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. Today, the Docs answer a wide range of general IVF questions that commonly come up during treatment. The discussion includes scenarios where fertilization rates are good but embryo development is poor, resulting in few or no usable embryos. The doctors explore possible contributing factors in both the egg and the sperm, test options that may provide more insight, and consider treatment strategies for future cycles. They also address procedural challenges during egg retrievals, medication considerations, and lifestyle factors that may impact outcomes. Other topics include treatment your doctor may consider if embryos do not develop well after fertilization. The hosts explain when DNA fragmentation testing for the male partner may be helpful and how advanced genetic testing, such as PGT-A+, can help determine whether the issue is related to egg or sperm quality. They discuss when growth hormone may be considered during stimulation and what evidence supports its use. The episode also covers what happens if an ovary cannot be safely accessed during an egg retrieval, why safety always comes first, and whether bowel prep or weight loss may improve access in future cycles. Additional questions addressed include whether this problem can recur, how GLP-1 medications should be managed around retrievals, whether breastfeeding impacts frozen embryo transfer success, and why sedation practices during egg retrieval vary between clinics and countries.

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.

Carrie Bedient MD (00:22)

And welcome to another episode of Fertility Docs Uncensored. I am one of your co-hosts, Dr. Carrie Bedient from the Fertility Center of Las Vegas. And I am joined by my two fantastically fantasmagorical co-hosts, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center.

Abby Eblen MD (00:37)

Hi guys.

Carrie Bedient MD (00:42)

How are you guys doing?

Susan Hudson MD (00:44)

Great

Abby Eblen MD (00:44)

Doing fabulous.

Carrie Bedient MD (00:45)

Any trips, escapes, or other adventures planned in the near future? ⁓

Susan Hudson MD (00:50)

So we are getting to go to Norway for break.

Carrie Bedient MD (00:54)

What does one do in Norway for spring break?

Abby Eblen MD (00:54)

Are you gonna go see the fjords? It’ll be cold.

Susan Hudson MD (00:58)

Well, kind of a long story, but interestingly enough, when you actually look at snow sports in Europe, the cost of those snow sports is less than what it is at a lot of places in the US. If you can get reasonable flights, it kind of sometimes ends up being just a wash. We also have very, very, very dear friends who are from Denmark.

Their son is working at a ski resort in Norway. We’re going to go to that particular resort, hang out with our friends for a while, spend a couple of days in Oslo and come back. It’ll be a little fast and furious, but it’ll be fun too.

Abby Eblen MD (01:38)

So Susan, just in case you get bored with skiing, I’ve been to Oslo as well, and I remember just outside the city is where they hosted the Olympics several years ago, and they have one of those ski jumps that you see where you go down and you go for a mile, it seems like, down and then you flip up in the air and you’re airborne and you come down. So just in case you wanna do something that will really give you a thrill, you can do that.

Susan Hudson MD (02:01)

So I would like to comment that I will not actually be skiing or snowboarding myself. I go for all the other things. I’m actually really looking forward to doing a sleigh ride. And I would really like, I did a sleigh ride when I was in Minnesota for fellowship. It was so much fun. And I went to do dog sledding that I have never done. that’s one thing that I’m really looking forward to doing is going on a dog sled.

Abby Eblen MD (02:33)

So I sort of did dog sledding in Alaska when I went on my cruise this summer, but the dogs pulled us in an ATV. It was their summer training. They had all these paths. It was to keep their muscles up and everything, but it literally, there were about six of us in this ATV and I guess it was a neutral and they had this path that they went on. It was actually the woman who came in fourth in the Iditarod. It was her dog camp, summer doggy camp. It was really fun. The dogs were really cute too, but it was fun.

Carrie Bedient MD (02:59)

So I have a question from the resident desert rat. How are you going to stay warm? What are you taking with you? How many layers? What are you wearing? And where do I get some?

Susan Hudson MD (03:02)

The temperature isn’t that cold. Lows are in the upper 20s. Highs are going to be in the 30s. It is cold, but it’s not negatives, okay?

Abby Eblen MD (03:14)

That’s pretty cold, Susan. Once the wind blows, then it’ll probably be negative or feel negative.

Carrie Bedient MD (03:23)

My question still stands.

