Dive into the world of assisted reproductive technology with us as we uncover the intriguing process of receptor upregulation and its critical role in IVF treatments. In this episode, we take a closer look at why birth control pills aren't just for contraception anymore; they're a pivotal prelude to successful IVF. Join us as we unravel the science behind this strategy, drawing parallels between common experiences and complex biological processes to illuminate how and why preparing the body beforehand can lead to better IVF outcomes. Whether you're a prospective patient seeking clarity on your journey to parenthood, a health enthusiast fascinated by human biology, or a medical professional keeping up with the field, this episode will arm you with knowledge and insights into the smart synchronization of hormones and health. Tune in to 'Unlocking the Secrets of Receptor Upregulation' and step into a world where science meets hope, one hormone at a time.
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Today we take a deeper dive into. How birth control helps your IVF cycle. And how worrying about over suppression is. Not as worrisome as you think. I'm, Dr. Mark Amols. And this is Taco about Fertility Tuesday. In previous podcasts, I've talked about why. Birth control is used. And I've also talked about how Priming. Which is what we do in the. Beginning of an IVF cycle, can have very suppressive effects and can have minimal. Suppressive effects from using birth control to progesterone only, to estrogen, or what some. People do, cold starts. So today I want to look into. That a little bit more depth. Because one of the things I see. Is that some people take this to. A level that's actually not true, meaning they're afraid to go on birth control and they're worried it's going to oversuppress them. And although that is true, and that. Can happen sometimes, they're not understanding the complete story and for that reason are. Not wanting to go on it when really it would benefit them. And so we're going to kind of talk about that today. So let's just first talk about Priming. Priming is where you get the ovaries ready for IVF. And like I stated, there are different types of Priming. You can use simple things like birth control. You can use things like progesterone only, which are called mini pills. You can use estrogen priming. You can even use no Priming at all and do what's called a cold start, where as soon as they start. The period, you start. You can even do a stimulation during the luteal phase. So you don't need any Priming. But the point is, why do we even prime? Is there a purpose? Because sometimes you can over suppress, where. If you give someone birth control on. The rot for too long, you can. Almost cause the body to not respond. As well because the eggs are just so suppressed. But it's not that simple where just. Going on birth control can cause that. Usually it's the length of time and. It has to do with the situation. So why do we put people on birth control? Well, a lot of people think that. People are put on birth control because we're just trying to synchronize their cycle. To our cycle so we can have some time off. And that's not actually true. Even clinics that are up all the. Time, meaning they never take a break, they constantly are doing IVF the whole. Month still put people on birth control. And that's because there's benefits to birth control. Now we're going to talk about those benefits. One of the first benefits of birth control is synchronization. And what this means is that if. You just stimulate someone right from their period, you'll get a spread of the follicles. When I mean a spread, I'm talking about the follicles may be between, let's. Say 20 and 12 mm, but the. Group of follicles is kind of spread. Out evenly through there. And so anyone who's ever done an IUI knows that usually there's like a big one, a medium one, small one. They'Re not all together. But the problem is that when the. Follicles are between about 15 and 20. Mm is when they're mature. So if you have a big spread. Then potentially you may get more eggs, but you'll actually end up getting fewer mature eggs. And so it's better to have fewer. Eggs if it means more of them are mature. Because what's the good of having 20. Eggs if only ten are mature versus. Only making 15 eggs where 14 of them are mature? And so that's one of the first. Reasons we use birth control for synchronization of the eggs. I, tell people, think of it like when you're going to run a race, you want everyone to start at the starting line. You don't want anyone cheating and we don't want any eggs cheating. So that's why we have everyone take. The birth control to synchronize them. But like I said, there's other ways to synchronize them, but there are situations where it may not be worth it. So I have patients who, let's say. Have only two or three eggs on their ovaries every month, meaning the follicles. And so in that situation, if I put them on birth control and let's say they made one less egg, that's a big deal. That's 50% or 33% of their egg quantity. So I may choose to do more. Like an estrogen priming, so I don't suppress as much. And although I'm going to get more. Of a spread, the thing is that at that point we are on, A kind of teeter totter deciding one. Risk is a little more than the other risk. And so I would rather take the. Risk of having spread versus having fewer. Eggs in that situation. But if you make plenty of eggs, such as if you make ten or. Twelve, if you make one less egg and get eleven, that's nothing to worry about. But there's another situation which we call upregulation of receptors. And what that means is that when. You'Re on birth control, you shut the brain down of making hormones and