{"version":"1.0.0","segments":[{"startTime":0.815,"endTime":3.671,"body":"Today we talk about IVF priming."},{"startTime":3.823,"endTime":6.435,"body":"A deeper dive into this topic."},{"startTime":7.415,"endTime":9.951,"body":"I'm Dr. Mark Amols and"},{"startTime":9.983,"endTime":12.527,"body":"this is Taco about"},{"startTime":12.591,"endTime":13.795,"body":"Fertility Tuesday."},{"startTime":25.495,"endTime":28.373,"body":"Back In December of 2024, I did an"},{"startTime":28.389,"endTime":31.277,"body":"episode on priming for IVF. It was titled"},{"startTime":31.341,"endTime":34.205,"body":"Balancing Synchronization and Suppression. But"},{"startTime":34.245,"endTime":37.101,"body":"today we're graduating from priming 101 and"},{"startTime":37.133,"endTime":40.013,"body":"going to priming 201. Because when it comes to IV"},{"startTime":40.029,"endTime":42.373,"body":"of success, the devils in the"},{"startTime":42.429,"endTime":45.341,"body":"details, and trust me, the devils"},{"startTime":45.453,"endTime":47.981,"body":"love to mess with eggs. Ever heard the devil"},{"startTime":48.013,"endTime":50.605,"body":"eggs? So, as we discussed the prior"},{"startTime":50.725,"endTime":53.533,"body":"podcast, priming before IVF"},{"startTime":53.669,"endTime":56.581,"body":"is often misunderstood. You might think of it"},{"startTime":56.613,"endTime":59.469,"body":"as just taking birth control, but it's much more"},{"startTime":59.517,"endTime":62.349,"body":"nuanced than that. Today we're not going to cover"},{"startTime":62.397,"endTime":65.365,"body":"the basics. We've done that before. But in this"},{"startTime":65.405,"endTime":68.221,"body":"episode, I want you to understand"},{"startTime":68.373,"endTime":71.345,"body":"how we choose the right priming strategy for each person"},{"startTime":71.685,"endTime":74.317,"body":"and why it's not a one size fits all"},{"startTime":74.461,"endTime":77.245,"body":"type of situation. We're diving into"},{"startTime":77.285,"endTime":80.265,"body":"real strategy, research and results."},{"startTime":80.645,"endTime":83.487,"body":"Think of this as, a kind of behind the scenes director's"},{"startTime":83.511,"endTime":86.375,"body":"gut of your IVF cycle. The first"},{"startTime":86.415,"endTime":89.247,"body":"question is, what is priming? Well, as you would see in my"},{"startTime":89.271,"endTime":91.855,"body":"last episode, priming is the pre"},{"startTime":91.895,"endTime":94.075,"body":"treatment before ovarian stimulation."},{"startTime":94.935,"endTime":97.875,"body":"Its goals are going to be synchronizing the follicles,"},{"startTime":98.335,"endTime":101.295,"body":"preventing cyst formation, modulating"},{"startTime":101.335,"endTime":104.063,"body":"the FSH and LH levels, improving the"},{"startTime":104.079,"endTime":106.666,"body":"follicular response, upregulating, the"},{"startTime":106.698,"endTime":108.99,"body":"FSH receptors to enhance stimulation."},{"startTime":109.65,"endTime":112.618,"body":"And sometimes it's just used to figure out how to"},{"startTime":112.634,"endTime":115.49,"body":"put you in the cycle. And yes, it can"},{"startTime":115.53,"endTime":118.458,"body":"absolutely backfire if done wrong. So as you"},{"startTime":118.474,"endTime":121.226,"body":"can see, although a lot of people think of"},{"startTime":121.338,"endTime":124.106,"body":"priming with birth control as just being a way"},{"startTime":124.178,"endTime":126.906,"body":"for the clinic to schedule your cycle,"},{"startTime":127.018,"endTime":128.71,"body":"there is more benefit."},{"startTime":129.33,"endTime":131.35,"body":"Synchronizing eggs is important."},{"startTime":132.0,"endTime":134.744,"body":"Stopping you from getting cyst is"},{"startTime":134.792,"endTime":137.14,"body":"important, allows you to go on with your ivhip cycle."