Susan Hudson MD (03:25)

So my general garb when I go to somewhere like this is I always have thermal underwear type things under my jeans because jeans do nothing or under whatever pants I’m wearing. I love my Birkenstock boots. They keep my feet so warm and cozy and I can say I’m almost every winterish spring break vacation I’ve gone on.

I don’t even have to wear socks in them because they’re so warm because they have wool on the inside. They’re they’re super great. And then, you got your hats and your coats and and that type of thing. I am packing a suit to wear in case I do get to go dog sledding, because I’m sure I would get cold doing that. But the other things that I’m going to do, I think just wearing good sensible winter wear. Not not the true February in Minnesota wear that I acquired, which I would not recommend to anybody having to go that far. I think going to winter places in February is probably the worst time of year for almost everywhere. That’s the time to go somewhere warm. March, it’s warming up.

Carrie Bedient MD (04:33)

Sure, sure, we all believe that. We all believe that. Now for things that we can actually believe, we are gonna do a question episode today and topic of today is the general IVF questions. So we get a lot of questions about things like failed cycles and the retrieval itself and very specific things, but we also get a lot of general just what else is gonna happen? Susan, what do you have?

Susan Hudson MD (04:58)

Okay, here’s our first one. Hi, I’ve been trying to conceive since the beginning of 2024. I’ve had a high fertilization rate, but very, very low number of those may get to blastocyst phase. Three egg retrievals, three fresh transfers, one frozen transfer, one chemical pregnancy. I’ve had all the tests done as my partner, DNA fragmentation, uterine biopsy, laparoscopy, genetic, and no one can find any reason why this is happening.

I know I should think it’s a good sign that there’s nothing wrong, but also would like to have something to work towards solving. As it is, we are just continuing with no change in circumstance. What are the possible reasons for a low blastocyst rate? No PGT testing in Germany, so I’m only looking at blasts. Thank you for your advice and your work.

Abby Eblen MD (05:39)

Yeah, I was actually just gonna mention in this country we have PGT-A plus and it gives us a sense for is it a sperm issue or is it an egg issue? And it doesn’t really tell you what that issue is but at least gives you some insight into which gametes the issue in case you wanted ⁓ to do donor egg or donor embryo. In Germany, I don’t know if you would be able to do that either but that’s the first thing I thought. The other things I thought about is, we may not really be able to figure out what the issue is. It sounds like you’ve done all the things that they’re able to do there to look at those things. And so ultimately that’s when we start thinking about other things outside the box, like growth hormone, if that’s something that you’re able to get, sometimes that can add a little extra boost to things, help your embryos grow better.

As far as an egg number, and I think you said you have a good egg number, but sometimes for patients that don’t have a real great egg number, sometimes I’ll also add in something really old, and that’s Clomid, and that’s helped my patients get more eggs. But for quality issues, that is a really tricky one, and I would say growth hormone would be something at least I would think about adding.

Susan Hudson MD (06:46)

Absolutely consider something like growth hormone. Also, we’ve talked about a number of supplements in our book The IVF Blueprint. We have a whole chapter on supplements things like coq10 Some newer supplements that we’ve had guests on that we’ve talked about NAD The primadine supplement primadine is good for both men and women antioxidants for the men.

Remember eggs and sperm. I don’t know how many times I’ve had patients come in. We’ve done an IVF cycle. We ended up with low blast rate or something along those lines. And I always give a list of supplements people need to be on. And they’ll be like, ⁓ no, I haven’t started those. If your physician has recommended certain supplements, start taking those because realistically for men or women, it takes about two to three months for any supplement to have its maximum efficacy. So starting that now so that when you’re getting to the point that it’s really crunch time, it can be having a positive impact.

Carrie Bedient MD (07:59)

Absolutely, I agree.

Susan Hudson MD (08:01)

I am doing IVF and I just had my first egg retrieval. I have diminished ovarian reserve and I’m 38. We had easily measured nine mature follicles going into the day of my trigger, but during the retrieval my doctor had a hard time imaging my right ovary and was only able to retrieve from my left. I ended up with only three eggs, one fertilized. I learned about the bad news when I woke up and I’m still in shock.

The doctor said that they tried everything and considered trying to go via the abdomen, but also couldn’t image my ovary that way either. She said at the time that could have just been an issue of anatomy, but that it could help to lose weight. How often does this happen and happen a second time? What can I do to prevent this in the future? This is a great question.

