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 cover everything patients should consider if they plan to start IVF in the next couple of months. They begin with practical but essential advice, especially at the start of a new year, such as re-verification of insurance to ensure the coverage you expect is still in place. They review important lifestyle considerations: diabetes and high blood pressure should be well controlled, weight-loss efforts should begin sooner rather than later if needed, and now is the time to adjust habits or foods that may not support fertility. The doctors discuss the importance of starting supplements early, especially prenatal vitamins, vitamin D, and folic acid, since these nutrients play a critical role even before pregnancy is detected. The team also reviews the value of an up-to-date physical exam and age-appropriate screenings, including mammograms for women over 40. They stress the importance of evaluating the male partner as well, including semen analysis and routine infectious disease testing required by most fertility clinics. Finally, they highlight key pre-IVF testing, such as saline sonograms to assess tubal patency, to ensure patients are ready to begin treatment without delay. Shady Grove Fertility sponsored this podcast.

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.

Abby Eblen MD (00:22)

Hi everyone, we’re back with another episode of Fertility Docs Uncensored. I’m one of your hosts, Dr. Abby Eblen from Nashville Fertility Center. And today I’m joined by my joyous and jubilant co-host, Dr. Susan Hudson from Texas Fertility Center.

Susan Hudson MD (00:35)

Hello

Abby Eblen MD (00:36)

and Dr. Carrie Bedient from the Fertility Center of Las Vegas. Hey, how you guys doing?

Carrie Bedient MD (00:39)

Hey!

Good, how are you?

Abby Eblen MD (00:44)

Good, gosh, know those last minute holiday shopping ideas are dancing through my head right now. I’m thinking of all the things I have to do. And I’m trying to think of something unique for my husband. And Susan, you told us a while ago about some ice or something that you got for your husband and that he had a particular kind of ice for his drink.

Susan Hudson MD (01:02)

I did, I did. This is actually, I’ve given him this a couple of times because he enjoys it so much. So, when you go out to a restaurant and you order an old-fashioned and they have the really fancy clear block of ice. So that’s called Fat Ice and you can buy it at at liquor stores. Now, if you go to your regular liquor store, they may have a small little six or eight pack of it, in skinny ice. Yeah, that’s funny. That’s good.

Abby Eblen MD (01:31)

The skinny ice.

Carrie Bedient MD (01:35)

Are we being pejorative?

Are we being judgmental calling this Fat Ice? Do we need to call it something different?

Susan Hudson MD (01:39)

No, it’s actually the brand. So it’s kind of like my dog is on Fat Dog Dog Food and name of the dog food is called Fat Dog. Okay. So it’s the same thing.

Abby Eblen MD (01:41)

A little judgy. okay.

Carrie Bedient MD (01:51)

Well, is it a goal to make the dog fat or to make the dog thin? I just want to be clear here. OK, I just checked it.

Susan Hudson MD (01:57)

Make the dog fit.

She has high triglycerides so we have to watch her diet.

Carrie Bedient MD (02:03)

Poor puppy.

Carrie Bedient MD (02:04)

Okay, sorry.

Susan Hudson MD (02:04)

It affects her liver enzymes, but back to the ice, back to the ice. So if you go to one of the bigger liquor stores, so in most cities, there’s probably a dominant liquor store chain and there’s usually one that’s more of kind of a distribution center. They will actually let you buy a case. And I think it’s either 80 or 100 cubes and they’re, they’re fantastic. And they’re you just get the case and you take it home and you stick it in your freezer. It’s really, really nice. But an additional touch to it is you can get on Amazon. There are these presses and all it is is it’s a stamper. If you imagine back in like olden times when you had a wax stamper that you would put your initial in. So it is just a metal stamper. It’s about three inches tall, it’s made of metal, you just run it under water and you put it down and it will put your initials so we have an H that we do ours and it is so cool and it’s so fancy and it’s it’s just one of those cool things to have.

Abby Eblen MD (03:16)

Okay, so I’m confused. So you buy the ice and then you stamp the ice? Is that what you’re saying?

Susan Hudson MD (03:19)

Yeah, so you stamp the ice when you make the drink.

Abby Eblen MD (03:22)

Okay, okay. How does the stamper stamp the ice if the ice is frozen?

Susan Hudson MD (03:27)

Because the stampers metal and literally just room temperature, it transfers heat into the ice very quickly. I didn’t wanna say that wrong because all of the scientists in my family were going to give me crap about this. It is transferring heat in a way that it essentially melts the ice so that you have an instant.

