{"version":"1.0.0","segments":[{"startTime":0.96,"endTime":3.825,"body":"Today we talk about different ways to prepare"},{"startTime":3.865,"endTime":6.833,"body":"for a frozen embryo transfer. Natural,"},{"startTime":7.009,"endTime":9.325,"body":"modified, and programmed."},{"startTime":10.265,"endTime":13.258,"body":"I'm, Dr. Mark Amels, and this"},{"startTime":13.442,"endTime":15.746,"body":"is Taco about Fertility"},{"startTime":15.826,"endTime":16.446,"body":"Tuesday."},{"startTime":27.986,"endTime":30.77,"body":"In today's episode, we're talking specifically"},{"startTime":30.818,"endTime":33.514,"body":"about frozen embryo transfers. If you've been through"},{"startTime":33.53,"endTime":36.162,"body":"ivf, there's a good chance you have frozen"},{"startTime":36.194,"endTime":39.026,"body":"embryos and you're ready for a transfer. Whether"},{"startTime":39.066,"endTime":41.858,"body":"it's the first, the second, maybe you're coming back for"},{"startTime":41.882,"endTime":44.802,"body":"another child. There's a good chance your embryos are"},{"startTime":44.834,"endTime":47.682,"body":"frozen. That's because overall, there has been a"},{"startTime":47.714,"endTime":50.09,"body":"shift in the way we do frozen embryo"},{"startTime":50.138,"endTime":53.05,"body":"transfers. In the past, we used to do fresh ones,"},{"startTime":53.098,"endTime":55.562,"body":"but now we freeze most embryos and do the transfers"},{"startTime":55.594,"endTime":58.454,"body":"later. It's not wrong to do fresh"},{"startTime":58.51,"endTime":61.329,"body":"transfers, and some places still do them, but, most do"},{"startTime":61.369,"endTime":64.249,"body":"frozen transfers. And so today we're going to talk"},{"startTime":64.289,"endTime":66.825,"body":"about the different types of transfer"},{"startTime":66.897,"endTime":69.289,"body":"processes, such as the"},{"startTime":69.329,"endTime":71.881,"body":"natural, modified natural and program"},{"startTime":71.985,"endTime":74.977,"body":"cycles. What I can tell you at first"},{"startTime":75.113,"endTime":77.737,"body":"is almost all programs are going to be doing"},{"startTime":77.793,"endTime":80.369,"body":"program cycles. That is going to be the norm."},{"startTime":80.529,"endTime":83.521,"body":"Additionally, they may have natural cycles as"},{"startTime":83.545,"endTime":85.869,"body":"well as modified natural cycles."},{"startTime":86.349,"endTime":89.213,"body":"So in this episode, we're going to talk about these different"},{"startTime":89.261,"endTime":92.253,"body":"techniques, we're going to talk about the pros and cons of each, and"},{"startTime":92.261,"endTime":95.141,"body":"then we're going to talk about why is one chosen over the"},{"startTime":95.165,"endTime":97.861,"body":"other and if maybe one might be better for you."},{"startTime":97.965,"endTime":100.965,"body":"So the first part is defining what is a frozen"},{"startTime":100.997,"endTime":103.957,"body":"embryo transfer. Essentially, it means that you have"},{"startTime":103.973,"endTime":106.877,"body":"an embryo that's frozen and now you are transferring it."},{"startTime":106.893,"endTime":109.749,"body":"So you're thawing it and then putting it back in the body,"},{"startTime":109.869,"endTime":112.807,"body":"versus a fresh transfer where the embryo was"},{"startTime":112.823,"endTime":115.551,"body":"growing in the petri dish and then was transferred"},{"startTime":115.615,"endTime":118.223,"body":"fresh into the uterus without ever being"},{"startTime":118.271,"endTime":121.111,"body":"frozen. The benefit of this is by freezing the"},{"startTime":121.135,"endTime":123.919,"body":"embryo, if you were in a cycle with high estrogen"},{"startTime":123.959,"endTime":126.583,"body":"levels, that could have caused progesterone levels to"},{"startTime":126.711,"endTime":129.591,"body":"rise, affecting then the implantation. So"},{"startTime":129.615,"endTime":132.063,"body":"by freezing it, we're able to give the"},{"startTime":132.111,"endTime":134.663,"body":"endometrium the most optimized"},{"startTime":134.751,"endTime":137.731,"body":"hormonal milieu for better receptivity"},{"startTime":137.855,"endTime":140.811,"body":"and to achieve a successful pregnancy. In the"},{"startTime":140.835,"endTime":143.279,"body":"past, we didn't do this because vitrification"},{"startTime":143.579,"endTime":146.331,"body":"wasn't around. And so the freezing and"},{"startTime":146.355,"endTime":149.251,"body":"thawing