{"version":"1.0.0","segments":[{"startTime":0.8,"endTime":3.534,"body":"Today we talk about a concept I think is quite"},{"startTime":3.574,"endTime":6.558,"body":"misunderstood. Batching in IVF"},{"startTime":6.606,"endTime":9.542,"body":"cycles. What does it mean? And what does"},{"startTime":9.558,"endTime":12.51,"body":"it mean for you? I'm Doctor"},{"startTime":12.542,"endTime":14.954,"body":"Mark Amos, and this"},{"startTime":15.294,"endTime":18.154,"body":"is taco, about fertility Tuesday."},{"startTime":30.124,"endTime":32.954,"body":"So, as I started the, podcast, I mentioned"},{"startTime":32.986,"endTime":35.514,"body":"that I think this is a very misunderstood"},{"startTime":35.586,"endTime":38.37,"body":"topic. A lot of patients will come to me and"},{"startTime":38.394,"endTime":41.394,"body":"say, do you guys batch? And I'm always"},{"startTime":41.426,"endTime":44.402,"body":"surprised when they ask me that, because I think, why would they care if we batch"},{"startTime":44.45,"endTime":47.41,"body":"our cycles? And then I started understanding"},{"startTime":47.434,"endTime":50.21,"body":"from a patient perspective, one of the concerns"},{"startTime":50.394,"endTime":53.29,"body":"is they feel like we're taking a square peg and trying to put"},{"startTime":53.314,"endTime":56.228,"body":"it through a round hole, meaning"},{"startTime":56.648,"endTime":59.6,"body":"that their body is being put on"},{"startTime":59.624,"endTime":62.512,"body":"birth control to fulfill our"},{"startTime":62.56,"endTime":65.176,"body":"need and not their need,"},{"startTime":65.312,"endTime":68.248,"body":"which makes a lot of sense. I could clearly see"},{"startTime":68.288,"endTime":71.024,"body":"how that's true, because with batching, there"},{"startTime":71.056,"endTime":73.72,"body":"are start dates, and so it would feel"},{"startTime":73.784,"endTime":76.744,"body":"like they're being pushed into a situation that may be bad"},{"startTime":76.776,"endTime":79.6,"body":"for them. But as we've talked about in"},{"startTime":79.624,"endTime":82.484,"body":"other podcasts, being on birth control is not a"},{"startTime":82.516,"endTime":85.364,"body":"bad thing. That is priming. And so you can"},{"startTime":85.396,"endTime":88.212,"body":"prime in many different ways. But the"},{"startTime":88.26,"endTime":91.004,"body":"reason for batching is slightly different. And"},{"startTime":91.036,"endTime":94.028,"body":"so I want to take a moment first to talk about what"},{"startTime":94.068,"endTime":96.852,"body":"batching is, and then talk about"},{"startTime":97.02,"endTime":99.42,"body":"why clinics use it and the benefits of"},{"startTime":99.444,"endTime":102.204,"body":"batching. And then we'll start talking about patients"},{"startTime":102.276,"endTime":104.768,"body":"concerns and what you can do about it."},{"startTime":105.708,"endTime":108.604,"body":"So the first question is, what's the definition of"},{"startTime":108.636,"endTime":111.28,"body":"batching? There are many"},{"startTime":111.424,"endTime":114.392,"body":"different ways to batch. So I think the classic way people"},{"startTime":114.44,"endTime":117.184,"body":"think of batching is everyone starts on the"},{"startTime":117.216,"endTime":120.216,"body":"same day, so they're all lined up, and all the"},{"startTime":120.232,"endTime":123.208,"body":"IVF cycles fall within a bell shaped curve over"},{"startTime":123.248,"endTime":125.508,"body":"the next month or weeks."},{"startTime":126.248,"endTime":128.668,"body":"But that's actually not what batching means."