What makes the uterus truly ready for an embryo transfer? Dr. Carrie Bedient and Dr. Susan Hudson break down the often-overlooked factors that can influence fertility treatment success—from uterine anatomy and endometrial lining patterns to fluid, thin lining, and when surgery or other interventions may be needed. Tune in for practical insights into what doctors are looking for before an embryo transfer—and what happens when things don’t go exactly as planned.

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 and welcome to another episode of Fertility Docs Uncensored. I am one of your hosts, Dr. Carrie Bedient from the Fertility Center of Las Vegas, and I am joined by my Meticulous Mary Master of Medicine co-host, Dr. Susan Hudson from Texas Fertility Center. How are you?

Susan Hudson MD (01:07)

Good. How are you doing, Carrie?

Carrie Bedient MD (01:08)

Good. I am fine, thank you.

Whenever you and I go to conferences, we pretty much always stay together because it’s like a sleepover party for grown-ups, which is fantastic. And we’ll get our little face masks and talk far, far more than either of us ever I think does anywhere else. But the million-dollar question is, are you a morning person or a night person?

Susan Hudson MD (01:33)

I am more of a morning person than a night person, but I’m a morning person that likes to be in my zone. When I’m by myself, I go to bed earlier than everybody else in my house and that type of thing because I need sleep. But I’m okay waking up early. It’s just I kind of need to be in my zone before having human communication.

Carrie Bedient MD (01:56)

Are you one of those people where it’s don’t talk to me until I’ve had my morning coffee and you have the mug to prove it?

Susan Hudson MD (02:02)

No, it really is actually independent of coffee because I actually don’t usually drink my coffee until I’m either on my way to work or at work. It’s more that I just have to I wanna get up, I’m very methodical and I think it’s that inner part of me. It’s I wake up, I wanna have control of I’m gonna take my shower, I’m going to brush my teeth, I’m gonna put on my makeup, I’m gonna get dressed. And I wanna deal with me before I deal with other people’s problems. I think that’s what it really comes down to.

Carrie Bedient MD (02:32)

That’s pretty fair. I am more of a night person than I am a morning person, as evidenced by the fact why we stay up way too late talking whenever we have our sleepovers.

Carrie Bedient MD (02:43)

Uh-huh. And I am usually up for a solid hour, if not more, after you go to bed because invariably at these things I have whatever presentation that I’m doing that I will look at the night before. And that’s when I make edits and and do all of those things. I have the capacity to be a morning person if I have gotten enough sleep, which in my life is rarely.

I don’t mind getting up. Like we had an a super early meeting that started at 5:30 AM my time. And I actually don’t mind getting up and out of the house and in my office where it’s nice and quiet and I can get a ton of stuff done. but most of the time I still end up staying late.

It ends up being a very poor decision. I like going to bed early. I just don’t do it very often because it’s the only quiet time in my house and nobody’s bothering me. And it’s the same stuff that you like. I just like to sit there and read my book or look at whatever random social media or fall down into whatever rabbit hole I happen to be in at that moment and not get bothered by everyone else. And sometimes 10, 11, 12 is the only time I get to do that.

Susan Hudson MD (03:50)

My eyelids have to meet each other around that time.

Carrie Bedient MD (03:53)

Yep. Yep. But I’m appreciative that you don’t snore so I can sit in my late night working in peace. So it’s good. Yeah.

Susan Hudson MD (04:00)

I do probably talk in my sleep when we’re together though. ‘Cause I’ve always been a talker and especially if I’m in a different place it it tends to be more common.

Carrie Bedient MD (04:10)

Hmm, maybe I’ll have to leave a tape recorder on next time because I don’t think I’ve never heard that. But I also sleep fairly heavily if it’s not either a small human or a small animal that’s making noises. Yeah, don’t pay attention to that at all. Okay, what is our question for the day?