the. Ovaries start looking for that hormone because they're used to it being there. And they're like, where's that hormone? I don't know where it is. And so it starts up regulating the receptors and making more of them. And by making more of those receptors, then when you eventually stop the birth control and you start the stimulation, which. Is FSH hormone, it will respond better because there's more receptors to respond. Think of this like a brand new restaurant that opens up, let's call it a taco restaurant. That's really good tacos. When the customers are coming, like the. FSH come into the ovary, they just keep serving tacos. They don't even have to advertise because everyone's coming in. But when sales are down, the restaurant realizes people aren't coming, maybe they're not aware of it. So they need to advertise more. They have to make more receptors. And then what will happen is people will come back and the process will go again. Well, just like in your body, when the hormones are missing, the body makes more receptors to try to find it. Where most of this confusion comes from. Is because of the word Dimitri ovarian reserve. As I always stated, it's a horrible. Word because it's a grab bag term meaning if you have fewer follicles, let's. Say your antrofocal count is, let's say. Six, we call it dimension ovarian reserve. Even if you have an ovary removed. We still call it dimension ovarian reserve. If your FSH level is high, we. Call it dimensional variant reserve. If your AMH is low, we call. It diminished ovarian reserve. But the problem is, it's like saying automobile. Whether you have a truck, a car, it doesn't matter. They're all automobiles. And that's what diminished ovarian reserve means. It's just saying that there could be an issue. But as I've always stated, if you've had a surgery that's been worked on. Your ovary and now you make fewer follicles, that's different than someone who has. Had no surgeries and makes fewer follicles. Because at that .1 is due to. A Iatrogenic reason, whereas the other one is just because of something different about that patient. So you would then think that someone who has the severest of the M. Menace ovarian reserve would not benefit from birth control. But that's absolutely not true. Matter of fact, when women are close. To menopause, such as Perimenopause, their FSH levels are so high that when we give medicine, they barely respond. If you think about it, that kind of makes sense. If the body is constantly sending hormones. Down and the ovary is barely making an egg, it's not going to upregulate the receptors because it's always seeing those hormones. Just like if people are always coming. To my favorite Mexican restaurant getting tacos, they're not going to have to advertise. So one of the things we can. Do when people have a high FSH. Level is by putting them on birth. Control and suppressing it for a period. Of time, that upregulation receptor actually allows. Them to respond better. So I have some women who actually don't get a period and their FSH. Level can be as high as like 50 or 60. And then what I do is I put them on birth control and suppress their FSH level until it's a normal level. And then once it's been at a normal level, I stop the birth control and I hit them with FSH as. Well as letrozol to cause their body to make endogenous FSH meaning internal. And usually I'm able to get them. To make a follicle. Now again, it's not always true for everyone, but the point I want you to understand is that birth control isn't always bad. Matter of fact, I would even say it's rarely bad. There are times we shouldn't use birth. Control, but for most people, the benefit is usually greater than the risk. In the end, quantity of eggs makes. Us feel good, but it's the quality. Of the eggs, such as the ones. That are mature, that actually get us pregnant. In the end, your doctor may do things different ways, and I just want you to understand why they're doing it. Whether they use birth control, whether they. Use estrogen, whether they use nothing at. All, those are all legitimate ways to do IVF. The point here is I want you to understand why are they doing birth control, and I don't want you to be so worried about it. Now, I can make the argument if you're on birth control for a very. Long time, that is concerning. So no one should ever be on birth control for three or six months. If you've been on it continuous that. Whole time, then you might want to. Take a break off of it before starting IVF. Now there's an exception to that where. If you have polycystic ovarian syndrome, you might be fine because you always have. A lot of follicles. But for regular people, being on birth control continuous for a year and then. Jumping into an IVF cycle may not go well. It's better to just take a month off to give your body a break and then proceed with the IVF cycle after you've had a chance to get. Back on the birth control. As I always say, never be afraid. To ask your doctor questions. If this is something that's worrying you, ask them and they'll let you know why they chose to do what they did. M. But don't be afraid that you. Were put on birth control. I can honestly say very few people are over suppressed on birth control. There are times I do not think it should be used. I think there are other forms that you can use, but the point is it rarely causes disadvantages and the vantages usually outweigh them. As always, I greatly appreciate everyone who listens to the podcast. You love us. Give us a five star review on your favorite medium, and if you have a friend who's going through this, then maybe I've met them. Please tell them about the podcast. As always, ah, I look forward to talking to you again next week on, talk about Fertility Tuesday. M.