What if understanding your hormones could change the way you approach fertility—and your overall health? In this episode, Dr. Carrie Bedient at Fertility Center of Las Vegas and Dr. Susan Hudson of Texas Fertility Center speak with Dr. Amy Divaraniya about Oova to track cycle hormones. Dr. Amy opens up about her personal fertility journey and introduces OoVA, a hormone-testing platform designed to help women better understand what’s happening throughout their menstrual cycle. She explains how OoVA uses urine-based hormone testing to track patterns, identify ovulation and luteal-phase changes, and provide personalized fertility insights. From irregular cycles and preconception planning to lifestyle changes and better conversations with healthcare providers, Amy explores how hormone data can give women a clearer picture of their reproductive health. Tune in for an insightful conversation about fertility, hormone tracking, and the growing role of technology in helping women take a more informed approach to their health.
Episode Transcript:
Susan Hudson (00:01)
You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.
Susan Hudson MD (00:22)
This episode is brought to you by Receptiva DX. What if unexplained infertility isn’t actually unexplained? For many women, hidden inflammation associated with endometriosis and other uterine conditions can go undetected for years, even when everything else appears normal. For more than a decade, fertility specialists have trusted Receptiva DX to provide deeper insight into the uterine environment.
Helping women and their physicians uncover answers and make more informed treatment decisions.
Carrie Bedient MD (00:52)
Hello everyone and welcome to another episode of Fertility Docs Uncensored. I am one of your hosts, Dr. Carrie Bediant from the Fertility Center of Las Vegas, joined by my fantastically gorgeous, invincible co-host, Dr. Susan Hudson from Texas Fertility Center.
Susan Hudson MD (01:07)
Hello everyone. How are y’all doing today?
Carrie Bedient MD (01:09)
And we are joined by Dr. Amy Divaraniya And she is the founder and CEO of Oova. We will get into a little bit more depth about what exactly Oova is and
how it can play a role in people’s fertility journeys. But Amy, when you and I were talking as we were deciding to set up this episode, you were at your parents’ house and you had a fabulous backdrop behind you.
Amy Divaraniya (01:34)
It was honestly that call and that trip that I realized how old my parents’ house is. I can’t
Carrie Bedient MD (01:39)
Yeah.
Amy Divaraniya (01:39)
even tell you how much pride I had that my mom made all these curtains, but she also made those curtains thirty five years ago.
Carrie Bedient MD (01:45)
Mm-hmm. I mean, it was a lovely floral pattern and it looked very nice. The only reason I can laugh at this is mostly because, and I can say this because my mom doesn’t listen to this podcast, but my mom’s house is the exact same way of you walk into it and it’s a time capsule into the nineties, which is not necessarily a bad thing, but also can we update it just a little bit?
Amy Divaraniya (02:11)
In her defense she did change the carpet to hardwood, but
Susan Hudson MD (02:15)
Good. It’s a step.
Amy Divaraniya (02:17)
Yes, I we can make fun of it so much, but there’s this level of comfort that you just cannot replicate without coming into your own childhood home. And if it didn’t have that feel and that old like, my this is my home, it wouldn’t feel like home.
I’ll give her a hard time, but I also don’t want her to change it secretly.
Carrie Bedient MD (02:32)
I bet she would be delighted to hear that.
Amy Divaraniya (02:34)
I hope so. I will make sure if you listens to this podcast.
Carrie Bedient MD (02:36)
I was gonna say we should definitely send her a tiny little snippet of this so that she knows how much her hard work is appreciated and how lovely it is to go home as an adult and be taken care of.
Amy Divaraniya (02:48)
Yeah, I will say going there for a couple of days totally, but staying there for a week, I’m like, I don’t know how I grew up in this house with these people. It’s time for me to go back to my home. But still it’s it definitely is reminiscent.
Carrie Bedient MD (02:59)
Yeah, it’s remarkable how quickly you can fall into past patterns when you go back to your childhood home. Susan, you live what, three doors down from your mom?
Susan Hudson MD (03:09)
Two doors down from my mom, but it’s not where I grew up. So it is in the same city where I grew up, but my childhood home my mom doesn’t live in anymore. After my dad passed away, it was too hard for her to stay there. But I do have to say that I do drive by that house periodically, and we had these two red park benches on our front patio, and they’re still there.