Carrie Bedient MD (08:46)

When we have an ovary that we can’t access, usually it’s because we can’t see it or we can’t safely get to it or both. And sometimes you get advance warning of this. So for example, if a person has a history of let’s say a myomectomy, which is known for causing a lot of scar tissue, or they’ve had other pelvic surgeries, or even if we’re just doing their monitoring and we have a really hard time accessing one ovary and we have to use abdominal ultrasounds to get there. Sometimes we’ll get advanced notice. Sometimes you don’t get advanced notice. Sometimes you’ve got an ovary that looks like it’s going to be accessible, but maybe it’s stuck on the opposite side of the uterus. And no matter how you push and pull, you just can’t get it down to a location where you can easily access it. And it doesn’t happen very often, but when it does, it’s devastating for patients because especially when we think we’re going to get eight or nine and you walk away with three it’s a very different feel.

A lot of it really depends on what the story is and what the monitoring is along the way. Sometimes it’s as simple as doing a bowel prep regimen so that your bowels are fully empty. And sometimes it means filling your bladder or not filling your bladder. And there’s not a single hard and fast rule of what you do. It’s sitting down talking with your doc. And if your doc is saying to lose weight, it’s probably because they think that that might actually be helpful. The needles we have are only so long. They’re very long, they’re not very wide, so they don’t register as any more than just a random blood draw, for example. But they’re pretty long, but you can’t get them longer than they come. If someone has a lot of extra tissue that we have to get through, that can really make a difference.

And it’s worth paying attention to if a doc says, hey, you we think you might need to lose weight. We don’t say that because we’re trying to be mean or spiteful or pass blame or anything like that. It’s because there’s a limit to the instruments we have. And we got to figure out how to work within those limits.

Abby Eblen MD (10:40)

Yeah, and would say safety is number one on our list. I know it’s important to get a good number of eggs and trust me, your doctor probably felt about as bad as you did because we never want to go in there thinking we’re going to get eight or 10 eggs and we only get two or three. That’s upsetting for all of us. Like Carrie has said before, we don’t want you to be disappointed, but we don’t want you to be disappointed and surprised. And that’s kind of what happens sometimes in that situation.

If we think that we’re going to have to enter a bowel, bladder, or blood vessel to get to your ovary, we’re not going to do it. So safety first. We don’t want to have you end up in the operating room in the hospital because we hit a blood vessel and didn’t see it and you bled a lot. That’s really the most important thing. The secondary thing is we want to get a good number of eggs. And I would say that, depending on your age and how well the eggs fertilize, sometimes you can still end up with a small number of eggs and still have a normal embryo or two, and it only takes one to get you pregnant. So again, we’re all on the same team. We all want the same things. We all want you to have a good number of eggs, but we also don’t want you to end up in the ICU and have to have a surgery because a blood vessel was injured in the process.

Susan Hudson MD (11:48)

And when we’re doing these egg retrievals, mean, everybody thinks of them as relatively minor procedures, but the fact is you have bowel, you have very large important blood vessels that are very close to the area of your ovary. Your safety is absolutely the most important thing. Even though we know you’re devastated, the devastation is unfortunately, sometimes a necessary evil compared to being sick or even potentially dying. We hate to think of that, but there’s a reason that’s on the consent forms you sign because it can be dangerous and we really have to have good visualization.

Carrie Bedient MD (12:29)

Another thing to consider you didn’t mention but occurred to me is that sometimes fibroids can make the difference here. And if you’ve got a really fibroid uterus that an ovary is hiding behind, having those fibroids removed can be helpful. And if that’s something that’s playing in, that’s worth a chat with your doc about whether or not a myomectomy would make sense before going to an egg retrieval again.

Abby Eblen MD (12:39)

And one last thing on the same topic, she mentioned what are the chances that this would happen again? Unfortunately, the chances are probably fairly good. Like Carrie said, there’s a lot of different things that we have to consider, but if it happened once, it could certainly happen again. So unfortunately, that’s kind of a recurring potential issue.

Susan Hudson MD (13:07)

Yeah. Okay. Our next one. Hello everyone. I found your podcast last year and it has been wonderful and very reassuring listening to your episodes. Thank you for listening. I am a single 40 year old starting infertility to be a single mother by choice. I went through my first retrieval about a month ago. We used gonal F 450 units and Louveris 75 units to stimulate.

