{"version":"1.0.0","segments":[{"startTime":1.08,"endTime":3.838,"body":"Today we talk about what happens"},{"startTime":3.934,"endTime":6.05,"body":"to the unfertilized egg."},{"startTime":7.11,"endTime":9.718,"body":"I'm Doctor Mark Amos and"},{"startTime":9.774,"endTime":12.23,"body":"this is taco. About"},{"startTime":12.31,"endTime":13.57,"body":"fertility Tuesday."},{"startTime":26.77,"endTime":29.186,"body":"So there's this question that I get asked a lot of"},{"startTime":29.218,"endTime":32.114,"body":"time and the first time I heard it I thought it"},{"startTime":32.122,"endTime":35.026,"body":"was kind of a silly thought. And then"},{"startTime":35.098,"endTime":37.882,"body":"over the years I've had a lot of"},{"startTime":37.906,"endTime":40.57,"body":"people ask this question and then I started"},{"startTime":40.61,"endTime":43.578,"body":"realizing that it's actually a very common"},{"startTime":43.714,"endTime":45.79,"body":"thought. And that is,"},{"startTime":46.61,"endTime":49.45,"body":"when an egg's not fertilized, what"},{"startTime":49.49,"endTime":51.874,"body":"happens to it? Have you ever"},{"startTime":51.922,"endTime":54.812,"body":"wondered what happens to that egg if it"},{"startTime":54.836,"endTime":57.652,"body":"doesn't meet a sperm? What happens if your"},{"startTime":57.676,"endTime":60.32,"body":"tubes are tied and the sperm can't get to it?"},{"startTime":61.22,"endTime":63.2,"body":"Does it affect your menstrual cycle?"},{"startTime":64.3,"endTime":66.68,"body":"This question, or thought"},{"startTime":67.66,"endTime":70.388,"body":"was more about the guy"},{"startTime":70.444,"endTime":73.2,"body":"thought when a woman has a menstrual cycle"},{"startTime":73.86,"endTime":76.51,"body":"that is her eggs coming out of her body."},{"startTime":78.62,"endTime":81.08,"body":"He thought since her tubes were blocked,"},{"startTime":81.66,"endTime":84.516,"body":"he was not sure what's going on, why she"},{"startTime":84.548,"endTime":87.508,"body":"gained a period. And again, when I first heard this I"},{"startTime":87.524,"endTime":90.48,"body":"thought, he's a guy and we're not that smart"},{"startTime":90.52,"endTime":93.46,"body":"anyway, so that's probably why he thinks that."},{"startTime":94.4,"endTime":97.232,"body":"But then I've had women ask that. I've"},{"startTime":97.256,"endTime":100.112,"body":"had many women after they lose their tubes go, am I going to still get my"},{"startTime":100.136,"endTime":102.912,"body":"menstrual period? And I think, why wouldn't you get your menstrual"},{"startTime":102.936,"endTime":105.466,"body":"period? I thought maybe they"},{"startTime":105.578,"endTime":108.49,"body":"misunderstand the tubes, that maybe they thought by the tubes"},{"startTime":108.53,"endTime":111.076,"body":"being blocked that maybe thats how the flow comes out. But"},{"startTime":111.092,"endTime":113.652,"body":"then when I asked the next"},{"startTime":113.7,"endTime":116.444,"body":"questions to figure this out, the thing they kept saying to me"},{"startTime":116.476,"endTime":119.316,"body":"was, oh, I thought what comes out"},{"startTime":119.412,"endTime":121.972,"body":"are the eggs. Thats what your menstrual cycle"},{"startTime":122.02,"endTime":124.764,"body":"is. And that was fascinating to me"},{"startTime":124.796,"endTime":127.636,"body":"because ill be honest, even before medical school I"},{"startTime":127.652,"endTime":130.645,"body":"actually understood that a little bit more"},{"startTime":130.701,"endTime":133.127,"body":"through sciences and stuff that it was"},{"startTime":133.247,"endTime":136.223,"body":"the uterus that was shedding. But"},{"startTime":136.255,"endTime":138.787,"body":"what I realized is this is a very common question,"},{"startTime":139.127,"endTime":141.975,"body":"the question of what happens to"},{"startTime":141.991,"endTime":144.879,"body":"that egg when it doesn't