Why Amy Schumer's IVFs Didn't Work and How to Make Your Next IVF Better

Dr. Amber Klimczak and Dr. Beverly Reed discuss how Amy Schumer opened up about her multiple unsuccessful IVF cycles. They discuss how to analyze an IVF cycle that didn't work. They discuss opportunities for improvement and how to learn from the past.

Transcript

0:06

Hi, I am Dr. Beverly Reed. And I'm Dr. Amber k Clack. And we are two peaks in a pod. Pod. Pod. Well, hi everybody. Welcome back. If you are watching the YouTube version of this, you may notice we have a different setup today. I'm trying out something different. Yes, very fancy. We can, I guess I can give a shout out to my friend Mike Morris. He is a podcast consultant and he came by and said, y'all need some color. So here we're with our pink color. So you guys can let us know if you like it. Yeah. We've been podcasting from like a dungeon room with just plain gray walls. Yes. I told him we could we do Lazy Girl podcast. I was like, we don't have much of a setup. We just, we're so busy we just tape record. Yeah. So today we put a little more effort in you guys. Let us know if you like it. Um, okay. Dr. Kay. So I wanted to ask you if you have heard about. Amy Schumer, she's a celebrity. You know her? Yes, definitely. Okay, good. Yeah, because you don't usually know the reality shows, but I feel like, you know, the actress and the actresses. Mm-hmm. She's comedian, you know, actress. Yes, yes. Yeah. Always like very down to earth, I feel like. Yes. She's so funny. Yes. Mm-hmm. Um, and, but you know, I always really appreciate it when celebrities are willing to open up about their fertility journeys, especially when it didn't necessarily have a happy ending. Yeah, absolutely. You know, isn't that so hard to share Sometimes, yes.'cause I think we've talked about this before where sometimes it feels like celebrities might be getting special treatment. Yeah. Like they're like, I don't understand why everything, every medical treatment they have works and mine doesn't. That's so true. And so it's, I think it is nice for a celebrity be. Celebrity to be transparent about something that was sort of a failure for them. Yeah.'cause I think, you know, from just a normal person perspective, we say, gosh, if a famous actress, you know, who can afford the best of the best everywhere. If she tries IVF and it doesn't work, then maybe it kind of can just make you feel. Not as alone. Mm-hmm. Or maybe trapped in your circumstances. Um, and so I thought maybe it would be good to talk about her case. Um, so she actually has a child, but then when she went to go have her second child, it sounds like she really struggled. Right. Have you heard her talk about her IVF journey? Yeah. Yeah. I know that she had released some statements about how tough. IVF is. Mm-hmm. And, um, yeah, I guess she had sort of secondary infertility. Mm-hmm. Mm-hmm. And I think it's so hard when you not only try IV F1 time, but multiple times. Mm-hmm. And it's still not working. And sadly, it sounds like she ended up deciding to close her journey after she wasn't finding success with IVF, right? Mm-hmm. Yeah. So I, our understanding from what she's released is that she went through multiple rounds of IVF, ultimately, I think they had one embryo available to transfer and mm-hmm. And that one didn't implant or wasn't successful and then decided to just sort of be content with her family size as it is and not pursue any further. Yeah. Yeah. Well, maybe we can talk about why IVF doesn't work Sometimes, and I will say even me before I was a fertility doctor. I actually thought I VF was a guarantee, right? You, it's kind of just, yes, it's mentioned in medical school and even during OB GYN, you kind of help monitor the patients and everything, but sometimes you don't have a true sense of the statistics. And I just always thought, oh, if, if you need to do IVF, you just do IVF and it's gonna work, it's gonna be fine. And I think that was one of the biggest things that shocked me as I was learning about fertility is. Age is such a big factor that with current science and technology, sometimes even the most aggressive treatment cannot overcome female age. Right. Right. And I think the other shocking thing for patients or people who might just be getting introduced to the idea of doing IVF is that you can understand success rates for one cha like one time. Mm-hmm. Right? Like Amy Schumer had one embryo or going through IV F1 time, and I think everyone kind of thinks. Well, if you can just go through it multiple times, at some point it might work. Mm-hmm. But I think it's really challenging to accept also that you could do this treatment several times like Amy Schumer did, and still not have success at the end of it. Yeah. Yeah. I wonder how old Amy was when