{"version":"1.0.0","segments":[{"startTime":0.84,"endTime":3.47,"body":"Today we talk about attrition rate,"},{"startTime":3.662,"endTime":5.79,"body":"the journey from eggs to"},{"startTime":5.822,"endTime":6.914,"body":"blastocyst."},{"startTime":7.894,"endTime":10.724,"body":"I'm, Doctor Mark Amos, and this"},{"startTime":11.064,"endTime":13.924,"body":"is taco. About fertility Tuesday."},{"startTime":23.184,"endTime":25.768,"body":"This is actually a really good follow"},{"startTime":25.816,"endTime":28.656,"body":"up episode to last week's episode."},{"startTime":28.84,"endTime":31.792,"body":"Last week's episode was talking about"},{"startTime":31.928,"endTime":34.888,"body":"how to determine how many embryos you'll"},{"startTime":34.936,"endTime":37.936,"body":"have at the end of a cycle, and"},{"startTime":37.96,"endTime":40.648,"body":"going backwards to determine how many eggs you need to start"},{"startTime":40.696,"endTime":43.484,"body":"with if you want to have selective insemination."},{"startTime":44.384,"endTime":46.44,"body":"In this week's episode, we're going to."},{"startTime":46.472,"endTime":49.284,"body":"Talk about the attrition rate and"},{"startTime":49.704,"endTime":50.064,"body":"what."},{"startTime":50.104,"endTime":52.956,"body":"To expect with the number of eggs you start with and how"},{"startTime":52.98,"endTime":55.036,"body":"many embryos to be expecting."},{"startTime":55.22,"endTime":57.9,"body":"See, in life, we get disappointed"},{"startTime":57.972,"endTime":58.228,"body":"when."},{"startTime":58.276,"endTime":60.9,"body":"Expectations are not met. And so the point of this"},{"startTime":60.932,"endTime":61.436,"body":"podcast."},{"startTime":61.5,"endTime":64.5,"body":"Is to help those expectations, because"},{"startTime":64.652,"endTime":64.892,"body":"I'll."},{"startTime":64.908,"endTime":65.944,"body":"Give you an example."},{"startTime":66.284,"endTime":68.204,"body":"I was at Denny's, and I love."},{"startTime":68.244,"endTime":71.204,"body":"Denny's moons over Miami. Hammy. It's one of my favorite breakfast"},{"startTime":71.244,"endTime":72.084,"body":"sandwiches."},{"startTime":72.244,"endTime":74.716,"body":"But when I was in flagstaff and I got the moons over"},{"startTime":74.74,"endTime":76.012,"body":"Miami, I."},{"startTime":76.028,"endTime":78.96,"body":"Couldn'T believe what I got. It only had, one piece of cheese on a little bit of"},{"startTime":78.976,"endTime":81.688,"body":"ham, where normally it has two pieces of cheeses and all this other stuff."},{"startTime":81.72,"endTime":84.654,"body":"And I was, I was sad. I thought, what"},{"startTime":84.678,"endTime":85.43,"body":"is going on here?"},{"startTime":85.486,"endTime":88.358,"body":"What created this sandwich so much different"},{"startTime":88.39,"endTime":89.122,"body":"than before?"},{"startTime":89.742,"endTime":92.122,"body":"Well, the same thing happens with IVF."},{"startTime":92.902,"endTime":95.862,"body":"Most people assume that they're going to"},{"startTime":95.902,"endTime":98.622,"body":"start with 20 eggs and they're probably going to get"},{"startTime":98.702,"endTime":101.134,"body":"20 embryos, but in."},{"startTime":101.158,"endTime":103.07,"body":"Reality, that is not true."},{"startTime":103.206,"endTime":105.678,"body":"Matter of fact, most of the time."},{"startTime":105.75,"endTime":107.334,"body":"The average number of eggs is somewhere."},{"startTime":107.358,"endTime":109.652,"body":"Between eight and twelve, and the average."},{"startTime":109.692,"endTime":112.032,"body":"Number of embryos at the end is between one and four."},{"startTime":112.892,"endTime":115.74,"body":"And there's a reason why that number drops over"},{"startTime":115.796,"endTime":118.788,"body":"time. And so what we're going to do is talk about that"},{"startTime":118.82,"endTime":121.748,"body":"process and talk about why the drop is there"},{"startTime":121.9,"endTime":124.468,"body":"and what factors could potentially affect that"},{"startTime":124.5,"endTime":126.112,"body":"drop even more."},{"startTime":126.532,"endTime":129.388,"body":"So sit back, grab a taco, and get"},{"startTime":129.42,"endTime":131.796,"body":"ready to talk about attrition rates."},{"startTime":131.924,"endTime":134.452,"body":"So, for those of you who are maybe just jumping into this"},{"startTime":134.492,"endTime":137.116,"body":"podcast and haven't listened to prior podcasts,"},{"startTime":137.244,"endTime":137.804,"body":"lets first."