meet sperm, it doesn't"},{"startTime":144.903,"endTime":147.871,"body":"become fertilized. So let's start first"},{"startTime":147.919,"endTime":150.775,"body":"with a premise that your period"},{"startTime":150.951,"endTime":153.943,"body":"is not the eggs coming out. Now I understand why people can"},{"startTime":153.975,"endTime":156.918,"body":"think that because technically if the egg gets picked"},{"startTime":156.958,"endTime":159.798,"body":"up and then it goes down the fallopian"},{"startTime":159.838,"endTime":162.294,"body":"tube in the uterus, well obviously it's going to come on"},{"startTime":162.326,"endTime":165.294,"body":"out when you have your period. But"},{"startTime":165.326,"endTime":168.262,"body":"if your tubes are blocked, you still get a period. So I see where that comes"},{"startTime":168.31,"endTime":170.886,"body":"from. But what the menstrual cycle really"},{"startTime":170.942,"endTime":173.174,"body":"is, is the inside of the"},{"startTime":173.206,"endTime":175.734,"body":"uterus is building up through the"},{"startTime":175.766,"endTime":178.67,"body":"month, and as it's building up, it's getting"},{"startTime":178.734,"endTime":181.536,"body":"ready for implantation. And if"},{"startTime":181.552,"endTime":184.2,"body":"that implantation doesnt occur with a fertilized"},{"startTime":184.264,"endTime":187.2,"body":"egg, then its being shed out and well get"},{"startTime":187.224,"endTime":190.104,"body":"into that in a minute. But at least first"},{"startTime":190.216,"endTime":193.032,"body":"part were going to say is the menses is not"},{"startTime":193.08,"endTime":195.312,"body":"the eggs coming out, its the uterine lying,"},{"startTime":195.36,"endTime":197.912,"body":"shedding. So lets start with the first"},{"startTime":197.96,"endTime":200.872,"body":"part, the egg. So every"},{"startTime":200.92,"endTime":203.84,"body":"month your body has multiple"},{"startTime":203.904,"endTime":206.88,"body":"follicles that grow. Those follicles are these sacs that"},{"startTime":206.904,"endTime":209.638,"body":"have an egg in it. Now, your body"},{"startTime":209.758,"endTime":211.974,"body":"naturally makes just one that"},{"startTime":212.006,"endTime":214.734,"body":"releases, but there's actually 1000 eggs that are"},{"startTime":214.766,"endTime":217.614,"body":"selected. And from those thousand, somewhere"},{"startTime":217.646,"endTime":220.378,"body":"around eight to maybe 20 start to grow,"},{"startTime":220.678,"endTime":223.414,"body":"and then those eight to 21 is selected to be"},{"startTime":223.446,"endTime":226.278,"body":"released. Whereas in other animals,"},{"startTime":226.358,"endTime":229.014,"body":"like cats, multiple of these follicles are"},{"startTime":229.046,"endTime":231.542,"body":"released. But in humans, it's just"},{"startTime":231.59,"endTime":234.45,"body":"usually one egg per month. But when"},{"startTime":234.474,"endTime":237.33,"body":"you get twins, which are fraternal, that's"},{"startTime":237.354,"endTime":240.226,"body":"the situation where you release two. Now, this"},{"startTime":240.282,"endTime":243.274,"body":"process happens regardless if you're trying to get"},{"startTime":243.306,"endTime":246.078,"body":"pregnant. That's why women have menstrual cycles."},{"startTime":246.658,"endTime":249.314,"body":"Now, when you release an egg, that"},{"startTime":249.386,"endTime":252.218,"body":"sac that's left over from where the egg"},{"startTime":252.258,"endTime":254.954,"body":"released closes and becomes a"},{"startTime":254.986,"endTime":257.97,"body":"corpus luteum, which is basically a progesterone factory that"},{"startTime":257.994,"endTime":260.814,"body":"makes progesterone to support a potential"},{"startTime":260.886,"endTime":263.75,"body":"pregnancy. Now, if that egg is"},{"startTime":263.774,"endTime":266.678,"body":"fertilized, that egg will keep working its