wasn't that good. And so it was scary to freeze"},{"startTime":149.275,"endTime":152.251,"body":"embryos, but now there's a much higher success"},{"startTime":152.315,"endTime":155.091,"body":"rate of thawing them. And for that reason, many"},{"startTime":155.155,"endTime":158.019,"body":"programs have moved to frozen embryo"},{"startTime":158.059,"endTime":160.707,"body":"transfers. The other benefit is it also"},{"startTime":160.763,"endTime":163.531,"body":"reduces ovarian hyperstimulation, since you"},{"startTime":163.555,"endTime":166.451,"body":"aren't creating hyperstimulation. And getting pregnant and"},{"startTime":166.475,"endTime":169.083,"body":"causing it then to turn into secondary"},{"startTime":169.171,"endTime":172.011,"body":"ovarian hyperstimulation. Now, a program"},{"startTime":172.115,"endTime":174.359,"body":"cycle is a cycle where you are"},{"startTime":174.899,"endTime":177.555,"body":"taking, like, estrogen, building up the"},{"startTime":177.587,"endTime":180.039,"body":"lining, and checking with ultrasounds."},{"startTime":180.379,"endTime":182.899,"body":"And then eventually, once the lining is thick"},{"startTime":182.939,"endTime":185.907,"body":"enough, then you start progesterone injections,"},{"startTime":186.003,"endTime":188.955,"body":"and then you do an embryo transfer. Now,"},{"startTime":188.987,"endTime":191.915,"body":"the estrogen you use can be different types. It can be"},{"startTime":191.987,"endTime":194.055,"body":"pills, be patches, it can be"},{"startTime":194.087,"endTime":196.903,"body":"injections. The point is, you're"},{"startTime":196.951,"endTime":199.679,"body":"programming it from the standpoint of you're giving estrogen,"},{"startTime":199.799,"endTime":202.655,"body":"you're watching the line grow, and you're controlling"},{"startTime":202.687,"endTime":205.231,"body":"it. And then you can pick the data exactly when to start the"},{"startTime":205.255,"endTime":207.899,"body":"progesterone before doing your transfer."},{"startTime":208.239,"endTime":211.239,"body":"Whereas in a natural cycle, what you are"},{"startTime":211.279,"endTime":214.279,"body":"doing is you're just allowing the patient to develop"},{"startTime":214.319,"endTime":217.279,"body":"a follicle on their own. And then some places will"},{"startTime":217.319,"endTime":220.217,"body":"actually check for LH rises by"},{"startTime":220.233,"endTime":222.833,"body":"checking ovulation kits. And then as soon as it's"},{"startTime":222.881,"endTime":224.709,"body":"positive, then they"},{"startTime":225.489,"endTime":228.029,"body":"perform the transfer approximately"},{"startTime":228.449,"endTime":231.069,"body":"five days from ovulation."},{"startTime":231.449,"endTime":233.801,"body":"Now, in a modified natural"},{"startTime":233.945,"endTime":236.785,"body":"cycle, we're not"},{"startTime":236.817,"endTime":239.457,"body":"leaving it completely to chance. So"},{"startTime":239.553,"endTime":242.417,"body":"sometimes the LH kits aren't perfect, you're not sure about the"},{"startTime":242.433,"endTime":245.343,"body":"ovulation. So now what we do is"},{"startTime":245.481,"endTime":248.331,"body":"we are watching natural ovulation. We might even give"},{"startTime":248.355,"endTime":251.067,"body":"some medicine like letrozole to boost the"},{"startTime":251.083,"endTime":253.755,"body":"stimulation a little bit. Then we watch those"},{"startTime":253.787,"endTime":256.699,"body":"follicles grow, and then when it gets to the point, when it's"},{"startTime":256.739,"endTime":259.579,"body":"ready, we then give a trigger shot."},{"startTime":259.739,"endTime":262.595,"body":"So that way we can time the transfer exactly"},{"startTime":262.627,"endTime":265.619,"body":"where we want to, and then we do the transfer."