she did IVF? I don't know. Do you know? No, but she's, I mean, she's pretty young in general. Yeah. She seems young to me. Mm-hmm. Yeah. Yeah. But sometimes people will come into my office feeling very old. And I'll say, you're not old, you're a little spring chicken. You know, they'll come in and they're like 32 or something. They're like, I'm so old. And I'm like, you're my youngest patient. I've seen all month. Whatcha talking about, you know? Um, or sometimes I see the opposite, where I'll have somebody coming in, you know, maybe they're 45 and they're like, I feel so young. And, and here's the thing too, I mean, they will look amazing. Take, they've taken really good care of their health, their. Skin, they've, I don't know, they've got some magic skin creams or something. They look like they're 25. Yeah. But maybe they're 45. And the hard part is, I feel like for those patients, that is where it's hardest to accept for them.'cause they feel young. They look young. But the ovaries don't always match up with that. Yes. Yeah. And for some patients, a visit to, you know, our office is the first time that really anyone has been straightforward with them about their fertility. Yeah. And that your prime fertile life is at such a young age. You know, it really. Seems like so many women are having success with IVF and, and treatments later, you know, late thirties and early forties, when in actuality it's still hard for these treatments to work at that age. Yeah, yeah, absolutely. Yeah. Well, let's kind of talk about some of the other reasons why IVF may not work, because as much as I, or as much as age is the most important factor, we also can't really do anything about it. So aside from just being able to tell people what their chances are based on their age, I tend not to focus on it too much. Mm-hmm. Because I say let's focus on things that are more actionable. And so I know you see a lot of patients who've tried IVF elsewhere, they do IVF with you. You're like, magic. They get pregnant. So like how, can you walk me through, uh, what, what do you ask them about their IVF cycles that they already did and, and that didn't work, and then how are you able to turn it around for them? Yeah. I mean, definitely to our listeners that are out there that might be going through IVF or have had had a failed IVF. Uh, cycle in the past, we are always o open to seeing second opinion patients. That's something that Dr. And Reed and I do quite a bit, and you don't even have to cycle with us. That's the first thing I tell my patients is I say, my role as your second opinion doctor is to arm you with information. So even if you live elsewhere or you're already attached to another clinic or doctor, at least you have. Some other information to go back to them and ask about. Right. And so I really try and break it down into three simple parts so that the patient can sort of take notes and understand what goes into one IVF cycle. So the way that I break it down is sort of the lead up to IVF, right? Getting your body ready for IVF and deciding what sort of lead in we wanna do. And then the IVF. Stimulation or protocol itself is sort of that part two. And then part three is this whole be behind the scenes part that a lot of people don't even know is happening or can be changed. And that's the embryology lab side of things. That's once your eggs come outta your body and we hand them off to the embryologist, what happens to them. Um, and so I like to walk through what they've done previously. Right. Because I say it's like playing Monday morning quarterback. Yeah. We're cheating, right? Yeah. Like we're not amazing. Specialist doctors that we have information that the first doctor that stimulated you didn't have. Right, right, right. And so we go through really in detail and try and figure out what didn't work for you. Yeah, right. And what other suggestions maybe could we do to try on, based off of your health history and your body and your ultrasound and your ovaries, can you know what things can we change that might be a better fit for you? And I think all three of those. Parts are really, really important. Yeah. Yeah. Well, and I would say maybe a couple things about that. First, I think you'll see from both of us, we're never gonna put down your fertility doctor, because sincerely, we know all the fertility doctors in town and all over and truly, when we talk to them, we know. They really do want you to get pregnant. Mm-hmm. None of us want to do a bad job for you. Um, so just knowing that everybody's coming from a good place, I think is important. They all wanna help you. Um, but sometimes people just have different styles. Right. Um, so let's say you go to an Italian restaurant and you have lasagna there. And you don't like it. And then you might go to