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, welcomes Dr. Ian Waldman, a reproductive endocrinologist with IVF Florida, to talk about what patients can do to plan ahead for IVF. Dr. Waldman emphasizes that one of the most important steps before starting IVF is taking care of yourself—both physically and emotionally. Enjoy the things that make you happy, optimize your health, and enter treatment feeling strong and supported. Trust your fertility team and make sure you have all your medications on hand, especially time-sensitive ones like your trigger shot. Planning ahead can make the process smoother and less stressful. Know when to contact your team after your egg retrieval, and don’t hesitate to reach out if something doesn’t feel right. Finally, try to avoid unnecessary stress, stay informed about when to expect updates from your clinic, and keep communication open with your physician so you can move through IVF with confidence and clarity. This podcast was sponsored by US 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. We are here today with my intelligent, imaginative, and illuminating co-hosts, Dr. Carrie Bedient from Fertility Center of Las Vegas.

Carrie Bedient MD (00:41)

A plus on the vowel adjectives.

Susan Hudson MD (00:44)

and Dr. Abby Eblen from Nashville Fertility Center.

Abby Eblen MD (00:49)

Hey everybody.

Susan Hudson MD (00:50)

I was inspired by our guest today, Dr. Ian Waldman from IVF Florida in Jacksonville.

Ian Waldman, MD (00:57)

So great to be here. Thanks so much for having me today.

Susan Hudson MD (00:59)

We are so excited to have you. We were talking a little bit beforehand that you’re a bit of a chess aficionado, is that correct?

Ian Waldman, MD (01:09)

I think the word they used growing up was nerd, but I like aficionado better.

Carrie Bedient MD (01:13)

Aficionado does sound a lot classier, which I’m sure is the exact vibe that you were giving off when you were on the high school chess team, right?

Ian Waldman, MD (01:23)

Let me tell you, I think it’s cool to play chess and I stand by that no matter what the jocks will tell you.

Abby Eblen MD (01:30)

Let me just say I’m impressed by the brain of somebody that plays chess. My son was a chess player for a short period of time. And so he can always think three steps ahead. And I bet you’re the same way. You just have that kind of mind where you can think about the third move away, whereas I can only think about the next move ahead.

Ian Waldman, MD (01:47)

I like to think that I can do it, certainly those who play professionally can think 10 games ahead. We’re on the move and some basic ideas, but certainly have carried that commitment to the same way I practice medicine, not just in chess as well. So really try to be a planner, especially with so many moving parts in what we do. I think it’s helpful.

Susan Hudson MD (02:08)

How old were you when you started playing chess?

Ian Waldman, MD (02:10)

Oh, I must have been four years old when I started playing. I remember I was home sick one day and my dad stayed home with me this time. He I remember looked bored with me and he said, you want to learn a new game? And I was like, yeah, sure. I guess here we are. And then from that point forward, I was hooked. We played probably every day for weeks. Fortunately I wasn’t sick that whole time, but yeah. And then really have been playing ever since with him and with my grandfather and now just still play pretty much every single day, at least on the phone or on the computer.

Carrie Bedient MD (02:46)

So how long did it take you to be able to beat him or your grandfather?

Ian Waldman, MD (02:52)

I beat my grandfather first Which probably was secondary to him just getting older because I don’t think there’s any real way I would ever have beaten him otherwise, but probably took This is the long game here. So it probably took maybe 15 years or something like that before I really beat them, you know at the beginning they’re like letting me do whatever I want, so I still enjoy it.

And then probably another few years after that, before I started playing competitively against my dad and he stopped giving me odds that were strongly in my favor. And now, less my dad doesn’t wanna play as much anymore these days. I’ve played too much and too long now at this point for him. He’s moved on to other interests. Be careful what you teach someone when they’re four years old.

Susan Hudson MD (03:37)

That’s very cool. That’s very cool. It’s neat to have something that was an interest of yours so young and that you still do that. And I think that that’s definitely said something for stamina and longevity and just good brain space. Absolutely.

Ian Waldman, MD (03:50)

I appreciate that you guys think this is a great hobby. I like it too, so it’s nice when other people think that.

Susan Hudson MD (03:56)

I’m actually the odd person out in my family and that most of my family plays chess. None of them are nearly at your level or anything like that, but it’s just, it’s something that I haven’t ever really jumped into. But I have to say, I’m always enamored by watching the game. It’s just, it’s so complicated. It really is.

Ian Waldman, MD (04:17)

Yeah, now I’m embarrassed to tell you if I’m any good or not. I just said I’ve been playing a while. I think I’m okay.

Carrie Bedient MD (04:23)

I’m fairly certain that you would beat most of the three of us. I don’t know how much Abby likes to play, but I’m fairly certain that you would win. So we’ll give you the benefit of doubt that you’re fabulous and gonna be a grand master.

Abby Eblen MD (04:33)

Yeah, I always get beat. I don’t like to play.

Ian Waldman, MD (04:37)

At least Grandmaster level, pretty much. ⁓

Carrie Bedient MD (04:40)

Yeah, yeah, yeah, you don’t have to correct us, we’ll never know.