},{"startTime":265.779,"endTime":268.635,"body":"So in the end, natural and"},{"startTime":268.667,"endTime":271.131,"body":"modified natural cycles can technically"},{"startTime":271.235,"endTime":274.157,"body":"use vaginal progesterone because you're"},{"startTime":274.213,"endTime":276.849,"body":"making progesterone naturally through the ovulation,"},{"startTime":277.549,"endTime":280.209,"body":"whereas with a programmed cycle,"},{"startTime":280.509,"endTime":282.821,"body":"you're going to need to use some type of injectable"},{"startTime":282.885,"endTime":285.566,"body":"progesterone. Now, some places may use injectable"},{"startTime":285.662,"endTime":288.454,"body":"plus vaginal progesterone, but"},{"startTime":288.486,"endTime":290.894,"body":"usually you will not use vaginal progesterone"},{"startTime":290.966,"endTime":293.934,"body":"alone in a program cycle. So let's dive"},{"startTime":293.966,"endTime":296.83,"body":"deeper into the differences of the pros"},{"startTime":296.854,"endTime":299.628,"body":"and cons of each one. Let's start"},{"startTime":299.668,"endTime":302.58,"body":"first with natural cycles. If you're someone who"},{"startTime":302.604,"endTime":305.508,"body":"likes to do things very natural, in this situation, there are no"},{"startTime":305.548,"endTime":308.028,"body":"medications, so you're using a natural"},{"startTime":308.148,"endTime":310.676,"body":"hormonal environment of your body to build up the"},{"startTime":310.692,"endTime":313.428,"body":"estrogen, to build up the lining. And so that also"},{"startTime":313.468,"endTime":316.308,"body":"leads to things like lower cost, fewer"},{"startTime":316.348,"endTime":318.828,"body":"side effects for medications. And as I mentioned"},{"startTime":318.868,"endTime":321.688,"body":"prior, you can use vaginal progesterone."},{"startTime":322.068,"endTime":324.942,"body":"So if you don't Want to supplement with"},{"startTime":325.1,"endTime":328.066,"body":"injectable, you can use vaginal. Now,"},{"startTime":328.082,"endTime":330.914,"body":"there may be some places that don't use any progesterone, but"},{"startTime":330.946,"endTime":333.818,"body":"I would not recommend that personally with an embryo"},{"startTime":333.858,"endTime":336.786,"body":"transfer, because if there is any type of luteal phase"},{"startTime":336.842,"endTime":339.434,"body":"defect and it's not recognized, you could have low"},{"startTime":339.466,"endTime":342.09,"body":"progesterone levels. And that is known to reduce the"},{"startTime":342.114,"endTime":344.93,"body":"success of an embryo transfer. Now,"},{"startTime":344.994,"endTime":347.746,"body":"one of the cons of this approach is if you are someone who doesn't have a"},{"startTime":347.762,"endTime":350.322,"body":"regular cycle, this is not possible. And it would actually"},{"startTime":350.37,"endTime":353.314,"body":"be somewhat inappropriate to use in someone"},{"startTime":353.346,"endTime":356.026,"body":"with irregular cycles, because now you don't know if the"},{"startTime":356.042,"endTime":358.73,"body":"ovulation is correct or not. And that would be taking too much"},{"startTime":358.794,"endTime":361.554,"body":"risk. And that's really one of the biggest things here, is"},{"startTime":361.586,"endTime":364.194,"body":"that to be able to use this, you have to have"},{"startTime":364.386,"endTime":366.398,"body":"basically pretty precise ovulation."},{"startTime":367.138,"endTime":370.082,"body":"And so if you're not very good at determining your ovulation,"},{"startTime":370.21,"endTime":373.122,"body":"it can throw things off because there's some bit of"},{"startTime":373.17,"endTime":376.146,"body":"unpredictability in this. And so you need someone who has"},{"startTime":376.202,"endTime":378.518,"body":"very regular cycles to be able to do this."},{"startTime":378.958,"endTime":381.778,"body":"There's also a higher risk of cycle cancellation."},{"startTime":382.278,"endTime":385.222,"body":"Not every place is open every single day. And so"},{"startTime":385.27,"endTime":388.03,"body":"if your ovulation falls in a time where your transfer should"},{"startTime":388.054,"endTime":391.046,"body":"be, let's say, on a holiday like Thanksgiving coming up,"},{"startTime":391.182,"endTime":393.63,"body":"you might have to get canceled by also having the"},{"startTime":393.654,"endTime":396.622,"body":"unpredictability of the timing, it means you can't even"},{"startTime":396.67,"endTime":399.062,"body":"plan ahead for the transfer. Now, once you"},{"startTime":399.11,"endTime":402.094,"body":"ovulate, you'll know when your transfer is going to be. But up to"},{"startTime":402.126,"endTime":405.096,"body":"that point, your schedule is kind of wide open waiting"},{"startTime":405.222,"endTime":407.526,"body":"to when you're going to transfer. Now, with the modified"},{"startTime":407.622,"endTime":410.622,"body":"natural FET cycle, it's going"},{"startTime":410.63,"endTime":413.526,"body":"to be somewhat similar to the natural cycle. But now we're adding"},{"startTime":413.582,"endTime":416.582,"body":"some medications, not