},{"startTime":137.868,"endTime":140.58,"body":"Discuss what happens in the IVF cycle."},{"startTime":140.756,"endTime":143.508,"body":"So what happens is when were usually on the birth"},{"startTime":143.54,"endTime":144.964,"body":"control to prime their."},{"startTime":144.988,"endTime":147.484,"body":"Ovaries to get ready for IVF, and that synchronizes the"},{"startTime":147.508,"endTime":150.412,"body":"eggs so theyre ready to eventually grow."},{"startTime":150.532,"endTime":151.972,"body":"And when we talk about growing more."},{"startTime":152.012,"endTime":154.796,"body":"Eggs, what were talking about is growing the"},{"startTime":154.844,"endTime":157.628,"body":"eggs that normally wouldnt have grown but were"},{"startTime":157.66,"endTime":158.94,"body":"not making eggs."},{"startTime":159.076,"endTime":161.964,"body":"So if someone starts with ten eggs at the beginning of month, even"},{"startTime":161.988,"endTime":164.9,"body":"though they release one egg, theres ten. There we"},{"startTime":164.916,"endTime":167.324,"body":"are making those other nine grow in IVF."},{"startTime":167.468,"endTime":169.632,"body":"Were not making eggs from nowhere."},{"startTime":170.172,"endTime":172.332,"body":"Now what happens is when you start."},{"startTime":172.372,"endTime":175.284,"body":"Giving medication to force those eggs"},{"startTime":175.308,"endTime":175.444,"body":"to."},{"startTime":175.468,"endTime":178.212,"body":"Grow, the follicles that contain the eggs is what"},{"startTime":178.252,"endTime":179.012,"body":"grows."},{"startTime":179.172,"endTime":181.508,"body":"And those follicles get bigger and bigger and bigger."},{"startTime":181.54,"endTime":183.228,"body":"And eventually theres a point where theyre."},{"startTime":183.26,"endTime":185.724,"body":"Ready to be removed, and at that."},{"startTime":185.748,"endTime":186.884,"body":"Point they take a shot, called a."},{"startTime":186.908,"endTime":189.592,"body":"Trigger shot, to make them release those eggs,"},{"startTime":190.642,"endTime":193.146,"body":"those follicles. A needle is then"},{"startTime":193.194,"endTime":194.434,"body":"placed to pull."},{"startTime":194.458,"endTime":197.002,"body":"The fluid from them, and inside those we find"},{"startTime":197.082,"endTime":199.562,"body":"eggs. Those eggs can then be"},{"startTime":199.602,"endTime":200.466,"body":"mature or."},{"startTime":200.514,"endTime":203.402,"body":"Immature, and if they're mature, they can be fertilized"},{"startTime":203.442,"endTime":205.13,"body":"with sperm, and that can."},{"startTime":205.146,"endTime":207.698,"body":"Be done either with ICSI or with standard"},{"startTime":207.73,"endTime":210.674,"body":"insemination, which means either with a needle or"},{"startTime":210.698,"endTime":212.582,"body":"just naturally let them fertilize."},{"startTime":213.322,"endTime":216.178,"body":"Then those eggs become"},{"startTime":216.29,"endTime":219.002,"body":"embryos, which are single cell embryos."},{"startTime":219.162,"endTime":222.114,"body":"Then those grow out the blastocyst, which."},{"startTime":222.178,"endTime":224.954,"body":"Are essentially the embryo that's going to."},{"startTime":224.978,"endTime":226.462,"body":"Implant into the uterus."},{"startTime":228.602,"endTime":231.042,"body":"Now that we've talked about the progression."},{"startTime":231.162,"endTime":232.862,"body":"Let'S talk about each step."},{"startTime":233.362,"endTime":236.194,"body":"Now, you're going through the IVF process, and"},{"startTime":236.298,"endTime":239.29,"body":"you are at the point of measuring the follicles. So"},{"startTime":239.306,"endTime":240.762,"body":"you're coming into your doctor's office."},{"startTime":240.842,"endTime":243.146,"body":"Several times a week, and they're looking."},{"startTime":243.194,"endTime":244.834,"body":"At your ovaries and seeing how big."},{"startTime":244.858,"endTime":246.184,"body":"The follicles are getting."},{"startTime":246.378,"endTime":247.908,"body":"As they're getting bigger, they'll say, okay."},{"startTime":247.94,"endTime":250.392,"body":"We see 15 eggs."},{"startTime":250.692,"endTime":253.54,"body":"Now, at some point they're going to be big enough where the"},{"startTime":253.556,"endTime":253.9,"body":"doctor is."},{"startTime":253.916,"endTime":256.708,"body":"Being ready to retrieve those eggs and you're going to take that"},{"startTime":256.74,"endTime":259.74,"body":"trigger shot. So that is the last point"},{"startTime":259.836,"endTime":261.352,"body":"that those eggs have to grow."