Infertility: Interview with specialist Dr. Tiffany Jones, MD

Getting pregnant isn't always easy. 

In this episode I speak with Dr. Jones, Reproductive Endocrinology and Infertility specialist and we discuss all things infertility. 

Do you have questions about the menstrual cycle, ovulation, infertility, what to expect when you see an infertility doctor and more? 
This is the episode for you!

Transcript

SPEAKER_02: 0:00

Hi everyone, it's been a while. Welcome back to the Four Vaginas Only podcast. I am back with some more episodes, and this is a very special one. It'll be the start of a few episodes where we discuss pregnancy and postpartum, which are the main reasons for my hiatus, and we'll talk about that in some episodes down the line. I'm so ready to start off this episode with a bop to my intro music. So let's do it. Hello and welcome to For Vaginas Only, the podcast about everything female. I'm your host, Dr. Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. In this episode, I have a great discussion with Dr. Tiffany Jones, a reproductive specialist in Dallas, Texas. We explain the menstrual cycle, infertility, we talk about ovulation predictor kits, what an infertility workup includes, and what to bring to your first infertility appointment, as well as all about infertility treatments. It's a little bit of a long one, but trust me, it's worth listening all the way through. So let's get to it. Welcome to uh the For Vaginas Only Podcast. I'm so glad to have you. I'm glad we could connect. Yeah. So nice to meet you. You too. So for everybody that's listening, um, Dr. Celestine, as you all know. And with me today, I have Dr. Tiffany Jones. Um, tell us a little bit about yourself, where you work, and um let the listeners hear about you.

SPEAKER_00: 1:37

Yeah, so I am a reproductive endocrinology and infertility specialist. Um so basically I'm Obi-Gyne trained, and then I did a three-year sub-specialty in infertility treatments. Um, I am word certified in OBGYN and I hail from Los Angeles, California, and I practice in Dallas, Texas. Um, after my residency in Obi-Gyne and at USC, I went to Mayo Clinic in Rochester. And then my my boyfriend, who I call my steadman, because we've been together since uh medical school, so that's about 13 years ago now. Um his family's here, so we decided to take roots here because uh there's no state tax and California is really expensive.

SPEAKER_02: 2:26

Yes, yes. I actually moved from West Virginia to New Jersey recently, and my husband's like, you know, it's way more expensive here than it was in West Virginia, so he's like cursing me. So today on the podcast, I really wanted to talk about some stuff that might seem basic to us, but one thing that I've realized a lot with the Four Vaginas Only podcast is that, well, the reason why I do it is because things that seem simple to me, everybody doesn't know, and everybody should know and have at least a basic understanding of it. Um so first and foremost, I wanted, we're talking about the menstrual cycle, we're talking about getting pregnant, we're talking about how a reproductive endocrinologist and infertility specialist can help you with those goals if you're having issues. But I like to start really from the beginning and talk about what exactly is a normal menstrual cycle. Yeah, just because your friend has, you know, a 28-day period, you've got a 21 or 22 one, doesn't mean it's not normal. So I always reinforce that a normal menstrual cycle can be anywhere from the 21 to 35 days. Um, but what do you talk about when it comes to the menstrual cycle and what's normal for your patients?