And the house has been sold multiple times, but these benches have just stayed with the house and it makes me have that warm and fuzzy feeling that I’m like, it’s so awesome to see a little piece of my childhood still there.
Amy Divaraniya (03:46)
They’re your benches.
Susan Hudson MD (03:47)
They are they are
Carrie Bedient MD (03:49)
That’s fantastic. All right, all benches aside, do we have a question to play with today?
Susan Hudson MD (03:54)
We do have a question. So our question for today is can a low intervention approach ever be better? I’ve done two stim cycles with very low blast rates. First, 150 of Follistim, 75 of Menopur, provera. She had eight M2s, 100% ICSI fertilization, one blast. The second had 225 of Follistim, 225 of Menopur, ganirelix, 7 mature eggs.
A hundred percent Ixy, zero blast. I’m thirty six, two point five AMH, everything normal. My husband had two percent morphology, hence the ICSI, otherwise normal, with low DNA fragmentation. We are healthy and active. We have conceived naturally three times one live birth in two thousand twenty three and a miscarriage ten months ago. We went straight to IVF, but now no one can explain our low blast rate. I have seen multiple doctors who advise trying again, but you know the definition of crazy. Should I try ovulation induction or IUI? Or am I kidding myself?
Carrie Bedient MD (04:54)
That’s a fantastic question. And I think the answer to this is one, my inclination would be get a little bit more information in the form of a SpermQT there. You already mentioned that DNA fragmentation sounded fine. And so I think a SpermQT is really helpful. That’s a test that looks at the functionality of the sperm. Is it able to break into the egg? And the way that I think about it is a semen analysis looks at can the sperm show up to the club and line up around the block? And a SpermQT looks at can they get past the bouncer? And they’re two very important functions. You need both. I think before you can really significantly get into the do you want to do a lower intervention IUI type approach, you may want to consider doing that one. Knowing that you’ve had two prior conceptions is helpful and promising, but it’s possible something’s changed health-wise that could impact that.
Beyond that, I would say my impression of those two cycles in terms of results is that they’re the same. And unfortunately, the way that that reads to patients is not at all the same because in one you got a blast, in the other you didn’t. But the difference between seven versus eight M2s, 100% fert, and zero to one blasts, those are the same results. And although there is a dramatically different feel and an even potential outcome from the perspective of the stim, that was pretty similar. Now I’d be really curious knowing that your AMH is 2.5, as good as it is, why we’re only getting eight eggs. I would anticipate far more than that. And I would actually for this one I’d think about pulling out growth hormone and and maybe some clomid and kinda tinkering a little bit. What would you do, Susan?
Susan Hudson MD (06:33)
Well, I would also be curious as to at what point are they triggering her? I’m concerned that it may be a situation that there are more follicles, but we’re not getting more mature eggs because they’re not pushing the follicles far enough. Now, back five, ten, fifteen years ago, we triggered at 18 millimeters.
We don’t do that anymore. Honestly, I can’t even remember the time I triggered with the maximum air. Like I know in the past I did that, but I’ve been doing it for so long that I’ve been pushing them that I don’t know when I did that last. And really watching those bigger follicles go get into that twenty-two, twenty-four, twenty-six range. And sometimes you even push them further than that, depending on where the main part of your cohort is. But I’m wondering if the cohort itself is not getting advanced enough.
But I do completely agree with you. I wasn’t sure what where you were going with the SpermQT, because I’m like, we did ICSI, but it’s if we’re going to do ovulation induction, making sure that the sperm have the capacity to get where they need to be without the ICSI. I do think that’s a great idea. But I do agree with the fact that I think we’ve had similar results. either adding growth hormone or letting those follicles get bigger, maybe and
It just feels like there just aren’t as many eggs as I would have expected for an AMH of two point five as well.
Carrie Bedient MD (07:49)
Mm-hmm. I wonder if there’s some form of endometriosis going on, and that’s why seeing a lower yield than maybe you would expect. And so maybe sticking more with the ganirelix and Orilissa and stronger meds like that may may help a little bit, a little bit of pretreatment. But there’s something else going on in here that we’re just missing that piece of information of why we’re only getting eight eggs from a 36 year old with an AMH of 2.5, because there’s some other piece of this puzzle that hasn’t come to light yet.