Ian Waldman, MD (04:43)

Now I’m gonna go after this and really feel sad about myself that I’m not anywhere close to a Grandmaster. The really sad thing is there’s probably six and seven year olds out there who are quite literally twice as good or more than I’ll be in my whole life after I’ve played for 30, 40 years. Some people just are amazing. I at least have longevity, if nothing else.

Carrie Bedient MD (05:05)

Keeps you off the streets.

Ian Waldman, MD (05:06)

In Florida that’s important, it rains all the time.

Carrie Bedient MD (05:08)

Susan, do we have a question today?

Susan Hudson MD (05:10)

We do, we do.

Susan Hudson MD (05:12)

Here at Docs Uncensored, we’ve spent years answering your toughest fertility questions and walking alongside you on the IVF journey. And now we’ve taken everything we’ve learned from helping thousands of patients and from the thoughtful questions you’ve sent in for us to answer and put it all in one resource, our brand new book, The IVF Blueprint. This book is your step-by-step guide through the entire IVF process written in the same conversational, down-to-earth style come to know from us. Whether you’re just starting to explore IVF or you’re already in the middle of treatment, the IVF Blueprint is designed to give you the clarity, confidence, and support you need. You can find the IVF Blueprint in print, as an ebook, and as an audiobook with a special conversation from us at the end, wherever books are sold. Links to purchase are also available on our website at fertilitydocsuncensored.com.

So if you’ve been wanting an easy to understand, compassionate guide to IVF, pick up the IVF Blueprint today and let’s take this journey together.

Susan Hudson MD (06:14)

All right, our question today is, I am 43, pursuing single motherhood with donor sperm. Starting at 42, had a polypectomy and then four failed IUIs, four different donors, and then moved to IVF. AMH is currently 3.25. That’s pretty darn good at 43. BMI 38 to 39, suspected PCOS, but I ovulate and menstruate regularly. First egg retrieval, 11 retrieved,

4 mature, 4 fertilized, 3 blast, 2 abnormal, and 1 high-level mosaic segmental. Second egg retrieval added Omnitrope at a different clinic, 19 retrieved, 13 mature, 8 fertilized, 1 blast, abnormal. Same donor for both egg retrievals and IUI number 4. Recent clean hysteroscopy in anticipation of transferring the high-level mosaic.

Receptiva positive for BCL6 at 3.2 and chronic moderate endometritis. Now starting two months of suppression. Why were the blast rates so different? Would another egg retrieval be worthwhile or a waste? Is there any hope of successfully conceiving or carrying with so many issues? I think this covers so many topics that are our patients for our patients who are in their 40s, often do have to balance a number of these things that this listener is saying. So let’s just start diving into this.

Carrie Bedient MD (07:47)

Ian, what did you notice about this question? Which corner of it do you want to tackle?

Ian Waldman, MD (07:52)

Yeah, this is a good one. I really think this, now I’m thinking back, I should have taken notes throughout it, ⁓ but at least I’ll the highlights. I’m sure I’m missing things, but a few. I think I’ll start with probably what the listener is getting at as the most important thing, which is how come they had, with such a good ovarian reserve and such a good egg number, ending up with an overall lower number of blasts. And I think this a little bit has to do actually with normal as opposed to abnormal physiology as we age. There’s a normal part of aging that occurs. And part of the reason IVF is so successful, and I have this conversation not infrequently, you have to look at the changing numbers and the loss throughout from the number of eggs, the number of mature eggs, the number that fertilize, that normally fertilize, and then go on to blast and normalize, or that are normal and are not, as actually part of the reason why IVF is so successful and not in spite of the reason it’s so successful. So in your 40s, realistically, only maybe about one out of eight or so, one out of every six eggs, somewhere in that general range, depending on the exact age, will be genetically normal. And so a normal process to occur is that many eggs will not be mature, many will not fertilize normally or culture out the blastocyst. And so we see these numbers with worsening quality eggs.

And that occurs as we get older. There’s other things that go on with that. I think in this person in particular, they had the positive Receptiva. So it was an endometriosis that could in theory have been negatively impacting egg quality. Also sounds like a little bit of excess adipose tissue and weight could certainly have impacted. know with increasing weight, there’s some things that can have changed particularly endocrinologically.

Other things were insulin resistance with the PCOS. I mean, this is a complex case that really have multiple different areas that are likely impacting the numbers. I think the fact that you have segmental mosaic is as frustrating of a diagnosis or whatever as a screening tool as that is. The good news is that has a pretty good chance of being genetically normal. And so I agree after good counseling, speaking probably to a medical geneticist or someone that can give you the, what this really means and what the data really looks like. I don’t think it’s unreasonable to really optimize yourself medically in preparation for a transfer of this embryo. Then, similarly, maximizing things, if you were considering doing another retrieval, I do think there’s some stuff that could be done.

Although always weighing that compared to age, think is really the most important predictor still.

Susan Hudson MD (10:32)

If you were going to recommend some additional things in another stimulation, so if she goes through her transfer is not successful, what are some things that you would suggest to potentially improve outcomes?

