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, we explain the initial fertility workup for patients seeing a fertility specialist for the first time. This includes evaluation of the uterus, fallopian tubes, sperm, and ovarian reserve using AMH testing. We discuss how fertility physicians assess egg count and why each component of the evaluation is important. We review ovulation tracking methods, including ovulation predictor kits, and explain how they are used to properly time intercourse. Timed intercourse is discussed as a first-line fertility treatment option, including when it may be effective and when additional intervention is recommended. We also cover fertility medications such as letrozole and clomiphene citrate, used with timed intercourse or with ultrasound follicular monitoring to track egg development. The role of Ovidrel in triggering ovulation and improving timing is explained, along with its benefits. Finally, we discuss intrauterine insemination and the use of the FemVue catheter, which can help deliver sperm more effectively to a specific fallopian tube. This episode provides a comprehensive overview of fertility treatment options that do not involve IVF. This podcast was sponsored by IVF Florida.
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 am joined by my articulate and arresting co-host, Dr. Susan Hudson from Texas Fertility Center.
Susan Hudson MD (00:37)
Hello everyone
Abby Eblen MD (00:39)
and Dr. Carrie Beading from the Fertility Center of Las Vegas. How are you guys doing?
Carrie Bedient MD (00:43)
Hello, and I would like to call attention to the fact that she said arresting not arrested.
Abby Eblen MD (00:48)
Okay, so my question today for you guys is have you ever had a brush with the law in any way? Maybe this is a little too personal, but just curious.
Carrie Bedient MD (00:56)
I mean, besides the occasional speeding ticket, was especially when I lived in Cleveland for residency, there was one area where they would speed trap because it dropped from 50 down to 35 in the space of a block when nothing else changed. I remember that street with some four letter words attached to it because I would always forget. But other than that.
Abby Eblen MD (01:19)
So are you one of those people that can get out of speeding tickets?
Carrie Bedient MD (01:23)
No, I don’t even try. I live in Vegas. I have the poker face of an angel. I just cannot, I don’t have a poker face when it comes to that. so, no, I did it. It’s fine.
Abby Eblen MD (01:34)
All right, so Susan, have you ever seen the inside of a jailhouse or?
Susan Hudson MD (01:38)
Never seen me inside of a jailhouse. However, I have only had one speeding ticket and it was when I was in college and it’s actually kind of a funny story. But all the other times I’ve been pulled over, I’ve not necessarily talked to, I think because when I get pulled over, I get so anxious. I think they know that I’m so repentant. And I’m just like…
Abby Eblen MD (02:02)
One time I was lucky enough to get out of a speeding ticket, but most of the times I’ve had more than one. One time I got out of one, but I don’t think it was because of my nice smile. I think he was just a nice guy and I was rushing to get to work.
Susan Hudson MD (02:14)
When I was in college, I got a speeding ticket and it was on Super Bowl weekend because I was heading from home back to college at Texas A&M. And we were, I was going through this little speed trap town called Dime Box, Texas. Okay. And I was, no, no, no, no, Dime Box.
Carrie Bedient MD (02:32)
Not Dimebag, Texas.
Susan Hudson MD (02:37)
And it’s actually kind of funny because back then the speed limit was 55. And so now the speed limit’s 75. So if it would have been now, I wouldn’t have gotten a ticket, but I was going 23 over the speed limit, which in Texas if you’re 25 over, that’s when they can take you in. So fortunately that didn’t happen. So I got the ticket, no big deal, went home, got back to school.
Carrie Bedient MD (02:52)
Whoa, that’s a felony!
Susan Hudson MD (03:03)
And then I did defensive driving to get it off my record and did all the things. Well, I had just turned 18. I did the defensive driving and I mailed all the stuff in. Well, I didn’t know back then that you should send important things like that certified so you have proof that it’s received.
So I had mailed it in and really hadn’t thought anything about it. And one day I was at my dorm and my dad called and my dad was not a telephone type of guy. And if my dad called me, it was one because something was wrong or he was calling to tease me about something. He had gotten home back in the days of answering machines and on our home answering machine back in New Braunfels, the judge had called saying there was a warrant out for my arrest.