Susan Hudson MD (08:18)
Also accept that especially if you’re in a non-mandated state you’ve laid out the cash for two IVF cycles that’s steep you have one live birth this is we really want to have another child secondary infertility is just as devastating as primary infertility, so we don’t want to discount that.
But I have had patients who have been in this similar situation. They said, we’re just going to do IUI cycle after IUI, and we’re really gonna have the endurance to just keep on going month after month. And we’ve been successful. It is positive that you’ve had a successful pregnancy in the past. And it was only three years ago. That’s nice information.
I think that there is some flexibility, but I do think getting a SpermQT makes sure you’re not wasting your money on those IUIs. But if that’s normal and you wanted to go down a path that’s less invasive. Now, when we say less invasive, I do recommend ovulation induction with intrauterine insemination because the combination of those two is what actually drives up pregnancy rates in ovulatory women. If you’re ovulating on your own and you only do ovulation induction, that really doesn’t push the needle, you’re just spending money and getting frustrated. And you may get pregnant, but it’s probably not because of what was the actual intervention, but the combination, the synergy of those two actions are what drives up the pregnancy rates. I think that would be a potential reasonable thing to consider.
Carrie Bedient MD (09:45)
Absolutely.
Well, getting to our topic at hand and segueing there, so Amy, as you were creating Oova, or perhaps the the impetus to create Oova, was your own fertility journey, which sounds like it had its own share of ups and downs and all of the the fun emotions that everybody experiences. So how did you fall into this fertility world? What brought you here in the first place?
Amy Divaraniya (10:10)
Yeah, hearing that’s patient story, it’s like bringing back so many things. I feel for the woman that wrote that in. But I found myself navigating a similar journey. I had several health journeys that was found myself navigating throughout life. From my first period, I struggled with irregular cycles and then after college I was misdiagnosed with polycystic ovarian syndrome.
I was put on metformin, I was put on birth control to help regulate the cycle. Neither really worked for me. And I had every side effect in the book. I became incredibly anemic, was bleeding pretty profusely, became depressed, had a lot of struggles that were ultimately due to the medication, only to find out three years later that I actually didn’t have PCOS and just had irregular cycles and just I could choose to live with it or beyond birth control if I wanted to. So it was a very flippant dismissal that I got of that diagnosis and no explanation. So it put this mistrust in me when it came to my fertility with the medical community. I didn’t really want a doctor to tell me how I could or could not get pregnant. When I found my partner and we decided to start trying to have a baby, we decided we’re gonna try to pursue this naturally. And if it didn’t happen, then being a parent just wasn’t in the cards for us. And it was honestly a very easy decision to make day one, but one of the toughest pills for me to swallow. Nothing could have prepared us for the journey that we ended up embarking on that day. We did everything right. I timed intercourse as we should. It was very exciting in the beginning. Both of us were on board. It got old real fast. And a pregnancy test that was negative month after month just became even more of a loss. And I found myself grieving something I never had. And it became worse and worse every subsequent cycle. But the worst part was that the tests themselves were kind of broken for me because I didn’t have a regular cycle. So I was barely getting highs or peaks. That smiley face never blinked for me in my journey. And it felt a little odd that I wasn’t ovulating for so many months because whatever irregular I was, I was still bleeding. And only to find out that all these tools were designed for women that had regular cycles. And if you had an irregular one, the technology was kind of not meant for you.
So I really was starting at a loss. It was this one day when I really thought I was pregnant. Mind you, at this point, I have now isolated myself from everybody. I’m not even kind of keying my partner into the discussion with me. I don’t tell him when I think we’re pregnant. But this one morning, I really thought we were. And I went in to take that pregnancy test and it was negative. And I was devastated. I mean, I was sitting on the floor looking for a ghost line with my dad’s magnifying glass. There was nothing there, but I was so sure it should have been there. And I realized that there was this moment that clicked for me that I’m sitting here with this like sixty year old magnifying glass trying to find a line. But technology is moving forward so fast. My PhD work was in such cool science and such cool analytics that I was doing. Yet none of that was being applied here.