Ian Waldman, MD (10:46)

Yeah, definitely. I think the first thing I do in any of these situations, I try to look back. I try to look back and say, okay, what happened differently in the first versus the second? Was it really only growth hormone? Was that really the only difference between the two? I doubt growth hormone harmed the cycle. Although we can’t say that definitively. I don’t think there’s really an adequate amount of data that really says that there’s no harm to it. So although that’s a big difference between the two, remind me again, it was five in the first one and then only one in the second one.

Susan Hudson MD (11:17)

Right, but just pure numbers. I’ll go over the numbers again. So her first egg retrieval, she had 11 retrieved, four were mature, four fertilized, three blasts, two abnormal, and then we had her segmental mosaic. And the second one, she had 19 retrieved, 13 were mature, eight fertilized, one blast, one abnormal. So I think she did actually, she got a lot, she got a good number more eggs. She definitely had better maturity.

So whatever the second clinic did for maturity, I think you need to do that again.

Carrie Bedient MD (11:52)

And stim too, because they got more eggs just overall.

Ian Waldman, MD (11:57)

Yeah, I didn’t remember the number of eggs. Particularly the maturity here is really the most astounding number. I mean, really to have three times the number of mature eggs. And maturity is something we often, I mean, there’s things that we can and things that we can’t really change. Maturity oftentimes is one that we can change. And so, maybe they learned something from the first cycle to the second cycle. Maybe you needed a little bit bigger eggs, maybe you did estrogen priming in the second one versus the first one had a little bit of a better cohort. They were growing more uniformly. Maybe the growth hormone for you really was actually particularly beneficial. So, looking back and seeing what was the difference between the two and like many things in reproductive medicine, despite the best eyes and probably all four of us could review this independently

and maybe end up with four completely different opinions on what the actual outcome difference was. But I think that’s where I would spend my time in reviewing these things. And as far as going forward, make sure optimizing things medically as much as you can do before another retrieval is really what I would try to maximize beforehand. Spending the time at this point in your low 40s here to maximize weight loss, there’s a great study that compared weight and age and really at some point age is just such a stronger predictor and weight loss takes a long time. I don’t think we have the benefit of the time here. So really things like, don’t drink, don’t smoke, now’s not really the time to really be trying really crazy new diets but really getting on ones that are known to work but not really being in a significant, caloric deficit state because that does affect the way the hypothalamic pituitary axis works. And so really, doing the things you can do on the quicker side as opposed to the longer side is really going to maximize outcomes here as much as we possibly can.

Susan Hudson MD (13:53)

Good stuff.

Carrie Bedient MD (13:54)

The other thing that pops up whenever you have a significant difference in blast number is what are they defining as a blast? Because there will be some clinics that take anything that is past the compact and more related stage and call it a blast and biopsy it. And there are others that will have different criteria. They’ll want it to be a little bit more stringent of what they’re doing. So that actually may be a part of it as well, as well as how many days they culture it out and how strict they are about biopsies. So that’s another thing that is different from clinic to clinic. It’s not good or bad, it’s just different.

Susan Hudson MD (14:27)

The other thing to know is, and I think I mentioned this in a previous episode, that we all tend to think of everybody being good and equal and everybody’s the same. And unfortunately, that’s also not the truth, that you can have a difference in quality in laboratory. And although that’s hard to define by all the measures that we have, that you may have found a better laboratory that could get embryos to grow better for you. So that’s also a possibility as well.

All right, well, we are going to talk about a very important subject today. And what we’re going to talk about are things that are important to do before you go to egg retrieval. And egg retrieval is such an important part of IVF, because that’s the that’s the point where we really start at the top of our funnel. And Carrie always talks about her funnel and attrition and how you start with this many eggs and you end up with this many embryos and eventually getting to babies. What are the first things that you talk to your patients about in preparing for an egg retrieval or things they need to be doing?

Ian Waldman, MD (15:41)

Yeah, the egg retrieval is intense, even leading up to it, right? You came into the office, we’ve done this huge amount of testing, we’ve bloodlet you to get a ton of labs and you’ve, checked the semen analysis, we’ve done all these tests, right? You really probably felt poked and prodded at this point. And so now we’re finally at the point where we’re deciding on treatments and ultimately decide for IVF. And obviously in the sort of modern era, there’s so much information out there, good and bad. It’s hard to know what is and isn’t good information. What I tell patients first and foremost, really above all of this, it’s intense. And if you have a partner that you’re going through, or if you have friends that are there just to support you, more than anything, be kind to yourself. Today there’s also more pressure from lots of different areas to put blame on one person or another.

And I always tell people you didn’t do this. No one, no one in the world, as much as I like to think I’m like a nice guy, no one wants to see me ever, professionally. Yeah, I’m glad they’re there. So being really kind to yourself and knowing that everyone is here to support you. And if you are finding people in your life that are not doing those, then maybe now is not the time to really spend a lot of energy with them, but also things like if you really like to get massages, there’s all these things that are out there. Should you get acupuncture? Should you do all these things? Medically, we can talk about it probably for whole episodes here. But realistically, I tell patients whatever will make you happy and get through it, because the most important thing is to get through and not drop out. Do that.

So if you love doing something, you love going to morning exercise classes, if you love to go for walks, whatever it may be, the first thing really is to just be kind to yourself and those around you and certainly don’t put any blame on yourself. Anyone who’s trying to make you feel that way is something you should try to cut out immediately.

