{"version":"1.0.0","segments":[{"startTime":1.055,"endTime":3.471,"body":"Today we talk about priming,"},{"startTime":3.663,"endTime":6.615,"body":"balancing, synchronization and suppression"},{"startTime":6.735,"endTime":8.955,"body":"to optimize your IVF outcome."},{"startTime":10.015,"endTime":12.773,"body":"I'm, Dr. Mark Amols and this"},{"startTime":13.113,"endTime":15.973,"body":"is Taco about Fertility Tuesday."},{"startTime":28.493,"endTime":31.421,"body":"Not all IVF cycles begin the same way."},{"startTime":31.597,"endTime":34.509,"body":"And thats for good reason. Today"},{"startTime":34.581,"endTime":37.485,"body":"I want to uncover how priming strategies set the"},{"startTime":37.509,"endTime":40.413,"body":"stage for success and why choosing the"},{"startTime":40.453,"endTime":43.429,"body":"right one can make all the difference. I"},{"startTime":43.461,"endTime":45.925,"body":"feel like priming has been"},{"startTime":45.949,"endTime":48.805,"body":"misunderstood. I see lots of posts"},{"startTime":48.829,"endTime":51.749,"body":"out there where people will talk about priming or"},{"startTime":51.781,"endTime":54.141,"body":"even when patients come in and will say theyre worried about"},{"startTime":54.197,"endTime":57.019,"body":"overupressing their eggs and they"},{"startTime":57.051,"endTime":60.035,"body":"should be worried because there is some truth to that. But"},{"startTime":60.059,"endTime":62.891,"body":"the question is there's this balance. And this"},{"startTime":62.947,"endTime":65.443,"body":"balance is, yes, you don't want to"},{"startTime":65.483,"endTime":67.523,"body":"overupprress, but you also want to have"},{"startTime":67.563,"endTime":70.435,"body":"synchronization. And depending on"},{"startTime":70.459,"endTime":72.643,"body":"the person, the right"},{"startTime":72.763,"endTime":75.515,"body":"treatment is going to be different for everyone. And"},{"startTime":75.539,"endTime":78.411,"body":"so I want to talk about that balance today and"},{"startTime":78.427,"endTime":81.407,"body":"then also want to talk about what the studies say and"},{"startTime":81.455,"endTime":84.295,"body":"whether there's even any truth to all of this. So"},{"startTime":84.319,"endTime":87.087,"body":"let's first start by introducing what are"},{"startTime":87.215,"endTime":89.883,"body":"the types of IVF priming? What does that mean?"},{"startTime":90.223,"endTime":93.191,"body":"Priming means to get the ovaries synchronized so"},{"startTime":93.207,"endTime":96.007,"body":"they have better development. But there's"},{"startTime":96.055,"endTime":98.823,"body":"also other purposes for priming. Priming"},{"startTime":98.863,"endTime":101.815,"body":"could be used to prevents from developing while"},{"startTime":101.839,"endTime":104.639,"body":"you're waiting to go through. IVF priming can be"},{"startTime":104.671,"endTime":107.359,"body":"used to synchronize you with a"},{"startTime":107.391,"endTime":110.219,"body":"cycle. Let's say if everyone's going to be starting in a few weeks,"},{"startTime":110.251,"endTime":113.083,"body":"it gets everyone on the same schedule. Priming can also"},{"startTime":113.123,"endTime":116.035,"body":"help get a better response. And one of the ways it"},{"startTime":116.059,"endTime":118.515,"body":"does that is by suppressing FSH"},{"startTime":118.579,"endTime":120.859,"body":"levels. It causes upgulation of"},{"startTime":120.891,"endTime":123.891,"body":"receptors and then your body may respond better"},{"startTime":124.027,"endTime":126.971,"body":"to the medications when you come off of the priming. So"},{"startTime":126.987,"endTime":129.703,"body":"in essence, it can be used for timing,"},{"startTime":130.123,"endTime":132.851,"body":"synchronization, modulation of"},{"startTime":132.987,"endTime":135.691,"body":"FSH levels and upre regulation of FSH"},{"startTime":135.747,"endTime":138.317,"body":"receptors. Now, there's going to be a few priming"},{"startTime":138.365,"endTime":141.341,"body":"methods. Now they may be called something different, but"},{"startTime":141.357,"endTime":144.221,"body":"they are generally going to be very similar to these. The"},{"startTime":144.237,"endTime":146.973,"body":"first is can be combined oral contraceptives."