Abby Eblen MD (03:44)

How cool. So that’s a double gift for my husband for Christmas because he loves old fashioned. So cool. Okay.

Susan Hudson MD (03:49)

Yeah. ⁓

Another thing is when you or he is making the drink, if you stamped it, pour along the sides, not over the stamp because that makes your stamp melt faster. So there’s a little technique in there, but it’s it’s super cool.

Abby Eblen MD (04:02)

That’s a cool little gift.

Carrie Bedient MD (04:09)

All these things that I never would have thought about.

Abby Eblen MD (04:11)

No, I would have never thought to buy ice in and of itself. That’s just kind of funny. But hey, it’s cool.

Carrie Bedient MD (04:17)

One of our friends has a Death Star ice cube mold. And so whenever we go to their house and they make something, they have little Death Stars that they drop into the rocks’ ⁓

Abby Eblen MD (04:21)

Hahaha! That is really cool. I like that.

Carrie Bedient MD (04:30)

Be a good Valentine’s Day gift for people.

Abby Eblen MD (04:32)

Yeah, there you go.

Susan Hudson MD (04:34)

All right, you can get them on Amazon. know that.

Abby Eblen MD (04:36)

Just search a little bit. Do a little… Yeah. All right. Now for more important things. Today, and we’re going to have a question first. I haven’t forgotten the question like I usually do, but we’re going to talk a little bit about if you’re doing IVF this coming year, and many people are January, February, or March, things that you may want to know about.

Susan Hudson MD (04:57)

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Abby Eblen MD (06:19)

Susan has a question for us.

Susan Hudson MD (06:21)

All right, our question today is, hi, I have a one-year-old born via IVF. Shout out to Dr. Eblen, who’s my amazing doctor. We’ve since moved cross country, so I’m working with a new local doctor, but would be so grateful for your expertise. We are now trying for baby number two. The first time we did five IUIs, one retrieval, two FETs. First was a biochemical pregnancy, second resulted in my daughter.

I did Receptiva plus Lupron for two months between transfer one and two. My BCL-6 was 3.4 when I did Receptiva. My question is, should we even try IUI for baby number two or do you think I would benefit from Lupron Depot again and IVF? I would love for my kids to be close in age and don’t want to lose too much time or go through the mental strain of so many rounds of IUI if the endo is likely back. Thank you.

Carrie Bedient MD (07:13)

All right, Dr. Eblen.

Abby Eblen MD (07:14)

Hi, well, her baby is a year old, she said.

Susan Hudson MD (07:17)

Yes.

Abby Eblen MD (07:18)

And how old is she?

Susan Hudson MD (07:18)

We don’t know.

Abby Eblen MD (07:19)

With Receptiva, we really don’t have a lot of experience with it using it for IUI. I think, particularly if you’re on the younger side of things, I mean, you must try three IUI cycles or so. I don’t think you have to jump immediately and do something like IVF to do, because typically we do Receptiva with IVF patients, and we’re going to transfer an embryo. I think it’s okay to try three ovulation induction cycles with IUI. And then if it doesn’t work, then you have a more clear cut answer in terms of what your next steps would be. What do you guys think?

Susan Hudson MD (07:46)

Also consider retreating with Lupron for two months and doing a few IUI cycles, especially if they don’t have coverage. Because I’m guessing by this question that she probably doesn’t have IVF coverage, so it’s probably going to come out of pocket. I don’t think it’s going to hurt anything.

And if it’s a way that you can suppress some BCL-6 and improve the likelihood of conception with IUI, I don’t think it’s going to hurt anything. It’s just going to take a couple of months. And it sounds like that the side effects of the depo Lupron weren’t so miserable for her that she wouldn’t consider doing it again.

Carrie Bedient MD (08:22)

I think that you had mentioned the number of, or the amount that came back positive on the BCL-6 that actually doesn’t have a whole lot of bearing on anything other than positive or negative. This is not something where we go back and retest to see is the number higher or lower. I don’t know if you were thinking about that at all. I think a lot of it is really how many kids do you want and what is your resilience and…tolerance for going through negative cycles. When IUIs work, they are amazeballs because you have a baby and it’s less involved, less expensive. But also you have a very small human being at home and that changes the calculus of all of this. And it can change the calculus in both directions. There are some people who find, all right, I’ve got one kid. I am so distracted that if I get a couple of negative IUIs, it’s not the same soul crushing negative result as it was before and then there are also people who are going to go look I can barely put my pants on in the morning and I just cannot. I think you need to think about where you and your partner and your family are in this point and what your overall plans are. Because if you say, look, I can’t take one more thing, then sure, go to IVF and jump a little faster. But if you’re like, you know what, I’ve got the resilience for this, let’s do it. Then I would definitely lean towards letrozole with the positive BCL-6 history and would consider doing the two months of Lupron like Susan mentioned and see how it goes. I think some of the is where are you mentally in all of this? Are you considerably better now that you have a small human or are you just drowning in a totally different way, which is frankly what most of us do when we have small human beings that are now fully dependent on us to care for them and there is no training class and there is no certificate that you actually know what to do with this child when you bring it home from the hospital, which is a completely separate podcast in general, but see where you are.