SPEAKER_00: 3:32

So I I generally have to start from the basics of you know what it is. I don't think we get a lot of uh good health education in our school system. So a typical cycle, we like to use 28 days. And so when you hear something like that, or when we use terms like normal, people don't understand that there's a normal distribution. So, like you said, 21 to 35 days is within the realm of normal, and whoever falls outside of that, you know, interval may have periods that are too frequent or too um infrequent. Uh, but I have to start off from it on a hormonal level because that's kind of what I do, yeah, and just explain to people how a cycle happens and why it being regular, whatever that time frame for you is important. So typically what I say is that you know our our system is regulated by the brain, as all all of our systems are, and there are hormones in the brain that stimulate the ovaries um which lie in the pelvis to uh produce other hormones that act upon our uterus. So I did bring my models because I love models. Let me tell you, we taught, like I am, you know, I'm not an artist, but I'm sensitive about my stuff. Okay. So I'm always drawing, and I'm an artist. I I draw, I draw, but like I said, I'm not an artist, so you're gonna work with me. But I brought my models with me today. So um, this is my little Yudi model. So hopefully this shows up for your viewers. Well, yeah. But pituitary gland in our brain, and that gland secretes hormones like follicle stimulating hormone and luteinizing hormones. And basically, in the ovary, which is here, the ovary is secreting um estrogen and progesterone and testosterone, so hormones that can regulate the cycle. And so estrogen is the most important part of growing the lining, which this is the uterus here, and the inside of the uterus is where the endometrial cavity is, and that lining grows every month, and it's growing all in preparation for pregnancy. And so, if a pregnancy occurs, the lining will sustain itself, but if it doesn't, a new cycle will commence to prepare us for pregnancy again. So estrogen starts to elevate it early in the cycle because of the follicle stimulating hormone. And once the estrogen reaches a threshold, an egg will be released from the ovary and travel through the fallopian tube, and maybe it's met by sperm, maybe fertilization occurs. But if it doesn't, then the progesterone that is secreted from the sac that's left behind once an egg is ovulated, that will go away. And so, as estrogen is what maintains the or what grows the lining, progesterone maintains it. So progesterone is very and we call it progestation. So progesterone. So if it if it's not needed anymore and it goes away, then so will the lining. And so then the lining will shed through the cervix and out through the vagina. And that happens every cycle if a cycle is regular. And how we get irregular cycles is something is not happening during that time. Mainly that I see it's we're not releasing an egg, and then there's no progesterone, so there's nothing to maintain this lining, and so it's truly not a cycle.

SPEAKER_02: 7:09

Right. Or the issue, or if you're having a hard time becoming pregnant, can happen at many different points along the way. Yeah. Um, so that's what's important to know, and it's nice to see that image. So anybody that's listening to the podcast, if you don't know, I do have a YouTube page and you can see what we're pointing to, you can see the diagram, and it helps visualize this just a little bit better. Yeah, yeah. So that's great. And ovulation, right? So when you say that's the most important or the most common reason why you see someone having issues becoming pregnant, um, is they're not releasing that egg. So why is it important to ovulate? Um, what actually triggers ovulation? What are the hormones that are important for ovulation?

SPEAKER_00: 7:53

So what triggers ovulation is a surge in the luteinizing hormone, which is also coming from that anterior pituitary gland. And it's in and there is a threshold of estrogen that is reached, and then we the body knows that there should be an egg that's ready to be matured. And so once that estrogen level up that is is reached, that threshold, then the luteinizing hormone that surges. So when women are tracking their ovulation on those home kits, um, they're usually tracking their urine for LH or luteinizing hormone. And it starts off very low, it's just very low, and then it just skyrockets. And about 36 hours off after the initiation of that um surge, an egg will be released.

SPEAKER_02: 8:44

Okay, so speaking of the ovulation predictor kits or OPK kits, if someone was trying to use them trying to get pregnant, what do you recommend? How did how do they use them? I recommend they follow what the box is, okay?

SPEAKER_00: 9:00

Can you read the box, please? Because I'm like, it's you know, generally it's the first void or early morning. And um, I I typically tell my patients to start around cycle day 10. There are some newer kits that I actually really like. Um, it's unfortunate that they're expensive, but um they're not color metric, meaning that they actually give you a number. You know, a lot of these kits are a happy or frowny face, a plus or minus, or it's uh shades of blue.

unknown: 9:30

Right.

SPEAKER_00: 9:30

And that I I get all these sticks, um they're like glued to a piece of paper, and then it's like, oh, I obviously that day it's like these sticks all look the same to me. So I know it's frustrating to the patients, but some of the trackers now um give you an actual level, so it'll be like five, five, then it's like 30. So you know you've surged. Um, but I I do think you have to follow the manufacturer's recommendation. But when I am telling people when they should start tracking, it's usually about cycle day 10 because um, you know, even if you're a shorter cycle, it's you know, the surge really shouldn't happen before that time. And you're really trying to see when the surge happens. You don't want to catch it at the peak because then you're really not gonna be able to say, you know, are you gonna ovulate in 12 hours or 24 hours? You're trying to start at that initial um part of the the surge where it's the onset.