excessive, but enough"},{"startTime":416.63,"endTime":419.614,"body":"to help support the follicular growth to get a better"},{"startTime":419.646,"endTime":422.526,"body":"ovulation and potentially a better corpus luteum"},{"startTime":422.662,"endTime":425.659,"body":"to, help with those hormones. One of the nice"},{"startTime":425.699,"endTime":428.699,"body":"things is because we're watching it with ultrasounds, the"},{"startTime":428.739,"endTime":431.591,"body":"timing is controlled. So what that does"},{"startTime":431.615,"endTime":434.615,"body":"is allows you to have a better idea of when your traffic"},{"startTime":434.647,"endTime":437.135,"body":"is going to be, because we can see as the follicles are"},{"startTime":437.167,"endTime":440.087,"body":"growing, when they're probably going to be ready. And we can maybe"},{"startTime":440.143,"endTime":443.127,"body":"adjust it a little bit to help with"},{"startTime":443.183,"endTime":445.935,"body":"scheduling conflicts. One of the benefits of a"},{"startTime":445.967,"endTime":448.671,"body":"modified natural cycle over a natural cycle is it"},{"startTime":448.695,"endTime":451.639,"body":"reduces the risk of premature ovulation because we're going to be using"},{"startTime":451.679,"endTime":454.519,"body":"an HCG trigger versus just"},{"startTime":454.639,"endTime":457.447,"body":"guesstimating where it is based off of the ovulation kit."},{"startTime":457.583,"endTime":460.543,"body":"In summary, some of the biggest benefits"},{"startTime":460.591,"endTime":463.535,"body":"of a modified natural cycle is that you get to use"},{"startTime":463.607,"endTime":466.551,"body":"fewer medications compared to a program cycle, but more"},{"startTime":466.575,"endTime":469.431,"body":"than the natural cycle, and has a lower cancellation"},{"startTime":469.495,"endTime":472.471,"body":"risk than the natural cycle, and yet still allows you"},{"startTime":472.495,"endTime":474.943,"body":"to use vaginal progesterone versus injectable"},{"startTime":475.031,"endTime":477.719,"body":"progesterone if you don't want to use injections."},{"startTime":477.879,"endTime":480.455,"body":"The benefit of program cycles is the"},{"startTime":480.487,"endTime":483.463,"body":"predictability and very easy to schedule. Matter of"},{"startTime":483.471,"endTime":486.425,"body":"fact, if you're out of state, such as at, our clinic, you"},{"startTime":486.457,"endTime":488.857,"body":"now know exactly what day you need to show up to do your"},{"startTime":488.913,"endTime":491.641,"body":"transfer. This allows families to be able"},{"startTime":491.665,"endTime":494.217,"body":"to come together because they know the day that it's going to"},{"startTime":494.233,"endTime":497.025,"body":"be. When it comes to natural cycles, we talked"},{"startTime":497.057,"endTime":499.977,"body":"about how irregular cycles are very difficult to"},{"startTime":499.993,"endTime":502.857,"body":"do and actually inappropriate to do in those situations. And"},{"startTime":502.873,"endTime":505.585,"body":"in those situations, you should either be using a modified"},{"startTime":505.657,"endTime":508.369,"body":"natural cycle or you could be using a program"},{"startTime":508.449,"endTime":511.121,"body":"cycle because their irregular cycles doesn't"},{"startTime":511.185,"endTime":513.849,"body":"matter anymore. One of the other benefits of a program"},{"startTime":513.929,"endTime":516.877,"body":"cycle is you have complete control. If the lining is"},{"startTime":516.893,"endTime":519.789,"body":"not ready, you can wait longer. If the lining"},{"startTime":519.829,"endTime":522.741,"body":"is ready earlier, you can then start progesterone"},{"startTime":522.805,"endTime":525.797,"body":"sooner and do the transfer sooner. You can't do that"},{"startTime":525.813,"endTime":528.693,"body":"with a natural or a modified natural cycle, because once"},{"startTime":528.741,"endTime":531.581,"body":"the body is ready to ovulate, that's the end."},{"startTime":531.725,"endTime":534.669,"body":"So the line's not thick enough or the line's not ready,"},{"startTime":534.749,"endTime":537.701,"body":"you can't just wait. Now, the obvious downsides of"},{"startTime":537.725,"endTime":540.591,"body":"a program cycle is it is the least natural when"},{"startTime":540.615,"endTime":543.537,"body":"it comes to doing, an embryo transfer. Now, as I"},{"startTime":543.569,"endTime":546.401,"body":"mentioned, that's not always a bad thing, because that allows things like"},{"startTime":546.441,"endTime":549.341,"body":"predictability and people that full control."