way"},{"startTime":266.718,"endTime":269.374,"body":"down the fallopian tube while it's fertilized,"},{"startTime":269.526,"endTime":272.462,"body":"become an embryo. That embryo will then"},{"startTime":272.55,"endTime":275.414,"body":"implant into the lining of the uterus that's been building up"},{"startTime":275.446,"endTime":278.014,"body":"through the month. And then that"},{"startTime":278.086,"endTime":280.902,"body":"embryo will start making hcg,"},{"startTime":281.07,"endTime":283.99,"body":"which comes from the syncidiotrophoblastic cells, which are"},{"startTime":284.014,"endTime":286.964,"body":"part of the placenta, that signal"},{"startTime":287.076,"endTime":289.764,"body":"goes back to the corpus"},{"startTime":289.796,"endTime":292.288,"body":"luteum and tells it, hey, stick around,"},{"startTime":292.868,"endTime":295.86,"body":"I need your progesterone for a while until I can make my own. And"},{"startTime":295.884,"endTime":298.82,"body":"that's exactly what happens. The baby sends back"},{"startTime":298.844,"endTime":301.572,"body":"the ECG, the corpus luteum keeps making"},{"startTime":301.62,"endTime":304.476,"body":"progesterone, and the pregnancy keeps moving forward."},{"startTime":304.612,"endTime":307.452,"body":"So that's the normal way things work. But"},{"startTime":307.5,"endTime":310.484,"body":"what if the egg never met sperm, which"},{"startTime":310.516,"endTime":313.166,"body":"can happen some months even when you're trying to."},{"startTime":313.332,"endTime":316.25,"body":"Well, that egg is still going to be picked up by"},{"startTime":316.274,"endTime":319.274,"body":"the fallopian tube, and that egg is then going to"},{"startTime":319.306,"endTime":322.13,"body":"work its way down the fallopian tube into the"},{"startTime":322.154,"endTime":324.466,"body":"uterus. But where things are going to go"},{"startTime":324.562,"endTime":327.122,"body":"different is that because that egg never"},{"startTime":327.17,"endTime":329.914,"body":"fertilized, its never going to make"},{"startTime":329.986,"endTime":332.818,"body":"hcg. And since it doesnt make the"},{"startTime":332.858,"endTime":335.634,"body":"hcg levels go up, the"},{"startTime":335.666,"endTime":338.482,"body":"corpus luteum only has a finite time of"},{"startTime":338.53,"endTime":341.234,"body":"life. That corpus luteum will"},{"startTime":341.266,"endTime":343.922,"body":"collapse after about twelve to 14 days."},{"startTime":344.09,"endTime":346.866,"body":"And when it does, the progesterone levels will drop. And"},{"startTime":346.882,"endTime":349.458,"body":"at that point, thats when you will"},{"startTime":349.578,"endTime":352.474,"body":"shed the lining of the endometrium, which is the"},{"startTime":352.506,"endTime":355.41,"body":"inside of the uterus, because the progesterone is"},{"startTime":355.434,"endTime":358.434,"body":"no longer supporting it. That is why it drops"},{"startTime":358.466,"endTime":361.466,"body":"out. So from a technical standpoint,"},{"startTime":361.642,"endTime":364.29,"body":"yes, when the woman has her"},{"startTime":364.314,"endTime":367.07,"body":"menses, there is an egg"},{"startTime":367.174,"endTime":370.07,"body":"in there. And technically, if she released more than"},{"startTime":370.094,"endTime":373.038,"body":"one egg, there is more than one egg in that"},{"startTime":373.078,"endTime":375.918,"body":"menstrual cycle being released, but most"},{"startTime":375.958,"endTime":378.698,"body":"of the eggs never get there. Of,"},{"startTime":378.648,"endTime":381.528,"body":"those thousands of eggs that shes going to lose that month that"},{"startTime":381.544,"endTime":384.144,"body":"were selected, most of them never even"},{"startTime":384.192,"endTime":387.056,"body":"grow. And of the ones that grow,"},{"startTime":387.208,"endTime":389.808,"body":"only the ones that are released"},{"startTime":389.984,"endTime":392.66,"body":"are the ones that will be in that menstrual cycle."