},{"startTime":147.133,"endTime":149.845,"body":"This is your estrogen progesterone combination"},{"startTime":149.989,"endTime":152.861,"body":"that makes up most birth controls. This can either be"},{"startTime":152.877,"endTime":155.433,"body":"in pill form, this could be in patches,"},{"startTime":156.133,"endTime":158.917,"body":"and theoretically could even be in the vaginal"},{"startTime":158.965,"endTime":161.605,"body":"ring. Now when it comes to the combined"},{"startTime":161.789,"endTime":164.113,"body":"contraception, that is going to be your"},{"startTime":164.193,"endTime":167.169,"body":"strongest priming agent. That is the one that's going to"},{"startTime":167.201,"endTime":170.177,"body":"prevent you from making cyst. That is the one that's going"},{"startTime":170.185,"endTime":173.161,"body":"to Reduce your FSSH levels the best. And that's"},{"startTime":173.217,"endTime":176.217,"body":"also the one that is the most commonly used. It's"},{"startTime":176.265,"endTime":179.177,"body":"also the one that can suppress you the most. Now,"},{"startTime":179.225,"endTime":182.041,"body":"after using a combined contraception,"},{"startTime":182.177,"endTime":184.889,"body":"then you get into the single hmum,"},{"startTime":185.028,"endTime":187.807,"body":"contraception priming agents such as progesterone"},{"startTime":187.895,"endTime":190.855,"body":"and estrogen. Progesterone is going"},{"startTime":190.879,"endTime":193.703,"body":"to be stronger than estrogen, but it's much"},{"startTime":193.743,"endTime":196.407,"body":"weaker than the combined. It will also help"},{"startTime":196.455,"endTime":199.047,"body":"synchronize follicles. It will also help"},{"startTime":199.175,"endTime":201.655,"body":"with reducing FSH levels"},{"startTime":201.799,"endTime":204.799,"body":"and increasing FSH receptors. But"},{"startTime":204.831,"endTime":207.378,"body":"it will have, less suppression than using the"},{"startTime":207.41,"endTime":210.098,"body":"combined contraception. And"},{"startTime":210.13,"endTime":212.502,"body":"estrogen is even weaker than progesterone."},{"startTime":212.962,"endTime":215.678,"body":"When you take estrogen, you will get some of the"},{"startTime":215.71,"endTime":218.534,"body":"similar effects, but you will have less"},{"startTime":218.638,"endTime":221.59,"body":"suppression. And then the very last method"},{"startTime":221.686,"endTime":224.574,"body":"is going to be what's called a cold start. And"},{"startTime":224.598,"endTime":227.518,"body":"that is basically where you're allowing your body to have a period"},{"startTime":227.63,"endTime":230.558,"body":"and your starting stimulation on the third day of your cycle"},{"startTime":230.59,"endTime":232.882,"body":"or second day with your natural"},{"startTime":233.222,"endTime":236.174,"body":"ovulatory process, as you would imagine,"},{"startTime":236.278,"endTime":239.046,"body":"you're going to have almost no synchronization"},{"startTime":239.214,"endTime":241.602,"body":"with a cold start being in the natural cycle,"},{"startTime":241.972,"endTime":244.804,"body":"you're also going to have more chances of"},{"startTime":244.828,"endTime":247.612,"body":"having a cyst present and you will have no regulation"},{"startTime":247.692,"endTime":250.316,"body":"of your FSH receptors and levels."},{"startTime":250.444,"endTime":253.34,"body":"This also means that you don't know when you're going to start your"},{"startTime":253.356,"endTime":256.292,"body":"IVF process until your period comes. And so this clin"},{"startTime":256.332,"endTime":259.22,"body":"is probably just running IVF all the time. Now, I"},{"startTime":259.236,"endTime":261.748,"body":"can tell you all these methods are used."},{"startTime":261.94,"endTime":264.804,"body":"I know some clinics that only do cold starts and they"},{"startTime":264.828,"endTime":267.468,"body":"just run all the time, and they just start people"},{"startTime":267.5,"endTime":270.318,"body":"when they get their periods. Most clin,"},{"startTime":270.39,"endTime":273.158,"body":"as I mentioned, will do combined contraception,"},{"startTime":273.35,"endTime":275.982,"body":"and then most will use some type of combination of using"},{"startTime":276.022,"endTime":278.83,"body":"estrogen only or progesterone only."