Abby Eblen MD (03:56)
So you have had a brush with the law.
Susan Hudson MD (04:02)
Well, I mean, technically, but essentially I called them up and explained to them the situation and I was just a dumb college student who didn’t know, and I was like, have it all done, it’s all right here, and it ended up being fine and I didn’t get any trouble, but that’s the closest to any real trouble that I’ve ever been in.
Abby Eblen MD (04:05)
Well, I’m glad you got out of that without any significant brush with the law or jail time. Today we’re going to talk about non-IVF options for fertility. But first, Susan, have you got a question for us?
Susan Hudson MD (04:35)
I do have a question for us. Our question today is, I have been listening for quite a while to prep for my first round of IVF. Thank you for listening. I’ve been trying to conceive for two and a half years with no luck. I have seven and nine year olds that were both conceived naturally at 28 and 31. I am now 38. My AMH is 4.09 and I have a right proximal block in my fallopian tube. I can’t imagine my tube is the only reason after this long that I haven’t conceived.
Is this a futile situation due to my age? I’m not open to donor eggs at this point and can truly afford only one round of IVF. Thank you for your input.
Thoughts?
Carrie Bedient MD (05:14)
38 years old with an AMH of 4.0? Go for it, girl. Yeah, I mean, unless there’s something big that we don’t realize in a situation like, you have, I can’t even think of something, because all the things that I’m coming up with would be reflected in the AMH.
Abby Eblen MD (05:18)
Pretty good.
Susan Hudson MD (05:33)
Obesity if at 38 your AMH is 4, with a higher AMH that you had in years past, you may not have been as ovulatory as you would have thought. Proximal blockage, probably a false positive statistically. So nothing I would lose too much sleep over and don’t forget the other half of the equation, it’s not all you, which means there could be a sperm issue, whether he has a normal semen analysis, has he had DNA fragmentation done? Have you had a SpermQT done, which looks at how well a sperm can bind to penetrate and actually fertilize the egg? Those are all other questions. And sometimes we don’t have an explanation. If we wrote a book about everything we know about getting pregnant and that second book about how to test those things, that second book is much, much, much shorter because realistically we don’t have a lot of tests that we can test in the human in real life situations and we’re left with treatment options, which are often great treatment options, but we don’t necessarily get a full conclusive this is the reason why you can’t get pregnant so far.
Abby Eblen MD (06:50)
Well, and the one other thing, with an AMH over four at 38, that’s excellent, because that means that there’s a really good chance that you’ll have a good number of eggs when you stimulate. But like we often say, we really don’t know about the quality of the eggs until we get them in the lab with the sperm. Most likely at 38, if you go through IVF with a good AMH, you’re going to have, hopefully one or two genetically normal embryos, but there’s still a chance that the quality of those eggs may not be that good. And that could certainly contribute as well. But I think overall, most of us would be really excited if we had a 38 year old with an AMH of four. That’s both really well for your outcome.
Susan Hudson MD (07:26)
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Abby Eblen MD (08:38)
Today we’re going to talk about non-IVF options for fertility. And since we’re sort of starting with that topic, we may also want to just give a brief summary of testing that we may do. Because I think a lot of people that may be listening to this episode maybe are new to fertility and new to fertility treatment. Carrie, give us some tests that you would do on a new infertility patient.
Carrie Bedient MD (08:59)
What guides the testing in general is that you need four things in order to get pregnant, uterus, tubes, ovaries, and sperm. And then the fifth is the general health category. Starting with the eggs, what we would do is an AMH is easy to get. It’s something that a regular OB-GYN can order very easily. It does not depend on what day of your cycle you’re in. It looks at the storage capacity, essentially, or storage status of the ovaries.