Susan Hudson MD (04:27)

Alright, our question for the day is: I had an HSG, and the radiology assistant said I had the smallest uterine cavity that she’d ever seen. She filled the catheter balloon with 1 CC and it almost completely filled my uterus. In addition, my uterine cavity is oval-shaped. The fallopian tubes are patent. My transvaginal ultrasound showed polycystic ovaries and a uterus measuring 8.2 centimeters by 4 centimeters by 3.3 centimeters. With a volume of 56cc. My OBGYN does not think I fit the other criteria for a PMOS diagnosis. What could a small oval-shaped uterine cavity mean? One week after positive home ovulation tests, my labs were FSH 2.9, LH 1.6, progesterone 13.18, prolactin 6.6, estradiol 123, DHEAS 180. My thyroid function is normal and no sign of insulin resistance on fasting glucose and insulin.

Carrie Bedient MD (05:25)

So the shorthand of that is she’s ovulating.

Susan Hudson MD (05:27)

Yes.

Carrie Bedient MD (05:28)

And it sounds like does not meet the criteria of PMOS. I mean, I didn’t hear anything about hirsuitism, which is hair growing where women generally do not want hair, or acne or those types of things. I didn’t hear a testosterone either, but it sounds like she doesn’t really meet the criteria of PMOS. That oval-shaped cavity, though, I’m interested in how they arrived at oval-shaped with the tubes patent, because by default, if the tubes are patent, they go off to the side and they taper out and you kind of get this upside-down pear shape. And so oval shape could mean that maybe the base is wider than it typically is, or…

Susan Hudson MD (06:09)

Maybe she has polyps that are obscuring some of what’s in the cornu, in the corners of the uterus.

Carrie Bedient MD (06:16)

Mm-hmm.

Susan Hudson MD (06:17)

It’s not blocked because the polyps are not plopping in front of the actual ostia or the opening to the fallopian tubes. But I would say this person probably needs a saline ultrasound or a hysteroscopy just to take a look. as to the size of your uterus.

I mean, it sounds pretty normal for somebody who hasn’t had a baby before. Sometimes we see a small uterus in people who haven’t had much estrogen exposure. Maybe if you were not ovulatory in the past and weren’t having, the normal rise and fall of estrogens with follicular recruitment, sometimes you see those people have a smaller uterus that after you start getting estrogen exposure, the uterus hypertrophies or gets bulkier. It does that when you get pregnant as well. So all in all, I wouldn’t be too concerned about the the uterus on the inside having an oval shape and that in itself being abnormal. But why you’re not seeing the cornu to make it kind of a triangle shape is a little unusual. So checking out the lining of the uterus in more detail with a saline ultrasound, which is way, way more sensitive, or with either an office or operating room hysteroscopy would be a reasonable thing to do.

Carrie Bedient MD (07:34)

I see one way that you would get that oval shape is if the uterus was rotated. So normally when they do the HSG, we expect the tubes to shoot out to the right and left, everybody’s anatomy is different.

And maybe your bladder’s full, your bowel’s full, whatever, and the uterus or the uterus is just rotated. I mean that doesn’t have a negative impact on fertility. It just is the way it is. If it’s rotated a little bit so that those tubal openings, the cornu, go out more front and back, and the dye obscures those details, which is very normal. That’s part of the test.

Then that could be another reason why it’s oval, where it doesn’t actually matter that it’s oval. And only blowing up to one CC, a lot of times that’s really all you need in order to block the cervical opening. Yes, you can blow it up to two, three, four, five, but if you don’t need to, it’s uncomfortable for the patient. So why would you?

Susan Hudson MD (08:25)

Absolutely.

Susan Hudson MD (08:28)

Let’s play a game.

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Carrie Bedient MD (09:27)

Let’s talk about endometrial linings today. And as we were discussing this topic before the episode and just setting our plan for the day, the original plan was to do thin lining, an evidence-based approach. And we decided to rename that. And why is that, Susan?

