{"version":"1.0.0","segments":[{"startTime":0.735,"endTime":3.399,"body":"Today we talk about why slow and steady"},{"startTime":3.487,"endTime":6.039,"body":"wins the race when it comes to single embryo"},{"startTime":6.087,"endTime":8.593,"body":"transfers. I'm, Dr. Mark"},{"startTime":8.633,"endTime":11.545,"body":"Amols and this is"},{"startTime":11.609,"endTime":13.973,"body":"Taco about Fertility Tuesday."},{"startTime":25.623,"endTime":28.215,"body":"When it comes to embryos, one might be the"},{"startTime":28.239,"endTime":31.223,"body":"loneliest number, but it's also the smartest number"},{"startTime":31.303,"endTime":33.719,"body":"if you're aiming for the best chances as"},{"startTime":33.791,"endTime":36.791,"body":"success. In last week's episode, we touched on"},{"startTime":36.807,"endTime":39.743,"body":"the statistics infertility and how"},{"startTime":39.783,"endTime":42.111,"body":"this idea that one embryo being"},{"startTime":42.167,"endTime":45.063,"body":"transferred consecutively can"},{"startTime":45.103,"endTime":47.847,"body":"actually have a higher chance than putting twomers back"},{"startTime":47.935,"endTime":50.847,"body":"at the same time. Well, in this week's episode we're going"},{"startTime":50.855,"endTime":53.847,"body":"to continue the conversation about statistics and ferility,"},{"startTime":53.895,"endTime":56.853,"body":"but specifically about this one topic"},{"startTime":57.013,"endTime":59.797,"body":"of why it's always better to put back"},{"startTime":59.925,"endTime":62.797,"body":"one embryo versus two in"},{"startTime":62.845,"endTime":65.341,"body":"most situations. In addition,"},{"startTime":65.477,"endTime":68.033,"body":"in 2019 we explored this question"},{"startTime":68.333,"endTime":71.205,"body":"with that episode, how many embryos should"},{"startTime":71.229,"endTime":73.957,"body":"I transfer? But today we're going to dig"},{"startTime":74.085,"endTime":76.757,"body":"deeper than before, reaffirming some of the past"},{"startTime":76.805,"endTime":79.733,"body":"device, but also clarifying why transferring"},{"startTime":79.773,"endTime":82.317,"body":"one embryo at a time may often be the best"},{"startTime":82.365,"endTime":85.033,"body":"choice, especially if you only"},{"startTime":85.073,"endTime":87.889,"body":"have two embryos to work with. There are two"},{"startTime":87.921,"endTime":90.897,"body":"main reasons for discussing this topic"},{"startTime":90.945,"endTime":93.921,"body":"again. The first is there has been a"},{"startTime":93.937,"endTime":96.937,"body":"big push in the community to force people"},{"startTime":96.985,"endTime":99.985,"body":"to only put back one embryo. And as I talked about in"},{"startTime":100.009,"endTime":102.833,"body":"my prior episode, we would allow"},{"startTime":102.873,"endTime":105.649,"body":"people to put back two embryos because I believe people should have the"},{"startTime":105.681,"endTime":108.681,"body":"choice. Unfortunately, this has"},{"startTime":108.737,"endTime":111.313,"body":"becoming even harder nowadays because now"},{"startTime":111.393,"endTime":114.319,"body":"insurances are pulling contracts if"},{"startTime":114.351,"endTime":116.847,"body":"people are doing two embryo transfers that are"},{"startTime":116.895,"endTime":119.727,"body":"not under the guidelines of the American"},{"startTime":119.775,"endTime":121.643,"body":"SOC reproductive medicines"},{"startTime":121.983,"endTime":124.711,"body":"recommendations. And so you're going to find"},{"startTime":124.887,"endTime":127.887,"body":"that anywhere you go, it's going to be"},{"startTime":127.935,"endTime":130.935,"body":"very difficult in certain situations to