},{"startTime":278.966,"endTime":281.838,"body":"Now, you can start those at different times. You can start"},{"startTime":281.87,"endTime":284.774,"body":"them in the beginning of the cycle, you can start them after"},{"startTime":284.798,"endTime":287.598,"body":"ovulation. So there are many ways to do this,"},{"startTime":287.71,"endTime":290.59,"body":"but I want to focus on these different types"},{"startTime":290.686,"endTime":293.206,"body":"of priming. Now that we've discussed the different"},{"startTime":293.254,"endTime":296.142,"body":"types, the question, as I said, is if we put them in order"},{"startTime":296.222,"endTime":299.18,"body":"of suppressiveness, combined is going to be"},{"startTime":299.196,"endTime":302.132,"body":"the highest, then the next suppressive is going to be progesterone."},{"startTime":302.172,"endTime":305.068,"body":"Being less, then less than that is estrogen priming"},{"startTime":305.14,"endTime":307.964,"body":"and the least is nothing. And"},{"startTime":307.988,"endTime":310.964,"body":"then in reverse, that's exactly the way"},{"startTime":311.028,"endTime":313.632,"body":"it is for synchronization of the follicles."},{"startTime":314.052,"endTime":316.684,"body":"The cold start is going to have the lowest synchronization,"},{"startTime":316.868,"endTime":319.5,"body":"followed by the estrogen followed by the"},{"startTime":319.516,"endTime":322.428,"body":"progesterone. With the most synchronization occurring through the"},{"startTime":322.46,"endTime":325.328,"body":"combined contraception. So what's the big"},{"startTime":325.36,"endTime":328.144,"body":"deal? So what if it suppresses you a little bit?"},{"startTime":328.248,"endTime":330.816,"body":"Well, you're right. If you'got 16"},{"startTime":330.904,"endTime":333.144,"body":"follicles and you get put on"},{"startTime":333.208,"endTime":335.992,"body":"contraception and maybe you would have made all 16"},{"startTime":336.112,"endTime":338.912,"body":"follicles grow, but with overupession you"},{"startTime":338.952,"endTime":341.944,"body":"only made 14 follicles grow. Or maybe it made your"},{"startTime":341.968,"endTime":344.864,"body":"cycles grow a little bit longer. That can feel like that's"},{"startTime":344.888,"endTime":347.648,"body":"a big drop. But"},{"startTime":347.84,"endTime":350.376,"body":"the thing is that there is this synchronization"},{"startTime":350.464,"endTime":353.342,"body":"occurs where the follicles group together"},{"startTime":353.462,"endTime":356.238,"body":"and grow as a group. And so let's take that"},{"startTime":356.27,"endTime":359.094,"body":"scenario where you have 16 follicles and"},{"startTime":359.118,"endTime":361.442,"body":"they're all growing, but they're spread out a bunch"},{"startTime":361.862,"endTime":364.83,"body":"and you get all 16 but the zone of"},{"startTime":364.846,"endTime":367.582,"body":"maturity, and we're just going to use this number, 15 to"},{"startTime":367.622,"endTime":370.622,"body":"20 is where they're going to be mature. Above that"},{"startTime":370.662,"endTime":373.55,"body":"there's a potential be post mature. Below that they could"},{"startTime":373.566,"endTime":376.27,"body":"be immature. Well, what if"},{"startTime":376.366,"endTime":378.814,"body":"only nine of those follicles fell between"},{"startTime":378.838,"endTime":381.8,"body":"them? All 16 grew, but"},{"startTime":381.856,"endTime":384.772,"body":"because they were spread out, only nine fell in that zone."