},{"startTime":137.96,"endTime":140.912,"body":"Increasing FSH receptors, but through"},{"startTime":140.936,"endTime":143.648,"body":"up regulation is going to increase your stimulation"},{"startTime":143.744,"endTime":146.04,"body":"efficiency. But with too much"},{"startTime":146.08,"endTime":148.96,"body":"depression, you may lose some eggs. With"},{"startTime":149.0,"endTime":151.976,"body":"too little suppression, you may get a leaf follicle"},{"startTime":152.008,"endTime":154.888,"body":"that ruins your cycle that needs to be canceled. This"},{"startTime":154.904,"endTime":157.89,"body":"is where the balancing comes in. So when"},{"startTime":157.89,"endTime":160.762,"body":"it comes to synchronization, the way I like to think of this is"},{"startTime":160.786,"endTime":163.786,"body":"if runners are going to be in a race, if you don't"},{"startTime":163.818,"endTime":166.802,"body":"put everyone on the starting line, then they're"},{"startTime":166.826,"endTime":169.626,"body":"going to just start whenever they want. And sometimes one of those"},{"startTime":169.658,"endTime":172.034,"body":"runners are going to be halfway down the track before the others"},{"startTime":172.082,"endTime":174.946,"body":"start. So synchronization gets"},{"startTime":175.018,"endTime":177.714,"body":"all of the runners to start the starting line"},{"startTime":177.882,"endTime":180.43,"body":"that's going to give us a better chance of synchronization."},{"startTime":180.73,"endTime":183.618,"body":"But why does it matter? Obviously, if you have a lead"},{"startTime":183.674,"endTime":186.568,"body":"f call situation, the follicles can be so far ahead it"},{"startTime":186.584,"endTime":189.504,"body":"may ruin your cycle. Now you have to let some eggs get too"},{"startTime":189.552,"endTime":191.688,"body":"big. That can lead to post"},{"startTime":191.744,"endTime":194.528,"body":"maturity, and then you have to try to get the other eggs to"},{"startTime":194.544,"endTime":197.368,"body":"grow behind those. If you have 16 eggs,"},{"startTime":197.424,"endTime":199.944,"body":"but then taking a birth control makes you only get 15"},{"startTime":199.992,"endTime":202.912,"body":"eggs, that's not a big deal. But if you only"},{"startTime":202.936,"endTime":205.84,"body":"have three follicles, even one being"},{"startTime":205.88,"endTime":208.712,"body":"suppressed is already too much. But it's"},{"startTime":208.736,"endTime":211.576,"body":"not just about synchronization. As I"},{"startTime":211.608,"endTime":214.416,"body":"mentioned, this also helps with"},{"startTime":214.568,"endTime":217.424,"body":"recruitment of follicles because it upregulates"},{"startTime":217.472,"endTime":220.112,"body":"deficits receptors. Some types of"},{"startTime":220.136,"endTime":222.656,"body":"prime is going to actually prevent"},{"startTime":222.728,"endTime":225.64,"body":"ovulation. So for example, if you start with a lubron"},{"startTime":225.72,"endTime":228.632,"body":"priming, you're going to continue it through the cycle,"},{"startTime":228.736,"endTime":231.672,"body":"which also then prevents you from ovulating. Now, it's important to"},{"startTime":231.736,"endTime":234.712,"body":"understand you don't have the prime to"},{"startTime":234.736,"endTime":237.144,"body":"do IVF. You think about it, when you do things"},{"startTime":237.192,"endTime":239.974,"body":"like IUIs, you don't prime"},{"startTime":240.022,"endTime":242.99,"body":"first. It doesn't mean you can't. But it's not very"},{"startTime":243.03,"endTime":245.998,"body":"common. And that's because you're just trying to get a few eggs. So it's"},{"startTime":246.014,"endTime":248.646,"body":"not a big deal of maybe they're not completely synchronized."},{"startTime":248.798,"endTime":251.486,"body":"It's like walking with three kids. It's okay if they're not"},{"startTime":251.518,"endTime":254.214,"body":"synchronized because you can see them all. But you take 20"},{"startTime":254.262,"endTime":257.158,"body":"kids and now you put them in the line because you need to see them"},{"startTime":257.174,"endTime":259.966,"body":"all at the same time there. Time synchronization is"},{"startTime":259.998,"endTime":262.878,"body":"good. There's time that's not needed. So when you don't"},{"startTime":262.894,"endTime":265.742,"body":"do any type of synchronization, we kind of call that a"},{"startTime":265.766,"endTime":268.662,"body":"cold start, where you just start simimulation on the second or"},{"startTime":268.686,"endTime":271.534,"body":"third day of your natural period. And many people do"},{"startTime":271.582,"endTime":274.323,"body":"very well with this. The challenge is, identifying who"},{"startTime":274.395,"endTime":277.323,"body":"benefits. And for most people, you don't want to learn through"},{"startTime":277.355,"endTime":280.283,"body":"trial and error that that didn't work for you. So instead of"},{"startTime":280.315,"endTime":283.003,"body":"guessing which patients will do better with cold starts,"},{"startTime":283.155,"endTime":285.923,"body":"most clinics will just do some type of priming. But"},{"startTime":285.955,"endTime":288.859,"body":"at that point, that's where we go into our toolbox to"},{"startTime":288.883,"endTime":291.865,"body":"determine what type of priming is best for you."