All of your eggs are there when you were born and each one of them is producing a tiny amount of a hormone called AMH, anti-mullerian hormone, and majority of those eggs that are there are in deep storage and only a couple come up at the beginning of each month. And when we look at the deep storage capacity, we’re looking at is your AMH high, low, mid-range? We want it to be 1.5 or greater.
In someone who’s over 35, we expect it to be less than that. In someone who’s really young, we expect it to be a decent amount higher than that. PCOS patients have really high levels a lot of the time. That’s one egg test to go after. And that one, any OB-GYN can do relatively easily and get accurate results, regardless of where you are in your cycle, those types of things.
Susan Hudson MD (10:14)
Some other egg tests that you may have done are an FSH and estradiol test. FSH is the hormone the brain produces that tells the ovaries what to do and estradiol is what the ovaries produce that talk back to the brain. There is some quantity component of it. I think of it more of a little bit of a quality reflection. And then you also have your antral follicle count, which is when they actually count the number of little follicles the houses of the eggs on each of your ovaries. Now if you have had an ultrasound with your general OBGYN you probably have not had a formal antral follicle count. There’s always an exception to the rule however most OBGYNs they may comment that there were follicles seen or lots of follicles or a few follicles but not an actual count and that actual count can be relatively predictive And no ovarian reserve testing is perfect. So we really, as fertility specialists, really like to get at least two, if not all three of these tests to get a full idea of what’s going on.
Abby Eblen MD (11:22)
The other testing you may want to get is you may want to get testing to look at your endometrium and in your fallopian tubes and those can actually be done in the same test either with something called a hysterosalpingogram, which is a test done by a radiologist. It’s where the radiologist puts radio opaque dye up inside the uterus and through the fallopian tubes and that way we can look at the contour of the uterus. We want to make sure it’s not lumpy, bumpy, because embryos generally like to implant in a really smooth, nice environment.
We also can see dye go through the fallopian tubes. And like the question earlier, if you have one open fallopian tube, we feel like there’s still a pretty good chance you can get pregnant with that tube. Tubes are like kidneys. It’s great to have two, but you only need one. If you have one that’s blocked and dilated at the far end, sometimes that can be a problem. Particularly with IVF, we know there’s data to suggest that lowers pregnancy rates. We don’t really know about that for sure. If you’re just trying to get pregnant through the good old fashioned way or through procedures in the office, but certainly some evaluation of the uterus is important. The other tests that can be done with ultrasound is a saline sonogram and different clinics give it different names, but it’s essentially where we put water up inside the uterine cavity. We open up the cavity almost like blowing air into a balloon. We can see if there’s lumpy, bumpy surfaces there. If there are, that may mean that you will have a procedure to get those lumpy, bumpy areas removed. It will also tell us about your tubes. We put water through the fallopian tubes.
And with the air bubbles in the water or with a special type of foam, we can tell if the tubes are open or not with that procedure as well.
Carrie Bedient MD (12:54)
There’s the ever popular topic of sperm because you, like we said, takes two to tango. You need the other half of that equation. And sometimes it’s really obvious when that’s not being produced for someone who’s a single mom by choice, who doesn’t have male partners, those types of things. But if you do have a male partner, we do want to make sure that a semen analysis is relatively normal.
Abby Eblen MD (13:00)
Takes two to tango.
Carrie Bedient MD (13:21)
This is collected in the oh so romantic way of masturbating into a cup. Then it’s evaluated for the volume, the concentration, so how many million sperm there are per milliliter fluid, the percent that are moving. That’s gotten a little bit more detailed relatively recently because the WHO just put out there, I think they’re on their sixth edition of the timeline. There’s not only motility, but there’s progressive motility, which is important because motility tells you whether or not it’s moving.
Abby Eblen MD (13:41)
Yeah.
Carrie Bedient MD (13:50)
But there’s a huge difference between Olympic swimmers and couch potatoes only reaching for the remote. And that difference is super important. And then of course, we’re looking at the morphology or the appearance, which is how many of them have the very classic appearance that we’re looking for with a tapered head, single tail, those types of things. Really it tells us, did the contestants show up for the pageant? Did they pass the beauty competition? And did they pass the talent competition?