},{"startTime":385.672,"endTime":388.552,"body":"And then you take the other scenario, you say, well, if I"},{"startTime":388.592,"endTime":391.464,"body":"took the contraception that was combined and I"},{"startTime":391.488,"endTime":393.952,"body":"got better synchronization, only"},{"startTime":394.072,"endTime":396.632,"body":"14 follicles were going to grow. But of those"},{"startTime":396.712,"endTime":399.632,"body":"14, 12 of them were in that"},{"startTime":399.672,"endTime":401.372,"body":"zone, maybe all 14"},{"startTime":402.352,"endTime":405.128,"body":"there. You can see how even though we"},{"startTime":405.2,"endTime":408.132,"body":"accept some of the mild suppression, the"},{"startTime":408.172,"endTime":410.732,"body":"synchronization actually makes up for it and we actually"},{"startTime":410.772,"endTime":413.308,"body":"get a better group"},{"startTime":413.5,"endTime":416.46,"body":"of eggs that are going to be mature. Now"},{"startTime":416.476,"endTime":419.348,"body":"that's just one sample. Whether, if we're talking about someone who"},{"startTime":419.38,"endTime":422.308,"body":"only makes three follicles. Well, if you"},{"startTime":422.34,"endTime":425.228,"body":"only make three follicles and you're over suppessed, you"},{"startTime":425.26,"endTime":427.756,"body":"only make two. That's a really big"},{"startTime":427.804,"endTime":430.588,"body":"drop. And so in that situation you"},{"startTime":430.62,"endTime":433.368,"body":"might want to have less suppression."},{"startTime":433.5,"endTime":436.232,"body":"So you can try to get all three of those follicles"},{"startTime":436.352,"endTime":438.784,"body":"versus only getting two, because then you would be losing"},{"startTime":438.928,"endTime":441.612,"body":"33% of your eggs."},{"startTime":442.152,"endTime":444.976,"body":"Now, even if they spread out a little bit, there's only three"},{"startTime":445.024,"endTime":447.896,"body":"follicles. So statistically"},{"startTime":447.984,"endTime":450.848,"body":"both two of them are going to be in the same maturity zone. So you're"},{"startTime":450.88,"endTime":453.752,"body":"still at the same number. So you don't really lose much in that"},{"startTime":453.792,"endTime":456.752,"body":"situation. So seems simple."},{"startTime":456.872,"endTime":459.744,"body":"If you have fewer eggs, less suppression. If you have"},{"startTime":459.768,"endTime":461.984,"body":"more follicles, more suppression,"},{"startTime":462.088,"endTime":465.08,"body":"right? Nope, that's wrong. So then"},{"startTime":465.096,"endTime":467.648,"body":"there's another thing you have to think about, which is early"},{"startTime":467.68,"endTime":470.68,"body":"recruitment and People who have higher FSH"},{"startTime":470.736,"endTime":473.4,"body":"levels are going to have early recruitment,"},{"startTime":473.456,"endTime":476.392,"body":"meaning their body starts"},{"startTime":476.472,"endTime":479.296,"body":"releasing FSH earlier than everybody else's."},{"startTime":479.424,"endTime":482.328,"body":"Most people, their max FSH levels can be around cycle"},{"startTime":482.36,"endTime":484.904,"body":"day two or three. But people who have early"},{"startTime":484.928,"endTime":487.912,"body":"recruitment might be having the highest FSH levels"},{"startTime":487.992,"endTime":490.882,"body":"release, let's say cycle day one or even before the cycle"},{"startTime":490.922,"endTime":493.762,"body":"starts. And what that does is it causes"},{"startTime":493.802,"endTime":496.542,"body":"the follicles to start to grow a little bit earlier."},{"startTime":497.082,"endTime":499.542,"body":"And so in that situation,"},{"startTime":500.202,"endTime":503.17,"body":"not using a priming agent could potentially lead to"},{"startTime":503.186,"endTime":506.058,"body":"a lead follicle every time. And so if you're doing"},{"startTime":506.09,"endTime":508.994,"body":"a cold start or an estrogen only type of"},{"startTime":509.018,"endTime":511.834,"body":"priming, you can end up running into the situation"},{"startTime":511.978,"endTime":514.922,"body":"where you have a lead follicle. And that's"},{"startTime":515.002,"endTime":517.81,"body":"frustrating because now there one follicle is ahead of all the other"},{"startTime":517.826,"endTime":520.674,"body":"follicles and you get this kind"},{"startTime":520.698,"endTime":523.57,"body":"of cohort that's ahead and a court that's behind. And"},{"startTime":523.586,"endTime":526.066,"body":"that can affect how early you have to start things like GAN"},{"startTime":526.114,"endTime":529.082,"body":"relics, how early you have to potentially"},{"startTime":529.122,"endTime":532.058,"body":"even trigger. So early recruitment is part of what we"},{"startTime":532.09,"endTime":534.866,"body":"use to determine what type of priming we're going to use."