},{"startTime":549.681,"endTime":552.513,"body":"But there also is higher costs now because now you're taking"},{"startTime":552.577,"endTime":555.177,"body":"daily medications. And so if you don't want to have to take"},{"startTime":555.209,"endTime":558.073,"body":"medications every day, this can be a cycle that you"},{"startTime":558.097,"endTime":560.977,"body":"may not like as much. And then there's also more side"},{"startTime":561.009,"endTime":563.889,"body":"effects because you're taking more medications. And with this type"},{"startTime":563.905,"endTime":566.217,"body":"of transfer, you do need to use injectable"},{"startTime":566.289,"endTime":568.807,"body":"progesterone. This is because since you don't"},{"startTime":568.839,"endTime":571.775,"body":"ovulate, you don't make a corpus luteum, which is what makes"},{"startTime":571.823,"endTime":574.783,"body":"progesterone. And so if you don't make a corpus luteum, you"},{"startTime":574.807,"endTime":577.583,"body":"have to get progesterone another way. And oral progesterone and"},{"startTime":577.607,"endTime":580.439,"body":"vaginal progesterone are not sufficient enough with a"},{"startTime":580.455,"endTime":583.415,"body":"frozen embryo transfer. Now, before I get into"},{"startTime":583.583,"endTime":586.583,"body":"how I choose to do a transfer with someone or why"},{"startTime":586.607,"endTime":589.535,"body":"I would recommend one over the other. I think it's first important"},{"startTime":589.583,"endTime":592.567,"body":"to understand that when you look at the pregnancy"},{"startTime":592.639,"endTime":595.177,"body":"rates between all these different types,"},{"startTime":595.319,"endTime":598.245,"body":"they're about the same. There's definitely a caveat"},{"startTime":598.293,"endTime":601.061,"body":"to this, which I'll get into, but overall, they're about"},{"startTime":601.101,"endTime":603.917,"body":"the same. I do find that"},{"startTime":604.069,"endTime":607.069,"body":"some papers have shown natural cycles do have"},{"startTime":607.085,"endTime":609.445,"body":"a lower pregnancy rate than modified"},{"startTime":609.533,"endTime":612.525,"body":"natural, but we don't know if it's because of the natural"},{"startTime":612.573,"endTime":615.149,"body":"cycle or is it because maybe something got missed, such as the"},{"startTime":615.165,"endTime":618.101,"body":"ovulation was incorrect. So you can't"},{"startTime":618.141,"endTime":620.965,"body":"really say it doesn't work as well. We just know that there are"},{"startTime":621.013,"endTime":623.271,"body":"more opportunities for error in those"},{"startTime":623.311,"endTime":626.167,"body":"situations. So overall, I'm a big fan"},{"startTime":626.199,"endTime":629.127,"body":"of program cycles. I think it allows you to have the most"},{"startTime":629.199,"endTime":631.535,"body":"control, and that way I can"},{"startTime":631.663,"endTime":634.439,"body":"adjust as needed. And I can also"},{"startTime":634.575,"endTime":637.575,"body":"know exactly when the transfer is going to be, which helps the patient as well"},{"startTime":637.623,"endTime":640.623,"body":"for planning purposes. As I mentioned, if you are"},{"startTime":640.647,"endTime":643.615,"body":"a clinic who is doing, let's say, natural cycles and program"},{"startTime":643.703,"endTime":646.663,"body":"cycles, then your menstrual regularity is going"},{"startTime":646.687,"endTime":649.403,"body":"to affect what you can do. If you have very"},{"startTime":649.427,"endTime":652.419,"body":"irregular cycles, you cannot do just a plain natural"},{"startTime":652.475,"endTime":655.195,"body":"cycle. You would have to at least do a modified natural"},{"startTime":655.243,"endTime":658.091,"body":"cycle or do a programmed cycle."