},{"startTime":291.961,"endTime":294.945,"body":"So let's define the different types of priming. There's going to"},{"startTime":294.961,"endTime":297.873,"body":"be the cold start, which again is just starting on the second or third"},{"startTime":297.905,"endTime":300.361,"body":"day of your period. Then there's the classical"},{"startTime":300.529,"endTime":302.757,"body":"OCPs, birth control pills,"},{"startTime":303.537,"endTime":305.877,"body":"Then there is estrogen priming,"},{"startTime":306.217,"endTime":308.825,"body":"progesterone priming is the next. Then there's"},{"startTime":308.881,"endTime":311.801,"body":"Lupron priming and there's even androgen priming."},{"startTime":311.889,"endTime":314.865,"body":"Now what's interesting is when you start some of those primings, some of"},{"startTime":314.881,"endTime":317.765,"body":"them can be started at the beginning of the period, some of"},{"startTime":317.781,"endTime":320.549,"body":"them can be started in the luteal phase after you"},{"startTime":320.573,"endTime":323.181,"body":"oulate. A newer protocol now"},{"startTime":323.309,"endTime":326.293,"body":"is using stimulation in the luteal phase."},{"startTime":326.405,"endTime":329.387,"body":"This would be very similar to, what people call duostim, where they"},{"startTime":329.467,"endTime":332.243,"body":"go through a retrieval and then as soon as they retrieve their eggs,"},{"startTime":332.315,"endTime":335.035,"body":"they start again. That way they're stimulating in the"},{"startTime":335.051,"endTime":337.939,"body":"luteal phase. So let's talk about the pros and cons of all"},{"startTime":337.963,"endTime":340.891,"body":"these different ones. So the pros of a cold"},{"startTime":340.939,"endTime":343.899,"body":"start is that there's no suppression. It's good for"},{"startTime":343.923,"endTime":346.795,"body":"people with regular predictable cycles. But the risk is"},{"startTime":346.971,"endTime":349.971,"body":"there's going to be very little synchronization. You can't really plan"},{"startTime":350.019,"endTime":352.643,"body":"around it because you don't know when your period is going to start. And"},{"startTime":352.675,"endTime":355.643,"body":"potentially you could have a cyst before you start the process, throwing"},{"startTime":355.675,"endTime":358.531,"body":"off the whole cycle. Whereas with birth control,"},{"startTime":358.659,"endTime":361.635,"body":"you can be suppressed with the birth control so you won't develop a cyst. So"},{"startTime":361.651,"endTime":364.619,"body":"that way you can start on the day you want to. Birth control"},{"startTime":364.643,"endTime":367.555,"body":"is going to give you great synchronization. It's going to"},{"startTime":367.571,"endTime":370.443,"body":"help prevent things like early recruitment and prevent cysts from"},{"startTime":370.475,"endTime":373.443,"body":"forming. However, for some people, it may not"},{"startTime":373.475,"endTime":376.123,"body":"be good people who it's going to overupprress."},{"startTime":376.315,"endTime":379.307,"body":"Women with diminish ovarian reserve, and that is"},{"startTime":379.427,"endTime":381.979,"body":"significant. Dimenish ovarian reserve may not benefit from birth"},{"startTime":382.043,"endTime":385.003,"body":"control. It's not a rule. There are times they do benefit"},{"startTime":385.035,"endTime":387.843,"body":"from it. Some women with polycystic ovarian syndrome"},{"startTime":387.915,"endTime":390.627,"body":"don't benefit as well from birth control. Some"},{"startTime":390.667,"endTime":393.627,"body":"do. And then the type of birth control you use matters"},{"startTime":393.667,"endTime":396.395,"body":"as well. When you're talking about taking"},{"startTime":396.451,"endTime":399.167,"body":"birth control for preventing pregnancy,"},{"startTime":399.287,"endTime":401.903,"body":"we usually like to use low dose birth controls."