},{"startTime":535.034,"endTime":537.794,"body":"But the other thing you have to look at, as I mentioned, was FSH"},{"startTime":537.858,"endTime":540.222,"body":"levels. If those are high,"},{"startTime":540.922,"endTime":543.666,"body":"the priming agents not going to suppress"},{"startTime":543.714,"endTime":546.462,"body":"them. And if it doesn't suppress them, you can"},{"startTime":546.502,"endTime":549.262,"body":"also develop follles past them. So for"},{"startTime":549.302,"endTime":552.142,"body":"example, let's say you're going to be priming someone for"},{"startTime":552.182,"endTime":554.566,"body":"two or three weeks. If you put them on the"},{"startTime":554.614,"endTime":557.566,"body":"combined contraception, the chances that"},{"startTime":557.574,"endTime":560.502,"body":"they're going to develop a follicle when you're ready to start"},{"startTime":560.582,"endTime":563.478,"body":"is very low. But if you have them only on estrogen"},{"startTime":563.55,"endTime":566.534,"body":"only then they may develop a falicle and now the"},{"startTime":566.558,"endTime":569.118,"body":"cycle gets canceled. And so you have to"},{"startTime":569.15,"endTime":572.03,"body":"utilize those things such as high FSH levels, such as"},{"startTime":572.046,"endTime":574.878,"body":"let's say 18 or 20, they are not going to say"},{"startTime":574.95,"endTime":577.934,"body":"suppressed with just estrogen. So"},{"startTime":577.958,"endTime":580.846,"body":"you might have to put them on progesterone only in the luteal"},{"startTime":580.894,"endTime":583.294,"body":"phase to stop them from developing that"},{"startTime":583.398,"endTime":586.27,"body":"follicle. We see this all the time when it comes"},{"startTime":586.326,"endTime":589.302,"body":"to frozen embryo transfers. Most"},{"startTime":589.342,"endTime":592.302,"body":"clin don't use Lupron. What we do is when someone gets their"},{"startTime":592.342,"endTime":595.23,"body":"menses, we put them on estrogen, build the lining up of"},{"startTime":595.246,"endTime":598.246,"body":"their uterus and then we put the embryo back. But there are s some"},{"startTime":598.294,"endTime":601.044,"body":"women who ovulate past that"},{"startTime":601.068,"endTime":603.836,"body":"estrogen and that's because their FSH levels"},{"startTime":603.964,"endTime":606.82,"body":"are so high that they're able to ovulate"},{"startTime":606.916,"endTime":609.78,"body":"past the estron. That's why you don't really have an estrogen"},{"startTime":609.836,"endTime":612.556,"body":"only birth control pill because it doesn't work very well."},{"startTime":612.684,"endTime":615.26,"body":"The same thing is you don't see progesterone only"},{"startTime":615.276,"endTime":617.836,"body":"pills that prevent ovulation."},{"startTime":618.004,"endTime":620.988,"body":"Those usually just prevent pregnancy. The"},{"startTime":621.02,"endTime":623.988,"body":"best way to prevent ovulation is going to be with a combined"},{"startTime":624.06,"endTime":626.888,"body":"contraception. Now there are some unique situations."},{"startTime":626.96,"endTime":629.816,"body":"For example, some people have, lets s say have had GI"},{"startTime":629.864,"endTime":632.544,"body":"surgeries and let's say they'absorb things as"},{"startTime":632.568,"endTime":635.344,"body":"well. They may need to go on patches"},{"startTime":635.488,"endTime":638.016,"body":"because the pills won't be absorbed well"},{"startTime":638.064,"endTime":640.648,"body":"enough. Another unique situation"},{"startTime":640.84,"endTime":643.792,"body":"is people who have blood clotting disorders. If they have blood"},{"startTime":643.832,"endTime":646.632,"body":"clotting disorders, you really don't want to put them on birth control,"},{"startTime":646.792,"endTime":649.344,"body":"even if it's for a short time, if they're a high risk."},{"startTime":649.528,"endTime":652.512,"body":"In that situation, we're going to use the progesterone only"},{"startTime":652.552,"endTime":655.377,"body":"priming method to reduce the risk of, blood clotting."