Susan Hudson MD (14:16)
In recent years, more and more tests have become available to evaluate sperm function. A couple of the tests that we tend to do more commonly are one looking at something called DNA fragmentation. DNA is our genetic code, it’s what’s held within the sperm. Sometimes as you go through life, have different exposures, different health issues.
That type of thing, you can have more breakage or fragmentation of that DNA. If that’s present, that can affect chances of pregnancy. It can also increase the chances of miscarriage, believe it or not, and there are things that we can do to help improve that situation or advice of things we can do to improve that situation. And then the other test that is a newer kid on the block, but we’ve had some episodes about before is something called SpermQT. And SpermQT looks at genes within the sperm that determine how well a sperm can bind to penetrate and actually fertilize the egg. And again, as you go through life, have different exposures, health issues, different things like this. Some of those genes can get abnormally turned on or off something called gene dysregulation.
If you have a high percentage of genes that are dysregulated, that can point you in certain treatment directions as well.
Abby Eblen MD (15:41)
And depending on kind of what your specific history is, there’s certain other groups of tests that we may want to do, like if you have breast discharge, that leads us to think that maybe a hormone called prolactin is elevated. Maybe there’s a problem with your thyroid. There’s things that we can also check, but the majority of tests really represent kind what we’ve just talked about. Like Carrie said, we want to make sure your tubes are open, your uterus is normal, your partner has good sperm, and the embryo has a good place to implant.
Those are really the lion share of what most reproductive endocrinologists would do. My best piece of advice is don’t start Googling, because there’s a lot of stuff out there that we haven’t done in 25 or 30 years. And if your doctor doesn’t do a post-coital test and you go in and go, why didn’t you do that post-coital test on me? They’ll look at you and laugh and go, we haven’t done that in a long time. So these are really the things that reasonable people I think would do as part of a workup, give or take maybe a few other little things, depending on your own personal history.
Susan Hudson MD (16:37)
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Susan Hudson MD (17:16)
So do we want to talk about our treatment options based on geography?
Abby Eblen MD (17:22)
Sure.
For the average person who walks through your door, they’ve had a workup, their workup is completely negative, meaning we found nothing. Everything looks pristine, and they look at you and they go, well, what are you gonna do now since you don’t know why I’m not able to get pregnant?
Carrie Bedient MD (17:36)
The first thing that we do is we take a look at are all of the mechanics, the timing working. The testing is a huge part of that because if you’ve got completely blocked tubes, for example, then it doesn’t matter how amazing everything else is, it’s not going to happen because the door is fully locked and even a battering ram is not really going to help you if you open it up, so you need to do other things. So we want to take a look at how often are you intercourse? Are you in the fertile window? Those types of things, every so often. Granted, we’ve all been doing this for a while. I imagine I’m not the only doc who’s heard this story. You want to make sure that everything is going in the right orifice?
It’s really hard to get pregnant when it’s not and, it sounds funny, but it certainly happens, worth checking. And we talk about the fertile window. The easiest, lowest cost, lowest impact, lowest everything way to approach this is making sure that you’re having intercourse at the right time of month. This is a lot easier to do for someone who is having regular cycles because it’s a little bit more predictable.
Abby Eblen MD (18:16)
It happens.
Carrie Bedient MD (18:38)
For those people who are having cycles that can come every one to six months, this is way less valuable for you because part of the problem is that that part of the process isn’t working. So you can’t predict what’s not happening. When we’re talking about the fertile window, ovulation predictor kits tend to be one of the easier ways to go about getting this. Basal body temperature may be something that you’ve heard of. That is not one of my particular favorites.
Primarily because it requires you to get up and take your temperature first thing in the morning. And the very first thought you greet the new day with is, I’m still not pregnant. Now, there’s some of the more recent technologies that make that a little bit easier. The OuraRing or some of the other biometric devices, wearables, those things can be very helpful.