And I’m still sitting here with a 60-year-old magnifying glass trying to find a line. So this is ridiculous. It has to change. I felt I didn’t have the data or the information to really understand what was going on with my body. And I wanted to change that. That’s really what the foundation for Oova came about. I realized that the foundation of all of our health is hormones. And if we could translate that language into something that a lay person can understand, all of a sudden she can start advocating for herself and asking the right questions. And in my eyes, a patient walking into your office informed is very different than somebody walking in defeated. And so I wanted to figure out how do we empower women to be more informed patients so they could get the care they deserved. And that’s really the foundation for Oova.
Susan Hudson MD (13:46)
That’s amazing.
Carrie Bedient MD (13:46)
That’s fantastic.
So what is Oova?
Amy Divaraniya (13:50)
So we at the core of it, we’re at home hormone testing platform. We currently measure three hormones, luteinizing hormone, progesterone, and estrogen through urine. The test is designed to be used daily. It’s a simple urine-based test. You pee in a cup, you dip the appropriate hormone test in, and then you scan it with your phone. There’s no devices, there’s no attachments, there’s no Bluetooth. We’re using these amazing cameras that we’re holding in our hands all day. And you get your quantitative results within seconds.
We’ve done a lot of work to clinically validate this, but the key thing is that we’re also HIPAA compliant. So if you’re working with a clinician, you can also share your data with your clinical team in real time. So everyone’s having the same conversation at the same time.
Susan Hudson MD (14:29)
Let’s play a game.
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Carrie Bedient MD (15:27)
That’s fantastic. So when someone goes to buy a kit, just in a very practical approach, what are they getting? Are they buying like the little hormone strips? How does this work? Do they get the app first? How do you do this?
Amy Divaraniya (15:39)
So it you buy a kit. And the kit comes with thirty test strips. I know this is the podcast, but I’ll show it to you and I’ll describe it a little bit. it looks like this. So every test strip is basically a urine based test and a plastic cartridge with a QR code on it. And there’s a window that where the lines will appear. So when you get your kit, you get fifteen test strips that measure estrogen and fifteen that measure lutinizing hormone and progesterone. Those are together on one test, or multiplexed, as we say.
When you download our app, you go through a pretty extensive onboarding process. We learn a lot about your cycle, if you have any reproductive conditions, if your what your health journey is, are you trying to conceive or something else? And then we will help you navigate which hormone to test on which day. And on those days, you would collect the urine sample, dip the test in, everything is labeled. We know exactly which hormone by this QR code, and you get your results within seconds.
Susan Hudson MD (16:26)
Very nice. When do you suggest someone to start looking at something like this? I mean, is this something that somebody should start doing if they’re not even considering trying for pregnancy or only after they’ve been trying for a while? When is it recommended?
Amy Divaraniya (16:40)
Yeah, sure. So I think the the conversation has shifted a bit in the past few years since Oova’s been in market. Initially it was designed for women that were actively trying to conceive, and they were basically at the step before going through ART. They’ve gone through the drugstore tasks, haven’t been able to conceive, and now Oova is really designed for those that need some personalized data and to understand their unique cycle.
But now what we’re starting to see is that a lot of women are coming to us when they’re not even ready to conceive yet, but they want a family plan. Is my cycle regular? I’m thinking of coming off of birth control. Has my cycle returned? What’s the lay of the land before I actively start trying to conceive? So they could be a bit more mentally prepared for it.
Carrie Bedient MD (17:19)
How does it work when you do have someone who’s got really irregular cycles? Maybe they go out two months between cycles and they’ve got these 15 test strips. How does the app navigate that when you truly may have no idea when to even start testing without having to go through a monster pile of strips?
Amy Divaraniya (17:40)
Yeah, absolutely. I like to say with Oova, we capture all the problem children, which is really majority of the population. It’s everyone that has some something going on. An irregular cycle or hormonal imbalance or reproductive condition, which is honestly like a pretty decent chunk of this population. We are really good at personalizing the experience for you. Of course, cycle one, we might have to go through some strips, especially if you have an extended cycle or really irregular cycle. We recommend that you buy our extended kit, which is basically 30 estrogen and 30 LH, progesterone. So you’re getting s 90 hormone measurements in that. But for the most part, we’re really good at helping you hone in on what days to test. So we can really understand where you are. And because it’s quantitative, we can learn what your baseline levels are and then detect fluctuations by comparing to that. So we’re not comparing you to that textbook curve and waiting for a threshold like the blinking smiley faces.