Susan Hudson MD (17:39)

I think that’s so, so important because being in the right mental space, going into your egg retrieval is, is so important. I mean, this is, this is probably one of the hardest things you’ll ever go through. And, hopefully, we end up with a positive result in the end, but the mind is a powerful thing. And we know that a diagnosis of infertility is as devastating as a diagnosis of cancer.

And a lot of people don’t know that. And I think it’s important for not only the people around you to understand that, but you to understand that yourself because you have to give yourself the grace to be able to walk through this journey.

Abby Eblen MD (18:21)

I think there’s a lot of fear too. Sometimes people can’t handle that fear very well and they either turn inward on themselves and blame themselves or they get angry with their partner or they get angry with the people in the clinic. And I think once we as physicians help patients recognize that the fear is driving a lot of their emotions sometimes and that, you we’re doing our best to help them through this. Then I think a lot of times that makes it better. People don’t realize, what a scary process this is. You’re spending a lot of money on this process. Your hopes and dreams are on this process. And more than anything else, you think what happens if I don’t get pregnant? That’s something to recognize too, as you go through this.

Carrie Bedient MD (18:55)

So in addition to item number one on the must-do list, which is being kind, what else are must-dos for patients?

Ian Waldman, MD (19:03)

Yeah, the next thing I do is, it sort of leads from one into the next and exactly what we’re saying, which is I want you as the patient to really trust your fertility provider and team. And in the end, that is one of the most important relationships. So, just like the woman who, of the original case we discussed here, she left her first clinic for a reason and found better results, but in the end, obviously we all hope that when you go to the next place, you’ll get even better results. But in the end, if you’re thinking you need to leave your fertility clinic, go get another opinion. And I tell my own patients this all the time. If at any moment you’re thinking that I’m not doing something that you really think I should be, I will help in every possible way to get you to anywhere else you want to be in the world. Because realistically, you need to rely and put a lot of faith into knowing that we are here for you.

We are doing everything we possibly can to get you to your goal. We’re not trying to push you along and just get to retrieval and just say, okay, great, another IVF, go along and everything. And that’s why I actually tell patients, I’m like, go to TikTok, go to podcast, go to your friend, go to your aunt, whoever, and get as much information as you possibly can. Anything that is interesting, any crazy thing someone told you to do, everywhere from take this route to stand upside down or to whatever, and come to me. I want to be the one. So I want to be the one that can parse out the stuff with data versus what doesn’t have data and where there’s data to show potentially harm and where maybe there’s just not data. And those are important distinctions. So I want patients to literally every step of the way to trust this relationship and hopefully we built that. And if not, they really should find someone who is going to give them that trust. And especially because of the fear, like you were saying, Abby, is that if they feel and know that we are really here for them and really working our tails off doing everything we know how to do to get them to the goal, we’re very much on the same team, shared goals. Then put the weight of the diagnosis, of the burden of this, try it as much as you can relieve yourself of it and give it to us. Let us carry that for you. And then ask us questions. That’s quite literally why we’re here. So I tell them, write down everything you’ve heard. Don’t go to places for answers, go for questions and let me be the one to help sort of go through and answer those things.

Patients are super reasonable in what they’re coming with. And in the end, just knowing they can come and ask something that sometimes they think is kind of crazy. And in the end, I’m sure we’ve all heard those questions a hundred times. Yeah, that’s the next thing that I try to really encourage.

Susan Hudson MD (21:44)

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Susan Hudson MD (22:23)

I think it’s important for our listeners and patients out there to know that very rarely is there something that someone hasn’t asked us before. I mean, no matter, I always say the only question that’s a bad question is the one that you didn’t ask because there’s no way for me to help you get the right information. And there’s a lot of noise out there. I mean, quite honestly, that’s the reason why we created this podcast was because we know that there’s a lot of noise, there’s a lot of opinions out there. I mean, we’ve got a lot of opinions here, but I would say that we usually agree on most things. There’s still some things that we disagree on, but that’s part of the art of medicine as well. There isn’t one pathway for this journey. There are lots of options, and sometimes one option may be better for you and your partner

than another one.

Carrie Bedient MD (23:18)

Totally agree.

Susan Hudson MD (23:19)

So what are some other things that you think are must-dos before going into egg retrieval?

Ian Waldman, MD (23:27)

All right, I’ve got a few more here. The next one that I have is a little bit of a discussion of goals. And I think this conversation as early on in the process really helps us discuss what patients say, hey, look, based on your goals of wanting two children, three children, one,

10, whatever the number is, and obviously, no one’s going to hold them to whatever number they give us. But in the end, really understanding that and then discussing a lot of the parameters that we do have and a lot of the statistics that are now like, this is one of the advantage, a little bit with AI, a little bit with large data, it helps give averages more than anything. And so we can say, if you’re 42, 43 years old and you have good ovarian reserve, the truth is that is a much higher likelihood of getting to your goal than someone else who maybe has much lower ovarian reserve. Or maybe we can counsel and say, hey, really look, you really may only need to do one or two cycles versus a person who has a goal of three children, but has an AMH of 0.2 or 0.3, meaning much lower ovarian reserve and the expectation of the number of eggs retrieved is going to be much lower. And I think setting them up for that realistic expectation is early on about what is and isn’t feasible. And obviously we would love to have those magic cases that everything just seems to go above what you really expect. But the truth is most things like all things in this, you revert to the mean. And so in the end, understanding that goal, if it’s one child, then really we know we need to get a euploid embryo or a good quality embryo, and we need to get you to maximize, to transfer. If you want more than one, do we need to bank embryos? Having those discussions and understanding will then also help in some of the other things I have to really get there. So I think an understanding of goals, and that’s part of the asking questions part of this.