},{"startTime":130.008,"endTime":132.728,"body":"All that means to batch is that one"},{"startTime":132.768,"endTime":135.408,"body":"point, your clinic is stopping doing IVIP"},{"startTime":135.448,"endTime":138.16,"body":"procedures. That means both retrievals"},{"startTime":138.264,"endTime":140.744,"body":"and transfers. So if you don't"},{"startTime":140.776,"endTime":143.72,"body":"batch, it means your clinic never takes"},{"startTime":143.744,"endTime":146.6,"body":"a break. It doesn't matter what day of the month"},{"startTime":146.624,"endTime":148.744,"body":"it is. The clinic is either doing"},{"startTime":148.816,"endTime":150.896,"body":"IVF retrievals,"},{"startTime":151.072,"endTime":153.952,"body":"transfers, or culturing embryos, and it"},{"startTime":154.0,"endTime":156.936,"body":"never stops. A clinic that batches"},{"startTime":157.072,"endTime":159.56,"body":"is going to at one point, stop for a period of"},{"startTime":159.584,"endTime":161.668,"body":"time and then restart up."},{"startTime":162.188,"endTime":165.076,"body":"Now, when I say batching as a wide"},{"startTime":165.132,"endTime":168.108,"body":"definition, what I'm talking about is there are"},{"startTime":168.148,"endTime":170.86,"body":"some clients that just do one cycle a"},{"startTime":170.884,"endTime":173.756,"body":"month and they have everyone start on the same"},{"startTime":173.812,"endTime":176.484,"body":"day. There are other places that batch"},{"startTime":176.636,"endTime":179.164,"body":"most of the month and then take a week"},{"startTime":179.196,"endTime":182.196,"body":"off. There are some that are on for two"},{"startTime":182.252,"endTime":185.244,"body":"weeks and two weeks off. The point is, the"},{"startTime":185.276,"endTime":188.052,"body":"word batching is just defining as"},{"startTime":188.1,"endTime":190.886,"body":"taking that break. How significant"},{"startTime":191.022,"endTime":193.822,"body":"that batching is and how it affects patients is"},{"startTime":193.87,"endTime":196.87,"body":"going to change. So some clinics"},{"startTime":196.974,"endTime":199.458,"body":"will start some patients, let's say, on Monday,"},{"startTime":199.838,"endTime":202.806,"body":"and then they will start some more patients on Tuesday, and"},{"startTime":202.822,"endTime":205.618,"body":"then Wednesday, and then Thursday and so on"},{"startTime":206.078,"endTime":208.458,"body":"until all the patients have gone through."},{"startTime":208.798,"endTime":211.438,"body":"And so then they get done by the end of the"},{"startTime":211.478,"endTime":214.438,"body":"month, and they go down for a week. Other"},{"startTime":214.478,"endTime":217.058,"body":"places may start everyone on that Monday,"},{"startTime":217.368,"endTime":219.92,"body":"and then the following Monday, start another batch of"},{"startTime":219.944,"endTime":222.896,"body":"people. Now, the question is, what is the"},{"startTime":222.952,"endTime":225.624,"body":"benefit of batching? So, from the"},{"startTime":225.656,"endTime":228.56,"body":"clinic side, the benefit is it allows"},{"startTime":228.584,"endTime":231.468,"body":"a lab to concentrate a lot of patients together."},{"startTime":231.928,"endTime":234.112,"body":"And so that allows for better use of"},{"startTime":234.16,"endTime":236.904,"body":"supplies, because you can share the supplies over"},{"startTime":236.936,"endTime":239.744,"body":"multiple patients versus having to individually use"},{"startTime":239.776,"endTime":242.704,"body":"it for one group. It allows for the"},{"startTime":242.736,"endTime":245.432,"body":"doctors and staff not to have to work every single"},{"startTime":245.48,"endTime":248.268,"body":"weekend and eventually have one weekend off"},{"startTime":248.388,"endTime":251.128,"body":"so they can be with family and go on trips."},{"startTime":251.468,"endTime":254.38,"body":"It also allows for some scheduling, because it allows"},{"startTime":254.404,"endTime":257.18,"body":"them, the doctors, to have days that they"},{"startTime":257.204,"endTime":260.036,"body":"can focus on patients for consultations"},{"startTime":260.212,"endTime":263.012,"body":"and things like follow ups and even procedures that they"},{"startTime":263.06,"endTime":265.988,"body":"wouldn't be able to do if they were waiting for IVF"},{"startTime":266.028,"endTime":268.828,"body":"all the time. And to understand that more,"},{"startTime":268.948,"endTime":271.668,"body":"what you have to understand is that we never know when"},{"startTime":271.708,"endTime":274.564,"body":"someone's going to undergo a retrieval. So we have to"},{"startTime":274.596,"endTime":276.924,"body":"basically block our entire morning for that"},{"startTime":276.956,"endTime":279.948,"body":"retrieval, whether it's going to happen or not."