Is this the right personality? Is it the right feel? If there’s something happening that you don’t trust the process, that’s a real important time to get a second opinion to be like, yes, what they’re doing does make sense from another person’s viewpoint because all these people have, we all have lots of years of, getting all this knowledge in our brain to put it put it together for your specific clinical scenario, but it may not be blatantly obvious at the offset.
Carrie Bedient MD (23:04)
Exactly. So what do you do when somebody comes back from their second opinion and they’ve had good conversation, whether this is a second opinion that you knew about ahead of time, whatever. What do you do when they come back and the stuff that they’re coming back with is something that you think is out there. It’s scientifically or logistically just a little off. How do you approach those patients? How do you tell them, what you think about that? Because you don’t want to come across all, I’m thinking of a highly technical and professional term. You don’t want to look like a butt hurt. But you also want to make sure that they have the information of your expertise, which is why they’re coming to you as well. And presumably, if they’ve come back to you, they want your opinion as opposed to just going off and going with the second clinic. So how do you approach that when it’s a squirrely opinion, but we also don’t want to come across like it’s a hurt ego on our part that is contributing to what we’re saying?
Nicole Marchetto, MD, MPH (24:09)
Yeah, I would say that it’s really important to explain why you’ve chosen not to do something and why it exists out there. If it’s something that may work, something that may be very expensive, but you can explain that the data are not strong enough to really support doing it in your case because the outcomes may not be drastically different and it might be an added expense. You can also say, this is why we don’t do it here, but if this is something you’re really interested in pursuing, it sounds like that practice does do it. I wouldn’t recommend it for your case at this point and that’s why we won’t do it here, but…you’re welcome to pursue that if you feel like it’s really important. But as long as I feel like I’ve given them the information necessary to make the decision that’s right for them. Because sometimes the data may not be that important to them in terms of whether or not they feel like they’ve tried everything under the sun. But it’s important that you explain how the data work and really why the test or the treatment plan was ever made in that case. So I think having that open conversation and saying, you know, everybody practices a little bit differently and some things are a little bit more fringe than others. And in some cases, I don’t think certain things are safe. And so I don’t want to put your health at risk or put the pregnancy at risk. But really, at the end of the day, they can make their own decisions about where to go and what to do.
Carrie Bedient MD (25:29)
Do you guys look at patients any differently when they go get a second opinion? And oftentimes there’s a lot of hurt feelings on their part because they’re in pain from everything they are going through. And we feel that as well because we’re very invested in our patients. But of course, it’s never gonna be the same because this is their family, their child that you’re talking about. So do you ever see a difference in how things work when patients…are very open about their communication versus when they leave, they disappear, they’re gone for months to years, and then they come back and say, okay, what’s our next step? What are we doing next?
Susan Hudson MD (26:06)
I think it’s one of those situations where it really has to do with why did you decide to go get a second opinion and getting a second opinion in itself is fine. I worry about patients who doctor hop for second opinions. So if you come to me and I’m the fifth doctor you’ve seen, like I said, most of us are doing similar things. Not everything’s going to be the same.
And if I’m really the fifth person you’ve seen, I doubt that all four people before me told you something wrong. Whereas being frustrated, being sad, grieving, really just needing to know is this the right thing? Should I be doing something else or I’m coming to you because I know we can do this at your clinic versus some, I can’t do it at my own clinic. I think those are very different situations.
The pure second opinion versus the doctor hopping, are different mindsets.
Abby Eblen MD (27:03)
And to that end, Susan, I would say, and I’m sure you would agree too, that somebody that’s seen five different doctors, there’s something more there than just seeking information. And I think you hit the nail on the head when you said they’re sad, they’re depressed, they’re frustrated. And honestly, I think seeking counseling, if they haven’t sought it at that point, is really the best route to go. I think they’re using intellectualization to try and look at everything on the internet and make sure that they’re doing everything. And I think in the long run, they’re just really sad and really frustrated. And I think it would be really helpful for them to see someone to help them with those emotions, to help them process those.
Carrie Bedient MD (27:37)
I think there’s a very different relationship that happens where someone just says, hey, we just want to talk to someone else and get that feel, whether they tell us that or not, versus if they leave in a huff, and they’re like, we don’t trust you anymore. That is very, different. And of course, it’s always fine to go get the second opinion. But when you no longer trust a doctor, no matter who they are, you should not be back in that practice.
And that feeling goes both ways because if you have felt to the extent where you have pretty much declared either through your words or your actions, I don’t trust you anymore, then you shouldn’t go back to them because they’re going to have to give you bad news at some point. There’s a decent chance of that. And when they give you bad news, you need to know that they did absolutely everything that they could to avoid that. And there’s a level of trust in that.
And so if you don’t have that trust, you shouldn’t be with them. Also from the physician side, when someone says, I don’t trust you anymore, we know full well that’s not a good working relationship because of everything that we have to do. And because now we’re starting to worry about everything that we say and we do. And that’s not a good setup for excellent care.
You want to know that your doctor is just automatically doing their best by you. And if you’re constantly second guessing that, and if they’re constantly second guessing like, well, if I do this, are they going to think it’s okay? Are they going to think I’m doing whatever reason?
Abby Eblen MD (29:09)
And we do that as physicians, right? We do do that as physicians.
Carrie Bedient MD (29:13)
100 % the decisions we make are very much based on the people we are treating because you can have three couples with the exact same story who need very different care because of who they are as people, what their personal beliefs are, what they have previously been through, what their economic situation is are thinking about the big picture here and try and be very communicative about that but but if that trust is gone then you shouldn’t be at that clinic for both your sake and your doctor’s sake because that’s not a good setup for getting where you need to be.