put"},{"startTime":130.959,"endTime":133.191,"body":"back more than one embryo. But"},{"startTime":133.247,"endTime":136.231,"body":"additionally, things have changed. The"},{"startTime":136.287,"endTime":138.497,"body":"quality of IVF has gone up"},{"startTime":138.695,"endTime":141.181,"body":"and with science, when things"},{"startTime":141.237,"endTime":144.141,"body":"change, we make adjustments. Everything"},{"startTime":144.197,"endTime":147.141,"body":"I talked about in that previous episode is still"},{"startTime":147.237,"endTime":150.037,"body":"true. But in today's episode we're going to talk"},{"startTime":150.085,"endTime":152.989,"body":"about why they want you to only put back one"},{"startTime":153.021,"endTime":155.893,"body":"embryo and why mathematically it actually"},{"startTime":155.933,"endTime":158.509,"body":"does improve your chances over two"},{"startTime":158.541,"endTime":161.381,"body":"embryos in certain situations. Now,"},{"startTime":161.397,"endTime":164.349,"body":"un last week's episode we discussed how in"},{"startTime":164.381,"endTime":167.057,"body":"probability there's a thing called cumulative rate."},{"startTime":167.205,"endTime":169.961,"body":"And that is where when you add"},{"startTime":170.057,"endTime":172.649,"body":"another chance, it doesn't just add"},{"startTime":172.681,"endTime":175.489,"body":"up directly. Meaning if your chances"},{"startTime":175.521,"endTime":178.225,"body":"are 60%, putting two"},{"startTime":178.249,"endTime":181.049,"body":"embryos back does not give you 120% because"},{"startTime":181.081,"endTime":183.973,"body":"you can't have over 100%."},{"startTime":184.433,"endTime":187.401,"body":"Therefore, that means if you put two embros"},{"startTime":187.457,"endTime":189.825,"body":"back, your chances won't be"},{"startTime":189.929,"endTime":192.545,"body":"120% but will actually be around"},{"startTime":192.649,"endTime":195.273,"body":"84%. Now it's important to"},{"startTime":195.353,"endTime":198.297,"body":"understand that when we're talking about chances, we're talking"},{"startTime":198.345,"endTime":201.313,"body":"about it's a higher chance of getting"},{"startTime":201.353,"endTime":203.625,"body":"at least one embryo to"},{"startTime":203.649,"endTime":206.193,"body":"implant and have live birth. The"},{"startTime":206.233,"endTime":209.097,"body":"84% does not mean your chances of them"},{"startTime":209.185,"endTime":212.041,"body":"both taking, such as twins. The problem with"},{"startTime":212.057,"endTime":214.545,"body":"this calculation is it's not taking into"},{"startTime":214.609,"endTime":217.417,"body":"account things that can occur, such as"},{"startTime":217.545,"endTime":219.857,"body":"subcharic hemorrhages, ectopic"},{"startTime":219.905,"endTime":222.591,"body":"pregnancies, or even having higher"},{"startTime":222.647,"endTime":225.599,"body":"complications with twins. And"},{"startTime":225.631,"endTime":228.015,"body":"so when you take those into"},{"startTime":228.079,"endTime":231.079,"body":"account, what you find is, is that"},{"startTime":231.151,"endTime":233.559,"body":"by putting back two euloid"},{"startTime":233.591,"endTime":236.383,"body":"embryos, you actually have"},{"startTime":236.463,"endTime":239.463,"body":"a lower chance than putting back one"},{"startTime":239.503,"endTime":242.123,"body":"euuplooid embryo consecutively."},{"startTime":242.543,"endTime":245.143,"body":"Now, what it doesn't mean is it doesn't"},{"startTime":245.183,"endTime":248.099,"body":"mean that putting back one embryo"},{"startTime":248.131,"endTime":250.819,"body":"is better than two. I've heard other"},{"startTime":250.851,"endTime":253.611,"body":"doctors or people say this, and that's ridiculous."