},{"startTime":280.068,"endTime":282.82,"body":"And that means patients can't be seen"},{"startTime":282.924,"endTime":285.82,"body":"during that time. I can't make a consult in a"},{"startTime":285.844,"endTime":288.798,"body":"day I don't know about. And so it, limits how many"},{"startTime":288.822,"endTime":290.946,"body":"patients can be seen at the clinic."},{"startTime":291.406,"endTime":294.326,"body":"Whereas if you batch, you know, okay, there's"},{"startTime":294.366,"endTime":297.31,"body":"going to be no retrievals or transfers during"},{"startTime":297.358,"endTime":300.302,"body":"this time. So I can now see patients and do"},{"startTime":300.334,"endTime":303.234,"body":"follow ups. And if your doctor is someone who's"},{"startTime":303.25,"endTime":305.89,"body":"at a satellite clinic, meaning that they don't even"},{"startTime":305.938,"endTime":308.77,"body":"reside at the clinic, that does the retrievals, then"},{"startTime":308.818,"endTime":311.61,"body":"they have to block that time also even to get"},{"startTime":311.658,"endTime":314.166,"body":"there in the case that they have retrievals."},{"startTime":314.866,"endTime":317.77,"body":"And so it becomes very inefficient for the clinic"},{"startTime":317.818,"endTime":320.562,"body":"and even for the patients in some ways, because now"},{"startTime":320.674,"endTime":323.546,"body":"you have more time to be with your doctor versus the doctor's"},{"startTime":323.586,"endTime":326.53,"body":"schedule being filled with times that he may or she"},{"startTime":326.578,"endTime":329.422,"body":"may never use. Now, on the"},{"startTime":329.454,"endTime":332.158,"body":"patient side of things, there's also some"},{"startTime":332.182,"endTime":335.006,"body":"benefits that may not be direct, but there are some"},{"startTime":335.046,"endTime":337.814,"body":"benefits to the quality of the lab. So, for"},{"startTime":337.83,"endTime":340.614,"body":"example, if a lab is up all the time,"},{"startTime":340.71,"endTime":343.546,"body":"that means the lab is not getting cleaned all the time"},{"startTime":343.886,"endTime":346.774,"body":"you cannot bring cleaning products into a lab when"},{"startTime":346.79,"endTime":349.506,"body":"there are embryos there, it will hurt the embryos."},{"startTime":349.846,"endTime":352.646,"body":"So the only time you can clean is when you"},{"startTime":352.686,"endTime":355.46,"body":"take a break. Most labs shut down"},{"startTime":355.508,"endTime":358.508,"body":"for at least once a year, if not twice a year, to"},{"startTime":358.532,"endTime":361.452,"body":"be able to do this. Deep cleaning. Clinics"},{"startTime":361.484,"endTime":363.958,"body":"that batch are, able to do the cleaning much more"},{"startTime":364.03,"endTime":366.702,"body":"often, which means there's a cleaner"},{"startTime":366.742,"endTime":369.51,"body":"lab, and that means possibly less free"},{"startTime":369.566,"endTime":372.27,"body":"radicals floating around. That also means"},{"startTime":372.326,"endTime":374.686,"body":"potentially more QC, meaning quality"},{"startTime":374.734,"endTime":377.47,"body":"control, because now when you're down,"},{"startTime":377.566,"endTime":380.082,"body":"there could be some testing that needs to be done."},{"startTime":380.462,"endTime":383.35,"body":"You wouldn't be able to do this with the lab being up all"},{"startTime":383.366,"endTime":386.142,"body":"the time because most, clinics are"},{"startTime":386.166,"endTime":388.862,"body":"using most of their equipment, so they can't do a lot of"},{"startTime":388.886,"endTime":391.69,"body":"testing on them when the equipment's being used,"},{"startTime":392.31,"endTime":394.878,"body":"especially when the patient's going through."