},{"startTime":402.095,"endTime":405.095,"body":"But when you're talking about for priming, you usually want"},{"startTime":405.111,"endTime":407.871,"body":"to use something with a little bit of a stronger progestin"},{"startTime":407.919,"endTime":410.663,"body":"component and will have at least a little bit higher estrogen"},{"startTime":410.695,"endTime":413.199,"body":"component. Now it's not wrong to use a different birth"},{"startTime":413.263,"endTime":416.199,"body":"control. It's just that if it's not strong enough,"},{"startTime":416.303,"endTime":419.143,"body":"you can then ovulate past it, which again"},{"startTime":419.215,"endTime":422.119,"body":"will cause your cycle to be canceled. When, when it comes"},{"startTime":422.143,"endTime":424.975,"body":"to estrogen priming, there are definitely two ways to do this. You"},{"startTime":424.991,"endTime":427.839,"body":"can start the estrogen at the Beginning of your cycle, like on"},{"startTime":427.863,"endTime":430.687,"body":"day two, or you can start in the luteal"},{"startTime":430.727,"endTime":433.415,"body":"phase. For me, I like to use it in the"},{"startTime":433.431,"endTime":436.263,"body":"luteal phase, especially for people who have early"},{"startTime":436.295,"endTime":439.279,"body":"recruitment, because I can then stop them from"},{"startTime":439.343,"endTime":441.547,"body":"developing follicles very early"},{"startTime":442.087,"endTime":445.007,"body":"versus if I start on day two of their cycle, theirby has"},{"startTime":445.087,"endTime":447.647,"body":"already recruited the follicles that may ovulate past"},{"startTime":447.687,"endTime":450.639,"body":"it. The people best for estrogen priming are"},{"startTime":450.663,"endTime":453.429,"body":"going to be people who really don't have high FSH levels,"},{"startTime":453.543,"endTime":456.385,"body":"and then you can just start them on the estrogen on the second day of"},{"startTime":456.401,"endTime":459.377,"body":"their period. This is actually very similar to when you're doing a"},{"startTime":459.417,"endTime":462.265,"body":"embryo transfer. You'll start the medicine on day two because it"},{"startTime":462.281,"endTime":465.121,"body":"will be good enough to suppress you. But for people who"},{"startTime":465.129,"endTime":467.393,"body":"have high FSH levels or known early"},{"startTime":467.425,"endTime":470.289,"body":"recruitment, which usually means you have a high cycle"},{"startTime":470.313,"endTime":473.289,"body":"day three, estrogen level, you're going to want to start that"},{"startTime":473.313,"endTime":476.233,"body":"estrogen in the luteal phase. Otherwise it"},{"startTime":476.265,"endTime":478.881,"body":"may be too late. By starting on day two, the"},{"startTime":478.929,"endTime":481.593,"body":"benefit of estrogen priming is that"},{"startTime":481.705,"endTime":484.609,"body":"you're able to get some mild synchronization. You also are"},{"startTime":484.633,"endTime":487.233,"body":"going to have less suppression. But the con"},{"startTime":487.265,"endTime":490.217,"body":"is the synchronization is going to be"},{"startTime":490.297,"endTime":493.169,"body":"okay, and it's not very suppressive. Many people"},{"startTime":493.233,"endTime":496.025,"body":"will ovulate past estzrogen priming,"},{"startTime":496.201,"endTime":498.593,"body":"especially if it's started at the start of a menstrual"},{"startTime":498.625,"endTime":501.577,"body":"cycle. The most significant type of priming"},{"startTime":501.617,"endTime":504.457,"body":"is going to be Lupron. This is what's called a gna"},{"startTime":504.537,"endTime":507.437,"body":"agonist, and this is very powerful."},{"startTime":507.477,"endTime":510.422,"body":"It actually suppresses the pituitary gland, putting you in like an, early"},{"startTime":510.454,"endTime":513.27,"body":"menopause. The benefit of it is it takes your body"},{"startTime":513.358,"endTime":516.238,"body":"completely out of it. There is no way you're going to need to develop"},{"startTime":516.262,"endTime":518.822,"body":"a follicle on this. There is no way you're going to have early"},{"startTime":518.854,"endTime":521.414,"body":"recruitment because your body can't do anything. It's basically"},{"startTime":521.47,"endTime":524.454,"body":"paralyzed. All of the growth is going to"},{"startTime":524.47,"endTime":527.278,"body":"come from the medications that we give it. As you can"},{"startTime":527.302,"endTime":530.174,"body":"imagine, in today's world where we have antagonists now"},{"startTime":530.27,"endTime":532.814,"body":"to prevent ovulation, we don't have to use"},{"startTime":532.87,"endTime":535.802,"body":"GRNH agonist, and so we don't have to