Carrie Bedient MD (25:22)

And I think a portion of setting goals is knowing what you do want, but also what you don’t want. Because there are some patients who are going to come in and say, I don’t ever want to use a donor. That is off the table for me. And then there are going to be other patients who say, I don’t want to be doing this a year from now. I want to get to the goal now. And granted, every patient who we see coming in, or most every patient, wants to use their own eggs and sperm, wants to be pregnant yesterday, if not the day before.

But there are layers of that, right? There are some people who are willing to work longer and harder to use their own eggs than someone who’s just like, no, I’m done with the trying part. I’m ready for the having part and whatever by any means necessary. Knowing how you want to get there and what you don’t want is just as important as a goal as what you do want.

Susan Hudson MD (26:14)

Yeah, I think that’s so, so important because realistically, if you have somebody come into your office and they’re like, I want to have a baby. Well, most of us are going to be able to achieve that. But really, it’s what are your limitations on what you’re willing to do to achieve that end?

And there’s not a right or wrong answer. The only right or wrong answer is the one that you feel in your heart. And so what we have to know, we don’t know what all those limitations are until you communicate that to us. And there’s so many things that feed into that. There’s ethics, religion, morals, just what you imagined your family being. It’s what are those conversations? However, I do have to say that what Ian was saying about having an idea of how many children you want to have, being one and done versus two, three, four, five.

Those are very, very different goals in a lot of situations. And it’s nothing we’re ever gonna make you live up to. What we wanna know is what is your ideal? And as we are getting more access, we are having more payors that are able to give insurance benefits, different things like that, where more people do have IVF accessible to them, knowing what those goals is so important.

Abby Eblen MD (27:34)

And I think one other important mental aspect too is being resilient because you may set these goals but then life happens and you get a curveball you don’t get any normal embryos or you get a high-level blastocyst that’s a mosaic.

You have to roll with the punches. You have to be able to just assume that things are not going to probably go perfectly and kind of roll with the punches because I think the people that keep bouncing back are ultimately the ones that are the most successful.

Susan Hudson MD (27:59)

What else we got?

Ian Waldman, MD (28:01)

All right, now I’m gonna get into more specific. All right, here we go. So these first ones I think are the most important though. Now’s the time. There’s no better time to maximize your health than now. That goes for everyone in the world. You have to take a time to do it. Every one of us have to decide it’s time to do it now. And this is a great reason to do it. So if you’ve been trying to get off

of smoking, too much caffeine, which I am very guilty of, the sugar, the whatever, now’s the time to eat healthier, don’t smoke, don’t drink. I tell patients to start acting as if you were to be pregnant. You are at that point and what you do today will impact. We know that the sort follicular milieu that

where that is around the egg is happening for months before we get the egg or the egg is even recruited. So the sooner you do it, the better the quality is of what’s around the egg. So now’s the time.

Abby Eblen MD (28:59)

That’s a great point.

Susan Hudson MD (29:00)

We have two chapters in our book, the IVF Blueprint, that are dedicated to just that. And so that’s why when you started mentioning this, I was like, oh man, after my own heart, this is awesome. Because it’s true. What you do now actually does have an impact and that goes into making sure your other health issues are taken care of. If you know your hemoglobin A1C is eight, you need to crack on down because none of us are gonna be excited about that.

Ian Waldman, MD (29:09)

I love it.

Ian Waldman, MD (29:31)

No, very much not. And your medical endocrinologist or primary care doctor should be aggressively working to help you.

Carrie Bedient MD (29:37)

Absolutely. All right, what are the other specifics for our people?

Ian Waldman, MD (29:39)

All right, Next one here. All right, now actually in the cycle, okay, you’ve been sent all your medications and everything that you have to go through all of your meds. Make sure you have everything, understand your calendar, understand that you everything because there are things, like I said, I’m a planner. There are things that are preventable and that will add so much unnecessary stress and not having your antagonist or whatever, not having your trigger shot, or anything, they’re not knowing how to mix a medication or inject it appropriately, or what are normal or abnormal signs. Before you even do a single injection, every one of those things should be able to be clearly answered for you and know the resources. So get the box, go through every single one, and make sure you know what each one does and what each one is.

Abby Eblen MD (30:08)

Yeah I’ll say without a doubt probably the worst phone call that we as physicians get is on a Saturday night at about 9 p.m. or 10 p.m. and we get the phone call that says, hey I don’t have my trigger shot here and I’m going to egg retrieval on Monday and you’re like no what do we do and that’s that’s the worst shot that’s the worst phone call to get because it’s hard to fix that problem because we typically can’t get those trigger shots particularly not late at night anyway for sure.