},{"startTime":395.054,"endTime":397.942,"body":"Now, it's important to understand not batching is also"},{"startTime":398.006,"endTime":400.886,"body":"not bad. But there is no question"},{"startTime":401.038,"endTime":403.942,"body":"that they can't clean the lab as much. Now, maybe if it's a"},{"startTime":403.966,"endTime":406.774,"body":"place that has a very big lab, maybe they can shut down one section,"},{"startTime":406.822,"endTime":409.742,"body":"clean one. But if they're all using the same air system, they"},{"startTime":409.766,"endTime":412.686,"body":"can't do that. There are many clinics"},{"startTime":412.758,"endTime":415.63,"body":"who would just let someone start their period and then"},{"startTime":415.67,"endTime":418.51,"body":"start a stimulation. And a lot of people"},{"startTime":418.55,"endTime":421.31,"body":"think, well, the reason my clinics not letting me do that is because they"},{"startTime":421.35,"endTime":424.262,"body":"batch. That's actually not true. Whether we batched"},{"startTime":424.286,"endTime":426.934,"body":"or not, I would almost always still"},{"startTime":427.022,"endTime":429.846,"body":"prime patients. And because priming has some"},{"startTime":429.878,"endTime":432.862,"body":"benefit. One of the things I talked about in one of our prior"},{"startTime":432.926,"endTime":435.686,"body":"episodes is that getting FSH levels"},{"startTime":435.718,"endTime":438.662,"body":"down a little bit lower to upregulate the receptors"},{"startTime":438.806,"endTime":441.606,"body":"helps with the stimulation. So"},{"startTime":441.718,"endTime":443.99,"body":"that concept that"},{"startTime":444.15,"endTime":446.966,"body":"batching is purely to"},{"startTime":447.158,"endTime":449.57,"body":"benefit the clinic is not completely true."},{"startTime":449.87,"endTime":452.742,"body":"Sometimes the reason why you're on birth control isn't because of the"},{"startTime":452.766,"endTime":455.59,"body":"batching, but it's because it actually"},{"startTime":455.63,"endTime":457.782,"body":"allows you to upregulate receptors."},{"startTime":457.966,"endTime":460.838,"body":"Now, you may be on the birth control for an extra"},{"startTime":460.894,"endTime":463.862,"body":"day or two because of batching, because you may line up a little bit better."},{"startTime":463.966,"endTime":466.836,"body":"But, most clinics have multiple days that they start. So"},{"startTime":466.868,"endTime":469.796,"body":"rarely are you being forced into a cycle thats not good for"},{"startTime":469.828,"endTime":472.812,"body":"you. Its just youre being manipulated a little bit around"},{"startTime":472.956,"endTime":475.788,"body":"to fit in the best cycle for you. That works with the"},{"startTime":475.804,"endTime":478.716,"body":"clinic as well. And then the batching is benefiting"},{"startTime":478.788,"endTime":481.16,"body":"you because youre able to clean the lab."},{"startTime":481.54,"endTime":484.356,"body":"So, for example, at my clinic, we batch"},{"startTime":484.428,"endTime":487.172,"body":"every month. Every month we do a deep clean."},{"startTime":487.236,"endTime":490.06,"body":"Were down for about one week. And during that one"},{"startTime":490.1,"endTime":493.05,"body":"week, there are no IVF procedures going on, no"},{"startTime":493.09,"endTime":495.882,"body":"transfers, no retrieval. And then"},{"startTime":495.906,"endTime":498.874,"body":"before we start the next month, we have a"},{"startTime":498.922,"endTime":501.81,"body":"brand new lab, basically a clean lab that's been deep"},{"startTime":501.85,"endTime":503.79,"body":"cleaned and ready to go."},{"startTime":504.13,"endTime":507.036,"body":"And I personally believe that helps"},{"startTime":507.084,"endTime":509.836,"body":"with pregnancy rates versus having a"},{"startTime":509.844,"endTime":512.836,"body":"lab constantly up. There's no chance for cleaning."