},{"startTime":253.707,"endTime":256.703,"body":"Of course there's a higher chance with two embryos."},{"startTime":257.563,"endTime":260.475,"body":"But what isn't obvious is that by"},{"startTime":260.499,"endTime":263.307,"body":"putting one embryo back and then let's say that"},{"startTime":263.355,"endTime":266.355,"body":"not working and put another embryo back, you actually"},{"startTime":266.379,"endTime":269.379,"body":"have a higher cumulative chance than if you"},{"startTime":269.411,"endTime":272.183,"body":"go and put both embryos back at the same time."},{"startTime":272.483,"endTime":275.417,"body":"And this increase can be significant"},{"startTime":275.505,"endTime":278.033,"body":"somewhere between about 3, even as high as"},{"startTime":278.073,"endTime":280.913,"body":"10% difference. And so if you think"},{"startTime":280.953,"endTime":283.793,"body":"about, think of all the things you do just"},{"startTime":283.833,"endTime":286.253,"body":"to improve your chances, a percent or two,"},{"startTime":286.833,"endTime":289.769,"body":"even embryo glue doesn't improve your chances that"},{"startTime":289.801,"endTime":292.801,"body":"much. Clinics that you go to to get"},{"startTime":292.857,"endTime":295.333,"body":"increased chances might be that different."},{"startTime":295.633,"endTime":298.609,"body":"And so in reality, the point here is"},{"startTime":298.641,"endTime":301.553,"body":"that if your goal is to have the highest chance and you want"},{"startTime":301.593,"endTime":304.425,"body":"to have the highest chance of come in the way with the live birth,"},{"startTime":304.609,"endTime":307.505,"body":"you are always better to put back one at a"},{"startTime":307.529,"endTime":310.313,"body":"time. If you have two embryos, then putting both"},{"startTime":310.353,"endTime":313.169,"body":"embryos back at the exact same time. Now,"},{"startTime":313.201,"endTime":316.153,"body":"my position hasn't changed. There is definitely some"},{"startTime":316.193,"endTime":318.773,"body":"cases of where two embryos make sense."},{"startTime":319.513,"endTime":322.329,"body":"And if you have a lot of embryos and you have a clinic"},{"startTime":322.361,"endTime":325.359,"body":"that's able to do that, because maybe they're a cash only clinic"},{"startTime":325.481,"endTime":328.307,"body":"and so they don't have to worry about losing contracts,"},{"startTime":328.435,"endTime":331.355,"body":"it's something to talk them about. Now,"},{"startTime":331.379,"endTime":334.227,"body":"the situations where it's still appropriate is"},{"startTime":334.275,"endTime":337.155,"body":"where if someone has, for example, low"},{"startTime":337.219,"endTime":339.931,"body":"quality embryos, so let's say they're not tested"},{"startTime":340.107,"endTime":342.779,"body":"and maybe they're poor quality, or day seven"},{"startTime":342.811,"endTime":345.579,"body":"embryos, it's not unreasonable to put too"},{"startTime":345.611,"endTime":348.339,"body":"bad because we know the actual potential of those embryos"},{"startTime":348.451,"endTime":351.227,"body":"are already low. The same would be true with"},{"startTime":351.275,"endTime":353.955,"body":"say, embryos that are mosaic or high mosaic."},{"startTime":354.139,"endTime":356.731,"body":"Another situation is when we're talking about"},{"startTime":356.907,"endTime":359.683,"body":"women who are more mature and did not do PGT"},{"startTime":359.723,"endTime":362.611,"body":"testing, those embryos have a lower"},{"startTime":362.667,"endTime":365.427,"body":"chance of being euoid and therefore"},{"startTime":365.515,"endTime":367.979,"body":"it's not unreasonable to put back more than"},{"startTime":368.011,"endTime":370.939,"body":"one. Now there are some places that"},{"startTime":370.971,"endTime":373.723,"body":"still do cleavage stage embryos and in that"},{"startTime":373.763,"endTime":376.619,"body":"situation too it makes sense to put back more than"},{"startTime":376.651,"endTime":379.247,"body":"one when you start advancing in age."