SPEAKER_02: 10:28

Yeah. And then when do you recommend that people start to have intercourse whenever they see that surge or begin to understand when that surge happens for them?

SPEAKER_00: 10:36

So I typically tell patients, you know, if it's on at all possible around cycle day 10 to start having sex every other day, um, especially if you're doing this just at home without, you know, any input from your Obi-Guyne or from a fertility specialist, because you know, in a shorter cycle, um let's just say if you have a 21-day cycle, you have to subtract 14 days from, you know, when you're you got your last period to figure out when you're gonna ovulate. Um, so if you're around day 10, I mean a 21-day cycle is shorter. Um, so that's kind of like around day seven, but typically most people ovulate around day 14. So if you start around day 10 and sperm is in the tract for about three to five days, you're just kind of replenishing it so that there's sperm there to meet the egg when you do ovulate. Some couples can't do that, of course, because of work, you know, you're tired, somebody's out of town. Yeah, but uh typically, if it's possible, uh that's a really good strategy because that's kind of your fertile window.

SPEAKER_02: 11:42

Okay. Um, I always tell my patients that as well. I usually use day nine. I don't know, when we were training, that's what we had always learned from my um, but it's a similar, similar concept, yeah. Um, so it's interesting, I guess it's more of a personal question. So it sounds like you have you like the ones better with the ovulation predictor kits that have the numbers. Yeah.

SPEAKER_00: 12:05

So um I I personally don't like ovulation predictor kits. Oh, I think I mean it's just like it makes things like a science project. And when I'm working with fertility patients, um, things that we don't get into enough is like the the lack of intimacy between the partners when people start to try to get pregnant. Um, you know, really I understand like you women want some control, and doing those things can be helpful to some people who just want to like make sure and double check. But really, it's just you know, if you have sex at the right time, then you're gonna catch it. Just like me doing an ultrasound. I an ultrasound doesn't make you ovulate, it just checks to see if you are. So if you have to watch the water boiling, sometimes it feels like it's never gonna come on. So I think it's a stressor. But why I like if if I had to pick one, um, and I don't promote for any of those tractors, that's why I haven't used their names, but um I do feel that, especially like if you think of polycystic ovary syndrome patients, the people who probably need them the most, well, their basal LH or baseline LH is higher. So you might have a positive all the time, and they come, Dr. Jones. Well, I ovulate. Well, when did it turn positive? Day nine. Girl, was a positive day 10? Yes. Was it positive day 11? Yes. Was it positive day 23? Yes. And it's like, well, okay, well, that's the longest surge and peak I've ever seen. And it's because it's always going to be positive because your baseline is at the threshold of the positive test.

SPEAKER_01: 13:49

Right.

SPEAKER_00: 13:49

So in those patients, it's um it's very wasteful of resources to continuously check. And, you know, and then on the other side, there's some people it never turns positive and they are ovulating. So the reason I like it to give me an actual number because I think it's easier to interpret than a you know, a shade of blue.

SPEAKER_02: 14:11

No, I agree. And I a lot of patients that come to me, I mean, obviously they come to me a lot of times a little earlier than they would come to you. They're just starting to try, and I'm like, and they're already asking me about ovulation predictor kits. I'm like, just have fun. Don't worry about it.

SPEAKER_00: 14:26

I tell people the most, I mean, like, and and fertility, you know, like infertility is a it's a disease, right? Yeah. But some people before they even are diagnosed with infertility, you know, it's just, you know, you've been trying for three months and it's like there's a there's sometimes where there's a level of impatience. And so I tell people, especially when they haven't tried for very long and there's no underlying issue that needs to be addressed sooner, is most babies were probably made in the club after night drinking, you know, where nobody's trying. And so it's really that when you start watching that clock, that a lot of times you just, you know, and then you start seeing everybody else with positive pregnancy tests and baby showers and all this. So you just start to notice it. But really, if you have sex around the right time and you give it some time, uh most people will get pregnant if they don't have infertility, right? Or a reason to, you know, like check for infertility early.