},{"startTime":512.924,"endTime":515.844,"body":"I've been in those clinics before, and at those clinics we"},{"startTime":515.868,"endTime":518.764,"body":"shut down once or twice a year to do a"},{"startTime":518.788,"endTime":521.744,"body":"deep clean. Now am I going to pretend that that makes our"},{"startTime":521.768,"endTime":524.664,"body":"clinic the best in the world? No, I think"},{"startTime":524.688,"endTime":527.512,"body":"it makes small differences. Matter of fact, I think it makes"},{"startTime":527.632,"endTime":530.424,"body":"more of a difference depending on who the patient is."},{"startTime":530.568,"endTime":533.408,"body":"Ive always made the comment that if youre young and youre 24, with"},{"startTime":533.44,"endTime":536.132,"body":"really very little fertility problems and maybe a sperm problem,"},{"startTime":536.432,"endTime":539.032,"body":"you can probably go to Bob's backyard IVF and do"},{"startTime":539.072,"endTime":541.612,"body":"just as well and become a way successful."},{"startTime":541.912,"endTime":544.816,"body":"But if youre someone whos failed multiple, multiple cycles"},{"startTime":544.984,"endTime":547.926,"body":"and now youre trying to get pregnant on maybe your 6th"},{"startTime":547.95,"endTime":550.79,"body":"or 7th ivF, it may help being"},{"startTime":550.822,"endTime":553.742,"body":"at a clinic that batches a little bit more to"},{"startTime":553.758,"endTime":556.686,"body":"be able to have a cleaner lab because those free radicals"},{"startTime":556.79,"endTime":559.766,"body":"may be the difference of it working or not for you. I think"},{"startTime":559.79,"endTime":562.702,"body":"the most important point here is don't look"},{"startTime":562.718,"endTime":565.446,"body":"at batching as bad. There"},{"startTime":565.51,"endTime":568.086,"body":"are going to be, though, outliers."},{"startTime":568.27,"endTime":571.006,"body":"Obviously. If your clinic is saying that, hey, we only do"},{"startTime":571.03,"endTime":574.03,"body":"ivf cycles in June and then again"},{"startTime":574.102,"endTime":576.962,"body":"in September, then yes, putting you"},{"startTime":576.978,"endTime":579.842,"body":"on birth control for several months to try to get you to line up with"},{"startTime":579.858,"endTime":582.73,"body":"that is not a good situation. You are"},{"startTime":582.762,"endTime":585.594,"body":"then taking a square peg, trying to put through a circle."},{"startTime":585.754,"endTime":588.578,"body":"But just because they batch within"},{"startTime":588.626,"endTime":591.254,"body":"the month does not make things bad."},{"startTime":592.114,"endTime":594.85,"body":"And like I mentioned, even if your clinic"},{"startTime":594.922,"endTime":597.898,"body":"wasn't batching, there is a very high chance"},{"startTime":597.946,"endTime":600.434,"body":"that they would be putting you on, birth control regardless."},{"startTime":600.874,"endTime":603.85,"body":"It's not there to make you line up, but it's also"},{"startTime":603.922,"endTime":606.842,"body":"there to help up regulate those receptors"},{"startTime":606.898,"endTime":609.722,"body":"to help improve your IVF cycle. And"},{"startTime":609.738,"endTime":612.57,"body":"there's plenty of evidence to back this up. We know"},{"startTime":612.602,"endTime":615.53,"body":"that labs that have better air systems do have"},{"startTime":615.602,"endTime":618.538,"body":"better pregnancy rates. When you're comparing"},{"startTime":618.586,"endTime":621.402,"body":"the complicated cases. Again, if you take"},{"startTime":621.458,"endTime":624.17,"body":"all the best cases, they probably can do well"},{"startTime":624.282,"endTime":627.214,"body":"anywhere. If we're just using pregnancy as"},{"startTime":627.254,"endTime":630.094,"body":"the outcome. But if you're looking at things like number"},{"startTime":630.134,"endTime":633.126,"body":"of blastocyst being made and let's"},{"startTime":633.15,"endTime":636.086,"body":"say cumulative pregnancies, then air condition"},{"startTime":636.15,"endTime":638.982,"body":"makes