},{"startTime":658.251,"endTime":661.003,"body":"This means women with polycystic ovarian syndrome"},{"startTime":661.107,"endTime":663.659,"body":"would need to at least do a modified natural or"},{"startTime":663.715,"endTime":666.683,"body":"programmed cycle. One of the other things I use when trying"},{"startTime":666.707,"endTime":669.563,"body":"to determine what's best for a patient is looking"},{"startTime":669.627,"endTime":672.563,"body":"at their comfort. There are some people that"},{"startTime":672.627,"endTime":675.455,"body":"just cannot tolerate the injections,"},{"startTime":675.543,"endTime":678.359,"body":"and maybe they've had a pregnancy before and they're like, I never want to do"},{"startTime":678.375,"endTime":680.962,"body":"that again. Maybe they have a, complete"},{"startTime":681.018,"endTime":683.794,"body":"fear of the needles. In that situation,"},{"startTime":683.954,"endTime":686.85,"body":"I'm going to use a modified natural over a"},{"startTime":686.882,"endTime":689.714,"body":"program because obviously I don't want to put them through something"},{"startTime":689.754,"endTime":692.604,"body":"they don't want to go through if it's that severe of, a"},{"startTime":692.644,"endTime":695.308,"body":"concern. The reason I like the program"},{"startTime":695.396,"endTime":698.396,"body":"cycle more is because not only do I have the control, but"},{"startTime":698.42,"endTime":701.392,"body":"I can check progesterone levels and know exactly where they're at."},{"startTime":701.548,"endTime":704.504,"body":"Whereas with a modified natural, the hormones are"},{"startTime":704.544,"endTime":707.264,"body":"coming from naturally, but also the vaginal"},{"startTime":707.304,"endTime":710.28,"body":"progesterone. And you can't measure the vaginal progesterone because it's"},{"startTime":710.312,"endTime":713.272,"body":"not the local progesterone that"},{"startTime":713.288,"endTime":716.232,"body":"you can measure. You can only measure the systemic, and there's not much"},{"startTime":716.288,"endTime":719.12,"body":"systemic that's coming from the vaginal progesterone."},{"startTime":719.232,"endTime":722.103,"body":"Now, as I mentioned, at, my clinic, I usually use the program"},{"startTime":722.191,"endTime":725.139,"body":"cycle, and I say over 90% of people use that."},{"startTime":725.599,"endTime":728.591,"body":"But one of the things I do is when a patient is going through the IVF"},{"startTime":728.655,"endTime":731.575,"body":"cycle, you'll notice that even though we're checking the follicles, we"},{"startTime":731.607,"endTime":734.557,"body":"keep doing a lining check. Now, part of"},{"startTime":734.573,"endTime":737.565,"body":"that's because in the past, when we did natural transfers all the time, with"},{"startTime":737.597,"endTime":740.373,"body":"fresh transfers, you would need to know that the lining"},{"startTime":740.421,"endTime":743.357,"body":"looks good. So you knew when you're going to be putting the"},{"startTime":743.373,"endTime":745.997,"body":"embryo back. It looked good to put the embryo back."},{"startTime":746.133,"endTime":748.869,"body":"But why do we keep doing frozen embryo"},{"startTime":748.909,"endTime":751.797,"body":"transfers? I mean, it's not like we care what the lining looks like, because we're not"},{"startTime":751.813,"endTime":754.549,"body":"going to transfer it into that lining. Well, for"},{"startTime":754.589,"endTime":757.561,"body":"me, why I keep doing it, it's because it gives me a"},{"startTime":757.585,"endTime":760.481,"body":"preview of what the endometrial line will look like when"},{"startTime":760.505,"endTime":763.109,"body":"we're ready to do an embryo transfer."},{"startTime":763.649,"endTime":766.489,"body":"And so I look at that number, and if it's very low,"},{"startTime":766.609,"endTime":769.497,"body":"then I know I need to be concerned. Eventually, when we get ready for the"},{"startTime":769.513,"endTime":772.353,"body":"embryo transfer, I can preemptively start"},{"startTime":772.401,"endTime":775.185,"body":"looking at things to figure out if there's other things we can do to"},{"startTime":775.217,"endTime":778.017,"body":"help. On the same token, if it goes"},{"startTime":778.073,"endTime":780.777,"body":"very well, but then we get ready for the program"},{"startTime":780.873,"endTime":783.649,"body":"cycle, and now they're struggling to build the lining,"},{"startTime":783.809,"endTime":786.793,"body":"then I can always say, hey, I remember when we did the natural"},{"startTime":786.841,"endTime":789.761,"body":"cycle, meaning the IVF cycle, I saw"},{"startTime":789.785,"endTime":792.761,"body":"her follicles growing, and once the estrogen level got to a certain"},{"startTime":792.825,"endTime":795.697,"body":"point, her lining looked good. So then I"},{"startTime":795.713,"endTime":798.505,"body":"can compare that estrogen level during the program cycle and"},{"startTime":798.537,"endTime":801.425,"body":"say, does