another Italian restaurant and they have the most amazing lasagna you've ever had. Right? What is it? It's different chefs, it's different recipes, it's the same meal. It's just made in a different way. Right. And I think our bodies are all. So different that sometimes just having a different chef can be a little bit helpful. If you tried one recipe that didn't work, maybe try another recipe and see if you do a little bit better with it, right? Absolutely. Yeah. Mm-hmm. Definitely. And I think recently, you know, Dr. Reed has really been, um. I think experimenting and getting into the data on some of these ways to prime IVF cycles, um, newer ways to prime IVF cycles. So when we talk about the prep month or leading into IVF, there's definitely some lifestyle modifications that we like to do for our. Or patients. Um, and then there's other kind of creative ways that I think a lot of patients have never even heard of. Mm-hmm. That you can do leading into, into your IVF cycle. What are some of those things they've done? Because I've had patients have success with this now as well. Yes. Oh yeah. Well, absolutely. Well, I guess it kind of goes back to. And I do try to reassure people too. If you've done IVF, it was for two reasons. One, to help you get pregnant, but the other reason is to learn more about your body and what is going on. And so when I go to look to see what their priming was, what their preparation month was, that's really where I try to focus and see, okay, you know, did, how did their follicles look? How many follicles did they have? Were they synchronized? And then really, how was their lifestyle at that time? I actually have just a really interesting story recently with a set of identical twins where one has totally normal egg count levels. The other one has very low egg count levels. And when I asked them about all their differences, one of the biggest differences was diet. And um, so one of them never missed a meal and had a. You know, diet full of variety and seafood. The other one says, I, I don't even like to eat. I don't want to eat. I don't have an appetite. And she says, what's that? Laughing. She said, I know. She said, I hate seafood. I eat like a toddler, is what she said. That's so interesting. Yeah. Um, she said, I eat chicken nuggets and fruit loops, you know? Um, and I thought it was so interesting because with identical twins, it takes out the genetic factor. A lot of us feel genetics are probably so important mm-hmm. To your ovarian reserve. But it really kind of told me, wow, things like nutrition can really make such a big impact. So during a preparation month, that is a great month to be eat, following a Mediterranean diet, avoiding all of the toxins around you, no smoking, no alcohol, um, no drug use for both partners, um, as well, really trying to optimize the sperm and the egg quality, getting really good sleep, lowering stress levels, um, as much as you can, avoiding any exposure to. Plastics and receipt paper. These all, all these things have BPA in them. So this is kind of the chance to really gear up so we can have the best cycle. Right, right. Yeah, I get asked about that a lot and we've, I think we've talked about this on, on our podcast before. Yeah. But even though maybe when we scan you and look at your ovaries and those. Follicles sitting on the surface of your ovary a month prior to doing your IVF cycle, even though those aren't the ones that we necessarily are gonna be growing in a month or two months. Um, there are still follicles in your ovary that are kind of like, sort of coming to the surface mm-hmm. For lack of a better explanation. And they are starting to experience a little bit of exposure. So, um, you know, in a, in a more. Priming type of way, you can maybe even increase your caloric intake. I've had some patients who are very, very thin, live, very stressful lives, and kind of like your identical twin that doesn't like to just don't eat enough to su sustain, um, their busy lives. And so, you know, we've even, you know, had them increase. Caloric intakes by, um, weight gaining shakes and things like that. And I have seen improvements Yeah. Um, in their IVF stimulation with that. That's great. Yeah. I really encourage my patients, if they're normal or low weight, to really make sure their body is always in a caloric excess, never in a caloric deficit because, and I don't think patients do it intentionally. I think sometimes they're, you know. Busy, they're too busy. Or some of them just love to work out so much. It's such a good stress reliever. Mm-hmm. But then they don't realize they're burning off. I'm burning off so many calories, they're not replacing them. And the way our bodies are made is, it's really just trying to protect our own bodies of like, Hey, if I don't have