},{"startTime":655.563,"endTime":658.389,"body":"Another benefit prior to frozen embro"},{"startTime":658.429,"endTime":660.969,"body":"transfers is if you were doing a fresh transfer"},{"startTime":661.549,"endTime":664.541,"body":"and you weren't really sure if you were getting a period or"},{"startTime":664.565,"endTime":667.198,"body":"with just a, uterine bleed, such as people with"},{"startTime":667.286,"endTime":670.286,"body":"polycystic ovarian syndrome. One of the best things about"},{"startTime":670.31,"endTime":673.27,"body":"birth control is you knew you were shedding your lining that"},{"startTime":673.302,"endTime":676.246,"body":"way. When you were putting an embryo back, you knew you shed your lining"},{"startTime":676.31,"endTime":679.126,"body":"completely and that way you were putting it back with a"},{"startTime":679.15,"endTime":681.622,"body":"new lining versus someone who"},{"startTime":681.678,"endTime":684.26,"body":"bled, thought they had their period"},{"startTime":684.452,"endTime":687.388,"body":"and then you were building up the lining on old tissue"},{"startTime":687.516,"endTime":690.324,"body":"and then doing a transfer. That's not that common"},{"startTime":690.364,"endTime":693.268,"body":"anymore since most people are doing frozen embryo transfers."},{"startTime":693.396,"endTime":695.948,"body":"But if you are doing a fresh transfer,"},{"startTime":696.116,"endTime":698.772,"body":"it is important to know that that period was really a"},{"startTime":698.828,"endTime":701.74,"body":"period. And that's part of the decision making when you're looking at"},{"startTime":701.772,"endTime":704.636,"body":"priming. If you have someone who doesn't get a period or"},{"startTime":704.66,"endTime":707.54,"body":"you question whether they get a period every month, that may"},{"startTime":707.572,"endTime":709.788,"body":"affect how you use the priming"},{"startTime":709.876,"endTime":712.084,"body":"protocols such as putting you on"},{"startTime":712.164,"endTime":714.932,"body":"contraception combined or esture and"},{"startTime":714.948,"endTime":717.892,"body":"progesterone only if you were some with pcos you"},{"startTime":717.908,"endTime":720.844,"body":"really couldn't do a cold start because you don't"},{"startTime":720.924,"endTime":723.852,"body":"actually get your natural period. And so at that point"},{"startTime":723.948,"endTime":726.268,"body":"you would either need to go on contraception or"},{"startTime":726.316,"endTime":729.268,"body":"progesterone to induce a period. Now one really"},{"startTime":729.316,"endTime":732.268,"body":"unique situation is people have very severe dimeinsional"},{"startTime":732.276,"endTime":735.2,"body":"ovarium reserve called premature ovarian"},{"startTime":735.232,"endTime":737.728,"body":"failure are also called ovarian insufficiency"},{"startTime":737.776,"endTime":740.472,"body":"syndrome. In this situation, women are either"},{"startTime":740.528,"endTime":743.128,"body":"near peramont menopause or are in"},{"startTime":743.176,"endTime":745.984,"body":"menopause completely and they don't even ovulate"},{"startTime":746.024,"endTime":749.008,"body":"anymore. And then you would think you"},{"startTime":749.016,"endTime":751.8,"body":"would want to use almost no suppression. But"},{"startTime":751.872,"endTime":754.032,"body":"interesting enough, if you give a very high"},{"startTime":754.088,"endTime":757.064,"body":"suppression and you get their FSSH levels that go down"},{"startTime":757.104,"endTime":759.564,"body":"for a long period of time, let's say like a month,"},{"startTime":759.874,"endTime":762.41,"body":"then you stop the birth control and you start high"},{"startTime":762.442,"endTime":765.13,"body":"stimulation, you can sometimes get them to ovulate."