Carrie Bedient MD (30:52)

The other thing is make sure about the calendar part. It’s not just you, it’s the people around you. So who’s gonna pick you up and take you home from the retrieval? Who’s gonna provide the sperm for this whole endeavor? And making sure that they are in town when they need to be because we all have stories of a partner who at the last minute said, to leave to go here for whatever reason and it throws a real big wrench into the whole operation. And sometimes the wrench can be really minimized, but sometimes it can’t be and it can have a huge impact on what we do. So, making sure that your other half knows what’s coming up and what the variations are because you’re going to be given a calendar, but that calendar is going to be changed based on what your body is doing. And it’s not set in stone.

Just because it says you’re going to take the trigger shot 12 days from now, that doesn’t mean that’s exactly when it’s going to happen. So building in the wiggle room is helpful.

Susan Hudson MD (31:52)

A couple of things, when you get that giant box, make sure you go through every single layer and don’t miss anything because we’ve all had patients who’ve accidentally thrown away liquid gold. All right? And the other thing is know that most clinics order enough medication to make it through 10, 11 days worth of stimulation.

And the reason is, is because most stimulations are probably gonna go right around there or a little bit longer. We don’t want you to have extra liquid gold sitting in your refrigerator. But with that, does put a little bit of responsibility onto you to make sure that if you’re running low on medications and you’re going into a weekend or a holiday or there’s bad weather coming in some part of the nation that could affect transport of medications to you, you have to make sure you have enough stuff. And so just be aware that you’re probably going to need to get refills. The nice thing about getting refills though for fertility medications is you can be very specific. You can say, I want three vials of Menopur, I want one 300-pen of gonal F, I want two cetrotides. You can be very specific on your refill so you don’t have to get the whole thing all over again, because you’re not going to need that.

But you need to be on top of what you have at home and how much longer your doctor is anticipating your stimulation. And if you think you might be running low, ask your doctor, ask your nurse, hey, do I need to make sure I have medicines through what date? When should I be anticipating things? Because again, we can’t, these are not medicines that you’re generally gonna be able to get at your local Walgreens.

And we’re certainly not gonna be able to help you at 10 o’clock at night.

Ian Waldman, MD (33:43)

And Carrie, I’m going to go off one of the things you said. On my list, a little out of order, but it’s so perfect, is the reliable transportation. I’m not going to send you home in a cab or an Uber. You’re going to just have to live in my office. We’re not going to allow this to happen. I’m not going to put you after you’ve had anesthesia with a stranger. And then similarly, if the transportation and your partner is the sperm source, then understanding when and how they need to be collecting. If it’s during a week, I tell patients here, it’s within seven days of this most likely, and that’s 99 % of the time, it’s going to be within those seven days, most likely, towards the middle of it, but it’s possible to not be. If there’s any possibility they might need to travel for almost anything, know that in advance and get a backup transportation, but also have them freeze sperm. And that way you avoid the last minute egg freeze, which nowadays is not as awful because of how good the vitrification and thaw is. But still don’t end up in that situation. I’m a planner, let’s have everything planned and that way we don’t have to worry about this. We know if they left because they have to fly to New York or whatever it is for a meeting, that’s fine. We know what we’re doing. So don’t worry.

And that health also goes for the male partners too. These guys always get off the hook. We rely so much on our female patients and everything to do really most of the heavy lifting here. And outside of an illness or something which is unavoidable, the guys need to also keep their health up. We’re now in a shifting mentality here where we’re spending more time learning about and optimizing the male side of fertility, which has really lagged behind. I mean, as much as women’s health is lagged behind. Within fertility, the male health actually has been the strong lag.

Abby Eblen MD (35:27)

Absolutely.

Susan Hudson MD (35:28)

And it’s so important. mean, we all see couples in our office that we’re like, okay, we’re to need to do IVF for whatever this reason is. And we definitely see health or lifestyle factors we know are going to impact sperm function. And we’re not telling you to do or not do the things that we think are impacting like smoking and drinking and using marijuana and

being overweight and having uncontrolled diabetes and high blood pressure and all of those things. We’re not just saying those things to make you feel bad in any way, shape, or form. We’re telling you that making changes in those parts of your life can actually have very, very meaningful impact in your fertility outcomes.

Ian Waldman, MD (36:17)

All right, I have a few more. And then these are some ones that I think have helped. The next one is, everything’s stressful. And the last thing anyone wants to decide, particularly when you’re frustrated and you’re injecting yourself and all those things is who’s cooking? So I’m a big believer in meal prepping and the whole week, the whole whatever, the whole two weeks should be prepped literally from day to day exactly what we’re eating,

exactly what we’re ordering, how it’s arriving here, whose responsibilities. It’s tough enough when you’re not going through this to have these conversations. And then on top of it, you’re like, I’ve been injecting myself for 11 straight days. You think I want to go make a casserole? Give me a break. So meal prepping, get it ready to go.

Abby Eblen MD (36:41)

Good idea. That’s a great point.