We’re doing something a lot more where we’re learning your baseline and waiting for a certain differential on a day to day basis to tell you, Yes, you’re ovulating or yes, you’re in your luteal phase. Let’s wait until the next cycle. It gets pretty smart pretty quickly.
Carrie Bedient MD (18:44)
How many cycles do you have to go through in order to build that baseline?
Amy Divaraniya (18:47)
We are great from cycle one because let’s say you just had a bleed and then you start testing, we know that your hormones are just bumping up from baseline. So we can test from there. But if you have a really irregular cycle or regardless, we often recommend that you test for two months or two cycles because women ovulate differently from both sides. We want to capture both of those cycles so we can help navigate you on that third or fourth or whatever maybe.
Susan Hudson MD (19:08)
Is there a group of people that you think this maybe is not a great idea for?
Amy Divaraniya (19:13)
Anyone that’s actively in hormonal birth control, the data won’t be as meaningful because if the birth control is working, it’s actually subduing a lot of the the hormones. You’re not going to see the fluctuations that you would expect. and then also if a patient is actively going through IVF, we would recommend that they don’t use Oova because their hormones are going to be substantially higher than what our test can measure. So they’ll get very false. Well, no, it’s not false, but it won’t be representative hormone patterns that they’re going to detect from Oova.
Susan Hudson MD (19:40)
And how do urine measurements of these type of hormones vary from blood measurements?
Amy Divaraniya (19:46)
Yeah, great question. so we’ve put a lot of our emphasis and our funding and everything into validating the test. We know for clinicians, for example, the gold standard is serum. Right. So if I’m going to tell you you can use Oova instead of blood tests, I need to at least meet the bar that you consider to be the gold standard. We get to a 99% correlation to serum for the biomarkers that we measure. We put a lot of emphasis on sensitivity and accuracy and all of our tests go out to two decimal places.
So it’s a very precise test, I guess we could say.
Carrie Bedient MD (20:15)
What other information do patients get from putting together these hormone profiles? And let’s say they do those two cycles back to back. Is there other information that they’re getting beyond just the I ovulated on day 26 this month and day 14 that month? What else are they picking up?
Amy Divaraniya (20:35)
There’s a lot. So hormones are just a piece of the puzzle. There’s so much more to this. Your symptoms matter a lot. Your symptoms are your body’s way of saying, This is what’s happening inside. Let’s translate that into is this good or bad? What we do with Oova is yes, we capture your hormone levels, we you your hormone trends, but we also translate it into a language that you can understand, even if you’re not a medical professional. So we will correlate your symptoms with your hormones.
When you talk about your cycle, not only are we telling you if you’re ovulating or not, but giving you details about your follicular phase and your luteal phase. I mean, the basic knowledge that a lot of patients have is pretty minimal. Oftentimes I will ask patients how long is your cycle, and they’ll say three days, because that’s how long they bled. And like, no, that’s not what a cycle is. Let’s get down to the basics. We really want to try to make sure again that the patient walking into your office is a lot more informed.
We’ll break down what our follicular phase is, how long it is, what is what does this mean, luteal phase, so on. And then what I think it starts getting more exciting is when we start looking at the hormone pattern over time. We define a hormonal archetype. It’s kind of a fun thing, but we will describe what pattern that we’re seeing and what symptoms are associated with that. What are some lifestyle modifications you can make to regulate some of the patterns that we detect? We don’t provide clinical care. So I will never say, you need to go get progesterone.
Or you need to go get a script for something. But we may say you may want to add some dietary supplements into your diet. Like not supplement by pill. I mean let’s add some greens or let’s add some like chia seeds to get some fiber into your diet, whatever it may be. We would add make those kinds of recommendations to help regulate some of the imbalances that we detect.
Carrie Bedient MD (22:09)
Do you get any extra information about the quality of ovulation by monitoring these long-term progesterone levels?