},{"startTime":765.242,"endTime":768.074,"body":"And so we call those premature overarian failure protocols"},{"startTime":768.154,"endTime":771.002,"body":"called POF protocols. So before we get into"},{"startTime":771.018,"endTime":773.314,"body":"the balancing of trying to balance the"},{"startTime":773.434,"endTime":776.426,"body":"suppression versus the synchronization, let's"},{"startTime":776.45,"endTime":779.346,"body":"take a deep dive into each priming method again. So when it"},{"startTime":779.37,"endTime":782.25,"body":"comes to the combined contraception, the vanances are"},{"startTime":782.322,"endTime":785.274,"body":"it's going to be effective in synchronizing follicles and preventing"},{"startTime":785.314,"endTime":787.772,"body":"cyst formation. It may up regulate"},{"startTime":787.828,"endTime":790.548,"body":"FSH receptors in patients with severe door"},{"startTime":790.636,"endTime":793.58,"body":"or with premature ovarian failure, improving"},{"startTime":793.612,"endTime":796.244,"body":"the ovarian response in that situation. The"},{"startTime":796.284,"endTime":798.628,"body":"disadvantage is it has a risk for"},{"startTime":798.716,"endTime":801.584,"body":"overuppression, especially with prolonged use."},{"startTime":801.924,"endTime":804.66,"body":"N may require longer stimulation or higher doses"},{"startTime":804.692,"endTime":807.144,"body":"canadropins because of the suppression."},{"startTime":807.484,"endTime":810.212,"body":"Ideal for patients with irregular cycles who form"},{"startTime":810.268,"endTime":813.264,"body":"cyst or who require some type of scheduling."},{"startTime":813.594,"endTime":816.506,"body":"Now, when it comes to progesterone only priming, the"},{"startTime":816.53,"endTime":819.45,"body":"advantages are it's going to prevent CST formation with minimal"},{"startTime":819.482,"endTime":822.242,"body":"ovarian suppression. The disadvantages are"},{"startTime":822.378,"endTime":825.314,"body":"it has limited synchronizations compared to the"},{"startTime":825.434,"endTime":828.066,"body":"combined contraception. This is going to be"},{"startTime":828.09,"endTime":830.814,"body":"ideal for patients at risk for overstimulation"},{"startTime":831.274,"endTime":833.866,"body":"or suppression issues. When it comes to the"},{"startTime":833.89,"endTime":836.626,"body":"estrogen only priming, it may improve"},{"startTime":836.73,"endTime":839.628,"body":"some minor follicular synchronization. But without"},{"startTime":839.786,"endTime":842.4,"body":"almost any suppression, the major"},{"startTime":842.432,"endTime":845.032,"body":"disadvantage is that you're not going to get the"},{"startTime":845.088,"endTime":848.084,"body":"synchronization and you have the risk of forming cyst."},{"startTime":848.464,"endTime":851.048,"body":"When it comes to the cold start, the biggest"},{"startTime":851.096,"endTime":853.944,"body":"advantage is natural without any suppression."},{"startTime":854.104,"endTime":857.016,"body":"The disadvantages completely the opposite. High risk"},{"startTime":857.04,"endTime":859.928,"body":"of assistst formation, high risk of not having"},{"startTime":859.976,"endTime":862.904,"body":"synchronization. But this can be used in people"},{"startTime":862.944,"endTime":865.656,"body":"with very predictable cycles who don't have, let's"},{"startTime":865.68,"endTime":868.546,"body":"say severe diminished ovarian reserve or"},{"startTime":868.61,"endTime":871.546,"body":"who are able to get cycles. This is why it's so"},{"startTime":871.61,"endTime":874.242,"body":"difficult when you're trying to pick a priming method"},{"startTime":874.378,"endTime":876.85,"body":"because there's this balance. And as"},{"startTime":876.882,"endTime":879.818,"body":"you deal with not trying to suppress"},{"startTime":879.906,"endTime":882.574,"body":"someone, they start developing cyst"},{"startTime":882.994,"endTime":885.93,"body":"and then you try to stop the cyst and"},{"startTime":885.962,"endTime":888.37,"body":"then you could overupress. And"},{"startTime":888.402,"endTime":891.13,"body":"so it could be somewhat frustrating"},{"startTime":891.202,"endTime":893.994,"body":"because sometimes you have to do it more than"},{"startTime":894.034,"endTime":896.792,"body":"once because there can be just things that you can't control."