SPEAKER_02: 15:26

Is it still considered a 20% chance each month of getting pregnant?

SPEAKER_00: 15:30

Do you still follow that statistic? That's why I say don't watch, don't watch that clock. Right. 20%, the opposite is the other side of that is 80. Right. So you it's a cumulative pregnancy rate that we're looking for, and that's why we give it a year for women who are under the age of 35 with no, you know, reasons, you know, it's not if you have a uterus full of fibroids, no, this is not a year wait. Right. If you have polycystic ovary syndrome and you never ovulate, do not wait a year. But if there's nothing going on, you have regular periods and there's there's no reason to intervene early, giving it a year, you know, 80% of people will get pregnant within a year, and 90% will get pregnant in two years. Um, so we recommend intervention at a year or at least a workup at that point.

SPEAKER_02: 16:18

Yeah. And is that still for those under 35 or what's the ages that you recommend? A year versus six months, or versus Yeah.

SPEAKER_00: 16:27

So 35 is our, you know, is our cutoff point. So if you're less than that, it's a year. And if you're over that, then it should be six months. And that's basically because after 35, if if there's infertility, you know the treatments really matter on age. So don't we don't want to waste another six months. That could be an effective treatment with just something as simple as Clomid. Um, so it's probably better to intervene earlier for people at 35. And but it but again, some people it might, you know, I've had people start their workup and they're pregnant after the HSG. We can't even finish.

SPEAKER_01: 17:08

So I know that baby too, though. Oh gosh.

SPEAKER_02: 17:13

A lot of my friends, I mean, I'm in like that age group where everybody is getting pregnant right now. So a lot of my friends that's happened too, you know, or they start their infertility work up and then they get pregnant naturally. Yeah. Um, so which is great.

SPEAKER_00: 17:24

That's a that's a good feeling.

SPEAKER_02: 17:26

Yeah, yeah, yeah, yeah. So when somebody comes to you, say they've been trying for a year under 35 or six months over 35, and their OBGIN, like myself, tells them, you know, I really think you probably need more specialized help. I guess let me back up. What's the what would you like their OBGIN to complete and to do before they get to you? That's my first question.

SPEAKER_00: 17:51

I think, you know, we all do a very thorough um history and physical. So that's my number one thing because, you know, in someone's history, especially their menstrual history, you're gonna pick up on cues, like you said, if your cycles are, you know, really irregular, you know, you're picking up ovulation issues, you know, if if if sexual frequency is not enough and you're counseling on how to improve that, if you are asking the real good questions, like, you know, is there any erectile fun dysfunction in the partner? You know, those are things that you could easily miss because we're OB Gyns, and that's not really something we, you're not gonna get into people's all-day business, but that's the business at hand, is you know, like, you know, we need two of you guys to make this one baby. And so um, those questions about the partner um can help identify some things that need intervention. I do think that we use um one of our best tools too infrequently, and that's the ultrasound. And as a black woman who knows that other black women are likely to have fibroids causing it, it's like, why are you waiting till my fibroids get to be 10 feet tall before we find it and you cutting me from stenasternum? So, you know, like those kind of things, um, you know, I think getting an ultrasound, because that's part of my assessment, and that would be helpful. I think a lot of obiguines are a little fearful of AMH. I'm not sure your feelings of it. I know AMH.

SPEAKER_02: 19:14

I love testing for AMH.