over"},{"startTime":535.834,"endTime":538.57,"body":"suppress people. But there still is a time that's"},{"startTime":538.618,"endTime":541.138,"body":"beneficial sometimes for people who"},{"startTime":541.242,"endTime":543.978,"body":"ovulate past everything you do, you can"},{"startTime":544.002,"endTime":546.898,"body":"use a GRNH agonist as long as they have good"},{"startTime":546.922,"endTime":549.882,"body":"ovarian reserve. Now, the"},{"startTime":549.954,"endTime":552.786,"body":"other group that may benefit from this are women with"},{"startTime":552.866,"endTime":555.73,"body":"endometriosis, especially if you're going to do a"},{"startTime":555.778,"endTime":558.674,"body":"transfer While being on lowbrn. Now you"},{"startTime":558.69,"endTime":561.334,"body":"can start it as a priming agent, go through the"},{"startTime":561.35,"endTime":564.238,"body":"ivf, keep them on the Loupron and then go"},{"startTime":564.302,"endTime":567.166,"body":"into the transfer. Now, this does not mean every person"},{"startTime":567.206,"endTime":569.926,"body":"with endometriosis should be on the gener H"},{"startTime":569.966,"endTime":572.862,"body":"agonist Lupron protocol. This protocol is"},{"startTime":572.894,"endTime":575.734,"body":"a very old protocol that everyone used to use, but we don't"},{"startTime":575.75,"endTime":578.718,"body":"use as much. But in the right conditions, it"},{"startTime":578.742,"endTime":581.654,"body":"may be worthwhile for most people with endometriosis."},{"startTime":581.75,"endTime":584.27,"body":"You're just going to do a standard antagonist"},{"startTime":584.318,"endTime":587.246,"body":"protocol. They may even put Femaar on to lower your"},{"startTime":587.286,"endTime":590.248,"body":"estrogen levels during the stimulation. But if you have good"},{"startTime":590.272,"endTime":593.056,"body":"ovarian reserve and you respond well, a long"},{"startTime":593.096,"endTime":596.024,"body":"Lupron gener agonist protocol is not always a"},{"startTime":596.04,"endTime":598.76,"body":"bad thing. Another type of priming is"},{"startTime":598.808,"endTime":601.744,"body":"progesterone priming. There's a couple ways to do this. You"},{"startTime":601.76,"endTime":604.136,"body":"can do just a weak progesterone like northingro"},{"startTime":604.176,"endTime":607.16,"body":"acetate or meddroxy progesterone, and you"},{"startTime":607.168,"endTime":609.976,"body":"can start that on the second day of their period"},{"startTime":610.096,"endTime":613.024,"body":"and use that kind of like a birth control. You can also start it"},{"startTime":613.04,"endTime":615.932,"body":"in the luteal phase as well. If you want to suppress someone."},{"startTime":616.064,"endTime":618.724,"body":"This is a little stronger than estrogen, so you're going to get"},{"startTime":618.74,"endTime":621.556,"body":"better synchronization. It's going to be a little bit more"},{"startTime":621.596,"endTime":624.508,"body":"suppressive than estrogen, but it's still not as"},{"startTime":624.532,"endTime":627.084,"body":"suppressive as birth control or even close to a"},{"startTime":627.1,"endTime":629.988,"body":"Lupron cycle. However, there is another"},{"startTime":630.012,"endTime":632.796,"body":"form of progesterone priming and that is where you actually continue"},{"startTime":632.836,"endTime":635.604,"body":"it into the cycle. Here you start"},{"startTime":635.66,"endTime":638.452,"body":"someone on the progesterone primum, keeping them on it,"},{"startTime":638.564,"endTime":641.044,"body":"and then just start the stimulation and never come off of"},{"startTime":641.06,"endTime":643.792,"body":"it. The purpose is it works"},{"startTime":643.864,"endTime":646.288,"body":"almost like an antagonist. It's going to suppress the"},{"startTime":646.312,"endTime":648.984,"body":"lh, which is sometimes great for people with polycystic"},{"startTime":649.0,"endTime":651.68,"body":"ovarian syndrome. And the chances of ovulation"},{"startTime":651.808,"endTime":654.392,"body":"during the cycle are very low. Now, there are some"},{"startTime":654.424,"endTime":657.2,"body":"downsides of this. One of them is you can get some irregular"},{"startTime":657.248,"endTime":660.24,"body":"bleeding. The other thing is you can't do a fresh transfer if"},{"startTime":660.248,"endTime":662.456,"body":"your clin is doing fresh transfers. But if you're doing"},{"startTime":662.496,"endTime":665.368,"body":"freezoles, it's actually a very