The other thing that can be helpful is there are kits out there. So rather than just an ovulation predictor kit where you’re peeing on a stick all the time, you can pee on little strips and get more sets of hormones that are out there. There’s lots of different apps that you work with your phone and everything transmits. And you can get a much better idea. The upshot, no matter how you’re getting those levels is approximately five days before you ovulate.
have sex roughly every other day. Does not have to be every day. The difference between every day and every other is maybe a couple of percentage points. It’s not very high. Certainly not worth making a sex chore to get those extra couple of points. And for sure, making sure you have sex the day you ovulate and the day after. Much beyond that, it is purely recreational.
Susan Hudson MD (20:08)
So another thing to think of to maximize your chances of pregnancy relatively simply is you may want to start some supplements. Now, of course, we’re all going to recommend you take a good quality prenatal vitamin. Now, prenatal vitamins are probably not going to increase your chances of pregnancy that much, but they are going to help improve the likelihood of a healthy pregnancy.
One of the major reasons we have you take them is we want to help prevent neural tube defects or defects that happen in the brain and spinal cord. And actually it’s really important for you to be taking those prenatal vitamins for ideally three months before trying to conceive. A lot of people listening, they’re tired, they’re worn out, they’ve stopped taking them because they just don’t wanna mess with them, but they’re very, very important.
When we’re actually talking about things that might help you improve your chances, some of those people who have irregular periods, periods not every 25 to 32 days, if your periods are more spaced out you often may be recommended to take some supplement called ovasitol which is a combination of two different types of inositols in a certain ratio that can improve the chances of you potentially ovulating on your own. And even if you end up needing some more medicine, it can make your body more sensitive to those medications. And if you have issues with blood sugar control, it can help those blood sugars get into better ranges.
Other things are antioxidants. Vitamin D is a big one, especially for those PCOS patients, but realize most of us are vitamin D deficient, so taking a little extra vitamin D is helpful. There are also a number of supplements that are available for men to help both motility and count.
There’s a ton of information about supplements in our book, The IVF Blueprint. We actually have a whole chapter dedicated to that. So a good reference point for those.
Abby Eblen MD (22:19)
And just as a corollary add on to what you saying Susan about ovulation for people with PCOS, some people realize this, but a lot of people don’t, that as little as losing as little as 10 pounds can make a difference in terms of you ovulating on your own and not needing us, a fertility doctor or an OBGYN to help you get pregnant. So that’s something to think about in terms of just your overall health as well. It will improve the health of your pregnancy as well.
Beyond supplements, if we want to get a little bit more proactive in terms of trying to get you pregnant, there’s some oral medications that we can use. One is known as Clomid or Clomiphene Citrate. The other is known as Femara or the other name is Letrazole. The purpose of both of those are to try and get you to ovulate consistently. Even if you ovulate consistently, sometimes it will help with your lining in the case of Letrazole.
Letrozole tends to have less side effects. It tends to be more tolerable for patients and helps time when you would have intercourse. As Carrie said, you can still do that with time intercourse. You can still take oral medicine and not have to do another procedure in the office. Although the American Society for Reproductive Medicine recommends in addition to that, also doing something called intrauterine insemination.
Susan Hudson MD (23:29)
And I think it’s very important for our listeners to understand that if you’re not ovulating on a regular basis, you’re potentially a great candidate if we have normal sperm parameters for you to just use the ovulation induction medication, so Clomid or Letrazole. However, if you’re having regular periods, there’s very good evidence that just taking Clomid or Letrazole with timed intercourse doesn’t push that notch up.
It doesn’t really increase your odds of pregnancy. It’s really by combining the ovulation induction or super ovulation with IUI. That’s where we get improved chances of pregnancy. And we all see it probably once a week, we have somebody who comes into our office and they’re like, I’ve done three or six months of Clomid with my OB-GYN and we’re like, okay, that’s great. Let’s start doing something else because that’s not just gonna be helpful.