enough calories for me, I'm not gonna have enough calories for a baby. Right. And so, um, I do think it's at a really important time to make sure that your nutrition is better, better than ever. Mm-hmm. Absolutely. So these are lifestyle tips, right? And I think you have probably heard of some of them, right? And you can incorporate them. But then there's other things that we can do in terms of medications and ways that we can lead into your IVF stimulation. And so some of the more traditional ones and, and probably the number one that I see mm-hmm. Way to lead into an IVF stimulation is that patients will be. Placed on just simple birth control pills, right? Mm-hmm. And I think this has a lot to do with timing. Mm-hmm. And just controlling the cycle and having more predictability. Yeah. Because there's a lot of planning that goes into IPF both for the patient. Mm-hmm. Doctor, the clinic, the embryology lab. There's a lot of things to coordinate. So birth control pills are certainly a nice way, um, that we can coordinate all of that. And for a lot of women, they work beautifully. Yeah. Right. To lead in. Absolutely. In time. Your IVF cycle. Yeah. Yeah. And. You know, I do think it's just a moment to recognize what a luxury it is that we have here, which is we have in-house full-time embryologists who will work night and day, weekends, holidays, whatever they need to do, um, to get our patients the best outcome. I. But realistically, there are some places that are providing access to care in more rural areas that may have trouble either recruiting, retaining, or paying somebody. Mm-hmm. To be there all the time. And so places like that sometimes use a technique called batching, where perhaps they fly in an embryologist quarterly. Maybe just four times a year or something. And when you're doing that, you really have to get all of your patients to be able to do their egg retrievals and transfers at the same time. And the only way to realistically do that in most cases, is to put everybody on birth control pills, because when you're on birth control pills, you can control when your period starts, when your simulation is gonna start and everything. And so I do think it's certainly reasonable for women who have normal or high ovarian reserve. Who have never tried IVF before and who are in, in an area where, um, their access to care may not be as great. And so no criticism there. But I will say it is really hard because there are some patients that may not do as well with IVF if they are primed with birth control pills. Definitely. Yeah, definitely. And then I would. Say, probably the next most common lead in that I see is just using estrogen of I'm of some form. Um, this is called estrogen priming, where, you know, estrogen is one component of, of birth control pills. That's usually where people have heard of it, but just estrogen by itself without any progesterone, and you usually start it in that. Menstrual cycle before you're gonna start IVF you started after you ovulate what we call the luteal phase or the second part of your menstrual cycle. You can do patches, you can do pills. There's lots of different ways you can do it. Um, the idea with estrogen priming is to synchronize all of your follicles as much as possible so that when you do get your period, which you will get a period just as expected. It's not really changing the timing much. When you do get your period and we pull you off that all of your follicles are sort of the same size and ready to go out of the gates at the same size. Yes. I think, you know. Mm-hmm. Estrogen priming is definitely one of my favorites, and I think it's because in particular we see a lot of patients with really low egg counts. Mm-hmm. And I do feel that a prolonged course of birth control pills can be too suppressive to the ovaries. Mm-hmm. You know, I'm even Okay sometimes with one or two weeks or something like that, but sometimes these patients are put on months of birth control pills and I think it's just. So hard for the ovaries to rebound quickly from that when you're doing IVF. But when you are just giving estrogen, I think it's so much more gentle and also it can actually upregulate the receptors on the follicles so that they are then more sensitive to those injection medications that you end up starting. Um, so I think it's a great option, especially too, if you are trying to get those follicles very synchronized in size. But I do like sometimes how you will do no priming. Sometimes they say the best doctors use the least medicine. Okay. And so, yeah, sometimes you'll do just kind of a random start, right? Yeah. I like to, I really like to look at my patients at a couple different points in their menstrual cycles. I will say that, that my patients sometimes are like, well, why do you scan me