},{"startTime":379.435,"endTime":382.327,"body":"But very few clicks now are doing cleavage stage"},{"startTime":382.375,"endTime":385.279,"body":"embryos. And so I'm keeping this mostly to"},{"startTime":385.351,"endTime":388.327,"body":"blastocyst when I talk about one versus"},{"startTime":388.375,"endTime":390.471,"body":"two. So let's talk about each"},{"startTime":390.527,"endTime":393.287,"body":"scenario. If you are"},{"startTime":393.455,"endTime":395.951,"body":"under 35 in almost"},{"startTime":396.047,"endTime":398.911,"body":"everyenario, if it's your first transfer,"},{"startTime":399.007,"endTime":401.487,"body":"whether it's a cleavage stage embryo or"},{"startTime":401.535,"endTime":404.399,"body":"blastocyst, it's recommended to put back"},{"startTime":404.551,"endTime":406.975,"body":"one embryo. ASRM does"},{"startTime":407.039,"endTime":409.983,"body":"have a side note that says if the embryos"},{"startTime":410.063,"endTime":412.843,"body":"are not euoid or favorable,"},{"startTime":413.343,"endTime":416.223,"body":"then in that situation it's not unreasonable to put"},{"startTime":416.263,"endTime":418.599,"body":"back two, but never more than two in that"},{"startTime":418.631,"endTime":421.487,"body":"situation. This again is going to be very poor"},{"startTime":421.535,"endTime":424.343,"body":"quality embryos. Embryos that are mosaic"},{"startTime":424.463,"endTime":427.363,"body":"or like we talked about day seven embryos."},{"startTime":427.703,"endTime":430.443,"body":"If you are age 35 to 37,"},{"startTime":431.023,"endTime":433.981,"body":"everything kind of stays the same. It's still recommended"},{"startTime":434.037,"endTime":436.965,"body":"by the American side of reproductive medicine to put back one"},{"startTime":437.029,"endTime":439.813,"body":"embryo whether they're Cleveland stage or"},{"startTime":439.853,"endTime":442.797,"body":"blastocyst stage if they're euoid or"},{"startTime":442.845,"endTime":445.313,"body":"not euploid as long as the embryo is favorable."},{"startTime":445.973,"endTime":448.253,"body":"Now if they're blastocyst and they're not"},{"startTime":448.293,"endTime":450.853,"body":"favorable, they do not recommend more than"},{"startTime":450.893,"endTime":453.869,"body":"two at any time. If"},{"startTime":453.901,"endTime":456.293,"body":"it's Cleveland stage but it's"},{"startTime":456.333,"endTime":459.177,"body":"not favorable, then"},{"startTime":459.265,"endTime":462.129,"body":"you can go up to three but"},{"startTime":462.161,"endTime":464.929,"body":"not more than that. When it comes to 38"},{"startTime":465.001,"endTime":467.913,"body":"and 40 age group, if you"},{"startTime":467.913,"endTime":470.253,"body":"are using cleavage stage embryos,"},{"startTime":470.633,"endTime":473.449,"body":"it's recommended that even if they"},{"startTime":473.481,"endTime":475.453,"body":"are favorable,"},{"startTime":476.153,"endTime":478.853,"body":"not having more than three,"},{"startTime":479.193,"endTime":481.733,"body":"if it's EUoID only one,"},{"startTime":482.073,"endTime":484.453,"body":"and if they're not favorable,"},{"startTime":485.163,"endTime":487.715,"body":"then up to four but no more."