},{"startTime":261.732,"endTime":264.652,"body":"So from that point, whatever number you."},{"startTime":264.692,"endTime":266.58,"body":"Have is the number of potential eggs."},{"startTime":266.596,"endTime":268.332,"body":"You have, but it is not the."},{"startTime":268.372,"endTime":270.192,"body":"Number of eggs that you can use."},{"startTime":270.892,"endTime":273.892,"body":"So let's use a couple numbers here. Let's just start with"},{"startTime":273.932,"endTime":276.762,"body":"ten to make it simple. A lot of people usually"},{"startTime":276.802,"endTime":277.114,"body":"do get."},{"startTime":277.138,"endTime":279.994,"body":"Above ten eggs, but it's an easy number to start with for the"},{"startTime":280.018,"endTime":282.25,"body":"math. So we start with ten"},{"startTime":282.346,"endTime":283.97,"body":"follicles and."},{"startTime":283.986,"endTime":286.538,"body":"Then we go to retrieve the eggs. Usually"},{"startTime":286.69,"endTime":289.682,"body":"most doctors get 100% of the eggs. Now it's possible"},{"startTime":289.762,"endTime":290.314,"body":"that there could be."},{"startTime":290.338,"endTime":292.65,"body":"Very difficult retrievals and you can end."},{"startTime":292.666,"endTime":295.65,"body":"Up with less eggs. But for this podcast, we're going to"},{"startTime":295.666,"endTime":298.554,"body":"assume 100%, because in general, most people do"},{"startTime":298.578,"endTime":301.376,"body":"get about 100% of the eggs that they're expecting."},{"startTime":301.554,"endTime":303.316,"body":"There is that rare moment you dont."},{"startTime":303.404,"endTime":304.86,"body":"And usually there is a reason behind."},{"startTime":304.916,"endTime":307.092,"body":"That, whether its the trigger shot was."},{"startTime":307.132,"endTime":310.076,"body":"Bad, whether there was something wrong with the eggs, they"},{"startTime":310.084,"endTime":313.014,"body":"were immature, theres even something wrong physically, with"},{"startTime":313.038,"endTime":313.462,"body":"that patient."},{"startTime":313.502,"endTime":316.438,"body":"That causes it more difficult to get the"},{"startTime":316.47,"endTime":319.286,"body":"eggs. Were going to assume 100%."},{"startTime":319.454,"endTime":322.334,"body":"Now we get all ten eggs. The part we"},{"startTime":322.358,"endTime":325.078,"body":"dont know is how many are going to be mature. In my"},{"startTime":325.11,"endTime":326.43,"body":"clinic, I do tell people."},{"startTime":326.486,"endTime":329.02,"body":"What I expect to be mature and."},{"startTime":329.076,"endTime":330.892,"body":"Im very conservative with that number."},{"startTime":331.052,"endTime":332.612,"body":"So, for example, I might say to."},{"startTime":332.612,"endTime":335.044,"body":"Them, youre going to get ten eggs, but I only think seven are going to be"},{"startTime":335.068,"endTime":338.068,"body":"mature. Your doctor may not give that"},{"startTime":338.1,"endTime":340.996,"body":"information ahead of time. So if they dont,"},{"startTime":341.084,"endTime":343.436,"body":"youre going to have to assume that not every"},{"startTime":343.524,"endTime":344.172,"body":"egg."},{"startTime":344.332,"endTime":347.012,"body":"Is going to be mature. So if we start with those ten."},{"startTime":347.052,"endTime":349.524,"body":"Eggs, there might only be eight that are"},{"startTime":349.548,"endTime":352.324,"body":"mature. Now, why this is an important"},{"startTime":352.428,"endTime":355.228,"body":"step is because when"},{"startTime":355.26,"endTime":357.812,"body":"you have immature eggs, you can't"},{"startTime":357.852,"endTime":359.312,"body":"fertilize them right away."},{"startTime":359.612,"endTime":362.5,"body":"Now, if you're doing standard insemination, you can put the"},{"startTime":362.516,"endTime":363.82,"body":"sperm with them and."},{"startTime":363.836,"endTime":365.952,"body":"You can hope overnight that they fertilize."},{"startTime":366.412,"endTime":368.644,"body":"But if you're talking about ICSI, you."},{"startTime":368.668,"endTime":371.628,"body":"Really can't fertilize them. Now, a lot of clanks may try, but"},{"startTime":371.74,"endTime":373.228,"body":"in the general sense, if they."},{"startTime":373.26,"endTime":376.084,"body":"Never mature, they won't end up becoming an"},{"startTime":376.108,"endTime":376.872,"body":"embryo."},{"startTime":377.332,"endTime":379.5,"body":"And so from that ten, assuming that."