I have two questions. When I arrived for retrieval, I found out that they do not actually sedate you. They give you fentanyl and Ativan and hope you fall asleep and don’t remember. Is this normal? When completing the retrieval, I had blood vessels, quote, get in the way of the right ovary and they were not able to retrieve any of the eggs. Are there ways to avoid this in the future? She got three mature eggs, one embryo.

Carrie Bedient MD (13:53)

That’s a pretty good embryo rate for just three eggs, especially at age 40. Like that is nothing to sneeze at. That’s a nice number. So I would say most clinics that certainly all the ones that I have been to, we do heavier sedation than that. There are cases in which we will offer less sedation or no sedation. Those are usually, at least in my case, those are cases where we’re only going to get one or two follicles and there’s a very significant calculation that we’re taking into effect whether it’s financial, whether it’s a clinical reason or a medical reason why we don’t want to sedate someone, whatever it may be. But usually if they’re, at least for me, if we’re going to get any more than about three follicles, I want you to be asleep much more than that. What do you guys do?

Abby Eblen MD (14:42)

So I think probably she’s from Europe based on the medicine that she was talking about. I will say when I first started out a long time ago, Propofol wasn’t available. So people were lot more lightly sedated. They could talk during the procedure, but most patients didn’t have a lot of discomfort. We gave them pain medicine as well. And like she said, they don’t, they didn’t remember it at the end because they got Ativan

I just wonder if it’s the availability of Propofol at her clinic, the cost of it. I don’t know who pays for that, but I wonder if it has something to do with that as well.

Susan Hudson MD (15:13)

Yeah, I can say in our area, most places are going to use Propofol. However, there are some local places who do similar sedations to this because they’re doing a less expensive retrieval. Unfortunately, it does cost more money to have more medicines. If you’re in a regulated, national health system, that’s probably what’s calling the shots for something like this.

Susan Hudson MD (15:38)

I practice in Texas and we have a lot of patients who get IVF in Mexico and a lot of them don’t have any sedation. Not that I would recommend that for anybody. I like it when my patients are nicely sedated, but I think there’s variability within the world and depending on how much you’re paying, unfortunately. And I think that may have been a factor in here.

Carrie Bedient MD (16:04)

One thing to consider about is if there’s anything else that they can do to get access to that other ovary with vessels in the way. This is a case where sedating you more may be beneficial because if they can fully knock you out, it gives us the opportunity to push a lot harder on your abdomen. And sometimes we can shift an ovary into a more favorable location. That’s a lot harder to do.

It does not feel good to have the weight of an adult human pushing on your abdomen with ovaries that are fully stimulated. There is a reason we want you sedated for that because we need to make sure that you’re breathing through it and we need to make sure that pain’s not an issue and that we can manipulate the way that we have to to get access to it without a patient making a sudden jump.

That’s going to take a safe needle stick into a non-safe needle stick range with all those big blood vessels in particular that are nearby.

Susan Hudson MD (16:56)

Absolutely.

Susan Hudson MD (16:57)

There’s something about spring that feels like possibility. The days are brighter, everything feels a little lighter, and for many of you, this may be the season you’re thinking about the next steps in your fertility journey. If IVF has been on your mind, we want you to feel hopeful, but also informed. At Fertility Docs Uncensored, we spent years answering your questions and helping patients navigate IVF with clarity and confidence. And we took everything we’ve learned, plus the thoughtful questions you’ve sent us, and created one comprehensive, easy to understand guide, the IVF Blueprint walks you step by step through the IVF process in the same straightforward down to earth style you know from us. We explain what to expect, how decisions are made, and what really matters so you can move forward feeling steady and supported. Whether you’re just starting to explore treatment this spring or already in the middle of it, the IVF Blueprint is designed to help you feel empowered every step of the way.

You can find it in print, ebook, and audiobook with a special conversation from the three of us at the end, wherever books are sold, and at FertilityDocsUncensored.com. If this season feels like a fresh start, let it be the one where you move forward with clarity, confidence, and real hope.