},{"startTime":487.899,"endTime":490.435,"body":"Now when comes to blastocyst, it's"},{"startTime":490.459,"endTime":493.323,"body":"recommended again if you ploed only one"},{"startTime":493.363,"endTime":496.331,"body":"embryo and if it's"},{"startTime":496.387,"endTime":499.299,"body":"favorable but let's say not tested up"},{"startTime":499.331,"endTime":502.283,"body":"to two and if it's not"},{"startTime":502.323,"endTime":504.983,"body":"favorable such as we said day seven embryos,"},{"startTime":505.403,"endTime":508.299,"body":"even up to three, but that's assuming not eu"},{"startTime":508.331,"endTime":511.235,"body":"ploid, the last category is going to be 41"},{"startTime":511.259,"endTime":513.383,"body":"and above. And basically"},{"startTime":513.923,"endTime":516.763,"body":"the same holds true. If it is a euloid"},{"startTime":516.803,"endTime":519.451,"body":"embryo you would put back one"},{"startTime":519.507,"endTime":521.971,"body":"embryo whether it's cleavage stage or"},{"startTime":522.027,"endTime":524.387,"body":"blastocyst. If it is not"},{"startTime":524.435,"endTime":527.259,"body":"tested then you can put up to"},{"startTime":527.331,"endTime":530.263,"body":"four at 41 to 42 and not more."},{"startTime":530.563,"endTime":533.443,"body":"And then again if it's not favorable and again not being"},{"startTime":533.483,"endTime":536.387,"body":"euoid, you could even theoret put up to"},{"startTime":536.435,"endTime":539.339,"body":"five, but not more. Now, when comes to"},{"startTime":539.371,"endTime":542.063,"body":"blastocyst, the rule remains the same."},{"startTime":542.363,"endTime":545.103,"body":"If it's euoid, one embryo"},{"startTime":545.403,"endTime":547.923,"body":"now, if it's not tested up to"},{"startTime":547.963,"endTime":549.983,"body":"three is reasonable."},{"startTime":550.803,"endTime":553.683,"body":"And if it is not euoid and not"},{"startTime":553.723,"endTime":556.423,"body":"favorable, still only three."},{"startTime":556.883,"endTime":559.819,"body":"And the big reason for this, why it doesn't go as much in"},{"startTime":559.851,"endTime":562.027,"body":"blastoc, is because they have already"},{"startTime":562.115,"endTime":565.043,"body":"undergone the attrition rate that should occur to"},{"startTime":565.083,"endTime":567.343,"body":"remove a lot of the abnormal embryos."},{"startTime":567.763,"endTime":570.571,"body":"And so it's dangerous to put back too many blastocystss."},{"startTime":570.627,"endTime":573.531,"body":"Whereas with cleavage stage embryos, there's so"},{"startTime":573.587,"endTime":576.133,"body":"many, abnormal still embryos are in there"},{"startTime":576.473,"endTime":579.337,"body":"that you can put back more. Now,"},{"startTime":579.505,"endTime":582.385,"body":"another important piece to understand is when we're talking about"},{"startTime":582.409,"endTime":585.313,"body":"this, we're talking about first embryo"},{"startTime":585.353,"endTime":588.281,"body":"transfers. No one is saying that if you have"},{"startTime":588.297,"endTime":591.265,"body":"had multiple failed embryo transfers or"},{"startTime":591.289,"endTime":593.905,"body":"in certain situations, you cannot put back more than one"},{"startTime":593.929,"endTime":596.383,"body":"embryo. Even if you have euloid"},{"startTime":596.423,"endTime":599.351,"body":"embryos, if it's been failing and failing and failing,"},{"startTime":599.407,"endTime":602.083,"body":"it's not unreasonable to put back more than one."