Abby Eblen MD (10:09)

Yeah.

Well, the other tricky part about all this is we’re just sort of saying our opinions. There’s no randomized perspective data that really tells us what to do. So we’re all just kind of adding our two cents in and then you kind of get to pick what you want to do.

Susan Hudson MD (10:22)

Definitely part of the art of medicine.

Abby Eblen MD (10:24)

That is right. That is right. Next we’re going to talk a little bit about things that you may want to think about to get ready for IVF if you’re doing it in the next few months. Susan, what would you say would be number one thing on your list that you need to do if you’re about to do IVF?

Susan Hudson MD (10:37)

Number one thing you need to do is on January 2nd is get your insurance re-verified. Because what was your coverage may not be your coverage now, sometimes for the better, sometimes for the worse, but that’s one of the first things you need to do. Because, mean, unfortunately for most of us, how much things cost for IVF is going to make a difference.

Abby Eblen MD (10:45)

That’s a great one. I hadn’t thought about that one actually.

Susan Hudson MD (11:03)

It’s much better to go into your cycle knowing what your coverage is, what you may have to do to bridge that gap and be able to make making sure resources are allocated

Susan Hudson MD (11:17)

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Abby Eblen MD (11:55)

Okay, Carrie, you’re up. What’s number two on the list?

Carrie Bedient MD (11:57)

Number two on the list is getting your ducks in a row. Everybody’s very used to the, as of January 1st, I am going to stop drinking. I’m going to only eat raw carrots with low fat dip. And I’m going to run six miles a day and blah, blah, blah, blah, blah, blah, blah, blah, blah. What I suggest is a couple of things. Number one, making sure that you’re medical conditions are neatly tied up and in order. If you’re a diabetic, make sure that you’re A1C is nice and low, ideally below seven. If you are someone with high blood pressure, make sure that your meds have been optimized so that you’re not really on the lisinopril anymore. You’re on the labetalol or the amylodipine or one of the ones that is more compatible with pregnancy. With the lifestyle components, one secret little, I don’t know if it’s a hack, it’s something that I’ve always found useful is I was thinking, okay, as of January 2nd, I am going to get it together.

But I try and start that really right around Christmas. And then between the 26th and the…the 30th, 31st, start to say, okay, I’m gonna start working out every day. I’m going to start make the effort to get the kitchen ready and to get rid of a lot of the crap and to take everything to work so that I can share all of the artery hardening foods that I love to bake and all of those things. That by the time you get to those first days, you’re a little bit more set for.

Yes, I’ve got my nice water bottle. Yes, I’ve got the things set up that I need to make those transitions a little bit easier.

Abby Eblen MD (13:34)

That’s a great idea. And to that end, this is adding to what Carrie was saying. If you need a physical exam, if you’ve not been to have your Pap smear in the past three to five years or seen your OBGYN, now’s the time to do that. And also if you’re 40 or older, now’s the time to think about having a mammogram. We definitely wanna make sure you’re healthy enough to get pregnant and that you don’t have some problem that they find on a mammogram or with an exam or something after you’re already pregnant. The other thing I would think about that also needs a little lag time as well, is supplements. The typical supplements that we tend to think about, those are prenatal vitamins. You get vitamin D and you also get folic acid in the prenatal vitamins, but a lot of us are indoors during the wintertime. So now would be the time to maybe bump up your dose of vitamin D. It wouldn’t hurt to get a little extra. We find that most people are deficient in vitamin D, even if you’re on a prenatal vitamin. The other supplement that’s really important, it’s also an antioxidant, is folic acid. And we know that that’s vitally important really early right after you get pregnant because it helps the neural tube or the backbone of the baby form correctly. Some people that are getting pregnant in good old fashioned way may not know for several weeks or months after they get pregnant. And by that time, the neural tube has already formed. Those are probably three big ones. Coenzyme Q10 can be really helpful for people, particularly if they’re older than the age of 35 or 40. We think that it may help the mitochondria, the powerhouse of the cell with cell division.