Susan Hudson MD (09:43)

Because there’s not a lot of evidence. At least there’s not a lot of evidence that is strong, incontroversial, and that people agree on. This is definitely a part of fertility care that fits into the art of medicine more than it fits into the evidence-based approach. As much as we like to have evidence, I think there’s a lot of things that people can try and may have impacts.

And it’s also a good time for us to discuss how important is the actual measurement of the lining of the uterus. Because we have patients who come in who get very, very upset because it’s like, my goodness, my lining is blank. And that might actually be okay.

Carrie Bedient MD (10:25)

So let’s start off with what is the endometrium? Like physiologically, what’s going on there? What is it, and why do we care about it?

Susan Hudson MD (10:33)

So the endometrium is the lining of the uterus. And that lining, when you have your period, you shed it. So essentially you do some spring cleaning. And then as your follicles grow, those follicles produce cells called granulosa cells, which produce estrogen. And that estrogen stimulates the lining to grow and become plush.

If you’re going through an embryo transfer cycle, you may use estrogen pills, tablets, injections to create the same effect. And there is a measurement that we do when you come in for your ultrasound to look at the thickness of the endometrium at this point in time. Now, something I’m going to mention is that after you ovulate, you start producing progesterone.

Or if you’re doing a programmed embryo transfer cycle, you may be doing your progesterone injections. If you’ve been through fertility care in the past, you may be like, hmm, why don’t they measure my lining after we start progesterone? Isn’t that important? Well, the fact of the matter is, is that progesterone causes a conformational change in the endometrium where it actually compacts.

It’s normal for that lining to be thinner than what it was prior to the progesterone. And there’s no real evidence to say that, my progesterone exposed lining needs to have a certain thickness.

Carrie Bedient MD (12:01)

So with that, as you are going through your monitoring appointments and you’re getting these measurements, there’s also a pattern that is typically described as well. What does that pattern mean? What is it actually describing?

Susan Hudson MD (12:15)

So the pattern that we expect to see when you have good estrogen exposure that is gradual and appropriate is a trilaminar stripe. So you have a bright white line, you have a little darker area, you have another bright white line, a darker area, and another bright white line. Kind of looks like a hamburger. And so that shows us that we have a good structure.

And potentially a structure that hasn’t been under inappropriate influence of progesterone. So when we start having that progesterone exposure, those darker areas start to get lighter and the very distinct lines start becoming hazy. And when you have full progesterone exposure, the whole thing is what we call heterogeneous. It just looks like mmm, like kind of grayish snow.

Carrie Bedient MD (13:12)

Okay, and looking at that pattern, at what point is that pattern really important? Do we pay attention to it? At what point where it looks different are we gonna say, we’re not moving forward right now, we’re gonna stop and change gear?

Susan Hudson MD (13:29)

So this is something that is definitely going to be doctor to doctor independent because some of us, like Carrie, really, really live and die by needing to have that trilaminar stripe. Some of us, some of us take it a little bit more with a grain of salt. Now, if I am doing an IUI cycle.

I have a different opinion of the lining than if I’m doing an IVF cycle. So if I’m doing an IUI cycle, if I’m doing a scan and it’s somebody who I expect to have follicles that have grown and I see a hazy lining and I don’t see follicles, and maybe I see a little fluid, that’s gonna make me very suspicious that maybe the person ovulated before coming in for their monitoring visit.

And so that gives us an additional piece of information. In my hands, I usually send those people off for labs to see where are we hormonally. Did we not recruit follicles or did we miss follicular development and you just ovulated on your own? If you are doing an embryo transfer cycle, I love seeing a beautiful trilaminar stripe. If my progesterone level is on a borderline and it’s looking hazy, then I may cancel because I’m like, mm-hmm. But I’m not gonna just cancel somebody because their stripe is not perfectly trilaminar if that progesterone level is nice and low. But again, that’s provider by provider.