},{"startTime":379.516,"endTime":382.142,"body":"We get all ten and they're all mature,"},{"startTime":382.442,"endTime":385.114,"body":"we expect 70% to 80% of them to"},{"startTime":385.138,"endTime":387.794,"body":"fertilize, which means we're only going to get"},{"startTime":387.858,"endTime":390.114,"body":"77 to eight"},{"startTime":390.258,"endTime":392.662,"body":"eggs that become embryos."},{"startTime":393.282,"endTime":395.762,"body":"Now, what can affect that? Well, a couple"},{"startTime":395.802,"endTime":397.982,"body":"things. So the sperm quality,"},{"startTime":398.442,"endTime":399.506,"body":"people who have."},{"startTime":399.594,"endTime":402.586,"body":"Bad sperm may even have poor quality"},{"startTime":402.634,"endTime":405.502,"body":"DNA in their sperm and that can affect fertilization."},{"startTime":406.102,"endTime":408.702,"body":"So that 70% could drop down to"},{"startTime":408.862,"endTime":411.682,"body":"50% and now there's only five embryos."},{"startTime":412.262,"endTime":414.55,"body":"Or there could be egg issues."},{"startTime":414.726,"endTime":415.79,"body":"Something wrong with eggs."},{"startTime":415.806,"endTime":417.974,"body":"So women who are more mature, sometimes."},{"startTime":417.998,"endTime":420.286,"body":"Their eggs can die during the fertilization"},{"startTime":420.374,"endTime":423.302,"body":"process, sometimes they don't fertilize as well."},{"startTime":423.462,"endTime":426.334,"body":"And so again, that could drop down to 50%. And now"},{"startTime":426.358,"endTime":429.318,"body":"you're with five embryos. But let's assume"},{"startTime":429.35,"endTime":430.83,"body":"this is the best case scenario."},{"startTime":430.926,"endTime":433.616,"body":"This is a Disney story. So we got"},{"startTime":433.704,"endTime":436.012,"body":"eight embryos from those ten eggs."},{"startTime":436.592,"endTime":439.448,"body":"Well, what's interesting is those eight embryos."},{"startTime":439.52,"endTime":442.464,"body":"Are the embryos now that will go on and become blastocyst, and"},{"startTime":442.488,"endTime":445.056,"body":"blastocysts have 100 plus"},{"startTime":445.104,"endTime":448.056,"body":"cells, whereas the embryo only had one cell. That"},{"startTime":448.064,"endTime":449.384,"body":"was just the combination of the."},{"startTime":449.408,"endTime":452.104,"body":"Sperm and egg that make the one cell embryo."},{"startTime":452.288,"endTime":453.808,"body":"And then they grow over these five."},{"startTime":453.88,"endTime":456.624,"body":"Days until they become a blastocyst."},{"startTime":456.808,"endTime":459.688,"body":"And just like you would think, it splits from one to"},{"startTime":459.72,"endTime":462.64,"body":"two cells to four cells to eight cells to"},{"startTime":462.696,"endTime":465.548,"body":"16 cells. Then around about"},{"startTime":465.58,"endTime":466.308,"body":"the third to fourth."},{"startTime":466.34,"endTime":468.54,"body":"Day, then becomes a morula, where there."},{"startTime":468.556,"endTime":470.924,"body":"Is now 30 something cells that start."},{"startTime":470.948,"endTime":473.752,"body":"To make a kind of dense ball,"},{"startTime":474.092,"endTime":476.844,"body":"and then that expands, and that becomes."},{"startTime":476.868,"endTime":479.748,"body":"A blast cyst, which is over 100 cells, usually by day five"},{"startTime":479.78,"endTime":482.668,"body":"or six. Now, during this journey from a"},{"startTime":482.7,"endTime":483.012,"body":"single."},{"startTime":483.052,"endTime":485.832,"body":"Cell to the blastocyst stage,"},{"startTime":486.372,"endTime":489.352,"body":"sometimes they'll stall, for example,"},{"startTime":489.752,"endTime":490.664,"body":"sometimes they wont make."},{"startTime":490.688,"endTime":492.168,"body":"It past day three or even past."},{"startTime":492.2,"endTime":493.612,"body":"A single cell stage."},{"startTime":494.232,"endTime":497.208,"body":"Now, we expect about 50% of the"},{"startTime":497.24,"endTime":499.32,"body":"embryos being at the single cell stage."},{"startTime":499.416,"endTime":501.412,"body":"To make it to the blastocyst stage."},{"startTime":502.272,"endTime":505.258,"body":"Any good clinic is going to be around that 50%. Now,"},{"startTime":505.208,"endTime":507.442,"body":"that doesnt mean youre going to get 50%."},{"startTime":508.022,"endTime":510.814,"body":"If youre someone who is 44, it may be"},{"startTime":510.878,"endTime":512.894,"body":"much less if youre someone."