},{"startTime":602.543,"endTime":605.431,"body":"What this is talking about is at least your first two"},{"startTime":605.487,"endTime":608.487,"body":"transfers should always be single embryo"},{"startTime":608.615,"endTime":611.263,"body":"if they're euoid. And then after"},{"startTime":611.303,"endTime":614.239,"body":"that is when you can start to look at potentially putting"},{"startTime":614.271,"endTime":616.999,"body":"back more than one. And this is for the benefit"},{"startTime":617.071,"endTime":619.911,"body":"of increasing your chances of coming away with a"},{"startTime":619.927,"endTime":622.805,"body":"pregnancy. And this"},{"startTime":622.829,"endTime":625.765,"body":"is because if you put two embryos back and"},{"startTime":625.789,"endTime":628.541,"body":"you assume that nothing is going to happen to either those embryos,"},{"startTime":628.637,"endTime":631.325,"body":"yes, things may go fine. But by putting two"},{"startTime":631.349,"endTime":634.245,"body":"embryos in there, you now take twice the risk of"},{"startTime":634.309,"endTime":637.133,"body":"something happening to one which could theoretically"},{"startTime":637.213,"endTime":639.885,"body":"affect the other embryo and you would lose both"},{"startTime":639.949,"endTime":642.877,"body":"embryos. A matter of fact, as"},{"startTime":642.925,"endTime":645.509,"body":"many people know, you can do a transfer. It just doesn't"},{"startTime":645.541,"endTime":648.485,"body":"work. And the reason why is there could be something, let's say at"},{"startTime":648.509,"endTime":651.421,"body":"the uterus or some condition at that time, maybe"},{"startTime":651.437,"endTime":654.229,"body":"you got a fever, and now if all your eggs in"},{"startTime":654.261,"endTime":657.149,"body":"one basket, you'lose them all. This is"},{"startTime":657.181,"endTime":659.965,"body":"why it's always best to put back one embryo when"},{"startTime":659.989,"endTime":662.821,"body":"it's euloid. Now, why are the"},{"startTime":662.837,"endTime":665.725,"body":"insuranceances pushing this so much? Is that they just"},{"startTime":665.749,"endTime":668.12,"body":"don't want people to have choice? Well, not"},{"startTime":668.16,"endTime":671.016,"body":"exactly as you would imagine. It has to do"},{"startTime":671.048,"endTime":673.832,"body":"with finances. When you have a"},{"startTime":673.896,"endTime":676.62,"body":"single embryo and you put it back and you get a"},{"startTime":676.66,"endTime":679.604,"body":"single live birth, the cost to insurances"},{"startTime":679.732,"endTime":682.0,"body":"is about $20,000 or less."},{"startTime":682.78,"endTime":685.692,"body":"As soon as you get twins, that cost goes up"},{"startTime":685.716,"endTime":688.284,"body":"to at least $100,000,"},{"startTime":688.452,"endTime":691.358,"body":"more than five times the cost of, just a single"},{"startTime":691.414,"endTime":694.31,"body":"delivery. And if you get triplets, it could be"},{"startTime":694.35,"endTime":697.318,"body":"anywhere between about 500,000 do to a"},{"startTime":697.334,"endTime":700.262,"body":"million dollars in cost due to all the"},{"startTime":700.286,"endTime":702.868,"body":"care that has to be for the babies. And that's"},{"startTime":702.924,"endTime":705.828,"body":"because multiples end up coming"},{"startTime":705.964,"endTime":708.884,"body":"earlier. You get preterm labor and can actually"},{"startTime":708.932,"endTime":711.88,"body":"lead to some complications. So"},{"startTime":712.34,"endTime":715.06,"body":"their reasoning isn't unfair,"},{"startTime":715.22,"endTime":718.108,"body":"it's just frustrating because we're adults and should be able"},{"startTime":718.124,"endTime":721.068,"body":"to make decisions. In the past episode I"},{"startTime":721.124,"endTime":723.964,"body":"discussed that by putting one embryo back,"},{"startTime":724.092,"endTime":727.06,"body":"your risk of twins is so small it's well below"},{"startTime":727.1,"endTime":729.8,"body":"1%. But by putting two"},{"startTime":729.84,"endTime":732.6,"body":"duploid embryos back, you increase your chance of"},{"startTime":732.64,"endTime":735.14,"body":"twins, sometimes over 40%."