},{"startTime":896.898,"endTime":899.78,"body":"Like for example, if you develop a cyst, your doctor"},{"startTime":899.812,"endTime":902.156,"body":"can stop the cyst from coming, but now you're going to be"},{"startTime":902.18,"endTime":904.588,"body":"oversupprressed. And so there's that"},{"startTime":904.636,"endTime":907.292,"body":"balance. But that means every month"},{"startTime":907.468,"endTime":910.348,"body":"you have to keep waiting to try again. And that can be very"},{"startTime":910.396,"endTime":913.204,"body":"frustrating. So it's important to understand that"},{"startTime":913.324,"endTime":916.316,"body":"in that balance that yes, I know you want to"},{"startTime":916.34,"endTime":918.94,"body":"move forward, but if I'm too"},{"startTime":918.972,"endTime":921.852,"body":"aggressive, I overupress. And if"},{"startTime":921.868,"endTime":924.772,"body":"I'm not aggressive enough, then you make"},{"startTime":924.868,"endTime":927.772,"body":"a assist. If you're a patient who has s been through this and had"},{"startTime":927.788,"endTime":930.772,"body":"to deal with this, you know what the frustration is like. I"},{"startTime":930.788,"endTime":933.444,"body":"think the main takeaway is to understand the importance"},{"startTime":933.484,"endTime":935.984,"body":"of individualizing priming protocols"},{"startTime":936.484,"endTime":939.1,"body":"and understanding that there is not"},{"startTime":939.212,"endTime":942.084,"body":"one right way for everyone and that if your"},{"startTime":942.124,"endTime":944.956,"body":"doctor is picking one method, it doesn't mean that they"},{"startTime":944.98,"endTime":947.94,"body":"don't care about overupressing you. But in your situation,"},{"startTime":948.012,"endTime":950.524,"body":"they're bouncing that synchronization"},{"startTime":950.824,"endTime":953.68,"body":"compared to overuppression. And now if you're one"},{"startTime":953.712,"endTime":956.56,"body":"who has enough eggs, they're willing to take"},{"startTime":956.592,"endTime":959.576,"body":"a small risk of some suppression if it means they"},{"startTime":959.6,"endTime":962.376,"body":"get better synchronization. Hopefully this may address"},{"startTime":962.4,"endTime":965.336,"body":"your concerns about why a specific protocol was chosen for"},{"startTime":965.36,"endTime":968.24,"body":"you or what happens if you over"},{"startTime":968.312,"endTime":971.112,"body":"underprime in that situation. In the"},{"startTime":971.128,"endTime":973.928,"body":"end, priming for IVF is more than just"},{"startTime":973.976,"endTime":976.868,"body":"preparation. It's about setting the perfect"},{"startTime":976.916,"endTime":979.744,"body":"stage for your journey to parenthood."},{"startTime":980.364,"endTime":983.26,"body":"Hopefully this episode was helpful for you. Maybe"},{"startTime":983.292,"endTime":986.044,"body":"this has been a frustrating part for you when you have"},{"startTime":986.084,"endTime":988.668,"body":"to keep trying different primings and get it"},{"startTime":988.716,"endTime":991.668,"body":"right. Maybe you just wanted to know about this or maybe"},{"startTime":991.676,"endTime":994.58,"body":"you have a friend who's going through this and might be frustrating. You want to let them know"},{"startTime":994.612,"endTime":997.228,"body":"about it. As always, if you like this"},{"startTime":997.276,"endTime":1000.172,"body":"podcast, I greatly appreciate if you can give us a five star"},{"startTime":1000.228,"endTime":1003.144,"body":"review on your favorite medium. Tell your friends about us"},{"startTime":1004.834,"endTime":1007.722,"body":"and get the word out about the podcast. I tried to give a"},{"startTime":1007.738,"endTime":1010.706,"body":"little more in depth science than some of the other podcasts"},{"startTime":1010.73,"endTime":1013.61,"body":"out there. That way I'm not just superficientially telling you stuff,"},{"startTime":1013.642,"endTime":1016.506,"body":"but really giving you what the reasoning is in our"},{"startTime":1016.53,"endTime":1019.442,"body":"heads as fertility doctors. I'm sorry I didn't have the"},{"startTime":1019.458,"endTime":1022.41,"body":"episode last week. I actually was quite sick as you probably heard"},{"startTime":1022.442,"endTime":1025.133,"body":"in the episode prior. Wasn't able to, do one."},{"startTime":1025.173,"endTime":1027.989,"body":"But I definitely will try to be here again every"},{"startTime":1028.021,"endTime":1030.685,"body":"week and I look forward to talking to you next week on"},{"startTime":1030.869,"endTime":1032.453,"body":"Talk about Fertility Tuesday."}]}