valid"},{"startTime":665.392,"endTime":668.2,"body":"beth the priming and can also be used as your"},{"startTime":668.248,"endTime":671.176,"body":"antagonist to prevent ovulation during the stimulation. There"},{"startTime":671.176,"endTime":673.632,"body":"are actually some studies out there that show that there's some non"},{"startTime":673.664,"endTime":676.368,"body":"inferiority of using this type of"},{"startTime":676.392,"endTime":679.232,"body":"progesteroin priming compared to antagonal"},{"startTime":679.264,"endTime":682.136,"body":"cycles. The last type of priming that I did not go"},{"startTime":682.176,"endTime":684.896,"body":"over in the prior podcast is androgen"},{"startTime":684.936,"endTime":687.408,"body":"priming. Now a lot of the patients will take"},{"startTime":687.472,"endTime":690.408,"body":"DHEA because we know that that will help"},{"startTime":690.592,"endTime":693.32,"body":"a quality and sometimes help even poor responders."},{"startTime":693.448,"endTime":696.328,"body":"But you have to take it for a very long time and evidence out"},{"startTime":696.352,"endTime":698.856,"body":"there is a little bit mixed. Some studies have shown a lot of"},{"startTime":698.896,"endTime":701.572,"body":"benefit, some have shown not much benefit,"},{"startTime":701.684,"endTime":704.176,"body":"but again you need to take it for about three months."},{"startTime":704.796,"endTime":707.788,"body":"The other option is theres some promising data"},{"startTime":707.892,"endTime":710.636,"body":"showing that testosterone for six to eight weeks may"},{"startTime":710.676,"endTime":713.292,"body":"help poor responders and improve egg"},{"startTime":713.324,"endTime":715.715,"body":"quality. Now kind of like dhea,"},{"startTime":716.055,"endTime":718.955,"body":"the studies are not very affirming."},{"startTime":719.335,"endTime":722.255,"body":"Some studies show theres some benefit, other studies show there isnt t."},{"startTime":722.295,"endTime":724.919,"body":"But overall there appears to be some"},{"startTime":724.967,"endTime":727.753,"body":"potential benefit. Now unlike the other priming"},{"startTime":727.849,"endTime":730.245,"body":"methods, in this situation"},{"startTime":730.865,"endTime":733.201,"body":"it is not the only agent for"},{"startTime":733.233,"endTime":736.057,"body":"priming. Sometimes people will use this with"},{"startTime":736.121,"endTime":738.833,"body":"other priming agents or they will use it alone."},{"startTime":739.009,"endTime":741.873,"body":"I personally don't use this. However I'm aware of it"},{"startTime":741.929,"endTime":744.889,"body":"and looking at it and seeing if it's a valid option in the future."},{"startTime":744.977,"endTime":747.753,"body":"So as you can see, choosing a primary method isn't"},{"startTime":747.809,"endTime":750.713,"body":"just any meany miny mo. It's"},{"startTime":750.729,"endTime":753.597,"body":"like cooking an egg. Whether you scramble it,"},{"startTime":753.741,"endTime":756.725,"body":"poach it sun side up, cook it all the way"},{"startTime":756.765,"endTime":759.541,"body":"through, each method can work"},{"startTime":759.693,"endTime":762.605,"body":"but each method can also be disastrous depending on your"},{"startTime":762.645,"endTime":764.941,"body":"taste and in this situation your"},{"startTime":764.973,"endTime":767.413,"body":"biology. So what does the research show?"},{"startTime":767.549,"endTime":770.293,"body":"Well, the research is not going to be"},{"startTime":770.389,"endTime":773.037,"body":"as beneficial as you would like. Basically"},{"startTime":773.221,"endTime":775.933,"body":"it's kind of all over the place. Research has"},{"startTime":775.989,"endTime":778.981,"body":"shown that when using priming you do"},{"startTime":779.053,"endTime":781.949,"body":"increase FSH receptor UP regulation"},{"startTime":782.117,"endTime":784.465,"body":"which does improve the response."