Carrie Bedient MD (24:24)
Typically there’s a bit of a difference when you’re doing ovulation induction with your OBGYN versus with a fertility specialist. Most of the time the OBGYN will say, okay, here’s your prescription, go forth and have sex, call me if you’re pregnant, call me if you’re not pregnant. And different OBGYNs will do different things. Some of them will have you check ovulation predictor kits to confirm that you ovulate. Some of them will have you come in on day 21 to 24-ish of your cycle and get blood work to confirm that you ovulated. Some will do ultrasounds and some don’t do anything and they just say give me a call depending on how it goes. All of those things can be the right way to go. There’s not a strong you absolutely have to do X, Y, and Z. By the time you get to a fertility office, we are far more obsessive and we love data.
We love our data. And so what we’ll do is we will very frequently have you get an ultrasound before you start. We make sure that you’re not pregnant, that there’s not a cyst there. We have you get an ultrasound after you take your medication. This is to make sure that it worked, but also that it didn’t work too well. We want you to have a baby. We don’t want you to have a basketball team. The goal here is to have your own show or your own streaming Netflix special about you and your 12 children that were all born out of one pregnancy. And we’ll frequently give you a trigger shot once we see that those eggs are nice and big. And that is the eviction notice for the eggs. Tell them to grow up and get out. And that’s an hCG, Ovidrel, Pregnyl, Novarel are some of the more common names of those medications. And those are ways that we use that adjacent testing and monitoring to help make sure that what you’re doing is something that is more likely to get you pregnant.
Similarly, if we do that follow-up ultrasound and we don’t see an egg growing, maybe we give it another couple of days. Maybe we just say, scrap this cycle, let’s up your dose next time. Because it’s a lot easier to start too low and go up than it is to go too high and have to backtrack.
Abby Eblen MD (26:20)
Susan, does everybody need the Ovidrel shot if they’re doing intrauterine insemination?
Susan Hudson MD (26:24)
I think I’m a big fan of Ovidrel. Realize that when you ovulate, your egg is only good for 12 hours. And by us giving you a medicine that’s going to make you ovulate at a certain time, that really does maximize egg and sperm exposure. There are some people who are not proponents of that, that they just do IUIs based on ovulation predictor kits.
That’s just not what I tend to do.
Carrie Bedient MD (26:51)
Keep in mind it’s not ovulating 12 hours after you take the injection. It’s the injection starts the process of ovulation and so that happens usually well over 24 hours later. It’s very common to say take your trigger shot tonight and we will see you in two mornings from now to get your IUI done.
Abby Eblen MD (27:10)
Some people out there may have done their homework and may have looked and seen that sometimes we’ll use injectable fertility drugs, more powerful drugs in the realm of office procedures. Tell me a little bit about that and what patients can expect based on recent data.
Susan Hudson MD (27:27)
When we do what we call gonadotropin cycles or the injectable medication cycles, you will generally use little injections just under the skin on a daily basis of medication. You are often seen more often. Instead of doing an ultrasound at the beginning of the cycle and then maybe a week or so later, you’ll probably come in every three days plus or minus for blood tests and ultrasounds to see how many follicles you are recruiting. Now, and then based on the size of the follicles in that situation, we do absolutely trigger your ovulation because the way the brain and the ovaries communicate, when we give those injectable medications, it does not work nearly as efficiently and as well. Now, the issue is with these injectable medications, this is the number one risk factor nowadays for getting pregnant with multiple pregnancies, especially higher order multiples, triplets, quadruplets, etc. And with recent data, it has really showed that if we can get you to ovulate using oral medications or oral plus a little bit of injectable medications, there’s really not good evidence any longer to support pure injectable medications because of that high risk. And although there’s lots of people out there who are like, I’d love to have two or three kids at the same time and just get it done, realize that is dangerous for mom. That is absolutely dangerous for babies. And it’s dangerous for relationships. As hard as it is to go through infertility, there’s very good data to say that marriages and relationships of people who have multiples is a much larger struggle. And even when you look at cost, that it costs exponentially more to raise two children simultaneously as it is to raise them sequentially as you would normally have them.