Susan Hudson MD (18:15)

Okay, our next one. Hi, I’m 39 AMH 1.95 AFC 24 no PCOS. All other labs normal. I’ve had two miscarriages in 2022 and 25. First IUI in 2023 on Clomid was successful one mature follicle. Second IUI in 2025 was unsuccessful same protocol had four mature follicles and we’re moving to IVF.

Plan is to do a fully medicated egg retrieval and then a natural transfer. I’ve always had a thin lining during my Clomid IUIs. Any idea why my RE is recommending any natural transfer should I push back. Thank you and love you ladies. Love you too.

Carrie Bedient MD (18:56)

Yay!

Abby Eblen MD (18:57)

So when you say natural transfer, there’s different ways that you can think about that. It may be fully natural, meaning you don’t have any medications. It can also be a modified natural where we use medicines. Typically in our practice, we use femara to help you ovulate. The timing of progesterone is really important and it probably doesn’t matter a whole bunch about whether you use estrogen patches, estrogen shots, or natural cycle as long as your lining gets thick.

⁓ And I wonder if maybe your REI is thinking, maybe you’ll do better with your own hormones than you would with estrogen patches, pills, or shots. That may be why they’re trying it. Typically, it’s one of those things when you try these cycles, you really don’t know how somebody’s gonna respond to them. I typically tend to do more patch protocols, although I’ve started doing more modified natural cycles as well. Sometimes one works better for a patient than the other.

You really don’t know until you get into the cycle how it’s gonna turn out. But what I would say is less money and less time would be invested into a modified natural cycle or a natural cycle. If you don’t have a good lining at that point, it’s really pretty easy to switch gears the next month and go into a program cycle if you needed to do that. So don’t think that’s a bad idea at all.

Susan Hudson MD (20:06)

Carrie, you’re our embryo transfer queen.

Carrie Bedient MD (20:08)

I don’t think that any one protocol is superior to another so long as you’re getting the outcome that you need. And a lot of this depends on what is your doc most comfortable with because we all have our preferences. Most of us can do any one of the variations out there, but we know what happens to work best in our hands. If your doc is suggesting that it’s a reasonable place to start, because at worst it doesn’t work, your lining doesn’t thicken up.

You stop, you cancel, and next month you do something different. And while that’s not something that anybody wants to hear, you can do the exact same protocol two months in a row and get completely different results. And sometimes you’ll have a thin lining that goes thick, the opposite fluid that is there or isn’t there, there’s a dozen different ways that this can go sideways or completely upside down. It’s just a willingness to say, all right, what do we have?

Let’s try it again, see what we get and keep going. As I think all three of us have said multiple times, one of the biggest markers of success in fertility treatment is persistence. Can you put your head down and keep going? Because if you put your head down and keep going, your doctor sure can. We made it through the better part of 15 years of training just to be able to have the privilege to help you. We know what stubbornness is. We know how to keep going, but we need you to be a part of that.

If you can keep your head down and keep going, your doc will stick with you.

Susan Hudson MD (21:25)

Another thing is that thin linings specifically on Clomid are very, common. With a natural cycle or a modified natural cycle with Femara or Letrozole, we tend to have better linings. Again, there’s not a right or wrong way, but I wouldn’t be totally panicked about my lining just because of how it looked on Clomid because most modified natural cycles, people are not going to use Clomid. They’re going to use Letrozole instead, which does not have that same negative effect on the endometrium or the lining of the uterus.

Okay, our next one. Hi ladies. Thank you for always filling my ears with knowledge. Thank you for listening. I’m from the UK age 37, DH 38. I feel the UK doesn’t push you as far as you could go on stims. I’ve had three cycles, two of which were 300 of gonal, 150 of leuvaris, dual trigger, and one round on pergovaris, dual trigger, all with cetrotide.

AFC is always around 12 or 14. The last two rounds have only seen 40 to 50 % maturity. Follicle sizes vary from cycle to cycle. Last cycle looked like below on day eight of stims went to day nine, then trigger day 10. So lining was 13. On the right, she had a, I’m gonna read these in numerical order, 8,9,9,10, 11, 13, 16, 18, 21. On the left, she had a six, a 13, and a 20. Only four were mature. Why do you think this is? I take all the supplements, BMI is 25. Are we just too old? We have a child already, naturally age six, just feel hopeless.