Carrie Bedient MD (14:59)

And Susan is absolutely right. Our my practice does tend to be far more obsessive about our linings. And I absolutely have canceled people because it didn’t look exactly the way that I wanted it to. And that’s got pros and cons. And when when you are looking at that, there’s a lot of nuance to it.

Because sometimes you will get that textbook perfect lining, but other times you will see areas where it’s starting to go that all white color and it’s losing the pattern that you want. And that’s not necessarily a terrible, this will never work thing, but you interpret it differently because keep in mind everything that we’re doing is not a cookie-cutter approach. Yes, the instructions to the patients may all be the same of come in on day eight or 10 or whatever it may be, so we can check your lining. But the way that we respond to those and the nuances of those instructions are going to be different from patient to patient. If you’ve got a 28-year-old who’s fortunate enough to have eight embryos that are euploid in storage, you’re going to approach that a lot differently than someone who’s 41, where you work damn hard to get that one embryo. And it’s not to say that embryos are any less precious in one case than the other, but the margin for error is different and different priorities are allowed to take place. So the 28-year-old who’s like, look, I don’t wanna stop, I don’t wanna cancel, I wanna keep going, we’re a lot more likely to say, all right, let’s give it a shot, than someone who we had to do three retrievals to just get that one embryo. of four. When you are looking at linings, what are the things that will make you say, cancel?

Susan Hudson MD (16:36)

So if I have fluid in the lining that hasn’t gone away after I start progesterone, then I’m gonna cancel. Some people will draw that fluid off and I would do that if I had tried a couple of cycles and couldn’t get anything else to work, but that would not be my first go-to.

Now sometimes just getting estrogen and some of those higher estrogen levels will make you get fluid. But as I mentioned, that conformational change that happens when you start the progesterone sometimes kind of squeezes out that fluid. So it’s not everybody who is fluid doesn’t get canceled, but I have those people come in for an extra ultrasound. If they have a cystic-looking endometrium, so we see little pockets of fluid in the endometrium.

That I really, really don’t like to see those. What about you, Carrie?

Carrie Bedient MD (17:27)

If I have fluid in the endometrium that doesn’t go away, and again, agree with I will drain it if we’ve done a couple of approaches. I’ve actually occasionally had people where they’ve come in the day of and they’ve persistently had fluid up until that point, and they have described, I had a ton of mucus this morning. And really the only thing that was in there was mucus, which is far less concerning than fluid for other reasons.

If I’ve got someone who is much thinner than I expect them to be, then that’s a situation where I’ll cancel. And the way that we gauge that is if I look at a lining and I’m looking for, eight is the general goal that I have for a minimum lining. If I look at that and I see I’m only at six, and I go back and I look at her stim cycle and I see, when when she was completely tanked up, we got to 10 or 11, I am not gonna transfer into that really thin lining. But if I look at her stim and I look at her diagnostic scans and the stuff that we’ve done along the way, and she just never gets thicker than that, that’s a different conversation because.

It’s worth saying, okay, we’ve tried this, we’ve tried this, we’ve tried this. We have never seen it get thick. We’re going to go through the standard steps of usually hysteroscopy and saline ultrasound and those types of things, making sure that the hormone levels are adequate in a couple of different ways by a modified natural cycle, by a fully programmed cycle. But if six is what we get and all we have ever seen is six, we’re a lot more likely to move forward with that. But if I know that I can get 10 or 11 and all I’m seeing is six, then I’m a lot less likely to to run with that cycle.

Susan Hudson MD (19:06)

So something that’s very important is to understand that there’s pretty good evidence that says that what that actual number of the lining is is actually relatively inconsequential. So I would say pretty much everybody feels warm and fuzzy about eight. There’s a decent number of people who feel like it’s fine over seven. And what’s becoming a growing trend is again paying attention to where do we start and where are we ending and how pretty is that ending. So if I have somebody who starts off with a two millimeter stripe and we haven’t ever been able to get a thick one, but we get it to go from two to six.