},{"startTime":735.44,"endTime":738.312,"body":"Which means you take almost an 80 to 100 times"},{"startTime":738.416,"endTime":741.4,"body":"more risk of having twins, but only increase"},{"startTime":741.44,"endTime":744.392,"body":"your pregnancy chances from 60% of"},{"startTime":744.416,"endTime":746.424,"body":"a live birth to just"},{"startTime":746.552,"endTime":749.424,"body":"84. And when taking into"},{"startTime":749.472,"endTime":752.312,"body":"account the risk even less than four, close to"},{"startTime":752.336,"endTime":755.286,"body":"around 75 up to around 80."},{"startTime":755.448,"endTime":758.29,"body":"So as you can see, you don't get much benefit,"},{"startTime":758.41,"endTime":760.87,"body":"but you get a lot more risk."},{"startTime":761.29,"endTime":764.282,"body":"Now, as I always say, these decisions"},{"startTime":764.346,"endTime":766.674,"body":"are personal and depend on your unique"},{"startTime":766.722,"endTime":769.426,"body":"circumstances. And you should talk to your physician about"},{"startTime":769.458,"endTime":772.458,"body":"this. You should always feel free to ask if"},{"startTime":772.474,"endTime":774.986,"body":"you can put 2 embr back. But I wanted you to"},{"startTime":775.058,"endTime":778.01,"body":"understand why many clinics are no"},{"startTime":778.05,"endTime":781.05,"body":"longer doing it and even the ones who are"},{"startTime":781.09,"endTime":783.4,"body":"okay with doing it are now being"},{"startTime":783.48,"endTime":786.392,"body":"forced to not do it. But I always like to look at"},{"startTime":786.416,"endTime":789.208,"body":"all sides and like I said, financially"},{"startTime":789.344,"endTime":792.104,"body":"the insurances are correct. It is"},{"startTime":792.192,"endTime":795.096,"body":"much more cost effective for them to only put"},{"startTime":795.128,"endTime":798.08,"body":"one back. And for patients, it"},{"startTime":798.16,"endTime":801.128,"body":"also is more effective to come away with a live birth."},{"startTime":801.264,"endTime":803.96,"body":"And like I said, we do some pretty crazy"},{"startTime":804.0,"endTime":806.82,"body":"things just to even increase our chances 1%."},{"startTime":807.2,"endTime":810.166,"body":"I see patients take 8, 10 bottles of"},{"startTime":810.198,"endTime":813.046,"body":"different pills just to improve their chances a tiny bit."},{"startTime":813.238,"endTime":815.814,"body":"So in reality, if the goal is to have a live"},{"startTime":815.862,"endTime":818.694,"body":"birth, then reality, one"},{"startTime":818.742,"endTime":821.702,"body":"embryo will increase your dreams of"},{"startTime":821.726,"endTime":824.71,"body":"having that live birth. Where I think this matters"},{"startTime":824.75,"endTime":827.49,"body":"the most is when you only have two embryos."},{"startTime":827.79,"endTime":830.654,"body":"I would never recommend anyone to put both embryos"},{"startTime":830.702,"endTime":833.606,"body":"back at the same time because you only"},{"startTime":833.638,"endTime":836.454,"body":"get one chance when you do that versus two"},{"startTime":836.502,"endTime":838.998,"body":"chances when you do it one at a"},{"startTime":839.014,"endTime":841.782,"body":"time. Like I said, you don't know what can happen."},{"startTime":841.886,"endTime":844.83,"body":"You can then begin a fever the next day and lose the pregnancies."},{"startTime":844.99,"endTime":847.966,"body":"Maybe in the middle will transfer, you cough and all of a sudden the catheter"},{"startTime":847.998,"endTime":850.438,"body":"hits the top of the uterus and doesn't work."