at a random time in my cycle? You know, you've probably heard if you're going through fertility treatment. You should have a day three ultrasound, you know, like you gotta get day one. And I've heard people get very stressed about getting in for day three. Yeah. And I'm like, look, I love to see what your ovaries look like at any point in your cycle. Yeah. Um, it's really helpful for me and I think it's helped me evolve as a doctor as well to see the different ways and responses and stimulation that I can get. Um, and so I do start a lot of people in different points of their menstrual cycle mm-hmm. Based on what I think their body is capable of and the waves. Of recruitment. Um, and so one of my favorite times to start is late in the luteal phase or that second part of your cycle right before you get a period. Um, my patients know that a lot of times I'll start them right then and it kind of freaks'em out'cause they might get their period during their simulation. So I always have to warm them. Yeah. Um, my favorite times to start, I really do like to do no, no intro if I don't have to. Yeah. Um, kind of no lead in if, if their cycle will fall when I want it to. Kinda late, late lu dealer Right. When they're about to bleed. Mm-hmm. That's like my favorite starts, I think. Yeah. Yeah. I really think that's something that I hope we can continue to educate people on, is that you don't need your period to come before you start your injections. Mm-hmm. Um, the old way of doing IVF. Yes, that was required because in the old way of doing IVF, once the eggs got pulled out, you were then subsequently doing a fresh embryo transfer. And if that's the case, then yes, your stimulation and your period need to be closely coordinated with each other. But with modern IVF. Where fresh transfers are almost never done anymore. I did have one recently, but they're almost never done anymore, um, in that case. And she's pregnant? Yes, she's pregnant. Yes. Um, but, but in the case of doing frozen embryo transfers like most people are doing now. Your uterus can be doing whatever it wants to do it. Your, your period can come, it cannot come. It doesn't matter. We just ignore the uterus during your stimulation. We stay focused on the ovaries and that is okay. And nothing to stress or worry about at all. Yeah, yeah, yeah. Do you ever use Lupron to lead into IVF cycles? Yes. I'm seeing actually more with my second hand, second opinion. Yeah. Patients. I've been seeing a lot more doctors. Yeah. Using Lupron to lead in and I, to me this is kind of like an older protocol. Yeah. So when I see it, yeah. And sometimes the patients actually do really well with it. So I'm curious kind of what your experience is. My patients never do well with it. I don't know what I'm doing, but, well, I think. First, it's interesting because this is where I always feel bad for our nurses. Mm-hmm. There are so many different kinds of Lupron. Right, that's true. So there's regular Lupron. Mm-hmm. There's Microdose Lupron, and then there's Depo Lupron, right? Mm-hmm. And so, um, the first two are the ones that sometimes we use during IVF. Um, I actually think, um, regular Lupron is great if you have somebody that has kind of the perfect ovarian reserve to do it. The problem is you can't use it on anybody who has a high ovarian reserve. Because if you're using Lupron, that medication is what you're using to keep from ovulating throughout the stimulation. If you're using that, it requires you to use an HCG trigger injection. And when you use an HCG trigger injection, you can be at higher risk for having Hyperstimulation syndrome. And so I think that's why we really don't see it a lot anymore. We used to see it a lot in the past. But nowadays, because they really like to reduce the risk of hyperstimulation, a lot of times this protocol is not chosen. So I usually would choose somebody who's middle of the road ovarian reserve. If their ovarian reserve is too low. I think sometimes it can be too suppressive. Mm-hmm. And so it kind of has to be the perfect patient. Um, but I, I have somebody on it this week too, and she's responding very nicely. I think it's great. You know how, um, during a regular IVF cycle, if you're not using Lupron, you have to use gana relics or sutra mm-hmm. Cide to keep you from ovulating. I get a lot of complaints about that medication. Like people will tell me it burns it itches and stuff like that. Mm-hmm. So it's kind of nice to use something that patients enjoy a little bit more, but I think it could be great for patients with endometriosis or with prior, um, egg quality issues or who really need better synchronization than I was able to achieve with estrogen priming. So I think it could. Be, um, a good one. And then the other one, microdose Lupron. So that one's a