Carrie Bedient MD (23:09)

Oh, I don’t think there’s need to feel hopeless on this one. Yeah, push them longer. Now I wonder, especially because this is happening in the UK and it’s oftentimes covered if they’re doing fresh transfers. Because if they’re doing fresh transfers, your lining’s already 13, you’ve already got a couple big ones, your progesterone may be going up, and so they may be forced into a corner where they have to trigger because in order to get the embryo, transfer in line, they’re stuck triggering at that point. But I think most of us who do lot of frozen embryo transfers, we just push those babies further. To me, that sounds like you could go out to day 12-13 easy of meds and then trigger if there’s a maturity issue. I like dual triggers with both the hCG component and a Lupron component. But what do you girls think?

Susan Hudson MD (23:59)

I think the good thing is that she got four mature eggs and I would have expected from that stimulation at that point in time to get four mature eggs. So I’m happy with what your ovaries are doing. I think you just need a few more days of stim to get more mature eggs and more chances. But I bet it’s potentially they’re weighing, if you’re doing a fresh embryo transfer that may be swinging their decision making.

Abby Eblen MD (24:08)

Yeah, me too.

Susan Hudson MD (24:27)

And because once your progesterone level starts to creep up, which we do see with these longer stims, then you aren’t necessarily a good candidate for a fresh embryo transfer anymore.

Abby Eblen MD (24:38)

Yeah, I I think that could very well be the case because back 20 years ago or less, even less than that, and we didn’t do frozen transfers as commonly as we do now. Two follicles greater than 18 were what we used to trigger. That was our trigger protocol. And that seems like what they’re doing as well. But one thing, and I agree with Susan, I would expect about four eggs from this and that’s what you got. I would say there’s about a three millimeter difference between those and the rest of them. So you do have some smaller ones.

The other thought may have been, well, she’s got small ones and she’s got these bigger ones. She’s 37, and I don’t remember what your AMH was, but they may have worried that if they pushed you too much, you might lose the bigger eggs and maybe wouldn’t get as many eggs. But I would agree if you were my patient, I would have at least pushed you another day and probably two days with this pattern of eggs, with the size of your eggs.

Carrie Bedient MD (25:26)

I mean, you can push eggs to 26, 28 millimeters or even beyond and still get good eggs from it. And so she’s got plenty of room to let those 10s, 11s, 12s get quite a bit bigger and at least get them in the 16 range to have a higher shot at maturity and getting an embryo from them. But you need to have a place that’s willing to do a frozen embryo transfer and be good at doing the freezing. Not everybody is really exceptional at freezing and that makes a difference.

Susan Hudson MD (25:52)

All right, our next one. I’m a 24 year old female going through my first IVF cycle. Diagnosed a PCOS with an AMH of 7.4. My partner also has male factor infertility. I had my egg retrieval in October, 24 retrieved, 18 mature, 12 fertilized, six blast, five PGT-A normal. I’m prepping for my first transfer. My doctor has prescribed an hCG trigger to take the evening post-transfer. I’ve never heard of this and would love your thoughts. Thanks so much.

Carrie Bedient MD (26:20)

They’re trying to make sure that the corpus luteum is functional, but they’re not wanting to interfere with the timing at all. This is the first time that I’ve heard about one being done post-transfer. ⁓ Usually we do it either at the time that we start progesterone or our clinic will oftentimes do it a couple days later, but still before transfer. The end result is the same. As long as you have a follicle that’s growing big, you can have a corpus luteum that’s functional with the hCG. The hCG will not at least based on the data we have so far, it’s not going to cause any damage. It may make interpreting pregnancy tests a little bit more challenging for those first couple of days because it’s going to take a while to come down, especially depending on what dose they gave you. This is where serial hCGs really make a difference because that first one, until it’s going up, you…you don’t necessarily know is this a result of a true pregnancy or just the holdover of the hCG levels. I don’t think they’re doing anything wrong, but it is a more unusual protocol that at least I haven’t heard about as much.

Susan Hudson MD (27:19)

Didn’t we have a guest on like a long time ago? Okay. And he talked about doing that. So, yeah.

Abby Eblen MD (27:23)

Bruce Lessey, Bruce Lessey, recurrent pregnancy loss, yeah. I’ve started doing that actually.