},{"startTime":512.918,"endTime":515.798,"body":"Who has really bad sperm. We tend to see sometimes that theyll."},{"startTime":515.83,"endTime":518.784,"body":"Stall around the cellular stage. But"},{"startTime":518.808,"endTime":521.492,"body":"again, lets assume were on this Disney story"},{"startTime":522.032,"endTime":524.896,"body":"and that of the eight embryos for"},{"startTime":524.944,"endTime":527.416,"body":"them make it to the blastocyst stage."},{"startTime":527.584,"endTime":530.112,"body":"So already weve gone from ten"},{"startTime":530.192,"endTime":530.616,"body":"eggs."},{"startTime":530.664,"endTime":532.92,"body":"Being retrieved all the way down to four"},{"startTime":532.976,"endTime":535.896,"body":"embryos, and well stick with this dizzy story."},{"startTime":535.944,"endTime":537.096,"body":"And this is going to be a princess."},{"startTime":537.184,"endTime":539.928,"body":"So we know shes under 35, because."},{"startTime":539.96,"endTime":542.712,"body":"I dont believe Disney has any princesses above"},{"startTime":542.752,"endTime":544.732,"body":"35, but please correct me if Im wrong."},{"startTime":545.242,"endTime":547.194,"body":"So if they're under 35, we know."},{"startTime":547.218,"endTime":549.698,"body":"That 60% of the eggs are going to be"},{"startTime":549.73,"endTime":550.422,"body":"normal."},{"startTime":550.882,"endTime":553.714,"body":"And so we're going to be looking at somewhere around"},{"startTime":553.898,"endTime":556.818,"body":"three to two embryos"},{"startTime":556.85,"endTime":559.662,"body":"from the blastocyst that would be genetically normal,"},{"startTime":560.042,"endTime":561.314,"body":"which means there's one or two."},{"startTime":561.338,"endTime":564.194,"body":"Of them that may be abnormal. And so from those"},{"startTime":564.258,"endTime":565.378,"body":"ten eggs, you."},{"startTime":565.41,"endTime":568.378,"body":"Now are left with two or three"},{"startTime":568.49,"endTime":571.438,"body":"euploid embryos. Now, what's interesting"},{"startTime":571.47,"endTime":574.094,"body":"is for that princess under 35, we know"},{"startTime":574.278,"endTime":575.302,"body":"that those three."},{"startTime":575.342,"endTime":577.494,"body":"Embryos, if they put them back sequentially."},{"startTime":577.598,"endTime":579.838,"body":"One at a time, we'd be looking."},{"startTime":579.87,"endTime":582.378,"body":"At around a, 90% chance of a live"},{"startTime":582.434,"endTime":585.354,"body":"birth. With the first embryo, it'd be close"},{"startTime":585.402,"endTime":588.378,"body":"to around 50. With the second embryo, we'd"},{"startTime":588.394,"endTime":591.33,"body":"be close to around 75. And with the third"},{"startTime":591.37,"endTime":594.178,"body":"embryo, we would be around 90%. And"},{"startTime":594.194,"endTime":597.17,"body":"so for someone under age 35,"},{"startTime":597.33,"endTime":600.074,"body":"ten eggs is usually enough to come away with at least one live"},{"startTime":600.122,"endTime":600.722,"body":"birth."},{"startTime":600.866,"endTime":603.018,"body":"And what's interesting about that is that's."},{"startTime":603.074,"endTime":605.946,"body":"Also the same number we talk about to have around"},{"startTime":605.978,"endTime":608.474,"body":"an 80% chance of live birth when freezing"},{"startTime":608.522,"endTime":611.378,"body":"eggs. Ten eggs equals one live birth"},{"startTime":611.434,"endTime":614.226,"body":"in women under age 35. So let's use"},{"startTime":614.258,"endTime":615.114,"body":"another example."},{"startTime":615.202,"endTime":617.778,"body":"Let's use 20 follicles are there."},{"startTime":617.954,"endTime":620.426,"body":"And of those 20 follicles, we get 20 eggs."},{"startTime":620.498,"endTime":623.432,"body":"Perfect. Of those 20 eggs,"},{"startTime":623.626,"endTime":626.516,"body":"maybe 100% immature. So we"},{"startTime":626.548,"endTime":628.652,"body":"fertilize them and lets say."},{"startTime":628.676,"endTime":631.516,"body":"With ICSI, 70% now were down"},{"startTime":631.548,"endTime":633.32,"body":"to 14 embryos."},{"startTime":633.66,"endTime":636.172,"body":"And from those 14 embryos then well."},{"startTime":636.196,"endTime":638.524,"body":"Be down to seven embryos."},{"startTime":638.692,"endTime":641.292,"body":"Because of the blastocyst, 50% make it"},{"startTime":641.316,"endTime":641.88,"body":"there."