SPEAKER_00: 19:16

Thank you. But if you have a patient who is trying to get pregnant and they fall in that criteria where they're tipping over to infertility, when you refer, it's nice if I have a landing pad of, you know, there's an ultrasound that has been done, so I can look at that and AMH, so I can like boom, okay. The AMH is low, it's high, it's normal. We can go somewhere with that instead of me doing my initial set assessment, they have nothing. And then it's like this longer drawn out process when I don't have any any basic right, like ring blasts. Yeah, yeah. I'm about saving that coin. So if it's been it's been like if you're if you're older and it's been six months, I will repeat some things. If it, if you're a young woman and you've had an AMH within a year, I typically don't repeat it. Okay. You know, ultrasounds we do all the time, even during treatment. So that that's a likelihood of getting repeated. But again, it gives us a nice baseline conversation to start with when a woman enters my office. So I really love that. And a semen analysis for the partner. I think that's completely appropriate for a basic workup of fertility to you know send the man 40% of the time, he's at least a contributory factor. And I know it's like pulling teeth trying to get him to go do it, but it is it gives a wealth of information to the couple and can probably identify some people who have some serious issues early.

SPEAKER_02: 20:45

Agreed. I totally agree. I that's usually part of the workup I do, but I've also I'm a little bit biased. I've also had a special interest in fertility for a long time.

unknown: 20:54

Yeah.

SPEAKER_02: 20:54

So I feel like I always have kind of like my finger on that pulse, like, what should I be doing? You know, so it's a little bit well, your patients are benefiting from that. So yeah, I hope so. So when they finally do get to you, what should they expect? Is there anything they should bring with them? Is there anything in particular that goes down in that first meeting that you'd like people to know about?

SPEAKER_00: 21:15

I would love it if my patients, um, my newly referred patients will bring their records. I mean, it is just, it's just so refreshing to start with something and to leave a doctor's office with some information. You know, and and I and I can educate you on like statistics and a worldview, a bird's eye view of what it is at this age group and that. But it's just really, I think as a patient, refreshing to say, you, this is me, this is what I think about you. And having records of things that have already been done is really helpful to start the conversation at a higher level. Um, and I think you know, if they do charting and things like that, that's very helpful. Um of people use period trackers um so um i think that's very helpful because one the what we remember and what is accurate are sometimes very different and so somebody be like oh reflex i have 28 day cycles and i'm looking through that phone like girl there's not one 28 day cycle you you done missed the whole January February I was stressed okay that you see that's not 28 days okay the tracker saying it's 45 so somebody ain't right and so it's just helpful right in those scenarios um to have that kind of information that's um a little bit more concrete and not rely on your memory um because honestly I couldn't tell you without my tracker you know how regular irregular my cycles are because I'm busy right you know it's not the best time of the month I'm not just you know and I'm not trying to get pregnant when you're trying to get pregnant you might be a little bit more um on top of it but using a track I tell people that all the time even when it comes to simple things like birth control pills I'm like I have a hard time taking them so I can't even imagine other people like remembering on time so it's just yeah exactly exactly all right so do you do any is it just counseling usually the first visit and then what happens next? So on a first visit I usually do counseling and when we were still doing first visits in the office I did an ultrasound because again it gives us some like this is you scenario and the next steps usually are some blood work if if it hasn't been done and I would say 90% of my patients don't come with any blood work. So we're doing blood work of AMH sometimes if it's correct in the cycle early in the cycle we do FSH and estrogen they're my least favorite of doing now because it is cycle dependent and you know I just feel like it kind of slows down the workup and it doesn't give me a lot of extra information over the AMH and ultrasound together. So blood work ultrasound and HSG I um have made a balance in my practice like I treat a lot of same-sex couples so it's really a situational infertility when it's two women right and so you know in that I give an option of um HSGs although the treatments can be so expensive that you don't want to find out in hindsight once you've done a couple of IUIs. People get real mad your tubes are blocked and we can do an IUI yeah but you know if there's no history of um STI, a sexually transmitted infection or if you know there's no endometriosis history or you know things like surgery to the pelvis that I am thinking we're gonna find tubal most of the time it's open and so I I do give some people the option of doing it but for the most part it's part of the initial evaluation. And then I do a cavity evaluation with a hysteroscopy we do them in the office. Okay. And there's a very high prevalence of polyps um in patients so in for infertility patients um so um in and an HSG can give you some kind of a cavity evaluation but the false positive rate is so high it's like is that a shadow is that a column I don't know what that is and for your listeners an HSG or histostalpingogram is just an X-ray I'm using iodinated dye that can be picked up on X-ray and if the dye goes in the uterus and it goes out the fallopian tubes I know they're open but if it doesn't go out the fallopian tube it's blocked or there's a tubal spasm that's preventing the fluid from going through and so that's how we could diagnose some tubal um blockage or even damage.