And it’s a beautiful trilaminar structure, and we’ve tried multiple things, and that seems to be where it is. I will often give that a try, and I’ve been successful. And it’s because really you’re watching for that change. I would say most people, when they start off at their baseline, they’re usually starting off at a at five millimeters. I would say that’s an average starting place. So if you’re starting off thinner and expecting to get to eight, that’s the same thing as five expecting to get to twelve. There’s also the balance of too thick. What are your what are your thoughts of too thick linings, Carrie?

Carrie Bedient MD (20:26)

depends on the person. And one of the things that I worry about with too thick linings is if they’re too thick throughout and I’m worried that there’s a polyp that’s grown in there that hasn’t been identified up until now. Sonohysts are great tests, but they’re not perfect. You can sometimes miss things. And while most polyps are not going to pop up in the space of a couple months, they can, we’ve all seen it. If there’s a lining that looks abnormally thick, If there’s a lining that looks irregularly thick, meaning it’s got a standard appearance everywhere else, and then in one spot it’s just really big or really opaque appearing, whatever, I’m much more likely to cancel and and do a little bit of extra investigation there. In general, once I start to hit about 16 or so, I’m thinking about it more. I may not cancel, but I am thinking about it a lot more because I want to know why it’s that thick. I want to know how stable is this? Are you having any bleeding? Is there anything else that I’m worried about in that? What about you?

Susan Hudson MD (21:23)

I don’t usually cancel people because of a thick lining, but I am suspicious as you described. I think we tend to see those thicker lining in women who have more weight on them. And that’s mainly because they’re having multiple sources of estrogen. So not only are they getting the estrogen we’re giving to them through their protocol, but fat tissue produces a form of estrogen and the uterus is greedy. It’s gimme, gimme, gimme. As long as it doesn’t look irregular, all those things you just talked about, I keep an eye on it, but like I said, I don’t usually cancel because of the lining’s too thick, but I do always go back and I’m like, hmm, when was the last time I looked in there?

Carrie Bedient MD (22:03)

What is your approach if you’ve got someone coming in and maybe it’s their first transfer and you already know, I’m worried about this lining, I’ve never seen it get very thick. What’s your default approach? Where do you usually start?

Susan Hudson MD (22:15)

Well, I usually start with what I normally do for people because what normally works normally works. So I start off with that, which is usually oral estrogen. We do oral estrogen twice a day, starting out for a week and then we increase it to three times a day. But when they come back in, that’s when I start changing up the protocol. Because oral estrogen is really nice.

It’s easy, it’s well tolerated. There is less of an ick factor than most of the other things we’re gonna be doing. If it works, great. From there, my next thing that I usually try is converting that oral estrogen to vaginal estrogen. And this is gonna sound really weird for anybody who hasn’t been through this before, but you can actually use those little blue pills and just stick them up your vagina, and the absorption is absolutely amazing. And I often will change maybe one of the three. And it depends on how thin it is, whether I’m like, okay, we’re just switching all the way to vaginal or do I just need to kick this up a notch? And then I’ll have them come back a week later, repeat labs, make sure labs are where I expect them to, and see what happens from there. From there, it becomes a lot more variable.

Carrie Bedient MD (23:28)

I would agree. I like program cycles. I appreciate their predictability and the way that we can control them. But I would say my second choice is, and sometimes first, depending on the patient, is to do a modified natural cycle. Sometimes it’s better to let the body make the estrogen that’s going to thicken up the lining.

And in those cases, you use typically letrazole to thicken up the lining by growing a follicle that’s producing its own estrogen. And we’ll oftentimes add in a little bit of estrogen as well to bump the levels and get the lining just a touch thicker. But that’s another way to go about it because sometimes less is more and doing a modified natural can get you to where you want to be. And sometimes truly a natural natural cycle where we don’t touch somebody at all can be helpful. And that’s particularly true of people who maybe have had pregnancies before, like gestational carriers, and their body just does better when it does what it wants to do without any input from the rest of us.