},{"startTime":784.765,"endTime":787.517,"body":"Research has shown that with andron priming there is"},{"startTime":787.581,"endTime":790.421,"body":"some improvement in poor responders and that with"},{"startTime":790.453,"endTime":793.349,"body":"DHEA it's not as convincing. However,"},{"startTime":793.437,"endTime":796.317,"body":"no one has ever come up with a nomogram. There is no"},{"startTime":796.381,"endTime":799.277,"body":"absolute way to know who needs what. This is where"},{"startTime":799.301,"endTime":802.141,"body":"your doctor takes the information about"},{"startTime":802.173,"endTime":804.701,"body":"you and then determines what's the best"},{"startTime":804.773,"endTime":807.191,"body":"option. Sometimes it's not"},{"startTime":807.223,"endTime":809.991,"body":"right. Maybe they start with estrogen priming and then you"},{"startTime":810.023,"endTime":812.847,"body":"ovulate past it and have to cancel a cycle and then they"},{"startTime":812.871,"endTime":815.767,"body":"go okay that didn't work, let's try something different."},{"startTime":815.871,"endTime":818.495,"body":"And that's because there is no research showing"},{"startTime":818.615,"endTime":821.567,"body":"which protocol is best for each person. We just know"},{"startTime":821.591,"endTime":824.063,"body":"that sometimes it can be better. So it's never"},{"startTime":824.119,"endTime":826.983,"body":"wrong. It's kind of like an educated guess when"},{"startTime":826.999,"endTime":829.823,"body":"they're picking that priming protocol. What we do know is"},{"startTime":829.839,"endTime":832.529,"body":"that cold starting everyone is not always good."},{"startTime":832.657,"endTime":835.513,"body":"That can be very bad for some people. Just like Putting"},{"startTime":835.569,"endTime":838.441,"body":"everyone on birth control would never be good. And that's really"},{"startTime":838.473,"endTime":841.417,"body":"what the research says. If you're taking everyone as a"},{"startTime":841.441,"endTime":844.201,"body":"whole, there doesn't seem to be much benefit."},{"startTime":844.313,"endTime":847.001,"body":"So whether you're doing cold start birth control,"},{"startTime":847.113,"endTime":849.833,"body":"estrogen priming or even progesterone"},{"startTime":849.889,"endTime":852.657,"body":"priming, there really isn't that much difference."},{"startTime":852.841,"endTime":855.561,"body":"However, that isn't true when you start looking at"},{"startTime":855.633,"endTime":858.527,"body":"tailored special populations. In"},{"startTime":858.551,"endTime":861.543,"body":"that situation, there is some benefit. When"},{"startTime":861.559,"endTime":864.159,"body":"you look at poor responders, there is a wide"},{"startTime":864.287,"endTime":867.199,"body":"spectrum of poor responders. A poor responder can be"},{"startTime":867.247,"endTime":869.935,"body":"someone who has, let's say, young but just"},{"startTime":869.975,"endTime":872.967,"body":"doesn't have a lot of eggs. A poor responder"},{"startTime":872.991,"endTime":875.943,"body":"can be someone who's 44 and doesn't"},{"startTime":875.959,"endTime":878.435,"body":"make a lot of eggs. But there's a difference there."},{"startTime":878.855,"endTime":881.795,"body":"If you take that first group who are young,"},{"startTime":882.535,"endTime":884.807,"body":"have a decent ovarian reserve, but are poor"},{"startTime":884.871,"endTime":887.151,"body":"responder, what we find is"},{"startTime":887.223,"endTime":890.031,"body":"OCPs, which are birth control actually"},{"startTime":890.063,"endTime":892.871,"body":"helped them versus if you gave that"},{"startTime":892.903,"endTime":895.367,"body":"birth control to someone who is older, who has fewer"},{"startTime":895.391,"endTime":897.675,"body":"eggs, it will likely hurt them."},{"startTime":898.255,"endTime":901.035,"body":"Polycyst ovarian syndrome is another area."},{"startTime":901.415,"endTime":904.383,"body":"Osops in some situations, such as a fresh"},{"startTime":904.439,"endTime":907.391,"body":"transfer is not good to do. It would be"},{"startTime":907.423,"endTime":909.075,"body":"better to give them something like"},{"startTime":909.895,"endTime":912.567,"body":"Proera to induce a period and just start them"},{"startTime":912.671,"endTime":915.335,"body":"or use one of those progestin protocols we talked"},{"startTime":915.375,"endTime":918.069,"body":"about. However, if you're doing a frozen transfer,"},{"startTime":918.157,"endTime":920.941,"body":"it's not going to matter as much. Someone with"},{"startTime":920.973,"endTime":923.605,"body":"a high, let's say baseline FSH level"},{"startTime":923.725,"endTime":926.653,"body":"has diminished ovarian reserve and they don't fall into"},{"startTime":926.669,"endTime":929.631,"body":"that first group of young with a good reserve but"},{"startTime":929.663,"endTime":932.543,"body":"poor response. So for them you don't want to give them"},{"startTime":932.559,"endTime":935.487,"body":"birth control. You would want to give them something like estrogen or"},{"startTime":935.511,"endTime":938.367,"body":"one of those progestne protocols which will"},{"startTime":938.391,"endTime":940.655,"body":"prevent early recruitment and get better"},{"startTime":940.695,"endTime":943.529,"body":"synchronization. Whereas if they did a cold"},{"startTime":943.577,"endTime":946.521,"body":"start, they would likely get early recruitment and have to cancel their"},{"startTime":946.553,"endTime":949.445,"body":"cycle. We talked about people with endometriosis."