it look good then? And if it still doesn't look"},{"startTime":801.457,"endTime":804.457,"body":"good, then I know for some reason her body isn't"},{"startTime":804.513,"endTime":807.465,"body":"responding as well to those medications. And then"},{"startTime":807.497,"endTime":809.737,"body":"I'll switch her over to a natural"},{"startTime":809.793,"endTime":812.481,"body":"cycle, specifically at our clinic, a modified"},{"startTime":812.545,"endTime":815.321,"body":"natural cycle. Now, there are some clinics who will"},{"startTime":815.345,"endTime":818.217,"body":"just try different things. So if one doesn't work, they jump"},{"startTime":818.233,"endTime":821.193,"body":"to another one. If that doesn't work, they jump to another one."},{"startTime":821.361,"endTime":824.249,"body":"Now, I personally don't think that's a good idea. I think"},{"startTime":824.289,"endTime":826.969,"body":"that you should be looking at it from the standpoint"},{"startTime":827.009,"endTime":829.737,"body":"of picking a method that works and then"},{"startTime":829.793,"endTime":832.785,"body":"making adjustments based off the data, not just trying"},{"startTime":832.857,"endTime":835.793,"body":"different things. So, for example, if I was using a program"},{"startTime":835.881,"endTime":838.709,"body":"cycle and everything was going well, but it just didn't"},{"startTime":838.749,"endTime":841.653,"body":"work in the transfer, I'm not concerned that the program"},{"startTime":841.741,"endTime":844.541,"body":"cycle was the reason why, but I'm concerned about maybe"},{"startTime":844.605,"endTime":847.477,"body":"timing issues. I might need to do things like doing the era,"},{"startTime":847.613,"endTime":850.533,"body":"or I might be worried about the Receptiva test"},{"startTime":850.581,"endTime":853.357,"body":"looking at the receptivity of the uterine lining, because"},{"startTime":853.413,"endTime":856.005,"body":"maybe they have underlying endometriosis or"},{"startTime":856.037,"endTime":858.845,"body":"inflammation. But the point is, I don't go just jumping"},{"startTime":858.877,"endTime":861.309,"body":"to different protocols, because it's not the"},{"startTime":861.349,"endTime":864.257,"body":"protocols that change things. The protocols are just"},{"startTime":864.273,"endTime":867.025,"body":"for us to get to that lining to do the transfer. And as I"},{"startTime":867.057,"endTime":869.889,"body":"mentioned, really one doesn't work"},{"startTime":869.929,"endTime":872.905,"body":"better than another when it comes to pregnancy rates. Now, I"},{"startTime":872.937,"endTime":875.449,"body":"mentioned that there really is no difference in the pregnancy"},{"startTime":875.489,"endTime":878.377,"body":"rates. I mentioned about how I think modified natural is"},{"startTime":878.393,"endTime":881.297,"body":"better than natural and have seen some papers that show there"},{"startTime":881.353,"endTime":884.225,"body":"might be a slightly higher chance of a"},{"startTime":884.257,"endTime":887.185,"body":"modified natural than the natural cycle. But I also"},{"startTime":887.217,"endTime":890.177,"body":"want to be fair and explain that there is also some papers out"},{"startTime":890.193,"endTime":892.625,"body":"there that say there might be trends of showing more"},{"startTime":892.697,"endTime":894.924,"body":"miscarriages when you do a program,"},{"startTime":895.391,"endTime":898.127,"body":"cycle versus a modified natural and natural"},{"startTime":898.183,"endTime":900.959,"body":"cycle. Now, it's important to keep in mind this is"},{"startTime":900.999,"endTime":903.799,"body":"not scientific evidence, just"},{"startTime":903.839,"endTime":906.671,"body":"showing certain trends, and there needs to be a study done to"},{"startTime":906.695,"endTime":909.639,"body":"actually determine if that is true. In summary,"},{"startTime":909.799,"endTime":912.407,"body":"it's important to know that there are different ways to do"},{"startTime":912.463,"endTime":915.335,"body":"embryo transfers. When you look at these different"},{"startTime":915.367,"endTime":917.753,"body":"things, there's cost differences, there's"},{"startTime":917.801,"endTime":920.681,"body":"logistical differences when it comes to timing, and there's"},{"startTime":920.705,"endTime":923.217,"body":"also emotional and physical differences between them."