},{"startTime":393.02,"endTime":395.716,"body":"So in reality, the menses"},{"startTime":395.828,"endTime":398.7,"body":"is basically just endometrial lining being"},{"startTime":398.74,"endTime":401.1,"body":"passed, and that only a"},{"startTime":401.18,"endTime":403.796,"body":"microscopic egg, which, if it wasn't"},{"startTime":403.828,"endTime":406.716,"body":"fertilized, is already degenerating, is"},{"startTime":406.748,"endTime":409.284,"body":"being passed with the menstrual cycle."},{"startTime":409.452,"endTime":411.828,"body":"This cycle of menstruation occurs"},{"startTime":411.924,"endTime":414.908,"body":"approximately about 450 times in the"},{"startTime":414.924,"endTime":417.476,"body":"woman's lifetime, and they"},{"startTime":417.588,"endTime":420.576,"body":"usually have about 400 chances"},{"startTime":420.688,"endTime":423.424,"body":"of ovulation to get pregnant."},{"startTime":423.552,"endTime":426.344,"body":"The discrepancy between those numbers is the fact"},{"startTime":426.392,"endTime":429.336,"body":"that women start menstruating, sometimes"},{"startTime":429.368,"endTime":431.304,"body":"very early, before they're even having"},{"startTime":431.432,"endTime":433.984,"body":"intercourse. And as women get"},{"startTime":434.032,"endTime":436.6,"body":"older, after 44, 45,"},{"startTime":436.76,"endTime":439.744,"body":"the chances of getting pregnant are very low. So there"},{"startTime":439.792,"endTime":442.712,"body":"is a portion of their life where they're having the menses, but"},{"startTime":442.736,"endTime":445.536,"body":"really can't get pregnant. Pregnancy really falls"},{"startTime":445.568,"endTime":448.4,"body":"into that, about 380 to"},{"startTime":448.44,"endTime":451.352,"body":"400 ovulations through your lifetime."},{"startTime":451.536,"endTime":454.312,"body":"That's actually one of the ways fertility doctors are able to"},{"startTime":454.336,"endTime":457.176,"body":"improve pregnancy rates, is by making more eggs, you're getting"},{"startTime":457.248,"endTime":460.192,"body":"more chances per ovulation. Naturally, you"},{"startTime":460.216,"endTime":463.096,"body":"only get twelve chances a year to get pregnant."},{"startTime":463.248,"endTime":466.208,"body":"But if you're making an extra egg every month now, you have"},{"startTime":466.224,"endTime":468.67,"body":"up to 24, chances in a year because you're making two"},{"startTime":468.71,"endTime":471.63,"body":"eggs, and potentially even more with other fertility"},{"startTime":471.67,"endTime":474.166,"body":"treatments. So, based off of what we talked"},{"startTime":474.198,"endTime":477.022,"body":"about, even if a woman's tubes are"},{"startTime":477.046,"endTime":479.806,"body":"blocked, she's still going to have amenses, because it"},{"startTime":479.838,"endTime":482.822,"body":"doesn't matter if the egg makes its way down to the"},{"startTime":482.846,"endTime":485.846,"body":"uterus, the egg's not fertilized, which means it's"},{"startTime":485.878,"endTime":488.814,"body":"never going to make hcg. And so"},{"startTime":488.982,"endTime":491.852,"body":"the, hormonal drop is what's going to"},{"startTime":491.868,"endTime":494.82,"body":"cause her to get her menses, not whether the egg made it"},{"startTime":494.852,"endTime":497.556,"body":"to the uterus. A slight"},{"startTime":497.62,"endTime":500.284,"body":"tangent to this topic, but still relevant"},{"startTime":500.444,"endTime":503.34,"body":"is this question about when you go through fertility"},{"startTime":503.372,"endTime":506.196,"body":"treatment then, and you're making more eggs, will you"},{"startTime":506.22,"endTime":509.156,"body":"then go into menopause early? Will you lose, the number of"},{"startTime":509.22,"endTime":512.028,"body":"eggs you lose every month will go"},{"startTime":512.076,"endTime":514.78,"body":"higher. And the answer is no, because as I"},{"startTime":514.812,"endTime":517.524,"body":"discussed, you're going to lose 1000"},{"startTime":517.604,"endTime":520.308,"body":"eggs pretty much every month. And"},{"startTime":520.436,"endTime":523.324,"body":"the eggs that we're removing from your body or that we're"},{"startTime":523.364,"endTime":526.292,"body":"making to ovulate extra are the same eggs"},{"startTime":526.308,"endTime":528.364,"body":"that were going to be lost anyways."