Susan Hudson MD (24:29)

Another thing that we can do is adding some supplements. Sometimes we add aspirin, sometimes we add some vitamin E. Those can increase blood supply and that type of thing. Sometimes we can see some evidence of improvement with that. And then we start getting into things that have probably a lot less evidence.

Carrie Bedient MD (24:50)

All right, these are the voodoo protocols. And every doc I know has them. And what are some of your favorite voodoo protocols? When you’ve tried the standard program cycle, modified natural, natural cycles, you’ve tried the different ways of giving estrogen. What else do you turn to?

Susan Hudson MD (25:08)

Yeah. I mean I can more say what are available versus I turn to because that’s gonna sometimes vary from person to person. I have used some Viagra in the past.

Carrie Bedient MD (25:17)

Yep. Estrogen is not the only little blue pill that we rely on.

Susan Hudson MD (25:22)

Exactly. I have not used PRP, but I know there are people who use PRP, whether it’s an infusion or however you’re going to use it. what are some other things, Carrie?

Carrie Bedient MD (25:33)

I tend to use cabergoline to help with blood flow. that’s kind of an easy thing.

Sometimes people use estrogen valerate or the estrogen injections, del estrogen, to thicken up the linings. That one, in addition to it being another injection, that estrogen sticks around longer. It’s one that just kind of keep in mind if you need to stop, cancel the cycle, or if you transfer and it doesn’t work, coming off of delestrogen takes longer to get your period usually.

Susan Hudson MD (26:01)

Sometimes people are using amniotic fluid membrane now to put that inside the uterus. I know I personally haven’t used it. I actually know somebody who has that done for their eyes to help with eye dryness. And I think this is like a new purpose of this substance. There’s a lot of unusual things out there. And I’m sure there’s other things that we can’t even think of.

It’s not that these other things are not useful, but just realize I would say I end up having to turn to one of these things maybe a couple times a year. This is not something that we experience on a weekly basis because most people were going to be able to get there sooner. One thing I would like to talk about is who are people that we would be most concerned about possibly having one of these stubborn thin linings.

Carrie Bedient MD (26:54)

Patients who’ve had uterine procedures before, especially D&Cs, where they go in and they scrape the uterus. And D&Cs are one of the most common procedures done in the world because they’re what occurs after miscarriages, they occur during terminations much of the time. They occur when someone’s having really heavy bleeding. They happen a lot after pregnancies, if a placenta or amniotic membrane has gotten stuck and the patient’s having bleeding and that needs to be removed.

They can happen during a variety of different clinical situations. And with the lining of the uterus, there’s two layers to it. There is the basement membrane or the basal layer and then there is the proliferative layer. Proliferative layer is what’s going to grow and come out every month. That basement membrane, that basal layer is the source of everything. And if that gets damaged, it is very hard to regenerate the proliferative layer. And so, for example, if someone’s had a D&C that was exceptionally rough for some reason, infection is the biggest thing that there’s a risk factor here. The other thing is really heavy bleeding where you have to stop it no matter what, because otherwise you’re at risk of the patient losing massive amounts of blood or expiring as a result of it. When that basement membrane or basal layer is damaged, then you can have a very thin lining. And sometimes it is damaged very uniformly throughout. Sometimes it’s not. Sometimes most of it is damaged and there’s a little pocket that you can rely on. I’ve definitely had patients where there was one tiny pocket of thick endometrium and that was the endometrium that we went for.

When we did the transfer, because even though you can’t glue an embryo in in its place exactly, you can at least preferentially transfer it where you want to. Sometimes we will see those types of endometria after procedures. But other procedures, in addition to D&Cs, like uterine artery embolization or endometrial ablations, those are intentional ways to damage the uterus and they absolutely serve wonderful functions when they’re needed, but they cause a lot of headaches for patients who need them to be thick after they go through that because those procedures are not meant to be done for someone who still wants to have babies.