a big difference. And that condition of"},{"startTime":638.998,"endTime":641.75,"body":"the air isn't just the system they use"},{"startTime":641.822,"endTime":644.726,"body":"to clean the place the air, but also how"},{"startTime":644.87,"endTime":647.678,"body":"the place is cleaned is it the same"},{"startTime":647.726,"endTime":650.702,"body":"dust that's been around for six months, or is it just dust that"},{"startTime":650.718,"endTime":653.636,"body":"came from the cells of the embryologist skin over"},{"startTime":653.66,"endTime":656.62,"body":"just the last few weeks? We all release dead"},{"startTime":656.652,"endTime":659.064,"body":"cells. Not to gross you out,"},{"startTime":659.444,"endTime":662.108,"body":"but the average human sheds"},{"startTime":662.156,"endTime":664.908,"body":"around 30,000 to 40,000 dead"},{"startTime":664.956,"endTime":667.692,"body":"skin cells every minute."},{"startTime":667.868,"endTime":670.844,"body":"That's millions a day per month."},{"startTime":671.004,"endTime":673.924,"body":"That's 1,000,000,005, hundred 12 million"},{"startTime":674.092,"endTime":676.644,"body":"skin cells. And within a month, that means"},{"startTime":676.812,"endTime":679.692,"body":"there's approximately 543.6 grams"},{"startTime":679.716,"endTime":682.55,"body":"of dead skin cells shed by the average person."},{"startTime":682.97,"endTime":685.546,"body":"That is half of a kilogram."},{"startTime":685.738,"endTime":688.362,"body":"I don't think you'd be shocked to know that could make a"},{"startTime":688.386,"endTime":690.922,"body":"difference in the cleanliness of the"},{"startTime":690.946,"endTime":693.89,"body":"lab. So, overall, the point of this"},{"startTime":693.93,"endTime":696.39,"body":"podcast was to help reassure you,"},{"startTime":696.81,"endTime":699.074,"body":"don't be concerned that your clinic does"},{"startTime":699.122,"endTime":702.026,"body":"batching. I think it's important to ask what their"},{"startTime":702.058,"endTime":704.762,"body":"batching is, because again, if you're a clinic that"},{"startTime":704.786,"endTime":707.29,"body":"only operates three times a"},{"startTime":707.33,"endTime":709.746,"body":"year, then that batching could be a little bit"},{"startTime":709.778,"endTime":712.578,"body":"detrimental, because being on birth control for three months"},{"startTime":712.714,"endTime":715.23,"body":"would be a concern. But"},{"startTime":715.69,"endTime":718.074,"body":"if the batching is there to be able to"},{"startTime":718.122,"endTime":720.874,"body":"help improve the lab,"},{"startTime":721.042,"endTime":723.87,"body":"and you're not on birth control for three months,"},{"startTime":724.29,"endTime":727.066,"body":"then there are actually major benefits to you"},{"startTime":727.138,"endTime":729.554,"body":"and to your embryos and having the highest quality"},{"startTime":729.602,"endTime":732.506,"body":"lab. And so it doesn't make labs"},{"startTime":732.538,"endTime":734.844,"body":"that don't batch every month"},{"startTime":734.972,"endTime":737.54,"body":"worse, and it doesn't make"},{"startTime":737.7,"endTime":740.012,"body":"labs that are continuously up"},{"startTime":740.156,"endTime":743.06,"body":"bad. But I want you to at least understand"},{"startTime":743.22,"endTime":746.196,"body":"what the reason behind the batching is and why"},{"startTime":746.228,"endTime":748.804,"body":"it still benefits you. And so"},{"startTime":748.932,"endTime":751.732,"body":"with one system, you're giving up the"},{"startTime":751.756,"endTime":754.372,"body":"cleansingness of the lab, but in the other"},{"startTime":754.436,"endTime":757.252,"body":"system, you might have to be on birth control for a"},{"startTime":757.276,"endTime":760.188,"body":"few days longer than you originally been"},{"startTime":760.284,"endTime":762.984,"body":"on. But the most important part to understand"},{"startTime":763.072,"endTime":765.952,"body":"is, even if the lab didnt batch,"},{"startTime":766.136,"endTime":768.992,"body":"most programs that are using batching"},{"startTime":769.016,"endTime":771.896,"body":"or not batching, are still using birth control."