The other newer one is called NAD or NAD plus. And it basically works also in the mitochondria, but just in a different way. It may also help with cell division as well. And it’s actually one of those supplements that’s known as longevity supplements. You may want to think about adding that one in too.

Susan Hudson MD (15:12)

And don’t leave your partner out in the supplement game. If your REI has advised him to be taking supplements or modifying lifestyle, all of those things have a big impact. It takes 72 days to make new sperm. Avoid the saunas, avoid the hot tubs on the ski vacation. We don’t want the little swimmers getting sizzled right before you go into IVF.

Carrie Bedient MD (15:38)

No par boiling the sperm.

Susan Hudson MD (15:41)

Exactly. And along that line, make sure you go get your flu shots. Flu shots are not perfect, but there is something called herd immunity. The more people who get flu shots and the more people around you who get flu shots, the less likely you are to get sick or get really, really sick. And the last thing somebody wants to happen is getting the flu in the middle of their IVF stimulation and having to get canceled because anesthesia is going to be like, this is a no go.

Carrie Bedient MD (16:07)

Well, and also not just anesthesia, eggs do not like fevers. If you were sick in the middle of your stim, we’re not going to get the same result. We might as well just cancel upfront, save you the money on the retrieval and do it again. Staying as healthy as you can, this applies to your partner as well. Sperm don’t like fever any more than eggs do. And in the same way that we don’t want you to parboil them in the spa, we don’t want you to parboil them because you’ve got a temp of 102.

That’s something that plays into that. One of the ways that I, and this is maybe more revealing more about how I am compulsive than anything else, but whenever I’m going into a time that I know is really stressful, I try and prep as much as possible. That can be things like making the meal planning and knowing approximately what we’re gonna eat when, even if it’s just an overall list. And when you…go to shop, do the shopping, do the Costco run or the Amazon order or whatever, getting the basics that you know you’re gonna need. The toilet paper, the paper towels, the laundry detergent, the things that when you run out of, it’s not a crisis, but it’s really annoying. Get rid of some of those minor irritations in your life. Get the oil changed on your car, rotate the tire. Random stuff like that that you know is going to come due in the time that you’re going through all the stress stuff, just prep it so you you don’t have to think about it and so you’re less likely you’re less likely to have some of those mini crises that they’re not really crises but they sure make your life more obnoxious and nobody needs that at any time and really not in the midst of an IVF cycle.

Abby Eblen MD (17:26)

One less thing to worry about.

And to that end, from a mental standpoint, if you know this is gonna be a stressful time, and I really don’t know anyone that’s ever done IVF that didn’t say it was stressful, physically for sure, but mentally as well, now might be a good time to, if you don’t see a therapist, it might be good to establish a relationship. Just because there’s a lot of mini roller coasters and then there’s one big roller coaster ride at the end where you find out whether or not you’re pregnant. That’s kind of a prolonged timeframe. That’s through, two to four months somewhere in that window. And so anything that you can do to get through this emotionally you wanna do because it’s just a hard time for everybody.

Susan Hudson MD (18:11)

Another thing to do is find out if you are covered by FMLA. And so for those of you listening, if you have been employed over a year, wherever you work, and this goes for your partner as well, and you work for an employer over a certain size, I don’t know exactly what that size is, you are covered so that…that while you are undergoing your treatment, that you can’t lose your job. This is a medical issue. This is not elective. This is a true medical issue and it is something that is protected under FMLA. If you need to have that paperwork done to help protect your job, get that to your office, give them plenty of time to be able to complete it. Usually it’s a little bit lengthy, so it’s not something we can turn around super quick.

We wanna make sure that you sitting there worrying about, no, am I gonna have a job because I’m being gone for doctor’s office visits, isn’t adding to your plate.

Carrie Bedient MD (19:08)

And note that FMLA is the approval to take the time off for those doctor’s appointments. In the setting of IVF, it isn’t necessarily saying you get a month off of work, and I’ve had a bunch of people ask us about this recently. I don’t necessarily want you to be off work for a month because I don’t want you at home stewing over everything that we’re doing because honestly, I think that that stress adds more and I think that is more detrimental than you just going to your job every day. FMLA is typically looking at, yes, you have the time to show up late to work that day to miss half your shift to whatever it may be, but it isn’t saying that you’re going to get two weeks off between your transfer and your pregnancy test or around the time of your retrieval and your stim because it’s not medically necessary for the vast majority of patients. And I think it’s actively detrimental because you are sitting at home thinking about everything you’re doing. And in this case, while avoidance is not in general a good lifetime strategy, in this case, I think this is actually an excellent strategy to keep yourself distracted from all of the stuff that you’re going through. And if work gives you an extra four hours to think about what Tom and accounting did and didn’t do, I would vote for that. I think it’s helpful to be thinking about something other than what your eggs are doing in the lab.