Susan Hudson MD (29:46)
I think the big thing that we’ve been talking about is trust. If you trust that your doctor is doing everything they can and you want to just make sure that there’s nothing else that could go on that they could add to your care. That is what I think is the fullness of a true second opinion versus transferring your care to another physician because you’ve lost that trust. I can tell you that
we feel it. We know when you’ve lost that trust and we’re doing everything we can do to regain it. But it is so much harder to get someone pregnant who doesn’t have that faith that it’s going to happen. I mean, we’ve all gone into that embryo transfer with that negative Nellie who’s like, this isn’t going to happen no matter what you do, blah, blah. And you’re just like, you just feel defeated before you walk in versus all working together as a team, patient, physician, nursing staff, administrative staff, everybody’s in there for that common goal. It just makes a huge difference.
Carrie Bedient MD (30:54)
Anything else that you guys think about second opinions? Sometimes patients think well, they’re never gonna know that I’ve got a second opinion and that’s sort of true, but it’s also sort of not true. How how do you guys know that someone’s gotten a second opinion without them ever telling you like saying… hey, I went to go see Dr. X. and
Abby Eblen MD (31:11)
I get those records release forms.
Nicole Marchetto, MD, MPH (31:13)
Yeah, I would say that sometimes they probably do go for a second opinion. You never find out. And it may be that they got a copy of their own records or they just said everything that was done. And sometimes I had a patient that went and did a whole cycle after we did a cycle for financial reasons and then came back when her insurance changed. And I was…curious about what they did and if they did anything different. So I think, just for the listeners out there, any patients, if you feel like you do have a relationship where you can disclose that it is interesting information for the physician, because it’s nice to see how other people practice and learn from what they did. And maybe the person had more success at their clinic. I do feel like there is a big difference in labs in terms of different practices. And so sometimes it may just be a matter of take your eggs and sperm and see what happens in somebody else’s lab, because maybe it’s, as whatever limitations there are with where they’re going for care now. But yeah, when I find out, I try to encourage them to let me know what the other person thought. So I can either be open to it for other patients or learn what the practice differences are at different centers.
Susan Hudson MD (32:25)
One thing that we do at our practice is sometimes when somebody is getting that second opinion, they’ll let us know, hey, I’m getting a second opinion because of blank. I’m having records transferred because of blank. And that helps us grow as a practice. And if it’s because somebody else takes a different insurance policy than us, then I’m like, okay, there’s not much I I personally can do about that other than us trying to get better contracts and different things like that.
But if there’s been an interaction that it’s, I’m getting the second opinion because of something else that can be helpful to us because although you may not want to continue with us or whatever that may be, we want to continually improve our practices, our teams and creating a inclusive and inviting environment for everyone. And so that really gives us good information for building the experience and the future for others.
Carrie Bedient MD (33:24)
And when you come back from a second opinion and you say, I got a second opinion and you leave it very generic. And then you come up with all these different ideas or say they recommended X, Y, and Z. A lot of times we’ll ask you who did you go see? And it’s very hard to separate this from personal egos. But part of the reason we’re asking about that is because while yes, 90 % of REs are going to be doing the best that they can by you.
There is a sub-segment of our field which we don’t agree with. And we may have personal knowledge of them that we will never tell to you because I don’t think any of us are ever gonna slam another doctor. Because that doesn’t help anybody, that doesn’t build trust anywhere, that’s not useful. But we will take it into account of, well, of course they said that because of XYZ thing that we know in the background that we are not going to share because it’s not professional and it’s not the right thing to do, but it will impact how we look at that decision and how we kind of phrase it and mirror it back to you and say, okay, well, these are the pros, these are the cons, this is why I do that, this is why I don’t do that, and this is why I may or may not think it’s a reasonable idea for you to try at this stage.
Susan Hudson MD (34:37)
That’s a great summary.
Nicole Marchetto, MD, MPH (34:37)
That is a great summary. I also think it’s important to also recognize that they may have some fatigue in going to one or two other opinions because they’re gonna get a lot of information and they’re not necessarily gonna feel comfortable parsing it out and knowing at that point, well, who do I trust and who do I go to? And at the end of the day, we are, for the most part, the practices are all trying to help you get pregnant. And so, sometimes it can be really difficult to think, well, is there one right decision? And the answer is most of the time, there’s probably not one right way of doing it. And and so, that’s where the conversations become helpful. The other the other factor that I think is important to make sure people realize is that if you are going for a second opinion, it may delay treatment, whether it is that you have to establish yourself with that practice or if they need to get other records or have other prerequisite requirements or perhaps they have a wait list for their IVF stim cycle. Looking at the big picture and seeing where they are in treatment, it’s important to also sympathize a little bit with those complications that come with the second opinion.
Susan Hudson MD (35:45)
Well, very good. Very good. Well, we have covered a very complicated but important subject of second opinions. And I’d like to thank Nicole, Dr. Nicole Marchetto, who again is at Shady Grove Fertility. She is mainly in the Lancaster and Chesterbrook offices in Pennsylvania. But thank you so much for joining us today.
Nicole Marchetto, MD, MPH (36:06)
Thank you very much for having me. It was a pleasure and I just love to talk with you guys about what we do on a daily basis.
Abby Eblen MD (36:12)
Thank you.
Susan Hudson MD (36:13)
Absolutely.
Anytime, anytime. And to our audience, thank you so much for listening and subscribe to Apple Podcasts to have next Tuesday’s episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.
Abby Eblen MD (36:29)
Visit us on fertilitydocsuncensored.com to submit specific questions and sign up for our email list. Keep an eye out for our book that’s being released September 23rd, the IVF Blueprint. Check us out on Instagram and now on TikTok.
Carrie Bedient MD (36:42)
And as always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we will talk to you soon. Bye.