},{"startTime":529.224,"endTime":531.564,"body":"All women have a natural decline"},{"startTime":531.904,"endTime":534.344,"body":"in their fertility reserve as they get"},{"startTime":534.464,"endTime":536.76,"body":"older. It's called a process of"},{"startTime":536.832,"endTime":538.928,"body":"atresia. And by age"},{"startTime":538.976,"endTime":541.424,"body":"35, most women only have"},{"startTime":541.504,"endTime":544.124,"body":"6% of their egg reserve remaining."},{"startTime":544.584,"endTime":547.152,"body":"So what happens at that point? There is a big"},{"startTime":547.208,"endTime":549.792,"body":"tipping point at which there is"},{"startTime":549.888,"endTime":552.864,"body":"higher miscarriage rates, lower fertility,"},{"startTime":553.024,"endTime":555.9,"body":"because now the rate is so much"},{"startTime":555.932,"endTime":558.764,"body":"lower and the quality of eggs goes"},{"startTime":558.804,"endTime":561.6,"body":"down more. Now, one interesting question came up from"},{"startTime":561.632,"endTime":564.524,"body":"someone was what if you dont have a uterus,"},{"startTime":564.864,"endTime":567.056,"body":"what happens to the egg after its"},{"startTime":567.08,"endTime":570.008,"body":"ovulated? Thats a great question because again,"},{"startTime":570.056,"endTime":573.024,"body":"if you were under the impression that the only"},{"startTime":573.064,"endTime":575.776,"body":"way the egg got out was through the uterus"},{"startTime":575.88,"endTime":578.664,"body":"and that was the menses, then itd be this idea theyre"},{"startTime":578.704,"endTime":581.346,"body":"building up somewhere in the body, but in"},{"startTime":581.37,"endTime":584.37,"body":"reality, the egg is still released, it would not be"},{"startTime":584.402,"endTime":586.802,"body":"fertilized. And after that 24"},{"startTime":586.858,"endTime":589.61,"body":"hours, that egg will undergo that atresia"},{"startTime":589.642,"endTime":592.45,"body":"process and will still die. And then it will"},{"startTime":592.482,"endTime":595.218,"body":"fall somewhere into the pelvis and be reabsorbed"},{"startTime":595.386,"endTime":597.522,"body":"into the lining of the"},{"startTime":597.618,"endTime":600.466,"body":"abdomen. Well, I know I"},{"startTime":600.49,"endTime":602.826,"body":"didnt uncover and unravel"},{"startTime":602.93,"endTime":605.85,"body":"the eggs essential question of"},{"startTime":605.882,"endTime":608.788,"body":"the universe tonight. Hopefully this was a helpful"},{"startTime":608.836,"endTime":611.504,"body":"episode to some. Maybe you had the same question."},{"startTime":612.044,"endTime":614.7,"body":"And if you found this episode helpful, as"},{"startTime":614.732,"endTime":617.124,"body":"always, share it with a friend who it might"},{"startTime":617.164,"endTime":620.044,"body":"benefit. And if you like the podcast,"},{"startTime":620.084,"endTime":623.028,"body":"as I always say, please give us a five star review on your"},{"startTime":623.076,"endTime":625.644,"body":"favorite medium. As always,"},{"startTime":625.804,"endTime":628.724,"body":"please come back again. I really look forward to talking to"},{"startTime":628.724,"endTime":631.412,"body":"you guys again next week on Taco Bell"},{"startTime":631.508,"endTime":632.704,"body":"fertility Tuesday."},{"startTime":635.584,"endTime":643.424,"body":"Subscribe"},{"startTime":643.434,"endTime":643.454,"body":"M."}]}