little tricky because you take the regular Lupron and dilute it way down. And I think that could be a great option too, because really it tries to give you a little flare or a little burst right at the beginning of your stimulation. But then when you keep taking that microdose Lupron, it helps keep you from ovulating. So again, you get to. Reduce your exposure to either gana relics or cetrotide. And I tend to use this in patients who have lower ovarian reserve or, um, patients who've maybe tried IVF with protocols before and just didn't respond very well. Mm-hmm. But yeah. Yeah. Mm-hmm. Can you tell our listeners a little bit about your testosterone priming? Oh my gosh. I'm so in love with testosterone lately. I think this is, um, you know, really interesting and new way to prime. Yeah. And, um, Dr. Reed's been having a lot of success with it, and I've recently done it on a couple of patients, and they did well as. As well. Yeah. Well, in this case, I really have to give a lot of credit to one of my patients who, you know, she had actually been doing one of the at-home fertility monitors and she was finding that her estrogen was low a lot. Mm-hmm. And she came in, we did her first round of IVF, and indeed her estrogen levels seemed low. We didn't get it, as many eggs as I would've expected and everything. And so we really tried to put our heads. Together to figure out why. What is the deal? Why is your estrogen low? And so as we thought through the process, we said, where does estrogen come from? It comes from the granulosis cells in the follicles. And certainly we had been stimulating the follicles, but we started to wonder, okay, did she have enough precursor to make estrogen? Well, the precursor to make estrogen is testosterone, actually. And so what we decided to do is we primed her with testosterone. We did a new IVF cycle and. Amazing difference between the two and, and so really I thought, wow, that was just so impressive. Maybe it was a coincidence. You know, that's oftentimes doctors will say, oh, it just one time it was a coincidence. And so I've been trying it on other people who had a similar presentation. I. And I do think it's really helpful in certain people. Now, do I think most patients need testosterone priming? I would say no because most patients have plenty of testosterone around in their body already. Their estrogen levels are already great. Their IVF cycle outcomes are already great. I. But when I see a patient where maybe their estrogen level was lower during their, during their IVF cycle than I would've expected, or they didn't give us as good of a yield in terms of quality or number, um, of eggs, I think it's great. I think it's something to try. It's not gonna hurt anything. Now I will say I am very against testosterone therapy in the long term, but just doing it for, you know, maybe three, four weeks before you actually start your IVF stimulation, I think can be really helpful. And I actually just did a retrieval on a patient today where, you know, she had tried IVF two times, she wasn't giving us eggs. And then ever since we testosterone primed her, she reliably gives us eggs every time she cycles. She does really well with it, so, so I'm a fan. Yeah, it, I mean it's definitely an interesting concept and I do have a lot of patients. Similarly who, yeah. I mean, sometimes I do test, um, patients thinking they're more of like A-P-C-O-S picture. Mm-hmm. And their testosterone levels undetectable. I've actually had a handful of patients in the last year that come back like that. Mm-hmm. So it is an interesting priming. Um, and so, you know, those, I think that's really the majority of the different prep ways. Yeah. And then you move into the stimulation. I know we've talked about different IVF. Treatment stimulation protocols before? Yeah. Dr. Reed talked about one, the micro flare. The flare is where we use Lupron to also. Um, you know, increase initially your response from your brain in recruiting your eggs, and then we give you the other medications, just like other stimulation protocols. Um, but I would say there's like a, you know, quite a few different stimulation protocols that we can try on. I describe this to my patients as I have a bunch of tools in my toolkit, right? Yeah. Um, the tools are sort of described by how we prevent you from ovulating. So the micro flare is, you know, named off after Microdose Lupron. The most traditional way that we stimulate is just with an antagonist, um, protocol where we use something like Gly or Seretide, and we can use and use hydroxy progesterone as an antagonist to prevent you from ovulating. Um, and those can be kind of similar cycles, but what we're often changing is the dose of the two types of medications that we're using to make your follicles grow. And those