},{"startTime":850.614,"endTime":852.966,"body":"So especially in the situation where you have two"},{"startTime":852.998,"endTime":855.758,"body":"embryos and both are EUoID,"},{"startTime":855.894,"endTime":858.422,"body":"I would always recommend one at a"},{"startTime":858.446,"endTime":860.966,"body":"time. And if you're younger, if not"},{"startTime":860.998,"endTime":863.816,"body":"tested, I would still recommend that. But as I"},{"startTime":863.848,"endTime":866.8,"body":"mentioned, there are situations where you are not testing"},{"startTime":866.84,"endTime":869.712,"body":"embryos, where patients are more mature, where the"},{"startTime":869.736,"endTime":872.736,"body":"embryo quality is poor, or even when implantation rates are"},{"startTime":872.768,"endTime":875.656,"body":"low that it is reasonable to put back"},{"startTime":875.688,"endTime":878.44,"body":"more than one. So it's not an always put back"},{"startTime":878.48,"endTime":881.176,"body":"one, it's just when first starting,"},{"startTime":881.328,"endTime":884.192,"body":"it's reasonable to only put back one to"},{"startTime":884.256,"endTime":887.224,"body":"improve your chances of success. And if your doctor"},{"startTime":887.312,"endTime":890.06,"body":"recommends putting back two, it doesn't"},{"startTime":890.1,"endTime":892.924,"body":"mean that they aren't doing the right thing,"},{"startTime":893.012,"endTime":895.756,"body":"it means that they believe in that situation"},{"startTime":895.868,"endTime":898.42,"body":"that's the best thing for you. And I would take their"},{"startTime":898.46,"endTime":901.188,"body":"advice. When I record these podcasts,"},{"startTime":901.324,"endTime":904.252,"body":"I don't know your exact situation and so everything I'm"},{"startTime":904.276,"endTime":906.972,"body":"talking about is somewhat generic. So again, it's"},{"startTime":907.036,"endTime":909.34,"body":"always important to talk to your doctor and realize that your"},{"startTime":909.38,"endTime":912.156,"body":"situation might be unique. So in"},{"startTime":912.188,"endTime":914.86,"body":"summary, single embryo transfers give"},{"startTime":914.9,"endTime":917.736,"body":"better cumulative success and minimize the"},{"startTime":917.768,"endTime":920.592,"body":"risk. So even if it feels like two"},{"startTime":920.616,"endTime":923.016,"body":"emeralds would give better odds, the math and"},{"startTime":923.048,"endTime":926.0,"body":"biology tell a different story. So just"},{"startTime":926.04,"endTime":928.832,"body":"like last episode, understanding probability"},{"startTime":928.936,"endTime":931.856,"body":"can lead to better decision making. Hopefully Ivet"},{"startTime":931.888,"endTime":934.44,"body":"bored you guys with these two episodes discussing"},{"startTime":934.48,"endTime":937.192,"body":"probability and math and hopefully this was"},{"startTime":937.216,"endTime":940.136,"body":"helpful to some people. If you liked this"},{"startTime":940.168,"endTime":942.872,"body":"episode and like the show, please tell your friends about"},{"startTime":942.896,"endTime":945.8,"body":"us and as always, give us a five star review on your favorite"},{"startTime":945.84,"endTime":948.808,"body":"medium. If you have any suggestions for the show, please send us"},{"startTime":948.824,"endTime":949.304,"body":"a message"},{"startTime":949.352,"endTime":952.344,"body":"atbftirectionffertility.com"},{"startTime":952.472,"endTime":955.224,"body":"we'll be more than happy to try and make an episode on that."},{"startTime":955.352,"endTime":958.296,"body":"I look forward to talking you again next week on Taco"},{"startTime":958.328,"endTime":959.6,"body":"Bel Fertility Tuesday."}]}