},{"startTime":949.745,"endTime":952.433,"body":"They could benefit from a lot of"},{"startTime":952.449,"endTime":955.445,"body":"suppression by suppressing their endometriosis."},{"startTime":955.905,"endTime":958.465,"body":"Another group which you would never believe are people with"},{"startTime":958.545,"endTime":961.401,"body":"severe din ovarian reserves such as premature ovarian"},{"startTime":961.433,"endTime":964.081,"body":"failure. These are women who have actually gone into early"},{"startTime":964.113,"endTime":966.761,"body":"menopause. And whats weird is they get them to"},{"startTime":966.793,"endTime":969.769,"body":"ovulate, you actually have to give them a high"},{"startTime":969.817,"endTime":972.793,"body":"suppression of birth control, sometimes double dose and"},{"startTime":972.809,"endTime":975.753,"body":"then with that a severe suppression, you then hit them"},{"startTime":975.769,"endTime":978.417,"body":"with an aggressive stimulation and they can yield eggs."},{"startTime":978.441,"endTime":981.145,"body":"Sometimes that's completely counterintuitive"},{"startTime":981.265,"endTime":984.081,"body":"to the other situation where someone has dimin ovarian reserve."},{"startTime":984.193,"endTime":986.593,"body":"The point is, there isn't one best"},{"startTime":986.649,"endTime":989.457,"body":"protocol. It has to be tailored to the"},{"startTime":989.481,"endTime":992.289,"body":"person. The point is, it's all"},{"startTime":992.337,"endTime":995.139,"body":"about strategy. Priming isn't about"},{"startTime":995.187,"endTime":997.915,"body":"doing more, it's about doing what's right"},{"startTime":997.995,"endTime":999.855,"body":"for your biology."},{"startTime":1000.795,"endTime":1003.555,"body":"Whether you're using estrogen to block early recruitment"},{"startTime":1003.635,"endTime":1006.571,"body":"or testosterone to wake up sleepy ovaries, the"},{"startTime":1006.603,"endTime":1009.427,"body":"key is individualization. So when you're"},{"startTime":1009.451,"endTime":1012.371,"body":"getting frustrated by switching priming protocols or"},{"startTime":1012.403,"endTime":1015.195,"body":"getting canceled cycles, know"},{"startTime":1015.275,"endTime":1018.083,"body":"that it's not trial and error out of guesswork."},{"startTime":1018.259,"endTime":1020.735,"body":"It's about dialing in what works for you."},{"startTime":1021.595,"endTime":1024.131,"body":"IVF is chess. It is not"},{"startTime":1024.163,"endTime":1026.539,"body":"checkers. Hopefully today's"},{"startTime":1026.587,"endTime":1029.227,"body":"episode helped you see the thought"},{"startTime":1029.331,"endTime":1032.259,"body":"process behind priming and why your cycle might look"},{"startTime":1032.307,"endTime":1035.091,"body":"different than someone else is. If you found this"},{"startTime":1035.123,"endTime":1037.971,"body":"episode valuable, please give us a five star review on your favorite"},{"startTime":1038.003,"endTime":1040.963,"body":"medium and share it with someone else in their IVF journey."},{"startTime":1041.099,"endTime":1043.875,"body":"The idea for this episode was brought to us by"},{"startTime":1043.995,"endTime":1046.832,"body":"Caitlylin, who is going through her own IVF journey and"},{"startTime":1046.848,"endTime":1049.776,"body":"recommended this episode topic. If you're interested in sending"},{"startTime":1049.8,"endTime":1052.24,"body":"me a topic that you'd like me to do, send it to"},{"startTime":1052.312,"endTime":1055.044,"body":"TBFT for Taco Bell fertility Tuesday"},{"startTime":1055.344,"endTime":1058.216,"body":"at newdirectionfertility.com and I'll"},{"startTime":1058.24,"endTime":1061.104,"body":"definitely put it on my list. Hope to see you"},{"startTime":1061.144,"endTime":1063.614,"body":"again next week. on Taco Bo"},{"startTime":1063.734,"endTime":1064.454,"body":"Fertility Tuesday."}]}