are really made up of FSH and lh. Um, oftentimes patients have heard of Manipur or Foti and go f. And so, you know, there's approaches where we can go really high on dosing or we can go really low on dosing, or we can change the ratio of one medication to the other. And so that's another thing that we'll look at for our second opinion patients. Mm-hmm. How were you dosed? What was your stimulation protocol? Mm-hmm. Do we feel like it was a. Good fit for what we're seeing when we're playing Monday morning quarterback. Right? Yes. That's what I really do when I'm giving a second opinion. Yeah, and I think sometimes it's not even that the doctor went too high or too low, it's just trying to maybe try the opposite of what they did. Mm-hmm. Right? Yeah. Whatever they chose, it's kind of like, Hey, it didn't work, so maybe let's do it the other way. Right? Absolutely. Yeah. Yeah. Mm-hmm. Yeah, and you know, there's. Then a bunch of add-on medications that we mm-hmm. Can look at and see, can we get a better response or better quality with adding on some of these medications. Some things you can ask about are maybe addition of Clomid, which is an oral medication that maybe can give you a little bit more oomph and stimulation or growth hormone, um, or Dexamethasone. Steroids during the stimulation. I mean, Metformin. Metformin. Mm-hmm. Yeah. Mm-hmm. I mean, there was, mm-hmm. Tons. I'm trying to think about any other, yeah, these are just addons. I think of them as different spices. Mm-hmm. To add to your recipe. Right. And not everybody is gonna need the same spices. That's where you really need your doctor to kind of advise you based on your situations, you know? So for example, somebody with PCOS and insulin resistance would probably do well by adding on some metformin, but then somebody maybe with lower egg counts or poor egg quality may do better with growth hormone, for example. So, yeah. Um, and then I think really one of the most important aspects of IVF that the patient almost never hears about, or really doesn't have a lot of understanding or explanation about is the embryology lab. Mm-hmm. Mm-hmm. Um, I always tell my patients like. You could have the worst IVF doctor in the whole country. Mm-hmm. But have a really good embryology lab and still probably be okay for your IVF cycle. That's, I mean, I think it's true.'cause you know, sometimes we're hard on ourselves. Sometimes I feel like I'm the worst doctor. But if I give our embryologist just one egg. They can do amazing things with it, so, yeah. Mm-hmm. Yeah. Mm-hmm. Yeah. So, um, and so I always like to walk my patients through a little bit of the behind the scenes of what our embryology lab does, what other embryology labs, um, and maybe offer or capable of and, and how we've modeled our embryology labs. So, um, I think something that's really important is having an embryologist and an embryology team that are willing to tailor the treatment plan. For the patient. I see Dr. Reed and Dr. Yang in the back. Mm-hmm. Discussing patients, yeah. All the time. And so, you know, when Dr. Reed has a really challenging IVF, you know, patient that she's designed this really specific protocol for it, she also oftentimes will ask Dr. Yang, do you think this add-on in the lab will help? Do you think that this particular way of going about. Um, inseminating the eggs or growing the eggs in culture or prepping the sperm are gonna make a difference in our success rate. And sometimes the lab just does not have the ability to change up the protocol. Mm-hmm. That much. Yeah. Or they may not be allowed. Yeah. Or allowed. Yeah. Sometimes they are. You know, especially the really big places. Mm-hmm. Actually, this is interesting too, not just for lab, but for fertility doctor, if those huge places they have rules. Mm-hmm. Because they want everybody to do it the same way for consistency, which may not be a bad thing, but then they lose the ability to customize. Mm-hmm. So I have a friend who's at a major fertility clinic. She's not allowed to give growth hormone. Interesting. Not allowed to give it, you know? And so I imagine their lab would probably have sim similar restrictions too. Mm-hmm. Yeah. So you know, some of the things that you may or may not have heard of that the lab might be able to do differently. So if your prior IVF cycle, you know, we kind of walk through once the eggs come out of the body. Where did things start to go wrong? Right? Maybe fertilization didn't go so well with your prior IVF cycle. There is a specific add-on, like calcium ion for that you can add in and potentially, right, there's mixed data potentially could help with fertilization. Um, or maybe it was the way they're prepping the sperm. I know, um, Dr. Reed uses zy a lot. Zy is a device in a different way to prep the