},{"startTime":642.26,"endTime":645.012,"body":"And from those seven we know about four of them will be"},{"startTime":645.036,"endTime":647.244,"body":"genetically normal because the princess is under age"},{"startTime":647.292,"endTime":649.884,"body":"35 and three of them will be genetically"},{"startTime":649.972,"endTime":652.898,"body":"abnormal. Now at this point, I wanna make sure that you"},{"startTime":652.914,"endTime":655.69,"body":"understand statistics do not present"},{"startTime":655.77,"endTime":658.338,"body":"themselves in small sample sizes."},{"startTime":658.474,"endTime":660.682,"body":"What I mean by this is when."},{"startTime":660.706,"endTime":663.61,"body":"I say four should be genetically normal, that doesn't mean all"},{"startTime":663.65,"endTime":666.522,"body":"seven can't be completely abnormal. And"},{"startTime":666.546,"endTime":669.466,"body":"that's because statistics don't really"},{"startTime":669.578,"endTime":672.498,"body":"follow the pattern in small sample sizes. So flip a"},{"startTime":672.514,"endTime":673.882,"body":"quarter three times and."},{"startTime":673.906,"endTime":676.074,"body":"You get three heads, still a normal corner."},{"startTime":676.122,"endTime":678.846,"body":"Flip it two more times. Now you have five heads, still"},{"startTime":678.958,"endTime":680.13,"body":"a normal quarter."},{"startTime":680.59,"endTime":682.366,"body":"Now you flip that quarter 100 times."},{"startTime":682.398,"endTime":685.27,"body":"And you tell me you get 100 heads. I know either you're lying or you"},{"startTime":685.31,"endTime":688.214,"body":"have a, ah, fake quarter. And that's because in"},{"startTime":688.262,"endTime":690.574,"body":"larger sample sizes we start to see"},{"startTime":690.622,"endTime":693.326,"body":"statistics. And so even if you, let's say, have"},{"startTime":693.358,"endTime":696.238,"body":"had four kids, five kids, six kids, and"},{"startTime":696.254,"endTime":699.094,"body":"they're all the same gender, we tend to start to think,"},{"startTime":699.142,"endTime":701.958,"body":"oh my goodness, this person only makes boys or girls."},{"startTime":702.134,"endTime":705.02,"body":"But in reality you just flip the quarter five"},{"startTime":705.1,"endTime":706.348,"body":"or six times."},{"startTime":706.524,"endTime":709.14,"body":"You need to flip that quarter 100 times, meaning have 100"},{"startTime":709.18,"endTime":711.892,"body":"babies before you could truly say that person only"},{"startTime":711.956,"endTime":714.932,"body":"makes boys or girls. So how does it pertain to"},{"startTime":714.956,"endTime":717.34,"body":"this? Well, I want you to understand"},{"startTime":717.46,"endTime":719.46,"body":"that there is always going to be"},{"startTime":719.5,"endTime":722.22,"body":"outliers if someone has a very bad"},{"startTime":722.26,"endTime":725.212,"body":"sperm sample, if someone has very poor egg quality,"},{"startTime":725.396,"endTime":728.308,"body":"all of these statistics can change, but"},{"startTime":728.324,"endTime":731.14,"body":"in general, you should think that you're getting close"},{"startTime":731.18,"endTime":734.014,"body":"to about 100% of your eggs retrieved."},{"startTime":734.172,"endTime":736.698,"body":"So starting with the follicles, if you."},{"startTime":736.714,"endTime":739.25,"body":"Wanted to be a little bit liberal with that number and say, well, just."},{"startTime":739.29,"endTime":742.282,"body":"In case my fertility doctor doesn't get."},{"startTime":742.306,"endTime":745.21,"body":"All the eggs, assume 90% to 95% will be"},{"startTime":745.25,"endTime":745.99,"body":"retrieved."},{"startTime":746.49,"endTime":749.394,"body":"When it comes to fertilization, think"},{"startTime":749.442,"endTime":749.77,"body":"somewhere."},{"startTime":749.81,"endTime":751.95,"body":"Between 70% to 90%."},{"startTime":753.01,"endTime":755.522,"body":"And then when it comes to blastulation,"},{"startTime":755.706,"endTime":758.402,"body":"think somewhere between 40 and 60%. So I'm"},{"startTime":758.426,"endTime":761.242,"body":"taking all clinics in and putting them in there, not"},{"startTime":761.306,"endTime":764.252,"body":"our clinic. Using those stats, then you should"},{"startTime":764.276,"endTime":767.052,"body":"be able to look at your situation and say, well, how many"},{"startTime":767.076,"endTime":770.028,"body":"eggs did I have retrieved? And have a better idea of how"},{"startTime":770.044,"endTime":772.788,"body":"many blastocyst youll get. And so"},{"startTime":772.884,"endTime":775.64,"body":"it comes to be about 25%."