Abby Eblen MD (20:21)

That is a very great point. Now switching gears a little bit, maybe over the holidays you and your partner decided, okay, we’re ready to jump in, we’re ready get going, but maybe you talked to your doctor a couple months ago. There may be some little details that you’ve forgotten. And actually, as a side note, I have a really good solution for that. We have this book called the IVF Blueprint, if you hadn’t heard about it. It’s a great book. It will go through all the details. But what I was actually really gonna say was there’s probably a lot of the tests that you’ve forgotten about that your doctor mentioned.

So there’s three big tests, well, two or three big tests. So Susan, what’s a big test that may take a little time on the front end? It’s not like you can just do it tomorrow and then go right into IVF.

Susan Hudson MD (21:01)

So if you haven’t had recent ovarian reserve testing, generally between six to 12 months, that is something and we usually like to do that at the beginning of your menstrual cycle. And so that’s something that takes a little timing.

Carrie Bedient MD (21:16)

Another set of tests that can be helpful is most of us are going to require a physical exam and a bunch of general lab work before we do things like stimulate your ovaries, put you to sleep for a retrieval. And this is checking diabetes, thyroid, anemia, infections, not just for you, but also on your partner. This also includes genetic carrier screening, which out of everything takes at least a couple of weeks to come back. And you want both you and whoever is providing sperm to do the same test. And so make sure that all of those things have been done. Like Abby said, this is not where you can call the fertility doc, get the appointment on January 2nd and be rocking and rolling ready to go by January 10th. A lot of these tests take a solid month because they’re timed with your menstrual cycle or they just take time to do.

Abby Eblen MD (21:59)

The other test is a saline sonogram, and you may have had one of those done maybe six months ago or eight months ago or 10 months ago. Most of us want a really pretty recent one. I like mine within six months of the last one because sometimes little polyps can pop up. And the worst case scenario is if you get ready to have an embryo transfer and we’re like, your lining’s thick. Where did that come from? We see a polyp there. That’s really disappointing. We really like to get that usually right as you’re starting into the cycle or certainly if it’s not before you do your retrieval, at least it has to be done before we transfer an embryo.

Susan Hudson MD (22:30)

If you haven’t had updated sperm parameters done as well, usually within a year, your clinic may want an updated semen analysis. If you need to have any testing for things like DNA fragmentation or SpermQT performed, looking at the quality of the sperm, those tests usually take a few weeks to get back. It’s good to get those under your belt sooner than later.

Abby Eblen MD (22:54)

Anything else you guys can think of?

The one other thing I would say, the other reason to get this done ahead of time is let your office know that you’re about to start because insurance will end with the way we began. Insurance is really important. Some cycles are held up just because we don’t have enough time to get it through the insurance and get approval for your cycle. Because if we start the cycle and you go through an egg retrieval without approval, that’s really bad. You’re to have to pay out of pocket for that cycle. That’s one of the things that sometimes will hold people up more so than either of the things we just discussed.

Susan Hudson MD (23:23)

For those listeners who are like, we are ready to get started, but we really haven’t established with somebody getting into an REI sooner than later is super important because just like we talked about this testing that you need to have done, we can’t jump straight into something without knowing what we’re dealing with. I see this more often in late spring when it’s April, May and teachers are getting out of school and they’re like, okay, I need to be pregnant in the next two months to make it through the calendar year and things like that. And we don’t usually turn things around that quickly. It just, we work on human physiology. You have menstrual cycles. We just, can’t make things happen that fast. If you’re needing something to happen within a specific timeframe, sooner than later, we can always drag something out. We can do an egg retrieval and do an embryo transfer later whenever it’s strategically the right time for you. But putting things off and then being like, no, we have to hurry up. That’s really hard to do. Unless you are in the situation that you are we wanna make sure all of our I’s are dotted, all of our T’s are crossed. We’re not missing any part of the diagnosis that could lead to a less than perfect outcome for you.

Abby Eblen MD (24:48)

Very good, any other thoughts? All right, well, hopefully have you all queued up to do IVF in the very near future. To our audience, thanks for listening. Tune in next week for more. Also be sure to subscribe and leave us a review on Apple Podcast.

We’d really love to hear from you.

Carrie Bedient MD (25:02)

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 local bookstore. And check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes.

Susan Hudson MD (25:17)

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’ll talk to you soon.