Susan Hudson MD (29:08)

People who have had fibroid surgery, that can also damage that basal layer. Other people that I’m concerned about, if you’ve had a history of tuberculosis, sometimes you can have tuberculosis in your uterus and that can damage that basal layer. People who are very, very, very thin. So if you have hypothalamic amenorrhea due to being a very thin person, you’re somebody that I’m worried that I may have some struggles in getting that lining thick enough. Someone who’s had long term IUD exposure. Now there’s not a lot of evidence out there saying that IUDs are detrimental to fertility long term. But I think observationally, more and more of us are seeing that long term IUD use can sometimes make it a little harder for us to kind of bounce back that uterine proliferation.

Carrie Bedient MD (30:04)

And I would say, at least in my experience, it’s not that having an IUD prevents it. It’s that it may take a couple extra months, a little bit more time than than we would otherwise be used to in order to get that lining thick. How and when does surgery play a role in helping with a thin lining?

Susan Hudson MD (30:21)

So surgery plays a role because sometimes there’s something structurally that you just can’t see any way else. So especially when you’re looking at embryo transfers, we know that if somebody has had two failed embryo transfers and a normal saline ultrasound, 30% of the time there’s something going on in the lining of the uterus that we can’t identify without looking directly in. And so considering a hysteroscopy where we put a little telescope into the uterus through the cervix is a pretty non-invasive procedure. Usually takes somewhere between 10 to 20 minutes, depending on the situation. It’s a pretty easy way for us to lay eyes on the lining and see if there is something structurally going on. Sometimes people have adhesions and have no history of surgeries, infections, all those types of things that that need to be ablated. Sometimes, we just need to go in and be like, hey, it looks crystal clear and and so that can give us reassurance as well.

Carrie Bedient MD (31:22)

Absolutely. Any other things you can think of in our approach to a thin lining?

Susan Hudson MD (31:26)

Don’t get hung up on a number. I know we talked about it earlier, but it’s one of those things that it is part of the art of medicine. Where you start and where you end is more important than what the actual value is. And, if you have questions, ask your doc. Say, hey, I’m noticing my lining’s pretty thin. What what are some of our goals here? How how are we planning on getting from point A to point B? And especially when people are planning for embryo transfers, you go in for your baseline ultrasound, they give you a calendar, you get your embryo transfer date. If you’re doing a program cycle and everybody’s so excited and you get pinned on that date, and then if you come in and your lining’s not quite where we want it to be, sometimes people take that very, very hard and realize that what we are here to do is to give you your best chances of that little embryo sticking and oftentimes it’s just an additional week. We need to make a tweak, we need to make an adjustment because we want that little embryo to have a wonderful little nursery to live in for the next nine months.

Carrie Bedient MD (32:33)

Absolutely. Well, I hope that this is helpful for some patients who are going through it. And we’re so glad that you joined us today. Thank you for spending a part of your day with us.

Susan Hudson MD (32:43)

If you enjoyed this episode, subscribe, leave a review, and send us your questions at fertilitydocsuncensored.com.

Carrie Bedient MD (32:49)

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 (32:58)

Before we go, remember, this podcast is for education and entertainment only.

Carrie Bedient MD (33:02)

While we are fertility doctors, we are not your fertility doctors.

Susan Hudson MD (33:06)

Nothing we discussed should replace medical advice from your own physician who knows your individual history and circumstances.

Carrie Bedient MD (33:12)

Thanks for listening. Bye.

Susan Hudson MD (33:14)

Bye

Susan Hudson MD (33:15)

This podcast is sponsored by ReceptivaDx. When fertility questions remain unanswered, ReceptivaDx helps reveal why. Trusted by fertility specialists for over a decade, ReceptivaDx identifies inflammatory changes in the uterine lining associated with endometriosis and other conditions that may interfere with implantation and pregnancy. From unexplained infertility, recurrent pregnancy loss, or simply undiagnosed pain, ReceptivaDx helps women and their physicians make more informed treatment decisions and move forward with confidence.