Amy Divaraniya (22:16)
Yes, we do. We don’t share that with the patient, but that is something that we can offer through our clinical portal because we’re very careful about what we tell a patient versus what we share with clinicians. From the clinician side, yes, you can start to detect that a patient’s progesterone is quite erratic. We call it the progesterone zigzag. And in those cases, it’s very clear that the ovulation wasn’t, the egg isn’t forming a proper corpus luteum. There is something that’s happening here, and then as a clinician, you can intervene and do as you wish.
But Oova won’t make that recommendation to you. We’ll show you the pattern and highlight it.
Susan Hudson MD (22:46)
How is this information shared with patients? Is it through an app? Is it through a conversation with somebody? How how do they get to understand what my body’s doing?
Amy Divaraniya (22:55)
It’s immediate. So you scan your test and then you get your results within seconds in the app. And then we provide the context right there. So it’s all within the user app.
Carrie Bedient MD (23:03)
If somebody has questions, can they talk to a real person or do they just have to take the data to their doctor and say, here, this is what I have, tell me what it means?
Amy Divaraniya (23:11)
We do offer clinical consults with our clinical team. So they can always come to us with questions. Again, we won’t provide the clinical care, but what we can do is arm you with the questions and discussions to have with your doctor. And then of course they would come to you with those specific questions and ask and they’d have the data to back it up. But yes, we’re happy to talk to patients about what the data means, what patterns we’re seeing and things that they can do.
Carrie Bedient MD (23:32)
What other types of things do you pick up for people who maybe do have normal cycles, where every roughly 28 days they bleed, it’s very routine, and then maybe they start doing this more intense monitoring. Is there other information that’s valuable to them that can get picked up in that time, even though they have those quote unquote normal cycles?
Amy Divaraniya (23:52)
There’s a lot. Again, hormones, I think, are just a piece of it. But when you start tracking with your hormones and then you layer on additional data, like for example, you can track your symptoms in our app. You can also integrate wearables into our platforms that we can merge your wearable data with our hormone patterns. You start to see some really interesting behaviors that associate with the hormone patterns that you may not have really paid attention to beyond tracking. One of the big things that we see quite often.
Is there’s a strong correlation between estrogen patterns and sleep quality. And so we’ve been publishing about this quite a bit. We presented this at a few conferences last year and this year, but we see a really strong estrogen decline happen on nights that women experience poor or irregular sleep. There’s that might be something you might kind of shrug away, but when you start to see this hormonal underpinning as to what’s causing that lack of sleep.
It starts to raise additional questions and things that you may be able to address on those specific days. We also see a strong correlation with migraines and progesterone patterns. A lot of women see this dramatic decline in progesterone happen in their luteal phase, and that leads to migraines. There’s things that can be done there too. It doesn’t always have to be medical. It could also be diet and the good habits that you can improve on those days. I think just getting that awareness has been really helpful for our users.
Susan Hudson MD (25:07)
Is there any information, say with somebody who has a regular menstrual period or even irregular menstrual period that you see something and you’re like, wow, you need to go see a doctor now? Like, do y’all ever have that piece of advice or is it just these are some modifications you might want to do?
Amy Divaraniya (25:25)
We won’t raise an alarm like that. And honestly there isn’t that much that we would see that would say, like, my gosh, you need to go see a doctor today. I think the only thing that I would really raise a flag for, but we don’t do it in product, is we can detect pregnancy pretty quickly in our platform because you start to see an LH and a progesterone behavior. It’s not actually LH, it’s beta HCG. That’s only present if you’re pregnant. And so we have non specific binding with that hormone.
If you see a certain pattern, then we will flag like, this patient may need to may benefit from getting a pregnancy test. Our support team may reach out to them, be like, Hey, everything cool? Do you want to go get a pregnancy test? And then we usually get very happy news.
Susan Hudson MD (26:02)
Do you ever note people who have very high baseline LH levels, whether it’s from things like PCOS or sometimes you have people who have severe diminished ovarian reserve who have those crazy high LH levels?
Amy Divaraniya (26:18)
Absolutely.
All the time. and for those patients, we actually don’t ping a false positive in that sense because we learn that their baseline is actually elevated. So again, that goes back to that differential that we’re looking for on a day-to-day basis. We wouldn’t flag ovulation for this user unless if we see a proper rise happen in that LH the proper estrogen pattern beforehand. There’s a lot of checks in this. It’s not just one hormone that we’re focusing on.