SPEAKER_02: 25:44

Right. And then a hysteroscopy is where we just look into the uterus directly with the camera and we can see what's inside of the uterus. Okay. So what are I know we talk about many different causes of infertility throughout this whole discussion but what are like the top three causes that you usually encounter so PCOS by far polycystic ovary syndrome where um a woman isn't ovulating that's like the number one thing I see and then male factor again it's very prevalent um and then the other factor is fibroids. So um I'm an African American physician I have probably 90% of my practice is African American women um all age ranges and it seems like no matter you know they might have said when I was training that fibroids happen you know like 30s 40s nah okay they happen early and then they get bigger in your 30s and 40s but yeah because I do an ultrasound I see them you know sometimes they're uh a cause for for infertility sometimes they're just uh like an incidental finding finding um but I they're very very common um especially in African American women right yeah back when I was training I did a whole entire like a research project for years just about fibroids so I mean learning being African American myself obviously a lot of my family members have fibroids but are saying the science behind it and how common it truly is was just it was crazy. It was interesting and I can't believe you see first of all I can't believe you have so many African American patients in your practice.

SPEAKER_00: 27:19

It's a blessing it's so I mean I have all I mean I have all ethnicities yeah but I am the only um African American um fertility specialist in Dallas that does full spectrum service my colleague Dr.

SPEAKER_02: 27:34

Lisa King in DeSoto Texas she is a um board certified reproductive endocrinologist but she doesn't do IVF right now so so it's just me and so um as I've built my practice I mean you know just people want to see who they want to see and I'm very blessed to have um that demographic as um part of my patient base a large part of it I'm sure they're so glad to find you you know yeah we have a good time yeah though we can't we can't share a wall with other doctors because we're we're in there clowning so that's awesome that's so great um so depending on I mean I know this might be a hard question to answer but um or maybe not I wanted to kind of discuss the different types of treatment options that are available um maybe starting with like what you would try first or you know why you would try this versus that or however you want to present it I've heard a lot you know about starting with IUIs and then you can go to IVF but I don't do this stuff so I want to hear from you.