Yeah, so he called it a rescue of the corpus luteum. So kind of what Carrie’s saying, won’t hurt anything. I mean, if anything, it’ll help your own body continue to produce your own progesterone a little bit longer. But typically there’s about a two week window there. Once you get the hCG shot, if you check an hCG before that, then you start thinking, my gosh, I’m pregnant. And it’s really just the holdover from the hCG shot. But it doesn’t hurt anything though. mean, that’s kind of interesting. I’ve never heard, like Carrie said, I’ve never heard of anybody doing that as part of…an FET cycle or natural cycle, but I mean, it’s certainly reasonable.

Carrie Bedient MD (28:03)

That episode that we were just referencing is number 171. And so if you want to go back and listen to it, that’s the one where we’re talking with Dr. Lessey. I think some of the mention about doing the hCG was actually in conversations around it. So I don’t remember off the top of my head if that was included, but I know that was when we were recording with him.

Abby Eblen MD (28:21)

Yeah, he did talk about that at the very end, one of the things he’s doing with, primarily he was talking about recurrent pregnancy loss patients and doing it with them and how that would rescue the corpus luteum. It’s like, if you plant a seed and you forget to water it, wilts and the hCG is like watering the flower. It helps the flower continue to grow, helps the corpus luteum continue to grow and continue to produce additional hCG, or at least that’s the thought anyway.

Carrie Bedient MD (28:43)

Yeah, interesting. Let us know how it works. We’re curious. There’s always anytime that someone comes up with a new protocol, we’re all intrigued and we’re like, okay, well, how did it work? Because we can come up with the, the mental math to justify anything. It’s just, do you have the data behind it?

Abby Eblen MD (28:46)

Yeah, interesting.

Susan Hudson MD (29:00)

Absolutely. All right. Our next one. Love the podcast. Thank you for listening. My husband 29 and me 31 have had a hard time with IVF. We each have an infertility diagnosis. I have lean PCOS and he has a very low sperm count and poor morphology. We have done two rounds of IVF retrieving a total of 27 eggs, but we only got two blastocysts total.

Most eggs were mature and fertilized. Thankfully one blast resulted in a healthy baby. We want one more baby, but we’re afraid of doing IVF again because of our low blast rate. Our doctor and embryology to have no clue why we have such trouble getting embryos. We eat well, don’t smoke or drink and exercise. My husband took Clomid to boost his count before our second round. Is there anything we could be missing? Give us all your suggestions. Thanks.

Sperm biopsy?

Carrie Bedient MD (29:48)

DNA fragmentation, potentially if they’re doing ICSI versus not, seeing if a SpermQT is helpful. If a SpermQT is abnormal, then you wouldn’t necessarily expect the same kind of insemination rate or fert rate. And that translates to a lower blast rate. So those are both thoughts to do. Playing around with the supplements, the CoQ10, the Primadine, the male fertility supplements, all of those things are potentials.

Managing your stress to the extent that you can.

Abby Eblen MD (30:15)

Of these eggs were immature or two because she’s a PCOS patient and it’s not unusual for PCOS patients to have a lot of immature eggs. Physicians sometimes are really worried about stimulating PCOS patients too far because you get a ton of eggs and a ton of eggs, sometimes the quality is not that great, but more importantly, we worry about really high estrogen levels and hyper stimulation. If you had 27 eggs and 15 of them are 20 and more immature, that would give us our answer why you only had two blastocysts. I think that would be helpful information to know. If that’s the case, you may want to consider, or your doctor may want to consider adding in HMG or human menopausal gonadotropin, which has both FSH and luteinizing hormone, and that can help sometimes with the maturity of the eggs.

Carrie Bedient MD (30:58)

All right, let’s do one more.

Susan Hudson MD (30:58)

Okay.

All right. Hello. I found your show to be helpful and appreciate the perspectives you all share. What research can you share about breastfeeding and FETs? Do you advise breastfeeding moms to wean before a transfer? I was blessed to welcome my baby, almost a toddler, with the help of IVF after two spontaneous ectopic pregnancies. I’m considering another transfer after 18 months postpartum, but I’m not ready to wean yet.

I’m 34 with unexplained infertility, but possible tubal issues due to the history of ectopic pregnancies. My HSG was normal.

Carrie Bedient MD (31:32)

What do you think?