Susan Hudson MD (26:43)
Are users aware of a high baseline LH level in that type of situation? Or is it just that it’s something that it’s like, you’re we’re not noting ovulation?
Amy Divaraniya (26:52)
They would see the actual levels. And so they may when they look at our reference ranges, they’re gonna be like, this is really high. But we don’t flag it as like this is the negative in any way. So we’re quite careful about the messaging in our platform. We’re very conscious of the mental state that a patient’s in when she’s going through a fertility journey with us. And we’re really careful about what we say and how we say it after living through it.
Like you know how sensitive women can be. And I’m really cautious about how we message things to those users.
Carrie Bedient MD (27:20)
What kind of interventions can people do before they go to the doctor with all this information?
Amy Divaraniya (27:26)
I mean, there’s a lot. We provide a lot of guidance on lifestyle modifications that you can make. And then we also provide them with a list of questions that they can go to their doctor with so they’re not just coming blind. We try to arm them a little bit. From those questions, it also starts to elicit okay, maybe I can address this. Like, should I add more iron to my diet or should I add more fiber to my diet? And why? And so we try to provide some education there, but we focus more so on lifestyle changes that you can make versus jumping into something that’s very therapeutic.
Those could all be done before you go see the doctor for sure.
Carrie Bedient MD (27:57)
But what kind of questions are useful for patients to have once they have this data in hand and they’re preparing for their first doctor visit where they’re gonna say, here, look, this is what I’ve got. What questions are helpful for them to ask to get the most out of both the data and the doc that they’re seeing?
Amy Divaraniya (28:15)
it depends on how much data we’re talking about. So let’s assume you’ve done two months of baseline. And you see that there’s irregularities in your cycle, they’re not equal lengths, very common, but often that can be kind of alarming. We see from our research that patients often think they have a 28-day cycle, but when they actually start measuring with Oova, 95% of patients didn’t. And they’re actually quite off. We just don’t realize it unless if you’re actually tracking it every single day.
And so I think starting even at the basics, my cycle feels a little irregular. Is this okay? Am I ovulating regularly? It starts to stim those questions of what is my egg count? Should I get my AMH tested? And I think you’re walking in not scared when you say we should get your AMH tested, all of a sudden the patient’s like, Wait, what does this mean? Now they’re like,
Okay, I understand why. And what we’ve heard from our clinical partners and from patients is that those discussions have felt a lot more well received and two-way versus the doctor just kind of speaking to a void and the patient trying to remember everything or putting their sound recorder on, trying to capture every note. Now it’s like, okay, I understand why you’re saying this to me. here’s another piece of information. Does this feed in or explain why this is off? And it all of a sudden it becomes a very interesting conversation for both parties.
Susan Hudson MD (29:25)
If someone’s interested in using Oova, how do they get it? Do they go to a store? Do they buy it online? How how does that work?
Amy Divaraniya (29:34)
That depends. we are available online, so you can buy us, go right to our website. You don’t need a prescription or anything. You can just get it directly there. A lot of our clinical partners also keep kits in stock. So if your doctor is one of our partners, they may offer it to you as part of a protocol. But I think the fastest way is probably just getting it from our website.
Susan Hudson MD (29:51)
And how much does the kit cost and does insurance cover this?
Amy Divaraniya (29:55)
It’s not covered by insurance yet. We are working on it, but it is HSA FSA eligible. It costs $129 a month if you do the subscription and you’ll get 45 hormonal measurements.
Carrie Bedient MD (30:05)
So after all of this, how did your fertility journey go?
Amy Divaraniya (30:09)
It went great. Oova is one year older than my son. It had a happy ending, but man, that was a journey that we went through to have him. And the great thing is that he’s aware of the journey. I think it’s important for him to know why Oova exists and how he came to be. I think it’s actually quite beautiful that he sees what we’re trying to build here and what we’re trying to do.
Carrie Bedient MD (30:28)
That’s fantastic.
Susan Hudson MD (30:29)
That’s awesome.
Carrie Bedient MD (30:30)
What kind of research have you guys done with Oova?