SPEAKER_00: 28:37

So there you really should be treating the underlying condition right so if I think it's fibroids then I will do a fibroid surgery and then send my patient to try some more on their own because that is the diagnosis. But we can do fertility treatments even in those patients outside of myomectomies. It's just kind of really what a patient desires to do. A lot of my fertility patients want to do things as naturally as possible. I mean it's you know it's just it's just how they feel and I always try to meet people where they are. So the the most successful treatment option is also the most expensive and that's IVF. Okay some people have to go straight to IVF be it an age issue where it's really recommended that they have genetic testing because you know the success rates for everything else is so low. If they have tubal factor infertility or very severe male factor um if they have recurrent pregnancy loss and you know they just want to do genetic testing on an embryo to make sure that it's normal those are indications why people go straight to IVF first. But it's very hard for everyone to go straight to IVF first because it's so expensive. And if that was the only treatment I could offer my patients I don't think that I would have as many patients as I do. Okay. So the other options are you know if if IVF is up here with success around 70% in some um age groups yeah everything else is like here okay and it's not that it it can't work but it's just when you think about how we get pregnant it's a little bit of miracle and magic okay an egg is one cell it's microscopic it's released into your body and then your fallopian tube has to find it or it finds your fallopian tube and then has to go up the wrong way of a slide which is your tube to then meet a sperm that happened you know when you had sex at the right time and the sperm swam the right way in the right tube and then it has to fertilize normally in that tube okay and then it has to start dividing correctly and I know from how we watch embryos divide in a lab that it don't happen all the time okay it's a perfect you know perfect system and then it has to get into the uterus from the tube and then start its implantation first hatch out of its shell because yes we start off in a shell too and then implant and grow and survive it is not an easy thing. And what IBF does is it takes away a lot of those uh things and it makes it happen right so I make an embryo and so and that embryo can hatch even in the lab and then it's put into the body and now all it has to do is stick. Even in IBF we can tell if something is genetically normal. So we've taken a lot of the you know barriers out of you know getting pregnant with all the things that have to happen in the body. So it and and so doing things like ovulation induction like clomid right so clomid can make you ovulate if you are not ovulating and if that's your only issue you would think oh yeah well now I'm gonna get pregnant off my first clomid cycle because now I'm ovulating it's like well no that's not the only thing okay yeah it's it's it's a lot more hurt we might release the egg but I don't know if the egg lands by the liver I don't know what an egg went I don't know no go pro cam is that small we don't know right so um you know it's it's a part of the battle but it's not the full picture and I've had plenty of patients get pregnant off of clomid and it's a counterpart letrazole or even using the injectable medications to really stimulate their ovary to release more eggs but most of the time it doesn't work. Right. You know like it is in in some age groups it's like eight percent you know after 35 wow you know who would do any treatment that's eight percent successful that's like nothing. Yeah you know but again I'm telling you like if I only could offer IVF then a lot of people would have no hope. Yeah and um you know it does work for some people but a lot of people end up doing multiple cycles yeah and then having to go on to something else and and that's incredibly frustrating and emotionally you know charging for patients um especially because the resources are often limited the intrauterine insemination you mentioned um I reserve that for patients who have unexplained infertility because we feel that you know maybe there's a cervical factor that we really can't identify concentrating the sperm um filtering it so it's the best quality sperm and putting it directly into the uterus instead of letting it be deposited into the vagina where it has to swim up the cervix and be filtered that way. That'll put a higher concentration in the body and hopefully the sperm will swim in the right direction to where they're supposed to go. But most studies show that that is increasing your success by about five percent so the you know like I said every I will do anything a patient I'll meet them where they are but we all have to be very cognizant of the data and being very thankful when it does happen but also being um understanding when that cycle doesn't um end up to what we want it because we understand that the statistics of it are that we'll end up needing to do multiple cycles to probably get to the baby and if not you know IBF may be something that we have to try. And what most people should really take away from this conversation is that the workup the diagnostic workup either if it's with your OB or with a specialist is generally covered by your insurance. So at least understanding what's going on even if you don't move forward with treatments because they're expensive or you know you just don't want to utilize treatments because of whatever your belief system is, understanding what the underlying cause is can really be helpful and um provide you with some good clarity.

SPEAKER_02: 35:06

Yeah this is great. I love this I feel like I have so many people that come to me including not even just patients. I mean friends, you know, family my mind is already blowing up just in this I'm like so I really feel like talking about where you start or even just make normalizing this you know what I mean? Because I feel like conversations like this are important so that more people can understand that this is a normal thing. This is very common. A lot of patients have to go through me as an OBGYN and end up with you as a reproductive specialist to get to their goal. So I just wanted to talk about that today and I'm so glad to talk to you about it and to get some insight from what you see every day and teaching me a little something too, you know I'd love for you to come back. Thank you to Dr. Jones for coming through and keeping it real on the Four Vaginas Only podcast. I really appreciate it. You can catch her in at her office in Dallas, Texas or she's also on Instagram at T Jones J-O-N-E-S-I-V-F-M-D. That's T Jones I V F M D. And as usual you can catch me at 4 Vaginas Only on Instagram, on Facebook and also on our new YouTube page where you can see a video of this very podcast episode and you can watch the diagrams and what we're pointing to and get a full grasp of exactly what we were talking about if you catch this on video form at the 4 Vaginas only YouTube page. And that's it for now bye guys see you in the next episode