sperm. Um, we're we're hoping to kinda choose better quality s. Sperm to be the ones selected to inseminate the eggs and ultimately have higher normal embryo rates, culation rates and things like that. So there's a lot of these things that we might run by our embryologist and And it's really nice because our embryologist gives us her real opinion, right? Yes. On whether or not she thinks it's a benefit. And she is brutally honest. She doesn't. She's brutally honest, which is great. Yeah. I was actually doing an embryo transfer today, and, and Dr. Yang said, it's a beautiful embryo. And the patient said, I believe you when you say that. And I'm like, you should, because she doesn't lie. Like if it's, if it's not a beautiful embryo, she's not gonna say it. So true. Yeah. Silence speaks sometimes with Dr. Yang. Yes. Was was Dr. Han? Yes. Yes. Yeah. Um, and you know, and the other thing is, um, once we inseminate the eggs, we're growing them in culture. We put them in little incubators, which are like little, you know, heating kind of devices where they're gonna grow for about a week. And the home and the type of incubator and the type of culture and the culture media that we use, all of these things can be changed up, um, based on the lab that you're using. And so it's interesting to know sometimes when you ask. People, they have no idea like what type of system was used. Yeah. Or you know, anything. It's hard to get that information, I think about the labs that are out there. Well, and I think too, the person that sometimes they're asking is their fertility doctor. Mm-hmm. And sadly, their fertility doctor often doesn't know either. Yeah. They kind of are like, whatever happens back there, whatever happens. Mm-hmm. You, but I think that's what's. Great. And really, I mean, I think we have an amazing lab and we largely owe that to you because you did the research. You found out what, what do all the best labs use? What is the exact equipment you use, what are the, um, recipes that they use for their media and all of these things. And so I think because of that, we do actually know what is going on in the lab. We're able to explain to you exactly the protocols that we use, but we also know it's the best that you can find anywhere. Right. Yeah. And a willingness to adapt. Yeah. You know, I will say that's the other thing that, um, Dr. Reed and Dr. Yang are really open to. Mm-hmm. You know, I think it's nice to have a clinic where if there is a new discovery mm-hmm. Or new data about something, we're always kind of willing to try it out. Yeah. You know, um, we always have different opinions mm-hmm. About what's best in the lab, and we have tried quite a few different ways to go about it in order to get our rates. To be so successful. Yeah. Yeah. And I do like to, because we're a newer lab. Mm-hmm. We have all brand new equipment. I mean, sometimes I've been to some of these other, you know, well-established IV life labs, but I'm looking around and I'm like, their equipment's like 20 years old. And I mean, can you imagine if you had to use a laptop computer that was 20 years old? I mean, technology has. Changed. Right? You need to keep this stuff updated. Um, but I say our equipment's brand new, but importantly not our embryologists, they're not brand new. Right. That's true. They are older and experienced. Um, really good hands and, and that's important. You kind of went opposites in that respect. Mm-hmm. New equipment, old embryologist, right? Yeah. Yeah. But it's just another piece of information I think you can be armed with like in a positive way. Yeah. You know, if you had a field IVF cycle, you might wanna go back, you're meeting, you know, for a consult with your doctor or your team, maybe you can ask them to kind of walk you through where did things go wrong along the way. Maybe you got eggs. But something happened after the eggs came out. I think it is really helpful to understand that side of things and look to see if you could benefit from some, maybe a change of lab. Mm-hmm. Or just do they offer any of these other things that could correct it along the way. Yeah. Yeah. Absolutely. Well, good. Okay. Well, I feel like we got through a lot today. So I guess to summarize, it's about preparing. It's about your stimulation, it's about the lab, and so I think probably the most important thing is if you're sitting there and you're thinking about, why didn't my IVF work? You know, we would just encourage you to say, you know what? You can take all of that information, take it to your fertility doctor and say, what can we learn from this? What can we do different? You know, is it reasonable to try again? And if we try again, how can we get to our, to our goal? And we wish you the best of luck. All right, y'all have a great week. Bye guys.