},{"startTime":776.1,"endTime":777.62,"body":"Again, it could be higher up to."},{"startTime":777.66,"endTime":780.132,"body":"33%, but in general,"},{"startTime":780.236,"endTime":782.828,"body":"25% to 33% is what you expect from the number."},{"startTime":782.844,"endTime":785.692,"body":"Of eggs you have to the number of blastocysts you get."},{"startTime":785.836,"endTime":787.084,"body":"And thats normal."},{"startTime":787.252,"endTime":789.092,"body":"Most people get between around eight to."},{"startTime":789.116,"endTime":790.958,"body":"Twelve eggs and come away with one."},{"startTime":790.974,"endTime":792.97,"body":"To four embryos, which would be normal."},{"startTime":793.59,"endTime":796.55,"body":"Now there are outliers. Like I just said, I had a patient"},{"startTime":796.59,"endTime":798.902,"body":"one time, she got something like."},{"startTime":799.046,"endTime":801.57,"body":"27 eggs, I believe it was."},{"startTime":801.95,"endTime":804.95,"body":"And of those 27 eggs, she got 26"},{"startTime":804.99,"endTime":805.31,"body":"embryos."},{"startTime":805.35,"endTime":808.198,"body":"And I remember she was actually very upset and saying like,"},{"startTime":808.294,"endTime":810.158,"body":"well, what happened that last embryo?"},{"startTime":810.334,"endTime":813.238,"body":"And im like you just basically pulled."},{"startTime":813.254,"endTime":816.006,"body":"Off a miracle and youre worried about why one egg"},{"startTime":816.038,"endTime":818.926,"body":"didnt make it. So sometimes"},{"startTime":818.958,"endTime":820.71,"body":"people have very weird expectations."},{"startTime":820.79,"endTime":823.33,"body":"So by you having right expectations,"},{"startTime":823.99,"endTime":826.534,"body":"you're going to come away, at least not"},{"startTime":826.582,"endTime":829.518,"body":"disappointed. But I've seen people"},{"startTime":829.574,"endTime":830.502,"body":"get three eggs."},{"startTime":830.606,"endTime":831.718,"body":"Three blasts from it."},{"startTime":831.774,"endTime":834.726,"body":"All three come back normal. And I've seen other people who"},{"startTime":834.758,"endTime":837.638,"body":"have 26 eggs and then end up"},{"startTime":837.654,"endTime":838.094,"body":"having."},{"startTime":838.222,"endTime":840.45,"body":"Very few blasts, sometimes even one."},{"startTime":841.07,"endTime":844.062,"body":"This is why I always bring up the point. The most"},{"startTime":844.166,"endTime":847.09,"body":"important part is the fertilization."},{"startTime":847.73,"endTime":850.226,"body":"It doesnt matter if you start with a million"},{"startTime":850.378,"endTime":851.19,"body":"eggs."},{"startTime":851.89,"endTime":854.69,"body":"If only ten fertilize, you"},{"startTime":854.73,"endTime":857.402,"body":"only have ten embryos to work with, and you."},{"startTime":857.426,"endTime":860.394,"body":"Cant get more blastocyst than the beginning embryo"},{"startTime":860.442,"endTime":862.666,"body":"number, whether its 100% or"},{"startTime":862.698,"endTime":863.594,"body":"50%."},{"startTime":863.762,"endTime":866.562,"body":"You still have to start with an embryo. So"},{"startTime":866.626,"endTime":869.53,"body":"that is going to be the biggest step where you should"},{"startTime":869.57,"endTime":870.602,"body":"be not."},{"startTime":870.666,"endTime":873.146,"body":"Worried, but really where youre holding your."},{"startTime":873.178,"endTime":876.102,"body":"Breath because your doctor is not going to have"},{"startTime":876.126,"endTime":878.13,"body":"problems getting eggs. That's very uncommon."},{"startTime":878.67,"endTime":881.65,"body":"And fertilization in general can be bad."},{"startTime":882.23,"endTime":883.918,"body":"But in general, it's about, like I."},{"startTime":883.934,"endTime":885.318,"body":"Said, that 70, 80%."},{"startTime":885.414,"endTime":888.022,"body":"But if you have"},{"startTime":888.086,"endTime":889.398,"body":"immature eggs, if."},{"startTime":889.414,"endTime":892.35,"body":"You had eggs that are dying at the time of fertilization and you"},{"startTime":892.39,"endTime":892.638,"body":"only."},{"startTime":892.694,"endTime":894.69,"body":"End up with a few embryos,"},{"startTime":895.63,"endTime":896.046,"body":"that's."},{"startTime":896.078,"endTime":898.958,"body":"Where now it gets a little more scary because now you're dependent on"},{"startTime":898.974,"endTime":901.918,"body":"the lab of hoping in every single of those embryos to make"},{"startTime":901.934,"endTime":903.054,"body":"it to blastocyst."