Amy Divaraniya (30:33)
So we’ve done a lot. And I think what’s really cool is because we get all the so-called problem children, we get these really cool subgroups that are often ignored in a lot of the larger studies that are published. So for example, we’ve done a lot of work looking at advanced maternal age and looking at ovulatory patterns there. We’ve tried to debunk a lot of the myths around our women’s cycles. So for example, thinking that 28 day cycles are the norm, we find that that’s actually not.
95% of women don’t have a 28-day cycle. So we should really be building for the non-28-day. We also think that ovulation happens right at the 50% point of our cycle. It is not true. It changes, especially as we age. What we’re trying to do is back up a lot of the assumptions that we have about the women’s reproductive system with data and really educate everyone on what is happening in our body instead of just swimming in all these assumptions.
Carrie Bedient MD (31:27)
What do you find about luteal phases? I have a lot of patients who come in doing the traditional OPKs where you pee on a stick, pick up that one surge, and then just start counting the days till their next period, and they’re completely agonizing over the fact that it’s not 14 days. What kind of patterns do you pick up and other information do you get?
Amy Divaraniya (31:46)
I was in that boat and I totally sympathize with those women because it’s not the case. So I can speak from personal experience, like my cycle, I barely got highs and peaks on the LH test because when I after using Oova, I learned my LH surge is just on the lower side. So my peak just never hit those thresholds. But I was ovulating. Those tests also didn’t measure progesterone, so I didn’t know if I was actually releasing an egg.
What we see in our data is quite interesting. One, the length of the luteal phase changes as women get older.
So it does get longer. And we shouldn’t be anchoring on that 14 day luteal phase. It could be longer and that could be very much normal for you. But it’s good for you to be aware of it. So you can time intercourse effectively. It also can take up to 72 hours for that corpus luteum to form after that LH surge to emit enough progesterone. You can still conceive in that time.
But a lot of women think like, I had my LH peak, let’s go get a pregnancy test. Am I pregnant? It doesn’t happen overnight like that. There’s still more time. There’s a lot more that needs to happen. So there’s a lot that can happen in the luteal phase. And then what’s also interesting is that we see a lot of luteal phase defect. I know clinicians don’t like that word, but we will often see that the progesterone just doesn’t stay stable after the LH surge. And it’s because the corpus luteum didn’t form well. So forget the term luteal phase defect for a second. The key message here is that the progesterone isn’t in that steady stream or plateauing as we should expect it to. And we should address that ’cause that could be a bigger problem.
There’s a lot in the luteal phase.
Carrie Bedient MD (33:14)
Yeah, that’s fantastic. All right. Perfect. Well, thank you for all of the extra information. We we appreciate it and our listeners very much appreciate it because when women come to us, they’re just at their wits’ end and so many rely on data. It helps them to feel comforted. It helps them to feel like they understand what’s going on. And so getting getting that extra boost of information is very valuable. So thank you so much for creating this. And I’m so glad that it worked for you.
Amy Divaraniya (33:45)
Thank you so much.
Susan Hudson MD (33:46)
Great to have had you here today.
Amy Divaraniya (33:48)
Thank you.
Carrie Bedient MD (33:48)
This has been Dr. Amy Divaraniya from Oova. And if you’re looking for those products, look online, go to their website, and hopefully they can be helpful to you along your way. And thank you so much for spending part of your day with us.
Amy Divaraniya (34:03)
Thank you so much for having me. It was great speaking with you guys.
Susan Hudson MD (34:05)
Absolutely. We’re glad to have had you. And for our listeners, if you have enjoyed this episode, subscribe, leave a review, and send us your questions at fertilitydocsuncensored.com.
Carrie Bedient MD (34:15)
If you want even more fertility information, pick up a copy of the IVF Blueprint, Our Practical Guide to Understanding Fertility Treatment IVF and the Decisions You’ll Face Along the Way.
Susan Hudson MD (34:24)
Before we go, remember this podcast is intended for education and entertainment only.
Carrie Bedient MD (34:29)
While we are fertility doctors, we are not your fertility doctors.
Susan Hudson MD (34:32)
Nothing we discuss should replace medical advice from your own physician who knows your individual history and circumstances.
Carrie Bedient MD (34:39)
Thank you for listening. Bye.