},{"startTime":772.088,"endTime":775.008,"body":"And there are very few clinics that just allow you"},{"startTime":775.024,"endTime":777.392,"body":"to start stimulation with your"},{"startTime":777.416,"endTime":780.368,"body":"menses, which we call cold start. We do it"},{"startTime":780.384,"endTime":783.352,"body":"as well. Matter of fact, every cancer patient that comes through is"},{"startTime":783.376,"endTime":785.98,"body":"usually a cold start, because we have to start them right away."},{"startTime":786.7,"endTime":789.692,"body":"But if we had the choice, most"},{"startTime":789.756,"endTime":792.596,"body":"doctors are going to do some type of"},{"startTime":792.628,"endTime":795.508,"body":"priming. I would even make the argument"},{"startTime":795.644,"endTime":798.34,"body":"that some of the clients that are not using priming"},{"startTime":798.46,"endTime":801.316,"body":"are even doing it for ulterior motives. Meaning"},{"startTime":801.468,"endTime":804.404,"body":"they want to get the patient in right away. They don't want them to second guess."},{"startTime":804.492,"endTime":807.436,"body":"They want them start as m soon as possible, because you can't change your mind once you"},{"startTime":807.468,"endTime":810.244,"body":"started. Now, I can't prove that,"},{"startTime":810.292,"endTime":813.076,"body":"but that's my personal opinion, because I don't see the"},{"startTime":813.108,"endTime":815.426,"body":"benefit of never putting people on"},{"startTime":815.458,"endTime":817.89,"body":"priming. There is absolute"},{"startTime":817.97,"endTime":820.406,"body":"evidence that there is benefits of being on,"},{"startTime":820.388,"endTime":823.3,"body":"priming. So if you never do it, there has to"},{"startTime":823.316,"endTime":826.1,"body":"be another reason for it, because it's definitely not for the"},{"startTime":826.116,"endTime":828.668,"body":"patient every time. There may be situations where it"},{"startTime":828.7,"endTime":831.66,"body":"is, but it is not true all"},{"startTime":831.676,"endTime":834.612,"body":"the time. As always, hopefully this"},{"startTime":834.652,"endTime":837.404,"body":"episode was helpful to you and that maybe have a better idea"},{"startTime":837.428,"endTime":840.376,"body":"of understanding, batching, and maybe something you"},{"startTime":840.384,"endTime":843.32,"body":"were concerned about, you were able to feel more comfortable about,"},{"startTime":843.376,"endTime":846.328,"body":"or maybe help you make a decision. But in the"},{"startTime":846.36,"endTime":849.056,"body":"end, as I always say, thank you so much"},{"startTime":849.104,"endTime":851.832,"body":"for coming and listening to this podcast. And as"},{"startTime":851.872,"endTime":854.76,"body":"always, please spread this podcast as much as you"},{"startTime":854.776,"endTime":857.704,"body":"can, because I don't advertise it, and so it's"},{"startTime":857.768,"endTime":860.648,"body":"you who does the advertising to let people know about it. And the more people"},{"startTime":860.68,"endTime":863.48,"body":"that listen to it just makes me more excited to do it."},{"startTime":863.576,"endTime":866.352,"body":"And so I really love seeing the comments that come in and"},{"startTime":866.392,"endTime":869.296,"body":"also seeing the numbers of people listening to"},{"startTime":869.304,"endTime":872.208,"body":"this show. If you love it, tell someone about it. Maybe"},{"startTime":872.24,"endTime":875.152,"body":"tell a family member and give us a good five star review if you really"},{"startTime":875.192,"endTime":877.888,"body":"like it. As always, the most important part"},{"startTime":877.92,"endTime":880.664,"body":"is to keep coming back. I look forward to"},{"startTime":880.688,"endTime":883.432,"body":"talking next week, on talk about fertility Tuesday."}]}