},{"startTime":903.182,"endTime":906.134,"body":"And if you're older, there's less likelihood that you're going"},{"startTime":906.142,"endTime":908.29,"body":"to get good blastulation rates."},{"startTime":909.15,"endTime":910.95,"body":"As I started in the beginning, this."},{"startTime":910.99,"endTime":912.85,"body":"Is not to be a"},{"startTime":913.31,"endTime":914.614,"body":"pessimistic view."},{"startTime":914.742,"endTime":917.23,"body":"This is to help people be more"},{"startTime":917.27,"endTime":918.942,"body":"prepared and what to expect."},{"startTime":919.086,"endTime":921.734,"body":"If you're expecting the worst, you're going to feel great."},{"startTime":921.782,"endTime":924.486,"body":"Then if you're expecting the best, you could get"},{"startTime":924.518,"endTime":927.078,"body":"disappointed, just like I did at that Denny's in"},{"startTime":927.094,"endTime":930.014,"body":"Flagstaff. I always tell my kids I have"},{"startTime":930.062,"endTime":932.902,"body":"low expectations, and the reason why is because I don't get"},{"startTime":932.926,"endTime":935.758,"body":"upset much, because if I keep my expectations low, I"},{"startTime":935.774,"endTime":937.05,"body":"won't be disappointed."},{"startTime":937.47,"endTime":939.262,"body":"Now, that doesn't mean you shouldn't keep."},{"startTime":939.286,"endTime":942.182,"body":"Your expectations for having a baby low."},{"startTime":942.286,"endTime":944.99,"body":"That's actually fairly good. Most people who are under"},{"startTime":945.03,"endTime":947.798,"body":"35 who go through IVF will come away with a live"},{"startTime":947.854,"endTime":950.686,"body":"birth. If you're age 40 and above, it usually takes two"},{"startTime":950.718,"endTime":953.414,"body":"ivfs. But again, very good chances are coming away with a live"},{"startTime":953.462,"endTime":956.39,"body":"birth. But one of the most stressful portions"},{"startTime":956.43,"endTime":959.09,"body":"of this whole process is that attrition rate."},{"startTime":959.45,"endTime":962.31,"body":"There's just something that feels so"},{"startTime":962.69,"endTime":964.986,"body":"wrong that you can start with so many."},{"startTime":965.018,"endTime":967.954,"body":"Aches and then with so few embryos. But the thing I always remind people"},{"startTime":968.042,"endTime":970.31,"body":"is this one important thing."},{"startTime":970.77,"endTime":973.266,"body":"The goal was to try to get"},{"startTime":973.298,"endTime":973.994,"body":"pregnant."},{"startTime":974.162,"endTime":975.442,"body":"And if that means you have to."},{"startTime":975.466,"endTime":978.146,"body":"Go through 30 eggs or whatever that."},{"startTime":978.178,"endTime":980.066,"body":"Number is to get to that one."},{"startTime":980.138,"endTime":982.994,"body":"Perfect embryo, that's why you did it."},{"startTime":983.122,"endTime":984.298,"body":"You did it to get to that."},{"startTime":984.354,"endTime":987.31,"body":"Perfect embryo to give you the highest chance of success."},{"startTime":987.91,"endTime":990.902,"body":"It's going to be basically your Michael Jordan of"},{"startTime":990.926,"endTime":993.83,"body":"embryos. Hopefully, if you're going through IVF, this"},{"startTime":993.87,"endTime":996.726,"body":"episode was helpful, and maybe it might help reduce"},{"startTime":996.758,"endTime":999.734,"body":"some stress when you went through it. If you have a family member"},{"startTime":999.782,"endTime":1002.702,"body":"who's going through IVF, or maybe even a friend, let them know"},{"startTime":1002.726,"endTime":1005.326,"body":"about this podcast and let them be prepared for that"},{"startTime":1005.358,"endTime":1008.31,"body":"attrition rate, because that journey from egg to"},{"startTime":1008.35,"endTime":1011.342,"body":"embryo is not as smooth as it looks like"},{"startTime":1011.366,"endTime":1014.266,"body":"it's going to be. As always, if you like"},{"startTime":1014.298,"endTime":1017.154,"body":"this podcast, please tell everyone about it."},{"startTime":1017.282,"endTime":1020.226,"body":"And if you're on your podcast, review us on your favorite"},{"startTime":1020.258,"endTime":1023.242,"body":"medium. But as always, as always, say, keep"},{"startTime":1023.266,"endTime":1025.93,"body":"coming back. And I look forward to seeing you again next week"},{"startTime":1025.97,"endTime":1028.37,"body":"on Taco Bell fertility Tuesday."}]}