},{"startTime":923.353,"endTime":926.097,"body":"Depending on your medical history, such as polycystic"},{"startTime":926.113,"endTime":929.105,"body":"ovarian syndrome, you may not even be a candidate for things"},{"startTime":929.137,"endTime":932.073,"body":"like natural cycles. And if you're someone who has maybe"},{"startTime":932.121,"endTime":935.065,"body":"had concerns with miscarriages, you may want"},{"startTime":935.097,"endTime":938.065,"body":"to use a programmed cycle. So now you can measure that"},{"startTime":938.097,"endTime":940.897,"body":"progesterone. That way you can keep a close eye on it."},{"startTime":940.913,"endTime":943.715,"body":"Since we know lower progesterone levels can affect"},{"startTime":943.857,"endTime":946.551,"body":"your chances as well as miscarriages. One of the"},{"startTime":946.575,"endTime":949.103,"body":"coolest things about fertility is it's constantly"},{"startTime":949.151,"endTime":951.823,"body":"changing. The science is amazing,"},{"startTime":951.991,"endTime":954.927,"body":"and we're adding AI to everything. We"},{"startTime":954.943,"endTime":957.895,"body":"are now doing much more studies than we ever have"},{"startTime":957.927,"endTime":960.375,"body":"in the past of new techniques"},{"startTime":960.567,"endTime":963.471,"body":"and new ways to analyze things."},{"startTime":963.655,"endTime":966.575,"body":"I wouldn't be surprised if in the future we"},{"startTime":966.607,"endTime":968.967,"body":"start having measurements of uterine"},{"startTime":969.023,"endTime":971.773,"body":"contractility and maybe even doing things"},{"startTime":971.821,"endTime":974.805,"body":"like looking at the metabolomic milieu"},{"startTime":974.877,"endTime":977.861,"body":"of the endometrium. Maybe someday there will even be a"},{"startTime":977.885,"endTime":980.781,"body":"test for which type of embryo transfer we"},{"startTime":980.805,"endTime":983.701,"body":"should do. But until then, I wanted to make sure at least"},{"startTime":983.725,"endTime":986.661,"body":"you knew about these and not to be worried about using each of"},{"startTime":986.685,"endTime":989.325,"body":"them and knowing which one kind of benefits more than"},{"startTime":989.357,"endTime":992.269,"body":"others, so you can be a further advocate in your"},{"startTime":992.309,"endTime":995.245,"body":"journey. As I always mentioned, it's never wrong"},{"startTime":995.317,"endTime":998.001,"body":"for a doctor to do one of these. It's"},{"startTime":998.025,"endTime":1000.869,"body":"also not wrong if they don't do one of these."},{"startTime":1001.329,"endTime":1004.001,"body":"The reason they do it is because what they're good at and their"},{"startTime":1004.025,"endTime":1006.961,"body":"pregnancy rates are because of doing what"},{"startTime":1006.985,"endTime":1009.465,"body":"they're good at. I hope this episode was helpful to"},{"startTime":1009.497,"endTime":1012.441,"body":"you. Maybe you know someone else who may be beneficial to"},{"startTime":1012.465,"endTime":1015.281,"body":"you. If you do, let them know about it."},{"startTime":1015.425,"endTime":1018.049,"body":"And if you like this podcast, as I always say,"},{"startTime":1018.209,"endTime":1021.209,"body":"please give us a five star review on your favorite medium"},{"startTime":1021.369,"endTime":1024.221,"body":"and tell your friends about us. I want to make sure that everyone also"},{"startTime":1024.285,"endTime":1027.221,"body":"knows about another show that I do with"},{"startTime":1027.285,"endTime":1029.829,"body":"Dr. Wael Salem called Sperm Eats"},{"startTime":1029.869,"endTime":1032.813,"body":"Egg, which is every other Wednesday. We've done"},{"startTime":1032.861,"endTime":1035.613,"body":"20 episodes so far this year and it's a great"},{"startTime":1035.661,"endTime":1038.661,"body":"place for education and also for you to ask your"},{"startTime":1038.685,"endTime":1041.325,"body":"questions directly live. While we're on"},{"startTime":1041.357,"endTime":1044.093,"body":"air this week, we have an amazing guest with us,"},{"startTime":1044.181,"endTime":1046.429,"body":"Allison Rogers, who is a great"},{"startTime":1046.509,"endTime":1049.429,"body":"reproductive doctor in Chicago. I hope you should"},{"startTime":1049.469,"endTime":1052.357,"body":"check out that episode. If I don't see you on Wednesday,"},{"startTime":1052.493,"endTime":1055.122,"body":"then, I look forward to seeing you again next week. talk about"},{"startTime":1055.266,"endTime":1056.09,"body":"fertility Tuesday."}]}