Susan Hudson MD (31:33)

Well, this is not unexplained infertility is the first thing. So you have tubal factor, even though you have a normal HSG, the HSG only looks at structure and it does not look at the micro architecture and it does not look at function. Just the fact that you’ve had two ectopic pregnancies, I want you to know that that is actually a diagnosis.

Abby Eblen MD (31:37)

Yeah, absolutely.

Susan Hudson MD (31:57)

As to the FET, some of it depends on the protocol that you’re going to do. You’ve been breastfeeding for a year and a half, so your prolactin level is probably not elevated, but I would definitely want to make sure that your prolactin level is not elevated at the time of embryo transfer. But realize that if you’re doing any type of supplementation for your FET, whether estrogen or progesterone, those hormones are going to be secreted in your breast milk. And that’s not something that we want a toddler exposed to. That’s like essentially giving your toddler oral hormones, which are gonna increase their hormone levels. I generally want somebody, because I do almost all program cycles, I want people to have weaned by the time we’re starting FET and I wanna have a normal prolactin level.

Carrie Bedient MD (32:48)

Even if you’re doing a natural cycle where you’re not giving additional hormones as a result of this, that’s another argument for wanting someone to wean because when your prolactin levels go high, which they will even if temporarily while you’re breastfeeding because of the nipple stimulation involved, that’s going to drop your estrogen levels. Your estrogen levels are what’s responsible for thickening up the lining of the uterus and so it doesn’t really work in your favor to continue doing it. Yes, people do get pregnant while still breastfeeding but

In this case, you have the luxury of time. If you’ve got a frozen embryo, then that embryo doesn’t know the difference between now and six months from now when maybe you are ready to wean. So enjoy your little one and enjoy the fact that you’re breastfeeding, it sounds like very successfully, and take that gift and enjoy it while you have it. And then when you’re ready for that part to be done, then work on the embryo transfer for your next one.

Abby Eblen MD (33:40)

Yeah, I’d just say it’s like layers of the onion. We don’t know what one little thing we may do that may make a difference, but we know probably breastfeeding is not optimal when you’re trying to get pregnant. You’ve worked really hard for this embryo. And like Carrie said, there’s no timetable based on the embryo. You may want to space your children a certain space apart, but I would just enjoy breastfeeding when you’re done, then go and have your transfer done.

Susan Hudson MD (34:03)

And I know you mentioned you’re 34 and people get really hung up on this. I’m 34, I’m almost 35, I’m gonna be advanced maternal age. Like nothing magical happens when we sing happy birthday to you. Your embryo is frozen in time from whenever you created it. So it’s actually younger than you are. So that’s great. Yes, your risks in pregnancy like high blood pressure issues, preeclampsia, diabetes in pregnancy, risk of C-section, preterm delivery.

All of those things gradually increase as we get into our upper 30s and early 40s, but nothing huge is going to make a big difference in six months of being able to let you wean when you’re ready to, and then be able to go towards the next door of your next pregnancy.

Carrie Bedient MD (34:47)

Even a year a little bit more than that. You’re in pretty safe ground here. So enjoy the gifts that you have and give yourself permission to take a breath and enjoy your family. All right. Anything more to add on any of these questions, any of these topics? I love the diversity of what we’re going through today. There are things that we don’t often think about, but patients do. So I’m glad we got to go through them.

Susan Hudson MD (35:13)

Shout out to our listeners across the world as well.

Carrie Bedient MD (35:16)

Yes, yes. Go check out episode 300 with Dr. Nadine Al Kaisi because she talks a lot about the international IVF components. She’s a doc from Germany, and so she’s very sweet and very interesting. So that episode was meant for you guys too. To our audience, thank you so much for listening. Please subscribe to Apple Podcasts to have next Tuesday’s episode pop up automatically for you. Be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Abby Eblen MD (35:44)

You can also visit us on fertilitydocsuncensored.com to ask a question for our Ask the Doc segment. Also check out our new book, the IVF Blueprint, to help you better understand IVF in detail. You can find it on Amazon, Barnes & Noble, and bookshop.org. We’d love for you to subscribe and leave review on Apple Podcast. We would really love to hear from you.

Susan Hudson MD (36:03)

Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes. And as always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we’ll talk to you soon. Bye.

Carrie Bedient MD (36:17)

Bye!