Susan Hudson MD (36:56)

You are a wise man, Ian. Let me tell you, there’s nothing that I get more angry about after I’ve, especially I’ve been traveling a lot to go see my outside clinic. There’s nothing that’s going to put me into a bigger tailspin than when I walk in and it’s like, so what are we doing for dinner? I’m like, really? 

I like that. That is great advice.

Ian Waldman, MD (37:23)

I’m glad you like it. Yeah, feel free to start recommending it. I think it should be as part of the the packets we hand out.

Carrie Bedient MD (37:30)

Absolutely gonna steal that one. In fact, may go on, yeah, that’s going on the lists, for sure.

Abby Eblen MD (37:32)

Yeah, I think that’s a great idea.

Susan Hudson MD (37:36)

It is.

Ian Waldman, MD (37:37)

Amazing. All right, good. I’m glad that there’s something I could teach such an amazing crew here. Here’s my next one. now, importance of timing, obviously, with the trigger. So now you’ve gotten through, your medications, now we’re throwing a curve ball, right? Okay, it’s time for trigger shot. Know the exact medications, the exact timing you’re supposed to take them. There’s really very little wiggle room here.

We know oftentimes a lot of clinics will do 36 hour triggers, which is probably, I don’t know if that’s what your clinics do. I’ve been in clinics that have done different than that as a routine. And of course we change it based on prior cycles. If you think you can get better maturity, but knowing the exact timing and the exact medications and how they work and what the plan is. So that’s another one that I just want to emphasize, which is, I’m out for dinner. It’s okay. I talked to my clinic two days ago. I forgot to take my meds.

At 7 p.m. I took them at 9 p.m. They reassured me. This is not that. If you’re taking your trigger shot really in any meaningful way, plus or minus, you could change outcomes for real here.

And then I also tell people to take the day of, I tell patients, you’re getting anesthesia, you need to take the day of the retrieval off and 24 hours afterwards. The anesthesia stays within your tissue for that long. And so any decisions you make within 24 hours is anesthesia, making decisions for you. No big purchases, you’re not allowed to go to work and buy or sell things. And particularly our medical community friends who are particularly bad at following these type of instructions.

It’s not fair to your patients or to you if you are going into work the next day and making medical decisions. For the goodness of all people, but you really have to take the time to recover. It’s not a small procedure as we like to say. It’s a procedure you’re getting anesthesia.

Susan Hudson MD (39:20)

We need to add Carrie’s, no dancing on tables, no gambling, and no visiting pet stores unaccompanied.

Ian Waldman, MD (39:28)

Gosh, the pet stores. No.

Carrie Bedient MD (39:30)

Although I always tell people if you go to the pet store and you acquire a new furry friend, you are morally obligated to bring it back to the clinic so I can cuddle it.

Ian Waldman, MD (39:37)

I love that one.

Carrie Bedient MD (39:40)

I’ve had this come true exactly once, but he was the cutest little puppy and I regret nothing.

Ian Waldman, MD (39:47)

Amazing, I love that. That’s so good.

Carrie Bedient MD (39:49)

The other thing I always tell my patients is, and Susan, I didn’t quite catch, I don’t know if you said this one or not, but no online shopping, have someone take away your phone and your Amazon passwords because I have never seen a patient more irate than post-retrieval. She’s like, you didn’t tell me not to go shopping. And we’re like, well, we thought that was inherent, but now it has become very explicit.

Take away, take away the passwords. Take away the passwords.

Ian Waldman, MD (40:20)

You will regret the decisions you make while on anesthesia. Because then you have all that stuff. You’ve got no inhibitions anymore. Let’s get the thing I’ve been coveting for the past six months. I don’t have any reason not to.

Susan Hudson MD (40:32)

Yeah, that could be really dangerous, especially with a Prime Day or Black Friday or Cyber Monday coming around. So be wary.

Ian Waldman, MD (40:44)

Christmas season is coming up. We could do some damage in this time of year.

All right, the next is important because it’s obviously important to note, know concerning signs. So now you’ve done the egg retrieval, you’ve gone home. Now you’re largely recovering. It’s a difficult time as many things are in fertility, because there’s very much lots of hurry up and wait in our field. And this is very much one of them. Lots is happening that you’re not seeing at this point. But one of the things that you have direct control over is understanding your body.

No one knows what’s going on with you better than you. So we need to really understand what are actual things that are dangerous, right? Lightheadedness and dizziness that’s sort of not protracted, rapid weight gain, inability to tolerate food, decreasing urine output. There’s a list of things. You really need to know them and the people around you should recognize them as well, both in the more immediate and…sort of medium time frames that you can make sure that you’re taking good care of yourself and that your providers can make sure that you’re safe in this sort of higher risk timeline.

Susan Hudson MD (41:46)

I’d like to make two comments on that. One, absolutely know that every clinic has an after hours emergency line. So if you are worried about something is not going the way it should, there is somebody that you can call. That’s number one. The other thing,

have somebody with you at home at night. That’s really important because you don’t know when things could change.

Ian Waldman, MD (42:14)

I love it.

Carrie Bedient MD (42:14)

Also, it’s really nice to have somebody go get you things when it does not feel good to say.

Abby Eblen MD (42:17)

Yeah, it’s nice to have somebody cook your meals, but back to the last one. Yeah.