Abby Eblen MD (29:35)
Yeah, and I would say just as a side note for me, I rarely do that much anymore. Occasionally I’ll see a patient that will come through that maybe is having trouble ovulating with oral medicine and maybe she’s a little bit older and maybe there’s some reasons why I think that she’s going have a little bit more difficult time. Sometimes I’ll do that, but I’m really, really, really, that’s a really, really rare individual in my practice anymore. What about you, Carrie? Do you guys do that much anymore?
Carrie Bedient MD (29:58)
Very rarely. And most of the time it’s because the math doesn’t work out for half a dozen reasons. The risk of multiples is one. The time it takes, I find those cycles take a lot longer to do. It’s not just your standard within 30 days, you’ve got a pregnancy test and you know yes or no. Usually it takes a lot longer than that because we have to be so cautious about getting the eggs to grow and not blowing out the ovaries with 10 eggs at a shot and putting you at higher risk of hyperstimulation syndrome. I think that the math of those, both in terms of time and the expense, tends not to be worth it. If you’re gonna go to all that trouble, let’s at least go to that trouble for a much higher success rate that has far less risk to it. I very rarely do it anymore. I didn’t like those cycles to begin with. And with the data out there, I really don’t like it now.
Abby Eblen MD (30:44)
Yeah, they’re really scary. just you can’t predict how somebody’s going to respond.
Carrie Bedient MD (30:50)
I have a question for both of you. Sometimes I’ll have patients come in who say, I want to do a double IUI, where they do back-to-back IUIs one day and then the very next day. I don’t tend to do a whole lot of these. What is your thought on these?
Abby Eblen MD (31:05)
The New England Journal of Medicine had an article that came out many years ago. It was a pretty well done study and it looked at the timing of intercourse in relationship to pregnancy. And generally, if you have sperm close to egg within a day or two, that’s reasonable. It doesn’t really enhance your ability if you do it two days in a row. It’s just more expensive and data doesn’t really bear out that it makes any difference.
Susan Hudson MD (31:28)
I don’t do it on people who have good sperm parameters. I will occasionally do it on people who don’t have IVF coverage or are really wanting to avoid IVF so that we can get in two collection situations a total number of sperm that brings it up to somewhere in that five to 10 million mark. I like having about 10 million sperm for IUIs with the final count.
I’ll do it in that situation. Logistically, it can be challenging. We all have people in our practice who drive hours and hours to get to us. That’s a hard decision to make, but sometimes there are people who want to do that to improve the sperm exposure when there just aren’t enough. Now, if it’s somebody who has good sperm numbers on an IUI, then I just do one.
Abby Eblen MD (32:20)
All right, any other things you guys wanna add in?
Carrie Bedient MD (32:23)
Most IUIs or most inseminations have been IUIs up until this point or intrauterine insemination where you place the catheter just in the middle of the uterus, put the sperm in and let it swim to where it needs to be. There’s a relatively new innovation out there for ITI, intratubal insemination, which is putting it right at the opening of the tube. And so that’s with a device called Femaseed. And it’s a little bit bigger, it’s a little bit more expensive, but it’s something you typically only do once or twice because if it’s going to work, it tends to work relatively quickly. What you do is you essentially block the sperm into that little corner so that the only place it can go run to is down the tube and towards the egg. That’s a relatively new big sister to IUIs.
It is not meant to replace IVF. The success rates are nowhere near IVF, but they are typically better than IUI. And for some patients, that’s a reasonable place to go. Okay.
Abby Eblen MD (33:19)
And check with your fertility clinic because not everybody has that device to use. If you want to do that, you may want to check with your fertility clinic first. All right. Well, to our audience, thanks for listening and tune in next week for more. Also be sure to subscribe and leave a review. We’d love to hear from you.
Carrie Bedient MD (33:35)
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Susan Hudson MD (33:49)
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. Bye!
Carrie Bedient MD (33:58)
Hi.
Abby Eblen MD (33:59)
Bye.