Carrie Bedient MD (42:21)

Yeah, that goes back to meal prepping, that goes back to a lot of other things and you’re gonna be moving more slowly. And this is something I don’t know about you guys, but I tell this and it’s surgeons are the worst out of everybody. Surgeons are 100 % the worst of you will not be moving as fast as you are used to be moving. And so plan accordingly.

Susan Hudson MD (42:40)

I know another thing that I find very important. If you need to call to talk to a doctor, please call yourself. I appreciate your partner loves you and cares for you. I appreciate your mom loves you and cares for you, but we really, really need to speak with you. It’s great if they’re there, and they can dial the phone for you. That’s completely fine, but know that you need to be the one communicating with your doctor.

Abby Eblen MD (43:08)

And one other thing I always tell patients too is please don’t go to work the next day. I mean, you probably can, but I personally couldn’t have gone to work the next day after an egg retrieval. I always say it’s like walking around with your size eight feet and size five shoes all day with your ovaries rubbing up against your abdominal wall. And most people just don’t feel great, particularly if you get a lot of eggs. And if there’s just four five, maybe you can work the next day. But give yourself a break. This is a surgery. It counts as a surgery. And so you deserve at least one day off after the surgery, if nothing else.

Susan Hudson MD (43:37)

All right, one more.

Ian Waldman, MD (43:38)

All right, I’ve got one more that I’ll share. And it’s part of the same thing, which is part of the planning, which is as part of the understanding of what the goals are or expectations and everything, and while we’re waiting to get the results of how many embryos were able to be frozen or how many were able to be PGT biopsied, and then we’re waiting for those results. Know when, lots of clinics do it different ways. Some of them just have a clear plan set of, hey, when you get your period, can start birth control pills and wait for the results and come off.

Or does your clinic set up an appointment for you to meet back up or does the embryologist call, whatever it is, know what the next steps are. And that way you’re not in limbo and and then two weeks go by and you’re annoyed and three weeks go by. All that’s very avoidable. Know whatever your provider does and their team does. I like to meet back up again after each sort of big thing that happens.

And so for me, if we’re just freezing embryos without PGT, I try to then schedule an appointment about a week after, and I try to leave some spots available, even if it’s for a quick five minute conversation, just to say, okay, we got this many, like we talked about, we had at least this many, we would jump into an embryo transfer with a medicated or a natural cycle or whatever it may be. Did anything change? Have you thought about it? And that way, okay, we had one more chance. Nope, we’re still on the same plan. All right, perfect. I’m gonna put it in, my nurse is gonna reach out. We’re gonna come up with roughly a date that works for you and for us for the embryo thaw and transfer and we’ll work backwards. Similarly, if we’re waiting for the PGT results, takes a little bit longer, of course. Do you start the birth control or if you’re a person who absolutely hates going with the birth control, that’s also fine too. The benefit of putting on it is for timing and getting there as fast as you possibly can. But knowing, okay, my cycle is going to be coming up at this time point. I obviously don’t want to lose a menstrual cycle, everything being so specifically timed. How do I make sure I know what’s going to happen beforehand? And that way, avoiding unnecessary stresses is so important. So if you just know exactly when you’re meeting again, or exactly what the plan is beforehand, as much as this process has a lot of unexpected ups and downs, these ones are avoidable. So we should avoid the ones that are.

Susan Hudson MD (45:43)

I think we have done a great job at covering what to know before your egg retrieval.

Carrie Bedient MD (45:50)

So let me see if I got the list. Number one, be kind to yourself. Number two, trust your team. Number three, set your goals. Number four, optimize your health, meds, conditions, all of it. Number five, prep your meds and your calendar. Six is prep your meals or know where they’re coming from. Seven is nail the trigger time. Eight is take the time off. Nine is knowing when to worry and what the phone number is when you are worried. And then 10 is know your next steps.

Ian Waldman, MD (46:22)

Love it.

Abby Eblen MD (46:23)

Wow, you got him, Carrie. I was writing him down really fast. So I can remember them. Great.

Carrie Bedient MD (46:23)

That’s it!

Ian Waldman, MD (46:26)

It’s perfect, I love it. Thank you,

Carrie Bedient MD (46:26)

That was awesome, list, Ian. Thank you.

Ian Waldman, MD (46:29)

I appreciate it. I’m sure there’s a million things that we could add to it and everything, but at least this seems like a good place to start.

Susan Hudson MD (46:37)

It is, and Ian, thank you for joining us today.

Carrie Bedient MD (46:38)

Absolutely.

Ian Waldman, MD (46:40)

This was a lot of fun. Thanks for having me.

Abby Eblen MD (46:42)

Thank you.

Susan Hudson MD (46:43)

Absolutely.

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.

Carrie Bedient MD (46:57)

Visit fertilitydocsuncensored.com to submit questions and sign up for our email list. Pick up your copy of the IVF Blueprint today at Amazon, Barnes & Noble, or your favorite bookstore, and check out Instagram and TikTok for quick hits of fertility tips between our weekly episodes.

Abby Eblen MD (47:13)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician.

Bye.

Susan Hudson MD (47:21)

Bye!